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Comment by djrogers | Hacker News Reader

That sounds great on the surface (putting $18k “back” into middle class pockets), but where will that money come from?

Every example of universal healthcare I’ve seen so far pays for it with huge payroll and income taxes. Payroll taxes have a direct and demonstrable effect on wages and hiring, and income taxes would just wipe out the benefit.

The problem with your idea is that it doesn’t actually do anything to contain healthcare insurance costs. Those costs have risen dramatically faster under the ACA than before, and they were already going up quickly.

I’m not opposed to universal healthcare at all, but you can’t just hand-wave and make it ‘free’, and with those costs I don’t think you’ll see the benefits to wages you’re looking for.

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Sure there are subtle implementation details, but let's not put the cart before the horse. The political and moral will to do it comes first, the details of how to work it out happens later. If we get to the point where the actual ruling class (not just the vast majority of Americans when polled) is willing to give in to the citizenry and give them universal healthcare and starts saying healthcare should be provided as a right to all Americans, there will be no issue getting the financial details worked out. They have an easy job; it's inherently more efficient (larger risk pool, no middleman), implementing even the expensive policies being proposed right now lead to savings of trillions. Though those savings are concentrated among the poor and middle class for whom health costs are huge and taxes are smaller, not senior vice presidents of health insurance companies . As it turns out in aggregate, it's not only already "free", it saves money.

You could try to implement a Piketty-style tax on capital. Of course, this would mean that the middle class gets lower retirement savings, but if we're living healthier and longer we can keep working longer. This, of course, assumes the bulk of the middle class wants to live healthier and longer, even if it means having to work harder.

Costs are contained by limiting treatment options and have a limited formulary.

e.g. If you don't have the money a 75 y.o. doesn't get a heart transplant.

IMO if you don't have the money you aren't entitled to the best care but this discussion needs to happen and be debated.

Our current system encourages good money to be spent on lost causes.

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