Showing posts with label Medicare for All. Show all posts
Showing posts with label Medicare for All. Show all posts

Wednesday, January 22, 2020

MODERN MONEY ILLUSION

Money is an abstraction, a political confection, a set of castles built on air. ~Sebastian Mallaby  

The aura of money has existed for a very, very long time. Ecclesiastes 10:19 asserts: Money answereth all things. During the course of human history many objects have been used as money to transact sales and pursue commerce including cocoa beans (in Mesoamerica) and cowrie shells (in Africa, India and China). Paleo-economists believe the first precious-metal coins were used as money in several places about the same time, around 600-500BC; in China’s Yellow River valley, in India’s Ganges River valley and by the king of Lydia in western Asia Minor (modern Turkey). In 1024, the Chinese government started issuing paper notes in standard denominations, which showed that banknotes (paper currency) could be a viable and facile form of money. The first European banknotes were issued in late 17th century Sweden.
But what about money here in the United States (US)? Glad you asked. In the 17th and much of the 18th centuries each of the original 13 American colonies issued their own banknotes (paper money). Thus, Pennsylvania and Rhode Island each had their own distinct currencies. Understandably, this was a hindrance to trade between the colonies, probably promoting a fair amount of barter exchange. Foreign coins, including the Spanish dollar, were also widely used as currency in the US until 1857. After a previous and unsuccessful attempt to create a useful, single currency for the new country, the US Continental Congress authorized the issuance of the US dollar in July 1785, backed by gold and silver.
US Federal banknotes were issued as the currency of our nation in 1863 to finance the Civil War. We finally discarded the Gold Standard in August 1971; meaning the government no longer officially backed its banknotes with gold bullion stored at Fort Knox and the New York Federal Reserve Bank. Somehow, we’ve survived much to the surprise of the gold “bugs.” After 1971, the only “promise” the government offers for your $20 Hamilton bill is another $20 bill.
Naturally, not everyone was happy about this lack of precious metal “backing.” Remember William Jennings Bryan’s “Cross of Gold” speech? It’s what’s lurking somewhere behind Martin Amis’ quote: Money is a fiction, an addiction and a tacit conspiracy. So it goes…
In January 2020, the US economy has $1.75 trillion circulating as Federal Reserve banknotes and about $245 million in coins. Interestingly, the $100 bill – with the almost-smiling Ben Franklin on its front side – is the most common bill now in circulation, just ahead of George Washington’s $1 bill. There were 13.4 billion $100 bills circulating at the end of 2018, representing over 75% of the total value of our currency.
As much as 80% of all our Ben Franklins is being used outside the US, making them one of our largest, and unreported, exports. Economically-ruptured Venezuela is the latest nation to become more “dollarized,” given that its peso is next-to-worthless. In fact, Ecuador and Zimbabwe officially use US dollars (especially $100 bills) as their currency. Other countries, including Panama, Cambodia, and the Bahamas, use the US dollar alongside their own currencies. Ben Franklin has taken many foreign excursions.
Now there’s a panoply of alternative “currencies” beyond cash, including credit cards (the pioneering Diners Club card was first used in 1950), debit cards and various electronic forms, including the (in)famous Bitcoin, as well as Apple Pay. According to the Federal Reserve Bank of San Francisco, US consumers use credit and debit cards for 34% of their purchases, electronic payments for 34%, checks for 20% and cash for only 9% of (mostly low-value) purchases.
Because money is such an elemental part of any economy, economists have spent lots of time thinking about it over the years and examining how the amount of it and its use affects economic conditions. Concepts such as the “velocity of money” and “money illusion” have sprouted from lofty ivory towers. We’ve come a long way from just using cowrie shells and precious-metal coins.
Money illusion was first discussed over 90 years ago by Yale professor Irving Fisher who observed that most people believe the illusion that the face value of their money (say the $20 value of Hamilton’s bill; the bill’s “nominal value” in econ-speak) represents its actual purchasing power. That’s not necessarily true. Such people aren’t aware that money’s purchasing power depends on general price level changes, the $20 bill’s “real value.” If overall prices rise due to inflationary forces, the $20 bill’s actual purchasing power is reduced; it doesn’t buy as much as it used to. Thus, this money illusion is present if there’s underlying broad pressure affecting many goods’ prices, but not (yet) changing people’s income/wage levels.
After 1990 the US average annual inflation rate has been very low, 1.6% per year, despite the vociferous, misguided fears of many conservatives. That’s in stark contrast to 1974 and 1980 when the OPEC-induced oil price shocks pushed our annual inflation rate to 11.0% and 13.5%, respectively. Those were the days. Not.
