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Comment by masterof0 | Hacker News Reader

Would this raise the tax rates for NYers?

The better question is whether NYers will pay more or less under this plan, not whether that payment is a tax or a premium.

i think the original question was better

Summary says it includes a "payroll assessment, similar to the Medicare tax"

It would be shocking if it didn’t

No, it wouldn't.

The European single-payer systems pay half what we do per-capita, factoring in private and public spending in both systems. The US system is wildly cost inefficient.

See the chart at https://data.oecd.org/healthres/health-spending.htm

Of course it'll raise tax rates. That money does come from somewhere. The real question is whether employers will raise salaries enough to compensate for the additional taxes, once they're no longer providing insurance as a benefit.

If I pay $10 in tax to save me $20 in costs, I'm not inclined to see that as a tax hike.

It’s still a tax hike, regardless of your rationalizing

Then a focus on tax rates instead of total cost is entirely disingenuous.

Not really, there are people who get great health care for free from their employer, and others who get a greatly discounted rate. Their employers will not necessarily savings with their employees.

The result for these employees could be more taxes for the same or worse care they’re already receiving.

In aggregate I believe it’s the right move but let’s not act like everyone wins here.

> Not really, there are people who get great health care for free from their employer, and others are a greatly discounted rate, who will not necessarily share savings with their employees.

Then require that savings be shared.

Make it a legal requirement that any company that has employer-provided healthcare must rebate employees the premium costs if they opt-out.

That makes no sense, salaries would simply be adjusted to compensate. The kind of bureaucracy you’re proposing is why things are already so complicated to begin with.

> That makes no sense, salaries would simply be adjusted to compensate.

If you cut the salaries of employees who opt-out, but not those who don't, you'd be in very clear violation of the law I'm suggesting.

No, what I’m saying is that they wouldn’t offer an alternative to the state run health care, as why would they anymore? No incentive.

I'm not seeing the downside.

The downside is that you could be paying more taxes for something that you already had.

Then perhaps it's time to unlink employment and health care coverage entirely.

No disagreement here.

> Not really, there are people who get great health care for free from their employer

It is not 'for free' it is part of your compensation! It's like saying your employer pays 6.2% + 1.45% in SS/Medicaid taxes 'for free'. That is part of your compensation.

I meant free in that you don’t pay a premium, but fair point.

> It’s still a tax hike, regardless of your rationalizing

You're already paying for health care coverage via monthly/annual premiums and via reduced salaries where your employer's portion is part of the 'total compensation' you get (but doesn't show up in your pay check).

Even if the amount at the end stays exactly the same it may be an improvement because (a) there are no "in network" worries about going to the "wrong" hospital or getting the "wrong" doctor", and (b) it is universal coverage so (i) you may not have to worry about losing your job and losing coverage as well as (ii) you can change jobs and have the same (universal) coverage.

That assumes you get the cost saving. If my company stopped paying for my insurance benefit and instead gave that money to me directly, and then I bought the cheapest plan I could find on the insurance exchange ... I'd be paying more, not less. By a fair amount.

That seems readily fixable; make it a legal requirement that companies that provide employer-provided healthcare pay the premium to the employee if they opt out.

In my case the premium wouldn't even come close to the marketplace cost. I'd be losing overall.

https://www.peoplekeep.com/blog/which-health-insurance-costs...

> Nationally, the analysis found that individual ACA Marketplace premiums are 10 percent lower than the average employer-sponsored insurance premium, after the adjustments.

(Which makes sense; it's a very large risk group.)

Okay, then congratulate my employer for beating the odds, I guess.

Numbers, please. This kind of claim is just mythology unless you have numbers to back it up.

Is this because your employer is paying part of the cost for the plan?

>The real question is whether employers will raise salaries enough to compensate for the additional taxes, once they're no longer providing insurance as a benefit.

I don't think that's even a question. The answer is no, they won't.

> The real question is whether employers will raise salaries enough to compensate for the additional taxes, once they're no longer providing insurance as a benefit.

Spoiler: they won’t. They’ll spin not having to pay a premium as a pay raise.

I think the idea that anything that worked in Europe would work here as well as there without inherent corruption and rent seeking is laughable.

The idea that the US is uniquely corrupt and rent-seek-y seems laughable.

There's no corruption in Italy? Eastern Europe?

The amount paid per capita and whether you would pay more taxes are not exclusive things.

I’m not sure why people keep bringing up Europe - the USA is not Europe. For one doctors are paid more in the USA compared to Europe, medicine is more expensive here, more of the R and D originates here, etc

Maybe good question to ask is what makes it more expensive? Is it bloated administration and insurance system? Or is there some fundamental other difference?

One reason is it is expensive to fund the research and testing and so the companies need to recoup that cost. They cannot in Europe and Canada due to price controls which means people in the US offset the cost. The US is basically subsidizing other Western countries.

^This guy gets it.

Also, in nearly every parliamentary system the state's ability to quickly invalidate patents by an act of parliament gives them even more leverage in the negotiations with drug companies.

A lot of that R&D is already funded with our taxes via the NIH.

A significant portion is not. Clinical trials are unbelievably expensive, see https://www.science.org/content/blog-post/drugs-come-compreh....

(actual data which undermines the political rhetoric around this topic)

"Critics of drug price regulation argue that free market pricing strategies and higher prices in the United States are instrumental to innovation. One might therefore expect the United States to be the most innovative given that it is the only country with a predominantly unregulated pharmaceutical market. However, US pharmaceutical innovation appeared to be roughly proportional to its national wealth and prescription drug spending. Our data suggest that the United States is important but not disproportionate in its contribution to pharmaceutical innovation. Interestingly, some countries with direct price control, profit control, or reference drug pricing appeared to innovate proportionally more than their contribution to the global GDP or prescription drug spending."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

> The amount paid per capita and whether you would pay more taxes are not exclusive things.

It'd be a deal even if it costs exactly the same.

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