Warren’s plan to finance Medicare-for-all pushes into dangerous and uncharted territory

November 7th, 2019

November 5, 2019

Democratic presidential candidate Elizabeth Warren last week mounted a passionate defense of universal government-provided health care and made a detailed case that it can be paid for without burdening the middle class. The vision of Medicare-for-all is immensely attractive and evokes health systems in other countries that perform much better than ours does. I could easily imagine supporting a well-designed Medicare-for-all plan.

However, no other country offers as broad coverage as Medicare-for-all would or claims to provide universal health insurance without taxing its middle class. With respect to the admirably detailed plan the Massachusetts senator laid out, there will, I suspect, be serious questions about the accuracy of her arithmetic, the impact on labor markets, the feasibility of applying Warren’s full set of proposed taxes to the rich, and the financial and economic impacts of the plan.

Campaign arithmetic is always optimistic, but errors are highly consequential with respect to a program that on some measures is eight times as large as the Trump tax cut. Warren estimates the revenue potential of increased Internal Revenue Service enforcement as being about 65 times as large as the Congressional Budget Office’s enforcement proposal. The University of Pennsylvania’s Natasha Sarin and I have been working to make the case that the CBO is far too pessimistic in its estimates of the potential for better enforcement to generate revenue. But the most optimistic scenario we can envision is still more than $1 trillion short of the Warren estimate.

Further, Warren’s plan would double the 3 percent tax on wealth over $1 billion that she has already proposed. Many experts believe the Warren wealth-tax revenue estimates are too high, perhaps by a factor of two, because they overestimate the wealth of the very rich and, as Sarin and I have argued, underestimate potential avoidance. Whatever the merits of these arguments, it is hard to see a defense for assuming — as the Warren proposal does — that wealth taxes can be doubled with no impact on avoidance, or that annual capital gains taxes can be levied without reducing the wealth tax base. The estimates are also infected by erroneous transcription of the CBO’s 10-year growth estimates and by a general failure to take account of interactions between the different tax measures proposed.

Second, there will be large labor market effects: Warren’s plan will discourage hiring, particularly of low-skilled workers, by firms that currently provide generous benefits. These firms will face the most burdensome taxes when they increase hiring and will gain the greatest cost savings by laying off workers. In addition, workers’ incentives to take jobs will be dulled because they will no longer be compensated with health benefits (which will become available regardless of what they do). There are further potential economic perversities as well: To cut costs, firms will be incentivized to get below the 50-employee threshold and scale back on current health benefits. And all the efforts that employers have engaged in to contain costs and to encourage prevention will become pointless.

Third, the combined tax impact of Warren’s various plans is extreme. While the case for more tax progressivity is compelling, and each of the Warren measures can be defended in isolation, there is the concern that their cumulative impact may be excessive should, as the Warren campaign repeatedly claims, they be borne only by the very wealthy. Here is a suggestive comparison: The total after-tax adjusted gross income of all those earning more than $1 million or more, as last reported by the IRS in its Statistics of Income publication, was under $1.1 trillion. The sum of all the new taxes on the wealthy proposed by Warren is of comparable magnitude: adding together around $310 billion a year in new wealth taxes; $330 billion a year in corporate taxes from her new proposals and her previous real corporate profits taxes; $240 billion a year from her new capital gains and finance tax proposals; at least $90 billion from her across-the-board 14.8 percent taxes of labor and investment income; and $190 billion in increased compliance. This totals nearly $1.2 trillion — more than millionaires’ total after-tax income.

Of course, this calculation is an oversimplification. Different taxpayers are situated differently and will be affected differently by any set of proposals. There will be tax collections from those who are not middle class but still earn less than $1 million a year. There are sources of “income” that will be taxed under the Medicare-for-all proposal that do not show up in current adjusted gross income — unrealized capital gains or corporate retained earnings, for example. On the other hand, it’s highly problematic given the avoidance and other bad incentives likely to result, to be anywhere in the ballpark of confiscatory taxation of high-income taxpayers.

Finally, what of the economic and financial effects of Warren’s proposals? A place to start is by thinking about the potential impact on the stock market. The market is valued as investors’ claim on future corporate earnings, which the Bureau of Economic Analysis estimates are about $1.8 trillion this year. As a result of all the tax claims just described, the Warren program would reduce investors’ claim on these earnings. Recognizing that some of these taxes fall on salary income or non-corporate business, it is reasonable to estimate that investors will pay an extra $500 billion to $600 billion in taxes related to corporate profits. Then, Medicare-for-all proponents cite a severe hit to health industry profits, currently on track to be over $200 billion this year. Then, there will be the broader impacts of overhauling regulation, often to serve vital social interests, in initiatives such as banning fracking and reforming the energy industry, stepping up financial regulation, a major increase in antitrust enforcement and the regulation of technology companies, and filling corporate board seats with labor representatives. It is hard to see an argument that investors’ claim on profits would fall less than a third. The figure could be considerably greater.

Because of abnormally high valuations, along with increased uncertainty and volatility, loss of business confidence and selling pressure from those in distress, the market would likely fall more than proportionally to earnings. Accurate market predictions are impossible and will in any event depend not on what is proposed but on what the market expects will actually take place. There is, however, the real risk of economic contraction following a sharp market decline, especially given that the current very low level of interest rates puts the Fed in a weak position to pursue counter-cyclical policy.

For decades, I have emphasized that corporate profits and the market do better when progressives are in power and have dismissed conservative fear-mongering about progressive policies.

This time seems different. Judged relative to gross domestic product, the Medicare-for-all program dwarfs the federal spending hikes of the New Deal and the Great Society. Presidents Franklin D. Roosevelt and Lyndon B. Johnson emphasized that their new benefits would be paid for by contributions from their middle-class beneficiaries. With Warren’s plan, it is the combination of vast new entitlements with total reliance on the top 1 percent for revenue that puts us in uncharted and, I fear, dangerous territory.