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Wednesday, August 29, 2018

Rethinking Medicare For All

I've long been a supporter of single payer healthcare. I believe(d) that the proposals to simply extend medicare to all citizens was the best way to do this. The idea being that it was the least disruptive proposal. It already met constitutional muster and the institutions needed to run it already existed even if there was a need for expansion. Also, this would relieve private businesses from paying for and administrating health insurance plans, which makes up a significant portion of employee "salaries and benefits". This would be, in effect, a tax cut for businesses. I did propose that corp taxes should go up a bit to cover the cost of expansion, but not to the extent that it wiped out the cost savings of no longer being responsible for healthcare for it's employees.

Yesterday I read an article in City-Journal that has me rethinking this.

First, I had no idea how medicare actually worked. I suspect most people who are not retired don't either:

hospitalization in Medicare Part A includes a $1,340 deductible for each benefit period. It imposes no coinsurance on the first 60 days of hospitalization, but a charge of $335 per day between 61 and 90 days in the hospital, and a charge of $670 per day over 90 days. Part B, the medical part of Medicare, includes a $183 yearly deducible and requires the patient to pay 20 percent of the Medicare-approved amount.

Part A, hospitalization, has no monthly cost, but Parts B and D, the medical and drug portions, demand monthly premiums just like any private insurance program. The monthly amount varies with income: retirees today pay $134 a month, on average. But with no copays or deductibles, plus the added benefits that Sanders’s bill seeks, those monthly premiums would surely rise, not least because working people have higher incomes than retirees. It is guesswork to put a figure on how much these costs would go up, though the current Medicare premium for those who want it—but have paid into the system for less than seven-and-a-half years—is $422 a month. And that’s for Medicare as it presently exists, not for the proposed luxury version

Well, that's not "free healthcare, is it"? Also:
Medicare presently covers some 58 million people in one or more of its plans. The government last year spent $597 billion on these beneficiaries, representing about 14 percent of all government spending, and generating 3 percent of economic activity. Had the country extended coverage to all 323 million Americans in 2017, it would have cost Washington more than $2.6 trillion, almost 65 percent of the total budget, and over 75 percent of government revenues for the year.

Clearly there is no way to "tax the rich" to pay for this. No seriously. There is no way to pay for this by "taxing the rich". If you tax the rich to the point that they are no longer "rich", then there goes your government income.

Of course the next juicy target would be the military. Good luck getting any huge military budget cut through congress. So for those of us who do believe that a single payer system would be good would do well to bone up on the numbers.