I believe there is a newer version of Prof. Fisher’s money illusion. It has arrived along-side several progressive Democrats’ plans for dramatically changing the scope and operations of the federal government.
Bernie Sanders and, to a lesser degree, Elizabeth Warren have expansive ideas about reprioritizing domestic policies to guarantee every man, woman and child their “basic economic rights” (BERs). Bernie has stated, “We must take up the unfinished business of the New Deal.” His unfinished BERs consist of:
Quality health care
As much education as needed to succeed
A good job paying a living wage with 12-weeks family leave
Affordable housing
Living in a clean environment
A secure retirement
The possible costs of providing Medicare for All, “free” college tuition, elimination of student loan debt, government-guaranteed jobs, increased Social Security payments, renewed environmental protection and other, unstinting progressive programs have been dutifully estimated. One guesstimate stated these programs could cost $42.5 trillion (T) over the first decade.
This titanic sum, $42.5T, would almost double the size of the federal government’s current expenditures. In the current fiscal year the government has budgeted $4.75T for all its expenditures, which represents about 21% of our GDP. Possibly doubling the size of the government over a fairly short period would be a very big deal that so far doesn’t seem to have garnered very much real (or nominal) discussion; it’s an illusory topic.
In a sense, because these costs are so profuse, and in the future, we seemingly don’t have to worry now. This thinking is consistent with the liberal Modern Money Theory which suggests that the government can pay for its expenditures and achieve full employment by issuing more money.
The above sum does not include undertaking the extensive Green New Deal (GND) programs announced last February by Rep. Ocasio-Cortez and Sen. Markley. If implemented, the GND endorses a “ten-year mobilization” that would include large-scale, national social programs like universal health care, food security and government-guaranteed jobs as the “new deal” portion of the GND. Its substantial Green initiatives portion would include creating net zero emissions energy production from both a thoroughly updated, totally non-fossil-fueled national electricity grid and an electrified national transportation network.
Ten-year cost estimates for the GND programs by Doug Holtz-Eakin, previously director of the Congressional Budget Office and very familiar with government fiscal programs and expenditures, are $52T to $93T. Mr. Holtz-Eakin believes the bulk of the estimated costs would be faced in implementing the GND’s new deal programs, although the Green initiatives would also have a very substantial price tag due to their inclusive scope and tight schedule.
The trillions of dollar sums for the progressives’ programs and the GND are unimaginably large, and thus subject to a more modern type of money illusion, principally because of these programs’ size, complexity and span.
If we arbitrarily assume there’s a 25% overlap between the GND’s new deal programs and Bernie’s BERs programs and use the mid-point of the mentioned GND cost estimates, the grand total of the combined efforts of the GND and BERs for ten-years would be $97,000,000,000,000 or ninety-seven trillion dollars. It’s nearly five times as big as our current GDP, the world’s largest.
To get a better visual sense of just how large $97T is, imagine Ben Franklin $100 bills that have been tightly stacked upright on their long side, so we can answer the question; gee, how long a heap of such Franklin $100s would equal $97 trillion? Not how large is $97T; how long is it? This stack would go around the world about 2¼ times at its circumference; a bit more than 56,400 miles of $100 bills. That’s a lot of money.
Our inability to sense just how large these numbers (and the programs’ expenditures/activities) could be is likely why we can’t fathom exactly what is being proposed. It’s a next-to-impossible illusion to imagine in much detail because it’s so big. Certainly, the Law of Unintended Consequences will be functioning throughout these efforts, as always.
This very progressive political vision would be very distinct from others that are now being promoted by different candidates. But should we as a nation try it? That’s what the true left-field progressives pretty much demand. When asked, how can we afford this? They evasively reply, how can we not afford it; continuing the illusion. Our collective answer is what this year’s primaries and election, in a mere 285 days, will hopefully help decide. The inaugural Democratic caucuses and primaries begin in a mere 12 days across farmy Iowa. 
Not to worry if you don’t get to Des Moines in time. After Iowa there are 56 more Dems primaries and/or caucuses, including the Northern Mariana Island caucuses, the Democrats Abroad primary and last but certainly not least, the US Virgin Island caucuses on June 6. No wonder we call it a party. I hope our money and programmatic illusions will be at least partially dispelled after mid-July’s convention. As Adam Smith aptly stated, all money is a matter of belief. So is politics.




