Remembering TCPaul, 2016-2019

Medicare for all

Looks like this is going to be a big issue in the next elect jdusolo01/29/19
One word: Socialism Boom case eviscerated! onefortheteam01/29/19
simply cannot understand opposition to this. ignorance kenco01/29/19
Socialism killed Ronald Reagan or at the very seriously maim onefortheteam01/29/19
Fine with me, but you have to cut immigration drastically. serbexo01/29/19
illegal immigrants would not get a Medicaid for all card. Le johnsmith01/30/19
Let's start with California. imoothereforeim01/29/19
I think we need something more like "VA for all" than "Medic onehell01/30/19
The US needs to embrace the developing world here. In LAT superttthero01/30/19
As I said above, you are absolutely right and in fact this i onehell01/31/19
Well actually working in California I can tell you what the bigsal01/30/19
The current medicare system has unfunded liabilities somewhe normshow01/30/19
Medicare for some, miniature American flags for others! A jorgedeclaro01/30/19
Let’s see a state, or multiple states do it successfully. rastaman01/30/19
Then present a way to pay for it. Take all the money pe johnsmith01/30/19
And Medicare for all people seem to be forgetting Medicare d jorgedeclaro01/30/19
There is a big reason big pharma and bug insurance and the m bigsal01/30/19
I think of it more with reference to the idea that Medicare onehell01/31/19
Why would you do that??? Take money from ppl perfectly capab rastaman01/31/19
someone who has insurance today might not have it tomorrow. johnsmith02/01/19
Just throwing out universal medicare seemed a misstep for Ka trijocker01/30/19
People against it often say, like Rasta, "let's see a state superttthero01/30/19
also, states cant do it because the fed would still make eve johnsmith01/30/19
Still not enough money. massivemissive01/31/19
I would happily trade Medicare for all for deporting all ill eagleton01/30/19
And a minefield. shuiz01/31/19
I want single payer, but there are many, many factors that m brokelawyer01/30/19
Yeah, ok. None of this makes any sense. midlaw01/30/19
I think it's just a slogan, like build the wall. But I could frida201/31/19
This pretty much nails it. Good post. batman01/31/19
I get the sense that when most people say they want a single massivemissive01/31/19
DRGs are an ineffective half-measure, like bundled payments. onehell01/31/19
“Having the government cutting insurance claim checks to p midlaw01/31/19
Medicaid is a mixed bag. States design their own programs so onehell02/01/19
I've actually worked at a VA hospital. It was the most bure massivemissive02/01/19
HAHA. This really isn't funny. But my wife interns at th captain02/01/19
Again, the conclusion does not follow from the premise. You onehell02/01/19
It does follow. What confidence should we have that it wou massivemissive02/02/19
yes, you would have to raise taxes on the middle class. But johnsmith02/01/19
the dirty secret is that countries with universal health car dingbat02/01/19
He said "taxes on working and middle class," which means pos normshow02/01/19
you're forgetting state taxes. Note: every country has prog dingbat02/02/19
Yea maybe if nobody had to pay for private health insurance normshow02/03/19
the biggest problem with the cost of health care is not who dingbat02/03/19
I would gladly pay $2000 per month extra in taxes to fund a jdusolo02/01/19
This. 180. midlaw02/02/19
If you want Medicare for all, it doesn't increase the amount normshow02/01/19
So you wouldn't mind if you had to wait behind a bunch of me bangbus02/03/19
I haven't worked out the details but there's gotta also be s normshow02/03/19
there is no shortage of resources in the U.S. There are a l dingbat02/04/19
Excellent inside the box thinking bangbus02/03/19



jdusolo (Jan 29, 2019 - 1:54 pm)

Looks like this is going to be a big issue in the next election.
https://www.cnn.com/2019/01/29/politics/harris-private-insurance-medicare/index.html

I have pretty good insurance through the state but am fully on board with this. I've had experience with a type of Medicare for all (lived in Northern Europe for a little bit) and simply cannot understand opposition to this.

