M4A: Is there anyone who would rather pay a higher premium versus a lower tax?

[DanTex]

I'm not talking about the GOP smears and all that. This is a question about the policy.

Suppose right now a person is having $10K deducted from their paycheck for health insurance. And with M4A, they'd have $5K deducted for a tax to fund the single payer.

Is there anyone who would rather end up with $5K less in their paycheck, simply because one is a "tax" and the other is the "premium"? Because this is what it boils down to.

[brooklynite]

1. Is there anyone who would rather have a choice?

Your question assumes that the health care received is equal/better than the private alternative. The average voter doesn't inherently trust the Government's ability to deliver on that promise. That's why we need the public option as a choice, to prove the quality and cost of a non-private program.

[ancianita]

9. 44 million single payer Americans say otherwise. Quality in any facility is as good as what's there

for private healthcare premium payers.

[democrattotheend]

18. Yes and no

Unfortunately, more providers are rejecting Medicare or limiting how many Medicare patients they take because the reimbursement rates are much lower than private insurance. This is something that can be fixed, but as far as I can tell - correct me if I am wrong - none of the candidates seems to be proposing that Medicare (for all or for all who want) raise provider reimbursement rates to put them somewhere on par with private insurance. This is a problem for both plans because unless provider rates are raised, Medicare for All Who Want will become second-class coverage that few people want because of lack of provider choice, and M4A would put some doctors and hospitals out of business, especially in rural areas, because they rely on private insurance payments that are arguably too high to make up for Medicare and Medicaid payments that sometimes don't even cover the cost of service. Regardless of which plan we have, provider rates need to be raised at least in some areas or the program won't work.

[ancianita]

36. MOST do not. Providers? You're talking about middlemen premium collectors who only give

unguaranteed coverage, only in in-network providers, only in regional markets, only in the current employer-based contracts, right?

This is pro-corporate hype to create FUD in the populace that can only benefit from m4A's
-- guaranteed coverage
-- all networked hospitals, both public and private, ANYwhere
-- nationwide health care, whether one lives in a car -- which over 20 million do -- nomad trailer, suburb or with grandma
-- employers able to give cash raises since they no longer are burdened with premium sharing as an employee benefit
-- No more Medicaid will be needed.

Plans are not coverage.

All those corporate "healthcare" skyscrapers in cities? Built on plans and denied coverage.

M4A is guaranteed coverage. Talk about savings. Talk about a healthier nation.

Rationalize cost/benefit all you want. I worked for an insurance brokerage firm in Chicago. My bosses told me outright that insurance is a racket. I've acted accordingly ever since, and am all the richer for it. And healthier.

[democrattotheend]

70. Providers doctors and hospitals

Not insurance companies.

And if you read my post, you will see that I strongly support at least making Medicare available for everyone. I think M4A is ideal in many ways, but with both plans, the devil is in the details. I see no reason why either could not fairly compensate doctors, especially primary care doctors and mental health providers who are underpaid. With M4A, the rate could probably be somewhere between what private insurance pays now and what Medicare currently pays, because the administrative costs would be lower for doctors.

[Hassin Bin Sober]

32. I think I remember reading 40% are on some form of government healthcare.

VA who does negotiate prescriptions
Medicare whose doesn’t negotiate prescriptions
Medicaid
Schip
Numerous state programs

All negotiating and limiting payments.

And then private insurance which has no incentive to limit costs beyond the contract year. In fact they have an incentive to watch costs rise because their cut also rises.

All while extracting billions in profits from you healthy working people. Only to lay them off on the government when they get old and sick.

Not to mention 80 million uninsured or underinsured and 68,000 people dying every year from lack of healthcare.

It’s an unsustainable chopped up segregated system. It’s not how an insurance system should work.

[DanTex]

13. Few people have a choice right now. And there will still be a choice for supplemental.

Most people get the health insurance their employers provide them. If the employer changes insurance companies, they have no choice. If the employer decides to reduce the coverage, they have no choice. If they lose their job, they lose their coverage.

As for the wealthy people for whom the status quo is a Bergdorf of healthcare, they'll be just fine.

