Bernie Sanders’s $32 trillion Medicare-for-all plan is actually kind of a bargain
S E E D E D C O N T E N T
$32 trillion.
That is how much federal spending would increase over 10 years under Bernie Sanders’s Medicare-for-all bill, according to a brand-new estimate from the libertarian-leaning Mercatus Center at George Mason University.
Before you question the source (like Sanders did ), you should know the left-leaning Urban Institute came up with the exact same number in 2016.
It sure sounds like a lot of money, and conservatives hopped all over the figure on Monday morning. But there are a lot of ways to think about $32 trillion — and one might be that it’s actually kind of a bargain.
Mercatus is projecting a $32 trillion increase in federal spending , above current projected government expenditures, from 2022 to 2031.
In terms of overall health care spending in the United States over the same period, however, they are actually projecting a slight reduction.
There is the rub. The federal government is going to spend a lot more money on health care, but the country is going to spend about the same.
“Lower spending is driven by lower provider payment rates, drug savings, and administrative cost savings,” Yevgeniy Feyman at the right-leaning Manhattan Institute told me. “It’s not clear to what extent those savings are politically feasible, and socially beneficial.”
(One concern is whether cuts to prescription drug spending would discourage medical innovation. It’s simply hard to know — Mercatus projects a $61 billion drop in drug spending in one year, but there would still be hundreds of billions of dollars spent annually on medications.)
When you consider a universal single-payer program would 1) cover every single American, eliminating uninsurance and 2) provide much more robust benefits, covering more services than get covered right now, then it starts to look like a good deal.
More people covered. More services covered. Same price, more or less.
The Mercatus Center bakes in some assumptions that could vary the actual cost quite a bit. For example, its scholars assume (as the Sanders bill dictates) that hospitals and doctors would be paid at Medicare rates, a cut from private insurance rates but an increase from Medicaid rates. If the real payment rate were different, it could affect the price tag significantly.
Still, this seems like a reasonable estimate from a group that we would expect to be pretty skeptical of single payer — and it still looks like kind of a good deal.
This is where politics enters into the mix. Conservatives are going to recite that large-sounding cost as often as they can. They were already jumping on it Monday morning. Many Americans still hold real reservations about making Big Government any bigger.
Single-payer supporters are going to have to come up with a persuasive case that, yes, the federal government is going to spend more, but overall spending won’t go up. Taxes are going to rise for somebody, but many or even most Americans could end up saving money on their premiums or on out-of-pocket costs.
We still haven’t seen the fine print on financing, and that will be a big part of this debate. We shouldn’t minimize that. There will be winners and losers, as there always are in health care reform.
It could be a winnable case, given evolving attitudes about a person’s right to health care. But polling shows many people’s opinions on this are still malleable. Persuasion is necessary.
But setting the politics aside, a closer look at these new estimates reveals “$32 trillion” isn’t quite as much as you might think.
Tags
Who is online
163 visitors
A doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan....(And that's assuming health providers willingly agree to accept drastically less money.) The reality is they, of course, won't and the cost will be significantly higher.
Good luck with that. Less in wages and higher taxes for less care.
Better care for lower costs.
Wrong. If you cut payments and salaries through government compulsion, health care providers will simply go out of business. Why should they go to all the trouble and expense of getting the training with an insufficient return to make a profit. That's the fallacy of Socialism, the job simply won't get done because people provide services for a good return, not through social conscience. Would you then advocate forcing people to take the training and work in the medical field for lower wages? If so, you quickly run into 13th Amendment problems (involuntary servitude).
I do not understand how Americans, who pay more and die younger, can blithely prattle on...
The Republican tax-cut-for-the-rich costs roughly one trillion dollars in lost tax revenue every year. And therefore that much more deficit each year.
Because liberty is far more important than life. That decision was made by this country in 1776 and has not changed. In the 50's I believe that they called it "Better dead than Red". It still applies.
My god.
In theoretical terms and once in a lifetime terms that may be true.
Unfortunately for your argument, people really dont lose any freedom from having to pay taxes.
If paying taxes cost you your freedom and you would be better off dead, why are you still here?
What the what???????
You don't lose your freedom by paying taxes, you lose it by not paying taxes.
I never said you have a choice and there is no consequence. You don't have a choice. But you don't lose freedom, you lose a portion of your money that is then used for the "common good".
Paying taxes does not = loss of freedom. Go to the Supreme Court and tell them that you don't want to pay taxes because it takes away your freedom and see what they say.
It's liberating to have access to medical care without going bankrupt, and it definitely makes one happier. Having the most expensive and least effective healthcare system in the developed world is a stigma, not a source of pride.
do not understand how Americans, who pay more and die younger, can blithely prattle on...
Maybe because Americans are not dumb to believe that life span equates directly to quality of a medical system. The research is out there Bob, instead of spotting lazy cliches, please educate yourself instead of relying on "schlocky" arguments, as Gregory Mankiw calls them.
Your first hint probably should have been that lifespans have decreased as Obamacare extended coverage to more people.
I received a death sentence the day I was born. So did you, you just haven't admitted it to yourself yet. Some things are more important than blindly clinging to the idea of living forever.
Of course you lose freedom. When the government seizes the fruit of your labor they deprive you of your freedom to choose where your money goes.
income taxes are enslavement to the state
Thomas Jefferson inaugural address March 4,1801
"what more is necessary to make us a happy and a prosperous people? Still one thing more, fellow citizens, a wise and frugal government, which shall restrain men from injuring one another, shall leave them otherwise free to regulate their own pursuits of industry and improvement, and shall not take from the mouth of labor the bread it has earned. This is the sum of good government; and this is necessary to close the circle of our felicities."
