Some numbers RE Medicare-for-all!


The discussions which have never occurred:
Should Candidate Warren (and even Candidate Sanders) be more forthcoming regarding the way they would fund a Medicare-for-all plan?

In this morning's post, we linked to Ron Brownstein's discussion of the projected cost of such a program—and Brownstein's discussion is daunting.

Brownstein's essay appears in The Atlantic. The first daunting chunk reads like this:
BROWNSTEIN (10/16/19): The Urban Institute, a center-left think tank highly respected among Democrats, is projecting that a plan similar to what Warren and Senator Bernie Sanders are pushing would require $34 trillion in additional federal spending over its first decade in operation. That’s more than the federal government’s total cost over the coming decade for Social Security, Medicare, and Medicaid combined, according to the most recent Congressional Budget Office projections.

In recent history, only during the height of World War II has the federal government tried to increase taxes, as a share of the economy, as fast as would be required to offset the cost of a single-payer plan, federal figures show.


The 10-year cost of $34 trillion that the study forecasts nearly matches the CBO’s estimate of how much money the federal government will spend over that period not only on all entitlement programs, but also on all federal income support, such as the Supplemental Nutrition Assistance Program.
Just for starters, Oof!

Almost surely, this will not be a normal political year. But even in an abnormal year, the kind of "heavy lift" described above would provide a giant target for the opposition, unless the heavy lift in question is somehow explained with a mesmerist's skill.

Could a Candidate Warren do that? We have no idea—and we can't stress strongly enough the fact that the coming year almost surely won't be normal in any way, and may well involve "the deluge."

That said, here's another daunting chunk from the Brownstein report:
BROWNSTEIN: The Urban Institute estimates that a single-payer plan would require $32 trillion in new tax revenue over the coming decade. That’s slightly less revenue than its projected cost, because it would generate some offsetting savings by eliminating certain tax benefits the government now provides, such as the exclusion for employer-provided health care.

How big a lift is it to raise $32 trillion? It’s almost 50 percent more than the total revenue the CBO projects Washington will collect from the personal income tax over the next decade (about $23.3 trillion). It’s more than double the amount the CBO projects Washington will collect over the next decade from the payroll tax that funds Social Security and part of Medicare (about $15.4 trillion). A $32 trillion tax increase would represent just over two-thirds of the revenue the CBO projects the federal government will collect from all sources over the next decade (just over $46 trillion.)

Taxes that can fill that big of a hole are not easy to identify. Even by Warren’s own estimates, which some liberal economists consider too optimistic, her proposed wealth tax on personal fortunes exceeding $50 million would raise just $2.75 trillion over the next decade. That’s less than what would be required to fund a single-payer plan for one year...
Oof! Such reporting suggests the possibility that our tribe's "resistance thinking" has inspired a type of political naivete and irrationality which may be hard to deal with when the numbers start hitting the fan in a general election—assuming that we even have such an election next year.

By normal standards, it sounds like Candidate Warren (and Candidate Sanders) are proposing an impossibility. This raises an obvious question:

If other countries can finance single-payer systems (or some near approximation), what makes the task so daunting for us? Once again, we're forced to offer these eye-popping data from the OECD as the basic start of an answer:
Per capita spending, health care, 2018
United States: $10,586
Canada: $4974
France: $4965
Japan: $4766
United Kingdom: $4070
The astounding per capita cost of American health care is a prime villain here. And given the spectacular dumbness of our political culture, we've never come close to having a discussion of where all that extra health care spending goes.

Candidates Sanders and Warren are proposing a massive, giant change in the way we manage health care. Generally speaking, a presidential campaign isn't the greatest place for conducting a massive, giant discussion.

Of course, given the astounding dumbness of our political culture, these big discussions never take place anywhere else. And needless to say, even as this cultural dumbness continues to sweep us toward perdition, we liberals keep assuring ourselves that we ourselves are The Very Smart People, with the unlettered rubes Over There cast as the hapless bumpkins.

