Here's my proposal for nation-wide health coverage

I'm not advocating the idea. I was talking about the cost of the idea. I did some research which I posted here:

http://www.politicalforum.com/index...-healthcare-can-be-accomplished.500686/page-3

... that shows why "Medicare for All" would cost that much. The cost could be split between employee and employer, but that is what it would cost.

One thing that I don't like is that everybody wants something for nothing. Everybody wants the magical, mystical "someone else" to pay for everything they want. Besides being curious as to what "Medicare for All" would cost, I was also trying to show that we can't have something for nothing, and there is no "someone else" to pay for it.

Of course, everyone hates that.

 

Under every system some get something for nothing. Some get nothing for something and some get a mix. That is true of every insurance type system

 

No, there are a TON of health insurance providers. That's part of the problem.

Normally when it comes to the healthcare debate, I find myself trying to get the right to accept some simple truths. This time I'll take a swing at the left.

American healthcare costs are incredibly expensive for two reasons: First, Americans fund the majority of the world's medical R&D. Second, American healthcare workers, from specialists to billing clerks, are well-paid and very numerous.

Simple fact: The difference in price between American and, say, Australian healthcare cannot be explained by profits made by insurance companies. Not even close. Not even a little close.

A single-payer system would probably work okay to solve the second problem. We could hire less people and pay them less. A single-payer system is also extremely unlikely. The easiest solution would be to reform our legal treatment of health insurance and especially our anti-trust regulations. Things would be much more efficient if we had a handful of big providers each of who was accepted just about everywhere. Make the health insurance market an oligopoly, and throw in some regulations to keep the leftists from going batshit over it.

The R&D problem is much more complicated. One solution is diplomatic, the United States could push for more international standardization of intellectual property law. That's not going to happen, flat-out. The second solution is simply to reduce R&D spending. That might be okay, I'm sure that some significant portion of it is wasteful. This would certainly reduce the number of good innovations, though. The third solution is just to pay the premium, and bear our cross for the good of humanity. This is the most likely solution.

I'm with the leftists on a number of reforms. First, mandatory health insurance. Second, subsidizing of high-risk pools. Third, the expenditure of whatever Federal funds are necessary to ensure that all Americans can afford their coverage. But I do want leftists to understand that single-payer is not going to happen, so they have to suck it up and work with, not against, the free market.

 

Yes, but a payroll tax system would get all employed people involved in paying for it. The less you earned, the less you'd pay and vice versa. And btw, sales taxes do the same thing. They're just collected by what you spend, not by what you earn.

The ACA has gigantic problems. I like Medicare for seniors, but not for all. There will be great resistance to a single-payer plan in the U.S. My preference is for ...

Medicaid for the unemployed and unemployable, Medicare for the elderly, and ...

Health insurance paid for by employers that covers employees and their dependents. This would be the one government mandate.

With these three legs of health care coverage, we'd have virtually everybody in the U.S. covered, and the three programs would be paid for.

 

In other words; if you're poor, go **** yourself.

Can you possibly see how some people may regard your model as...slightly...how to put it...lacking in reason?

 

I fail to see exactly how that differs significantly from the system pre ACA. Or are you going to mandate that all employers provide full health insurance for all their employees and dependants and then have the government specify exactly what that insurance would cover. And then are the self employed going to be covered by the same rules?

 

Good questions.

Yes, the mandate would be that all employers must provide health insurance for all their employees and dependents. There would be no exclusions in coverage for preexisting conditions, and children could stay on their parents' plans until age 26. But beyond that, I would let free market forces and personal choice play a strong role. For example ...

The employer offers a job for x amount of money and a health insurance plan that pays 60% of medical expenses. (This could be the government mandated minimum.) But the employer is also offering the same job for less money but with a health plan that pays 80% of medical expenses. Or the employee can take the job for even less money but with a health plan that pays 90% of expenses. This gives the employee some control over their own money. The young, single person may choose more take-home money and the 60% plan, while the married person with children may choose less take-home money, but the 90% plan.

