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

AILSA CHANG, HOST:

Elizabeth Warren today answered some big questions about how she would implement "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, BYLINE: 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 sweeping program this would be - a total overhaul.

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 coverage, 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 contention, 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 touting 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 premiums.

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 detailed plan from a woman who is known for detailed plans.

CHANG: Sure.

KURTZLEBEN: So yeah, the numbers add up. But the assumptions underlying 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 accurately? How easy would it be to evade? Now those are real questions that will continue. And almost to preempt 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 defense 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.

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