How would you pay for Medicare For All?

[Recursion]

For all of the vocal support here on DU for Medicare For All I rarely see this addressed, and I don't think it can be a serious proposal until it is (Sanders just advocated it but, unless they cut out that part, he didn't address this question). This is why Vermont gave up on Single Payer recently too.

Currently, the Medicare Part A premium is $407 / month (for most retirees this comes out of the Trust Fund, but that won't be able to happen with Medicare For All), and the full price of Medicare Part B is $335.70 / month (this is subsidized for retirees depending on their income -- again, the trust fund can't also cover current workers here). With zero subsidy, that's $742.70 / month for a A + B benefit scheme that does not include prescription drugs or nursing homes (the two biggest growth sectors in health care costs), and leaves enough people dissatisfied that Medicare Advantage is extremely popular. This also leaves you a $147 deductible, for a monthly price just north of $750.

It's likely that expanding the covered population would lower premiums -- how much, and what's the basis for the number you pick?

It's also likely that with no private insurance market, providers would have to negotiate higher prices with Medicare -- how much, and what's the basis for the number you pick?

Usage would probably go up if user fees don't block access to health care anymore. Do you use copays to return that signal? How much are they? If not, how much will usage (and so cost) go up?

If $750 per month per person is at least the right ballpark, how do we pay for it? In principle this would free up our current insurance payments, but few people pay that much for insurance. It would also free up our employer's insurance payments for us, but there's no reason to think businesses would give that money to employees rather than pocketing it. So do you raise a new payroll tax?

$750 per month per person works out to $240 billion per year, or about half of the Defense Budget, or about one third of Social Security benefits.

What ballpark of premium do you expect someone at the median income to pay? As an example, Ontario charges premiums of about $50 / month and has a 2% payroll tax dedicated to the health care system. Roughly what level of user premiums vs. copays vs. payroll taxes do you want, and can you get the numbers from that to at least have the correct amount of digits?

If you do it largely through taxes, is this a dedicated levy, or does it go through the general fund?

[randys1]

1. First you have to eliminate for profit hospitals other than those who cater to rich people.

By eliminating the 25% profit/overhead built into private healthcare systems and going with the 2% overhead cost of medicare, you get yourself off to a great start.

You employ all current health insurance rank and file in the new medicare for all, or whatever you wanna call it, so that helps a lot.

You put income tax rates back where they were before Reagan came in and you make corps pay their taxes.

You make it so anyone with a medical license or degree in America who wants to practice in AMerica must participate in the new system, where many of them will make less money.

But you provide free education, paid for by taxation, and more people will become doctors.

That is just a start...Pharmaceutical industry will be much greater regulated, generics will be regulated in cost, etc.

As to the making less money, this will mostly apply to specialists who make way too much in some cases.

[Donald Ian Rankin]

161. ...you're going to lower the cost of health care by closing hospitals? N.T.

[randys1]

179. Dont close them, absorb them and make them part of the system, unless the owner

wants to go it alone without any income from the system and rely solely on rich people who want private rooms, and those will exist.

It is hard for people who have spent their entire lives under the thumb of radical capitalism to see the insanity of it all.

To allow a for profit motive to decide if you have water or not...To have decent healthcare or not, totally insane.

To allow a family to buy half of the island of Maui, and keep it their private island FOREVER

Something that could and would happen if teaparty were to have total control of our government.

INSANE

Try and think outside the box. Try and start from the point where you dont accept everything you have been told to accept.

Then we could have a very interesting conversation as to how you would go about fixing this terribly broken system of capitalism.

(I have to laugh MY ASS off, when I think of the Bernie supporters I have to argue with all the time, hell they even blocked me from the Bernie group , what they havent figure out yet is Bernie and I have a lot in common, always have...some of them, not so much me thinks)

[Warren Stupidity]

2. Like every other developed nation.

Through the tax system. Remember it is an "all in" system, meaning that millions of very healthy people will be paying in and not using those services, unlike medicare now, where it is the single highest risk pool - the elderly - essentially all of whom are using the system at the maximum rate.

What you've done is assume that the cost structure for the elderly would be the cost structure for the whole population, and that is a ridiculous assumption.

We somehow manage to pay for the current for profit insurance system - in which supposedly with ACA everyone is covered. Medicare for all would reduce the total cost of that by removing all profit from the system - somewhere around 20% of the total cost.

A better question would be how on earth do we think we can afford to not move to medicare for all?

[Recursion]

4. I've specifically not done that

What you've done is assume that the cost structure for the elderly would be the cost structure for the whole population

No, I specifically said it would bring the premiums down, and I asked for something more specific than hand-waving about how much it would bring them down.

[Warren Stupidity]

7. Take the current total cost of providing insurance outside of medicare.

Subtract 20% off the top.

Divide by the total number of people paying into the payroll tax system.

[Recursion]

8. Now you're making the ridiculous assumption that usage won't go up

It's pretty clear usage will go up if user fees no longer prevent people from seeking health care.

[Warren Stupidity]

14. It is not clear at all that discouraging people from using health services reduces costs

in fact quite the opposite may be true.

Again every other major developed industrial economy provides universal healthcare that exceeds the measurable quality of our system at a much lower cost per capita. Why you think our doing so would not have the same results is a mystery. Perhaps you are baking in an assumption of abject corruption that would mandate pouring money into the coffers of the health insurance industry, oh wait, that is the current system.

[FourScore]

196. It costs $750/mo because they're OLD! Start a thread asking each DUer their average monthly medical

costs. Very few will be $750.00/month.

[Warren Stupidity]

197. I pointed out that problem up thread. The op insists that despite using the 750 figure to

demonstrate unaffordability, he wasn't using the 750 figure.

The op is starting from "we can't afford universal healthcare" and working backwards from there. He has no answer for the simple fact that we are currently "affording" something that is not quite universal healthcare at a much higher per capita cost with much shittier results than every other major industrial democracy. Essentially everyone does it better than we do at a lower cost, but we somehow cannot afford to take advantage of using any of the successful models for delivering quality affordable universal healthcare.

[suffragette]

