Universal Healthcare?

[samclem]

What I propose is to have everyone in (2).

What is the justification for making HI expenses tax deductible? There's no deduction for food, shelter, etc (except as provided for by the personal exemption/standard deduction). Making HI costs deductible provides a relatively larger benefit to higher income people and to the extent it is a govt subsidy it can be expected to increase prices (more dollars chasing the same amount of goods/services).
If we assume a given national tax burden, every reduction in national taxed income results in a necessary increase in tax rates. I'd prefer fewer carveouts and lower rates, barring some good reason for doing otherwise.

 

[pb4uski]

Ironically, while the ACA makes it easier in one way to get away from employer-sponsored plans (because the exchanges/infrastructure is in place to accept those with formerly-provided employer plan), it penalizes employers who go that route (through the[-] fine/taxes[/-] whatever). But I think employers will increasingly choose to dump their plans regardless of the fine, and the CBO thinks so, too

I wonder if an employer would be subject to a fine/tax if they replaced their HI plan with a monetary "allowance" to the employee that would be taxable income to the employee. Even if it were expense neutral to the employer at adoption, the employer would be spared exposure to future cost increases and the treasury would get revenue in the form of more individual income taxes rather than the fine/tax on the employer and it would level the playing field between employer-provided HI and directly purchased individual HI.

It could also solve the potential issue where employers end up providing different subsidies for individual, couple and family coverage since it would be the same amount for each employee. Employers shouldn't compensate differently depending on marital/family status so HI subsidies shouldn't be different either.

 

[pb4uski]

What is the justification for making HI expenses tax deductible? There's no deduction for food, shelter, etc (except as provided for by the personal exemption/standard deduction). Making HI costs deductible provides a relatively larger benefit to higher income people and to the extent it is a govt subsidy (more dollars chasing the same amount of service it can be expected to increase costs (more dollars chasing the same amount of goods/services).
If we assume a given national tax burden, every reduction in national taxed income results in a necessary increase in tax rates. I'd prefer fewer carveouts and lower rates, barring some good reason for doing otherwise.

You could make the same argument for medical expenses, property taxes, state income taxes, mortgage interest, charitable contributions, and all other deductible expenses. There is a deduction for shelter now in the form of property taxes and mortgage interest.

If I were king I would get rid of all itemized deductions but I don't see that happening, so the idea would be to make the tax implication of health insurance the same whether it is deductible or not. IMO, it is politically more palatable to make employer-provided HI taxable to the employee and deductible by the employee to level the playing field with taxpayers who have to purchase their own HI.

 

[scrabbler1]

You could make the same argument for medical expenses, property taxes, state income taxes, mortgage interest, charitable contributions, and all other deductible expenses. There is a deduction for shelter now in the form of property taxes and mortgage interest.

If I were king I would get rid of all itemized deductions but I don't see that happening, so the idea would be to make the tax implication of health insurance the same whether it is deductible or not. IMO, it is politically more palatable to make employer-provided HI taxable to the employee and deductible by the employee to level the playing field with taxpayers who have to purchase their own HI.

+1 although I'd only get rid of some deductions and cap others.

My proposal to move everyone into the middle type [(2)] would very likely increase tax revenue because there is more income to be taxed in (1) moving to (2) than income taxes lost by moving (3) to (2).

I'd actually prefer fewer carveouts with rates not being lowered because we have had too many carveouts and credits and tax cuts which never had any base-broadening offset but that's a subject for another thread, perhaps.

 

[imoldernu]

As the US spends twice as much on healthcare as our Canadian neighbors, the question naturally arises not just "Why", but also "Where". Not just how much, but where does the extra money go?

This article, while rather intense in detail, offers some insight into the costs... not just the cost to the taxpayer, but the differential in Prices, Procedures, and Administrative Expenses. With the roughly "par" value of the US and Candian dollar, it points up the effect of legislation and regulations.
Medical Spending Differences in the United States and Canada: The Role of Prices, Procedures, and Administrative Expenses

But that is just part one... Part two would be Pharma regulations, and Part three might be the approval of standards for medical fixtures and equipment required for government reimbursement.

