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Huge inequalities exist when it comes to health insurance, and it's not between "the 1%" and the working poor. The richest and poorest Americans tend not to pay much for their own health care as it is. The real inequality concerning health insurance is between very similar families across the country, whose small arbitrary technicality-level differences are what determines whether they pay jack squat for health care or whether they pay out the nose.
Example #1: Two virtually identical different families of five live in Anchorage, Alaska, each of which has annual household income of $180,000. One parent of one of the families has a Deputy Commissioner job with the State of Alaska and brings in $100,000 a year. Her spouse runs a business that brings in the other $80k. The other family co-runs a business that brings in $180k per year. The family whose primary breadwinner works for the state pays less than $1,000 per year for all the health care the family needs. No premium sharing, and relatively tiny deductible expense despite having three children and a spouse on the plan. Platinum health benefits. The other family has to pay over $40,000 per year just in premiums for a "silver plan."
Society "values" (if you will) each of these families the same. Both are "worth" $180,000 in gross income to those families, according to what society wants to pay them for their work. When two families have the same household gross income but one has to pay over 40 times the amount of money for health insurance coverage than what another family pays, just because one spouse happens to have employer-sponsored health coverage, that is the real inequality here, and that inequality is vast and mind-bending considering the otherwise sameness of these respective families.
Example #2: Two virtually identical couples (same ages, same city) living in a small-medium sized Alaska town are expecting their first child. One couple brings in $45,000 annually and the other brings in $55,000. The couple that brings in $45,000 qualifies for Denali KidCare and pays nothing for the transportation to where babies are delivered 3 weeks before the due date, paid lodging, reimbursement for meals, other transportation, free hospital stay (C-section delivery). Nothing. Medicaid pays for all of it. Their out of pocket expenses are virtually zero. The couple that brings in $55,000 does not qualify for Denali KidCare but has employer-sponsored health insurance. Which is great for them because they too need a C-section delivery. But they also for travel, lodging, pay $3,000 of deductible expenses, and another $2,000 of co-insurance expense (because their delivery was also by C-section). So here again you have two very similarly situated families whose health care costs differ wildly (relative to their income) based on arbitrary and small differences. One family has it made, the other is absolutely crap out of luck. This is the real inequality as it concerns health care.
If I am the family that makes $55,000 and has to pay a fifth of my annual after-tax income to have a child, why should I be enraged about how many billions of dollars Jeff Bezos has? Should I join the Democratic Party and just incessantly whine about how rich the rich are? We could confiscate 100% of Jeff Bezos' wealth and it would fund the nation's health for 11 days. The real unfairness is that someone who earns just a tiny bit less than me pays nothing while I pay dearly. Or if I'm the business owner who pulls in $180,000, I am pissed that because my income happens to derive from my own business that I created with my partner, I have to pay over a fifth of my annual income just on premiums while the family next door that makes the same as we do pays virtually nothing, all because one of them happens to work for the State.
That is the real inequality, and it's extreme and it's arbitrary and it's indefensible. The thing I think single payer would do address THIS inequality, the real inequality as it concerns today's health care, is make the de facto funding of the nation's health care relative to income, by involving a corresponding income tax. Some will still whine, but they will be paying a relatively similar percentage of their income on health like everyone else with an income does, which is about as fair as it gets. What we have now is lightyears from fair as far as cost goes.
Example #1: Two virtually identical different families of five live in Anchorage, Alaska, each of which has annual household income of $180,000. One parent of one of the families has a Deputy Commissioner job with the State of Alaska and brings in $100,000 a year. Her spouse runs a business that brings in the other $80k. The other family co-runs a business that brings in $180k per year. The family whose primary breadwinner works for the state pays less than $1,000 per year for all the health care the family needs. No premium sharing, and relatively tiny deductible expense despite having three children and a spouse on the plan. Platinum health benefits. The other family has to pay over $40,000 per year just in premiums for a "silver plan."
Society "values" (if you will) each of these families the same. Both are "worth" $180,000 in gross income to those families, according to what society wants to pay them for their work. When two families have the same household gross income but one has to pay over 40 times the amount of money for health insurance coverage than what another family pays, just because one spouse happens to have employer-sponsored health coverage, that is the real inequality here, and that inequality is vast and mind-bending considering the otherwise sameness of these respective families.
Example #2: Two virtually identical couples (same ages, same city) living in a small-medium sized Alaska town are expecting their first child. One couple brings in $45,000 annually and the other brings in $55,000. The couple that brings in $45,000 qualifies for Denali KidCare and pays nothing for the transportation to where babies are delivered 3 weeks before the due date, paid lodging, reimbursement for meals, other transportation, free hospital stay (C-section delivery). Nothing. Medicaid pays for all of it. Their out of pocket expenses are virtually zero. The couple that brings in $55,000 does not qualify for Denali KidCare but has employer-sponsored health insurance. Which is great for them because they too need a C-section delivery. But they also for travel, lodging, pay $3,000 of deductible expenses, and another $2,000 of co-insurance expense (because their delivery was also by C-section). So here again you have two very similarly situated families whose health care costs differ wildly (relative to their income) based on arbitrary and small differences. One family has it made, the other is absolutely crap out of luck. This is the real inequality as it concerns health care.
If I am the family that makes $55,000 and has to pay a fifth of my annual after-tax income to have a child, why should I be enraged about how many billions of dollars Jeff Bezos has? Should I join the Democratic Party and just incessantly whine about how rich the rich are? We could confiscate 100% of Jeff Bezos' wealth and it would fund the nation's health for 11 days. The real unfairness is that someone who earns just a tiny bit less than me pays nothing while I pay dearly. Or if I'm the business owner who pulls in $180,000, I am pissed that because my income happens to derive from my own business that I created with my partner, I have to pay over a fifth of my annual income just on premiums while the family next door that makes the same as we do pays virtually nothing, all because one of them happens to work for the State.
That is the real inequality, and it's extreme and it's arbitrary and it's indefensible. The thing I think single payer would do address THIS inequality, the real inequality as it concerns today's health care, is make the de facto funding of the nation's health care relative to income, by involving a corresponding income tax. Some will still whine, but they will be paying a relatively similar percentage of their income on health like everyone else with an income does, which is about as fair as it gets. What we have now is lightyears from fair as far as cost goes.