[uponit7771]

20. This if false, I do have a choice right now to just go uncovered if I want to.

[thesquanderer]

38. Yes, that is the one and only choice that is truly being taken away in these proposals. (n/t)

[at140]

54. The worst healthcare is when one can't afford deductibles to use it!

M4A has so many savings which are hard to see when looked at superficially.
People on Medicare are by a large majority happy about their health insurance.
Why not make every American happy likewise?

[ancianita]

2. Source for this $5K figure? Because the numbers don't seem to call for any M4A premium that high.

[ibegurpard]

8. I believe he was engaging in a hypothetical argument

[ancianita]

11. Ah. Well, the numbers can really sell M4A.

[CalFione]

3. It is meaningless, if it can't pass

And there isn't going to be even 10 votes in the Senate for something that blows a $25T hole in the debt.


It doesn't matter how wonderful it is in theory - if it can never pass.

[ancianita]

12. Source for the 25T debt claim?

[CalFione]

15. here

https://www.crfb.org/blogs/how-much-would-sen-bernie-sanderss-single-payer-plan-cost

[ancianita]

35. Thanks. The cost differentials are big, but from my readings from PNHP, administrative savings are

much higher than CRFB's estimate because the industry's admin costs are, almost to a healthcare company, above the 15% saved under the Sanders plan. Off the top, eliminate private sector admin costs and you save 15%-20% of premium costs off the bat.

The debt also rolls, you should understand. Put in a lump like it is, it looks like a prima facia dismissal, but it shouldn't be presented that way.

With 44,000,000 now paying Medicare $100 -$200 (my cost, the highest charged), it's in the black. All the nationwide structure is in place for administering greater numbers. There are huge medical complexes everywhere.

With 283,000,000 Americans more paying no more than I do, that's $6.8 Trillion to paying for services in structures that both single payer and private premium payers now share; it will also pay for folded over personnel that already exist in the private sector.

This can ONLY be a big gain for families who pay at least $6,000 to who-knows-what per year right now.

Taxes to pay for it? No more than $2,000 additional a year for GUARANTEED COVERAGE ANYWHERE.

WAY cheaper and a much better deal than a year's worth of premiums -- for UNGUARANTEED COVERAGE, and ONLY in-network, only in a region, only with the current employers.

[Happy Hoosier]

62. I'm willing to bet the transition costs...

... will be HUGE. And that the administrative savings will take MUCH longer to realize. Keep in mind that we have to figure out what to do with all those unemployed insurance workers.

I think we need to work toward this. But I think we need to make those move in discrete steps, rather than just jumping off the cliff and hoping we can construct a parachute before we hit the ground.

[ancianita]

63. Warren has already said that eliminating the Big Fossil YEARLY $5 TRILLION SUBSIDY will help pay

for all that. Along with debt relief for college students going into the work force, child care from cradle to age 5. She said it in the last debate.

So there's that. It's a great use of wasted taxpayer dollars.

[Happy Hoosier]

64. It'll help.

Obviously, I'm a Liz fan!

[ancianita]

65. A LOT.

[Cuthbert Allgood]

14. Let's assume "not Sanders" wins the presidency and the Rs keep the Senate.

Under that (likely) scenario, please tell me what policy from "not Sanders" is going to get passed through the Senate.

Spoilers: NOTHING WILL.

So we should just not even try then.

[CalFione]

23. The court cases against Obamacare will be dropped, the Health Dept will reinforce it

and we can start from that base to try to improve it with a public option.


Saving Obamacare is a worthy first goal - and that can only happen if we win the White House.

[Cuthbert Allgood]

26. So you are saying that a Republican led Senate is going to pass a public option?

You can't be serious.

[CalFione]

28. No.

I'm saying winning the WH preserves Obamacare, so we live to fight another day.


And, if we win the WH, there's a good chance we get the 3-seat pickup we need to take the senate too.



But if we lose the WH (which is likelier if Bernie is the nominee) - not only do we not get more healthcare coverage, we lose the protections we already have with Obamacare.

