Elizabeth Warren Admits Her Medicare For All Will Cost 2 Million Jobs

catkinZ8a

Warren Admits Universal Medicare Would Result in Two Million Lost Jobs


Senator Elizabeth Warren (D., Mass.) agreed on Wednesday with an assessment that a “medicare for all” plan would eliminate roughly two million jobs.


Warren was speaking during an interview at New Hampshire Public Radio.


“An economist at the University of Massachusetts, Amherst, told Kaiser Health News earlier this year that that could result in about 2 million jobs lost,” mostly within the healthcare industry, said NHPR reporter Casey McDermott.


“So I agree,” Warren replied. “I think this is part of the cost issue and should be part of a cost plan.”

The economist cited by McDermott, Robert Pollin of the Political Economy Research Institute at the University of Massachusetts, had stated politicians who want to set up a “medicare for all” system would need a plan for how to treat those who would lose their jobs.


Warren previously said she hasn’t nailed down the specifics of her medicare proposal. The Senator has vacillated between endorsing Bernie Sanders’s plan and calling it a “framework,” whose details she plans to fill out.


In the Wednesday interview, McDermott asked Warren when prospective voters would be able to see her full medicare proposal.


“Soon,” Warren answered. She also declined to specify whether the plan would raise taxes on middle class workers.


“We will see most likely rich people’s costs go up, corporations costs go up, but the costs to middle class families will go down,” Warren asserted. “I will not sign any legislation into law for which costs for middle class families do not go down.”


Sanders on Tuesday also declined to provide specific details as to how he would pay for his universal medicare plan.


“”You’re asking me to come up with an exact detailed plan of how every American — how much you’re going to pay more in taxes, how much I’m going to pay,” Sanders told CNBC. “I don’t think I have to do that right now.”


https://www.msn.com/en-us/news/politics/warren-admits-universal-medicare-would-result-in-two-million-lost-jobs/ar-AAJDmw2#page=2



https://twitter.com/FrancisBrennan/status/1189553177017888768/video/1

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maifleur01

It would depend on how it was implemented if any jobs would be lost or restructured perhaps from one company to another. People either do not know or do not remember that both Medicare and Medicaid is handled by companies that bid on the contract.

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catkinZ8a

A wealth tax would only pay for 40%.

It'd cost trillions--that we do not have.

Tax increases will spike for the Middle Class.

It'd take away private health insurance, wake up.

Long waiting lines, people will die waiting.

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patriciae_gw(07)

Why long wait lines? The same clinics and doctors would exist. The same procedures performed. The big difference would be in how it is paid for. Medicare does an amazing job of keeping down costs but our entire medical system is padded out of shape to build in a ton of profit. That is going to have to change if we want health care for all.

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ubro(2a)

Long waiting lines, people will die waiting.

Bahahahahhaah, spoken like a person who does not understand a good public medicare system.

It'd take away private health insurance, wake up.

That is also not true, we have private health insurance as well as our medicare, your facts are not correct.

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elvis

So Sanders and Warren want the government to decide on how much disposable income the citizens have. How thoughtful of them. What's next? Food rationing?

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Carro

Warren's caring response was, "Meh, we need to trim the fat and save costs".

So, you see, she's doing the taxpayers a favor!

Her story was much different when Federal workers were on furlow.

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elvis

I imagine that commies like AOC, Sanders, and Warren envision themselves enthroned and above it all, future rulers of the little people who don't know what's good for them.

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Chi

"Long waiting lines, people will die waiting"

People are dying now because they can't afford prescription medications and preventative care.

Imagine dying because you have diabetes and can't afford enough insulin to live. Barbaric.

https://www.npr.org/sections/health-shots/2018/09/01/641615877/insulins-high-cost-leads-to-lethal-rationing

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maifleur01

Has nothing to do with age. I read about all kinds of things. You know, even recent history although my personal favorite is the 1600s. History does repeat itself.

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bob_cville

At some level these 2 million jobs can be viewed as parasitic losses -- meaning that there is some large aggregate amount that people (or their employers) are paying for health care coverage, from that amount the salaries of those 2 million people, plus the other costs, expenses, profits, advertising, etc, of the health insurance companies is subtracted, the remaining amount actually goes to pay for medicine, doctors, procedures, tests and other direct health care expenses.

It wouldn't surprise me to find that the amount siphoned off to support the entire infrastructure of the health insurance corporations equaled or exceeded the amount that actually went to pay for health care.

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maifleur01

Apparently it slipped someone's mind that I have mentioned that I was alive during the McCarthy era. I do remember the fear in peoples voices and the worry that if they protested they would be the next person whose lives were ruined because of the mere suggestion that they might have had a conversation with someone who was thought to be a communist. Anyone that spoke out about the hearings lost a lot.

If the posters on here continue as they are this country will again be in a similar condition where only "correct" thinking people are accepted and all the rest should be shunned and their lives ruined. While they do not seem to see that what they apparently think of as being a game is serious similar actions have had terrible consequences through out the centuries.

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

Amazing thread! USA Citizens pay more than anyone on earth for healthcare, but as soon as someone suggests that maybe a fix is needed, the commie/socialist bull dust appears.


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Chi

It's very much the "I've got mine and don't want to pay for yours" mentality instead of seeing the bigger picture. It's pretty sad and explains so much about American culture.

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cattyles

Bob is right and good riddance to all those jobs that worked at not paying legitimate claims.

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patriciae_gw(07)

We pay more than anyone else when we can and when we cant we get to die. That is how it is now. But nothing needs to change. You cant have more people with health care. One thing is not going to fix the mess we have made. We have to rethink the entire system we use so that everyone can have health care. Those of you who don't want change should have to live with the bodies in your Livingroom. the problem we have is not insurance, it is care and you cant get that in our present system without insurance. Don't think you can go to the ER. They do not treat cancer or high blood pressure or diabetes.

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

I've written before about this and it is waste of time, but anyway.

I have private hospital health cover. It costs me $A3600 a year. No health cover and if your income is above X you pay the medicare levy. Doesn't seem to matter all that much which plan you have.

I have belonged to the one fund for over 60 years. When medicare arrived there were all sorts of plans available and you needed to be an Actuary to work out which one was best.

