Matthew Holt

Uwe and Heritage agree: we need a tax-funded universal pool

When you’re at a party and someone explains to you that they just read a great article in the NY Times explaining why Peggy Noonan doesn’t understand basic math, and you know that they’re referring to Uwe Reinhardt, then you’re over-wonked. That’s surely my condition

Here’s what Uwe said—you can’t just ban medical underwriting as Noonan suggested, because the individual insurance market will collapse. Both the history of New Jersey (and Washington state) in the 1990s, and in current Massachusetts where people can buy insurance or pay a lesser fine, show that healthy people won’t buy insurance until they need it.

The answer is to force everyone into a universal insurance pool

But of course, that means younger and healthier people will likely pay more. For the good folks from Heritage writing on the WSJ Opinion page this is an outrage. Using their complex model they came up with the amazing analysis that if you give uninsured younger people with no health condition the choice of paying a smaller fine or a higher premium—surprise surprise—most will pay the fine. And of course that’s exactly what’s happened in Massachusetts.

The problem is of course that most younger people who have no insurance are in low wage jobs, They therefore place a much higher value on receiving money now than forgoing it to later stave of a potential risk of catastrophe from having no insurance

So we deal with this in a very sensible way in the rest of society’s transactions.

We tax people who have money, and spend it on public goods like education, social security for seniors, defense, roads, prisons, mailmen, firemen, airline security, etc, etc, etc. Many of us would argue that we spend too much or too little on one sector or another. Almost everyone has ideas for how we could better spend what we do spend. But implicit in all of this is that people pay more than they receive at certain times of their lives and vice versa. And equally implicit is that if you have more money you pay relatively more. Therefore the uninsured low wage twenty-something of today can expect to pay much more in a couple of decades, and then be a recipient of the largesse of the succeeding generation about thirty years later than that when they line up for social security.

However, the concept of using a tax system which manages to redistribute money between generations and collects from those with different incomes—and more or less succeeds in every other sphere of society—for health care is apparently far too appalling for Americans to contemplate. But it’s the only rational answer to the problem that both Uwe and the Heritage folks point out

Instead we end up with the irrational answer. And today’s version is that if you want to marry a hot blonde, you can—so long as you can add her to your group health insurance. And of course the group (i.e. employer) who ends up insuring the lucky blonde via her future husband is of course effectively going to be redistributing its money to him and her.

This really would be funny if it wasn’t so tragic.

Categories: Matthew Holt

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46 replies »

  1. But just remember: any relief you get from the trial lawyers will come, not from the people yearning for their Battleship Potemkin moment, but from the guys sporting
    Women Want Me
    Fish Fear Me
    stickers on the rear bumpers of their Tundras.
    Got to run for my survivalist meeting. We’re doing edible roots and Locke’s Second Treatise today.

  2. “The labor unions, of course, have made their position clear on this issue – reform healthcare and health insurance but don’t cut us.”
    Agreed Barry. Same old, reform the other guy, not me.

  3. “However it still remains that the “evil”, “going broke government”, subsidizes mortgage interest for homeowners who do not need it and are not in the business of rental property. Would you be willing to give up this entitlement to lower the deficit?”
    Absolutely Yes! However, I haven’t paid any mortgage interest in over 31 years.:) In all seriousness, I would also be willing to give up the tax preference for employer provided health insurance even though it would cost my family over $5K in higher federal and state income taxes as well as FICA taxes assuming federal income tax rates were not reduced. The CBO estimates the cost of the health insurance tax preference at well north of $200 billion per year. The labor unions, of course, have made their position clear on this issue – reform healthcare and health insurance but don’t cut us. The same is true for doctors and trial lawyers. Hospitals and Pharma put a little something on the table but it’s a relative pittance in the overall scheme of things.