Do you pay income taxes 'pastor'?
Yes I do. From my self employment. I have never taken a salary from ministry. I’ve always paid my own way in the ministry.
More than 90% of what we receive goes to help the needy here in the US and overseas
All this concern for the needy and nothing for the uninsured?
Like most leftists you assume that caring only comes through government
Frederic Bastiat correctly refuted this false accusation by you Socialists in his famous Treatise, The Law in 1850
“Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain"
The only things this fantasy lacks are a unicorn and some pixie dust.
Horseshit.
A person who must constantly live in fear of losing everything isn't really free.
Europeans simply do not have that worry. They are free in a way that most Americans are not
That’s laughable. I’ve been to Europe and not only is it a terrible place to live (except perhaps some of the rural areas), I could never willing live under their slavery to the state.
its already horrendous here, but not yet as bad as Europe
When you can't answer the particular case, you flee to pointless generalities. You run away.
Then you lose your "freedom" when you drive down a highway because you may have wanted to cut across someone's lawn. You lose your freedom when you are forced not to park in a handicapped space, you lose your freedom when you have to put your trash is a receptacle for pickup instead of being able to throw it out your car window. You lose your freedom when they force you to wear trunks in the community swimming pool.
Get over yourself.
Deleted
Let me make it clear to you
slavemasters told their slaves that they didn’t realize how good they have it because they don’t have day to day life worries
Instead of plantation owners, government is the slave owner
removed for context
"Pastor", the Supreme Court has ruled on the constitutionality of taxes. You lose.
If you want to believe the nonsense that you lose "freedom" when you pay taxes, who am I to deprive you of your convictions?
I'm on French health-care.
So I already have that proof.
There was one state that already tried it (I think it was Vermont) and it failed faster and more completely than Obama care .
Utter rubbish is what it is.
Huh?
I know I'm not going to live forever dear.
No one is silly
Hmm, last I checked, Sweden, Canada, EU all still have doctors, hospitals, private practices..etc
Doctors and hospitals lose money on Medicare and Medicaid reimbursements that’s why the charge insurance companies more to recoup those losses.
socialized health care has never worked
The French system is going under and both France and Germany now encourage the purchase of private insurance to lesson the load on government
France's Health-Care System Is Going Broke
By Albertina Torsoli January 03, 2013
For decades, France has held up its health-care system as a model to the world. Homeopathic remedies, support tights, and taxi rides to the hospital are among the many costs reimbursed by the health-care branch of France’s social security system, known as l’assurance maladie .
Yet France’s looming recession and a steady increase in chronic diseases including diabetes threaten to change that, says Willy Hodin, who heads Groupe PHR, an umbrella organization for 2,200 French pharmacies. The health system exceeds its budget by billions of euros each year, and in the face of rising costs, taxpayer-funded benefits such as spa treatments, which the French have long justified as preventive care, now look more like expendable luxuries. “Reform is needed fast,” Hodin says. “The most optimistic believe this system can survive another five to six years. The less optimistic don’t think it will last more than three.”
France’s health system now requires doctors to reduce the number of drugs they prescribe and to substitute generics for brand-name pharmaceuticals. The government says cuts in the cost of prescription medicines will save €530 million ($702.4 million) in 2013.
The tinkering appears to have succeeded in bringing down costs, though it’s unclear by how much. The government projects the health-care system’s 2013 shortfall will be about €5.1 billion, down from €11.6 billion in 2010. Yet that forecast may be optimistic, since it’s based on the assumption that the economy will grow 0.8 percent—double the European Commission’s estimate. France’s system “is simply unaffordable, unsustainable, and the manner in which it’s financed is a huge burden on the economy,” says Nicholas Spiro, managing director of Spiro Sovereign Strategy in London. “The French are not being realistic.”
I've lived in France for forty-five years... and there have always been scary headlines about the system going broke. It hasn't. It won't.
The system is supposed to break even, which is obviously impossible with a budget in the tens of billions. Even a tiny percentage deficit results in huge numbers if stupidly projected into the future. Only a tiny percentage correction is needed to make those monstrous future deficits disappear. This yo-yo is standard practice.
Your five-year-old article is just more of the same ignorant / alarmist claptrap.
Complementary insurance, to pick up what basic insurance does not, has been part of the system since its inception over fifty years ago. That part is covered by non-government insurers.
Either your article's author didn't know what she was talking about... or she was intentionally misleading.
I dont understand why America thinks we need to reinvent universal healthcare. Most of the civilized world has it, study what's out there and see what could be best adapted to our country.
That is absolute crap. We already have Medicare that works great for seniors, expanding that to everybody would be the fastest and least expensive way to implement.
If it didn't it would be solely because the Republican party would be constantly trying to dismantle it.
Why? Are Americans too stupid to accomplish what every other developed nation has done?
We have a plan covering 75 million people paid for a different 156 million people and a trust fund that will be depleted inside of 10 years unless major intervention is undertaken. So naturally the "solution" to this is to quadruple the number of people covered while not changing the number of people paying in. What could possibly go wrong?
Look it up, I've given a few links here and there. Come to the table with some specifics. So far the right just dismisses and tries to keep a small perspective on the subject and few seem to know how it works and why its cheaper.
Its been 5 years since that hit piece was written, i think France is still doing just fine.
My only worry is that I can only get a prescription for six months of medicines, and we now spend more than half the year in Arizona.