[George II]

4. It's not an either or situation. And as far as the amount of tax, no one knows how much it will be.

[Happy Hoosier]

5. I want a plan that includes a realistic transition and....

shows a functional program before I have to entrust my health care to it.

Build something that works and people will flock to it.

Tell people they have to give up what they have and trust Bernie it will work out of the gate? Good luck with that.

[FiveGoodMen]

6. Many hold a quasi-religious conviction that private enterprise must be supported, lauded, untethered

Giving more money to the rich SEEMS like the right thing to do (to those idiots).

Churches are responsible for an awful lot of it.

[George II]

10. Some hold a quasi-religious conviction that private enterprise must be destroyed.

[ibegurpard]

7. Not only that

It would remove the burden of paying for healthcare costs from employers... particularly small businesses.

[Hoyt]

17. Well, Warren's main funding source is a tax on businesses. Fine with that, but she should be honest

[ibegurpard]

22. a tax on business is still going to be far less

than what they're picking up now

[Hoyt]

25. Don't bet on it. Prior to Nov 2019, Warren was projecting cost of MFA at $3.5 Trillion. Now,

she's saying $5.2 Trillion annually. What's next?

[ibegurpard]

30. you are conflating the the cost of a total program

with the cost an individual business may or may not pay in taxes versus what they pay in providing insurance benefits?
That's not even close to an honest argument... without getting into the weeds on the details.

[Hoyt]

34. Yes, that is total program. Taxes will have to pay for that. So businesses will be hit with a tax.

They will have no option but to pay it, or go out of business if burden becomes too great.

Should they pay less, probably. Although there is no guarantee of that. In fact, program costs will likely expand quickly, requiring ever increasing taxes.

And what about businesses that don't provide health insurance now, or new startups that previously might have gone years before providing a health plan. They will now have a tax.

Talk about less than honest arguments.

[ibegurpard]

39. Again

They are paying for the cost of health insurance now. you are making the argument that this would be an additional cost. The cost of paying for health insurance goes away and instead everyone is now paying a tax to pay for single-payer. We can have an argument about what is going to cost more but you can't keep moving the goalposts or pretending this would be saddling anyone with ADDITIONAL taxes on top of what they're already paying.

[Hoyt]

43. Let me make it simple for you. Suppose a business doesn't provide health insurance, now.

Under Warren's plan, will they get taxed?

Suppose a business provides a cut rate plan, because that is all the struggling business can provide. Could the new tax be greater than the premiums they are paying for cruddy coverage?

I get that in the aggregate, the country should pay less overall. But when you get to the micro-level, it's not as clear. There will be people/businesses paying more than before, some will pay less. I think Warren and Sanders' supporters think all will pay less.

And, as Warren found out when she finally broke down and had someone look at it -- $3.5 Trillion a year is not enough when you provide 100% coverage, dental to people who have gone without too long, etc. She upped her projection to $5.2 T. Who knows if that is right?

I agree completely that everyone should be covered. I believe a government system will be cheaper, unless they screw it up, which is possible. I don't believe in forcing it on people who don't trust the government or want that coverage without trying it. That's a prescription for failure, or years of GOPer control.

[Hoyt]

16. Apparently so. Some people -- many ignorant -- don't trust a government plan. Yet, Sanders

and Warren continue to push shoving it down these poor soul's throats, even though they've said we don't want/trust it.

I agree completely that MFA would be great, but other don't.

So, offer a Public Option -- with increased subsidies -- or we can sit here and continue arguing this same junk for decades until someone wises up.

Seems simple to me.

[ancianita]

42. That lack of trust comes from being bamboozled by corporate "healthcare" PR that muddles their

own numbers. What they don't tell Americans is that they stay rich from inflated premium pricing and trillions made from unguaranteed, and so denied, coverage when Americans need it.

M4A will have to be transparent, and its transparency alone will guarantee more trust that Americans will get

-- guaranteed coverage
-- all networked hospitals, both public and private, ANYwhere
-- nationwide health care, whether one lives in a car -- which over 20 million do -- nomad trailer, suburb or with grandma
-- employers able to give cash raises since they no longer are burdened with premium sharing as an employee benefit
-- No more Medicaid will be needed.

