# The USA Goes Full Single-Payer. How Much Does It Cost, How Much To Raise Taxes, Etc. **URL:** \ **Category:** Factual Questions\ **Created:** [June 27, 2017, 1:45am UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957 "2017-06-27T01:45:25Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [June 27, 2017, 4:33pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/21 "2017-06-27T16:33:44Z")
> [@DSYoungEsq](#): > > An approximation could be extrapolated from California’s assessment: > > California has roughly 1/8th of the population of the US. So we can multiply the cost for California’s proposed single-payer by 8 to get a rough estimate. That cost as estimated was $400B. That would make the cost nationwide about $3.2T. That’s almost doubling the annual national expenditures. In other words, you’d have to more than double annual tax rates on ALL FEDERAL TAXES to pay for it. > > Now, a couple caveats: First of all, California was trying for a best of all worlds scenario, specifically, no rationing of care. That’s unlikely to be tried anywhere (for precisely the cost reason). Secondly, not all of the proposed cost would be an increase, because of course to the extent that the federal government pays for Medicaid, that would just be blended in. 3.2 Trillion is how much the US currently spends on healthcare so this is a good estimate of how much it would cost the US to run the system annually. Every government in the US collects about 6.6 trillion in taxes annually. The Federal government is projected to collect 3.6 trillion in 2018. Federal taxes would have to go up 95% to pay for this. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [June 27, 2017, 4:34pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/22 "2017-06-27T16:34:49Z")
> [@Shodan](#): > > True, although [64% of hospitals lose money on Medicare patients](https://www.forbes.com/sites/aroy/2011/09/21/medpac-64-of-hospitals-lose-money-on-medicare-patients/#3b76121121b8), and [most hospitals lose money on each Medicaid patient they treat](http://www.modernhealthcare.com/article/20151031/MAGAZINE/310319982). If the US goes single-payer, there won’t be any patients to shift the losses to, so costs will have to rise back to their current level where insured patients make up the difference. TANSTAAFL. > > So basically we would need to raise taxes to replace whatever we are spending on insurance premiums now. > > And the increased availability, especially of preventative services, would increase costs overall - Why exactly do you think preventative services will increase total costs? Prevention prevents expensive problems. If preventative services don’t lead to better outcomes, then they aren’t worth doing, by definition. So compare the costs of preventing one HIV infection to the lifetime cost of treating an HIV infection. Which do you think is cheaper? And before you complain that the public shouldn’t have to pay the cost of treating HIV infection, what do you think we already do? This is what people who dread the cost of universal coverage can’t seem to understand. In this country we can’t commit to paying the medical bills of poor people, yet we can’t bring ourselves to throw them out of the hospitals to die in the gutter either. And so hospitals treat the homeless guy and eat the cost and pass the savings on to the people who can pay. So congratulations, you’re already paying for the homeless bum, you’re just paying for it in a hideously inefficient and opaque process. But we’re happy to pay more for our own health care to keep the undeserving from getting health care. It reminds me of the old Russian joke. Ivan the peasant is digging in his cabbage patch and he comes across a lamp. He rubs the lamp and a genie comes out. “I’ll grant you one wish,” says the Genie. “What, only one wish? I thought I got three?” “I’m a Russian Genie, I can only afford to give you one wish.” Ivan grumbles a bit, then says, “Well, you know my neighbor Vlad? He has this cow that produces so much milk, Vlad always has plenty for his family, even enough to sell the extra. And the cow produces calves every year, strong and healthy.” And the Genie goes, “Ah, so you want a cow like Vlad’s, eh? Not too difficult.” And Ivan goes, “No, of course not! I want Vlad’s cow to die!” ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 4:36pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/23 "2017-06-27T16:36:54Z")
That’s assuming you want everything free at the point of service though, which I think is a bit ambitious. It should be free for only the poorest patients, with everyone else paying modest co-pays, and with many procedures not covered at all due to lack of effectiveness or cost. I don’t think any country has even close to 100% of health costs covered by the government. Everyone’s spending extra money outside the system at some point. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 4:43pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/24 "2017-06-27T16:43:48Z")