Friday, May 24, 2019

CAVEAT EMPTOR POLITICO

In politics, absurdity is not a handicap. ~ Napoleon 


Promising a multitude of equality-filled rainbows when they’re elected, virtually all of the 23 fervent Democratic presidential candidates have been campaigning for a brighter future, come Nov 3, 2020. That’s a mere 529 days away. Given recent trends and Trump’s example (he formally began his reelection campaign on his Jan 20, 2017 inauguration); I expect the 2024 campaigns to begin just after we’ve finished 2020’s Thanksgiving stuffing. Oh, my.
As long as one anointed Dem is successful, a brighter future isn’t terribly hard to imagine, given our Drama-King president’s continuing record of fear-based ukases and misinformed, damaging policies covering all substantive issues.
What is hard now for every one of these candidates is first getting anyone to care what they are saying, including Iowans, where the earliest Democratic caucuses are but 255 days away. And second, for a specific candidate in the 22andMe throng, does anyone know I’m in the race and how can I distinguish my positions from everyone else’s, assuming somebody cares? At this point, it’s the very rare person outside of the political-media complex or the Washington DC beltway that cares at all.
Nevertheless, the media is overflowing with a plethora of “latest polls.” RealClear Politics lists 58 political polls being undertaken over just the past two weeks. At this neonatal state of the presidential campaign such polls hardly mean anything beyond whether the polled somebodies have ever heard of the candidate. Have you heard of Marianne Williamson or Wayne Messam? No matter who you now might possibly favor for president in 2020, there’s at least one extant poll that will support your choice in some fashion. Current polls about who’s winning the contest for the Dems’ candidate are essentially chaff, not kernels of worthwhile wheat. What else is excessive?
As of Apr 15, when there were only 15 announced candidates (not including Joe Biden), they had already raised $118.5 million. Bernie Sanders has the biggest war chest with $20.7M in his coffers (probably including the $6.1M left over from his 2016 campaign); Juan Castro was last at $1.1M. Naturally, the political-media complex has been reaping large sums of money from the candidates’ ads in this nascent stage of campaigning. According to the Federal Election Commission’s first-quarter filing, 12 of the Dem candidates spent $6.7 million on online advertising and assembling their digital strategy. Each and every Dem candidate is now in full, 24/7 primary voter acquisition mode. Realistically, the vast majority of these 23 candidates are at best competing for consideration as vice president, senator or governor in the Nov 2020 elections.  
These Dem candidates imply that ordinary people, together with their acolytes, won’t be paying any taxes for their plans, only the rich will be. Now they’re simply summarizing what their policies will somehow accomplish, like end inequality, perfect healthcare, put everyone back to work, pay reparations, provide debt- and tuition-free college education, reduce the voting age to 16 years and rapidly clean-up our environment. Such programs will require raising beaucoup government revenues, through increased taxes and public debt financing. Only a few candidates admit these fiscal consequences.
Meanwhile our strategy-free, solipsistic president persists in telling us that China has been paying for his tariffs (I’d give him 4 Pinocchios, adopting the Washington Post’s fact-checker icon) and that the Dems, especially these presidential candidates, are extreme socialists (another 4 Pinocchios), along with his ever-growing multitude of other fact-free fictions. His campaign now has $65.7M to spend, far exceeding that raised by any Dem. L
The Dem campaigns’ diminutive fiscal standing, together with our economy’s sustained strength (3.6% unemployment, 3.2% increase in average worker’s earnings, with 3.2% real GDP growth), represent ample challenges that any Dem will be facing to conquer #45. Defeating Trump will require victories in enough states beyond the coastal true blue ones so the winning Dem graduates triumphantly from the Electoral College, although probably not debt-free.
