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Thursday, November 7, 2019

Warren's M4A financing plan

Elizabeth Warren over the last few weeks has faced questions over how she imagines financing Medicare for All -- and who, in the end, would be better or worse off.  On Friday, she answered those questions by sketching out how much she envisions a new government-run health care system costing and, then, how the government would pay for it.

Here's the thumbnail version of what she proposes: She would hike taxes on corporations and the rich. She would repurpose the money employers and states now spend on their own health insurance programs. She would pull money from elsewhere in the federal budget and, critically, she would control spending throughout the health care industry -- not just for drug makers, but for doctors and hospitals too.

The plan is complex and so it will be a while before analysts figure out exactly what it entails and where all the hidden tradeoffs are. The numbers add up, at least on paper, and she's got some highly respected experts, including former Obama administration officials Don Berwick and Betsey Stevenson, vouching for the feasibility of different plan components.

Still, plenty of experts are already wondering about the provision to keep employers paying for health care -- and whether it can work as Warren intends. Others are questioning her campaign's assumptions of massive new savings from administrative simplification and whether she's accounted appropriately for other variables, like the fact that people who get better health insurance tend to consume a lot more health care.

And then there are the daunting political challenges that any Medicare for All plan, including the original bill from Bernie Sanders, would face. Corporations will fight the new taxes and the health care industry will oppose the new cost controls, arguing, rightly or wrongly, that they will undermine quality and timeliness of treatment, even as the plan eliminates financial barriers to care. That could resonate with a public that, however unhappy about the status quo, also lacks faith in government.

Could Warren's plan work in the real world? Should we judge it as a schematic, or a statement of priorities and values? Is it more or less honest than the typical campaign document -- and how does it compare to what Republicans have put forward? These are all good questions, about which honest people can disagree. 

But at the very least, we can stop asking how Warren would pay for a single-payer health care plan and start asking whether her approach to policy makes sense for the country.

Here's a tweetstorm with some more thoughts:

And then the full story at HuffPost, from Friday, with my colleague Kevin Robillard:

Jonathan Cohn