LudwigsFountain said:
wifeisafurd said:
bearlyamazing said:
Many of the countries that have nationalized healthcare have long waiting times, too. Many Canadians come to America for healthcare.
One of the big problems paying for nationalized healthcare is that we already have a big tax burden here with income taxes, payroll/social security tax (double the tax at 15.3% for self-employed), property taxes, state taxes in most states, gas tax and sales tax. Our economy and economic growth would be crushed with the tax increases required to pay for a plan like MFA.
2/3 of the country are on employer paid/cost shared healthcare or Medicare/Medicaid. It's a noble goal to try and get to 100% but they have to come up with some other feasible way to get the other 1/3 better healthcare options without blowing up the economy. The deficit's already horrendously bad. It would explode with a MFA plan or if we bear all the burden, it will crush growth and consumer spending. No way to spin around that fact.
You do understand that under medicare today, most people (81%) have insurance supplements that pay for a substantial portion of their costs? This is a huge shift in dollars from the employer to the individual. And you do understand that the individual (unless below certain poverty lines) pays premumims for the base coverage? There seems to be some misconception that medicare if free or a give away. It isn't. And part D (meds) is high co-pays. So there is a huge cost shift from employer to a retired individual. I really think you don't know how medicare works.
What Medicare does do is provide everyone that qualifies insurance, and contain costs by being a huge provider (for example, essentially no doctor can afford to not accept Medicare's lower payments since it is such a large provider). They theory is that if is essentially the only provider, the costs will go down even further. It is not free, most everyone on Medicare pays something. It is not perfect. Drug costs can be high, certain things are not covered, there are coverage gaps - thus, you need to pay for a supplement. There are other complaints as well, but the point is there is no perfect system - at least not one than is cost-effective.
I'm on Medicare. You clearly are not. It isn't a give away or budget buster. The Supplementary Medical Insurance Trust Fund is expected to be adequately funded over the next 10 years and beyond because premium income and general revenue income for Parts B and D are reset each year to cover expected costs. Part A is still is positive, but expecting to need higher than planned premium increases starting in 2048 assuming Obamacare remains good law and some provisions in Trump's 2019 budget pass (so far there seems to be bipartisan support). If not, there will be higher than expected premiums sooner. There is more complexity, but in general, I'm not seeing where your claims come from.
Doctors and other health care providers will make less. Will that mean less doctors in the long run, maybe. What happens in most places is certain doctors, the top guys in specialities, become private doctors for the rich, who will pay above national health care prices. So for most things you see a national doctor and for the very serious stuff you may use a private doctor or health facility. That is how it works in Australia which has a system close to MFA. The Canadian system is different than Medicare, it's based on individual taxes and Canadians paying for a 30% co-pay. But provider costs are much lower due to the government monopoly, so that 30% is more manageable. Unlike Medicare, you must see you general doctor first (they are the gate keeper) and depending on the urgency of your condition you get seen by a specialist doctor or get a specialized test (this doesn't apply to emergencies obviously). So there can be less wait or more wait. That simply isn't the system under Medicare..
You need to remember that it is the individual, not the employer, who pays for medicare currently, so I don't get some of the discussion, unless Sanders is going to do a Warren and tax the wealthy, transactions, etc.. That is not my understanding. Sanders's version for financing Medicare-for-all includes raising employer-side payroll taxes by 7.5 percentage points in order to raise roughly $3.9 trillion over 10 years. On average, this is less than what employers are currently spending on premium contributions for their employees, so workers and employers should generally come out ahead under this system. Companies with younger employees will probably lose. those not covered by an employer plan will have to pay taxes instead of premiums (this probably is to fit within the SCOTUS legal decision on Obamacare). I think the supplemental insurance will stay be paid by individuals and I'm not sure what he is doing on co-pays, etc. There is a progressive tax rate which I will not try to explain.
The point is that while the structure of Sanders's plan is broadly progressive and broadly beneficial to most households and companies, the exact calculus of who ends up ahead and who does not hinges on a complicated set of factors. There will be some losers and winners. Sorta like Trump's tax cuts.
Can you be more specific about the bolded statement. The vast majority of Medicare beneficiaries don't pay any premiums for Part A. If you pay any amount of Medicare tax for more than 40 quarters, you are not charged a premium. Also it was my understanding that the Part A fund is expected to become exhausted far sooner than 2048, so I looked up the 2019 Medicare Trustee report and sure enough, that fund is projected for exhaustion in 2026. Personally, I think that's optimistic because the projections assume that the cost-savings provisions of the laws in place will be observed even though they typically get eliminated or watered down in the annual budget process. In fact, the trustees started recognizing this phenomenon a while back by inserting this caveat in the report:
"In view of these issues [primarily the one I noted above], it is important to note that the actual future costs for Medicare may exceed the projections shown in this report, possibly by substantial amounts."
