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Lost in points like this, where you’re trying to scare people by saying a large number, is that the distinction between a Medicare for All type of system and the current private system is less about how much it costs and much more about who the middleman is.

* In M4A, Americans will pay ~$30T/10yr to providers through the government as a middleman.

* In the current private system, Americans will pay ~$30T/10yr to providers through whichever company their employer has selected as a middleman.

The only cost question re: M4A is whether Americans will spend slightly more or slightly less overall when costs are increased because coverage is extended to 10% more people, and costs are decreased by:

- massive efficiency gains of a single payer,

- elimination of profit to shareholders who siphon money away from care,

- better preventative care that reduces or eliminates more expensive catastrophic care.

And additional intangible benefits like:

- not having your healthcare decided by your employer,

- having the ability to be an entrepreneur and/or start a small business while having the security of healthcare,

- the fact that small business will be able to better compete with huge corporations for desirable employees because they won’t have to offer health benefits themselves.

My point wasn’t to take a dig at M4A. (I'm a proponent of universal healthcare, though I'd prefer extending ACA.) I mentioned it because OP talked about sweating medical bills. The point is that the cost of providing healthcare to everyone is vastly more than the wealth of even billionaires. (By the way, the expert estimate linked from Warren's own site is $52 trillion/10 years, not $30 trillion.)

No, but her plan isn't the only one out there. Bernie's plan was estimated I believe at 23 billion over 10 years, which a right wing think tank actually (accidently) proved would cost less than we're paying now.

But in 25 years how much does the system improve, what if it's like 50T over the 1st 10 years, then 30T the 2nd because of gains in efficiency? There's a lot of 'in the air' variables as well, where it could end up being 30 or 40T over 10 years if the efficiencies are higher than expected or if we can better negotiate terms w/ drug companies.

If we legalize weed and shrooms and tax them at the national level, that itself would also be a great way to gain money for healthcare. We also can easily halve our military spending and still have a strong national defense. Also adding a VAT may be a good idea, we could even give discounts to citizens so immigrants and visitors travelling in America also help offset our healthcare costs. For instance say vat is 4%, and we charge 12% for non-citizens it would A. discourage illegal immigration, and B. it would stop people worrying about immigrants because they'd have to pay higher VAT than everyone else, so they'd be tax payers and not just 'using the system'...

This is maddening. The problem with the US healthcare system is that we're paying ~$30T/10yr†, not who we're paying it to. The idea that locking those exorbitant costs in would be a win is baffling.

The efficiency gains of single payer are overrated. We pay more than other countries do in admin overhead, but admin overhead itself is a small fraction of total costs, and as a percentage of our spend, admin costs would necessarily rise, probably dramatically, if Medicare starts covering 30 year olds in addition to 68 year olds.

† I'm just taking your number here, not interrogating it.

Indeed. We already effectively have single payer system for large segments of the population, the Medicare itself. It still didn't push the costs down to European levels for Medicare recipients.

The US needs cheaper healthcare, but single payer won't achieve that.

Part of the reason for that is that Medicare is forbidden by law to negotiate prices the way other insurance companies can as a result of the GOP's Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

It can't be much of the reason, because prescription drugs are, contrary to popular opinion, actually a relatively small component of US healthcare spending.

The other thing about rayiner's post is that the language he uses is quite informative of his political views. Notice how he uses the phrase "confiscate wealth" to describe taxation, as opposed to, say, "paying their fair share".

My political views are pro-taxation and pro-public services. (Except we should have the Swedes or Singaporeans come over to run our public services.) Which is why I think waging a class war against billionaires for a piddling $275 billion in additional revenue, while not increasing taxes on people making up to $250,000, is pure insanity. European countries have figured out how to pay for public services with middle class taxes. We should follow their lead instead of dreaming about wealth taxes.

Also, I used “confiscate” in the context of literally taking all of billionaires’ money.

Warren's tax plan starts at the $50 million threshold. Not sure why you are counting only billionaires, or only the top 400.

Her math adds up.

https://www.washingtonpost.com/politics/2019/11/05/warrens-p...

https://www.nytimes.com/2019/11/01/opinion/did-warren-pass-t...

Warren’s wealth tax doubles to 6% at the billionaire level. (France’s and Sweden's highest wealth tax was 1.5% until they got rid of it.)

Warren’s calculations just prove why the whole fixation on billionaires and income inequality is a distraction. You're talking about a wealth tax that is unconstitutional, at levels that are completely unprecedented. You're talking about risking capital flight, and setting political capital on fire, to move the United States far to the left of Europe. (What a great campaign ad for Donald Trump! Warren is proposing to do something that even France realized was a bad idea.) And for what? Is it going to pay for M4A? Or balance the budget? No. Not even theoretically.

