But if we enact single payer, your taxes will go up!

[eridani]

All I have to say to that is that anyone who prefers a $900/month "premium" to a $200/month "tax" shouldn't be allowed outside without adult supervision.

[hobbit709]

1. The other question is "How did they live this long without being reminded to breathe?"

[Vinca]

2. Exactly right.

I've always thought the country could save mountains of money if we did away with the VA, Medicare, Medicaid and any other program and just had one single-payer healthcare program. We could have VA facilities available to specialize in war injuries, but everyone would get the same card, doctors would have no choice in the matter and we'd be healthier and happier.

[bigwillq]

4. Congrats on 25,000 posts!

[Vinca]

5. Wow - I'm half asleep and didnt even notice. Thanks!

[DustyJoe]

6. facilities

We could have VA facilities available to specialize in war injuries

Really no need for special facilities run by the VA. There is nothing a veteran can have happen today that a public/private modern hospital or facility cannot treat rather than the mostly outdated VA facilities. VA doctors are great when you can see one, but so are public/private docs. Case in point, I had to go to a regular hospital to get a 35yr old piece of schrapnel removed missed by field surgeons because the VA hospital had an 11 month wait list for surgery. Costly, but I was able to walk better 11 months early.

[Vinca]

9. I've heard people discuss the VA hospitals re this issue and apparently they've got especially

good programs for people who have lost limbs and need prosthetics. There are specialized centers for cancer and heart disease and other problems so I don't see why it doesn't make sense to leave some VA hospitals open as specialty hospitals. They would be providing healthcare like any other hospital and it would have nothing to do with the basic single-payer healthcare if we had it.

[DustyJoe]

10. Granted

I live in a state that has ONE VA hospital for the entire state. But great private cancer and heart facilities. The bigger population states that have specialty hospitals you describe definitely should remain, but I don't believe they should be VA run facilities, but available for all citizens. The big push right now with the VA is to have veterans not living close to a VA facility to be able to use any public/private facilities.

[Vinca]

11. That's pretty much what I mean.

And, in the meantime, a veteran should be able to get care anywhere.

[Lee-Lee]

13. VA hospitals very wildly from facility to facility

For many reasons.

Ones in areas where there is a nice quality of life get better staffed because while the VA pays on a set Federal scale the ones in nicer locations to live can attract better doctors.

How influential is your member of Congress and are they in the majority party? Congress funds the VA and senior members on the right committees get things funneled to hospitals in their district.

So it's very hit and miss. Some thing are horrible all around- like try to get a good OB-GYN at the VA, I had to fight hard just to get permission to drive to a different facility so I could have a female.

And, of course it is heavily rationed. Most people think if your a vet then that is all it takes to be covered, but in reality they break vets down into different priority groups and some won't get any care, and some will get limited care, and some get most stuff covered.

[upaloopa]

56. You pay into Medicare and Medicaid is single payer

as is the VA.
You want to throw the baby out with the bath water.
Poor people and Veterans have single payer.

[Vinca]

61. I don't understand your comment.

Everyone should be covered under one program rather than all the separate entities we currently have. It would simplify things and probably consolidate a half dozen government agencies into one.

[upaloopa]

63. No it wouldn't

The problem with the VA is that it is under funded. Medicaid works well.
Centralizing it all would get rid of what works and subject it to the lowest common denominator of service.
Central planning and organization is not a good idea.

[SickOfTheOnePct]

66. I can't tell

Are you for or against single payer?

[hifiguy]

69. Check the avatar.

There's your answer.

[upaloopa]

81. Like I said the VA and Medicaid are all ready single payer.

I am for single payer because I believe there should not be a profit motive in health care. If we let the VA and Medicaid bargain with drug companies it would bring down prices for drugs.
I was a controller of a medical clinic with 21 doctors. We have a lot of work to do to change our model of insurance reimbursement to single payer. The ACA was a step in that direction
I now work for a county mental health dept. The ACA now with Medicaid expansion reimburses us 100% for new Medicaid clients. These were people who were mostly single older males who were previously indigent patients.
Nothing is as black and white as we would like it to be.
That is what I find wrong with Bernie supporters. You have no plan or understanding of what it takes to get what you want. You act as if only you care about people. It gets tiring.

[SickOfTheOnePct]

82. If you're for single payer when it comes to the VA and Medicaid

why are you against it for everyone else in the country that doesn't fall into one of those two groups.

[upaloopa]

84. I just posted I am for single payer

I said it isn't as easy to do as you think.
We have the whole for profit system to unwind
You just can't elect Bernie and switch to single payer in 2017.
Can't you see the complications involved?
We can get there but it takes work.
That is why Hillary says she is a progressive who likes to get things done.

[rhett o rick]

86. Are you saying that HRC is currently advocating for single payer? nm

[JimDandy]

100. The Third Way Progressive Party has one member: Hillary Clinton.

The real Third Way think tank that Clinton is actually closely associated with has fought single-payer tooth and nail. Clinton will never "do" anything to make single-payer a reality. Oh sure, she might at some point say she is for single-payer, but only if it's a done deal, and it's politically useful to say so. Like how she now is against the TPP, after it's a done deal, and after conducting focus groups and determining it politically useful to say she is, and since well, her opponent, Bernie, has been rock steady on opposing it.

[upaloopa]

104. I'd like to see proof that Hilary belongs to a third way think tank. And not some Bernie

supporter's blog.

[kristopher]

124. Do you understand what the 'new democrat' movement is?

It's a philosophy based on social liberalism and economic conservatism. Why not look at her positions over the years and use that yardstick to make up your own mind about what kind of governing philosophy she is at home with?
In my opinion, she isn't particularly progressive in either area but ymmv.

