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Why is Medicare for all bad? (3 Viewers)

The Commish said:
I don't know if Bernie's plan is still on his site or if it's been taken down to tweak, but during 2016 it was:

1.  Reclamation of funds from companies they got from tax breaks for providing healthcare (they wouldn't need to provide that any more, so the tax break goes back to the gov't).

2.  Business Payroll tax

3. Household (I think it was 4% before...based on income)

4.  Taxes on the rich (income based)

5.  Taxes on wealth (net work based)

6.  Increase estate tax
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I assume this is what you are referencing: OPTIONS TO FINANCE MEDICARE FOR ALL

The breakdown in that document is as follows, all over a 10 year period (matching your numbers 1-6):

  1. Savings from Health Tax Expenditures (tax breaks that would become obsolete) = $4.2T
  2. 7.5 percent income-based premium paid by employers = $3.9T
  3. 4 percent income-based premium paid by households = $3.5T
  4. Make the Personal Income Tax More Progressive (i.e., tax the wealthy) = $1.8T
  5. Establish a Wealth Tax on the Top 0.1 percent = $1.3T
  6. Make the Estate Tax More Progressive = $249B
  7. Close the Gingrich-Edwards Loophole and Create Parity for Wealthy Business Owners = $247B
  8. Impose a one-time tax on currently held offshore profits = $767B
  9. Impose a Fee on Large Financial Institutions = $117B
  10. Repeal Corporate Accounting Gimmicks = $112B
That totals to $16.2T over 10 years... less than half of the $32.6T in projected increase in federal budget commitments that would be triggered by M4A... even under the best case scenario assumptions, which are likely unrealistic to some degree... meaning it is actually worse.

So this is an invalid proposal. Where is the other $16.4T+ coming from? Items 1, 7, and 10 above are presumably set and cannot increase... so doubling items 2-6 and 8-9 won't get there. What would we do, impose a 20% income-based premium paid by employers and a 10% income-based premium paid by households? NFW. And that is where this breaks down.

Politicians don't tend to sweat the details, but details matter when it comes to adding a program that will cost multi-trillions every year.

 
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Just Win Baby said:
I assume this is what you are referencing: OPTIONS TO FINANCE MEDICARE FOR ALL

The breakdown in that document is as follows, all over a 10 year period (matching your numbers 1-6):

  1. Savings from Health Tax Expenditures (tax breaks that would become obsolete) = $4.2T
  2. 7.5 percent income-based premium paid by employers = $3.9T
  3. 4 percent income-based premium paid by households = $3.5T
  4. Make the Personal Income Tax More Progressive (i.e., tax the wealthy) = $1.8T
  5. Establish a Wealth Tax on the Top 0.1 percent = $1.3T
  6. Make the Estate Tax More Progressive = $249B
  7. Close the Gingrich-Edwards Loophole and Create Parity for Wealthy Business Owners = $247B
  8. Impose a one-time tax on currently held offshore profits = $767B
  9. Impose a Fee on Large Financial Institutions = $117B
  10. Repeal Corporate Accounting Gimmicks = $112B
That totals to $16.2T over 10 years... less than half of the $32.6T in projected increase in federal budget commitments that would be triggered by M4A... even under the best case scenario assumptions, which are likely unrealistic to some degree... meaning it is actually worse.

So this is an invalid proposal. Where is the other $16.4T+ coming from? Items 1, 7, and 10 above are presumably set and cannot increase... so doubling items 2-6 and 8-9 won't get there. What would we do, impose a 20% income-based premium paid by employers and a 10% income-based premium paid by households? NFW. And that is where this breaks down.

Politicians don't tend to sweat the details, but details matter when it comes to adding a program that will cost multi-trillions every year.
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No...i've never seen that doc.  I was going off memory and it doesn't appear to be on his page now.  I think there was also a corporate tax on top of #1 also.  I guess he's taken it down from last election cycle.  It made up right at 30T with the other 2T coming from increase of our taxes.  Not sure what you base all these assumptions on, but this isn't the list that I remember seeing.

 
The Commish said:
No...i've never seen that doc.  I was going off memory and it doesn't appear to be on his page now.  I think there was also a corporate tax on top of #1 also.  I guess he's taken it down from last election cycle.  It made up right at 30T with the other 2T coming from increase of our taxes.  Not sure what you base all these assumptions on, but this isn't the list that I remember seeing.
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To be clear, I didn't state any assumptions. I cited data from the document posted on Sanders' web site, which I linked.

