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Once We Get a Broad-based Set of New Taxes in Place, We Can Reform Health Insurance...
Your tax dollars at work...generating ideas for more tax dollars!
House Democrats have lots of potential targets for higher taxes as they aim to expand health care coverage to reach the roughly 50 million that experts say are uninsured.
Also under consideration are higher alcohol taxes, increases to the Medicare payroll tax and a value-added tax, a sort of national sales tax, of up to 1.5 percent or more....
The final price tag for that effort could top $1 trillion, with cuts to Medicare and Medicaid covering the rest of the cost.
The tax options include:
_ Increasing the price of soda and other sugary drinks by 10 cents a can.
_ Applying a potential 2 percent income tax increase to single taxpayers earning more than $200,000 a year and households earning more than $250,000.
_ A new employer payroll tax could target 3 percent of employers' health care expenditures.
_ Taxing employer-provided health insurance benefits above certain levels -- a less likely option but one that still is in the running.
More from USA Today via the Cincinnati Enquirer.
This all sounds great, boys! How's that economic recovery coming? And the promise not to raise taxes on anyone other than Joe the Plumber?
Meanwhile, the Senate is "struggling" to reduce a $1.6 trillion plan into a mere $1 trillion. Which means that when the House and Senate get together, the final bill will be announced as north of a trillion. And the final price in reality? If Medicare is any indication, it will be a gazillion over that:
At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly "conservative" estimate. But in 1990 Medicare actually cost $107 billion.
Which is a stat that should be hauled out and put on the table every time someone talks about government intervention in health care as a cost-containment measure. There's little doubt that a government-run system (either directly or indirectly) will be a bureaucratic nightmare; there's also little doubt that any reduction in overall spending will come from denying coverage rather than making it more cost-effective.
Another thing to bring up is the simple fact that, as Reason's Brian Doherty has pointed out, "health care systems don't equal health."
As [author John] Goodman notes, "beyond some basic public health measures, there is not much correlation internationally between health care inputs and the overall health of a population." Our health is far more in our own hands—depending on our own behavior, from exercise to diet to risk taking—than politicians would have us believe. That reality, combined with the fact that we could spend our entire GDP on health care without satisfying all individual demand for it, leads to the conclusion that no policy reforms, even the most market-leaning, will solve all, or even most, of any loosely conceived health care "crisis."
More on that here. It's not a trivial point: The constant equation of being insured with being healthy and with having access to health care is vastly misleading. These are simply not the same things, but their conflation does push the cost of medicine way, way up. What has truly perverted medical care and costs in this country is an insurance system that doesn't simply insure against catastrophic or high-dollar fixes (as is the case with home and auto insurance), but the standard protocol of covering at least part of all routine procedures, checkups, you name it. Why in the world does, say, a cholesterol test cost more than $5 or $10? Because the labs and the doctors and you name it can pass along the costs to third parties (chief among these is the government, which currently picks up 45 percent of all medical spending).
And a final point about the "uninsured." About 45 percent of them could either purchase coverage if they chose to or qualify for existing government programs. Why not push that as a first-step solution rather than taxing Mountain Dew? And as important, what are the deep implications on behavior of the government effectively controlling the health of the state? Does that give crusaders, whether of the right or left, an even more intrusive opening into policing how we live, eat, breathe, love, and recreate? Can we just ban skiing and sailboarding and everything else folks such as John Kerry do with impunity? Papa Bush, no more skydiving! How many Sonny Bono-Michael Kennedy types can we afford clogging the nation's emergency rooms and using up precious health-care resources?
Watch Reason.tv's "Get Some: How to fix America's health insurance crisis." Go here for links, embed code, iPod, HD versions.
|6.19.09 @ 9:23AM|#
Apparently, there are some people in the USA who think they can
get Swedish levels of welfare without Swedish levels of
taxation.
Then there are those who have no problem with Swedish levels of
taxation as long as some other guy is paying them.
Incidentally, even the Swedes are getting tired of Swedish levels
of taxation.
|6.19.09 @ 9:29AM|#
The government is making me want to vomit. But I guess that's ok, because they'll pay for my zofran.
creech|6.19.09 @ 9:39AM|#
If so many Americans have now bought the idea that your life belongs to the government, then there should be no complaints from them when government requires them to behave however the electoral majority wishes. So shut up when the piper's tune tells you to stop rock climbing or skateboarding, stop drinking fermented grapes or grain, stop burning carbon to attend frivolous rock concerts or protests in Washington or visiting some organic produce stand thirty miles out in the country on a beautiful Sunday afternoon.
|6.19.09 @ 9:40AM|#
Mmmmm, the Voracity
of Hope:
Let me tell you how it will be;
There's one for you, nineteen for me.
'Cause I'm the taxman,
Yeah, I'm the taxman.