With rare exception, no candidate has revealed how their programs will specifically work or how they’ll be funded. However, Sen. Elizabeth Warren bravely stated in January that if elected, she would implement a new wealth tax imposed on the top 0.1% of income-earners and later added a new, larger corporate profits tax to finance several of her proposed pro-equality programs. Her policies would reduce student debt, provide free tuition and fees for students in public colleges and offer universal child care and early-childhood education. In making these and other definitive proposals she has positioned herself as the early race’s wonky, “I’ve got a plan” leader in the Dem candidate flock. Consequently, she has twice the number of paid campaign staff as Sen. Sanders. She needs such intellectual firepower to keep churning out thorough position/policy papers like no other candidate.
Actually implementing such wealth and profits taxes is far more problematic. Effecting such new taxes as federal statutes assumes the Dems keep control of the House, gain control of the Senate with her in the White House. Her proposed wealth tax will also need to overcome a number of legal and execution issues that have contributed to eight OECD nations getting rid of their existing wealth taxes. No matter; they are clever ideas that distinguish her from all other candidates. Successful politicians are rarely criticized for under-promising during their campaigns.
It’s quite safe for a progressive Dem like Sen. Warren to propose a wealth tax, because the people she’s casting votes for (progressives for sure, millennials and maybe folks who shower after, not before they work) rightly don’t consider themselves rich enough to be subject to her wealth tax. Her appeals for new government programs, like those of other Dem candidates, are portrayed as basically costless for their targeted potential primary voters. Other folks, the rich ones across the proverbial freeway or tracks will pick up the tax tab, not them. Each candidate knows a “free” program beats all others.
Progressive Dems are proposing momentous, major programs that, if enacted, will have substantial effects, including many unforeseen ones, on our economy and us. This is the “revolution” that Bernie et al. are focused on creating. Programs like Medicare for All and the Green New Deal will influence virtually every aspect of our lives. By voting for either Michael, Joe, Bill, Cory, Steve, Pete, Julian, John, Tulsi, Kirsten, Kamela, John, Jay, Amy, Wayne, Seth, Beto, Tim, Bernie, Eric, Elizabeth, Marianne, Andrew or even another Dem (are there any?), we expect our lives will be significantly improved and nirvana will move much closer to us.
At this point we consumers, taxpayers and eventual voters are mostly left in the dark about how these candidates’ policies and programs will actually affect our lives and what they will cost us. With such evidence we can make more knowledgeable decisions when we’re deciding who to vote for by also knowing how this person’s proposed programs will affect us. Such particulars can illuminate how a candidate’s policies will influence us individually and collectively.
As the Dems canter around their political race course and the field inevitably narrows, starting after the first debates on June 26 and 27, we will hopefully start receiving additional details so we can make more-informed judgements in the voting booth.
Knowing such details matters. Bernie’s single-payer Medicare for All Plan (M4A) has been endorsed by at least five other Dem candidates: Cory, Tulsi, Kirsten, Kamela and Elizabeth. When polls asking about his M4A state that it will eliminate all private health insurance and will increase individuals’ taxes, this program’s support drops dramatically to just 13%. Most published polls show a small majority of respondents favoring M4A; these polls never state the very likely (and unpopular) consequences in their questions.
Thus, we citizens should demand more details, the sooner the better, as well as abide by caveat emptor politico, denoting let the voter beware (my fractured alteration of the well-known 500-year old Latin phrase).






Thursday, September 28, 2017

GOLDEN MEDICARE FOR ALL

Will it be another Democratic Cross of Gold?


