« The Weeds

Paying for single-payer

2019-11-05

Jane, Dara, and Matt on Elizabeth Warren's Medicare-for-all financing plan and its critics.

What to read:

"Elizabeth Warren’s plan to pay for Medicare-for-all, explained" by Ezra Klein, Vox

"The Sanders-Warren dispute about how to pay for Medicare-for-all, explained" by Matthew Yglesias, Vox

"From Incremental to Comprehensive Health Reform: How Various Reform Options Compare on Coverage and Costs" Urban Institute (white paper)

Hosts:

Matthew Yglesias (@mattyglesias), Senior correspondent, Vox

Jane Coaston (@cjane87), Senior politics reporter, Vox

Dara Lind (@DLind), Immigration reporter, ProPublica

More to explore:

Subscribe to Impeachment, Explained on Apple Podcasts, Spotify, Stitcher, Overcast, Pocket Casts, or your favorite podcast app to get stay updated on this story every week.

About Vox

Vox is a news network that helps you cut through the noise and understand what's really driving the events in the headlines.

Follow Us: Vox.com

Facebook group: The Weeds

Learn more about your ad choices. Visit podcastchoices.com/adchoices

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Support for this episode, country Clicker lose an average of three hours every day. Switching between all our work apps, but you can get them back with click on a flexible platform that brings all your central tools at one place. People prioritize tasks, collaborate on docks, chat with your team and track comes it's why? Companies like Hoover and web flow use click up as their mission Control Centre, placing every other after we're using before up even guarantees to help you save one day a week and get more done, it's completely customizable and it's free forever to dry click up today, click up without com, slash weeds, Yeah, this is Marquez Brownie, acre amicably hd, and this is Andrew Manga Nellie. We will introduce you to our podcast way, formed the newest addition to the Vocs media podcast network, so I've spent- over ten years reviewing tech products and consumer electronics for millions of people on the incubation to channel and now on the way forward
ass Andrew and I use that experience to dig even deeper into latest tech for smartphones too. I max to electric cars. So if you're gadget lover or attack head or if you just want to figure out whether the latest gadget is worth your harder in cash, give us a lesson sacred fine way, form the empty beefy podcast on your favorite Pakistan. Every Friday see over there. I went to my my facts straight Lou allow one which another set of the weeds on the box media access networks. I Matthew place. He is here today with Jane Coastal Pro public as derelict and in memory of of Sarah Cliff, we just we had to do a weeds on Elizabeth Morin. Releasing plan to finance Medicare for all, this had been sort of dogging her across multiple presidential.
bates she had seemed like she wanted to stay vague on how exactly this was gonna work, which I think, kind of thing, a lot of politicians would do for like such an aspiration all and legislatively unlikely programme, but, like her whole, stick is about how she has allowed plans, so it seemed to demand the construction of some kind of plan and in turn her putting out some kind of plan, because it both speaks to you, no expense visions of health care, this financing and to the broader dispute about much detail. You need to go into an a presidential primary and their relations between putting together detailed plans, actually accomplishing in a legislative goals and office meant the required the weeds episode about that. Absolutely especially because this is not your subjection a plan that actually is a plan that is like by having this plan. It means
I've been thinking a lot about this. This is not the actual plan itself yeah. This is the actual plan itself. This is not like a symbolic plan. This is an actual plan with like attacks plan that was developed by the former chief economist Labour Department, this their cost estimates. There is actual, like math here, I'm interested, especially to hear from met on how the actual numbers on facts and figures actually work, because the basic premise of warrants Medicare for our plan is that it would not require purportedly a taxi increase in the middle class, while I think can it Bernie Sanders said like WWW, probably require some higher taxes, but that would be worth it in order to get something good everyone, but I basically, I want to switch over the mat now because he can explain the numbers I had been working on a peace and the peace was to say that what Warren had been doing was saying. Look, I'm gonna, give everybody lower costs. You know she'd been sort of promising.
And I was working on a peace after having spoken to a lot of experts and and stuff like that- and people in centres is camp as well. Saying that I didn't think it was gonna be possible to fulfil. Warns promise that I thought that you could deliver a plan that lower costs for all sort of categories of people, but not literally, We bought it that there were like too much complexity and heterogeneity in the system, but wines team had been Connell. I am not talking to me about this It was like ready to go with the peace. I suddenly got Lord from them, they were like hey we're come out with a plain tomorrow. I want to talk to us about it. You don't give me a preview of the remix any. It blew mind cause this plan is: is audacious in a number of respects to make its make its math work. That starts with just the total amount of money that you need. I, like a lot of people, had been working off. An urban institute report
goes into costs over allotted different of care healthcare options, as she thinks for a bunch of reasons that she can spend seven trillion dollars less than urban thought they would, and so that's like that's about the amount of money that her team estimates would be spent in the absence of Medicare. For all right, yes, I mean exactly mean she's, basically saying that by cutting provider payments in particular, really sharp cut to prescription drugs, payments and sort of modest, but significant cuts in payments to hospitals and specialist physician did they can bring unit costs down a lot and so that, even though there will be more treatments, Dolby, less aggregate national healthcare spending. So as an argument that familiar to anybody who remembers the debate over the ach when there is a lot of talk about bending the cost curve and how you know it's a general principle,
microeconomics, that when you only have one customer that providers are forced to cut prices to compete for that customers and its anti ac turned out. Interestingly, in this regard right, there was a lot of scepticism that the easiest cos. our mechanisms were going to work and in fact, a lot mechanisms were never brought on line and sort of didn't work politically, but costs the clause correctly bent right. So we never really put it to the test and one view is well. It was a giant coincidence and, unlike the Asia sort of succeeded by accident, another view is that the threat of these men Hers was effective in changing the system. Another view is that certain things that people in helping him services were optimistic about, but that congressional budget office wouldn't score were actually incredibly effective, but look we start like. We never really found out what was going on, because the cosgrove did in fact band. So you know what