[TheKentuckian]

137. She was a cofounder of the fucking DLC, stop feigning ignorance.

[Jim Beard]

159. True

and it hasn't changed.

[bvar22]

143. We can't move to Single Payer because..

...its TOO hard.

[still_one]

153. No, you can't move to Single Payer because in case you didn't notice we don't have the votes in

Congress for it

[kristopher]

150. What I hear you saying...

"We have the whole for profit system to unwind
You just can't elect Bernie and switch to single payer in 2017.
Can't you see the complications involved?
We can get there but it takes work. "

You are criticizing our desire to move to Single Payer when (1) you've elsewhere misdefined single payer.

"You pay into Medicare and Medicaid is single payer as is the VA. You want to throw the baby out with the bath water. Poor people and Veterans have single payer."

Where in your thinking, are the actual mechanics for the pathway Hillary is going to provide? You are hinging your entire belief on the fallacy of supporting Bernie on the fact that he has no specific plan and you imply that he and we are too stupid to realize that the are going to be "complications involved" in the the mechanics of change.

And yet, you offer no path that we can examine and decide for ourselves whether or not such plan is valid.

Do you see our problem with your input?

What I perceive in the discussion is a glossing over of the need to lay down a marker that sets our goal. Any good plan BEGINS WITH A GOAL.

Hillary refuses to even set the goal because it "is complicated". You have incorporated the message her campaign is presenting for consumption correctly.


(1) http://www.democraticunderground.com/?com=view_post&forum=1002&pid=7305780

[truebluegreen]

116. FYI the VA is truly socialized medicine,

not single payer: the VA owns the facilities and employs the doctors and health care providers. But of course as a health care professional you knew that. I wish other Hillary supporters understood things better! Then we could make a real plan.

[TheKentuckian]

139. No it isn't. Making the insurance cartel too big to fail and legally cementing them as gatekeeper is

in no way a step toward single payer but rather a defense against it unless the monopoly drive is allowed to continue and we end up with one huge monolith and that would still be a gross perversion of the idea and pretty much exactly the opposite except it would be one corporation vacuuming up all our money so it would be "single" it that way but I see that as unlikely and we will maintain at least the big 3 for the foreseeable future.

There is nothing in the structure of the Wealthcare and Profit Protection Act that is about moving to single payer over any time frame...none. The assertion is not only false but intentionally misleading and wholly dishonest.

[kristopher]

147. What you are describing is, by definition, not 'single' payer

a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

What is Single Payer?
Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.

The Expanded and Improved Medicare for All Act, H.R. 676, based on PNHP’s JAMA-published Physicians’ Proposal, would establish an American single-payer health insurance system.

http://www.pnhp.org/facts/what-is-single-payer

[Cal Carpenter]

156. We have a lot of work to UNdo to change our model of insurance...

"We have a lot of work to UNdo to change our model of insurance reimbursement to single payer."

There, I fixed it for you.

You argue that we can't do what all of our peers (along with dozens of what are referred to as 'third world' countries) are doing and in many cases have been doing for decades? Really? Come on.

It's not like this is unprecedented. It is the NORM across the globe.

I can't fathom that any thinking, compassionate person would make excuses for it, primary elections notwithstanding.

[TBF]

67. "Central planning and organization is not a good idea"

Idea of the day from the conservative wing of the party.

Sigh.

[hifiguy]

73. It's just the tamer version of the RWNJ cloud-shouting

heard last night. That phrase is a dead giveaway of a reichwinger.

[Vinca]

79. So you're opposed to single-payer?

I'd say you were in the minority.

[Recursion]

135. Even Canada doesn't run it nationally

It's run by each province.

[kristopher]

110. Centralized planning would eliminate price gouging by doctors.

They could no longer play off one provider against another.

No wonder you're against it.

[Recursion]

136. Why is Canada against it?

They administer by province, like we do with Medicaid, which was I thought the poster's point.

[DustyJoe]

3. taxes vs premiums

Depending on the actual number of 'taxpayers' ie 'employed' vs unemployed or non-tax filers I don't think they really have a handle on the tax vs premium comparison. But you do bring up an interesting comparison that the single-payer/raise taxes group needs to be very open and public about. A positive proven ratio like you illustrate would be a great seller for approval of a tax hike to pay for it.

[NewJeffCT]

15. But, but, but

If I don't want health insurance for my family and me, you're forcing me to pay an extra $200/month!
(that's usually one of the arguments as well - you don't have the option to get no insurance.)

[retrowire]

24. whats the counter to that?

because I heard someone criticize obamacare for this forced fee and I didn't know how to counter. do people really not have a choice?

[NewJeffCT]

30. right now

any sort of penalty/fee for not having Obamacare, or another type of health insurance, is pretty small, though the penalty amount will grow over the next 3-4 years. The fees help to pay for the cost of administering Obamacare.

Not sure what to say about people who whine about not wanting any health insurance other than saying that almost everybody pays into Social Security, many states require drivers to have car insurance, etc.

[2naSalit]

46. There are those

who have been damaged by healthcare "providers/professionals" and have an aversion to seeking help because of that set of issues. Some don't care to feed the medical industrial complex beast...

it's an argument that has merit in many cases and there are some who don't want to be kept alive no matter the cost or limitations. For some death would be preferable to being kept alive for the sake of not dying. I have heard these arguments and I have a hard time arguing against them in the cases I have known.

Personally, I think that the fear of death is one of the ways that the medical industrial complex keeps us paying with every cent we'll ever earn even though the quality of life declines to the point that there is no quality to life... but we're still breathing and for some that's all that matters.

