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If the Dems Want to Beat Trump, They Should Embrace Medicare for All
If Democrats want to convince voters that they will make their lives better, they need to be identified with policies that will make their lives better.
Aug 24, 2025
At a time when we don’t know if we will have real elections in 2026 and 2028, it may seem a bit absurd to be plotting an agenda for Democrats, but it is essential. While polls show approval for US President Donald Trump and Republicans is plummeting, people are not flocking back to the Democrats.
A major reason is that people don’t know what Democrats stand for, other than not being Donald Trump. While that is an important credential, democracy does still mean something to many people, and that alone is not likely to convince voters to come out and pull the Democratic lever.
Most people do feel they are being screwed by the rich. They have a good case, which has gotten a lot better in the seven months Donald Trump has been in office. His endless tax breaks for the rich and corporations, coupled with all sorts of government giveaways from his crypto scams to giving the right to dump their crap on our lawns (i.e. pollute without constraints), should convince any doubters that we have a government by and for the rich.
But the Democrats need to make the case that they are something different. That will be hard when so many are openly in bed with crypto scammers and other Wall Street high rollers.
Moving to universal Medicare will be difficult both politically and practically, but it can be done.
If they want to convince voters that they will make their lives better, they need to be identified with policies that will make their lives better. Some of these should be obvious.
Raising the minimum wage to $18 an hour is a straightforward one. Minimum wage hikes always poll well, and when referendums have appeared on the ballot, they win even in heavily Republican states like Arkansas. And there is now extensive research showing that modest increases in the minimum wage do not result in job loss.
Workers want to join unions but are stifled by current labor law. Strong protections for worker rights should go a long way here. Suppose we not only had a worker-friendly National Labor Relations Board, but we also had serious sanctions for violations. I suspect fewer bosses would break the law if they were looking at jail time.
That would at least be symmetric. A union official faces jail time if they ignore a court’s back to work order. It seems an employer who continually breaks the law to obstruct workers’ efforts to organize should face similar consequences.
But an item that really should be top of the list is universal Medicare. This had seemed like a big lift to me and many others, which would require a long phase-in period. But Trump and the Republicans’ radical attack on the current hodgepodge system of providing healthcare, coupled with Trump’s extreme uses of executive power, convinced me that we can move quickly in this direction.
The Budget and the Resources for Universal Medicare
In moving toward universal Medicare, it is important to recognize the distinction between the budgetary implications and the real demands on resources. There is no doubt that a universal Medicare program will require a large amount of additional spending, although the increase can be exaggerated.
We will save at least $400 billion a year (5% of the federal budget) on what we pay the insurance industry to shuffle papers and deny people care. Prescription drugs and other pharmaceutical products would also be cheap if the government didn’t give out patent monopolies for these items. We will spend over $700 billion this year for drugs that would likely cost around $150 billion in a free market. The difference of $550 billion comes to $4,400 per household annually.
Contrary to what is often asserted, government makes drugs expensive. We need less government to make them cheap, not more. The same is true for medical equipment, like scanning machines.
We do need to provide incentives to develop new drugs and equipment, but there are alternatives to granting patent monopolies. We can pay people. The National Institutes of Health and other government agencies used to spend over $50 billion a year on biomedical research.
Insofar as it is necessary to raise revenue, Trump has shown us how easy it can be.
We can triple this sum and make all findings fully open source so that new drugs can be produced as generics the day they are approved. This would both make drugs cheap and eliminate most of the motivation for corruption in the pharmaceutical industry.
It’s also worth pointing out that a major reason insurers are so determined to limit care is the high prices of drugs and medical equipment. If a year’s treatment with a drug costs $100,000, as is the case with some new cancer drugs, an insurer will try to avoid paying it. If the cost were around $1,000, which would likely be the case in the absence of patent monopolies, there would be little concern about using the drug, if a doctor determined it to be the best treatment.
But even moving quickly to bring costs down in the healthcare sector, we will still need considerably more money to pay for a universal healthcare system than what the government pays for our current system. This is a place where Trump’s erratic policies have done us a great service.
First, we need to remember that the actual constraint to the government’s spending is not revenue, it is the availability of real resources. In the case of universal Medicare that means the doctors, physicians’ assistants, nurses, medical technicians, home healthcare aides, and other people who directly provide healthcare to patients.
