New York Single Payer. $91 Billion. (2 Viewers)

[glvsav37]

Why would your employer care if the employee got $15,000 or an insurance company got $15,000? 

The corporate tax issue is something to deal with. Do employers currently pay taxes on their current contributions to health care? 

because an expense is an expense...and for some (not all) companies, eliminating an expense and boosting the profit margin is all they care about. Many workers have been working for $X as their in-pocket salary without ever knowing what the actual employer contribution is too the HC. 

I don't take my companies HC b/c my wife is a teacher. I've brought it up at each interview and had maybe a 30% success rate of having my actual salary adjusted for it. My current employer told me flat out that they don't do that. 

In today's world when companies are cutting everything back, why would this scenario cause it to suddenly be a utopia and the bosses start handing out raises?

 

[RedmondLonghorn]

I pay $500 a month and my family of four is fully insured with very high quality coverage. I'd imagine anyone in the same stadium as me would much rather keep as is, than double their taxes for ####tier coverage. 

Your company also pays, and gets a tax deduction too. 

One of the problems with the current system is that few people have any idea what their insurance or healthcare costs.

 

[dickey moe]

And it will do absolutely nothing to reduce costs, which is the main problem.

 

[Ilov80s]

And it will do absolutely nothing to reduce costs, which is the main problem.

Why not or better yet what CAN we do to lower it?

 

[Ilov80s]

because an expense is an expense...and for some (not all) companies, eliminating an expense and boosting the profit margin is all they care about. Many workers have been working for $X as their in-pocket salary without ever knowing what the actual employer contribution is too the HC. 

I don't take my companies HC b/c my wife is a teacher. I've brought it up at each interview and had maybe a 30% success rate of having my actual salary adjusted for it. My current employer told me flat out that they don't do that. 

In today's world when companies are cutting everything back, why would this scenario cause it to suddenly be a utopia and the bosses start handing out raises?

That's a major issue as well-greedy employers and ignorant employees. Also, seems another reason labor unions seem important.

 

[glvsav37]

That's a major issue as well-greedy employers and ignorant employees. Also, seems another reason labor unions seem important.

...and why do you think they are trying to be broken all over the country? 

don't get me wrong, I don't disagree with you. If by chance there was a way to shift the cost of HC off of the employer it would be wonderful for many reasons. But if anyone thought that the savings would automatically be shifted to the workforce then you are kidding yourself. Its not going to happen b/c very little corporate breaks trickle down.  

Edit: I don't actually blame 'greedy' employers in all instances. HC costs are a major hurdle for many small businesses who are trying to grow and are often the difference between expanding and hiring new employees vs not and working their current employees harder.

 

[Ilov80s]

...and why do you think they are trying to be broken all over the country? 

don't get me wrong, I don't disagree with you. If by chance there was a way to shift the cost of HC off of the employer it would be wonderful for many reasons. But if anyone thought that the savings would automatically be shifted to the workforce then you are kidding yourself. Its not going to happen b/c very little corporate breaks trickle down.  

Edit: I don't actually blame 'greedy' employers in all instances. HC costs are a major hurdle for many small businesses who are trying to grow and are often the difference between expanding and hiring new employees vs not and working their current employees harder.

Trying to be broken? Honestly, they mostly have. You would think the populist pro trump segment would be screaming for pro labor and pro labor union reform. Instead, they are voting against it. This I'll never understand. 

How do we undo the insane tilting of wealth that's happened in this contry since the 50s-70s? I can't imagine our economy really progressing until this happens.

 

[lod001]

If we want to solve healthcare in this country, the first step is to get serious about helping the public become healthier. Any other approach is just treating the symptoms instead of the disease.

You mean force all these fat people to exercise? Remove the rascals from Walmart and make them walk around like they used to? When you walk around just look at how fat and out of shape most of the humanoids are. that really is the issue that needs fixed.

Either that or increase payments made by the fat people. Lose that fat and lower your payments.

 

[fantasycurse42]

Your company also pays, and gets a tax deduction too. 

One of the problems with the current system is that few people have any idea what their insurance or healthcare costs.

I can log into Wageworks and check out what they pay, I'm aware they're paying a ton, but I really don't care. Having great benefits is important to me.

I vaguely remember logging in at the beginning of the year bc I noticed my out of pocket had gone up in 2017, it was something silly like $1500 they were paying IIRC.