One approach the US could take is simply to have single payer for major costs only. There’s no rule saying you have to make everything free, nor is there a rule stating that everything has to be covered. In fact, you simply cannot cover everything so I think an argument can be made for covering the expensive stuff and not the cheap stuff. Most people don’t contemplate financial ruin over a broken leg or having a baby. It’s cancer or heart disease that keeps people up at night, and yet governments seem focused on delivering the small stuff, because it’s poiltically popular. Every time someone has a good experience for a minor issue, they love the health care system. And if someone can’t get a drug that will extend their life for six months, well, they won’t complain for long. But our system should be designed around human welfare and science, not politics. Cancer and heart disease and AIDS should take priority over pushing out babies, and putting someone’s arm in a sling. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [June 27, 2017, 4:51pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/25 "2017-06-27T16:51:15Z")
> [@Lemur866](#): > > Why exactly do you think preventative services will increase total costs? Prevention prevents expensive problems. Did you happen to read what I cited? That’s why. Regards, Shodan ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 27, 2017, 4:51pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/26 "2017-06-27T16:51:44Z")
> [@Chimera](#): > > As I stated in another thread; > > France: Taxes = 20-24% of GDP. Health Expenditures 11.5% of GDP. > > So they could spend half their budget on it and have plenty left. > > USA: Taxes = 18-21% of GDP\*. Health Expenditures 17.1% of GDP. > > - Republicans want to limit this to below 20%. > > So on the USA side, we spend nearly 50% more of our GDP on health expenses. We could not do this with current -or- future levels of taxation without cutting those expenses by at least 1/3rd. This would be relatively easy if we had the political will to do so, but as so much of that excess cash goes straight to our politicians to prevent it, it would take some serious change on our side. % spent of GDP is not very meaningful. After all, it may include many expensive procedures not covered, such as plastic surgery. It also includes our extreme cost of healing the homeless in Emergency rooms at a County Hospital. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 27, 2017, 4:54pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/27 "2017-06-27T16:54:56Z")
> [@adaher](#): > > California’s problems might be the willingness to cover illegals. That raises costs substantially for California but is a non-starter here. Well, it’s really a non-starter for California too, but California’s unique politics makes it necessary for them to promise to cover illegals, which in turn makes it impossible for them to implement single payer. But that’s how politics works, the politicians would rather not have single payer than have it “wrong” by excluding illegals. So, let them die? Make them go to the County ER, which is ten times more expensive? However, there are- at most - 2MM “illegals” in CA and 40MM pop, so covering illegals raises the bill by 5%. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 27, 2017, 4:58pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/28 "2017-06-27T16:58:15Z")
In France they have a extra 5.25% tax, plus co-pays. I think the USA thus could likely manage a system where there is a extra 6% tax across the board. ---
**Author:** ![RealityChuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/realitychuck/32/195_2.png) [@RealityChuck](https://boards.straightdope.com/u/RealityChuck)\ **Post date:** [June 27, 2017, 5:04pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/29 "2017-06-27T17:04:44Z")
The big issue is controlling costs. The cost of healthcare have been skyrocketing for many reasons, but the lack of control has been a big one. This shows up most obviously in drug prices. Everyone knows about Martin Shkrelli and the big increase in the cost of epipens, but drug companies have been raising their prices across the board for years. Even generic drugs are going up and there certainly seems to be some signs of collusion on generic drug prices (but enforcement of antitrust laws has been weak for years). But, ultimately, the US has the most expensive medical costs of any developed country (I’ve seen the story that you could move to Spain, spend two years there to establish residency, then have your surgery and it will cost less than getting it in the US). One thing about single payer is that you can restrict price increases. That’s one reason it won’t go into effect: too many wealthy people and corporations stand to lose out. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [June 27, 2017, 5:14pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/30 "2017-06-27T17:14:41Z")
> [@adaher](#): > > And it wouldn’t replace all premiums. Unions aren’t giving up their gold plated plans to be covered by the national system. Given that reality, rather than the basket of taxes most European countries use, you’d probably need one big fat payroll tax that unions would be exempt from. :dubious: I have to do some errands, but I do remember clearly that on the way to the ACA it was noticed that one big union group leader did agree with supporting ACA even though he knew it would affect the unions and their plans. I think you are forgetting that many do look at the common good of all workers. BTW a lot of the nice things one does enjoy nowadays were the result of union people going also to the extreme of dying for the cause. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 5:23pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/31 "2017-06-27T17:23:22Z")