Could some kind jdu'ers educate to me as to why they oppose this?

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onefortheteam (Jan 29, 2019 - 2:13 pm)

One word: Socialism


Boom case eviscerated!

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kenco (Jan 29, 2019 - 2:44 pm)

simply cannot understand opposition to this.


ignorance is bliss

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onefortheteam (Jan 29, 2019 - 2:51 pm)

Socialism killed Ronald Reagan or at the very seriously maimed him.

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serbexo (Jan 29, 2019 - 2:36 pm)

Fine with me, but you have to cut immigration drastically.

If the denominator (people) keeps growing, the numerator (money) must too. Eventually you run out of money.

Generous welfare state, open borders. Pick one.

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johnsmith (Jan 30, 2019 - 2:01 pm)

illegal immigrants would not get a Medicaid for all card. Legal immigrants often pay taxes.

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imoothereforeim (Jan 29, 2019 - 3:15 pm)

Let's start with California.

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onehell (Jan 30, 2019 - 11:59 am)

I think we need something more like "VA for all" than "Medicare for all."

The largest single-payer system in the world, UK's NHS, doesn't just pay for treatment - they provide it. They own the facilities and employ the nurses and doctors. Private healthcare exists in parallel with the NHS and is mostly paid for with private insurance.

Medicare for all would be quite different from the NHS model because you'd primarily just be writing checks to private providers. You'd have more leverage to negotiate rates but it's still fundamentally an insurance/indemnity model.

people would have to get accustomed to the idea that they can't just go wherever they want unless they pay for it privately, but an NHS style model would be better.

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superttthero (Jan 30, 2019 - 2:16 pm)

The US needs to embrace the developing world here.

In LATAM, a lot of countries have supposed top tier private system where 10-20% of the population gets immediate customer service minded care. The rest of the masses go to ugly city hospital/clinics and get adequate services. Emergency services are paid either at the city hospital/clinics or reimbursed at the private places if that's where you ended up and couldn't be transferred.

The problem here is that LAWs in the middle/lower/working classes think they are above it and rather go bankrupt when an illness hits or rather go without medical care till it's too late than have to go to the same hospital as someone they consider beneath them. That or any idea that is remotely social in nature and they shriek like its the end of the world.

Agree with sexbersexobro in part. We need to tackle illegal immigration more directly as a condition and requisite to a good social network of services, and to reform legal immigration.

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onehell (Jan 31, 2019 - 12:12 pm)

As I said above, you are absolutely right and in fact this is not confined to the developing world. Again, the largest "single-payer" system in the world is the UK NHS and it is not really "single payer" so much as a "single provider" system, where the government owns the actual hospital or clinic rather than just paying insurance claims to it and the docs who have privileges to practice there. The docs are just government employees paid a salary, like the VA system on a massive scale.

And yes, this creates a two-tiered system where people who can afford it may go outside the national system, either by paying cash or securing private insurance. But we already have a tiered system, it's just that people with a blue cross and/or Medicare card consider themselves to be in the upper tier and don't want to lose that status. And in fact, people with significant disposable income already bypass insurance entirely even in the US, as is seen with the rising popularity of "concierge medicine" all-cash practices. As you rightly said "adequate care" provided within a nationalized system might not be a "customer-service focused" experience, but there's not much evidence that the actual outcomes are any worse and in fact they're often better.

Plus, people in the USA who *think* they have great insurance and are thus some kind of VIP are often surprised when they go to an in-network hospital but the doctor they see is out-of-network and then they get "balance billed" for the professional services, often in amounts that are downright bankrupting. Only people on Medicaid are fully protected from that, so the status a lot of middle class people currently think they have isn't as good as it appears, because while an ordinary doctor visit might be a very pleasant experience, in an emergency they can be very surprised as to how little protection their blue cross card provides when they need it most. That's because the insurer will only pay X, but if the provider is not in-network, they have no contractual right to limit the charge to X and thus the provider is free to charge whatever they want, take whatever insurance pays, and pursue the patient personally for the difference.