18. New Yorker had an excellent article in 2005 debunking this moral hazard theory about usage

http://www.newyorker.com/magazine/2005/08/29/the-moral-hazard-myth

In 1968, the economist Mark Pauly argued that moral hazard played an enormous role in medicine, and, as John Nyman writes in his book “The Theory of the Demand for Health Insurance,” Pauly’s paper has become the “single most influential article in the health economics literature.” Nyman, an economist at the University of Minnesota, says that the fear of moral hazard lies behind the thicket of co-payments and deductibles and utilization reviews which characterizes the American health-insurance system. Fear of moral hazard, Nyman writes, also explains “the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage (for example, national health insurance or expanded Medicare benefits) in the U.S.”

~~~
The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.

[Recursion]

29. If usage doesn't go up what's the point?

If people aren't actually going to use more medical services why do we bother?

[suffragette]

38. The point is more people having access to actual health care and them being able to access

It when they need it.

The point you are arguing about people then using "more medical services" is aptly addressed and disputed throughout the article I posted.

[Recursion]

97. Insurance companies, for all their flaws, are very good at predicting what things will cost

And insurance companies realized a while ago that discouraging health care use with copays is cheaper in the long term than providing full health care.

I guess I've never been really persuaded that with the current provider set-up we could provide full medical coverage without it costing a lot more than it does now. But then I think the providers, rather than the insurers, are the big problem here.

[suffragette]

123. I think they're good at maximizing their profits, at the expense

Of people and societal good.

[hifiguy]

126. And paying obscene salaries to top executives.

One of the simplest rules of any economic problem is that when middlemen are involved costs go up and quality of service goes down and the more middlemen there are the greater the problem becomes. Those profits have to be squeezed out of someone, and it's always the common people, for the benefit of the rich.

[suffragette]

128. Exactly so. As long as it's a profit generator for these executives, they'll fight

Tooth and nail to keep the system as it is.

[JDPriestly]

156. You can have co-pays and still have Medicare for all.

I have co-pays now that I am on Medicare. They went up. Sometimes I pay a $20 co-pay for medications, sometimes $6. But very poor people should not have to pay co-pays for medications.

I'm pretty healthy, so I don't use many medications. Not as many as many people my age.

[lumberjack_jeff]

145. A system that emphasizes health rather than quarterly earnings would be an improvement.

I don't think people want more heart bypasses, more insulin and more emphysema therapy.

We'd like longer healthy lifespans. Frequent, ongoing primary care, as opposed to dramatic hospital intervention, is the key.

[JDPriestly]

158. I hate waiting in doctor's offices.

I had a condition for a couple of years that required me to go back and back and back to the doctor to figure out what was wrong. What a pain. I just hated it. A person who seeks medical care when he/she doesn't need it needs a more interesting life. Doctors' offices are uniformly boring.

I think that prior to the internet, people might have gone to the doctor just for social contact. Very unlikely today.

Maybe that is just my view. I think, however, that it is more likely that people will not go to the doctor often enough than it is that people will go too often.

Kaiser has a website on which you can look up answers to questions about your medical care. There is Med-Line (spelling??) and other similar reputable medical information on the internet. I think that the additional costs of overuse of medical services will be more than compensated for by increased efficiencies due to computers and better organization of medical data and medical records. Makes a little extra work for doctors at the moment, but saves it and prevents medical errors in the future.

I'm very optimistic about the future of medical care. Single payer would be great, but the big gains are going to be from greater investment in knowledge about the mind and disease and better communication between doctors and patients. That's my opinion. I'm very optimistic. I think medical care will get cheaper.

[Aerows]

92. I'd prefer people seek health care

when the health care they need addresses it before it becomes a full blown medical emergency that costs hundreds of thousands of dollars.

Because that's what you advocate when you say you don't want people seeking health care.

I mean, holy crap, people might actually learn how to better take care of themselves before they end up having a heart attack on an operating table. Gosh, how expensive it will be if people learn not to get sick and have preventative medicine to keep them well before they keel over and die.

Recursion, my friend, you have increasingly gone right wing, lately. I'm not sure why. Everyone is, of course, welcome to their opinions, but when I see a friend go off the rails, I'm going to speak up and ask.

[Recursion]

95. Huh? I want people to seek health care, but I recognize it costs money

Copays are a way to discourage insured people from getting health care to keep costs down. That's their point. It's why insurance companies (and Medicare) use them. (For that matter, if preventive care actually does end up costing less, why did it take a legal change to make insurance companies provide it for free? For all their flaws, insurance companies are pretty good at figuring out what things cost over the long term.)

I've never been fully convinced that accessible health care will end up being cheaper than people being sick and dying sooner. That is, I think we really are going to have to face that providing all the health care Americans need is going to end up costing more than we're paying now. I don't know that that's true but I definitely think it's possible. I know a ton of people who have avoided treatments because of money. I think it's tempting to simply assert that paying for those treatments will save money in the long run but I don't have any evidence that that is true and I think we should own up to the possibility that it isn't.

Personally I would like to see the FQHC system massively expanded rather than mucking about with Medicare; I think the problem is with the providers rather than the financing.

[Fumesucker]

133. If we just left people to die that's one thing, it probably would be cheaper to do that

But to a big extent we don't, we withhold medical care as much as possible until they are about to croak and then spend extreme measures extending their lives in agony and misery at great expense.

[Recursion]

134. But is that *actually* more expensive?

Last edited Tue Jun 30, 2015, 06:26 AM - Edit history (1)

I've seen ambiguous studies on that. Is it actually more expensive to let early interventions slip until a crisis? Insurance companies pre-ACA wanted to discourage nearly every non-emergency intervention from day 1, and had to be dragged by Obama care kicking and screaming into doing preventative medicine for free.

This suggests to me that they believe that putting off interventions until a crisis is cheaper; otherwise they would have been urging customers to do preventative care all the time rather than trying to avoid it. And figuring out what things cost is something insurers are very good at.

[JDPriestly]

160. Why do greedy people gamble?

Interestingly, doctors that I know like to care for their patients and want to give the best care possible.

It is when you get shareholders who want to make money off of their money and not from providing good service and caring for patients that you get all these complicated delays in treatment.

Maybe insurance companies refused preventative medicine because they figured they could collect the premiums for the insurance while denying care and then, if the insured became ill, refuse healthcare coverage somehow. It may also have been the case than when people became ill, they lost their jobs, could no longer afford health insurance and then the insurance company could keep the premiums paid while the insureds were healthy and avoid paying for medical care after the person was too sick to work. Don't ever underestimate the sheer ugly, inhuman, uncaring soulless beings who will do anything to make that extra dollar.

One of the good things that I experienced in single payer programs in Europe was the sense I had that my doctor was the decider when it came to what healthcare I needed and should get. That was the big benefit. The managers of the single payer system did not permit money to be wasted. But the doctors were more in charge of your medical care. Here, the insurance company may be deciding whether you get a medication or not. I suspect that the incentive to deny needed treatments has been reduced by Obamacare, and that is one of the reasons I support Obamacare.

Doctors should be in charge of health care decisions (with the patient of course), not a for-profit insurance company with its cold, financial calculations. I would probably not be alive today had a for-profit been making medical decisions about the birth of my second child. Nor would she. I never forget that.

[Recursion]

167. Is there a single payer program in Europe?

I cant think of a country in Europe that does single payer, but maybe Scandinavia somewhere.

Since there are in fact finite resources there has to be someone, somewhere, who decides whether or not person A should receive intervention B. The way we do it in the US is paricularly galling, but that decision doesn't go away just because you finance health spending differently. (e.g., a friend of mine with a rare disease that gets treated here but not in Australia recently traveled to Australia to lobby for them to add it to their NHS schedule.)

[Hestia]

182. This may help

https://en.wikipedia.org/wiki/Single-payer_health_care

...

Single-payer health insurance collects all medical fees, then pays for all services, through a single government (or government-related) source.[2] In wealthy nations, this kind of publicly managed insurance is typically extended to all citizens and legal residents. Examples include the United Kingdom's National Health Service, Australia's Medicare, Canada's Medicare, and Taiwan's National Health Insurance.

