DSA - How Will this Work?

[baltimorened]

I don't even want Medicare for all but I think it's a little absurd to claim that all of us who want to get more people to covered would refuse to pay more. You've now had two for two telling you they understand the deal with this so I'd ask you remove the "left is liars" talking point and keep focused.

ok, I know I'm getting old and forget some things (not much by the way) but when did I post the "left is Liars"? .

I don't think I've ever used those words. I think some on the left might be misguided or look through blue colored glasses, but I don't think any poster on here right or left is intentionally Lying. And to be clear I think some on the right look through red colored glasses and might be misguided, but I don't think any of them are intentionally Lying, even the ones you have called "liar"

But you didn't answer my fundamental questions.....

 

[FLaw47]

ok, I know I'm getting old and forget some things (not much by the way) but when did I post the "left is Liars"? .

I don't think I've ever used those words. I think some on the left might be misguided or look through blue colored glasses, but I don't think any poster on here right or left is intentionally Lying. And to be clear I think some on the right look through red colored glasses and might be misguided, but I don't think any of them are intentionally Lying, even the ones you have called "liar"

But you didn't answer my fundamental questions.....

I was editorializing your argument that the left wouldn't pay more for Healthcare.

Which fundamental questions am I supposed to be answering? I don't know the specifics of a policy that hasn't come to a vote.

 

[scotchtiger]

I have consistently said I'm will to pay more so everyone can have coverage. In case you've missed it, I'm saying it explicitly again.

This is one reason I appreciate having discussions with you. We may disagree, but I think you are coming from a place of sound knowledge and honest intent.

I don’t feel that way about most people, and in particular a lot of the new additions to the board. And certainly not a lot of the general public. When they lobby for more government programs or free government healthcare, I think the vast majority fall into one or more of these buckets:

They think taxing billionaires will magically pay for it. Several on the board fit this category.

They think taxing the “rich” will pay for it, but don’t have a reasonable understanding of what is rich or how the actual tax structure would work.

Don’t really care where the money comes from as long as it’s not from them.

Have absolutely no idea how any of it works - including taxes - and just want free ****.

Say they are fine paying more for it, but know that in reality the cost to them will be negligible at best.

It’s hard for me to take someone seriously when they ask for more free stuff from the government and 1) want someone else to pay for it, 2) seem genuinely ignorant about how the funding will work and 3) have little to no intent of seeing adverse financial impact to themselves as a result of the proposed entitlement.

You don’t fit that description, which makes you unique in these conversations.

 

[Jerome Silberman]

This is one reason I appreciate having discussions with you. We may disagree, but I think you are coming from a place of sound knowledge and honest intent.

I don’t feel that way about most people, and in particular a lot of the new additions to the board. And certainly not a lot of the general public. When they lobby for more government programs or free government healthcare, I think the vast majority fall into one or more of these buckets:

They think taxing billionaires will magically pay for it. Several on the board fit this category.

They think taxing the “rich” will pay for it, but don’t have a reasonable understanding of what is rich or how the actual tax structure would work.

Don’t really care where the money comes from as long as it’s not from them.

Have absolutely no idea how any of it works - including taxes - and just want free ****.

Say they are fine paying more for it, but know that in reality the cost to them will be negligible at best.

It’s hard for me to take someone seriously when they ask for more free stuff from the government and 1) want someone else to pay for it, 2) seem genuinely ignorant about how the funding will work and 3) have little to no intent of seeing adverse financial impact to themselves as a result of the proposed entitlement.

You don’t fit that description, which makes you unique in these conversations.

You should attempt to consider that he is not all that unique in understanding there is a cost to doing buisness and that your assumptions about ignorant people wanting free stuff are only partially correct. That would probably get you closer to the truth, or at least break you out of the habit of assuming the worst of people you don't agree with and the best of those you do.

Both thought processes are equally damaging.

