I’m drafting off this thread, which, though it discussed healthcare only tangentially, offered some conservative perspectives that sort of surprised me – namely, the (seeming) acceptance of the need for both universal coverage, and some level of government involvement. If these sentiments are widely shared by conservatives, it seems to bode well for the future of universal coverage, because it means there’s broad agreement on ends, and disagreement only on means.
As regards means, I’d like to resurrect a healthcare proposal that I’ve floated on these boards before, to see whether it in fact could satisfy both sides. In summary, it goes like this: employers pay a per-employee tax to the government, and individuals get to choose an insurance plan of their liking, which is paid for by the government at a set rate. Larger employers would pay the full levy, smaller employers a reduced levy.
The objections, I think, will fall into two buckets:
Why this payment mechanism? The answer: because it’s familiar. Businesses are already, by and large, paying for healthcare, and under this scheme, they would continue to do so. Most in fact would save money, because instead of having to administer the benefit, and negotiate with employees and insurers over the benefit, they would simply pay a per-head charge to the feds. Individuals would like it, because they wouldn’t have to pay any additional taxes. Politically, this seems palatable to both individuals and business.
Why maintain the insurance companies as intermediaries? The answer: because they already exist, with a fully elaborated infrastructure. And after all, somebody has to pay and adjudicate claims, whether it’s industry or a bureaucracy. Also, keeping insurance companies around honors market forces, since insurers would need to compete with each for customers, compete to provide efficient service, and compete to strike the most favorable deals with providers.
What I’m proposing would minimize disruption, while extending coverage to everyone. I’m sure there are specific details that people might quibble with, or find less than optimal, but what I’m curious about is whether there are large philosophical – or practical – objections to what I have proposed.
But I think some of the conservative support for universal health care comes from the idea that US companies’ health care costs are one of the things that drag them down when competing with companies from countries where there is universal health care. I think some of the conservative support for universal health care comes out of this. And unless the government gets a much better deal on coverage than companies are getting now, most companies’ insurance costs would go up with a plan like this, since they’d be paying for more people to be covered.
I actually think companies would come out ahead. It’s not like they don’t indirectly pay now for the uninsured, both in their taxes and in higher insurance premiums (the way the system works today is that hospitals have to cover their costs for treating the uninsured and underinsured by passing the costs along to the insured).
Plus, with a more rational system, you can realize efficiencies that are unthinkable today. Bottom line, I think companies would pay less, and probably see less cost inflation than they do today.
I think the immediate problem would be that businesses that employ greater numbers of low wage workers would favor a health care tax of a fixed percentage rather than a per worker flat fee. One major result of the system you propose is that a McDonalds franchise (or something else with relatively more low paid workers) are going to have health care costs explode under such a system, while your typical boutique law firm might have costs go way down. That doesn’t really strike me as an economically good idea, since the incentive for employers will be to hide low wage workers from the system in order to avoid taxes. That’s already a problem with payroll taxes, I think a per employee tax would worsen it substantially.
Good points, but I think some comparatively minor tinkering such as you suggest (percentage of wages, rather than per-head tax), could make it right.
And I should clarify that I’m not looking for business to shoulder the entire load. Today the government pays about half of all healthcare costs, and I would continue to use that funding stream.
I agree that conservatives are talking this up, but I think it is because there is a growing public sentiment for some major fix. Thinks have gotten a lot worse for most people since Hillary tried to do something, and even people with good health insurance are paying a lot more.
The question is how sincere are they? Would they actually fix something or are they going to pretend to fix it. I can see the proposal in the OP as being called a tax increase, and I can see conservatives objecting to all that money going to the government. Aren’t health spending accounts a more likely solution. Yes, some conservative intellectuals are coming around to a more reasonable answer, but I’m not sure that the run of the mill politician is ready yet. What the candidate will promise will be interesting, since the Dems agree but for some noise.
Thanks for the link. Typical. Not one word acknowledging that those who can’t afford insurance might be a problem. It’s all our fault for running off to the doctor for fun. I believe I’ve seen some conservative proposals that converge a lot better with liberal ones than this - but this is what we’d get, at best, with Republicans in charge.
What about the unemployed or part-time workers? The big problem with employer-provided health care is it ties you to a job for health care. (COBRA makes it possible to tide one over for less than 18 month stints without such a health-care providing job…but then you are screwed beyond that.)