The standard usage of the term "single-payer health care" refers to health insurance, as opposed to healthcare delivery, operating as a public service and offered to citizens and legal residents towards providing near-universal or universal health care. The fund can be managed by the government directly or as a publicly owned and regulated agency.[2] Some writers describe publicly administered health care systems as "single-payer plans". Some writers have described any system of health care which intends to cover the entire population, such as voucher plans, as "single-payer plans",[3] although this is uncommon usage.

Another link: https://en.wikipedia.org/wiki/Health_system#International_comparisons

[Recursion]

184. I suppose UK could be called single payer, though that's not commonly done

That's usually just called "government operated". "Single payer" I've usually seen single payer meaning "entirely government run health insurance", which is relatively rare and, unless you stretch the definition to include the UK, unknown in Europe.

[JDPriestly]

157. A big challenge in our healthcare system if care for the mentally

ill and for drug abusers.

A single-payer system might make it easier to identify people with special problems and needs that require care for those kinds of problems.

Drug addiction and mental illness are medical problems, but more important, they can complicate the delivery of medical care. Right now, we tend to pretend that treatment for drug addiction is just making drugs illegal and keeping them from addicts. It's more complicated than that. Drug-seeking is a problem, a big problem in this country (especially in hospitals).

Mental illness makes the delivery of healthcare to its victims very difficult. It would be great if the mentally ill who are also, say, homeless, or estranged from family for some reason, could be identified in the healthcare system and treated perhaps by doctors specifically trained to communicate with them and treat them. Again, let compassion be the guide.

Just thought I would mention this.

[JDPriestly]

154. Some European countries use a lot more nurse practitioners than

we do. That will cover a lot of the added usage because that added usage is likely to be for care that can be provided by nurse practitioners, and their time and skills are cheaper than those of doctors. Doctors will like this because they won't be stuck dealing with minor conditions that are "boring" for the best of them.

We want Americans to be healthy. That's the point of health insurance. So more usage of the health insurance system if a good thing.

There is some although not a lot of efficiency gained when patients more readily seek medical care. Americans all too often delay getting care until their condition is really bad. Medicare for all discourages those delays.

In the US we have a certain amount of wasteful use of insurance coverage because people don't always have access to help lines, nurses lines, etc. that advise about whether a condition requires medical care or not. If we had Medicare for All, we could organize that sort of information to patients better.

My health insurance provider is Kaiser. I love it. They remind you if you haven't had the tests you need. They are really concerned about their patients. One of the doctors helped me avoid a rather risky operation by advising me of a remedy that was quite simple. He just told me I needed to do a certain thing to prepare for the surgery. That treatment solved my problem (a genetic problem that is not that common), and I did not need the operation. Getting medical advice early when a problem is developing may save a lot of expensive medical care later.

I lived in European countries in which I enjoyed single payer healthcare. It was organized in different ways. A real government-run single payer in one country, non-profits in another country. The services were paid for out of payroll taxes and those taxes were assessed as a percentage of the pay. The taxes seemed high, but we got a lot for it. (We were raising two children, and we could take them to the doctor as needed.)

I must say based on my experience that most working people will not seek medical care they don't need provided that those working people have adequate vacation time. In most European countries, mandatory vacation time is generous, so I did not see a lot of wasteful use of medical care. The exception was maybe gynecology. I could never be sure, but I suspected that some middle aged women back then were not working, were depressed and went to the doctor when they did not need to. I could be very wrong about that. I was young and just saw a lot of middle-aged women in the gynecology doctor's office. Maybe they were really sick. At the time, I had severe migraines and was treated in my doctor's office on occasion. I don't think overuse of medical services would be a big problem if we had real universal healthcare.

Obamacare is wonderful, but it is not universal healthcare. A lot of people are not eligible and/or cannot afford it, I understand.

We pay more per person for our health care than do Europeans who, as far as I can tell, have various forms of single-payer insurance.

One interesting note: In the European countries in which I lived, dental insurance was also single payer. But, in one country in which I had some work done, I was told that the actual work was covered but that, for many treatments, the anesthetic was not covered. You had to pay for that. I just thought that was kind of interesting.

We desperately need single payer dental insurance. Americans need dental care. But I suppose that the 1% will think that far too expensive.

I had two babies, both cesareans, in Europe. Great care. Especially in France where the doctors saved my life. I am not exaggerating. They saved my life and my baby's life. We had moved to France to take a job that did not materialize. If it had not been for the generosity of the French and their single-payer system and the Austrian system under which we were insured, we would have, I guess, both of us, just died.

So I support single-payer insurance. I believe it is scandalous, an insult to the goodness of the people of our country, that we do not have universal healthcare. I am pleased with Obamacare. I think it could be better if it were single payer, but let's take things one step at a time.

For me, single payer insurance means non-profit insurance. Not necessarily directly government-run, but managed hand-in-hand in a private, non-profit sector that is strongly regulated by the government. That is my concept.

Sorry for the long post, but you asked for detailed responses.

[LanternWaste]

189. You of course, have objective data to validate your allegation, yes?

"t's pretty clear usage will go up if user fees no longer prevent people..."

You of course, have objective data to validate your allegation, rather than a simple, post hoc ergo prompter hoc fallacy, yes?

[on point]

94. Not only 20% profit eliminated, but single payer is more cost efficient

By eliminating all the extra overhead of different forms, systems and companies that now burden health care providers

Also much of auto insurance is about who pays the medical bills in an accident now eliminated.

I am sure there will be other savings as well

My impression is employed Europeans pay about 100 per month and have a co pay of 10-20 dollars equivalent to keep the unneeded access down.

Perhaps some others from Europe can chime in on their costs to provide some reality

[Warren Stupidity]

115. I'm trying to keep it simple as possible as the op is determined to prove it can't work.

[on point]

119. Gotcha. Your initial point is sufficient, but there are additional arguments in reserve! :-)

[Cleita]

3. Not this again. It has been explained over and over.

All that money that insurance companies collect in premiums would go into single payer instead. Yes you would pay premiums for it. I have Medicare and my premiums are deducted from my Social Security. The great thing about it is that since it will cost half as much per capita for health care as we pay now it will be more cost effective, especially when bringing in younger and healthier participants who won't be using the system as much as the elderly Medicare recipients do today.

The rest of your concerns are basically Heritage foundation bullshit. All money going into medical care today will be diverted to a more efficient system of delivery and probably over time become less costly. Nothing will change as far as more taxes and the hair on fire scenarios.

[Recursion]

6. Most of the money going to insurance companies comes from employers, not workers

So, like I asked, do you raise a payroll tax? What level of premiums are you talking about?

[Cleita]

10. Yes you raise the payroll tax and the employers, relieved of the

burden of providing health insurance, will have to put that money into payroll. The money won't change just how it's distributed. It will be more efficient this way.

[Recursion]

12. This would make low-wage jobs more expensive for employers

Some people think that's a good thing, incidentally, so that's not necessarily a strike. But currently-uninsured positions would be more expensive for employers, which would discourage their creation (think McDonald's -- then again I'm fine with the argument that we should just let automation take all of the low-paying jobs anyways...)

[Cleita]

13. Yes. For once they are going to have to pay up. Incidentally, back in the day

when I had a small restaurant, I tried to get group health insurance for my employees, I was turned down because my industry was considered too risky and I didn't have enough employees. I wonder how many small business owners have this problem today? As far as the McDonalds of the world, it's time they stepped up to the plate and paid decent wages to their employees so that a PR tax for health care is not a burden to them

[Travis_0004]

140. Or they just automate a few more jobs

[Cleita]

141. They can. They already have. My job has pretty much been automated across

retail industry (bookkeeping). But there are just some jobs machina can't do.

[daleanime]

91. You do realize that you're on the 'better people die....

then cost me $' side of a fictional argument?

The reality is that the majority of people would save money over their lifetime, and would live longer and healthier lives.


But please carry on.

[Recursion]

186. No, and accusing anyone who talks seriously about how to pay for it of that

