I thank adaher for asking these questions. Still I’m unclear whether his underlying message is “I really want single-payer; here’s how we can cooperate to get it.” Or is the message “You can’t have single payer; here’s why.” ?
Here are my 2¢:
Some of the big advantages of single-payer are reduced costs and regulated costs. Won’t a parallel system of private insurers interfere with that? Isn’t the success of Canada’s single-payer due in large part to prohibitions against private payments?
If some states create state-wide single payer and other states do not, Americans with pre-existing conditions will have incentive to move to a UHC state. Is this considered a problem? (I suppose healthy people would have an incentive to move away from the UHC state.)
What happens to existing employer-sponsored insurance for workers and retirees? If they’re voided, the employees will suffer a sudden surge in payroll taxes, with their salaries still lower than normal to reflect benefits that are no longer paid.
The Tobin tax can not be used as a major revenue source. (I support Tobin tax because it reduces liquidity, not despite it! Recent financial crises have resulted from obsessively excessive liquidity.)
I agree that U.S. politics are increasingly dysfunctional. I think this is due to the powerful influence of money in opinion formation. Political progress will not be easy in the U.S. until the dumbing-down of politics is reversed. As is, with political discourse at 4th-grade level, politicians no longer even try to fool sixth-graders, as in this example:
Every subject in Britain is issued with an NHS number, very probably at birth ( unlike the National Insurance number, for work/taxes which one applies for after school ) so one then gets free treatment for most things.
Of course emergency treatment is available for all in the country, subject or not.
It’s all most humiliating having a number as a condition for getting free stuff; just like as if they were to issue you a number in the army. Faceless civil servants directing nameless cyphers in the brutal Orwellian machine, instead of the warm and fuzzy welcoming understanding of efficient American bureaucracy. “Would you like cookies with that ?”
Our European neighbours and ourselves have reciprocal agreements. So we don’t get a lot of Swiss and Italians sneaking in. We have illegal immigrants, but them getting free healthcare is one tenth of the concern over the future water supply.
By the text linked to earlier, residents are eligible for service regardless of immigration status. That doesn’t mean that everyone is a resident, regardless of immigration status. It just means that Mexican citizens who live in California are treated like American citizens living in California; and Mexican citizens who live in Mexico are treated like American citizens who live in Oregon.
Mind you, I’m not saying I think this policy is necessarily wise. But your criticism that anyone can pop over the border at their whim and have tons and tons of medical care is valid.
Why doesn’t corporate America support single payer? If that happened, no economic catastrophe would be necessary.
Suppose a case was presented to large employers that the payroll tax they’d have to pay for single payer would be significantly (like, say, 20%) lower than what they are typically paying in health care premiums. Plus of course they can get out of the whole business of administering health care insurance, which is a monumental pain in the butt.
The only reason I came up with as to why corporations wouldn’t be lining up for such a deal is that they’d think they were losing flexibility. But let’s face it – most of that flexibility is illusory.
One aspect that seems to always be overlooked in these discussions is that companies will no longer have to provide health insurance to their employees. My previous employer paid 75% of my monthly premiums. Multiply this by all the workers currently covered by employer contributions, and you have a yuuuuge pool of ‘free money’ that is now available for reinvestment (or massive bonuses). Anyone have an idea of how that would stack up against corporate tax breaks?
It’s neither, actually. What I’ve come to realize since the REpublicans took over everything is that we’re going to have to have universal health care. So now it becomes a matter of how best to deliver it. ACA has advantages over single payer and single payer has advantages over ACA. The biggest advantages of single payer are that it is undoubtedly constitutional, whereas ACA had some infirmities in that regard, and it’s the cheapest solution. ACA’s best aspects are competition, choice, and less of a government funding commitment than single payer would entail. I believe the cost of ACA right now is something like $120 billion/year for the government’s share, whereas single payer would end up costing at least 10 times that.
My own preference would probably lean towards fixing ACA now, but I don’t think either party is really invested in that law. The GOP hates it and Democrats are already looking beyond it. So we’ll have to see how the single payer fight goes first, plus what condition ACA is in, when the dust settles.
Canada isn’t far. I don’t see this as much of a problem, provided states have strict residency requirements.
It is, because how does an illegal immigrant prove residency. Also when dealing with illegals, you have the issue of trusting whatever documentation they do provide. California’s history suggests they won’t be too concerned about checking.
Corporate America probably would support single payer if it substantially reduced their costs. The problem is that most American single payer plans feature corporations and rich individuals bearing 90% of the cost, which means they pay a lot more than they do now. I’m sure if Europe could have funded UHC that way, they would have. But politically it’s a nonstarter and the funding numbers don’t work out in any case.
Put forward a plan where UHC is primarily funded by a social insurance tax or sales tax, and that would probably gain a lot of corporate support.
BTW, one overlooked aspect of single payer that I think Republicans should fight for if single payer appears to be inevitable, is enhancing state sovereignty by funding it in part by elimination of all federal funding to states. States should still see a huge spending reduction because they will no longer be responsible for Medicaid spending. The feds could defray some of that cost by eliminating all money to states and every state should still come out well ahead. And states would no longer be dependent on the federal government for anything and could be freer to implement their own policies on a variety of issues.
I don’t know about GOP politicians, but I think if you made that kind of offer that a lot of conservative/libertarian intellectual types not in politics would be intrigued.
I think you might be right. One thing to remember with our health insurance system is that, dysfunctional as it seems, about 91% of America is covered with something, either private or public, and 90% of them are OK with what they have. And even though everyone complains about our health-care system, the vast majority of people are OK with what they themselves have. So, single-payer would be a huge reorganization of part of the economy where probably 4 out of 5 people are OK with what they have. In any other topic, that would be a gigantic consensus. But in healthcare, it’s considered a problem, because other countries have 100% universal coverage, and the like.
Personally, I like not having single-payer. I don’t want it. But it’s not the Bolshevik plot that some make it out to be. Single-payer is a real thing that can work, as has been shown in other countries. I just happen to like the US system, which while not perfect, is very dynamic with great doctors, and some very good innovative care, etc. I think our system evolved as a patch-work, and that’s fine with me. We should add another patch to the quilt, and get the coverage up above 95%. That, to me, would be the next logical step.
So you are asserting that California will not check the residency of suspected Mexican residents to the same degree they will check the residence of suspected Arizona residents?
Are you suggesting that instead of pocketing that money, they would hand it over to the government to pay for UHC? Such a scenario would still be revenue-neutral to my company (who would pay that money to the government instead of an insurer). I wouldn’t have to pay my insurance contribution (giving me a 7% increase in take-home pay), and a large part of the tax burden to pay for universal coverage would be reduced. Let’s say the tax cost is an additional 7%. That would mean that my company doesn’t pay any additional money than it already does, I would take home the same amount of money, and everyone gets health care.
Also, corporate America is then freed from annual negotiations with insurers and having to deal with employee questions about healthcare. HR departments from coast to coast would cheer.
IMHO, the push here might come from small business - rate changes and hassle for small firms is much greater than for firms with a large risk pool. Plus rates for small firms is rising faster and as a result the number of small firms offering healthcare is falling.
I am not sure employee take home pay would rise but employee healthcare costs could stabilize.