Oh, well, Mexico is only a half-hour away...
Medicare for all or single payer ignores what insurers and the medical profession have been dealing with for decades-COST SHIFTING
When Congress or presidents like Obama direct reductions in reimbursements or reductions in pricing for procedures, those costs are passed on to the rest of Americans in higher prices to those with health insurance
Adapting "Medicare for all" or single payer will mean there is no longer an avenue to absorb those losses inflicted by Medicare and Medicaid.
Secondly, as has been noted elsewhere, to contain costs it would require dramatic reductions in salaries for health professionals, anywhere from 33-66% similar to European models.
Average salaries for nurses in Europe approx $2668 a month or $32016 (USD a year
Average salary for nurses in the US is $48-86k per year and I know many RN's in CA who earn well over 100k per year
(RN)/Hourly_Rate
How much does a Nurse in California make?
The average Nurse salary in California is approximately $2,190 per week, which meets the national average.
CA nurses average $101,750 a year per BLS
Self-employed family doctors pick up salaries of about £103,000 – ($133, 900 USD)
US average is $188,000
http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2f_Doctors/Salary
Another Medicare fact. Medicare Claims Administration is done by Insurance companies, NOT the Federal Government
Medicare Administrative Contractors
Since Medicare’s inception in 1966, private health care insurers have processed medical claims for Medicare beneficiaries. Originally these entities were known as Part A Fiscal Intermediaries (FI) and Part B carriers. In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition Regulation (FAR) . Learn more about MACs at What is a MAC . Learn more about MAC current events at What’s New .
Let's cut the crap. The numbers aren't complicated.
Americans pay a lot more, and they don't live as long.
So the obvious conclusion is that America is doing it wrong.
Any government involvement in ones decisions about their health is tyranny.
Poor health outcomes for Americans are almost entirely due to poor health choices,
Cultures who make good lifestyle choices have the best longevity, all without universal healthcare
Yeah, We know. Government bad, Jesus good. Got it.
"The state remains, as it was in the beginning, the common enemy of all well-disposed, industrious and decent men.” ~H. L. Mencken (1880-1956)
"The care of every man's soul belongs to himself. But what if he neglect the care of it? Well what if he neglect the care of his health or his estate, which would more nearly relate to the state. Will the magistrate make a law that he not be poor or sick? Laws provide against injury from others; but not from ourselves." —Thomas Jefferson
The crap in question is this idiotic proposal.
I'm glad you agree. We spend just under $10k per person per year on healthcare in this country. Unless you're willing to pay that amount of tax for every member of your family, this is all just another elaborate steaming pile of leftist bullshit where you try to get somebody else to pay your bills.
Our providers make several times what they do in other countries, and "walking distance" in America stops at the end of our driveways. Massive amounts of our illnesses are self-inflicted in ways that other countries choose not to behave.
Like I said, "America does it wrong."
So what would be your solution to insurance companies denying coverage to people that cannot afford their medications or treatments? My daughter would be dead if pre-existing conditions were still allowed to be excluded for payment by the insurance she pays for. Her treatments are in excess of $5000.00 a month. I can't pay that can you?
Americans pay more, for less life expectancy.
End of story.
Nail hit on head.
It's kinda sorta "duh!"
How much less am I going to be paying if I have to pay for mine plus a burger flipper a beach bum and a junkie on skid row?
Don't worry, Dean. You aren't rich enough.
Well we are in agreement there.
I don't see single payer helping us get off our fat asses, though.
Nor do I. I've spent some time looking at health-care systems around the world. There are all-public (UK's NHS) all-private (Switzerland) and every imaginable variation in between. None are perfect, but thet all give better results than the American system, and they all cost far less.
The "secret" is simple: the insurer(s) must have no role whatsoever in medical decisions. The first the insurer(s) know of a medical act is the order (not "request") to pay.
There is nothing upstream of the medical process. No "prior accord", no... lawyers...
The insurer(s) cannot improve their bottom line by skimping on treatment. They can improve their bottom line by streamlining all administrative processes. (I have a smart card, to pay my doctor and pharmacist - no paper at all. Computers split the bills to the appropriate insurers.)
The practitioners' professional associations oversee costs after the fact.
Interesting how you group people working for low wages in with junkies and bums.
OK. Fine. But there's a whole massive shitload more to it than that.
It's a commonly held but epically large fantasy that "streamlining administration" is going to get costs under control. But it can actually improve the quality of care. We're starting to see more modernized data management make physicians' jobs easier, but it's not nearly widespread enough.
What do you propose? As detailed as possible...
I posted this on your other seed, so you can ignore it there if you don't want to be bored twice.
We have three issues to address. 1. Access to care 2. Cost of care 3. Lifestyle and general health
Issue 1: Access to care - insurance
The cost of insurance is driven by the cost of care, so we'll cover that in a minute. Keep the guaranteed issue and no pre-ex limitations of the ACA. They actually existed in small business plans for decades prior to the ACA in 38 states, so insurers know exactly how to manage them. Get rid of the individual mandate for good, as it is wholly unnecessary and hugely unpopular.
Then, do one of two things. Either make Medicaid a Federal-only program and bump the qualification level to 138% nationwide. ...or...and this is better... Make Medicaid a Federal-only voucher program and roll it into the healthcare exchange so those people can have the same coverage as everybody else. Then, combine the application for any other kind of US govt assistance with the application for Medicaid, and require any person receiving public assistance to demonstrate health coverage.