Oh my, until Tuesday we again faced a Republican radical alternative to the Affordable Care Act (ACA). One more repeal effort with great feeling, but no wisdom.
This time the Republican folly was the Graham-Cassidy bill, which had virtually nothing to do with healthcare and everything to do with febrile efforts to resurrect states’ rights, block grants, keeping donors contented and passing anything that has “healthcare” somewhere in its first sentence or two. The announcements that Senators Rand Paul, John McCain and Susan Collins would not support this latest Republican effort to dismantle the ACA is what passes the low threshold of good news for the 319 million (M)  people who have some type of healthcare coverage.
However, Graham-Cassidy is not the only radical idea that Congress has for replacing the ACA. Nope, on September 13 Senator Bernie Sanders introduced his “Medicare for All Act of 2017” proposal that would end the ACA, replace it by expanding Medicare and provide it to every American, not just to those of us who are 65 or older. It would also increase the services now provided by Medicare to include dental, vision and hearing aid coverage. In 2015 (the latest year data are available) Medicare covered 43.3M people, representing 13.4% of Americans. The goal of expanding healthcare coverage to be universal is worthy; it’s the objective of the ACA.
The progressive left-side of the Democratic Party has enthusiastically supported Sen. Sanders’ new, universal healthcare proposal for the nation. These supporters include 16 other senators who are co-sponsoring his proposal, six of whom are up for election next fall, and 119 Democratic Representatives in the House. Sen. Sanders’ proposal, like the previous one he created nearly four years ago, has zero chance of being considered in this Republican-led Congress because by themselves the minority Democrats have no legislative power.
Nevertheless, his 2017 Medicare for All plan is rapidly becoming a necessary political talisman for liberal Democrats, reflecting a leftward shift of the Democratic Party. Its supporters are a rising political clan that has defiantly stuck its single-payer healthcare flag into the political sandbox. These Democrats reflexively prefer the Medicare for All designation rather than “single-payer” because Medicare is a well-regarded, very popular government program; even right-wing Tea Partiers have usually avoided directly denouncing Medicare. In contrast, single-payer frankly connotes BIG government, something that may appeal to long-devoted progressives, but far fewer others. So Medicare for All it is.
These are relatively cheery times for Bernie’s single-payer healthcare backers. Because it has yet to be an actual piece of legislation, no one needs to provide many details about how it would be structured or financed and no one needs to round up Congressional votes.
The proposed bill proffers nothing about how Medicare for All would be funded. His proposed Act says that American healthcare will be greatly improved, offers a basic description of the plan and how this improvement would be implemented. As now described, Bernie’s plan would phase in the provision of universal healthcare to these hundreds of millions of people over a four-year period. To say this four-year implementation effort would be a challenge is to significantly downplay the extent of the new healthcare market’s likely turmoil.
Sen. Sanders has separately provided funding “options” that added up to $1.62 trillion (T) dollars per year during its first decade. I’ll talk about these later. Critics say this funding level is wholly inadequate. They have a point, in 2015 the US spent $3.2T on healthcare ($9,990 per person), representing an all too impressive 17.8% of our GDP. Sen. Sanders’ funding options would cover just 50.6% of current healthcare expenditures.
I believe Bernie’s’ new Medicare for All plan can serve an important purpose to muster Democrats into action amid the Republican’s fusillade of ill-considered efforts to replace Obamacare. The Graham-Cassidy bill is merely the latest and most contemptable, which is saying something, but not the last. However, I fear that by making Medicare for All the official Democratic plan for fixing American healthcare (that in this case means completely retreating from the ACA), it could become a modern-day Cross of Gold for Democrats in next year’s elections.
At the July 1896 Democratic National Convention William Jennings Bryan delivered one of the greatest political speeches in American history, his Cross of Gold speech. The defining issue of that year’s presidential campaign was how to get the American economy out of the continuing, severe depression that starting in 1893 and bring the nation back to prosperity. The Bank Panic of 1896 (when many depositors simultaneously asked for their checking account funds in cash) was emblematic of the severe economic troubles that beset most Americans that year. The previous three years were equally bleak. There was a bank panic in 1893, one-quarter of US railroads – then the new technology sector – declared bankruptcy (including the Pennsylvania Railroad), Wall Street stocks dropped precipitously, a series of violent labor strikes occurred and unemployment rose to between 12% and 14.5% in the election year, unemployment in some cities was twice as high. And we think the 2007-09 recession was bad.
