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Adding Up Warren's 'Medicare For All' Plan


"Medicare for All" has been a rallying cry in the Democratic primary. But how to pay for it? Elizabeth Warren was pressed on that in the October debate.


ELIZABETH WARREN: And for hardworking middle-class families, costs will go down.

SIMON: And now she's released her plan. Julie Rovner joins us to see if it all adds up. She's chief Washington correspondent for Kaiser Health News.

Julie, thanks so much for being with us.

JULIE ROVNER: Thanks for having me.

SIMON: One of the issues with Medicare for All, the idea of expanding Medicare to cover all Americans, is that it can take a few different forms. In order to pay for it, Elizabeth Warren had to sketch out exactly what her version would look like, right?

ROVNER: That's right. This is very much different from what Bernie Sanders even introduced in the Senate. There were many, many questions that were - remained unanswered in his proposal that Elizabeth Warren has gone in and answered, which she needed to do because it's hard to say how much something's going to cost unless you know exactly how much you're planning to pay for it. And she has gone in and said, basically, how much she's planning on paying for a lot of the health care that people now consume.

SIMON: Help us understand the structure that she's proposed with the codicil that she says she wants billionaires and businesses to pay for.

ROVNER: That's right. She said that in most cases, she wants to pay hospitals and doctors what Medicare now pays - what Medicare for senior citizens, which would be very different from the Medicare we're talking about...

SIMON: Yeah.

ROVNER: ...In Medicare for All. Though - that is considerably less than many private payers pay doctors and hospitals. They will not like having their payments reduced to that level, but that does make everything cheaper and makes it easier for her to finance and easier to finance by basically taxing the rich, which is essentially what she's doing. She would also require people who are paying in now - not individuals, but businesses and states - to continue to pay, and that would also help finance this new system going forward.

SIMON: Do the numbers add up?

ROVNER: They add up to what she says it would cost. She says that they would be able to raise money by better enforcement of the tax laws, which is something that everybody wishes would happen. She's got some money in there from reforming immigration, which suggests she's planning on reforming immigration before she does health care. So there are a lot of ways that it might or might not add up. It would add up if everything she anticipates happens.

SIMON: Senator Warren says taxes would not go up on the middle class. Is that practical?

ROVNER: Well, there's - it's one thing to say that taxes won't go up on the middle class. Under her plan, taxes won't go up on the middle class. It's another thing to say that people in the middle class would pay less overall than they do now for health care. Yes, health care would be free at the point of service, but it's hard to know how much the employers would continue to pay. And that is money that's basically out of workers' paychecks. And if you have very generous benefits now and/or you don't use very much health care, in the end, you might actually not end up paying less than you pay now. It depends what you have now to know whether your costs won't go up.

SIMON: How did Medicare for All become such a rallying point in the Democratic Party not so long after Democrats had claimed credit for reforming health care with the Affordable Care Act?

ROVNER: Well, I think the idea of Medicare for All is that it's easy, or at least it sounds easy that everybody would have what seniors have. The government would fund it. It would be - we would be able to save money. It would be more administratively simple.

Of course, it turns out - and if you read Elizabeth Warren's plan, it reads like a graduate seminar in health policy - Medicare for All is anything but easy because the health care system is incredibly complex, and moving to something more streamlined would be extremely difficult.

SIMON: So for this plan to work, a lot of things would have to fall into place that she or any president would have to get through Congress.

ROVNER: That's right. And I think the other thing is that we normally don't see presidential candidates putting out proposals of this specificity, although this is Elizabeth Warren's brand is to put out these very specific, very complicated plans. But this is mostly something that a president doesn't do. This is something that Congress would have to do. Generally, presidents like to leave it to Congress to work their will. She has, however, come out, and she believes that it is in her interest politically right now to have this specific a plan with proposals to pay for it.

SIMON: Kaiser Health News chief Washington correspondent Julie Rovner, thanks so much for being back with us.

ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.

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