It makes those people less likely to switch jobs, or start new self-employed projects of their own.
Particularly if you have children >18.
And if they’re under 18, just make them directors and pay them $100 for attending each monthly board meeting.
Thankfully, they're finally closing the loophole. Many doctors with private practices were reducing their tax burdens significantly by stating that their 14 year children were "medical receptionists". It's ridiculous to grant further tax avoidance loopholes to the already wealthy.
I stopped counting when my medical bills hit $750,000. It is probably double that by now. Again, normal healthy 40 year old guy that rode his bike everywhere who woke up one day with a sore throat that ended up never going away.
I don't agree or disagree with the claims, but they're not easily refuted because they're not falsifiable. They amount to "we should do this because I think it's better". It's not persuasive. A better argument would be, "We all want to take care of poor people and improve our economy--we can do both and here is the data". Of course there will still be lots of friction and lobbying and so on, but at least it's a compelling argument.
I don't think it is too easy, to find such facts and figures. Can you give us some links to them?
None of which means it isn't true (it is), or that it isn't important (it is), but that's why it doesn't get used as an argument very much.
How can we know? Because if they were pro small business they would be pro universal healthcare, so that it would be easy to start your own business.
I suspect the "right" is actually sincere. But it so happens that ideas giving more power to private businesses tend to disproportionally benefit larger businesses over the smaller ones (this is a natural advantage of having scale and capital). The ideas surgically targeted to benefit smaller businesses? The "targeted" aspect tends to pattern-match to the "left", so they get rejected. The end result looks like the "right" was dishonest, but IMO it's just the ass-backwards stupid fixation on ideology over problem solving that causes this. And the same thing applies to the "left".
It should be like the green new deal - the economics of eg Medicare4All is similar in that it’d greatly improve life for small business as well as families.
Edit: it's true. If you are a democrat candidate and this is the angle you push, it's not going to work. But you already know that.
Especially - freedom to pick any doctor as they are all in-network.
Family had experience with California PCIP insurance (bridge for pre-existing condition after ACA was voted in, but before it took effect). The PCIP was amazing - PPO-like benefits, using MediCare network (close to 100% doctors take it) and quality services. Of course, unfortunately, the ACA/exchange provided policies are nowhere close to how good PCIP was.
If we could get the PCIP-like option, it would truly change lives for the better.
Any doctor? Doctors can take so many patients. Though it may benefit a large number of people, some may end up worse. Those who have the best doctors currently (because they can pay) may no longer be able to have those doctors.
Second, you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing.
And to take this sideways... my favorite health care model is the Japanese system. It's actually quite similar to the American system (private employer-provided insurance, private providers), but with one key difference... a government commission fixes the prices for all medical goods and services. No more negotiating between providers and insurers. So no "networks".
It leads directly to the situation you described. It also leads to costing half as much as the US, for universal coverage and better outcomes. I'll take that trade, thank you.
It wouldn't, but if I needed to get a doctor, I might no longer be able to get a very good one.
Remember that cheaper prices for medical care means the smartest, best people may not become doctors.
> you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing.
I don't believe the current system is "unfair". Why is it? Most Americans like what they have; it is the bottom few percent who are unhappy. Is that "unfair"? At what percentage does that become the case? Must most of society change to accommodate a small, dissatisfied minority?
Without government regulation, health care would be much cheaper. Why must I purchase coverage for a hysterectomy or for birth control as part of a plan? I will never need these services. Wasted money.
What of experimental treatments? I know a person who is alive thanks to an experimental treatment that was reasonably priced. All it amounted to was an antibiotic regimen far outside the bounds of the CDC-recommended one, out-patient. The problem with single-payer is that I cannot do that, because there is a single payer - the feds. I may not pay for my own procedures (and my friend would not have been able to do so), even though this was quite affordable, because it was not on "the list".
Fixing prices is a possibility (albeit not one of which I am as fond), though we would need to allow procedures to be done out side of that (for those which were not approved, or for those who could not get availability and could pay). It is basic economics that price ceilings create shortages; who gets treatment? We are back at square one: I think it should be ordered by those who should pay. I trust dollars to be "fairer" than an opaque system, and would rather the coverage I can get be a known quantity than be at the mercy of the whims of a bureaucrat.