Plans are not coverage. A public option only muddles the outright benefits of M4A. It's cover for continuing the private healthcare industry's attack on currently working, high quality single payer coverage and services that 44 million other Americans already get.

[Hoyt]

45. No, the lack of trust comes from Warren and Sanders' saying, "They know better and their plan

is what every American is going to have to accept, like it or not."

I'd take the government plan in a second. But, apparently there are a lot of folks -- the majority -- who wouldn't.

[ancianita]

50. THAT there is wrong. They say exactly what plan costs AND greater benefits to ALL Americans will

be. Don't pit your self-satisfaction against the greater health of the whole country under their plans.

This is not about them, anyway.

This is about a vision of good health for the nation. At least they're trying to sell it to people beaten down by PR lies about how private is always better than public services. That's bullshit.

You don't know about the majority. No one's ever polled them.

[Hoyt]

52. Nope, they are pushing "MFA, whether you want/trust it or not."

[ancianita]

53. Cite that quote. Show a source. That's your interpretation presented as fact.

[Hoyt]

55. Christ, that is what "Medicare-for-All" means. The operative word is "All." It's SINGLE payer.

"All" and "Single," mean "no other choice" in this context.

[ancianita]

58. Oh, okay. But YOU use it as some weaponized threat with your "no other choice" implication.

What "no other choice" should be used in their context of Americans not NEEDING another choice.

If Americans choose not to get it, they can buy the satin sheets private corporate choice.

M4A does not enforce paying or joining and there is no penalty for going private.

That's what you don't say.

[uponit7771]

19. The math doesn't work ... PERIOD!!! ...

[ancianita]

44. Yes, it does. Even common sense looks at private vs public cost shows that M4A tax is way lower

than anyone now pays in private corporate "healthcare."

[TwilightZone]

21. Some people aren't paying any premiums or are paying very low ones.

Primarily in situations where their employers cover most or all of the cost. Places like that do still exist.

Those are some of the people it will be difficult to sell on M4A. They will go from zero to whatever the no-one-really-knows-yet number would be in M4A.

[DanTex]

24. But the employers do. Employees don't technically pay payroll taxes either, employers do.

Even if the employer is paying the premiums, it's still ultimately being deducted from employees paychecks, just like payroll taxes are.

[Freddie]

29. And do you seriously think

That if employers pay less for healthcare (say a % of wages rather than premiums) they’re going to put the $$ saved in your paycheck? I have a bridge to sell you.

[DanTex]

31. Yes, for the same reason that if they have to pay a lot more for healthcare,

then take-home pay will be lower. Employers look at total compensation including benefits.

[TexasTowelie]

61. .

[DanTex]

69. Yes, that is how labor markets work.

[Midnightwalk]

27. Isn't that the premise of buy in?

Better if I answer completely.

You promise me a 5K tax rise now for a proposed 10K savings later on with the benefits murky and I am going to be very wary.

You demonstrate that I can really come out 5K ahead for an equivalent plan and I’ll take that every time.

That’s what I think the plans that start with buy in achieve. It makes the plan and savings concrete rather than a matter of trust.

[krissey]

33. Does it matter Dan? Sanders, his staffer and AOC all said within days it wasn't going to happen.

The rest of us is not going to jump on this band wagon of illusion just because Sanders wants us to. He gotta about all he will on this cart ride.

[RandySF]

37. My taxes will be higher than my premium

And a lot of people have no premiums.

[ibegurpard]

40. your premium?

AND your out-of-pockets? AND your deductibles? What insurance plan has no premium that actually pays for anything without sky-high deductibles and out-of-pockets? Please point me to it because I'd love to sign up.

[drray23]

48. mine has no deductibles, my employer pays most of the premium.

I pay $192.00 a month, my employer pays the rest. I have zero deductible, no in/out of network restrictions, no need to get referrals for specialists.