  4. “property owners right off their interest which allows them to lower their rent so in fact renters do get subsidized”
    As an Ex landlord who had to price the rent based on market conditions, the interest deduction, or any other deduction, did not factor into determining rental rates, it did however make going into the rental business easier due to the write offs. What was the highest determining factor was supply and demand. You can argue that tax deductions do soften rental rates, but rental rates are more sensitive to location and renter income, irrespective of the interest deduction. Florida recently capped property tax increases for rental property, which would have been deductible, but for which landlords were pushing for the cap anyway. I think renters would like the deduction in their hands instead of the landlord’s and then find their best rent. However it still remains that the “evil”, “going broke government”, subsidizes mortgage interest for homeowners who do not need it and are not in the business of rental property. Would you be willing to give up this entitlement to lower the deficit?

  5. I stand cheerfully corrected on the “progressive” beverage of choice. As for the “boilerplate,” sure you’re not confusing me with Frank? (No offence to Frank, who seems to be spot on).
    You rub salt in old wounds with your mention of Novartis and Glaxo. Some years ago, seduced by progressive assurances that Big Pharma is reaping obscene profits, I made modest investments in each. Left a smoking hole in my IRA.

  6. archcon, a lot of your stuff is conservative boilerplate and already known as such by most readers here (e.g. is the rest of the world really “freeloading” on US pharmaceutical research? Have you heard of companies like Glaxo, sanofi, novartis, Bayer etc.? Does taxpayer money play a role in US medical research? Moreover, is social mobility higher in the US or in current bolshevikh Germany? and so on).
    But some stuff you clearly get wrong. The liberal’s drink is not “frapuccino” (a starbuck’s drink), but maybe cappucino, or more typical, as in the famous club for growth 2004 ads, latte. Stay on message !
    But of course my post is patronizing, the usual attitude of the powerful liberal elite. White conservatives, whether they own pick ups, banks or both, have been, to paraphrase John Lennon, clearly, clearly “the nigger of the world”. And as such, archcon, be assured of my bleeding heart liberal compassion.

  7. ” it’s called the mortgage tax deduction, which by the way is not available to renters to subsidize their shelter costs.”
    Hello Peter , how are you sir? Please note for future reference property owners right off their interest which allows them to lower their rent so in fact renters do get subsidized

  8. MG this is THCB if you want to hear my rants on defence spending then go to TDSB, someone of us do post on topic

  9. “O Canada! Why is your son, Danny Williams, Premier of Newfoundland, coming to the U.S. for heart surgery?
    This is like shooting birds on the ground.”
    I wondered how long it would take for you to post this one. Here’s the link to the Toronto Star article.–u-s-bloggers-weigh-in-on-danny-williams-surgery?bn=1
    Nothing so far has indicated he could not have been treated effectively in Canada or why he chose whatever hospital he did. Some background on NewFoundland. It traditionally been considered Canada’s most severe “Have Not” provinces which means it receives more tax dollars from the rest of Canada than it pays. Much of the money Ottawa gives/gave Newfoundland has been unemployment funds for it’s cronically spotty employment market, which until Hibernia Oil, was mostly fishing, mining. Newfoundland is always trying to get more money from Ottawa which may have led to the Premier’s decision. What’s interesting in the Star article is this:
    One Politico reader suggested that Williams, whose known for his often adversarial relationship with the federal Conservative government, was well aware of how the move might reflect on Ottawa.
    “Danny Williams is known for trying to embarrass the Canadian government,” he wrote.
    “The reason he’s going down south is because he can afford the $50,000 cost of getting surgery.”
    So if you think one rich Canadian guy going to the U.S. reflects on the entire Canadian health system do these links reflect the entire U.S. heathcare system?:

  10. O Canada! Why is your son, Danny Williams, Premier of Newfoundland, coming to the U.S. for heart surgery?
    This is like shooting birds on the ground.

