10 ms·

Elizabeth Warren’s ‘Medicare for All’ Math

31 points by Bostonian 7y ago

unmole 7y ago
From the Guidelines: > Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.
claudeganon 7y ago
Matt Bruenig did a good breakdown of the shortcomings of Warren’s plan here: https://www.peoplespolicyproject.org/2019/11/01/warrens-perpetual-medicare-head-tax-is-unworkable-and-bad/ https://www.peoplespolicyproject.org/2019/11/01/warrens-perp... As well as the more rational avenues through which Medicare for All could be funded: https://www.peoplespolicyproject.org/2019/10/30/how-to-approach-medicare-for-all-financing/ https://www.peoplespolicyproject.org/2019/10/30/how-to-appro...
- peterwoerner 7y ago
  A point which I didn't think of: we are already paying for everyone's healthcare. Doctors and hospitals can't turn anyone away and they aren't losing money. So it's really an accounting problem how do we collect the money which people and businesses are already paying and how to distribute which Medicare already does sufficiently well.
  - jfnixon 7y ago
    That's not quite correct. Hospitals can't turn away patients with life-threatening conditions until they are stable. In practice that means everyone gets triaged. A better system would run public clinics, staffed by PAs and nurse practitioners (with possibly a physician) near the ER, and force the people who have had a cough for two weeks to go to the clinic first. Work everyone near the top of their training, and give hospitals safe harbor for sending non-emergency patients to the clinic first. That's just one sensible (I think) proposal. We don't need to refinance the current system, we need to completely reengineer it.
    - jmartini 7y ago
      This comment reminds of some of the hospitals in India where up-skilling is becoming commonplace to remain efficient and cost-effective. https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper https://www.bloomberg.com/news/features/2019-03-26/the-world...
Waterluvian 7y ago
I struggle with any plan that lines up 99% of people to raid the wealth of 1% of people. It reminds me of the idea that minorities need the most protection because by nature, almost by definition, the majority doesn't have their interests in mind. A democratic system makes it very easy to hurt and further marginalize those people. This is probably an unpopular opinion so I'll add: I'm not a billionaire, I'm not even a millionaire, and I know there's a lot of valid (but not necessarily good) arguments for why rich people deserve to pay more. But my moral compass is spinning.
- JoeAltmaier 7y ago
  Don't forget, those 1% are hoarding 99% of all money. (Ok its really 0.1% of the people). Think of it not so much as reverse-discrimination, but rather a revolution. Returning the economic system to something that works, instead of the broken dysfunctional mess its gotten into. I agree we need more than tax adjustments to complete the task. The paths money follows need realigning, back to something like they used to follow in the 70's or something. But its a start.
  - Waterluvian 7y ago
    So it's okay to set the rules and then retroactively change them and take money away from those who managed to do really well?
    - JoeAltmaier 7y ago
      Don't be a troll. They didn't "do really well". They looted the economy for essentially all the wealth in the world, by changing the rules so only they win. Changing the rules back, is no more or less moral.
  - el_don_almighty 7y ago
    That money is out making more money by investing in the macroeconomy. It isn't sitting in their bedsheets. Bill Gates doesn't sleep on a pile of gold like scrooge mcduck. He created something the world needed and valued. Now his money out creating new things. Money does NOT follow the laws of thermodynamics
gorgoiler 7y ago
This all sounded great until the wealth tax came up: “The top 1 percent [...] would pay taxes on increases in investment value annually, instead of waiting until assets are sold.” Taxing all stockholders of a company on the fiction that they all could have sold all their shares at the maximum possible price, without crashing the price, is naively out of touch with how markets actually work. Investments, especially stock, have no precise value until they are sold. It’s unfair to preemptively tax a capital gain before the capital gain has occurred. Otherwise the IRS will assess your unsold Beanie Baby net worth to have increased by $14k and tax you on 20% of it come the end of the year when in fact it turns out your collection has no resale value at all on an open market. This is just as silly as market cap — the idea that just because someone paid $X to buy 0.1% of a company that’s currently in high demand and short supply it does not follow that, should every stock holder suddenly decide to panic sell 100% of the company, they would collectively get $X,000 in return.
- mdorazio 7y ago
  Do you have another proposal for implementing a wealth tax in a way that's easily enforced? I don't necessarily support a wealth tax via stocks, but it seems pretty close to the way startup stock options get taxed for employees pre-IPO, so it's not like there isn't a precedent here.
  - gorgoiler 7y ago
