"Nothing says 'fascist' more to Americans than denying them choice, especially choice over something as personal as health insurance."
Political Scientist Peter Lemieux
Medicare for All holds out the potential of dramatically reducing health care costs. Even the conservative pro-Trump New York Post posts an op-ed noting insurance costs are out of control.
Let me introduce it by noting that the employer premium for single coverage for an employee in 2017 is $6,690, and for family coverage is $18,764. And most of these plans have deductibles and co-pays to limit costs. Those costs are imbedded in personnel costs for an employer.
Under any system, someone is going to pay some large amount of money. Even if Medicare for All reduced overall costs by 30% while expanding coverage to everyone and adding the dental, vision, and mental health benefits widely discussed--an extraordinary achievement if it were to happen--it would still mean an extra $13,000 cost per family.
It is being discussed as inevitable new taxes on the middle class.
Yesterday this blog suggested that Medicare for All proponents focus on the employer saving, with the benefit being rebated in the form of W-2 wages (perhaps excluded from taxation.) I warned that the risk of losing something known--ones current employer-subsidized insurance--plus the prospect of higher taxes--all combined to make Medicare for All frightening for many.
Change the focus, this blog argued, from taxes to wage increase--a net plus for all but the wealthiest Americans.
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| Lemieux, age 17 |
Peter Lemieux was a classmate in college. He is a political scientist, with a Ph.D. from MIT. He taught there an at the University of Rochester, where his courses and research focused on political behavior, particularly voting. He also taught statistics for political scientists. He shares some of his work at his website: His work is rigorous and statistical.
The photograph is from the Freshman Register, what people in 1967 used before Zuckerberg morphed it into something bigger.
Guest Post by Peter Lemieux
You'd have to have a much greater level of trust in government than most of us do to believe that personal savings on private insurance would offset the massive tax increases required to finance a nationalized system. We just gave a massive gift to the wealthiest among us in the 2018 tax reform. Why would we imagine that taxes for national health insurance would be imposed in a fair manner? We can't even get rid of the ceiling on FICA-taxable earnings, something that would make it much easier for Social Security to survive in an era where the number of retirees grows faster than those paying taxes to support them.
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| https://www.politicsbythenumbers.org |
The same arguments apply to a carbon tax, whose economic basis was reiterated just today by economist Justin Wolfers on Twitter:
https://twitter.com/JustinWolfers/status/1175161296037261312
Tax-and-subsidy schemes make sense as a matter of economic theory, and I generally subscribe to them in theory. But I don't see our government as sufficiently well-intentioned to distribute those tax proceeds to those most injured by the tax. Does anyone really think the US government would redistribute the proceeds of a carbon tax to subsidize poorer households facing an increase in their heating costs? I don't, and I suspect most Americans don't either.
Trump has been quick to subsidize farmers for the costs imposed by his stupid tariffs. Do you think he would have reacted the same way if those bearing the costs were poor people living in Illinois or New York?
I think Warren's adherence to her insurance plan is her biggest liability as a candidate in the general election. (Supporting decriminalization of border crossings is her second biggest liability). I hope she recants and adopts some flavor of the public option. Otherwise I worry that she cannot be elected. She needs to do this gracefully and soon. It will only become more difficult to explain a shift in position as we get closer to the election."
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Note: Readers who want details on the recent cost of health care embedded in personnel costs might consult this report by the Kaiser Family Foundation. It provides authoritative information the burden to employers--which simultaneously provides a political and fiscal opportunity. Someone will benefit if that burden is off loaded.
http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2017
7 comments:
What if Peter Sage offered to pay for free health care for anyone who lived under his roof? Right now, only Peter and his spouse live under that roof, so he only pays for health insurance premiums for two. What if Peter left his front door open, and invited all 220,000 Jackson County residents to move into his house? Of course, then Peter would be financially responsible for paying for the health insurance premiums for all those 220,000 living with him. Those 220,000 would bankrupt Peter. This is what Elizabeth Warren and the Democrats are proposing by offering both free healthcare for all and open borders at the same time. You're going to have every illegal alien in the world wanting to move to America for free healthcare. Many have never had healthcare in their lives, so they are in poor physical condition. Who is going to pay for all of this? (Democrats don't have a clue) Add that to free college, and free everything else offered by the Democrats, and America will become one big Ponzi scheme just like Argentina. Seniors have paid Medicare taxes, and have waited a lifetime for Medicare. It's their turn for Medicare. It will be everybody else's turn when they turn 65 years old as well.
