"How will you pay for it?" is not the hard question with Medicare For All

[Recursion]

Already the press is chasing its tail on that. That's the easy question: you pay for it with taxes. At that level realistically you'd probably need a VAT like every other country uses to pay for health care, but however you pay for it, you raise enough taxes to meet the outlays. That's the "easy" question.

Here's the harder question: do you require doctors and hospitals to accept it, and (this is essentially the same question) do you forbid private insurers from duplicating it?

Furthermore, if doctors and hospitals are required to accept it, are they allowed to bill more than the Medicare reimbursement rate?

These questions may sound wonky but they're so absolutely foundational to what this plan actually means that I don't see the point of releasing it without answers.

[Kahuna7]

1. Should a single person pay the same tax as a family of four...or six?

That should be explained.

[Cuthbert Allgood]

10. Should a family with no car pay taxes that support roads?

Should a couple with no kids pay the same in taxes for schools as a family with four kids?

YES. That's how society works.

[Kahuna7]

14. Yeah? I'd like to see how the politicians explain that. Right now..

with my employer healthcare, there are different rates for single,spouse only and families. As a single, I pay $180.00 a month. People with a spouse pay more than singles. Families pay a great deal more. So, your little analogy is not quite apt in this instance.

[George II]

16. That's not a reasonable analogy, even if a family doesn't have a car they rely...

...goods and services that are delivered via roads. Plus many states assess taxes that are used to maintain the roads - gas taxes, car registration fees, tolls, automobile property taxes. If a family doesn't have a car they don't pay any of those four taxes/fees.

[Cuthbert Allgood]

21. So my federal tax dollars don't go to infrastructure?

What about schools? Should people be able to opt out of property tax if they don't have kids?

What is this, Libertarian Underground?

[progressoid]

46. Libertarian Underground!

I regretfully had a discussion with a libertarian while waiting for a parade to start about these very things - road maintenance, firefighters etc. He got tired of me and continued down the street to hand out more of his little pamphlets. Fast forward about 10 years and now I see him at city council meetings in the audience wearing a red cap that reads "taxation is theft".

[InAbLuEsTaTe]

51. And they also rely on the health of the people providing the goods and services delivered via roads.

Bernie & Elizabeth 2020!!!
Welcome to the revolution!!!

[George II]

52. What does that have to do with it? SMH.

[InAbLuEsTaTe]

53. Can someone help him out? I've given up.

Bernie & Elizabeth 2020!!!
Welcome to the revolution!!!

[George II]

54. SMH II.

[Demsrule86]

19. Try selling that to the electorate...we go down in flames.

[Kahuna7]

20. And, I'll tax you to give you Medicare for all but you will still have to purchase supplemental

coverage to cover all the stuff that M4A doesn't cover. Really???

[Demsrule86]

26. Right and those poor suckers on the ACA paying all their usual shit plus higher taxes while they

wait their turn. DISASTER!

[Cuthbert Allgood]

22. That's how taxes work.

That's how society works. Unbelievable.

[Kahuna7]

24. Everybody doesn't pay the same taxes. There are different filing statuses for

singles, vs. couples and families.That's how society works. Unbelievable.

[Cuthbert Allgood]

36. That isn't the same as the libertarian crap you are talking about.

I don't pay less in property taxes if I don't have kids.

[Demsrule86]

25. No that is how we lose. Attempting to force an ideologically driven program that few want

Into existence by raising taxes. What could go wrong ?

[Cuthbert Allgood]

35. "few want"?

It polls a lot more popular than that.

[Demsrule86]

39. Not when workplace insurance goes away...17 % approval.

[Recursion]

50. Nope. 13%-17% depending on the poll

Americans love the idea of Medicare for Everybody, and they like employer-sponsored insurance for themselves much better. Democrats ignore this at our peril.

[Yavin4]

42. Should I have to pay for a F-22 fighter jet?

Or tanks that are completely useless in modern warfare?

[George II]

55. Or F-35s?

[WeekiWater]

2. The answers to those questions should at least be generally...

Outlined in the release of any plan.

Agree.

[BlueFlorida]

3. It is all moot

Most people (some 87%) like their employer provided plan and don't want medicare.

ACA was thought to be a government run plan and Democrats lost even safe seats in 2010.

This WILL be a government run plan and it will be suicidal for Democrats to champion it. It is a political stunt and it will backfire badly.

[Demsrule86]

5. +100000

[Hortensis]

11. Sanders' totalitarian plan agree 100%. However, there are

other plans respectful of people's wishes and right to choose that will achieve the universal, or close to, coverage almost all Americans do want.

Americans across the spectrum like the ACA already and refuse to give it up. However, they will for what will, in fact, be our next incremental stage toward universal healthcare, whether under the ACA name and structure or another.

