More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?

[Nickyjo]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

We already have single payer in various forms. We just don't let everyone benefit from it, just old people, vets, and the poor.

 

[Nickyjo]

I'm assuming that proportionately, this low income person should PAY (instead of sucking from government resources) just like me. Why is that difficult to understand? Many of the low income wage earners get more in tax refunds than they even pay in ...

I get more from SS and Medicare than I paid in, as do many others. No difference. I suspect you also suck from government resources in some way. We all do.

 

[jotathought]

I get more from SS and Medicare than I paid in, as do many others. No difference. I suspect you also suck from government resources in some way. We all do.

No .. not really .. I'm one of those "bastards" that is evil because he makes money ...

 

[jotathought]

Yes, so you are saying we should do away with refundable child credits and the earned income credit, and make them pay more in federal income taxes. That is simply a recipe to increase the poverty rate substantially.

No .. I'm saying EVERYONE should be ..

How many people in poverty have a cell phone? Internet? TV? something they can't afford? Enough said ..

 

[ALiberalModerate]

No .. I'm saying EVERYONE should be ..

How many people in poverty have a cell phone? Internet? TV? something they can't afford? Enough said ..

I don't you have ever lived in poverty. A cell phone and internet are both necessities in 2022.

 

[mrjurrs]

FiveThirtyEight had a nice article this week looking at the recent surge in interest in some sort of state-level single-payer health care program, as well as the barriers to that approach. Plus a little foray into looking at the recent state attempts at state-level "public option" plans as an alternative to a larger systemic shake-up.

More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?


The barriers aren't mysterious, they tend to fall into three intertwined categories.

• Regulatory. The biggest challenge here revolves around the fact that most people with private insurance have employer-based coverage, and most people with employer-based coverage are in self-funded plans (i.e., their employer effectively is their insurer, putting aside funds to pay for their health needs). And states can't regulate self-funded plans. That's a big one and would likely require either a very successful persuasion campaign aimed at employers doing business in the state, or more likely some heavy lifting by the state's Congressional delegation to write an exemption into federal law.
• Financial. There's two pieces to this, one of which intersects with the regulatory questions: (1) re-capturing federal money that currently flows into the state via various avenues (Medicare, Medicare, and Affordable Care Act premium subsidies), and (2) raising revenue to capture the rest from the state's tax base. The former requires some deft maneuvering but has some prospects based on various waiver authorities built into federal law, while the latter perhaps requires convincing enough people that their increased tax burden would just offset what they're currently spending on insurance premiums.
• Political. All changes create winners and losers, and it's generally easy to galvanize potential losers against their potential losses than potential winners around their potential gains. The losers could be hospitals, or insurers, or just people who think their tax burden will in fact increase by more than the value of their current premiums. The more a state tries to convince almost everyone they will win, the more generous the promises become and the more concentrated the losses become (galvanizing the losers even more, and leading to proposals more and more people scoff at as unrealistic).

Are these challenges insurmountable for a state? Maybe, but still seemingly less so than first trying to implement a single-payer system at the national level. And arguably some sort of successful state-level implementation ought to happen before considering any sort of national program. So who'll step up and take the plunge first? California? New York? Massachusetts?

They are failing because Americans don't understand what it is. They think about the expense without thinking of the cost.

Regulatory issues would disappear when the tax benefits of providing employee benefits disappear.
Financial would diminish if included with the law was a requirement for employers to add what they currently pay for employee health plans to employees paychecks.
Political would disappear when we move to government funded campaigns and donations from the health insurance sector dries up.

imo

 

[Nickyjo]

No .. not really .. I'm one of those "bastards" that is evil because he makes money ...

Really? You don't use the post office, the interstate, you haven't incorporated your business? You have never deducted mortgage interest or depreciation on a rental property? We all in one way or another suck at a givernment teat, just different ones.

 

[jotathought]

Really? You don't use the post office, the interstate, you haven't incorporated your business? You have never deducted mortgage interest or depreciation on a rental property? We all in one way or another suck at a givernment teat, just different ones.

Regardless of deductions .. I still pay income taxes on my wages.