For those people who can afford insurance but just don't take it, make them responsible for their claims. Allow providers to submit unpaid bills more than 180 days old to the US Treasury for reimbursement. Then, have that bill deducted from that person's income tax refund until it's paid. When people realize they are going to be held responsible for their obligations, they will grow up and take care of their affairs.
Issue 2: Cost
Contrary to fantasy, you can't actually drive drastic cuts through the system and expect it to survive. Hospitals, providers, manufacturers and everybody else in that industry makes multi-year commitments based on projected revenue. You don't want them defaulting on their bonds and killing the teachers' and firefighters' pension plans.
However, you can slow and eventually halt the madness. Simply freeze Medicare reimbursement rates. Announce it a couple of years in advance, so everybody has time to plan. Set the drug price cap at some multiple of what other governments pay. For example, "Medicare will pay 10% more than the average cost of XXX drug in Canada, Australia, and the United Kingdom". Most private insurance plans drive their reimbursement rates as a multiple of Medicare payments, so slowing that train is key to everything.
When the federal govt stops "just paying more", it will stop enabling inefficiency. Systems will improve because the major stakeholders will feel a need to improve them. Currently, they don't. Under M4A, they certainly don't, and never will.
Further, we need to reintroduce medical questions for health insurance. The ACA unwittingly concentrates all the very sickest people into the very smallest pool. Prior to 2010, 38 states operated high-risk pools, where unhealthy individuals could get insurance, and then have very high their claims subsidized by all other insured people in their state. The ACA did away with those programs, and in doing so allowed insurers to get away from those high-risk individuals by simply declining to offer individual purchase plans. That's why the insurers who stayed have lost so much money and why so many have dropped out of that business along the way. The remedy for that is simple. Reintroduce those risk pools (or create a federal one), and force every health insurer to assume their proportional share of those liabilities. Now the sickest people can get the same insurance as the healthiest ones, and one small section of the population doesn't get bled to death.
Issue 3: Health
You can't have a serious discussion about outcomes without discussing obesity, smoking, poor diet, lack of exercise, and the hundreds of billions we spend because of the decisions some of us make. Obesity alone directly accounts for over 8% of total healthcare spending and smoking accounts for another 5%.
I believe it is the Constitutional right of every American to be fat and/or to smoke. But I'm not convinced it should cost the rest of us more money.
I was watching a show on Netflix the other night. It part of the "dirty money" series they are currently showing.
The Epic Grift of Netflix 's 'Dirty Money' - The Atlantic
Netflix ’s new six-part documentary series is an enthralling take on cons and corporate malfeasance, from money laundering for cartels to the Trump Organization.
-
This particular episode was about the pharmaceutical company Valeant. A few years ago Valeant started raising the price of prescription drugs to the point where a pill that had cost 20 dollars now cost 700. The treatment for one year became appx 250,000 dollars. Even with insurance paying the brunt of it , the copay on the drug would still bankrupt most people over time.
The CEO of Valeant said that his job is to increase share value for stockholders. Valeant was a company that bought up other pharma companies and sought ways to maximize profit. They barely even had a research dept. It was all about making money through juicing the value of shares in the company. A scam.
Health care should not be a profit making business. That is where we go wrong , because there will always be cheaters, crooks and grifters out there, and often there are a lot of cheaters, crooks and grifters out there. Does anyone doubt that medical billing fraud occurs every day in the US? No one cares about that. We care about someone cheating on 20 dollars worth of food stamps.
We need a version of nationalized medicine like every other developed country in the world has.
$32 trillion? Is this sustainable? Sounds like too many people and not enough taxpayers.
Single Payer? Absolutely, if the nation considers it an investment for themselves. Of course, the 'private for profit' faction of the system would have to decide whether they want to participate and decline the top end salaries and stratosphere benefits and retirements. Pensions and 401k's for everybody. Three and a half per cent operating margins are fair enough for the private sector should they desire to participate. Of course, this means no more fleets of private jets, fly commercial like everyone else. And, no more company private golf course retreats either.
Healthcare profits are far less than assumed by the left
“In fact, as a Commonwealth Fund report shows, from 2012 to 2014 insurers spent 87 to 88 percent of premiums just paying claims, leaving relatively little to pay the salaries of the thousands of employees who provide customer service, the clerks who enroll and dis-enroll customers, and all of the other administrative costs of a labor-intensive business.
The truth is that health insurance is not a hugely profitable industry; profit margins often run in the low single digits. By contrast large drug companies regularly report double-digit margins.
In 2014, the first full year of Obamacare, only about 1/3 of insurers generated any profit; the rest lost money. This explains why for-pofit insurers like United Healthcare are no longer participating in Obama-Care.”
For the first two quarters of 2018: healthcare facilities averaged 3.31% profit
I don't know of any politicians who say that... but it's true.
Run the numbers. It's not rocket science. America is the richest nation on Earth. Of course America could pay... but the ultra-rich prefer to buy another yacht.
Why should anyone pay another person's way in life?
Work for what you want, earn what you need.
Sure comrade, you have no problem seizing what someone else earned to pay the expenses of another person who didn’t earn it.
Marx would be proud of you
I don't want to insult you, but that is an ignorant statement. Everybody pays when others aren't covered, and choosing not to be covered is also forcing us to pay when you have that heart attack or car accident. There is so much information not tainted by politics if you choose to really go deep into healthcare and what works and what doesn't. Maternal deaths are worse in the USA than any other developed country (nice when gop is trying to force all pregnancies to term at the same time). There are reasons our costs are the highest and our outcomes aren't as good. You would not be paying for another persons way of life, you'd be getting a benefit, as would employers and everyday Americans. Check out information that goes beyond sound bites because there is so much more out there.