We liberals! Our journalists and our academics have endlessly avoided such discussions as this. For decades, we ourselves have failed to notice this criminal dumbness, but we feel completely sure that the blame all rests Over There.

By the way, this is the oldest, dumbest and most tribal of all "human" stories. Or so the top anthropologists say, speaking to us from the future, where they're all huddled in caves.

By the way: Have you ever seen Our Own Rhodes Scholar discuss this matter, or anything like it? No, and you never will. She's too busy telling us about what Ed Meese once did. Also, Dick Nixon! So cool!

Still and all, make no mistake—by dint of eternal rule of law, we're the brightest of all known humans. The dumbness is all Over There!


  1. "By normal standards, it sounds like Candidate Warren (and Candidate Sanders) are proposing an impossibility."

    Don't worry, dear Bob; everything you hear from your zombie cult VIPs is pure and unadulterated bullshit.

    They have no intention to do anything at all, other than what's ordered by their bosses, the banksters.

    Back in 2008, The Psycho-Witch and Barry The Demigod were both loudly proclaiming their hatred for NAFTA, accusing each other of not hating it strongly enough. Then Barry The Demigod gets elected, and - puff - no more mentioning of NAFTA.

    That's the way your cult operates.

    1. It's only an impossibility because Republicans are awful people, who are afraid a nickel of benefits might go to a black person.
      In other news, Republicans are bad-mouthing the United States by making believe all of its riches aren't worth shit.

      IOW, it's just another day of the week with Republicans fucking over the citizenry.

    2. Mao, it seems odd to me - on the one hand, according to you, Warren and Sanders only do "what's ordered by their bosses, the banksters" yet on the other Trump and the GOP minions attack on them is that they are socialists or commies. Are the banksters pro-socialism? And how does this work? Can you identify any of these banksters? Do these dem candidates get memo from banksters on what policies to advocate or what actions to take? And what evidence do you have for this? How are your accusations any different than those claiming the world is controlled by the Rothchilds [though maybe you claim that also]? To have any credibility, you need to provide real evidence, rather than conclusory, evidence-free, assertions.

    3. Dembot, didn't I tell you a million times already that 'socialism' is a thing of the past, of the 20th c.?

      The current dichotomy is globalism (global financial capitalism) vs. sovereignism (national interest).

      Dialectics, man. And it doesn't matter what words politicians use, don't be a fool.

    4. AC/MA,
      As I explained before, you are simply noticing the Russo-GOP axis. The GOP frightens their base by portraying Dems as radical socialist/communists intent on occupying their summer homes in the mountains and stealing all heir golfs.
      The Russo front tells the democratic base how all the dems are elitist corporate/globalist/wall street sellouts.

      Mao is a stalwart soldier on the Russo front.

    5. Ah, I see our dear Hillary is back, and still dreaming of making it to the top, eh?

      Saw your outstanding comedy performance today, about Gabbard and Stein. The material is a bit dated, but still a great laugh; thank you, dear.

      It would be truly wonderful if you jumped into the ring; I can't wait.

    6. Mao, again as always a total deflection (plus the ad hominem, junior high school style Dembot label utterly without foundation). It's Trump and his followers who are the ones labeling them as socialists, not me. Why don't you tell that to Trump and his followers. You completely ignored my question about proof of your claim that Warren and Sanders their orders from "banksters." Apparently, you have no proof and can't answer the question and your allegation is apparently made up by you out of thin air.

    7. Dembot, Warren and Sanders don't take orders from banksters. They fight among themselves for the privilege to take orders from banksters.

      Although I'm not so sure about Sanders. I've always assumed he's a fake candidate, who's only there for other zombie VIPs to demonstrate that they are not 'socialists'. Incidentally, the fake Indian keeps saying she loves capitalism.

