Elizabeth Warren’s ‘Medicare For All’ Plan Is Utopian And Probably Unconstitutional

Senator Elizabeth Warren released a more detailed version of her 'Medicare For All" plan late last week. It leaves much to be desired.

Senator and Presidential candidate Elizabeth Warren put forward a much more detailed version of her “Medicare For All” plan late last week, and it has proven to be so unrealistic that even many of her fellow Democrats are criticizing it:

WASHINGTON — Senator Elizabeth Warren on Friday revealed her plan to pay for an expansive transformation of the nation’s health care system, proposing huge tax increases on businesses and wealthy Americans to help cover $20.5 trillion in new federal spending.

The plan represents a significant bet that enough voters will favor an approach that dismantles the current system and replaces it with “Medicare for all,” a government-run health insurance program. And it comes after decades in which Democrats have largely tiptoed around policy proposals that relied on major tax increases and Republicans ran on tax cuts.

While the proposal allows Ms. Warren to say she is not raising taxes on the middle class, it opened her to renewed charges that her plan is too radical to pass through Congress. It represents an extraordinary embrace of the tax system to redistribute wealth and re-engineer one of the pillars of the American economy, with measures that would double her proposed wealth tax on billionaires and impose new levies on investment gains and even stock trades.

“This debate has moved so far and so fast within the Democratic Party, it makes your head spin,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation. “Ideas that used to be political third rails are now being proposed by one of the leading candidates for president.”

(…)

Under Ms. Warren’s plan, private health insurance — which now covers most of the population — would be eliminated and replaced by free government health coverage for all Americans. That is a fundamental shift from a market-driven system that has defined health care in the United States for decades but produced vast inequities in quality, service and cost.

Ms. Warren would pay for the new federal spending, $20.5 trillion over 10 years, through a mix of sources, including:

  • Requiring employers to pay the government a similar amount to what they are currently spending on their employees’ health care, totaling $8.8 trillion over a decade.

  • Changing how investment gains are taxed for the top 1 percent of households, raising $2 trillion, and ramping up her signature wealth tax proposal to be steeper on billionaires, raising another $1 trillion.

  • Creating a tax on financial transactions like stock trades, bringing in $800 billion.

Beyond the $20.5 trillion total, she is also counting on states and local governments to contribute an additional $6.1 trillion to help pay for the system.

Like Mr. Sanders, Ms. Warren would essentially eliminate medical costs for individuals, including premiums, deductibles and other out-of-pocket expenses. But it is not clear if her plan would cover the costs of free health care for everyone. It relies on ambitious assumptions about how much it can lower payments to hospitals, doctors and pharmaceutical companies, and how cheaply such a large system could be run.

Several economists have said providing free health care would cost trillions more over a decade.

“We made different assumptions, because we didn’t think these kinds of assumptions were realistic,” said Linda Blumberg, a health economist at the Urban Institute, whose detailed assessment of Medicare for all found it would require $34 trillion in added federal spending.

This isn’t the first introduction of Warren’s health care insurance plan, of course, but it is the first to detail in any respect at all how she would pay for the plan. As pretty much everyone expected, that part of the plan involves higher taxes:

Ms. Warren’s proposal shows just how large a reorganization of spending Medicare for all represents. By eliminating private health insurance and bringing every American into a federal system, trillions of dollars of spending by households, employers and state governments would be transferred into the federal budget over the course of a decade.

Ms. Warren tries to minimize fiscal disruption by asking the big payers in the current system to keep paying. Her tax on employers is meant to replace the amount that companies now pay directly to health insurers. (Small businesses would be exempt if they are not currently paying for their employees’ health care.) She has also proposed that states pay the federal government what they currently spend to cover state workers and low-income residents under the Medicaid program.

But to help replace an estimated $11 trillion in health care spending that would be borne by American households over a decade — on premiums, deductibles and other out-of-pocket costs — Ms. Warren lays out a series of new taxes on corporations and wealthy people.

She would raise $3 trillion in total from two proposals to tax the richest Americans. She has previously said that her wealth tax proposal would impose a 3 percent annual tax on net worth over $1 billion; she would now raise that to 6 percent. For the top 1 percent of households, she would tax investment gains annually instead of when the investments are sold.

Ms. Warren is also counting on stronger tax enforcement to bring in more than $2 trillion in taxes that would otherwise go uncollected, as well as $800 billion in cuts to military spending. And she is banking on passing an overhaul of immigration laws — which itself would be a huge political feat — and gaining revenue from additional taxes paid by immigrants.

With all of this, Warren is insisting that she will not be required to raise taxes on the middle class notwithstanding the fact that it is questionable at best that her tax plan would be sufficient to pay for the increased costs that would be incurred by the Federal Government. For example, her estimate that she could increase Federal tax revenues by as much as $2 trillion dollars simply by being more aggressive in tax enforcement seems dubious at best. One reason for this is that many of the people who owe taxes to the Federal Government are already in a financial hole and, as the saying goes, you can’t get blood from a stone. Additionally, such increased enforcement would require hiring more IRS employees and giving them more power, neither of which are politically popular regardless of who the President might be. Additionally, her proposal to tax the wealth, as opposed to the income, of the richest Americans is, to put it mildly of dubious Constitutional merit and would likely face a long court battle.

Specifically, Warren’s tax plan suffers from the following Constitutional defects:

If a hypothetical President Warren ends up at the losing end of the court battle, then a significant part of her revenue stream will disappear into thin air. Finally, her attempt to get more than $6 trillion into Federal coffers by getting money from the states carries with it Constitutional and practical concerns and raises the prospect that even many of her fellow Democrats on Capitol Hill and in Governor’s Mansions and state legislatures would oppose the plan. Additionally, such a demand would cause significant fiscal problems for the states that would reverberate across the country and, most likely, cause the biggest problems for blue states such as New York and California

Moreover, as Megan McArdle notes, Warren’s math simply doesn’t add up”:

To wit: Warren says she can deliver a generous Medicare-for-all plan with only $20.5 trillion in additional federal spending. That’s a quarter to a third less than any serious estimate of the plan from outside her campaign. How will she get there? Why, by slashing administrative costs and then mandating that everything else cost less. Warren is not exactly the first progressive reformer to have this same idea, and if she pushes forward with it, she will be but the next in a long line to discover that she can’t make it work, politically or economically. As Philip Klein of the Washington Examiner dryly noted, Warren could just as well have written that Mexico was going to pay for her big, beautiful plan.