 

[upsideguy]

Who will pay for it, and what percentage of the population will actually contribute to the funding (considering nearly 50% of wage earners pay $0 in income taxes)?

Moot. wage earners all pay social security and medicare. It would be easy to establish this as a payroll tax.

 

[jotathought]

Moot. wage earners all pay social security and medicare. It would be easy to establish this as a payroll tax.

Yet .. that's not income tax .. which many on the left deem should be covered by "the rich.." however, notice that everyone pays the same rate for FICA unlike income taxes?

 

[WorldWatcher]

Yet .. that's not income tax .. which many on the left deem should be covered by "the rich.." however, notice that everyone pays the same rate for FICA unlike income taxes?

That's not true.

Someone earning $100,000 in wages pays 7.65% for FICA. Someone earning $1,000,000 in wages pays less of a percentage. Someone earning $10,000,000 pays even less of a percentage.

The reason is SS has a cap of - give me a second - got it - $147,000 in 2022. (Less in previous years.) Therefore FICA decreases as a percentage of wages as wage income increases.

WW

 

[jotathought]

That's not true.

Someone earning $100,000 in wages pays 7.65% for FICA. Someone earning $1,000,000 in wages pays less of a percentage. Someone earning $10,000,000 pays even less of a percentage.

The reason is SS has a cap of - give me a second - got it - $147,000 in 2022. (Less in previous years.) Therefore FICA decreases as a percentage of wages as wage income increases.

WW

The cap has nothing to do with those making less than it .. everyone below the cap pays the same percentage ... their "equal share" ... just like income tax should be.

 

[WorldWatcher]

The cap has nothing to do with those making less than it .. everyone below the cap pays the same percentage ... their "equal share" ... just like income tax should be.

You said: " ... notice that everyone pays the same rate for FICA ..."

I demonstrated that is a false statement. Let me correct it for you: "" ... notice that everyone pays the same rate for FICA whose wages don't exceed the SS cap, those getting wages in excess of the cap pay lower rates as a percentage of wages. ..."

Glad I could assist you.

WW

 

[bomberfox]

FiveThirtyEight had a nice article this week looking at the recent surge in interest in some sort of state-level single-payer health care program, as well as the barriers to that approach. Plus a little foray into looking at the recent state attempts at state-level "public option" plans as an alternative to a larger systemic shake-up.

More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?


The barriers aren't mysterious, they tend to fall into three intertwined categories.

• Regulatory. The biggest challenge here revolves around the fact that most people with private insurance have employer-based coverage, and most people with employer-based coverage are in self-funded plans (i.e., their employer effectively is their insurer, putting aside funds to pay for their health needs). And states can't regulate self-funded plans. That's a big one and would likely require either a very successful persuasion campaign aimed at employers doing business in the state, or more likely some heavy lifting by the state's Congressional delegation to write an exemption into federal law.
• Financial. There's two pieces to this, one of which intersects with the regulatory questions: (1) re-capturing federal money that currently flows into the state via various avenues (Medicare, Medicare, and Affordable Care Act premium subsidies), and (2) raising revenue to capture the rest from the state's tax base. The former requires some deft maneuvering but has some prospects based on various waiver authorities built into federal law, while the latter perhaps requires convincing enough people that their increased tax burden would just offset what they're currently spending on insurance premiums.
• Political. All changes create winners and losers, and it's generally easy to galvanize potential losers against their potential losses than potential winners around their potential gains. The losers could be hospitals, or insurers, or just people who think their tax burden will in fact increase by more than the value of their current premiums. The more a state tries to convince almost everyone they will win, the more generous the promises become and the more concentrated the losses become (galvanizing the losers even more, and leading to proposals more and more people scoff at as unrealistic).

Are these challenges insurmountable for a state? Maybe, but still seemingly less so than first trying to implement a single-payer system at the national level. And arguably some sort of successful state-level implementation ought to happen before considering any sort of national program. So who'll step up and take the plunge first? California? New York? Massachusetts?

Not really insurmountable in the political divide among moderates even longtime republicans like my dad.

