To pay for Medicare For All (MFA) the average worker would pay $23,000 in annual Medicare taxes

Great Debates
41

I wasn’t aware that medical care was less expensive on islands. :confused:

Yes, the US is big; but as I recall from Econ 101, there’s something called “economies of scale” - the bigger the operation, the more economical it can be to run it.

The US has areas of high population density and low population density; so do places like the UK and the Scandavavian countries. So too does Canada. Those are just factors that need to be taken into account; they’re not unique to the US.

Plus, the US is a federation, just like Canada. That means that you can take advantage of one of the strengths of your system: general design of the system, plus funding, at the federal level, but implementation by the states and municipalities, to take into account local conditions. That’s how it works in Canada, the UK, and essentially in the EU as well. The EU collectively has a larger population than the US, but health care is delivered by the individual nations, with delegation to local governments, through the subsidiarity principle of the EU.

None of the things that you have mentioned are deal-breakers. They are factors to be taken into account in designing a system.

42

And this terminology, of course, is part of the pseudo-ideological disinformation process that keeps ordinary Americans (especially the poor) ignorant, that keeps them voting against their own interests. Universal healthcare is not “socialism”, at least not by the American definition of the word (“things only evil communists do”). UHC a basic requirement in any civilized society.

If healthcare paid for by taxation is “socialist” healthcare, then why isn’t defense paid for by taxation “socialist” defense?

43

So many things wrong with this OP.

For starters, about 60% of all medical costs are already paid by the public sector (medicare, medicaid, VA, CDC, NIH, health insurance for public employees, tax credits for health insurance, ACA subsidies, etc). That funding will be rolled into M4A funding.

M4A is not going from 0% public funding to 100% public funding. Realistically, it is going from 60% public funding to 85-100% public funding for health care.

M4A will hopefully reduce medical spending by 10-20%. Meaning we now have a shortfall of 20-30% of medical spending that has to be obtained via taxes.

That is also assuming there is 0 private spending under a M4A system, which is probably untrue. Even in M4A, it’ll probably be 90% public, 10% private spending (very few systems have no private spending in them).

So assume a 90/10 split as opposed to the 60/40 split we have now. And assume a 10% savings from M4A. Instead of paying 60% of 3.2 trillion in taxes (the 1.92 trillion we currently pay) we would pay 90% of 2.9 trillion, so 2.6 trillion in taxes to fund M4A.

M4A would cost about $700 billion in new taxes, not 3.2 trillion in new taxes.

How would we raise the $700 billion? A mix of payroll taxes and progressive taxes on income and investment. Multiple studies have already been done on this.

It’d probably be a payroll tax of 5-10%, combined with taxes on higher income earners for stock selling, income, capital gains, etc.

As it stands, the medicare tax is about 2.9% on income earners (3.8% on high income earners) and it raises almost $300 billion. So in theory just a payroll tax of 8% split evenly between employer and employee could raise the $700 billion needed.

Also due to high levels of income inequality, ‘average’ is a very misleading term. An ‘average’ spending of $23,000 a year could mean that one rich person pays $20 million a year in taxes and a thousand working class people pay $2000 a year in taxes.

44

This is not entirely true. In Ontario at least, the employer pays a health care tax fo 1.4% of payroll with an exemption on the first $450,000 in payroll. As a small business with 50 staff, I paid close to $75,000 in EHT to the province each year.

45

Exactly. The OP is using a time-worn Internet debate strategy: throw out a proposition using vague terms to try to scare the shit out of people, and when challenged on the facile debating tactic, run and hide.

46

Yes, we currently have a 100% socialist military. Funding for the executive branch as well as both houses of Congress and the Supreme Court have all been socialized. One could make the argument that the introduction of capitalist lobbying dollars into the system is actually corruption and against the wishes of the Founders, that the system is most pure when it is most socialist.

Now, not the entire economy, silly. Nobody is proposing turning this place into the USSR. Just the things that are appropriate for the government to manage, like the military, funding to operate the branches of government obviously, and now the debate is, also healthcare?

