How to fix America's financial relationship to healthcare
micheleincalifornia.blogspot.com
micheleincalifornia.blogspot.com
Really hard to take the article seriously when it crams so much misinformation into one paragraph. There is no such thing as "bumping you up into the next tax bracket." The marginal extra dollar might be taxed at a higher rate, but the dollars below that will be taxed the same as before.
Moreover, the fact that health insurance isn't taxed now can't explain the origin of the industry. Initially, health insurance was taxed just like any other non-cash benefit. A tax break on health insurance was implemented as a way to offer some relief from the wage controls of WWII: http://www.npr.org/sections/health-shots/2012/12/04/16643424.... But such a tax break wouldn't have come about if the industry didn't already exist.
I assume this is something along the lines of:
Employer: "We can offer you an additional $3k/year in income but it will be taxed at 40%. Or we can offer you 3k in health benefits tax free. Which do you prefer?"
I'm taking about the 1950 here, when the top marginal rate was around 90%.
Edit: grammar.
http://taxfoundation.org/article/us-federal-individual-incom...
Meanwhile, the median household income in 1950 was under $5,000 (in 1950 dollars):
http://web.stanford.edu/class/polisci120a/immigration/Median...
So although there were very high marginal rates at the top, they applied only to people making over 40 times the median income. And just to pay a higher marginal rate than 2015's maximum of 39.6%, one needed to be making around three times the median income in 1950.
So you'll need another explanation, because it's unlikely that the risk of being bumped to an ultra-high marginal rate was an issue widespread enough to spur the offer of untaxed health care. And as others have pointed out, it's well-documented that the actual reason was a reaction to wartime wage controls -- given the choice, companies would have simply offered more cash.
On the other hand, having grown up with a public health system (in Ireland, whose model is almost identical with the UK's NHS), I'm strongly of the opinion that the necessarily higher rates of income tax are well worth it. Why? Because when you get sick you just go the doctor, and if the doctor's clinical opinion is that you need additional care, you go to the hospital. There is no financial decision-making involved, there's no additional paperwork to be filled out (not by you anyway), and you don't have to have conversations about who's in or out of your provider network in the normal course of events. The only focus is on your clinical care and recovery needs. Is it perfect, of course not - but when you develop a medical problem, you get to focus on that rather than having to split your attention between medical, financial, and administrative worries. My experience of the American healthcare system is that while there are many sincere and selfless people working in it, the system itself is badly corrupted and wildly inefficient.
One objection I've heard from opponents of single payer healthcare is that if going to the doctor is free or almost so, doctor's offices will be filled with hypochondriacs and genuinely needy patients will be crowded out. I have never seen any evidence for this claim, and it doesn't match my experience. Most people don't like going to the doctor because it makes them nervous, it's icky, and they dislike being around other sick people in the waiting room - same as everywhere. Of course there are some hypochondriacs out there, and doctors quickly become skilled at spotting them and running them off. It may be a bit harder in these days of WebMd, but I am disinclined to believe that a tiny number of hypochondriacs are the major obstacle to restructuring and industry comprising 10-15% of our economy.
I don't see Americans adverse to Medicare, which is essentially single-payer for anyone over 65. Why does being under 65 mean you should die in the street without healthcare?
Single payer is cheaper/more efficient than our current system. We just need to find the political will to implement it, and cut the legs out from anyone attempting to stymie that change who is currently profiting from the status quo.
http://www.nerdwallet.com/blog/health/medical-bills/nerdwall...
There is a long history of Puritanical thought running in American culture, in which personal virtue is reflected in outcomes.
Realistically all legal choices and activities have to be covered, or you would be arbitrarily victimising certain groups.
And food deserts are a very real thing. If you live in one of those you haven't even much of a choice regarding obesity.
Moreover, "limited government" in the context of American founding principles refers to the allocation of responsibilities between states and the federal government, not the overall scope of government.
There is, in fact, a principled originalist argument for universal healthcare. First, it has always been assumed that the states have the power to provide for the welfare of their citizens, as well as to police their behavior and morals. The states are, in that regard, decidedly not "limited governments" of "enumerated powers." State-level universal healthcare is contrary to no founding principle.
Second, the Commerce Clause was incorporated into the Constitution to allow the federal government to solve what we today would recognize as economic collective action or free-rider problems. At the time it was aimed to address the collective action problem of free trade. It's good for the United States as a whole, but individual states have a short-term incentive to erect trade barriers. The purpose of the Commerce Clause was to allow the federal government to counter-act those short term incentives. Precisely the same problem exists with state-level universal healthcare. Even if most people in a state want it, they can't enact it because it's too easy for people from neighboring states to free-ride on those services. The Commerce Clause is thus properly invoked for resolving that problem at the federal level.
