How should we pay for single payer health insurance.

[county worker]

It seems to me that single payer will require more income into the Federal Treasury. Who's taxes should rise to pay for it?

[phantom power]

1. Three things...

1) Raise everybody's taxes to pay for it -- we won't need to be paying private insurance premiums, so we will have the money. It will be a net improvement, since single payer will give us all lower rates. If we want to raise taxes on rich people more than other people, I won't cry, but really everybody can help pay for it and still come out ahead.

2) If, for some reason, we feel the need to find money elsewhere, we could cut our current military budget in half and still be spending way more than any other country on military spending.

3) This entire framing of "how do we pay for it" was started by the hypocritical GOP tools, who suddenly re-discovered their inner fiscal-hawk after 8 years of binge spending and tax cutting by BushCo. Well, now we're in an actual by-god deflationary recession, and the very last thing you want to do when that happens is start cutting govt spending, even if it has to be on deficit.

[county worker]

15. Who should pay for it or how will we pay for it is not a partisan question

It is a very realistic question that needs to be answered before we have a bill in Congress.

[DJ13]

2. A good portion of it would be from the same place as current insurance

Employer contributions.

Single payer would be cheaper, so the employer contributions would be smaller and it would be nearly enough to cover everyone (once insurer profit is stripped out).

But it only works if its truly single payer, the hodge podge bastardization of insurance and public plans wont have enough savings to be effective.

[billyoc]

3. Administrative cost savings would pay for the entire program.

Don't fall for the "How are we going to pay for it?" meme.

[county worker]

17. Not true. I did not fall for anything it is a question that has to be answered.

I do reporting for Medicare and it is a lot of work. A single payer would require a lot more work on top of it. You can't spend money with out tracking how it is spent.

You fell for the "lower administration costs meme."

[billyoc]

19. That's ridiculous. "A lot of work" for county employees doesn't add up to $400 billion

paid to corporate middlemen. And I got that from Bernie Sanders.

[county worker]

25. $400 billion is paid for administration?

I use to be a controller at a medical clinic. You have direct costs like the doctor and nurse, supplies, medications. Then you have the overhead costs.

Doctors took 40 to 60 cents on every dollar that came in as revenue. That left 60 to 40 percent for overhead and direct expenses not counting the doctor.

Say 50 cents on every dollar for nurses, supplies, medications, all building costs, all housekeeping, all billing and collections, all accounting.

So you say that that 50 cents will go down to something lower?

Or are doctors going to make less?

[billyoc]

29. You're counting backwards, just look at the corporate insurance profits off the top.

[endarkenment]

36. The insurance companies are taking 20-30% off the top

in administrative costs for providing absolutely no healthcare at all. That chunk is taken for the effort involved in moving funds between accounts. The same task is performed by the government for somewhere between 2-4%, i.e. 1/10 of the private overhead.

[dflprincess]

4. Whatever tax it is,

I think it would need to go into a "lockbox" (remember when Gore got laughed at wanting that for Social Security) and not into the general revenue fund - otherwise everytime programs got cut the health care system would be the first to get hit.

Perhaps it should be a surcharge on taxable income or an additonal percent of income tax paid. That way it would be a more progressive tax and most of us would still be breaking even or saving money compared to what insurance and/or medical care is currently costing us.

[endarkenment]

5. It seems to me that there would be increased total health care provided

at a decreased per capita cost with most likely a decreased aggregate total cost, and that focusing on one aspect of the cost structure without taking the whole system into account is a game that the enemies of progressive reform would very much like us to play.

To answer your question: a hefty increase in the medicare payroll tax, split 50/50 employer/employee, with no exceptions and no cap.

[Oregone]

6. Why not just progressively raise it using a marginal rate tax model on all taxable entities?

Isn't medicare capped? Why make it anymore complicated to fund this than other government expenditures? Why use a model that shifts the burden downward? Just tax income and raise the top marginal rates (if not all). Taxing capital gains as income wouldn't be a bad approach also.


ON EDIT: I see you put "no cap" and "no exceptions" in there. Yeah, that would help of course make it all make more sense.

[endarkenment]

10. medicare is not capped.

and of course I agree that all income should be taxed at the same progressively increasing rates with a generous floor at the bottom and no cap at the top.

[gcomeau]

7. Bogus question.

Click on this link:

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

Go to page 8. Take a long hard look at only the "public spending" portion of that graph. Wirth the exception of Luxemburgh and Norway what cvountry spends more tax dollars per capita on health care right now that the U.S.? None. Canada... that horrifyingly expensive single payer system that eats up all those tax dollars? It spends LESS tax dollars per capita on health care that the U.S. does.

If you implement the damn system properly there is no increase in costs except over the short term to cover the transition expenses.

[TahitiNut]

8. Double the 'HI' portion of "OASDI/HI" payroll tax and add 2% sales tax for sale/exchange of stock.

Voila. EVERYONE winds up paying less.

[damntexdem]

9. How should we pay for universal health insurance?

Single-payer would be more efficient, so require less payment for health insurance.

And higher insurance premiums effectively constitute private "taxes" on all those with private health insurance.

