4 ms·

there's a fundamental flaw in the reasoning: if single payer healthcare plans save money, why do we need higher tax rates?

atroyn 11y ago
Because the increase in taxes would be more than offset by savings in other areas?
furyg3 11y ago
Because the payer changes? Maybe I don't understand your question...
gotothrowaway 11y ago
To cover the currently uninsured/underinsured, I imagine.
- ctdonath 11y ago
  That's what the current "Obamacare" plan was supposed to solve. After thrusting much of the health system firmly under government control, raising costs substantially, and literally fining people for being unable to afford more expensive plans, we're left with ... the same number of un- & under-insured people.
  - daeken 11y ago
    > we're left with ... the same number of un- & under-insured people. No, we're not. "Gallup reported in July 2014 that the uninsured rate among adults 18 and over fell from 18.0% in Q3 2013 to 13.4% by Q2 2014." More Americans are insured today than ever before, both in absolute numbers and as a percentage of the population. This doesn't mean that the ACA is responsible, but saying that we have the same number of under/uninsured people is simply false.
  - delecti 11y ago
    > we're left with ... the same number of un- & under-insured people That's untrue. http://www.gallup.com/poll/182348/uninsured-rate-dips-first-quarter.aspx http://www.gallup.com/poll/182348/uninsured-rate-dips-first-...
  - clavalle 11y ago
    The uninsured rate has been cut in half under Obamacare. >According to an ongoing NHIS / CDC study the current uninsured rate of 9.2% for 2015 is the lowest in over 50 years. It started at 18%.
  - mhalle 11y ago
    > After thrusting much of the health system firmly under government control, Everyone outside of Medicare is in private insurance, which is regulated but not "firmly under government control". > raising costs substantially, While there is debate about whether the ACA has slowed the rate of healthcare inflation in its short life, there is no evidence that it has "raised costs substantially" across the system. > literally fining people for being unable to afford more expensive plans Fining people for choosing not to pay for health care if they are able. Everyone needs health care, most everyone gets (possibly lacking) healthcare when they need it, and it costs money. The previous solution, brought to you by Ronald Reagan, was the mandate that hospital emergency rooms couldn't turn people away who needed help. A humane concept, but poor social or economic policy for addressing the healthcare system in the large.
  - dragonwriter 11y ago
    > That's what the current "Obamacare" plan was supposed to solve. And it reduce the problem considerably (though less than it would have without the bizarre Supreme Court decision that Congress can't actually set the terms on which states get federal Medicaid funds, and particularly change the rules on Medicaid to require states accepting federal money to expand coverage -- which resulted in a number of states opting out of the expansion in Medicaid coverage that was intended to cover the lowest-income portion of the uninsured population not already covered by Medicaid -- the higher-income segment was addressed by the exchange-and-subsidy system.) > After thrusting much of the health system firmly under government control, raising costs substantially, and literally fining people for being unable to afford more expensive plans, we're left with ... the same number of un- & under-insured people. Actually, a much smaller number, but still more than many people would like.
fisherjeff 11y ago
I think think the idea is that the burden of a higher tax will be lower than that of a lower tax rate plus private insurance.
jeffmk 11y ago
Your taxes may go up, but the claim is that the amount your taxes go up will cost less than the healthcare premiums/out-of-pockets/copays/prescriptions/etc. you have to pay, thus the average individual's net cost for healthcare is lower.
dmm 11y ago
In a single payer system the govt is the only one who pays for healthcare. That means even if healthcare spending is the same or less, the portion of healthcare paid for by the govt increases greatly, requiring higher taxes.
- ctdonath 11y ago
  Medicaid & Medicare are practically "single payer" government-monopoly health insurance plans. They're notorious for severely under-paying doctors et al, to the point that many refuse to take such patients at all.
  - pgeorgi 11y ago
    Good luck trying to pick the highest bidder when all your potential patients are in the same single payer scheme.
  - dmm 11y ago
    I have no opinion on healthcare funding. I was just explaining how a lower total cost could still result in greater govt spending and taxes.
avar 11y ago
