Elizabeth Warren says her plan will result in "everyone get[ting] the care they need, when they need it, and nobody goes broke."  It appears that senators, such as Ms. Warren, are excused from the worst effects of Medicare.

I have a friend with a chronic back problem that needed an operation.  She got a run-around from her Medicare program for years and finally paid $13,000 to have the operation done privately.  My parents were briefly resident in a Medicare nursing home.  It was terrible, with demented people wandering around screaming, etc.  When they moved to a non-Medicare nursing home, the difference was between a zoo and a 4-star hotel.  The cost was only marginally higher.  However, doctors declined to visit the patients in the nursing home because the reimbursement was extremely low under Medicare.  If you go to a medical facility that mostly deals with seniors, such as an eye clinic, you will find assembly-line medicine: long waits and brief visits to the doctor.

If you have a problem with a private insurance company, it is feasible to sue it, and the company fears that.  If you have a problem with Medicare, forget about it.  You're dealing with a giant government bureaucracy that is very difficult to sue and that will deal with you in its own sweet time.  I know of a case where an appeal was not answered for years.  You may be dead long before you get satisfaction.

In Britain, everyone who can possibly afford it has private insurance and has nothing to do with the National Health Service.  In the U.S., every effort is made to force seniors to enroll in Medicare Part A.  They are denied Social Security if they refuse to enroll.  The optional parts of Medicare and the necessary supplement from a private insurer are not cheap, either, for seniors above the poverty level.  Medicare is far from free and pays only 80% of expenses.

Medicare tries to be a monopoly for seniors.  There are price controls that prevent going to the best private doctors who don't accept Medicare.  The monopoly is not tightly enforced currently.  There are loopholes, such as concierge doctors that are allowed by the government.

In Canada, they have what amounts to Medicare for All.  You may have to wait months to get a C.T. scan or years to get a knee replacement.  It is illegal to bypass the system by paying a private doctor.  People with serious medical problems routinely go to the United States to get medical care, paying from their own pockets.  If the Elizabeth Warren system is implemented, to which country will Americans go to for medical care?  Some possibilities are Germany, Taiwan, and Singapore.  Likely, major American medical organizations would move across the border with Mexico in order to be free to practice good medicine.

The Medicare system tries to control the vast medical industry by an elaborate system of regulation.  For example, there are CPT codes used to identify different medical conditions.  There are 68,000 numerical codes.  In spite of the vast effort to control the system with elaborate regulation, Medicare fraud is a huge industry, stealing billions from the government.

Warren's proposed tax system to pay for Medicare for all is truly a nightmare.  She seems oblivious to the practical problems with her proposals.  Or maybe she does understand the problems and likes the problems since they give the government the upper hand in any tax dispute.  For example, she proposes to abolish the feature of estate tax law that unrealized capital gains are forgiven on death.  This is a practical matter, because it can be difficult to figure out the basis of property purchased many years ago.  She also wants to boost long-term capital gains taxes from 20% to 37% or perhaps to 41%.  So if someone dies and has stock purchased 50 years ago for $5,000 that is now worth $100,000, the estate would be taxed 41% of the 95% gain, with a 40% estate tax on the remainder.  The heirs would be left with $23,000 of the original $100,000.  Keep in mind that in the last 50 years, there has been 534% inflation, and the original $5,000 purchase would be valued at $32,000 today just due to inflation.  If Warren's proposal were accepted, many estates would require forensic accountants to dig through the records or have the government assign an arbitrary basis favoring the government.  In tax matters, you have to prove innocence.

Currently, the tax on corporate profits is 21% at the corporate level and 20–24% on dividends at the stockholder level.  The overall tax on profits distributed to the owners of the corporation is 40%, in line with the maximum tax on earned income of 37%.  Previous to Trump's tax reform, the tax at the corporate level was 35%, and the overall tax on the owners was 48% compared to the previous tax on earned income of 40%.  Self-employed people pay additional taxes on income.

Warren proposes an annual tax on assets, 2% of assets above $50 million and 6% above $1 billion.  We know that the camel is just getting its nose under the tent and that in the end, we will be sharing our bed with it.  The mechanics of this will be formidable.  For stocks traded on an exchange, calculating the asset value is easy.  But what about a partnership running a business?  That gets complicated.  Appraised value is normally what a buyer would pay to purchase something.  What if the something is filled with poison pills?  Suppose that the partnership agreement obliges a certain portion of the profits to be paid to the founder's favorite charity — say, his daughter?  Who is going to want to buy that something for anything but a low price?  These sorts of schemes have been used for a long time to avoid estate taxes, and it is not easy to distinguish between an arrangement devised to avoid estate taxes and a legitimate business arrangement.  Lawyers are paid to make it hard to distinguish the two.

Put in a wealth tax, and the wealthy will start spending their time figuring out how to avoid the tax rather than how to invest their wealth in a manner profitable for themselves and thus for society.  Really rich people may renounce their U.S. citizenship and take up citizenship in a friendlier jurisdiction, such as Sweden.

Of course, Warren does not utter a peep about the student loan scam.  That's how law professors make money.

Norman Rogers writes often about politics and energy.  He has websites: ClimateViews.com, NevadaSolarScam.com, and DumbEnergy.com.

Image: Gage Skidmore via Flickr.