I rarely take offense to your posts.
And this one is not one of the rare times.
Our health as a nation has far more to do with our diets and exercise regimens than healthcare professionals.
I want every able-bodied adult to pay their own way. I don't mind HELPING someone down on their luck, but it shouldn't be a way of life.
And the post I was responding to said some things about rent, schooling, and guaranteed incomes. I won't go along with any of that bs.
As far as pregnancies go, abortions are legal in every state. And birth control of one form or another is on virtually every other corner in America, at relatively cheap prices. It isn't my duty to pay for anyone's birth control or abortions.
Unless of course one can actually....well...you know....."count".
Do show us those numbers.
Oh good, I really didn't want to.
I really want Americans to understand what they don't know. There are so many good models out there to bring into a discussion on how to have the best system for us, and when we never get into specifics it just seems to go in circles. I've lived overseas and have had the good fortune to experience life in a national health service, and it is nothing like what is described in the scare tactics we hear from the gop. We got great care without the fear of cost. In Ireland we got the upgrade from the basic public service (so affordable), and back then we had doctor house calls! Emergencies were dealt with, no problems at all. In the US heath costs are getting closer to 20% of our gdp, which is the highest in the world. And we are unhealthier, not all from our habits! From pollution and carcinogens and god knows what, hereditary problems, accidents, disabilities, the list is endless. We are going bankrupt and many can't even afford any care. We need real discussions with real solutions, with proven track records, not political ideology. There are some things worth paying for through taxes instead of individually, and this is one of them. But lets get the ball rolling with something positive as opposed to breaking what was in place with nothing to replace it with. People are impacted right now.
Oh, and maternal death rates should have been noted as unacceptable in this country in 2018. The worst in the developed world. Horrible.
Personally, I don't think the govt. should be involved in healthcare insurance. If govt. want to be involved in healthcare, then go all out.
Let the govt. open hospitals and clinics, hire doctors, nurses, lab techs, etc.
Allow anyone on govt. sponsored healthcare of any type to go to these places. No paperwork, no insurance forms necessary.
Allow anyone to choose for themselves which they want--private insurance or govt. healthcare. if you choose govt. healthcare you go only to govt. facilities or bear the costs yourself.
I did already.
There aren't government facilities, they are normal doctors and normal medical offices. In Ireland the company paid for the upgraded level of service, and we paid a bit more for 'private' services, for example when I had my son we didn't use the national maternity hospital, (although many friends did), but I don't regret spending a tiny bit more for 5 fabulous days in a 'private' hospital (huge private room) and great food. The key is that even that is cheaper when all the costs are lower. My daughter got ear surgeries, all on national health, all good. In the UK prescription medicine for children was free! Sure there can be wait times for non-emergency surgeries in some areas some times, just like here. But everybody has access to the care. It is cheaper for everyone, and I know Americans would love it if they knew what it was. Including you I bet.
Exactly. That would be mostly non-emergency and elective surgeries, correct?
personally, I like my insurance plan I and my employer pay for without govt. subsidies.
One thing I very, very rarely hear in America:
"I am going to Europe for medical attention".
And when I have heard it, it is usually for some experimental treatment not approved in the US.
Yes, emergencies are addressed immediately, and ongoing care for chronic illnesses as well.
See, those employer paid costs (which many employers can't afford to provide) are paid for by employees. In the form of lower wages and narrowing benefits. The high costs are paid by every American in one way or another. Your focus on 'gov't subsidies' is misplaced. There are many different models to compare, but when the overall costs and portion of the gdp goes down, it can be used for other things like infrastructure, paying down the debt, defense, shore up Social Security, lots to choose from. If employers didn't have to deal with ever rising costs of insurance, MAYBE wages would go up for real.
have to remember that 32 t figure is a 10 year figure , so 3 t a year is the number that could be looked at to consider feasibility, and with that number one will have to ask , how much more will taxes be across the board, not just at the upper levels , and where potential cuts in other areas be .
Indeed!
I'll seed an article tomorrow that compares US health-care with other countries.
Remember that American life expectancy is less than other nations.
Poor health outcomes for Americans are almost entirely due to poor health choices,
Cultures who make good lifestyle choices have the best longevity, all without universal healthcare
That's the part they like to pretend doesn't exist.
Americans have poor health in large part because of poor diet and exercise regimes.
Not one damn thing to do with health care being provided.
The whole article tomorrow. If you're in a hurry, it took three minutes on Google.
And sinners too, right? Those unhealthy heathens!
Did you read the seed?
Right. A 90% increase in spending is cheap
That's because it is.
Asking people who are so poor they are exempt from paying income tax to "put some skin in the game", by paying income tax, is literally saying that you want to make poor people poorer, intentionally.
Funny how that works around the world John - really funny. You earn what your talent, ethics, morals, education and experience dictate per the organization you work for.
Doesn't work that way for you, eh?
Nonsense. The tax code does not make people poorer or richer. Minimum wage does not make people poorer or richer.
These things serve one purpose and one purpose only.....they make poor people and bleeding heart emotional liberals "feel better". In doing so, they buy the votes of people who have zero understanding of wealth.
The way you intentionally make poor people poorer is to continually reduce the standards in their schools, and then tell them the only way they'll ever be successful is if they go to college.
