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which were vouched for by
prominent economists re-
cruited by her campaign.
“When fully imple-
mented, my approach to
Medicare for all would mark
one of the greatest federal
expansions of middle class
wealth in our history,” War-
ren wrote in a post on Me-
dium describing her plan.
She said at campaign stop in
Iowa that the single-payer
system could be achieved
“without raising taxes 1 cent
on middle-class families.”
Her plan offers Demo-
crats the promise of a
healthcare system without
the vast inequities that
mark the current one. It also
illustrates how heavy a polit-
ical lift would be required.
The political fight to achieve
it would risk eclipsing any-
thing else a new Democratic
president might want to
pursue in a four-year term.
A Medicare-for-all sys-
tem would replace existing
healthcare plans for the
more than 156 million Ameri-
cans who currently have in-
surance through their jobs.
It would vastly increase the
federal government’s role,
expanding federal spending
by roughly a third. And it
would impose major new
taxes on the wealthy and
push down payments to doc-
tors, hospitals, drug compa-
nies and the insurance in-
dustry, which have all re-
peatedly shown their ability
to block proposals that
could reduce their incomes.
The plan was immedi-
ately attacked by Warren’s
more moderate Democratic
rivals as financially burden-
some, mathematically sus-
pect and politically unrealis-
tic.
Warren unveiled her plan
at a key moment in the cam-
paign: Polls over the last few
weeks have shown her in first
or second place in the Demo-
cratic race in key states that
hold contests early in the
nominating season. Surveys
also show former Vice Presi-
dent Joe Biden fading in sev-
eral of those states, although
he continues to lead in most
nationwide polls.
The debate over how far
to go in restructuring the
healthcare system has con-
sistently served as a key is-
sue differentiating Warren
and Sanders on the one side
from more centrist rivals, in-
cluding Biden, Mayor Pete
Buttigieg of South Bend,
Ind., and Sen. Amy Klobu-
char of Minnesota.
Warren maintains that a
single-payer, Medicare-for-
all system could cover every-
one in the U.S. and provide
expanded benefits, includ-
ing long-term care and vi-
sion and dental coverage, for
roughly what the country is
currently slated to spend on
healthcare — about $52 tril-
lion over a decade.
Covering more people
with more benefits for the
same cost would require
holding down the amounts
paid to doctors and hospi-
tals, limiting doctors to the
rates currently paid by Med-
icare and hospitals to
slightly above current Medi-
care rates. Her proposal also
includes measures to sharp-
ly reduce drug prices.
But even if overall costs
did not increase, govern-
ment spending would surge
under the Warren plan to
make up for the money cur-
rently generated by premi-
ums and out-of-pocket costs
for families.
The tab to the federal
government would be
roughly $20.5 trillion over the
next decade — about a one-
third increase in the total
federal budget.
Instead of income tax
hikes, Warren would cover
nearly half of that cost by
collecting $9.1 trillion in ad-
ditional taxes from corpora-
tions and high-income fam-
ilies over the next 10 years.
The amount would
eclipse the wealth tax War-
ren has earlier proposed to
fund such things as student
debt relief and free public
college. Several liberal econ-
omists have already warned
the wealth tax might gener-
ate only a fraction of the rev-
enue she envisions.
Warren would cover
much of the rest of the cost
by requiring employers to
continue paying, on average,
what they currently pay to
cover their workers under
group insurance plans. In-
stead of paying an insurance
company, however, they
would pay the government.
Their bill would be calcu-
lated based on their average
spending on employee
health insurance over the
last few years.
Warren argues the cost
would be less onerous than
what those employers cur-
rently face, as they would be
shielded from existing run-
away healthcare price in-
creases because costs would
not rise faster than inflation
under her plan. Many small
businesses that currently
don’t pay for healthcare for
their workers would be ex-
empt, and states would keep
paying roughly what they al-
ready do to cover govern-
ment workers and low-in-
come residents on Medicaid.
“We can generate almost
half of what we need to cover
Medicare for all just by ask-
ing employers to pay slightly
less than what they are proj-
ected to pay today,” Warren
wrote.
Biden’s campaign aides
said such fees are essentially
a payroll tax that will be
passed onto middle-class
workers and accused War-
ren of “double talk.”