  11. Ach, now Barney Frank is saying the Party is in “full, fake cheerleading mode” over HCR, just to let the “base” down easy. And we came so close…so close. . . It’s those angry white pickup driving males, and, you know, they slap their women on the bottom and tell them how to vote, and they do as they’re told. Sure, a lot of them are “educated,” but you know what passes for education in flyover. How many of them could intelligently discuss gender identity crisis over a cup of frappuccino? Primitive and unteachable, the lot of them. Surely they won’t be so obstructive over climate change legislation. We’re on the edge of extinction, as you know. And we have promises to keep.

    “The United States of America cannot afford to provide its citizens the same level of health care that the Mother Country affords its citizens.”
    Uh .. the USA is not Germany. People here have FREEDOM to be more than their parents. If that offends you — shouldn’t you live in Germany?
    More to the point: Europe and Asia have been *freeloading* off USA medical research for decades. (And the USA nuclear umbrella – different subject)
    Why don’t you get them to pay their fair share?
    Y’know — do something positive?

  13. “I really think we need a tax-funded universal housing pool. I could use an “upgrade.”
    You already do, it’s called the mortgage tax deduction, which by the way is not available to renters to subsidize their shelter costs.
    “It is most refreshing to see these admissions that “health care reform” will increase the financial burdens of those who are presently insured.”
    archon, from reading your posts it appears that you are covered by a company plan – if so would that be an insurance company’s plan where you pay no premiums?
    “and content ourselves, beyond that, with the quality of care we can afford.”
    Don’t you mean “content THEMSELVES” with the quality “THEY” can afford, because you don’t include yourself in that group? And what “standard” would that be?

  14. “We don’t have obligations on fighter jets 40 years out”
    Do you think weapon systems magically remain themselves over 40 years? There are incredibly expensive operating and maintenance costs on fighter plans (or any military unit) as they age.

  15. Tax-funded universal pool is too much of an overreach at this point because there isn’t enough pain to go around. I bet this is where we end up sooner than later especially if this reform bill gets killed. Just not enough White Americans who are independents support it.
    I do find it kind of ironic though how Nate always rants on here about issues that aren’t really healthcare-related (including Social Security) yet you NEVER hear him rant about other federal financial boondoogles including defense-related spending.
    Take for example the F-35 which Gates just removed the incompetent Marine general in charge of the program and that Lockhead-Martin won’t receive their $614M in performance bonuses. Not a single major US news outlet is discussing that story or the details regarding what an utter boondoogle this plane is including being 5x over budget now at $100M/plane, its stealth signature in question (likely can knock it down with a handheld Russian/Chinese portable AA weapon for $60k), and its operating & upkeep makes it incredibly cost-ineffective.
    Stick to healthcare-oriented stuff.

  16. Clap your hands and stamp your feet!
    Obamacare just can’t be beat!
    “Our way” “no way,” take your pick–
    Compromise is not our shtick!

  17. Let me understand this, archon41.
    The United States of America cannot afford to provide its citizens the same level of health care that the Mother Country affords its citizens.
    Neither can the US afford the level of care that Germany or Japan provide for their citizens.
    Is that what we are saying? If so, how on earth did we get here?

  18. It is most refreshing to see these admissions that “health care reform” will increase the financial burdens of those who are presently insured. Let us suppose further that the costs of all these marvelous therapies, procedures, drugs, etc. is due not to some evil conspiracy (I know I’m leaving some here), but to economic realities. To point to statistical disparities between ourselves and other countries here proves very little, since we have not adopted their “standardized” systems of care, and they do not have our tort liability burdens. Perhaps the cold, hard fact is that high-end care is outstripping our ability to pay, with no “quick fix” available. We can “standardize,” or ration, or we can establish an adequate “safety net,” and content ourselves, beyond that, with the quality of care we can afford. Increase the co-pays enough, and people will make the decisions they need to make.