I would be quite interested to see a breakdown of what you remember about covering the $32T, since it would obviously be quite different from the document I found on his web site. In fact, if he has a plan for $32T, I don't even see why he would have a document posted that covers $16T... which makes me doubt your memory.

ETA: With regard to "I think there was also a corporate tax on top of #1 also," that's what #2 is.

 
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Just Win Baby said:
I am not aware that any politicians advocating for M4A have actually put forth a plan that shows how this tremendous cost will be covered. If anyone has seen that, please link.
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I am not sure that any politician actually fully pays for whatever their proposal is or nor.  Medicare for All tends to mean different things to different politicians so I'm guessing some of the "buy in" versions do pay for it mostly out of premiums.  I think it we should just be honest -  We need to raise federal taxes by about 14% give or take to replace what is currently collected in premiums (9%), local and state taxes (2%), and out of pocket (3%) or whatever the actual numbers are.  While this is a flat rate it is less regressive than flat dollar amounts currently being collected.  Yes there would be sticker shock and the politics of this would be ugly, but the reality is that the economy is already taxed by these amounts today and this is just streamlining the collection.  So hopefully a few politicians can just start laying it out Perot style and be honest with the masses.

 
Bottomfeeder Sports said:
I am not sure that any politician actually fully pays for whatever their proposal is or nor.  Medicare for All tends to mean different things to different politicians so I'm guessing some of the "buy in" versions do pay for it mostly out of premiums.  I think it we should just be honest -  We need to raise federal taxes by about 14% give or take to replace what is currently collected in premiums (9%), local and state taxes (2%), and out of pocket (3%) or whatever the actual numbers are.  While this is a flat rate it is less regressive than flat dollar amounts currently being collected.  Yes there would be sticker shock and the politics of this would be ugly, but the reality is that the economy is already taxed by these amounts today and this is just streamlining the collection.  So hopefully a few politicians can just start laying it out Perot style and be honest with the masses.
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Perot style didn't work very well... (I voted for him, but knew I was throwing away my vote...)

What you say makes sense, I just don't think we have seen a politician since Perot who was/would be willing to "be honest with the masses" about that level of tax increase. And if there were a few politicians willing to do it, I don't think they would get the support needed to get anything passed. And then they would get voted out of office...

 
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Just Win Baby said:
To be clear, I didn't state any assumptions. I cited data from the document posted on Sanders' web site, which I linked.

I would be quite interested to see a breakdown of what you remember about covering the $32T, since it would obviously be quite different from the document I found on his web site. In fact, if he has a plan for $32T, I don't even see why he would have a document posted that covers $16T... which makes me doubt your memory.

ETA: With regard to "I think there was also a corporate tax on top of #1 also," that's what #2 is.
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This is what I was referring to:

Items 1, 7, and 10 above are presumably set and cannot increase
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And as I said, I was going off what I remembered from 2016 elections.  I was doing well to get out what I put in that first post and am sort of surprised I remembered correctly :lol:    If anyone comes out with detail on their plan it will be him.  Just have to wait for it to come out I guess....and who knows, what you linked might be it this time around...I don't know :shrug:  

 
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The Commish said:
This is what I was referring to:
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Ah, I see. Regarding items 1, 7, and 10:

  • Item 1 is about tax breaks that would become obsolete. Obsolete is a binary thing; once obsolete, there is no more money to be gained there.
  • Item 7 is about closing a loophole. Again, that is a binary thing; once closed, there is no more money to be gained there.
  • Item 10 is about repealing 'gimmicks'. Again, that is a binary thing; once repealed, there is no more money to be gained there.
The Commish said:
And as I said, I was going off what I remembered from 2016 elections.  I was doing well to get out what I put in that first post and am sort of surprised I remembered correctly :lol:
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Yes, that was quite good from memory.

The Commish said:
who knows, what you linked might be it this time around...I don't know :shrug:  
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If what I linked is his plan, it is woefully insufficient, since it doesn't even cover half of the extra expenses. If this is the best anyone can do, I don't think M4A will ever get passed without an Obamacare-like super majority and methodology.

 
I should note here that I'd prefer a government plan introduced to the private markets to compete with everyone else.  It's my feeling that jumping straight to M4A would be incredibly painful given the current situation with healthcare and health insurance in this country.  If that's letting people buy into existing Medicare and tweaking Medicare to accommodate, ok.  If that's creating a brand new plan and leaving Medicare alone, that's ok too.  I feel like the government needs to PROVE themselves on a larger scale than just Medicare before handing over the keys.  If they are proven worthy and successful, there shouldn't be an issue.  If they fail, they fail and we can move on.

