
Elizabeth Warren’s ‘Medicare for All’ Math - Bostonian
https://www.nytimes.com/2019/11/01/upshot/elizabeth-warrens-medicare-for-all-math.html
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gorgoiler
This all sounded great until the wealth tax came up:

“The top 1 percent [...] would pay taxes on increases in investment value
annually, instead of waiting until assets are sold.”

Taxing all stockholders of a company on the fiction that they all could have
sold all their shares at the maximum possible price, without crashing the
price, is naively out of touch with how markets actually work.

Investments, especially stock, have no precise value until they are sold. It’s
unfair to preemptively tax a capital gain before the capital gain has
occurred. Otherwise the IRS will assess your unsold Beanie Baby net worth to
have increased by $14k and tax you on 20% of it come the end of the year when
in fact it turns out your collection has no resale value at all on an open
market.

This is just as silly as _market cap_ — the idea that just because someone
paid $X to buy 0.1% of a company that’s currently in high demand and short
supply it does not follow that, should every stock holder suddenly decide to
panic sell 100% of the company, they would collectively get $X,000 in return.

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lidHanteyk
How else can we avoid austerity? The entire point is to prevent dollars from
sitting idle. Also, are you _really_ a one-percenter, or just cosplaying?

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gorgoiler
I’m not in the 1%, not even close. Everyone deserves to be treated fairly
though, even the wealthiest. I don’t think a wealth tax, specifically, is
fair. Increased taxation of actual money would be.

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claudeganon
Matt Bruenig did a good breakdown of the shortcomings of Warren’s plan here:

[https://www.peoplespolicyproject.org/2019/11/01/warrens-
perp...](https://www.peoplespolicyproject.org/2019/11/01/warrens-perpetual-
medicare-head-tax-is-unworkable-and-bad/)

As well as the more rational avenues through which Medicare for All could be
funded:

[https://www.peoplespolicyproject.org/2019/10/30/how-to-
appro...](https://www.peoplespolicyproject.org/2019/10/30/how-to-approach-
medicare-for-all-financing/)

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peterwoerner
A point which I didn't think of: we are already paying for everyone's
healthcare. Doctors and hospitals can't turn anyone away and they aren't
losing money. So it's really an accounting problem how do we collect the money
which people and businesses are already paying and how to distribute which
Medicare already does sufficiently well.

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jfnixon
That's not quite correct. Hospitals can't turn away patients with life-
threatening conditions until they are stable. In practice that means everyone
gets triaged. A better system would run public clinics, staffed by PAs and
nurse practitioners (with possibly a physician) near the ER, and force the
people who have had a cough for two weeks to go to the clinic first. Work
everyone near the top of their training, and give hospitals safe harbor for
sending non-emergency patients to the clinic first.

That's just one sensible (I think) proposal. We don't need to refinance the
current system, we need to completely reengineer it.

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jmartini
This comment reminds of some of the hospitals in India where up-skilling is
becoming commonplace to remain efficient and cost-effective.
[https://www.bloomberg.com/news/features/2019-03-26/the-
world...](https://www.bloomberg.com/news/features/2019-03-26/the-world-s-
cheapest-hospital-has-to-get-even-cheaper)

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Waterluvian
I struggle with any plan that lines up 99% of people to raid the wealth of 1%
of people. It reminds me of the idea that minorities need the most protection
because by nature, almost by definition, the majority doesn't have their
interests in mind. A democratic system makes it very easy to hurt and further
marginalize those people.

This is probably an unpopular opinion so I'll add: I'm not a billionaire, I'm
not even a millionaire, and I know there's a lot of valid (but not necessarily
good) arguments for why rich people deserve to pay more. But my moral compass
is spinning.

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JoeAltmaier
Don't forget, those 1% are hoarding 99% of all money. (Ok its really 0.1% of
the people).

Think of it not so much as reverse-discrimination, but rather a revolution.
Returning the economic system to something that works, instead of the broken
dysfunctional mess its gotten into.

I agree we need more than tax adjustments to complete the task. The paths
money follows need realigning, back to something like they used to follow in
the 70's or something. But its a start.

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el_don_almighty
That money is out making more money by investing in the macroeconomy. It isn't
sitting in their bedsheets. Bill Gates doesn't sleep on a pile of gold like
scrooge mcduck. He created something the world needed and valued. Now his
money out creating new things. Money does NOT follow the laws of
thermodynamics

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lidHanteyk
Implication: People who cannot create things that the world needs or values,
should not have as much money. However, our society requires a modicum of
money for survival. How do you square our failure to give people a modicum
with the moral implications of being unable to produce value?

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zozbot234
The sum of money that's genuinely "required for survival" is so low as to be
almost insubstantial. People, even the extreme poor in fact, spend a _lot_ of
their discretionary income on what amounts to social inclusion, not bare
survival. (But social inclusion is basically a collective good, that's far
more cheaply delivered by altering social norms in a direction that boosts
provision of social capital.)

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toastal
I'm quite concerned as a self-employed American contractor abroad. Shifting
the costs to employers might very well include myself. While I don't mind my
taxes going up per se, expanding current Medicare to all ages as the system
currently exists means I still wouldn't get coverage as there's no deals with
foreign systems or vouchers or exemptions for Americans abroad from the bill
that I read. This would mean I'd more than likely have to pay even more than
the current compulsory 12.4% for Medicare to still not get any usable health
coverage outside the States. The current health system lets me exempt myself
from the healthcare tax being based elsewhere.

I'm very much in favor of Medicare for All as a whole as it's shown to
definitely bring down the average cost per American as well as remove the
middle-man insurance companies taking their cut and give the government better
leverage against drug prices and services. However, considering many proposed
M4A plans are covering green card holders and undocumented workers, it would
be nice to know that citizens abroad could be in the loop too with a name like
"for all".

Also, can change the abbreviated version to "M∀"?

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votepaunchy
> This would mean I'd more than likely have to pay even more than the current
> compulsory 12.4% for Medicare

Social Security is 12.4%, Medicare is 2.9%.

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toastal
You are right about the chunk of the 15.3%--I read, meaning misread, it like 5
times the last couple of days. I also missed the threshold for low-earning
self-employment being exempt skimming the 20 pages of the proposal. I guess my
fears have subsided, although I believe I would still prefer some sort of
coverage.

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innagadadavida
Governments have a poor track record to manage our money. Are there any
proposals to just regulate insurance providers, pharmaceuticals and hospitals
as non-profits? In addition other industries that provide for basic human
necessities should simply be regulated as non-profits. It is simply perverse
for insurance companies to profit out of my misfortunes and further optimize
those profits to pander to industry and investor whims.

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zozbot234
An enterprise which is "regulated as a non-profit" is just a for-profit
enterprise with opaque money flows, corruption etc. etc. Genuine non-profit
enterprises require commitment, and the private sector is better able to
deliver that.

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innagadadavida
Not disagreeing with you, but wouldn’t the government be more successfully
regulating and policing these health non-profits instead of becoming a health
provider? I’m only speculating the relative success between the two options.

From an election standpoint, it also seems like a good way to galvanize the
support bases - something that presidential candidates are looking for
currently.

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zozbot234
Our approach to the healthcare sector should start from _de-regulation_ , not
piling even more red tape on it. That would be the best way to decrease undue
profit margins in the industry as well.

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ykevinator
The easier solution is letting small business buy into medicare.

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mdorazio
That seems pretty strongly like a non-solution because if you lose your job at
a BigCo (which employ over 40% of Americans, and rising), you're still
completely hosed.

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unmole
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