We currently have over 18 million employed in these jobs. We would need considerably more to adequately meet the country’s healthcare needs. We already have shortages in many occupations, and there is a huge problem of access in rural areas and some inner-city neighborhoods.
We can’t immediately fill this shortfall since many of these fields require years of training. If the country moved to universal Medicare, radically ramping up training programs in healthcare fields should be a top priority. We need to go the Immigration and Customs Enforcement route here and offer huge recruitment bonuses. People can be paid tens of thousands of dollars for entering and then completing programs in physical therapy, nursing, and other health-related fields.
We also should be turning to foreign countries for assistance. There already are large numbers of immigrants working in healthcare in the United States. The Trump administration is hard at work deporting many of them. That will make it more difficult to attract foreign healthcare workers in the future, but hopefully a progressive Democratic administration can convince the world that the United States has returned to sanity.
There is an issue that by bringing large numbers of healthcare workers to the United States, especially doctors, we will be depriving poorer countries of desperately needed healthcare providers. There is a simple answer to this. We pay these countries to train two or three healthcare workers for every one that comes here.
This is a classic story of the winners from trade compensating the losers that economists always talk about when pushing trade deals through Congress, but never actually happens after they take effect. The logic is actually solid; the problem is the political will. Anyhow, we can give this compensation and create a win-win situation, if there is political support for it.
Getting back to the budget situation, the problem from large deficits is that they can push the economy beyond its capacity and lead to inflation. That doesn’t seem to be the problem at present, where the economy is showing considerable weakness. It’s hard to say what the world will look like if and when a progressive Democratic administration comes into power.
Insofar as it is necessary to raise revenue, Trump has shown us how easy it can be. He set the country on a course to raise close to $400 billion a year in taxes (more than $4 trillion over a decade), without even getting approval from Congress.
His method of ad hoc tariffs is probably about the worst way to raise revenue, but it does show that it is possible to raise large amounts of revenue. The better routes would be raising income taxes on high-end earners and a corporate income tax that we actually collect. (Either mandate companies give the government non-voting shares of corporate stock, or make returns to shareholders the basis for the income tax; proposals that are too simple for great policy minds to understand.)
We also should apply a modest sales tax to stock trades of say 0.1%. This will hugely reduce the bloat in the financial sector and cost the vast majority of households nothing. The politicians whining that a middle-class family with $400,000 in a 401(k) could end up paying another $100 a year in taxes should be told to eat shit and die. They are shilling for Wall Street: full stop.
Anyhow, the dire budget calculations showing that if we never do anything about deficits, in 2040 or 2050 we will have an incredibly high interest burden might be a good way to employ budget wonks, but they should not be treated as serious basis for policy. We can and do change budgets all the time, and if we do face problems where deficits are pushing the economy beyond its capacity, we know how to raise taxes and, if need be, cut less useful spending.
Moving to universal Medicare will be difficult both politically and practically, but it can be done. Democrats really should have it at the center of their political agenda.
‘There Will Be Pain’: How Trump Tax Giveaways to the Rich Hurt Small Businesses and Working People
“Congress has a choice—they can either extend a failed policy or create tax reform that actually works for Main Street and communities.”
Feb 13, 2025
As the Trump administration and congressional Republicans pursue trillions of dollars in new tax giveaways for wealthy individuals and corporations, economists and pollsters this week are warning about how devastating the GOP's plan would be for small businesses and working families.
There Will Be Pain is the matter-of-fact title of a Thursday report from Josh Bivens, chief economist at the Economic Policy Institute (EPI). It details how extending the expiring provisions from the tax law that Republican lawmakers passed and Trump signed in 2017 "will have painful trade-offs for the U.S. economy and most Americans."
"The U.S. 'fiscal gap'—how much taxes need to be raised or spending cut to keep public debt stable as a share of gross domestic product—was entirely created by the Republican tax cuts of 2001, 2003, and 2017," Bivens wrote. "The 'tax gap'—the amount of taxes owed but not paid each year—is currently larger than the overall fiscal gap. It is driven by the richest U.S. households and businesses cheating the law and underpaying taxes."
