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We continue to trend towards the opposite of where we should be heading. We should want less government in delivering health care services. The government adds so much to the cost of health care - and it is a huge reason why health care is priced so high.
No one knows how taxes would be affected because no one knows what rules government would create as time passes.
The problem is that people are trying to get what they want. No one speaks of sustainability. Nothing with government is sustainable. They have racked up $20 trillion in debt. That is not sustaining. Why we want to give them more control of our lives, I don't get.
If you want affordability, remove the government from the process. Otherwise, it's all talk and affordability is just a dream.
To make things affordable, the less number of people involved, the better. Health care should primarily be a matter of you and your doctor. Let him figure the costs, add in his markups, and that's it - no government, no employers should be involved in routine health care. When the full force of the government is added in to the equation, that's a huge amount of overhead that's added through personnel, processing, and unnecessary regulations.
As long as government subsidizes a product - whatever it is - prices will spike.
Right now I am paying around $10,000/year for our (husband and wife) health care. That includes insurance premiums, some deductible, co-pays, etc.. For $10 grand a year I can afford a pretty substantial tax hike and still come out whole.
We continue to trend towards the opposite of where we should be heading. We should want less government in delivering health care services. The government adds so much to the cost of health care - and it is a huge reason why health care is priced so high.
No one knows how taxes would be affected because no one knows what rules government would create as time passes.
The problem is that people are trying to get what they want. No one speaks of sustainability. Nothing with government is sustainable. They have racked up $20 trillion in debt. That is not sustaining. Why we want to give them more control of our lives, I don't get.
If you want affordability, remove the government from the process. Otherwise, it's all talk and affordability is just a dream.
To make things affordable, the less number of people involved, the better. Health care should primarily be a matter of you and your doctor. Let him figure the costs, add in his markups, and that's it - no government, no employers should be involved in routine health care. When the full force of the government is added in to the equation, that's a huge amount of overhead that's added through personnel, processing, and unnecessary regulations.
The only problem with the free market is you have hundreds of thousands of people who are running companies that are not of interest in serving the people. Since they MUST profit to survive... something has to give, either serve less people or more expensive healthcare and/or both.
If you were the government, the last thing you'd want is either of those scenarios which is what is happening right now. So Uncle Sam of course is going to come down on the healthcare industry since free-market healthcare has had it's longest run in any industrialized country.
We continue to trend towards the opposite of where we should be heading. We should want less government in delivering health care services. The government adds so much to the cost of health care - and it is a huge reason why health care is priced so high.
It doesn't have to be this way. I've acknowledged this point many times in the past and I've argued that the reason for it is the fault of those who want UHC. Generalizing, they have refused to condemn government waste and fraud. They have refused to hold accountable those responsible for that.
It doesn't have to be that way.
No one knows how taxes would be affected because no one knows what rules government would create as time passes.
Quote:
The problem is that people are trying to get what they want. No one speaks of sustainability. Nothing with government is sustainable. They have racked up $20 trillion in debt. That is not sustaining. Why we want to give them more control of our lives, I don't get.
If you want affordability, remove the government from the process. Otherwise, it's all talk and affordability is just a dream.
To make things affordable, the less number of people involved, the better. Health care should primarily be a matter of you and your doctor. Let him figure the costs, add in his markups, and that's it - no government, no employers should be involved in routine health care. When the full force of the government is added in to the equation, that's a huge amount of overhead that's added through personnel, processing, and unnecessary regulations.
Millions can NOT afford this. As noted a few posts back, the 20 something trying to make ends meet by being a waiter has to show up to work even though he has the flu as he can not afford any other option.
Untreated flu then ends up getting him a trip to the E.R. which you will pay for anyway.
We continue to trend towards the opposite of where we should be heading. We should want less government in delivering health care services. The government adds so much to the cost of health care - and it is a huge reason why health care is priced so high.
Not true.
According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
The cost and failures of something like the V.A. are because of waste, fraud and corruption in large part. The unjustifiable actions are what are costly, not the cost of administering paperwork.
Until we recognize, admit this and demand 100% accountability we are not going to solve this problem.
Bernie Sanders was pushing for single payer and he had a proposal for how it would work, including taxes. In his plan taxes for middle class Americans would go up 2.2%, so about $1100 for someone with a $50k of income. I believe you would also pay the Medicare premium, which is about $100/month. Total cost to that family = $2300/year. Compare that to the current average cost of $5000/year for insurance. So your taxes go up but your premiums go way down and all in all, you pay less.