> [@DrDeth](#): > > So, let them die? Make them go to the County ER, which is ten times more expensive? > > However, there are- at most - 2MM “illegals” in CA and 40MM pop, so covering illegals raises the bill by 5%. You’re leaving out the fact that California would become even more of a magnet for illegals. They’d go bankrupt in ten years. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 5:24pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/32 "2017-06-27T17:24:59Z")
> [@GIGObuster](#): > > :dubious: > > I have to do some errands, but I do remember clearly that on the way to the ACA it was noticed that one big union group leader did agree with supporting ACA even though he knew it would affect the unions and their plans. > > I think you are forgetting that many do look at the common good of all workers. BTW a lot of the nice things one does enjoy nowadays were the result of union people going also to the extreme of dying for the cause. Unions supported ACA. And they wanted the excise tax out. Unions are not even willing to pay that much to contribute to everyone else’s health care. They want to keep their plans and they want other people to pay for health care for everyone else. If the unions won’t pay an excise tax on their generous plans, they certainly won’t pay higher income taxes for it. They have their awesome health care, so keeping them outside the single payer system is going to be a minimal demand. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [June 27, 2017, 5:31pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/33 "2017-06-27T17:31:37Z")
> [@Shodan](#): > > True, although [64% of hospitals lose money on Medicare patients](https://www.forbes.com/sites/aroy/2011/09/21/medpac-64-of-hospitals-lose-money-on-medicare-patients/#3b76121121b8), and [most hospitals lose money on each Medicaid patient they treat](http://www.modernhealthcare.com/article/20151031/MAGAZINE/310319982). If the US goes single-payer, there won’t be any patients to shift the losses to, so costs will have to rise back to their current level where insured patients make up the difference. TANSTAAFL. > > So basically we would need to raise taxes to replace whatever we are spending on insurance premiums now. > > And the increased availability, especially of preventative services, would increase costs overall - > [Cite](http://www.justfacts.com/healthcare.asp). > > Regards, > Shodan I think you seriously misunderstand. A significant hit of a hospital’s $100 Aspirin costs relate to having to treat people essentially for free. The poor come into Emergency, unable to pay for anything, and the hospital has to provide basic care. Who pays for that? The people with insurance. they pay double so others get free. End result, people with no money get free care, people who have some assets get to declare bankruptcy, and the ones with insurance pay for them. BTW, a single payer system is just that. Everyone is covered. Therefore, there would be no private insurance for the same coverage. Why would an employer - or employee - pay insurance payments when they get the same coverage for less or nothing from the state? here in Canada, Employer-paid Blue Cross or similar insurance is for the extras only - ambulance rides, dental, prescription drugs, private hospital room, even TV rental in hospital. Also, as I mentioned, the provinces essentially took over every hospital and they are in as public, non-profit entities with a budget given by the health system. That need for profit disappears. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 5:33pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/34 "2017-06-27T17:33:57Z")
Actually, they hit cashpayers. Insurance companies can bargain. The government can REALLY bargain. Cashpayers are the ones who make it up. In other words, the uninsured or minimally insured who pay their bills and don’t realize that you’re supposed to bargain just like insurance companies do. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 27, 2017, 5:37pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/35 "2017-06-27T17:37:13Z")
> [@adaher](#): > > You’re leaving out the fact that California would become even more of a magnet for illegals. They’d go bankrupt in ten years. It is to laugh. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [June 27, 2017, 5:41pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/36 "2017-06-27T17:41:08Z")