Let's say you make $1000 taxed at 20%, so you have $800 take-home. You spend $400 of that on health insurance. Now you have $400 left, or 40% of the initial amount with a 60% effective "tax" rate. If your taxes increase to say 40% but health insurance is included your taxes have nominally gone up 20%, but down 20% if you consider non-tax costs that were folded into your taxes. As anyone who's moved between countries can tell you, it doesn't make any sense to just consider what the tax rate is, instead you have to think about fixed costs (health care, housing, food, transportation, ...), deduct that from your pre-tax pay, and you're left with your effective taxation as it were. Administrative changes in the government can increase your taxes but have the effect of increasing your take-home pay, that's effectively what Sanders is proposing. There's no flaw in this reasoning, on the contrary you seem to have the fundamental flaw in your reasoning of assuming that the only way for the government to save you money is to reduce your tax rate.
chumich1 11y ago
The savings comes from no longer paying for private insurance which is currently extremely expensive
Spooky23 11y ago
The single payer is the taxpayer vs. the current model where you have a split between rate-payers and employer/medicare/medicaid.
clavalle 11y ago
People who are paying insurance premiums and taxes currently put money in two areas we'll call 'insurance' and 'tax' for convenience sake (and because it accurately reflects reality). The money in the 'insurance' area goes toward paying private medical costs. If those private medical costs disappear and are shifted to public costs under a single payer plan, they don't go away, merely move under that other column. From then on, no money need be put into the 'insurance' area. Yay! But now, the 'tax' area has to pay out more since it took on those costs so much of the money that would have been put in the 'insurance' area must be put over in the 'tax' area to cover the medical costs that have not disappeared but been recatagorized in terms of what pool it is paid out of. Even if those private medical costs are halved somehow, saving the payee money in the process, the 'tax' area would still need to be bolstered to handle the additional burden. Thus, higher taxes even though overall money is saved.
- sharemywin 11y ago
  I read somewhere that insurance company profits are the things you save in a single payer system. insurance "expenses" would be shifted to government expenses.
  - clavalle 11y ago
    There are all kinds of savings in a single payer system. You eliminate the overhead of dealing with disparate billing systems. You can more easily find waste and fraud since all data is flowing into one place in a single comparable format. And, most importantly, you have the power of being the only buyer in a market which can pretty much dictate what price they will pay as long as it doesn't drive the providers directly out of business. But it is disingenuous for OP to suggest that because taxes go up it is an overall worse situation for those paying those taxes, implying there is no way they would save money.
adventured 11y ago
There's a very simple answer: the middle class pays very low income taxes in America. Nearly all of the income tax burden is on the top 25%. If you want to shuttle over half the population into a new single payer health insurance system, they're almost all going to be a (big) net drain. It's an inherent consequence of a highly progressive tax system. Your typical middle class single person is now spending $300 to $400 per month on health insurance (employer sponsored is closer to $100 per month, but that's merely subsidization), and you want to shift them into single payer, then you have to recover that $300 to $400 via taxation. The median in the US has an effective income tax of about 3% to 5%. Put another way, putting all of that toward their new single payer insurance, wouldn't come close to covering how much they'll cost you (and that's before getting into family cost structures).
- kefka 11y ago
  > the middle class pays very low income taxes in America Citation needed. There's "fees", "taxes" and all sorts of hidden ways that eat into the middle class. Not only that, but how much "Fees" were in the eggs you bought? None, right? Not really: they're just bundled in and hidden. Ever get a speeding ticket? That's a fucking tax. Property tax, car "license plates" - tax. Gas has taxes, and a lot of them. As does alcohol. And then there's sales tax- just because you sold something. Hell, there's taxes for dying. But myopically, it looks small. I'd wager that these 'little bits' here and there by far exceeds the percent paid in taxes than the top 1%.. and we know it hurts the middle class far worse.
  - refurb 11y ago
    The top 10% (over $125K/yr) pay 70% of all income tax in the US. In 1990, it was 55%.[1] [1]http://www.ntu.org/foundation/page/who-pays-income-taxes http://www.ntu.org/foundation/page/who-pays-income-taxes
    - kefka 11y ago
      But they at most work with IRS numbers regarding federal income tax. Lets be real here: any money that's leaving my pocket that goes towards "compliance", "fees", "fines", "tickets", or what have you is Tax. Now, I don't have a problem with tax itself (as a concept). I get that services need to be paid for, and that's us. But what I want to know, is out of my paycheck, how much really is taxed? No one can answer that.