says here is certainly possible in principle, and when I was tweeting about this, I got some angry die. There is being like nobody's gonna, do more work for less pay, and, if you recall the wit, we did an episode backwards. we hear about these S catch one doktor strike, and you know when Canada rolled out at they call it Medicare that their system, it did in fact produce an effort by medical professionals till I go got, but eventually they broke and did it. So this is a question of like politics like. Could you actually force these kind of cuts on the system? mathematically. You definitely can right. I mean if you look at how much specialists earn isn't like asking them to take. A pay cut is going to lead to them starving in the streets or something is kind of hard to she gets essentially seven trillion in savings there that I would have thought she could have. Then she's got like a bunch of taxes on the ridge, a financial transaction tax at a very high, a thirty five percent global sort of time,
on foreign earnings, that that's a proposal that look at a world wide tax on- U S, companies, foreign earnings has been in the mix from leftwing people, but they usually been proposing like percent tax, thirty five, as it is a high rate for that firm she's got a financial transactions tax. Her wealth tax, which people have talked about a lot she's, now doubled. So it can be a six percent wealth tax. She claims that stepped up tax enforcement. Could raise two point: three trillion dollars, which is not early wrong, but I would say it's a very optimistic reed was like the republican claims, the? U can balance the inner that you can get a lot, Is it a balancing the budget by cutting waste fraud and abuse in government programmes? Rightly, yes, you can probably squeeze some blood from that, but ultimately its blood from a stone, and I think that I mean that gets to the next point here, which is basically that warrant part of this is at war and would pass comprehensively
mission were here. I want you to do more than four hundred billion dollars, a new tax bill income, and I think we should stay there just for a little bit, but just listen, there's two things: one is immigration form the others. Eight hundred billion dollars comes from eliminating the overseas contingency operation fund in the defence Department, which is this kind of like war slush fund and so Those two even combined are not really that much money, but it's like unrelated controversial issues then to what I think is sort of the two conceptual hundred pieces of this which their their questions about their work. Letty, although the math on them is very clear right She says that the federal government can capture the money that states currently spend on health care. I was prepared to go to press with an hour very confidently, asserting that you can't do this, for federalism reasons. Elizabeth wine is a is a lawyer. She is a constitutional law professor. She has
of lawyers and their team, they they claim to believe that they can win this out. I can tell you that they can't, but if we want were the medicate expansion debate right Congress and the Obama administration tried to do something to basically force stay, to expand. Medicaid ends. One unexpectedly, six three Supreme Court majority ruled that that was a kind of illicit common during of state authority. What one is talking about doing here is much more. It seems to me much more across that lie she's, saying because my federal programme makes your state Medicaid programme and your eye, you, no other state healthcare programmes, unnecessary, I am going to make you pay into the federal fund to support that broken, in general. We don't do things that way you can.
have maintenance of effort as a requirement to receive federal grants, but these are not optional federal grants, and one consequence of this is that blue states that have more generous Medicaid programmes are sort of gonna be disadvantaged in the future visa, be bred states she's, not a political one jens there's a lot of constitutional questions. Somebody put it the other way. If you imagine this past right now, you sort of kick the hot potato. John Roberts right, you have several ability clause, so Roberts can blow a six trillion dollar hall and the deficit. If you HANS do, but the plane is already passed and inserted does matter. Anyway. That's trillions of dollars, in that state recapture wedge, I'm not sure legally, you can do then the other thing she does She wants to say and she's going to direct We and literally capture the trillions of
dollars that employers spend on their employees healthcare that, like you, will just go and tally up. How much do you spend per employee and healthcare, and then you have to give ninety eight percent of that to the federal government. It doesn't pay for the whole thing by any means, but it's the kind of all the concept that makes the costs go down for everyone, except billion where's our very rich people work. it is to say not that she's not replace it. Employer insurance contributions with a new tax. That's levelled in a sort of equitable basis. It is just literally the money goes into the federal government and that delivers on that in point tried because it's ninety eight percent is a guarantee that every employers, healthcare costs, go down, that every sort of middle class worker and including low income people, my beyond Medicaid or veterans, were vs benefits like everybody just wind up with a better deal as a result of this includes a lot of I'd like horizontal equity question
because, right now, if your employer is very generous right, that's a cost to the employer and they probably on at eight may result in lower salaries, but the upside is that they get to tell you right when they're trying to hire people like hey. We have this really good health insurance programme. Under the new plan, everybody's health insurance programme will be just as good, but some. Lawyers, are paying much much more for an inch isn't really make. It is We make sense conceptually, but it deliver Those are the promises and it shows the tension between actually like a common sense description which is like we're gonna, give everybody a better deal on their health insurance and actually requires you to create a system, is very complicated and back end verses, a simpler system like every employers, gonna pay, whatever tax is like easy describe and sort of makes sense, but calculating how they would impact any given. Person is very complicated. This is kind of wit
one of the things where the warrant team has acknowledged that as detailed as this plan. As there are more details, they still need to fill in lake. They have said that there is to be some kind of princes in plan that they're going to put out which, probably, would address the fact that you don't want a situation where, five years after you pass Medicare for all employees a is still paying a ton more to the government than employer B for the exact same stuff, but This does kind of get it some of the matter. Questions of for his detailed ape as this is- and it is, you know It'S- it's answering a court. In debt, Bernie Sanders, and many in the Democratic Party, don't even think it appropriate to be discussing at this point its due, a lot of fairly detailed math. It still doesn't getting the level of granularity that would be required to actually figure out how it would work and yet its committing policy in all sorts of ways they make it in arguably both less flexible in a legislative context, and me