  19. Paolo you need to do a little reserach on Medicare Advantage. Medicare HMOs deliver basic medicare benefits for 97% of the cost as Medicare does. It is the extra benefits that cost more.
    Medicare has made promises of benefits it does not have the money to pay. We don’t have obligations on fighter jets 40 years out. Government could eliminate this debt if they just came out and said as of 1/1/11 no one has Medicare anymore. Bam long term liability gone no more BK. Granted they would be tared, feathered, then hung but they would be out of debt.
    Margalit nice way to frame that, forgoing expensive meals should be expected but you can’t forgo preventive care. WOuldn’t preventive care be more like a trip to McDonals then Morton’s? There is plenty of expensive care we could forgo that would actually have a positive effect on our health.

  20. In that case, Kim, I do agree. Let’s pick a nice, basic Federal Employee health benefit and make it the base line that we offer to everybody and finance it with taxation. Have Medicare and Medicaid rolled in and the government pays those folks’ share. It doesn’t have to be a public plan run by the government. It could be private plans that get reimbursed by the government which is the single collector of premiums. For the wealthy, there would be all sorts of perks to buy through competing private insurers.
    And to Barry’s point of taxation being to much for a young couple, please remember that in this perfect world (which will never happen), the employer will have to pay out much higher salaries in lieu of the former health benefits (rather funny notion, I presume).
    So what is wrong with this picture? Of course, prices and basic benefits would be regulated by the government, and that is probably the end of this little exercise in futility.

  21. Margalite – I don’t quite follow why foregoing basic health care equates to foregoing eating in an expensive restaurant or living in an expensive house, rather than just foregoing proper nutrition or housing. Certainly it is well established that poor nutrition, especially in the early years, has long-ranging effects, as does being homeless. I don’t buy the argument that basic adequate health care is more important in kind than basic nutrition or housing – they are all important. Yes, people do often make poor short-term decisions…people having rights means that they don’t always do what you’d like them to do.
    Based on the health care reform debates to date, we as a society seem to not be too concerned with preventive dental or vision care, which arguably are as important as preventive medical care. Where do we draw the line about what is essential and what is not?
    Let’s keep in mind that the original post was about creating a universal, tax-based risk pool for health care, and that is what my original post responded to. I’m not opposed to mandates or to people having insurance – I merely point out that not all costs place the same burden, and don’t necessarily have to be addressed the same way.

  22. I think it is highly unlikely that we will move the financing of health insurance from employer coverage for the roughly 160 million who currently have it to progressive taxation. Revisions to health insurance systems in most developed countries generally build on what is in place and has been in place for decades.
    Even if it were somehow possible to switch from employer provided health insurance to taxpayer financing, I don’t think the middle class has any idea of what that would mean for them. In Germany, for example, which spends roughly half as much per capita as we do, the financing system there is a payroll tax split with half nominally paid by the employer and half by the employee. The sum of the two pieces is 15% of income for the broad middle class. In the U.S., the value of employer paid family coverage probably exceeds that, especially for unionized workers in both the public and private sector with robust insurance.
    Picture a young couple a few years out of college just starting their careers. Both are healthy and unlikely to need much healthcare aside from maternity benefits if they decide to have children. To ask them to pay 15% of their income for health insurance on top of 15.3% (including the employer share) for FICA taxes plus federal income taxes plus (probably) state income taxes plus sales taxes plus property taxes if they buy a home or as part of their rent if they lease an apartment is likely to leave them feeling put upon to say the least. It’s one thing to talk about collectivism and everyone contributing to a health insurance pool if family coverage could be had for $1,000-$2,000 per year like auto insurance. It’s a different equation when we’re talking about $13-$15K for family coverage.
    Having said all that, I think there is plenty that employers and labor unions can do to help their employees or union members understand that they need to start to care about what healthcare services, tests, procedures and drugs cost even when insurance is paying. Some hospitals and large physician groups are paid much more than others for the same work not because of higher quality but because they have significant local market power. At the very least, we need to empower referring doctors with information about insurers’ contracted reimbursement rates, hospital infection rates, readmission rates, volume of surgeries performed, etc. so they can refer their patients to the most cost-effective hospitals.
    With the exception of care delivered under emergency conditions, which is only a small piece of the healthcare pie, more cost-effective referrals could easily be made if price and quality information were available in an easily accessible, user friendly format to both patients and referring doctors.
    We can also attack healthcare costs via malpractice reform including safe harbor protection for doctors who follow evidence based guidelines, a more sensible approach to end of life care, and a more vigorous effort to combat fraud, especially in the Medicare and Medicaid programs. For starters, Medicare could take 30 days to pay its bills instead of five or ten. Thirty days is the standard payment term in virtually every other area of U.S. commerce. Finally, every provider and every beneficiary over 18 and under 65 applying for government benefits of any kind should be required to have a smart ID card with a biometric identifier. As a taxpayer, I don’t think it’s too much to ask people who apply for taxpayer funded benefits of any kind to prove that they are who they say they are.

