Single-payer health care would cost a small fraction compared to Obama's trillion-$$ plan

[brentspeak]

According to http://www.washingtonpost.com/wp-dyn/content/article/2009/05/26/AR2009052602909_pf.html">this article in the Washington Post, even Democrats are pushing for a national sales tax in a desperate bid to stave off fiscal disaster fueled in part by Obama's trillion-dollar expansion of health care coverage. But this could be averted completely simply by switching to a single-payer health care system:

http://www.pnhp.org/facts/singlepayer_faq.php#subsidies

Won’t this raise my taxes?

Currently, about 60% of our health care system is financed by public money: federal and state taxes, property taxes and tax subsidies. These funds pay for Medicare, Medicaid, the VA, coverage for public employees (including police and teachers), elected officials, military personnel, etc. There are also hefty tax subsidies to employers to help pay for their employees’ health insurance. About 20% of health care is financed by all of us individually through out-of-pocket payments, such as co-pays, deductibles, the uninsured paying directly for care, people paying privately for premiums, etc. Private employers only pay 21% of health care costs. In all, it is a very “regressive” way to finance health care, in that the poor pay a much higher percentage of their income for health care than higher income individuals do.

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

Currently, 47 million people have no insurance and hundreds of thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but those who currently offer coverage would, on average, pay less. For most large employers, a payroll tax in the 7% range would mean they would pay slightly less than they currently do (about 8.5%). No employer, moreover, would gain a competitive advantage because he had scrimped on employee health benefits. And health insurance would disappear from the bargaining table between employers and employees.

Of course, the biggest change would be that everyone would have the same comprehensive health coverage, including all medical, hospital, eye care, dental care, long-term care, and mental health services. Currently, many people and businesses are paying huge premiums for insurance so full of gaps like co-payments, deductibles and uncovered services that it would be almost worthless if they were to have a serious illness.

As opposed to Obama's trillion-dollar health coverage plan, the single-payer system actually pays for itself and provides better quality health care than any piece-meal national health insurance program.

[DrToast]

1. A national sales tax would be great

Thanks for the article.

[brentspeak]

3. No surprise that you support both a regressive tax AND Obama wasting trillion-$$

A completely needless waste, as the article points out.

[DrToast]

4. Did you read the article?

A national sales tax doesn't have to be regressive. Further, it's better than an income tax as it encourages savings and discourages consumption.

By the way, single payer is not going to happen, nor should it. I don't understand this fetish over single payer. The best health care plans in the world aren't single payer. Yet somehow people have adopted this notion that it's the only way to solve our problems. All hail single payer!

[snowdays]

6. and i do not understand the "fetish" of caving to the insurance industry.

[DrToast]

8. Seems to be working well for France

But I guess the best health care system in the world isn't good enough for the US.

[Oregone]

9. How can consumption tax not be regressive?

Why shouldn't single payer happen? Whats wrong with having a single, public-owned health insurance company the pays out on claims?

[DrToast]

10. It's in the article.

And why shouldn't single payer happen? Because public-private plans have been more effective. Isn't that a good enough reason?

[Oregone]

11. Where have public/private plans been more effective?

And further, what were the conditions (legislation) causing them to be so? To add to this, what is the likelihood that the US would get the need legislation to make this work? Referring to Schumer's plan, wouldn't a single-payer system be far more effective?

Where in the article does it talk about a consumption tax not being regressive?

"The vouchers would, under the Emanuel-Fuchs plan, be paid for through a value-added tax (VAT), essentially a sales tax on all manufactured goods and services. This is a highly regressive way of financing such a plan, since low-income people spend a much larger percentage of their income on purchases of goods and services than do higher-income people."

[DrToast]

12. France has a hyrbrid system

It's ranked as the best in the world.

As to the VAT, there's a few ways it is not regressive. The article mentions one: by giving poor people health care they gain more than they lose. The other option, which the article doesn't mention, is to provide tax refunds to poor people so they get the money back they pay on the VAT tax.

