In most cases you’d pay nothing more for this system than you’re already paying; you’d just be paying it in a different way.
While I’m sure your article is well researched and accurate, I simply have made it a priority to not waste time delving into the minutia of how any program is “paid for” at the federal level because no one has yet figured that out except for a handful of economists. Medicare4All would be paid for just as is any other federal spending. Congress would approve the legislation to instruct the Fed to fund the program and the Fed would then mark up the proper Treasury accounts with keystrokes on a computer, creating brand new money for every dime spent.
At that point, the program is “paid for”, end of story.
Are there other considerations that are important to such a large undertaking as this? Of course, but none of them are relevant to “paying for” it. Will it add to deficits? Hell yes, but that is not the evil we have been led to believe. In fact, deficit spending is required to maintain a balance of currency necessary to provide for economic growth, retire private sector debt, pay taxes or purchase bonds, and to supply a means of storing value from commerce and wages (savings). A “balanced” budget is another way of saying 100% tax rate.
The questions that will need to be addressed deal with a larger picture of our economy than simple numbers of spending and taxes. Will we have the required infrastructure and personnel in the right places? Will our education system be able to produce a higher level of skills needed, or will we be better off by allowing more procedures to be performed at lower skill levels, such as nurse practitioners? Most of these issues will be self-regulating within the industry, but we do need to be aware of them before we overload the system.
The one big issue to be concerned with, and will inevitably determine if a tax is needed at all, will be “How will we deal with somewhat over a million people potentially made unemployed in the insurance industry?” Just adding to the misery index should not be an acceptable outcome of the program and may present fiscal demands that require more money to be left in the private sector to create economic stimulus even above that of people no longer paying premiums.
Sure, the stimulus of no premiums weighing down the economy without productive benefits will be considerable, but we shouldn’t discount the potential need of that many unemployed people and we owe them more than the present safety net affords. If the deficit hawks rule the day we could see deflationary pressure far beyond what we’ve already experienced with decades of forced austerity to service a mostly meaningless number. I know several very qualified macro-economists who claim that a tax “CUT”, or some dedicated additional spending may be required.
We have been shooting ourselves in the foot with our needless obsession with deficits and debt as if the US government, the monopoly issuer of the currency, functioned like our household budget process for so long that the first inclination when advocating for spending is to go shake some dollar trees, rich people and business, to see what we can “afford”. This is literally killing our economy and has caused immense misery that shouldn’t go along with the wealthiest nation in world history. A program designed to mitigate misery shouldn’t add to that via misguided gold standard economics.