    Wealth is how much money you have to spend, not what your theoretical paper worth is. The government can’t buy medicine or fix roads with theoretical paper worth, and until you can buy food with stocks / shares / yachts / art, it shouldn’t be treated as if it is taxable currency. Taxing the flow of money is the only moral way a government can bring in revenue and the only way to increase that revenue is to raise taxes. Higher income tax and higher capital gains tax means the more you benefit from sharing this society with everyone else, the more responsibility you take for funding it through taxation.
    - ac29 7y ago
      Conflating stocks with yachts or art doesn't make sense. The stock market is extremely liquid (unlike the market for yachts or art), so from a practical standpoint assets in the form of stocks are extremely close to cash in terms of "money you have to spend".
ykevinator 7y ago
The easier solution is letting small business buy into medicare.
- mdorazio 7y ago
  That seems pretty strongly like a non-solution because if you lose your job at a BigCo (which employ over 40% of Americans, and rising), you're still completely hosed.
toastal 7y ago
I'm quite concerned as a self-employed American contractor abroad. Shifting the costs to employers might very well include myself. While I don't mind my taxes going up per se, expanding current Medicare to all ages as the system currently exists means I still wouldn't get coverage as there's no deals with foreign systems or vouchers or exemptions for Americans abroad from the bill that I read. This would mean I'd more than likely have to pay even more than the current compulsory 12.4% for Medicare to still not get any usable health coverage outside the States. The current health system lets me exempt myself from the healthcare tax being based elsewhere. I'm very much in favor of Medicare for All as a whole as it's shown to definitely bring down the average cost per American as well as remove the middle-man insurance companies taking their cut and give the government better leverage against drug prices and services. However, considering many proposed M4A plans are covering green card holders and undocumented workers, it would be nice to know that citizens abroad could be in the loop too with a name like "for all". Also, can change the abbreviated version to "M∀"?
- votepaunchy 7y ago
  > This would mean I'd more than likely have to pay even more than the current compulsory 12.4% for Medicare Social Security is 12.4%, Medicare is 2.9%.
  - toastal 7y ago
    You are right about the chunk of the 15.3%--I read, meaning misread, it like 5 times the last couple of days. I also missed the threshold for low-earning self-employment being exempt skimming the 20 pages of the proposal. I guess my fears have subsided, although I believe I would still prefer some sort of coverage.
innagadadavida 7y ago
Governments have a poor track record to manage our money. Are there any proposals to just regulate insurance providers, pharmaceuticals and hospitals as non-profits? In addition other industries that provide for basic human necessities should simply be regulated as non-profits. It is simply perverse for insurance companies to profit out of my misfortunes and further optimize those profits to pander to industry and investor whims.
- zozbot234 7y ago
  An enterprise which is "regulated as a non-profit" is just a for-profit enterprise with opaque money flows, corruption etc. etc. Genuine non-profit enterprises require commitment, and the private sector is better able to deliver that.
  - innagadadavida 7y ago
    Not disagreeing with you, but wouldn’t the government be more successfully regulating and policing these health non-profits instead of becoming a health provider? I’m only speculating the relative success between the two options. From an election standpoint, it also seems like a good way to galvanize the support bases - something that presidential candidates are looking for currently.
    - zozbot234 7y ago
      Our approach to the healthcare sector should start from de-regulation, not piling even more red tape on it. That would be the best way to decrease undue profit margins in the industry as well.
  - gremlinsinc 7y ago
    What if government could enforce CEO caps of 500k. No bonuses. No sales staff. Transparent prices both on insurer/hospital side. 100% tax of company profits at end of the year use or lose all the income earned. Basically make it impossible for corruption/self-enrichment at the expense of others. Also make insurance a national thing, i.e. plans cross state-lines. How much money is wasted because an insurer needs to hire people who know the laws of utah, more people to work within the laws of AZ, etc... and create plans centered around different states and their nuances? If we can streamline some of this stuff, and make it uniform across the nation maybe they save money and pass that savings to us. (I say this as possible solutions to the non-profit thing, but I'm a huge supporter of Single-payer). There's other options on the table for sure, but something definitely needs to change. Better we bankrupt the entire country than 100k people die from Cancer over the next 10 years who could've lived, had children, and one of those children end up discovering FTL drives or curing Global Warming.

