美国国家公共电台 NPR Here's How Warren Finds $20.5 Trillion To Pay For 'Medicare For All'

 

AILSA CHANG, HOST:

Elizabeth Warren today answered some big questions about how she would implement¹ "Medicare for All" if she's elected president. Rivals and reporters have been pressing Warren for details on how she would fund a government-run health insurance program that covered every American. Well, NPR's Danielle Kurtzleben has been going through Warren's new plan and joins us now with the details.

Hey, Danielle.

DANIELLE KURTZLEBEN, BYLINE²: Hey, Alisa.

CHANG: All right, let's start with the big question here. How much does Warren say this plan would cost in total?

KURTZLEBEN: Fifty-two trillion dollars. That's a...

CHANG: A lot of money.

KURTZLEBEN: ..Lot. Yes, yes, over the span of 10 years. Now I want to be clear that is total. That is not all new funding. And we will get to the details on that in a minute here. Now she is saying $20.5 trillion, over 10 years again, would be in new federal funding, so new revenues the government has to bring in. To put some perspective around this, by one estimate, that would be a nearly 50% increase in federal revenues over the next 10 years.

CHANG: Wow.

KURTZLEBEN: Right. You say wow. And that's a lot of money. And it gets at just a sweeping³ program this would be - a total overhaul⁴.

CHANG: That said, the whole time, Warren's been stressing that middle-class families would pay less than they do now, that overall, the country would save on health care. How could that possibly happen given that there's this huge price tag?

KURTZLEBEN: Right. So let's go back to that initial number, that $52 trillion. That is an estimate from a think tank called the Urban Institute for how much money will be spent in the entire American health care system over the next 10 years - so employers, consumers on private coverage⁵, by the federal government, by state governments, everybody. Under Warren's plan, she thinks that cost would stay roughly the same while insuring everybody. So she says this is a bargain.

Now some of this, she says, is just money shifting around. For instance, employers are currently estimated to pay about $9 trillion over - toward health care over the next 10 years. Warren's plan says they would pay nearly all of that, instead of to private insurers, just to the government in the form of a tax. Now opponents are already coming out against this - Joe Biden, for example, saying this tax will just end up being passed on to middle-class workers. So this is going to be a point of contention⁶, I would bet.

CHANG: And even with that, that still leaves - what? - trillions more to fill in here, right? Warren's been confronted about this over and over, this question, will this raise middle-class taxes. How has she answered that?

KURTZLEBEN: So this plan says that there won't be any new taxes on middle-class Americans, rather she leans a lot on new taxes on people who have more than a billion dollars in wealth, so even higher wealth taxes than she has proposed in the past - in addition to that, new taxes on large corporations. Now, in fact, she's touting⁷ that many middle-class Americans will have more take-home pay because they won't be handing that money over in terms - in the form of premiums⁸.

CHANG: Right.

KURTZLEBEN: However, that additional take-home pay will now be taxable. So some revenue will come from some middle-class Americans.

CHANG: So does the math actually work out the way Warren is claiming it works out?

KURTZLEBEN: OK, so this is a detailed⁹ plan from a woman who is known for detailed plans.

CHANG: Sure.

KURTZLEBEN: So yeah, the numbers add up. But the assumptions underlying¹⁰ these numbers are the things that we are going to be picking apart, that experts will be for the coming weeks. For example, this plan would pay doctors what Medicare currently pays doctors. It would pay hospitals a little more than that. Now what's important here is that is far less than private insurers generally pay those places. So there is a big question as to how doctors and hospitals would weather this plan.

There are also questions about other taxes. Now since she introduced the idea of a wealth tax, there have been big questions about how do you enforce that. How do you assess a person's wealth accurately¹¹? How easy would it be to evade¹²? Now those are real questions that will continue. And almost to preempt¹³ that, she has said that tighter tax enforcement is going to be a big part of how she wants to bring in more revenues. One other thing here is just that this plan is very complex. It involves potentially immigration reform. It involves some cuts to defense¹⁴ spending. So there are a lot of assumptions here...

CHANG: Yeah.

KURTZLEBEN: ...A lot of moving parts.

CHANG: And how long would Warren allow for a transition to Medicare for All from what we have now?

KURTZLEBEN: That is a great question. This would be a huge transition. She has said her transition plan will be coming in the coming weeks. But that transition is really where some of these tough choices, some of the tough things could happen to get us to Medicare for All.

CHANG: That's NPR's Danielle Kurtzleben.

Thanks, Danielle.

KURTZLEBEN: Thank you.

(SOUNDBITE OF BONOBO'S "LINKED")

1 implement   

n.(pl.)工具，器具；vt.实行，实施，执行

参考例句：

• Don't undertake a project unless you can implement it.不要承担一项计划，除非你能完成这项计划。
• The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 sweeping   

adj.范围广大的，一扫无遗的

参考例句：

• The citizens voted for sweeping reforms.公民投票支持全面的改革。
• Can you hear the wind sweeping through the branches?你能听到风掠过树枝的声音吗？

4 overhaul   

v./n.大修，仔细检查

参考例句：

• Master Worker Wang is responsible for the overhaul of this grinder.王师傅主修这台磨床。
• It is generally appreciated that the rail network needs a complete overhaul.众所周知，铁路系统需要大检修。

5 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

6 contention   

n.争论，争辩，论战；论点，主张

参考例句：

• The pay increase is the key point of contention. 加薪是争论的焦点。
• The real bone of contention,as you know,is money.你知道，争论的真正焦点是钱的问题。

7 touting   

v.兜售( tout的现在分词 )；招揽；侦查；探听赛马情报

参考例句：

• He's been touting his novel around publishers for years. 他几年来一直到处找出版商兜售自己的小说。 来自《简明英汉词典》
• Technology industry leaders are touting cars as a hot area for growth. 科技产业领袖吹捧为增长热点地区的汽车。 来自互联网

8 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

9 detailed   

adj.详细的，详尽的，极注意细节的，完全的

参考例句：

• He had made a detailed study of the terrain.他对地形作了缜密的研究。
• A detailed list of our publications is available on request.我们的出版物有一份详细的目录备索。

10 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。

11 accurately   

adv.准确地，精确地

参考例句：

• It is hard to hit the ball accurately.准确地击中球很难。
• Now scientists can forecast the weather accurately.现在科学家们能准确地预报天气。

12 evade   

vt.逃避，回避；避开，躲避

参考例句：

• He tried to evade the embarrassing question.他企图回避这令人难堪的问题。
• You are in charge of the job.How could you evade the issue?你是负责人，你怎么能对这个问题不置可否？

13 preempt   

v.先发制人；先取

参考例句：

• We arrived early at the theatre so as to preempt the front seats.我们早早来到剧院，以便捷足先登占到前排座位。
• He pre-empted any decision to sack him.他预先阻止了所有解雇他的决定。

14 defense   

n.防御，保卫；[pl.]防务工事；辩护，答辩

参考例句：

• The accused has the right to defense.被告人有权获得辩护。
• The war has impacted the area with military and defense workers.战争使那个地区挤满了军队和防御工程人员。