UK health delays, this is what Universal healthcare brings
“NHS extends suspension of all non-urgent care as doctors warn of winter crisis
Officials estimate this could lead to up to 55,000 deferred operations
January 2, 2018
The intervention comes after The Independent revealed “tragic” cases of patients being left on the floor with “serious fractures”, while nurses were being drafted in to deal with demand for ambulances.”
All that and its STILL better that the USA. As is EVERY OTHER DEVELOPED COUNTRY.
Just crunched some simple numbers , I used the annual cost of 3 trillion , and the current US population of 328 million , and came up with a $ 9146.34 roughly per person that the government will have to figure out a way to collect those funds from the US tax payers which is actually less than the total population , so it will end up being more from the taxpayers to pay the per person price on cost , over what the government already spends.
So the ??question is, how do they plan on paying for it
Wipe out about half of that population total since they are largely exempt from federal income taxes.
I guess they think money grows on trees.
cant wipe out the population total , now the taxes levied on the tax payers will go up expotentionally as certain catagories are exempt from taxes. placing the burden on those remaining.
remember the parable about the 10 guys who went to the bar and paid progressively, worked fine until the bar keep threw them a curve , when dividing the refund , they all complained about the one who got the most? beat the crap out of him for defending getting more back . well the next Friday he didn't show up so didn't pay his "share", to the others finding out between them all they couldn't cover the bill.
same will happen here in this situation.
Moral of the story : don't kick that golden goose in its egg layer, if you do you wont get any eggs.....
stupid parable, there are extremely rich people living all over the world in countries with higher taxes than the U.S. nd even those with Universal Healthcare...The horror, why haven't all those rich people moved the U.S> already where we don't make them pay extra taxes for healthcare.
my point, no one is going anywhere, so enough with the drama.
Most people understand that a parable is a made up story intended to show a point , the moral usually included in the end. In this case I might of should called it a "Fractured fairytale" ( yes I remember those cartoons).
Cant say the rich wont just up and leave , they do , for their own choices , a couple of examples would be that French actor that took Russian citizenship to lower his tax burden that france imposed on his holdings and earnings , another example would be one of the co founders of Facebook that decided to become a citizen of Singapore, rather than pay US taxes.
That is just 2 examples I can think of , and I am sure others can think of more . so saying it isn't going to happen , doesn't mean it cant and wont happen.
Alternatively, we might take note that only ONE actor did this... and Depardieu is nutzoid in more ways than just this...
Oh I agree Bob , it was one that came to mind, but there are others as I said that have expatriated , taken up different citizenships .
I forget what the expatriation rate is , and most usually do keep their US citizenship but many also pick up dual citizenship elsewhere. ( I am of the opinion there should be no dual citizenship at least for the US, but that is for a different discussion).
And the only reason I was and do look into the ex pat issue , is I am considering it for myself sometime in the next decade or so if I do decide to go that route.
I lived in France for a dozen years before taking French citizenship. I was very active in amateur basketball, but only citizens could be on the regional management committee.
I wasn't "naturalized" under French law. As spouse of a French citizen, I was automatically a French citizen. But France was unaware of the fact, so I had to go before a judge and declare my citizenship.
Fifty years ago, the US didn't allow dual citizenship. The government declared that taking out another citizenship implied renunciation of American citizenship. Then the Supreme Court said, "What is this 'implied' shit? Where does the Constitution 'imply' anything about citizenship?" And suddenly... dual citizenship was OK...
I wrote to the embassy, saying that I was taking French citizenship, but in no way meant to renounce the American. I've renewed my US passport several times since then, with no trouble.
Here's who pays what :
That top quintile has about $ 200 000 per family per year, for about 12 million families, or $ 2.4 trillion. So, roughly, 1 point of taxation is $ 100 billion in tax revenues, for just the top quintile .
I'll let you do the rest.
Oh, and... let's not forget that today Americans pay more for health-care than any others. Instead of putting money in shareholders' pockets, it might be a better idea to spend it on health-care.
so your saying the money is already there? it is just how it is currently being spent and structured by the Gooberment ?…. and no one will have to pay more?
and you have title to a bridge to sell me ,right?
I wish republicans would actually go into this issue and learn about it on a deeper level than dismissal and soundbites. We have the most expensive and least effective healthcare in the world! There is NO system like ours because its a failed system! It is inhibiting the economy because employers are stuck in the middle too, as are their employees. Check out other systems. Try them out if you can, it helps if you have first hand experience. I can tell you there is nothing better than not worrying about health, and never had a problem getting care, EVER. There are things to learn from the different models and this country can find a much better way to have healthy people and free up that part of the economy for wages and infrastructure. Paying almost a fifth of the economy in health costs is not a good thing.
The Sanders plan requires an additional $3.2 trillion/yr. According to your data, taxing the top quintile at 100% still doesn't begin to pay for this scheme.
All this assumes you can cover 30 million more people for the same amount you're paying now (which you can't), and that expenses won't inflate over the next 10 years (which they will).
While saving the the government ~$200 billion/yr. The report concluded that the annual savings between implementation of Sanders's plan (2022) to 2031 would be $2 trillion. So, do nothing and spend more and leave millions of people uninsured and tens of millions under-insured OR have universal health care and spend less. No wonder the rightwing hates this idea.
No. From the seed:
Americans now put those $ 3.2 trillion in the hands of for-profit organizations whose purpose is NOT to provide health-care, but rather to maximize shareholder dividends. There is a blatant conflict of interest: every dollar spent on health-care is a dollar that doesn't go to the shareholders.
The primary advantage of the Sanders plan is not that it is single-payer. (in fact, the format is of no importance at all.) It is getting Americans' health-care money out of shareholder pockets and into health-care.
