Petition to expand Medicare to be the Single Payer Healthcare System for the USA

[roseyscot]

Let's say this is true. Raise my Medicare taxes by 15%, and I can drop my health insurance coverage?

Let me run the numbers.

Increasing my family's FICA taxes by 15% comes to about a $425 annual increase. My family's health insurance currently costs $4,125 annually.

OK. Sold.

If that's all it takes for the whole country to be well insured and for every American to be able to drop their private coverage, then I agree. I'll sign up too. All those unemployed insurance industry workers can be employed elsewhere with the tens of thousands of dollars per employee that the rest of the country's companies will be saving. Starting to sound appealing...

[jclay]

How to Fight Big Medical Bills - The Atlantic

It's an unfortunate title but worth reading. One of the not so fabulous characteristics of our "system".

[sine]

Let's say this is true. Raise my Medicare taxes by 15%, and I can drop my health insurance coverage?

Let me run the numbers.

Increasing my family's FICA taxes by 15% comes to about a $425 annual increase. My family's health insurance currently costs $4,125 annually.

OK. Sold.

Alas, not going to happen.

I suspect that at a minimum, a 15% increase in federal income taxes would be needed in order to pay for a half decent single payer system. Federal sales tax might be needed. Some deductions (mortgage interest for example) would have to be eliminated. If I'm not mistaken, close to half of workers in the USA pay no federal income tax. That would have to change.

This based on having lived and worked in a country with "social" healthcare.

[Dallas Tex]

Let's say this is true. Raise my Medicare taxes by 15%, and I can drop my health insurance coverage?

Let me run the numbers.

Increasing my family's FICA taxes by 15% comes to about a $425 annual increase. My family's health insurance currently costs $4,125 annually.

OK. Sold.

I hate most 'everything' government. But I'd do this deal in an effing heartbeat.

Can you imagine the impact on businesses that no longer have to carry the cost of employee healthcare? It'd make it easier to hire more employees.

Would quality of healthcare go down? Maybe, but the quality of healthcare varies widely anyway. Typically rural healthcare isn't as good as urban healthcare. That doesn't stop anyone from living in rural parts of the country.

[Will Neide]

How to Fight Big Medical Bills - The Atlantic

It's an unfortunate title but worth reading. One of the not so fabulous characteristics of our "system".

United Healthcare is miserable. After years and years of fighting with them, the hospital system I work in has had to stop dealing with them. It's currently tied up in a lawsuit since they owe millions. You can't do business with an entity if you are constantly losing $$.

[Christian Fox]

Let's say this is true. Raise my Medicare taxes by 15%, and I can drop my health insurance coverage?

Let me run the numbers.

Increasing my family's FICA taxes by 15% comes to about a $425 annual increase. My family's health insurance currently costs $4,125 annually.

OK. Sold.

They only reason increasing your FICA by 15% comes to $425 is because it's capped. Medicare is not; it's an uncapped 2.9% flat tax. A 15% increase in your medicare tax would be a straight up 15% increase to your effective tax rate. So, take your salary and multiply it by 15%, then write a check. How's that feel now?

[Dallas Tex]

They only reason increasing your FICA by 15% comes to $425 is because it's capped. Medicare is not; it's an uncapped 2.9% flat tax. A 15% increase in your medicare tax would be a straight up 15% increase to your effective tax rate. So, take your salary and multiply it by 15%, then write a check. How's that feel now?

Feels like a good deal. Say a guy earns 100k per year, he's probably already paying $15,000 annual for healthcare insurance, deductibles, etc. if he has a family.

Since it now cost his employer much less to employ him, he may be in a position to negotiate a raise.

Again , i'd take that deal.

[Will Neide]

Kind of hard to discuss yearly costs without discussing yearly coverage.

[Christian Fox]

Feels like a good deal. Say a guy earns 100k per year, he's probably already paying $15,000 annual for healthcare insurance, deductibles, etc. if he has a family.

Since it now cost his employer much less to employ him, he may be in a position to negotiate a raise.

Again , i'd take that deal.

Well, given that a family of four policy is around $15k/yr, it stops being a good deal at about exactly the $100k level. If you make less than $100k, sure, why not! If you are okay with a family that makes $300k/yr paying $45k for a $15k policy, then I guess it works for you.

[Will Neide]

Since it now cost his employer much less to employ him, he may be in a position to negotiate a raise.

Again , i'd take that deal.

On the surface, this deal looks favorable to me as well. I'd have a bunch of questions if this became a viable option.

[davids]

They only reason increasing your FICA by 15% comes to $425 is because it's capped. Medicare is not; it's an uncapped 2.9% flat tax. A 15% increase in your medicare tax would be a straight up 15% increase to your effective tax rate. So, take your salary and multiply it by 15%, then write a check. How's that feel now?

I think your math is wrong. Rosey implied that Medicare docs accept a reimbursement 15% lower than regular. So I did the math for raising Medicare rates by 15%.

Raising Medicare rates by 15% would mean raising the Medicare tax rate from 2.9% to 3.335%, a 0.435% tax increase. That would be about $1000/year for my family. More that $435, sure. But not 15% of my total income! And still a lot less than what we pay for our HMO health insurance.

[dogrange]

I think your math is wrong. Rosey implied that Medicare docs accept a reimbursement 15% lower than regular. So I did the math for raising Medicare rates by 15%.

Raising Medicare rates by 15% would mean raising the Medicare tax rate from 2.9% to 3.335%, a 0.435% tax increase. That would be about $1000/year for my family. More that $435, sure. But not 15% of my total income! And still a lot less than what we pay for our HMO health insurance.