There is a most common fee for nearly every procedure. Medicos do not have to charge the most common fee.

My GP doesn't ( he wants a life) so I trot along, pay $70 and the refund of the most common fee amount is in my bank account next day. Thank you enormous medicare computer. The enormous all-knowing medicare computer has looked at the Dragon woman and my expenses for the year to date and I am getting increased refunds till the end of the year.

How to pay for all this ? There is an Australia wide goods and services tax.

Much more intricate than this rough detail, but any way. I believe in free enterprise and business shouldn't have to pay for employees health fund cover.

How you unscramble the mess, I have no idea. Good Luck.

edited to fix typos.

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Ziemia(6a)

Edited -

This is an interesting view..

"So ...[they] ... want the government to decide on how much disposable income the citizens have."

This is different how?

Besides, health expenses paid by citizens impact our disposable income.

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Iris GW

We should continue supporting an inefficient process just so some people can keep their jobs? Scratching my head here ....

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Carro

I wonder if the loss of those jobs will offset the pricetag of $52 TRILLION.

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Iris GW

We should continue supporting an inefficient process just so some people can keep their jobs? Scratching my head here ....

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Carro

I'm scratching my head at anyone who would be so delusional to think that the government would wind up cutting costs and even more laughable, be efficient!

As Ronald Reagan said, "The most terrifying words in the English language are: I'm from the government and I'm here to help."

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Iris GW

But if it were possible, should we avoid cutting jobs just to keep something inefficient going?

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catkinZ8a

GRAB YOUR WALLET! THIS IS ON TOP OF WHAT YOU'RE ALREADY BEING TAXED!

Choices for Financing Medicare for All: A Preliminary Analysis

Oct 28, 2019

Proposals to adopt single-payer health care in the United States have grown in popularity in recent years, as numerous lawmakers and presidential candidates have embraced Medicare for All. However, few have grappled with how to finance the new costs imposed on the federal government. By most estimates, Medicare for All would cost the federal government about $30 trillion over the next decade. How this cost is financed would have considerable distributional, economic, and policy implications.

In the coming months, the Committee for a Responsible Federal Budget will publish a detailed analysis describing numerous ways to finance Medicare for All and the consequences and trade-offs associated with each choice. This paper provides our preliminary estimates of the magnitude of each potential change and a brief discussion of the types of trade-offs policymakers will need to consider.

We find that Medicare for All could be financed with:

  • A 32 percent payroll tax
  • A 25 percent income surtax
  • A 42 percent value-added tax (VAT)
  • A mandatory public premium averaging $7,500 per capita – the equivalent of $12,000 per individual not otherwise on public insurance
  • More than doubling all individual and corporate income tax rates
  • An 80 percent reduction in non-health federal spending
  • A 108 percent of Gross Domestic Product (GDP) increase in the national debt
  • Impossibly high taxes on high earners, corporations, and the financial sector
  • A combination of approaches

Each of these choices would have consequences for the distribution of income, growth in the economy, and ability to raise new revenue. Some of these consequences could be balanced against each other by adopting a combination approach that includes smaller versions of several of the options as well as additional policies.

Consequences could also be mitigated through aggressive efforts to lower per-person health care costs and/or by substantially scaling back the generosity or comprehensiveness of Medicare for All.

The Cost of Medicare for All

Though it is a somewhat amorphous term, the term Medicare for All has come to represent proposals that offer universal, single-payer health insurance coverage for virtually all health care services (including dental, vision, and long-term care) with no meaningful premiums, deductibles, copayments, or restrictive networks.

In theory, Medicare for All may increase or decrease national health expenditures, which is the total amount spent on health care by all private and public sources. Cost increases would come from covering those who are currently uninsured; expanding coverage to include services like dental, vision, and long-term care; and eliminating deductibles and copayments that currently help curb utilization. Cost reductions would come from lower administrative costs and significantly lower payments to medical providers and drug manufacturers.

Regardless of the impact on total national health expenditures, adopting Medicare for All would mean shifting virtually all private health costs to the federal government. Most independent estimates of Medicare for All find it would cost the federal government $25 trillion to $36 trillion over ten years (though not all incorporate long-term care coverage). Most recently, the Urban Institute estimated Medicare for All would cost $34 trillion over the next decade, or $32 trillion net of income tax effects. These estimates represent additional costs on top of the $16 trillion the federal government is already projected to spend on major health programs over the next decade.

The bulk of this expense represents the direct cost of eliminating premiums, copayments, and other out-of-pocket costs. That spending will total nearly $2 trillion this year alone. Replacing it will require significant new funds regardless of changes to national health expenditures.

Options for Financing Medicare for All

For the purpose of our analysis, we assume Medicare for All would cost $30 trillion over the next decade net of new revenue – roughly the midpoint of a variety of estimates. Though much of this cost represents savings to the private sector, it nonetheless needs to be financed through higher taxes, lower spending, more borrowing, or some combination of the three.

Our estimates are rough and preliminary, do not account for economic feedback, and may change modestly in our final analysis. Importantly, the options we present are illustrative rather than prescriptive. Their economic, distributional, and other consequences should be weighed relative to each other and against the effects of eliminating all premiums and out-of-pocket spending and providing comprehensive, universal health coverage through the federal government.

We estimate that policymakers could finance Medicare for All over the next decade in any of the following ways:1