 

[scotchtiger]

You should attempt to consider that he is not all that unique in understanding there is a cost to doing buisness and that your assumptions about ignorant people wanting free stuff are only partially correct. That would probably get you closer to the truth, or at least break you out of the habit of assuming the worst of people you don't agree with and the best of those you do.

Both thought processes are equally damaging.

I don’t think I’m off by much. Some may be well-intentioned, but know they won’t be the ones paying for much of anything. Only like 20% of taxpayers pay more than $10k in federal income taxes. So when we’re talking about offsetting healthcare expenses that generally exceed this with premiums, etc, it’s reasonable for most people to assume their taxes won’t double.

All of this stuff will fall to a small percentage of us. The top 2% already pay roughly half of all federal income taxes. When Biden and Harris proposed tax hikes, they targeted this group ($400K+). Safe to say this group will have the bullseye on it when Dems go looking for people to pay for universal healthcare, paid family leave, paid childcare and their other giveaways.

Given that, it’s logical to assume the vast majority won’t be paying for these things, which would influence many of their opinions on the policies. Who doesn’t want free healthcare, child care and paid family leave without a corresponding tax hike? Right?

 

[Jerome Silberman]

I don’t think I’m off by much. Some may be well-intentioned, but know they won’t be the ones paying for much of anything. Only like 20% of taxpayers pay more than $10k in federal income taxes. So when we’re talking about offsetting healthcare expenses that generally exceed this with premiums, etc, it’s reasonable for most people to assume their taxes won’t double.

All of this stuff will fall to a small percentage of us. The top 2% already pay roughly half of all federal income taxes. When Biden and Harris proposed tax hikes, they targeted this group ($400K+). Safe to say this group will have the bullseye on it when Dems go looking for people to pay for universal healthcare, paid family leave, paid childcare and their other giveaways.

Given that, it’s logical to assume the vast majority won’t be paying for these things, which would influence many of their opinions on the policies. Who doesn’t want free healthcare, child care and paid family leave without a corresponding tax hike? Right?

Sure everyone likes a free lunch, but that's not what I was talking about. I get a sense you probably know that already.

You seem to be implying that you are a high wage earner and have no need for assistance, amd I want to congratulate you and assure you that that does not make me feel anything but a small amount of happiness that you don't have to worry. Others do have to worry about the cost of healthcare derailing their life's work and many more will face extremely uncomfortable and expensive decisions as their parents, themselves and their children require care, and I don't think it's naive or stupid for people to have a general concern for them or how insurance costs continue to rise at an untenable rate for the vast majority of the nation.

For you to assume it's an outlier to have the opinion that something can and should be done to make healthcare easier to access and have enough care to understand the possible challenges is lazy and potentially insulting.

 

[scotchtiger]

Sure everyone likes a free lunch, but that's not what I was talking about. I get a sense you probably know that already.

You seem to be implying that you are a high wage earner and have no need for assistance, amd I want to congratulate you and assure you that that does not make me feel anything but a small amount of happiness that you don't have to worry. Others do have to worry about the cost of healthcare derailing their life's work and many more will face extremely uncomfortable and expensive decisions as their parents, themselves and their children require care, and I don't think it's naive or stupid for people to have a general concern for them or how insurance costs continue to rise at an untenable rate for the vast majority of the nation.

For you to assume it's an outlier to have the opinion that something can and should be done to make healthcare easier to access and have enough care to understand the possible challenges is lazy and potentially insulting.

Oh I acknowledge those are real challenges. But don’t see how simply shifting who pays the premiums changes things in the right direction. US healthcare has SO MANY issues, but simply changing from employer and employee premiums to higher taxes doesn’t seem like it does much to fix the real issues.

We need to viscously attack the obesity epidemic. We need to aggressively improve our food supply. We need to address food deserts so everyone has healthy options. We need to drive waste out of healthcare delivery. We need to invest in AI and robotics to automate elements of healthcare delivery, reduce costs and expand access. We need tort reform. And on and on.

UHS does nothing to solve many of the issues. So I just see it as an attempt to shift the cost, which doesn’t seem productive at all. And it makes me wonder why people support it if that’s the case.