It's a dicey argument. I see a lot of good that can come with single payer, and given the choice, I would go with single payer because it exists within a context of equality. The concept that nobody is supposed to die is where I take issue with our current system and ideology... we're all going to die at some point and there is no prescribed (by nature) age at which it's okay to die. Could it be that modern medicine has usurped the natural life/death cycle to the point that we have succeeded in overpopulating the planet? It seems that in many ways our desire to control nature will be our undoing - relative to extinction of our species and many other species along with us - on many levels.

In full disclosure, I am bewildered and undecided in how I feel about these arguments from day to day.

[Art_from_Ark]

92. There are differences among those insurances

Social Security is essentially a government-run pension fund. You pay into it when you're working and expect to receive benefits when you retire.

Car insurance is only required of people who drive cars, and that is mostly for the benefit of people who might be the victim of an accident caused by a person covered by the policy.

Obamacare as it is today is a mishmash of private health insurance policies that run the gamut from very good to hardly-worth-the-paper-they're-printed-on.

[padfun]

31. Tell them they are leeching off of the public

which they are. Because nobody needs health care until they need health care.

It's like car insurance. Nobody would pay if they all used that same excuse.

[SickOfTheOnePct]

44. Yep, that's an argument

but a stupid one.

As we all know, everyone needs healthcare at one time or another, so it's pay me now, or pay me later.

I do think that even under single payer, people should be able to go outside of the system for healthcare if they choose to do so (and pay for it). They should still have to pay the taxes to support single payer, but if they don't want to use it, fine - they can pay themselves, either out of pocket or through an individual policy that they pay full price for.

[portlander23]

7. Just saying is all

[B Calm]

8. I don't see how republicans get away with calling theirselves conservative.

[ProfessorGAC]

12. My Question Would Be "Can You Prove It?"

In a comprehensive model, i'm sure the economies of scale would generate enough savings to easily offset costs that would apply to deductibles and co-pays that would make, at least, revenue neutral to nearly every "taxpayer".
So, if someone says that to me, i'd have to ask them for their econometric proof.

Of course, i'll be waiting a LLLOOONNNGGG time.

[SickOfTheOnePct]

16. Agreed

And under single-payer, I don't really see the economies of scale even coming into play, unless I'm missing something big.

The advantage of single-payer is universal access without the individual having to worry about how to pay for it, not the overall cost savings.

[hifiguy]

74. Tens of millions of people in the pool

will be younger people who make little use of the system in any given period of years. They're paying in and taking virtually nothing out. Classic risk-spreading.

That much is very obvious.

[SickOfTheOnePct]

76. That doesn't bring down the cost of healthcare itself

Just puts more money in the pool to ensure that everyone can get care.

I'm in favor of single-payer healthcare, but it's appeal is universal coverage, not cost savings in the aggregate.

[mdbl]

105. It depends on..

how much of the profiteers are removed from the process. Getting rid of the sales middle men alone will save the system millions that you pay to insurance and pharmaceutical companies right now.

[SickOfTheOnePct]

109. My bad, I wasn't clear

When I use the term "healthcare", I'm talking about the actual care itself, not all of the insurance crap we pay for now.

I agree that billions of dollars would be saved by cutting out the insurance piece, but that money would go to provide actual healthcare to people that don't have it now, even if they have insurance. Which is the best thing about single payer.

[joshcryer]

18. There are plenty of studies showing the cost savings:

See page 8: http://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_7.31.13_proofed.pdf

https://www.healthcare-now.org/wp-content/uploads/2008/09/0312friedman.pdf

But the savings in the OP are somewhat exaggerated. You're saving the 20%-30% overhead costs of running private insurance as opposed to the 1% of Medicare for All. Your $900 / month premium would go down to $720-$630. Obviously this is a simple calculation, however, since the currant insurance program does not cover everyone and people are opting for the fines or laying low, it also doesn't consider the undocumented population either. But it's still substantial.

[ProfessorGAC]

20. Um!

I think you missed the point. I was saying that this is what i would ask those who are concerned about the tax increase.

I made it clear in my post where i thought the savings would come from and therefore be at least revenue neutral to the average taxpayer.

[joshcryer]

23. I did not read your post that way at all.

Sorry if there was confusion but it reads like you wanted proof of the economics, not that you were posing some hypothetical about those asking about it. There's not a more than 300% cost savings as posed by the OP. In some districts (especially states that expanded Medicaid) the savings would be non-existent.

[ProfessorGAC]

34. It Was the Way the OP Was Phrased

I was addressing the question as to what people complaining about it being a tax would be told.

That's where we got our wires crossed.

[joshcryer]

36. OK I totally understand now.

I took your response as a response to the post and not the title. Makes sense, sorry.

[ProfessorGAC]

39. Hey, Wires Crossed

No apologies needed. We're good!

[libtodeath]

19. It also needs to go along with a 50% cut in the military budget

at that point taxes already being paid would be applied to saving people rather than killing them.

[ProfessorGAC]

21. I'd Good With That

We spend WAY(!!!!!!!!) too much on that part of the budget. Geez, 10% would be a phenomenal start.

[NewJeffCT]

32. considering how difficult it is to get even a minor cut

to the defense budget, the best thing to hope for in the short term is for it to not increase. With the F-35, the Pentagon said it did not need the extra engine that was being built for the plane. However, it was still a huge deal to cancel something that the military itself did not want.

Longer term, definitely need to look at cuts. But, all the jobs in probably every state would need to be replaced - the Military Industrial Complex is a big jobs machine.

[ProfessorGAC]

35. Yep!

They build aircraft carriers the Navy said they didn't need or want! So, the F-35 is yet another example.

[quakerboy]

94. That seems pretty simple

Canada. The UK.

And done.

[ProfessorGAC]

111. Apparently I Wasn't Clear

I'm asking those who just want to see it as a tax increase prove it. I don't need proof that single payer is a better system. The economics of it are patently obvious.

