Hm. Earlier in the thread I showed how the cost of a Medicare based UHC is only 36 billion above the Current Public Expenditure, before adding half the “other.” Of course, Medicare only pays 80% of costs, but that pretty much cancels out with the current out-of-pocket expenses.
So I think your point (1) the 1,4 T would mostly be saved money.
It’s about time for this thread to be closed. Linden Arden has been shown to be acting in bad faith and nothing is going to change.
I made a thread here for the related debate on the Mercatus report.
Let’s keep the ‘bad faith’ accusations out of this thread, please.
If you must, you know where the Pit is.
I haven’t seen any post whose main line of argument is that you’re “a mean poopyhead”. The argument that I made, and that others have made, is that your stubborn insistence on assuming that the cost of single-payer can be determined by taking current total health care costs and dividing by population is naive and yields absurd results, and has no real-world applicability. Your “tax policy center” cite is worthless because their numbers just add up the costs of existing programs like Medicare, Medicaid, and CHIP – all of which have to operate under the current severely broken hugely inefficient system.
There have been hundreds if not thousands of article written on the cost savings inherent in single payer, and the empirical evidence for it comes from the laboratory called “the rest of the world”, most notably the OECD countries and major industrialized nations with economies similar to the US. One such article appeared in the AMA Journal of Ethics some years ago, and makes exactly those points, stating for instance that:
We will not solve our health care crisis as long as private insurance plays a dominant role. We should correct the flaws of the current Medicare program and extend this coverage to all age groups. This approach was well described in 2003 in the Physicians for a National Health Program’s “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” …
… A single-payer model would eliminate the inefficiencies of fragmentation by converting public programs such as Medicare, Medicaid, and CHIP into a single administratively efficient financing system. Streamlined billing under single payer would save physicians vast amounts in overhead.
The Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance cited above is also worth a read.
Likewise the late health care economist Uwe Reinhardt has written extensively on the subject, like this article: US health care prices are the elephant in the room.
Some of the cited figures are staggering. The total hospitalization and medical costs associated with an appendectomy are $3,408 in the UK; in the US, the average is $13,851, and the 95th percentile $29,426. These incredible costs lead to poorer utilization and poorer health outcomes in the US compared to other first-world nations and are entirely due to the complexity of many different disparate insurance programs and different insurers, with their hamfisted methods of claim-based cost control, with the incredible volume of paperwork associated with all of it, and with the lack of any central authority with any interest or ability to regulate fees and ensure uniform and transparent costs. Almost as amazing as the incredible costs of health care in the US is how secretive and variable the costs are, and how difficult it is to get any information about them from providers or insurers.
The result of this uncontained disaster is that present health care costs and their uncontrolled rate of increase are simply not sustainable. For many families with modest incomes the total real outlay on health care is approaching half their household income. Unlike your ridiculous hypotheticals of what “taxes” might be for single-payer, the reality is that these costs are real and these huge inefficiencies have to be paid for by some combination of insurance and personal and employer contributions to it and out-of-pocket costs. No amount of spin changes the fact that costs like those cited above are true nowhere else in the world, nor that access to the best medically necessary health care in the US is often blocked by financial issues and is increasingly available only to the wealthy, another fact that is true nowhere else in the civilized world.
It is perhaps worth noting at this point that Mercator is a libertarian think-tank with a stated bias towards free markets and a history of misleading arguments on health care. Part of the push for Medicare For All is fixing the system, which, in the USA, is almost uniquely broken. You could not pay me enough to make returning to the USA worthwhile for me, unless you were offering me absurdly above-market rates.
That is strictly federal spending, and doesn’t include everything. It doesn’t include health insurance for public sector employees (cops, firemen, people who work at universities, etc etc)
Medicaid is also heavily funded on the state level. So are various other state and local programs.
Programs like the NIH, NIMH, CDC, etc. are probably considered health spending and those are public.
The total figure is closer to 60%.
Also keep in mind that study was from 2002, and we’ve had several public sector expansions in health care since then. The SCHIP expansions under Obama, the ACA, medicare part D under Bush, Romneycare, Healthy San Francisco, etc. The number now is probably in the mid 60% range.
So I stand by my statement, about 60-65% of all medical spending in the US is done by the public sector (federal, state and local) when you include public health programs, subsidies, tax credits, etc.
Also you claimed yourself medicare for all would save 2 trillion, which is only about 6% of medical spending over a decade.
But that was a study done by the Koch brothers to discredit medicare for all, and it still found a 6% savings.
William Hsiao is a world respected health care economist who has helped design the health care systems in a lot of nations. He was tasked with designing a single payer plan for Vermont.
He calculated that single payer in Vermont (had they actually enacted it) would reduce medical spending by 25% over ten years.
At the end of 10 years, medical spending under ‘doing nothing’ would be $12,500 a year. Had they enacted single payer, it would’ve been $9,500 a year in medical spending after ten years.
So again, 60% of $12,500 is $7500. 90% of $9500 is $8550. So in Vermont it would’ve been an extra $1000 a year in taxes to fund single payer after ten years. Hardly a killer.
