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Medicare is generally a better insurance than ACA policies, but Medicare-for-all is also a massively more expensive proposition than the ACA. First, you have to directly fund the plan for everyone you are putting on it. Then people would drop work policies for Medicare policies in a way they haven't for ACA plans. To top it off, the loss of commercial plan patients would make most hospitals in America almost immediately insolvent, and then you'd have to raise the Medicaid payment rates to the Medicare level to prevent a massive wave of hospital closures.
Since you're replacing private spending with direct government spending and higher medicaid reimbursement rates you're talking around 8% of GDP in additional government spending. Where is that coming from? If for example you want to raise taxes on wages, that's about 40% of GDP, so ~20% increase in every tax bracket would do the trick. So if you're paying say 33% of your income in income and payroll taxes now, that would need to increase to around 53%. Alternatively, corporate profit is around 10% of GDP -- except that's already highly enough taxed that you could take everything still left not already taxed and not have enough to fund the program.
They'll live. Adjustments will have to be made. The gravy train is over
They'll live. Adjustments will have to be made. The gravy train is over
"They" will make "adjustments" is hand-waving. Who and what? You want the government to do a really expensive thing, you need a funding source which is sufficiently large, politically viable, and tapping won't cause severe second-order consequences.
edit: for something smaller you can get around this constraint by inflating the debt more, but this is sufficiently large that putting it on the national credit card would single-handedly result in a default and/or inflationary currency collapse a decade or two out, since you're talking a ~8% increase in primary deficit, plus increase in interest as existing debt rolls over and people are less willing to hold treasuries because of a 10%+ total primary deficit, plus interest on that increased debt in out years. So even if you can deficit-finance a smaller thing (to a point), this is too big for that.
Insurance company profit margins are generally low single digits. The largest profit takers in healthcare are pharma companies.
Where do you think the costs come from? Insurance admin + profit generally runs 10-15%. Drug cost has huge profit margins and is the fastest growing big thing, but is still smaller (for now, couple decades of current trend will change that if nothing snaps first) than the 2 big sources of spending, which are professional services and hospitals.
As an ED nurse, what do you make? ~$40 an hour? Add 30% for overhead. How is someone making ~$15/hour with major medical needs ever supposed to find your time affordable? Now, someone with your level of education spending the same number of years in the same field could probably do as well as you do so not saying your wage is inappropriate, but it's easier to blame third parties than look in the mirror and realize people making a third of what you do or less, who after taxes on their income, overhead on yours etc. would have to work most of a day to afford an hour of your time, are going to struggle to afford your services, under any payment mechanism where you are paid that much & someone else isn't picking up the tab for them.
No, over-reliance on insurance, which dictates costs, is pretty much the linch-pin for the problem.
"They" will make "adjustments" is hand-waving. Who and what? You want the government to do a really expensive thing, you need a funding source which is sufficiently large, politically viable, and tapping won't cause severe second-order consequences.
edit: for something smaller you can get around this constraint by inflating the debt more, but this is sufficiently large that putting it on the national credit card would single-handedly result in a default and/or inflationary currency collapse a decade or two out, since you're talking a ~8% increase in primary deficit, plus increase in interest as existing debt rolls over and people are less willing to hold treasuries because of a 10%+ total primary deficit, plus interest on that increased debt in out years. So even if you can deficit-finance a smaller thing (to a point), this is too big for that.
It's easy. Treat Wall St. transactions like they are grocery items for sale and slap a 1% sales tax on every transaction. Exceptions can be made, like how PA has sales tax but no sales tax on unprepared food and clothing, for 401ks and other retirement vehicles. Wall Street changes money to the order of billions of dollars a day. The only people a sales tax would hurt are those who engage in flash trading, doing hundreds of trades every second. Now you're taxing the 0.1%, the people that an income tax would never touch anyway. Problem solved
02-18-2017, 12:43 PM
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n/a posts
Quote:
Originally Posted by blanker
What the hell are you smoking? He's one of the most reasonable Repubs in Congress.
If you really believe that, then there is no pleasing you.
He can be both.
Paul Ryan is, in fact, an uncaring hypocrite. He's the quintessential conservative: "I've got mine so f*** you, loser!" He got government benefits as a teenager and has spent most of his adult life on the government dole too.
He seems to be genuinely unable to recognize that he got where he is because government was there when he needed it.
And he's still one of the most reasonable Republicans in office. That's insane.
Insurance company profit margins are generally low single digits. The largest profit takers in healthcare are pharma companies.
Where do you think the costs come from? Insurance admin + profit generally runs 10-15%. Drug cost has huge profit margins and is the fastest growing big thing, but is still smaller (for now, couple decades of current trend will change that if nothing snaps first) than the 2 big sources of spending, which are professional services and hospitals.
As an ED nurse, what do you make? ~$40 an hour? Add 30% for overhead. How is someone making ~$15/hour with major medical needs ever supposed to find your time affordable? Now, someone with your level of education spending the same number of years in the same field could probably do as well as you do so not saying your wage is inappropriate, but it's easier to blame third parties than look in the mirror and realize people making a third of what you do or less, who after taxes on their income, overhead on yours etc. would have to work most of a day to afford an hour of your time, are going to struggle to afford your services, under any payment mechanism where you are paid that much & someone else isn't picking up the tab for them.
1. Costs come from a deliberate shortage of providers (physicians, physician's assistants, nurse practitioners), but especially physicians. We do not have enough medical schools in this country. That's why you see so many foreign doctors. Increase the the number of physicians and their prices will go down. It's just like oil. Supply and demand. Guess who likes to keep the number of doctors low? DOCTORS! We also need more teaching hospitals so providers, nurses and ancillary personnel can do clinicals. Now, do you think the AMA is going to let Congress build 100 medical schools and hospitals and hand them over to the states?
2. Prescription drugs are expensive because (Sen) Phil Gramm decided that the government was not going to buy in bulk and negotiate better prices. Why? Because his wife was working for Merck. The GOPrs are pos. They want a "businessman" to run the country, but they don't want the government to buy like Walmart: in bulk and dirt cheap. Do you think big pharma is going to let Congress do the right thing?
3. Hospitals DO NOT bill for nursing services. That "expense" is included in what they charge you for the bed/day. How may patients do you think I take care of in one hour? That varies on assignment, acuity, local events, full moon, etc. It can be from 4 to 20 during a code purple. Overhead? Oh, yeah We're a restaurant too. Please. We charge for supplies and medications. The ones who cannot "afford my services" are the drunks and the addicts that demand and consume an indescribable amount of resources.
4. Do you know how long it takes to get a prior authorization for a test, a medication, etc. Have you a clue how many different forms/criteria EACH insurance plan has? All that stuff is time consuming and requires a lot of personnel.
We need to rethink the way we deliver healthcare in this country. We can do that without insurance companies.
It's easy. Treat Wall St. transactions like they are grocery items for sale and slap a 1% sales tax on every transaction. Exceptions can be made, like how PA has sales tax but no sales tax on unprepared food and clothing, for 401ks and other retirement vehicles. Wall Street changes money to the order of billions of dollars a day. The only people a sales tax would hurt are those who engage in flash trading, doing hundreds of trades every second. Now you're taxing the 0.1%, the people that an income tax would never touch anyway. Problem solved
Good idea-make it a transaction tax.
They can pay for the frigging wall too since employers are the ones benefiting from illegal labor. Make it 2%.
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