I'm addressing the folks mentioned in the OP who just want to complain that it means more taxes. I want THEM to prove it will cost them more.

[quakerboy]

126. I appologise for missing that

[kristopher]

108. It's extremely easy to prove and the evidence is literally all over the world

Just google up a comparison of the US to other nations in areas of health care costs and outcomes.

The savings in administrative costs are only a small fraction of what's achieved by making the government the designated "shopper" watching over the providers.

A thing as simple as routine X-rays can vary from about $30 to $800 dollars here and the average consumer has to determine the difference. When they try to find prices they are usually met with a was of obfuscation designed to frustrate the effort.

In other words, the med industry not only capitalizes on the time costs of learning to shop for even routine treatments, but they work diligently to increase those time costs to prevent comparative shopping.

That being the case, a centralized purchasing entity that can act to standardize costs via market power is the only effective solution.

[ProfessorGAC]

112. See Post 111

I confused everyone, i guess, by addressing the folks mentioned in the OP.

[kristopher]

113. Your post might have been a bit ambiguous, but it was sickoftheonepct's post...

...that lent it a consistent reading. You didn't dispute those patently false claims that were made in agreement with the unintended message. On rereading, sans that responding post 16, I'd have certainly taken it as you intended.

Thanks for the clarification.

[ProfessorGAC]

119. No Problem

I should have used quotes and repeated the statement in the OP. That would have made it much clearer.

[thesquanderer]

14. Concept is right, but I doubt most people are paying $900/month premiums. (n/t)

[jeff47]

25. I'm paying about $700.

Employer coverage, me + spouse + kids.

[Maedhros]

77. But most people are paying huge deductibles and have benefit maximums.

Those have a huge impact on cost.

[libtodeath]

17. If taxes are aimed at the 1% as they should be then most wont have to pay much at all.

[ryan_cats]

22. What

What about the people who don't understand unintended consequences, do they get outside privileges?

[LanternWaste]

64. What about people who don't understand 'relevance', do they still get to post?

What about people who don't understand 'relevance', do they still get to post?

[Warren Stupidity]

88. I think this was an attempt at the right wing

talking point that the upstanding moral John Galt should not have to pay for the health care of his slovenly couch potato neighbor. Until of course he himself gets sick despite all his upstandingness and then his neighbor damn well better pay for him.

[Enthusiast]

26. K&R! This post deserves hundreds of recommendations!

"All I have to say to that is that anyone who prefers a $900/month "premium" to a $200/month "tax" shouldn't be allowed outside without adult supervision."

Fabulous!

[Shandris]

58. No it doesn't. It's appallingly privileged and self-serving.

Premiums are picked up (in most states, at present) for the poor, but taxes do not carry that same privilege (particularly when you're talking about a service that literally every single person will use at some point in their lives). So that $200 that seems so inconsequential to you because you're currently paying $900 is a sudden $200 out of nowhere to a family making next to nothing already.

Don't get me wrong, I'm in favor of single payer too (oh WOW am I in favor of it!). It will need some careful work to avoid unintentional tripe just like this, though, and too many are only thinking of it in terms of themselves. Given what I've seen of our politicians (our meaning 'American', not 'Democratic'), I don't trust that they'll think about the less fortunate one whit if we're not doing it every time the topic comes up.

[kristopher]

115. There is no need for such caution

The OP is a demonstration and not too far off the mark. In a single payer system the premiums are linked to income - problem solved.

[Enthusiast]

118. +1!

[Shandris]

122. Remember, there is no 'premium' under the OP's statement. There is tax.

Let's see. Are there any other taxes that are related to this kind of topic? FICA and Medicare/SS are a good example. Now, how low do those go when my income is below poverty level? They don't -- they're fully assessed regardless of my income.

Taxes don't uniformly get written away like premium subsidies do. If you want to call for some kind of single premium then fine (and I support it!), but making it a TAX has the likelihood of hurting the people you claim to be wanting to help. Seems like a small nitpick, is actually monumentally important.

[kristopher]

123. I don't exactly understand your point

I see the point of the OP as being not so much to make a written-in-stone proposal but rather to compare a 'government' health care solution to a 'private sector' health care solution - thus the use of 'taxes' vs 'premiums'.

In actual practice how you collect the money wouldn't have a bearing on the way you apportion responsibility for payment. You can make either method of collection a progressive system related to income.

I lived in Japan for a long time and raised a family with two children there. Our premium (about $110/mo in the 80s-90s) was set when we filed our taxes, and was collected as part of the monthly (no one is paid weekly) withholdings from my pay. However, unlike a tax, if I didn't want to participate in the national health program, I could easily opt out.
So the opt out provision is distinctly different than what we think of as a tax, even though the method of setting the amount of the premium and collecting it was via the tax structure.

One more thing - filing taxes there involved taking my yearly pay statement, together with a postcard sent to me by the government as a reminder, to a local government office. I'd go to the counter, they'd check their records of my previous filings, confirm the size of my family and then fill out about 6 blanks on the reminder postcard they'd sent me.

That was it, about 5-10 minutes in and out. Everyone who has income, no matter how low it might be, pays at least a pittance in taxes.

[Enthusiast]

27. If we compare the cost effectiveness of existing single payer systems

we see that we could realize tremendous savings with no loss in the quality of health care.

Too many people want to completely ignore the excellent track record of universal single payer.

[FrodosPet]

28. Low income would not have to pay, correct?

Are we talking an AVERAGE monthly tax of $200, as a percentage of income over the first $20,000?

[mountain grammy]

29. And paying for insurance that actually covers stuff

at 80% with a deductible less than $200. Medicare for all, right the fuck NOW!

[liberal N proud]

33. People have been conditioned to hate taxes

Regardless of how much it will save them or what it might provide for them.