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bigsal (Jan 30, 2019 - 3:07 pm)

Well actually working in California I can tell you what the hundred percent certainty that undocumented people will only get whatever services are provided to them by the state. They will not get Medicare they are not entitled to a cent from the federal government.

However because of emtala they have to be treated wherever they present and to be honest it would be super inhumane and quite disgusting to not treat them when they pop into an emergency room regardless of their immigration status.

Consequently I have no freaking clue what this discussion has to do with immigration other than to divert it from the obvious logical conclusion that we need socialized medicine.

America is the richest nation in the world and unable to do what broke-ass Cuba can do come on.

If you want to have a intelligent discussion on costs let's start talking about limiting the upcharge that patients have to pay for Abilify or for say tetrabenazine or other random drugs that have been around forever

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normshow (Jan 30, 2019 - 3:16 pm)

The current medicare system has unfunded liabilities somewhere north of $40 trillion. Possibly hundreds of trillions of dollars have already been promised to people in the future, but the money does not exist. This goes unaddressed in every election cycle because the plan is to get elected, ignore it, and then have someone else deal with it in the future.

This will eventually overwhelm the government's budget as the medicare expenses go up every year (as do the $300 billion+ interest payments on the national debt). It isn't a matter of whether or not you think it is a good idea, it is a matter of how they are going to realistically execute this plan and have it sustainable long-term.

Even phrasing it as "why do you oppose this" is wrong-headed. Is there a plan that has been presented that makes any sense long-term? If no, then they can pass as many programs as they want, but it will inevitably end in crisis.

The reason to oppose it is because Medicare has already driven up prices for medicine because costs are not contained the way that automobiles or food, things that are subject to market forces, are contained. People are way too emotional to discuss this issue... "but it helped grandma get surgery." Sure, many people have been helped by Medicare, but that temporary assistance comes with long-term unplayable debts that the government will continue to pretend don't exist.

The reason not to bother having this conversation is because the entire medical and insurance system has been messed up for decades, so if I raise these points, people accuse me of loving the system that existed in 2007 and proclaim that the free market failed. This reveals that people love to spout off but have no interest in understanding the problems with the current system. But people just want to argue and say that I am evil and I don't care about grandma if I raise the point that Medicare is an expensive failure that never made sense in the first place and has contributed to the never-ending political fight over who gets to live and die.

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jorgedeclaro (Jan 30, 2019 - 3:19 pm)

Medicare for some, miniature American flags for others!

As Brandeis said, states are supposed to be laboratories of democracy for liberal policies which will eventually become constitutionally mandated by a future Warren Court. Let’s see a state pull off Medicare for all.

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rastaman (Jan 30, 2019 - 3:30 pm)

Let’s see a state, or multiple states do it successfully. Then present a way to pay for it. We are running HUGE deficits, and Medicare/Medicaid are a major component to that. It’s easy to claim “let’s raise taxes.” But ok, put forth a plan that raises taxes-to include on the poor and middle class as they would benefit the most.

Also, this is something to consider-the R&D done in the medical world is fielded largely by the huge profits and revenues of the mostly private medical industry in this country. What happens to the worlds brain trust when this money goes away?

Also, basic supply and demand-if you want to push prices down, we are going to need more doctors, etc. what’s the plan for that.

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johnsmith (Jan 30, 2019 - 5:16 pm)

Then present a way to pay for it.


Take all the money people and their employers pay towards premiums for health insurance. Add to that all the money we pay for medicare, Medicaid, VA care, child health plus, etc.

Everyone seems to forget that we wont be paying monthly premiums under a medicare for all. We can put that money everyone used to pay for their health insurance premiums and put it towards medicare for for all

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jorgedeclaro (Jan 30, 2019 - 7:45 pm)

And Medicare for all people seem to be forgetting Medicare doesn’t pay for everything. You’re taking every health care dollar spent anywhere in the country to pay for a program that pays about 50% of total healthcare expenses for people on Medicare.