[tnlurker]

11. I currently pay almost $3,000 per year in just premiums

This is a company sponsored plan so they pick up at least half.

On top of that I have co-pays and out of pocket cost for medicines and dental and eye care.

So you could raise my taxes by 3000 per year and I am still better off with single payer.

[county worker]

22. I think your response is the most sensible here.

If we paid into a pool the money we spend on insurance and out of pocket expenses now we may have a better system since the pool of people would be huge and we could lower everyone's cost I think. I don't think single payer would cost $3000 per year per person if we reduced health care costs.

[endarkenment]

37. thank you for your most excellent response. nt

[lovuian]

12. Its easy and soooo affordable

Give me that budget
First Get out of Iraq
Second Get out of Afghanistan
Third cut the Military budget in half
Fourth Have all insurance companies taken over by the Government
and the Hospitals and employees be US Civil employees
thats every body

Pharmaceuticals will be forced to pay the prices the hugest buyer wants
so we can name our prices

Companies won't have to pay for their employees anymore so they can chip in more
and definitely the richest people need to pay more

thats a few trillion

oh and stop bailing out the Banks and invest in PEOPLE children and make a better life

Its easy lets do it

[DireStrike]

13. Top 1%, or top 10%, or corporate taxes should rise. Because nobody else can afford it. -nt-

[slipslidingaway]

14. Another question - How to we pay for the public option?

Cost for both systems need to be discussed so I gave your thread a rec.

:)

[county worker]

20. Thanks.

I like the response of the person paying $3000 for insurance and other out of pocket expenses. If the money spent on insurance by all of us went into a pool we would have better coverage with single payer I think.

[slipslidingaway]

30. YW, if we are comparing systems we need to look at the cost of

each as well, unfortunately that is not what is being done.

[LWolf]

16. HR 676 has already outlined a good plan. nt

[EFerrari]

18. Well, wouldn't the cost of drugs and equipment and admin fall

significantly in a single payer model?

[county worker]

23. Most likely since the payer has all the leverage.

Of course business could stop making drugs. I think that if the countries with single payer dictated to the drug industry what the cost of drugs would be, the cost would be less.

[EFerrari]

27. We pay more for everything here and that's why I think that our cost

would go down, not up, with single payer. That's why Big Pharma and the insurance industry is fighting so hard. Our taxes wouldn't need to go up, as far as I can tell.

Bernie Sanders was on Amy's show yesterday, speaking to this topic:

http://www.democracynow.org/2009/6/9/sen_bernie_sanders_and_nurses_union

The "health care" lobby is simply trying to frighten us into keeping them afloat. It doesn't seem to have much to do with reality.

[Lydia Leftcoast]

31. I recently translated the vanity autobiography of the CEO

of a Japanese pharmaceutical company.

He came right out and said that drug companies all over the world treat America as their cash cow because we're the only First World country that allows advertising to consumers and doesn't regulate prescription drug prices.

So if we regulate Big Pharma, they literally have nowhere else to go.

[Jakes Progress]

21. We're already paying for health care.

We're just not getting it.

Whatever health care goes on is paid for. Doctors aren't going hungry. Employers pay for some, but that money could go for higher pay for employees or it could be taxed. We pay taxes for the emergency rooms that are the primary care facilities for those without insurance. We pay taxes to support county hospitals that serve the poor.

We are already paying. But much of what we are already paying goes to insurance profits and advertising for insurance and pharma.

It would take an idiot to work out a system where a single payer system would cost more when you don't have the profits and operating expenses of the insurance companies to maintain.

[Eric J in MN]

24. We should add more upper income tax brackets. NT

NT

[wolfgangmo]

26. Well you could pay for it like Canada does...

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

And if I may point our the logical falacy, you have generalized your experience with medicare which is not currently adequately funded for administration and auditing, thus the paperwork, and ASSUMED that the same paperwork would be in place for the new system. It is a classic example of trying to compare apples to oranges, or flesh eating zombies in the case of insurance companies.

There is no reason to believe that if will. One of the reasons that it is so burdensome now is that it is placed in a system that has 100's of players with 100's of rules and standards. In such a system no one knows exactly why one treatment covered under one plan is not covered under another. It adds layers of administrative work and workers. In a streamlined system there is only one simple one page form to file and auditing is very easy. Cost overruns and complications are taken care of.

Another advantage to the Canadian system is that the person making medical decisions in Canada is your Doctor. In the states the person making the medical call is an insurance company clerk whose training seems to be learning how to say no in hundreds of ways.

Cheers.

[harun]

28. Cutting military spending.

[mvd]

35. Cutting out the administrative costs should help, plus..

what you mentioned and increasing now low taxes on the rich (while closing corporate tax loopholes).

[blindpig]

32. Tax wealth. n/t

[flvegan]

33. We could probably end a couple wars and take care of it.

Then, legalize marijuana and tax it like cigs.

[Stinky The Clown]

34. Take all the money that people and companies pay now for private insurance ..............

......... and tell them to stop paying it.

Less than that total, paid as taxes, will insure everyone in the country.