 

[Jerome Silberman]

Oh I acknowledge those are real challenges. But don’t see how simply shifting who pays the premiums changes things in the right direction. US healthcare has SO MANY issues, but simply changing from employer and employee premiums to higher taxes doesn’t seem like it does much to fix the real issues.

We need to viscously attack the obesity epidemic. We need to aggressively improve our food supply. We need to address food deserts so everyone has healthy options. We need to drive waste out of healthcare delivery. We need to invest in AI and robotics to automate elements of healthcare delivery, reduce costs and expand access. We need tort reform. And on and on.

UHS does nothing to solve many of the issues. So I just see it as an attempt to shift the cost, which doesn’t seem productive at all. And it makes me wonder why people support it if that’s the case.

Again, I respect your thoughts on the problems and potential issues with trying to address them, everyone who has ever once looked into it knows it's a minefield.

My comments were about how you're starting from the assumption that people that hold differing views are ignorant and lazy. There are ways forward, with some probably being very uncomfortable for people that don't remember what that feels like. But, it's not impossible and their are models that are cheaper, have less cost and don't result in industries with outsized control over our law making.

Im comfortable disagreeing with you that what we have is as good as it gets, but that doesn't mean I'm going to sit quiet as you assume most people that share my views are slobbering idiots looking to steal from others. Some are, and some want to keep things just as they are because they extract a mountain of wealth from the sick and dying.

I choose not to worry too much about those people's opinions, even if they happen to be close to mine.

To put it more bluntly, I can see when someone is using character assassination to unfairly dismiss an opinion that has little to do with character at all and I think it's dumb no matter who does it. And frankly, there are tens of millions of adults all over the political spectrum in this country that could use a reminder that that dog don't hunt.

 

[baltimorened]

I was editorializing your argument that the left wouldn't pay more for Healthcare.

Which fundamental questions am I supposed to be answering? I don't know the specifics of a policy that hasn't come to a vote.

well editorializing that way really isn't fair.

well let's start easily..is it the government's responsibility to provide healthcare to it's citizens?

 

[prlyles]

Hard to believe every other industrialized country has figured out universal health care in some form and we're stumped. And not a single politician in any of those countries runs on converting to a US-style system. Weird, huh?

You took the words right out of my mouth.

 

[scotchtiger]

Again, I respect your thoughts on the problems and potential issues with trying to address them, everyone who has ever once looked into it knows it's a minefield.

My comments were about how you're starting from the assumption that people that hold differing views are ignorant and lazy. There are ways forward, with some probably being very uncomfortable for people that don't remember what that feels like. But, it's not impossible and their are models that are cheaper, have less cost and don't result in industries with outsized control over our law making.

Im comfortable disagreeing with you that what we have is as good as it gets, but that doesn't mean I'm going to sit quiet as you assume most people that share my views are slobbering idiots looking to steal from others. Some are, and some want to keep things just as they are because they extract a mountain of wealth from the sick and dying.

I choose not to worry too much about those people's opinions, even if they happen to be close to mine.

To put it more bluntly, I can see when someone is using character assassination to unfairly dismiss an opinion that has little to do with character at all and I think it's dumb no matter who does it. And frankly, there are tens of millions of adults all over the political spectrum in this country that could use a reminder that that dog don't hunt.

I didn’t say all are slobbering idiots or are lazy if you re-read my post. I listed a number of categories that a majority of people may fall into, not categories that apply to everyone. I also didn’t say that what we have is as good as it gets.

And it’s just math when I say most people assume they will pay less in the model they are seeking. And that they expect the “rich” to pay more. How well-intentioned they are may vary, but I’m not even sure how we’re disagreeing there. These are widely held views on the left.

 

[TarponSpringsNole]

I'm fully aware of that,.. What you don't seem to understand is that in the ultimate single payer scenario those non-contributors will both expect and receive 100% the same level of care that the contributors are now receiving,... One of two things will have to happen,.. Either my currently acceptable cost for excellent healthcare goes up so that everyone can receive that product, or the quality of my healthcare goes down to a level that's deemed to be marginally acceptable to the average,... Neither are acceptable to me.