This would be an important competitive point between employers. Imagine three similar but competing businesses. One offers x dollars and the 60% health plan. But the other offers x dollars plus the 80% health plan. And one offers x dollars and the 90% health plan. See what happens? Before long they're all offering the 90% plan. If they don't, their employees are going to start defecting to the one that does. And who are the best employees going to work for? The best employer of course. There would be an added incentive to be a good employer and a good employee.

Small businesses would not have to pay more for health insurance than large businesses. They could join an Association that could represent millions of small business employees that would do their bidding to the insurance companies for them, seeking the best deal for their members. In this manner, the small business with only 5 employees would have just as much leverage with the insurance companies as say, AT&T. This would, of course, spur competition between insurance companies.

According to the Bureau on Labor Statistics, 10% of American workers are self-employed. According to statistics compiled by the Kaiser Foundation, 36% of self-employed people are uninsured. This means that about 6 out of 10 self-employed people are insured. This number of uninsured self-employed people is small, roughly 4% of the entire workforce. I am not sure what the answer is for those people, but I'd be willing to bet that we could put our collective heads together and come up with something. In any case, it's a small problem, not a large one, that would have to be worked out.

I see my suggestion as a compromise between those who want government run health care and those who want government to stay out of it and who like our for-profit system of health care. My suggestion does a have government mandate, but it leaves the rest to personal choice and marketplace competition. Most importantly, my suggestion gets almost everyone covered, it doesn't raise taxes or cost the government anything, and this is good for everyone. Medicare for seniors, Medicaid for the unemployed and unemployable, and employer-provided health insurance for the rest of us. I have had employer-provided health insurance all my life, and it has taken care of me and my family just fine.

Seth

 

But you said that your plan would require employers tompay for health insurance for their employees and thair family. Now you appear to be saying that is not the case and insurance will be a negotiated benefit. That is what we have now and less and less employers are offering insurance and those that do are shifting more of the cost to the employees. Negotiation of benefits does work where their is a scarcity of employees meeting the necessary criteria for employment. In other words at the level of middle to upper management but not true at the lower ranks.

 

Lets say a single mother earns $25,000 per year. How much money will she get to afford a $15,000 family plan?

 

I don't know how I caused a misunderstanding. The employees immediate family would be covered. Spouse and children. Period. That would be a part of the government mandate.

What percentage the plan paid would be a choice for the employee to make. A business would have to pay for a plan that paid the government-mandated minimum percent of medical expenses. (I used 60% as an arbitrary example.) Now if the employer chose to make his offer x dollars plus the 60% plan, what I would want is for the employee to be able to opt for the 80% or 90% plan by simply making up the difference in its cost as a pre-tax deduction right out of their pay. The insurance company could be required by the government mandate to make these multiple plans available to every business they serviced.

There are a couple of cost-saving measures we could institute for businesses. For one, we could eliminate "double coverage". If two spouses are working, only one receives coverage from one of the employers, and the other spouse is covered under that plan. In other words, one family, one plan, even if two are working. I know from personal experience with my own insurance company that some employers are already doing this. Another thing we could do for business would be to let medical insurance costs be counted as a direct dollar for dollar deduction against any corporate/business income tax owed. They could deduct down to "0" tax owed. I think that would be a very fair trade-off, balancing the public interest against the government interest of bringing in revenue. Remember, this plan I'm proposing would vastly reduce the need for Medicaid because even people working for low wages would be covered. This would save both state and federal government money, since both contribute to Medicaid. That minimum wage worker working at the gas station would no longer have any need for Medicaid because their employer was providing their coverage.

We are nearly at full employment in this country. I think it is important to do everything in our power to keep the economy humming along at a good strong pace. We can help American workers by limiting immigration. Not eliminating it, limiting it and controlling it. Too much immigration drives down wages, no doubt. We can also try to make the business environment as desirable as we possibly can in the U.S. Let's do everything in our power to induce companies to want to locate, remain, and produce here.