Extending the Tax Cuts and Jobs Act (TCJA) provisions, currently set to expire at the end of this year, "would increase the fiscal gap by nearly 50%, from 2.1% to 3.3%," Bivens explained. "No matter how these tax cuts are financed, the result will hurt most working families, especially low-income households."
"Cuts to key social insurance and income support programs like Supplemental Nutrition Assistance Program (SNAP, commonly called food stamps) or Medicaid would do substantial damage to the nation's future workforce by depriving millions of children today of key health and developmental supports," he warned.
"Further, cuts of this size, if phased in quickly, would at minimum require the Federal Reserve to aggressively cut interest rates to avoid a recession," Bivens continued, "and could quite easily overwhelm any attempt by the Fed to buffer the economy from their effect, leading to recession and job losses."
The Republican playbook offers normal people crumbs and gives the cake to the rich. Extending Trump's 2017 tax cuts will give the bottom 60% $1.10 per day - but will give the top 1% $165 per day. Paying for this generosity to the top will cost working families dearly.
— Economic Policy Institute ( @epi.org) February 13, 2025 at 12:21 PM
Bivens argued that "expanding public investment and raising federal revenue via taxes that mostly come from high-income households is the most optimal way to close fiscal gap, boost economic productivity, and produce a fairer economy."
"If TCJA expansions for the rich are inevitable, this leaves three options: running deficits, increasing regressive taxes (in the form of tariffs, for example), or spending cuts," he added. "While none of these options is ideal, running deficits has the potential to be less harmful for American families, whereas regressive taxation and spending cuts will categorically cause the most harm."
The think tank published Bivens' report as a national coalition, Small Business for America's Future, released its findings from a survey of 863 small business owners' sentiments on the tax code, conducted from mid-December to late January.
The survey shows that just 3% of small business owners hired more workers as a result of the TCJA, 6% increased investments or employee wages, and 9% were able to pay down debts. Meanwhile, 43% reported no positive impact from the 2017 law.
The coalition found that small business owners are critical of the U.S. tax code in general and the TCJA specifically. Of those surveyed, 91% of said the tax code "favors large corporations over small businesses" and 76% report that wealthy individuals and big companies benefited most from the 2017 law, which critics have long called the "GOP Tax Scam."
The TCJA's small business pass-through deduction lets owners exclude up to 20% of their qualified business income from federal income tax. However, critics have called it complex and the survey shows that 39% of owners weren't sure if they claim the benefit.
The survey also highlights solutions that are popular with owners, such as exempting the first $25,000 of profit from federal income tax, creating a simplified standard deduction, making the tax code less complicated, and modernizing the Internal Revenue Service. Additionally, 61% of respondents support raising the corporate tax rate to pay for new small business tax benefits.
"By slashing the corporate tax rate permanently from 35% to 21%, while offering most small business owners only a temporary and complex 20% tax deduction, the TCJA created a two-tier tax system that overwhelmingly favored large corporations," said Walt Rowen, co-chair of Small Business for America's Future and president of the Susquehanna Glass Company in Pennsylvania.
"This isn't just hurting business owners—it's failing workers, families and local economies in every community across the country," Rowen added. "Now, Congress has a choice—they can either extend a failed policy or create tax reform that actually works for Main Street and communities."
The GOP controls the White House and both chambers of Congress, but those surveyed by the coalition were divided in terms of political parties: 23% said they didn't know or preferred not to say while 29% identified as Republicans, 25% as Democrats, and 19% as Independents. More than three-quarters were age 55 or older, 56% were white, and just over half were men. A quarter of owners listed themselves as the only employee, and nearly half had just 1-10 workers.
"Small businesses create jobs, drive innovation, and provide essential services in every community across America. But this law has done nothing to help them fulfill their potential," said Anne Zimmerman, a coalition co-chair and certified public accountant in Ohio. "When nearly 40% of small business owners can't even determine if they received the law's main small business tax deduction, while large corporations got an immediate and permanent tax cut, something is fundamentally wrong with our approach."
The small business survey and EPI's report followed polling released Tuesday by Data for Progress, Groundwork Collaborative, and the Student Borrower Protection Center that shows a majority of Americans believe not only that the rich pay too little in taxes but also that lawmakers shouldn't slash popular programs to give them more tax cuts.