31 points by Bostonian 7y ago

From the Guidelines: > Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.

claudeganon 7y ago

Matt Bruenig did a good breakdown of the shortcomings of Warren’s plan here: https://www.peoplespolicyproject.org/2019/11/01/warrens-perpetual-medicare-head-tax-is-unworkable-and-bad/ https://www.peoplespolicyproject.org/2019/11/01/warrens-perp... As well as the more rational avenues through which Medicare for All could be funded: https://www.peoplespolicyproject.org/2019/10/30/how-to-approach-medicare-for-all-financing/ https://www.peoplespolicyproject.org/2019/10/30/how-to-appro...

peterwoerner 7y ago
A point which I didn't think of: we are already paying for everyone's healthcare. Doctors and hospitals can't turn anyone away and they aren't losing money. So it's really an accounting problem how do we collect the money which people and businesses are already paying and how to distribute which Medicare already does sufficiently well.
- jfnixon 7y ago
  That's not quite correct. Hospitals can't turn away patients with life-threatening conditions until they are stable. In practice that means everyone gets triaged. A better system would run public clinics, staffed by PAs and nurse practitioners (with possibly a physician) near the ER, and force the people who have had a cough for two weeks to go to the clinic first. Work everyone near the top of their training, and give hospitals safe harbor for sending non-emergency patients to the clinic first. That's just one sensible (I think) proposal. We don't need to refinance the current system, we need to completely reengineer it.
  - jmartini 7y ago
    This comment reminds of some of the hospitals in India where up-skilling is becoming commonplace to remain efficient and cost-effective. https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper https://www.bloomberg.com/news/features/2019-03-26/the-world...

Waterluvian 7y ago

I struggle with any plan that lines up 99% of people to raid the wealth of 1% of people. It reminds me of the idea that minorities need the most protection because by nature, almost by definition, the majority doesn't have their interests in mind. A democratic system makes it very easy to hurt and further marginalize those people. This is probably an unpopular opinion so I'll add: I'm not a billionaire, I'm not even a millionaire, and I know there's a lot of valid (but not necessarily good) arguments for why rich people deserve to pay more. But my moral compass is spinning.

JoeAltmaier 7y ago
Don't forget, those 1% are hoarding 99% of all money. (Ok its really 0.1% of the people). Think of it not so much as reverse-discrimination, but rather a revolution. Returning the economic system to something that works, instead of the broken dysfunctional mess its gotten into. I agree we need more than tax adjustments to complete the task. The paths money follows need realigning, back to something like they used to follow in the 70's or something. But its a start.
- Waterluvian 7y ago
  So it's okay to set the rules and then retroactively change them and take money away from those who managed to do really well?
  - JoeAltmaier 7y ago
    Don't be a troll. They didn't "do really well". They looted the economy for essentially all the wealth in the world, by changing the rules so only they win. Changing the rules back, is no more or less moral.
- el_don_almighty 7y ago
  That money is out making more money by investing in the macroeconomy. It isn't sitting in their bedsheets. Bill Gates doesn't sleep on a pile of gold like scrooge mcduck. He created something the world needed and valued. Now his money out creating new things. Money does NOT follow the laws of thermodynamics

gorgoiler 7y ago

This all sounded great until the wealth tax came up: “The top 1 percent [...] would pay taxes on increases in investment value annually, instead of waiting until assets are sold.” Taxing all stockholders of a company on the fiction that they all could have sold all their shares at the maximum possible price, without crashing the price, is naively out of touch with how markets actually work. Investments, especially stock, have no precise value until they are sold. It’s unfair to preemptively tax a capital gain before the capital gain has occurred. Otherwise the IRS will assess your unsold Beanie Baby net worth to have increased by $14k and tax you on 20% of it come the end of the year when in fact it turns out your collection has no resale value at all on an open market. This is just as silly as market cap — the idea that just because someone paid $X to buy 0.1% of a company that’s currently in high demand and short supply it does not follow that, should every stock holder suddenly decide to panic sell 100% of the company, they would collectively get $X,000 in return.