One example of Part 3 might be that medicare, on approval, may ok full or partial cost of products such as hospital type beds, walkers, or wheelchairs. Besides requiring Doctor approval, the items must be approved by medicare... manufactured according specification. While this may be good for the patient, the standards may set costs that could be non competitive. Ie. an item that receives approval, using standards that are only met by a single supplier. Yes, there are competitive bidding opportunities, but decisions may be suspect... allowing approval on standards that set a higher cost bar or retooling by manufacturers.
Durable medical equipment (DME) coverage | Medicare.gov

 

[Bryan Barnfellow]

That sounds like a sensible system to me other than the restriction to be treated in your own canton. Is there some provision for people who travel or do you need to buy a supplemental policy if you travel?

Switzerland is a federation of 26 strong cantons. The federal government has very little power (federal taxes are dwarfed by cantonal and municipal taxes, and the federal government keeps our 3 fighter jets in the air ;-)

Thus, the restriction to within your canton's borders. I believe that the Swiss insurers will pay for emergency treatment costs in other countries; but not normal run-of-the-mill health services.

I forgot one other benefit -- the Swiss insurers will pay a significant portion of your gym costs. They recognize that it will save money in the long run.

BB

 

[nuke_diver]

This is an interesting discussion...though I imagine it will never really happen here. IMO there still is too much of the "for profit" mentality when it comes to HC. As a Canadian living in the US I've gotten to see both sides. As I (rapidly) approach retirement the CDN system has a lot of appeal to me. If I move to BC my HC cost will be in the 1-3K a year depending on what I get and what I need (ie buying travel ins etc). In the US it will be in the 15K range for my wife and myself depending on what ACA policy we get and what we actually need (early on with both healthy not much but an accident could change that in a hurry). In terms of budgeting it is much easier to budget for HC in the CDN system as I don't need to budget for such a large reserve....just in case. I could live on a lot less there than here.


But the weather won't be near so nice....I mean it hasn't snowed in 24yrs that I've been here ...least not at sea level

 

[nvestysly]

I have lived in Switzerland for about 5 years now and like the Swiss model.

It is "universal" in the sense that it is compulsory for everyone in the country who is here for more than 3 months. However it is not a single payer plan and is not connected to employment, which makes it portable. Individuals pay for it and do so all of their lives. If you cannot pay the whole premium, your canton (=state) will assist you based on your income. But you own the policy/contract.

There are no pre-existing conditions exclusions and your premiums cannot go up due to your own medical experience -- they are tied to your age group.
My premiums have gone up 1 or 2% each year at most. One year they did not go up at all. It was a shock.

For the basic insurance plan, which is compulsory, the government (or a governament commission, not sure) determines what illnesses are covered and publishes a drug formulary; but it is very comprehensive. It's like the US Blue Cross/Blue Shield used to be. There is no hassle with getting health services (you can go to a general practitioner or directly to a specialist). You show your insurance card and they bill the insurer.

The basic plan is reasonably priced and includes medications and even spa treatments if these are prescribed by a doctor for physical ailments or stress/burnout. Also if you are physically unable to care for yourself or your home due to an illness, you can receive home help until you are better. Some alternative medicines are covered as is acupuncture, for example. So you get doctor visits, lab stuff, medications/equipment, and hospitalization.

What you do not get is a private room in a hospital (only semi-private) or the ability to go outside your canton for treatment. If you want that, you buy a supplemental policy, which about 20-30% of Swiss residents do. It allows for some other benefits as well. Most people are okay with the basic plan. You can never be dumped by your insurer and you can change once a year to another if you would like. The medical staff are well trained and often speak very good English. My wife had a small procedure at our local hospital and was kept in hospital for most of a week (!) to be sure she was okay, and then we had help with house stuff for two weeks following.

There are about 60 nonprofit companies which offer insurance plans, competing on some aspects of price and service.

So in summary, I like that it is not connected to my j*b, making it portable. It is compulsory, so the healthy youngsters are in the pool as well. It covers things like medications and is generally form-free and has the bonus of no hassles/gamesmanship. The companies pay the bills and we are almost never on the 'phone with them as we constantly were when we lived in the US.

One small worry. Switzerland is a true direct democracy. This means citizens can change laws based on majority vote. There is a nationwide referendum this month to switch out the current system with a single-payer government system supported by taxes. I cannot believe this will be better for us; but I don't have a vote here.