maybe depending on who you ask less viable politically said. There's its. To bear in mind that there is kind of both a discussion about what exactly is in here and are they good ideas are not in the discussion about? Was it a good idea to put this out and would be a good idea to kind of continue to build out this proposal, threat primary to answer the questions that are raised by the proposal itself, so I think we should probably take a break, and then I want to get back to the brief discussion we had earlier about just kind of some of the intricacies of this plan. We live with a lot of noise between pings, the dings, the emails labelled urgent. That aren't really that urgent, it's hard to cut through the static zero. When, on the things that really matter just like, we can train our bodies to be better running faster lifting heavier. We could train our minds to stay focused to all the noise. We live with step. One download head space, it's races and have loaded with guiding meditations designed to offer a daily dose of mindfulness concessions for every situation like three minute S, away
meditation when you're overwhelmed by the day and even meditations, you could do it. You, kids, when you're all of run by the day had space has been like a really cool To have during these sort of difficult pandemic in quarantine kind of times has been hard, sometimes till I get a little time for yourself a little space for yourself- and this is, a great way to create some. Just like a little like isolation around myself do something that is cool that helps get me a little more grounded will more centred a little more ready to face the rest of the day, so it is truly a cut above other meditation haps because it relies on clinically validated researched help. You feel better, improve sleep, boost, focus, reduce stress, you deserved, feel happier and had spaces. Meditation me simple, good, ahead: space, dot com, slash weeds for a free one month. Try this heads based outcome: slash weeds for free month with access to head spaces, full library meditations, for every situation. This is the best deal offered right now had to head space tat Complex needs today.
Feels like you, don't even have hours in the day to get everything done. He might because you're missing out on three of them were those two hours cup. I we fell into a deep, dark abyss that opens up when we switch between workers at those we hours to all the productive time we miss out on thanks to at home distractions, disorganization fatigue. It's no wonder the days future work should work with clear up. It does look up as a flexible productivity platform, the wings or you work at one place. That's all you chats apps docks and ass. One centralized place like Michigan from companies like goober. Google use click up to make the days more, managed projects, people and goals more effectively, but for teams of all sizes industries cook up to pleasingly fast feature. one thousand plus integrations- must have for anyone wanting to track, manage and tackle their work in one place. You're always back with clear up trade free today took up the dot com, slash weeds, something
that. I think all of us have points express frustration about during the course of this primary is that it seems to have been taken for Greece, did by not just candidates, but I think especially debate moderators. That healthcare is going to be the legislative priority of the next democratic president and so the literally the reason that this proposal exists because debate after debate after debate featured really detail lines of questioning on what does your healthcare plan look like so the warring camp is both spawning to this an doing something that kind of makes it clear that they couldn't actually do healthcare first because they're assuming that they pass to major major major pieces of legislation, tax reform and comprehensive immigration or form either as the same bill with healthcare reform, which both I'm sure runs into a lot of constitutional problems in mind blowing in terms of the vote, counting you would have to do or that they would past three freely
piece of legislation in presumably a single congress, and it's not a realistic assumption way back early The primary Kamel a Harris said something really honest. You only get in a wonder maybe two big belts, a congress, and so it's really ingenuous to make big promises that rely on getting stuff through Congress V warring care. peers to be assuming that they can pass three big bills in the same congress or, alternatively, there end of admitting that healthcare wouldn't be their first legislative priority? It's a very, very beard thing them to be assuming, and I think we should talk more about kind of the political class in addition to the literal capital that this plan would take. Why wouldn't say admitted right
why has actually, I think been one of the clearest of the candidates are. Obviously all the candidates are not like super clear about issue prioritization, because it's not in our interests to tell anyone that like they need to go second, but wine has been. I think, one of the clearest candidates about the fact that, like her central concern, is passing her vision of like anti corruption, legislation where did like she really disease american politics through the lens of the administrative state, regulation and the issues that she has worked on all of her life and that she ate like will put a lot of emphasis on the staffing of the regulatory agencies, but they then legible, if we like she, is very concerned about corruption, because corruption in the political process leeches into those in industry of questions that then secondarily too, that she's interested in questions of political power right, and so that goes to the
regional. Like that wealth tax idea, it goes to labour law reform right and she, because of her plans, stick she was never able to say like look the reason, I'm not doing. A detailed healthcare plan is that I have made it pretty clear Like I don't know, I I mean it's it's gotten hard to say this in the age but like this is actually where I am like, I believe in Principle Medicare for aught, like. I think that that is a good idea, but I dont think that it would be a good idea to go. Do it in twenty twenty one right, like I think, there's other fish to fry and that there are sort of small ways you can make the healthcare system better, and I ve always felt like that's. What warrant has been saying about this she's no committed herself to this plan? We're like yes, I mean, if you take it like a epidemic. traits that a plan can be written and that like, if the political obstacles, all fall away. You know so much the better, but like everything that