  • Impose a 32 percent payroll tax. Currently, most wage income is subject to a 15.3 percent payroll tax divided evenly between workers and employers to fund Social Security and Medicare. Wages above $133,000 are subject to either a 2.9 percent or 3.8 percent payroll tax to fund Medicare. We estimate a new 32 percent payroll tax, divided evenly between workers and employers, would raise roughly $30 trillion over a decade. This tax would apply to all wages, not just those below a taxable maximum. An equivalent amount of revenue could be raised with a 23 percent payroll tax on the employee side only or a 48 percent tax on the employer side.2 A 32 percent payroll tax would raise the total payroll tax rate on most wage income to above 47 percent and the rate for high-wage earners to nearly 36 percent. It would apply to all earned income.
  • Establish a 25 percent income surtax on adjusted gross income (AGI) above the standard deduction. Under current law, households pay taxes on their income under a progressive rate structure that ranges from 10 percent to 37 percent, with preferential rates for long-term capital gains and qualified dividends as well as deductions for mortgage interest, charitable giving, state and local taxes up to $10,000, pass-through business income, and other purposes. There is also a standard deduction of $12,200 for individuals and $24,400 for married couples. We estimate a 25 percent income surtax above the standard deduction threshold – which would apply to all AGI without deductions or preferences – would raise roughly $30 trillion over a decade.3 This surtax would effectively increase the bottom income tax rate from 10 to 35 percent, the top income tax rate from 37 to 62 percent, and the top capital gains and dividends rate from 24 to 49 percent.
  • Enact a 42 percent value-added tax (VAT). Whereas most developed countries raise a substantial share of their revenue through a tax on consumption – known as a VAT – the United States only taxes consumption broadly through state and local sales taxes. A VAT could be introduced at the federal level to finance Medicare for All. Based on estimates from the Congressional Budget Office (CBO), we project a broad-based VAT of 42 percent would raise about $30 trillion over a decade. The first-order effect of this VAT would be to increase the prices of most goods and services by 42 percent; the VAT would thus represent 30 percent of costs on a tax-inclusive basis, which is more comparable to an equivalent income or payroll tax rate increase. Importantly, a VAT can be designed in a number of different ways, and a different tax base would change the required tax rate.
  • Require a mandatory public premium averaging $7,500 per capita – the equivalent of $12,000 per individual not otherwise on public insurance. Currently, most Americans are charged health insurance premiums – the majority of which are paid by employers on their behalf. Though current Medicare for All proposals call for ending premiums, policymakers could consider financing Medicare for All through mandatory fixed-dollar payments to the federal government. These payments would be a form of head tax but could resemble premiums in a number of ways. For example, they could vary based on household size and could be paid in part or in whole by employers. They could also be reduced or waived for some individuals, perhaps based on income. In 2021, we estimate those premiums would need to average about $7,500 per capita or $20,000 per household (including single-person households) and is the average applied to all individuals, including retirees, children, and low-income individuals. As an illustrative example, fully exempting everyone who would otherwise be on Medicare, Medicaid, or CHIP would increase the premiums by over 60 percent to more than $12,000 per individual.
  • More than double all individual and corporate income tax rates. Under current law, ordinary income is taxed under a progressive rate structure with a bottom rate of 10 percent and a top rate of 37 percent, while long-term capital gains and qualified dividends are taxed at a top rate of 23.8 percent and corporate income at a rate of 21 percent. Assuming capital gains are taxed at death and pass-through income is no longer deductible,4 we estimate that doubling all individual income tax rates would raise $20 trillion to $25 trillion over a decade, and doubling the corporate rate would raise about $2 trillion. Some additional revenue would be needed on top of these increases to reach $30 trillion in total revenue. This option differs from the income surtax in a number of ways, especially because it would represent a much smaller tax increase for lower-income taxpayers. Under this scenario, the bottom ordinary income tax rate would be raised to 20 percent, the top ordinary rate would be 74 percent, capital gains would be taxed at a top rate of 47.6 percent, and the corporate tax rate would be 42 percent.
  • Reduce non-health federal spending by 80 percent. The federal government is projected to spend $60 trillion over the next decade, including $16 trillion on health care and $6 trillion on interest costs. Accounting roughly for the taxation of certain federal benefits, we estimate that financing the full cost of Medicare for All with spending cuts would require cutting the remaining federal budget by 80 percent.5 Cuts of this magnitude are unrealistically large and certainly could not be imposed on a short timeline. For illustrative purposes, an 80 percent cut to Social Security would mean reducing the average new benefit from about $18,000 per year to $3,600 per year, and an 80 percent cut to the military would mean, among other things, reducing the number of soldiers and officers from about 1.3 million today to 270,000.
  • More than double the national debt to 205 percent of the economy. Federal debt held by the public currently totals about $17 trillion, or 79 percent of GDP. Under current law, debt is projected to reach 97 percent of GDP by 2030. Assuming no changes in projected interest rates or economic growth, deficit-financing Medicare for All over the next decade would require about $34 trillion of new borrowing including interest, which is the equivalent of 108 percent of GDP by 2030. As a result, debt would rise above 205 percent of GDP, more than double its currently projected level. This would put debt in 2030 at almost five times its historic average of 42 percent and nearly twice the historic record of 106 percent (set after World War II). Under this scenario, debt would continue to grow rapidly beyond 2030.
  • Impose impossibly high taxes on high earners, corporations, and the financial sector. There is not enough annual income available among higher earners to finance the full cost of Medicare for All. On a static basis, even increasing the top two income tax rates (applying to individuals making over $204,000 per year and couples making over $408,000 per year) to 100 percent would not raise $30 trillion over a decade. In reality, a tax increase that large would actually lose revenue because it would institute marginal tax rates above 100 percent when other taxes are incorporated – effectively requiring people to pay rather than be paid to work, earn business income, or sell capital assets. We previously found that an extremely aggressive package of tax hikes on high earners, corporations, and the financial sector might cover one-third of the $30 trillion cost of Medicare for All. Our very rough estimates showed that over the next decade raising the top two individual and pass-through rates to 70 percent would raise about $2 trillion, phasing out most tax breaks for higher earners (assuming that 70 percent top rate) could very generously raise another $2 trillion, and doubling the corporate tax rate would raise $2 trillion. We also found that a wealth tax or “mark-to-market” capital gains taxation could raise $3 trillion, and the combination of a financial transaction tax and a tax on large financial institutions could raise about $1 trillion. Other taxes on high earners and the wealthy could raise some additional funds.
  • Enact a combination of approaches. Rather than identify a single revenue source to finance Medicare for All, policymakers could combine several options. For example, one could combine a 16 percent employer-side payroll tax with a public premium averaging $3,000 per capita, $5 trillion of taxes on high earners and corporations, and $1 trillion of spending cuts. Other small options, such as a higher excise taxes on alcohol, tobacco, or sugary drinks, could also be included, as could policies to require or encourage state governments to contribute to offsetting the cost of Medicare for All. Adopting smaller versions of several policies may prove more viable than adopting any one policy in full.

