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"The United States has by far the most progressive income, payroll, wealth and property taxes of any developed country. Scandinavian social democracies like Denmark, Sweden and Norway have quite regressive direct taxes, as do the Netherlands and Switzerland.
...The disparity is even starker when you bring sales taxes into the mix, as VATs are an extremely important source of revenue for most European countries as well as Australia and Canada.
...UC Davis's Peter Lindert has argued in his book "Growing Public" that European social democracies were only able to develop the programs they did because they used efficient consumption taxes that didn't lower growth as much as progressive income taxes, particularly those on capital income. European countries needed tax systems that could raise a lot of money without hurting growth, and only regressive consumption taxes fit the bill.
...Prasad and Deng found that the progressivity of countries' tax codes is negatively correlated with the amount of redistribution they do. In English: The less progressive the [tax] code, the more progressive the system."
Would you be willing to switch the US to a regressive tax system, like those countries have, to fund it? That means flattening the federal income tax rates and implementing a 20-25% VAT to pay for it.
None of them even know the difference between the Bismarck System and the Beveridge System.
The FICA tax for Medicare does not fully fund Medicare, which is why money from the General Fund has to be taken to fund Medicare.
In other words, the first thing that needs to be done is Congress needs to increase the FICA HI (Medicare) tax rate to a level that will allow it to be self-funding.
The Medicare Trustees have begged Congress every single year, since year 2000, to raise the tax rate, and Congress under both the Bush and Obama Administrations has failed or refused to do so.
The Population 65+ is 47,269,000 (see LNU00000097 from BLS).
2014 is the latest year of data available and Medicare spending was $618.7 Billion (a 20% increase from 2013).
Total payroll for the US for 2015 was $6.4 TRILLION
The HI payroll tax of 2.9% (1.45% each for employer and employee) has to be increased to 9.6% (4.8% each for employer and employee) in order to fund Medicare at current levels.
In order to cover the other 270 Million Americans would require a hefty increase in the HI payroll tax rate, at least to 18% (9% for employer and employee).
You are about the only other person in this forum that understands this stuff. Lol
Yep. Like I said, there's a minimum of a 10 year FICA taxpaying waiting period for eligibility for Medicare, PLUS the additional premium costs once one is enrolled in Medicare.
I think I lost most in just explaining the basics. I didn't even get into the details.
Keep in mind, I've worked in the industry for a long time. Private, state, federal level. From claims to contracting, regulation to transactions, benefit configuration, finance, trend, and data analysis.
Whenever I hear the term, my first question does one mean single payer or coverage for all.
Maybe I can be convinced but how do those that advocate it systematically see it set up? Who administers it? Provider rates? Who sets coverage guidelines?
I could post a long list but either we'll get there or not. I just want to hear how it well 'work'.
Thanks
You are putting the mouse cursor on France/Germany/Israel/Sweden UHC, right click, copy, move the mouse to USA, right click, paste.
Keep in mind, I've worked in the industry for a long time. Private, state, federal level. From claims to contracting, regulation to transactions, benefit configuration, finance, trend, and data analysis.
Whenever I hear the term, my first question does one mean single payer or coverage for all.
Maybe I can be convinced but how do those that advocate it systematically see it set up? Who administers it? Provider rates? Who sets coverage guidelines?
I could post a long list but either we'll get there or not. I just want to hear how it well 'work'.
Thanks
There is no limit to the number of different types of systems that qualify as "Universal Healthcare."
Perhaps you're thinking of single-payer healthcare?
No reason to reinvent the wheel - as far as I'm concerned, the German system is worth a hard look, I was a user for few years. (Some processes could undoubtedly be streamlined, it's a centuries-old system.)
For the basics: Mandatory enrollment, mandatory minimum coverage levels, arranged by law and enacted by regulations. The regulatory body takes input from a larger body with representation from physicians, hospitals, business, labor and pharma. The insurance companies providing the basic are mostly privately held nonprofits and the user can pick between them, although most go with an employer plan - sounds familiar. For employed people, the fee is a fixed percentage of their income. For those living on public means, the municipality will pay. Doctors run their own private practices, hospitals are mostly independent & non-profit, or university hospitals, and they are reimbursed from insurance at fixed, negotiated rates.
re: Municipality paying for public health insurance.
This would really stretch the limits of the American system. I cannot think of any examples of the federal government forcing a municipality to levy taxes and pay for something.
Typically a municipality exists as a sub-entity of state government, so only a state could tell the municipality to fund something. I'm not sure if it would be legal to have the federal government do it.
And that's sort of the problem -- it'd be difficult to make that work, because i think it'd be illegal for the feds to do, and if you left it up to the states, at least half the U.S. states would dig their heels in and refuse to participate on ideological grounds.
Furthermore, the U.S. has big-time wealth/income segregation between cities. Annexation laws aren't very robust. So you'd have some very poor cities where probably 50-80% of the people needed municipally-funded insurance, supported by only a fraction of the population. This would cause sales/property taxes in certain areas to rise far beyond levels that would be reasonable, and cause further declines in poorer areas.
There is no limit to the number of different types of systems that qualify as "Universal Healthcare."
Perhaps you're thinking of single-payer healthcare?
I started this by asking those who want universal care see its structure. After talking to some and answering some questions, then going for a run, I explained the logistics of converting to a single payer.
Universal care will never be fully achieved unless those who don't enroll are imprisoned, in which case they would get it.
re: Municipality paying for public health insurance.
This would really stretch the limits of the American system. I cannot think of any examples of the federal government forcing a municipality to levy taxes and pay for something.
Typically a municipality exists as a sub-entity of state government, so only a state could tell the municipality to fund something. I'm not sure if it would be legal to have the federal government do it.
And that's sort of the problem -- it'd be difficult to make that work, because i think it'd be illegal for the feds to do, and if you left it up to the states, at least half the U.S. states would dig their heels in and refuse to participate on ideological grounds.
Furthermore, the U.S. has big-time wealth/income segregation between cities. Annexation laws aren't very robust. So you'd have some very poor cities where probably 50-80% of the people needed municipally-funded insurance, supported by only a fraction of the population. This would cause sales/property taxes in certain areas to rise far beyond levels that would be reasonable, and cause further declines in poorer areas.
Medicaid is free with no premiums and serves our poorest citizens currently along with many seniors on Medicare who are in private nursing facilities.
I think we should have a flat sales tax set up in each state to pay for Medicaid for all.
I don't know why the comparison to Medicare is being brought up as IMO that is not a single payer system IMO.
States should be able to set up their system however they want. I think it will boost competition and economic growth between states and make some more attractive to others for business and residents.
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