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Comment by threeseed | Hacker News Reader

Pretty disingenuous study.

If you move to a Medicare for All policy it would shift employer health care costs to the government. Which they would never be able to financially support especially with the challenges of an ageing population and excessive debt. And so when they say it saves $450b it's not taxpayers. It's mostly employers.

There is a reason that countries that started with M4A e.g. Australia, UK have all transitioned to a public-private mix because it's simply not sustainable otherwise.

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That's why the Medicare for all will still be funded, in part, through a business tax. The difference being you've removed the for-profit middlemen, so the healthcare costs are less for businesses than the privatized hybrid version we have now.

The important issue with Warren's "plan" is that it's essentially a $8,000 per year per employee head tax, so it's a regressive tax. An afterthought in the expense of hiring a very highly-paid employee, but a not-insignificant expense of hiring a lower-paid employee.

Not to mention that her plan exempts contractors and business under 50 employees, so it incentivizes businesses to to lean on contract labor or reorganize themselves into smaller sub-companies - a small paperwork expense in the scheme of things.

The business tax should be universal to stamp out avoidance and scaled to all payroll spend so it's at least not regressive, even if it's not a progressive tax.

The problem with a new business tax is that it doesn't come for free.

Increasing businesses taxes reduces international competitiveness which can reduce taxation collected in other areas. Also politically it's an incredibly hard thing to implement.

And remember you have to do this at the same time as you're implementing Medicare for All. Making it a pretty radical transition by any measure.

Oh I agree it's a radical change from what we have now (Although the resulting system is one many countries have already succeeded with). I was merely pointing out how if the program - and the tax to support it - is not truly universal, you have created incentives for businesses to weasel out of it.

The exemptions are billed as being "pro-small-business" but that's a BS talking point. Universal medicare for all would take away all that healthcare-plan-administration overhead that small businesses already have to deal with and pay for. Plus the extraneous benefits of having employees and customers who aren't pressured to avoid basic health care and preventative care and then go bankrupt when they need a larger procedure.

But I think only a radical change can have any real effect. You have to get the denying-care-for-profit insurance bloodsuckers out of the system completely; any concessions to them should be viewed with extreme suspicion.

Mandating businesses to pay health insurance costs for employees under the current system is already reducing international competitiveness.

Medicare-for-all makes the U.S. more competitive by making healthcare similar to other developed nations.

Exactly the health care costs are less for businesses. But that's not coming through efficiencies but largely through the US government picking up the tab for it.

Which is completely fine because it's what happens elsewhere in the world. But there is no discussion around the impacts to budgets and taxpayers which is the challenge the faced Australia and UK for example.

You are underestimating the record profits that insurance companies make. Those will not be needed since Govt. is not in it to make money. That is another efficiency.

Government is anything but efficient, or cheap.

You will end up with multiple redundant bureaucracies overlapping the same areas, spending tax money and blowing up budgets like it's going out of style, skyrocketing our already skyrocketed national debt, and you will lose any choice in the matter.

Good luck trimming those departments and fixing the bloat once it's implemented, because our federal government cannot do that even now.

This article is pie in the sky, it doesn't reflect the realities of the bloat and cost already present in our government.

The most efficiently ran part of our government is the military, and the amount of black holes in the accounting, the cost, it makes your eyes simply boggle.

>The most efficiently ran part of our government is the military

I mean that's just objectively wrong. The US Postal Service is likely the most efficient among government agencies. Medicare is also very efficient even compared to private insurance.

So I'm not sure where this fear of inefficiency is coming from when we're going to leverage one of the most efficient government programs in the US. And I'm more curious as to why people even care about the national debt bullshit anymore considering we've seen one side be completely willing to blow up the deficit for the sake of giving the rich socialism.

> a business tax

Businesses have proven themselves to be very clever in finding ways to avoid paying taxes. They’ve had a harder time figuring out to avoid paying salaries and benefits.

The UK system is still the same from the user point of view as in 1944? It's now somewhat stretched but fundamentally you don't need to deal with insurers, billing, etc.

No, it's because big interests have paid them to decrease taxation on the top earners.

There is a reason the income gap between different classes of the population is growing larger. That income gap is what should be funding these.

Policies of austerity are a direct result of the rich getting richer, not that it's not sustainable.

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