And finally, I believe that a good day's work should be rewarded. I think that we hurt ourselves when we put workers in a position of working all day and not being able to survive without government assistance. Let's allow the middle class and the lower income class the ability to go out and work and be rewarded with at least some money and, for heaven's sake, the ability to have health care for themselves and their families. This should not be too much to ask, and by so doing, we instill a positive work ethic and pride in a day's work, no matter what it is. It's hard to have a positive work ethic when welfare and dependence is a better deal. Let's let our people work and be rewarded for it.

 

Am I missing something? Is the employer required to provide full healthcare or 60% or some other percentage of the healthcare cost? And is the employee required by law to pay the remainder or is what the employee pays up to the employee.

And heathcare coverage is part of the union contract not up to the individual so does the union decide the percentage or the employer.

Here are a few numbers to consider. Average insurance cost for family of three is $830/ month for annual cost about $10,000 with deductable being approx $7000 for annual cost about $17,000 per year. If employer pays 60% of the insurance the employee ends up paying $4000 for insurance plus $7000 deductable got total cost $11,000. Just not going to work for the average income family without some type of additional government subsidy.

 

What I had in mind was health care insurance that covers pretty much everything, but at varying rates of payment to the medical provider. So, for example, if you have the 60% plan, and you incur a medical bill of $1000, the insurance company pays $600. You would be left with a bill of $400. You don't pay premiums for the 60% plan. (Again, 60% is an arbitrary number I'm using just for the sake of our discussion.) That insurance is required of your employer by government mandate. Now if you want an 80% or 90% plan, there is a deduction taken out of your pay that is the difference between the cost of the 60% plan and the better plan you're choosing. If you choose the 90% plan, and you're having money deducted from your pay to cover the difference, when you incur that $1000 bill, the insurance company pays $900, and you pay $100.

The flaw with this is when medical bills are much higher. The poor and middle classes, and even the upper middle class, are not going to be able to afford the residual amount left over after the insurance payment if the bill is really high. The answer to that problem would have to be a stop-loss component in these plans, that is, where the insurance company pays a higher amount on large bills, limiting the residual amount paid by the patient.

I wish to emphasize that my suggestion is just meant as a general concept, that being that employers pay for medical insurance. But it's only a starting point for the discussion. For example ...

You brought up the cost of deductibles. That caused me to think that perhaps another way to do this would be to mandate that all these employer-provided plans were 90 or even 100% reimbursement plans, but with varying deductibles instead of varying reimbursement rates. So if you're young and healthy, you may want a higher deductible, but bring home more money. If you're middle-aged and successful, you too may want to bring home more money and have a higher deductible because you know you can afford the higher deductible. But if you're married with three children, you may wish to bring home less money but have a very low deductible. The idea behind having these choices is to let people have some control and responsibility. And the other idea behind these choices is to spur competition for the best employees. Like I said before, if you have two competing businesses offering essentially the same money for their jobs, but one has a better insurance plan than the other one does, that company is going to be able to attract better employees. The better company could do that by paying for the government-mandated level of insurance plus paying for a higher level as a company benefit rather than having the employee pay for it. At the same time, if I start my working life with a company that only provides the government-mandated minimum medical insurance, I'm going to want to create a great track record with that company, get some experience and training, and keep my eyes open for the opportunity to move on to a better company in the future. And that's why I think a lot of companies would find themselves eventually providing the higher level of insurance as a company-paid benefit. This is already true with the best companies that provide medical insurance.

I am not necessarily locked into the idea of pinning this concept on reimbursement rates. Your thoughts about deductibles spurred me to think about deductibles as being the variable. This is what happens when people actually talk to each other and listen to each other.

All of this would need to be discussed and worked out, but the general concept is that employers pay for the lion's share of the insurance, and the employee and the employer are given some choices they may make.

Like I said, I've had company-provided health insurance all my life while raising 2 children to adulthood, and it has worked well through many medical issues. I'd probably be penniless today if I hadn't had it all these years.

