So do you ever wonder what it would cost for America to implement Canadian single payer

[Monk06]

health care?

Here is a rough breakdown

TAXES:

Federal Marginal income tax rate of:
15% for the first $40,726
29% for income over $126,264

see: http://www.taxtips.ca/taxrates/canada.htm

FEDERAL FUNDING FOR HEALTH CARE

Federal Transfer payments for health care
The Canada Health Transfer Payment to
provinces will reach
$24 billion in 2009-10 and will reach over $30 billion in 2013-14.

A US Federal Health Transfer Payment
to the states by the Federal Government would
be very close to ten times the above figure or:

$240 Billion 2009-10 rising to $600 Billion in 2013-14

see: http://www.fin.gc.ca/fedprov/cht-eng.asp

This is just food for thought bear in mind that Canada's
per capita national debt is slightly higher than the US
and the US budget deficit is roughly equivalent to the
entire GDP of Canada.

Currently Canada is running a budget deficit of $17 Billion/yr
projected to be $85 Billion over five years.

To project a composite budget deficit on the US; again using
a factor of 10 (due to the fact that The US has 10X the
population of Canada but per capita GNP of the US and Canada
are almost identical), implies that the US budget deficit should
be 10X that of Canada or $170 Billion per year - $200 Billion over
five years. Unfortunately the US is posting a budget deficit of
$1.27 Trillion in the first 10 months of 2009.

From the above I conclude that on strictly fiscal terms the US
could have Canadian style single payer health care tomorrow if
it were not for exponential rise in the Federal budget due to
corporate bailouts.

Americans will not see Canadian style federally funded health
care and you can blame Goldman Sachs, BOA, Chrysler, GM, the Fed
as well the entire US Defense industry for that.

[billyoc]

1. Eliminating administrative costs and executive salaries would pay for the whole thing.

Lollipops for the kids included.

[Monk06]

3. There is a fair argument to be made for that. I'm just trying to make a fair fiscal arguemtent

That from the standpoint of taxation and budget
levels alone the US can afford the Canadian system.

[fascisthunter]

4. .

[MannyGoldstein]

2. Canada Spends 1/3 Less Per Person On Health Care

The rest is details, really.

[Monk06]

5. See my reply to billyoc above

[Festivito]

27. Isn't that Canada pays 2/3 less than US?

We're at 8160 per capita, they're at 3500 per capita. They could probably be at 3000 per capita were it not for being so close to the US and having US people crossing the border requiring them to issue and check for health cards, secondly they have Canadians crossing the border and have to insure them at the unnecessarily high US rates when needed.

They pay about 1/3 of what we pay.

[rurallib]

6. So - how much does the average Canadian pay in premiums per year

versus the US?
And how about deductibles? Mine is $10,000. Is that comparable to Canadian deductibles?
And what about the car insurance medical? How much is that in Canada? Compare to US, please?
And what about their medical for workman's comp? How much is that in Canada? Compare to US, please?
And how many go bankrupt or lose their houses in Canada due to health care related debts compared to the US?

These numbers are also very relevant when comparing the two systems.
If HC premiums were simply diverted to the treasury ......

[Monk06]

8. Here is the premium and subsidy scedule for BC. Other provinces are similar

British Columbia Ministry of Health
MSP Premiums

In B.C., premiums are payable for MSP coverage and are based on family size and income. The monthly rates are:

$54 for one person
$96 for a family of two
$108 for a family of three or more

MSP premium invoicing is administered by the Ministry of Finance, through Revenue Services of British Columbia. For information about the payment of premiums, see that Ministry’s web site under Medical Services Plan Invoicing.

A person who is no longer eligible for benefits (no longer a resident of B.C.) must notify MSP of the reason for cancellation, the date of the departure from B.C. and his/her new address (see the form for Permanent Move Outside B.C.). Failure to pay premiums does not constitute notification to cancel benefits.

Premium Assistance

Assistance with the payment of premiums is available to Canadian citizens or holders of permanent resident status (landed immigrants) who have held that status and been resident in Canada for the past 12 consecutive months.

There are two premium assistance programs that offer subsidies to those in financial need: regular premium assistance and temporary premium assistance.

Regular Premium Assistance

Regular premium assistance offers subsidies ranging from 20 to 100 per cent, based on an individual's net income (or a couple's combined net income) for the preceding tax year, less deductions for age, family size and disability. If the resulting amount referred to as "adjusted net income" is $28,000 or below, a subsidy is available. See the Monthly Premium Rates chart below for full details of premium assistance rates.