Which tells us that, so great is the waste and inefficiency in the present health care system dominated by private insurance, that if the US had a single-payer system like the UK or Canada, or a nationally regulated community-rated multi-payer system like Germany, and had comparable costs, then existing federal health expenditures alone would be enough to provide universal coverage for everyone. Which is a rather remarkable fact. Comprehensive health care reform has the potential, if costs could be brought down to the level that comparable industrialized countries have been able to maintain, to give every single American guaranteed health care for no more public money than is being spent already. And insurance premiums would completely disappear, along with the useless parasitic businesses that charge them.
Maybe that’s too much to hope for, but it’s a powerful statement about how much money is being wasted and why US health care is such a disaster. And while it may not be realistic to hope that provider fees and hospitalization costs could be rolled back to the same levels as in economically similar countries, they surely could be rolled back very significantly, since present costs have all the tremendous present inefficiencies built in to them. Ultimately, doctors are concerned about net income, not what their fees are. And, to a surprising extent, tend to ascribe a lot of value to being freed from frustrating and demeaning battles and hassles with insurance company bureaucrats.
It seems to me that the OP’s entire argument can be summed up as “This is how much we currently pay for health care, so it’s also the amount that we would pay under Medicare For All. And that’s so unimaginably much more than what we’re currently paying that it’s absurd.”
I think OP is far more misguided/misleading than that.
Our current healthcare expenditure is very roughly 50% public 50% private (including individual out-of-pocket expense).
OP implies that if we simply keep our total healthcare budget the same, but now make it a ~100% public UHC system, that requires a vast amount of new funding. Of course it doesn’t, it’s simply a question of redirecting the existing 50% private funding. The bulk of that is corporate expenditure on private health insurance, which could simply be redirected (via corporate taxation) to fund UHC instead.
Even on the assumption of no savings at all in the overall budget, given that the current budget is obviously already being funded, we don’t require net new funding overall. We might find that corporate tax goes up, offset by corporate savings on private health premiums; or that income tax goes up a little, offset by savings in out-of-pocket health expenditure. But the net effect would be, by definition, zero sum - since the current budget is already being funded.
Do you think that by not going to a UHC, costs will be contained better?
If so, please explain.
If not, then what is your point here?
Here’s one of many cost analyses that have been done on the costs of single-payer. The problem with any such analysis is that it has to make many assumptions which are then immediately challenged by one or both sides; that particular analysis largely neglects the very important effects of cost control enabled by single payer, and so in my view grossly overestimates the cost of single payer compared to the status quo. Nevertheless, even crippled by that constraint (which keeps US health costs far above that of the rest of the industrialized world into the foreseeable future), the following benefits are apparent from the study of how single-payer would affect New York State, even without cost controls:
[ul]
[li]We would spend less money overall, while spending more on actual health care and covering more people and services.[/li][/ul]
[ul]
[li]Any new taxes would be effectively replacing the premiums you and your employer already pay.[/li][/ul]
[ul]
[li]Due to the progressive nature of taxation, some higher-income people would pay more, but the working and middle classes would pay less.[/li][/ul]
That last item, of course, is the deal-killer among the wealthy plutocracy who essentially own and operate Congress.
Anyway, the complexity and necessary assumptions around estimating actual total costs is why it generally makes more sense to analyze the cost savings and systematic advantages that accrue from different aspects of single payer, as per some of the cites I provided in post #65. One can then construct realistic cost scenarios based on reasonable assumptions.
Ah, but apparently the OP thinks spending $1,000 on health care with insurance companies is goof, but spending it on taxes for MFA is bad. Which no soubt would be the Republican position, but it is still a bankrupt one.
I live in the UK.
Recently I had a series of medical procedures (checking for bowel cancer, diagnosing and removing gallstones.)
Since our National Health Service is prepaid through taxes, the total cost to me was £0. (N.B. We don’t get charged for ambulance trips etc.)
My friend in Las Vegas reckons the same treatment I received would have cost over $200,000 in the US.
Having made that point, let me emphasise that the key to why the US system costs so much is … profit for insurance companies, drug providers, accountants, administrators, lawyers etc.
If that doesn’t convince you, perhaps the US could abandon the completely useless ‘War on Drugs’ and spend the annual cost of about $50,000,000,000 on a decent health service instead.
You realize that any increased cost for those over 65 are already covered by the government, right? Do you want to add “Medicare isn’t working” to your argument?
And more than just economy of scale, any type of insurance is more efficient the bigger the bigger the population. MFA could be a lot more efficient thatn Canada or the UK because of this. Not to mention that data analytic techniques applied to all health care visits could reduce a lot of fraud.
Having followed and participated the healthcare threads here since I quit working, I have concluded that US Healthcare via individual insurance is popular because Americans are easily convinced that if healthcare were paid by taxes some undeserving people would get some of their money.
Yes, this is the point. All we have to do is add a tax to business that would more or less equal what they spend on healthcare for their employees.
Then bump up the medicare tax bit so it is actually less than what the average household spends on health care.
And there ya go. Medicare for all, with no actual increase in healthcare spending.
So let us take some big corp. They spend say, $1Million a year. Now, we add a tax of $1M a year, and they pay that instead of healthcare.
Net is zero.