Proponents of a single-payer system have long benefited from the impracticability of universal, state-sponsored health coverage in America. “‘Medicare-for-all’ is a way for Democrats to say basically, ‘Hey, we understand that this is an issue, and we’re willing to do something about it,’” Democratic pollster Nancy Zdunkewicz confessed. In other words, it’s not a health-care plan, per se; it’s a statement of principles. That’s in part why universalizing Medicare polls relatively well; it is a progressive value proposition, not a realistic policy proposal with costs as well as benefits. Sen. Elizabeth Warren has chosen to forego this advantage.
On Friday, the senator from Massachusetts released a plan to pay for her proposal to all but nationalize the health-insurance industry, which is a commendable gesture of deference to the good faith of her critics. Still, her plan is predicated on a variety of dubious assumptions. Among them, that you are extremely gullible.
First, the toplines: Warren’s campaign estimates her plan to finance her universal health-care system comes in at a staggering $52 trillion over a decade with just over $20 trillion in new federal spending. That would be bad enough if it was accurate, but it’s likely a wild underestimate. Kenneth Thorpe, chairman of Emory University’s health-policy department, estimates that no less than $35 trillion in new spending over ten years would finance such a program. Independent analyses by the Urban Institute and George Mason University’s Mercatus Center (left and right-leaning institutions, respectively) both pegged the cost of a similar program at roughly $32 trillion over a decade. It’s a bad sign that this exercise in appeasing critics of Warren’s signature agenda item cannot even be undertaken without fudging the overall price tag.
Warren’s plan to finance this spending spree consists of a variety of new taxes on all sorts of economic activities, most of which are designed to communicate to voters that it’s the wealthy—not the middle-class—who will foot the bill for single-payer. That is a sustainable message only so long as voters who receive their insurance through an employer do not look upon the compensation they receive in health-care benefits as compensation. Because if they do, they may resent the fact that Warren’s plan empowers the federal government to requisition the funds employers spend on health insurance, transforming it into a mandatory “employer’s Medicare contribution” (i.e., a tax).
Among the funding mechanisms Warren presses into service is her vaunted “wealth tax”—a constitutionally dubious proposal to force the wealthy to itemize their liquid and illiquid assets every year so that the government might expropriate a portion of their total “wealth.” The Massachusetts senator originally envisioned a 2 percent tax on households worth more than $50 million and a 3 percent tax on those worth more than $1 billion, but Warren already spent that improbable capital on unlikely proposals to finance education programs like universal childcare provisions and student-loan debt forgiveness. So, the senator has quietly doubled her wealth tax on high earners to 6 percent. And yet, despite the new incentives to avoid exposing some costly assets to the IRS, Warren’s plan assumes that the avoidance rate will remain unchanged at 15 percent.
Warren once took the concept of avoidance seriously enough to envision a 40 percent penalty on Americans who sought to avoid her new tax on assets by fleeing the country. By failing to update her estimates, the senator is tacitly confessing the unfeasibility of her plan.
It is only fair to note that Warren’s proposal doesn’t consist exclusively of tax hikes. The senator also envisions some funding to accrue from other sources. Among them, a more thorough tax-code-enforcement regime that she estimates would recoup $2.3 trillion in revenue. That astonishing amount is only about 40 times what the Congressional Budget Office estimates the IRS could generate from new enforcement initiatives. Warren also assumes that around $400 billion would flow into the treasury from the newly legalized illegal immigrant population if Congress passed comprehensive immigration reform. But just waving off the most contentious political issue of our time is, suffice it to say, a risky bet.
Warren spent the weekend defending the proposal she released on Friday, and it has not been a pretty picture. “It doesn’t raise taxes on anybody but billionaires,” Warren said of her plan. If you believe 607 Americans alone can finance this package, Warren also has a Green New Deal to sell you.
“A part of my healthcare plan of Medicare-for-all is making sure that rural hospitals get enough money and enough federal support that they can all stay open,” Warren insisted. And she will save those overstressed hospitals (and the doctors, nurses, and administrative personnel that staff them) by forcing them to accept lower reimbursement rates for care—lower even than the Urban Institute’s estimates—which are already sometimes half what private insurance pays.
“No one gets left behind,” Warren asserted when asked what will become of the private health-insurance professionals displaced by her scheme. “Some of the people currently working in health insurance will work in other parts of insurance—in life insurance, in auto insurance, in car insurance.” Forget for a moment that “car” and “auto” insurance are synonymous; It doesn’t exactly inspire confidence that our foremost aspiring social engineer believes the professional expertise required to navigate the health and car insurance industries is negligible. Fear not, Warren adds. Some of those who wish to continue to ply the trade they’ve devoted their lives to can transition into the ever-expanding public sector.
No one could be happier with the rollout of Warren’s pay-for proposal than Bernie Sanders. He has steadfastly refused to produce a comprehensive proposal to fund his plan because its primary value is being just unrealistic enough to remain attractive. By putting meat on single-payer’s bones, Warren has done her plan more damage than any of its moderate Democratic critics ever could.