Warren’s revenue ideas are, if anything, even more exquisitely incredible. Take her proposed wealth taxes — no, not the 3 percent ultra-millionaire wealth tax she has already pledged for other things, but an entirely new 3 percent tax on all wealth over $1 billion. The tax would, Warren says, raise $1 trillion over 10 years.

On another, more important level, the idea is ludicrous in terms of the tax code and basic common sense. After adding in the ultra-millionaire’s tax and factoring in the other capital taxes Warren wants to levy — on financial transactions, on unrealized capital gains, on corporations — we’d be asking every billionaire to hand over more than two-thirds of their total wealth over a 10-year period. If the government actually managed to collect it, their fortunes would rapidly erode — and so would tax collections. The plan might be a good way to smash wealth, but it’s a terrible way to fund the nation’s health-care system.

This, of course, is the problem with all of Warren’s plans, of course. Whether it’s health care, or student loans, or whatever else you might point to. When it comes down to asking how she’d pay for it, it inevitably comes down to taking more and more out of what she calls the “ultra-wealthy.” This will end in only two ways, either she’ll get to the point where she can’t get any more significant revenue from the so-called rich or she will create more and more incentives for these people to station their wealth outside the country in ways that would make it exempt from her new taxes. The end result? Either a hypothetical President Warren would be forced to admit that her promise of no new taxes on the middle class is a lie or she’d have to retool the entire plan.

As McArdle goes on to note, the saving grace of Warren revealing the details of her plan now is that even if she did become President it would effectively be dead in the water:

The best you can say for all of this is that none of it will happen. If Warren makes it to the White House, and tries to pass a plan, the Congressional Budget Office will eventually attach more reasonable numbers, with more defensible assumptions, sparking an even more spectacular political blowback than the one that greeted Friday’s announcement. Outside of the progressive Twitterati, there isn’t necessarily an enormous constituency for spending $20.5 trillion to herd every American into a national health insurance program; there would be even less support for spending what Warren’s plan would actually cost.

This, in the end, is what makes Warren’s plan the most unrealistic. For all her claims to “have a plan for that,” Warren has yet to explain how she’d get all of this through Congress. First of all, as McArdles notes one of the first things that would happen after such a plan is introduced is that it would face scrutiny from the Congressional Budget Office, which will most likely work from far more realistic economic and taxation assumptions than Waren is working from. This is what happened to early versions of the Affordable Care Act, of course, and it led to major revisions to the plan to address the questions raised by those initial CBO scores. Second, it assumes that Warren could keep her own party united behind such a radical change to both health care, tax law, and the relationship between the Federal Government and the states. Third, it assumes that Democrats will gain control of the Senate and ignores the reality of the legislative filibuster which, despite the urging of progressives, is not going anywhere. Finally, it fails to even recognize that it would be competing for revenue with all of Warren’s other ambitious “plans.”

Taking all of that into consideration, it seems clear that, much like her other plans, Warren”s “Medicare For All” plan is unrealistic, probably unconstitutional in at least its taxation ideas, and politically impossible to pass into law.

Other than…….

FILED UNDER: Campaign 2020, Elizabeth Warren, Health Care, Politicians, US Politics
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. Stormy Dragon says:

    Good thing for her plans we now have a precedent that the President + 34 senators means the constitution no longer applies to anything.

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  2. Teve says:

    I can spend an hour writing an essay about this but instead I’ll just hit the bullet points. A few years ago I had just started a new job and didn’t have insurance yet and was in a massive car wreck that put me in intensive care in Tallahassee for 5 days. I now have $100,000 in hospital bills I’ll never be able to pay. Bankruptcy wouldn’t make them go away, my credit is destroyed forever, I can’t imagine ever buying a house, or even renting most apartments, and every paycheck I will have for the rest of my life will be garnished at the maximum rate of 25%. I just had to get another deferment on my student loans, and hopefully when the deferment is over I’ll be able to make payments again. A friend of mine has type 1 diabetes and went into ketoacidosis one weekend and now has tens of thousands of dollars she’s struggling to deal with. I just read yesterday about people who have seizures who wear clothing and bracelets that say “Don’t call an ambulance” because every time somebody does that they are another two grand in debt. I just read last month that the hot new thing in healthcare is private equity companies buying up medical practices so they can hit every patient with huge Out of Network bills.

    It’s not like this in smart countries. The current US healthcare system is a fucking dystopia.

    WARREN 2020!

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  3. Sleeping Dog says:

    I’m having a hard time getting worked up over a plan that won’t happen.

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  4. Nightcrawler says:

    We’re never going to have a sane healthcare system in this country, because we don’t live in a society; we live in an economy. Sick people don’t “contribute” to the economy, or they don’t “contribute enough,” so the patriotic thing to do is die so we don’t cost anybody anything.

    I’m a cancer survivor. I know that one day, the cancer will come back, or I’ll get hit by another serious injury or illness and not be able to pay for it.

    Knowing that I’m going to go down spectacularly and in flames, I live for today. I do what I want, as much as I can, now. I don’t save or plan for the future, because I know that’s pointless. It is highly unlikely I have one unless I can become a millionaire (which is my greatest life regret — not making millions).

    I’m glad I didn’t have kids, if for no other reason than they’d be subject to cancer, too.

    The only difference between me and everyone who claims they’re “healthy” is that I am cognizant of the “24” clock hanging over my head. I was “healthy” too — until I wasn’t. Those people pinching pennies and saving and putting things off will one day find themselves in a situation where all that money they “saved” will be sucked into the healthcare system.

    I at least got to meet THE ENTIRE CAST OF THE X-FILES! I can die knowing that!

    YOLO!

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  5. de stijl says:

    We were founded on a radical idea.

    And I love that Warren is a total policy wonk. Not as window dressing to smarten up her campaign, but it’s her preferred space.

    Go, Liz, go!

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  6. Scott F. says:

    This, in the end, is what makes Warren’s plan the most unrealistic. For all her claims to “have a plan for that,” Warren has yet to explain how she’d get all of this through Congress.

