So, I've spent a lot of tonight researching healthcare. At first I looked overseas at what other countries are doing, but I quickly realized any model they have cannot and will not apply to the US. A much as neolibs love to go on about how public option plans work for Germany, or as much as we like to talk about how great Canada and the UK's systems are, the US is ****ed. I wouldn't normally curse on this blog, but that's the only way I can describe it, we are completely, and utterly ****ed.
Let's untangle this to some extent.
Americans pay 17% of our GDP per capita for healthcare, these other countries pay around 11%. Our cost just on our public systems alone are comparable to what other countries pay for all of their healthcare. We used to pay similar amounts of money as other countries on healthcare, but since 1970 the differences grew. Other countries have figured this crap out decades ago, but our costs have ballooned as we have a broken system that is literally just about the worst ways to do things. We should have solved these problems 50 years ago, bur we didn't so now we're paying for it. Kind of like how if you dont get preventative healthcare early you pay for treating a full blown disease. It's an ironic comparison.
To go into the factors for why our healthcare is so expensive:
1) We literally have multiple systems. We have the exchanges, medicare, medicaid, the VA, and various forms of private insurance. Not only does this make the system fragmented, but it creates tons of what David Graeber calls BS jobs in which we need an army of administrators just to talk to all of the different parties in the system and parlay for them the system to work. This is a huge reason Bernie's medicare for all plan just decided we could axe $500 billion off of costs just by switching over. By having a single system, we could just save all that money and get rid of all of those unnecessary jobs.
2) The profit motive combined with lack of oversight. Our government sucks at regulating the health insurance industry. It sucks at reining costs in. Our drug prices are ridiculous, people in medical jobs are given inflated salaries, and in my experience, this is often defended by the fact that medical school is so expensive (which makes a valid argument for bringing student debt down and making public colleges free), and generally speaking in a market of supply and demand, the rule of the game is "your money or your life." So people pay whatever they're charged regardless of how insane it is.
3) We test a lot because a private system means doctors do tons of tests to cover their butts from lawsuits.
In addition, there are other problems I've seen over the years.
4) Lack of coverage means some people skip on paying bills anyway, meaning everyone else has to pay more. We're all paying for the freeloaders whether we realize it or not.
5) Fixing the problems is difficult. Our system doesn't work like other countries. In Canada for example, the provincial (state) governments often set up insurance, but in the US, state governments refuse to. We tried expanding medicaid under the ACA but small government zealots in red states often don't and even in states that have the sign up process is complex and arcane in my experience (say this as an uninsured person myself), making the experience way harder than it should be. And honestly, making it simpler is going to be difficult as that can run into constitutional challenges of federalism, etc. For this system to work in the US, the entire system likely will need to be managed by the federal government, as state governments often won't play ball and forcing them could run into constitutional challenges.
That said, we're on our own. We can't just look at what other countries do and emulate it. If we take on all costs ourselves like other countries do, we're often paying twice as much for the same stuff because our prices have inflated so much in the past half century. And because our government isn't their government, trying to simply say "let's do what Germany/UK/Canada does" is just not going to work. An American solution needs to address American problems in the American system.
And let's face it, a non universal plan is just gonna suck. Democrats love to push these ideas that just tweak a few things here and there, and that doesn't solve anything. ACA fixed some problems but left us to rot in a lot of ways. A Biden-esque public option would just be more of the same. Oh hey, we tweaked some more stuff. Now you can BUY some sort of plan on the market place for who knows what price that costs who knows what with who knows what deductibles and copays, but hey, progress! Yeah, gonna be honest. Only reason I've kind of given these plans ANY credibility in the past few days is because of the laffer curve argument. While I believe America CAN fund a medicare for all plan, it cannot necessarily fund both that and a full UBI at the poverty line, without potentially running into some barriers. Bernie's plan would raise the government budget by $1.75 trillion, and would impose a 7% payroll tax and a 4% household tax to pay for healthcare, basically imposing a 11% tax just to fund healthcare. That is, too much.
But there's hope. I did some research, and it appears that Bernie's plan isn't the only one that has truly universal coverage. Bernie's plan is just the most famous, and also the most expansive. As this video points out, Bernie's plan basically takes medicare, puts it on steroids, and gives it to everyone. It is the most comprehensive and brute forcey type plans. But that brute force comes at a terrible cost, and that is, its terrible cost that compromises my potential ability to do a UBI.