 
The Commish said:
I should note here that I'd prefer a government plan introduced to the private markets to compete with everyone else.  It's my feeling that jumping straight to M4A would be incredibly painful given the current situation with healthcare and health insurance in this country.  If that's letting people buy into existing Medicare and tweaking Medicare to accommodate, ok.  If that's creating a brand new plan and leaving Medicare alone, that's ok too.  I feel like the government needs to PROVE themselves on a larger scale than just Medicare before handing over the keys.  If they are proven worthy and successful, there shouldn't be an issue.  If they fail, they fail and we can move on.
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:goodposting:  

 
The Commish said:
I should note here that I'd prefer a government plan introduced to the private markets to compete with everyone else.  It's my feeling that jumping straight to M4A would be incredibly painful given the current situation with healthcare and health insurance in this country.  If that's letting people buy into existing Medicare and tweaking Medicare to accommodate, ok.  If that's creating a brand new plan and leaving Medicare alone, that's ok too.  I feel like the government needs to PROVE themselves on a larger scale than just Medicare before handing over the keys.  If they are proven worthy and successful, there shouldn't be an issue.  If they fail, they fail and we can move on.
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Probably so. But one potential downside to consider: health insurance companies are the most powerful special interests in the healthcare sector. As a result, in a U.S.-style democracy, any "Medicare-for-whoever-chooses-it-over-traditional-insurance" program will be largely designed by health insurance lobbyists. It wouldn't be a complete shock if they designed the program to be somewhat uncompetitive on purpose. (And that's on top of whatever uncompetitiveness happens by accident.)

 
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Maurile Tremblay said:
Probably so. But one potential downside to consider: health insurance companies are the most powerful special interests in the healthcare sector. As a result, in a U.S.-style democracy, any "Medicare-for-whoever-chooses-it-over-traditional-insurance" program will be largely designed by health insurance lobbyists. It wouldn't be a complete shock if they designed the program to be somewhat uncompetitive on purpose. (And that's on top of whatever uncompetitiveness happens by accident.)
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I can't imagine the leaders of the M4A campaign would allow that to happen, but I am confident those lobbies would absolutely be behind the politicians fighting against it.  How much the creators allow them to influence the legislation is surely a legit concern.

 
Bottomfeeder Sports said:
But why should providers be paid the same as today when a large chunk of their cost go away?  Billing is expensive.  And while billing won't completely go away as there would still be billing of Medicare the complexity of billing many payers and the pure cost of patient billing goes away.  On the flip side this would mean a lot of people (some percentage of that .67 FTEs per provider) would become unemployed along with all of those insurance company employees mentioned above.
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Just wanted to say that I'm not sure how much of the data from those studies is still relevant as it is all pre-2014 which is when the EHR mandate went into effect.  To give you an idea, the organization I work for has a Billing and Coding staff of 5 FTE for 30 providers.  Also, I can also say that while EHR systems have leaned out many operational support functions, as a NYS Article 28 facility that receives Federal 330 funding, any savings is being offset by increases in Compliance and Regulatory costs. 

I know it's cliche to say but it really is true....whenever you're designing a healthcare system, decide which two of availability, affordability and quality you want.          

 
jonrolly said:
Just wanted to say that I'm not sure how much of the data from those studies is still relevant as it is all pre-2014 which is when the EHR mandate went into effect.  To give you an idea, the organization I work for has a Billing and Coding staff of 5 FTE for 30 providers.  Also, I can also say that while EHR systems have leaned out many operational support functions, as a NYS Article 28 facility that receives Federal 330 funding, any savings is being offset by increases in Compliance and Regulatory costs. 

I know it's cliche to say but it really is true....whenever you're designing a healthcare system, decide which two of availability, affordability and quality you want.          
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EHR would seem to lower that cost in the elimination of most "charge entry" and related record retention  with automation.  It would also "direct" providers in areas such as referrals, covered drug lists, and other areas with carrier specific rules.  Probably a few more items that I cannot think of at the moment to reduce billing complexities.  So good point.  But the billing of Medicare and the billing of private plans still remains different beasts.  If for no other reason than Medicare doesn't "deny" claims (outside of technical "edits") but instead performs audits after the fact.  And then billing patients - especially when the billed amount hits about $200  is expensive.