You don’t like poor people. It’s quite evident. You’re the worst kind of boomer. Selfish af.

And universal health care can definitely be implemented here. I’d pay more in taxes to see it happen.

 

[bdgan]

you don't even have to go that far...we take in about $5.3 trillion in taxes...our healthcare in the US costs $5.3 trillion...

Now the DSA folks will tell us that we're going to tax the rich to pay for all the programs. What they don't tell you is at what income level is "rich" Biden had it at $400k....not sure how many Americans will go for that.

By the way the DSA advocates won't lay out exactly how they get to the $trillion in revenue they need...because they don't know

The $5.3 trillion in healthcare isn't just the federal government:

• Federal government: 31% of total NHE ($1,644.6 billion)
• Households: 28% ($1,400 billion)
• Private business: 18% ($931.7 billion)
• State and local governments: 16% ($820 billion)
• Other private revenues: 6%

The $5.3 trillion we take in is only the Federal Government. State and local governments collect another $5 trillion.

 

[Jerome Silberman]

I didn’t say all are slobbering idiots or are lazy if you re-read my post. I listed a number of categories that a majority of people may fall into, not categories that apply to everyone. I also didn’t say that what we have is as good as it gets.

And it’s just math when I say most people assume they will pay less in the model they are seeking. And that they expect the “rich” to pay more. How well-intentioned they are may vary, but I’m not even sure how we’re disagreeing there. These are widely held views on the left.

What are?

 

[bdgan]

I'm not DSA and I'm not really in favor of a single payer healthcare plan at this juncture. However, the math for this isn't actually that complicated and a lot of people are just being willfully stupid.

Taxes would absolutely to have to go up on basically everyone. However:
*Employers would no longer be paying for healthcare at the same rates. That can be replaced with a tax or with higher salaries for employees.
*People on employer health plans would no longer have private premiums, that goes to either a tax or premiums for your public plan

The idea is that most people would pay less in increased taxes than they'd save in premiums and healthcare expenditures. That likely would not be true for some well off people (likely to include myself) because having progressive income tax increases is an easy lever to pull.

Please do not move the goalposts and ask about how good of an idea this is or isn't, or if I think it's fair to the ScotchTigers of the world. I asked the question that was asked.

For the record I agree that the strongest advocates for this aren't being serious in describing how it'd precisely be paid for. Elizabeth Warren tried and was punished for it. But let's not pretend that hand waiving away details is unique to the DSA. I've yet to see a GOP tax cut paid for either on paper or in reality.

Good fair minded post.

There's no doubt in my mind that universal healthcare would cost a lot of money because it would include coverage for 30 million more people. That alone would cost an additional $500 billion.

Some argue that the cost for everybody would be less because we would eliminate insurance company profits and overheard. The problem is the profits aren't very high and it takes a leap of faith to believe the government will be more efficient.

I'm confident that companies wouldn't save any money because whatever they currently spend would be replaced by a healthcare payroll tax.

It would be difficult to have most people paying less in increased taxes than they'd save in premiums. The big reason is the $500 billion to cover 30 million more people won't be offset by lower corporate profits and administrative costs. Then it would come down to who pays more. Politicians have to be able to convince ~60% of voters that they will save money so those with high incomes would have to be hit the hardest. It would probably be like Canada where the healthcare tax is hidden inside federal and provincial taxes. It's difficult to tell exactly how much of your tax bill is going towards health insurance but I've read things that suggest some are paying just a few thousand, most are paying about 6 thousand, and people making $500k are paying over 60 thousand. It's a big redistribution program.

 

[bdgan]

DSA accounts for 2% of Democrats in Congress so… I wouldn’t spend too much time worrying about their crazy policies.

As much as the GOP wants you to believe it, the DSA is actually not the face of the Democratic Party.

Yes but the number is growing. Who would have expected Mamdani to became mayor of NYC?