he has ever said about healthcare policy. It seems to me it s like big blaring signs that like this is an actual gonna happen. Guys right like this is a the goal document. It shows that mathematically you can give everybody this help air without raising taxes on the middle class. But none of that is to say that, like she will and Man since it like she's gonna, like darkly, betray anybody, but like this is done. The political system works right. There's not going to be a comprehensive ethics reform, a brand new wealth tax, a comprehensive immigration reform, and then we come back and do this like. care bill in August like this is no no way right leg, so you can kick the tyres on this and see something like the numbers add up but like if we don't get your hopes up but, like I said, don't worry too much about
It's your theory of the cases that she put out this very detailed document, so the people stop asking her about it essentially yet so in a sense, it is kind of a it at a finger it actually happen, but it is, as you say, a political document kind of a symbolic look. I did it. I said that this is what we would do if we had the ability to do it, because, as our colleague as recline, he wrote a peace. That was basically saying that the question is not what Medicare for all looks like it. What can pass and what's pass in the actual you're, not in the hypothetical we get. Everyone on board, we launch a people's revolution and we get this done, but what can actually pass and actual Congress with actual people who are elected to actual Congress to Kennedy had earlier gotten themselves into. One of these like raised a hand things because they had all been talking about their different healthcare ideas and they were saying what would you provided by governments subsidize health insurance to undocumented immigrants, and they all
committed themselves to doing, and that's an idea that poles very, very, very, very, very poorly I'm also undocumented immigrants, of course, cannot vote. So it's not like an obvious kind of winter the in summing Obama, had not said he would do. Nobody gave like really detailed explanations of what that meant right, and so one thing that you see coming through from this page is Warren. Moving towards a more politically palatable answer to that question. Which is that which also like makes more sense, would like there's no on that debate stage who believes There should be eleven million undocumented, yes, but just to say that the solution to the healthcare problems of the long settled undocumented population is to give them legal status and a path to citizenship, right and so Actually that's the significance of this, not like her This is so unrealistic. She's coming on the four hundred billion dollars, biggest four hundred billion is round
error in the conduct of this fifty seven trillion dollar healthcare plan, like totally minor modeling errors, are gonna completely swamp, that four hundred billion what's important is that she committed to giving insurance to everybody right which he is saying Here- is that the logical sequence of how that happens is that people going to have their status regular ized. and then they're gonna get insurance the same way. Everybody else does, rather than that, it's gonna be the hop across offence, and now you get a free doctors visit right. Any It's a lot more sense right as a as a logical privatisation of the efforts, because nobody has ever said that, like Medicare for all new the cover, just like random people who live in Bolivia right like it's a programme for America
but you can't exclude millions of people who are living here and are settled in the country, but the reasons progressives dont want to exclude those people are just the same reasons that they want to give them legal status that they want that did the day. This is in an immigration policy question right, not really health policy question. Let me thank the other reason that its useful to understand that conference of immigration from is basically a footnote in this plan is that it can be a footnote contacts of a democratic primary, no Democrat running for the presidency is saying we shouldn't legalised these people. Basically, all of them appear too find onto the exact same immigration or form framework that everybody signed off on and in twenty. Sixteen that everybody Democrats got on board with in the first half of this decade. The problem, of course, is not only is that our democratic votes not sufficient to pass something, but that, like, as we learned into thirteen when one side of the island so bought into this is the framework by
which we can make this happen legislatively it doesn't allow for a ton of the kind of horse trading that often is required typical marginal members Congress and get a bill to pass, and so that kind of over big DNS, while it's definitely gonna, be problem for comprehensive immigration or form the next time, it comes up also think, is something that it would be good to think about in the context of democratic primary candy putting together these very detailed plans when President's dont really legislation and often Legislation has to changed substantially between when its introduced and when it passes in order to gather about scanned, I mean so much realistically right, I mean more than I think any other issue. The fate of immigration policy in a twenty twenty one Congress is gonna hinge, both unlike what actually happens,
twenty twenty election, but also on the very easy question of like what happens in the in the land of takes. I would say that right now, they predominant view of Trump is that he is broadly unpopular, but his political standing as me. held up by over performing in key midwestern swing, states that are very low, latino populations and very large numbers of non college. Whites were sceptical of immigration as long as that The sort of dominant narrative that, like tat immigration, politics help lift him up among his ordinary baseline. It just really hard to see anything getting done on immigration policy, absent like crushing blow outbreak it is very important to remember that as much as immigration. Politics are events driven the window, comprehensive immigration or form opened with the twenty twelve election, and that takes coming out of that and closed with the primary.
Of air candour, undertakes coming out of massive twenty twelve election, led to these completely opposite, takes in which immigration anti immigration. Politics had doomed Republicans in Nevada and Colorado and pass Grand Junior, which led to the famous GNP autopsy document, which is premature. We have to do this and you get to the gang of eight. Well here we are now it's it's fascinating. How takes power? This appointment argument appears be someday. We I want to assemble a panel of people who did twenty twelve election takes, and we can all. We cannot go back over what the hell we were. Thinking exactly It was always been obvious. There is not a ton of latina voters in Ohio and we knew was an important swing state in TWAIN twelve, but there was a mass insanity, so I did thing about mourns plan that I think will get to you know if, if you really want to take it seriously from our Awashanks prospect,
Dave is just like. This is not how social insurance works internationally. Right weather think the math adds up where the six percent wealth tax on billionaires or or whatever, that you Social Security Classic Medicare foreign welfare states there financed, usually by the broad based taxes by value added taxes and by payroll taxes and the reason for that right am I mean that their revenue based reasons for it, but I would see if you think about a conceptual right, the eye, dear of social security. Is that it's just it's a smart idea for society to collective eyes, the risk of outliving, your retirement savings for healthcare right it's a smart idea for society to collective eyes, health risks and primarily to redistribute from healthy, too sick right rather from rich, too poor, and that's why it's a health