  23. Now, what kind of right wing wack-a-doodle would insist that people fund their own health care, to the best of their ability?
    Tell us about the Ministry of Dietary Laws you would like to set up, Peter.

  24. YES
    “Requiring everyone to buy insurance is a way to invest in the future.”
    Like the logger in the schlock-umentary “Sicko.”
    How does someone in a risky business NOT have accident insurance?
    How does that become MY problem?
    Personal responsibility — will it die as a part of HCR?

    ” .. There is another difference between health care and food or housing ..”
    Yes. More than 40% of USA medical costs are due to over-eating, smoking, dope, booze, and “extreme living.”
    Why do I have to pay for others’ stupidity?
    Why is it my problem?
    We’re our brother’s keeper. It is not a blank check, nor license to gorge, smoke, dope, booze, or party all night for 50 years.

  26. These arguments drive me crazy.
    Young people have children who’re notorious for going to the doctor. The have ills that need attention. Ones without money spend their future health avoiding care today.
    Requiring everyone to buy insurance is a way to invest in the future.

  27. There is another difference between health care and food or housing. Foregoing expensive meals, or expensive homes today does not have any long term effect on your future capacity of enjoying French restaurants or suburban living, if and when you land that dream job, or your little startup business finds its stride.
    Not so with health care. Foregoing prenatal care or preventive care, for example, may very well result in a forever unhealthy baby, or that silent hypertension could turn into a death sentence down the road even if your financial circumstances change dramatically.
    Basically adequate health care is not as discretionary as cherries and plush carpeting.
    You could argue that people should budget accordingly and show some responsibility for their own lives and go get that minimum amount of care. However, studies upon studies have shown that this is not the case. People, when they have to budget, prioritize immediate needs higher than something elusive like their health status in the future.
    We could stop here and leave it all to personal responsibility. The problem is that when these “irresponsible” folks get really sick, the costs of treating them are born by the big pool, which makes the costs of everybody else go up.
    So, discounting the humanitarian element, wouldn’t it be more cost effective for society to just take care of everybody from the get-go?

    We ALREADY have a progressive federal income tax.
    At least 50% of Americans, net-net, do NOT pay federal income taxes.
    Even the lib-burr-al Urban Institute is concerned, because those who do not pay have “no skin in the game” and just keep demanding more “bread and circuses.”
    Facts. How mean, they are.
    ” .. What we need, as you suggest, is a progressive income tax ..”

  29. People talk about health care costs as though they are monolithic, and need to be treated uniformly. For most people in most years, though, expenses are not that great and certainly are budgetable, except for the very poor (or the very sick). Catastrophic situations are where the big expenses come in, and a good argument could well be made for spreading those across a more universal societal pool. For other types of health care expenses, though, it’s hard to see why they should be treated differently than other personal expenses, including such essentials as food or housing (where the very poor do get subsidies, but the rest of the population expect to and do pay themselves).
    A big difference with health care, of course, is that with food or housing we don’t have other people “prescribing” what we should get…and who may have a vested financial interest in how much we consume. In health care we view that someone else (aka, insurers or the government) is paying for these routine expenses, not realizing that the “someone else” financing our expenses is like Pogo’s infamous enemy.