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bigsal (Jan 30, 2019 - 8:43 pm)

There is a big reason big pharma and bug insurance and the maga rethuglicans dont want it....it will make the insurance companies less profitable and will reduce costs.

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onehell (Jan 31, 2019 - 2:07 pm)

I think of it more with reference to the idea that Medicare is not completely free to the patient. You have to pay your part B premium for non-hospital services, and you need to buy Medigap to fill the donut holes and Part D for drugs. I don't think of this as "medicare not paying for everything" so much as just the idea that there are some things for which there is a premium.

Alternatively, you can also sign up for a Medicare Advantage plan, where you basically trade comprehensive coverage for a narrow network offered by a private but Medicare-contracted health insurer. Some of the MA plans that have especially narrow networks will even charge no premium at all beyond what you already have to pay for Part B, though these options will typically have especially narrow networks. Once in an MA plan though, you get it all. Parts A, B and D, plus what is in effect a medigap policy. It's all just kinda bundled. You'll see MA plans marketing themselves all over the place: On TV, at kiosks in malls, some of them even throwing in freebies like gym memberships or whatever. It's a competitive marketplace.

Finally, if you're too poor for any of these things you may qualify for Medicaid too. If so, you become a "dual eligible" meaning you have both Medicare and Medicaid and Medicaid picks up whatever Medicare doesn't. On the Medicare side, dual eligibles can also enroll in a D-SNP (a dual eligible special needs plan) which is a special medicare advantage plan for people on both medicare and Medicaid.

And if you're still working or your former employer provides retiree insurance, you can also supplement Medicare with private insurance.

So Medicare can get you everything, albeit a bit indirectly, but how much that's going to cost is going to depend on how much freedom of choice you demand, and your MA plan options will vary depending on where you live.

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rastaman (Jan 31, 2019 - 9:51 pm)

Why would you do that??? Take money from ppl perfectly capable of paying for medical care on their own? The uninsured have the most to gain-how would we get them to share in and absorb some of the costs? Get rid of EIC? Other forms of welfare?

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johnsmith (Feb 1, 2019 - 11:03 am)

someone who has insurance today might not have it tomorrow.

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trijocker (Jan 30, 2019 - 3:32 pm)

Just throwing out universal medicare seemed a misstep for Kamala
Trumpsters will label her a socialist, just like they did Andrew Gillum.
Why didn't she do more research about or give some thought to what most of America thinks before speaking. Going way to the left will just alienate the Trump base.
She should have given more thought to realistic alternatives before just throwing it out there, yeah Universal medicare, why not?

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superttthero (Jan 30, 2019 - 3:35 pm)

People against it often say, like Rasta, "let's see a state do it."

I don't think a state could unless it could prevent deadbeats or the very sick from other states moving to poor areas of the state just for the free healthcare. If any states or a group of states did this, it would get a flood of sick or uninsured people's coming.

This is why, and I said it above, as a nation, strong immigration policies and a strong border are necessary if we want a strong social safety net and social programs. Can't have ultra-liberal immigration policies and lots of nice tax-paid for services.

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johnsmith (Jan 30, 2019 - 5:18 pm)

also, states cant do it because the fed would still make everyone pay taxes towards medicare/Medicaid. You'd be paying taxes for federal medicare/Medicaid and paying for your states universal healthcare program at the same time.

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massivemissive (Jan 31, 2019 - 12:45 pm)

Still not enough money.

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eagleton (Jan 30, 2019 - 5:24 pm)

I would happily trade Medicare for all for deporting all illegal immigrants and an immigration moratorium.

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shuiz (Jan 31, 2019 - 2:50 am)

And a minefield.

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brokelawyer (Jan 30, 2019 - 8:54 pm)

I want single payer, but there are many, many factors that make Medicare for All impossible. Start with the cost. Move on to the doctors and PI lawyers, who have powerful lobbies to fight this. The unions will fight extremely hard too. Next we will have to repeal ERISA, and the existing plans will be a logistical nightmare. Do we divert federal funding to existing state agencies? Another nightmare beyond comprehension.