BB

Switzerland is a federation of 26 strong cantons. The federal government has very little power (federal taxes are dwarfed by cantonal and municipal taxes, and the federal government keeps our 3 fighter jets in the air ;-)

Thus, the restriction to within your canton's borders. I believe that the Swiss insurers will pay for emergency treatment costs in other countries; but not normal run-of-the-mill health services.

I forgot one other benefit -- the Swiss insurers will pay a significant portion of your gym costs. They recognize that it will save money in the long run.

BB

Thanks for taking time to elaborate on the Swiss healthcare system. Your comments give me reason to believe what I thought was true - I like the Swiss approach and believe it could be adapted to the United States and be quite successful.

As others have mentioned in this thread, there are so many convoluted reasons the U.S. healthcare system is in it's current state. We've given so many tax incentives to corporations and individuals that nobody wants to change. Everyone is at the trough and likes the food they receive (to some degree). Now we've interjected direct subsidies to individuals and it's going to be hard to get that horse back in the barn.

We really need to start over and the Swiss system appears to be a good starting point. So back to the OP... my answer remains NO if we are discussing variations on what people currently think of as Universal Health Care and my answer would be YES if we are discussing an approach that is significantly different compared to how we administer health care / insurance today. Remove the employer association, make it truly portable - individuals obtain the coverage they want, allow for a voucher/subsidy depending on income (and means), provide for transparent pricing policies and make the individual more aware of how and where the money is spent and that there is not an infinite supply of money to address your every ailment.

My earlier comment on the need for a limit (or cap) was not intended to say an individual would not receive treatment but to say there are a variety of ways to treat ailments and some cost less than others. Yes, it is currently very difficult to obtain pricing. I've even been told "why do you care, insurance is paying for it!" when I inquired about the charges for a colonoscopy. Slowly, providers are changing their methods - I recently asked about prices for treatment of tennis elbow and within 5 minutes I was given itemized pricing for the arm brace, physical therapy and a steroid injection. That allowed me to determine which approach (or all three) I wanted to pursue.

 

[pb4uski]

....If I move to BC my HC cost will be in the 1-3K a year depending on what I get and what I need (ie buying travel ins etc). In the US it will be in the 15K range for my wife and myself depending on what ACA policy we get and what we actually need (early on with both healthy not much but an accident could change that in a hurry). In terms of budgeting it is much easier to budget for HC in the CDN system as I don't need to budget for such a large reserve....just in case. I could live on a lot less there than here.
....

What will your taxes be in BC vs here? Federal, state/provincial, sales/VAT, etc.

This link suggests Vancouver is 14% more costly than LA but it doesn't address income taxes that I can tell. I assume that sales tax/VAT are covered in the items listed.

http://www.numbeo.com/cost-of-livin...&city2=Vancouver&amount=1,000.00&currency=USD

 

[nuke_diver]

using that link...which isn't going to be quite right because I would not live in Vancouver...all big cities are expensive I get and I wouldn't rent in either

You would need around 5,564.72C$ (5,038.23$) in Vancouver to maintain the same standard of life that you can have with 5,300.00$ in San Jose, CA (assuming you rent in both cities).

So $200 more a month...I'm not sure if that counts HC. Here HC is about 20% of my expected retirement total budget. Taxes are another 20 or so and the rest is living expenses. I checked into taxes and while it's a bit hard to tell because there is the possibility of double taxes tax rates in BC while not working (passive income) seem to be similar or less than US taxes. I have a friend who's a CFO in Maryland who told me similar information a while ago. While working the US is clearly cheaper, when not working the delta is less dramatic.

In order to do that move there would need to be a lot more research. The wife thinks it better to move to WA which would certainly be cheaper than either place.

My biggest expense to move to either place will be the loss of my killer gym membership deal which is $97/yr for life at 24hr fitness. None of those in any place we are considering moving.

 

[candrew]

IMO, health care should be treated as a human right, not as another commodity. We've come to embrace the idea of public safety, safe drinking water and other similar "public" services to be equally accessible to all, regardless of one's ability to pay. I doubt any of us would argue that those are life necesseties and minimum requirements of an advanced society. Why should access to routine, quality healthcare be any different? If I dial 911, no one is first asking me for my "public safety insurance card" prior to dispatching the police or fire dept.

