Sunday, October 20, 2019

Warren's focus on who bears "costs" in her Medicare for All plan

Warren's focus on "costs" when she defends her Medicare for All plan is a sham and a shame. She is unwilling to state that taxes will increase for just about everyone and refuses to disclose why costs for anyone would decrease and by how much. We need honest debate to solve the difficult problems we face, not vague promises.


Why doesn't she say something like this?
Costs for rich people would increase by $500 because their health insurance premia and health care payments would decrease by $1,000 but their taxes would increase by $1,500.
Costs for middle-income people would decrease by $200 because their health insurance premia and health care payments would decrease by $600 and their taxes would decrease by  $800.
I suspect that four reasons drive her to avoid such clear statements. First, repeating that, "costs will increase for rich people and large corporations and costs will decrease for middle-income people" may be a brilliant political tactic. Second, clear statements about the plan might reveal flaws in the plan. Third, clear statements might reveal how little impact is has on people with middle incomes. Fourth, individual outcomes differ from averages.

The first reason to repeat endlessly that, "costs will increase for rich people and large corporations and costs will decrease for middle-income people" is that it might be a brilliant political tactic. At a recent debate, she got to repeat the line about six times. I suspect if middle-income people hear the line enough, they might believe that the plan would be good for them. If people simply want to know whether or not to "like" something and want to avoid cognitive load, her tactic may be the best way to build and maintain support for her candidacy. 

A second reason to avoid clear statements about the plan is that they might reveal flaws in the plan. They might reveal that the analysis is flawed because the numbers "don't add up". They might reveal that her plan treats people who think she is talking about them when she says "middle income" as rich people. 

The third reason for obfuscation is that clear statement reveal how little impact is has on people with middle incomes. I am having trouble finding big reductions in costs for middle-income folks in my back of the envelope calculations because middle income is where the tax revenue is. Bank robbers rob banks and politicians tax the middle class because that's where the money is. If the decrease is small, the middle income folks she is counting on to support her may say, "Why bother?" 

The final reason for obfuscation is that details might reveal that individual outcomes differ from averages. For example, costs might decrease for most middle-income people but increase for others. Once the others recognize that the plan increases their costs, she begins to lose support. Moreover, even people with projected cost decreases may wonder if they will benefit when revision occurs, and they are smart enough to know that revision will occur. 

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