    How any policy from any candidate, Republican or Democratic, would get through our current dysfunctional Congress is a open question in all cases, isn’t it?.

    What is ‘unrealistic’ is the idea that the US can keep muddling through with only modest tweaks here and there and somehow survive as a country considering the trajectory we are on. Look at the riots in Chile and tell me that the dramatically increasing wealth inequality we are seeing here is sustainable in the long term. Look at our health outcomes, be it unnecessary suffering or medical bankruptcy, and tell me that the US can continue to stand alone among developed countries without universally providing a public good like health care. Look at the consensus data and tell me we can keep ignoring the big international efforts needed to address climate change. Look at the Republican’s full embrace of Trumpism and tell me we can hand wave away the corruption rampant in government and business.

    Give me Elizabeth Warren’s bold call for ‘big, structural change’ as I can accept that not all of her plans will become reality, but at least I’ll know she sees at least some of the massive challenge that inevitably lies ahead and that she knows changes must be made or they will be thrust upon us. Don’t give me a timid call for a return to some better time in the country’s past – be it MAGA or the Obama years – because I can’t believe that person has frakking clue about what is happening in the world.

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  7. Nightcrawler says:

    @Sleeping Dog:

    That’s what I don’t get. Everybody is all up in arms about this and other universal healthcare proposals that are about as likely to happen as David Duchovny showing up at my door and proposing marriage. In fact, if I were to crunch numbers, the probability of the latter is probably higher, like, 0.000000001% as opposed to the 0.000000000000001% probability of public healthcare in the U.S.

    I’m not holding my breath thinking a millionaire actor will show up and save me, and I sure as heck ain’t holding my breath for universal healthcare, either.

    Here’s what’s going to happen: Obamacare will be abolished by the SCOTUS next year. We will return to what we had before, with some changes. Medicaid will be block-granted and be even more difficult to qualify for; states will have years-long waiting lists, like they do for Section 8 housing. If you’ve got cancer and need treatment now, too bad, so sad. You’ll croak long before your number on the waiting list is called.

    Got money? Spend it on something YOU want. Do what you want NOW, as much as you can, while you can.

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  8. de stijl says:

    Every other advanced country on this planet has a saner health care system than ours.

    Why not us, and why not now?

    As Teve and Nightcrawler show, what we have does not work. 99% of us are one bad day away from financial ruin. That is unsustainable.

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  9. Daryl and his brother Darryl says:

    I’ll wait for the rigorous comparison to tax cuts that paid for themselves, and Mexico’s wall payments…

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  10. Sleeping Dog says:

    @Nightcrawler:
    Unless RBG dies before the Obamacare case reaches the Supremes it will survive 5-4 with Roberts being the swing vote.

    The larger problems that most of these healthcare plans ignore, whether Dem or Repug, is cost, which is only addressed on the margins and supply, which is barely addressed at all and if it is, the concern is keeping rural hospitals open.

    A continuing problem which lurks in the shadows and effects both of these, is the consolidation of medical providers where in any given SMSA one or two providers can control 70-80% of the market. This market power means that they can demand the reimbursement level they want from insurers, rather than the insurers having leverage over the providers. Only the Fed Gov has the power to cower the medical industry.

    A smart politician would have a winning proposal if they accomplished the following:
    – Universal coverage, but not necessarily free and limited to basic coverage where additional coverage can be purchased.
    – Reduce cost per patient to the average of the industrialized nations that have universal healthcare.
    -Increase the availability of healthcare by 30% (I pulled this # out my a$%)

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  11. Slugger says:

    In dollars and cents, the US healthcare system is the most expensive in the world without getting outstanding results. I wonder if economists can give us a dollar equivalent of the anxiety and uncertainty that burdens many like Teve above. I am not endorsing any particular fix but do note that those who claim that a fix would cost trillions seem to be unaware that every other nation can do better than we do and that our system has huge costs in suffering and insecurity that may not show up on any balance sheet but certainly show up in the lives of Americans.

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  12. Nightcrawler says:

    Teve — I am truly sorry about your situation, as well as your friend’s. I wish I were in a position to help everyone, just as I wish I could save every abandoned shelter animal, but I’m not, so all I can do is offer empathy.

    de stijl – Why not us, and why not now? I reiterate: because we don’t live in a society; we live in an economy. I ripped that off from someone on Quora because it encapsulates the U.S. so well. There’s no money in treating sick people, especially people with chronic illnesses.

    If I’d had a kid, I would tell them that they needed to either become a millionaire or marry one, preferably the former, because then it’s your money, not somebody else’s; it will still be yours even if they leave. I wish I hadn’t even dated until I made at least six figures; dating got in the way of me making as much money as I could have. That is my single biggest life regret — not “loving more” or any other such emo nonsense.

    (Unfortunately, if I had produced children, my obsession with making money would probably have led them to run off with, like, baristas or McDonald’s clerks for no other reason than to give me the middle finger. You don’t realize how bad things are until you’re told you have cancer.)

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  13. Nightcrawler says:

    our system has huge costs in suffering and insecurity that may not show up on any balance sheet but certainly show up in the lives of Americans.

    And that’s why it doesn’t matter. Americans don’t care unless it shows up on a balance sheet — and that balance sheet had better show a profit for them.

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  14. Hal_10000 says:

    I’ve been arguing for a while that you can’t pay for universal healthcare without taxing the middle class and heavily. That’s how every country that has universal healthcare does it. High incomes tax rates, VATs, payroll taxes, etc. That’s how every country does it.

    So, in a way, I’m grateful to Warren for going out and proving us right by concocting the most absurd and deceptive plan imaginable so that she can claim M4A can be finances off the backs of the rich. A few highlights:

    1) She claims that her plan will come in $7-10 trillion under the price tag estimated by the Urban Institute and other think tanks. And those estimates are probably low. She assumed this by concocting a whole bunch of theoreticals, all of which would have to happen in order for the cost to be close. And all of which would alienate the stake-holders she needs on her side to get this done.

    2) She claims it would be an $11 trillion tax cut for the middle class which is incredibly deceptive. You can’t have employers pay health insurance fees to the federal government AND put that same money into their employees’ paychecks. The money has to come from somewhere.