Chad|6.19.09 @ 9:41AM|#
measure. There's little doubt that a government-run system
(either directly or indirectly) will be a bureaucratic
nightmare
I find this comment a bit odd. It is our current system that is the
world-champion of bureaucratic nightmares. Single payer systems
have far less paperwork, and it is reflected in the price.
No realistic conservative alternative to the single-payer system
makes a substantial dent in the bureaucracy.
What has truly perverted medical care and costs in this country
is an insurance system that doesn't simply insure against
catastrophic or high-dollar fixes (as is the case with home and
auto insurance), but the standard protocol of covering at least
part of all routine procedures, checkups, you name it.
Therein lies the problem. If we have anywhere near enough co-pays
and deductibles to significantly reduce these moral hazards,
serious illnesses end up costing so much that the sick people go
bankrupt - defeating the entire point of having insurance in the
first place. There is no happy middle ground here,
unfortunately.
|6.19.09 @ 9:41AM|#
It's not a trivial point: The constant equation of being
insured with being healthy and with having access to health care is
vastly misleading.
Health insurance is a magic talisman which will prevent you from
getting sick. That's why they call it "insurance".
|6.19.09 @ 9:45AM|#
Single payer systems have far less paperwork, and it is
reflected in the price.
Mmmm'kay.
Dave Krueger|6.19.09 @ 9:53AM|#
Wow. A small value added tax to fund health care? You mean small like income taxes when they were first introduced?
Xeones|6.19.09 @ 9:57AM|#
It is our current system that is the world-champion of
bureaucratic nightmares. Single payer systems have far less
paperwork, and it is reflected in the price.
Oh, Chad. You were spoofing along so convincingly, and then you had
to blow it. I laughed, though.
|6.19.09 @ 9:57AM|#
What do you even say in the face of stuff like this? Once these
taxes are put in place, that's it. They're there forever.
Excuse me, I need to go scream into a pillow until my voice gives
out.
Rich|6.19.09 @ 9:58AM|#
Life, liberty, and the pursuit of happiness. The pundits should debate (at the risk of being labelled "heartless") why health insurance is considered a right. I dare say some people are more at risk of losing everything through lawsuits than illness. Perhaps all Americans should be guaranteed legal assistance and "umbrella" coverage.
Dave Krueger|6.19.09 @ 10:05AM|#
There is only one thing that will significantly reduce health
care costs in the U.S. and that's aggressive competition. It's that
simple. All the government can do is create an illusion that the
prices are under control.
And, just like with the auto companies and electronics
manufacturers, it's going to be foreign competition that finally
overcomes government and industry beliefs that health care can
successfully defy the laws of economics.
|6.19.09 @ 10:07AM|#
In the middle of the worst recession in 50 years lets raise taxes. Great plan. Nothing helps with healthcare like poverty.
Sean W. Malone|6.19.09 @ 10:10AM|#
Actually, one more...
Nothing helps the poor like an increase in the cost of beer, soda,
& food.
|6.19.09 @ 10:14AM|#
Nothing helps the poor like an increase in the cost of beer,
soda, & food.
Hark! I hear in the distance the grand liberal refrain: "We're
saving them from themselves..."
|6.19.09 @ 10:22AM|#
I'm re-writing The Little Red Hen. In this newer, more progressive version, the dog, the duck, and the cat realize the power of democracy. They form their own political party made up of like-minded soulless losers. Their platform is they let the smug little red hen plant her wheat. They let the little workaholic cut the wheat. They watch the hen thresh the wheat and grind it into flour. They smoke crack while she makes the flour into bread. Then they take their fair share. Fuck that greedy selfish bitch.
Xeones|6.19.09 @ 10:25AM|#
And, just like with the auto companies and electronics
manufacturers, it's going to be foreign
competition that finally overcomes government and industry
beliefs that health care can successfully defy the laws of
economics.
I, for one, am not looking forward to going to Mexico if i need
medication or something.
Chad|6.19.09 @ 10:42AM|#
P Brooks | June 19, 2009, 9:45am | #
Single payer systems have far less paperwork, and it is reflected
in the price.
Mmmm'kay.
http://cthealth.server101.com/healthcare_bureaucracy_u_s__vs__canada.htm
Apparently you haven't done a bit of research or thinking on the
topic. Please bother to do so before replying. Thanks.
We spend an enormous amount on paperwork and general bureacracy,
far more than anyone else. It is a large component of our overall
high costs.
|6.19.09 @ 10:51AM|#
http://www.cnn.com/2009/POLITICS/06/19/sotu.cleveland.clinic/index.html?eref=rss_latest
cognitive dissonance, anyone?
|6.19.09 @ 10:51AM|#
http://www.canada.com/Health+wait+times+require+action+docs/1712025/story.html
Months long wait for treatment for cancer in Canada. The canadian
health system is just a killing machine. No wonder leftists like it
so much. Chad, why do you hate sick people so much?
kc|6.19.09 @ 10:51AM|#
My lovely state of Massachusetts is in the 3rd year of mandated
health insurance and mandated types of coverage (e.g., we have to
buy Rx coverage) made more palatable by huge subsidies to help
people buy the insurance. Universal coverage (not), more choice
(not), lower costs (definitely not). This is why Obama and others
pushing health care reform don't mention Massachusetts, even tho
it's the only state (so far) with mandated coverage.
