OF COURSE Bernie Sanders Won't Say How to Pay for Medicare for All


On Tuesday, Bernie Sanders told CNBC's John Harwood that he doesn't think he has to tell the American people how he will pay for his government-only Medicare for All health care plan. Because, Sanders said, it's more important to get Americans to understand that we already pay a ton for our health care and wants it to be an article of faith that it will save money for "the vast majority of Americans."

Pardon me if this is eerily reminiscent of when Republicans go around telling everyone how their tax cuts are going to be most beneficial to the middle class, or that those tax cuts will pay for themselves, or the like.

Pardon me if the American people are not willing to uproot an entire system that now incorporates subsidies, an expanded, income-based Medicaid in most states, and a prohibition against discrimination based on medical conditions based on an article of faith. Pardon me if I'm especially suspicious that we are being asked to put that faith in a person who has spent nearly 40 years in politics - almost 30 in one chamber or other of the United States Congress and has had no success in passing into law any significant bill in which he is the lead sponsor.

There's a reason why Bernie Sanders doesn't want to talk about how to pay for a government-only Medicare for All, which is not only a radical shift from the overall health coverage architecture of this country but also a drastic tearaway from Medicare itself.

It's not only that a single-payer, government-only Medicare for All plan will cost more than the entire amount of the federal receipts today ($3.3 trillion), and by some estimates, it would rival total federal spending ($4.1 trillion). This means that in order to pay for it all by increasing taxes, total federal tax revenue would have to grow by at least two-thirds, more if we also wanted to do something about the deficit. That may not mean everyone is going to have their taxes raised by 70%, but if the people proposing the plan don't tell us precisely how they will raise this revenue, people will make assumptions.

It's not simply that contrary to all of Bernie Sanders's rhetoric that equate universal coverage with the elimination of private health insurance, no developed country actually has an everything-covered-by-the-central-government approach. Bernie Sanders's plan would ostensibly cover all medical, dental, and vision care, prescription drugs and long term care. No other country does that. Not. One. In Canada, the country proponents bring up the most often - not least because their public health insurance system is named 'Medicare', prescription drugs are covered by private insurance, and provinces, not the federal government in Ottawa, run the public coverage plan.

I mean, yes, these are all factors. Who wants to talk about how much it will cost when you can just talk about "free" health care? Who wants to get into the details of what other countries have when you can just pretend everyone has the same model?

But it's more than that.

Bernie Sanders's Senate office, as it turns out, did release a document with "ideas" to pay for the Medicare for All legislation he introduced, and some of us chose to read it. Surprise of surprises, it turns out that some of the claims he and his campaign surrogates are making about Medicare for All don't square with his own ideas about how to pay for it.

One challenge Sanders's campaign has had to cope with is that completely upending the current system of health care will take away plans from people who are satisfied with their current coverage, among them a large group would be union employees whose collective bargaining has ensured for them a great health plan. For months now, he and his campaign surrogates have been claiming that taking health care out of collective bargaining would be a boon to union employees, who could negotiate higher pay instead.

At the mothership, I decided to have a look at whether, overall, removing health care as compensation would actually increase wages (especially union wages), and to no one's great exclaim it turned out to be untrue. And here is the punchline: Bernie Sanders knows that.

How do I know he knows that? Because among the ideas his Senate office released to pay for Medicare for All is the restoration, to the federal government, of all revenue currently lost from making employer-based health insurance tax-exempt. Employers do not have to pay taxes on health benefits (and also on wages), and Bernie's office assumes that under Medicare for All, corporations would have to pay taxes on those dollars since they couldn't use them to pay for health benefits for their employees. The only way that's possible is if the corporations add those dollars to their bottom line rather than to employee pay. If they added those to employee pay, the expense could not be counted as part of their profit, and hence, could not be taxed.

Oops.

So you see, it's not really safe for people who don't propose serious ideas to put out plans to pay for those ideas. Because if they do...

Some insolent fool like yours truly might decide to actually read them.




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