What you’ve just proposed is basically the way the government is starting to outsource Medicare coverage. Not the per employee tax part, but the rest of it is the coming trend in Medicare. The govt. pays private companies to administer Medicare Parts A&B, to offer Part D and sometime offer extra benefits (like well visit coverage) through Part C.
That’s a more workable and realistic plan than any I’ve seen offered from anyone on the left, and would solve a lot of the problems in the system. And it did cover poor folks- “Medicaid should be extended to cover anyone who cannot afford such catastrophic insurance.”. Maybe you just missed that part.
Which means they won’t be able to afford the preventative care that might prevent the need for catastrophic coverage. Real smart.
But the point is that this is the old stuff we’ve been hearing for years. Is there truly convergence, or just lip service to address the real concerns people have?
To elaborate on what Weirddave said, Medicare does, in fact, cover preventive care. in fact, they require that intermediaries cover those services with no referrals required. So if you need, say, a colonoscopy, you’ll get it.
The vast majority of insurers follow Medicare in terms of what services are covered, how often they’ll be reimbursed, and at what level. Private insurers are also not stupid. They know that the $500-1000 or so for that colonoscopy can save tens of thousands of dollars in chemo, surgery and other treatment costs should the patient have colorectal cancer.
I actually like the idea of a universal Medicare Advantage program. The government would pay private insurers for a certain level of service, and those who want additional coverage would pay the overage. Private insurers would not be allowed to cherry-pick its subscribers; there would be no need to since the risk pool is theoretically so large. Care providers would not be allowed to cherry-pick patients on the basis of insurance.
Is this system perfect? No. But at such a large scale, it’s probably going to be the one that makes the most people happy. Insurers will still be around, so there wouldn’t be a massive loss of jobs. People will be able to choose how much coverage they want and how much they’re willing to pay for it; people who spend the money will still get more services, but everyone’s got something, which is better than nothing.
Sorry, I should have made clear that though the funding mechanism in this proposal is employer based, access to insurance isn’t. Everyone would be covered, regardless of their employment.
This is not so different from what I’m proposing. Insurers could also offer additional coverage as an inducement for people to join their plan, rather than a competitors’ – which, again, resembles today’s Medicare Advantage scheme.
But you’ll have to remind me whether you’re representing a conservative viewpoint or not!
ISTM that rather than have a per-employee fee on a sliding basis, it would make more sense just to increase the corporate income tax in a manner that did about the same thing.
After all, that collection mechanism already exists; creating a second collection mechanism parallel to the first, to collect what are essentially taxes from the same entities seems wasteful as well as unnecessary.
Out there in the real world, just lip service - if that - from the GOP.
Maybe an attempt at co-opting, if the Dem nominee proves to be genuinely serious about pushing for universal health care. If the GOP keeps the Presidency this fall, then that’ll disappear. If they lose it, then we can expect a repeat of 1994 when the GOP offered up its alternative to ClintonCare, then voted against their own alternative once they realized they had ClintonCare beat.
I don’t know how much corporate income tax smaller employers pay. Moreover, there are various strategies even big companies can do to avoid paying corporate income tax. I’d like the healthcare levy to be paid by every employer, big or small, on a sliding scale, regardless of what they pay in corporate taxes.
I was talking about the link, which did not propose extending Medicare to more people. It did propose increasing drug benefits, and decreasing support for lengthy hospital stays. The article pooh-poohs the problem of emergency room visits.
Now, the outsourcing of Medicare seems to actually be more expensive than what the government does. But that’s not important. Is the a conservative proposal to extend Medicare to many more people? That would be fine with me in principle, maybe with some tweaks. I didn’t see that in the referenced article at all.
I have seen proposals for mandatory catastrophic coverage combined with spending accounts, and that was what I was referring to.
You’re too young to remember how the AMA and the conservatives ranted and raved when Medicare was proposed in the '60s. They sure as hell called it socialized medicine. I’m not against Medicare at all (I’ll be on it sooner than I’d like) and if one calls a single payer system for all Medicare, I won’t mind. However catastrophic coverage is not Medicare, and neither is a Health Spending Account.
We’d have to figure out how to fund it, but maybe a good slogan would be: Medicare: It’s not just for geezers anymore!