doesn't really help single payer move forward.

[yeoman6987]

19. Don't forget the secondary insurance

That is big time needed to cover what Medicare doesn't cover which is way more then the Medicare and covers less then Medicare but is definitely necessary or you would be in big trouble if something happens.

[Cleita]

23. They could do it without the secondary insurance and give full coverage.

However even with secondary, the Medicare program calls the shots so you don't get all the denied claims. When Medicare approves then the secondary has to follow suit. However I wish Medicare offered secondary as a choice. I'd gladly buy it because I'm sure they could offer it for half of what Blue Cross or UHC charges.

[yeoman6987]

24. That would be an interesting way to do it

Even young folks who have insurance from their employer could buy a secondary Medicare policy to pay the rest of the costs. That'd be great.

[Recursion]

27. France has a 30% copay with supplementary private insurance after that

Do we want that, or something more like Canada?

[Cleita]

47. I want something like Canada and 70% do, however, when France crafted their plan,

they knew they would not get the insurance industry out, so they came up with the compromise and I think maybe we could do something similar. However, France does pay 100% for basic primary care for people who are elderly, incapacitated, or otherwise too poor to afford insurance. The insurance companies can't touch that. Would our insurance companies be willing to do that?

[still_one]

5. It is a valid question. There is no single solution, and it has to be coordinated to be successful.

Allocating less to the defense budget and increasing taxes. (Easier said then done with this Congress)

It really isn't rocket science

[eShirl]

9. Raise taxes on the extremely wealthy people.

And since corporations are people, that includes extremely wealthy corporations.

[Recursion]

11. A dedicated levy, or a surtax into the general fund?

And how much?

I'm looking for something more specific than "tax the rich" and "health care will get cheaper".

[yeoman6987]

20. I thought we were doing that to cover the cost of college

And preschool education. Will there be any money left over from that tax on the wealthy?

[Erich Bloodaxe BSN]

44. They own most of the wealth in the world.

Ramp up the estate taxes and take it back.

[yeoman6987]

69. World? We are talking US

And college and preK will take up most of the increase.

[eShirl]

84. If not, their tax rate is ridiculously low for an advanced Western country, and needs to come up.

n/t

[mmonk]

15. The same way. Adding younger healthier people would bring medical costs down.

[Recursion]

16. How much? If it's not $750, roughly what is it? (nt)

[yeoman6987]

21. Elderly pay around 350 a month

Between Medicare and their supplement so I would say that is what it would cost for everyone most likely.

[Recursion]

25. $750. The difference is made up by the trust fund

See the links in my OP

[mmonk]

42. Your points do not invalidate mine.

[Recursion]

46. Right but the money has to come from somewhere.

And I'm asking where.

[aspirant]

81. Garnish your wages or maybe volunteer them

[mnhtnbb]

17. Give up subsidizing nuclear weapons?

For Pete's sake, this is an argument of priorities, not limited resources.

http://thediplomat.com/2014/01/us-to-spend-1-trillion-on-nukes/

http://www.ananuclear.org/weapons

[HooptieWagon]

22. A deduction, like SS.

And it likely wouldn't have to be very big. Currently there are multiple healthcare systems; VA, Medicare, Medicaid, and healthcare insurance bought by government employers at Fed, State, and local levels. This seems rather inefficient. A single payer system would likely save enough money to almost pay for itself. Imagine the budget savings to state and municipalities?

[Vinca]

26. The same way SS is funded.

When the profit motive is removed, an aspirin won't cost $10 in the hospital. It would be much more affordable than the current for-profit insurance system.

[Recursion]

28. Wait. What does this have to do with for-profit hospitals?

Single payer doesn't keep hospitals from being for-profit.

[csziggy]

114. Medicare is much more efficient at prosecuting fraud than insurance companies

Medicare has a fiduciary responsibility to reduce costs and one way is to reduce overcharging and fraud. Private insurance companies do not seem to be interested in doing either. Over and over I'd read of cases where patients have pointed out to private insurance companies that they were charged for tests or services not performed or over charged for simple supplies - and the insurance companies did nothing.

For profit medical providers might find that they cannot blatantly over charge if the health coverage was supplied by a Medicare for All system administered by the government. They would be much more closely audited (jobs for those people who had been submitting and re-submitting insurance claims!) and their fraud would be discovered.

[Recursion]

116. Insurance companies don't care how much they pay providers?

I have trouble believing that -- insurance companies also have a fiduciary responsibility, and fight with providers tooth and nail to pay as little as possible.

For profit medical providers might find that they cannot blatantly over charge if the health coverage was supplied by a Medicare for All system administered by the government.

I agree. They "might".

[Vinca]

122. If everyone is covered by the same system, it's much easier to contain costs.

A hospital may well be "for profit," but Medicare can say the going rate for a hip replacement is $30,000 and that's the way it is. I shopped around before having a hip replacement and hospitals charge anywhere from $20,000 to $100,000++. It's the latter hospital that is making healthcare unaffordable for the masses. If one hospital can do it for $20,000, there's no reason to throw in an extra $80,000 to increase the profit margin.

[Lint Head]

30. Cut the military budget in half and realocate the money.

[Recursion]

31. Which programs do you want to cut? (nt)

[Marr]

53. What *military spending* could be cut?

In a system where this happens:

http://www.military.com/daily-news/2014/12/18/congress-again-buys-abrams-tanks-the-army-doesnt-want.html

I doubt it would be very hard to find places where costs could be pared down. We pay for new jets we don't need, tanks we don't need... all sorts of gear that is primarily designed to funnel money to manufacturers... and that's not even addressing the money we all pay to deploy our forces into dubious engagements that only seem to service the investments of the same people who say we can't afford national healthcare. Domestic surveillance operations could do with a big audit as well, I should think.

[Lint Head]

192. Yes. We spend 800 times more on the military than all

other militarized countries in the world combined. Just spend 400 times more or 100 times more. We would still have the most advanced military in the world.

[truebluegreen]

58. All of them. nt

[Lint Head]

194. +100!

[Adrahil]

177. Even if we were to do that, that probably wouldn't cover it.

Also, that's a nifty soundbite, but what specifically would you cut?

[Lint Head]

193. Across the board.

[Stinky The Clown]

32. A tax that would save every American real money

Pay for it with a tax increase. The tax would be offset, almost always by a dollar amount greater than the new tax, with the removal of the cost for private insurance.

[Recursion]

33. Most of us don't pay 750/month for insurance

So you're assuming the premium will come down. How much do you think it will come down?

[Stinky The Clown]

48. Where did $750 come from?

Also, the actual rate tax (analogous to an insurance premium) will have to be determined by government actuaries.

In such a scheme, everyone is in the pool and the cost for older people is offset by younger people paying their fair share. It will be the lowest possible cost for the greatest number of people.

[Recursion]

52. $750 is the monthly premium for part A and part B

I posted the links in the OP. Most seniors pay a smaller premium because they are subsidised by the trust fund.

[truebluegreen]

62. ...for the least healthy portion of the population, just by virtue of age.

[Recursion]

76. So, how much less do you expect this to be?

I'm not asking for actuarial tables, I'm asking for an order of magnitude of what you expect.

[truebluegreen]

86. You are asking the wrong person,

because I for one do not care. It is the moral thing to do, and therefore we should do it...since we're the Greatest Country (and the Bestest Christian Country!) on Earth, Evah.

But in more concrete terms, I would expect a figure something less than half of the sum total of what we spend in this country already, divided by the population. There's your back of the napkin figure. Satisfied?

[Stinky The Clown]

124. I would agree with that - back-of-the-napkin-wise.

I'd guess someplace between 20% and 50% less

[Hestia]

183. Some facts

July 2013: Economist Gerald Friedman, Ph.D., University of Massachusetts, Amherst

“Under the single-payer system created by HR 676 [the Expanded and Improved Medicare for All Act, introduced by Rep. John Conyers Jr., D-Mich.], the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else.

“Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014.

“Health care financing in the U.S. is regressive, weighing heaviest on the poor, the working class, and the sick. With the progressive financing plan outlined for HR 676, 95% of all U.S. households would save money.

“HR 676 would also establish a system for future cost control using proven-effective methods such as negotiated fees, global budgets, and capital planning. Over time, reduced health cost inflation over the next decade (“bending the cost curve”) would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.”

Excerpted from “Funding HR 676: The Expanded and Improved Medicare for All Act, How we can afford a national single-payer health plan,” July 30, 2013.

http://www.pnhp.org/facts/single-payer-system-cost

You know, you can go look all this up for yourself

[csziggy]

118. Oddly, if you divide the $9000 per person the US spends on health care

By the US population of about 320 million (See my post below for the sources of that information.), it comes out to $750 per person per year. And to $62.50 per month.

Right now with my ACA subsidy my husband and I are paying $165 per month - the subsidy is just under $1300 per month.