It's like "taking all the guns" or "deporting all the illegals." There just ain't no freaking way to do it.

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midlaw (Jan 30, 2019 - 10:17 pm)

Yeah, ok. None of this makes any sense.

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frida2 (Jan 31, 2019 - 8:53 am)

I think it's just a slogan, like build the wall. But I could see us actually getting a Medicare buy-in option for people under 65. Basically it would just be another insurance option, that is reasonably priced. That would not be very disruptive to the healthcare market.

Conservatives being scared of Medicare for all is just as silly as someone thinking we're getting a wall along the entire southern border.

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batman (Jan 31, 2019 - 4:54 pm)

This pretty much nails it. Good post.

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massivemissive (Jan 31, 2019 - 1:02 pm)

I get the sense that when most people say they want a single payer system what they really mean is that they want universal care. Most European countries either never had a single payer system or no longer have single-payer systems. Most are basically social insurance systems.

A single payer system such as Medicare for all (or worse, a VA system for all) would simply multiply the cost inefficiencies these systems already inject into the healthcare market. Does anyone really think that DRGs are cost saving rather they just costly?

If the Dems want to get universal care here in the USA it would be helpful if they were more precise about the goals. That is, the political message ought to be improving social insurance rather than forcing everyone to get Medicare (which isn't free anyway, just ask some old people).

The dirty secret though is that countries that have universal healthcare are only able to afford it by massive taxes on the working and middle class. Sorry, I know all you lefties have this fantasy that taxing all of the rich people will do it, but the math doesn't work that way (plus, the rich are just too powerful to allow that to happen anyways).

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onehell (Jan 31, 2019 - 4:49 pm)

DRGs are an ineffective half-measure, like bundled payments. If you really want to move from paying for volume to paying for value, you need to move to capitation. So I agree that they're not good, but not because the notion is a bad idea. It's just that half-measures may be worse than nothing, but in no way is the traditional fee-for-service volume based payment system defensible. It's just easier, like paying by the pound at the grocery store. The providers get paid the more they do, the regulators understand a "pay and chase" system that lets them throw up seemingly impressive fraud recovery numbers, and the payers can negotiate rates for codes which is what they know best.

As to saying "VA for all" would raise inefficiencies, I don't necessarily think so. This is not a problem "the market" can solve. Yes the government should own the hospitals, and then it should concentrate on improving them. Having the government cutting insurance claim checks to profitseeking private companies instead of just running it themselves has already proven that it is not a solution. Just because the current government-run hospitals have not necessarily been fantastic either means nothing other than that the government-run hospitals need improvement. "The government sucks at doing X, therefore the private sector would do it better" is a case of "the conclusion does not follow from the premise."

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midlaw (Jan 31, 2019 - 10:02 pm)

“Having the government cutting insurance claim checks to profitseeking private companies instead of just running it themselves has already proven that it is not a solution”

And yet this is done the world over at much lower cost than in the US. It is also done by Medicare (and Medicaid) two of the more efficient segments of the health care economy. Onehell is talking his book here.

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onehell (Feb 1, 2019 - 1:09 pm)

Medicaid is a mixed bag. States design their own programs so some are great and others not so much, and they all have strengths and weaknesses in different ways. Medicaid is also straining under the weight of moving from a safety-net program to one which insures a significant portion of the population.

Medicare is a confusing mess. Part A, Part B, Part D, Medigap, Medicare Advantage plans. There are entire industries of counselors to help new enrollees figure out how to navigate Medicare, many paid to sell supplemental policies or MA plans. And it's just as confusing for providers and hospitals, filled with compliance traps where practices that are totally normal in every other industry, such as referral arrangements and even leases, can get you thrown in jail if you're not careful. Take a look at a Medicare Cost Report sometime and tell me it's an efficient system.

And incidentally, none of this is in my own self-interest. A lot of this complexity is what keeps me employed. Doesn't mean I think it's a good thing for society.