  30. “And asking one to bleed for people in the $75,000 to $100,000 income group because they’ve incurred so much debt for things they really, really want that they can’t afford insurance?”
    What debt would that be archon41, housing, education, transportation, 401k, maybe even healthcare? At least a progressive tax system for healthare would get something from them. Sure we could just force people to buy health insurance, thing is your industry has allowed costs to rise to such grotesque levels that you might want to discuss this with other industries in the economy that provide jobs who also want/need that same disposable income. We’ll just force automakers to reduce their prices because we need it for healthcare, or oil companies to drop their prices because we need it for healthcare, or universities to lower their tuition because we need it for healthcare, or that house you want to sell, just drop the price because the rest of us need it for healthcare.

  31. I wonder how support for Bush’s and company Iraq War would have turned out if it’s “advocates felt it should be funded by progessive governmental taxation rather than trying to slick people into believing it could be done without significant cost to themselves”?
    Why do so called “conservatives” think of themselves as more fiscally responsible when they fight investment now for future needs/costs all the time. They don’t want taxes to build/re-build decaying infastructure, they don’t want pollution/environmental contols to prevent sickness/degradation, they don’t want fees/levies/taxes to ensure clean drinking water, they don’t want gas taxes to fix/build roads, they don’t want energy taxes to transition to more sustainable/efficient energy production, they don’t want taxes to combat global warming, they don’t want anything that looks or smells like a tax to ensure a less troublesome future for anyone’s grandchildren but only to allow the present generation to party on while these problems get put aside for someone else’s just born child to pay for and solve.
    If you wonder why that the Democratic health reform bill was going to balloon the deficit it’s because NO ONE, not even conservatives, wanted to pay for anything, they wanted someone else to pay for it.

  32. Maggie,
    Income is not wealth. A senior couple should have a greater nest egg for whatever they wish to spend it on. A young couple hopes to have a nest egg.
    Most people will be fine without healthcare as you envision it. You make it sound like people will ignite and die right there if they don’t get healthcare.
    Insurance and government are why costs are out of control; the patient is not determining the value to them of the service they consume. They would consume differently if they directly bore the cost.
    Someone tell me how it is done elsewhere, with all the bells and whistles that Americans demand. If they don’t get what Americans get, then you tell America they can’t have it their way.

