Elzabeth Warren's Medicare for All math

The most positive thing you can say about the health care financing plan from Sen. Elizabeth Warren, D-Mass., is this: She failed, but she failed in an impossible feat.

The feat was getting the math on Vermont Independent Sen. Bernie Sanders' specific version of "Medicare for All" to add up. Which means: offering more generous coverage than currently exists anywhere on Earth in a country that likely has the highest health care prices and still somehow saving the country money in the process.

Sanders' Medicare for All plan (like his entire political career) is arguably more about pushing the Democratic Party leftward, not coming up with real, implementable policies — or at least, not doing the homework required to determine if his proposals are real, implementable policies.

Yes, Sanders loves to talk about how he "wrote the damn bill" on Medicare for All. But he hasn't even attempted to figure out its financing. That would require him to document his claim that middle-class Americans will come out ahead financially even if their taxes go up.

Warren, on the other hand, has cast herself as more than a mere Overton-window-expander. She's not just about professing values but offering specific, serious, in-the-weeds implementation of those values. By golly, she always has "a plan for that."

So she decided to construct a detailed financing plan for ... Sanders' proposal.

Why she boxed herself into her rival's bill is unclear. Medicare for All is a popular brand, sure, but it's a vague slogan that means different things to different voters. And polling suggests Sanders' particular interpretation of that slogan, which includes eliminating private insurance, is not actually a political winner.

Plus, as Warren herself persuasively argued back in January, there are "lots of paths" to get to universal health coverage, which is the broad objective voters care about.

These paths don't all require shunting everyone onto single-payer. In fact, there are "lots of paths" to get to single-payer that don't look like Sanders' specific version of single-payer. These include considerably cheaper proposals that — as in the existing Medicare system — have some modest cost-sharing, such as through income-based premiums.

Warren is also a deft communicator and an imaginative, even visionary, policy wonk. Yet she still decided to hitch her wagon to his idea.

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So, Warren did Sanders' homework for him. And she determined that in order to pull off Sanders' promises, you need to make some extremely generous assumptions.

On both sides of the ledger.

On the cost side, Warren takes existing, independent estimates for how much money a given proposal would save and then ratchets them up much higher. For instance, the Urban Institute recently estimated that a single-payer system might cut drug costs by 30% from commercial prices. Warren instead suggested she'd cut payment rates for branded drugs by more than double that.

"We felt we were making pretty optimistic, aggressive assumptions," said Linda Blumberg, a health economist and co-author of the Urban Institute analysis. "They're making more optimistic, more aggressive assumptions."

On the revenue-raising side, Warren likewise proposes some ideas that might be good on their own merits, but then dramatically overstates their impact.

Increasing the enforcement budget of the Internal Revenue Service, for example, is a no-brainer for raising tax revenues. But Warren's plan says it would raise 40 times as much money as the Congressional Budget Office estimates.

Likewise, however little sympathy you might have for the billionaires subject to her 6% annual wealth tax, the Warren team's projections for how much money it'd raise beggar belief, given foreseeable tax evasion and avoidance. Eventually she's going to run out of billionaires to tax, and she'll have to reach into pockets further down the income ladder.

When Joe Biden's campaign accused her of "mathematical gymnastics," Warren batted away such criticisms as "Republican talking points." Which is strange, because until recently, I thought it was indeed the Democrats who cared about practicing good math.

The peculiar thing is this: If you stripped away the most inflated, least convincing assumptions in Warren's proposal, it could in fact raise enough money to get us to universal coverage without a single-payer system. Heck, we could even pay for a version of single-payer that looks more like merely expanding the existing Medicare program to all Americans – a proposal the Urban Institute has dubbed "single-payer lite," and that has income-based cost-sharing and Obamacare-style minimum benefits.

Good job, Sen. Warren, in attempting to do Sanders' homework for him. It showed us what a fool's errand his plan is. But we'd all be better served if you used your talents to come up with a different assignment.

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Catherine Rampell's email is crampell@washpost.com, @crampell.

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Opinion Editor

Opinion editor for The Billings Gazette.