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How about you nationalize your healthcare, so people like that are not depended on their work to get the care they need?
by project2501a 9mo ago
How about you nationalize your healthcare, so people like that are not depended on their work to get the care they need?
- bagels 9mo agoWhat role did you specifically play in your country's nationalization of healthcare?
- cheesecakejava 9mo agoMaybe not that person above, but I’ve continually voted in support of it and initiatives to expand it
- WalterBright 9mo agoEmployer provided health care insurance came about during WW2 because Roosevelt froze wages. Companies discovered they could "raise" wages by paying for the insurance themselves. The practice persisted because employer paid health insurance is tax-deductible, while it isn't if a person pays it out of pocket. The obvious solution is to make it tax-deductible.
- jagged-chisel 9mo agoI don’t see how this addresses the comment you replied to.
- WalterBright 9mo agoI suggested an alternative solution to the one proposed by the comment I replied to.
- jagged-chisel 9mo agoI don’t understand how “make it tax-deductible” is an alternative to “nationalize healthcare so it’s not tied to employment.”
- WalterBright 9mo agoSorry, I don't know how to make it any clearer.
- jagged-chisel 9mo agoIt’s already tax deductible. Just saying “make it tax deductible” doesn’t explain what you mean.
- WalterBright 9mo agoIt's complicated. From google: * You must pay the premiums with after-tax money. * Your total qualified, unreimbursed medical and dental expenses (including premiums and costs like co-pays, deductibles, prescription medications, etc.) must exceed 7.5% of your Adjusted Gross Income (AGI). * You can only deduct the amount of expenses that exceeds this 7.5% threshold. * You must choose to itemize deductions instead of taking the standard deduction. Most taxpayers use the standard deduction as it is often larger than their total itemized deductions.
- jagged-chisel 9mo agoOh, you’re suggesting making health insurance premiums tax deductible for the individual. I agree that’s a step in the right direction.
- zeroonetwothree 9mo agoIt would make insurance less tied to employment without nationalizing it.
- wwweston 9mo agoIt doesn’t. It’s part of a rosary of things people wield to stave off thinking about the topic. You can do other things besides nationalizing all care or insurance, but when you hear people talk about “open up markets to cross state competition”, or “everyone gets an HSA”, or “make insurance tax deductible/it’s fdr’s fault”, it’s rarely about the specific policy, those are liturgical texts / catechisms designed to give the impression of solutions without substance. Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group (of people generally healthy enough to work) and that’s one way of getting balanced risk pool if you’re not doing community rating or a societ wide pool.
- Dylan16807 9mo ago> Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group From what I saw, the combination of "no exclusions for pre-existing coverage" and "penalty for not having health insurance" worked pretty well to balance the risk pools without nationalized healthcare. I would still like nationalized healthcare, but I think there are other ways to fix the problem at hand of people being dependent on their jobs for healthcare.
- wwweston 9mo agoAbsolutely. I'm a fan of the ACA's patchwork of wonky choices including no pre-existing exclusions and community rating. Additionally the subsidies made it genuinely accessible for most, at least where they made it through attempts to hamstring them. It's been one of the most helpful practically advanced policy achievements of my lifetime, even with all the effort to destroy it (which has recently found new success and may even succeed entirely in the end). Universal insurance could be better, and perhaps the day will even come when the American electorate recognizes priorities like this and candidates who will advance that kind of policy, contrary habits of the past notwithstanding.
- y7 9mo ago> The obvious solution is to make it tax-deductible. Or make employer paid health insurance count as income and therefore not tax-deductible.
- WalterBright 9mo agoTrue. Total employee compensation is around 145% of their salary. The government could tax that extra 45%, but I doubt that would fly politically. Typical accounts of employee compensation only measure wages and salaries. I've only seen the WSJ using total employee compensation, which is a far more realistic figure.
- okasaki 9mo agoThat's how it works in the UK
- deleted 9mo ago[deleted]
- wombatpm 9mo agoOr lower the age for Medicare every year until everyone is covered.
- SpaceNoodled 9mo agoWe could just lower it once, to zero, and be done with it.
- WalterBright 9mo agoWe could. Who is going to pay that bill?
- arcticbull 9mo agoWell you see it would free up a huge amount of money that employers are currently paying to insurers. If you take that money (by raising the Medicare premium on employees), plus the existing medicaid budget, existing medicare tax and payroll tax contributions America's healthcare system would receive over 40% more money to cover care per capita than the next leading contestant. Almost 2X the OECD average. In PPP dollars no less. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-... "But where would the money come from" is one of the wildest questions to ask about a system that already costs double the average. I'd say, give or take, the same place its coming from now, but like, less.