Even with the 20% profit the health insurance companies are guaranteed, that is still higher than the cost of health care per capita indicates health insurance should be!

[DanTex]

34. Payroll or income tax, basically.

In broad terms what would happen is that the money that businesses now spend on health benefits would instead go to the government to pay for medicare. Whether it's payed by employees or employers doesn't matter much.

[Recursion]

98. Well, it matters to the employee and the employer...

Let's say the $750 premium goes down 50% if we include the entire population. I've never paid close to that much for insurance, so this would be a huge increase for me. I have no idea what my employers have paid for my insurance (that's in the W-2 now, though, IIRC); that's about $4K per year. If that's less than they were paying for insurance, win-win. OTOH lots of employers still pay $0 for insurance (plus whatever the ACA fee is -- is it less than $4K?)

[DanTex]

109. According to the standard economic theory (which I think is accurate in this case),

it wouldn't matter. If the employer pays the tax directly, then the salaries will be lower. If not, the salaries will be higher.

The other thing is, if it were a payroll or income tax, it would be probably based on a percentage of income, which would have a redistributive effect.

For example, let's say that right now every employer pays $750 for the healthcare of each employee. That $750, although invisible to workers, is part of the total compensation. Which means that, if they didn't have to pay healthcare anymore, they'd have an extra $750 per employee, which assuming competitive markets would result in a raise of $750 per employee.

Then comes the medicare tax. This would average out to $750 per employee across the economy, but higher-paid workers would end up paying more of the tax. So lower paid employees would benefit: they get paid $750 more, and pay some of it back in taxes but not all. And on the higher end, it would be the opposite, a raise of $750, but more than $750 in new taxes.

So that's the general idea. Workers who's current employers don't provide health insurance will see a tax increase with no corresponding increase in wages, but they will also get health insurance rather than having to pay for it themselves.

There will be some people who lose out in the deal, without doubt. If you currently pay for non-employer-based healthcare and you earn enough so that your share of the new tax will be higher than your current rate, then you lose money. Also, people who currently get healthcare from employers, but make large salaries, will lose out because they will be subsidizing lower wage workers.

Of course, there are a lot of assumptions and variables. It would depend largely on how the tax is implemented. If they cap it like SS that could greatly reduce the redistributive effects. I don't know how this works in other countries. Looks like $750 a month per capita would come out to an 18% income tax, and I'm pretty sure people earning $10M a year would cry foul if suddenly they have to pay $1.8M per year for healthcare.


One more thing on edit. $750 seems like a reasonable ballpark for the per-capita cost. According to my brief googling, healthcare costs in the US are about $9000 annually per person, which comes out to exactly $750 per month. This also means that $750 per month is probably a reasonable estimate of what employers pay for healthcare in the status quo on average. Maybe a little lower because of copays and other things, but ballpark.

[MineralMan]

35. Single pool; single payer

Birth to death universal coverage, with premiums following standardized age related policies. After age 65, premiums are based, as they are today, on subsidized standards. Premium subsidies for people in poverty and at some multiple of poverty level, based on standard poverty level criteria. Employer pays a portion of the premiums in a percentage to be set by law. Everyone is in the system, nobody gets to opt out. Period.

Then, have the single payer limit maximum payments for services delivered. Pharmaceutical prices based on similar pricing as negotiated by the VA. Again, subsidized payments for elderly and poor, and support for new pharmaceuticals with a maximum out of pocket limit. Profit limitations on major providers like hospitals with incentives for non-profit providers.

The calculations would be complex, but are already being done by private insurance companies on a smaller scale.

I think this would reduce the average premiums to affordable levels. Taxpayer funding for subsidized premium support.

Those are the basics of how I'd do it.

[Recursion]

40. Why can nobody give a number here?

Has Brookings not studied this? Has anybody?

[MineralMan]

45. The reason there are no numbers is that there is not

a solid framework for the system yet. There have been any number of possible arrangements proposed. It would be possible to do a calculation about premiums for any completely configured system, and impossible otherwise.

There are too many question and too many variables for a simple answer to be possible.

I'm sure it has been studied and calculated, but based on parameters set by someone. Can't understand it without a fully specced-out system.

[taught_me_patience]

65. Vermont calculated it

To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion.

Shumlin’s office estimated the state would need to impose new personal income taxes of up to 9.5 percent, on top of current rates that range from 3.55 to 8.95 percent. Businesses would be hit with an 11.5 percent payroll tax, on top of 7.65 percent payroll taxes employer pay for Social Security and Medicare.


https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-single-payer-health-plan/VTAEZFGpWvTen0QFahW0pO/story.html

[Erich Bloodaxe BSN]

49. Why do you expect us to have a number you don't have?

Do you expect that we have some special 'in' that isn't available to you? If Brookings or somebody else has studied this, why are you asking us and not going out there and looking up that data yourself? Is DU your personal research staff? Are you paying us to look things up for you?

[MineralMan]

51. None of us here is even close to competent to figure this out.

That would take a serious team effort, and that costs $$$.

[Erich Bloodaxe BSN]

54. I actually think there are probably plenty of folks who could do a competent job, given the data

but as you say, it would take time and money.

[Recursion]

55. How can you advocate a policy you have no numbers on?

I'm not even sure what that means. "I want a large budget change that I can't actually specify"?

[MineralMan]

64. Because we're already paying for it anyhow.

By removing part of the profit motive and equalizing or evening out the cost across the entire population, there would be savings. No doubt about that at all. Even just moving administration into a single, non-profit government entity, rather than multiple, for-profit entities, the savings would be considerable.

There's no doubt we could save money and deliver more heathcare to more people with something like Medicare for all. But, a comprehensive single-payer program could do even more. By controlling the amount paid for services, rather than having multiple pricing strategies for each provider, we'd also realize economies.

The current system, if you want to call it a system, is so fractured and uneven in its distribution and costs, that any centralization would have obvious benefits. Other nations have done it successfully, so we have multiple models to examine.

Single payer healthcare delivers better care for less cost. How much better and how large the savings depends on how the system is configured. Any number about individual cost is useless unless the parameters of the system are completely known. They are not known, so no numbers can be provided.

You're asking for a number that can't be calculated with such a limited amount of information as simple "Medicare for all."

[Erich Bloodaxe BSN]

82. I advocate not going 95 mph on the highway.

But I don't have the numbers to tell you how many more people will die if we raise the speed limits to 95.

But I suppose you're 'not even sure what that means', since I don't know the exact number of extra deaths that would result.

[merrily]

36. again, you are using the cost for elderly and disabled. For younger people, it's closer to zero a

year than it is to over 700 a month.

Typical.

[Recursion]

37. Why is it so hard to get a damn number here?

How much lower do you think it will be than $750?

[MineralMan]

41. It's impossible to say without doing the calculations, and

those can be done only after setting up the parameters for the entire system. Too many variables until all the parameters are set.

[Recursion]

43. What the hell are we talking about then?

If there isn't even a cocktail napkin scoring associated with this, why does anybody expect people to take it seriously?

If people can't do more than a hand-waving of "it will be less, really" then how is this idea ready for prime time?

[MineralMan]

50. Frankly, it's not ready for primetime.

It's an interesting idea, of course, but would take a serious effort to come up with a complete system layout. That costs money.

If you want a bottom-line price per person figure, get the total paid out annually for healthcare in the United States and divide that by the population. I don't have those numbers, so I can't do the calculation. However, if price controls are part of the plan, the total healthcare cost number might change dramatically. Delivery by non-profits exclusively would lower the cost. But that's not how it works now. An age-related cost structure would, of course, make an average number useless, and that would probably be part of the equation.

Again, too many variables. It's way complex.

[tkmorris]

72. And thus you reveal your true purpose

As has been pointed out to you repeatedly, there is no one single methodology of achieving "Medicare for All". There are as many ways to achieve it as there are angels on the head of the nearest pin, and there will not be any specific, detailed answers to your questions until an actual plan is decided upon. Even then there will be some fuzziness because while it is reasonable to assume a certain measure of savings per capita when compared to current costs it is not possible to know what precisely those figures will eventually be.

Personally I think all of this misses the point by the proverbial mile. The real question is "Can we do it?", and since we can look around and see that virtually EVERYONE else in the Western World already has done something similar the answer to that is obvious. So then we are left with "Why shouldn't we do it?"

