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.Just for starters, Oof!
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.
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.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.
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...
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, 2018The 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.
United States: $10,586
United Kingdom: $4070
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!