I am willing to write a guest blog for you as a capitalist, daughter of a Surgeon and former hospital employee who has come to support Medicare for All. Yes, you can support capitalism and also support single payer health insurance!
Mr. Sage made the following comment about FICA (social security) taxes, and it's true: "We can't even get rid of the ceiling on FICA-taxable earnings, something that would make it much easier for Social Security to survive in an era where the number of retirees grows faster than those paying taxes to support them".
Currently, FICA is only taxed on wages up to $132,900, while there is no wage cap for Medicare taxes. This means that an entertainer or hedge fund manager earning $30 million annually only pays 6.2% in social security taxes (FICA) on their wages (with an equal employer match) up to a $132,900 wage ceiling, and $29.9 million in wages avoids being taxed for social security.
When someone is earning multi-millions annually, then they can afford to pay the Medicare tax on unlimited earnings. This move would help stabilize Medicare financially.
I to hear from guest blogger Jeanne Chouard.
If Medicare for All (or something similar) is simply impossible, Why do other western nations have this type of coverage??
If MFA is so scary to Americans, Why is Medicare popular with seniors? So popular that some seniors are terrified of losing it by expanding it??
Currently, Medicare offers Traditional Medicare and Medicare Advantage plans. Would MFA also offer both options?
Peter, I think it is clear that you are against MFA.
I would like to hear from guest blogger Jeanne Chouard. ��
Some supporters of Medicare for All think it nearly inconceivable that anyone of good conscience could be reluctant. And yet most Democratic candidates are reluctant, which might be a clue. Either they lack that good conscience or—just maybe—there are reasons for concerns.
I have concerns. Not opposition, exactly, but concerns.
1.. it is a huge change in an area of enormous personal consequence. I worry the government or any other institution will screw it up. The ACA rollout was a bad first impression.
2. I like having options so I don’t feel stuck. If ATT jacks me around I can move to Verizon or t Mobile. That makes me feel good.
3. I like my Medicare and my employer and I paid 3% of my income for 35 years finally to be eligible. I feel invested and protective. I worry that increasing its size by 6 will mess up something I paid for waiting to get.
4. I worry that putting it onto taxpayers will mean that high i income people will pay more by far than they do now. In one sense, greatit is just progressive taxation at work. But it also means there will become a new motivated group opposing MedicAre, the people who pay in far more than they get, ie well paid professionals and the truly wealthy—the donor class. Today they are ok with Medicare, but after M4A many will not be. They will be paying for other people’s health care. They will notice they are paying for health care for smokers, for the obese, for drug users, for people who drink and then need a $500,000 liver transplant, and they will resent it. They have political clout. They will be a relentless enemy. Currently Medicare is t a big target, but it will become one.
I have more concerns, but those are a start.
Am I dead wrong? Well, let me simply say that others share my views and supporters diss us at their electoral peril. Better to fix the concerns, or explain them away, But the concerns are real.
There's a piece that I haven't heard in the overall MFA conversation, a big one when it comes to the math. One reason we pay much more per capita for healthcare than any other country is that employers who provide employee health coverage pass those costs on to us in the price of goods & services--it's overhead they have to cover. So it's said that $1000-$1500 of the price of a new car, depending on details, pays for autoworkers healthcare; that price increment on the car you buy is part of our national healthcare bill.
So if we figure out the path to a universal single-payer system and take that burden off the shoulders of the automaker, what happens to that $1000-$1500? Does it still go to the automaker's bottom-line profit (if the market allows) or does the car's retail price drop by that amount, offsetting the car-buyer's tax increase to pay for single-payer health care? If the second, which seems fair and logical, how's that system deployed and enforced?
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