My biggest question: why do you want to force those who can pay onto the same plan? That is a part of single-payer that makes no sense. Why not let those who like their existing coverage keep it, as most Americans still do? [0]
There was an article that surfaced about an Indian hospital that had industrialized common health-care procedures. A four-year degree is not essential for these; why is it required? If we commoditize common and routine procedures via removal of barriers to entry, we can greatly increase the benefit without forcing those who like what they have to become worse off and without hurting more complicated situations.
Lastly, the problem with socialized medicine is that it cannot afford to spend beyond a certain amount per-person on average. End-of-life care is enormously expensive in America, but is better than in other places. [1]
Many of us may say it is foolish to spend upwards of a million dollars for a few more years of life, but having spoken to a few dying people, most say something to the effect of that they would give every thing they have for a few more weeks (the exception being those in exceptional pain, those with loss of senses, etc.).
EDIT: Downvoters care to comment?
[0] https://news.gallup.com/poll/245195/americans-rate-healthcar...
[1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
As for the "smartest, best" people becoming doctors... I don't think medicine is a path chosen simply because it's lucrative, in most cases. It's chosen because it's challenging (or sometimes, because it's expected). And those in it for the money are in paths of lucrative-but-socially-useless things like cosmetic surgery. High pay is incidental here.
Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk.
Single payer systems - like Medicare, for example - are quite capable of covering experimental treatments. Why are you saying they can't? You're ignoring plain facts here. And it's possible that your experimental coverage might not be covered by your private insurer, either. I've been in that boat myself.
Fixed pricing is a far, far more transparent system than the current system of negotiating prices for the same things between different providers/insurers, so the same hospital charges $1.10 for aspirin here and $1.25 there. It also solves the problem of localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative.
Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance (I work in that market). Wealthier people can afford additional coverage above and beyond single player. The single payer provides a guaranteed baseline, and covers basics so private insurers can focus on corner cases, extremes, and luxuries.
"End of life care is enormously expensive in America, but it is better than other places." Yeah, Medicare is single payer, right?
Insurance is supposed to hedge against risk. You might need a broken arm; I will never need a hysterectomy or birth control (especially not the type covered by insurance).
> localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative.
And if the rural hospitals then shut down due to not being able to cover costs?
> Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance
The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option.
> Yeah, Medicare is single payer, right?
Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.
Hedge against group risk. Why should I pay for your house burning down because it started on your deck? I don't have a deck. That's a terrible way of looking at it. The bigger the group/risk pool, the cheaper it is for everyone.
> And if the rural hospitals then shut down due to not being able to cover costs?
Sorry, that's not how socialized programs work. If there's particular need in communities they receive more funding. Or, the government flies people to nearby communities to seek treatment (see Northern Canada, Svalbard, etc).
> The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option.
That's fine. Two tier is also fine. What's not fine is the status quo.
> Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.
Medicare subsidizes the private market by taking literally all the worst customers out of the risk pool. You've got this completely backwards. Without Medicare private cover would be astronomically expensive or have no margin.
I tried to downshift in 2017 but ended up having a $1400/mo health ins. payment for my family and me and that was more than my mortgage, which was about $650/mo. At least with the mortgage you know your future costs. I have since paid off the mortgage, so if we stay put, I have only property taxes to worry about.
Now, the last question is: What will taxpayers bearing the cost of everyone'se healthcare do to my taxes? The US is $21 Trillion in the hole and counting. I won't be paying much income tax, only taxes on capital gains and dividends.
My only other concern is that food prices keep rising like crazy, so do things like car insurance, homeowners' insurance, bills, etc.
I don't like private health ins--I work at a major provider and I know full well how billions get wasted. However, I think government taking it over is going to be the worst thing the US has seen since probably the Civil War. I'm certainly not paying for it all, you can go figure it out for yourselves.
Do it! We've got more people than jobs necessary anyways, certainly once automation enters full swing.
> I tried to downshift in 2017 but ended up having a $1400/mo health ins. payment for my family and me and that was more than my mortgage, which was about $650/mo. At least with the mortgage you know your future costs.
This sounds like single payer will provide you with freedom.
> Now, the last question is: What will taxpayers bearing the cost of everyone's healthcare do to my taxes? The US is $21 Trillion in the hole and counting. I won't be paying much income tax, only taxes on capital gains and dividends.