VATs are good policy. They encourage people to save more and consume less, which this country desperately needs. There's a reason they're so common throughout the world.

I'm all for taxing the rich, but that's not going to be enough to do everything Obama wants.

[slipslidingaway]

14. How much of a role do private For Profit companies play in France...

hard to imagine their profits and salaries are anything like the US companies.

[snowdays]

15. so, is the WH prepared to undo our anti-trust laws?

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8435180

[Oregone]

16. You missed the further questions about the legislation...

You mention France, but you neglect to see where the US is going in terms of its "public option". A single-payer will give you a pretty clear result (care is paid for by a single entity). But a hybrid system is HIGHLY dependent upon the laws that govern its fundamental structure. Do you have faith in US legislators to implement and effective hybrid system?

Do you realize that an unfunded health insurance company that has no real ability to force doctor's to accept it and has no real ability to negotiate decent prices could be a disaster? Further, if legislation mandated health coverage but did not require private insurers to cover *anyone* and pay claims appropriately, this could produce a system worse than the status quo? Essentially, all the private companies need to do is shed high-risk consumers to the public plan. Their profits would soar as their coverage becomes less high-risk. On the other hand, the unfunded public option would be weighed down with high-risk patients who constantly need expensive medical care. It would essentially go bankrupt. In the meantime, without being able to force doctors to accept it, they would lack the basic ability to even pay out for the services of their patients. This could be a mess.

And potentially, in the US, it might be helpful, but on its current track....The problem is that a public/private system is highly open to interpretation and exploitation. You have to have clear and firm laws to be able to regulate it and make it work. It can be great, more of the same, or shittier, depending upon the approach.

On the other hand, you know what you get with single-payer. There isn't much room to negotiate and water it down, period, due to its defining nature.


As far as your argument that a VAT isn't regressive if it pays for a progressive service (get more than you pay), well, thats just utter bullshit and fuzzy logic. You can almost always argue, under almost ANY tax system (regressive included), that dollar for dollar, the services the poor receive always outweigh what they pay. I mean, hell, what is the ROI to the poor, on a dollar basis, they receive when paying for roads and police (its invaluable)? You can stretch this notion to eliminate the concept of there ever being a regressive tax, period. But we know that isn't the truth. The bottom line is there are many ways to raise government funds to pay for services everyone receives. The regressive nature should not be judged on what the population receives, but rather, how those funds are raised. If the poor pay a larger percentage of their income or wealth in a certain tax, it is regressive. And no amount of refunds you give out will balance out what an upper-middle class person pays proportionally to their income compared to the super rich. Much of those refunds on consumption taxes leave out those in the "middle" (who are still very much on the bottom compared to those who own 90% of the wealth in a society).

[DrToast]

17. If we're going to have major health care reform

I see no reason to shoot for the best.

And it sounds like your problem isn't with VAT, but that the wealthy don't pay enough in taxes. I happen to agree with that, but you can't cut off your nose to spite your face. We need a VAT AND a more progressive income tax structure. It's not a matter of one or the other.

[Oregone]

18. "I see no reason to shoot for the best."

LOL.

How about, "Because we can (or should be able to)". You know...the Democrats have a massive majority and a mandate.

Do you see a reason to even shoot for something "better"? Because on the Schumer plan, itll probably be a tad bit worse I betcha.

And single-payer may not by the "best" anyway. Its simply a way to make sure things get paid for, for everyone, from public and private providers alike, at reasonable rates. Its actually beyond pragmatic.

Yes, I have an issue with the wealthy not paying "enough", but implementing a regressive tax isn't going anywhere to fix that positively (it actually makes the problem worse). You say we need both but I got to disagree. If they simply adjusted the top marginal rate to the average rate under Ronald Reagan (56% mind you, from an anemic 35%), the US would have plenty of money (raised more progressively) to cover this entire mess. If they simply started taxing capital gains fairly as income (instead of at a flat 15%), we would again have more than enough money to cover this.