“The mathematical gym-
nastics in this plan are all
geared toward hiding a sim-
ple truth from voters: it’s im-
possible to pay for Medicare
for all without middle-class
tax increases,” said a state-
ment from deputy Biden
campaign manager Kate
Bedingfield.
“To accomplish this
sleight of hand, her proposal
dramatically understates its
cost, overstates its savings,
inflates the revenue, and
pretends that an employer
payroll tax increase is some-
thing else.”
But the Biden protests
come as a new poll shows
Democratic voters in Iowa
favoring the single-payer ap-
proach by a margin of
roughly 3 to 1.
The poll by the New York
Times and Sienna College
had other bad news for Bid-
en. It showed Warren as the
Iowa front-runner. The for-
mer vice president was in a
close three-way matchup for
second place with Sanders
and Buttigieg. And voters
were just as confident in
Warren or Sanders to defeat
Donald Trump as they were
in Biden.
Although Iowa Demo-
crats say they like the idea of
a single-payer plan, the new
taxes and the limits on pay-
ments to doctors and hospi-
tals in the Warren plan al-
most certainly will provide
fresh lines of attack for her
opponents.
Warren’s tax proposals
include a substantial in-
crease in her wealth tax,
aimed largely at billionaires.
The taxes on fortunes larger
than $1 billion would soar to
6%, double what the candi-
date earlier proposed.
In addition to the wealth
tax, Warren would hit the
richest 1% of Americans with
a new annual capital gains
tax. Her plan also calls for
several trillion dollars of new
taxes on financial firms and
large corporations. They in-
clude rolling back the tax
cuts signed into law by Presi-
dent Trump, but also go far
beyond that.
Among the new taxes
would be one on financial
transactions, with levies col-
lected when stocks and
bonds are bought and sold.
Large financial institutions
would pay a new “systemic
risk fee.”
Corporations would lose
trillions of dollars of tax de-
ductions they are currently
eligible to claim, and firms
that move their profits
abroad would be targeted
with substantial new levies.
To collect all of this mon-
ey the senator is arguing for
a significant expansion of
the Internal Revenue Serv-
ice.
“The wealthy and their
allies in Washington have
worked to slash the IRS
budget, leaving it without
the resources it needs,” War-
ren wrote. She argued that
the “tax gap” in the U.S., the
money that is currently
owed to the IRS but is going
unpaid and uncollected, is
substantially larger than it is
in other wealthy nations,
such as the United King-
dom.
As Warren has with her
other plans, she presented
this one with a stamp of ap-
proval from pedigreed ex-
perts in the field.
Donald Berwick, the
head of Medicare and Medi-
caid under President Oba-
ma, was part of the team
that signed off on the viabili-
ty of Warren’s cost-cutting
proposals.
Those plans include ag-
gressive measures that
would upend the healthcare
industry. Warren suggests
the nation’s 10-year tab for
healthcare could be
trimmed by $1.8 trillion sim-
ply by cutting out the com-
plex, often incomprehensi-
ble billing practices of insur-
ance companies, which bur-
den doctors and patients
with bloated administrative
costs.
The plan also relies on
other big, politically tough
policy shifts. Warren counts
on Congress passing com-
prehensive immigration re-
form that would legalize the
roughly 10.5 million undocu-
mented residents of the U.S.
— a move that would make
those people taxpayers and
thereby boost federal reve-
nue. She would also pare
down the military, cutting its
budget by $800 billion over a
decade.
Sanders has avoided po-
tential attacks by staying
vague on such details.
“You’re asking me to
come up with an exact de-
tailed plan of how every
American — how much
you’re going to pay more in
taxes, how much I’m going
to pay,” he said on CNBC
earlier this week. “I don’t
think I have to do that right
now.”
Times staff writer Melanie
Mason in Des Moines
contributed to this report.
Warren outlines ‘Medicare for all’ funding
[Warren,from A1]
ELIZABETH WARRENgreets supporters before Iowa Democrats’ Liberty and
Justice candidate event in Des Moines. Her plan doesn’t raise middle-class taxes.
Charlie NeibergallAssociated Press