atroyn 11y ago

Because the increase in taxes would be more than offset by savings in other areas?

furyg3 11y ago

Because the payer changes? Maybe I don't understand your question...

gotothrowaway 11y ago

To cover the currently uninsured/underinsured, I imagine.

ctdonath 11y ago
That's what the current "Obamacare" plan was supposed to solve. After thrusting much of the health system firmly under government control, raising costs substantially, and literally fining people for being unable to afford more expensive plans, we're left with ... the same number of un- & under-insured people.
- daeken 11y ago
  > we're left with ... the same number of un- & under-insured people. No, we're not. "Gallup reported in July 2014 that the uninsured rate among adults 18 and over fell from 18.0% in Q3 2013 to 13.4% by Q2 2014." More Americans are insured today than ever before, both in absolute numbers and as a percentage of the population. This doesn't mean that the ACA is responsible, but saying that we have the same number of under/uninsured people is simply false.
- delecti 11y ago
  > we're left with ... the same number of un- & under-insured people That's untrue. http://www.gallup.com/poll/182348/uninsured-rate-dips-first-quarter.aspx http://www.gallup.com/poll/182348/uninsured-rate-dips-first-...
- clavalle 11y ago
  The uninsured rate has been cut in half under Obamacare. >According to an ongoing NHIS / CDC study the current uninsured rate of 9.2% for 2015 is the lowest in over 50 years. It started at 18%.
- mhalle 11y ago
  > After thrusting much of the health system firmly under government control, Everyone outside of Medicare is in private insurance, which is regulated but not "firmly under government control". > raising costs substantially, While there is debate about whether the ACA has slowed the rate of healthcare inflation in its short life, there is no evidence that it has "raised costs substantially" across the system. > literally fining people for being unable to afford more expensive plans Fining people for choosing not to pay for health care if they are able. Everyone needs health care, most everyone gets (possibly lacking) healthcare when they need it, and it costs money. The previous solution, brought to you by Ronald Reagan, was the mandate that hospital emergency rooms couldn't turn people away who needed help. A humane concept, but poor social or economic policy for addressing the healthcare system in the large.
- dragonwriter 11y ago
  > That's what the current "Obamacare" plan was supposed to solve. And it reduce the problem considerably (though less than it would have without the bizarre Supreme Court decision that Congress can't actually set the terms on which states get federal Medicaid funds, and particularly change the rules on Medicaid to require states accepting federal money to expand coverage -- which resulted in a number of states opting out of the expansion in Medicaid coverage that was intended to cover the lowest-income portion of the uninsured population not already covered by Medicaid -- the higher-income segment was addressed by the exchange-and-subsidy system.) > After thrusting much of the health system firmly under government control, raising costs substantially, and literally fining people for being unable to afford more expensive plans, we're left with ... the same number of un- & under-insured people. Actually, a much smaller number, but still more than many people would like.

fisherjeff 11y ago

I think think the idea is that the burden of a higher tax will be lower than that of a lower tax rate plus private insurance.

jeffmk 11y ago

Your taxes may go up, but the claim is that the amount your taxes go up will cost less than the healthcare premiums/out-of-pockets/copays/prescriptions/etc. you have to pay, thus the average individual's net cost for healthcare is lower.

dmm 11y ago

In a single payer system the govt is the only one who pays for healthcare. That means even if healthcare spending is the same or less, the portion of healthcare paid for by the govt increases greatly, requiring higher taxes.

ctdonath 11y ago
Medicaid & Medicare are practically "single payer" government-monopoly health insurance plans. They're notorious for severely under-paying doctors et al, to the point that many refuse to take such patients at all.
- pgeorgi 11y ago
  Good luck trying to pick the highest bidder when all your potential patients are in the same single payer scheme.
- dmm 11y ago
  I have no opinion on healthcare funding. I was just explaining how a lower total cost could still result in greater govt spending and taxes.