Heck, just the millions who want it but resent that the Democratic Party achieved it, and under President Obama!, are already wooed halfway there by a name change alone. Medicare for All!
Sanders' plan may not be brilliant, or achievable, but that reassuringly familiar and simple-sounding name is brilliant and caught fire immediately.

[zipplewrath]

4. Payroll taxes

Unless we want to give the major corporations another big windfall, part of the funding is going to come from the employers that will be "relieved" of the burden of funding their employees health insurance. That'll probably be in the form of a payroll tax.

And there will be assuredly a transitional period where first ONLY people NOT covered by their employer are eligible to "buy in" to Medicare. Basically, it's the "public option". In fact, we may start with only people over say 50 can buy in. At some point it can be expanded either in terms of age, or in terms of allowing employers to purchase Medicare for their employees instead of going through the private markets. At some point so many people will be within the Medicare system, it may not be necessary to force "everyone" into the system.

[Demsrule86]

6. And in the meantime what about those on the ACA?

[zipplewrath]

7. They're already covered

I suspect however that when they see the costs of Medicare, they'll switch as soon as they are eligible.

[Demsrule86]

13. They won't be. The ACA needs work assuming SCOTUS doesn't use MFA TO destroy it.

and your version of the MFA roll out does very little to help those who need it.

[Demsrule86]

17. I suspect it won't happen...so those who can't get it for who knows how long

Will be forced to pay crippling taxes, deductibles ( ACA) and premiums. Oh well that will work.

[marylandblue]

12. This is not what Sanders is proposing and that's part of the problem.

He is proposing a much bigger change that could have unpredictable and negative consequences for people who will get no benefits, at.least.in the short term.

[Kahuna7]

23. What he proposes would upend the entire Medicare system and I can promised you..

the seniors will vote in droves against that happening.

[marylandblue]

29. Everyone will vote against it except millenials on their parents insurance

or who don't have employer provide insurance.

[Kahuna7]

31. Right now it's just a pithy slogan. I don't support any of the candidates

who have endorsed it. They come across as followers, not leaders.

[Kahuna7]

15. Everybody doesn't work. You can't tax people who don't work. A VAT maybe? nt

[doompatrol39]

8. Anyone who gets asked that question needs to respond to the obvious...

...why does nobody ask that about tax cuts for the wealthy? Why does nobody ask that with regard to military expenditures, wars, or any number of other things?

That fact that far too many Democrats not only DON'T push back with that response but actually FEED INTO that false narrative is infuriating.

[Demsrule86]

40. And those answer will never work.

[Yavin4]

44. We are acculturated to believe that wealthy people are superior to us

And that we have to be able to fight wars all across the globe at any given time or foreigners will invade your small town USA.

[doompatrol39]

45. Because too many Dems have bought into Republican framing...

...of those things. Until our people start pushing back on that it will only become more ingrained in our society and harder to dig out from.

[Hortensis]

9. :) But how will we pay for what's not included

is more of the same question. And what will not be included when there is only one centralized plan subject to changes by the party in power? It doesn't even begin to be simple at all.

There are about as many MfA and Medicare for America plans out there as there are candidates now. For an example, Mayor Pete uses the term MfA, but diverges very substantially from Sanders' radical plan forcing the entire nation on one system, as do most of the candidates now.

Particularly in not doing away with private insurance entirely, as Sanders wants. 160,000,000 Americans have workplace insurance, and a majority, most of them registered voters, don't want to give it up. As was shown by the swift, negative reaction that just caused Kamala Harris to walk back her comment that she was ready to see the end of private insurance companies. And that's when almost no one is listening yet. You're so right that what people will accept is a big question.

Buttigieg:

"If the framework we're using is Medicare, a lot of people who have Medicare also have Medicare supplements, Medicare Advantage, something like that," Buttigieg added. "So if we want to make Medicare available to everybody, whether it's as a public option to buy in or simply establishing that as how the payer structure works in this country, that's going to be the center of gravity."

And if we need a road, a gradual way to get there, then we can start with Medicare for all who want it by making some version of Medicare available on the exchanges for people to opt into, as part of the pathway to Medicare for all so that you can try before you buy so to speak as a country."

He seems to be suggesting tax dollars would pay for what would be a standard package of Medicare benefits for all, but extra coverages would be available for purchase through private insurance companies. As Medicare is now.

I'm not crazy about that. I much prefer the Medicare for America plan for universal coverage. It allows all who want to go on a comprehensive government program to do so, with assistance for those who can't afford the deductibles and others who can afford to pay in somewhat doing so. While those who like what they have now would be free to stay with it. It's expected that over time by far most would migrate to the national health insurance, but choice would remain.

[Kahuna7]

18. There's a whole lot that Medicare doesn't provide for young people. Keep

threatening to mess with Medicare and find out how to step on the third rail. MediCAID for all.