Except that debate is already partly settled, we have had partially socialized medicine in this country since the New Deal. Socialized retirement subsidies, too. Get this, they named that program Social Security! :smack: And of course socialized education, at least to a point, but that is a whole nother debate.

I hear you. The right-wing propaganda machine does a good job constructing these land mines in people’s minds such that even discussing the topic causes a major emotional reaction that derails the whole thing. Maybe teaching kids a little philosophy and rhetoric would be doing them a favor by making them more free and less susceptible to propaganda. But we have to be real about what we’re up against- purposefully misinformed people who are led to believe that anyone who favors improving our medical system in the interests of the public at large is some drooling, bug-eyed Liberal :eek:, marching rank-and-file, hive-mind style, in the armies of Satan to destroy America. I am hardly even exaggerating. We have to be real and deal with this.

47

You appear to have forgotten about Canada, which is larger, and which is also one of the most sparsely populated countries in the world. Yet single-payer works just fine, and provides universal health care coverage at half the cost in the US. Looks like another fanciful theory bites the dust.

Agreed. The US health care system is fundamentally, structurally broken, and the OP rather ridiculously assumes that the costs of MFA or single-payer or whatever you want to call it can be determined by simple arithmetic that divides today’s costs by the number of patients, and done!

No, what arithmetic and a bit of straightforward logic tells us is the following. Today’s astronomical costs – unique in the world – are actually being paid, in real dollars, through a combination of taxes, insurance premiums, and out-of-pocket extortion in the form of deductibles, co-pays, and insurance payout limits. A properly structured universal system can drastically reduce these costs; the best example is probably Canada which is essentially USA North, except with health care, gun control, and the relatively liberal politics of the US Northeast. Using Canada as an example you don’t have to deal with arguments about radically different culture or societal norms or drastically lower cost of living; Canada’s modern hospitals and doctors’ offices are indistinguishable from their US counterparts, yet health care costs in total are half of what they are in the US per capita, and paid for through a progressive taxation system, and in some cases also with a small health care surcharge applied progressively as a function of income.

So obviously, the economic numbers work and it can be done. The ONLY obstacle in the US is political. I agree that single-payer can’t happen as long as there are right-wing lunatics dedicated to obstructing it at every turn – largely with misinformation and scaremongering – but I’m skeptical that this right-wing lunacy will be viable over the long term. Extremely stupid ideas that mainly arise out of the self-interest of those profiting from them can only exist as long as the lies are believed and believable.

48

Thanks. I wasn’t aware that Ontario had a payroll tax on the employers. I would just comment that this shows that even in a federation where the federal government sets the general rules for a UHC system, the provincial/state governments can still have considerable flexibility on how to administer and fund it.

49

I think the one real mistake you are making is the assumption that the tax to pay for Medicare for All would not be progressive. Every version of some form of “single payer healthcare” that I have heard proposed made it clear that it will be paid for primarily by increasing tax on “the 1%.”

50

But you are still granting the loaded OP - the assumption that it needs to be “paid for” at all. The overwhelming evidence from every other developed nation is that implementation of UHC would save a vast amount of money.

51

By the fourth or fifth refutation, I don’t think you can call it an assumption any more. Perhaps a dogma.

52

Not bad, providing every worker gets a $23,000 a year raise

53

Finally someone has addressed my question from a basic cost accounting view rather than “you’re a mean poopyhead” view.

Federal government spending on healthcare today:

$1.1 trillion

In 2018 dollars we expect to spend $3.2 trillion (there is no 20% cost savings).

That leaves a gap of $2.1 trillion to be funded by taxpayers.

2/3 of $23,000 is more like $15,000 per worker.

Thank you.

54

See all those posts ahead of yours? You should read them.

55

Well there is the error. That we keep pointing out. You think that “the rest” is a constant.

We DON’T in fact expect to spend 3.2 trillion under a UHC system. That is the* reason *for changing. 3.2 trillion is far above any kind of reasonable spending, and its due to the current aberrant setup.