    3) She imposes mark-to-market capital gains taxes, overseas earnings taxes, a wealth tax, a financial transactions tax, etc.. What’s more, she assumes that because each tax has a study supporting it, you can simply add all those revenue estimate together. But you can’t. You’re sometimes taxing the same dollar. And while one of those taxes might not damage, all of them? Bonds interest rates would have to go up dramatically to make them a paying investment, which would cost trillions in new interest. Of the dozen counties that have tried a wealth tax, all but two abandoned it because it didn’t work. Yet she cavalierly assumes she can triple those wealth taxes with no problem. She also doubles down on our absurd overseas taxation system which almost no other nation uses.

    4) She also assumes that we will decriminalize all illegal immigrant, bringing in new revenue. As if that won’t be a massive political fight on its own.

    This has only confirmed my opinion of Warren as a faux wonk, someone who, like Al Gore before her, is good at repeating progressive talking points (and therefore being proclaimed brilliant by progressives) but doesn’t really understand the policies she’s proposing.

    But … as I sad, I’m grateful. Warren may have killed M4A stone dead with this absurd proposal.

    “Our healthcare system has problems” is not an argument for this plan. The plan has to hold together on its own. And this one does not.

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  15. Sleeping Dog says:

    Early in the campaign, one of the things that concerned me about Warren, was her tendency to handle some issues like a monkey effin a football. The best example being her native american heritage claims. She seemed to have learned from that and moved on, but now here we are and she’s tying herself in knots over MFA, a proposal, no matter which Dem is nominated, will never see the light of day.

    A better response would have been: MFA is the best for the US, but there is a lack of support for it, here are the alternatives…

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  16. grumpy realist says:

    @Hal_10000: At least Warren’s trying to come up with something to solve our incredibly dysfunctional healthcare system.

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  17. Teve says:

    @Sleeping Dog: you don’t begin a negotiation by giving up what you want.

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  18. de stijl says:

    Every dream has a name

    And names tell a story

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  19. de stijl says:

    A dream of a better life.
    For you and yours.

    Everybody else except us figured this out decades ago. Their economies survived and thrived.

    Why not us, and why not now?

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  20. Sleeping Dog says:

    @Teve:
    Nor do you begin negotiations from a position that is so far fetched that other interested parties can effectively ignore it.

    It’s doubtful that MFA would garner the support of 30 Dem Senators and maybe 125 Dem congresscritters, how does that make it an effective opening proposal for negotiations for major change in how healthcare is delivered and paid for in the US?

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  21. Hal_10000 says:

    @grumpy realist:

    Sorry, but you don’t get an A for effort in this game. Coming with something that involves fairy dust and creative accounting isn’t helping with the dysfunctional system. It’s setting reform back. Or did we learn nothing from the Clinton healthcare debacle. Say what you want about Obamacare. At least it was a realistic approach to the problem. And at least it passed.

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  22. de stijl says:

    We have settled on a feudalistic health care system. Probably unintentionally, but functionally feudalism.

    And we are the serfs.

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  23. EddieInCA says:

    Warren’s M4A will be the death of her campaign eventually.

    If she honestly presents the cost, she’s dead, because the price point in regards to taxes is too high for most people to stomach, once they see the real costs.

    If she fudges the cost, trying to make it more palatable, her competitors on the Democratic side will pillory her (rightly so) for not being honest.

    It’s a rock and a hard place. Good idea. But no way to pay for it realistically.

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  24. Jen says:

    Our healthcare system, as noted repeatedly above, is a fvcking mess, and it’s just getting worse. I can’t get wound up about Warren’s plan because it won’t happen.

    What WILL happen is the monstrous, awful, demonization of her plan by Republicans if she’s nominated. She’ll be *penalized* for putting forth an idea to address the dystopian sh!tstorm of our healthcare system. (Note: I just typed “healthscare” system and was tempted to leave the error.)

    As sure as the sun rises in the East, Republicans will vilify anyone with a healthcare reform idea, and older voters–who are already covered by a government-run program!–will march in lockstep to the voting booth to vote against her for it.

    One reason for this is that many of the people who owe taxes to the Federal Government are already in a financial hole and, as the saying goes, you can’t get blood from a stone. Additionally, such increased enforcement would require hiring more IRS employees and giving them more power, neither of which are politically popular regardless of who the President might be.

    This is another thing that drives me nuts. In order to collect taxes from people who haven’t been paying them (and I’m not sure all of those folks are *truly* unable to pay) we would need to hire more people. Improved collection–getting people to pay what they f#$%ing owe–would help everyone. And yet, getting to the point where we could actually DO that is unpopular.

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  25. de stijl says:

    Every other industrialized nation on Earth does this better than us.

    We have a wealth of knowledge immediately available as to what works and what doesn’t.

    We are not stupid. I believe in us. We can do this.

    (Actually, we’re definitely pretty stupid.)

    That was my coach voice.

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  26. Jay L Gischer says:

    Frankly, I think the 2016 election showed that you can go a long, long way with fairy dust. Fairy dust nearly got Bernie the nomination as a complete outsider, and it put Trump in the White House.

    Apparently, voters like fairy dust.

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  27. drj says:

    @Hal_10000:

    I’ve been arguing for a while that you can’t pay for universal healthcare without taxing the middle class and heavily. That’s how every country that has universal healthcare does it. High incomes tax rates, VATs, payroll taxes, etc. That’s how every country does it.

    This is misleading.

    Because you are implying that the middle class isn’t already taxed heavily, which it is – at least in comparison to the wealthy.

    Some figures:

    Total tax revenue as percentage of GDP is ca. 27% in the US, which is roughly 10-15% lower than in other developed countries.

    But the tax burden on labor is 32%. Add sales and property taxes and you are getting a lot closer to the OECD average.

    But in other countries people get stuff for their taxes, such as subsidized healthcare, subsidized higher education, relatively decent unemployment insurance, you name it.

    For instance, how does an annual out-of-pocket healthcare premium of $1500 sound, with a max annual deductible of $500 and outcomes that are comparable to the US? (Oh, and kids are free.)

    That is the kind of shit that people in other countries get.

