— from David Turnoy —
In the most recent Democratic Presidential Debate, now that Elizabeth Warren is a frontrunner, a few of the lower-polling candidates decided to try to make a name for themselves by attacking Warren over the cost of Medicare for All and how to pay for it. This is not a really genuine question, just a way to attract attention. Experts have put out studies showing how to pay for Medicare for All, and Bernie Sanders lists many possibilities. Now that she is being questioned so intently, Elizabeth Warren will be releasing a plan in the next few weeks, something she and her campaign have been working on carefully but didn’t want to release until it was ready.
For those who are skeptical, luckily we have an expert on this subject right here in the islands. Dr. John Geyman has been a longtime supporter of a single payer or Medicare for All system, having published several books on the subject. His latest offerings are Struggling and Dying Under Trumpcare: How We Can Fix This Fiasco, a full-length book, and a pamphlet entitled Common Sense: The Case for and Against Medicare for All, both available locally. The information I will present in the next two paragraphs is taken from these two sources, both published this year, so they are very current.
“Patients, families, and taxpayers can afford Medicare for All. We have had two major studies that tell us for sure that universal coverage through Medicare for All can be largely paid for by savings. The first study by Gerald Friedman, professor of economics at the University of Massachusetts, projected in 2013 that NHI [National Health Insurance aka Medicare for All] will save about $592 billion annually by cutting our administrative waste of private insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion) through negotiated drug prices and bulk purchasing.” (Common Sense, p. 7) Under this plan, which includes a progressive tax plan to go along with the savings mentioned above, 95% of Americans would pay less in taxes than they do now for insurance and health care. “…middle-class Americans will see savings of up to 14 percent, while high-income Americans will have only a small increase in their total health care spending.”
(Struggling and Dying, p. 173)
“The second study, released on November 30, 2018, by the Political Economy Research Institute (PERI), at the University of Massachusetts-Amherst, finds that single-payer NHI will save the U.S. $5.1 trillion over a decade through savings from multi-payer health care spending in our current profit-driven market-based system. The PERI study estimates that total annual health care spending will increase from $3.2 trillion to $3.6 trillion due to many people getting care that that they previously had to forgo. However, that number would be reduced to $2.93 trillion a year by massive savings in administrative, pharmaceutical, and provider payment spending.”
(Common Sense, p. 8)
This study also relies on new progressive taxes to offset the increased cost of providing coverage to everyone.
There are a myriad number of options for financing Medicare for All. Bernie Sanders lists the following in a PDF entitled “Financing Medicare for All”, which you can find HERE.
- Creating a 4 percent income-based premium paid by employees, exempting the first $29,000 in income for a family of four;
- Imposing a 7.5 percent income-based premium paid by employers, exempting the first $2 million in payroll to protect small businesses;
- Eliminating health tax expenditures;
- Making the federal income tax more progressive, including a marginal tax rate of up to 70 percent on those making above $10 million, taxing earned and unearned income at the same rates, and limiting tax deductions for filers in the top tax bracket;
- Making the estate tax more progressive, including a 77 percent top rate on an inheritance above $1 billion;
- Establishing a tax on extreme wealth;
- Closing the “Gingrich-Edwards Loophole”;
- Imposing a fee on large financial institutions; and
- Repealing corporate accounting gimmicks.
These are just some of the policies that could provide revenue to finance
Medicare for All. Under every single one of these options the average American family will save thousands of dollars a year because it will no longer be writing large checks to private health insurance companies.”
It shouldn’t surprise anyone that once you take the profit out of health care, great savings can be realized. Should healthcare be a for-profit enterprise, or should it be a human right? That may be the real bottom line here that some candidates are not being honest about. If we continue to have a for-profit system, with CEOs making millions of dollars and health care companies contributing large amounts of cash to the campaigns of candidates so that those candidates continue to support a for-profit system, nothing will improve.; the same cycle will keep going round and round. In addition, our current Medicare system spends only 2% on overhead costs, whereas private insurance spends more than six times this amount on overhead costs. It is pretty clear that a government-run Medicare for All would continue that efficiency.
Interestingly, between Medicare, Medicaid, and other medical programs currently paid for by the government, “The largest share of national health expenditures already comes from the government, amounting to $26 trillion out of the $47 trillion, or 55 percent, of what our country will spend on health care from 2018 to 2027.” (Centers for Medicare and Medicaid Services, National Health Expenditure Data, Table 16) Government programs are nonprofit, more efficient, and already covering more than half of our medical expenditures. It makes sense to bring the rest of our health care system under the same program.
This is informative and educational, but I wonder why no one except Jill Stein in the 2016 election dared to suggest cutting the military budget in half. Imagine all the things we could pay for!
Trying to argue that slashing one part of the Federal budget to fund another, and that other being ten time larger already and growing faster than general inflation while consuming an ever greater proportion of our national economics hopefully will mark the death of a trope in US politics.
It’s like arguing that finishing your soggy corn flakes will help starving children in Biafra.
Similarly, trying to argue the fine points of healthcare policy ~ that admittedly NO ONE understands because they cannot explain it TO ANY ONE ~ begs the question of why an issue of universal concern has no trusted sources.
Who pays? Not a business accounting problem.
There are some things that are difficult not because they are complicated, but because they are not.
I suggest we on Orcas have a unique insight into this mockery of the decent and the fair and the mindful. . and who pays.
I agree. I’ve worked in healthcare finance/regulation for more than 40 years. The problem is that the candidates are loath to explain that there will be higher taxes on most people, likely a payroll tax going into a separate new trust fund. What the American consumer fails to understand is that, at the same time, there will be no monthly health insurance premiums, which run upwards of $700/per person these days in the small business market (~$8000) and no ridiculously high deductibles, which force an individual or a family to pay $5000-7000 out of pocket before the insurance kicks in. Also, no more multiple sets of rules and payment methodologies. No more excess paperwork and confusion every new enrollment period. No more reliance on employers for health insurance access, and no more games in assigning employees part-time status to avoid benefits.
Who pays in the long run? The health “insurance” companies, which–if they continue to exist–will make far less than the billions they’ve been raking in this century. The signs we’ve seen at certain rallies “Government Hands Off My Medicare” reflect a sad ignorance on the part of much of the electorate. “Government” (the federal one) has been running Medicare for 50 years. It’s accepted by all hospitals and clinics and almost all practitioners. Ask a senior whether he or she would trade their Medicare for private insurance. Not likely.
About 70% of Americans support a “single payer” or Medicare For All system. The author of this piece has a great point: the corporations take their profits and reinvest the money into lobbying firms that exist solely to perpetuate the status quo. These people are playing games with our lives and getting rich off of our maladies. It’s time for the government to end this plague of profiteers and provide fair, affordable medical coverage for everyone who wants it.