But at this point I don’t think you are debating in good faith. Still, these debates are being read by far more people than those who post, or register, so thank you for the opportunity to take that one apart.

56

Where do you think health care costs are trending?

Because of aging, diabetes, fitness, etc health care costs are going up fast. You’re right - they are not constant. But you actually think health care costs are going down? Or could go down with the MFA?

If costs go up just 5% a year what will they be in 2030?

57

Right. The line, “$2.1 T will have to be picked up by the taxpayers” is more of an omissive political talking point that the Dems’ avoiding letting the issue be boiled down to a bumper sticker tax number.

You see, the $2.1 T is already being paid by the taxpayer, through our clunky, current system. The proposed system ostensibly costs far less. It is kind of propagandistic of anyone to focus on wringing a tax cost figure out of a proponent of this proposal while omitting the bigger picture of lower costs for everyone, especially the poor.

Isn’t it also true that poor, out if work coal miners would receive cost-free health care under this system? All they have to do is show up at a clinic. Maybe there is a small co pay, but that is it. No wrangling with insurance companies, no back and forth with changing Obamacare premiums- just show up. I thought pubbies made a virtue out of simplicity?

58

Yes, this would be the starting assumption. US healthcare costs are ridiculous. Twice what they are per person in nations that cover their entire populations and get better results. Twice the expected costs and the average of developed nations. Adjusted for population.

The laws of economics don’t work different for the US. There are no special exceptions that we cannot spot. Health Care Economics is a branch of economics that has a lot of work done in it. And 3.2 trillion is a very serious amount of money. Its been looked at by some very serious people.

US healthcare costs are twice what they should be due to the system. With a normal system, they should be half what they are currently. Remember how I showed earlier in this thread that Medicare patient cost is pretty normal for the developed world and not twice as much just because its in the US? Because its a normal government healthcare system, within the variations of such, and so the costs are normal.

That is not to say that costs would not keep rising in in such a system after normalizing. But they’d rise from a normal base level, and probably at a normal rate. Would you rather have them go up 5 % a year from a starting point of 3.2 trillion rather than a starting point of 1.6 trillion ?

59

Do you have a cite for this? That it’s specifically facilities and salaries that are causing the inflated expenditures? Because from what I understand, large parts of it have to do with price gouging.

Again, you’re completely missing quite a few things here. You really haven’t responded to the post you just quoted, beyond the one point that a significant portion of our healthcare is already government-funded and wouldn’t be affected by this. You ignored structural issues. You ignored that most of those covered by MFA are healthy, whereas most of those covered by medicare are not. And so on and so forth. There’s a lot of reasons why the way you present this is misleading.

As others keep pointing out, the US is a massive outlier (“off the chart”). A huge portion of this comes down to our system, and there’s no reason to believe that our system will continue to be so absurdly expensive once we switch to a system more in line with what everyone else has. It’s not rocket science; we are literally the only developed country in the world that hasn’t figured it out yet.

60

Complete nonsense. You keep implying (in bad faith, at this point) that UHC is an “extra” cost. We already pay for our healthcare.

If you can’t grasp such a basic idea, then let me lay out some simple numbers for you as an example.

Current system

2017, in millions.

taken from the first link “NHE Tables” at the bottom of the page, first table

$1,532 MM = Total Current Public Expenditure*
$1,428 MM = Private Health Insurance*
$365 MM = Individual out-of-pocket expenditure

$3,325 = total expenditure

(*I have assumed the “Other” categories in the table split 50/50 between public/private)

New UHC system

Make the simplistic assumptions that costs don’t change, and that we move to 100% free-at-the-point-of-service public healthcare. Two things happen:

(1) The $1,428 MM that is being paid for private healthcare (mostly by private employers) drops to zero, and the same amount is now paid to the government in higher corporate taxation (whether payroll based or otherwise). No net impact for employers, no impact for the individual worker.

(2) Income tax goes up by $365 MM to fund what is currently being paid as out-of-pocket expense. But out-of-pocket expenses drop to zero.

Net impact to individual = zero.