But let's not stop at failing at a state level, let's go
national!
|6.19.09 @ 11:14AM|#
Apparently you haven't done a bit of research or thinking on
the topic. Please bother to do so before replying.
Thanks.
*clutches chest, falls to floor*
Gilbert Martin|6.19.09 @ 11:14AM|#
"in 1966, Medicare cost $3 billion. The House Ways and Means
Committee estimated that Medicare would cost only about $ 12
billion by 1990 (a figure that included an allowance for
inflation). This was a supposedly "conservative" estimate. But in
1990 Medicare actually cost $107 billion.
Which is a stat that should be hauled out and put on the table
every time someone talks about government intervention in health
care as a cost-containment measure."
Indeed it should be.
But you can count on every liberal both inside and outside the
media to studiously ignore it as if it never actually happened or
"doesn't count" as being relevant to the issue.
Gimlet|6.19.09 @ 11:16AM|#
kc,
I remember when Dukakus was running for president and he and the
media kept saying that MA had this fantastic health care system and
that if he were elected president, he would use that model for the
entire country.
And I thought, if (and that's a mighty big if) the MA system is so
great, then doesn't that demonstrate that health care is best
handled at the state level not the fed?
IceTrey|6.19.09 @ 11:33AM|#
If the government was truly interested in lowering the total cost of health care they would encourage smoking, overeating, not exercising and other unhealthy lifestyle choices. It's been proven time and again that the sooner you die the less you cost the system.
|6.19.09 @ 11:35AM|#
"We spend an enormous amount on paperwork and general
bureacracy, far more than anyone else. It is a large component of
our overall high costs."
Apparently, this is more important to Chad than the quality of
care.
kc|6.19.09 @ 12:07PM|#
Gimlet,
Wow does that take me back. Remember Dukakis in the tank? Anecdote:
years ago, I almost pinned him between my car and his when pulling
away from the curb at Logan airport; two apologies: I stopped in
time, and this was after he left elected office. Personally, tho,
he seemed like a nice guy.
Paul|6.19.09 @ 1:29PM|#
Also under consideration are higher alcohol taxes, increases
to the Medicare payroll tax and a value-added tax, a sort of
national sales tax, of up to 1.5 percent or more....
I ask our progressive friends again, when exactly did a
national sales tax stop being regressive? I want the fucking time
and date when this happened. Then I want a 100 word explanation as
to why.
Sam Grove|6.19.09 @ 1:56PM|#
We spend an enormous amount on paperwork and general
bureacracy
Why is this so?
Paul|6.19.09 @ 2:48PM|#
We spend an enormous amount on paperwork and general
bureacracy, far more than anyone else. It is a large component of
our overall high costs.
I run into this a lot. We have a lot of paperwork! Conclusion:
Single payer healthcare!
That's a non sequitur. The conclusion is not obviously a single
payer system. The conclusion is that there are needs for reform.
What exactly that reform is, and what pathway it takes is very much
up to argument. Decoupling insurance from employers is one place to
start. Regulatory reform is another place to start.
Paul|6.19.09 @ 2:53PM|#
How's this for an Inconvenient Truth:
Probably the most surprising discovery of the paper was that Americans partake in more preventive care than Canadians.
o Mammograms: 88.6% of American females 40-69 had ever had a mammogram compared to 72.3% of Canadians.
o PAP smear: 86.3% of American females 20-69 had a PAP smear in the last 3 years compared to 75.1% of Canadians.
o Prostate screening: 54.2% of American men 40-69 had ever had a PSA test compared to 16.4% of Canadians.
As an economist, I attributed this finding to moral hazard: Canadians know that if they would get a disease that their government will pay for their care. Thus, they may be less motivated to ask for preventive services. One of my medical school colleagues noted, however, that physician recommendations also play a large part in the amount of care given. Further, most patients strongly wish to avoid disease, not simply due to cost considerations, but because of the physical and mental impact the disease would have on their life.
http://healthcare-economist.com/2007/10/02/health-care-system-grudge-match-canada-vs-us/
Telly|6.19.09 @ 2:56PM|#
God, fucking assholes! They fucking suck! Arrrrughghgh! I want to hit something! I wish they'd all just drink a taxed up coke and choke on it! Fucking idiots!
Colonel_Angus|6.20.09 @ 12:36AM|#
"My lovely state of Massachusetts is in the 3rd year of mandated
health insurance and mandated types of coverage..."
Wow, I never knew that about Mass. I think it just broke the
state's tie with Illinois in my list as the second worst state. My
new standing is as follows:
1. California
2. Mass
3. Illinois
4. Thinking about Mississippi... I haven't really put much thought
beyond those top three.
(2 and 3 previously tied)
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