    Taxes on the wealthy ARE the answer, because if the middle class faces a net tax burden of say 35%, then the wealthy must pay far, far less to get to a tax revenue to GDP ratio of 27%.

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  28. gVOR08 says:

    I was struck by a line in a WAPO story a few days ago. A female gynecologist wrote a book called The Vagina Bible, sort of womens’ health for dummies. Somebody’s mailing a copy to every member of congress. Admittedly a stunt as people mail books congresscritters won’t read to them every day. But as the WAPO writer says,

    I like the premise of the stunt: that laws should come from a place of compassion and science, not point-scoring and punishment.

    Republicans still want to kill Obamacare. And for no reason except that it was a D plan so they’ve spent years demonizing it. Otherwise the Republican health care plan is the conservative plan for everything – that’s just the way things are, nothing can be done. Maybe, if we get rid of enough Republicans, we can get closer to compassion and science.

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  29. de stijl says:

    This notion that we cannot be better is repulsive.

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  30. Michael Reynolds says:

    I love Warren, I’ve given her money, but @Hal_10000: and @EddieInCA: are right, this is not a good plan. She is way out over her skis for something that has zero chance of passing. High political risk for no policy gain. Taking political risk for realistically-attainable policy gain, I respect that. But this is about nothing but undercutting Bernie, it was a tactical move that exposes her strategically. That’s bad generalship and it revives my concerns about her political savvy.

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  31. Han says:

    @Hal_10000:

    2) She claims it would be an $11 trillion tax cut for the middle class which is incredibly deceptive. You can’t have employers pay health insurance fees to the federal government AND put that same money into their employees’ paychecks. The money has to come from somewhere.

    I don’t believe this is accurate. Most business-provided health insurance that I’ve seen is partly paid for by the employer, and partly by the employee. As I understand it, businesses would give the federal government the money they’ve been paying towards health insurance, and people would keep the portion they’ve been paying. That’s not double-counting, nor is it deceptive.

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  32. DrDaveT says:

    Under Ms. Warren’s plan, private health insurance — which now covers most of the population — would be eliminated and replaced by free government health coverage for all Americans. That is a fundamental shift from a market-driven system that has defined health care in the United States for decades but produced vast inequities in quality, service and cost.

    Even when mostly telling it like it is, the media can’t avoid spreading the old lie that the current system is “market-driven”, thereby engaging reflexive defense of the status quo from people who believe the Invisible Hand is the only hand that works.

    There is nothing “market-driven” about our current system. It consists of competing monopolies and cartels, with the government regulating the crap out of everything and the local monopolies extracting all the rents they can. “Keeping the population as healthy as possible” doesn’t figure, not even in the fine print.

    The purpose of government is to deal with externalities the market can’t handle and leverage economies of scale: national defense, international relations, major infrastructure, public education, police and fire services, water and sewer and power and communications systems, disaster relief, environmental protection, and (goddammit) public health. A “market-based” approach to public health makes no more sense than a market-based approach to the Navy or the police or the highway system.

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  33. Han says:

    For example, her estimate that she could increase Federal tax revenues by as much as $2 trillion dollars simply by being more aggressive in tax enforcement seems dubious at best. One reason for this is that many of the people who owe taxes to the Federal Government are already in a financial hole and, as the saying goes, you can’t get blood from a stone.

    Yeah, turnips like these: There’s 3.5 year’s worth right there. Can you imagine how much further ahead we would be if we hired 1,000 new IRS agents whose sole purpose was auditing the 1,00o highest income earners in the country?

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  34. Pylon says:

    If universal medicare is utopian, then a lot of countries are utopia. Seriously, though, if other countries can figure it out, so can the US. I haven’t checked Warren’s math (though I trust her homework a lot more than Megan McCardle’s). But pretty much any such policy is based on projections and assumptions. I doubt it’s any worse on that basis than trickle down economics, corporate relocation tax incentives, etc. And, bottom line, even if she admits error in developing the actual policy and has to increase middle class tax, the bottom line savings to businesses and individuals should be there, since that’s the experience elsewhere.

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  35. EddieInCA says:

    When the very liberal Speaker of the House, publicly, says your plan is unrealistic, you should take the hint. She’s telling you IT WILL NEVER PASS A DEMOCRATIC HOUSE.

    So don’t double down. Stop it. Pull back. When you’re in a hole, stop digging.

    https://www.google.com/search?client=firefox-b-1-d&q=pelosi+medicare+for+all

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  36. Jen says:

    @gVOR08:

    And for no reason except that it was a D plan

    And yet it wasn’t…it was rebranded Romneycare, but they had so fiercely attacked Obamacare that he couldn’t use his signature reform as a campaign issue in 2012.

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  37. Mikey says:

    @de stijl:

    Every other industrialized nation on Earth does this better than us.

    We have a wealth of knowledge immediately available as to what works and what doesn’t.

    That’s what always frustrates me about this debate. We have two dozen examples from which we could draw, but we go around and around with unworkable plans because we can’t seem to admit somewhere else might maybe do something better than we do. It’s ludicrous.

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  38. DrDaveT says:

    @Mikey:

    We have two dozen examples from which we could draw, but we go around and around with unworkable plans because we can’t seem to admit somewhere else might maybe do something better than we do.

    I am repeatedly flummoxed by the Reverse American Exceptionalism that insists those solutions can’t work here, because (mumble freedom mumble independent mumble market mumble socialism).

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  39. wr says:

    @Hal_10000: “. Say what you want about Obamacare. At least it was a realistic approach to the problem. And at least it passed.”

    And let me guess — you were all in favor of it. You weren’t one of those conservatives screaming that it was socialism and would destroy the country. You said “bring it on,” thus giving you credibility when you complain about Warren’s plan…

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  40. gVOR08 says:

    @Jen: Romney not only couldn’t use his signature (only?) accomplishment, he pushed it completely down the memory hole. Nobody used it against him. I do not understand how he gets away with that.

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  41. wr says:

    ” For all her claims to “have a plan for that,” Warren has yet to explain how she’d get all of this through Congress.”

    Oh, look — Doug has a new rule for Democratic (only) candidates. Not only does the candidate have to present a complete plan AND accompany it with a complete plan to pay for it, now the Democrat has to accompany that with a plan for passing it through Congress.