 
Recent article on the challenge of paying for M4A: Why Paying for Single Payer Is Such a Political Quagmire

WIth regard to the article's "third hurdle," it says: "...the rest gets kicked in by their companies, which employees experience through lower salaries but don’t necessarily see. How are voters going to react when they hear that single payer would require raising taxes $10,000 or $15,000 per worker (or maybe more), when they think they pay maybe half that?"

Perhaps that issue would be offset if the shift from private system to M4A resulted in raises for all of those workers equivalent to the amount their companies were paying for their healthcare... but I don't see that happening. The cost of M4A is so high that it should be expected to result in significant taxes on businesses as well as citizens, so the businesses will likely have no savings to convert to salary increases.

IMO whoever ends up as the Democratic candidate will (should) get hammered over this by the Republicans. Plus, aside from paying for it, there are all the other ripple effects (e.g., unemployment for people working in the private healthcare industry, the fact that the stocks of these companies are a non-trivial component of the stock market, etc.). I think a Democratic candidate who pushes this aggressively could lose the election on this issue.

 
Just Win Baby said:
Recent article on the challenge of paying for M4A: Why Paying for Single Payer Is Such a Political Quagmire

WIth regard to the article's "third hurdle," it says: "...the rest gets kicked in by their companies, which employees experience through lower salaries but don’t necessarily see. How are voters going to react when they hear that single payer would require raising taxes $10,000 or $15,000 per worker (or maybe more), when they think they pay maybe half that?"

Perhaps that issue would be offset if the shift from private system to M4A resulted in raises for all of those workers equivalent to the amount their companies were paying for their healthcare... but I don't see that happening. The cost of M4A is so high that it should be expected to result in significant taxes on businesses as well as citizens, so the businesses will likely have no savings to convert to salary increases.

IMO whoever ends up as the Democratic candidate will (should) get hammered over this by the Republicans. Plus, aside from paying for it, there are all the other ripple effects (e.g., unemployment for people working in the private healthcare industry, the fact that the stocks of these companies are a non-trivial component of the stock market, etc.). I think a Democratic candidate who pushes this aggressively could lose the election on this issue.
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Nah. They should just lie and say you’ll save $2000 a year and keep your doctor. We’ll gobble it up. 

 
timschochet said:
I agree that they don’t have an alternative approach, though Chuck Todd noted yesterday  that they might end up, by default, defending some form of Obamacare- how ironic and hilarious would that be? 

And yes they will shout “socialism!” to the rooftops. Problem is, it might work...
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You listen to Chuck Todd?

 
IC FBGCav said:
Tell me.  I know facts though, watch out.
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massive cost to people who work is the #1 thing and, we already have a national health care system - its called the VA

and the VA gets it right sometimes, but often time it doesn't. I've watched my Dad and brother in law work through the VA system for years. Its Govt ran - it sucks

with rare exception, anytime the Fed Govt gets involved its going to be an inferior service/product compared to private industry and its going to cost way more 

 
timschochet said:
That’s an old post of mine. But yes of course. One of my favorite interviewers. I love Meet the Press, always have. He’s great. 
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He's no Tim Russert, or even Bill Monroe.   Perhaps they need someone a little less bias than Chuck Todd.

 
And I don’t care about bias if someone is good interviewer. You know who was a great interviewer? Bill O Reilly. A pompous jerk otherwise, but I miss his interviews. 

 
timschochet said:
And I don’t care about bias if someone is good interviewer. You know who was a great interviewer? Bill O Reilly. A pompous jerk otherwise, but I miss his interviews. 
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Bill Monroe Meet the Press - 

"On camera Mr. Monroe was serious and direct. In 1976, soon after becoming the permanent moderator, he grilled Gov. George C. Wallace of Alabama, who had once championed segregation and was running for president. “Have you personally changed your views about segregation?” Mr. Monroe asked.

When Mr. Wallace did not respond directly, Mr. Monroe interrupted him and repeated the question twice more. Mr. Wallace went on to say that race relations were better in the South than in other parts of the country."

You should care about bias, because that dictates the questions asked and its tone.  Always leaning left, as you are.  Of course you agree with his bias, so I understand why you would like him.

 
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I see the shift happening here too...interesting.  In conversations I've had recently, people are ignoring medicare as an example of "government funded health care' and now focus on the VA as if the VA model is closer to what we'd see in M4A than Medicare.  I'll never understand why people want to create such silly disingenuous arguments that are so transparently bad.  

NOTE:  The VA DOES suck and it has been an abomination for decades and only gotten worse because of all the wars our government insists on being in.  There is a myriad of reasons why using the VA as an example for comparison to government funded healthcare is flat out wrong and dishonest.