That is true unless they are building a new sports arena at the tax payers expense for a corporation to play gladiators in.

[lumberjack_jeff]

37. Health care is 17% of GDP.

It is reasonable to expect that your family's share would be about 17% of your gross family income, or $17,000 for a family grossing $100k.

The system has gotten way out of hand - $200/month isn't gonna cut it.

[joshcryer]

41. It'd be closer to 13% due to the overhead.

Of course you'd also be losing a lot of jobs that overhead creates, too, so that might impact GDP and make it a wash.

[lumberjack_jeff]

42. That overhead woudn't go away immediately.

In this political system the best you can hope for is a solution that holds expenses where they are while the gdp continues to grow.

I think it would take 30 years after creating single payer to get it to 13% of gdp.

[Recursion]

132. Except that 30 million more people would be getting covered, which raises the costs

Ironically, if they use health care at the same rate as the insured do, it takes us pretty much right back up to 17%.

[kristopher]

160. The REASON for SP is cost control

The medical industries can't game the system. Single payer (mostly) turns the industry from what is called Price Makers to Price Takers.

what's a cartel?

In economics, a cartel is an agreement between competing firms to control prices or exclude entry of a new competitor in a market. It is a formal organization of sellers or buyers that agree to fix selling prices, purchase prices, or reduce production using a variety of tactics.

Think of it this way: How does the purchaser who is able to negotiate on your behalf prevent the seller from charging exorbitant costs for the product?
In this case the medical community has a variety of methods to charge much more profit than a "market' would provide them. They do it with things like cartels (American Medical Associate or the American Dental Association) or regulations that their lobbyists have had passed which restrict competition (importing medicine).

The insurance companies can't counter these cartels. Enabling them, as profit seeking entities, to price fix on the consumer's behalf would be a legal bucket of worms that would probably screw the consumer even more.

That's where single payer comes in. Forming our own cartel that sends nearly ALL the money being spent on health care through a single faucet breaks the back of the medical cartels with this result. (The further to the left, the lower the cost per person and the higher on the chart the better overall health care outcomes.)



As you can see the numbers used in the OP actually have some validity.

[Recursion]

161. Then why does Medicare pay so much more than other countries' systems? (nt)

[kristopher]

162. Because medicare isn't able to counteract the cartels.

It only represents a small slice of the pie and even though it can negotiate some, it is (by law in many instances) a price taker.

ETA: Medicare is not "Single Payer"

What is Single Payer?
Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.

The Expanded and Improved Medicare for All Act, H.R. 676, based on PNHP’s JAMA-published Physicians’ Proposal, would establish an American single-payer health insurance system.
http://www.pnhp.org/facts/what-is-single-payer

[B Calm]

38. Republicans in my county have been saying the same thing about black topping

county roads. I live on a 1/2 mile long gravel road with ten other houses. You'd think the county would save money by black topping the road. On this 1/2 mile stretch is a steep hill that always washes away ever time we get a good rain. A few days later here comes the county road trucks with expensive loads of gravel, a road grader, etc to fix the hill. When I've mentioned the waste of tax dollars spent on maintaining this stretch of road, they reply about the high cost of blacktopping. I've lived here since 1978 and just the cost of gravel alone through the years would have blacktopped this road numerous times. I wouldn't mind my tax dollars going up a little if that's what it would take to get them to do it. I'm so fucking sick of (wrongfully called conservative) republicans!

[LuvNewcastle]

107. Your county supervisor probably owns the gravel pit.

Or his brother-in-law does.

[RichVRichV]

43. Funny enough I just had this discussion with someone else.

I calculated what it would cost if we payed for it using a flat payroll tax that everyone contributed to equally (one of many ways it could be payed for). You can see the post here.

This is based on the single payer bill that was submitted to congress a while back and estimated to cost $15 trillion over 10 years, or average $1.5 trillion a year.

We know that in 2014 Medicare raised $227.4 billion for 2.9% of payroll. That comes out to $78.414 billion raised per 1% taxed. For a $1.5 trillion program, that comes out to about a 19.2% tax. That can either go all 19.2% on the employee or 9.6% on employee and 9.6% on the employer (like other payroll taxes).



All someone has to do is take their gross pay from a paycheck, subtract 19.2% off of it (or 9.6% if it's a split payment like social security and medicare), and add back what they currently deduct for health care.

A recent average gross paycheck for me was $550. I spend $49.31 a paycheck on health insurance. If all 19.2% comes out of my paycheck then I would spend $105.60 and get back $49.31 (from current insurance) for a total of $56.29 of reduced income. If it's split between employee and employer, like other payroll taxes, then it would cost my employer $52.80 and me an additional $3.49 a paycheck (weekly).



Again, this is only one of many ways it could be payed for. It's just a very simple way to calculate.

[dembotoz]

45. the problem is those who get heath insurance as part of an employee bene package

they have NO clue what the insurance costs the company and they don't care

to them their healthcare is pretty much free and they only see the tax

short sighted
yes


low information
yes

its like seniors who want to cut all federal programs but are shocked when you tell them that would include ss and medicare...those are not federal programs! they whine.....

[Nuclear Unicorn]

47. Colorado has SP as a referendum for 2016. It will rely on a 10% payroll tax.

[RichVRichV]

48. I'm really interested to see how this goes.

It's going to be a fight to get it passed. You know the private insurance industry will spend a fortune to scuttle it.



Colorado is leading the way once again.

[eridani]

97. I'm not at all enthusiastic. In Seattle's new city council district system--

--there were 9 candidates for District 1 in the primary. One guy told me that he wasn't going to vote in the primary because he didn't want to read up on 9 candidates. People like him will not read a complex initiative, and will then vote no because they don't understand it. For each policy wonk/political junky, there are 200 voters wh are neither.