system right and in value added tax payroll taxes- they are mildly redistributive, but, like the point of the Universal Health insurance system, is to make sure that sick people are getting care and everybody's paying into it. If you just want to live the playing field between rich and poor, which is not like a crazy thing to do. But the most natural thing to do is to take rich people's money and then give money to be right right, rather than take which people's money and give health insurance to people our wines plan and endemic democratic party thinking in general, which you now see everything right. It's what we want to give subsidized childcare and we're going to do it by closing corporate tax loopholes, sway Do something odd about the narrow logic of like every a needs a z to exactly offset it, but then, particularly in those terms with like every new programme needs a redistributive pay for and its because, like public opinion,
is very friendly to taxing the rich and very hostile to taxing the middle class, but like the difference between a generous welfare state and stingy, one, normally is actually like societies, belief in the value of public services versus private consumption right and then a conceptually separate question is like the levelling of income gaps across the playing field and basically all Democrats tend to like squash these two things together, Warren just squashes them together like a lot because sheet, because she has so many plans and because her plans are so ambitious, but there's actually something a little bit weird about it. this underlines plan if inequality went away right. If some of the other thing she wants to do like strengthening labour unions and regulating the financial sector better right at an anti trust. If all this stuff worked and we had a much more egalitarian society, then her
care system wouldn't work, because it's all based on taxing the like excess wealth of a small minority of people, we're talking ever with about kind of unquestioned assumptions among democratic already insiders about what is innocent politically palatable in. I think that one of those is they ve really into like the idea of the submerged state right that benefits, preferably universal benefits, but certainly benefits that aren't obviously redistributive are going to be more politically palatable, then over redistribution, and that does lead to make some big policy problems as he raised, but in a The extent to which this is even this you meant was really poses its as policy driving politics and we're going to take on a massive massive fight with very entrenched healthcare industries- and you know the very fight that Obama administration avoided in passing the Asia and we're going to win because we're right it isn't
certain respects what kind of one level below that of politics driving policy document. But I think that there is. I want to dig in a little more on what you mentioned. in passing, which is the the assumption that, for every a you have to have an often lost z, because that gets into you know, obviously, reason that this proposal was put out there to begin with, but also I think some of the critiques you know both from Warren's laughed and ten I'm her defenders in sucked, in talking about responses to the plan that I think it's worth kind of area. On the one hand, I mean is the little silly to be like, while we can just have a multi trillion dollars. and with no taxes, a you know what I have sometimes said on twitter to troll, but you know it is true, if you think about it right, one point all here, and why is that, like this money? he's getting spent one where the other and a lot of it is being spent by state local governments, and even if you can't do this like for Malta
where the federal government seizes the money. If seen, local ones were relieved of that spending obligation like they would probably to reduce taxes, because it's like the biggest line on their budget right and if employers were relieved of the obligation to provide health insurance to people, they would spend more money on wages and salaries thread and again, to be clear, not me, though, like super nice guys and like hey, everyone gets a fifteen percent raise, but because, if you just have way more cash on your balance sheet right if its weight cheaper to hire people you're going to add employees? If you have demand for your customers, you know that many will get spent right. It doesn't just pile up like Scrooge Macduff style and health insurance subsidies are on not taxable under the current system, but anything else. Businesses could spend the money on whether they give people raise is whether the higher more workers, even if they just pay up more dividends to which people? That's all taxable ride so like that revenue would would come into play. People would have more money
would buy stuff, and that generates economic activity right and it. like you, would all work itself out to me right, you might you'd prob, to change them taxes somewhere down line, but like it's ok, the problem is actually in the health care system right, which is like There are a lot of kind of assertions here, about utilization and and and this kind of thing, but like there's, no, an army of unemployed doctors right who can just like mobilize to go, provide these extra healthcare services. Nor is it true that there is an intellect stay in the number of twenty two year old who decide to take em can go to med school right. I mean there's. Actually a blue formal cap on that and rural hospitals are tending to clothes, and then you know they each other kind of endeavour, was sad stories about. Why they're doing that, but think the basic thing is that you can't like make medical professionals want to live
in small towns and be non specialised, relatively low income practitioners, it makes more sense for them to move to. The suburbs of big city is work narrow. Specialty is, unlike that does in you, people lot of ideas about a change that including some in in warrants plan, but it's like when you run healthcare system. It's a gift address. These topics like the facilities have to be somewhere and more so than the like. How do you pay for it? It's the like. What do you actually do? That's like that, the challenge Question about running healthcare system, the virtue international, like libertarian sense ride, did like that. The virtue of a more marketing system is that you need to decide in a centralized debate
this right, like how many MRI machines go to boys, but, like you do, if the government is gonna, be controlling all of the payments, or at least it would be irresponsible, just assume it's gonna work itself out because even currently doesn't seem to be working itself out- all that. Well, it's going to work out worse. If you guarantee people that they will be able to find customers physically wherever they go right, they're going to cluster in like places where they want to go, not in places where patients need care also, I think, be kind of broader question of what does it mean to I acknowledge that something needs to be paid for right, belike, the it's less that they have different healthcare proposals at this point than that war and his kind of a ceded to a demand that Bernie receipts refuses to recede too, because the bringing the burning camps take is this is not a conversation that is suited to oppress until primary. This is not something that the government needs to feel obligated to do you shouldn't to assume that there is going to be an asset for everything, but the law- and there is also