 

[m.knox]

How will it work? Don't ask Co Chair Megan Romer. She doesn't know..... lol... Pure emotional nonsense. And these people are now in control of the democratic party...

Look at that last paragraph. She is genuinely stupid.

DSA bigwig struggles to explain what ‘taxing the rich’ means in embarrassing interview: ‘Privileged idiot’​

https://nypost.com/2026/08/08/us-ne...xing-the-rich-means-in-embarassing-interview/

Megan Romer, one of the two national co-chairs of the organization, seemed bewildered by a question from the magazine’s editor David Remnick about one of the DSA’s signature positions.

“Well, what does ‘taxing the hell out of them’ mean?’” Remnick asked on the episode of The New Yorker Radio Hour titled “How Socialist Is the DSA? Megan Romer Explains“.

“Uh, yeah, you know, again, I don’t have like a solid…” Romer awkwardly chuckled.

“But shouldn’t you?” Remnick pressed. “If you’re the co-chair of the DSA, shouldn’t you be more specific than ‘taxing the hell’ out of something? What exactly do you mean?”

“Um, that’s a good question,” Romer said, her eyes widened in shock that someone would challenge her beyond the catchy slogan that was often used by Mayor Mamdani during his campaign.

“So again, it’s democracy, right?” she continued. “And we have to look at what we have to spend and what we need. We don’t want to depend on the existence of millionaires because that means people are still getting exploited.”

 

[bdgan]

Hard to believe every other industrialized country has figured out universal health care in some form and we're stumped. And not a single politician in any of those countries runs on converting to a US-style system. Weird, huh?

True but their taxes are much higher and their economies tend to be weaker. They've also had to make sacrifices to keep healthcare costs low (limits on medical liability, more difficulty getting treatment for some ailments).

I try not to criticize other countries. Some people would prefer their system and others wouldn't. Things are different, not necessarily better or worse. One nice thing in western European countries is that they live in their cities. We've moved to the suburbs and have allowed our cities to decay. The flip side of that is they pay $9/gal for gas and ride bikes or take trains to work. They don't drive Ford F150s and their homes are only half the size of American homes. Which is better depends on the individual. Same with healthcare.

My criticism is people wanting our healthcare at half the price. That's not realistic and it certainly wouldn't be the case just because the government runs it.

 

[bdgan]

we pay 1.5X what any other country spends on health care...for our unique system that doesn't deliver better results

but sure...there's no way to afford what every other country does for much less

People argue that our healthcare system delivers worse results because we have lower life expectancy. I think we have lower life expectancy because we're a nation of fat arses. The obesity rate in the USA is 42%. UK 29%, GER 24%, Spain 19%, France 13%.

I don't think there's any question that our healthcare system is too expensive. I just don't think we would significantly reduce the cost just by having the federal government run it.

 

[scotchtiger]

What are?

Lower healthcare costs. Higher taxes on the "rich."

Presumably, most feel that the healthcare costs will drop by more than their taxes will go up, due to the second item. Or due to a lack of understanding of what drives cost in US healthcare.

 

[FLaw47]

This is one reason I appreciate having discussions with you. We may disagree, but I think you are coming from a place of sound knowledge and honest intent.

I don’t feel that way about most people, and in particular a lot of the new additions to the board. And certainly not a lot of the general public. When they lobby for more government programs or free government healthcare, I think the vast majority fall into one or more of these buckets:

They think taxing billionaires will magically pay for it. Several on the board fit this category.

They think taxing the “rich” will pay for it, but don’t have a reasonable understanding of what is rich or how the actual tax structure would work.

Don’t really care where the money comes from as long as it’s not from them.

Have absolutely no idea how any of it works - including taxes - and just want free ****.

Say they are fine paying more for it, but know that in reality the cost to them will be negligible at best.

It’s hard for me to take someone seriously when they ask for more free stuff from the government and 1) want someone else to pay for it, 2) seem genuinely ignorant about how the funding will work and 3) have little to no intent of seeing adverse financial impact to themselves as a result of the proposed entitlement.