[SickOfTheOnePct]

51. How are they going to handle Medicare recipients?

I've looked at the sites discussing the proposal, but I haven't seen where it addresses Medicare recipients.

[RichVRichV]

55. From what I read in a seperate article the state program can't override Medicare or VA health care.

So medicare will stay intact in the state and the single payer will act as a supplemental to medicare.

[SickOfTheOnePct]

57. Thanks for the info

I'm guessing it will have no effect on military medical benefits either.

Definitely a step in the right direction.

[gd770226]

52. 10% is way too much

10% payroll tax is way too much. I could not afford that and if my state did that I would have to move out.

I pay just under 100 dollars a paycheck now. so that would be 2600 dollars a year. My salary is 100K so 10% would be 10K. A 7400 dollar tax increase. No thank you.

[pinebox]

53. And how much is your insurance monthly?

I'm curious.

[hifiguy]

72. So many think it's "in addition to"

when it's actually "instead of."

[SickOfTheOnePct]

54. The 10% is split

6.5% will be paid by the employer, 3.5% will be paid by the employee.

So for you, it would be $3500/year v. $2600/year, a $900/year increase.

I didn't see any details regarding whether or not there will be deductibles and co-pays under the Colorado plan, but if those are eliminated, and depending on your current plan, that $900 could be made up fairly quickly.

[RichVRichV]

59. Assuming they get payed every other week (which looks to be the case)

That comes out to a loss of just over $36 a paycheck. They may have to skip one family meal eating out a paycheck to cover it, if they don't outright make that up in savings from current incidental medical costs.


Though in the short term it might also mean a longer time between pay raises, as the employer will have to make up for their end of the payments beyond what they already pay into health care (if they even do pay into it currently).


Still it's worth it for 100% coverage of everyone in the state and no longer having to worry about catastrophic health care bills.

[SickOfTheOnePct]

60. I agree that it's a step in the right direction

but I would really like to see what the actual plan is for active and retired military members and their families, Medicare recipients, VA recipients, federal retirees, etc. Unless all of that is addressed, there won't be 100% coverage, although it will obviously be much better than it is now, without question.

Active and retired federal and military employees will be the sticky ones...they can't force those employees or the federal government to pay the 10% payroll tax.

[RichVRichV]

62. No clue on that one.

All I've read is that Medicare recipients will receive supplemental coverage under the plan. That's all I've found on that so far. The fact that it only has to cover the 20% (presumed) not covered by medicare for 65+ will dramatically keep it's costs down as that is the most expensive demographic on health care.

My default assumption is that if you don't receive benefits from the program you wouldn't have to pay into it (that's how most government programs work). But I have no proof of that.



I've read there's two taxes covering it. One is the 10% payroll tax, and the other is 10% premium on any non-payroll income ("capped at $350,000 that would be tax deductible and would come with some exclusions" 1).

[SickOfTheOnePct]

65. Thanks for the link!

I'll be watching this to see what the funding stream looks like...when I see a 10% tax on non-payroll, my first question is "What exclusions are available?"

Good stuff though.

[Live and Learn]

98. I wouldn't mind paying that to ensure everyone got healthcare but that isn't the real cost.

Still, hard to imagine you being so fortunate and not being willing to sacrifice a bit for the good of others,

[gd770226]

120. fortunate?

Fortunate for what? Because I have a high salary?

My original comment was made on the original assumption that it was a 10% payroll tax. The original poster has since explained that that is split between the employee and employer. I will stick with objection to a 10% tax, but add that at the 3.5% rate it is not nearly as bad.

However, even at only a 900 dollar a year increase, enough already. I live and work in NJ, a very very expensive state to live in. I am also divorced and pay child support for my 2 children. Also, I am a bit of a victim of the current economy. My divorce was final 5 years ago. 6 months after the divorce I lost my job. Had no job for 13 months. During that time there is no relief for child support and I ended up building up a big debt to the ex-wife. also wiped out what little bit of savings I had after divorce. When I got a job it was for 45K less than I had previously made. But still pay child support at the original rate. It took 3 years to pay back all the money I owed on the child support. and even after getting raises for the past 3 years at my job I am still well below my previous salary. And yes, the divorce and child support are more my financial "problem" than taxes are, but it all adds up. So, after all payroll deductions ( 401K ( 3% ), fed taxes, state taxes, social security, medical and child support ) I get to keep 44 cents of every dollar I make. It was like 36% when I was paying the back money. THen throw in very high rents in nj if you want to live in a decent neighborhood, etc. etc. The money goes very fast.

So yeah, I get sensitive when there are possible increases like this. Now I don't live in CO, but if this passes in one state it would grow to others and NJ would probably be one of the first to do it, as they usually are near the front on issues like this.

I just feel like in today's United States I'm just treading water. I get a small raise and there is some new tax or expense to just eat it up. I cringe every time I hear a politician say that they need new streams of revenue. I don't mind paying my taxes and never have, I just feel like I am right at the place where I am taxed enough. Before my divorce and unemployment I felt the government did a good job and that the safety net was very important, I still feel the safety net is important. I just don't feel that it is, or ever will be there for me. It was not there for me when I lost my job, and It wasn't there for me to make the divorce process fair and enquitable. So I want to view the government as being on my side and everybodies side, but that has not been my personal experience.

[TheKentuckian]

141. The mandate now is 9.5%. Why is it perfectly acceptable for people that make way under 100k

to be responsible for that but it is too much for you?

Also, do you really think your plan is anything like $100 a paycheck? It is probably a whole lot closer to 4 times that or more, you just don't see it.

[rhett o rick]

87. I think that's the SP that the 1% are pushing for. Don't tax the 1% to cover the masses'

health coverage. I think that's where HRC stands.