For a nation like the U.S. that declares "life, liberty & the pursuit of happiness" to be its tenents, the fact that a significant percentage of our population must do without access to routine, quality, preventative healthcare solely because they can't afford it is unacceptable. All of us benefit by having a healthier society. It lowers the cost of doing business through improved productivity. As individuals have their chronic health conditions more effectively managed through access to routine, preventative care, costs begin to go down by reducing E.R. visits and inpatient hospital stays.

Expanded, improved Medicare made available to every American - cradle to grave - is the answer. Medicare is actually administered very cost effectively - at less than 5%. An earlier poster mentioned it is going "broke", when in fact it is because the program must insure a relatively narrow band of our population (the elderly & disabled) whose healthcare needs consume significant resources are why Medicare costs rise disproportionately. Expanding "the risk pool" to include everyone, cutting out private health insurance companies (useless middlemen that contribute NOTHING to health care) and permitting Medicare to negotiate drug prices would significantly drive down per capita health care costs in the U.S.

And BTW folks - stating that anyone can go to the E.R. and be treated "free of charge" is not healthcare. It is in fact the most expensive form of treatment and least effective means of keeping people "healthy".

 

[Rustic23]

Switzerland has about 8,000,000 people, so not a bad system for say NYC, about the same size! Now my guess is if you compare the socio-economic background of the two you will find they are not that close to each other, and the Swiss system would quickly collapse even in a confined space as NYC much less one that spreads from Hawaii to NY, Alaska to Florida.

 

[pb4uski]

IMO, health care should be treated as a human right....

I could not disagree more. Read the Constitution and Bill of Rights - health care isn't in there.

I suppose that in your view food is a human right too so the next thing you will propose is free food for everyone?

 

[razztazz]

I could not disagree more. Read the Constitution and Bill of Rights - health care isn't in there.

And where does it say something has to be black-letter in the constitution in order for The People to actuate it? The answer is: Is need not be. Rights are what we want them to be. The Constitution does not proscribe universal med insurance.

I suppose that in your view food is a human right too so the next thing you will propose is free food for everyone?

Psssssshhh![MOD EDIT]

 

[M Paquette]

I could not disagree more. Read the Constitution and Bill of Rights - health care isn't in there.

Fortunately, in their wisdom the Founding Fathers had anticipated your disagreement.

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

-- Ninth Amendment to the United States Constitution

James Madison commented:

It has been objected also against a Bill of Rights, that, by enumerating particular exceptions to the grant of power, it would disparage those rights which were not placed in that enumeration; and it might follow by implication, that those rights which were not singled out, were intended to be assigned into the hands of the General Government, and were consequently insecure. This is one of the most plausible arguments I have ever heard against the admission of a bill of rights into this system; but, I conceive, that it may be guarded against. I have attempted it, as gentlemen may see by turning to the last clause of the fourth resolution.

So, after the enumeration of specific rights, the great residuum remains the rights of the people. Now, as to whether or not access to healthcare is in fact a right of the people is a matter of debate.

There are those who believe that only true natural rights are those which impose no [FONT=times new roman,times]affirmative[/FONT] obligations on others, but require only that one not act contrary to the rights of others. As a right to healthcare would require an affirmative obligation on the provider of such care to exist, under this interpretation healthcare cannot be a true natural right. (Rand-Rothbard-Cato school; Smith-Heinlein is best summarized as "TANSTAAFL!")

This is countered by those who believe that access to healthcare is a moral right, and promotion of such access is a legitimate function of government, as part of the exercise of "unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

The reader is invited to familiarize himself with the arguments around the topic here:
Right to Health Care ProCon.org

Further debate on the subject of whether access to healthcare is a human right is best done somewhere else. (That's sort of a hint.)

 

[brett]

People who live outside the US just do not get it.

What they see is the wealthiest country in the world that is inherently unable to provide all of it's citizens access to health care. This is a stunning indictment for those of us who live in different countries and who have experienced other systems/travelled extensively.

It is a system that appears to have been shaped by insurance companies, hospital corporations, and drug companies. Does anyone really think that even one of these organizations place national health and well being ahead of their corporate well being/shareholder return?