Why is it so good? Because in my line of work, it's a benefit that is used to attract and retain the best talent. I also have paid medical leave and six weeks of paid vacation every year. I could get paid way more in other places but the benefits are what I traded the higher salary for.

It's true for many people who are in unions (we are not unionized) in other parts of the economy.

That's why I think pushing for public option is a much better approach. People who are not as fortunate as I am to get top-notch coverage from work will be able to sign up on it. Over time, we will slowly move towards universal coverage via this option.

[RandySF]

49. Nevada Culbuary Workers have not premium or deductible

Nor do San Francisco Local 2 workers. And I had no out of pocket for my anxiety therapy last year.

[ibegurpard]

67. Well that's nice for you

not many others get anything even remotely close to that.

[R B Garr]

41. Exactly, and it's not even close.

The endless BS over this is beyond inane. People will not have patience with this CF. Not to mention, the insults and hostility all over a couple questions. It’s a total disaster.

[ancianita]

46. MOST people's taxes will be WAY lower than their current premiums. And for your lower premiums,

do you get

-- guaranteed coverage
-- all networked hospitals, both public and private, ANYwhere

Because there are no such private premium service like these.

[Turbineguy]

47. With a premium / administrative rate of 15%

The insurance companies benefit from higher prices for medical care. Higher prices, higher premiums, bigger rake-off. Somewhere around 50% of money is gobbled up by the various well-rooted inefficiencies in the system.

My question is what to do with the several million people who become unemployed? United Healthcare employs 300,000 people.

And then there's the GOP marketing of the current system and it's ultimate outcome they desire.

The fact is that the current economic costs are hard to quantify since they don't include the costs society picks up for bankruptcies and early deaths.

I think it's a mistake to try and and justify M4A as an economic proposition because you get bogged down in numbers. Obviously you are going to save money and have a better system. Who gives a shit how much you save? It should be justified on a moral and philosophical basis of enlightened self-interest.

"Do you want to get sick because you came in contact with someone who can't afford to see a Doctor?" "How does getting sick and dying young benefit you?" "Is a healthy society something that we want?"

[ancianita]

51. Thank you!

[brewens]

56. People want to know they aren't losing the part of their pay health insurance takes up.

Employers need to still contribute the equivalent of what they do now, or there has to be a plan that makes them increase wages accordingly. Convince people that they get better coverage and their disposable income stays the same, or better yet, goes up.

It's not that they love those health care plans so much. They just aren't convinced they gain anything yet. I'd say cutting out the middleman should allow for giving people a better deal.

[Happy Hoosier]

60. This is a big deal.

The portion of my insurance premium (75%) my company pays is part of my compensation. I want to ensure any plan actually considers that. And not just generically.

[ibegurpard]

68. That's fair

[ehrnst]

57. You really expect people to treat these numbers you dreamed up as some sort of actual choice they

would have if Bernie is elected?

The numbers you pull from your head are not facts, data, policy or a realistic scenario... any more than Obama statement "if you like your doctor you can keep your doctor."



Green Mountain Care in Vermont failed in part because the 11% tax hike was not going to fly even in the state with the political will to elect Sanders as a Senator.

That is a real situation that actually happened.

But do go on posting OP after OP, if you need the attention.

[Hoyt]

59. Actually, there will be a number of well-off people willing to pay more not to be in the same

system most of us will have.

In fact, I'll bet 20% or more will opt for higher cost, concierge type care to go to select professional providers and hospitals. There are Medicare beneficiaries right now, who go to doctors who have dropped out of Medicare. These patients keep there Medicare coverage in case that get really sick (ie, expensively sick).

That's going to be another issue that will have to be dealt with in implementing a single payer system.

Please note, I am not for this -- because it will siphon off physicians, etc., who are perceived as higher quality -- but I bet it will be found unconstitutional to force people into a public system.

[eilen]

66. Systemic change like that...

first off, just junking ACA and starting all over again- is just crazy talk and ignores all kinds of unintended consequences.

I include blanket student loan forgiveness, federally funded free college, and every other "free" deal offered by the self described democratic socialist.

The expansion of government would exceed GWBush levels.