$32 trillion over 10 years is $3.2 trillion/yr....additional tax revenue required....which was the stipulation in the previous post.
Do you know who HCA is? Pfizer? Tenet? How about HCP? Omega Healthcare? Merk? C'mon now.
The amount of naivete involved in this statement is....very unfortunately....not atypical of Bernie supporters. There is LOT more to this $3.5 trillion dollar than you seem to realize.
Dude...seriously. Read the report. It says none of those things.
Here's the link.
I'm going to assume you're not really stupid enough to think we only have two options.
They are corporations that rake in a great deal of money by holding sick people for ransom: "Pay or die".
What part of
... ... do you not understand?
The $3.2 trillion in additional taxes would be more than offset by eliminating all payments to private insurers.
Or are you saying that you oppose taxes even when they cost less than the same payment to private entities? Is yours a dogmatic position, rather than a pragmatic one?
They are corporations....with shareholders....that will all exist quite happily in your "non shareholder" utopian fantasy.
Really?
So your plan is to replace the $1.1 trillion paid to private insurers with $3.2 trillion paid to the US govt.... and you think this is "savings".
Do you understand how appallingly bad that math is?
BTW...over $1 trillion of the $1.1 trillion is paid by corporations. But you think it's better if individuals pay that.
And you ask me if MY position is "dogmatic"......
Ok... I'm done.
The "private payments" aren't only to insurers. You're adding apples and oranges.
Why should the corporate contribution diminish?
Since the beginning of this conversation, you have sought only "why nothing can be done". I'm done.
Having to face the fact your plan doesn't work proving too difficult?
You said this:
Payments to private insurers were about $1.1 trillion in 2016, according to CMS. Please endeavor to clarify how $1.1 trillion "more than offsets" $3.2 trillion. Now if you didn't mean that, please feel free to clarify. But I will always assume you actually mean what you say. Sorry if that's inconvenient.
Because you will be changing it from a voluntary expense they must endure in order to compete for talent....to a tax, which they avoid and all costs and have proven brilliantly adept at doing so.
Do you honestly believe those are the only two options? I presumed you were more intelligent than that.
Please do tell me you're not one of those agonizingly tedious people who support Bernicare simply because it's the only alternative they can comprehend.
I'm done.
what makes you think everyone should be required to pay the same amount?
Aren't we all equal in the eyes of the law?
What--do you want to charge more for those who use more healthcare?
health care should be paid for by a progressive income tax the same way everything else in the federal budget is paid for
No it should be paid for by the individual and the government should not be involved.
interestingly enough. I support single payer. and I support the money coming from "income taxes"
but I draw the line at federal management. (deal breaker)
if a state screws up we can move to other states.
if the feds screw up, and they will, we can not move to another country.
btw we must also kill the insurance companies.... no reason they should even be in the loop.
and federal collected funds going to the states? I'm totally in
Why?
What will be next? We pay for everyone's housing and food, too?
If you dont have healthy people help to pay the cost for the sick, as insurance, then most Americans will never be able to afford getting sick and will lose their houses, life savings etc. Is that what you want Dean ?
that is actually a state issue.
losing a primary home because "healthcare bill collection" never happens in texas or any state with a similar homestead act.
however...
passing a national homestead act? very fukin good idea... seriously
Yup - you're a Democrat. Evidently you don't want people working for what they want or, in their minds, need.
Sad.
Most countries have an independent agency to run their health-care system. It's not government, neither federal nor state. It collects and disburses money, outside the national budget.
The French system (Caisse nationale d'assurance maladie) is run by a board with representatives from business, unions, and the government. (Interestingly, there have been several occasions when business and unions have allied to "keep the damned gummint's hands off" that "independent money"...)
There are offices in all towns of any significance. Most practitioners are private-practice (except for those in the equivalent of "state hospitals", for example).
We choose our "family doctor" who takes care of minor problems and oversees relations with specialists for major problems - mine tells me when he thinks it's time to see my cardiologist (arrhythmia), roughly every two years.
Almost everyone takes out complementary insurance for whatever is not covered by the national insurance. This is provided by private insurance companies. (This could be a bridge between the current American mess and something effective/efficient.)
I didn't say that is what everyone would pay now is it John , I even pointed out that those that actually do pay taxes( those that do not get a refund that is usually more than they actually pay in) would pay more to make up the difference, I simply stated what the cost per person would be .
medicare icurrently is an entitlement we all pay into through our payroll taxes and is already done so progressively, the more you earn the more you pay in , and yes it is an entitlement for those that have paid in simply by virtue of the fact that one has paid into the system for use at a later date.
this proposal uses medicare as a model , but it isn't medicare, actually thinking about it , if this proposal came about , things like medicare and medicaide VA medical benefits would all go away be cause this proposal would replace not only the insurance industry and the individual as the primary payer , to a single entity responsible for it all from birth to death. So there would be no need for those other things. they would be redundant.
And if this is actually the case , it looks like what is desired is to take all the funds already collected for medicare , and those to be allotted by congress for the other programs and pool all those funds together and redesign the system to cover everyone as I said from cradle to grave.
It is an interesting idea , my question is , is it feasible?
And there in lies the crux , convincing those healthier that they need to purchase health insurance early on in life .
most of the 20 somethings and going into the mid 30s , usually have that 10 foot tall and bullet proof mentality unless they are faced with a health issue that has the ability to affect their earning capability. Some will and have learned the hard way , some have witnessed it happen to family or friends , but all usually have in the back of their minds it wont happen to them , but if it does there is a social safety net that will pick up the slack after the fact.
