The Swamp

Steve of phpBB wrote: ↑Tue Jan 28, 2020 5:59 pmIt's too difficult to fix because we aren't starting from scratch. We have had a system evolve in response to various incentives for seventy-five or eighty years, thus entrenching a system that basically works for tens of millions of people who have a lot of clout.

10s of millions of 300+ million total. That paragraph is the reason we won't, not the reason we can't.

mister d wrote: ↑Tue Jan 28, 2020 6:10 pm

Steve of phpBB wrote: ↑Tue Jan 28, 2020 5:59 pmIt's too difficult to fix because we aren't starting from scratch. We have had a system evolve in response to various incentives for seventy-five or eighty years, thus entrenching a system that basically works for tens of millions of people who have a lot of clout.

10s of millions of 300+ million total. That paragraph is the reason we won't, not the reason we can't.

To be clear, I think about half the country is covered by employer-furnished private insurance.

Edit: To be more clear, I do think having tens of millions of people be okay with our system means that really we *can't* change it. Because we are, for better or worse, a democracy. Obviously with vote suppression and the like, we're not a complete democracy. But we are close enough that a proposed massive change to our economy that makes tens of millions of voters scared for their health coverage is not going to happen.

But again - IT DOESN'T NEED TO HAPPEN. WE DO NOT NEED SINGLE PAYER IN ORDER TO ACHIEVE UNIVERSAL COVERAGE. AND EVEN IF SINGLE PAYER IS MARGINALLY BETTER THAN OTHER METHODS, THE MARGINAL DIFFERENCE ISN'T WORTH FUCKING OVER ALL OF OUR OTHER NEEDS. ESPECIALLY IF ALL WE ARE REALLY DOING IS TAKING A SYMBOLIC STAND THAT WILL RE-ELECT TRUMP.

Sorry for shouting, it's just dammit, this is such an obvious point that I see ignored day after day by countless progressives and liberals.

mister d wrote: ↑Tue Jan 28, 2020 6:06 pm To the first point, isn't that all still part of the same equation? If its not taxed on one side, its taxed on the other. That $45K becomes part of a higher personal income tax, as does every other dollar paid to every partner and employee over the course of the year. No one is or should be pretending single payer means your future income is your present day income plus your out-of-pocket health, just that your overall costs from all angles will decrease and you'll be shielded from a worst case scenario.

I don't think this really works out, though.

Between me and my partners, let's assume we pay around $200K per year for health insurance. (It's more than that.) Single payer happens, and now I no longer have any moral obligation to pay that for my employees' benefit. So we have a huge windfall.

Let's assume that we pass $100K of that money to our employees.

The other $100K becomes additional personal income to my and my partners.

My employees pay, say, 20% of their marginal income in personal income tax. That's $20,000 in money going back to the government.

Let's say we pay 35% of our marginal income in taxes (I am not in that high of a bracket, though I wish I were). That's another $35,000 in additional taxes.

So the government gets an additional $55,000 in taxes from me and my employees. Meanwhile, the government is now picking up the medical expenses that we used to get for that $200K.

The government is clearly more efficient than an insurance company. But still, there's no way it can only pay $55K for the care that used to cost us $200K. So while taxes from reduced premiums are clearly going to pay for *part* of the increased government spending, they aren't going to come even close to paying for all of it.

You need to massively raise tax rates or impose other taxes. Which, presumably, we already want to do so we can have more public transit and solar power and electric cars and reduced college expenses and housing subsidies and social security.

And if that $200K serves as a 10% bonus to your employees, that means you have $2.2MM in salary expenses subject to the higher tax rates, right? Ignoring all other options and complications and everything, stripping out excess costs and raising taxes offset by the loss of healtcare expenses has the ability to cover this. Has it not been economically proven that, over a decade, single payer is less expensive than the present state?