The details are not important, not now. We know enough to be able to ballpark what it will cost with enough accuracy to begin the process.

[Recursion]

73. Single payer is very rare among industrialized countries

Most countries either have a national health system or a hybrid public/private system. Canada is very much an outlier.

[merrily]

56. You got a number in my prior post. Health care for most 22 year old costs next to nothing a year.

If you want exact figures, call the Congress. No one supplies me with the data anyone would need to come up with a firm number. But I know it doesn't cost the same for a disabled person or an 85 year old as it does for a 21 year old. Why is it so hard for you to acknowledge that? Why do you keep using the highest possible figure?

[Recursion]

57. Because I want to know how much less it will be

I even said so in the OP.

Do you want age-tiered premiums?

[merrily]

61. YOU want to know how much less it will be, so I have to tell you?

Surely, you see the logical flaw.

BTW, this is a message board, where people post for free, not the Congressional Budget Office.

[taught_me_patience]

66. Because it is really expensive, as Vermont found out

https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-single-payer-health-plan/VTAEZFGpWvTen0QFahW0pO/story.html

To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion.

Shumlin’s office estimated the state would need to impose new personal income taxes of up to 9.5 percent, on top of current rates that range from 3.55 to 8.95 percent. Businesses would be hit with an 11.5 percent payroll tax, on top of 7.65 percent payroll taxes employer pay for Social Security and Medicare.

[taught_me_patience]

70. That's about $575/person/mo

Vermont's population is 620k and the cost is $4.3B. I think that includes the cost of medicare. If it doesn't, then 16% of the population is over 65, so the cost/person is $690/mo.

[Recursion]

74. Was the VA going to keep operating in VT?

I don't remember from their proposal

[bornskeptic]

162. Current spending on healthcare in the US is around $3 trillion.

That comes to about $9000 per year per person. That's $750 per month, so $750 might be a pretty good estimate. Actually the average cost for Medicare enrollees is considerably higher than that, since Recursion's $750 did not include the cost of prescription drug coverage and supplemental insurance. Even if we could get per capita cost as low as it is in other developed countries, it would still be around $500 per month.

[merrily]

163. Other nations spend much less and get much better outcomes.

For what we spend, we are getting some of the worst health care in the industrialized world.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=6923691

[merrily]

165. This article is a few years old. However, aside from inflation, I don't think

all that much has changed.

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

Our system has been broken a long time, both independently and in comparison with other nations. It has cost us a lot in every possible way. However, we've had a stubborn resistance to fixing it. Obamacare helped some, but we have to do better.

[Adrahil]

178. We spend SO MUCH on end of life care. n/t

[Erich Bloodaxe BSN]

39. Let's see, how can we raise some money...

1. Slash the defense budget in half. Axe the F-35, get out of foreign adventurism, close some foreign bases, and get out of the 'world policeman' business, and into the 'part of joint UN projects' one.

2. Make the estate tax graduated, so that it's 50% above 2 million, 60% above 5 million, 70% above 10 million, 80% above 25 million, 90% above 50 million. Do the same with the income tax.

3. Remove the cap on SS.

4. Transaction tax on all equity trades.

5. Tariffs on products made by American companies that are made offshore and imported back into the states.

6. Extra taxes on American companies with more employees overseas than in the US.

That probably puts enough money in the coffers to do a few things with.

[Adrahil]

59. $750/mo per person? Seems like a lot.

My insurance is about that for our whole family, counting my own contribution and my company's share.

[Recursion]

89. The Medicare population is mostly old

So it's going to be less than $750 if it is applied to everyone. (But how much less?)

[Adrahil]

99. I dunno... maybe that's right.

I did a quick back-of-the-envelope calculation based on annual expenditures, and it came in not far from that. Even assuming some elective procedures not being covered, it probably wouldn't be much cheaper than $500/person.

We really need to figure out how to get end-of-life care under control. I bet that drives the number up pretty considerably.

[Recursion]

100. Medicare doesn't cover long-term and end of life care, and the $750 doesn't include drugs

Right now the way Medicare handles end-of-life care is by paying for IIRC three weeks of it, then requiring the family to sell all their assets until they are poor enough to be on Medicaid, at which point Medicaid pays for it. And then if the estate has anything left, in many states Medicaid becomes a claimant against the estate.

Yeah, we need to do better.

[Adrahil]

104. My estimate came in higher than your number.

My guess is a big chunk of that is end-of-life. I just read a study that says that Medicare spends about 25% of it's budget on the 5% of beneficiaries who die each year.... and that's WITH the limit you spoke of.

That's clearly not sustainable for a public health system. I'm not sure what to do about that. I'll see what I can out about how other countries do it.

[Recursion]

106. Other countries are a lot less heroic with some interventions

However, so much as tip toe near that idea and ZOMG DEATH PANELZ!!!

[bornskeptic]

164. You have extremely inexpensive insurance then.

My insurance, including my share and my employer's share, is about $1300 per month. That's for my wife and me. It would be a little more if we had children.

[Adrahil]

175. I was Wrongy McWrongikins.

Your post made me go back and check and I was WAY off.

Total between me and my employer for me+family is $1500/mo. Don't know what I was thinking.

[orpupilofnature57]

60. What we're going to paying pharmaceutical megalopolis those and their off-shore money should, WHO

would work toward holding their feet to the fire instead of kissing them, you got it .

[gollygee]

63. I'll just leave this here

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/

We spend a great deal of money on healthcare. We don't need to spend more money. We need to change how the money is specifically gotten - stop taking it from one place and take it from another place instead - but we don't need more. We need to rearrange how we're getting it and how we're spending it.

For instance, if my husband and I stopped having the money taken out of my husband's paycheck for our contribution to our insurance, and started paying it in a tax instead, it would make no difference to us. If his workplace stopped paying their contribution to the insurance company and paid it in a business tax instead, it would make no difference to them. The money is out there.

[Hoyt]

67. Sad fact is, if you cut out the overhead -- which won't be easy -- the resultant premium or taxes

applicable will be so much that people will still gripe, especially when you add in drugs and nursing homes.

And, it will be worse without a system of utilization review, developing drug formularies, etc.

You've got to have an infrastructure to do this, and the Medicare system doesn't have that. Heck, Medicare uses insurance companies to pay claims, enroll providers, do a little utilization review, run the Part D Drug program, etc.

I'm for a universal health system, although I think a few large insurers and a robust public option might be the way to go for awhile. But, I'm not opposed to Medicare for all, but it's going to cost a ton and produce a lot of complaints.

People are gonna gripe, and the first time the government says, "Nope, we are not paying for that treatment, it costs too much compared to the benefit," folks are going to go nuts.

We have to change our system, and as patients, we have to change our expectations.

[Adrahil]

110. I find myself in broad agreement with you.

I'd like to see a move away from employer-based health care. The only way to do that, of course, if "transfer" the expenditures of employers and employees on health insurance into the new system.

You and I both know that this will (or at least would) be cast as a massive tax increase. And many employers would try to game it so that weren't transferring their contributions to the new system.

Ugh. Depressing.

We DO need a public option available nation-wide, though.

[samsingh]

68. stop letting repugs steal money for their corporate masters

[Cleita]

79. Ding..ding...ding!

Yes, you are right.

[LonePirate]

71. I would implement all of these changes

1. Convert all current employer/employee insurance premiums to the new system via a new fee/tax.
2. Increase the current Medicare payroll tax to at least 3% and make it progressive (such as adding 2% for the first 0 added above $100K with the rate doubling for each 0 added).
3. Institute a new Medicare tax on non-wage income of at least 5% so that grifters like Romney will be required to chip in to the system. Make it similarly progressive as well.
4. Eliminate carried interest and raise the capital gains tax rate.
5. Allow the government to negotiate drug prices (although this may be implied).
6. Train more military medical personnel and have them work at centers across the country while we are not at war in order to help eliminate staff shortages.

[Recursion]

83. Thanks

1. Convert all current employer/employee insurance premiums to the new system via a new fee/tax.

There are vast differences in what different employers and employees pay. Do you want to "freeze" current contributions, or even them out?

2. Increase the current Medicare payroll tax to at least 3% and make it progressive (such as adding 2% for the first 0 added above $100K with the rate doubling for each 0 added).

I like this idea. Currently Medicare and SS are funded regressively with the cap; even just making it flat would be an improvement, though I more or less understand the political history of why it is how it is.

3. Institute a new Medicare tax on non-wage income of at least 5% so that grifters like Romney will be required to chip in to the system. Make it similarly progressive as well.