While the financing options above are quite large in magnitude, they could be reduced significantly by reducing the cost of Medicare for All itself.

These cost reductions could be achieved in part by reforming or reducing provider payments, improving care coordination, and identifying policies to reduce excessive utilization of care. Our Budget Offsets Bank incudes numerous options to reduce the cost of traditional Medicare; some of these options would save much more if applied to a comprehensive Medicare for All program.

Cost reductions could also be achieved by scaling back the generosity of a Medicare for All program. For example, the Urban Institute recently estimated that a Medicare for All plan that required cost sharing to cover between 5 and 20 percent of medical costs (depending on income) and covered only core health benefits (not vision, dental, hearing, or long-term services and supports) would cost the federal government half as much per person as a comprehensive Medicare for All plan. A $15 trillion cost could be financed with a 15 percent payroll tax, as compared to the 32 percent payroll tax required to fund $30 trillion.

Choices and Trade-Offs in Financing Medicare for All

Deciding how to finance Medicare for All involves weighing significant trade-offs amongst options as well as relative to the current system. Indeed, the design of Medicare for All financing may have as much distributional, economic, and policy importance as the adoption of Medicare for All itself.

While many Americans are enrolled in heavily subsidized Medicare, Medicaid, or private insurance plans, the majority of Americans pay for their health care through premiums (especially employer-paid premiums), deductibles, copayments, and coinsurance.

While premiums and cost sharing are not a form of taxation, they do share some features in common with a “head tax” – a fixed-dollar tax imposed on every person. For those with employer-provided health insurance especially, premiums generally remain fixed regardless of changes in income. Like head taxes, insurance premiums would thus be regressive if measured relative to income among those who pay them (though many of the lowest earners on Medicaid or receiving exchange subsidies pay little or no premiums). Also like a head tax, premiums are economically efficient in the sense that they create very little economic distortion and do not generally disincentivize more work, investment, or productivity. Finally, because premiums and cost sharing don’t affect marginal tax rates or returns to work and investment, they have little effect on the government’s ability to raise revenue.

Any plan to replace current premiums and cost sharing must weigh how the new finance scheme will impact income distribution, economic output, and tax capacity. In the coming months, the Committee for a Responsible Federal Budget will release a full report evaluating the various effects of most of the options mentioned in this paper.

From a distributional standpoint, most of the options we put forward above would be more progressive on average than current law, though the impact would vary person to person and many of the options would represent a cost increase for lower-income individuals and families who currently benefit from Medicaid and exchange subsidies. Options would differ in their distributional impact. To get a broad sense of how distribution may differ, a recent CBO study shows that in 2016 the top income quintile (indirectly) paid less than 40 percent of employer-side health premiums, but they paid more than 85 percent of individual and corporate income taxes and would have paid over 50 percent of a new flat payroll tax. The top percentile paid about 2 percent of premiums, but they paid over 40 percent of income taxes and would have paid 10 percent of a new flat payroll tax.

At the same time, most of the options we present would shrink the economy compared to the current system. The 32 percent payroll tax hike, for example, would increase the effective marginal tax rate on labor by about 23 percent after accounting for various interactions. Penn Wharton Budget Model recently estimated that an 11.25 percent payroll tax increase used to pay for a Universal Basic Income (UBI) would reduce GDP by 1.7 percent.6 This suggests that financing Medicare for All with a payroll tax would shrink the size of the economy by about 3.5 percent by 2030 – though the actual effect may differ. This economic impact would be the equivalent of a $3,200 reduction in per-person income and would result in a 6.5 percent reduction in hours worked – a 9 million person reduction in full-time equivalent (FTE) workers in 2030.

Deficit-financing Medicare for All would be far more damaging to the economy. Assuming that such a massive increase in the debt would not roil financial markets or lead to high inflation, we estimate that a 108 percent of GDP increase in the federal debt would shrink the size of the economy by roughly 5 percent in 2030 – the equivalent of a $4,500 reduction in per-person income – and far more in the following years. This is a low-end estimate of economic impact because it implicitly assumes few limits on the amount of foreign savings available to purchase Treasury bonds. Because deficit-financing would have little direct impact on the incentive to work, we estimate a 0.7 percent or 1 million FTE reduction in work hours by 2030.

An additional consideration is how much tax capacity any of these financing options might leave for future policymakers aiming to raise revenue to pay for new programs, fund existing ones, or reduce deficits. The best economic literature suggests a revenue-maximizing tax rate of between 63 and 73 percent,7 after which further rate increases actually lose revenue. Tax rates approaching these high levels would reduce the ability of policymakers to raise revenue in the future.

con't.

https://www.crfb.org/papers/choices-financing-medicare-all-preliminary-anal\

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Ziemia(6a)

, of course

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Carro

Iris, thinking it's possible given the knowns in ANY government-run equation, that informs us that government is at it's core, slow, bulky, inefficient and once created, feeds itself first and foremost, and indefinitely. Inertia. It will just keep going and growing and costing more.

That's the case with ALL government.

It is healthier to keep healthcare private, and I think and really do believe, that Americans can accomplish this without the Federal gov't. We have medicare and the VA. That's more that our gov't can handle already.

Let's get the healthcare moonshot, which could take many forms. Just NOT government-only run. Let's keep and fix Ocare and keep private healthcare insurance.

The solution will be an amalgamation of both, not one or the other

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catkinZ8a

con't.


Under current law, the top effective marginal tax rate (accounting for state and local taxes in a typical state) is about 48 percent. That rate would rise to 69 percent after a 32 percent payroll tax hike (the increase is smaller than the tax due to interactions with the tax base), 73 percent after a 25 percent income surtax, and 85 percent if income tax rates were doubled. In other words, each of these options would bring the top rate close to or above the revenue-maximizing rate.

Conclusion

Regardless of its impact on national health expenditures, Medicare for All would shift substantial costs from the private sector to the federal government. By most estimates, a comprehensive Medicare for All plan that expands coverage to every U.S. resident for nearly all medical services and eliminates premiums and cost sharing would cost the federal government roughly $30 trillion over a decade.

Policymakers have a number of options available to finance the $30 trillion cost of Medicare for All, but each option would come with its own set of trade-offs.