My idea requires no new taxes. It requires no new government spending, and it actually reduces government expense by reducing Medicaid expenses. It gets almost everyone covered by insurance - Medicare, Medicaid, or employer-provided covers almost everyone. And it supports the value of work, rather than sloth and dependence. If our politicians try to impose Universal Health Care or Medicare For All - whatever you want to call it - there is going to be a tremendous fight in this country over how to pay for it. Government will have to bring in new taxes to pay for it, and the fight will be vicious. The debate over how to pay for it could quite possibly sink the whole idea. My idea avoids all of that. I see it as a compromise that employs a government mandate while leaving in place the free market system.

You asked about union contracts. I don't think much would change. The company would provide the government-mandated minimum medical insurance, and the unions could negotiate with the employer for a higher level than the minimum. That part would still all be negotiable.

Looking forward to your feedback.

 

I think the difficulty is that you are coming at this from the position I suspect of a management position in a company that provides good health insurance and where it is part of the negotiated package of employment. I was there and had cadillac health insurance. Then I left to become a full time artist who had to buy his own insurance with a pre existing condition.

Believe me they are two entirely separate worlds. And my cadillac corporate insurance was completly different from the hourly insurance negotiated as part of the union contract.

I also went to India for major surgery which cost about thirty grand in India and would have been around one hundred fifty grand plus in America.

All that said the real issue in America is the total spending on healthcare as percentage of GDP. Most of the world does it better and much cheaper. Just playing around the edges sn't going to fix the real problem.

But taking your proposal seriously if companies and individuals can deduct the full cost of healthcare that will be a major federal expense. And financing catastrophic coverage is a major issue. Does the government do that? That is an issue that the Trump plan ducked almost completly because the cost is hugh. Most people could not deal with a ten or twenty percent deductable cost for cancer treatment without going broke.

It is just not easy but I do not think it is an impossible task to make people understand that raising taxes for universal healthcare would be a cost break even or even an overall cost reduction for most individuals. My guess is the real reason this will never happen is because the wealthy already have great healthcare and have no incentive to see taxes raised to pay for the same healthcare for everyone.

 

I have had insurance supplied by both a union contract and the corporate insurance. My experience has been good with both. Tell me, when you worked as a full time artist, were you employed by someone else, or were you self employed? If you were employed by someone else, then my idea would have taken care of you. If you were self employed, then you would have been among the 10% who are self employed. As I said earlier, I haven't figured out how to make sure self employed people have medical insurance, although there must be a solution. It occurs to me that one way a self employed person could be insured would be to be married to a working spouse. Remember, under my plan, a worker receives medical insurance that covers them and their immediate family. It also occurs to me that if you choose to be self employed, and you're not covered by a working spouse, you should first create a business plan that includes paying for your own health insurance. Perhaps this is what we could use some of those Medicaid dollars for. Remember, the government would be saving a lot of money under this plan of mine by taking an awful lot of people off Medicaid. Perhaps there could be a law that allowed self employed people earning under a certain amount to get assistance from the government until they are making enough to pay for their own insurance. I looked it up, and the government spends $574 billion a year on Medicaid, and my plan would eliminate an awful lot of that expense. I would have no problem diverting some of that cost savings to self employed people who needed help.

You also mentioned that you had a preexisting condition. I will tell you that I am not a fan of excluding people from insurance or hiking their rates for preexisting conditions. Under my plan, this wouldn't be an issue. If you were healthy enough to work, your employer would just add you to their group insurance when they hired you, no questions asked.

If you were not healthy enough to work, you would become one of the unemployable, and you would be covered by Medicaid.

The cost of health care in the U.S. is a problem, but I don't know what the fix is, unless the government takes over the entire health care industry - the medical schools, the hospitals, the equipment and medicine manufacturers, and the doctors, nurses and techs. And that's not going to happen. For better or worse, our society is pretty much wedded to the free market, capitalistic model, and there would be tremendous resistance from many quarters to trying to change that.

Well, my proposal was that companies would get to deduct their health care expenses down to zero taxes owed. I would think that would be fair for the self employed as well. I think the greater public interest is served that way. In theory, we have government to make our lives better and safer, but we are not to be made slaves to government. In other words, it works for us, not the opposite. Besides, remember that $574 billion government spends on Medicaid? They would suddenly have that expense significantly slashed under this proposal of mine.

