OK- I am not a health economist, so let’s try to keep this civil. It’s just an idea and I am wondering if it would work- I am completely open to reasons why it won’t work, though please save your breath if the only reason is “coz its teh socialist!”
New payroll tax, paid by the employer. A % of salary. This should(?) allow the tax to be low enough to not kill small business and low wage jobs, as they would be offset by the higher earners.
Exchange-style system allowing competition among private insurers. No more gold/bronze/etc. All plans have to deliver the same floor of benefits (deductible of X, coverage of Y, etc). No difference in cost, but plans would hopefully compete on service, lowering deductible, etc.
Anyone who does not sign up for a plan is automatically enrolled in a default plan. If those who don’t bother to sign up are generally desirable (remember, the insurer is getting paid by the state, so probably you have a lot of lazy young healthy people who are attractive to insurers)- plans could bid to the state for these enrollees. Or they could be assigned proportionally
Those who can’t pay in (because they don’t work) are covered, choose a plan like anyone else, but are subsidized by the rest of the system. No more family plans. A family can choose to all sign up for the same plan, but to each his own.
I would imagine these plans as middle of the road level, and people would still have the option of supplemental plans either individually or through employers.
Fer Fuck’s Sake, include dental. How do we have kids with broken teeth?
My thinking is that by expanding the enrolees to the whole of the working population, we could try to create a sustainable pool. And perhaps through policy actually drive down the relentless and unsustainable growth in health care costs.
How about we just employers entirely out of being involved with the employees’ health insurance? Let them offer supplemental plans, or life insurance, or disability insurance, or things like that, but disconnect basic health insurance and employment. That way people won’t be locked into jobs and employers can hire talented folks who happen to have a chronic problem without fear of that driving up insurance costs.
The OP sounds a lot like The German health insurance system - as long as you make the insurance companies non-profit.
Corporate tax returns should show (since they deduct them) annual healthcare expenditures (including employee contributions). So, make the tax for each firm the same as last year’s or the national average, whichever is greater. Tax should leave employees with no extra burden and is shown on paystub.
Now index that tax to the annual inflation in healthcare costs so we all have an interest in seeing it controlled.
If the magic of the market fails to rein in costs, I guess we will need some price controls like other OECD nations.
To why I propose a payroll tax: I like this because it could be an itemized line on everyone’s paycheck and we’d all see how expensive insurance is. There would need to be a tax to pay for it, and burying it in regular income tax would make it, and its costs, more opaque.
It’s true universal coverage, and I think the upside is it doesn’t screw the middle class as the current ACA seems to (those who aren’t getting much/any subsidies), because it’s a flat % across the board, and as I said, make it payable by employers. Yes, it will factor into pay as part of the burden.
Presumably a lot of employers would drop or reduce their insurance plans, but as long as the service floor is adequate, that’s OK. So for those that offer insurance, hopefully this would not add to their costs since they would be able to offer less (or none) of their own.
It would bite harder on the McDonalds and Wal Marts, but I am fine with that since I feel they are a big part of the insurance problem, employing strategies to avoid offering insurance to many of their employees. A side benefit would be the elimination of the current incentives to keep employees’ hours below full-time thresholds (something I experienced when I was young and working part time)
What I wish I knew was what the tax would have to be to cover it.
In my proposal the insurance would be unrelated to employment. Only that a payroll tax would be implemented to pay for it. But if one leaves a job the insurance continues. Even homeless people are auto-enrolled
I would leave open the supplemental, though. I don’t see the public getting on board with paying for things that are seen as cosmetic/optional (IVF might be a good example of that). And I suspect that good jobs would offer that as a way of attracting and retaining talent.
All payroll taxes are payed by the employee not the employer.
Is this going to replace Medicare and Medicaid or be a supplement to them.
Why would you think this would save any money, you are covering millions of new people and doing it through taxation which means you would get some deadweight loss in addition to the new spending?
It should not be that hard to come up with a number as to what the tax needs to be. Look at the money raised by the current payroll taxes and compare that with the money you need to raise.
The cost of any payroll tax are shared between employers and employees. The exact share that each pays is going to depend on the elasticity of the supply and demand curves.
I have become convinced that ANY system involving private health insurance, is going to be relatively “lame.”