ACA already did that, didn't it? (It's not progressive, but unearned income is now levied for Medicare.)

4. Eliminate carried interest and raise the capital gains tax rate.

I'm all for it. How much does it raise? And would that just go to the general fund?

5. Allow the government to negotiate drug prices (although this may be implied).

This. Yesterday.

6. Train more military medical personnel and have them work at centers across the country while we are not at war in order to help eliminate staff shortages.

This gets closer to my ideal which is to expand the VA and FQHC system; I think we should look at that more than social insurance, personally...

[NCTraveler]

75. Seperate line item federal tax on income.

Progressive in nature.

[Recursion]

78. Interesting. Most of our other social insurance is funded regressively

But I agree it would have to be a separate line item going to a separate fund to keep Congress's hands out of it.

Personally I would like a carbon-focused VAT, but that's an idea that's not going anywhere...

[polichick]

77. Stop robbing from the people to fund fake for-profit wars...

and spend the peoples' money on the people.

[Warpy]

80. Lifting the laughably low cap on taxable earnings is a start

Wages also have to rise. Rising wages means rising revenues, both income taxes and OASDI and Medicare premiums.

Return it to pay as you go. Get Congress's mitts off any surplus.

Medicare is already insuring the most expensive population, the old folks. Expanding the pool to the young and relatively healthy is not going to be massively expensive. If premiums rise, they won't rise by much.

[Recursion]

85. If wages had kept up with productivity we wouldn't have many problems

However that disconnect has happened throughout the industrialized world, and the rest of the countries still managed.

[Warpy]

107. Yes, the PTB kept wages low because they were afraid of inflation

and issued credit to make up for that so we'd continue to buy their crap at inflated prices.

Now we're in the end game, servicing the debt accrued has prevented people from buying anything, wages are going nowhere, and banksters are starting to panic. Low wages, in the meantime, did nothing to curb inflation because they didn't cause it.

We're about to live in interesting times again.

[guillaumeb]

87. The same way that it is done in Canada.

All Canadians receive a health benefit card and use it to prove eligibility for services. There are no co-pays and other US style hidden costs. (In B.C. there is a premium surcharge)

The Canadian system provides better care and access to care at about 40% of the US cost.

It is funded by taxes. Each province sets a spending amount, and prices are regulated by the government. That is why drugs are much cheaper in Canada, and doctors generally make less than their US counterparts.

The only people who lose out in the Canadian system are the insurance and pharmaceutical companies.

[Recursion]

88. Canada also has premiums in some provinces

Ranging from $50 to $200 per month.

Interestingly, how Canada did it was by mandating the provinces do it. Are you suggesting we mandate the states provide a Medicare system?

How much do you think the tax increase would be to do this? Vermont's was going to be pretty big, and that's a relatively rich and healthy state.

[guillaumeb]

93. I did mention the B.C. premium/surcharge.

Manitoba was the first province to implement province wide health care and that was followed by country wide care. each province sets a budget, but your card works everywhere.

The Canadian tax rates equal about 40% of income vs. about 28% in the US. Plus each province imposes sales and services taxes.

In addition, the rich are taxed at a higher rate than in the US.

So more taxes, especially on the rich, but better services and "free" healthcare. Imagine that! That spending more on actual service and less on insurance company profit leads to a better outcome.

Plus, if over 60% of US Federal taxes did NOT go to the war machine there might be more to spend on things like healthcare, infrastructure, and education.

[Recursion]

96. So you're talking about (roughly) a 10% tax increase

if we're going to be roughly like Canada.

Thank you. That is the kind of thing I'm looking for. I want to have some sense of what scale of taxes we're talking about.

[guillaumeb]

102. Plus so much depends on the wording.

People in the US seem to hate the word taxes. But insurance premiums in the US are not called taxes. Co-pays and deductibles are not called taxes. Paying much more for medication is not called taxes. But they are part of the costs of healthcare. (And dying for lack of access to healthcare does not count in this equation.)

The point is that total costs for healthcare are much higher in the US than in Canada.

[Recursion]

103. And most of us have no idea how much our employers contribute to our insurance

I mean, I know it's on the W-2 now but I don't think I even bothered to look.

The point is that total costs for healthcare are much higher in the US than in Canada.

Which is why my inclination is to look at providers rather than financing, but finance reform (single payer) has sucked all of the oxygen out of any other aspect of healthcare policy...

[Rosa Luxemburg]

90. The more you earn the more you pay

not a flat rate. It would depend on income?

[Kalidurga]

101. Cut the military budget in half for one.

400 billion would go a long way to providing medical care for 40 million US citizens. The thing people are not talking about is having medicare for all doesn't mean free health care for 330 million people. Most people already have insurance, so the increase in costs for people already insured will be minimal if there is even an increase there. So let's call the increase in spending 288,000,000,000 billion dollars for the 40 million that are currently uninsured, even though it's likely to be only a fraction of that. You're welcome.

[Recursion]

105. So Medicare would be like a Federal public option there?

That's interesting... I don't think I've seen anybody propose that. Is there still an employer mandate for insurance?

[Kalidurga]

108. Yes, exactly

I had no idea no one else proposed that. I think it should just be a tax that comes out of your check like social security. If you are not working because of a disability or age then you are covered how ever Medicare is covered. I don't think it should be insurance per se, but a mixed system would be alright by me. I don't care as long as everyone has access to medical care and fewer people need medical care because we aren't blowing them up and our citizens aren't getting shot at because they aren't on some useless imperialist mission.

[GeorgeGist]

111. Per capita spending on healthcare in the US is over $8000/year.

I think that should cover it.

[Recursion]

112. But it's not the case that every person is spending $8000

Whom do you expect to pay for what?

[csziggy]

113. We as a nation are already paying for health insurance

But much of what we are paying goes to for profit corporations, either in the medical or the insurance industry. And with the system we have now, health care is provided unevenly and for too many people not at all.

The US spends more per capita than nearly every country in the world - $9,146 in 2014. Only Norway and Switzerland are higher, according to the World Bank. http://data.worldbank.org/indicator/SH.XPD.PCAP?order=wbapi_data_value_2013+wbapi_data_value+wbapi_data_value-last&sort=asc

Our population is just under 320 million (2014 - 318,857,056: http://quickfacts.census.gov/qfd/states/00000.html) so that is $2,880,000,000,000 per year and going up.

Right now that money is paid out by an unwieldy combination of public, private, employer supplied, individually enrolled, Medicare, Medicaid, VA, and straight out of pocket. Just simplifying the system so that medical providers don't have to employ large staffs just to wade through the various insurance systems would save billions. Insurance companies (since ACA) take about 20% just for profit - Medicare is about 5% (from memory, maybe not accurate) so right there is another 15% savings.

With a unified system, everyone would pay in according to some formula for assessing a percentage of income. Everyone would have access to basic healthcare so they would get better preventative care. That would reduce future health care costs overall.

Right now Medicare is taken from paychecks against future need at a rate of 2.9% (half paid by the employer, half by the employee) - that money would go into the general medical care fund. The amount paid by the Veteran's Administration for healthcare for retired military would go into it. The amount the US government now pays for their employees would be added in - same for every state, county and municipality. If every working person paid two times that percentage to cover their current and future health needs - without having to also pay for an employer selected policy that is subsidized by the federal government - they would likely be happy once they understood the advantages.

The money is there but far too much of it is sucked up as profits by insurance companies, or by overcharging by privatized medical systems, or by the ungainly bureaucracy required by the many different forms of coverage we now have.

[Recursion]

117. Medicare for all doesn't touch the providers' profit, which is where I think the problem is

I still think the finance side is the wrong direction to come at this from.

[Zorra]

120. Something similar to the way all the other industrialized countries of the world do it. nt

[Recursion]

121. That's about 50 different ways, each with their own pros and cons (nt)

[Yo_Mama]

125. Excellent post, but you aren't going to get many to engage with it.

We would need an additional 10-12% payroll tax.

That's why people won't engage with it. The German payroll tax to fund healthcare is about 15% (it was cut to 14.5% as a result of the GR) and is now 14.6% plus a surcharge of 0.9%, so 15% is close enough.

As an aid to this discussion, here's a Wiki link going through payroll taxes in various nations:
https://en.wikipedia.org/wiki/Payroll_tax

People want to believe they can get all this for free, but they can't.

[WinkyDink]

130. Quite the comment, for being the 125th.

[Recursion]

132. 12% is what I keep coming up with

Which is a hard sell, and we need to face that fact.

[JEB]

136. I spend more than that for health insurance

that I can't afford to use.

[Recursion]

138. Your insurance costs 12% of your gross pay?