You don’t fit that description, which makes you unique in these conversations.

Well shucks, that was very kind. Thank you. I think someone else responded but I do think there are others like me on the board, though.

Oh I acknowledge those are real challenges. But don’t see how simply shifting who pays the premiums changes things in the right direction. US healthcare has SO MANY issues, but simply changing from employer and employee premiums to higher taxes doesn’t seem like it does much to fix the real issues.

We need to viscously attack the obesity epidemic. We need to aggressively improve our food supply. We need to address food deserts so everyone has healthy options. We need to drive waste out of healthcare delivery. We need to invest in AI and robotics to automate elements of healthcare delivery, reduce costs and expand access. We need tort reform. And on and on.

UHS does nothing to solve many of the issues. So I just see it as an attempt to shift the cost, which doesn’t seem productive at all. And it makes me wonder why people support it if that’s the case.

Even if universal healthcare doesn't tackle every one of the issues you've mentioned (which is not to say those issues shouldn't be tackled), it would still be a win to have everyone covered (or coverable) not through their employer:

• People like me would be able to retire before they're eligible for Medicare at a more reasonable cost
• Importantly it means that people aren't handcuffed to their employers so badly. More people would feel empowered to go start their own businesses, businesses would have to compete on benefits other than healthcare, and the labor in the labor market would have an easier time switching employers (which would drive up wages, at least at the margins).

 

[FLaw47]

well editorializing that way really isn't fair.

well let's start easily..is it the government's responsibility to provide healthcare to it's citizens?

In this day and age, the government should ensure that all citizens are able to receive quality healthcare at an affordable price, yes. There are a variety of avenues to achieve that but I believe we should have that expectation.

 

[Jerome Silberman]

Lower healthcare costs. Higher taxes on the "rich."

Presumably, most feel that the healthcare costs will drop by more than their taxes will go up, due to the second item. Or due to a lack of understanding of what drives cost in US healthcare.

Neat assumption. Clearly you're stuck in this mindset so I'll just leave you be.

 

[FLaw47]

I was about to critique one of my comrades but decided to do a little bit of research first.

You can see the image below. While our medical providers do get paid more, the plurality of our excess costs do seem to be related to administration. FWIW, I've seen similar numbers in other places.

Link

 

[scotchtiger]

I was about to critique one of my comrades but decided to do a little bit of research first.

You can see the image below. While our medical providers do get paid more, the plurality of our excess costs do seem to be related to administration. FWIW, I've seen similar numbers in other places.

Link

View attachment 1390612

I posted this elsewhere, but the majority of government healthcare coverage is administered by private insurers. 55% of Medicare. 75% of Medicaid. 100% of Medicare Part D.

Combined with much of this administration expense resting with providers, I don't know that UHC solves the issue.

I do think we need to address administrative waste and inefficiency, but I look at that as a separate issue from UHC. And one that can and should be tackled independently of Medicare for All like proposals. It's also something that would receive near unanimous support across party lines.

 

[FLaw47]

I posted this elsewhere, but the majority of government healthcare coverage is administered by private insurers. 55% of Medicare. 75% of Medicaid. 100% of Medicare Part D.

Combined with much of this administration expense resting with providers, I don't know that UHC solves the issue.

I don't know the right way to address but Germany also has a multi-payer system and our relative administrative costs are 70% higher than theirs.

I do think we need to address administrative waste and inefficiency, but I look at that as a separate issue from UHC. And one that can and should be tackled independently of Medicare for All like proposals. It's also something that would receive near unanimous support across party lines.

I don't think a policy that tackled insurance costs on their own would have bi-partisan support. That's a lot of jobs that would be eliminated and I think the GOP would reflexively fight against any standardization.

 

[scotchtiger]

I don't think a policy that tackled insurance costs on their own would have bi-partisan support. That's a lot of jobs that would be eliminated and I think the GOP would reflexively fight against any standardization.

AI may take care of this for us without government involvement.