That video lists 10 potential plans out there, including four versions of actual universal healthcare. I'm not particularly interested in the other 6 band aid proposals here, unless I find not one of those four universal plans suitable. I am someone who believes that we need a healthcare system that makes coverage universal and easy to access, cheap or free at the point of service, but also is more affordable than Bernie's plan.
The other three candidates
The House Medicare For All Bill
This bill apparently does much the same kind of thing as Sanders' bill, but there's no clear funding mechanism in it. Next.
This one was easy. It had no details for how to pay for it so I can't properly analyze it, now can I?
Medicare extra for all
This plan transitions us to Medicare for All more slowly than a full single payer bill. It would enroll all newborns and people turning 65 into medicare extra. People who lack health insurance would also get medicare extra. People with other healthcare would retain that. Over time, everyone would eventually get medicare extra and the current system would eventually die out.
This plan looks like it would cost around $280-450 billion, which seems far more affordable than Bernie's plan. This seems about right, and what my target is for affordable healthcare coverage. Far more affordable than Bernie's $1.75 trillion, but far more comprehensive than Biden's dinky $75 billion a year plan that would be like peeing on a wildfire.
Proposed taxes for it include:
Wealth tax- $275 billion a year.
Reform capital gains taxes- $200 billion a year.
Surtax on top incomes- $50 billion a year
Financial transactions tax- $100 billion a year
Repealing Trump Tax Cuts for corporations - $170 billion a year
Repealing other Trump tax cuts- $80 billion a year
Closing loopholes that allow rich people to dodge payroll taxes on medicare- $30 billion a year
In addition, other funding mechanisms come from excluding people currently on medicare proper or in the private market, as well as potentially payroll taxes.
All in all, if it costs what it does and it actually gets the job done, I could live with this. This is far better than what Biden's doing while being far more affordable than Bernie's plan. This would likely not threaten the laffer limits establishing UBI and M4A would do. It would allow a slow, gradual transition to medicare for all that would likely reduce costs along the way and ensure we pay a sane portion of our GDP on healthcare like every other civilized country in the world.
Medicare for America Act
This plan would put everyone currently outside of the employer based healthcare system on Medicare for America. This includes everyone on a government plan, the uninsured, and those on the individual market.
This plan would not eliminate private insurance and unlike medicare extra, has no mechanisms to push people toward the medicare for all system.
Looking at the taxation section of the law, it would impose a 5% tax on people making over $500k, so it would tax the rich directly on income, contributing to the laffer curve. It would raise the medicare payroll tax to 4%. It would raise net investment income tax. It would introduce excise taxes on tobacco products, alcohol, and sugary drinks.
So, this bill would raise income on top earners by 8%. This is less than Bernie's plan, but still not as good as the medicare extra plan in my opinion which shifted taxation toward wealth taxes, capital gains, and corporate taxation. It would raise the federal burden on the rich from 33% to 41%, meaning UBI would bring it up to 61%. Or with local taxes, it would raise it from 47% to 55%, which would give me the ability to tax at 15% before hitting the 70% laffer curve.
Honestly, I like medicare extra better, but this is still better than bernie's plan.
And to be fair, I think we could rectify this issue just by removing the surtax. I already know from my own UBI tinkerings in which I proposed a nearly identical tax that such a tax would only net $90 billion, which is nothing, so maybe I shouldn't even worry. Just shifting that aspect to something else, anything else, would likely solve the problem. If we didn't have that surtax but replaced it, with, say, a wealth tax, or a corporate tax hike, we could easily make up that revenue and only have an increased tax of 3% on people, meaning a 20% UBI tax would be viable.
Conclusion
Honestly, this has shifted me back toward supporting a full UBI with a full medicare for all plan. The thing is, there are multiple versions of Medicare for all, and they all do different things. The best way to do medicare for all isn't by brute forcing it Bernie style, but by implementing a system that covers everyone, while still maintaining private coverage from now. That can cut costs significantly, making it far more affordable. Over time, we can expand healthcare coverage to account for more people, having a full medicare for all system. And, from what I can tell, these plans likely only cost around $200-500 billion or so a year, rather than the insane $2.75 trillion total cost of Bernie's plan. While the cost of these plans will likely rise over time, as more people get public insurance, hopefully we can fund them in a way that's more sustainable.
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