One thing I've really learned here is how crazily variable this is; that still just sounds crazy to me. Even when I was delivering pizza it only cost me like $50 per month to do an HMO.

[joshcryer]

144. Vermont couldn't implement single payer for that reason.

They were going to have to raise the payroll tax a lot.

[Thinkingabout]

127. Before really proposing national health care one needs to produce ways to pay for

The for a national health insurance. This will be worked out one day by careful planning.

[WinkyDink]

129. Is the Defense budget "a designated levy"? See how it can work now?

[Recursion]

131. No, which is why it's a political football and the Army gets howitzers it doesn't want

but can't afford to armor the Humvees.

[Paulie]

135. The Federal government is already spending 1.1 Trillion annually

On just Medicare and Medicaid.

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html

Private insurance is spending another Trillion annually.

Roll in the VA and there is a lot of money. If they need more, just print it.

[Recursion]

137. So $1.1 trillion covers 1/3 or so of the population

55 million on medicare; 67 million on medicaid (dual eligibility means some of those are the same people) and 5 million in the VA; call it 110 million unique people.

So that's about 60% of total US medical spending being public sector, covering about 33% of Americans (generally they are the most expensive Americans to cover so that's not as weird as it sounds). But we're still talking about at least doubling what the government currently spends on health care if we expand that to everybody. And that doesn't even get in to the 15 million undocumented immigrants...

[Paulie]

139. Plus the money currently being spent on private insurance

That instead of going to insurance conpanies then to providers it goes into the system.

[riderinthestorm]

142. .003% transaction tax on every $100 stock trade

that would actually fund a great many other things as well as Medicare for all.

[Hekate]

143. How about one Trident missile out of the military budget? or even two?

The tiniest sliver shaved off of that hideously inflated entitlement every year would do it handsomely and the Dept of Defense would scarcely notice it after the lobbyists stopped having their tantrums.

The point is, this is not a zero sum game for all the programs that make life better unless we allow it to be. WE HAVE THE MONEY. We just have to reallocate some of it.

[lumberjack_jeff]

146. How do we pay for the system we have now? It costs 17% of gdp.

Medical care in this country costs each of us $9000 a year.

It'd be pretty tough for any replacement system to fuck that up.

[Cleita]

147. That money is not being used efficiently for health care.

It's funneling into the coffers of those who steal it from us. If we take control medical care will cost us less than half of your inflated figure.

[Rex]

148. Rainbows.

[McCamy Taylor]

149. First, we do not collect a voluntary premium. We make it a tax.

Then, we copy the health care systems of Canada and France that spend less that half per person per year to get results that are much better. Because with cradle to grave single payer, the single payer will invest in disease prevention. Universal health care at age sixty five is foolish, because you do not get a Chance to prevent disease, you only treat the costs of failing to prevent disease.

[Recursion]

150. Canada and France have very different systems. We can't copy both

Canada has a Medicare system run by each province and paid for by a combination of premiums and a payroll tax. France has a national insurance that pays for 70% of medical expenses and a private insurance market to cover the remaining 30%.

[JonLP24]

151. I'd let the Libertarians decide

a joke based on the gentrification thread from a Libertarian who wrote the article focusing on labors costs & cost of construction instead of demand as to housing prices.

[JDPriestly]

152. Instead of paying your insurance premium to a private company,

you pay it to a non-profit or perhaps government-run or government-sponsored company.

We used to have mostly non-profit health insurance. There was I believe always a little for-profit health insurance on the market. That changed maybe in the 1970s and 1980s, maybe even later. I recall having non-profit insurance when I was young.

The administrative costs for Medicare are, I read a few years ago, lower than for private health insurance premiums.

One requirement is that everyone has to have either the Medicare for all or a private insurance policy. That is important because it should not be up to hospitals and caregivers to have to figure out how to pay for the medical care of the uninsured.

So it's really a no-brainer.

Medicare for all simply moves the money paid to the private sector for health insurance into a single-payer fund.

[Recursion]

168. All my insurance has been nonprofit except one

It wasn't particularly cheaper.

[merrily]

153. As a society, we are already paying for Medicare for All, or close to it.

Whether Emergency Rooms and other providers absorb some of the cost, or highly profitable insurance companies absorb some of it, or people pay out of pocket or do without. Medicare premiums, which are required by law, also help pay.

As a society, we pay more for health care than other nations, yet have worse care than many nations, so we also pay via a sicker population.

As a society, we also find a way pay for whatever we decide are our priorities. Our military contractors seem to be a priority for which we always have many millions. We don't even end a contract for already obsolete equipment and aircraft. Somehow, we find a way to pay for crap we already KNOW we can't use.

After 911, we somehow found a way to pay for massive new NSA and Homeland Security operations, on top of all the "defense" and intel we already had before 911 in the Pentagon, the FBI, the CIA, the Secret Service and on and on. No one worried much how to pay for the Patriot Act or the Iraq War before mandating them. We still seem a lot more worried about the political ramifications and optics of those than we are about paying for them. We also found a way to pay for Obamacare, which, overall, is more costly to society as a whole than Medicare for all would be, including employer and individual mandates.

If we really want Medicare for All, we will find a way to pay for it, maybe more than one way. If we really don't want it, we'll pretend a way to pay for it is what is standing in our way.

[eridani]

155. Really dtupid question, given that we pay twice per capita what other developed countries pay

We just spend the money on providing health care instead of insurance company profits and administrative bullshit.

[Recursion]

169. Norway spends more than us per capita

Though they get better results for it.

Currently we find health care through an absurdly complex variety of sources: employers, workers,private insurance, and public spending. You can't just say "we spend the money in one place" because "we" aren't spending the money right now; a bunch of different groups are. Do you want to tax individuals? Businesses? At what rate?

[JustAnotherGen]

159. If you want Medicare Insurance

You should be able to check a box through payroll. Start there. Currently working - healthcare through employer is 6K a year - pooling resources with 40 million people as opposed to 140K people - when you use less and John uses more - increases the fund. As well, it needs to be based on income. You make 100K a year - you pay more into the fund than someone making 25K a year.

You shouldn't be dependent on an employer for health insurance. The only way you can take it with you when you go is through general Medicare.ive had USAA Auto insurance since 1989 - just considering post college - Ive had five employers. My auto insurance hasn't had to change once.

I want the same deal for health care coverage - and the only way to keep costs of the plan down for those with less is to increase the size of the pool.

Another way - make just a few simple plans - but levy a service tax on high earners. OP uses Canada's 2% payroll tax - I could 5-10% - to offset costs for a woman making less. She pays 1/4 %

[99Forever]

166. Precisely what the fuck is your problem with everyone having access to decent health care?

How to pay for it? Tax the fuck out of the 1%. Problem solved. Next stupid fucking question.

[Recursion]

170. Precisely what the fuck is your problem with paying for Single Payer?

I'm starting to doubt how serious people are about single payer given how pissed they get when someone asks how it's going to be paid for.

Tax the fuck out of the 1%

I thought we were doing that to pay for college.

[99Forever]

171. I told you how to pay for it.

That it doesn't please you is irrelevant. Now answer my original question, precisely what the fuck is your problem with everyone having access to decent health care? And quit dodging it.

[Recursion]

172. Nothing. I'm for it

That's why I'm asking how people want to pay for it.

[99Forever]

173. And I answered it.

We can afford whatever the war machine wants to blow hundreds of billion$ pouring into the latest high tech killing device or fun toys for the asshole generals desire, we can damn sure take that black hole of waste and spend it making We the People's lives better instead. Cut the military budget by 80% and we're STILL over-spending.

[Romulox]

181. He's trying to be this board's "freakonomics" guy. It doesn't work very well. nt

[riderinthestorm]

188. +1. He's blowing by answers up thread. I proposed a financial transaction tax (FTT)

crickets...

[B Calm]

174. Tariffs

[WDIM]

176. Take all the money we spend bombing and killing

And pay for peoples healthcare instead.

[Romulox]

180. Like every other developed country on the planet. Next silly question? nt

[Recursion]

185. That's about 50 different ways, each with their own pros and cons

Which one do you want?

[Romulox]

190. None of which are possible here, we are to be assured! We get your schtick. nt

[Recursion]

191. Most of them are, but advocates need to get behind one

Simply raising a "change things!" banner is essentially useless. Personally I think the Netherlands probably offers the easiest transition model for us.

[Orsino]

187. Tax the rich.

I'm more worried about the employment crisis that will ensue, and suggest that we move as many insurance employees as possible into federal jobs in Medicare billing.

[craigmatic]

195. I don't think my generation will get a chance to retire before 70. We might as well get this we'll

need it.