[Hoyt]

151. Bet it doesn't pass, people just can't grasp it would be cheaper and likely better care.

[Warpy]

49. No shit!

and should probably wear a helmet.

People won't mind higher taxes if they get something besides a bloated military and crumbling infrastructure. That's why the only tax whiners in Europe are the very rich.

[taught_me_patience]

50. Do you believe single payer is only going to cost $200/mo?

Wow... I'd like to have some of what you're smoking.

When Vermont looked at single payer, they concluded that it would cost 9.5% income tax increase and 11.5% payroll tax. If the average monthly income of a FTE is 3,000, then the average person would have paid $600/mo in taxes... nothing close to $200. Your numbers are way off.

[RichVRichV]

70. Colorado's doesn't work that way.

It has two taxes, a 10% payroll tax (3.5% employee, 6.5% employer) and a 10% non-payroll income premium (with some unknown tax exemptions). The two taxes don't stack, they cover different forms of income.

On the payroll side $3000 gross income would result in $105 cost to the employee and $195 to the employer. On non-payroll income $3000 would result in $300 tax (but again, there are exemptions there).

[eridani]

128. That's what calculations on the Washington Health Security Trust show

Of course, that's just the individual tax. there would also be a payroll tax. Seniors would be on Medicare and have WHST as a very cheap part B plus part D substitute

Under WHST, who pays?

Those who don’t pay (38% of the population)
Kids—1.604 million
People below 150% of poverty level—0.757 million
Excluded categories
Native Americans—0.085 million
Federal employees—0.142 million
Workers under the Taft-Hartley Act—0.106 million
Remaining payers—4.057 million (62% of the population)
Total—6.751 million

Where does the money come from?

Business payroll taxes
Tax on payroll over $500K/year from 10% to 12%
Tax on payroll under $500K/year from 1% to 1.2%

Taxes on individuals
$100/month to $150/month for ages 18-64
$75/month to $100/month for 65 and over (to supplement regular Medicare)

Other state revenue sources
State Health Services Account
Health Care Authority
Tobacco Settlement funds
Community Health Center Funding

Doing the math—low end; 10%/1% payroll; $100/$75 individual

Payroll tax revenue = $10.58 billion
Individual tax revenue = $4.69 billion
Other state revenue = $4.80 billion

Total = $19.89 billion
Estimated Fox report expenses by Method 1 = $19.3 billion

Doing the math—high end: 12%/1.2% payroll; $200/$100 individual

Payroll tax revenue = $12.69 billion
Individual tax revenue = $6.95 billion
Other state revenue = $4.80 billion

Total = $24.64 billion
Estimated Fox report expenses by Method 2 = $24.0 billion
Estimated Fox report expenses by Method 3 = $26.3 billion

[hifiguy]

68. Trying to pound that point through some people's heads

is like trying to hammer a piece of spaghetti into a chunk of metallized hydrogen.

If we could turn our bottomless national reserves of 100% pure stupidity into clean energy we would have enough to last 100,000 years and warp drive by next year's Festivus.

[RichVRichV]

71. I'd settle for harnessing the boundless energy of kids.

I'm thinking something like hamster wheels with games inside.

Ever notice how in people energy and focus are inverse of one another?

[bvar22]

75. With the elimination of the For Profit Insurance Vultures,

I would expect prices to ease once we cut out their share.
A National Health Care Program would also have IMMENSE collective bargaining power over the Hospitals and Drug Providers.

We could see quite a drop if we can see it through.

[Recursion]

134. That's overstated

That's where our $2 trillion is going.

"Stuff" is pharma and devices.

"Overhead" is both government program overhead and insurance company profit.

"Services" is where we're overpaying.

[bvar22]

146. If we went to Single Payer, "Services" would immediately drop.

Hospitals keep a large administrative staff JUST to handle the different Insurance Companies and Billing.
That goes away, immediately saving money in what you called "Administrative" costs.


Services in the ER cost many times what they do in the clinic.
If everyone has Insurance, then the ER can handle emergencies, and the routine only pay Hospital Cost instead of ER cost. (and the $8.00 aspirin disappears)

MORE "services" saved.

The category you called "stuff" will also become competitive, from drugs, to new equipment. A single Insurance plan with EVERYONE enrolled has immense collective bargaining power.

I could go through the list, but anyone can see you were incorrect about Single Payer not saving money in the Hospital.

[Recursion]

149. Well, no, it would stay where it is

We'd be cutting provider rates by about 10%, and adding 30 million more people; if they use services at the same rate as the currently insured, it's pretty much a wash.

[jwirr]

78. Especially when the $900 premium does not provide universal

health care and the $200 tax does.

[ibegurpard]

80. yup

And you or your employer will no longer be paying premiums. Oh the horror!

[spanone]

83. K&R...

[FiveGoodMen]

85. VERY well put!

[ErikJ]

91. Yes, But we also need more sin taxes..and lots more doctors.

The AMA is a doctors union that purposely keeps the supply of doctors limited so they can get higher fees. So we'll have to break that chokehold and double or triple the number of doctors, especially of GP family doctors.

Then we'll have to lay more of the responsibility on the public and private sector for taking better care of their health by imposing sin taxes on the sweet processed junk foods/drinks and higher taxes on cigs and alcohol to also help pay for the public health programs.

[liberal_at_heart]

93. Exactly. Thank you. The simple answer is that the rich are so lacking in compassion that they would

rather pay $900/month on a premium on their individual plan than pay a $200/month tax that would help pay for someone else's health care. Especially when all they have to do is get their accountant to get them extra tax loopholes to write off their medical expenses.

[DrBulldog]

95. This thread is just another garbage bucket for the morons.

But isn't it fascinating the rest of the world has single payer and are able to spend a total of only half the cost we pay on medical care?