the kind of broader democratic base. Reaction to discussions like, though, you. Ve been having that pointed the holes in this plan that you know in some of the assumptions which, in its kind of bees this sense can be expressed as well. The media didn't say anything one trumps at Metzger pay for the wall, which is rather like all of us, like when the trouble illustration literally put out a white paper about paying for the wall. I wrote something about it and I think three other people too there's. No one else took it seriously, because no one else thought that let's go. Paying for the wall was a serious proposal so and Mexico is in fact not painting of fun fact it can. I think you reflect underlying conviction among some democratic voters that, because Democrats are currently much more concerned with the details of governance, then Republican seem to be at least and in public discourse that Democrats end up being the victim
of a double standard where the media is allowing Republicans to slide, which may or may not be true, but there are also is. legitimate question of several months out from the first primary almost a year out from exactly you're out from election day easy appropriate to do and that a candidate have all of the fund up answers to the things that they want the republic to do, because I am, I think that the answer to that, though, is like it's probably not fair to demand it, but it is being demanded of specifically it was both Warren biggest pick that you're? The difference here between worn and sanders? Is that you they both understand how legislation works. They both serve in the Senate, but I think that
with one. She believes innocence of kind of a real mobile in an effort to Ezra Basic resented, it's kind of a more populous strategy, whereas that Sanders pretty much thinks that, like you, Americans will support european style taxes and retire or turn for a european style. Social welfare state and Democrats just have to make the argument and not be afraid to do so, and so it's interesting because here you kind of sea the more centrist row. avoid candidates like PETE Boat, a judge saying like the math, is controversial on warrants plan, but I think that there is something to be said about the fact that, on that doing the math at all or the Democrats are doing the math at all and that there is kind of an understanding that the math is necessary, that the likelihood of this happening as necessary that, that I think Democrats rely on not just the idea of possibility, but on lightning could this work.
Could we actually do it because you? I think that there is something to be said, and there is an entire podcasting be done about how the media players into this, because you saw a lot of responses from conservative sing like saying Mexico would pay for the one made more sense than this plant, or am I know it didn't, but if you treat them, but you, I think the only way that that makes even remote sense is that if you treat paint Mexico paying for the world, as this involved metaphor for curtailing both undocumented immigration and illegal immigration, but not all, a wall which is actually not what treatment at all Democrats are really focused, or some Democrats, specifically the ones were running, are really focused on likelihood, whereas the democratic base is focused on stability. Ok, I let's, let's take a second break and then not do a white paper and an end to this you, like. Basically anyone listening to this right now, I'm willing to bet that you are you're dealing with stress, maybe there's a
of it like an overwhelming amount, or maybe it's more like a low but steady, drumbeat background stress, remember how you are experiencing stress. It's likely fucking mood you energy in so many other areas of your life, you feel like stress, is starting to take over stranger relationships and shorten your temper probably tend to unload and better help is perfect, for that better help is customized online therapy that offers videophone even live chat sessions with your therapists should hope to see anyone on camera. If you don't want you it's much more affordable than in person therapy and you could start communicating with a therapist none forty eight hours I'm a distressing, its unbiased feedback. You be pretty surprise when you can gain for it see if it's for you, the weeds, sponsored by better help and listeners, get ten percent off the first month, better help dot com such weeds, that's, b, e t, T, R, HD, LP, dot, com, slash weeds. This episode is brought to you by fan: do football is back and the best bet you can make
is downloading the fan Dual Sports Bookshop. It doesn't matter if new to gambling or an old pro fan. Dual has something for everyone and as an official, sports betting partner of the NFL. You know your bats are safe, there's also never been a better time to use. Fan do because right now you'll, get up to one thousand dollars back if your first, but doesn't when you can turn a small wager into a big payday with the same game, parlay that just sign up with a promo code, Spotify Place, your first bat risk free on fan, dual sports book down fan dual today. Twenty one plus and present in Pennsylvania. First online, real money wager only refund you'd as non withdrawal side. Credit that expires in fourteen days. Restrictions apply, see terms at sports booked out, fan. Dual dotcom gambling problem call one eight hundred gambler.
Apologies. There is no white paper this week. However, I will put in show notes the urban institutes paper on how much they think a bunch of different health reform options will take that sort of been. In the background of this conversation, if you, if you enjoy papers that that's how good you know, the asymmetry rate at which I think a lot of liberals perceive acutely- and I think is real and it is important to understand that it doesn't come from the media. It actually comes from the internal dynamics of the party you write sit like a very reasonable suspicion that a person might have had about Donald Trump, is that he was not in fact, to deliver on some of his policy commitments right, the reason that one should be skeptical of that is that they were so poorly worked out right
I mean there are many reasons to be sceptical, but I mean like a if you heard there was a poorly worked out and that he on occasion appeared to have at best glancing knowledge and understanding of citizens and give somebody came to me and they were like. I really one over Donald Trump and I was a girl. Why, and they were Well, because I am against it sure, but also I really want a universal health care system and Trump has said we're going to cover every body and the governor. I do it I would have said to you. I think you should have a lot of scepticism of then claim and like one thing I would point to is that he had never released a plan. That would do anything like that right, but Republicans it's on the media right. It's republican stakeholders themselves. we're not raising those kinds of questions about this right. Whereas Democrat That's are operating into an environment where, because for a whole bunch of reasons but like