Under Bernie's plan, rich people (income over $250k) would pay a larger share.
Politifact broke down Sanders' plan and came to the conclusion that it will require a LOT more funding than the plan stipulates. 5% of the nation's earners would have to cough up 117 billion, the rest of America would pay in 126 billion, and Sanders claimed the rest would come from "trimming fat". The article states a lot of good pros and cons to be considered. It's a long read but necessary for those who want to know the details.
With promises of lower costs and health care for every American, Bernie Sanders’ pitch for a single-payer system sounds like a no-brainer for the country’s bottom line.
But would it actually work?
CNN’s Dana Bash asked the Democratic presidential candidate about the reality of his signature proposal Jan. 3 on State of the Union.
"You really can pay for that without raising taxes on the middle class?" Bash asked. "It just seems hard to believe."
"There are a variety of ways to go forward, Dana," Sanders said. "Our proposal will save the average middle-class family thousands of dollars a year in health care."
Bash and Sanders had a similar exchange about his plan after President Barack Obama’s State of the Union on Jan. 12, 2016, with Sanders insisting it will save the middle class thousands.
Sanders’ proposal is one of the centerpieces of his campaign, so we wanted to examine it in detail. We found that it’s possible the middle class could see savings, but experts disagreed on whether Sanders’ plan pays for itself, based on what he’s laid out so far. The plan seems to rely on the most optimistic scenario for cost savings and efficiency.
Prescribed savings
Sanders proposes to expand Medicare, the health safety net that covers those over 65, to all Americans. He hasn’t released a full plan yet, but he points to previous legislation he’s introduced, namely a 2013 bill for a single-payer Medicare-for-all system, as his general gameplan.
To pay for it, Sanders would impose broad-based taxes: a 6.7 percent payroll tax on employers and a 2.2 percent tax on individual incomes under $200,000 or joint incomes under $250,000. (Progressively higher rates for higher-income earners are described in his 2013 bill.)
Sanders’ campaign says his Medicare-for-all plan would save the average American family $3,855 to $5,173 in annual health care costs.
Instead of an insurance premium, a family making $50,000 — roughly the median family income — would only pay $1,100 in health care income taxes. That’s $3,855 less than what it would pay out-of-pocket for the average premium ($4,955, according to the Kaiser Family Foundation) and $5,173 less if a deductible ($1,318, for individual coverage) is factored in.
As for employers, the 6.7 percent payroll tax means employers would put up $3,350 for family coverage. That’s also thousands less than the average employer premium contribution of $12,591.
Health policy experts say, however, that listing the health care income tax as the only cost to families is misleading.
Missing details
It’s unclear whether Sanders would eliminate deductibles and co-pays. These costs currently exist under Medicare, and his 2013 bill makes no mention of changing the system. But the breakdown from his campaign lists both as $0.
The 6.7 percent payroll tax should also be counted as a worker cost, since it most likely would come out of wages rather than employers’ pockets, experts said. That’s because the sticker price of employer-based insurance isn’t what employers are actually spending.
Employers "pay nothing for insurance in reality," as health care is a fringe benefit of a total compensation package, said Gerard Anderson, a professor of health policy at Johns Hopkins University. So when employers stop providing insurance and are required to pay into single-payer, less money will be available for paychecks.
With this adjustment, the average family would save $505 to $1,823 a year.
Like a free lunch, of course, there ain’t no such thing as free health care. So where is the money to provide universal coverage coming from?
A clean bill of health?
As far as we can tell, Sanders’ plan has not yet been analyzed by independent think tanks or academics. So we ran back-of-the-envelope estimates for revenue from Sanders’ health care taxes using 2013 tax return data from the Internal Revenue Service.
By our napkin calculations, those making more than $200,000 — roughly the top 5 percent of income earners — would contribute about $117 billion to the single-payer system, while everyone else would pay in $126 billion. Payroll taxes yield an additional $432 billion for a total of $675 billion.
That’s still $599 billion short of what the country actually spent on health care in 2013 ($949 billion in premiums and $325 billion for out-of-pocket expenses, according to the Centers for Medicare and Medicaid Services).
Sanders says his system would make up for that shortfall by trimming costs, as the government would have more leverage to negotiate with health providers.
