Educate me: serious proposals on single-payer health care in US

[Left_Hand_of_Dorkness]

First: no way is this happening before 2019, and almost certainly not then. But with ACA technically the law of the land, with Trump’s explicit hope that it explodes, with Ryan failing to get anything else passed, I’m starting to think that single-payer is going to gain momentum over the next decade. So I’m thinking it’s time to take it seriously.

A bit of Googling is finding this proposal as the most serious-looking proposal I can unearth. Is this the best one out there?

Funding seems to me to be the single biggest hurdle. Their proposal says, under funding:

Total expenditures under the NHP would be limited to approximately the same proportion of GDP as the year prior to its establishment. While the needed funds could be garnered in a variety of ways, we favor the use of progressive taxes in order to reduce income inequality – itself an important social determinant of poor health.

During a transition period, all public funds currently spent on health care – including Medicare, Medicaid, and state and local health care programs – would be redirected to the unified NHP budget. Such public spending – together with tax subsidies for employer-paid insurance and government expenditures for public workers’ health benefits – already accounts for 60% of total U.S. health expenditures.28 Additional funds would be raised through taxes, though importantly these would be fully offset by a decrease in out-of-pocket spending and premiums.

During the transition period, these additional public funds could be raised through a variety of measures, e.g. redirecting employers’ health benefit spending to the NHP through payroll taxes. In the longer term, however, direct funding through progressive taxes would be fairer. By unburdening employers, the NHP would facilitate entrepreneurship while increasing the global competitiveness of American business.

I’d love to see some numbers attached to this. How would the costs look for:
-A low-income person with no current medical insurance?
-A person with median income with coverage through work?
-A business owner who does/does not pay for insurance for employees?
-A billionaire?

If politics could be swept away, what savings could be gained via changes in the patent system? What would be the savings if insurance no longer became a profitable enterprise?

I know we’ve had many threads on the subject. Right now, I’m most interested in looking at the costs; if there’s been a thread with this focus, I’d love a link!

[SmartAlecCat]

Look at Medicare as an example. Suppose over a reasonable transition period that the minimum age for Medicare was lowered periodically until it covered everyone. Taxes, of course, would be tweaked to break even.

Medicare, to be sure, has its own problems, and perhaps should pay more for some procedures, but as a general framework has been very successful. There are few advocating trading it to let the elderly take a fixed subsidy equivalent to a Medicare ‘premium’ and shop for their own policy on the open market.

[Tee]

This was a good find. I think the plan has merit, sketchy on details though.

@Left_Hand_of_Dorkness

If politics could be swept away, what savings could be gained via changes in the patent system? What would be the savings if insurance no longer became a profitable enterprise?

In this plan, private insurance does not exist and health care facilities no longer are profitable enterprises. I rearranged your quote some because of that, in order to get to this:

@Left_Hand_of_Dorkness

I’d love to see some numbers attached to this. How would the costs look for:

-A low-income person with no current medical insurance?
-A person with median income with coverage through work?
-A business owner who does/does not pay for insurance for employees?
-A billionaire?

• Assume a local non-profit health care facility exists to serve the population. I’m a fairly low-income person and the NHP would take care of all of my health care needs, along with everyone else of any or no income.
• Tax receipts pay for this. Employers probably won’t save much beyond paperwork.
• I don’t know or care what billionaires do as long as they are paying a fair share of taxes.

That’s my take on it.

[elbows]

Where I live it’s kinda like this: (the percentages etc, are inaccurate, I’m unsure where they currently stand, but you’ll still get the idea!)

Low income/not employed/student: these people get insurance through a subsidy program. Because it’s far cheaper to subsidize insurance payments for those that are poor, than pay their actual hospital bills.

Employed coverage through work; whatever the insurance rate (based on your income), you pay half, it comes off every paycheque, and the employer matches your payment.

Business owner. No, you have to match your employee contributions, for full time employees.

Millionaire, you’d have to pay both your portion and the employer portion. But the top rate would likely cap out at everyone earning more than $500K.

Everybody has the same coverage. Most everything is covered. (New things come along, it’s a process to constantly add the latest things!) Show your card at the Dr office. No forms, no opening your wallet, losing your house or college fund! Open heart surgery, three months neonatal ICU, every Dr visit, every specialist consult, cancer treatment, etc, etc, all covered.

But it’s not pay to purchase, you can’t demand an MRI. Your Drs determine all access to resources. ( And you never deal with an insurance company. Ditto for hospital and Dr office, how’s that for cost savings? ) But you can’t get faster, better care, because you have great insurance! Everyone has the same insurance.

Ours doesn’t cover teeth or eyes, you have to manage those yourself. Unless you’re in the first group, then there are programs to access.

But premiums are very low as we are effectively one very large, province sized group. Our hospitals and health services are run like police services, without profit. That also reduces premiums substantially.

So, you know how much it is, most everyone pays the same, it comes off every cheque, covers everything, (not prescription drugs until you’re retired, but prices are low as negotiated by a large block!), everyone has the same coverage. Whenever you or your family are hurt or unhealthy, you never have to think, “How am I gonna afford this?” And when you’re sick, you won’t put it off because you can’t afford it!

It’s not perfect, there are times when it’s inefficient, or bottlenecks, etc. But mostly, largely Canadians are pretty happy with it.

But I don’t know how a country with an exploitive capitalist entrenched system can get there. That’s a pretty hard train to turn off its track. It would be a Herculean task, with a LOT of powerful players trying to take you down!

I think your best hope is for a start up Health Care Coop (not for profit), financed by Bill Gates/Oprah. People would sign up in the gazillions and they’d gain powers to strike real and effective deals with health care providers.