 
JohnnyU said:
Of course you agree with his bias, so I understand why you would like him.
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I like Chuck Todd because he doesn’t suck up. You remember Larry King?? He was a liberal and  I couldn’t stand his interviews because all the questions were softballs. Just like Sean Hannity. No tough questions at all. Rachel Maddow is a poor interviewer. Chris Wallace is very good. Hugh Hewitt is a great interviewer, maybe the best ever for me. 

Everybody is biased. The question is how well do you perform? 

 
timschochet said:
I like Chuck Todd because he doesn’t suck up. You remember Larry King?? He was a liberal and  I couldn’t stand his interviews because all the questions were softballs. Just like Sean Hannity. No tough questions at all. Rachel Maddow is a poor interviewer. Chris Wallace is very good. Hugh Hewitt is a great interviewer, maybe the best ever for me. 

Everybody is biased. The question is how well do you perform? 
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I understand where you are coming from, but IMO a show like Meet the Press should be less bias, especially considering its history.  Someone like Todd kind of makes it a little one sided. 

 
The Commish said:
I see the shift happening here too...interesting.  In conversations I've had recently, people are ignoring medicare as an example of "government funded health care' and now focus on the VA as if the VA model is closer to what we'd see in M4A than Medicare.  I'll never understand why people want to create such silly disingenuous arguments that are so transparently bad.  

NOTE:  The VA DOES suck and it has been an abomination for decades and only gotten worse because of all the wars our government insists on being in.  There is a myriad of reasons why using the VA as an example for comparison to government funded healthcare is flat out wrong and dishonest.
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The Government has been responsible for creating and managing 5 significant healthcare programs: ACA, Medicare, Medicaid, VHA, and IHS. Overall, with regard to efficiency and effectiveness, it is an unimpressive track record at best.

IMO it is fair to suggest that Medicare is the most comparable program to consider when thinking about how the Govt might implement M4A. But "most comparable" doesn't make it a good comparison, considering how different M4A would be. Most notably, Medicare covers about 15% of the US population. There is no program in USG history that is comparable to scaling Medicare to cover 100% of the US population.

From a total Government coverage perspective, from 2016:

  • US population - 325M
  • Medicaid and CHIP - 68M
  • Medicare - 53M
  • VHA - 15M
  • ACA - 12M
  • IHS - 2M
So in 2016, USG healthcare programs covered about 150M of 325M Americans, about 46%. Again, no comparison to M4A, but much closer to being representative of the right scale than just looking at Medicare... but including all of these programs includes all of their issues, including VHA and IHS issues.

Furthermore, a significant portion of those covered under Medicare pay to have supplemental coverage, and those on ACA who are not fully subsidized also bear a portion of their cost. That cost sharing is not supported by at least some of the M4A plans (e.g., Sanders').

There is also the issue of reducing all healthcare payments to Medicare levels. It is not at all clear how that would affect healthcare providers, hospitals, etc. Some claim that the reduction in bureaucracy/administration will offset the reduction in payments, but I have never seen anything that gives me confidence in that premise.

I guess I rambled some here. Agree VHA is not a good point of comparison on its own, but, frankly, I don't think there is a particularly useful comparison.

 
Just Win Baby said:
I guess I rambled some here. Agree VHA is not a good point of comparison on its own, but, frankly, I don't think there is a particularly useful comparison.
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Agree with this 100%  the isn't a good comparison. I am merely pointing out my observation that those insisting to compare have shifted from using Medicare to the VA. They can answer why that is but i think i know the answer. 

 
Mile High said:
Well see in other countries who have some kind of healthcare for all sometimes it takes days to see a Doctor, so better to keep people without healthcare, because time is more important or something, something. 
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Is there evidence of worse health outcomes in those countries? Is there any potential harm in having rapid care too accessible?

The US doesn't have the best quality care in the world, but performs more tests/procedures than many countries with better healthcare metrics. Coincidence? 

 
Jackstraw said:
I went to a fundraiser for the YMCA this weekend and part of it was exotic cars. Got to see various 200-400K cars owned by local physicians. As I am struggling to pay for employee healthcare it kind of chaps my ###. 
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What kind of cars should physicians own? 

 
jonessed said:
:shrug:  

When you have “x” symptoms odds are you have {a b c d}.  If “d” happens to be really bad, but highly unlikely the doctor might want to wait to wait and see how things progress.  Me?  I would prefer to know before then so, if I can afford it, I pay more money.  I get the MRI done early.
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This line of thinking leads to a lot of unnecessary tests, with incidental findings leading to more needless testing/procedures with potential for complications. “VIP care” is seldom associated with better health outcomes.

 
timschochet said:
Now lets talk long term, and my biggest fear about this: with the insurance companies removed and the federal government paying all costs, at some point in the future budget concerns will cause the government to renegotiate hospital costs. Which means that eventually doctors will be paid less. Drug companies will be paid less. There will be less innovation, and smart people who might have chosen a career in medicine will now choose other professions that pay more. Are we putting at risk the overall quality of medicine, as well as future cures and treatment?