Plus, again, it's not so much the world over. Most of the care the NHS provides is given at its own facilities. A healthcare system that is based on indemnifying people against costs charged by private, for-profit operators is not the norm. It's a weird artifact of a WWII-era wage freeze that led employers to come up with the idea of offering health insurance.

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massivemissive (Feb 1, 2019 - 10:36 am)

I've actually worked at a VA hospital. It was the most bureaucratic, inefficient, poor delivery of care system I've ever experienced or could dream of.

Let me tell you a story. My first day at the VA I was shown my office. I observed that my new office didn't have a trash can. I asked where I could get one. I was told to fill out a form in triplicate and the trash can would be delivered in 6 weeks.

Yeah, the VA is not what we want for our healthcare. Trust me.

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captain (Feb 1, 2019 - 11:13 am)

HAHA.

This really isn't funny. But my wife interns at the VA right now, and this is 100% spot on.

She was assisting a doctor perform some very mundane procedure - something that would take 1 person about 15 minutes to do. But the rule was that they needed a doctor present, some kind of slp assistant and a note taker (3 people!). Her job was to go find those three people. Apparently they were all in a break room in the hospital playing on their phones. When she asked one of them to come and assist, there was a big fight about whose turn it was.

The procedure had to be postponed and the vet - who all the while was expressing his desire to be put out of his misery - was wheeled back to his room.

This is just a sliver of what goes on at the VA - and I assume other government agencies - EVERY DAMN DAY.

This is why I have such a problem with folks that mindlessly push tax increases. They have no idea how inefficiently these dollars are being spent. They have no idea that increased taxes for VA, schools, etc, just go into a giant pit of worthless government bureaucracy. I get that their heart is in the right place. Sure, if money fixed some of these societal woes, I'd be on board too. But it really won't and hasn't.

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onehell (Feb 1, 2019 - 1:03 pm)

Again, the conclusion does not follow from the premise. You are basically saying "current VA system sucks, therefore, any government-run healthcare provider would suck."

It reminds me of the decision to close all the mental asylums as part of the deinstitutionalization movement. The places were terrible and abuses were rampant, but just closing them resulted in those same people ending up in jail.

We should have reformed the mental hospitals, not just shut them down. Same premise here. No one is saying the quality of something like the VA is fantastic, but this is not an inevitable result of government running anything as many people seem to think. The postal service is an example of a government enterprise which is able to serve the entire country and even compete successfully with private-sector alternatives. This idea that government is fundamentally incompetent at anything it endeavors to do is not necessarily true, or it is made into a self-fulfilling prophecy by the way things are funded.

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massivemissive (Feb 2, 2019 - 11:40 am)

It does follow. What confidence should we have that it would be any different?

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johnsmith (Feb 1, 2019 - 11:06 am)

yes, you would have to raise taxes on the middle class. But the middle class would no longer have to pay premiums every month.

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dingbat (Feb 1, 2019 - 1:43 pm)

the dirty secret is that countries with universal health care don't have ridiculously high taxes.

In the U.S. the top marginal tax rate is 37% federal, but most states add a state income tax. 30 states charge 5% or more. More than three quarter of the country has a combined marginal tax rate of 42%+

That's higher than England, France, Norway, Switzerland (40%) Iceland and New Zealand (37.2%, 38%), and only barely behind Spain and Italy (43%), Germany and Australia(45%), and Ireland (46%). And don't forget that those countries all subsidize higher education too.


As an aside, there are only four countries in the world with a top marginal tax rate over 50%, Cameroon, Denmark, Sweden, and The Netherlands.

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normshow (Feb 1, 2019 - 8:37 pm)

He said "taxes on working and middle class," which means posting the highest tax brackets isn't the relevant statistic.

The UK income tax rates and brackets for 2018/19 are:

Personal allowance - Up to £11,850 - 0%
Basic rate - £11,851 to £46,350 - 20%
Higher rate - £46,351 to £150,000 - 40%
Additional rate Over £150,000 - 45%

The conversion is a little off because of pounds vs. $$, but equivalent tax brackets in US are 12% (down from 20%) and 22-24% (down from 40%).