In this preliminary analysis, we estimate the cost could be covered with a 32 percent payroll tax, a 25 percent income surtax, a 42 percent value-added tax, or a public premium averaging $7,500 per capita or more than $12,000 per individual who wouldn’t otherwise be enrolled in Medicare, Medicaid, or CHIP. Medicare for All could also be paid for by more than doubling individual and corporate income tax rates, reducing federal spending by 80 percent, or increasing the national debt by 108 percent of GDP. Tax increases on high earners, corporations, and the financial sector by themselves could not cover much more than one-third of the cost of Medicare for All.

Rather than adopting any one of the proposals above, policymakers could also consider a combination of approaches to finance Medicare for All. Reducing the cost, scope, or generosity of Medicare for All would also reduce the magnitude of needed financing.

In deciding how to finance Medicare for All, policymakers must consider the distributional, economic, and policy consequences of replacing premiums and cost sharing with various alternatives. Most of the options we put forward are more progressive on average than current law but would shrink economic output and bring the top tax rate up to its revenue-maximizing level – leaving little capacity for further taxes.

This paper will be followed by a more detailed analysis of the various consequences of different financing options.

https://www.crfb.org/papers/choices-financing-medicare-all-preliminary-anal\

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catkinZ8a

Confiscating wealth of all billionaires wouldn't pay for three average years of 'Medicare for all'

by Philip Klein | October 28, 2019 01:36 PM


Massachusetts Sen. Elizabeth Warren is scrambling to figure out how she would pay for a "Medicare for all" proposal without raising taxes on the middle class. But even if she were to confiscate the wealth of all of the billionaires in the United States, it wouldn't even pay for three average years of Vermont Sen. Bernie Sanders's plan to socialize health insurance that she supports.


The liberal Urban Institute has calculated that a plan along the lines of what Sanders and Warren are advocating would raise federal spending by $34 trillion over a decade. The study does not include a year-by-year breakdown, but the average annual cost over 10 years would thus be $3.4 trillion, or $10.2 trillion for three years.


Yet earlier this year, Forbes estimated that the 2,153 billionaires in the U.S. have a collective net worth of $8.7 trillion. That means even if the government were to magically vacuum up all of their wealth without any economic distortion, it wouldn't even pay for a third of the cost of the plan in the coming decade.


Of course, if this were done, in the second decade, when the program's cost would be even higher, the government would be out of billionaires to tax.


The largest revenue raiser Warren has proposed during her campaign is a wealth tax, which she claims would raise $2.75 trillion, not enough to cover a year of the healthcare proposal. Either way, she has already pledged to use the wealth tax to pay for universal child care, universal pre-K, a K-12 plan, a plan to raise child care worker pay, free college, and canceling student loan debt.


https://www.washingtonexaminer.com/opinion/confiscating-wealth-of-all-billionaires-wouldnt-pay-for-3-average-years-of-medicare-for-all

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catkinZ8a

Philip Klein | November 01, 2019 10:59 AM


Sen. Elizabeth Warren on Friday came out with her long-awaited plan to "pay for" the “Medicare for all” proposal she supports. But it is not actually a serious proposal to solve problems that have vexed health economists for decades. It is, instead, a complete joke. She may as well have said Mexico is going to pay for it.


Going through the plan this morning, these areas particularly strike me as laughable.

Warren comes up about $14 trillion short. Warren proposes a blizzard of tax hikes — on payrolls, financial transactions, corporations, and the wealthy — and promises to save money by combating tax fraud. These add up to about $20 trillion. So even if they raise all of the money she claims (doubtful), she would still be left with a huge gap relative to the $34 trillion cost of a program as generous as what she’s proposing, according to an estimate from the liberal Urban Institute.


She lies about middle-class tax increases. Warren’s effort to unveil a financing plan arose out of a campaign talking point that she wouldn’t raise middle-class taxes. In the new plan, she insists, “We don’t need to raise taxes on the middle class by one penny to finance Medicare for All.” But the largest single tax increase she proposes is an $8.8 trillion tax on payrolls, which inevitably will fall on the middle class. Her defense of this is that both the middle class and businesses would be better off on net because they’d be saving money on premiums and administrative costs. Yet even if this were true, this would still count as a tax increase. As I’ve noted before, people may believe that paying property taxes and sending their kids to public school is a good deal on net. But they still think of property taxes as taxes and increases in property taxes as tax increases. In reality, however, even this gives her too much credit because of the phantom savings.


Over $7 trillion in phantom savings. Warren’s plan leans heavily on the idea that the money the United States is already paying on healthcare is more than enough to finance her healthcare vision. As a nation, we are already on track to spend $52 trillion on healthcare over the next decade, and she claims her plan would be lower than that due to reduced administrative costs, insurer profits, and so on. Yet the Urban Institutelooked at a plan along the lines of what she is proposing, considered potential savings from administration, and found it would raise national health spending by $7 trillion to $59 trillion. As their analysis concluded, “By our estimates, the increase in spending for people with this new generous coverage would outweigh the savings from lower prices for health care providers and lower administrative costs. As a result, total national spending would increase, even taking into account greatly reduced household, employer, and state government spending.” In other words, even if the plan has some offsetting savings, it would still be promising free health, vision, and dental coverage to every American, without premiums, copays, deductibles — all of which should be expected to dramatically increase consumption.


$2.3 trillion in magic revenue from combating tax fraud. The Warren proposal ludicrously claims that with some increase in tax enforcement, the government would raise "about $2.3 trillion in additional federal revenue without a single new tax.” For decades, whenever politicians have drawn a blank in attempting to fill a financing nut, they always turn to eliminating “waste, fraud, and abuse” as a sort of free money. It's an old trick, but it’s quite remarkable for Warren to count on it raising more money than the 10-year cost of Obamacare.


Miraculously claims to cut doctors’ pay without cutting doctors’ pay. One of the most difficult questions faced by policymakers trying to figure out the U.S. healthcare financing puzzle is what to do about compensation to doctors and hospitals. They make up a majority of U.S. health spending. Squeeze them too much, and it could lead to fewer providers and thus severe access problems when tens of millions of people are being added to the system. Let them continue to charge high prices while having the government pick up the tab, and the cost of socialized health insurance is that much more expensive. I dinged Warren in my column this week for not outlining what she would do about compensation. At first blush, it seems that she’s finally changing her tune and acknowledging the need to bring down their pay to achieve savings. Instead, she ended up presenting payment cuts as something totally cost-free.