> [@adaher](#): > > Unions supported ACA. And they wanted the excise tax out. Unions are not even willing to pay that much to contribute to everyone else’s health care. They want to keep their plans and they want other people to pay for health care for everyone else. > > If the unions won’t pay an excise tax on their generous plans, they certainly won’t pay higher income taxes for it. They have their awesome health care, so keeping them outside the single payer system is going to be a minimal demand. You are then like Elmer Fudd that has not realized that the floor is gone in this hypothetical. IMHO a lot of the union members will realize that many people, and not just a good number of their members, will save a lot in the long run. What you are describing is the current system were the unions exist mostly because the corporations would drop their insurance if they were not making demands as a united front. Once single payer is present one very powerful reason why unions exist nowadays will be gone. And I do think that many union people do realize it, but then again they also realize that they are not only fighting for just the workers that are members. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 5:46pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/37 "2017-06-27T17:46:48Z")
ACA exists and it’s not causing unions to want to drop their plans. It doesn’t even make them want to pay to support ACA. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [June 27, 2017, 6:58pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/38 "2017-06-27T18:58:55Z")
The ACA exists today, is it going to exist next week? Just because the Republican “Tax cuts for the rich paid for by eliminating health care” plan is incredibly unpopular that doesn’t mean the Republicans won’t pass it. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 27, 2017, 7:02pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/39 "2017-06-27T19:02:10Z")
True, but unions aren’t staying out of ACA due to uncertainty. It’s pretty simple: “I got mine, you get your own. We’ll politically support you getting your own, but our members aren’t giving up what they’ve got or helping you pay for it.” That’s pretty much how it will go for single payer as well. You can expect unions to endorse it, but only if their members are exempt. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [June 27, 2017, 7:36pm UTC](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957/40 "2017-06-27T19:36:16Z")
Well, according to [CNN](http://www.cnn.com/2017/06/27/opinions/fixing-americas-health-care-sachs/index.html) in an article today, the US could potentially save $1 trillion by going with a single payer. > [@](#): > > Of the two options, Obamacare is vastly more just. The Republican plan is ghastly. But America has a much better choice: health for all at far lower costs. > This might seem like an out-of-reach goal or a political slogan, but it is neither. Every other rich country uses the same medical technology, gets the same or better health outcomes, and pays vastly lower sums. > > Why the disparity? Health care in America is big business, and in America big business means big lobbying and big campaign contributions, the public interest be damned. > Health care is our biggest economic sector, far ahead of the military, Wall Street and the auto and tech industries. It is pushing 18% of national income, compared with 10% to 12% of national income in the other high-income countries. > In line with its economic size, it ranks first in total lobbying, with a recorded $152 million in lobbying spending in 2017 and an estimated $273 million in federal campaign contributions in the 2016 election cycle, divided roughly equally between the parties. > [@](#): > > Here’s a 10-point plan Congress should consider. > First, move to capitation for Medicare, Medicaid and the tax-exempt private health insurance plans. Under capitation, hospitals and physician groups receive an annual “global budget” based on their patient population, not reimbursement on a fee-for-service basis. > Second, limit the compensation of hospital CEOs and top managers. The pay of not-for-profit hospital CEOs and top managers, for example, could be capped at $1 million per year. > Third, require Medicare and other public providers to negotiate drug prices on a rational basis, taking account of research and development incentives and the manufacturing costs of the medicines. > Fourth, use emergency power to override patents (such as compulsory licensing of patent-protected drugs) to set maximum prices on drugs for public health emergencies (such as for HIV and hepatitis C). > Fifth, radically simplify regulatory procedures for bringing quality generic drugs to the market, including through importation, by simplifying Food and Drug Administration procedures. > Sixth, facilitate “task shifting” from doctors to lower-cost health workers for routine procedures, especially when new computer applications can support the decision process. > Seven, in all public and private plans, cap the annual payment of deductibles and cost-sharing by households to a limited fraction of household income, as is done in many high-income countries. > Eight, use part of the annual saving of $1 trillion to expand home visits for community-based health care to combat the epidemics of obesity, opioids, mental illness and others. > Nine, rein in the advertising and other marketing by the pharmaceutical and fast-food industries that has created, alone among the high-income world, a nation of addiction and obesity. > Ten, offer a public plan to meet these conditions to compete with private plans. Medicare for all is one such possibility. [Previous page](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957.md?page=1) [Next page](https://boards.straightdope.com/t/the-usa-goes-full-single-payer-how-much-does-it-cost-how-much-to-raise-taxes-etc/789957.md?page=3)