your constituency is have a lot of questions for the candidates about what they're really going to do, and so they, I don't really think that releasing this plan in this way does make it more likely that Warren will deliver on these healthcare commitments. But that's where it comes from right is a sense that they would not trust. If somebody just got up, there was like I'm going to make things way better for people of color in America and then had no expert vision of what TAT meant or how they were going to do that. Voters reaction to that would be very negative. Fright descended the meat. he would be able. What do you mean? What's your plan, for that is that the voters themselves would not react well to like a white person coming up on state, and making a totally non substantive commitment about that stuff. Right there were questions. Bernie can get away with less detail on Medicare for all, because he is known, as the guy has been talking about this for decades and decades, and the people who like Bernie Sanders, have no doubt
that he is really committed to pursuing single pair healthcare. Wine is trying to establish her bona fides right, but by doing this kind of stuff and like that's what Democrats are about and there costs and benefits to having that kind of approach to things There are real benefits to like your base being willing to let you get away with a lot like slipshod stuff about, like it's worth, saying that, like Trump, does not deliver like, including on the wall. Right, isn't that, like Mexico is paying for the wall, but like he kept saying that, like we had to A solid barrier right and like he hasn't built a barrier, because the solid barrier idea didn't make sense and they put themselves to promising in a five hundred miles of new financing and like the last year of his first term, because they really really want to have that for the election. But they haven't on whole lot in the first three years. They think it's also worth pointing out the lake Republicans who failed to take the problem of Trump, not
having any policy commitments seriously has in fact resulted in some problems for republican members of Congress right. There is a big New York Times package over the weekend on trumps use of twitter and the more interesting things was just buried, and there is a quote that from has told, where's of Congress. Not You believe what his office of Legislative Affairs says about what bills he will support until you see from him endorsing it, which really undermines the offers of legislative affairs ability to negotiate with members of Congress and has, in fact, resulted in. You know, trumps kind of will here. won't. He stick under hiding you know, efforts to repeal Obama CARE, for example. Twenty seventeen, so it's not We, like Republicans, are good. no way with everything by not holding helps to a higher standard, but I do think that there is, in addition to consider accountability a little of democratic self conception at play here, which is, as I said a few weeks ago. The Democrats establishment Democrats are
really bought in right now on being the party of Order Muppets and that they are the ones who care enough about the federal government to run it competently, and that means that sometimes have to make hard decisions and compromises, because it's better to do than to just like let the whole thing burned down and that is not something that can be one hundred percent reduced to a response to constituents. That, I think, is a party elite mindset that Bernie Sanders just doesn't have doesnt by into the idea that Democrats have to be willing do whatever it takes to see a bishop of state even at the expense of ideological principle. I mean it. It's it's funny, because I think that it must be at your hearing this from a kind of rank and file Democrats record of the democratic base that they are tired of order muppets. They would much rather
interpret the experience of attempting to put a cat into a carrier than be an order. Muppet you, the idea that in response to trap and how one of the challenges and I've talked about this, a lot is that when Trump said you trot was very effective, realizing that actually it's a really great idea, just say whatever anybody wants to hear and then not do any of it, but it turned out that you'll win said things like we're: gonna have health care for everybody. It's not mean anything by that everybody just recognised and people heard their imagination that he was both the most pro life president or the most pro eligibility president also was goin to care to guarantee health care for everyone and the devil. Rats who I think I feel as if well, and that we need to prove that we're not like that that we can actually do all of this stuff, I think, is challenging because you are attempting to play chess with azure, it's not work. You're, not gonna, get anywhere like it's, not your there is it.
To be. I yes! Well, I will respond to this with my own plan. I talked a little bit last year and that college talking about how you oh bomber care, repeal which you a lot of people. A lot of Republicans were like this is what we're going to do, because we ve got trumpet office. We ve got all the power. Do not turn that truck. Wasn't really that interested. doing it, and so I think it's challenging, and it actually is one of those moments right thick personally, I think that Sanders is idea of just being like. No, I don't have to explain how this is going to be paid for, because one that I've been talking about this issue for more than forty years and two were dealing with a president who, basically just billet, guess sure taxes fine, whatever. I think it's really challenging when you have this internal debate within one party that is very much like Army the Party of order, or are we the party, a party of fuck? These people need to be
His order, and, in fact, is the one thing that war and has in common with Barack Obama and Bill Clinton Wade, is that all three of them were like law school professors before they politicians are in some senses concurrently and that's like a one mentality right like they're, very into like, like law, some like what they say and the whole way law works. Is that like little words make a big difference right and it's not about big ideas and, and things have to be consistent, and so, even though they have very different ideological principles and and warns ideological principles. I think our lot closer to Bernie Sanders is right. Then, like Bernie, psych. I don't know he's like he's like a guy right, he's out he's a political activist really who became a politician and an didn't go to law school Right Am Yenoki has just. I got more a looser, moralistic way of talking about most kinds of star afraid in anything
