Ending the Stranglehold of Health Care Costs on American Families

  • 24 million people won’t have coverage, and millions can’t get long-term care.
  • 63 million have coverage gaps or substandard coverage that could break down if they actually get sick. And millions who have health insurance will end up going broke at least in part from medical costs anyway.
  • Together, the American people will pay $11 trillion of that bill themselves in the form of premiums, deductibles, copays, out-of-network, and other expensive medical equipment and care they pay for out-of-pocket — all while America’s wealthiest individuals and biggest companies pay far less in taxes than in other major countries.
  • Every person in America — all 331 million people — will have full health coverage, and coverage for long-term care.
  • Everybody gets the doctors and the treatments they need, when they need them. No more restrictive provider networks, no more insurance companies denying coverage for prescribed treatments, and no more going broke over medical bills.
  • The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people. And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases.

The Cost of Medicare for All

A serious conversation about how to pay for Medicare for All requires, first, determining how much such a system would cost.

  • Existing federal spending on Medicare and Medicaid will help fund Medicare for All.
  • Existing state spending on health insurance will continue in the form of payments to Medicare — but states would be better off because they’d have more long-term predictability, and they’d pay less over time because these costs will grow more slowly than they do today.
  • Existing total private sector employer contributions to health insurance will continue in the form of contributions to Medicare — but employers would be better off because under the design of my plan, they’d pay less than they would have otherwise.
  • Employers would collectively save $200 billion over the next ten years.
  • Employers receive far more certainty about how their health care costs will vary over time and affect their finances.
  • Small businesses — who often suffer when competing for employees because they can’t afford to offer health care coverage — would no longer be at a competitive disadvantage against bigger businesses.
  • Employers can reduce their Employer Medicare Contribution by supporting unionization efforts and negotiating with workers to provide better wages and benefits — reducing costs and promoting collective bargaining at the same time.
  • Because my plan holds health care cost growth to GDP levels, businesses will have stable balance sheets that grow with the economy instead of crowding out other priorities.
  • Substantially increase funding for the IRS, including the Criminal Investigation Division. The Treasury Department estimated in its Fiscal Year 2017 budget request that every $1 invested in IRS enforcement brings in nearly $6 in additional revenue — not even including an indirect deterrence effect three times that amount.
  • Expand third-party reporting and withholding requirements. Research shows that third-party reporting and withholding cuts down on the tax misreporting rate substantially.
  • Strengthen enforcement of the Foreign Account Tax Compliance Act (FATCA). FATCA requires foreign financial institutions to report the holdings and income of U.S. taxpayers, but the IRS is generally not systematically matching these reports to individual tax returns. We also don’t hold foreign financial firms truly accountable for ignoring their reporting obligations. Automatically matching FATCA reports to tax returns and instituting sanctions for non-compliant foreign financial institutions would help narrow the tax gap.
  • Simplify tax filing obligations in line with other comparable countries with lower tax gaps, including by adopting my Tax Filing Simplification Act and using “smart returns” to improve honest reporting.
  • Redirect enforcement resources away from low-income taxpayers towards high-income taxpayers.
  • Increase the nonfiler compliance program, strengthen reporting requirements for international income, use existing currency transaction reports to enforce cash income compliance, and increase reporting requirements for virtual- or crypto-currencies, as suggested by the Treasury Department’s Inspector General.
  • Allow employees who disclose tax evasion and abuse to use the protections of the False Claims Act and other whistleblower protections.

Achieving Medicare for All

Of course, moving to this kind of system will not be easy and will not happen overnight. This is why every serious proposal for Medicare for All contemplates a significant transition period.

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