William Jennings Bryan was a populist who supported “free silver,” farmers and factory workers. He decried big business and the gold standard that he believed had largely caused the bank panics and depression. His mesmerizing nomination speech at the Convention concluded with the often-quoted phrase, “You shall not crucify mankind upon a cross of gold.”
His speech propelled him to the Democratic presidential nomination. He lost to Republican William McKinley on November 3 by 95 Electoral College votes. William Harpine, a noted historian who has studied Bryan’s candidacy and the 1896 campaign, said “Bryan's speech cast a net for the true believers, but only for the true believers. By appealing in such an uncompromising way to the agrarian elements and to the [American] West, Bryan neglected the national audience who would vote in the November election.” In a real sense, Bryan’s populist Cross of Gold speech was the glittery vein that led to the realigning 1896 election, which kept the Democrats outside the White House for 28 of the next 36 years.
The 2016 election was certainly a realigning one, at least in the initial nine-months of Mr. Trump’s besotted presidency. If the Democrats rearrange their policy priorities around a progressive, true-believer single-payer healthcare system, I find it all too straightforward to believe it would inimically affect their electoral chances in 2018 and perhaps beyond.
As a slogan, Medicare for All sounds more enticing than any of the Republicans’ ideas to “enhance” healthcare. But in many ways it’s a far more radical departure from ACA than any alternative yet considered. It would fundamentally restructure our healthcare system by placing the federal government completely in charge as the “single payer.” In its expanded role, single-payer healthcare will require far more tax revenues.
Under Medicare for All the 178M people who have healthcare plans either through their employer or the individual market and the 112M on either Medicare, Medicaid or another public program, there would no longer be health insurance companies or the current health exchanges providing it. Private health insurance companies like Aetna, UnitedHealth, Kaiser and Anthem (Blue Cross/Blue Shield) would entirely disappear and the over 500,000 people who work in the health insurance industry would mostly be out of their jobs. When implemented, only the federal government would provide and pay for individuals’ healthcare. Most beneficially, the 29M people who remain uninsured would receive healthcare (it’s “for All,” after all).
With Medicare for All, doctors, nurses, hospitals, pharmaceutical companies and their customers would face a completely different market with one supplier, different stakeholders, incentives, operational requirements and regulations. Despite the potential benefits that supporters proclaim, with a brand-new national healthcare system, the psychic pain and frustration during its initial operation will be substantial. If you doubt this, just remember the flawed roll-out of the ACA’s website access to HHS health exchange.
Under Sen. Sanders’ plan, individual’s health insurance premium payments would drop to zero for virtually all people and businesses who offer health insurance for their employees. This is good, very good. In their stead, the government would pay for all healthcare expenses via higher taxes.
Unfortunately, these clear savings may not be that obvious for many people. That’s because the millions of employees whose healthcare is connected with their job, don’t directly write a monthly premium check to their healthcare provider. Instead, it’s indirect and automatically deducted from their paycheck, via the firm’s payroll system. Virtually all (96%) of US employees receive their paychecks from a payroll service’s direct-deposit service.
If employers decide to increase wages/salaries by the full amount of their premium savings, take-home pay would be larger, less the increased federal tax withheld.[1] This is good. But it’s not apparent in Sen. Sanders’ Act that employers would be obligated to do that. Thus, the premium savings may not be all that obvious. However, increases in nearly everyone’s federal taxes would be much more noticeable, if only from the media’s likely substantial attention.  
How does Sen. Sanders suggest his Medicare for All plan would be paid for? Federal taxes would broadly expand and rise for almost everyone and every business, substantially for some higher-income people and businesses. The payment options Sen. Sanders’ proposes include a 7.5% payroll tax increase paid by businesses (except for small businesses) that could likely reduce people’s premium savings, a 4% personal income tax premium, probably more for high-income households, a broader and increased estate tax, a new “wealth tax” levied on the Top 0.1%, a financial transactions tax and a “one-time” tax on overseas corporate profits.