I say this all as someone who wants universal healthcare to be implemented (even though I'm pessimistic about it saving any money). I think Warren's proposal with respect to employer-side payments is actually pretty clever. But the wealth tax is a huge political liability, and it could take M4A with it. And when that happens, it won't be the fault of billionaires (the wealth tax wasn't going to raise the necessary revenue anyway). It'll be the fault of people making $200,000 who think they are "middle class" and shouldn't have to pay the same level of taxes their counterparts in Europe pay.

Why is the Warren head tax (the "employer-side payments", which will be taken out of the hides of employees the same way health insurance costs already are) "clever"? Aren't head taxes generally problematic?

I like the idea of keeping things similar to what people are already paying as a starting point. Although I hadn’t realized that it would end up being a head tax rather than a payroll tax.

This comment doesn't say anything; it's simply innuendo.

> If people lose confidence in the system because of that it’s because they can’t multiply. Elizabeth Warren’s new health plan will cost $50 trillion over ten years. Middle class Americans make $8 trillion a year, compared to about $130 billion for America’s billionaires.

To anyone who might take this as an indication Warren's plan will increase HC spending, if we do nothing average yearly HC spending for the 2020s in the US is going to be over 5T anyway. It was at ~3.65T last year, and growing fast.

People obsessed with "how will we pay for it" just don't understand. The skewed distribution of wealth creates a situation where people don't have time and energy left over from their hustle to take care of themselves and to take care of each other in basic ways. People are sacrificing to the gods of capitalism. Correcting the skewed distribution of wealth would shift agency back to people to mind the business of living life up close, rather than having their life energy extracted.

This is part of a degrowth mindset, and it will freak people out who flee from the shame of not winning, who cannot handle pauses or idle time, who must have control over other peopes' lives. But we can't have those people running this planet into the fire. They're gonna have to learn to be alright.

>The skewed distribution of wealth creates a situation where people don't have time and energy left over from their hustle to take care of themselves and to take care of each other in basic ways.

Can you help me understand this better? Because I see this sentiment often. I'm just gonna do some quick math... Bezos + Gates + Musk + Zuckerberg = let's round up to $300 Billion. Divide that evenly among the 327 million US population. I'd get $917. Do you believe that I will take better care of myself or be a better father in the long run if I get a one-time bonus of $917?

Right now, people with a lot of money basically dictate how people with not enough money use their time. How do they do this? By effectively withholding housing and food unless the people with not enough money do the work that the people with more money tell them to do... Often at the cost of taking care of their kids, of their bodies, of their mental health, of their living spaces. Money as a tool for distributing resources and collective decision making is at odds with money as a tool for domination, exploitation and extortion.

Modifying the distribution of wealth isn't about chopping up the richest peoples money and handing it out to everyone else. It's about altering the flows of the dynamical system so that power is continually distributed in an equitable way, one that optimizes more peoples' ability to thrive and co-create healthy lives.

It's about changing the meaning of having vs not having money, it's about reducing the intensity of the leverage people have over one another, and about freeing people to have basic autonomy and agency in their lives.

I find it a bit naive that the whole system would work like some sort of highway robbery :-) I'm pretty sure that's not what's meant when people talk of "wealth redistribution". Your argument looks like a strawman to me.

I'm not trying to make an argument, I'm trying to understand what the GP means in practice. I know people sometimes use questions passive aggressively, but that wasn't my intent. A more even distribution of all the wealth looks like people having a few thousand dollars of wealth. Much less if we're equalizing the whole world and not just the US. What are we imagining happens?

I'm from a former Communist state (one of those states that became Communist at Soviet-tank-barrel-point :-) ). So Communism doesn't have much appeal to me.

My personal perspective is that equalizing things fully doesn't work. You want incentives to motivate people. However, it's quite amazing what motivates people - after all, for the average billionaire going from $62bn to $63bn isn't really some sort of milestone, unless they somehow surpass some other billionaire. Sometimes the things that motivate people are a lot more fine grained that it seems. So pure financial motivation is rarely the main incentive.

On the other hand, such huge imbalances do eat away at democratic principles.

My personal opinion is that at some point, companies should be treated as utilities/companies of vital national interest. After all, that's how rich people make most of their money, through shares, not through salaries.

So, basically, once a company is taller than X, the country this company is based on gets a certain share of the company, 5%, 10%, 20%, it doesn't matter. I'd also make these shares non-voting. Even better, I'd force these companies to give out a certain percentage of these shares to employees (after all, they're "the people").