 

[Juxtatarot]

The dollars mentioned in the OP's article seem odd to me.

The annual cost estimates given in the article swing between $91 billion and $226 billion. New York State had 19,378,102 residents according to the 2010 census (link), with ~13% 65 years old or older (and thus not covered by NY's single-payer plan).

That leaves about 16.8 million residents to be covered by a single-payer health system. $91 billion divided by 16.8 million is just under $5,400/yr per person covered. $226 billion would be about $13,400/yr per person covered.

Really? We can't cover everyone for an average few thousand per year per person? And 13k per year ... come on.

I recall from a thread earlier this year that many employers were paying about $8K per employee for individual coverage.

 

[fantasycurse42]

This is one of the main many reasons State level single payer isn't a good model.

FYP

 

[Boston]

Whatever dollar figures are being used will be doubled...the combination of government and health care can almost guarantee that...

 

[ffldrew]

I wonder what the cost savings would be to a company that doesn't have to hire a bunch of people to buy and administer insurance benefits each year. Has to be significant in some cases especially as companies have scrambled in the last few years to keep cost to employer and employees under control. 

 

[baymen]

I wonder what the cost savings would be to a company that doesn't have to hire a bunch of people to buy and administer insurance benefits each year. Has to be significant in some cases especially as companies have scrambled in the last few years to keep cost to employer and employees under control. 

IMO, this is the most important calculation for the single payer model.  

A single state universal health insurance model will not work.  It will have to be federal. 

My understanding in other developed economies is that the cost for universal health insurance/care is borne by all with VAT, higher income tax rates and some institutionalization of health care in general,  Unless every one is willing to pay in and I mean all classes of income and spending to pay for it, then it will never be realized.

My hope one day that it happens and I believe it will,

 

[Badm]

For the sake of argument, let's say it doubles everyone's taxes, but at the same time you get a tax write off equal to the amounts both you and your employer are already paying in for health insurance (which now would all go to the single payer instead)- and the net difference to you is around $200 more a month. But everybody gets health care. 

And also for the sake of argument, put aside all questions of efficiency, keeping your doctor, etc. Assume that all of that is satisfactory. The question then becomes: would you be willing to pay $200 more a month to make sure that everyone in your state (or in the USA) gets healthcare? 

Because I think I would. 

No one benefits when things are given for free. How many Times do we need to repeat these horrible decisions before this is realized???

 

[flapgreen]

I pay $500 a month and my family of four is fully insured with very high quality coverage. I'd imagine anyone in the same stadium as me would much rather keep as is, than double their taxes for ####tier coverage. 

Do you work for the state? That's cheaper than I've heard of anywhere except for state or government. 

 

[ffldrew]

No one benefits when things are given for free. How many Times do we need to repeat these horrible decisions before this is realized???

If I'm paying taxes is it "free"?

 

[Statorama]

Somehow, I doubt that money would make its way into my bank account.

People who think that employers..out of the goodness of their hearts...would pass along these savings to the employees are dreaming.  

 

[NutterButter]

People who think that employers..out of the goodness of their hearts...would pass along these savings to the employees are dreaming.  

In essence its like a tax cut for corporations which I thought was a good thing

 

[Statorama]

In essence its like a tax cut for corporations which I thought was a good thing

Companies will be overjoyed and reap record profits.  That still doesn't mean that money will find its way to me.

Now if you want to argue that it will help keep me employed, or that they may hire additional workers...that I might buy

 

[Jayded]

EXACTLY!

Other states use a performance based system. Hospitals/clinics that do the best are reimbursed better and the insurance company will pick up more for that provider. We are seeing some insurers doing this in Wisconsin already... you can go to Doctor A and we will pay 90%, or you can go to Doctor B and we will pay 75%. We pay Doctor A more because he has better results. It WORKS

Isn't this essentially the gist of the MACRA law? It still doesn't solve the rising cost problem, but at least it incentivizes quality. 

 

[NutterButter]

Companies will be overjoyed and reap cord profits.  That still doesn't mean that money will find its way to me.

Now if you want to argue that it will help keep me employed, or that they may hire additional workers...that I might buy

Yeah, maybe not directly, but you'd certainly benefit indirectly.  Maybe not dollar for dollar, but a good amount would come back to you through some manner.   Its just like corporate tax cuts.   If not, why would we be supporting that but not this

 

[glvsav37]

Companies will be overjoyed and reap cord profits.  That still doesn't mean that money will find its way to me.

Now if you want to argue that it will help keep me employed, or that they may hire additional workers...that I might buy

In essence its like a tax cut for corporations which I thought was a good thing

So while it is a profit for the company, it is basically a huge pay cut for the employee in the form of their individual taxes sharply increasing. 

 

[NutterButter]

So while it is a profit for the company, it is basically a huge pay cut for the employee in the form of their individual taxes sharply increasing. 

Really depends on the employee's income as well as investments.  Most people don't pay dividend, interest or cap gains.    So for most people it just comes down to the payroll tax.   Depending on the their current premiums, it could be close to a wash.    

 

[glvsav37]

Yeah, maybe not directly, but you'd certainly benefit indirectly.  Maybe not dollar for dollar, but a good amount would come back to you through some manner.   Its just like corporate tax cuts.   If not, why would we be supporting that but not this

Because most tax cuts don't trickle down to the lower level employees. Yet they will get stuck holding 100% of the bag of their healthcare now. 

I'm not a fan of HC tied to your employment. But you cant just flip the plan and think its a net positive. HC has to be paid somehow and its either through corporate contributions or higher taxes. If HC wasn't tied to your job, it could empower some to try and start businesses or work for themselves or change jobs w/o fear of leaving their family exposed. 

 

 

[glvsav37]

Really depends on the employee's income as well as investments.  Most people don't pay dividend, interest or cap gains.    So for most people it just comes down to the payroll tax.   Depending on the their current premiums, it could be close to a wash.    

IDK, I'm not an accountant. But I cant see how doubling my taxes (at $9K year on Long Island NY) and keeping my current salary static work out for me. 

 

[NutterButter]

Because most tax cuts don't trickle down to the lower level employees. Yet they will get stuck holding 100% of the bag of their healthcare now. 

I'm not a fan of HC tied to your employment. But you cant just flip the plan and think its a net positive. HC has to be paid somehow and its either through corporate contributions or higher taxes. If HC wasn't tied to your job, it could empower some to try and start businesses or work for themselves or change jobs w/o fear of leaving their family exposed. 

 

So let's say its someone making 50k.  I'd imagine they'd be hit with the low end of the payroll tax increase range so 9% which amounts to 4.5k.   Forgive me if I'm out of touch, but is that too much to have to pay for health insurance.   And that's assuming that none of that employer savings trickles down which might be a bit of a stretch.   

 

[Aerial Assault]

Amazing that this mythical country (I'll call it "France") manages to have universal health care - which is not "socialized medicine" - and still operate as a functioning state.  Why, I hear that this "France" even still has doctors who didn't all leave for some physicians' paradise where they can charge patients anything they want to subsidize their high incomes!!  Wonder how they do it?  

 

[glvsav37]

So let's say its someone making 50k.  I'd imagine they'd be hit with the low end of the payroll tax increase range so 9% which amounts to 4.5k.   Forgive me if I'm out of touch, but is that too much to have to pay for health insurance.   And that's assuming that none of that employer savings trickles down which might be a bit of a stretch.   

Actually, I wasn't thinking income tax...I hear "State" and I think property tax. But even still, we are taxed to the balls here on Long Island and most people are living pay check to paycheck (not that I defend that). I personally work 3 jobs (mainly bc i'm a workaholic)  to ensure that my family doesn't live like that. All this would mean then for me is even more of my money being used for everyone else, vs my 1st job taking care of that and the rest of my income mine. 

Again, i'm a big fan of removing HC from your job, I just dont know if having it cost more than the whole current state budget (as per the OPs link) is feasible. 

 

[Dr Oadi]

IDK, I'm not an accountant. But I cant see how doubling my taxes (at $9K year on Long Island NY) and keeping my current salary static work out for me. 

It doesn't matter if it works out for you.  Think about the poor you selfish person!

 

[Dr Oadi]

Amazing that this mythical country (I'll call it "France") manages to have universal health care - which is not "socialized medicine" - and still operate as a functioning state.  Why, I hear that this "France" even still has doctors who didn't all leave for some physicians' paradise where they can charge patients anything they want to subsidize their high incomes!!  Wonder how they do it?  

 Social charges up to 50% for employer and 30% for employees and 45% for the self employed and only covers 77% of health expenditures. That's how this mythical country does it.

If you can call 25% unemployment for the young and a 10+% National unemployment rate functional.

That's a depression in America nowadays. 

At least they don't ban private insurance though. 

 

[Aerial Assault]

 Social charges up to 50% for employer and 30% for employees and 45% for the self employed and only covers 77% of health expenditures. That's how this mythical country does it.

If you can call 25% unemployment for the young and a 10+% National unemployment rate functional.

That's a depression in America nowadays. 

At least they don't ban private insurance though. 

  Every single figure you cited is completely wrong.  Bravo.  

 

[Dr Oadi]

  Every single figure you cited is completely wrong.  Bravo.  

Is it? Interesting.

 

[hagmania]

Isn't this essentially the gist of the MACRA law? It still doesn't solve the rising cost problem, but at least it incentivizes quality. 

Cost assessment is coming in 2018.

 

[Aerial Assault]

Is it? Interesting.

Had a feeling Wiki was on the way.  That youth UE figure has been debunked too due to questionable metrics.  BTW the US figure is nearly the same if you make the proper adjustments.  Of course the US feels like a failed state too ATM, at least at the top. :(

 

[MarvinTScamper]

obviously, the difference in this wouldn't be "you used to pay $600, no you get taxed $600" for either the company OR for you.   The doubling of taxes is so that the huge number of people NOT paying for insurance, or who CAN'T get insurance because of whatever condition, now will all be covered, regardless.   And anyone who pays taxes is going to pay a lot more FOR them.   

The compassionate left will argue "everyone deserves health care."  But do they deserve the same level/quality?  Do they deserve it even if they smoke like a chimney?  Do they deserve it if they weigh 500 lbs?  Have a pre-existing condition?  Those people cost 5-10x more, and usually don't have it at all.

Brutal question, but at least with individual states, you'd have the right to move away.

 

[glvsav37]

It doesn't matter if it works out for you.  Think about the poor you selfish person!

I love this line of thinking.  Yes.  Let's #### up my whole way of life that I've worked hard for because of the poor (and sometimes lazy #### ups).   This rational is what's turning this country into a "screw it someone else will take care of me" mentality.  

I have no issues helping the "poor".  A good majority of my taxes already do that. So please continue to tax me over and above that just because "it's helping the poor".  That will really make me motivated to keep on working.  

 

[culdeus]

Here's a spoiler, I'll tell you how this all ends.

• Corporations right now pay a ton in heath care premiums.  Let's call this figure Y.
  
• People even at these corporations pay premiums and out of pocket spend.  Let's call this figure X.
  
• The government gives tax breaks in the form of HSA and other deductions in corporate taxes.  I'll call this Z.
  
• X+Y+Z is the spend I will call "C" for the corporate and government total spend on corporate citizen health care.
  
• This also sets aside medicare taxes for now, but will get back to that.
  

Now for regular people at smaller jobs you have a different situation

• Premiums and out of pocket tend to be much higher.  
  
• Many people just pay nothing and take chance of bankruptcy if something bad goes wrong.
  
• Government now pays in form of medicaid/medicare
  

So for the average person the Y+Z spend from corporations and government isn't there.

So here is what will happen.  Corporations driven by greed will go to GOP congressmen and say they want to stop paying in at Y, therefore reducing government tax writeoffs Z.  They also don't want to buy healthcare products. So what happens?

• Big corporations drive money into medicare that they were driving towards private care, but ideally at a discount both to the government (from tax breaks) and from themselves due to not needing to deal with overhead.
  
• Government runs the entire insurance industry out of medicare for working class, we pay taxes to have poorer class on medicaid.  Done.
  

You can argue against single payer and universal health care all you want, but once corporations say they have paid enough already GOP will cave and we get universal medicare.

 

[[icon]]

Just to add another state to the mix - California is proposing the same thing.  Cost: $200 billion a year.  Or roughly double the state's entire budget. 

Most media outlets reporting $400 Billion cost of Universal healthcare for California. 

On a state with a total budget of $180 Billion 

Lol California.... the land of fruits and nuts. 

 

[Statorama]

Here's a spoiler, I'll tell you how this all ends.

Long story short, you'll pay more to get worse care.

But hey, at least everyone will have access to worse care.

