As the Iowa Democratic caucuses draw near, and as the field of Democratic candidates have narrowed even further, the ongoing wrangling over what the future of health care will look like continues to divide the Democratic Party.
And the divisions center around a government Medicare-for-all plan touted by some as "socialism," and proposals to build on the Affordable Care Act, which includes providing Americans with a choice of opting into a government-funded health plan or retaining private health insurance.
Sens. Elizabeth Warren and Bernie Sanders both agree, at least in principle, on the concept of universal enrollment in a government health program devoid of premiums, deductibles, or copayments, with the wealthy footing the bill. Both senators advocate cuts in payment rates to pharmaceutical companies, hospitals, and other health industry areas. The question is, which plan is the more sound proposal that will have the consensus in Congress? When it comes down to which Americans are burdened with the tax to pay for a health plan, the result is a reduction in American workers' net income. Former Vice President Joe Biden has cited the need to increase tax credits as a way for people to avoid paying 8.5 percent or more of their net income for health premiums.
Sanders' plan, in terms of financing Medicare-for-all, involves the increase in employer-side payroll taxes by 7.5 percent points to bring in around $3.9 trillion over a 10-year period. Sanders's vision is a graduated system where the employer-side payroll tax would be less for workers earning below $80,000 a year, but higher for more affluent workers. And under Sanders' Medicare-for-all, lower-income households that don't even have health coverage would reap coverage because of a modest tax increase. Lest we forget that unlike Warren, Sanders said there will be a tax increase on the middle class.
Consider, however, the simplistic nature of Warren's health care vision, which involves the absence of any new tax. The Warren proposal means companies that employ over 50 workers will calculate the current average health expenditure, and pay 98 percent of that to the government. Warren's program will change the way employers provide health insurance, but employers will pay into a government-run fund. This could result in a level playing field in terms of every worker receiving the same health insurance plan. After all, I think the U.S. is in dire need of simplifying health care.
The key contrast between the Sanders and the Warren proposals are the type of taxes imposed, with Sanders proposing a flat tax on wage income while Warren is proposing a type of regressive tax that will fall on the shoulders of employers. Meanwhile, Pete Buttigieg touts health care reform that provides Americans with a choice so they do not have to lose their private coverage. Buttigieg's stance on renegotiating prescription drug prices - in an era where Medicare D prohibits such negotiations - is a necessity. The House of Representatives was able to pass a bill that would cap out-of-pocket prescription drug costs for Medicare enrollees, and direct the federal government to negotiate the price of lifesaving medications, although the Senate bill does not contain any provision that covers the negotiation of drug prices.
In the final analysis, primary season will continue to feature the candidates defining their health proposals in unique terms, thus differentiating themselves against one another. But primary season will eventually conclude with a nominated candidate who will have to put ideological differences aside to build coalitions as well as consensus.
Brent Been is a Tahlequah educator with a special emphasis on civics and history.