    Meanwhile Republican candidates merely have to promise that unicorns will fart gold and that will allow them to slash taxes on billionaires…

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  42. wr says:

    @EddieInCA: You know what people really respect in a politician? The willingness to back off their beliefs the second they’re challenged on them. That’s always a winning strategy!

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  43. Sleeping Dog says:

    @Pylon:
    Universal healthcare isn’t Utopian, you’re correct many countries provide it, but none, not even UK and Canada are trying to provide it in a healthcare environment that is similar to the US.

    Variations on a Theme: A Look at Universal Health Coverage in Eight Countries

    And if you really want to go deep into the weeds:
    https://www.commonwealthfund.org/publications/2019/apr/considering-single-payer-proposals-lessons-from-abroad

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  44. Just nutha ignint cracker says:

    @EddieInCA: I don’t think that costs have to be too high, but it would take some rational thinking about what our technology can do compared to what it should do.

    Case in point: 2 weeks ago, at age 67, I had my first ever colonoscopy. For me, it wasn’t traumatic; it only rose to the level of nuisance and as to why I never had one before the answer is easy–when I was 50, I didn’t have insurance (you’d be amazed at the things no one cares about regarding your health when you are uninsured) and by the time I was 55, I had relocated to Korea, where almost no one gets a colonoscopy. In any event, I had one, they found polyps (I am over 60, so there’s no surprise there) and have recommended that I return for another one in three years–when I’ll be 70.

    My question is “why come back?” What’s the point? They’ll find more polyps. They will either be benign as these were or precancerous. In event B, they’ll wait while more new polyps either stay precancerous or become tumors. At which point we’ll need to discuss the qualifications for treatment of a 72+ year old with COPD as a surgical/chemo treatment candidate.

    Even better question: why at 67 are my doctor and Medicare insisting that they need to know that I don’t have cancer to the point that the system is willing to pay several thousand dollars to investigate?

    Now I get that this is all going to harken back to the whole “begging for our lives before Obama’s Death Panels” flap, but why shouldn’t we be having those discussions? We have the capacity and technology to do amazing things, but we need to stop demanding that they be availed in every single case. Our healthcare is too expensive, but we also use too much of it to too little benefit.

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  45. Just nutha ignint cracker says:

    @drj: And as the balance of both income distribution and capital continue to shift to the top, taxing the wealthy will become more reasonable because, as the trends continue along current lines, that is where the money is going to be.

    How’s that for irony?

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  46. Mister Bluster says:

    My brother has lived in Southern California for 40+ years. He will be 66 in August. About 10 years ago his leg started to swell. Since he was out of work and had no health insurance he did not see a doctor right away.
    After a few days it was so bad he had to go to the ER. He was admitted to the hospital and diagnosed with phlebitis. I don’t recall how long his hospital stay was but it added up to several days at least.
    I had just been laid off a job so I decided to make the 1900 mile drive to his house to see if I could help out.
    By the time I got there he was back home under his wife’s care. Fortunately the hospital stay had him well on the way to recovery. However the doctors trashed him for not coming in sooner.
    The whole affair would have gone better for him and the hospital stay would have been shorter if diagnosis was made and treatment had started earlier.
    He was able to walk but driving was at least a few days off.
    I took him back to the hospital for a checkup and a visit to the billing office to see if he qualified for any financial assistance. He had already received the bills for thousands of $$$$$$$$.
    Billing told him: “No, you make too much money to qualify for any public assistance but go to that office down the hall over there to see if they can help you out.”
    I don’t remember the the sign on the door but when he came back out he was a happy guy!
    It was some sort of private charity. They told him that if he paid a few hundred dollars based on his income that they would pay off the balance of the billing for that month. The aforementioned thousands of $$$$$$$!
    And if there was a balance the following month, which would likely be lower, he could pay a small amount and they would cover the rest.
    And that’s the way it went. He ended up paying a few hundred dollars and after a couple of billing cycles the balance was wiped out.
    The kicker to all this is that if he had known that the private charity assistance was available when he first got sick he would not have waited to go to the hospital. His treatment would have started sooner. The hospital stay would not have been as long and everything would have likely cost less.
    Health care in these United States.

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  47. DrDaveT says:

    @Jen:

    Improved collection–getting people to pay what they f#$%ing owe–would help everyone. And yet, getting to the point where we could actually DO that is unpopular.

    Various analysts, including GAO, have estimated that the return on investment for funding collection of unpaid taxes already owed would be at least 8 to 1. (No, that money is not owed by poor people, and if it were those would be the last accounts the IRS would waste time on.) Republicans have been strangling the IRS for decades now, because that is extremely popular with both the ignorant and their donor base. Yet another example of deliberately hurting the nation in order to protect power.

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  48. Gustopher says:

    @Just nutha ignint cracker:

    My question is “why come back?” What’s the point? They’ll find more polyps. They will either be benign as these were or precancerous. In event B, they’ll wait while more new polyps either stay precancerous or become tumors. At which point we’ll need to discuss the qualifications for treatment of a 72+ year old with COPD as a surgical/chemo treatment candidate.

    The precancerous polyps are removed in a colonoscopy. Think of the colonoscopy as more of a polyp pruning than a strictly diagnostic procedure.

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  49. Pylon says:

    @Sleeping Dog:

    First, my use of “utopian” was a direct comment about the title. But in answer to your point, the health care “environment” is not different in other countries. The articles you linked simply point out differences between other countries’ “universal” health care plans, as far as coverage, funding, etc. The fact plans have various differences doesn’t mean the concept is impossible, nor does it mean you can’t pick the preferred model or draw aspects from several.

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  50. JKB says:

    So all I hear from Democrats is how White, heterosexual, cis-gendered people are horrible and should just die, especially men. Then in the next breath they say that “woke” government bureaucrats should control health care for everyone. People with logic-privilege can infer how those two beliefs would interact.

    As they say, you can’t fight city hall. Especially when you are waiting for an opening at the cath lab in 3 or 4 weeks as it is in Newfoundland. Oh, they’ll let you lounge in ICU, but then your small business will go under. The protocol in the US is to have the dye test done in a cath lab within a couple hours of arriving at the ER so they can then put in the stent and get you recovering.