How so? If you are a resident, you get "free" care. If not, you get a bill. Is this not how Canada works WRT Americans who need to use the Canadian health system?
The Constitution imposes an open market on commerce and movement within the United States. The Commerce Clause exists to give the federal government the power to address the economic issues that arise as a consequence of that.
Personally I think it's the combination of anti-socialism brainwashing and the "I got mine so screw you" attitude too many people have.
Associating a working health care system with the government interfering with your life and impinging on freedom is completely insane.
I've been unemployed for 9 months and now have to pay the individual mandate for 6 of those months. I think the Supreme Court was bought or blackmailed on that one. We need a system, but not this one and it can't be opt-in or get fined! Maybe a sales tax would work.
Maybe someday the US will get on board with providing a better solution. In the mean time, direct primary care is a legal loophole in the ACA that cuts out the middleman. Perhaps if it grows enough, we can eventually move towards something more civilized.
Thank you for commenting.
Did it offer any kind of discount for minor or major dental work (e.g., cavity removal, wisdom tooth removal)? Or was this covered by your health insurance?
In my opinion, as the right to health care is a basic human right, the state should be responsible for providing its citizens with health care - and as all citizens are equal, so should the health care be.
Unfortunately, Germany isn't perfect either - privately insured patients get faster access to specialized MDs, they enjoy better quality of service (esp. dentals and glasses/eyewear) and the basic insurance (Gesetzliche Krankenkasse) is in fact a staggering number of distinct insurances, each of course carrying its own administrative bloat and its own deals with pharma companies. This may result in a doctor giving two identical receipts for medication - and because the two patients are insured at different companies, they get different generics with all the problems this causes (e.g. different colors of the pills, leading to lower stick-through rate because patients mistrust changes, or different composition leading to different absorption rate even though the medical compound is identical).
There's a shitload of money wasted in healthcare, not only in the US, and the poorest people (as always) have to suffer.
The situation of having that many insurances is certainly bloat, but interestingly enough, it led to the situation where some of them operate with a deficit, while others operate quite efficiently. With the current legal situation, and literally hundreds of companies still being around, I'm not sure this is something that can be streamlined in the next few decades. People would lose jobs, after all.
Private insurance companies exist in Germany, Australia, Canada, etc. because it's about choice. If everyone was given a perfectly functional Toyota Camry, people would still buy Porsches and Ferraris simply because they want the ultimate. Healthcare is no different.
>it baffles me that people think the same government that pisses away billions on big digs, pointless fighter jets, and whatever else would magically save us billions on health care
And yet Healthcare costs more in America than any other developed country. So the evidence is clear that when the government does it, it is cheaper.
When the American government does damn near anything it costs more than when any other government in the world does something. Showing that other governments can do something cheaper does not demonstrate that the American government can as well. I have much more faith in the ability of a European government to set up a social program than I do my own.
Calling healthcare a human right is implying that we have the right to take from others what we need, even if indirectly via the police-power of the state (i.e., threat of violence or actual violence if necessary). To take this further, it means we have the right to a portion of another citizens labor.
Now, don't get me wrong. Talking about what governments should provide their citizens as part of their benefits package is important, but calling healthcare a right is a stretch. None of the rights on the UN or US Bill of Rights involve coercion towards other citizens to provide said rights.
As I get older, I have mellowed a great deal, and I understand how smart people can reasonably disagree about a large number of things...but I honestly can't fathom how intelligent people can fail to grasp that you can't possibly have a 'right' to a finite, tangible resource which you yourself don't produce.
Medical professionals and equipment are finite, tangible resources. No matter how capitalist or socialist your health care system, you are subject to limits on how much time, energy, and money you devote to health care.
How about donor organs? is there some infinite source of hearts and livers out there I'm unaware of?
Once you accept the fact that a given resource is rivalrous, you have to come up with some way to distribute it. Currently, that mechanism is money. If you get rid of that, then you have to replace it with _something_..whether it be algorithms, favor-economies, or central planning.
Now if you want to argue that insurance companies distort the market, then I probably agree with you (though I think there is room for interesting discussion here...). Certainly I think a single-payer solution is preferable to the current status quo, which mandates that individuals purchase insurance from private companies.
You can also increase the supply by opening up medical schools and giving more students the chance to attempt to become doctors without needing 10s of thousands of dollars.