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Wed Sep 13, 2017, 06:51 PM

 

Vox, on how much taxation would be required to pay for Sanders' Medicare for All

One helpful frame of reference, however, is to look at Vermont's 2014 effort to build a single-payer system. The state ultimately estimated it would need to create an 11.5 payroll tax and a 9 percent income tax to finance a state-level, universal coverage plan. That plan also wasn't quite as generous as the one Sanders proposes.

My hunch — and it is just that; we need a lot more analysis from think tanks and the CBO to figure this out — is that the Sanders plan would need some revenue sources in the ballpark of what Vermont ultimately thought was necessary to finance its own single-payer plans.


https://www.vox.com/policy-and-politics/2017/9/13/16304474/medicare-for-all-plan-cost-bernie-sanders

11 replies, 1174 views

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Reply Vox, on how much taxation would be required to pay for Sanders' Medicare for All (Original post)
Pugster Sep 13 OP
guillaumeb Sep 13 #1
Pugster Sep 13 #2
Adrahil Sep 13 #3
Blue_true Sep 13 #5
Adrahil Sep 13 #10
guillaumeb Sep 13 #4
Egnever Sep 13 #7
Egnever Sep 13 #9
TCJ70 Sep 13 #6
ucrdem Sep 13 #8
JCMach1 Sep 13 #11

Response to Pugster (Original post)

Wed Sep 13, 2017, 07:24 PM

1. Insurance companies charge premiums.

And co-pays, and out of pocket expenses. All of these things represent additional payments on top of the hefty premiums. The US pays literally twice per person what Canada pays and Canada has a higher ranked system with better health outcomes.

Actual fact, as opposed to rhetoric.

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Response to guillaumeb (Reply #1)

Wed Sep 13, 2017, 07:56 PM

2. Why did Vermont give up on the idea?

 

If it's my understanding that costs were too high.

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Response to Pugster (Reply #2)

Wed Sep 13, 2017, 07:58 PM

3. We need to talk about funding up front.

I mean, other countries manage to do this, so it can be done. But we have to be brutally honesr up front and any proposal must include funding as a fundamental aprt of the proposal.

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Response to Adrahil (Reply #3)

Wed Sep 13, 2017, 09:06 PM

5. Other countries were rebuilding from WWII mostly when they did it.

There were exceptions, Canada, New Zealand, Australia.

It is easier to set a new health system when your old one had been blown to hell and the populace is desperate for any system that has central control and prevents profiteering.

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Response to Blue_true (Reply #5)

Wed Sep 13, 2017, 10:55 PM

10. Yes, of course, but the point is...

It's not impossible to make the numbers work. But the transformation has to be considered in the whole.

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Response to Pugster (Reply #2)

Wed Sep 13, 2017, 07:58 PM

4. Medicare for All spreads the cost over the entire population.

Economy of scale.

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Response to Pugster (Reply #2)

Wed Sep 13, 2017, 09:13 PM

7. They had problems with funding for a couple of reasons.

Vermont’s public failure is especially frustrating to single-payer advocates because, they note, the Shumlin framework, which had gotten approval of the state legislature minus that key financing element, wasn’t really a true single-payer plan. Notably, large businesses that operate in multiple states would have been exempt. And it was unclear whether or how enrollees in federal plans like Medicare and TRICARE could be integrated into the state’s plan.

Those exemptions cut into the funding base while adding administrative complexity, eliminating one of the potential cost-saving elements of single-payer: simplicity.

“There are some practical problems in the idea of state-based policy,” Coates said, acknowledging the huge federal role in financing and regulating health care.

There are also the political obstacles, which are “on steroids,” said Andrew McGuire, a leading activist in California, another traditional center of single-payer activism. Insurance companies, which would be essentially put out of business, are fiercely opposed, and Americans inherently distrust government-run anything — a sentiment not improved by the ACA rollout last year.


http://www.politico.com/story/2014/12/single-payer-vermont-113711

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Response to Pugster (Reply #2)

Wed Sep 13, 2017, 09:21 PM

9. Another explanation

The basic problem with any kind of state-based health reform—right or left—is that the federal government is by far the primary player in U.S. health care. The federal government subsidizes employer-sponsored health insurance to the tune of $500 billion a year, through the tax code. It spends even more on Medicare for the elderly, and finances the majority of Medicaid for the poor.

The Vermont plan aimed to replace employer-sponsored and individually-purchased private insurance with a single, state-run insurer. But the state couldn’t preempt Medicare, or military health care, or large companies that directly pay for their workers’ health care using a process called self-insurance. Indeed, the Hsiao-Gruber report makes clear that for the Vermont plan to work, the state would need to gain waivers from Medicare, Medicaid, and Obamacare.

In addition, the state couldn’t prevent people from getting private health insurance in neighboring states like New Hampshire.

Hence, one of the key purported advantages of single-payer health care—that doctors and hospitals would only have to work with one insurer, simplifying their paperwork—turned out to be impossible.


https://www.forbes.com/sites/theapothecary/2014/12/21/6-reasons-why-vermonts-single-payer-health-plan-was-doomed-from-the-start/#3f6bb2504850

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Response to Pugster (Original post)

Wed Sep 13, 2017, 09:13 PM

6. It's a little disingenuous to post this without comment...

...the highlighted portion is what Vermont was looking at with it's single-payer efforts and then the article never answers the question in the headline but just includes a "hunch".

What a joke of an effort to discredit Medicare-For-All.

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Response to Pugster (Original post)

Wed Sep 13, 2017, 09:18 PM

8. At the very best it would simply regulate private insurance plans.

Kind of like the ACA, only infinitely worse, because Trump would be making the deal. But let's keep reinventing the wheel.

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Response to Pugster (Original post)

Wed Sep 13, 2017, 11:07 PM

11. Make it a Premium, not a tax

Framing matters here

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