We'd have fewer billionaires, we'd have more stable middle class people, we'd have higher state revenues, we'd have less of a disconnect between totally private companies, regular people and governments.

As the owner of a company, you have a choice: create a huge company and have to share the spoils or stay small and nimble and have greater control.

Let's imagine the US govt takes 10% of the shares of Amazon. These are non-voting shares. Amazon doesn't pay a dividend as far as I know, so what is the point? The government doesn't have control over the company, the government doesn't get any revenue. The government can't sell the shares because then it just has to come confiscate 10% more shares from Amazon.

How do I, as a regular citizen, benefit from this? Is there some mechanism I'm not seeing? Because it feels like it's just a meaningless paper transfer.

Amazon won't pay dividends for a while. A country lasts centuries.

Secondly, that's why I was also thinking of a variant where employees get shares, too.

What is the difference between Amazon giving me, an imaginary Amazon employee, $100 in cash vs $100 in stock? Amazon is a publicly traded company, so any employee can choose to buy stock. Is the idea to force the employees to hold the stock without being allowed to sell it? If they can't sell it, what value do they get from it?

As an investment strategy, I never hold stock in a company I'm working for. That puts too many eggs in one basket. If the company fails for some reason, not only have I lost my job but I've also lost my retirement savings. I would personally oppose being compensated in company stock and would sell it ASAP if given the option.

Dividends, influence (the employee shares would have voting rights).

I'm not saying it's the best option or something I studied deeply, but we need something better.

Otherwise, with automation, we're back to feudalism.

> Do you believe that I will take better care of myself or be a better father in the long run if I get a one-time bonus of $917?

Your POV fails to take into account the utility and time-value of the redistributed dollars. It's the difference between some unelected doofus having tons of power because of their stationary dollars, or building a universal pre-k and/or healthcare system.

I know I'd personally work less if I wasn't "blessed with the opportunity of choice" of terrible insurance plans offered by my employer where an emergency appendectomy leads to $5k in bills... or if I could work 75% time and reduce daycare hours.

It's still not clear to me how we are going to get the outcome you're looking for.

If the wealth is redistributed to the people (the mechanism isn't important) then that amounts to a few thousand dollars per person. This isn't the kind of money that would allow wide-spread reduction in work hours. My expectation is that most people will liquify that wealth and spend it over a long weekend. Do you have a different expectation?

If rather than being given directly to the people, instead the state keeps that money, are you predicting that Donald Trump will use it to build you a new school?

Regarding reduction of work hours, I’m a subscriber to the prevalence of “bullshit jobs” theory. Remove the power from corporate overlords via redistribution and put those resources under more democratic control. As a bonus people will take ownership over their schedule.

Sure, with less people working we may not have forty choices of toilet paper or same day delivery of counterfeit trinkets... but I’m more than ok with that. It will be necessary to reduce carbon emissions, anyway.

> We spend way too much time worrying about the wealth of a small group of people that, in the end, doesn’t add up to that large a fraction of total wealth or income.

People focus on billionaires due to the fact that they are the most stark representation of the deeply unequal society in which they live. Wealth inequality is very real, please refer to the following: https://www.stlouisfed.org/open-vault/2019/august/wealth-ine... It's a rhetorical device

> Middle class Americans make $8 trillion a year, compared to about $130 billion for America’s billionaires.

So the group of people who leverage capital to sustain themselves and don't have to work have lower net income than the group of people who have to work to have a roof over their head?

> $50 trillion

I love how these numbers increasingly grow. First it was 36 trillion from the well-known Cato institute. Mind you, this was actually going to save money in the long term, so we have to bump up the number. The United states spend almost 2x per capita what Canada does on healthcare, so it seems pretty odd that we'd use current pricing systems to estimate the cost when the original M4A bill expressly increases leverage to negotiate. $50 trillion is a spook.

> So the group of people who leverage capital to sustain themselves and don't have to work have lower net income than the group of people who have to work to have a roof over their head?

He’s talking about the aggregate income earned by the group. So the delta in individual incomes is offset by the massive delta in group sizes.

Huh, this is interesting. I completely missed the fact that these two groups are massively differently sized. So his 8 trillion vs 130 billion is laughable. If you define the "middle class" as roughly 50 percent of the population (this is pretty low considering how this word is actually used), then the billionaires 130 billion greatly outstrips the 8 trillion per person. There's just shy of 600 billionaires in the US vs roughly 160 million "middle class" then the per individual income is 50k vs 222k. Pretty Stark even when you completely disregard the wealth elephant in the room

Whether you look at things per-person or per-group is a matter of adopting a punitive outlook versus a practical outlook. If your goal is punitive, sure, it's relevant that the average billionaire makes hundreds of millions of dollars per year, while the average middle class person might make $80,000.