The current adjusted net income thresholds are:
$20,000 - 100 percent subsidy
$22,000 - 80 percent subsidy
$24,000 - 60 percent subsidy
$26,000 - 40 percent subsidy
$28,000 - 20 percent subsidy

The regular premium assistance was enhanced effective July 1, 2005, to allow more British Columbians to qualify and to allow those already receiving a partial subsidy to qualify for a higher subsidy level.

Prior to July 1, 2005, the adjusted net income thresholds were:
$16,000 - 100 percent subsidy
$18,000 - 80 percent subsidy
$20,000 - 60 percent subsidy
$22,000 - 40 percent subsidy
$24,000 - 20 percent subsidy

To apply for premium assistance, you need to complete and return an application form to MSP. Forms are available online (go to Application for Premium Assistance), through MSP's Forms-by-Fax service, at Service BC Centres or by contacting MSP.

If you are applying for assistance based on the earlier tax year please provide a photocopy of the Notice of Assessment/Re-assessment from the Canada Revenue Agency which shows net income for that taxation year. If you are married, or living in a marriage-like relationship, a photocopy of your spouse's Notice of Assessment/Re-assessment is also required.

Note: Families receiving full and partial premium assistance may be eligible for additional health care services through the Healthy Kids program of the Ministry of Employment and Income Assistance.

Temporary Premium Assistance

Temporary premium assistance offers a 100 per cent subsidy for a short term based on unexpected financial hardship. See the Ministry of Small Business and Revenue's web site, under Temporary Premium Assistance, for more information.

Monthly Premium Rates

Five levels of assistance, based on adjusted net income for the previous year, are available. Current rates:

Adjusted Net Income Subsidy Level One Person Family of Two Family of 3 or more
$0 - $20,000 100% premium assistance 0.00 $0.00 $0.00
$20,001 - $22,000 80% premium assistance $10.80 $19.20 $21.60
$22,001 - $24,000 60% premium assistance $21.60 $38.40 $43.20
$24,001 - $26,000 40% premium assistance $32.40 $57.60 $64.80
$26,001 - $28,000 20% premium assistance $43.20 $76.80 $86.40
Over $28,000 Full Rate $54.00 $96.00 $108.00


Income Verification

To verify eligibility, each person who applies for premium assistance authorizes the Canada Revenue Agency to release income information to the Ministry of Health and/or Health Insurance BC from the person's tax returns. Verification takes place each year and, where appropriate, MSP adjusts the monthly premium of beneficiaries upward or downward based on the information received.


http://www.health.gov.bc.ca/msp/infoben/premium.html

[Oregone]

9. As far as deductibles and copays, nothing

At least in BC. Im not sure about car insurance medical. That is also single-payer in BC via ICBC and I don't have a car regged there yet.

Near zero go bankrupt in Canada and lose their homes due to medical bills.

This is why the WHO rankings aren't the entire picture. There are more important health care measures that simply misses, and Canada is in a whole other league than the US (not just 7 places ahead).

[Monk06]

10. Minor correction. It is impossible to incure debt due to medical bills in Canada

The only debt you can owe is for unpaid premiums
and if you can't pay premiums you qualify for
100% subsidy.

[rurallib]

22. My point being that what the government covers is only part of the picture

I believe Canadians don't have to carry medical insurance on their car insurance, nor do they need worker's comp medical. Why would they? All medical is already covered.

[Monk06]

26. BCers have to carry a minimum $1.0 M in liability insurance on their ICBC auto insurance

and in addition to lost wages Workman's Comp
pays for any medical expenses that will enable
you to continue working eg physio, prosthetics
and retraining for disability capable employment.

At least that's my recollection going back twenty
years or so. Mind you Worker's Comp has never been
worker friendly up here so things might have changed.

[John Q. Citizen]

7. Wow, that's so much cheaper than the 2.5 trillion a year we are currently spending for health care.

So you are saying if we save 2 trillion a year in expenditures it's unaffordable? That makes no sense.

Of the 2.5 trillion we currently spend on health care, about half of that is government expenditures and half is private expenditures. So even by that measure we would be saving huge amounts according to your figures.

By the way, 10 x 30 billion is 300 billion not 600 billion. You might want to check your arithmetic.

[Monk06]

19. I am not making a case that you would save huge amounts of money

under a Canadian system. I merely extrapolating the costs
of the Canadian system onto the US economy. I am aware that
my argument is hypothetical and I am under no illusions that
Americans will ever see a government run single payer system.

The medical establishment will not allow it and have the power
to prevent it. The reason why is that they are a very profitable
monopoly.

Here's another per capita comparison between the US and Canada

In 2006, per-capita spending for health care in the U.S. was US$6,714; in Canada, US$3,678.<5> The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%.<5> In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending, and U.S. government expenditure on health care was just under 83% of total Canadian spending (public and private).<6>

http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

The source is Wiki but the quotes are cited and consistent with figures I've seen from
other sources

[John Q. Citizen]

20. Oh, we already have some government run single payer systems so I'm sure that

at some point we will get one for health care.