    First, what is the best the socialists, in their writings, can offer us? What do the most optimistic of them say? That our subsistence will be guaranteed, while we work; that some of us, the best of us, may earn a surplus above what is actually necessary for our subsistence; and that surplus, like a good child, we may “keep to spend.” We may not use it to better our condition, we may not, if a fisherman, buy another boat with it, if a farmer, another field ; we may not invest it, or use it productively ; but we can spend it like the good child, on candy — on something we consume, or waste it, or throw it away.

    Could not the African slave do as much? In fact, is not this whole position exactly that of the … slave? He, too, was guaranteed his sustenance; he, too, was allowed to keep and spend the extra money he made by working overtime; but he was not allowed to better his condition, to engage in trade, to invest it, to change his lot in life. Precisely what makes a slave is that he is allowed no use of productive capital to make wealth on his own account. The only difference is that under socialism, I may not be compelled to labor (I don’t even know as to that — socialists differ on the point), actually compelled, by the lash, or any other force than hunger. And the only other difference is that the … slave was under the orders of one man, while the subject of socialism will be under the orders of a committee of ward heelers. You will say, the slave could not choose his master, but we shall elect the ward politician. So we do now. Will that help much? Suppose the man with a grievance didn’t vote for him?

    –Socialism; a speech delivered in Faneuil hall, February 7th, 1903, by Frederic J. Stimson

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  51. Chip Daniels says:

    Has anyone noticed the sudden appearance of Deficit Hawkery, after three years of nodding acceptance of trillion dollar deficits?

    We hear shrieks about “Trillions! Of Dollars! Over Decades!” as if we aren’t right now staring at Trillions Of Dollars Of Deficits created by the wars, by Medicare Prescription Drug benefit, by the upper class tax cuts all of which were enthusiastically embraced by the republicans.

    But now of course, when it appears Trillions will be spent to heal sick Americans, it is an existential threat.

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  52. Teve says:

    Reasonably-priced healthcare is utopian foolishness. Now if you’ll excuse me I’ll go back to watching my show about how military personnel in the Southwest can shoot missiles at brown people on the other side of the world using satellites and flying robots.

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  53. Michael Reynolds says:

    @JKB:
    I see. So the people of Denmark, Norway, Netherlands, Sweden are slaves.

    They seem to be remarkably happy slaves.

    The peoples of 18 countries all rate themselves as happier than we rate ourselves. They are all more socialist than we are.

    There are 46 countries with longer lifespans than ours, including pretty much every democratic socialist country.

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  54. Sleeping Dog says:

    @Pylon:

    You will note that in none of the countries mentioned in the Commonwealth articles are providing healthcare for the entire population, at no out of pocket costs, for all forms of treatment including dental and eye exams. The UK owns the healthcare delivery system while the it is privatized in the US. Also note that in the UK and Canada, part of the cost passed to consumers is in the form of rationing.

    I’m all for universal coverage and access to/for healthcare, but if we let the perfect become the enemy of the good we won’t have either.

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  55. wr says:

    @JKB: “So all I hear from Democrats is how White, heterosexual, cis-gendered people are horrible and should just die, especially men.”

    Dude, when you go out in public wearing your MAGA hate and your Fuck Your Feelings T-shirt and “Democrats” tell you to fuck off and die, they’re really not addressing all white, heterosexual, cis-gendered people. They mean you.

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  56. JKB says:

    @wr:

    So you are saying only people who wear MAGA hats or other disapproved of speech will be denied healthcare under the single provider system? Of course, they can always write their congressperson, and might get a response if their campaign “donation” was large enough.

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  57. Mister Bluster says:

    @Mister Bluster:..About 10 years ago his leg started to swell.

    The sentence should read: “About 10 years ago one of his legs started to swell.”

    I know I proofed this item several times before I finally posted it. I even moved it to TextEdit and saved it so I could shut down MacBook Air and go back to it later.
    When I finally did post it I took advantage of the click to edit function to change something or other.
    Even with all that it was only when I read it an hour and a half later that I noticed that it was written so that my brother could easily be envisioned as a person with only one leg before the malady struck him.
    In fact if he had not sought medical attention as soon as he did he might have ended up that way.
    I am happy to report that he made a full recovery and the disease has not recurred.
    As I recall he was prescribed some medication (blood thinner? I don’t know.) but that regimen ended long ago.
    In the future I am going to follow the advice of a neighbor when it comes to proofreading.
    Try reading it backwards and see how many mistakes you catch.

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  58. Sleeping Dog says:

    @Mister Bluster:

    We know what your meant! 🙂

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  59. Mister Bluster says:

    So you are saying only people who wear MAGA hats or other disapproved of speech will be denied healthcare under the single provider system?

    @wr: is not proposing policy for any presidential candidate and none of the proposals from any of the candidates have stated restrictions on coverage based on wardrobe.
    You really need to stop lying.

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  60. Mister Bluster says:

    @Mister Bluster:…I don’t remember the the sign on the door…

    D’OH!

    Spam filter: D’OH! D’OH!!

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  61. Jim Brown 32 says:

    @Teve: I had a similar unexpected bill close to 20k. I told the hospital I couldn’t pay and it stayed on my credit for 7 years. The debt collectors tried various tactics to keep in on beyond 7 years but they cant. It took an additional year to get it sorted out but the unpaid medical Bill’s did come off my credit. Hope you get it sorted out.

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  62. DrDaveT says:

    @JKB:

    So all I hear from Democrats is how White, heterosexual, cis-gendered people are horrible and should just die, especially men.

    Then you desperately need to get your ears checked, because literally nobody is saying that, or anything close to that. But then you knew that…

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  63. grumpy realist says:

    @JKB: Have you ever thought maybe that it is really just you?

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  64. Just nutha ignint cracker says:

    @Gustopher: Irrespective of how one looks at the procedure, my comment centered on the rationale for having the procedure at all. Do non-cancerous polyps even need to be discovered? Pruned? If the gubmint is paying for it, is this what you want your tax dollars spent on? If you were going to pay for it out of your pocket, would you pony up however many thousand dollars for it–every 3-5 years, starting at 50 (forty-five if you have risk factors)? If you wouldn’t should the government in the absence of some quantifiable risk factor? For my money, I’d rather see them spend it on vaccinations for poor children, or hospice care, or any number of other things than “we probably won’t find anything important, but it’s not costing you anything, so let’s just go ahead.”

