Mass­a­chu­setts Sen­a­tor Eliz­a­beth War­ren has pro­posed over $20 tril­lion in pub­lic invest­ment to fund her auda­cious health­care plan, known as Medicare For All.

On Fri­day the War­ren cam­paign released a detailed plan argu­ing for a num­ber of new tax­es on cor­po­ra­tions and the wealth­i­est Amer­i­cans, along with off­sets and oth­er rev­enue-increas­ing mea­sures, to pro­vide health­care to all.

Sen­a­tor Eliz­a­beth War­ren par­tic­i­pates in the Net­roots Nation 2019 pres­i­den­tial forum (Pho­to: Andrew Villeneuve/Northwest Pro­gres­sive Institute)

In an email to sup­port­ers, War­ren linked her Medicare For All pro­pos­al to her decades of work research­ing bank­rupt­cy. The num­ber one rea­son that Amer­i­cans go bank­rupt is the cost of health care, and three out of four fam­i­lies who declare bank­rupt­cy over health issues had insur­ance which failed to cov­er their needs.

Under the cur­rent sys­tem, eighty-sev­en mil­lion Amer­i­cans are unin­sured or “under­in­sured,” while tens of mil­lions more avoid pick­ing up pre­scrip­tions, miss crit­i­cal appoint­ments or skip rec­om­mend­ed tests. Even for those who have ade­quate insur­ance, the aver­age fam­i­ly of four pays over $12,000 a year in pre­mi­ums and out-of-pock­et costs, a num­ber that ris­es every year.

War­ren argued that a humane health­care sys­tem should have “two absolute non-nego­tiables”: no Amer­i­can should ever die or go bank­rupt because of health­care costs; and every Amer­i­can should be able to see the doc­tors they need and get treat­ment, “with­out hav­ing to fig­ure out who is in-net­work. No for-prof­it insur­ance com­pa­ny should be able to stop anyone…from get­ting the treat­ment they need.”

Warren’s new pro­pos­als not only seek to address the huge cost of health­care for ordi­nary Amer­i­cans, but also answer the ques­tion that dogged her in the last Demo­c­ra­t­ic pres­i­den­tial pri­ma­ry debate – name­ly, whether she would increase tax­es on mid­dle income fam­i­lies – with a resound­ing “no.”

Under Warren’s plan, com­pa­nies would pay in tax­es what they pre­vi­ous­ly paid for pri­vate employ­ee insur­ance, which would raise around $8.8 tril­lion over the decade. An assort­ment of new tax­es on wealth, invest­ments and finan­cial trans­ac­tions (that would fall on the wealth­i­est Amer­i­cans) would raise $4 tril­lion more. A slimmed down defense bud­get could also yield mon­ey for the plan.

The increase in rev­enue would pro­vide for an enor­mous over­haul of the U.S. health­care sys­tem. If Con­gress cre­at­ed a com­pre­hen­sive sin­gle pay­er plan for all Amer­i­cans, employ­er-spon­sored insur­ance would become irrel­e­vant, free­ing mil­lions of employ­ees of the fear of los­ing health cov­er­age if they leave their job.

What’s more, the thou­sands of dol­lars spent per fam­i­ly on copays, deductibles, out-of-pock­et costs and pre­mi­ums would be elim­i­nat­ed. Per­haps most impor­tant­ly of all, the mil­lions of Amer­i­cans cur­rent­ly unin­sured would have full coverage.

Sen­a­tor Eliz­a­beth War­ren address­es a huge crowd in Seat­tle with the icon­ic Space Nee­dle in the back­ground (Pho­to: Bob­by Aiyer/Northwest Pro­gres­sive Institute)

Warren’s main Demo­c­ra­t­ic rival quick­ly crit­i­cized her proposals.

The cam­paign of Joe Biden – who favors expand­ing the Patient Pro­tec­tion Act — said the plan was “unre­al­is­tic” and argued that “It’s impos­si­ble to pay for Medicare for All with­out mid­dle-class tax increases.”

In recent Demo­c­ra­t­ic pri­ma­ry debates, the argu­ment over the costs of Medicare for All have usu­al­ly been framed in one of two ways: Biden and oth­er neolib­er­al can­di­dates argue that Medicare for All would increase tax­es – par­tic­u­lar­ly empha­siz­ing the poten­tial bur­den on the mid­dle class – while War­ren and her pro­gres­sive col­leagues have argued that over­all costs for health­care (inclu­sive of insur­ance pay­ments and tax­es) will be dra­mat­i­cal­ly reduced for the aver­age family.

In her recent announce­ment, War­ren pre­empt­ed crit­i­cisms over tax­es by point­ing out that the sav­ings her plan would offer ordi­nary Amer­i­cans would be larg­er than the wealth­i­est saved through Trump’s gigan­tic 2017 tax scam.

The finan­cial ben­e­fits of a Medicare for All sys­tem would like­ly be expansive.

Under the cur­rent sys­tem, health care providers (par­tic­u­lar­ly phar­ma­ceu­ti­cal com­pa­nies) reg­u­lar­ly gouge prices on essen­tial prod­ucts and ser­vices – remem­ber the antics of “Phar­ma Bro” Mar­tin Shkre­li – with patients vir­tu­al­ly pow­er­less to resist. Sen­a­tor War­ren plans to put the weight of the fed­er­al gov­ern­ment behind an aggres­sive nego­ti­a­tion sys­tem, which could pres­sure health­care providers to reduce prices for pre­scrip­tion drugs by as much as 70%.

Most coun­tries in the indus­tri­al­ized world have some ver­sion of uni­ver­sal health­care, and few politi­cians in those coun­tries would argue for an Amer­i­can-style mar­ket-based sys­tem. In the Unit­ed King­dom, for exam­ple, the right wing pop­u­lar­ized Brex­it by promis­ing £350 mil­lion ($453 mil­lion) a week for the Nation­al Health Ser­vice – Britain’s pub­licly-run health care system.

Medicare For All can’t and won’t be deliv­ered overnight, but sup­port is build­ing for the idea of expand­ing Medicare to cov­er all Americans.

Eliz­a­beth War­ren evi­dent­ly fig­ured the time was ripe to address the tired old “How will you pay for that?” ques­tion, which jour­nal­ists always seem to ask Demo­c­ra­t­ic can­di­dates, but rarely ask Repub­li­can candidates.

The cam­paign also released an expert let­ter on cost esti­mate of Medicare for All, an expert let­ter on financ­ing Medicare for All, and a cal­cu­la­tor in addi­tion to the plan itself. All these mate­ri­als are avail­able to the pub­lic and the press.