Even a Koch funded study found that the cost of providing cover is +/- 5%-ish the amount we're spending on medical cover right now, and other studies have shown Medicare does a better job of controlling costs than private insurers. The way the system would be executed is that the amount employers are currently paying private insurers would be redirected to the public purse, either via payroll tax or via personal income tax, or both. No new money needs to suddenly appear from thin air, it's just getting re-allocated.
You won't be paying much income tax, others will. Dividends are usually treated as ordinary income, FWIW.
> I don't like private health ins--I work at a major provider and I know full well how billions get wasted. However, I think government taking it over is going to be the worst thing the US has seen since probably the Civil War. I'm certainly not paying for it all, you can go figure it out for yourselves.
And yet you were planning to go on Medicare right? People in America seem to like Medicare. Why is it socialized medicine only becomes "good" once you hit 65? It's like parents trying to explain alcohol to children: It's really really bad until you turn 21 then suddenly its really really good.
Here's the study that showed Medicare and Medicaid control costs better than private insurers: https://www.modernhealthcare.com/article/20190211/NEWS/19021...
Do all other OECD countries cover nursing homes for free until death? That's the case when liens apply - not hospitalization.
https://www.aarp.org/health/medicare-insurance/info-1996/are...
I don't think it is entirely unreasonable that medicaid - a medical program for poor people - has the right to put a lien on someone's estate. Normally people on medicaid don't even have estates (or else they wouldn't meet the asset test), but for some reason we don't count house equity for the asset qualification criteria. Very unfair for renters - this at least somewhat equalizes things.
The NHS in the UK does, yeah [1]. In Ontario, end-of-life care is also provided and long-term care is provided for ~$1800CAD per month if you can afford it, and it may be free if not via a combination of CPP, social security and income-based subsidies. [2] In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older [3]. The Netherlands does too [4]. The rest of the OECD I'm not sure. Most developed systems do offer something.
The health system really is better pretty much everywhere else in the OECD. And remember! Every one of the systems I mentioned spends less per capita than the US. In some cases like Canada half.
> I don't think it is entirely unreasonable that medicaid - a medical program for poor people - has the right to put a lien on someone's estate. Normally people on medicaid don't even have estates (or else they wouldn't meet the asset test), but for some reason we don't count house equity for the asset qualification criteria. Very unfair for renters - this at least somewhat equalizes things.
While I don't believe in inter-generational wealth I'd argue this furthers the cycle of debt and poverty by taking an estate away from those who could most benefit - the poorest.
[1] https://www.nhs.uk/conditions/end-of-life-care/hospice-care/
[2] https://www.ontario.ca/page/get-help-paying-long-term-care
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462881/
[4] https://www.researchgate.net/publication/304653227_Long-Term...
http://fortune.com/2017/08/21/bernie-sanders-medicare-for-al...
Being trapped as the vassal of a giant corporation just to not-die is in direct opposition to the very concept of liberty. Being able to quit your job and create your own business is an essential freedom. But liberal politicians are unwilling to market that way, and so the neoliberal political class gets to argue for the preservation of a system that benefits the wealthy and the corporate at the expense of the liberty (and wallets!) of ordinary people as the "free market". Feh.
This argument has in fact been made by a great many liberals and moderates, many times, going back to Clinton's (failed) attempt to pass a single-payer health system.
I’ve been involved in hiring decisions where HR brought up the healthcare costs to complain, then stated clearly we can’t use that as a criteria for hiring.
I have doubts that human brains can separate out that kind of statement from our actions.
Under the ACA, small businesses all end up lumped together in the same state-wide risk pool, so if my small business hires old or sick people it's very unlikely to affect our premiums. In most places this risk pool is larger and somewhat less morbid than the individual market.
It's not hard to put a dollar amount on the value of employer provided health insurance, and then use that when calculating your total compensation at one job versus another. Functionally I don't see how it's any different than your employer paying you the amount you would need to buy insurance.
Could you expand on what makes health insurance special in this regard?
What is a bit annoying for start-up founders is that health insurance premiums are only tax deductible/paid with pre-tax money if the plan is offered by your employer (may be you).
I didn't understand this until I started my own business. I was desperately trying to find a job during the '08 crash to get health insurance for my family but was unable to find one.
As a last resort I started my own consultancy which turned out to be a fantastic opportunity.
Self paying for health care was a massive barrier to starting my own business.
Once I hired people health care benefits were frequently top of their list in interview questions.