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  65. Just nutha ignint cracker says:

    @JKB:

    So all I hear from Democrats is how White, heterosexual, cis-gendered people are horrible and should just die, especially men.

    WTF???!!! Dude, you REALLY, REALLLLLLLLLY gotta stop listening to the voices in your head. Motherforking Shirtballs!

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  66. Just nutha ignint cracker says:

    @Sleeping Dog:

    part of the cost passed to consumers is in the form of rationing.

    Just to nitpick a little, requiring access to health insurance is another form of rationing (as well as representing a price support to doctors by protecting them from actual market forces/competition). Markets primarily function as rationing tools by clearing product gluts and compensating for shortages.

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  67. gVOR08 says:

    @JKB: I believe poor reading comprehension is a prerequisite for conservatism. Thank you for the demonstration.

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  68. JKB says:

    @Mister Bluster: and none of the proposals from any of the candidates have stated restrictions on coverage based on wardrobe.

    They don’t have to say it for it to be inferred from the rhetoric of Democrats as a whole. In addition, lying Obama said repeatedly that if you like your healthcare provider, you can keep your healthcare provider, but one Obamacare was enforceable by government violence of penalty and prosecution, you couldn’t.

    So really are you so dumb as to think that you can only consider what a politician actually says and not infer the actual implementation or misuse in the future?

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  69. Mister Bluster says:

    I never believed President Puke when he said Mexico would pay for his wall.
    I knew that was just for suckers.

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  70. Monala says:

    @Just nutha ignint cracker: fascinating, huh? A 60-plus comment thread about healthcare among people who primarily identify as liberals or Democrats, and not one single person said a thing about how all white, heterosexual, cis gender people should just die (in fact , many of the discussion participants are themselves white, heterosexual, cis gendered and -gasp!- male). Yet somehow that’s all JKB hears.

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  71. Pylon says:

    My response to Sleeping Dog appears to be in moderation. Short version: health care isn’t “rationed” in Canada. There are indeed some procedures which aren’t covered but it’s because they are not deemed essential. It’s not an unusual list – non-accident related cosmetic surgery, etc. Dental and vision aren’t included, though that may change. Those are financial issues aside from rationing. And there are really no unacceptable wait times. I would wager I can see a GP as fast as any American. Surgery wait time varies according to procedure, but this is often as convenient for the patient as the doctor – it gives you time to arrange leave from work to recover from your hip surgery for example.

    No system is perfect, but the cost is better and the outcomes are better, statistically speaking, in a publicly funded system.

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  72. Pylon says:

    @JKB: They don’t have to say it for it to be inferred from the rhetoric of Democrats as a whole.

    So “all I hear” means “all I understand”.

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  73. wr says:

    @JKB: Why, yes, that’s exactly what I was saying. The fact that it is not reflected in a single word I wrote just shows what a genius you are at understanding subtext.

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  74. Pylon says:

    Of course, JKB couldn’t help lying about wait times for cath labs in Newfoundland. First, the eaits were about distance, not money, Newfoundland being a large and sparely populated province, with only one city. But even before recent improvements, the wait for a non-emergency cath procedure from the farthest location (Labrador) was only 11 days (and now it’s 6).

    https://www.medtronic.com/ca-en/about/news/Eastern_Health_article_April_2019.html

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  75. Just nutha ignint cracker says:

    @Monala: He really (reeeeeaaaasaalllllly) needs to stop listening to those voices in his head, as I noted. They’re very malicious, and I hope he will come to see that they only mean him harm.

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  76. Gustopher says:

    @Just nutha ignint cracker:

    Irrespective of how one looks at the procedure, my comment centered on the rationale for having the procedure at all. Do non-cancerous polyps even need to be discovered? Pruned? If the gubmint is paying for it, is this what you want your tax dollars spent on? If you were going to pay for it out of your pocket, would you pony up however many thousand dollars for it–every 3-5 years, starting at 50 (forty-five if you have risk factors)?

    Yes, yes, yes and I might push my luck by a few years.

    Pruning the polyps means they don’t become colon cancer. And, if they have found precancerous polyps now, the risk of them in the future is greater.

    Taking healthy 50+ year olds for a regular pruning is going to be much cheaper than cancer treatments for those who would otherwise develop cancer. It’s a simple, cost-effective preventative procedure.

    Now, if you’re likely to die from something else before the next pruning, then maybe it makes sense to skip this one.

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  77. al Ameda says:

    @Michael Reynolds:

    I love Warren, I’ve given her money, but @Hal_10000: and @EddieInCA: are right, this is not a good plan. She is way out over her skis for something that has zero chance of passing. High political risk for no policy gain.

    Exactly.

    Some of my closes friends are life-long politics junkies, are very liberal, and support Warren. Both they, and I, are of the opinion that Warren made a big tactical mistake in putting out a detailed M4A plan. For two reasons: (1) it cedes a lot of ground to Republicans to develop those Warren/Stalin hit ads, and (2) M4A has virtually no chance of passing. Hope I’m wrong but …

    Democrats are lousy at politics.

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  78. Just nutha ignint cracker says:

    @Gustopher: I agree with you. Taking 50 year olds in for “a pruning” is probably a good idea overall. So in the interest of your health, I will choose to pass on a procedure that, at 67 years old (twenty years older than 50 when I would take my next one at 70) [edit:] seems to have limited utility. You can have the funds they would waste on mine (because at 70, I won’t qualify for surgery or chemo–and maybe not radiation) to do one your next one. Or they can be used for someone who will benefit from the treatment because that person is significantly younger than I am. But we will still need to start thinking this way if we’re going to give everybody the free stuff that I and my insurer are paying half the cost of now.

    Fortunately, they didn’t find any cancer in my prunings. I think we should all count that as win and move on. For my interests and needs, I won’t need to know if they would find polyps when I’m 70 although I confident that they will and they will probably be benign again. When you have COPD (and have been asthmatic for your whole life) there are worse thing available to die from than cancer.

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