A four-year transition programwould require employers to fork over what they now pay to insurersto the federal government instead, an estimated $8.8 trillion over10 years. (Photo: Bloomberg)

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Estimates from outside the Warren camp have put the cost of herproposed Medicare for All plan at as high as $34trillion over 10 years, but Senator Elizabeth Warren, D-MA, herselfhas finally released details on how the plan would be paid for andputs the cost at $20.5 trillion.

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CNN reports that the Warren estimate comes throughthe assistance of "prominent economists and health policy experts"who "reached that figure in large part by requiring state and localgovernment to continue paying the $6 trillion they now spend onMedicaid, the Children's Health Insurance Program and publicemployee premiums." The projection also assumes loweradministrative costs, lower drug prices and a resulting lower totalof health care spending.

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Related: Health insurers mount battle against Medicare forAll

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Critics of Medicare for All in general—including some Democrats,like former vice president Joe Biden—have been saying that theproposed program, whether from Warren or from Senator BernieSanders, I-VT, is too costly and can't succeed. And Warren wascoming in for criticism for not having released a plan to pay forher M4A proposal.

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But the plan is now out, and Warren says that, unlike one of theclaims by critics, the middle class will not be subject to highertaxes under her plan. Instead, states, employers, large businesses,Wall Street and the wealthy will be on the hook for the cost of theprogram, the report says, with billionaires coming in for anadditional tax on their net worth.

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"My transition plan will take seriously and addresssubstantively the concerns of unions, individuals with privateinsurance, hospitals, people who work for private health insurers,and medical professionals who worry about what a new system willmean for them," Warren said.

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A four-year transition program would require employers to forkover what they now pay to insurers to the federal governmentinstead, an estimated $8.8 trillion over 10 years as an "EmployerMedicare Contribution."

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In addition, billionaires would have to cough up three cents perdollar on net worth higher than $1 billion—on top of Warren'searlier proposed wealth tax of 3 percentage points on billionaires.And the richest one percent would also get taxed on capital gainsannually instead of at the time of sale, at a higher capital gainsrate that would match income taxes. These measures are estimated toraise $3 trillion.

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The IRS would be empowered to go after tax fraud and tax evasionby the wealthy, estimated to raise another $2.3 trillion.

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The financial sector and large corporations would be subject toa financial transaction tax of 0.01 percent on the sale of stocks,bonds and derivatives, as well as to significantly changedcorporate tax law—projected to raise another $1.4 trillion.

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Comprehensive immigrant reform would bring in another $1.2trillion in tax revenue from employed immigrants, who would alsoboost the population. Warren would also eliminate the Pentagon'sOverseas Contingency Operations fund and directing that money toMedicare for All.

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And last but far from least, employees who would no longer haveto pay their share of health care premiums would see an increase intheir take-home pay—which would then be taxed and raise anadditional $1.4 trillion.

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In addition to her own team, Warren relied on four other expertsto come up with the numbers: Simon Johnson, the former chiefeconomist at the IMF; Mark Zandi, the chief economist at Moody'sAnalytics; Betsey Stevenson, a former member of the Council ofEconomic Advisers under Barack Obama, and Don Berwick, who servedas an administrator of the Centers for Medicare and MedicaidServices in the Obama administration.

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Berwick, for his part, wrote in a USA Today op-ed that assertions by theopposition of higher costs and taxes are wrong. Berwick wrote, "Thetruth is the opposite. Medicare for All would sharply reduceoverall spending on health care. It can be thoughtfully designed toreduce total costs for the vast majority of American families,while improving the quality of the care they get."

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And even other economists are weighing in on the criticism ofthe opposition that taxes will go up even for the middle class. Inan opinion piece in The Guardian, Emmanuel Saez and Gabriel Zucman,economics professors at the University of California, Berkeley,asserted that "[n]ot only would universal health care reduce taxesfor most people, it would also lead to the biggest take-home payraise in a generation for most workers."

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.