- 8note 9mo agowould it actually be that different of a bill? i imagine its already doing the most expensive part, treating people who are almost dead who have lots of procedures that could be done. picking up people that need basically no care sounds pretty cheap by comparison
- WalterBright 9mo agoEstimates of Medicare errors, fraud and abuse are around $60 billion. Greatly increasing the scope of it will, inevitably, increase that figure.
- hysan 9mo agoWouldn’t that leave out the set of people who have no income? For example, long term unemployed, adults switching careers and needing to take a long time off for education, etc? While the solution gets close, I don’t think it’s strictly the same thing. Add on top of that our unnecessarily complicated tax system and this sounds even less equivalent.
- trollbridge 9mo agoNote that a freshly laid off person will usually qualify for generous Medicaid benefits, including in WA state.
- _DeadFred_ 9mo agoWhat does 'usually' mean? In my experience 'usually' has never worked in my favor. Say it does, does it kick in immediately? What do they have to do to switch over providers? Does all currently being coveraged treatment just move over to being covered by Medicaid automatically or will they need re-approvals? If you are saying they are covered either way, why not just have consistent healthcare coverage for them and for everyone, all the time?
- trollbridge 9mo agoIn my state it would kick in immediately. You would report your current income, which is now $0 since you just lost your job. Virtually every provider in my state is in-network for the various Medicaid options to choose from, so you would not need to "switch over providers". It's usually better than private insurance. As far as "why not just have consistent healthcare coverage for them and for everyone, all the time", because it would be very expensive to do so? Medicaid covers poorer Americans (including people who just lost their jobs), not the entire population.
- deleted 9mo ago[deleted]
- mindcrime 9mo ago(Looking at this from an American centric point-of-view): The Czar of health-care in the US today is a brain-worm addled, drug-addicted, vaccine-denying, conspiracy mongering, incompetent jackass. And the overall current administration has shown itself to be hostile to basically anyone who isn't a cis-gendered, white, heterosexual, Christian male. How many of us really trust these people to make good decisions regarding our health-care? A position that they (or their delegates) would find themselves in if we "nationalize health care". I think this is a classic example of an idea that sounds good on paper, but doesn't survive contact with reality.
- rgblambda 9mo agoI would imagine individual states would manage their own health services, with the federal government acting as more of a coordinating and standard setting body. At least that's how it works in UK, Spain etc.
- ghurtado 9mo agoThere's probably no federal agency less related to the issue of nationalized healthcare than the DHHS.
- ethbr1 9mo agoYou know CMS is under HHS, right?
- mindcrime 9mo agoEven so, the issues I am referring to go all the way to the top (POTUS) and descend down through everybody in the reporting chain to various degrees. And even for people who are Trump supporters, just ask yourself the question "What happens if the ONE PERSON I HATE MOST gets elected POTUS in a world where I depend on the federal government for health care?" I know in years past we all though the US government was somewhat immune for really radical swings in direction and what-not, but I think now we have an existence proof that really sudden and radical changes can happen.
- 9mo ago
- KetoManx64 9mo agoHow about you do some research on the kind of healthcare that people in countries with socialized healthcare receive. 6 month waitlists for a cancer screenings, multi day emergency room waits for broken bones, maybe you've heard of the oh so wonderful death pods in Canada? Our system is by no means the best, but I'll take it any day over socialized systems.
- acdha 9mo agoCan you cite the sources you researched? I’ve known people from all over the world and none of them found that to be true: the American healthcare system was commented on in disbelief over both the cost and difficulty of getting treatment compared to where they had previously lived.
- KetoManx64 9mo agoThe first result when you Google Canada's healthcare waiting lists: https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ Yes it is. The system has some very deep issues due to government involvement/meddling with both healthcare and insurance, but at least you can still receive life saving treatment in a timely manner. They can be in disbelief all the want, but when people in countries with socialized healthcare get cancer or other life threatening medical conditions they come to the US and a private healthcare to get treated.
- adi_kurian 9mo ago5 million people in the OECD come to the US every year to get created for their cancer?
- acdha 9mo agoThat’s one country, and I note that the authors of that paper directly contradict your thesis: “the Commonwealth Fund’s survey results show that other universal health care systems (eg, the Netherlands, Switzerland, Germany, Australia, and France) have much shorter wait times than Canada does” The American system is also not looking so good as our wait times have been going up and access has been worsening for much of the country, especially over the last year.