  33. I really think we need a tax-funded universal housing pool. I could use an “upgrade.”

  34. Matthew–
    Yes, Uwe is, as usual, right.
    And, you say it is odd that we are willing to pay for so many things through a progressive tax system–with those who have more paying more, and those who have less, payng less — but not for health care.
    This may go back to the fact that, in the distant past, our doctors redistributed income from the wealthy to the poor for us.
    Typically they charged wealthy patients significantly more than they charged middle-class patients for the same service. And when treating poor patients they would accept a pie or a cake as payment or even a basket of eggs as payment.
    So in this way, they “taxed” the wealthy to pay for care for the poor.
    In the distant past, hospitals were charitable organizaions often run by religous organizaions: Catholic hospitals, Jewish hospitals etc. I have my problems with the Catholic church, but the nuns were far more altruistic than most of today’s hospital CEOs.
    As medicine became a for-profit private-sector business, with even doctors thinking of themsleves as entrepreneurs hospitals and doctors began charging virtually everyone (except the families of other doctors) the same fees.
    At that point, our government didn’t do what governments in other coutntires have done: it didn’t intervne to insure equitable access to good care.
    We are the only developed country in the world that has chosen to turn healthcare into a largely unregulated for-profit business.
    That laissez-faire attitude seems to carry over to the American public’s view of healthcare . . .every man for himself.
    Just one quibble with your analysis: If you look at the Census Bureau’s household median income data broken down by the age of the head of household, you’ll discover that by and large, younger households don’t earn that much less than older households. Particularly as you get to people in their early 30s, they are not earning that much less than people in their late 50s.
    Well-educated upwardly mobile people do watch their income grow as they get older. But a great many Americans don’t. They are lucky if their wages keep up with inflation over time. (For the past twenty years, the average worker’s wages haven’t even done that.)
    People like you and I think of older people as wealthier because we while we know youong people struggling to make ends meet as they put their careers together, we don’t know many poor old people.
    But here are the facts as of 2006 (the most recent numbers I found quickly, but they illustrate the point)
    Households 25-34 — median household income $49,600
    35-44 median $60,405
    45-54 median income $64,800
    55-64 median income $54,500
    So the argument that younger people shouldn’t have to contribut to heatlh care for people in thier late 50s because older Americans have so much more money is bogus.
    People in their late 50s and early 60s earn significantly less than those 35-44, and not that much more than households 25-44.
    Moreover, the average older American has little savings. Only a small segment of the U.S. population became wealthy over the past 30 years thanks to increases in the stock market, bonsues and pay hikes.
    The wealthiest 10 percent were in a position to save and accumulate some wealth–that’s about it. At the height of the bull market close to 50% of Americans owned no stocks or mutual funds. And most people have tiny portfolios that are wiped out becuase they tend ot get in late and then sell when the market is down.
    As for home equity, if memory serves,
    , among people who own their own homes only 20% who are in their 60s have paid off their mortage.
    Bottom line: there are many people in their late 20s and 30s who earn significantly more than many in their late 50s and early 60s.
    The notion that the young shouldn’t have to help those older Americans because older Americans are so much wealthier is bogus.
    What we need, as you suggest, is a progressive income tax that would require that contribute more based on what they earn, regardless of age. (As in some Euoropean countires, I would tax investment income along with earned income to pay for health care for all.)
    The VAT tax that Zeke Emanuel and Victor Fuchs talk about in their book (Health Care For All?) also would be extremely progressive, and makes sense in many ways. But it would be very complicated to explain to Americans why it is progressive, and the idea that a VAT tax has a European pedicare would upset many.

  35. Nate, how can Medicaid and Medicare part B/D be bankrupt, but defense not be bankrupt? They are both funded via the federal government’s general revenue?

  36. “If it requires 15K in private insurance premium then it is safe to assume it will take at least 20K in taxes to provide an inferior product.”
    Sure. Just look at our experience with Medicare advantage. Private companies and the “free market” will always provide a better product for a lower price, no matter what!

  37. not any where close to enough money Margalit. When Congress passed medicare that is exactly what they did, we need to collect $x then we can promise to pay y benefits. everything CBO has estimated cost for Medicare they have been wrong. Now we have 100 trillion of promised Medicare benefits with no funding to pay them. That is over and above the funding that is in place. Just to fund the promises already made we need to increases taxes 100 trillion dollars.
    In actuality I am paying taxes for care I won’t receive in the future. Just like my SS statement says in big warnings I am paying taxes for SS benefits I won’t receive.
    If Congress can’t accuratly budget for Medicare and Medicaid how do you expect they will suddenly get it right for the rest of us? The federal government has never successfully managed any health program let alone one of this size. If it requires 15K in private insurance premium then it is safe to assume it will take at least 20K in taxes to provide an inferior product. This is a trade off the public does not want to take.
    Matt, don’t they require people like you to take citizenship classes before they let you in? SS, defence, and 60% of education are federal taxes, moving to NV won’t relieve you of those. Nice straw man by the way, does he have a name? I never said police, fire, defence where bankrupt only SS, Medicare, Medicaid. Bankruptcy doesn’t mean you can’t pay your bills today it means your debts exceed your assets and you won’t be able to pay them without relief or restructure.

