The movement for single-payer health care has taken some big strides forward in recent years. Sen. Bernie Sanders, I-Vt., put the issue at the center of the Democratic Party’s debate with his run for president in 2016. In partnership with the nurses union and other champions, he then got 19 senators to co-sponsor his bill in 2017. After Democrats took back the House of Representatives, we demanded and got hearings in multiple powerful committees on the fantastic bill spearheaded by Rep. Pramila Jayapal, D-Wash. (The successor to that of the progressive hero and former Michigan Rep. John Conyers, who died this week.)
These were our victories, earned by a movement that has been fighting for many decades.
The plan that Massachusetts Sen. Elizabeth Warren just released is another enormous win for us. It will help persuade our friends and families and neighbors to support Medicare for All, and in the not-too-distant future, to convince Congress too. Here’s why.
To begin, her plan covers everybody, with zero out-of-pocket expenses. “Medicare for All” is a great brand. So is “Free Healthcare for Everybody.” And that’s the central promise of the Sanders and Jayapal bills, and the Warren proposal as well. You get the doctors and caregivers and treatments you need, for free. That’s it. It is a deeply appealing vision (as evidenced by the enthusiasm that Bernie generates among the working class) that we can use to drive enormous turnout from voters who often stay home out of cynicism about what either party will do for them.
Eliminating the cost of health care will mean many thousands of dollars back every year for families throughout the country. It’ll come to $11 trillion in savings over 10 years. For my sisters and brothers in red, let me put it this way: It would represent the largest redistribution of wealth since the Great Society, or maybe the New Deal, or maybe even the Emancipation Proclamation. (Can some economists or historians help me out here?)
Warren shows how a single-payer system, and only a single-payer system, will dramatically reduce costs.
But won’t the government take it all back in taxes? This, my comrades, is where Senator Warren performs what is perhaps the greatest feat of public policy jujitsu that I have ever seen.
Her plan doesn’t raise taxes on working families. Lately, debate moderators have been salivating at the idea of getting Warren to admit that her plan will be paid for by creating a new employer-side tax. (Bernie has already said as much — because he’s a no-bullshit, courageous guy, and everyone has been assuming that it would be necessary.) And her debate-stage admission would then be the subject of a billion dollars in Republican advertisements. This was the trap that was being set for Warren, according smart observers like Paul Krugman and Zach Carter, and it could have disastrous political consequences. (They even had me worried. Honestly.)
But then Warren did what she does best: her fucking homework. She consulted the experts, she double-checked the numbers, and she dropped a codex of wisdom right in the middle of the teacher’s desk. And the political reverberations may be felt for decades.
Just imagine what will happen when the debate moderators ask her next time how she’ll pay for her plan. She can answer honestly and with authority that Medicare for All will mean zero health care costs and no increases in taxes for all but the wealthiest Americans.
So how does she pay for it? Here is where the brilliance of this plan’s political economy really shines brightest. Warren pays for her plan by targeting the bad actors who are making our health care system so expensive and wasteful and our economy so rigged and unequal.
On the revenue side, she eliminates the ability of corporations to hide their profits overseas and the ability of megawealthy families like the Kochs and the Waltons and the Sacklers to avoid taxes through accounting gimmicks and the capital gains loophole. She bumps up her wealth tax. She funds the IRS properly, so the agency can actually collect that revenue (Republican lobbyists and lawmakers have starved it for decades because they are, um, corrupt). And then the plan fills in the revenue with an employer-side tax that is equal to current employer health care expenses. (Warren makes some smart decisions in order to reward, rather than penalize, high-road employers who are currently providing great health care coverage and especially those with unionized workforces. It’s a clever way to encourage corporations to let their workers unionize, and if you’re interested in that level of detail, you should go read the plan).
Then, Warren shows how a single-payer system, and only a single-payer system, will dramatically reduce costs. This is what all credible analyses make clear: With only Medicare paying the bills, we get huge savings. Administrative costs plummet. Wasteful billing and cost-shifting disappears. Outrageous drug prices get negotiated down to something reasonable.
This is why Medicare for All works so much better than the public-option plans that other candidates are offering. We can’t get those savings if “Medicare for all who want it” is competing with a bunch of private insurers. Doctors and hospitals wouldn’t save any money or time, like they would under single payer. And we wouldn’t be able to rein in absurd expenses from the pharmaceutical and medical device industries, or monopoly hospital corporations. (She also cuts immoral and wasteful spending on wars. Yes, please.)
Historically, single-payer advocates have focused on the human benefits of more and better health care coverage. And rightfully so. That is what matters the most. But we’ve simultaneously shied away from discussing the cost, because the numbers are just so big. And that is why this plan is such a landmark. It turns our perceived weakness into a powerful strength. From now on, when we’re asked how to pay for the program, we can point to the very same corporate interests who are trying to defeat us.
Do the numbers add up, or is this a hocus-pocus political trick? You won’t be surprised that various fancy, respected policy wonks helped run the calculations and fill in the details.
We shouldn’t be surprised. After all, Warren spent most of her career as one of the nation’s experts on middle-class family costs, and wrote one of the major game-changing studies exposing the severity of medical bankruptcies. Her co-authors? David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program.
PNHP is holding its annual meeting this weekend in Philadelphia. Dave and Steffie founded the organization in 1987 (when I had just graduated from diapers). It was the height of the Reagan Revolution, but they had inherited from their forebears a vision for a more just and equitable society — in which health care is finally treated as a human right.
It is a multigenerational vision. A multigenerational struggle. And a multigenerational movement. And, together, we can celebrate this moment because we are that much closer to our promised land.
Ady Barkan is the author of Eyes to the Wind: A Memoir of Love and Death, Hope and Resistance.