avar 11y ago

Let's say you make $1000 taxed at 20%, so you have $800 take-home. You spend $400 of that on health insurance. Now you have $400 left, or 40% of the initial amount with a 60% effective "tax" rate. If your taxes increase to say 40% but health insurance is included your taxes have nominally gone up 20%, but down 20% if you consider non-tax costs that were folded into your taxes. As anyone who's moved between countries can tell you, it doesn't make any sense to just consider what the tax rate is, instead you have to think about fixed costs (health care, housing, food, transportation, ...), deduct that from your pre-tax pay, and you're left with your effective taxation as it were. Administrative changes in the government can increase your taxes but have the effect of increasing your take-home pay, that's effectively what Sanders is proposing. There's no flaw in this reasoning, on the contrary you seem to have the fundamental flaw in your reasoning of assuming that the only way for the government to save you money is to reduce your tax rate.

chumich1 11y ago

The savings comes from no longer paying for private insurance which is currently extremely expensive

Spooky23 11y ago

The single payer is the taxpayer vs. the current model where you have a split between rate-payers and employer/medicare/medicaid.

clavalle 11y ago

People who are paying insurance premiums and taxes currently put money in two areas we'll call 'insurance' and 'tax' for convenience sake (and because it accurately reflects reality). The money in the 'insurance' area goes toward paying private medical costs. If those private medical costs disappear and are shifted to public costs under a single payer plan, they don't go away, merely move under that other column. From then on, no money need be put into the 'insurance' area. Yay! But now, the 'tax' area has to pay out more since it took on those costs so much of the money that would have been put in the 'insurance' area must be put over in the 'tax' area to cover the medical costs that have not disappeared but been recatagorized in terms of what pool it is paid out of. Even if those private medical costs are halved somehow, saving the payee money in the process, the 'tax' area would still need to be bolstered to handle the additional burden. Thus, higher taxes even though overall money is saved.

sharemywin 11y ago
I read somewhere that insurance company profits are the things you save in a single payer system. insurance "expenses" would be shifted to government expenses.
- clavalle 11y ago
  There are all kinds of savings in a single payer system. You eliminate the overhead of dealing with disparate billing systems. You can more easily find waste and fraud since all data is flowing into one place in a single comparable format. And, most importantly, you have the power of being the only buyer in a market which can pretty much dictate what price they will pay as long as it doesn't drive the providers directly out of business. But it is disingenuous for OP to suggest that because taxes go up it is an overall worse situation for those paying those taxes, implying there is no way they would save money.

adventured 11y ago

There's a very simple answer: the middle class pays very low income taxes in America. Nearly all of the income tax burden is on the top 25%. If you want to shuttle over half the population into a new single payer health insurance system, they're almost all going to be a (big) net drain. It's an inherent consequence of a highly progressive tax system. Your typical middle class single person is now spending $300 to $400 per month on health insurance (employer sponsored is closer to $100 per month, but that's merely subsidization), and you want to shift them into single payer, then you have to recover that $300 to $400 via taxation. The median in the US has an effective income tax of about 3% to 5%. Put another way, putting all of that toward their new single payer insurance, wouldn't come close to covering how much they'll cost you (and that's before getting into family cost structures).

kefka 11y ago
> the middle class pays very low income taxes in America Citation needed. There's "fees", "taxes" and all sorts of hidden ways that eat into the middle class. Not only that, but how much "Fees" were in the eggs you bought? None, right? Not really: they're just bundled in and hidden. Ever get a speeding ticket? That's a fucking tax. Property tax, car "license plates" - tax. Gas has taxes, and a lot of them. As does alcohol. And then there's sales tax- just because you sold something. Hell, there's taxes for dying. But myopically, it looks small. I'd wager that these 'little bits' here and there by far exceeds the percent paid in taxes than the top 1%.. and we know it hurts the middle class far worse.
- refurb 11y ago
  The top 10% (over $125K/yr) pay 70% of all income tax in the US. In 1990, it was 55%.[1] [1]http://www.ntu.org/foundation/page/who-pays-income-taxes http://www.ntu.org/foundation/page/who-pays-income-taxes
  - kefka 11y ago
    But they at most work with IRS numbers regarding federal income tax. Lets be real here: any money that's leaving my pocket that goes towards "compliance", "fees", "fines", "tickets", or what have you is Tax. Now, I don't have a problem with tax itself (as a concept). I get that services need to be paid for, and that's us. But what I want to know, is out of my paycheck, how much really is taxed? No one can answer that.