Could getting single payer be this simple?

[cynatnite]

Let’s begin by imagining that Congress and the president decided to adopt a genuinely radical health care plan—the kind in place in most of the industrialized world. They decide on a “single-payer” system, where the government raises revenue with taxes, and pays the doctor, hospital and lab bills for just about everyone.

Put aside the question of whether this is a good idea, or an economically sustainable notion. The question is: would such a law be constitutional?

The answer, unquestionably, is “yes.” In fact, it would be the simplest law in the world to enact. All the Congress would need to do is to take the Medicare law and strike out the words “over 65.” Why is it constitutional? For the same reason Medicare and Social Security are: the taxing power. Its reach is immense. During World War II, the maximum income tax rate was 91 per cent (it was paid by few, thanks to loopholes, but still). The same Congress that could abolish the estate tax could set just about whatever limit it chose; it could impose a 100 percent tax on estates over, say, $5 million. If it decided that a national sales tax was an answer to huge budget deficits, it could impose one at whatever level it chose.

http://news.yahoo.com/supreme-irony--would-a--single-payer--health-care-plan-be-less-vulnerable-to-the-court-than-the-affordable-health-care-act-.html

Of course, it wouldn't be this easy, but I love the simplicity of the idea.

[phantom power]

1. The Dems could sponsor this, and make the GOP filibuster it.

But they won't.

[Marie Marie]

17. And that assumes that NO democrat would vote against it.

When pigs fly. Thank you DINOs.

[Spike89]

29. Well, they wouldn't if they knew it wouldn't pass...

I'm assuming the "make the repugs fillibuster" would actually be the goal so that it would be a campaign issue. Even the bluedog dems who are opposed maybe could get behind making the republicans look bad.

[kemah]

2. I believe that it will follow the Canadian model.

One province or state installed one payer. The rest of the provinces followed suit, as they saw how successful and cost effective it was. Vermont and California are vying to install one payer system and if it passes then the other states will follow suit, because you can not demagogue success.

[suffragette]

15. Great point

[cali]

36. agreed. and it's already passed in Vermont and being contsructed

[Politicalboi]

3. The idea of 65

Is that YOU paid throughout the years. But if we spent on health care like we do defense, we would be in better shape. I hope we get single payer some day.

[TheWraith]

18. We currently spend a lot more on healthcare than on defense.

Medicare and Medicaid alone total up to about $800 billion a year, which is about $100 billion more than all defense spending even factoring in Afghanistan.

[Cleita]

4. Most of us, who think about this, have known that this is the best, simplest

and most cost effective universal health care system around. However, as long as there is one insurance company or for profit health care plan out there, it will never happen. Until we figure out how to drive them out of this business, they will throw every resource they have to stifle such a plan.

[librechik]

5. couldn't it just be issued to Medicare as an executive order?

That would make it even simpler. Just a routine rule change. No oversight needed.

[patrice]

7. I believe that Bernie Sanders said something very like that shortly after passage of ACA 2010.

It may be that progressives are keeping that particular card close to their chests, in case there is something that could be done to block it. Perhaps we have passed the point of no return by now? In any case, I bet the opposition has thoroughly researched this possibility.

My theory is that they are going to yield to something anyway, but that they want THEIR name on it and they want to control the terms, in order to bust current and future unions, and to protect their campaign donors' salaries and bonuses.

[jeff47]

11. AFAIK, the "65 and older" part is written in the law

So the administration couldn't arbitrarily change that.

In addition, adding everyone else to Medicare will require money. Congress would have to approve paying for it even if the President could change the 65+ part.

[librechik]

13. there are already mechanisms to pay for Medicare within the law

wouldn't the same mechanisms just expand to include those under 65? (i know, I'm dreaming--it seems so easy in my imagination)

[TheWraith]

19. Those mechanisms are already expanded to those under 65.

You're paying for Medicare right now. That's part of payroll taxes. It's like Social Security, everybody pays currently to cover the people now eligible.

[librechik]

20. thought so--just change from a teeny tiny tax to a tiny tax.

spread the pain around, but a 1% overhead, it's still going to save money in the long run (if we get price controls on procedures and prescriptions too)

[TheWraith]

21. A bit more than a tiny tax.

Even by advocates optimistic estimates, it would be 5%, or about $2,200 a year for someone making the median wage. Also, it would be a flat tax, and as such a regressive one.

[librechik]

31. hmm--from 3% to 5% seems tiny to me.

But then that is the enormous tax break the entire govt has ground to a halt over. A return to 37% (under Clinton) from 34% under Bush. I may be a hair off.

[jeff47]

38. They can not expand without Congressional approval.

Think of it this way: There's already an income tax. The executive branch can't change income tax rates. Only Congress can.

Same with the taxes that support Medicare. The executive branch can't just increase the tax rate to cover all the new beneficiaries.

[YellowRubberDuckie]

6. With that thinking...

Last edited Tue Jun 12, 2012, 04:59 PM - Edit history (1)

...health insurance companies wouldn't be completely wiped out. We'd still have to have policies to cover the things that Single Payer wouldn't. You'd think the GOP could get behind this, but since the dems thought it up, they'd rather cut off their noses to spite their faces.

[jeff47]

8. Health care wouldn't. Health insurance would be wiped out

And health care companies would be less profitable. Thus GOP resistance.

[librechik]

14. why would health insurance be wiped out? They would merely have to compete

for the many folkks who won't like Medicare's limitations and want to pay for better coverage. NHS in UK didn't wipe out their insurance industry, or in Switzerland for that matter. Only who pays for the coverage changes.

[jeff47]

27. Because Medicare would be cheaper, more widely accepted

and not refuse care because it's an odd Tuesday in October with a waxing moon.