mdorazio 7y ago
Do you have another proposal for implementing a wealth tax in a way that's easily enforced? I don't necessarily support a wealth tax via stocks, but it seems pretty close to the way startup stock options get taxed for employees pre-IPO, so it's not like there isn't a precedent here.
- gorgoiler 7y ago
  Wealth is how much money you have to spend, not what your theoretical paper worth is. The government can’t buy medicine or fix roads with theoretical paper worth, and until you can buy food with stocks / shares / yachts / art, it shouldn’t be treated as if it is taxable currency. Taxing the flow of money is the only moral way a government can bring in revenue and the only way to increase that revenue is to raise taxes. Higher income tax and higher capital gains tax means the more you benefit from sharing this society with everyone else, the more responsibility you take for funding it through taxation.
  - ac29 7y ago
    Conflating stocks with yachts or art doesn't make sense. The stock market is extremely liquid (unlike the market for yachts or art), so from a practical standpoint assets in the form of stocks are extremely close to cash in terms of "money you have to spend".

ykevinator 7y ago

The easier solution is letting small business buy into medicare.

mdorazio 7y ago
That seems pretty strongly like a non-solution because if you lose your job at a BigCo (which employ over 40% of Americans, and rising), you're still completely hosed.

toastal 7y ago

I'm quite concerned as a self-employed American contractor abroad. Shifting the costs to employers might very well include myself. While I don't mind my taxes going up per se, expanding current Medicare to all ages as the system currently exists means I still wouldn't get coverage as there's no deals with foreign systems or vouchers or exemptions for Americans abroad from the bill that I read. This would mean I'd more than likely have to pay even more than the current compulsory 12.4% for Medicare to still not get any usable health coverage outside the States. The current health system lets me exempt myself from the healthcare tax being based elsewhere. I'm very much in favor of Medicare for All as a whole as it's shown to definitely bring down the average cost per American as well as remove the middle-man insurance companies taking their cut and give the government better leverage against drug prices and services. However, considering many proposed M4A plans are covering green card holders and undocumented workers, it would be nice to know that citizens abroad could be in the loop too with a name like "for all". Also, can change the abbreviated version to "M∀"?

votepaunchy 7y ago
> This would mean I'd more than likely have to pay even more than the current compulsory 12.4% for Medicare Social Security is 12.4%, Medicare is 2.9%.
- toastal 7y ago
  You are right about the chunk of the 15.3%--I read, meaning misread, it like 5 times the last couple of days. I also missed the threshold for low-earning self-employment being exempt skimming the 20 pages of the proposal. I guess my fears have subsided, although I believe I would still prefer some sort of coverage.

innagadadavida 7y ago

Governments have a poor track record to manage our money. Are there any proposals to just regulate insurance providers, pharmaceuticals and hospitals as non-profits? In addition other industries that provide for basic human necessities should simply be regulated as non-profits. It is simply perverse for insurance companies to profit out of my misfortunes and further optimize those profits to pander to industry and investor whims.

zozbot234 7y ago
An enterprise which is "regulated as a non-profit" is just a for-profit enterprise with opaque money flows, corruption etc. etc. Genuine non-profit enterprises require commitment, and the private sector is better able to deliver that.
- innagadadavida 7y ago
  Not disagreeing with you, but wouldn’t the government be more successfully regulating and policing these health non-profits instead of becoming a health provider? I’m only speculating the relative success between the two options. From an election standpoint, it also seems like a good way to galvanize the support bases - something that presidential candidates are looking for currently.
  - zozbot234 7y ago
    Our approach to the healthcare sector should start from de-regulation, not piling even more red tape on it. That would be the best way to decrease undue profit margins in the industry as well.
- gremlinsinc 7y ago
  What if government could enforce CEO caps of 500k. No bonuses. No sales staff. Transparent prices both on insurer/hospital side. 100% tax of company profits at end of the year use or lose all the income earned. Basically make it impossible for corruption/self-enrichment at the expense of others. Also make insurance a national thing, i.e. plans cross state-lines. How much money is wasted because an insurer needs to hire people who know the laws of utah, more people to work within the laws of AZ, etc... and create plans centered around different states and their nuances? If we can streamline some of this stuff, and make it uniform across the nation maybe they save money and pass that savings to us. (I say this as possible solutions to the non-profit thing, but I'm a huge supporter of Single-payer). There's other options on the table for sure, but something definitely needs to change. Better we bankrupt the entire country than 100k people die from Cancer over the next 10 years who could've lived, had children, and one of those children end up discovering FTL drives or curing Global Warming.