If you're saying that Medicare are taxes are going to go up I couldn't agree more except I think that will happen far sooner that 2048.
Really good question on Part A. OMB number which I can't figure out how to link. Please note the assumptions in my post.
Those "going broke" headlines are all about Part A, and only Part A. Sorry this gets complicated but here it goes.
Part A is hospital and hospice or long term facilities (note that coverage is limited if it gets to that), not doctors, meds, or everything else. I probably should have said a few more times I was speaking generally, since Medicare is complicated. But Medicare Par
t A is funded primarily by payroll taxes (FICA), general allocations by Congress funded by certain income taxes, insurance premiums, and earnings on the funds held by the Trust Fund.
Most people age 65 or older are eligible for free Part A if they have worked and paid Medicare taxes long enough (usually 10 years). The issue then on Part A to cover these people is whether you have to raise the payroll tax more. For Medicare for all, you then have to add people who have not paid in under 65 who should have less hospital time in general, but let's not go there to answer your question and only look at the present. To the numbers:
Around 15% (depending on the year, etc) pay premiums and the premise is that premiums rise generally with the CPI, and what the provider is paid rises at that rate as well. In other words, the provider bear the brunt of there costs rising faster than the CPI and they then try to put these costs on privately insured patients and the uninsured, by doing things like trying to charge $50 dollars for giving you aspirin. Every once in a while hospitals succeed in getting more money and that usually means an increase in taxes and occasionally premiums.
On the income tax side, Part A is also maintained through taxes on social security benefits, a special tax on high income people of .9%. The payroll tax side is 1.45% paid by employees, and 2.5% for high income workers. The self-employed pay higher taxes, and there are some other complications. The assumption was that population would alway increase, so that the funds could be used for retirees, which of course doesn't work when the baby boomers retire and the number of beneficiaries is outpacing the number of people who pay into the program and it also doesn't work if everyone, not just retirees, are on Medicare.
As of mid-2019, the trust funds were earning an average interest rate of 2.845% on their securities. Part A has over a Trillion Dollars in reserves.
The question is really about when does a gap develop on the payroll side (as subsidized by income taxes and investment earrings), as the beneficiary growth overtakes population, and it would become a pay as you go system. The projections are all over the place, and vary by assumption. But there was a magic date in the media of 2026. Because it anticipated the aging Boomers, the Part A built up a trust fund while its costs were relatively low. But the commentary is that reserve is rapidly being drained, and, in 2026, will be out the money.
Obamacare added a tax to shore up Plan A (but also added people to Medicare) and in his last two years, Obama cut Medicare spending on the backs of providers, and the Trump budget adds $500 billon annually to Plan A, again on the backs of providers, which changes the doomsday projections. The other thing under the Trump budget is complicated.
Currently, if you start taking Social Security before age 65, you automatically get signed up for Part A when you hit that Medicare-eligible age.
Waiting until after age 65 to tap Social Security results in automatic sign-up, for Part A as well. And while you could choose to opt out of Part B (outpatient care) if you have coverage elsewhere, you must remain enrolled in Part A or pay a steep price. The only way they can opt out of Part A is either not to apply for Social Security in the first place or, if you already have, repay the Social Security Administration all the money you received and anything Medicare has spent on their health care. Meanwhile, although Part A is free as long as you have at least a 10-year work history of contributing to the program through payroll taxes, it can also cause snags if your other insurance is a high-deductible health plan with a health savings account, or HSA. That's because under current rules, you cannot contribute to an HSA if you are on Medicare, even if only Part A. Offered in conjunction with high-deductible health savings plans, HSA's come with a triple tax benefit: Contributions, earnings and qualified withdrawals are tax-free. However, as mentioned, you can't contribute to an HSA if you're on Medicare, even if just Part A. Trump's budget would change that by allowing beneficiaries with high-deductible health plans to make tax-deductible contributions to HSAs or to medical savings accounts. The concept is that employees now wait longer to retire, and will delay Part A choosing instead to build-up HSAs and other plans for tax deductions. While this plan helps Plan A solvency, it costs the general plan an estimate $16 billon a year which is added to the deficit. (Basically future taxpayers will subsidize Plan A more).
This means Obama and Trump have cut money for provider, not participant benefits. PolitiFact - It's wrong to claim Trump budget cuts $845 billion from Medicare (
https://www.politifact.com/factchecks/2019/mar/26/joe-biden/trump-medicare-budget-cuts-billion/) and Trump is substituting in tax benefits to stay off Plan A. Again, note my assumptions is the post that (1) Obamacare stays in place, and (2) Trump's budget, at least with respect to Medicare, sticks.
The alternative fix for to all this, in a non Medicare for all scenario, is simply to raise premiums and payroll taxes more than projected. However, Obama and Trump generally have gone the cost cutting route since it is less painful politically.