A very simple way would be to expand Medicare by 5 years every year on Jan 1st.

In 12 or 13 years then everyone would be covered.


Your figures indicted we would save huge amounts of money with a single payer system. 2.5 trillion compared to 300 billion a year is major savings. I'm not sure it would be that much saved because the numbers look like they would come out different based on the wiki numbers. I'm thinking your numbers in the op didn't include provincial amounts put into health care but just the federal amounts.

We will get to see the CBOs analysis of the Medicare for All Act very soon. (HR676)It's going to be debated on the house floor and put up for a vote of the full house in September.

[Monk06]

21. That is probably the best solution for one thing Medicare is familiar

The first step would be to cover children and
working poor earning less than $20,000 per year.
That is the official cut off point for full subsidy
under BC Med

[DeepBlueC]

11. Isn't there a difference between the cost of

operating a single payer system and implementing it? We would essentially be shutting down a network of functioning bureaucracies to replace them with an entirely new one. There are economic costs involved in eliminating businesses and the administration involved in them. And then new costs involved in creating an entirely new one out of nothing. In the first instance we create, for one thing, a lot of job loss and they are not absorbed seamlessly by any new bureaucracy. And a new bureaucracy of everything is not going to be running perfectly at the beginning or for quite some time. Yet people's lives depend on it. The startup is massively expensive and the initial functioning is likely to falter. That's why all countries seem to build a national health care system out of the structures already in place. And it's why France's is different from the U.K.'s is different from the Netherlands.

If you want value for money and effectiveness you have to find a way to use what you have and build on that.

[Monk06]

13. Theoretically all it would take was to mandate that private hospitals accept patients

on a single payer plan and submit bills to the Federal
Government. They already do that now in the US under Medicare
IIRC but there is a lot of fraud and over charging.

The administrative structure also already exists with Medicare
which is why the expansion of Medicare to universal single payer
would be the way to go. The apparatus for collecting payroll taxes
and administrating Medicare is already in place. It would just be
expanded to all employees.

The only job loss would be in the private insurance sector but these
would be absorbed into insuring medical coverage for non essential care
like cosmetic surgery, dental care much the same as private insurance for
medical and dental procedures not covered by Canadian Health care.

I also brought up another idea floated about DU of Insurance trusts, where
private insurers could underwrite the cost of part of the single payer system
for a fair return on investment like through a government bond issue

[DeepBlueC]

16. Stockholders might challenge the legality of that

That supplementary insurance is small potatoes compared to the insurance industry as a whole. And insurers already offer coverage for these suppplementary things in the US so I don't see that as picking up any slack.

[Monk06]

17. That's the probem with a privately owned medical system. Shareholder's rights trump patient rights.

That's why Tommy Douglas took over the hospitals
and kicked the insurance companies out of Saskatchewan.

Because the overriding principle of Canadian health care
in that adequate health care was the right of every citizen
and the interests of private investors should not determine
what type and level of medical care people receive.

[DeepBlueC]

18. Yes, I get it, I'm Canadian as well

If you take something you have to compensate those you have taken it from. Generally there is a 'sale' invoved and you know who will get the better end of that bargoon should it happen in the U.S. Won't have to go to Somalia to find pirates. Hence the infrastructure expense I mentioned before has a tendency to balloon unpredictably.

[dsc]

12. two things

One, you have a typo in your post. The federal transfer payment would be 300 billion not 600 billion. Two, you are leaving out the Value Added Tax which is a huge tax in Canada that has no equivalent here. In fairness, that needs to be mentioned.

[Monk06]

14. Time's up on edits so yes the US equivelant transfer payment would be $300 Billion not $600 Billion

[Monk06]

15. By value added you mean the GST ?

If that's what you mean then GST revenue during 2007-08

Total $29.9B or
$5.0B per percentage point of tax

Expand that to the US and you have $299.00B in VAT
or $50B per percentage point in order to raise the
needed revenue that you say is missing from my
table napkin arithmetic.

Whether this is doable politically in the US I do
not know. Probably not.

[dsc]

24. If it went to a program that had wide benefits it might be

I would be strongly opposed if it merely replaced income tax revenue.

[Monk06]

25. Well as it turns out the income from GST is almost exactly equal to the

Health Transfer Payments to the provinces. So
it is possible to pay for single payer with a
reasonable VAT nation wide.

[slackmaster]

23. Canadian military spending for 2009 = $19.1 billion; US military spending for 2009 = $738 billion

:nuke: