At best, any arguments against a true universal health care system run by "the people" (i.e. the government) are naive, defy common sense, or invoke some sort of "magical" capitalism. At worst, these arguments are deliberately deceptive and manipulative, meant to promote agendas that are selfish or political. Common sense would tell us that eliminating a vast profit-motivated bureaucracy would reduce costs likewise, as do the examples of all the countries that have done so. Common sense would tell us that "an ounce of prevention is worth a pound of cure" so providing health care for everyone will again greatly lower costs.
Common sense would also tell us that the "freedom" to choose ones insurance is a phony one and an unnecessary burden on everyone involved. It is a gamble and a risk where there need be none. We should ALL just get the health care that we need, not just hope that we have chosen the right "plan" to do so.
It is disingenuous and deceptive to stress any tax hike while ignoring the absolute elimination of health care costs to individuals and families. If my taxes go up 5000 but I pay 10000 less for health care shouldn't I be happy? Shouldn't we all? Do we really care about the details and labels (new taxes, oh my!) if the bottom line is better? As to the subject of this article, how about a little "faith" in capitalism? You know, how the "free market" will reward those employers who pass on their savings and punish those who don't?
With the discussion of possibly allowing for insurance coverage, again, to exclude pre-existing conditions how do these studies consider the costs related to the elimination of pre-existing conditions exclusion and related costs to the individual, as well employer? In some cases, prior to elimination of existing conditions exclusion people might have been reluctant to change jobs due to possible exclusion in insurance coverage. What is the value of the insurance coverage to provide for pre-existing conditions, as without such coverage financial burden is on the individual. Seems meaningless without such analysis.
There’s data to support any conclusion. Health Care should be viewed like air. It’s necessary and can’t be denied to anyone without dire consequences. Since we all need and use it we all should pay for it. And a progressive income tax is the best way to pay for things for everyone, like defense. Let the market determine how much to pay for widgets but not for Health Care. Unless you agree that it’s necessary your conclusions will be unconvincing.
1
This is an academic-style analysis that assumes frictionless labor markets, symmetric information, etc. Maybe in a low-paid, gig-economy job like Uber, Lyft, or TaskRabbit, this would be a reasonable assumption. But then, they don't have health care.
In reality, there's a lot of overhead and cost in changing jobs---at least good ones. And most people don't really know what their employer is paying for their healthcare---only that the cost keeps going up and the quality/coverage keeps going down.
So employers would surely do what they did with the tax cut. Maybe give a one-time token to employees, but the bulk to shareholders via stock buybacks, and the rest to executives and lobbyists.
So the study quoted says that employers reduce wages when health insurance cost go up and the assumption is that when employers health insurance costs go down, they'll raise wages? I'm not sure what planet you live on but in the one where I live employers take cost reductions as profit. The idea that employers will say "oh wow, look at all the money we're saving on health insurance! Let's give it back to our hardworking employees. It's only fair, right?" is a trickle-down pipe dream.
4
30 years in Medicine: I have not met One Person, not one, who told me they wanted their employer based insurance or exchange based insurance back once they were Medicare Eligible.
Lots more protections built into Medicare. Much lower costs. Everyone except an Insurance Executive should support Medicare For All.
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@CS 30 years in medicine should tell you that people on Medicare still have to buy supplements and long term care policies for what Medicare doesn’t cover. Premiums for those policies would obviously increase in this scenario. Your assertion that insurance companies don’t profit from mfa is obviously flawed.
2
I believe it for a minute that employers will willingly increase wages simply because medical coverage costs goes down. The ONLY thing that wages will go up, is when employers desperately need workers but can't find any.
3
@tiddle yeah. Remember when they got the big tax cut from the republicans and passed it on to all of us employees? That was awesome. Bet they do the same with the healthcare savings. /s
3
@JM, Exactly. For-profit enterprises are there to make a profit, they are not charity. Why would they willingly give up profits and share with employees (or even customers) when they can line their own pockets some more?
It is thus that all those trickle-down economics that GOP (when they talk about how marvellous tax cuts are), and now neo-liberals like Sanders and Warren (when they talk about pie-in-the-sky initiatives like M4A), will never work.
1
If people actually believe that their costs combining their amount paid in taxes + their medical out of pocket costs will be lower with "Medicare for All" they are wrong and here is why:
- There is not going to be a massive Doctor or Nurse layoff or reduction in incomes in order to achieve this.
- Therefore, if you cut out insurance companies you save....say 20%...this savings will be gone in 3 years or less as healthcare costs/ spending increase to adjust to wage increases the medical community enjoys + the insatiable appetite for healthcare services that will be unleashed with the reality that everyone now has "Medicare for All" and has no barrier between them and the utilization of healthcare.
- 3 Years later we will have the same costs we have today but it will all be paid by taxes. Year 4 and beyond the costs will rise just as fast.
- Enter Rationing of care to the rescue to keep your taxes somewhat manageable....
- Do you think "Rationing for All" will be the slogan for this new endeavor? Doubtful...remember if you like your doctor you can keep them? This one will be an even bigger whopper of a lie to get this passed.
2
How did we get employer funded healthcare? There were wage and price controls during WWII and a tough labor market. To attract workers when wages were frozen, benefits increased.
So why should we be locked into employer funded insurance when so much else has changed? Competitiveness would increase all around if employers weren’t paying for healthcare and we had a more efficient and effective healthcare delivery system. Aren’t we capitalists after all?
Employers don’t pay all of healthcare presently, but the health bill, all 3.5 Trillion dollars is paid annually. We as health consumers and the government pick up the rest of the tab; another drag on wages you haven’t calculated.
And for that we get one of the most wasteful and inefficient healthcare “system” ever conceived with no leverage to improve it and a high incentive to shift costs. We will not get effective population-based medicine unless all are included in the plan. Just try to effectively fight a Coronavirus pandemic with millions without healthcare. Leave out 11 million illegal aliens and see how that works.
5
The question would be will that money make it into the paycheck of the employees or into the dividend check of the stockholder or the paycheck of the CEO.
2
Private health insurance is just as good as Medicare 4 All, aside from:
1. much higher premiums, deductibles, & co-pays.
2. significantly higher administration costs.
3. out-of-network ripoffs & surprises.
4. claim denials, no payment guarantee, & other hassles.
5. high paid executives & profit margins you pay for.
6. added costs of advertising.
7. possibility of being dropped.
8. the job lock & reduction of entrepreneurship.
9. the lower wages you get from employer subsidizing it.
10. the smaller/unhealthier risk pool that raises costs.
So let's all fight for the status quo! But seriously, I'm sick of this being an issue in the debates. Private insurance isn't some magical thing to cling on to. It's grossly overpriced, unfair, inefficient, & cruel. The only Medicare 4 All debates should be about how long the transition period should be, & how to fund it.
11
I'll point out something relatively obvious: Employers SHOULD PREFER that "compensation" goes to healthcare(all else being equal)
Say $70k is the total compensation for an employee.
Option 1) $60k in wages and $10k in healthcare.
Option 2) $50K in wages and $20k in healthcare.
Wouldn't an employer PREFER Option 2? They know a healthy employee(+ family) = a reliable productive employee. An a side-benefit, benefits are more difficult to transfer. More cynically, lower "wages" typically means changing jobs is more difficult....you can't afford to wait for better compensation very long
@Matt
Can I add:
Option 2: FICA tax paid by employer is only on $50k versus $60k
This saves the employer over $700.00 per year per employee x 2 because they match FICA with their version called FUTA.
So many people in denial. You don't have the votes!
Seriously, you keep trying to make rational arguments in *a country where Donald Trump is the President*.
You don't have the votes to keep basic elements in ACA in place, and just lucky that McCain *just barely* preserved at least some of it.
You don't have the votes to have the government negotiate drug prices, even for the *existing* Medicare population.
You don't have the votes to expand the number of physicians, and prevent ghost billing, and require competition for hospitals to keep prices down.
And so on, and so on.
And you don't have the votes because the majority of people in the US don't want to lose their privilege relative to "those people". They don't care if Europeans have a better system, they only care that they are better off than someone here in the USA. Sad but true, and backed up by science.
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@arty
. Consider these points. a prorated tax percentage applied across all levels. A leveled healthcare system with fixed negotiated costs but still able to offer the pay for play side to those who think they need something extra, no more insurance premiums and a bajillion plans to confuse you, no more deductibles No more 80/20 plan on top of the deductibles.
Lowered drug costs. Employers no longer have to provide insurance plans to employees so they could actually pay a decent wage and still save money. They would pay on their share of earning at the same percentage rate as you. no such thing as pre-existing condition. No more picking up the emergency room costs for the uninsured. Healthier overall population so less missed work days.
Prorated example:
50,000 salary taxed at say 10% is 5000.00 for healthcare but no more Premium deduction from your pay no out of pocket deductible no 80/20 extra cost, negotiated controlled drug costs and the employer doesn’t have to pay a share of health cost so they could easily give raises as it will not be a required part of your pay
The same percentage applied across all wage levels has everyone contributing equally.
Of 33 industrialized countries 32 offer a Universal type health care. Only the US doesn’t. The next 5 top countries pay for it with a tax which averages between 8 and 12 %. Currently we average 17.6 % or our wages to pay for our health care that is dropping in world ranking yearly.
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@azigon
You haven't answered what I said:
*You don't have the votes.*
If we had the votes, we would have dealt with what is on my list.
@arty You are making the faulty assumption that the "majority of the people" are the ones making the decisions in congress. They aren't. Less than a 1/3 of the country's population can stop ANY bill from moving in the Senate. That's the problem.
The majority of the PEOPLE are in favor of everything you just listed.
2
No tax like a wealth tax has ever raised any meaningful amount of money
Certainly less than the amount forecasted.
See the notorious luxury tax of the 90’s....it killed so many jobs and raised so little money, it was abandoned.
The same will happen with wealth tax... taxable wealth will evaporate and leave the middle class to bear the funding burden of a single payer system.
Amazingly, this entire article ignores one very key point: if employees don’t get their health insurance through their employer, then many employees can change jobs much more easily. This will force wages up as employers have to bid against each other for employees without the chip of health insurance. It will also allow employees to walk out of poor working conditions which they only tolerate now to keep their health insurance. This will force some employers at least to improve their working conditions, hours, short-notice scheduling practices, poor environmental conditions, noisy work areas, etc.
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@Larry Johnson
They do not have the 'handcuffs' the ACA cured that. Go start your own business, be an entrepreneur, there is nothing stopping you.
@Tom ACA made healthcare available, not affordable
A better headline and premise might have been "Will Your Quality of Life Rise Under 'Medicare for All'? It Depends on the Labor Market." The bottom line includes one's health and welfare, not just net wages.
3
Time to lay this inaccuracy to rest
Current restrictions on residency training programs by the AMA and other institutions reduces supply of physicians...
The AMA has no control over the number of residencies or residency training slots. They are limited by Federal payments through Medicare.
1
True and we better raise this cap on the number of residencies quickly.
We have the med schools grads but not everyone can match with a program.
This is a waste of our subsidizing the cost of medical, as is the case albeit subtle in every state.
This is a no brainer. Congress can do it now....there is legislation floating around.
Moved from US to Canada about an year ago -- if I compare dollar-dollar the Canadian provincial 'medicare' amount taken out of my paycheck is marginally more that what I used to pay in US to get coverage for my whole family -- a net loss per paycheck (with a lot fewer benefit, unless I take additional supplemental coverage for my family).
1
@VC While you may be seeing a net loss per paycheck, are you considering the cost at point of service, i.e. reduced / non-existent co-pays and deductibles?
Here in Japan, taxes that come out of my paycheck for health insurance are marginally greater than what I'd pay in premiums for my company's 90/10 plan in the US, however actual out of pocket costs to health care providers (of which I have complete choice, BTW) are SIGNIFICANTLY cheaper. Just one example: My wife recently spent 3 weeks in the hospital for heart failure & ultra high blood pressure. After all was said & done (including multiple CTs, MRIs, food, drugs, etc), our out of pocket cost was around US$500.
This kind of healthcare is done in every other 1st world country in the world, so why can't we do the same in the US? Does it simply come down to greed and putting profits over people?
2
How about this: Employers don't pay for health care but give that extra money directly to employees, dollar for dollar. They then go on an exchange of sorts and buy the policy of their choosing, from a menu that include a public option, Medicare for those who want it. Families get the policy that meets their needs and when it doesn't cover something, well, they picked it. Employers would be thrilled to get health care off their bottom line. And health insurance would be portable across jobs. This would have to include a mandate to buy something, fair, no pre-existing conditions pricing and subsidies for low income families.
Conservative get to keep private insurance, liberals get a public option and subsidies, businesses get to take heath care off their expense ledger. Win win win
I also suspect that after a few years of seeing what health care actually costs a medicare for all/single payer will look a lot better
5
My only concern with is is whether it's possible, legally, to coerce employers to hand that money directly to employees in weak labor markets where the employers will certainly try to keep that money if possible.
This doesn't have to be a question. The law implementing a "Medicare for All" could -require- that any difference between what employer-provided health insurance costs the employer now, and what the MFA bill would be, *must* be paid to the employee.
This could be capped at a limited number of years, e.g. "for the next ten years after implementation, the difference between the total employer contribution to employee heath insurance and the MFA tax amount *must* be paid to the employee. This will be taxed as ordinary income for the employee".
Working roughly, with my own personal numbers, my employer currently contributes ~9% of my gross salary in the 'cost of health coverage'. A further ~1.5% is deducted from my salary as part of the 'Social Security and Medicare' taxes -already-. My employer also pays that ~1.5%... so it looks like if the total tax amount for MFA is below 12% of my current gross salary, I'd be getting an increase in my taxable income. Plus health insurance.
YMMV, but it seems like this could be done in a straighforward way. My employer is *already* paying that full amount - all that would be changed is 'paying to whom', and who gets anything left. With Medicare having very low overhead and administrative costs, and with them negotiating the cost of healthcare procedures, it seems likely that the near 20% of GDP currently spent could be reduced over some time, while preserving coverage and quality. And everyone would be covered, unlike now.
6
One of my concerns is the lack of a plan to increase the supply of medical professionals. Current restrictions on residency training programs by the AMA and other institutions reduces supply of physicians and thus mandates higher earnings. Medical education has also become very expensive. This is a result of government subsidies (unlimited loans) causing tuition inflation predicated on the gainful employment as a specialist that will facilitate a large salary to pay that debt down. This encourages specialists over primary care and has created a heavily indebted group of physicians where burnout becomes rampant. This will not be fixed overnight or even in several years. It will require investment at the state level in public medical education, increased GME funding for training programs, and a change from 4 years of undergrad with 4 years of medical school to shorter, 4-6 year programs like in other advanced countries. Additionally, States should loosen requirements to allow physicians completing an internship to practice in primary care. Many states already allow for NP/PA as licensed providers with much less training, but require significantly longer training for physicians. This makes little sense. Insurance companies are driving this by not reimbursing certain physicians. It may take a decade, but increasing the supply will have to be a main factor. Eliminating private insurance will make some aspects of primary care better, but reorganization of training is a must.
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Higher paid employees would get a bigger share of any reduction in their employers contribution toward health insurance.
If employers are paying $7,000 for individual coverage and $20,000 for family coverage, they are not going to give pay increases based on whether someone has dependents.
Further, if the employer no longer had to provide health insurance, they are not going to give a $20,000 wage employee a $7,000 or $20,000 pay increase, but they might very well give such extra compensation increases to $150,000 to $200,000 executives.
Like most progressive schemes, the rich get richer and the poor are lucky if they don't lose ground.
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@ebmem - as opposed to many "conservative" schemes, where the rich get richer, and the poor definitely lose ground. Sorry, but the law could easily require that cost differences be paid where a difference exists.
3
Am I the only one here who believes our paychecks would actually get smaller? How could this scheme possibly be paid for by increasing the taxes on the rich? There aren't enough wealthy people out there to fund the hundreds of billion of dollars this program is going to cost each year. Come on people, don't fall into the same trap that we did with Obamacare. At that time I was "told" that I would save $2,400 a year in premiums, but the reality is that I earn too much to qualify for a subsidy and wound up paying 3x what I was paying prior.
As George Bush once said "Fool me once, shame on me. Fool me, you can't get fooled".
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@Marc Jordan
Since the administrative costs of universal healthcare would be far lower than the present 15%, and costs for service, and especially medications would be far lower due to single payer, obviously the AVERAGE individual would pay less while EVERYBODY would get medical care. Why can't you understand that NOBODY needs insurance- everybody needs medical care.
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@Marc Jordan
However, due to Obamacare, 450,000 Virginians can now get Expanded Medicaid.
Without access to Expanded Medicaid, my brother died in 2011... before Obamacare was passed. He would have qualified under Obamacare. He died of High Blood Pressure induced Congestive Heart Failure. My brilliant brother is dead.
Next year, when I lose my health insurance because the ex left me. The Obamacare Exchanges will ensure that I am ABLE to buy insurance for a mere 30% of my income. That's WITH the subsidy. Then there will be another $2500 deductible.
Prior to Obamacare, insurance for a woman my age in my health would not have been available at all. I would have had to go uninsured, without care, or paid out of pocket which would have left me impoverished and trying to string together charity care... which would have probably killed me sooner rather than later.
Recently, a friend of mine passed after several years of illness. The last few years of her life, she probably cost Medicare several MILLION dollars in care. She had kidney failure, diabetes, congestive heart failure, and several other maladies.
Most of them were CAUSED because she had no insurance from age 50-65... the SAME fate facing me.
Except thanks to people like you, paying somewhat more...
I might not die at 67.
I will live in poverty, but I will be ABLE to buy insurance between 50-65, because there will actually BE insurance TO BUY. And Medicare might not spend MILLIONS keeping me alive from 65-67.
4
This is a good start to air all sorts of issues hidden by the politicians and the press about what is the actual cost of the current healthcare system (per capita) we have in this country. When the anatomical structure is revealed followed by numbers estimating the implicit cost, we can then compare it to the new taxes that will be raised (progressively of course).
The press and the status quo politicians of both parties obfuscate analyses like this one.
Bernie is the only one out there who speaks the truth. He could use some help from some academic economists to figure out the numbers. I am sure Saez or Zucman will help out. Professor Gerald Friedman tried last time and was ridiculed by our own Paul Hillary Krugman. (Oh, it’s not his middle name! Sorry didn’t realize).
2
@Blunt In fact, healthcare economists constructed Elizabeth Warren's proposal for her in all its detail. The bottom line: savings of $11 trillion over 10 years. And that is moderate considering how inexpensive European systems are.
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@Sean
We have experience with Medicare. Most services are subject to price controls, and it is touted as having low overhead. Medicare pays providers at least 50% more than European single payer government systems pay providers.
What that means, is that even assuming you can maintain price controls at the current levels, despite the fact that with everyone covered there is no one for hospitals to overcharge in their cost shifting, American medical costs are not going to decline to the European or Canadian cost.
Another interesting fact is that Medicare Advantage plans, which are not entitled to price controls, which offer more benefits than traditional Medicare, and have to eke out profit and overhead, cost the taxpayer less per capita than traditional Medicare.
Those technocrat economists have some fancy computer models but little reliability.
They are the same guys who claimed Obamacare would not add one thin dime to the national debt [$1.5 trillion and counting] and that the average household would save $2500 in annual medical costs because of reduced cost shifting. For every household that saved $2500, there are ten households who are paying $5000 more for less.
It is pretty clear that taxes will rise for everybody, not just the wealthy (in whatever way these are defined). In every country with universal healthcare, taxes are raised to pay for it, whether income taxes, a dedicated health tax, VAT or some combination thereof. This by itself is not necessarily a bad thing if what you get for your higher taxes is worth it. In case of M4A, however, it clearly is not. First, no universal healthcare can cover everything, which is why all European countries have supplementary private insurance to plug the holes in the public system. Bernie’s proposal would outlaw it. Second, in a country as large and stratified as the US, the one-size-fits-all insurance would be a disaster, reducing everybody to the lowest common denominator. Recently my husband had an elective surgery. It went well and the service we received was wonderful. In a truly universal healthcare system with no supplementary private insurance we would likely have to wait much longer and he would have to share his room with a random stranger. Some form of universal healthcare that would provide a basic coverage to everybody is a good idea. Enforced equality is not.
1
@Mor It is a myth that "supplemental private insurance" somehow is necessary in Europe. National health insurance covers all important treatments. Supplemental insurance, such as that in the UK, merely pays for a single hospital room versus being in a room with other patients.
No European goes without treatment. And no European goes bankrupt due to medical expenses. It's unheard of.
12
@Sean first, many European countries, such as Switzerland and the Netherlands, rely on private insurance to provide universal coverage. Second, no European goes without A treatment but not necessarily THE treatment they want. And finally, who decides what “important treatments” are? You? The government? Canada, for example, does not fully cover visual and dental care and 30 percent of Canadians have private insurance to cover it. Do you know something these people don’t?
4
@Mor Actually, there are panels of doctors that decide what the appropriate treatments are, and set those for the nation. And most European countries publish formularies for medicines they pay for. Those countries refuse to pay for new medicines that can't prove their better than older and cheaper medicines. That dramatically controls drug costs. No country in Europe pays more than half per person for drugs compared with American drug costs.
6
"Ultimately, someone would have to pay for Medicare for all, so not everyone would be better off."
While it is true that some people may have to pay somewhat more, the bottom line is that we would spend a lot less on average so many more would pay a lot less. There are two ways to see this.
1. We spent $3.65 TRILLION on healthcare in 2018. The long term average of medical inflation is 5.29%. A simple compound interest computation shows that if we do not change the system, we can expect to spend in excess of $50 TRILLION in the next ten years. No estimate of the 10 year cost of M4A is over $35 TRILLION. So we can expect to save over $15 TRILLION.
2. Here are the per capita figures for health care costs in 2016 in PPP dollars which take the cost of living into consideration:
US - 9507.2
Austria - 5227.3
Belgium - 4839.8
France - 4500.4
Germany - 5550.6
Luxembourg - 7462.8
The Netherlands - 5385.4
Switzerland - 7919.0
Sweden - 5487.5
Denmark - 5199.3
UK - 4192.5
Canada - 4643.7
OECD Average - 4003
All of the above countries has a universal government healthcare system like M4A. All are ranked higher than the US in the WHO ranking of healthcare systems.
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@Len Charlap
Len, the question isn't whether any of the Euro-style systems are better... it's not even close; ours is completely irrational.
But go back 3 comments to what I said about *getting there*. We have, over the last 70-odd years, distorted the healthcare system to such an extent that 'fixing it' has so many obstacles that it will take decades to achieve, if it is even possible.
You aren't going to convince people who have a privilege to give it up that easily.
3
@Len Charlap how about some facts? None of these countries have anything like M4A as per Sanders’ plan. Germany, Switzerland and the Netherlands use private companies to provide universal coverage (in the Netherlands, private health insurance is mandatory, so it’s more like Obamacare). Even in the UK where NHS is a true single-payer system, there is private insurance for those who can afford it. There will be none under Sanders’ plan. I am really tired of Bernie bros disseminating half-truths and outright lies to mask the radicalism of their proposed governmental takeover of healthcare.
4
@Mor But the European "private companies" are not-for-profit, and the prices for both drugs and procedures are set by the government. So unlike in America, those "private" companies can't gouge the people, and can't set their own prices. As everywhere in Europe, the government sets the prices, and forbids the insurance companies from making massive profits.
Not for profit!!
12
Seems pretty simple. As part of a new healthcare, I.e. M4A, employers are required to pass the cost of healthcare back to employees. It’s simply moving money from one column to another.
3
@JKile, Wrong. This is what they do right now----you are actually paying 100% of your healthcare costs and then some, in addition to also paying for the private profits that the health insurers generate for their shareholders. And that's if you can even afford the co-pay in the first place. The for-profit health insurers keep your money as profit and will fight you tooth & nail to not pay for any of your healthcare if they can. Do you get it yet? No other highly developed country does what we do when it comes to healthcare. We're #1 at being the worst here.
3
$600 a month. Let's also remember that it isn't spread out equally. Small groups can use age based rates, and ages influence composite rating which everyone else uses. This hurts older workers and their employers. Contributions are often for employees only, hurting those with kids. While I'a healthy, young guy on my parents plan, I'm the one who stands to lose the most if the system changes. And I want it to change.
2
Here's why M4All will never happen.
You could fix the healthcare system tomorrow by eliminating the tax subsidy that is currently in place for employer-based plans.
If your plan supposedly "costs" 12K (combined employee and employer, and lets say the tax rate is 33%, you will have 8K to use for whatever you like, and the government will get 4K in taxes. Options:
1. You will take 4K from some other spending to pay the same amount for health insurance.
2. You will shop around for a cheaper way to get health care... meaning the market will determine who gets what in the industry. That should lower costs, bringing us more in line with European countries.
But remember, the government now has the 4K to spend as it sees fit. That 4K is plenty to fund programs to cover people who don't currently have healthcare, and probably a few other things, if you elect Democrats. (Republicans would just use it to cut taxes for the wealthy.)
OK, folks. How is M4All different from what I just said? People with employer health insurance will be giving up what they have so the government can help "those others".
Neither the managers nor the workers... union or non-union...are going to be willing to do that.
1
@arty You're forgetting that with for-profit insurers out of the picture, with government setting drug prices, as they do everywhere else, no more price gouging!
Huge difference. We pay double for drugs that Europeans do. And our MRI prices are through the roof compared with Switzerland.
It's about profits!!
9
@Sean
What does any of what you said have to do with what I said?
It's about whether people are willing to give up their privilege in order to make life better for the people without the privilege. And they are not.
Unions fought to destroy the provision in ACA that would limit the tax exemption for employer insurance plans.
Do you think the people currently on Medicare want all those currently uninsured people using up their doctor's time?
You people are just in denial about the real world. Who exactly do you think is going to vote for the plan other than those with no coverage now?
2
@arty, LOL at Americans thinking they are privileged (and the better for it) to pay MORE for WORSE healthcare. We are such morons in this country, really.
3
There is something wrong with this picture. Most comments are about how to get enough money from somewhere to pay for our health care. Do you all think the military ever has to worry about how their bases and wars are going to be paid for? No, they get their share as a given. How come there’s always money for war but when Aunt Fannie gets cancer, too bad for her!!!! There IS enough money in this government for our health care! It is a matter of priorities!
19
@Linda McKim-Bell, Short answer: fiat money, fractional reserve banking and the fact that the US dollar is the world's reserve currency. The government can actually pay for whatever it wants to and it does (as you said, case in point: the military does). It's a question of political will. Our national priorities are terribly out of order.
2
Not if you work in "healthcare."
3
I've lived in countries with universal public health insurance/care. Even as an illegal immigrant in those countries, I got far better care for zero or very low cost, compared to the bad care, and ludicrously high premiums, deductibles, limits, loopholes, and co-pays of my health insurance here in the USA.
I don't know even one American who loves their health insurance company. Medicare for All would be a blessing. I'm tired of people slagging it.
25
Would it matter? If you can keep more of your current pay rather than spend it on co-payments, etc. then that is pretty much a pay raise.
9
What about the 16 or so million people who work in the healthcare industry? Hard to imagine their wages going up even if their employers no longer have to pay for their healthcare.
4
They could find other jobs that will pay more, and they won't worry about their healthcare, contrary to the people who are losing their jobs today.
10
@edv Need to be specific: no nurses or doctors or lab techs would lose their jobs. And more would be hired to fill the need in rural areas.
The only people losing their jobs would be those working for for-profit insurance companies and their CEO's. And those people can get unemployment and look for something else.
Healthcare providers will not lose their jobs!!
5
The answer is obvious. The law simply requires that employers now subsidizing employee health insurance add that dollar amount to their paychecks. Employees will be thrilled to get it so they can buy a new car, remodel the house, pay down high-interest credit cards and even save for retirement. The economic stimulus will be huge. "Putting more money in the pockets of consumers" should make Republicans ecstatic too. They're always preached that tax cuts supercharge the economy, on the same principle, but this time it really will work!
8
@abigail49 And then, what happens in year 2 and year 3 and so on. Will we have a federal government agency whose job it is to analyze the market wage for every job and determine whether in every year the implicit cost of healthcare is included in wages? Why not just have the federal government set everyone's wages?
2
@Jim I am not seeing the problem..now you get subsidized health insurance...next year you get that amount in wages added to your salary. Now you have a higher salary and medicare for all (and probably some higher taxes.) In year 2 or 3 the same conditions prevail...why would salaries go down? or if they did it would be to labor market conditions, just like they do now.
4
@Jim In Year 1, your paycheck goes from $40K to $50K. It stays there. It's your new baseline salary because the employer transferred his cash contribution to your private healthcare plan to your paycheck instead of paying it to an insurance company on your behalf. You have the government plan as good as or better than the private plan, you have money to spend any way you want to, and, yes, you may pay a little more tax but not as much as you and your employer were paying to private insurance companies. Net gain for employees.
3
Medicare for all is a poor option. Obamacare reworked is much better.
3
How come? Define 'better'. Better for whom?
3
@NOTATE REDMOND Except for the 27 MILLION people who never had authentic access to insurance or health care under the ACA.
3
@yulia
Yea this guy doesn’t seem to realize Obamacare will be declared unconstitutional after the election no matter who wins. the tax part of the mandate was voted out by republicans and that was the crux of the last Supreme Court decision that said that it was constitutional. Obama care is doomed Medicare for all is the way to go, single payer like the rest of the Western world
3
Be careful what you wish for.
2
There was a long stretch of recent history where employer-paid health care was obviously a sound approach. Such a system limits fear of immigrants and others free-riding and encouraged employers to take care of their employees, who often stayed for a whole career and faced serious health risks at work.
Thanks to a low birth rate and widespread idiocy, today's arguments about immigration rarely pivot on health care costs. Thanks to international competition, automation, shorter job tenures and other factors, employers have less of an influence on employee health for many workers.
If we want to preserve more domestic jobs as automation marches on, taking this burden away from employers could be a huge first step, one with far less severe perverse effects than some other popular proposals.
4
Here is what will happen with M4A:
1) Public-service will demand pay increase, and get it, as politicians need the votes
2) Wealthy/corps will shield from taxes by moving off-shore or complex legal structures
3) Middle class (non-trust fund, working professionals) will pay for both, with worse healthcare
Why healthcare will be worse:
1) Doctors/nurses will have lower salary to control costs.
Implications: Best doctors/nurses will open private practices for rich-only; At-risk non-rich patients mortality will increase; Overall stats will improve since at-risk patients utilize most of the services.
2) Services will be rationed to control costs
Implications: at-risk non-rich patients mortality will increase (stage 4 cancer patients can't wait); government, not a private health insurer that can be sued, will determine how long you will need to wait and which procedure is necessary (think DMV)
3) Drug innovation for rare diseases will slow down.
Implications: Those with rare conditions will face higher mortality.
So let's not be blind to the fact that the reason M4A works in other countries (Canada/Europe) is that the less fortunate from health perspective have less of a chance to survive/get treatment, and strict government control defines how healthcare is administered. Again, if you are a healthy individual, without complications, you will be ok, just as now.
For most middle class, economically, we will be worse off, and healthcare will be worse.
This is honest. Now vote!
3
I don't see any validity in your arguments. 1) I don't see anything bad in wage increase of the public workers, 2) I don't see why wouldn't the wealthy companies/Corps move to other countries to avoid the higher health cost in the US 3) the middle class is already paying both ways, taxes, premiums, deductibles and inferior healthcare. I don't think the M4A will be worse: 1) there are not so many the rich people that could support huge army of the doctors with the private practice, 2) the healthcare is already rationed in most dramatical way by restrictive access for those who has no insurance, and by insurance companies for whose who have one. 3) Because the most research is done on the States money anyway, the pharma will have to choose : to lag behind competitors, or takes the research data and develop new drugs at more reasonable cost.
9
@Investor123
Most of your post is just silly scaremongering.
Compare systems across most of the democratic world, and you'll find that most countries with a form of health care for all have a higher life expectancy than the USA, which ranked 29th in 2017.
And our health care here is as good as any. Yes, we have wait times for elective surgeries, but if you have an emergency, you get world-class treatment.
America just can't get it together. The rest of the democratic world wonders what is wrong with you.
11
@Investor123 but mortality rates are worse here than in Germany, France, England, Canada, Japan, etc. People there are not dying and falling off the roles.
9
This is all just nickering around the edges; a few billion here and a few billion there. Sounds like a lot. It's not: The U.S. healthcare "system" involves the flow of trillions and trillions of dollars. And the costs associated with its dysfunction (lost productivity; homelessness; a large swath of the population that's needlessly sick for lack of care) amounts to trillions more.
Come on, people, why are we even arguing? No other modern economy -- none! -- has this problem.
Do you have great employer-based healthcare? Me too. But, look outside your bubble! You'll see the US healthcare system is a disaster for most, is getting worse, and will never, ever improve. Why? Here's why:
Our system is focused on creating wealth first, not health. Health is a distant second. Making people healthy is not the goal of our for-profit system; it's a "cost of doing business." That's screwy!
Forget about the cost-shifting and who pays for what for two seconds, and imagine how much better our nation would be without needless sickness, early death and infant mortality.
Our people could focus on working, advancing careers, achieving a better education and improving community instead of being sick, worrying about getting sick or taking care of sick family members.
Improving the overall health in the U.S. to the level found in other countries will make us all wealthier in the aggregate, not just the chosen few who run the right companies and own the right stocks.
20
I don't care if my wages go up or down with Medicare for all because what I am getting is peace of mind and, frankly, that's priceless because stress of medical bills is killing me.
23
Corporate America should support it! Let us assume you are head of household and employed with an annual salary of $60k. For your healthcare benefit, your employer now pays $14k per year and you pay $6k per year, excluding copay, deductible, and cost of medicine (Wall Street Journal, September 25, 2019). At the rate of healthcare cost increase, by 2027 your employer is likely to pay $21k for the same coverage and your share would rise to $9k. Instead of negotiating with insurance companies for reduced coverage or alternatively asking you to pay a higher percentage for your share, your employer could rely on Medicare for All and no longer be responsible for healthcare benefit. By doing so, your employer would agree to raise your salary by $10k in lieu of their $14k contribution, and you would be responsible for a new healthcare tax. Assuming a 10% healthcare tax rate, your healthcare tax would be $7k (10% of your new annual salary of $70k). With that you are pocketing a $9k bonus [$10k (raise) - $7k (tax) + $6k (your healthcare coverage contribution that you no longer pay)], and saving on copays, deductibles and cost of medicine. With Medicare for All, both employer and employee win.
7
I have a hard time believing that anyone’s wages will go up significantly regardless of sector, and it’s guaranteed that wages for healthcare workers will go down as government “controls prices” by reducing what they pay for services, regardless of the real cost of treatment. We have already seen this with current Medicare and Medicaid reimbursements.
And you have to ask what kind of quality of care everyone will be getting when doctors, nurses, therapists, laboratorians, pharmacists, etc are having to care for more and more people while having less and less help, because the first thing struggling hospitals will do is cut the workforce. How many more mistakes will happen when each of these workers is trying to accomplish 2 or 3 times the workload, rushing to get things done because they have to move on to the next patient?
I believe we need to find ways to cover everyone and that healthcare should be a right, but these Medicare for all plans scare me because the politicians proposing them have little understanding of how any of this works. And “running fast and breaking things” will not work out well for anyone - at least not in the near future.
4
I think we have much better understanding of Medicare works than of an undefined system that supposedly 'better' than Medicare. After all we have our own experience, as well as experience of many other countries that have similar to Medicare system
3
@Beth I also think hospitals and other institutions are already doing more with less because they want more and more profit. It is not just health insurers that are trying to get rich, it is also hospitals, drug companies, and some doctors. Whatever we end up with will have to take that into consideration.
3
Beth, our current insurance system has been around for a long time and is totally broken. High costs, millions uninsured, spiraling drug costs, personal bankruptcy. The system is rigged for profits, not care. As some guy named Albert Einstein once said, “The definition of insanity is doing the same thing over and over again, but expecting different results." I'm willing to run fast and break a few things to fix this mess.
The solution is obvious, except perhaps to Americans. Wahtever legislation implements universal health care should require all employers to add back to employees' wages whatever cost saving companies achieve through not having to pay insurance premiums.
It is astounding that the cost of family health insurance is over $20,000 and there are probably co-pays etc. as well. In Canada we probably pay a few thousand dollars extra in taxes for health coverage and no co-pays. Cetainly nothing close to $10,000. Everybody will be far better of under a universal single payer system except insurance companies and their employees. Of course taxes will go up, but only at a fraction of the cost of health insurance.
12
So... how will corporations respond under a national healthcare plan?
Will they indeed let the benefits of their own cost savings flow down to the employees? Or will they simply soak it up and pass it to shareholders?
I'm betting they pass it on to shareholders.. unless any legislation specifically prohibits them from doing so.
13
Rather than looking for wage increases, I’m looking for reduced healthcare costs. We can’t always make decisions based on how much money it puts in our pockets, but rather we need to consider how it provides healthcare to a huge segment of society.
If we can’t do total healthcare for all, how about we provide preventative (two dental visits/year; eye exams every other year; six-month wellness checks; diet and exercise counseling, for example) care at no cost and let insurance cover the rest. You opt for the level of coverage extra insurance provides: total=highest premiums—>none=$0.
Preventative care will reduce crises—especially those that grow out of unaddressed but preventable conditions that currently end up as visits to urgent care and emergency rooms.
Who’s with me?
2
@JSBNoWI
What matters is total cost of healthcare for the consumer. And as is true in most things in life... there is NO single silver bullet.
So, any combination of more money in the consumers pocket to offset any actual costs not covered (copays and deductibles, which are likely to persist even under a national healthcare plan) and better cost management overall in the healthcare system is a benefit overall.
4
Chuck—
Actually, the consumer only comes into the equation when figuring what he/she can afford to cover. The system can change to benefit the consumer in terms of healthcare but, dollars to donuts, it will not be cheaper. I don’t expect it to be more expensive, either, but I know the middle people—including insurance providers—are not giving anything up.
@Chuck In fact, in Canada there are no co-pays. Nor in Britain. Or Germany. Or France.
Indeed, in Britain no one is ever presented with a bill to pay for healthcare. From birth to death.
Never!
3
I just never trust elected officials when they say my wages will go up. I’m a liberal democrat and quite fond of many government programs, but I just don’t believe there will be a benefit with Medicare for All. First, I believe, there will be massive confusion, and there will be numerous instances when people get worse care. I think there are better ways to transition to a system that gives everyone health care without a massive upheaval. I will vote for Bernie if he’s the nominee, but I believe many moderates will not vote, or stick with Trump on this one issue.
5
@Michael Feeley Wait a minute. Massive confusion need not happen. We already have Medicare for some. Presumably we have learned a lot from that experience and may be able to apply to a generalized implementation. And who says we have to implement it all at once? It could be phased in over a decade or more relatively painlessly. What if we only provided free check ups for all at first? Expand that to free urgent care for all. Ask for some cost sharing, just like Medicare.
9
@Independent One I was thinking to phase it in by adding ages at both ends of the scale. Start by offering it to children under 1 year of age and adults 62 and up, then when that's stabilized, children under 5 and adults 60 and up, and so on.
3
@Michael Feeley
Check out Senator Warren's plan. It does phase in options for access to Medicare, while also protecting and improving the ACA as long as it is needed, cutting the costs of prescription drugs and moving in stages to Medicare for All. She is in agreement with Sanders on the long term goals but takes very different approac getting there. Also, as I understand her, she assumes private insurance will cease to be needed, or will remain only for those who can afford to buy it or as a way to obtain a fully private room, or some other "extra" that a person might want. As I read it, there is no requirement that private insurance be totally eliminated; just that folks will not actually need it so it will not be a major industry as it is today.
2
I am fortunate to hold a union job, one that I've held for a long time and my benefits package is excellent, thanks to my union. I am deeply sympathetic to those without health care or with expensive sub-par plans and I certainly support expanding Obamacare and making any necessary changes. But I do not want to give up my benefits to make that happen, nor should I have to. I've worked for this, I've earned this, and I've supported unions my entire life because of this, among many other reasons.
9
@Jolton
I feel you. We also have great benefits in my family. But I also know we could lose those at the drop of a dime.
6
@Jolton
YOU are part of the narrative problem with any move toward a national healthcare plan.
It's just a new spin on "not in my backyard" and is deeply selfish in nature.
10
@Jolton I don't know what industry you're in, but for many unions it's a fact that healthcare consumes a significant amount of bargaining effort. How much time does your bargaining team spend maintaining your standard of coverage during contract negotiations?
If healthcare was a given, your union could leverage its power for better wages and other benefits instead of fending off attacks on healthcare from management.
7
Simply eliminate the tax break that businesses get to provide health care.
Wages and salaries are still deductible so the employer either increases these or pays taxes on the additional savings (revenues).
As others have noted, this would also need to include modifications to the tax code which would be done, anyway, with a Democratically controlled government.
It seems that conservatives hold capitalism, while sauce for the goose, is not sauce for the gander.
If taxes charged employers are passed along to employees and customers (in the form of lower wages and higher prices), then expenses borne by employers are ALSO passed along to employees and customers.
My W-2 discloses that the cost of my family health benefit plan was nearly $24,000 in 2019. If my employer and I needn't pay that $24,000, that $24,000 is going to be passed along to customers (in the form of reduced prices), employees (in the form of higher wages), or ownership (in the form of increased profits).
The law of supply & demand dictates the lion's share of this $24,000 windfall will not end up in profits, and the stickiness of pricing dictates it won't be handed out to customers either. The majority will go to employees, thanks to employees' freedom to leave for greener pastures.
4
@Sam I Am
For any publicly traded company.. the savings will either be "offshored" in a tax haven, or passed on to shareholders. Most likely some of both.
Employees... will get zilch out of this unless there is ironclad legislation that companies can find no legal loophole in (good luck with that).
4
@Sam I Am "The majority will go to employees, thanks to employees' freedom to leave for greener pastures." <<
@Chuck
You may not believe in the law of supply and demand, but I assure you that private equity does. If corporations decide to put the windfall into profits, they will be outcompeted within weeks. There is a cost of capital, and private equity will be thrilled to extract a 1% profit on that by capturing the market by offering lower prices to customers and higher wages to employees.
The US should try to achieve or surpass the disposable income of industrialized nations with government subsidized healthcare. The concern should be with after tax disposable income and not ust wages.
Forgetting the fact that companies may not pass on 100% of the $9,000 savings, most of the savings will be eaten up by higher taxes that the government will need to collect to fund M4A. In other words net after taxes you will be at least another $9,000.
Don’t people get it nothing is for free. The government will need $6 Trillion, rich people will be lucky to pay another $500B. Everybody’s else will have to pay up.
2
@sjw51 Don't most proponents of M4A plan to pay for it by taxing the rich? And even if it is replaced by taxes on the middle class, at the very least government run healthcare system wouldn't have executives with 8 digit salaries increasing the cost of healthcare. Nearly every other western country has public health care, and they pay about half of what we do for better health outcomes.
11
@sjw51
As long as we're "not forgetting" things, a few more:
As with private insurance, the bigger the pool of patients, the lower the cost per patient. When everybody is covered treatment costs are reduced significantly.
When there is a single payer there will be a single paperwork/reporting regime producing potentially massive savings.
When everyone is covered demand will drop precipitously for the most expensive care on earth: emergency rooms.
As people learn to rely on and use care the costs of treatment will decrease as problems are addressed earlier in their course or avoided altogether.
Bear in mind that a shift to single payer will provide over a trillion dollar reduction in such things as overhead, salaries and benefits, and especially marketing and lobbying costs.
Expect a similar reduction in legal costs.
A few commenters below assert the "portability" of care from one job to another is a myth, but their objections are based on issues in the job market. With single payer if you get a new job your care is unaffected. You don't have to take it with you because it never left.
The benefits, economic benefits, of a reliably healthy population are almost too numerous and too large to count.
There may those who would not want single payer plans; their objections are purely political, based in dogma rather than fact, reinforced by the mistaken notion that American business is not already massively subsidized by government.
15
@sjw51
Insurance companies are an extra layer of bureaucracy that add to the cost of care. If the US switches to a single payer plan it will have the ability to do more to control cost and ensure quality of care, this would bring down the overall cost.
12
These studies are looking at the trade-off between wages and health benefits that has evolved over time and reached an equilibrium. But in an abrupt transition to Medicare for All, employers would be faced with an immediate, transactional decision: what to do with the windfall from no longer having to provide health insurance? They could raise wages or they could boost profit.
Unless Medicare comes with rules or taxes guiding this answer, I'll bet that at least some of it goes to profit. Now over time, a new equilibrium might be reached as workers move to jobs with higher wages. But in the short term, employees aren't likely to flee an employer who pocketed some of the savings.
5
@Ken L But when businesses are given more money (like through a tax cut) they reinvest that money in their workers--sorry, can't keep that up with a straight face. Corporations have shown us again and again what happens when they have more money in their pockets--I don't expect most workers would see those healthcare costs as increased wages without legal action requiring so.
5
@Ken L They won't pay less. Warren's plan, and some extent Sanders plan, assume that they can get the current spending from companies to offset the cost of the benefit. This is a moot discussion because the transition will definitely cost more as all of those who have avoided care will need to be incorporated. Even at lower Medicare rates, this won't result in reduced costs even if savings are achieved on previously treated patients as the added number of treatments will outpace those savings. This is good for health, but not necessarily the math. I have seen 30-40% of current costs are associated with prescription drug prices. This could be reduced quite easily by allowing Medicaid to refuse to cover expensive, unproven medications (currently has to cover all approved treatments) and allow Medicare to negotiate drug prices. This can create a floor for medication costs that will trickle down through the private system as well.
Additionally, requiring standardized billing and approval forms at the national level for all public and private coverage will drastically reduce overhead while streamlining the process.
I bring up these issues because a rapid transition away from private insurance has to be completed in waves to prevent price and coverage shocks. Physicians and providers will not just show up in certain areas because a new law passes. It will require massive reordering of health care delivery systems that will leave large holes in coverage.
One number that has stayed consistent for about 30 years now is that healthcare providers (hospitals, doctors' offices, etc.) report that about 25% of their administrative costs is for managing submission of claims and getting reimbursement from healthcare insurers (I am assuming that figure includes submissions to CMS and state Medicaid).
A single-payer system would potentially reduce that expense, which is a good thing since that expense doesn't really contribute to the quality of healthcare that we receive in the US.
What is ALWAYS left out of this conversation is the ever-increasing cost of healthcare services, the continued consolidation of providers into vast often monopolistic networks, and what seems to be an increasing number of for-profit healthcare providers. Mention is sometimes made of the cost of prescriptions, but no one talks about the pharmacy benefit managers that require maintenance medications to be filled through their mail-order pharmacies -- there are now 2 very large PBMs in the US and no one talks about the impact they have on the cost of medications.
Let's also not forget that Congress has set restrictions on what services and medications are covered (no abortion services, for example, if you are on Medicaid) - what will happen when we don't have a choice? Will women once again pay more for some kind of private insurance to cover services that are important to them?
I've been asking these questions since "Medicare for All" became a buzzword
3
@Sheri DH In fact, based on the experience of other countries, single-payer wouldn't "potentially reduce that expense," it would dramatically reduce that expense!
The massive costs added by for-profit insurance companies is related to 1) profit, which is not permitted in other countries, and 2) admin that is directly related to rejecting claims and figuring out how to maximize profits.
1
Most experts say there is about 4 trillion dollars being spent in the U.S. healthcare system annually. It is a combination of employer sponsored plans, government plans, and individual insurance plans. All are profit driven, hence the high cost. Likewise, there is no accountability of the providers.
Having spent a career in the Labor Movement, I can tell you with firsthand knowledge employees sacrifice wages for healthcare benefits. At the end of all successful bargaining sessions, both sides count up the total costs of the new agreement, and it includes the added cost of healthcare benefits.
The current system is a hodge podge of mixed programs, none which rein in the high cost of securing healthcare. It won't be an easy measure to transition from the current system to one which grants coverage to everyone, but at some point the current system will become unsustainable. We should be in the planning stages of the transition now until waiting for its eventual collapse.
4
The assumption is that employees can easily change jobs.
Certainly not true for those over 50, or with specialized skills, or in geographical areas with limited competition for labor, or those grandfathered in for some benefits, like pensions.
In other words, in theory this sounds nice, but if anyone implements it, be prepared for a political bloodbath.
5
For all of the mouthpieces for insurance company profit-taking commenting on here, out of all the countries with a Medicare for all type approach, exactly zero of them are considering scrapping their systems, not even their right-wing parties. Of course they debate efficiencies, trade-offs, and tweaks, as they should, but no one is talking about going backwards. Facts.
13
If you think that taking away the cost of insurance will lead to companies paying you more, think again. Did you make more when corporate taxes went down? I didn't. The company used the cash to buy back it's own stock, raising the price which benefited senior management not rank and file employees.
On Medicare for all, I manage my mother's healthcare. She buys a Medicare Advantage plan, their customer service is excellent and her coverage is more comprehensive than my employer paid insurance. I work for a large healthcare company so the industry you are in doesn't mean a better plan. If I could buy into Medicare at 61 years old and buy a supplement I would retire early, opening a spot for a younger employee.
11
@Pat Baker, this is why we the people must demand that our representatives include in the legislation for M4A that employers must pass on their healthcare cost savings to their employees in the form of higher wages. I don't trust that they would do this own their own out of the goodness of their hearts either.
Having lived in various European countries for many years - all with some form of a government paid health care plan - I can tell you that EVERYONE pays something toward health care in the form of taxation. Value Added Taxes. Payroll taxes on employees. Payroll taxes on employers. That goes for the CEO down to the lowliest employees. I can also tell you that the overall charges within European countries for medical procedures are dramatically lower than they are in the US. All of this is true and still, those health care systems run large deficits. Every American has to know that whatever Bernie Sanders or anyone else tells you your taxes and your employer's taxes are going to go up. A lot. The rich guy down the street is not going to be able to cover you, nor should he. Everyone benefits. Everyone should pay. And they will because there is no other alternative. And if it is going to work here then every person on the health care food chain is going to have to take a pay cut or the deficits will wipe out our economy.
10
@Joinparis
Yes, health care is going to cost money no matter what the system is--we are already paying for health care, all of us, already. Though some cannot afford access at all. That's where progressive taxation can help. The top earners would contribute to help make sure the lowest earners have access to health care.
And a single payer plan will bring down health care costs.
5
@Joinparis
The deficit problem could be solved by doing away with the 2018 Tax Reform Bill
4
@Joinparis
What you fail to mention is 30 years of shifting the tax burden on to workers from the wealthy. While the rich guy (and corporation) down the street may not pay ALL of it, they certainly need to pay a bigger share than they are now. Who do you think is footing the (exorbitant) bill now?
4
Given the amount of time and analysis that has gone into pumping up M4A it has to be disheartening to progressives that there isn't a clearer and cleaner way to evidence the myriad benefits they claim will accrue to all Americans.
If all we know is that under M4A SOME wages would rise for SOME people, then progressives will have no chance to convince 157 million Americans that better coverage and better wages awaits them if they would just give up that fundamental American ideal: the freedom to choose what is best for you and your family.
This is a profound flaw in M4A and it's why many more people support M4A-Who-Want-It as the logical alternative to the election day catastrophe that awaits the candidate that supports M4A.
6
Of course the all people will benefit, because they all will have access to cheaper healthcare independently who is their employer. Some will benefit more because their wages will go up.
4
@John Amen! Well said.
1
If the funding sources are higher taxes on corporations and the stockholders that own the corporations, what is the source of the money to raise the wages? The stockholders need more money to stay whole as do the corporations since they will pay out more money. It is just a big wash. Individual employees that have higher market demand will get higher salaries, but that occurs in any system.
1
@Michael Blazin
"The stockholders need more money to stay whole as do the corporations" Wrong. Compare average earnings to the growth of corporate profits and the stock market over the last 30 years. We are in need of a major correction.
Large stockholders and corporations won't like it, of course, but they've had it all their way for far too long.
Well, if health insurance one of the perk to lure the workers, in absence of need for the health insurances, the employers should fine either another perk or increase the salaries to stay competitive in hiring.
3
My employer's benefit page lists our total compensation packages, including health care. If that cost was eliminated for them, I would expect to see it funneled to me. And everyone I work with would advocate for that change and I fully expect it would go through. But I work for a non profit. Workers in other areas would need to be knowledgeable and prepared to organize and fight for their total compensation packages as well - and most people in the corporate sector are worked so hard, they have little energy left at the end of the day or week to organize and advocate for themselves.
3
@Megan
The direct payment of that cost may disappear but I guarantee you that your employer will ultimately be hit with as large or larger tax bill to fund Medicare for All. No windfall is coming your way.
3
That could be true or could be not. In the industry where employers compete for employees they will have to find some ways to lure them, doesn't matter what they pay in taxes.
1
The people who would definitely lose wages under M4A are the people who work for insurance companies. Count on them to fight against it very very hard.
9
I expect, but there millions more who losing their salaries to support people in the health insurance industry. They may counter the health insurance workers.
3
Nice try...
There is NO chance employee comp would rise if Medicare for all were implemented.
Employers would add that to their bottom line revenue and or re-invest into the company.
Follow up article if it were deployed.
5 steps on how to ask my boss for a raise “I want my heath-care money back”
Sorry Bernie/Warren supporters but what’s next? How to get reimbursed for paying your kids college tuition?
6
@Paul re "There is NO chance employee comp would rise if Medicare for all were implemented."
Actually, there are SOME chances. For example, were employers to lose their exalted status as gatekeepers to American healthcare, employees would be freer to search around for greener employment pastures. And they couldn't be cowed in to submitting to lower or stagnant wages by employers' threats (explicit or implied) to reduce healthcare benefits in retribution.
And then there's the bottom line: Americans now spend about twice as much on healthcare as do other developed countries, for which they receive demonstrably worse overall results. It's hard to imagine that halving the cost of something that consumes nearly 20% of GDP wouldn't benefit all Americans' bottom lines, i.e., "compensation" in the broad sense.
Unfortunately, Democrats seem to not understand that none of these advantages depend on abolishing private insurance and replacing it with s single-payer system, which is what they mean by "Medicare for all." Many countries (including Germany, often thought to have the best healthcare) rely heavily on private companies for insuring healthcare. Our system needs radical change, but single-payer doesn't have to be part of that change.
1
You failed to factor in that people who have access to health care go to a provider earlier when they detect a change. Early diagnosis leads to earlier treatment when less damage has occurred. Early treatment can mean a cure or a dramatically improve course of care. This reduces overall medical cost and saves lives. It results in a healthier workforce with less absenteeism.
Sounds like a real shame, doesn't it?
17
@nora m Great post! Also factor in the fact that there are about 30% excess costs for current private health insurance that is wasted on healthcare companies paying big bonuses to company executives and the billions spent on lobbying our corrupt Legislators to keep the current broken system.
2
@nora m Unfortunately there are not enough doctors and other medical resources as it is in the USA. M4A will make the demand for doctors appointments etc worse since there will be many more trying to use the same amount of resources.
1
@George Washington That's what they said about Obamacare, but not only did the doctors cope, but the hospitals benefited from having many more patients who had health insurance. So their uncollectible bills fell sharply.
If we need more doctors to treat sick Americans, then our society should train more doctors. Healthcare should be a right, as it is everywhere else in the developed world.
2
Those who believe that wages would "of course" rise if M4A were enacted are incredibly naive and have forgotten the history of American Big Business. Unless there is a statutory reason to apply savings from health insurance costs to wages, or clear market forces forcing employers to increase wages, one can safely assume that most savings from M4A will serve to increase corporate profits. As direct health insurance costs to business are overt (i.e., what is the per employee premium?), it would be reasonably easy to include in any M4A law that some percent of this savings (say 60% or so) must be paid to workers in the form of wage increases with the remainder being split between the business and the gov't (say 25% business/15% gov't); these figures are not the result of any economic analysis but rather seem to pass the "fairness" test. This would not make M4A any less expensive, but would codify in law a benefit to all parties.
7
"But to the extent the cost of health insurance is shifted away from employers and to the federal government under Medicare for all, it seems wages would rise, at least for some people."
WE are the federal government - all of us. It is not a sugar daddy or Mom & Dad which will pay for our costs without a cost to each of us. I support the idea of a single-payer system, which covers everyone (there are a number of working models on the world stage). All of them cost money. Whether we pay in co-pays/deductibles, with lower wages, with higher taxes or some combination of all of those, we will have to pay. There is NO such thing as "free healthcare" for all. And, no, "the wealthy" cannot pay for our healthcare, our childcare, and our higher educations all by themselves.
22
@Anne-Marie Hislop Agreed. And the progressives keep trying to shift the goalposts on who they consider 'the elites" and 'the wealthy." Anyone who thinks the actual wealthy won't use their resources not to contribute their fair share while leaving the rest of us middle- and upper-middle income earners holding the bag would probably be more than happy to buy that bridge you're selling. And I'm a lifelong Dem!
3
@Anne-Marie Hislop
you are completely ignoring how the tax system is structured and how it should be restructured. The fact that we all pay taxes is a facile argument. The question is who pays how much.
@Anne-Marie Hislop
All great points. FYI, the world stage doesn't endorse only single-payer systems. Private health insurance works very well when people demand it. See, e.g., https://www.vox.com/health-care/2019/2/12/18215430/single-payer-private-health-insurance-harris-sanders.
All great/effective healthcare systems have one thing in common: They are NOT predicated on profit. Beyond that, it doesn't really matter who writes and administers insurance policies -- those are just details.
2
There is no commentary in this article about the severe biasing of the tax-free status of health insurance premiums paid by both employers and employees. A dollar of health insurance premiums paid by either is not taxable — an antiquated idea which has long outlived its usefulness. If it were paid in wages, it would be taxable.
9
The question ignores the fact that Medicare funding now is insufficient to keep Medicare going. Prices will have to rise, and a great deal more if there was no higher offsets from private insurance, which is the difference, especially in rural health care centers, between staying open and closing. For all those who say they can do it, why can't we? It's not a simple answer, even though politicians will say so to get your vote. It took Canada 20 years to evolve into their present system. It was painfully slow, with doctor's strikes, and it moved province by province. Germany started on this path 100 years ago. France, etc. same. There are embedded costs in the US system that can't be changed overnight: hospitals, the cost of a medical degree, salaries, large distances (go see how First Nations people health care is in upper Manitoba, etc. - not good), to name a few. Health care costs are much lower in Switzerland (40%), with better results without public funded health care. So, it's not just public vs. private debate, it's about supply, transparency of cost, patients over profits (all Swiss insurers are private and non-profit). Bernie's dictum that some 2M who work in the private insurance business will just have to find jobs elsewhere is as naive as it is arrogant. We all know the current system is a disaster, but magic wand solutions don't work over night because some career politician says so. It's evolution not revolution.
12
Swiss system is the second most expensive one among developed nations. The Government plays a big role in mandating the insurance and in regulation of the prices. Swiss doesn't have employer-based insurance, as the US. With Medicare for all the prices will fall, because the Government will have much stronger bargaining power, the pool of people will be much larger and much more diverse than in case of today's Medicare that has mostly old a people who require a lot of care. Sure, it will require some time to work every issue, but if we will not start right now, we will all be bankrupted by our healthcare.
2
@Mark
So intentionally slow walk it so insurers and investors can continue to pull money out of the system?
Very few people change jobs because of compensation, unless the compensation is truly out of wack with alternative employers. Most people leave because their managers are awful, the corporate culture is toxic or their personal situation changes.
5
@NH I have changed jobs plenty of times for compensation. Employers don't all pay the same for the same work, period.
3
The savings estimate probably rely on a substantial reduction in overall health costs as a result of moving to single payer. The problem is those overall health savings assume provider payment reductions that may not materialize. Provider lobbies have been very successful in stifling attempts to reduce or even hold constant their payments in the existing Medicare program. Even Sanders and Warren have criticized "cuts" to Medicare that were actually attempts to hold down increases in payments to providers.
5
There must be huge savings to be realized when the insurance companies are kicked off the gravy train they've been on. And, as a corollary, there will be significant job losses in that industry. It would be helpful if the candidates for president dealt with that matter realistically with suggestions on how they will ease the pain on insurance workers.
2
How is that any different than those workers that lose their jobs to innovation ( coal, factory workers, hotel workers during the recession, etc)? When the recession of 2008 hit, many jobs were lost, many people had to change their business. look at realtors: there are many online options that don't require a realtor, but that doesn't stop people needing a new career.
12
@daved re "It would be helpful if the candidates for president dealt with that matter realistically...."
AMEN to that. Unfortunately, how many Americans have enough interest -- let alone discipline -- to follow complex economic and social issues? Candidates speak in soundbites and nonsense -- saying as little as possible in as many words as possible -- because they know that's how most voters think. Just look who's in the White House.
Surprised wages never get discussed when the healthcare topic is debated. All sides know wages will take a hit. And, as the author suggests, some markets more than others.
A few good things may come out of this wage dilemma. One, there is a dire need for some healthcare workers vs others. Free tuition would go along way to attract workers to needed jobs. (I also think this would help counties and cities train more plumber and electricians.)
There is a huge discrepancy between the top person paid and the bottom. This could be a way to level compensation among employees. It could pave the way for other businesses and industries to do the same.
If you are a healthcare worker and you hate unions you’ll have to quit hating them in order to get a fair wage and benefits package.
Hopefully radically changing the healthcare system would finally get a long overdue labor movement going.
6
Medicare for all has to mean FOR ALL. Public employee unions should not be able to negotiate different coverage. FDR was right about government employees joining unions.
4
@James Miller
I missed something. What would there be to negotiate if we all got our health care covered under a federal plan? Negotiating now is necessary, but why would it be if the employer was no longer required to provide coverage?
1
@James Miller With universal healthcare that covers every American, regardless of his job, then unions won't have to negotiate it.
Better for everyone!
1
Who is Frakt? Whose side is he on? Whose payroll is he on?
1
Included in the regulations should be a stipulation that employers increase employees' wages by the net amount (after tax) that the corporation pays for healthcare. Many corporations provide each employee with an annual statement of the cost of benefits so it is easy for employers to determine the cost per employee. If there is no regulation requiring an increase in wages, unscrupulous employers will not increase wages appropriately. In addition, the cost of goods should decrease as well.
3
Taking this article one bit further, it isn't gross wages, health insurance costs, or tax rates that ultimately matter; it is what is left after tax/after benefit/after savings to spend.
So, lowering one item (such as health care costs) but raising another (taxes) can make a worker worse off (since taxes can't be reduced by losing weight or eating better, health care costs can be reduced by making better decisions and choosing a cheaper plan with HSA).
Remember, 50% of US workers spend less than $500/year on out-of-pocket health care; so we are fairly risk tolerant. A constant tax rate, no matter how healthy or unhealthy we are takes out a positive force in the marketplace (economic incentive to be healthier).
1
Got it. Corporations, under Sanders, will be off the hook for medical costs, but "rich people" will make up the difference. In what world does that make any sense?
11
@KCPhillips - Corporations are never on the hook for anything. They get a tax deduction for many costs, including providing health insurance. And anything they pay for is passed on to the people who buy products/services from the company in the form of higher pricing.
14
@KCPhillips First, keep in mind that in Sanders' plan, the government would regulate drug prices, as Canada and European countries do. So those prices go down by half overnight. And the government would set procedure prices, presumably based on the norms elsewhere. So those costs go down dramatically. And with no need to pay insurance companies billions in profits, and no need for massive overhead by insurance companies, healthcare costs begin to converge with the vastly less expensive levels of other developed nations.
And, yes, that makes perfect sense!
1
I believe that one of the reasons you would not see a one-to-one match between employee health benefits and wages could be that employers get a tax deduction for the cost of providing employee health insurance.
Also, a significant reason that employees don't necessarily value the health insurance benefits they receive is because they are not taxed on them. What the company pays for employee health insurance should be considered a fully taxable benefit that is added to an employees income. Were this done, I'd wager that employees would have a much clearer picture as to how great their [mostly] employer paid health insurance benefit is!
7
You are throwing around the phrase tax deduction when referring to corporations paying some or all of their employees health insurance. What you are talking about is a business expense, much like advertising or office supplies, all of which reduce the companies income.
1
Employees may value health benefits less than wages because most of them don’t use their health benefit every day, but they do use their wage benefit every day, every time they spend money on anything.
1
The reality of Medicare for All is Mediloss for All. In Canada, getting an MRI can take months to get. There, carrying personal medical insurance enhances medical care. Drugs may be cheaper. But if medical care ins insufficient, what use is cheaper medication?
5
@my2sons Canada's healthcare system is superior in all ways to the US profit centre model. Unless of course, you are ridiculously wealthy. Nothing in your comment is true about care in Canada.
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@my2sons
If it's an emergency, you'll get a MRI in the same day in Canada.
13
@my2sons In the U.S, getting an MRI can take forever if you don't have insurance or "upfront money". Fixed it for ya, no charge.
15
Wages are unlikely to go up. For one, the elimination of the Cadillac Tax has not led to reports of increased wages. Second, employers have been reducing benefits for the last 30 years but these savings are not passed on to employees. Will employers also consider that they will pay higher taxes in lieu of health insurance? Lastly, most employees do not consider health benefits as a trade off with pay. Perhaps some employees will have the economic power to negotiate, but this is unlikely to be the case for most industries.
17
This article completely ignores the anomalous tax treatment of employer-provided health insurance.
Normally anything of value you receive from your employer is taxable income. This is necessary because otherwise we'd have many folks getting paid with stuff rather than money because of the tax savings. Then they'd have to trade most of the stuff they got for the stuff they actually need or want, recreating a barter economy.
But employer-provided health insurance is not taxable. This is an implicit government subsidy. Which would be withdrawn under Medicare for All. So while employees might find that their gross pay went up by the value of the now vanished employer-provided health insurance they would find that their net pay had only gone up partially.
The key fact is that employers can write-off the full cost of health insurance while the worker is not taxed on the benefit.
I'm not arguing against single-payer but the tax implications should be recognized.
We might consider providing a robust Public Option and then begin reducing the amount the employer can write-off to 90% of the cost, then the following year 80% etc
As the tax benefit slowly vanishes we could transition smoothly to a new system. There really doesn't seem to be any good reason to involve employers in health insurance.
19
@Jack Toner Your point is an important one - our tax structure has provided hidden subsidies. It is also a point at which change can be made.
However, some of the tax benefits are changing. Before the Affordable Care Act I could write off the cost of health care as a business expense for a "C" corporation. I also wrote off the cost of long-term care insurance this way. Now it no longer makes a difference whether my company pays or I pay for insurance. I am cynical enough to think that it is likely large companies still get the breaks I used to get.
Bernie et al should dump the term "medicare for all" because medicare as we know it is terribly lacking, but studies say people like medicare so they use that term. Single payer is the more descriptively correct term.
Whatever the name it is a long game plan, one bound to be troubled, and probably more expensive in the transition, but in the long run should be far more beneficial to most Americans, especially the paycheck to paycheck class. It is also the best way to reign in costs. As long as health care is a for profit business, such as fee for service, there will be those who cheat and game the system.
10
@Caded Actually, "Medicare" is the name created by Canada for its system of universal healthcare. We borrowed the name for our healthcare system for seniors.
Far from the transition being "troubled," that is not the experience of countries that implemented universal healthcare after World War II, or of Switzerland and Taiwan which implemented their plans in the 1990's. Nor, for that fact, was the implementation of Medicare for the elderly in the 1960s "troubled."
We can do this effectively and quickly. Lots of models to use from abroad.
We can this this!
10
There might be other benefits with Medicare for All. Employers would no longer have to administer the plans and would have more resources to make better products and services. Also, they would have fewer benefits to hold over the employees head, so the employees might find it easier to change jobs. The workforce might become better paid , more fulfilled, and more productive.
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@Bob Cook Most employers hire insurance companies to run their plans. And you're ignoring the tax subsidy that all employer-provided plans receive. This article claims that most of the money saved would go into wages. Do you disagree? Or did you not bother to actually read the article you're commenting on?
Also the notion that benefits are something that employers "hold over the employees head" is a strange one. I think it's more like they use various benefits to entice folks to work for them.
Back before Obamacare did away with limitations on coverage of pre-existing conditions this was a major impediment to folks who wanted to leave a particular job. Trump is, of course, trying to weaken this protection while also, of course, lying about it.
So the issue you raise could be resolved by strengthening Obamacare, no need for Medicare for All in this context. Not saying there aren't good arguments for it in other contexts.
5
@Jack Toner
There are absolutely costs by companies to administering insurance plans. First, they need to renegotiate the plan every year with the insurance company/companies. Then they need to develop/distribute information for all employees for the open enrollment period. During open enrollment, there are sometimes informational sessions for employees about the changes in benefits. New hires usually get a benefits orientation. Terminating employees usually get an exit interview where they need to be advised of the status of and options for their insurance. There are people who are available to answer questions and run interference with the insurance companies. Every employee gets time to actually complete open enrollment. So time is taken away from work for all employees, and large companies usually hire a benefits staff whose sole job is to work on the insurance. I would think that companies would like to get rid of this responsibility, unless it does give them something to "hold over their employees' heads" or for purely ideological reasons.
19
@Jack Toner Yes, it is true employers use benefits to entice employees to work for them but, they also entice employees who are miserables in their jobs to stay with them. Those employees should leave and work somewhere else starts business for everyones benefit.
"Do you disagree? Or did you not bother to actually read the article you're commenting on?"
I am not agreeing or disagreeing. I am just saying there may be other benefits. However the economic benefits may be overstated. There are large tax deductions for employer provided Health insurance. The employer gets a large tax deduction from their income taxes and the employee gets a tax free fringe benefit. Those will be lost under Medicare for all. Subtract those from the premiums and add the income tax the employee will have to pay on any new income. I also think in the current environment the first beneficiary of any new money will be the shareholders.
You might get some back in your paycheck if your employer is generous, but you would lose on the end of higher taxes to pay for the insurance. The government would need money to pay all the claims. They currently do not have a big pot of gold to draw from. So that would come form workers in the form of taxes. Which will not be offset by a few dollar raise that some very generous employers might give.
8
It would be simple enough for the legislation enacting Medicare For All to REQUIRE employers who are now providing insurance to raise the cash wages of all their employees by the amount the employer is no longer paying for their insurance.
This will probably be necessary in order to make Medicare For All politically possible, since markets take time to adjust and since many people do not believe they would do so even after time.
3
@Paul deLespinasse - Nope! Because the employer is getting a tax deduction for the amount of money they pay towards employee health insurance. And the tax rate of each company is different, so there is no way to figure out a gross savings number for each company.
3
@Joseph But each employer can easily figure out how much health care costs per employee and then apply their tax rate to that amount. In addition, the cost of goods should decrease.
@Paul deLespinasse You do realize that in many industries it would be cheaper to "rightsize" the workforce rather than increase their wages. So do we also outlaw layoffs?
1
This all assumes that everyone has Medicare for all and no private option is allowed. That is the basic insurance. In Canada your employer alos pays for the employees private insurance. Without the private insurance you get substandard care and it can take months to see a doctor. You know we will have to buy medicare part D or no doctor will see you. My in-laws pay $900 a month for their part D coverage.
7
@Keith
That's simply not true.
#1, our basic medical care is NOT substandard - take a look at the most important health indicators - we beat you Americans on every single one of them, from infant mortality to longevity.
#2, the additional private insurance offered by man insurers costs nowhere near $900/month, but what it does cost is paid by our employers.
What you don't seem to understand is that your healthcare 'system' is hugely expensive BECAUSE of all those private operators.
It's the because of all the admin required and since in Canada for the basic coverage that anyone could survive on, there is only one payer, we save tremendously.
38
@Keith That is not correct. Care is the same whether you have insurance or not. Private insurance pays for things like vision and dental, massage therapy and things like a private hospital room. And "it can take months to see a doctor"? Are you serious? Or a believer in the corporate effort to make Canada's healthcare system as dysfunctional and lucrative as the one you must really, really enjoy while going bankrupt from ghost billing. That does not happen in Canada.
23
@Keith
Medicare Part D pays for (a portion of) prescription drug costs. The nationwide average premium cost for a Part D plan is about $34 per month (you can Google it). Enrollment in Medicare Part D is entirely optional and has nothing to do with whether a doctor will see you or not.
11
Our people have earned the right to "Medicare for All." Let's give in another name, American Universal Healthcare.
Let our tax dollars pay for Universal Healthcare. Those of us who can pay for it, do, and those of us who can't, are subsidized until we can, if we can.
It's time to get the insurance companies, middlemen and PBM's out of our healthcare. There should be no monetary incentive involved in caring for our people.
If it works in other countries, and it does, it can work in America. It's sickening to see the level of avarice involved in our healthcare today. I want to know when I need to see a doctor or have a procedure, that my care is devoid of influence from insurance executives and PBM's whose only interest is in grinding out every last penny from my visit or procedure.
It's time to do the right thing for our people.
37
@Pamela L. I agree with you. "Universal Care" sounds like a great name!
However, as for getting all the middlemen, private insurance, PBM's and so forth out of our healthcare, it is going to be like prying a leech or tick off of someone.
All of those entities pay many lobbyists and make significant political campaign donations and they will all fight tooth and nail to maintain their business as usual.
The only way to cleanup our healthcare and insurance is to remove money from politics. That means we need to fund political campaigns mainly out of the public till, restrict political donations to something small like say $500 or less (including those lunch and dinner plate affairs) and shorten the campaigns to maybe 8 weeks maximum (which of course will get the media advertising industry upset).
Someone like Sander or perhaps Warren are the only candidates that could possibly want to tackle this mess! So why isn't anyone talking about money in campagins in the debates so far?
6
@Joseph I've heard Warren discuss it alot. She also specifically addresses overturning Citizens United on her website: We can take immediate legislative action and make big, structural changes to how campaigns are financed. But to truly end the corruption of our democracy, we must also pass a constitutional amendment to overturn the Supreme Court’s disastrous decisions in Citizens United and Buckley v. Valeo. A constitutional amendment will allow Congress to regulate election spending, establish public financing as the sole way to finance elections, and bring an end to the era of big money in politics.
7
I haven't had a raise in the last 7 years without medicare so it couldn't hurt.
23
The government does such an outstanding job handling things like road repair, public transportation, homelessness etc I can’t wait till they are in charge of my health care that should work out smoothly
10
@EAH
Foolishly short-sighted.
Some things ARE much better provided by government, and healthcare - look at the stats - is clearly one of them.
24
@EAH
Well, current Medicare recipients love their Medicare. Explain that.....
9
@Ray - Medicare has a lot of holes in it unless you buy Supplemental insurance and even then, there are still too many holes.
But compared to health plans I had over the years while working, it is a breath of fresh air.
After 3 years on it, I have yet to have any MD services or operations turned down! questioned.
9
Medicare is means tested meaning the more money you make the more you pay in premiums. Also, it's foolish to think that taxes would not rise for almost every American if we have a single payer type system. The fuzzy math people like Warren has been putting forth is very very fuzzy and inaccurate. Almost every person in Canada pays from $400 to $50K a year based on income - I saw this written somewhere a while back.
3
@Anita Your income has to be fairly large for it to cause your Medicare premiums to rise. I speak from experience because we had a large capital gain which triggered one year of high premiums.
So calling it means-tested is at best an exaggeration.
Perhaps you shouldn't believe everything you see "written somewhere".
Also just calling someone's math "fuzzy" without backing that up is utterly bogus.
17
Currently, I pay $3000/year in insurance premiums, plus an additional $3000/year to actually use my insurance in the name of copays, and Rx costs. That's with no dental or eyecare. So, even with your estimate of $400/year that they pay in Canada? I'll take it. Heck, I'll continue to pay $3000/year if it means I can get care without fighting my insurance company. Imagine scheduling a doctor's appointment and not having to pay when you get there, pay for the Rx you need, and receive that bill in the mail because you didn't meant your deductible yet. And don't give me crap about a wait time. I called the other day for an appointment and I have one for 7 weeks from now. The Dr. shortage and wait times is not as related to health insurance as insurance companies want you to think.
I don't understand why the cost of healthcare always focused on the paycheck portion. I don't know anyone who doesn't pay a copay of some sort. My friend on Medicaid pays $5 for a Dr. visit. My mother in law paid $300 for her hip surgery. But neither of them pay the $3000/premium.
And for those that can't believe healthcare prices would decrease, consider the fact that right now those with insurance are already paying for those uninsured. Medicare and Medicaid may not reimburse much, but the hospital is taking a full on loss on the uninsured. And since most hospitals have shareholders, they don't take the loss. They pass it on to others.
2
@Anita It is important to really understand the math on the large scale to the small. It is also important to look at where the benefits flow. On the large national scale, it is hard to argue against spending 11% of GDP rather than 18% of GDP. On a statewide scale, what share would be paid by employers, user fees, state taxes and federal taxes? How would that vary from what we do today? On a personal scale, how would those changes affect you?
Some people hate "taxes" so much they would rather pay $15,000+ a year in fees (health insurance costs, deductibles, etc.) than $10,000 in taxes. I have never bought the demonizing of taxes but rather prefer to look at my total spending and what I get in return.
My naive notion that we the people are the government appears to have been overtaken by corporations and their lobbyists, I continue to think we can take responsibility for our healthcare spending and delivery of services. On a large scale it will cost less and provide better service. On a personal scale, a few people may pay more. Along the way there will be many difficult decisions to craft a system that is equitable and supports both good health care and a strong economy.
1
The real problem is horrific inefficiency and parasitic profits in the US Health "care" Industry.
Americans pay about three times as much as UK citizens, for a worse service. Huge amounts of American money are spent on billing and accounting, not to mention obscene profits at every level.
None of the 90% will be better off until we cut the GREED out of the obscene American system.
51
I think we forget how many people could retire right now if they had guaranteed healthcare coverage. This would lead to more competitive job market and I believe higher wages. And more higher paying jobs for younger people.
75
@Jacob Exactly. My husband would have retired if it were not for healthcare. He will retire once I am 65.
17
Even if not retire - perhaps voluntarily taking oneself out of the job market - perhaps for elder care, child care or volunteering in areas of need.
15
Is the plan really Medicare for All?
Because Medicare isn’t free; there is a standard monthly premium for Medicare Part B, currently $144.60, which increases as income increases. Also, it pays for 80% of covered health care costs, with the enrollee paying the remaining 20% — and there is no cap on the out-or-pocket amount. That’s why many Medicare enrollees buy additional insurance (Medigap insurance) or enroll in a Medicare Advantage Plan (which are often similar to HMOs or PPOs).
But though it’s not free, it’s far better than the private market. I’ve been on both in my 60s.
32
@Dr. J Medicare can cover whatever Congress determines it can cover, it is not set in stone. Coverage included in Medicare For All will reflect what the enacting legislation says.
14
@Dr. J - Bernie's plan is IMPROVED Medicare for all. No co-pays or deductibles, mental, drugs and dental coverage, etc. Google it.
And it still will be a hellofa lot cheaper than what we have today.
1
When budgeting each year, public sector employers here in Florida plan on 30-40% per employee for benefits. If they didn't have to pay that cost, I don't think they would put that money into salaries.
4
But unions could negotiate for higher raises. I was a union member during most of my career. Health insurance always meant lower raises.
6
@Zejee As a lifelong union member, I couldn't disagree with you more.
Healthcare costs are a huge drag on the US economy. Breaking the tie between employment and health coverage will have a positive impact on employee mobility. In a tight labor market, this should allow wages to rise a bit more (and maybe increase entrepreneurship). More importantly, if we can get healthcare's share of GDP down to more reasonable levels (each 1% is $200B), investment will likely rise, and with it (we hope) productivity. That is, until Republicans find a way to siphon off the proceeds and give it to the 70 or so families who own the party.
55
@Mike
Maybe, maybe not.
You cannot simply ignore the power of special interests to take any great plan of politicians and turn it into an ineffective rube-goldberg system that benefits special interests and not actual American's healthcare.
1
The Upshot claims: "Ultimately, someone would have to pay for Medicare for all, so not everyone would be better off."
This ignores the glaring fact that in every other developed country per capita healthcare costs are half those in the United States, or less, while outcomes are vastly better for the entire population.
Further, it is clear that most workers and families would be better off with universal healthcare offered by the government, because today's system administers healthcare costs in the form of a poll tax: most people are charged healthcare costs irrespective of their incomes. So, as Emmanuel Saez points out in his book, "The Triumph of Inequality," the middle class, when healthcare costs are calculated in, are suffering under an effective tax rate of 40%, vastly higher than for the wealthy.
Freeing up the working and middle classes from this devastating burden of high healthcare costs, whether born directly, or indirectly in terms of lower wages, will produce income that can be used for far more goods and services that are out of reach now.
Universal healthcare is not a "cost" to the society, or to some, but a boon to the entire economy.
106
@Sean
It is not clear that M4A would be a better system, as opposed to say, M4A-who-want-it. I will not dispute your passion for the subject, but I will say that you are making a subjective argument based on your own personal views. The literature, as evidenced by this article, is quite split on the real benefits and costs of M4A.
That something like M4A works elsewhere is irrelevant because the success or failure of a government administered system is inherently tied to the form and function of THAT government and it's citizens historical relationship to it. You can't just import the Swedish or Danish system here and expect that it will work. Americans have a historical bias against big government and an even more bias to hold onto the freedom to choose what is best for them.
I, for one, do not find your argument convincing and am not ready to give up my right to choose the best healthcare option for me and my family.
4
@Sean wrote: This ignores the glaring fact that in every other developed country per capita healthcare costs are half those in the United States, or less, while outcomes are vastly better for the entire population.
While true.. this is by virtue of having said national health plans in place for decades now.. while the US has perpetuated a for profit private approach for the most part.
Putting a national health care system in place in a nation as large and diverse, and business profit oriented as the US... IS NOT going to suddenly normalize health care costs to that of peer nations. Too much momentum for too many years in the US system for that to happen overnight, or even within 5 years. It would take at least a generation of running such a plan to effectively contain costs and bring them down modestly year over year.
We are talking about a 4 trillion dollar beast here. Not to mention, history has demonstrated that republicans will spend inordinate effort and time to chip away at any such system at the same time and pace as the new system is attempting to bring down health costs over the long term.
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@John - And when you reach 65 will you go looking for a private healthcare plan?
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A further aspect of employer-supportef health insurance economics is the fact of underlying tax expenditure. The employer benefit is not taxed as income. As with any other tax expenditure, someone else has to pay for the taxes not collected on that income - either current, or in the future, through debt service. In addition, all of the cost of health insurance for public (federal, state, county, city, military) employees is already paid for, except for the worker contribution, by tax dollars.
The tax increase issue is largely a red herring. It's more a re-distribution of tax liability, accompanied by a probable decrease in the cost per person covered, that is more likely to happen. So the effect on after-tax income, as opposed to pay, is what the focus of discussion should be.
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It is nonsense to suggest that employers will voluntarily use freed-up funds to pay employees more.
While that might happen in isolated cases, it is hardly likely for most employers, especially large corporations, to share their new-found wealth.
And even Bernie Sanders has had to admit that taxes will have to go up for the middle class in order to pay for Medicare for All.
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@Mon Ray Bernie Sanders has pointed out that while premiums paid to the government to finance universal healthcare will go up, premiums paid to for-profit insurance companies will go down, or disappear. That means Americans will pay far less for their healthcare.
Indeed, Senator Warren's plan estimates that the American people will pay $11 trillion less over the next decade than it would with the current system.
$11 trillion. Less. That is a great deal.
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@Sean And at what cost to retirement plans that have invested in healthcare? Watch the market effects.
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@Margo They'll invest in something else.
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The short answer to your headline question is no if done right.
Just about every other peer country has figured it out. They have universal, quality, affordable health care for all their citizens.
The trick for almost all of them is to have a mixture of private enterprise and gov't control which just about all of them have.
if you go too far toward private enterprise you have the current de facto criminal system that we have.
If you do what England does, go too far to the other side, you have a bureaucratic mess that is constantly in financial trouble.
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"Unionized workers are better able to bargain for higher compensation than individual workers, who are more easily let go and replaced with others."
Ergo, (R)onny and the (R)egressives decided it was high time to kill off those nasty unions.
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Even if wages don't go up, I'd rather pay for healthcare that can easily travel between jobs than one that isn't that great and goes away if I leave my current job
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@Leah
That's your preference, and it comes down to having the ability to choose that option versus someone making the choice for you.
I actually prefer my current employer sponsored healthcare than anything that medicare or M4A will provide. Again, that's my choice.
Any candidate that wants to take away my right to choose (looking at you Bernie and you Liz) will not get my vote, period.
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@Leah
It is nonsense to suggest that employers will voluntarily use freed-up funds to pay employees more.
While that might happen in isolated cases, it is hardly likely for most employers, especially large corporations, to share their new-found wealth.
And even Bernie Sanders has had to admit that taxes will have to go up for the middle class in order to pay for Medicare for All.
@John
But here's the catch, John. It is more expensive for your company to continue your private health insurance (the insurance cost has to come out of that employer money) than for your company to pay, in taxes, for you to be covered by medicare. It is all of the money companies are paying to insurance companies for private health insurance that we need to cover everyone via medicare for all. And why do you care? I've found that all of my doctors continued to treat me under Medicare after I turned 65. It made no difference to me who was paying my medical bills.
Anyone who thinks that employers will pay their employees more if there is government provided health insurance should put a bid in for a certain bridge in New York City.
Under some plans the amount companies pay for health insurance would be redirected to the government to keep the cost to taxpayers down. And the only way that the companies could be forced to raise employee pay if they could keep the savings would be a mandated salary increase, which could be offset by replacing the current workforce.
The golden rule is that he who has the gold makes the rules, and that the rules guarantee that he who has the gold gets to keep it.
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Employees may or may not receive higher wages. Missing is a consideration that the new payer, the government, picks up the tab. Government as in the taxpayers pick up the tab. Thus either more personal taxes or more corporate taxes, the wage earner is effected. Or deficit borrowing which pushes the amount to be paid into future generations. There’s no free money here, only redistribution of where the money comes from. In the end the taxpayers carry the burden for government spending. It’s more difficult to see with the federal government as they can print and borrow money, as well as being further removed from us. Closer are state and local governments. These governments can’t print money and have borrowing restrictions as well as budget deficit restrictions. Witness the state of New York, whose generous Medicare provisions are being attributed as causing its massive budget deficit, drawing money from other line items and ultimately raising taxes.
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@Byron
You are correct, it is all about the redistribution of money. I would like to see a higher minimum-wage, and better benefits all across-the-board then more billionaires. The Trump administration is clearly into making billionaires of friends and family. They are leaving us with a legacy of corruption from the very top of our government right down to the very bottom. It’s disgusting. And if that isn’t bad enough, thanks to hypocritic political expedience of the greed of their prosperity gospel, they have killed Christ’s reputation and it won’t be rising again in three days.
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If Democrats have enough sway to get Medicare-For-All enacted, I suspect they will also have enough sway to legislate that any employer savings on healthcare be matched dollar for dollar with wage increases. Not sure how that would be implemented, or even if constitutional, but they will try.
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