I worked on single-payer healthcare legislation for US Rep. John Conyers (D-MI), my hometown Congressman from Detroit and an early leader on the issue with Rep. Jim McDermott (D-WA) in the 90’s. It’s not surprising the idea has gone nowhere in the 26 years since. While my heart is in it as a means of universal coverage, Bernie’s “Medicare for All” proposal as dropped this week is a conversation piece, and that’s it. It’s DOA as legislation.
Calling it “Medicare for All” is what should have happened 30 years ago – the public and the vast majority of providers strongly support Medicare, which is really single payer for older Americans.
A way around this would be Medicare Advantage for All – single payer that’s privately administered and tightly regulated to achieve a public good. That would be a distinctly American take on what all other industrialized nations have done to insure all their citizens. But it would necessitate raising taxes to make up for the ongoing administrative costs beyond what I think most Americans could stomach. Forbes’ great Bruce Japsen made the same point today.
It’s telling Bernie didn’t include pay-fors in his bill, because funding universal coverage is what’s most controversial about single payer. Today he laid out some ideas for how to pay for it, and most are pipe dreams:
- Elimination of special tax breaks: $4.2 trillion over 10 years. The main target: company-provided health benefits for employees. They would no longer be needed.
- Business payroll tax: $3.9 trillion over 10 years. Companies would pay a 7.5% income-based fee, but Sanders asserts it would cost them less overall compared to the current system.
- Household premiums: $3.4 trillion over 10 years. Families would pay a 4% income-based fee, considerably less than what they pay now.
- Higher taxes on the rich: $1.8 trillion over 10 years. Raise marginal rates to as high as 52% on the richest Americans. The current top rate is about 39.6%. Also, limit deductions and treat taxes on dividends and capital gains equally.
- A new net wealth tax: $1.3 trillion over 10 years. This new tax would apply to the wealthiest 0.1%, or 160,000 households. A 1% annual tax would be applied to net worth exceeding $21 million.
- One-time tax on offshore profits: $767 billion over 10 years. Sanders wants to tax profits of American companies that are earned and held in other countries. These profits are not taxed until they are returned home under current U.S. law.
- Increased estate taxes: $249 billion over 10 years.
- Fee on large Wall Street banks: $117 billion over 10 years. The six largest U..S. financial institutions would get the bill.
This bill is more of a gut-check for Democrats on universal coverage when the GOP is going out of its way to strip coverage from millions. Bernie’s “Medicare for All” and its recent support is the reaction to the relentless Republican campaign to repeal and replace the Affordable Care Act. It’s a litmus test for 2020 candidates-in-waiting (just look at the faces on that stage with Bernie) than it is a serious proposal with real prospects, especially with Trump in the White House. Yes, Trump supported single payer in 2010, but as we’ve seen in the last 10 months, his words mean nothing. The “Yes’s” supporting Bernie are a who’s-who of 2020 presidential contenders: Bernie himself, Kamala Harris, Cory Booker, Elizabeth Warren, maybe even Al Franken.
When serious health policymakers on committees of jurisdiction like Ron Wyden or Patty Murray sign on, then I’ll start getting excited. Until then, this is a liberal dreamer sewing circle – and that’s from a single-payer warrior for almost three decades.
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