So these are the main reasons I have trouble making up my mind. 
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While innovation may suffer, why is everyone convinced we can’t maintain a pool of excellent physicians with reduced compensation? Med school applications are near all time highs, with more than enough qualified applicants. How are other countries able to find good doctors while paying less than the US?

 
Bottomfeeder Sports said:
But why should providers be paid the same as today when a large chunk of their cost go away?  Billing is expensive.  And while billing won't completely go away as there would still be billing of Medicare the complexity of billing many payers and the pure cost of patient billing goes away.  On the flip side this would mean a lot of people (some percentage of that .67 FTEs per provider) would become unemployed along with all of those insurance company employees mentioned above.
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Reigning in unnecessary middle people (coders/billers/utilization management/insurance admin) would go a long way to reducing costs. As all these jobs add nothing to quality/provision of healthcare, I see no reason they need to be preserved.

 
It's baffling to me that people don't see the public option as the next logical step in this whole fiasco.  Put a plan out there anyone can get on if they want to.  Allow the full weight of the government to negotiate prices with the private industry leaders and let the chips fall where they may.  The plan will either succeed or fail....then we'll know once and for all.  

 
Shula-holic said:
The costs associated and tax options are briefly touched on here:

https://finance.yahoo.com/news/the-democratic-plan-for-a-42-national-sales-tax-202549219.html?.tsrc=daily_mail&uh_test=1_04
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These "scare" articles are all the same.   They act like the 3.5 Trillion in NHE (as of 2017) all needs to be found in new taxes.  So we need an additional 42% VAT, or an additional 32% payroll tax, or an additional 25% on all income to raise the $3 trillion that Medicare For All is projected to cost.   But we don't need to raise $3 trillion in additional spending.  For starters the federal government is already covering 20% of that total for Medicare.  The Feds and states are grabbing another 17% for Medicaid.   Add in government employees and veterans and other miscellaneous items and about half of the total is already included in existing taxes.  (link for most of this).   Then figure in that the average family is already over 10% of income for their own premiums and deductibles and copays which all go away and those big scary tax hike numbers just become nonsense.  The amount on average that we all spend will be approximately the same just spread out differently among individuals.  (Yes there will be individual losers with any policy change.)

 
The Commish said:
It's baffling to me that people don't see the public option as the next logical step in this whole fiasco.  Put a plan out there anyone can get on if they want to.  Allow the full weight of the government to negotiate prices with the private industry leaders and let the chips fall where they may.  The plan will either succeed or fail....then we'll know once and for all.  
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It shouldn't really be baffling.  A plan with little overhead cost and tens of millions in the pool could only fail via sabotage,  The opposition is because there is no mystery where the chips will fall.

 
Bottomfeeder Sports said:
These "scare" articles are all the same.   They act like the 3.5 Trillion in NHE (as of 2017) all needs to be found in new taxes.  So we need an additional 42% VAT, or an additional 32% payroll tax, or an additional 25% on all income to raise the $3 trillion that Medicare For All is projected to cost.   But we don't need to raise $3 trillion in additional spending.  For starters the federal government is already covering 20% of that total for Medicare.  The Feds and states are grabbing another 17% for Medicaid.   Add in government employees and veterans and other miscellaneous items and about half of the total is already included in existing taxes.  (link for most of this).   Then figure in that the average family is already over 10% of income for their own premiums and deductibles and copays which all go away and those big scary tax hike numbers just become nonsense.  The amount on average that we all spend will be approximately the same just spread out differently among individuals.  (Yes there will be individual losers with any policy change.)
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Scare tactics is a good phrase. It's like we're supposed to pretend what is happening in western Europe isn't really happening. If we're so "special" that we don't think it will work here, then it's only because we've worshiped too long at the altar of rapacious capitalism.