 

[fightingillini]

If we want to solve healthcare in this country, the first step is to get serious about helping the public become healthier. Any other approach is just treating the symptoms instead of the disease.

Not only we need to help the public become more healthy, we also need to serious to how we deal with end of life care. 

 

[Sand]

Most media outlets reporting $400 Billion cost of Universal healthcare for California. 

On a state with a total budget of $180 Billion 

Lol California.... the land of fruits and nuts. 

I'm sure Moonbeam loves this.  Everyone can get free treatment on our new bullet trains!

 

[matttyl]

whoa. you get that through work though- right? I pay roughly that for my ACA coverage which went from being decent, to ok, to junk at this point. Kids are on a separate plan. Prior to ACA, as an independent contractor I was paying almost $2200/month for my family of four.

In New York, if I recall correctly - right?  Yeah, they went very "ACA like" back in the 90s or early 2000s and the entire state went into a death spiral. 

 

[matttyl]

Right but that is part of your compensation. You could be getting paid all of that money. 

And taxed on all of it as well, even without the additional taxes which would be needed to pay for this in his state. 

Lets say right now his employer is paying $1,500 a month for his family's coverage, and he's paying the other $500.  So first off you're assuming that his employer will just give him all the money they're paying on his behalf (as it's his "compensation") - which may or may not happen.  So that's a "raise" of $18,000 a year - likely pushing his family into an even higher federal tax bracket from the start, and that entire amount itself is taxable.  So say he keeps $12,000 of that after federal taxes.  His state taxes will have to double (at least) so that the state could pay for this.  From there, the coverage the state will likely have for this "single payer" option will be worse than the coverage he already has today (most likely in network availability). 

 

[matttyl]

So you are saying the State insurance would pay much less than the doctors are used to?

Sorry, I am honestly a moron when it comes to insurance. 

Yes, much less.  Some doctors and facilities get half or even a quarter for a service with a Medicare/Medicaid person than they do with someone with private insurance. 

 

[matttyl]

It seems weird to me that people assume their employers are basically waiting to rip them off on health care compensation in the name of higher profits, yet seem perfectly content to keep pouring money into private insurance. 

What do you think the profit margin is for those private insurance companies....vs the companies these people work for?

 

[matttyl]

For the sake of argument, let's say it doubles everyone's taxes, but at the same time you get a tax write off equal to the amounts both you and your employer are already paying in for health insurance (which now would all go to the single payer instead)- and the net difference to you is around $200 more a month. But everybody gets health care. 

And also for the sake of argument, put aside all questions of efficiency, keeping your doctor, etc. Assume that all of that is satisfactory. The question then becomes: would you be willing to pay $200 more a month to make sure that everyone in your state (or in the USA) gets healthcare? 

Because I think I would. 

Well sure I would - but you're making far too many assumptions here.  It won't work like that.  Just see what's happened with the ACA individual market - just like I said, after all the promises were made there. 

 

[matttyl]

I'm all for this. My wife and I pay about $700 a month for "meh" coverage (3k deductible/etc). Pretty sure my taxes won't go up that much.

Yes, it's lousy for the people who have great plans from their job. But you know, those are few and far between these days, and yes, they will be going away as time goes on.  We used to have great coverage. Then last year my wife's job said "can't afford it anymore", and we went from Platinum to Silver. 

They are?  It's roughly half the country.

 

[matttyl]

The dollars mentioned in the OP's article seem odd to me.

The annual cost estimates given in the article swing between $91 billion and $226 billion. New York State had 19,378,102 residents according to the 2010 census (link), with ~13% 65 years old or older (and thus not covered by NY's single-payer plan).

That leaves about 16.8 million residents to be covered by a single-payer health system. $91 billion divided by 16.8 million is just under $5,400/yr per person covered. $226 billion would be about $13,400/yr per person covered.

Really? We can't cover everyone for an average few thousand per year per person? And 13k per year ... come on.

No, we can't.  We as a country spent about $4T on healthcare in 2014.  Lets just say it's remained level since that number - and we have a population of about 320M.  That's $12,500 per person - pretty darn close to that $13k/yr per person ain't it?

 

[Jobber]

Not only we need to help the public become more healthy, we also need to serious to how we deal with end of life care. 

EOL care is a problem. Medicating and keeping alive essentially corpses with a pulse.