  38. Nate, this is a country of 300M people. Nothing will work the same across the board for everybody. Education is not a failure across the board. Education fails where many other social support structures are broken. And, yes, I agree throwing money at schools without addressing the underlying social problems, will not work.
    Health care outcomes will probably have the same spotty record for the same exact reason, if we were funding by taxation, which we are not.
    We are paying taxes for care we will be receiving in the future (Medicare) and for charity care that we are not receiving (Medicaid). We do not pay taxes for our care today.
    Take the estimated $15K in premiums for a family and whatever it is for an individual, make it progressive and mandatory, and throw that into the tax man’s collection box. That is what I mean by collecting. Will there be enough money then?

  39. I’m moving to Nevada to be like Nate where they pay for Social Security, defense, fire, education, police et al from voluntary contributions and user fees.
    Had I just known that was the case I’d have felt no need to protest the Iraq war, I’d just have moved to Incline Village. I feel so foolish, but Nate has shown me the light!
    And if all those examples are bankrupt, how come the checks they send out seem to clear the bank?
    Oh, and by the way Nate the US mail has lost money 10 of the last 11 quarters. But sure, there’s no tax support for that, is there….after all it’s too small to not fail

  40. WOW, where are you living Matt and Margalit?
    “we don’t have enough money because we’re not collecting any.”
    I’m sorry how do we fund Medicaid and Medicare? Over 50% of all healthcare spending is from government sources, how can you claim we don’t collect any?
    education – Failure and proven spending has no link to quality otherwise DC would have the best schools in the world.
    social security – Insolvant, 34 trillion in promised benefits it doesn’t have the money to pay
    roads – deplorable condition, majority of American bridges not safe and many not salvagable. Noticeable movement to privitised and toll roads strictly because the current funding method is a failure. COme on Matt you live in CA your really going to argue tax supported public roads have worked? How many years since you last left your house?
    Post office – Matt your in the US not UK, our postoffice is not tax supported, it is bailed out now and then but it is funded 100% by user fees.
    Airlines – Again Matt getting your countries mised up, user fees make up a large portion of funding.
    If you go through Matts list he didn’t name a single example where funding through taxes has worked, hald aren’t even funded by taxes but those couple he did get rights are all bankrupt.

    Your detested Michael Porter from HBS advocates a universal pool for the worst cases (e.g., cancer). Everyone knows, those are the cases that drain the most resources.
    There is nothing new here.
    BTW: there is still no sighting of a “bottomless pit of taxpayer money” to pay for the Democrats’ 3,000 page HCR proposals. Also known as the “wish list” that makes Santa Claus seem like Scrooge.

  42. Time to come out of the jungle, guys. The Emperor has signed the instruments of surrender. This is now an exercise in what might have been.
    If the advocates of HCR really felt that it should be funded by progressive governmental taxation, perhaps they should have said that, rather than trying to slick people into believing it could be done without significant cost to themselves. Did you really expect them, for sake of example, to buy into the theory that funding the needs of the ill could be offloaded to the insurers without severe repercussions for the rest of us? And asking one to bleed for people in the $75,000 to $100,000 income group because they’ve incurred so much debt for things they really, really want that they can’t afford insurance? Or maybe you just didn’t throw enough egalitarian snark at the less enthusiastic.

  43. MD as HELL, we don’t have enough money because we’re not collecting any. Instead, healthcare money is collected by private insurers and frankly, I’m getting a bit tired of hearing about their measly profit margins.
    Is it that much better to pay $12K to Anthem every year instead of paying it directly to the tax man?
    Please don’t say that there is some sacred freedom right to not pay the $12K. All this particular freedom means is that someone else is footing the bill sooner or later….

  44. Matthew,
    For all the tax funded activities there is enough money. Thre is not enough money for healthcare, as envisioned by you. If there was, you could just expand Medicaid. Of course a lot of us don’t take Medicaid because the reimbursement sucks, unless you are a pediatrician. Then you make it up on volume.
    But Medicaid is bankrupting the states. There is not enough money.
    We cannot borrow for healthcare. Period. Our national debt is sending us all into servitude; we are soon to be owned by our lenders, and I don’t mean Wall Street.
    Is healthcare reform such a drug to you that you will mortgage the country just to get it?