My thoughts too.

[sine]

I think your math is wrong. Rosey implied that Medicare docs accept a reimbursement 15% lower than regular. So I did the math for raising Medicare rates by 15%.

Raising Medicare rates by 15% would mean raising the Medicare tax rate from 2.9% to 3.335%, a 0.435% tax increase. That would be about $1000/year for my family. More that $435, sure. But not 15% of my total income! And still a lot less than what we pay for our HMO health insurance.

Post indicated 15% below cost.

[Will Neide]

I think Rosey was throwing out a random ball park number just for illustration. Medicaid typically reimburses about 80% of what private insurance pays. Medicare reimburses far less, sometimes only 50%.

[Jonathan]

The statement above that Medicare rates are money losers seems dubious to me. I'd belive it if we are talking about Manhattan or other large wealthy urban centers with high costs. Our entire medical industry in Florida is supported by Medicare. They aren't making up losses with each visit on volume. Medicaid patients in FL really get poor healthcare but Medicare is wide open and happily taken. I'd also belive that lower Medicare payments have sped up the consolidation of private practices by hospitals, but hospitals are making money with Medicare. System wide I don't see how it can be a losing proposition. I'd be open to hearing how though, if it's true.

[Will Neide]

The statement above that Medicare rates are money losers seems dubious to me. I'd belive it if we are talking about Manhattan or other large wealthy urban centers with high costs. Our entire medical industry in Florida is supported by Medicare. They aren't making up losses with each visit on volume. Medicaid patients in FL really get poor healthcare but Medicare is wide open and happily taken. I'd also belive that lower Medicare payments have sped up the consolidation of private practices by hospitals, but hospitals are making money with Medicare. System wide I don't see how it can be a losing proposition. I'd be open to hearing how though, if it's true.

I don't have the math to support or refute an argument for either outcome in regards to medicare/Medicaid reimbursements, BUT I believe the lower reimbursement rates are often offset by the amount of care needed for each patient on each visit. Medicare and Medicaid patients tend to have more billable items since they, on average, have more needs. I suppose this could, or does, lead to issues of medicare/Medicaid fraud.

[Jonathan]

I don't have the math to support or refute an argument for either outcome in regards to medicare/Medicaid reimbursements, BUT I believe the lower reimbursement rates are often offset by the amount of care needed for each patient on each visit. Medicare and Medicaid patients tend to have more billable items since they, on average, have more needs. I suppose this could, or does, lead to issues of medicare/Medicaid fraud.

I agree and it's why a blanket statement that Medicare is unprofitable doesn't make all that much sense. Doctors and hospitals are making Medicare profitable. You will also find that Florida hospitals are the among the biggest billers of Medicare and our Govenor was CEO of HCA when they received the largest ever fine for over billing and defrauding Medicare. Still, running a practice in Orlando has to be a much different financial proposition than Manhattan, Downtown Boston, San Francisco etc but I assume those populations are younger and are more likely to have private insurance. Medicaid here is a mess. You may need to drive 200 miles to find a specialist who is open to new Medicaid patients. They are precisely the folks who can't afford to drive regularly like that.

[Christian Fox]

I think your math is wrong. Rosey implied that Medicare docs accept a reimbursement 15% lower than regular. So I did the math for raising Medicare rates by 15%.

Raising Medicare rates by 15% would mean raising the Medicare tax rate from 2.9% to 3.335%, a 0.435% tax increase. That would be about $1000/year for my family. More that $435, sure. But not 15% of my total income! And still a lot less than what we pay for our HMO health insurance.

ok, I misunderstood. I read it quickly as raising "to" not "by". Your 2.9% medicare tax partially funds the healthcare of about 50 million people. Fully funding the healthcare of 300 million isn't going to be accomplished by a 15% increase of the 2.9%.

I agree and it's why a blanket statement that Medicare is unprofitable doesn't make all that much sense. Doctors and hospitals are making Medicare profitable. You will also find that Florida hospitals are the among the biggest billers of Medicare and our Govenor was CEO of HCA when they received the largest ever fine for over billing and defrauding Medicare. Still, running a practice in Orlando has to be a much different financial proposition than Manhattan, Downtown Boston, San Francisco etc but I assume those populations are younger and are more likely to have private insurance. Medicaid here is a mess. You may need to drive 200 miles to find a specialist who is open to new Medicaid patients. They are precisely the folks who can't afford to drive regularly like that.

The cynic in me says Medicare works because of the demographic it serves; old folks who vote in droves. Medicaid provides pretty crappy care, because, well...poor folks. I think it's fairly well documented that when Medicare reimbursement rates go down, the number of tests/procedures ordered goes up. And forget New York doctors, many of them won't accept any insurance, let alone Medicare. You pay them out of pocket and deal with insurance on your own.

[Jonathan]

Fun with numbers...the average person uses 600k of Medicare benefits (I've read that in an investment trade rag, I wish I had the source). At a 2.9% tax rate that is about 20 million in career earnings it would take to pay for what you use. A married person with a non working spouse would need 40mil in earnings to pay for what they use. How many people today who consider themselves pretty well off (even the top 1%) will hit that? Not many.

This onion has a lot of layers. End of life care, tort reform, educational costs etc all need to be addressed. It's all part of where we are at. It's why the term "single payer" is a buzz word that functionally means nothing.

[Will Neide]

It's all part of where we are at. It's why the term "single payer" is a buzz word that functionally means nothing.

True. I think "single payer" isn't even clearly defined within this thread. It could mean many things to many people.