"Americans might not always see eye to eye, but one thing's clear: Nearly every voter—across party lines—wants to protect Medicare, Medicaid, Social Security, and SNAP," said Groundwork Collaborative. "Meanwhile, the GOP is pushing to gut them for even more tax breaks for the wealthy."
What Mob Movies Teach Us About GOP Tax Policy
The Trump administration’s disastrous tax law paved the way for corporate America’s “mink coats and Cadillacs” moment.
Aug 22, 2024
In one of the more memorable scenes from the Scorcese mob classic Goodfellas, Jimmy scolds his co-conspirators for flaunting the spoils of their infamous Lufthansa Heist—the 1978 theft of $6 million in cash and jewels from New York’s JFK Airport.
“Didn’t I tell you not to get anything?” Jimmy snaps at Johnny, who had arrived at the Christmas party in a new pink Cadillac. Moments later, Frank walks in alongside a date donning a new mink coat, and Jimmy is incensed. “In two days, one guy gets a Caddy and one guy gets a $20,000 mink!”
The mob logic portrayed here—that when you hit a major lick, it’s best to lay low and not attract attention—seems innocent by the standards of the Trump administration’s signature heist: the 2017 Tax Cuts and Jobs Act (TCJA). That law paved the way for corporate America’s “mink coats and Cadillacs” moment by slashing the corporate tax rate from 35% to 21%—robbing the public of roughly $1.3 trillion and further enriching billionaires and top executives. In Goodfellas terms, that’s equal to 46,428 inflation-adjusted Lufthansa heists. And like Johnny and Frank, the corporations who scored the biggest windfalls have since done the opposite of lay low. They have instead gone on a years-long profiteering binge, rolling out some of the most egregious tactics to cash in even further.
In typical trickle-down fashion, the corporate rate cut was sold as a boon to workers and ordinary families. The Trump administration said the TCJA’s most expensive provision would boost wages to the tune of $4,000 per year. That promise, it turns out, was a fraud. According to a recent study, 90% of American workers received zero dollars from the TCJA’s corporate rate cut. Meanwhile, executive pay soared, and stock buybacks hit a record high $1 trillion in the year after it passed.
So what did the typical American family get if not a major boost in income? Junk fees, deceptive scams at the grocery store, price gouging, and major collusion scandals in everything from meatpacking to rentals to oil and gas. It can be said that the TCJA unleashed a greatest hits of predatory tactics by rewarding otherwise too-risky pricing schemes that push consumer loyalty to the brink. Lower taxes and record profits also mean more money to buy lobbying power in Washington to push for more tax cuts. In that way, our dangerously low-tax environment exposes all of us to the worst and riskiest corporate behavior.
Higher corporate taxation means fewer opportunities to hoard profits and rip off consumers, and more opportunities to invest in healthcare, child care, education, and jobs—the things proven to improve quality of life and democratize economic opportunity.
According to a February study from the Institute on Taxation and Economic Policy (ITEP), 342 profitable corporations paid an effective tax rate of 14.1% from 2018 to 2022, well below the 21% signed into law by the Trump administration. Layered onto decades of corporate tax cuts, the TCJA pushed the U.S. to the very bottom of the OECD in terms of revenue raised from corporations as a share of the economy. And Republicans are poised to go even further if former U.S. President Donald Trump retakes the White House.
A recent analysis from CAP Action found that Trump’s plan to cut the corporate tax rate even further to 15% would provide the top 100 U.S. companies with an additional $48 billion gift every year. This means even more breathing room to test out the next wave of ripoff schemes needed to satisfy investors. Whether it’s major credit card companies jacking up APRs even further, Amazon running more casino-style pricing experiments, or Tyson Foods deploying more algorithms to allegedly collude on meat prices, lower taxation offers a sweet incentive to profiteer at the expense of consumers.
Raising the corporate tax rate won’t fix everything that’s broken with corporate America or our economy. But it will fundamentally change the economic rules. Higher corporate taxation means fewer opportunities to hoard profits and rip off consumers, and more opportunities to invest in healthcare, child care, education, and jobs—the things proven to improve quality of life and democratize economic opportunity.
Since the Trump tax cuts, the largest corporations have flaunted their record profits like caddies and minks, bragging on earnings calls about the new tricks they’re using to raise prices on consumers. The era of tax heists must end if we are to stop them. The time to end it is now.
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