Switzerland has only private insurance. It is not a single-payer system. However, it's very highly regulated, so insurance companies have to offer basic insurance to anyone at a regulated price.

Insurance in the UK is not for treatment, but for "upgrades" during treatment. Such as a private room, faster access to doctors in non-emergencies, etc.

Besides, we would not want private insurance companies to compete with Medicare-for-all. They would only accept the healthiest patients, reducing cost-sharing and thus making Medicare more expensive. And since Medicare's existence would be the private company's cost control, that would make private insurance more expensive.

If private companies want to tack on some additional benefits as in the UK, fine. But it would be best for everyone if everyone was in Medicare.

[librechik]

30. it mystifies me why competing in the open market would necessarily kill these dinosaurs

seems to me like they would be forced to behave properly, once the monopoly they have is cracked. But they would hardly disappear. They haven't disappeared in ANY market with a public option, merely sized down. It's just a different paradigm when the profit motive (which is illegal everywhere but the US) is removed from the situation. it's a relatively new phenomenon here, too.

[jeff47]

37. They require profit. Medicare doesn't.

Thus they have to charge more in order to get profit, or they go out of business.

They haven't disappeared in ANY market with a public option

Please cite a country with an actual public option where public and private insurance competes for basic healthcare insurance.

As this list indicates, the vast majority of countries with a national health care provide basic services via public insurance and various add-ons are provided by private insurance.

It's just a different paradigm when the profit motive is removed from the situation.

So private insurance companies are in business because......? They just really, really want to bust their asses for no money? Private insurance exists to create profit for private insurance companies. Even in massively-regulated markets like Switzerland.

[YellowRubberDuckie]

25. I was drugged earlier. I meant insurance, not care.

[TheKentuckian]

9. I'm not getting why you think the GOP would support single payer and think

the opposition is about who thought it up (which I'm not sure about either seeing as it has been implemented all over the place for some time).

I'd argue that single payer is directly in opposition to their ideology and general goal of squeezing out every opportunity for exploitative profit. Giving the government the purse strings creates the potential of using that power to control costs and slow growth. Hell, just removing a layer of profitable companies is antithetical to their whole world view.

[freshwest]

10. The egos of people who consider themselves 'better' for having 'paid more,' is the issue.

As long as that divide exists in this nation, this will not happen, not by Congress, political party or executive decree. This is not a technical matter, but a societal one.

Although striking the age factor would be a great way to attempt to jump start the dialog that needs to take place to unify the country. Until that is done, people who believe they are better than so many others, will elect people to represent their interests above those others.

The elegance of the solution suggested might work if people can see through their prejudices.

JMHO.

[eallen]

12. I've often thought it a shame that Congress didn't do something close to this....

Instead of the Affordable Health Care Act.

Of course, they couldn't have passed it, all at once. It would have been too controversial.

What they could have done is just lowered the qualifying age for Medicare to 55. That would get the ball rolling.

[cthulu2016]

16. Almost that easy

I would reduce the eligibility age by one year every 4-6 months to allow time for some things to be worked out along the way.

(Since, for eaxample, medicare would end up covering pediatric and even pre-natal medicine and probably doesn't have schedules for that sort of thing.)

[Iliyah]

22. The GOP won't go for it.

Simple ugly fact.

[kudzu22]

23. Couple problems with that

First, Medicare isn't single payer. There are competing/supplemental plans out there for over-65 patients. In order to get to true single-payer you'd have to outlaw all other plans, and forbid doctors and hospitals from taking cash for services. Could be some constitutional issues there.

Second, you'd have to have huge tax increases to finance it. You proposed a national sales tax (even the GOP has proposed this) but I'm not sure that would pass constitutional muster either. The 16th Amendment authorizes a tax on incomes, not sales. Could take a constitutional amendment to get a national sales tax.

Alternatively, you could just raise income taxes, but you'd necessarily have to raise them on the lower and middle classes as well. Something this big could not be financed solely by the 1%.

I think your best bet would be the gradual lowering of Medicare age, rather than an all-at-once approach.

[AnotherMcIntosh]

24. This would mean that all the health-care stock-owning politiicans and related parties would have to

sell their stock.

That will never happen.

Will the U.S. Supreme Court uphold the mandatory-purchase-of-health-insurance provision (origionally a Republican idea)? It depends. What are the odds that none of them, their trusts, or related parties own health-care stock? How many bought health-care stock immediately before the Bill was signed?

[yodermon]

26. 18 million uninsured Americans suddenly get Insurance and immediate access to a Doctor?

The system would collapse because there aren't enough doctors /infrastructure / etc.

Not that Medicare for all is a bad idea.. it isn't .. i just needs to be phased in somehow.

Care is already rationed based on ability to pay. Take away current rationing strategies ==> system gridlock.

[cynatnite]

28. It's been recommended in this thread that this be phased in over a period of time...

such as by age. It would have to be slowly, IMO...perhaps 10 years or something like that.

I think the ER's would find relief since uninsured get a large portion of their care there.

[hughee99]

35. Exactly.

Already, the local doctors in my town have stopped accepting new patients. If you want new doctors, and will set some limits on how profitable a doctor can be (necessary cost controls) you'll have to also do something about the cost of medical school, or you won't have enough doctors to support the system long-term.

Then there's also hospitals, nurses, administrators, labs and equipment, etc... It has to be phased in or it will likely be so bad initially that it won't survive.

[libtodeath]

32. The RW will never agree because it would empower we the people over the 1%

[SickOfTheOnePct]

33. An optional buy-in to Medicare for anyone that wants it would be the way to start

That will result in regular health insurance becoming so expensive that most people can't afford it, and it will eventually die out.

[3waygeek]

34. It won't happen, in large part because the Republicans have struck the words "over 65"

from their IQ requirements for candidates.