Warren claims that her plan would pay doctors and nonhospital providers at Medicare rates, which are higher than what Medicaid pays, but lower than what private insurance pays. That may sound like a pay cut, but Warren claims, “While private insurance companies pay higher rates, this system would be expected to continue compensating providers at roughly the same overall rate that they are currently receiving.” How can that be? Because of those exaggerated administrative savings! So there you have it — Warren came up with a magic way to cut doctors’ pay without cutting doctors’ pay that no health economist has previously thought of!





https://www.washingtonexaminer.com/opinion/elizabeth-warren-may-as-well-have-said-mexico-is-going-to-pay-for-medicare-for-all

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catkinZ8a

Billionaires will flee this country so fast your head will spin!

Radical Socialist Elizabeth Warren is insane if she thinks America will elect her president.

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ubro(2a)

Billionaires will flee this country so fast your head will spin!

well let them go, that is what the right wing response is when anyone on the left complains about the countries policies. Again greed and wealth rears it's ugly head.

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Iris GW

So can we just answer the question: should we keep jobs to continue inefficiency or not?

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Carro

catkin, the wealthy are not going to park their dollars where Warren can get her hands on it.

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Carro


Iris GW

So can we just answer the question: should we keep jobs to continue inefficiency or not?

Let me suggest you go back and look at the Left's response to ANY government cuts which Trump has done, and then you tell us, ok?

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Iris GW

This tit for tat is really not a way to have a conversation.

Were those cuts based on inefficiency? If not then we're not having the same conversation.

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Carro

Iris GW

This tit for tat is really not a way to have a conversation.

Neither is construction straw man arguments.

Bottom line, Iris, cutting those jobs wouldn't even be like a drop in the ocean. It would be less, by orders of magnitude. That's how ridiculous Warren's proposing that theose 2 million jobs would somehow offset her healthcare boondoggle.


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Iris GW

that theose 2 million jobs would somehow offset her healthcare boondoggle.

Is she saying that? I hear her saying that some jobs will go away because of the change. Setting expectations. Not that they pay for (offset) the change.

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katrina_ellen

Its always the middle class that pays. The poor are on the receiving end, and the rich have too much flexibility with their lawyers, CPA's and other forms of moving money out of taxable income. But big government solutions always work right?

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dandyfopp

My elders all seem to love their Social Security and Medicare.

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Carro

Is she saying that? I hear her saying that some jobs will go away because of the change. Setting expectations. Not that they pay for (offset) the change.

I'm not listening to what Warren is saying, because it's dishonest in the way that she's not being straight with us. Jobs will go away and that's terrible, but not as terrible as how much taxes will go up for that middle class she says she wants better for.

There's no way she can get the money she needs from the "wealthy". No. Way.

Warren can't extract half the world's GDP to pay for her plan. Can't do it.

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Carro

dandyfopp

My elders all seem to love their Social Security and Medicare.

Mine too! And I hope that despite hearing for decades there's not going to be anything left for me once I join and draw, that I will love it too!!!!


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katrina_ellen

And SS and Medicare are always on the brink of disaster. Its a ponzi scheme that's only kept alive by those who are currently contributing to those taxes.

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

Lol, these conversations have been going on for yonks, anyway at least since 2007 on the old garden web conversations page.

Scare words Socialist, Communist, Single Payer, Tax

There is a problem. that cannot be fixed and that is the USA spends more on health care per Capita than any other country. Should be less with economies of scale?

Spending all that moular should also result in great health outcomes in many areas.

Single payer???? The Australian system is best described as mixed public and private.

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Iris GW

I'm not listening to what Warren is saying

Well, that explains some of what you're saying.

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chisue

When reading these rants against change in how to finance and improve health care, remember whose ox is being gored. Vested interests are making a fortune under this 'system' and will fight tooth and nail to keep profiting.

As for 'socialism', isn't Joe McCarthy DEAD?

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Iris GW
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Ann

I think this may be the end for those hoping for Warren to be the nominee. I think this was a good day for Trump, Biden, other Dem candidates, and (potentially) yet to get in the race candidates.

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Iris GW

Just curious, Ann: did you read what she wrote?

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Ann

No Iris, I've just been hearing about it on the news - TV and radio as I was out and about this morning.

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Iris GW

Right now, America’s total bill for health care is projected to be $52 trillion for the next ten years. That money will come from four places: the federal government, state governments, employers, and individuals who need care. Under my approach to Medicare for All, most of these funding sources will remain the same, too.

  • Existing federal spending on Medicare and Medicaid will help fund Medicare for All.
  • Existing state spending on health insurance will continue in the form of payments to Medicare — but states would be better off because they’d have more long-term predictability, and they’d pay less over time because these costs will grow more slowly than they do today.
  • Existing total private sector employer contributions to health insurance will continue in the form of contributions to Medicare — but employers would be better off because under the design of my plan, they’d pay less than they would have otherwise.

Here’s the main difference: Individual health care spending.

Over the next ten years, individuals will spend $11 trillion on health care in the form of premiums, deductibles, copays, and out-of-pocket costs. Under my Medicare for All plan, that amount will drop from $11 trillion to practically zero.

I asked top experts — Mark Zandi, the Chief Economist of Moody’s Analytics; Betsey Stevenson, the former Chief Economist for the Obama Labor Department; and Simon Johnson — to examine options for how we can make up that $11 trillion difference. They conclude that it can be done largely with new taxes on financial firms, giant corporations, and the top 1% — and making sure the rich stop evading the taxes we already have.

That’s right: We don’t need to raise taxes on the middle class by one penny to finance Medicare for All.

Source: https://medium.com/@teamwarren/ending-the-stranglehold-of-health-care-costs-on-american-families-bf8286b13086

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catkinZ8a

Medicare for all is the Radical Socialist Democrat's Chernobyl!


Why ‘Medicare for All’ Will Sink the Democrats

Steven Rattner

OCTOBER 24, 2017

Originally appeared in the The New York Times.