But I don't think Americans are punitive. They're not deeply troubled by the mere fact that there is someone out there with $8 billion. To the extent they care about billionaires, they're concerned about whether they're paying a fair amount to support the county that gave them so much. And from that perspective, what matters is the aggregate income of the group. And $130-150 billion just isn't much compared to the $6-7 trillion in annual government spending in the U.S.

Politicians thrive by disguising the punitive outlook as a practical outlook. They point to how much money Zuckerberg or Bezos have, and quickly pivot to how they could pay for universal healthcare, universal education, etc. A necessary aspect of that strategy is keeping people ignorant of the fact that even confiscating the total income of every billionaire would only pay for say 25% of U.S. higher education spending, or 4% of U.S. health spending.

> But I don't think Americans are punitive.

I don't think this is a remotely justifiable belief. We have the highest prisoner rate per capita, we sanction anyone the second they step out of line, and the entire two prior decades have been shaped by a collective trauma that pushed us into seeking retributive justice against anyone--regardless of their actual role.

I fail to remember which Puerto Rican uprising this was during, but there was a mother who was jailed for the crime of making her husband and children breakfast. When slavery was finally ended, the 10 years of reconstruction was met immediately with horrific acts of terrorism and reactionary violence to reassert white supremacy.

Punitive Justice is a core tenet of the American civil religion.

> People focus on billionaires due to the fact that they are the most stark representation of the deeply unequal society in which they live. Wealth inequality is very real, please refer to the following: https://www.stlouisfed.org/open-vault/2019/august/wealth-ine... It's a rhetorical device

It's a rhetorical device that distracts from real problems and real solutions. Look at Warren's wealth tax proposal. It's blatantly unconstitutional and without precedent in the OECD. And what's the upshot? Just $275 billion in revenue per year. Compared to the $1 trillion or more we could raise by implementing a VAT, like every other OECD country has, or bringing payroll taxes in line with other OECD countries.

Focusing on billionaires also distracts from the nature of our "deeply unequal society." Look at the U.S. income distribution: https://taxfoundation.org/summary-latest-federal-income-tax-...; https://www.aei.org/carpe-diem/fair-share-top-400-us-taxpaye....

The top 400 taxpayers earned $127 billion in 2014, let's say an even $150 billion in 2018. There were 70 million returns filed by the bottom 50%. If you took all billionaires' income and redistributed it among the bottom 50%, they'd have about $2,000 a year more, or a bit more than 10%. But look at the top 50% minus the top 1%. (Even Sanders considers the 98th percentile to be "middle class" given his tax plan wouldn't raise taxes on people with household incomes under $250,000.) They have $7 trillion in income, versus about $1.1 trillion in income for the bottom half. If you want to talk about income inequality, that's the root of it. And that's the most significant kind of income inequality in terms of impact on peoples' daily lives. Billionaires aren't the ones driving up housing prices in urban neighborhoods and driving out people of color. Billionaires also aren't the ones that would be directly affected by the increases in VAT and payroll taxes that would be required to move to a more European model of taxation and public services.

If you took all personal income ($10 trillion) and divided it evenly among all filers (140 million), you get about $71,000. If you or your household make more than that, you benefit from inequality.

> So the group of people who leverage capital to sustain themselves and don't have to work have lower net income than the group of people who have to work to have a roof over their head?

Zuckerberg doesn't work? Buffet doesn't work? Kylie Jenner doesn't work?

> I love how these numbers increasingly grow.

The $50 trillion number was calculated by Warren's own experts: https://assets.ctfassets.net/4ubxbgy9463z/2Tg9oB55ICu2vtYBaK... (linked from: https://elizabethwarren.com/plans/paying-for-m4a)

Credit to Warren, her analysis doesn't assume that Medicare for All will result in massive cost savings, which I think is highly unlikely given the American political system.

> Zuckerberg doesn't work? Buffet doesn't work? Kylie Jenner doesn't work? > don't have to work

One of these things is not like the other. Don't be so slippery, please.

Your comment is posted as a matter of fact, but includes no sources/citations

Its probably true, just cherry picked.

Currently healthcare will be 52trill over ten years

Warrens plan from two estimates is 52-59 trill over ten years.

Billionaire thing seems wrong. Forbes 400 richest americans has 2.96 trillion total between them. Lowest person on the list has networth of 2.8 bill

You’re both right because GP was talking about annual income

The US economy already pays for near-universal healthcare through insurance premiums. The money already exists.