That's why it was good that you made me think about deductibles earlier in our conversation. The more I think about it, the more I think that if we are going to give people choices, it should be in deductibles, not reimbursement rates. Let the insurance companies negotiate reimbursements to providers, and let the consumer have some choices on the cost of their insurance through varying deductibles. As for something catastrophic like cancer treatment, there has to be a stop-loss amount. That's the maximum amount you pay after the deductible and co-pays. That amount has to be something realistic and reasonable. The whole purpose of this whole issue is that we want people to get the care they need and without going broke.

I think you're right. And it's not just Republicans and conservatives. There are rich liberals who are not very anxious to pay more to cover more people. And, in general, people are a little afraid of change. Add to that that we are culturally and traditionally a free market, capitalistic society. That's a lot of hurdles to get over before we are going to have universal care in this country.

My proposal is a compromise. There is a government mandate, but it then leaves the free market to take it from there. It gets virtually everyone covered. It costs the government nothing. It actually saves the government a lot of money, helping to lower the annual federal deficit. No new taxes either.

My compromise proposal has something for everyone I think. And something for everyone to complain about. "Free market" people don't like a government mandate, but they like the free market. "Medicare for All" people like the idea of a government mandate to get everybody covered, but they don't like the capitalistic free market aspect of my idea.

Something for everybody, but neither side gets everything. That's called "compromise".

Keep the feedback coming. Good discussion we've got going.

 

Assuming that this refers to general taxes collected, not Social Security and Payroll taxes that are dedicated and all go into the Social Security Trust fund for distribution, for 2016 the amount of general tax revenue was only $2,152 billion. One percent of that's only $21.52 billion and that doesn't go very far based upon the roughly 125 million households because it's only $172.16 a year. That won't even fund one month's health insurance in the United State for a single person. The voucher would be absolutely worthless (just like the GOP's recent replacement plan for Obamacare).

Doesn't anyone even run the math before making stupid proposals?

 

This would pay for what exactly?

 

In real-life, real-world terms, with real-world expectations, can anyone propose a better system than the one used today in Germany?

NO, it's not perfect, and YES, it is implemented in a country which taxes its citizens quite a lot more than we Americans are taxed -- but, for one thing, medicine, and all pharmaceuticals, costs substantially less in Germany, and most health situations are still taken care of fairly quickly (especially by general European appointment standards) and still relatively in the customary professional way (even though a lot of German-born, 'White' doctors move to Canada, the UK, and the United States, where they can make a lot more money).

Link: https://transferwise.com/us/blog/healthcare-system-in-germany

 

Something tells me that any system implemented in Germany is going to work better than if that same system had been implemented in some other country.
That's just one thing to be a bit cautious about.

 

My point was let's focus on the funding side rather than the expected results side.
What's going to be a "reasonable" amount of funding taken from people to pay for this?

 

Well, all I know is that my friends in Germany tell me both the 'good', and the 'bad' about the medical/pharmaceutical sectors in Germany today, and, overall, it sounds pretty good. AND, it costs the Germans a HELL of a lot less -- particularly the medicine!

The quality of the healthcare is, as far as I can determine, every bit as good there as it is here. You pay a good deal more in taxes in Germany overall -- it is true! And, that covers not only healthcare but a lot of other aspects of life, too. Some of that I agree with, and some of it I think of as just more European-style Socialism. It works well for them....

 

Wonder what would happen to German pharmaceutical investment if they weren't allowed to sell in the U.S. market.

U.S. consumers are basically the ones funding pharmaceutical research through the high prices they pay.

 

We pay a 2% levy and that is topped up by federal and state monies

BUT that covers EVERYTHING from subsidised pharmacy to free hospitals and all of the health infrastructure necessary to keep a population healthy

 

You are NOT funding original research

What you are funding is the Pharmaceuticals making copycat drugs and patenting them so that they maintain control of the market

Original research is done with government funding at universities

 

That may be how it works in Australia, but in the US, basic science is funded by the NIH, and research for pharmaceuticals are funded by drug companies.

 

Proof???