Before the ACA days the way insurers use to entice those people were with lower cost coverage plans , some plans could be tailored to the individual as needed , it use to be the individual could pick ala carte the coverage they desired , a young person might only have wanted a catastrophic injury policy , but nothing that would cover something else . and the way they also did it as an enticement was who was covered in those specific pools.
post ACA , those pools have been expanded , coverage cannot be denied, actually the only way to deny coverage is to not be in the business at all. and the only way the Ins co could do anything is raise the price to defray what they were paying out because they had to accept everyone . the tipping point is and will be and has been , when the cost of the ins , was more than the cost of the fine the government imposed for not having coverage.
personally I think it is all in the way the message is presented and enforced.
Good recap. The consequence is a universal mandate. Everybody pays into the system, as of the first paycheck (or any other revenue).
"Universal" health-care must work both ways.
More people in this country have insurance than own homes.
Sounds a little Chicken Little to me!
Single payer is not about healthy people paying the cost for the sick. It's about 20% of the people paying the cost for everybody.
If someone else has pointed this out I apologize for the repetition but I really didn't feel like reading every comment in this long list of them. Republicans made a big deal out of the "huge cost" of this plan while conveniently ignoring the fact that the report concluded that Sanders's plan would cost the government $2T LESS than doing nothing about health care between now an 2031.
That's actually not what it says.
I'm am so glad you said that, Jack. There's nothing I like better than to shoot down someone so sure of himself and so, so wrong:
Jack, this is what comes from having your head stuck in the rightwing pukefunnel all day, every day.
Oh...the irony.....
You said this:
In reality, the report indicates a figure of $32 trillion increased govt spending over 10 years. Do I need to detail for you the difference between government healthcare spending and total healthcare spending? Or had forgotten there is a difference?
The elephant in the room no leftist must ever acknowledge is that 20% of current US healthcare spending comes from corporations who willingly provide insurance for their employees. This money would have to be replaced. Please don't suggest something as stupid as "increased corporate taxes". Do I need to help you remember how inept we are at actually collecting taxes from corporations?
So, you're sticking with you false claim that Sanders plan would increase rather than reduce the amount of government spending despite being provided proof of its falseness. I expected that. Also unsurprising is your pivot to the largely irrelevant matter of what the private sector pays for health care. You don't seem to understand that having universal, single payer health care would largely eliminate the need for that vast majority of individuals and companies to buy private insurance. That doesn't mean private individual and group insurance plans would go away altogether, of course, but a massive expense to businesses and individuals would be removed if so desired. Stick a fork in yourself, Jack. You're done.
P.S. Look up the definition of "irony" so you might learn to use the term correctly.
What the left isn’t telling you about the Bernie Sanders Universal Healthcare plan
“The largest opponents of the single payer plan include hospital systems, physicians, and providers. The plan proposes payments comparable to rates that currently exist in Medicare. However, these rates are significantly less generous than those of private insurances and practitioners rely heavily on private insurance pay rates to be able to treat Medicare recipients. Eliminating the source of higher pay threatens to cut as much as 20% of physicians’ income and the plan could face delays due to lobbying from medical interest groups such as American Medical Association.
The promises in fiscal savings that the single payer plan proposes has undergone much scrutiny. According to research conducted by Emory University researchers, the plan’s costs were under-calculated by about $1 trillion annually. In addition, the campaign’s generous Medicare expansion in eligibility as well as expanded benefits requires, after further research conducted by Emory university, a 20% increase in income-based taxes rather than the proposed 8.4%.”
I am sure many on the left will be okay just as long as the doctors and nurses make a living wage.
I think $15 per hour should just about do it, right?
So, it might mean the people who really want to be doctors instead of millionaires will go to medical school.
There are many ways to become a millionaire besides being a doctor.
Many doctors are not millionaires.
You think most doctors are millionaires?
and do you support the 30-40% pay cuts to nurses to bring them inline with Europe
Of course there are. Scumbag's way was the easiest: being born in a rich family and then ripping people off for the rest of his scummy life. But, I digress:
Here's a graphic that might help you get it. How long do you think it would take all the specialists on that graph making more than $250,000/yr to become millionaires?
BTW, I've got my nut so there's no envy or jealousy going on here. Doctors in every country with single-payer government run universal health care are also in the top income levels. Doctors will do just fine no matter who's paying them.
You don't become a doctor for the money. If that's the only reason, that's wrong and don't go into medicine.
What people earn doesn't make them millionaires--it is the amount they save.
We just understand that atheist hates capitalism
Oh sweetie. How embarrassing for you.
You're talking about government spending and you want to pretend private spending is really government spending. Do you do that for everything? I don't know how this "incoherent angry raving socialist" thing typically works. So...like....when Americans spend $100 million going to see the new Avengers movie...does that count as "government spending" as well? Is it sort of like "the government refrained from taxing every last dime, so any money spent by the proletariat is really government money the party generously allowed them to keep? Do you like "leave The People's house, get in The People's car, drive on The People's road and go see The People's movie"?
You don't seem to understand the term "additional". As in $32 trillion "additional" government spending. "Additional" does not mean "reduce", even in MillenialSpeak.
Yeah. I think I said that. So you're all gung ho on corporate welfare, as long as it gets a "win" for Team Socialist? OK then. deleted
ya fancy yourselves as little social engineers huh?
how bout you do not worry why people do what they do....
liberty - look it up - not going away
how much of a narcissist does one have to be to tell other people how much they should make and why they should make it?