Repeal-and-replace may be done for now, but for Senator Bernie Sanders, the war is just beginning — and it has already become a fracas that is dividing the Democratic Party, to its detriment.

Mr. Sanders — who, of course, isn’t even a registered Democrat — is banging on about what he calls “Medicare for All,” a government-run plan that would provide health care coverage for every American.

But now the crusty Vermont independent wants to be a senatorial pied piper for Democrats. He has made his proposal into a kind of litmus test for who is a “good Democrat,” inveigling 16 of his colleagues — more than a third of Senate Democrats — into endorsing it.

A goodly number of those senators are presidential hopefuls, leaving their prospective campaigns open to attack from Republicans salivating to capitalize on an idea that has historically been a political graveyard. Remember Hillarycare?

As a centrist Democrat, I’m scared to see my party pulled into positions that are both bad politics and dubious policy. And I’m disappointed that few of our party’s moderates are willing to resist the freight train coming at us from the left.

I understand why Mr. Sanders and his acolytes believe that sweeping progressive ideas — however unrealistic they may be — might capture the public imagination better than the more carefully constructed proposals of centrists, policies that are harder to articulate and can come across as mushy.

But the Sanders approach didn’t work for George McGovern in 1972 or Michael Dukakis in 1988, and I don’t believe it will work for Democrats in 2018 or 2020.

Yes, recent polls seem to indicate rising support for single payer. But when factors like whether taxes would be raised or the Affordable Care Act would be repealed are introduced, the consensus swings to opposition.

Spellbound Democrats should also consider the fate of past single payer proposals. In Sanders’s home state of Vermont, a single payer plan was abandoned after an analysis found that it would require a near doubling of the state budget (and increasing taxes similarly).

In Colorado last November, a whopping 80 percent of voters rejected a universal plan, again over taxes and costs. And for similar reasons, California recently shelved a single-payer proposal.

Amid the many complications of Medicare for All, the question of what would happen to the 157 million Americans who get their insurance from their employers and the 19 million who are enrolled in Medicare Advantage loom large.

To be sure, some Democratic senators seem to be supporting Medicare for All as a lever to achieve more modest goals, like a public option within the existing health care exchanges.

For example, Al Franken of Minnesota called the Sanders proposal “aspirational” and “a starting point for where we need to go as a country.”

More like the starting point of a political nightmare for Democrats. For one thing, Mr. Sanders has been unabashed in his attacks on “the establishment wing of the Democratic Party” and has intimated that primary challenges may be in the offing.

For another, when the Republicans unleash their inevitable blitzkrieg, I doubt voters will recognize the subtleties in positions like Mr. Franken’s.

Privately, many moderate Democratic senators are harshly critical of Sanders’s tactics. “It’s radioactive for me,” one Democrat facing re-election in 2018 told me.

But publicly, even Democratic senators who have declined to endorse Medicare for All have done so in measured terms to avoid antagonizing the progressives.

“The first thing has to be to protect the health care people have now and stabilize markets,” said Debbie Stabenow of Michigan.

Instead of Medicare for All, we Democrats should be focused on “Better Jobs for All” — big ideas for addressing our most pressing economic challenge. That is: the wage stagnation that has left too many Americans behind, particularly white working-class men.

That’s not an easy problem to solve, but we know the solutions revolve around people-centric initiatives like improving education, providing more training and retraining and increasing worker mobility.

To buttress those programs, it’s time to move ahead with rebuilding our infrastructure and restoring government investment spending on research and development.

In doing so, let’s not forget that only about a quarter of voters consider themselves liberals; the balance self-identify as moderates or conservatives.

Our model of democratic capitalism has stood us well for more than two centuries; now is not the time to embrace the kinds of ideas, often involving deep government economic intervention, that have often fallen short elsewhere, notably in much of Europe.

On present course and speed, we can take back the House of Representatives in 2018 and defeat President Trump in 2020 — unless we Democrats do something stupid, like nominating candidates from the fringe of our party.

https://stevenrattner.com/article/why-medicare-for-all-will-sink-the-democrats/

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catkinZ8a

Progressivism is pie in the sky.

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mrskjun(9)

According to Warren, Medicare as we know it will go away. In other words, this is not Medicare for all, but Socialized medicine. Of course according to Warren, those two million jobs that would be lost, they can sell life insurance instead. I suppose with the inability to see drs in a timely manner, more will need life insurance. We are constantly being told that Medicare and Social Security is going broke. We never hear that welfare and food stamps are. So the two million who might lose their jobs could take advantage of that.

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Jenn TheCaLLisComingFromInsideTheHouse(5)

Right now doctors and nurses have gotten themselves up to a HUGE rate of burnout, largely from having them do all the paperwork and whatnot that these HMO/PPO companies really should be doing for them instead of focusing on just patient care...

We're losing doctors and higher level healthcare workers in critical fields, it started with mental health providers and expanded outwards, kind of hard to see how we're supposed to pull off sending high-risk individuals to appropriate mental health care providers before they can go commit a mass shooting with that problem now!

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chisue

Drug costs would go down a lot if we outlawed advertising of prescription medications --like the rest of the First World. (Count the advertising world in the corner fighting to keep the status quo.)

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chase_gw

There sure seems to be a lot of people who have no idea what the term socialism much less " socialised medicine " means.

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Jenn TheCaLLisComingFromInsideTheHouse(5)

I keep seeing a commercial here that's presented by the American biopharmaceutical corporations, saying that we're currently the leader in biopharmaceutical research and development, and we'll lose that if we try to lower costs or regulate them more (paraphrasing, mine). I think that this is almost as bad as the ads run by the HSUS (humane society of the US) with all the puppies and kittens despite less than half of one percent of the money they bring in going to actual puppies and kittens at shelters. Duplicitous and harmful to the places that actually do things to help real puppies and kittens like your local humane society. The pharmaceutical companies don't want to lose their money and they know that we've put up with giving them so much for so long that some people might just give up the fight and let them continue to suck people dry for another generation or two. :P

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

Just a reminder, if you go to the University of Google and look up health costs per Capita in US dollars you find...