    8. Mao,
      If you believed any of your faux hatred of bankers, you'd vote for Warren.
      Instead, your obvious deep, deep love of the Establishment bankers, (i.e the thugs who crashed the economy through fraud) comes through on every one of your posts.

    9. @ 3:51 PM,
      Oh dear. Major Gabbard just called you "the queen of warmongers, embodiment of corruption, and personification of the rot".

      Not bad, but I personally prefer 'Psycho-Witch'. Y'know, the same thing, but shorter.

    10. Gabbard?
      I think you mean "Sacajawea".

    11. Sure, Mao is a huge fan of the Establishment, who often comes off as one-note moron, but that doesn't mean he's not the genius of the Conservative movement.

  2. 'For decades, we ourselves have failed to notice this criminal dumbness, but we feel completely sure that the blame all rests Over There.'

    You mean clueless, lying, Trumpanzees when say "we" ?

  3. “these big discussions never take place anywhere else.”

    ...he says, after quoting from a report...discussing it.

    (It was noted in comments to the previous post that the Urban Institute did *not* analyze Bernie’s/Warren’s plan. Brownstein’s article, through an attempted sleight of hand, says the Institute analyzes a plan “similar to what Warren and Senator Bernie Sanders are pushing “. “Similar” is doing way too much work there. Somerby ought to note this, and quit either accidentally or purposely adopting centrist or right-wing framing of this.)

    “a presidential campaign isn't the greatest place for conducting a massive, giant discussion”

    Why, exactly? Somerby doesn’t say. Perhaps someone could research FDR’s ‘32 campaign to determine whether FDR stayed away from a massive, giant discussion about ending the Great Depression, and how the media did all the leg work.

    It seems to me that presidential campaigns are just the place for massive, giant discussions about important aspirational goals, *especially* if the media isn’t doing it, as Somerby suggests. They have to be dragged into it by someone, and who better than a presidential candidate?

    1. FDR benefitted from living in a different era.

      People read newspapers - lots of them, and all competing for stories -- and ladies home magazines were like 300 pages a month. People in the media also weren't being hired for their looks.

    2. It seems to me that folks are criticizing Warren because she chose not to explain the complexities of health care financing in a 30 second sound bite.

    3. 5:52 PM writes:

      Perhaps someone could research FDR’s ‘32 campaign to determine whether FDR stayed away from a massive, giant discussion about ending the Great Depression, and how the media did all the leg work.

      Actually, three members of the press pool traveling with him on the campaign trail in 1932 wrote FDR's boldest speech during that campaign cycle about how a Roosevelt administration would deal with the Great Depression. That was FDR's Oglethorpe University Commencement Address LINK:

      QUOTE The controversial content of Roosevelt’s Oglethorpe address had an almost impromptu genesis at Warm Springs, where the governor was visiting his favorite picnic spot with three members of the press corps.

      They were bantering good-naturedly with FDR, teasing him about his insipid campaign speeches since the “forgotten man” address. Roosevelt and his speech writers had not yet prepared the upcoming commencement speech, and the only background documents in hand were some biographical notes on James Oglethorpe, for whom the university was named.

      FDR playfully challenged the writers, saying, “Well if you boys don’t like my speeches, why don’t you take a hand in drafting one yourselves?” Ernest Lindly of the New York Herald Tribune quickly responded, “All right, I will”; and he did. The other journalists, Walter Brown and Louis Ruppel, did some editing but the final speech was Lindley’s draft.



    4. In this speech FDR directly rejects the Hoover/Mellonism approach to dealing with the Great Depression and outlines what would be his administration's strategy for dealing with the crisis [my emphasis] LINK:

      QUOTE ...We shall continue to need capital for the production of newly-invented devices, for the replacement of equipment worn out or rendered obsolete by our technical progress; we need better housing in many of our cities and we still need in many parts of the country more good roads, canals, parks and other improvements.