 
The Commish said:
It's baffling to me that people don't see the public option as the next logical step in this whole fiasco.  Put a plan out there anyone can get on if they want to.  Allow the full weight of the government to negotiate prices with the private industry leaders and let the chips fall where they may.  The plan will either succeed or fail....then we'll know once and for all.  
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There needs to be assistance for the elderly and minorities..If you don't provide that, it will fail for sure.

 
supermike80 said:
The Commish said:
It's baffling to me that people don't see the public option as the next logical step in this whole fiasco.  Put a plan out there anyone can get on if they want to.  Allow the full weight of the government to negotiate prices with the private industry leaders and let the chips fall where they may.  The plan will either succeed or fail....then we'll know once and for all.  
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There needs to be assistance for the elderly and minorities..If you don't provide that, it will fail for sure.
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:confused:  

 
Bottomfeeder Sports said:
These "scare" articles are all the same.   They act like the 3.5 Trillion in NHE (as of 2017) all needs to be found in new taxes.  So we need an additional 42% VAT, or an additional 32% payroll tax, or an additional 25% on all income to raise the $3 trillion that Medicare For All is projected to cost.   But we don't need to raise $3 trillion in additional spending.  For starters the federal government is already covering 20% of that total for Medicare.  The Feds and states are grabbing another 17% for Medicaid.   Add in government employees and veterans and other miscellaneous items and about half of the total is already included in existing taxes.  (link for most of this).   Then figure in that the average family is already over 10% of income for their own premiums and deductibles and copays which all go away and those big scary tax hike numbers just become nonsense.  The amount on average that we all spend will be approximately the same just spread out differently among individuals.  (Yes there will be individual losers with any policy change.)
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I don't think it is a "scare" article at all. The article cites several different projections over a 10 year period and settles on  $30T as a midpoint. That is $30T above and beyond the currently planned Federal healthcare spending. That is already inclusive of reducing payments to Medicare levels, improving efficiency, etc.

Are you saying you dispute this number? If you do, what do you think the real number is?

If you don't disagree with the number, how do you expect the Federal Government to absorb an extra $3T+ per year in healthcare spending?

 
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Just Win Baby said:
I don't think it is a "scare" article at all. The article cites several different projections over a 10 year period and settles on  $30T as a midpoint. That is $30T above and beyond the currently planned Federal healthcare spending. That is already inclusive of reducing payments to Medicare levels, improving efficiency, etc.

Are you saying you dispute this number? If you do, what do you think the real number is?

If you don't disagree with the number, how do you expect the Federal Government to absorb an extra $3T+ per year in healthcare spending?
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Is it $30T above and beyond all healthcare spending?

 
Terminalxylem said:
While innovation may suffer, why is everyone convinced we can’t maintain a pool of excellent physicians with reduced compensation? Med school applications are near all time highs, with more than enough qualified applicants. How are other countries able to find good doctors while paying less than the US?
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Agreed, what profession are these doctors or potential med students going to go into that they are going to make more than physicians with "reduced" compensation?  Are they going to go to another country to practice?  Oh wait, all those other countries have government provided medical plans...

 
roadkill1292 said:
Is it $30T above and beyond all healthcare spending?
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From the paper linked in the article:

Most independent estimates of Medicare for All find it would cost the federal government $25 trillion to $36 trillion over ten years (though not all incorporate long-term care coverage). Most recently, the Urban Institute estimated Medicare for All would cost $34 trillion over the next decade, or $32 trillion net of income tax effects. These estimates represent additional costs on top of the $16 trillion the federal government is already projected to spend on major health programs over the next decade... For the purpose of our analysis, we assume Medicare for All would cost $30 trillion over the next decade net of new revenue – roughly the midpoint of a variety of estimates.
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roadkill1292 said:
Are you're sure you're understanding the question? If all costs are transferred to the federal government, will those costs be more or less than the sum of all costs from all parties now?
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Are you sure you are understanding my posts? I am posting about Federal healthcare spending, which will increase dramatically, and how the Government will plan to cover that increase.

I'm sure your point is that the total cost will remain roughly the same, it's just that the Government will pay for all of it instead that cost being split between Government and private spending. While I assume that is generally correct, we need to understand the details.

Anyone who wants to seriously advocate M4A in the Government and the upcoming election needs to be able to articulate how much the Federal budget will increase and how they plan to cover that increase. That is the point of the article that was characterized here as a "scare" article.

 
Just Win Baby said:
I don't think it is a "scare" article at all. The article cites several different projections over a 10 year period and settles on  $30T as a midpoint. That is $30T above and beyond the currently planned Federal healthcare spending. That is already inclusive of reducing payments to Medicare levels, improving efficiency, etc.