Unlike now, his Medicare for All program would operate with an annual budget, a significant change. Establishing a yearly Medicare budget represents a fundamental modification that would soon force tradeoffs between services offered and expenses, to stay within budget. Such a Medicare budget would be subject to political forces that have been highly skewed away from cost-cutting or limiting what medical procedures are available to patients. Additionally, because 80% of US healthcare system spending is on medical care provided by doctors and hospitals, it’s likely that cutting healthcare costs will be as torturous and painful as it has been under ACA. Because of their prominence, reductions in doctors’ and other healthcare processionals’ compensation would be prime targets for savings.
The American Medical Association (representing doctors’ interests), the American Hospital Association (representing hospitals’ interests) and other medical/health lobbies have been very effective in preserving their clients’ well-being for decades. As an example, an American family doctor’s average salary is $207,000, about 160% higher than an English general practitioner’s operating within the UK single-payer system. Effecting cost reductions and improved efficiencies with Medicare for All will be exceptionally tough, just as it has been with ACA. For these reasons Bernie’s Medicare for All will likely remain fairly pricy.
Thus, if Medicare for All ever sees the legislative light of day, the adage, healthcare policy always involves tax policy will hold. Creating the required new and increased taxes will be highly contentious and broadly disliked. It is the rare citizen who gladly pays more taxes, especially new ones.
Governments have imposed taxes since at least Egyptian times, when Pharaohs used tax collectors then known as scribes to amass needed money, including from taxes on cooking oil. More recently, American history is replete with citizens protesting taxes, including the famous Boston Tea Party in 1773, when the words were uttered, “no taxation without representation” to dispute British taxes on tea. Our Revolution started two years later.
In June the media broadly announced the results of a Kaiser Family Foundation Health Tracking Poll that indicated there was a modest increase in the public’s support for single-payer health insurance to a majority; 55% of respondents said they were in favor of a government-based national health plan (single-payer/Medicare-for-all), 40% were opposed. Less reported was that the slim, “in favor” majority was quite fragile and disappeared when those people in favor were told that opponents might state such a plan would either ”give the government too much control over healthcare” or “require many Americans to pay more in taxes.” Respondents in favor of Medicare for all then changed their mind; opposition to single-payer increased and became a 62% majority of respondents (from hearing about more government control) and increased to 60% (from more taxes).
Significant popular opposition to single-payer healthcare and its perceived large costs have halted each of three liberal, blue states – California, Colorado and Vermont – from implementing their state-wide universal healthcare plans. A single-payer bill, the Healthy California Act, was introduced in the California Legislature this spring but was later dropped after the bill’s hefty anticipated costs – $400B per year – became known and opposition grew. I have previously discussed California’s fractured initial foray into single-payer healthcare. A Colorado single-payer referendum last November was decisively voted down 79% to 21%. Issues included an additional 10% payroll tax to fund ColoradoCare and how Medicare patients would be served.
Finally, in 2011 Bernie’s home state legislature passed the structure for a Vermont single-payer healthcare system, the first and only state to do so at this point. But three years later the legislature abandoned the effort because they couldn’t figure out how to finance it. Experts had estimated that the system would require state taxes to double, roughly $2B in extra tax revenues.
Could Medicare for All be another Democratic cross of gold? I believe it’s a risky, radical policy position for Democrats to take because it would run completely counter to the tamer, more broadly-accepted approach of improving the existing ACA. Appealing to voters for at least a $162B tax increase for the initial decade of Medicare for All will be an election-losing fantasy that, like William Jennings Bryan’s defeat, could lead to longer-term negative consequences. Democrats should remember what happened 121 years ago. Lashing themselves to a cross of golden healthcare is a mistake.





[1] It’s not clear whether the Medicare for All Act’s increased payroll tax would preserve the substantial tax-break businesses have long received by paying for employees’ healthcare expenses with pre-tax dollars. This tax-break has been estimated to be $250B per year, probably the government’s largest single subsidy, more than 60% larger than the mortgage interest deduction subsidy.