 

[baltimorened]

Yes but the number is growing. Who would have expected Mamdani to became mayor of NYC?

the Nazi and/or communists party started with just a few.....

like I have posted, the democrats need the DSA in order to take control of the Congress. the DSA will control - with their votes - what the democrats are able to pass...remember the Republican tea party?

 

[tarheelbybirth1]

Some argue that the cost for everybody would be less because we would eliminate insurance company profits and overheard. The problem is the profits aren't very high and it takes a leap of faith to believe the government will be more efficient.

The overhead is enormous. Imagine the elimination of all c-suite executive compensation at every insurance company not to mention all their supporting infrastructure.

 

[baltimorened]

True but their taxes are much higher and their economies tend to be weaker. They've also had to make sacrifices to keep healthcare costs low (limits on medical liability, more difficulty getting treatment for some ailments).

I try not to criticize other countries. Some people would prefer their system and others wouldn't. Things are different, not necessarily better or worse. One nice thing in western European countries is that they live in their cities. We've moved to the suburbs and have allowed our cities to decay. The flip side of that is they pay $9/gal for gas and ride bikes or take trains to work. They don't drive Ford F150s and their homes are only half the size of American homes. Which is better depends on the individual. Same with healthcare.

My criticism is people wanting our healthcare at half the price. That's not realistic and it certainly wouldn't be the case just because the government runs it.

here's a point that doesn't come up with very often...someone has to administer the healthcare system. Even in a single payer or Medicare for all, just like today's Medicare, someone has to a prove procedures before they are administered, someone has to make the payouts, maintain the records, balance the books...all the things insurance companies do today. The federal government actually contracts with outside companies to administer Medicare and states contract with outside companies to administer Medicaid.

In a single payer system or Medicare for all, these functions don't go away. So, neither will all the employees insurance companies employ today. Health insurance companies, on average, generate a profit of between 6-8%. For me, it stand to reason that if the government went to a government "run" system, they will have to contract for the needed services...likely though a bidding process. Would the hired companies be willing to work for free giving up these margins? I don't know....but my point is that all those who are counting on the large administrative savings are probably going to be disappointed.

 

[tarheelbybirth1]

True but their taxes are much higher and their economies tend to be weaker. They've also had to make sacrifices to keep healthcare costs low (limits on medical liability, more difficulty getting treatment for some ailments).

To be fair, their limits on medical liability exist because no individual has to sue - going up against an entire dept of corporate lawyers - for the money necessary to pay for their lifelong care. That's built into the system.

 

[baltimorened]

In this day and age, the government should ensure that all citizens are able to receive quality healthcare at an affordable price, yes. There are a variety of avenues to achieve that but I believe we should have that expectation.

again I ask, wasn't that the purpose of the ACA...Medicaid for the poor, Medicare for the elderly and ACA for everyone not otherwise covered?

 

[FLaw47]

here's a point that doesn't come up with very often...someone has to administer the healthcare system. Even in a single payer or Medicare for all, just like today's Medicare, someone has to a prove procedures before they are administered, someone has to make the payouts, maintain the records, balance the books...all the things insurance companies do today. The federal government actually contracts with outside companies to administer Medicare and states contract with outside companies to administer Medicaid.

In a single payer system or Medicare for all, these functions don't go away. So, neither will all the employees insurance companies employ today. Health insurance companies, on average, generate a profit of between 6-8%. For me, it stand to reason that if the government went to a government "run" system, they will have to contract for the needed services...likely though a bidding process. Would the hired companies be willing to work for free giving up these margins? I don't know....but my point is that all those who are counting on the large administrative savings are probably going to be disappointed.

I'm not sure this is the sort of thing that needs to be private, to be honest. I actually agree that actual insurance has been reasonably well solved by the private sector but just having the admin be handled by the government isn't impossible (in single payer).

 

[FLaw47]

again I ask, wasn't that the purpose of the ACA...Medicaid for the poor, Medicare for the elderly and ACA for everyone not otherwise covered?