46k pounds = 60k $$, so every dollar above $60k would see a massive (close to doubling) on taxes. I'm guessing it is similar for the other countries you posted, but you just proved massivemissive's point that it would be a giant tax increase on the middle class.

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dingbat (Feb 2, 2019 - 10:18 pm)

you're forgetting state taxes.
Note: every country has progressive taxes, and the curve does vary from country to country. In France, from 26k euro to 71k euro it's 30%. In Norway, tax on ordinary income is 23% (Switzerland is canton-specific, so it varies a lot depending on location)

More importantly, you're also forgetting the cost of private health insurance, which most people would be able to stop paying.

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normshow (Feb 3, 2019 - 10:52 am)

Yea maybe if nobody had to pay for private health insurance anymore then it could work out better. But then why bother with Obamacare, which clearly doesn't solve the problem, instead of directly passing a single payer law? That strikes me as a very dishonest approach, yet that is the mainstream opinion.

Looking at the numbers, America's tax system seems a lot more progressive than the UK because the burden is clearly much more heavy on the middle class in UK.

In America the middle class get a much larger break because the higher tax brackets don't start until $150k, but there is a huge jump to 40% at $60k in UK.

None of this makes any sense to me when people continue to ignore the current unfunded liabilities of Medicare. Above, a poster referred to Medicare as one of the "more efficient" segments, but he really can only make that claim by ignoring the $50 trillion+ of unfunded liabilities that become a major burden over the coming decades. It is only efficient in the sense that they don't fund it honestly, plan to accumulate $infinite debt and pray that it works out somehow, and then walk around calling it efficient.

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dingbat (Feb 3, 2019 - 2:19 pm)

the biggest problem with the cost of health care is not who pays for it (private insurance, medicare, etc.), but why it costs so much. Every aspect of medical care in the U.S. costs significantly more than in the rest of the developed world.

Without solving that, the rest is irrelevant.

Medicare-for-all may put some downward pressure, but it would only be a small part of the solution

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jdusolo (Feb 1, 2019 - 1:56 pm)

I would gladly pay $2000 per month extra in taxes to fund a "Medicare for all". Thats what my employer and I pay in premiums anyway so shouldn't really affect my take home.

Of course the rub will likely be in what I get in return but the fact that I can take 6 months off from my job or switch jobs or even retire early without batting an eyelid about my health is something I really value.

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midlaw (Feb 2, 2019 - 1:34 am)

This. 180.

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normshow (Feb 1, 2019 - 8:30 pm)

If you want Medicare for all, it doesn't increase the amount of medical resources available, so they have to decide how to apportion the access to doctors, equipment, and pharmaceuticals. I propose that everyone gets ranked by body fat %, so the higher body fat %, the further down the waiting list you go. Let's get some incentives going!

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bangbus (Feb 3, 2019 - 1:34 am)

So you wouldn't mind if you had to wait behind a bunch of meth addicts...and...upperdecker?

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normshow (Feb 3, 2019 - 10:44 am)

I haven't worked out the details but there's gotta also be some option for people to pay to skip the line. Doesn't really make sense to me to make it illegal for someone pay for their own surgery if they want to, which is implied in a totally government-run system.

I just want to emphasize what seems to always be lost in this conversation, which is that switching to a government-run system doesn't create more resources, so there will always be a way to ration out the medical services. People talk about single payer as if it means that everybody gets all the healthcare services they need, but if there's a bunch of overweight people causing their own health issues, treating them naturally becomes a large % of the expenditures.

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dingbat (Feb 4, 2019 - 11:17 am)

there is no shortage of resources in the U.S.
There are a lot of factors that artificially raise the costs.

see e.g. Mylan, or Turing Pharmaceuticals

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bangbus (Feb 3, 2019 - 11:04 am)

Excellent inside the box thinking

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