Experts agreed that single-payer gets you more bang for your buck by reducing administrative overhead, hospital and doctor's’ fees, and prescription drug prices. But some say Sanders is overestimating the potential reductions.
With Sanders’ proposed taxes, costs would need to be trimmed by roughly 42 to 47 percent — a tall order when "the most generous estimates of how much you could cut cost are on the order of 20 percent," said Sherry Glied, a professor of health policy and economics at New York University who’s served in the George H.W. Bush, Clinton and Obama administrations.
"And there are a lot of people who don’t believe those numbers are possible," she said. "Single-payer saves money, but it doesn’t save all the money in the system."
Joseph Antos, a health policy economist with the conservative American Enterprise Institute, said, "The kind of money he’s talking about goes way beyond any plausible guess about how much inefficiency can be ‘wrung out of the system’ — a phrase that makes one think this should be easy when it is very difficult to do."
Brighter views
Others, however, are more optimistic that Sanders’ plan could be actuarially sound.
"The tax rates are probably on the low side of what would be necessary, but not out of the ballpark," said Peter Hussey, a healthy policy analyst at the RAND Corporation, adding that they would work only with significant cost savings and lower benefits.
Hussey pointed to other financing models with higher taxes. In Sanders’ own Vermont, the proposed single-payer state system would require a payroll tax of 11.5 percent and a sliding income tax of 0 to 9.5 percent. A national single-payer system would require a payroll tax of 11.7 percent, according to the National Institute for Health Care Reform.
Gerald Friedman, a health economist at the University of Massachusetts Amherst, analyzed a different 2013 Medicare-for-all bill proposed by Rep. John Conyers, D-Mich., and concluded it would be enough to cover everyone, upgrade benefits and save the country $5 trillion over a decade.
But beyond a 6-percent income tax and a sliding payroll tax of 3 to 6 percent, that would require a financial transaction tax (Sanders included this in his 2013 bill but has since committed the tax to free college tuition) as well an estate tax, a capital gains tax and a cap on high-income tax deductions. (Sanders has proposed these but hasn’t said they’ll be used to pay for health care.)
Friedman calculated that with the extra taxes and some tweaks, Sanders’ plan would provide ample coverage and even generate a surplus of $51 billion. Meanwhile, he said, middle-class families would still save thousands, inequality in care and costs would be dramatically reduced, and the overall population would be healthier.
Bitter pills
Even if we set aside the issue of a potentially unbalanced ledger, experts point out several other problems with Sanders’ simple promise of savings.
First, it’s not guaranteed that workers will have the same quality or amount of care under a Medicare-for-all system.
Most employer-based health insurance policies currently have more comprehensive coverage than traditional Medicare, pointed out William Hsiao, a leading health economist at Harvard University who designed universal coverage systems for Vermont, China, Sweden, and South Africa, to name a few.
While Sanders argues that single-payer will make the health system more efficient, "we have seen no evidence of this from the Medicare program, whose cost has grown substantially faster than the economy for most of the last 50 years," Antos said.
Second, reduced costs could also create issues with access. Lower drug prices limit funding for research and development, lower physicians’ salaries disincentivize people going into medicine, lower fees could bankrupt hospitals, and people would have less choice in health plans, listed Hussey.
And finally, experts expressed skepticism that lawmakers would ever pass Sanders’ single-payer system, which would require a tax increase of hundreds of billions.
"Keep in mind each dollar saved is a reduction in someone’s income, which is part of why this plan is politically untenable," said Don Taylor, a professor of health policy at Duke University. "But if you could wave your hand and do it, we could spend less."
Between $500 billion (this number assumes health care costs would be around 13% of GDP under a Medicare-for-all system) and $1 trillion (this number assumes no savings at all and we would pay 17.8% of GDP on health care).
The least we should be able to do is to manage to get health care costs down to about 14-15% of GDP. That would still be by far the highest in the world. It would mean roughly $750 billion and can easily be generated through a combination of a small payroll tax and a 5% national sales tax for example. The benefits of funding health care through taxation is of course that it takes into account ability to pay so people making millions pay more into the system than someone on $50k a year.
According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
Everywhere that government is involved in the revenue stream of private industry, prices increase. They add no value to the product... just overhead. See college education...
Let's note the difference. Sanders had a real plan. Maybe it needed tweaking and discussed but he had a plan. Trump didn't.
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