Australia $4708

USA $9892

There is problem there, either in the USA health cost or at the University of Google?

As I said in another thread, it is a worry that those darned Scientists keep finding ways to keep us old codgers alive and well.


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Ann

"There sure seems to be a lot of people who have no idea what the term socialism much less " socialised medicine " means."

Oh, we very much understand what socialized medicine means, which is exactly why so many don't want to spend 30-50 trillion to get it. Those on Medicare or approaching Medicare need a solid education on what the ramifications will be to that program. Once that happens, I think it will be hard to find one vote for M4A from the 65+ age group.

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Ann

"I keep seeing a commercial here that's presented by the American biopharmaceutical corporations, saying that we're currently the leader in biopharmaceutical research and development"

Are you disputing that the U.S. is the leader?

https://morningconsult.com/opinions/america-leads-biopharmaceutical-innovation-lets-keep-it-that-way/


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chisue

You may be fine paying General Mills $4 a box for Cheerios to cover marketing costs. I'm not fine with Glaxo charging $500/month to cover advertising for the asthma maintenance inhaler Advair. It's the same unchanged/unimproved product they have sold for 20 years for whatever number they can make up without laughing.

Like Cheerios, ingredients for Advair cost pennies. I can choose another breakfast cereal, but without this inhalant, I will stop breathing. (You know what happens then.)

As for pharmaceutical R&D, few discoveries offer benefits beyond the 4% fudge factor that exists in all comparison trials, and most are aimed at treating common (largest market) problems.

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margaritadina

Did she say what it is going to cost the rest of us? (I know it will be nightmare, just wanted to hear her opinion)))))

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margaritadina

''

ubro(2a)

It'd take away private health insurance, wake up.
That is also not true, we have private health insurance as well as our medicare, your facts are not correct.

''

''You can keep your doctor'' and ''you will be able to afford your health care insurance for the price of a cell phone'' Where did I hear it and from whom? Oh, that's right! From the same man who said ''If your mother breaks her hip, just give her a pill"' - the last one is true, you can't get a hip replacement after 80 any more!

Everything else was a lie. Lower middle class was busted hard with unbelievably high premiums and deductibles.

And here is another lie from the same party - no one gets good care in socialized medical system. No one with private or employer provided health insurance will vote for this insanity - fool me once, shame on you, ''fool me twice'' doesn't fly in America.

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

"And here is another lie from the same party - no one gets good care in socialized medical system. No one with private or employer provided health insurance will vote for this insanity - fool me once, shame on you, ''fool me twice'' doesn't fly in America."

Absolute bull dust. A couple of years ago I spent 5 days in a public hospital. It was fine. Here, there is no emergency admittance at private hospitals. If you have an emergency, you are admitted to a public hospital. That happened early one morning when I had difficulty talking to the cat.


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mrskjun(9)

arthum. the same can be said of education. We spend more per student than almost anyone. And look at their test scores.

Fool me once, like you can keep your dr.? So we should go for fool me twice?

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

The thing about the no choice of Doctors happened I think in the early days in the UK . Do not know what happens there now.

No one tells you which GP to use here. The choice is up to the individual.

Do not know where the concept of the most common fee came from. Doctors can charge the most common fee or anything they like. if you go to a GP who charges the most common fee, the consultation will be "free". Otherwise, you pay the bill and the refund of the most common fee will be in your bank account next day.

No idea about education. it never seems to be under discussion, "apart from student debt which might be a problem in many countries".


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Ann

Arthur, out of curiosity, what percentage of the people go to a doc who charges the only the common fee and what percentage of the people pay more to go to a different doc? Along the same line, what percentage of docs charge the common fee and what percentage charge more? Just an educated guess would be great. I'm just curious.

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Ann

Arthur, I just read most of this. It was interesting. I think I understand more about your system now.


https://www.mydr.com.au/first-aid-self-care/australian-health-system-how-it-works

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arthurm2015(Micro-Climate, Zone 10b Sydney, Australia)

The system has been a work in progress for a long time. Sure there are problems, waiting times in the public hospital system for hip and knee surgery and so on. At least medical horror stories are not common here!


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floral_uk z.8/9 SW UK

I haven't read all the posts because I really can't take much of what is being said seriously. The misinformation is astounding. To quote Arthur, 'absolute bull dust'. However, let it be known that we can choose our doctors here. Both GPs and specialists. You can choose your surgeon. You can choose which hospital you go to. You can have private health insurance too if you wish. But 90% of the population don't bother. And even if you do have it you'll end up with the NHS if you have anything serious since the private sector isn't interested in dealing with anything difficult or expensive. They need to make their profits.

Btw my 83 year old neighbour had a new hip this spring. There is no age cut off if you are good enough health to support the operation.

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Ann

"There is no age cut off if you are good enough health to support the operation."

Goodness, I hope not!

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floral_uk z.8/9 SW UK

You misunderstand my meaning, Ann. I was referring back to Margaritadina's post which said 'you can't get a hip replacement after 80 any more.' That's simply not true and I was giving an example known to me personally.

And here is another hideous lie, 'no one gets good care in socialized medical system'. The depths of ignorance exhibited in that statement are sickening. Not to mention the appalling insult to the thousands of dedicated and highly qualified people who work in our NHS and deliver excellent care to every citizen. That kind of ignorant vilification makes my blood boil.


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Ann

Floral, if you're happy with the healthcare system in your country, that's great. It shouldn't matter what people from other countries think or what they may want or like in their own country.

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Ann

Here in the U.S., Medicare for all was a hot topic and here on HT, there was a great deal of conversation about the popularity of the concept several months ago. When the realism of the system and its cost moved into the topic, it quickly became a topic many are almost running from and as fast as they can. Here is the U.S., Dems were so excited to run on healthcare as their primary policy focus. That very topic might end up being the topic that buries them in the next election. In other words, the topic they felt was going to be so much to their benefit as far as voters were concerned, looks like it might end up being just the opposite and very much to their detriment.

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floral_uk z.8/9 SW UK

It doesn't matter to me what people think but it matters to me when they base their opinions on lies and factual errors. I should have thought everyone would be concerned about that. I'm sure you'd not want me to pontificate about the way things are done in the USA using factually incorrect statements.

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