[DrToast]

21. Sorry, I mistyped

I see no reason NOT to shoot for the best.

It sounds like you're acknowledging that single payer wouldn't be the best, but it would be easier. So no, I don't buy that. If we're going to do a major health care reform, I want the best system available.

[Oregone]

25. Alright, I see how you are saying that

But "the best" may be beyond non-viable in the US. The best way to provide health care may be a complete socialization of all health care facilities. But, that idea is completely unfeasible and beyond in the US, and management would perhaps be greatly challenging. So, in terms of operation and management, I welcome the notion of pragmatism (in terms of "politics", I do not).

As for a hybrid system, yes, the "best" one would be great, but as I pointed out, this approach (public/private) is greatly open to exploitation and manipulation. There isn't really a public debate talking about the "best" way to approach this, or thinking of copying France as a model. Rather, the debate right now is how to open up a "public option" as a symbol to the people, while not hampering the profits of the private industry.

And I would further argue, that in terms of models that simply PAY for service, single-payer is by far the best system in theory (despite the success of France). The problem with single-payer in practice is that it is simply not funded enough. In response, they have to negotiate low prices for services, which cuts the profits of hospitals in certain fields, thereby cutting the doctor's pay, and eventually the desirability of the job (and supply of doctors). The public underfunding influences the availability of services in the market by price manipulation. Low availability of services cause wait lists (but they already have those in the US, and every other country for that matter).

If you are willing to fund single-payer appropriately, then it will be more effective at paying for quality care than any other such system involving multiple payers and profits. The main single-payer drawback is that funding can be politically manipulated from a central source, thereby damaging the entire system (for example, belligerent Republicans can destroy the entire country's care with a single bill to cut its funding). In optimal conditions, from administrative costs, to the complete lack of profits, you aren't going to be able to pay for 100% of all necessary services for 100% of the people at cheaper rates.

[cascadiance]

20. Then we need to RETURN to a 70-90% top marginal tax rate FIRST!

If you don't do that first, it won't get done, and we'll have one more legislative piece of crap from our corporatist serving government that will bury our country deeper and deeper into the mess we're in already.

[snowdays]

24. This is JOKE 'reform" when single players are not even at the discussion table.

[eridani]

35. Those "effective" plans are 90% public and 10% private n/t

[cascadiance]

19. A national sales tax WILL not generate revenue when people aren't spending money!

And they'll continue to not spend money until the wealth gap of our country can be restored to non-depression levels, and restore some sense of job security again, which we don't have now.

To see an example of this, look how badly the state of Washington is doing as a sales tax only revenue state...

http://seattletimes.nwsource.com/html/politics/2008765126_revenue20m.html

The only thing that will start generating real revenue to fund this sort of thing is not any sort of sales tax, but raising significantly more money from top marginal income tax rates, some sort of wealth tax, and/or a better balancing of income between the top and the bottom than we have now. Until that happens, sales tax won't be a reliable source of revenue for such a program. Even payroll tax is suffering now as a regressive tax to the point that they've not got it being increased for inflation this coming year for similar reasons that it doesn't get money from where all of the money is going now (the top of the income/wealth ladder). That also affects payment of medicare benefits too.

Now, perhaps taxing things like cigarettes, or other consumables that arguably generate more cost for health care is arguably a good tax to help steer people into spending their money more wisely, but it should NOT be relied upon as a means to fund this system. If people were to stop buying cigarettes and alcohol, etc. to avoid such taxes, we might be healthier, but then we reduce the revenue coming in to cover other health issues.

Larger corporate taxes would also be logical, since a lot of their unchecked/untested products invading the market now is arguably causing the increasing amounts of health problems such as diabetes and cancer, and THEY should have to pay more to get their increased profits when they don't factoring in the externalized costs they are pushing on to society when they make products that produce more health problems.