10 states refused to expand Medicaid. Also, why do you keep circling back to the ACA? Is there anyone on the board who thinks where we are is sufficient? The ACA tried to greatly expand coverage. In some ways it succeeded. Let's do more.

 

[bdgan]

The overhead is enormous. Imagine the elimination of all c-suite executive compensation at every insurance company not to mention all their supporting infrastructure.

There is certainly some of that but much less than you might think. Insurance companies have competitors and stockholders. Higher premiums could lead to lost business and low profits can lead to fewer/unhappy investors. Lower profits would also eat into c-suite earnings because a lot of their compensation is stock.

Let's say a CEO makes a $40 million for a company with $400 million of revenues. If that CEO agreed to work for free that money could be used to lower premiums by 1/100th of 1%.

If the large insurance companies were so inefficient tell me why none of the government subsidized non profit co-ops were able to compete.

P.S. I agree that some big company executives are overpaid. My solution would be to make the compensation committee independent. I think there's a lot of I'll scratch your back if you scratch mine in the good old boys network. Where we disagree is that these companies are huge and if the 5 highest paid executives took a 50% pay cut it would only be enough to increase rank and file wages by a smidgen. You're not going to reduce $15k per person premiums to $9k per person by cutting c-suite pay. The math doesn't hold up.

 

[bdgan]

The overhead is enormous. Imagine the elimination of all c-suite executive compensation at every insurance company not to mention all their supporting infrastructure.

Try doing math

 

[tarheelbybirth1]

Try doing math

Try counting the army of support personnel for those c-suite personnel. And we're talking across the entire industry. What about the physical infrastructure that houses them and all of their competitors. Your premium pays for that glass palace and the overlapping and overlapping and overlapping functions for each of those companies and it buys the corporate jet and the house in Switzerland. And I'm not saying eliminating that fixes the problem, but it isn't some trivial portion of your insurance premium.

 

[bdgan]

here's a point that doesn't come up with very often...someone has to administer the healthcare system. Even in a single payer or Medicare for all, just like today's Medicare, someone has to a prove procedures before they are administered, someone has to make the payouts, maintain the records, balance the books...all the things insurance companies do today. The federal government actually contracts with outside companies to administer Medicare and states contract with outside companies to administer Medicaid.

In a single payer system or Medicare for all, these functions don't go away. So, neither will all the employees insurance companies employ today. Health insurance companies, on average, generate a profit of between 6-8%. For me, it stand to reason that if the government went to a government "run" system, they will have to contract for the needed services...likely though a bidding process. Would the hired companies be willing to work for free giving up these margins? I don't know....but my point is that all those who are counting on the large administrative savings are probably going to be disappointed.

I think there might be some administrative savings with single payer. Just not as much as people think. Some look at the low administrative cost for Medicare but they ignore the HHS does plan design/marketing and the SS/IRS collects the money. Somebody is going to have to manage the trust fund and that didn't work out well for SS & Medicare. One guy argues that you wouldn't have to go through open enrollment because everybody would be automatically enrolled at birth. The only way that would be true is if there were no options. Everybody would have to get the same coverage.

I think the insurance companies have become very efficient. That's why the non-profit subsidized co-ops couldn't compete. IMO this would at best save $200 billion per year. That's about 4% which is better than nothing but it's a far cry from cutting costs in half to match many European countries.

 

[bdgan]

again I ask, wasn't that the purpose of the ACA...Medicaid for the poor, Medicare for the elderly and ACA for everyone not otherwise covered?

The promise was that everybody would save $2,500/yr because the co-ops would compete with for profit insurers and the government would reduce reimbursement rates to providers. That was a huge fail.

 

[FLaw47]

The promise was that everybody would save $2,500/yr because the co-ops would compete with for profit insurers and the government would reduce reimbursement rates to providers. That was a huge fail.

Let's not overstate what this program was - it was $2.4 Billion in funding to start up the co-ops (so almost nothing), the enrollees where much more sick (expensive) than typical, and congress immediately cut funding to them.