      But it seems to me probable that our physical economic plant will not expand in the future at the same rate at which it has expanded in the past. We may build more factories, but the fact remains that we have enough now to supply all of our domestic needs, and more, if they are used. With these factories we can now make more shoes, more textiles, more steel, more radios, more automobiles, more of almost everything than we can use.

      No, our basic trouble was not an insufficiency of capital. It was an insufficient distribution of buying power coupled with an over-sufficient speculation in production. While wages rose in many of our industries, they did not as a whole rise proportionately to the reward to capital, and at the same time the purchasing power of other great groups of our population was permitted to shrink.

      We accumulated such a superabundance of capital that our great bankers were vying with each other, some of them employing questionable methods, in their efforts to lend this capital at home and abroad.

      I believe that we are at the threshold of a fundamental change in our popular economic thought, that in the future we are going to think less about the producer and more about the consumer. Do what we may have to do to inject life into our ailing economic order, we cannot make it endure for long unless we can bring about a wiser, more equitable distribution of the national income.

  4. Too bad Somerby doesn't read his comments. It would save him some embarrassment.

    A big giant change in the way we do health care would not doubt require a vote by congress. That means that elected representatives from all over the country would have their staffs review the details, solicit testimony from experts and then hold a vote on a detailed plan that would include real cost estimates.

    Warren doesn't have to do this heavy lifting herself, nor does Sanders, and only foolish people with animosity toward Democrats are calling for such a thing.

  5. Very sorry over the shocking death of Elijah Cummings. I remember Somerby recently saying that Rep. Cummings was his congressman.

  6. Well said on health care. We never discuss why our costs are so much higher than other industrial nations and they cover everyone. Hint:Big Pharma and the insurance companies.

    1. Um, Bernie Sanders and Elizabeth Warren are talking about that very thing.

  7. Hayes/MSNBC did a town hall with Sanders. Healthcare was a big topic:

    Hayes also had a town hall this year with AOC on climate change.

    It isn’t clear why Somerby ignores these kinds of things, and then says “no one discusses it.”

    He seems to be concerned that Maddow doesn’t discuss these things, and that that shows that “no one” discusses them.

    Or here’s an idea: why doesn’t Somerby take his eye off the “helpful hints” and style sections long enough to read articles like this one:

    Or this one:

    1. 'It isn’t clear why Somerby ignores these kinds of things, and then says “no one discusses it.” '

      Because Somerby is a liar.

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  9. The writer at the Atlantic (didn’t read it) seems to have forgotten an important transitional phase in the MFA debate: the shifting of the money spent for insurance premiums to a tax-based system. Don’t know the actual numbers meself, but if the overhead spent on Medicare is as advertised (minus the appalling fraud by private players), then a tax based system should be less expensive.

    Sander’s plan doesn’t just happen if he becomes President, obviously. But if it’s popular enough, it might pass. And there is a four-year transition plan. As far as the actual taxes, here’s what I found in a cursory search. Hey, who knew health care spending was actually a player in GDP? Or maybe I misread that part. Whatever.



  10. A current problem is the shortage of doctor. There are lots of doctors in the area around Stanford University, yet I often have to wait a couple of months for an appointment with a specialist. Medicare for All would increase the demand. What we really need is some way to increase the supply.

    Increasing the supply of doctors is a daunting task. However, I wish our federal government had the ability to take on a task like this, rather than simply robbing Peter to pay Paul.

    1. Doctors can be trained in foreign countries, where its cheaper. The US can then pay those foreign countries for the doctors they send here.
      It works when we want to squeeze what we pay labor in manufacturing. It can work to squeeze what we pay labor to doctors (and lawyers, dentists, other professionals) as well.

    2. Doctors have a very high burnout rate, much like teachers. It might help to improve working conditions in the field and try to figure out how to retain the doctors you currently have, before planning to make the profession worse for those who work in it.

    3. Doctors need to be paid a pittance. If not, how will they ever learn to pull themselves up by their bootstraps?

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