 

[rahl]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

We already have a single national payer system, and it is wildly popular. Most americans are in favor of expanding that system to everyone.

 

[MrWonka]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

60% of American's poll support Medicare for All, so you're just flat wrong about that.

 

[American]

Possibly, but that's the point...risk pool size is the cornerstone of making single payer work properly.
Canada managed because they did it in 1967, Britain managed to implement fully socialized healthcare because they did it in 1948.
To make it happen in America today, it's going to take a risk pool of a couple of hundred million people ideally, not 20, 30 or forty million.

At the very least it would require a multi-state risk pool, say perhaps California, Oregon, Washington, Arizona, Nevada and New Mexico, thus combining
the Pacific Northwest and the Southwest....64,815,238 people.

It's the cornerstone of all insurance. The real point is WHO'S managing it. Govt sucks as managing anything except maybe the military.

 

[American]

60% of American's poll support Medicare for All, so you're just flat wrong about that.

Most Americans probably don't know what Medicare for All is.

 

[jotathought]

You said: " ... notice that everyone pays the same rate for FICA ..."

I demonstrated that is a false statement. Let me correct it for you: "" ... notice that everyone pays the same rate for FICA whose wages don't exceed the SS cap, those getting wages in excess of the cap pay lower rates as a percentage of wages. ..."

Glad I could assist you.

WW

sigh .. nice dodge there ... and you know what I mean ... those below the cap, including wage earners who don't pay income tax, will pay the same amount. Just like income taxes should be....

 

[Nickyjo]

Regardless of deductions .. I still pay income taxes on my wages.

Fine, so you get some breaks from the govt. My point is that we all do, rich and poor.

 

[Manc Skipper]

I don't you have ever lived in poverty. A cell phone and internet are both necessities in 2022.

In the UK, you HAVE to have a smartphone if you're unemployed in order to seek work. If you don't they sanction you and stop your benefits.

Man on Universal Credit says Jobcentre demanded he get a smartphone

A Universal Credit claimant has alleged that his local Jobcentre ordered him to purchase a smartphone for his job search because his basic model was not good enough.

inews.co.uk

 

[WorldWatcher]

sigh .. nice dodge there ... and you know what I mean ... those below the cap, including wage earners who don't pay income tax, will pay the same amount. Just like income taxes should be....

Psst, you brought FICA into the discussion, not me.

Not dodge, you made a incorrect statement as I just pointed it out.

Have a nice day.

WW

 

[jotathought]

Fine, so you get some breaks from the govt. My point is that we all do, rich and poor.

They are called deductions .. and for many of the 48% - 50% of wage earners, especially in the lower brackets, that equates to more money than they paid in ... e.g. earned income credit. If the left is going to talk about the rich paying their "fair share," what happened to equitable outcomes with all wage earners on paying income taxes?

 

[Nickyjo]

They are called deductions .. and for many of the 48% - 50% of wage earners, especially in the lower brackets, that equates to more money than they paid in ... e.g. earned income credit. If the left is going to talk about the rich paying their "fair share," what happened to equitable outcomes with all wage earners on paying income taxes?

Frankly, I agree with you, that all wage earners should pay something. The fairest system in my view would be one with a sliding scale of tax rates — and no deductions, except perhaps for dependents. Why should I get to deduct mortgage interest payments -as I did- on a second house, a ski cabin? I sold it and didn’t have to pay cap gains cause I bought another rental property with the dough. And I get to deduct depreciation on that house that quadrupled in value, as if it were a tractor. My renters get nothing. Yes, all these sorts of things benefit say, realtors or banks, but how is that different than food stamps? (For the record, I think food stamps was a better program when one had to pay a small amount to get them.)

I used to work with California growers. Their attitude was that it was them, God, the earth and the weather that produced their wealth, forgetting the imported labor they had gotten, the dams built for them, the research done at Ag colleges, etc.

 

[Checkerboard Strangler]

It's the cornerstone of all insurance. The real point is WHO'S managing it. Govt sucks as managing anything except maybe the military.

Govt managed care is turning out to be on par with pvt sector.
Corporate bureaucracy is still bureaucracy, you know.