[busymom]

2. hmmm

ugh. State sales tax, national sales tax, property taxes, state taxes, federal taxes, social security, tax increases. When do we start cutting some pork out of the budget? I don't know how it is for everyone else, but we have already had to cut back on what we are buying pretty substantially. Adding a national sales tax will make that worse for us...if that is actually on the table and I haven't misunderstood.

Where can we start cutting costs to be able to fund health care?

[snowdays]

5. We start the cutting by NOT increasing to start with (as the OP points out)

[snowdays]

7. Off to the greatest:-)

[slipslidingaway]

13. knr - another thread in GD - link...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5729099&mesg_id=5729099


They are trying to find a way to finance a "public option" but will not even consider discussion of a single-payer system.

We have to protect the corporate profits.

:(


Health insurance industry CEO salary survey, stay calm for this

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=5726665&mesg_id=5726665

"Ron Williams - Aetna

Total Compensation: $24,300,112

Details: Williams earned $24,300,112 in total compensation for 2008, with more than half of that ($13,537,365) coming from option awards. He also received an additional $6,456,630 in stock awards to go along with his base salary of $1,091,764."


Ron Williams was invited to speak at the first Senate Finance Committee roundtable discussion.


http://finance.senate.gov/sitepages/hearing042109.htm

http://finance.senate.gov/sitepages/hearings.htm

http://finance.senate.gov/sitepages/hearing050509.html

http://finance.senate.gov/sitepages/hearing051209.html

[snowdays]

22. ah, so they are represented at the WH table but Single payer is not...........

dammmmmmmmmmmmmmmmm

[slipslidingaway]

28. Of course they get a seat at the table, but this was at the Senate

Finance Committee hearing.

[JimWis]

23. Thanks for the article. I am a single payer advocate, and I have

studied it. The article confirmed one of the things I wasn't sure of. I am assuming that with single payer, we would not need Medicare, Medicaid, the government employee insurance, veterans medical coverage, the new child insurance and maybe other. This would mean a huge government savings. And if you have a 2% income tax for this, wouldn't you lose the 1.45% medicare tax you are paying now. So an employee would have to pay and increase of 0.55 % in payroll taxes in order to have total medical coverage, with any doctor they choose, plus eye care and dental. And no copays, no deductibles, no pre-existing concerns. Every American citizen would be covered from cradle to grave. Think of the savings to both citizens and government.

[snowdays]

26. Yes, we would have only one administrative structure in

place that will hold down costs. Right now each of those programs have an expensive administrative structure in place.

[snowdays]

27. Single payer includes eye and dental and long term . Lets have it.

[slipslidingaway]

29. Doubtful that the public option would include eye, dental, mental

health etc.

[snowdays]

30. we may not even get a public option but if we do it will be a watered

down version.

[slipslidingaway]

31. I think we'll get a public option, but it will be watered down

sufficiently so that it will not be real threat to the private insurance companies anytime soon...IMHO.

And it will not include all the other services that SP would include.

[snowdays]

33. some 'reform' huh!!

[dflprincess]

36. I think any public option will be set up to fail

so Congress and their owners can point to it as "proof" that a government run system can't work.

[slipslidingaway]

37. That is a possibility as well...after HC reform is enacted we'll hear

more about controling Medicare costs, everything is being done in stages instead of looking at the whole picture.

[dflprincess]

38. Listen closely - they're not talking about health CARE reform

they're looking for a way to protect the insurance companies, not improve our access to care. We have to stop using the terms that are currently being tossed around in an attempt to fool us into thinking something might actually get done for our benefit.

[slipslidingaway]

39. You are correct - The Health Insurance Company Protection Act

HICPA or HIPA.

What should we call it?

[slipslidingaway]

32. I like this guy, he explains quite a bit in 2 minutes...

http://www.youtube.com/watch?v=IoPjExTu-dM

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=385&topic_id=317276&mesg_id=317276

"...Companies whose sole purpose is to move money, have no place in our health care delivery system..."

[creeksneakers2]

34. I can't find enough information in the essay

to make the numbers add up.