It makes no sense. It is inevitable that the insurance companies, who are, and have to be, dedicated to making a profit only (not making sure people become healthy, in other words) will put pressure on providers to refuse service, or to limit it, such that patients wont get the optimum care.
The reason I finally came around to supporting something more like making health care a basic citizenship right (paid for by taxes), despite being a capitalist myself in most ways, is that I can’t figure ANY way for the standard ways that capitalism works, to support the desired result of a healthy people.
Profit motive leads to charging EXTRA for services, not looking for ways to reduce costs; it leads to PREVENTING the use of the latest experimental methods, and actually ENCOURAGES the vendors to use the most expensive methods they can, to get results.
Making health care a task for EMPLOYERS to deal with, is idiotic, because it forces people in all manner of industries entirely unrelated to health, to sidetrack resources and funds to deal with health concerns. That causes EVERYONE’S costs to rise, and makes the country less competitive.
Is there a way to financially reward health success? That would be ideal.
I suppose it would make sense that this could take the place of Medicare. To be honest, I hadn’t thought about it. It makes sense to have one system, but I mentioned that I did not see the base plan as a “cadillac.” As seniors tend to have more medical needs, I wouldn’t want to see them screwed… Maybe there’s a 65+ extra benefit? Need to think about that one.
Perhaps I misused a term. I was under the impression that a payroll tax just meant one that is taken from the pay packet, and can be paid either by the employee (ie, income tax) or by the employer (ie, unemployment or the employers half of SS). I think what I meant was clear
I didn’t say it would necessarily save money. If we add to the insurance rolls, it probably means spending more money. But it has become clear to me that it is a moral imperative that we make healthcare available to everyone, and in a practical way that doesn’t bankrupt them. You are free to disagree. I also believe that helth care costs are rising too damn fast, and as a secondary aspect of this proposal it would be nice if we could slow down or reverse that
Well, if the math is so easy, show me, while taking into account how this proposal might influence the risk profile, how many employers would drop their plans in favor of the govt one, etc.
Now, Puddlegum, those were good questions, but that felt a little like a driveby shooting. What are your thoughts?
It’s a great question but man does it open a can of worms …
How about it cost you $x but if the US cut back on the 20 or so aircraft carrier fleet it would cost you $Z.
Or if the US properly invested in mental health and preventative healthcare it would sav you $Y
Or if the political class stopped taking bribes from big Pharma the drug bll would be $V
And so on … In other words, it opens up a whole new conversation, and it takes years - decades in fact - to hone the new industry to be what the people want, prioritised in public spending accordingly.
The USA ball park figure right now has to be insane - it’s 18% of GDP for goodness sake, 50% greater than comparative nations.
(One of the big selling points for the NHS at its foundation was precisely that it got away from all the problems of an essentially employment-linked insurance scheme: no variabilities in coverage for employees’ families, no need for employer-provider links, just one single scheme covering everyone, paid for by one set of comprehensible taxes for a common service tied to clinical need - but that was in the days of “doctor knows best”, of course…)
Well, obviously any cost of the employee is borne, ultimately by him. But there is a psychological aspect of who writes the check. My experience is that most people don’t even begin to understand their own taxes. Also, by making the employer pay it the employee’s take home pay isn’t suddenly impacted on day one. The cost of the new tax would be absorbed through various means (pay offer to new employees, product pricing) of course, and yes impacting the workers.
I think the OP should read up on the German system. This sounds very similar to it.
Which may not be an advantage, my personal impression of many of the “How about this for healthcare…” is that they go to some incredible contortions to avoid learning from the examples out there.
Accidentally duplicating one of them may lose the face-saving psychological/political advantage of not having to admit learning from the rest of the world.
It is interesting though that people who are Health Care Economists have been known to single out the German system as the easiest one to transition the US setup to, as far as I remember.
In addition to German healthcare, the experience of Switzerland is instructive.
After a hard fought universal healthcare reform was implemented - which included an insurance mandate - attempts to roll back the reform failed because it had become so popular.
Are they treating brain tumors in the UK with aspirin?
"With few resource constraints, healthcare systems like America’s and Germany’s tend to go with the most expensive treatment option possible. An American might find himself in an MRI machine for a headache that a British doctor would have treated with an aspirin and a smile.
Similarly, “In Germany, it will always be an operation,” Göpffarth said. “Meanwhile, France and the U.K. tend to try drugs first and operations later.”