[marym625]

96. exactly!

K&R!

[Warren DeMontague]

99. If ONLY there were some other, regular expense that would go away, which would offset that cost!

Hmmmm! Verily, 'tis a conundrum.

[KG]

101. 'affordable' is the first lie about ACA

[merrily]

102. The OP has a familiar ring, but I'll rec it again.

[WinkyDink]

103. WHY SHOULD THEY? There's more than enough from the "Defense" (WAR) budget to use.

[DFW]

106. Sooner or later (and probably later, knowing that we're swimming upstream)

This WILL happen. It is ultimately the only logical conclusion of the mess we now face. There will be complications, waits, angry physicians, overworked hospital staff, complaints about overworked hospital staff, and Republican governments trying to figure out ways to fiddle with it and insert some kind of German solution, where if you have outside (and VERY expensive--they asked me to pay €2500 a MONTH) supplemental insurance, you get quicker and better care, which theoretically doesn't exist, but does anyway.

But way down the road, single payer is the solution the populace will ultimately demand--not as a privilege, but a right.

If we can insist on a "right" to bear arms, we can jolly well demand a right to be healthy.

[IronLionZion]

114. Show them Canada's tax rates

http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html
Federal tax rates for 2015
15% on the first $44,701 of taxable income, +
22% on the next $44,700 of taxable income (on the portion of taxable income over $44,701 up to $89,401), +
26% on the next $49,185 of taxable income (on the portion of taxable income over $89,401 up to $138,586), +
29% of taxable income over $138,586.

That should be doable for most everyone.

Then show them how much is spent/wasted on defense contractors and war if you really want to find some places to cut spending.

[NobodyHere]

129. So what are tax deductions/credits like in Canada?

I really have no idea.

[MADem]

152. Don't forget this....

https://en.wikipedia.org/wiki/Goods_and_Services_Tax_(Canada)

[SickOfTheOnePct]

154. Those are the federal tax rates

Aren't there also provincial income taxes on top of that?

[raouldukelives]

117. Something is going to have to happen.

In an ever shortening window the world changing effects of climate change are being felt. The phrase "We ain't seen nothing yet!" springs to mind.

As our food chain is disrupted, as our growing seasons become nigh undefinable, as we suffer more and more crumbling infrastructure, as we have less and less wealth to deal with national emergencies, regional disaster assistance, rebuilding, climate refugees, homelessness, hunger.

At the time when we really need to be strengthening the public safety net, massively, to shield people and cities from the current and coming damages done by oil corporations and Wall St lobbyists, they will be smaller than ever.

The young get it. The old and invested are just trying to hold out a bit longer. Like plantation owners clinging to human suffering to ease labor on themselves.

[hill2016]

121. how do you get $200 per month?

Assuming it costs $1.5 trillion (based on an estimate) and there are about 120 million taxpayers in the US, that works out to $12,500 per taxpayer or about $1,000 / month.

Obviously the cost will be shared with companies but where's your source for $200 / month?

[kristopher]

125. You should Question your Assumptions

[Orsino]

127. THEIR taxes will go up.

Whose? The ones telling you that yours will go up, that's whose.

If we do it right.

[pnwmom]

130. How do you figure we could pay for single payer with a $200 a month tax?

That is the kind of number Ben Carson has been throwing around for his medical savings accounts, and he's dead wrong. We cannot provide for everyone's medical care for an average cost of $200 a month.

[eridani]

131. See post #128 n/t

[Recursion]

133. It would take either a 10% payroll levy and 10% corporate tax, or an 18% VAT

And even that is ignoring the 30 million currently uninsured, who will be getting treatment.

Until people get serious about how expensive SP would be and owning up to that, it's going nowhere.

[SickOfTheOnePct]

138. Exactly

I'm in favor single payer, but the idea that is will be less expensive in the aggregate is ridiculous. Reading through HR 676, Medicare for All, and looking at the different funding streams that will be required show that it will obviously be more expensive.

That's not a bad thing, as it provides universal coverage, but it's not a money saver in the aggregate.

[Recursion]

140. We have 30 million uninsured people

So even if overhead reductions reduce costs 10% (which is more than anybody claims), we would wind up at the same cost.

Europe does this with a VAT. I still think that's the right way.

[SickOfTheOnePct]

142. Universal single payer is going to cost more than what we spend now

Take a look at HR 676 - it shows that even with the savings involved in getting rid of the insurance middleman, we're still going to need additional funding to provided comprehensive coverage to everyone.

That's not a bad thing, it just is what it is.

[bvar22]

144. Its cheaper to just let people suffer & die.

"it just is what it is."



A National Program with everyone enrolled, cradle to grave, will have immense Collective Bargaining Power with every single Health Provider, hospital, clinic, Home Health Service, and Drug Company.
NO MORE will an aspirin cost $9 in a hospital.
ER costs would drop rapidly, and will be used FOR Emergencies....not health care.

Prices here would quickly fall to European levels.

[SickOfTheOnePct]

145. There will be savings on drug costs without a doubt

But that's about it. Without enough doctors to take on the millions of additional patients, I personally don't see a big savings in physicians costs.

You seem to think I'm against single payer - I'm not. But people need to realize that it's going to be expensive in the aggregate, although for the majority of individuals it will be less than they pay now.

[hill2016]

155. then

why are doctors dropping Medicare/Medicaid patients which have immense bargaining power (they set the rates they are willing to pay).

[Recursion]

157. How much does Medicare pay for aspirin in a hospital right now?

It's lower than what Anthem pays, but it's still way, way too high. Medicare pays more than the health care systems in any other country. Prices are the problem.

[greymattermom]

148. Why call it a tax at all?

Just call it a premium for universal insurance.

[Kalidurga]

158. LOL OMG that is what I was going to say.