It's a different kind of rhetorical scheme, but the other thing that I think we're to me like plans, ism falls down for all of these candidates is But what is the constitutional role of the president of the United States and the president's plays a very important role in the legislative process to important strike, but its agenda setting and it's a negative veto, and one thing you never hear the Kindle talking about is like what would you not do right? So like when you, when you hear you know. Joe Biden has a kind of discourse of bringing things back to normal and his good relationships with Senate Republicans and inviolable and progressives offer a lot of scepticism that, like having a beer with much Mcconnell, is really getting get. Things done, and I think that's all completely true. What is not as evident air is that view was by partisan legislation that happened when Obama was president,
also bipartisan legislation that didn't happen when Obama was president sometime because Senate Republicans were obstructionists, but summers because the White House scuttled thing swayed. There were Democrats who wanted to do a deal that would allow companies to take their offshore cash back to the? U S at a very discount tax rate and then call that a pay for that would finance and infrastructure programme and the White House scuttled that idea right. A different light could have not scandal, and you don't you look at it right at the time I cited with Obama. I thought like this, is a bad idea. This repatriation gimmick we shouldn't given to it. If you look at the concept this is of Obama not doing it. It's that Trump wound up doing that patriotism, gimmick and instead of using it to pay for immigration, used to pay for more tax cuts, which I think in retrospect makes it look like. Well. Probably Democrats should have done that deal right, but that kind of judgment
like what will you give in to? It is actually a big part of being president is about an It's not on the agenda here at all where's like what we demand. Congress do, like that's, doesn't happen like at all, like. No, no president achieves that when they try to me. You saw this Trump with the wall sat down milk. Everyone always fails when their effort to get things done is essay like I'm not can allow the. Basic operation of the government, unless I get my way on this president's have a lot of ways to get things done, but like that way does not work. and no one is saying: they're gonna. Do it exactly I'm, so I would always be more interested in these questions of. Like is anybody up there saying I will Scott all an incremental healthcare reform idea, because I think it's important to keep working toward utopian Medicare for our vision. I dont think based on their records. that either Warren or Sanders would do that, but it would be in
lasting peace, a train to stay out if somebody would but like Bernie for I see I warn you know to say there are many paths forward on this, and also to me, like this whole debate is a low frustratingly fake yeah. I mean it that there is in this very odd sentiment to express on the weeds, but I think there is an argument to be made that so far the twenty twenty democratic primer has been overly focused on policy, and I mean that, unlike there needs to be more talk of narrative and vision and how to be Trump, and all of that I mean what does it mean to be an American? I mean that in the sense that the more that presidential primaries becomes calls for proposing pieces of legislation? The more you run into a the over baking problem that might make it harder to be flexible. passing legislation in future. But be we don't see France is between candidates in where are they be willing to draw lines visa V Congress and in order to get back on the hobbyhorse that matters, I have both Spencer
a month on, you know, you don't hear what they would do with the executive branch, and those kinds of things that are regardless of who is in Congress, things that are that the president is going to the ability to do maybe have gotten short shrift because of these questions that, ultimately, any president is going to to leave a little bit of leeway for Congress. It is you can have it. We ve leeway for Congress, who said also want something as big as this rightly. These cost estimates are like somebody else. Does the right like It's good, I'm guessing constructive for warning to say what she thinks you could do. Policy wise, but like one thing that some people working in Congress, I pointed out to me- is that like, if you were to try to about right, you'd see everybody was bought. It say, there's like fifty five senators. Well, I guess in principle I want to do Medicare for all now. How do we do it? They would need to start putting forward ideas like warns ideas, for
how do you control costs and then they would need to submit those ideas to the congressional Budget Office and hear back C B, o like what does C b, o think of those ideas, and then, if we see beheld, thinks isn't what the authors think they then need to decide what their next step swayed. Do they chain their ideas. Do they tell the symbiotic, go fuck itself fright like it's a real choice, but it's just difficult to predict in advance, right and like this is writing the SBA writing any big, complicated piece of legislation involves auditors, ping pong where you have to consult back with your colleagues to consult back with the experts. You have to look at the media reaction to different things that are going on. This is also why you can't past three major bills and Congress for you. I I mean there's a logistical difficulties, but it's also just like you can say like ex Ante. Exactly how are you gonna set hospital payment rates
because it's not essentially, is not up to the president unilaterally. It is not up to any body unilaterally like it's an inherently collective process in which you need to live, see what's up an enemy, and I guess that an unsatisfying answered to deliver on a debate stage. But I mean to me it's not that there's like too much focus on policy exactly, but I guess kind of the foot policy is a little Faye gets like it's not reflective of how policy making happen straight in a real kind of way, and I think, with some of these candidates, you can c in the shadows like what it is there actually talking about and what their thinking again for wine I mean, I feel, that she's saying like she is not going to put a super a priority on health reform. Did she both doesn't believe in these For mental solutions, and also
see a short term path to a huge change, so she's gonna work on some other topics, theirs a valid and sir to me, but again is not like four Lee what's being said about any of this, so what makes it a little hard to now? In conclusion, let Matt moderator presidential debate, you cowards. Ah, yes, wherever and she come on the weeds, I think I'll I'll candidates always welcome, always always very, very, very welcome. So, ok, so thanks guys thanks, Jane Dara things, as always to our sponsors. Thanks are deaf editor for engineering, this episode and to Jackson, beer found for producing an editing and the weeds will be back on Friday, accessible, affordable broadband helps community. Reach toward their american dream for students, lectures on a Chavez means rising above the poverty line and becoming valedictorian of international high school at Langley Park, and thanks to access from eighteen t, it can help these
dreams turning turn into reality. That's my eighteen to use, two billion dollar three year, commitment to help close the digital divide to more Americans, have a chance to succeed, to learn more, http dot com, slash connecting communities.
Transcript generated on 2021-09-10.