[Hortensis]

43. Yes. The devil's always in the details -- the final ones.

A big issue is designing legality as strong as possible to withstand the Republicans attempts to destroy it. The plan Beto supports, Medicare for America, is believed to be significantly stronger in that respect than Sanders' revolution-by-legislative-fiat version.

As for coverages, though, I wouldn't expect a plan that people would agree to replace the ACA to have less than it provides now, or not much less at least. UNLESS the Republicans got power at a point where they could sabotage the ACA's replacement... I'm sure they're scheming to create chances to do just that.

But that aside, considering everything, the ACA's performed magnificently so far and I'm a huge fan of those who created it. Those very much include Nancy Pelosi, who played a huge role in getting far more of it passed than opponents intended. Battle royale. She and the rest'll do the same for and play another huge role in developing healthcare's next incremental development.

[stonecutter357]

27. Average Cost of Aircraft Carrier .

An Aircraft Carrier named CVN-78 Gerald R Ford that is located in the United States has a cost of around $13.5 billion. The maintenance and operational cost and the maintenance cost of a large size Aircraft Carrier run around $160 million per year.

[marylandblue]

30. Sure, so run for ending the American empire, and you'll free up lot's of money

But that will create a separate set of economic and political problems, while M4A would still cost more than the entire defense budget.

[stonecutter357]

32. Cool Story, Bro , !

[marylandblue]

37. Have you never thought about why we have so many expensive aircraft carriers?

[stonecutter357]

38. why we have so many expensive aircraft carriers?

so we can kill brown/Muslim people , in places most of us will never GO !

[marylandblue]

41. And what do you think an empire does? More importantly,

why do empires, all empires, do such things? It isn't just for shits and grins. That's just a fringe benefit.

[Freethinker65]

28. Start with a Medicare buy in. You will see some early retirements, freeing up long held jobs.

Many of those opting in will be upper level career professionals primarily working until Medicare kicks in. Those jobs will then be available for younger employees at perhaps slightly lower than the retirees pay grade. Employee provided insurance will not immediately, or perhaps ever, entirely go away. Retirees under 65 have guaranteed Medicare health insurance a few years early for a fee.

As more people gradually decide to buy into Medicare rather than opt for individual traditional for-profit plans (which even when healthy but older and/or having a preexisting condition requiring little expensive care but actuarially less desireable tend to be extremely costly with exclusions and/or high deductibles) the system will have some time to adjust.

If all employees were aware of the true cost for their now employee provided insurance (your monthly paycheck donation PLUS thousands per year paid by the employer), some would understand the potential benefit.

I get so tired of explaining that the total cost provided for employee provided health insurance for individuals and family policies is much greater than the amount directly taken out of their paycheck.

[Kahuna7]

33. Medicare buy in for ages 50 and up. Medicaid buy ins aka ACA for everyone else. nt

[TCJ70]

34. An "unlimited" buy-in or complete move to M4A is my standard this primary season...

...on healthcare, at least. None of the 55, then 50, then 40 gradual step down plans will fly with me. Open it up as an option and let people choose.

I'd also like to see, as part of the law, that the money previously used to subsidize employee healthcare plans be required to be payed to the employees in their regular checks. It's already part of the employees compensation so why not roll that over to them directly?

[tkmorris]

47. And yet, virtually every other first world nation has managed...

to answer these questions, or similar. In fact, the answers they have come up with are almost as varied as they are popular. And they ARE popular, everywhere you go.

Except here of course.

It seems to me the answers can't really be that difficult after all.

[Recursion]

48. So why skip them? (nt)

[KayF]

49. those seem like good questions

I assume such a massive reform will be unimaginably complicated, there will be many such questions.

[madville]

56. They'll screw it up and keep money flowing to the insurance companies

They'll most likely leave it as an 80/20 plan in order to get it even close to passing. Then require everyone to buy a supplemental policy from an insurance company to cover the 20%. In the end we get additional taxes and are still paying a premium to an insurance company. It's a pipe dream that the insurance companies will be regulated out of existence in our lifetimes, the industry is too large and has friends on both sides of the aisle.

[rickford66]

57. Right now, people with no insurance, pay for the insurance of others.

A percentage of everything you spend goes towards someone's health insurance. Very few people pay the full cost of employer supplied insurance. Private insurance pockets 20% off the top to pay your bill after finding ways to limit your coverage. I believe, just like Trump, people have no idea how medical insurance works or insurance in general.

[Recursion]

58. 12%, not 20%, and that includes administration

And not-for-profit insurers aren't any cheaper, so I don't think that's the problem

[rickford66]

59. Before the ACA I believe it was about 20%

I understand Medicare and maybe Medicaid have overheads of about 3%. I should have said that. Sorry.

[Recursion]

60. They don't really. That 3% is their overhead before they hand off to the private insurer

Medicaid takes the Federal and state money and then hands the money to Anthem, who does the actual provisioning. So, yeah, they "only" lose 3% in the process of doing that.