Are you saying you dispute this number? If you do, what do you think the real number is?

If you don't disagree with the number, how do you expect the Federal Government to absorb an extra $3T+ per year in healthcare spending?
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The article is using a bunch of true statements to misrepresent the costs.  Over ten years when NHE almost doubles if we do nothing (3.5 to 6 trillion) makes the annual number just under 50% higher than the actual current numbers.   Narrowly focusing on only ...

Just Win Baby said:
These estimates represent additional costs on top of the $16 trillion the federal government is already projected to spend on major health programs over the next decade.
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...ignores that there is also significant spending already built into our taxes for state share of Medicaid and for government employees*.  And then we get gems such as 

The bulk of this expense represents the direct cost of eliminating premiums, copayments, and other out-of-pocket costs. That spending will total nearly $2 trillion this year alone. Replacing it will require significant new funds regardless of changes to national health expenditures.
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Agreed -except this is paid for by on average 10% of our income that is already being largely "taxed" up front out of our paychecks.  Somehow this will require a 25% tax to replace?

*I am also double counting a bit as some of this is the government as employer's share of government employee's benefits.   While economist will argue correctly that this is all income,  it doesn't seem likely that this is all just shifted to employee paychecks - especially government employee paychecks - "Wait you're raising taxes and giving government workers a 8% raise?"

My math is that the average worker is paying just under 3% of income for Medicare.   A little less for Medicaid - split between state and federal.  Another percentage or two other programs.  So the average person is already taxed at 6 or 7%.  10% is premiums and out of pocket.  Figure charities and other miscellaneous close the gaps to get to the 18% give or take of the economy that is healthcare.   My math shows that the vast majority of NHE is already paid for by deductions out of the average person's paycheck.  

So yes saying that you need to pay an additional 42% VAT, or see your payroll tax go up 32%, or your income tax go up 25% to pay for M4A is just to throw out scary numbers to scare voters.

 
Just Win Baby said:
Are you sure you are understanding my posts? I am posting about Federal healthcare spending, which will increase dramatically, and how the Government will plan to cover that increase.

I'm sure your point is that the total cost will remain roughly the same, it's just that the Government will pay for all of it instead that cost being split between Government and private spending. While I assume that is generally correct, we need to understand the details.

Anyone who wants to seriously advocate M4A in the Government and the upcoming election needs to be able to articulate how much the Federal budget will increase and how they plan to cover that increase. That is the point of the article that was characterized here as a "scare" article.
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I don't know how detailed you want me to be. I generally try to elect people who direct professionals in accomplishing these administrative details. Depending on how much you make, your taxes may (will probably) go up more than your insurance costs may decrease. And vice versa. Ditto for employers. 

If we're going to haggle forever about the kinds of "details" you're worried about, we'll always be too paralyzed by fear to even take the first step. And if we don't ever take the first step, then the existing health care system in this country is gonna break us. It's unsustainable in its present form. We don't have to reinvent the wheel, either. There are road maps out there.

 
Bottomfeeder Sports said:
The article is using a bunch of true statements to misrepresent the costs.  Over ten years when NHE almost doubles if we do nothing (3.5 to 6 trillion) makes the annual number just under 50% higher than the actual current numbers.
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If I am understanding you correctly, I don't think this is true. For example, the Mercatus study linked and discussed on the previous page shows that CMS projects NHE at $4.5T and Federal healthcare spending of $1.7T in 2022. So Federal healthcare spending is projected to be about 38% of NHE. That is very similar to the ratio over the 10 year projections identified in the article.

So using  the 10 year projection does not change anything about ratios.

Bottomfeeder Sports said:
Just Win Baby said:
These estimates represent additional costs on top of the $16 trillion the federal government is already projected to spend on major health programs over the next decade.
Click to expand...
...ignores that there is also significant spending already built into our taxes for state share of Medicaid and for government employees*.
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State and local government healthcare spending covers about 17% of NHE. I'm unclear on whether or not that would remain static under M4A. I'm not sure it would, since Medicare is a Federal program, as I assume M4A would be.

Even if it would remain, this shows that Federal, state, and local governments combine to cover about 55% of NHE. That still leaves 45% in additional NHE to be picked up by the Federal government under M4A. Using the 2022 numbers above in this post, that suggests the following breakdown:

  • 4.5T NHE
  • - 1.7T in already planned Federal spending
  • - 4.5T * 17% = 0.8T in state and local government spending
  • = 2.0T in additional Federal spending
  • = 117% increase in Federal spending
The question remains, how to pay for it?

 
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