(The one thing I agree with you on is the "I just won't hire" point if it becomes a punitive payroll or headcount tax. I'd much rather see it be tied to corporate revenues so its unavoidable and protected from any fancy accounting, but I'm sure for that reason it would also fail.)

IMO one of the biggest issues with respect to funding single-payer is that we're going to have a right-wing Supreme Court for the next generation thanks to Mitch McConnell and the Merrick Garland fiasco. The wealth taxes that Warren and Sanders have proposed would raise a ton of revenue without imposing hardships on anyone. But I'm highly skeptical that they'd survive a Constitutional challenge before the current Supreme Court.

But I also think Steve is significantly overestimating the degree of satisfaction that people have with private insurance. I'm a pretty healthy 35 year old with "good" private insurance. But just within the last 7 years or so I've had multiple times where my insurers charged significant out-of-pocket costs that would have imposed a major burden if I were a working class or middle class person supporting a family. These include a bill for thousands of dollars in connection with a one-night hospital stay that was ordered by doctors at one of the best hospitals in the world. Just last month I was hit with a bill for hundreds of dollars extra because I forgot to pack a prescription while traveling and needed a short-term refill. I'd imagine my experiences in this regard are not particularly uncommon, I'm just lucky enough that they've occurred during a time when I had well-paying jobs and no kids to support.

Big yup on the last part too as I've been on both sides. First kid, a c-section, cost us $17.28 out of pocket. Second kid, also a c-section, cost us close to $17K because of different coverage and split maximums. The answer lies somewhere in the middle in terms of how much my money ideally would have indirectly covered but, like you said, we were fortunate to not have a birth be a financially devastating event.

mister d wrote: ↑Tue Jan 28, 2020 7:32 pm And if that $200K serves as a 10% bonus to your employees, that means you have $2.2MM in salary expenses subject to the higher tax rates, right?

I don’t think I understand this. Can you explain it a little more?


(Also, yes, on an aggregate basis, single payer and other universal systems would cost less than what we have. No doubt. But I’ve never seen a good plan to re-allocate the costs in a way that doesn’t require a massive across-the-board tax increase.)

There will be a massive across the board tax increase. It will pay for itself with a massive across the board health care cost decrease. This feels like saying “how can you buy a house knowing there will be a massive increase to your mortgage expenses” without acknowledging rent expenses will disappear.

Joe K wrote: ↑Tue Jan 28, 2020 7:51 pm IMO one of the biggest issues with respect to funding single-payer is that we're going to have a right-wing Supreme Court for the next generation thanks to Mitch McConnell and the Merrick Garland fiasco. The wealth taxes that Warren and Sanders have proposed would raise a ton of revenue without imposing hardships on anyone. But I'm highly skeptical that they'd survive a Constitutional challenge before the current Supreme Court.

But I also think Steve is significantly overestimating the degree of satisfaction that people have with private insurance. I'm a pretty healthy 35 year old with "good" private insurance. But just within the last 7 years or so I've had multiple times where my insurers charged significant out-of-pocket costs that would have imposed a major burden if I were a working class or middle class person supporting a family. These include a bill for thousands of dollars in connection with a one-night hospital stay that was ordered by doctors at one of the best hospitals in the world. Just last month I was hit with a bill for hundreds of dollars extra because I forgot to pack a prescription while traveling and needed a short-term refill. I'd imagine my experiences in this regard are not particularly uncommon, I'm just lucky enough that they've occurred during a time when I had well-paying jobs and no kids to support.

This. In 2019 my wife had a thyroid test and a pain in her hip that was treated by first an exam/xray then therapy. Our out-of-pocket cost was ~$7,000. A few years ago she had two cysts surgically removed from her hand over the course of two years. Our out-of-pocket for those were $6,000 & $5,000 respectively. Anytime someone talks about how great private insurance is I want to scream.

I understand the debate but there is one other cost often not taken into account and that is administrative cost of employers managing their benefits programs. Even if it is a small company with one HR assistant who only manages the relationship with a third-party administrator there is still cost there. I never understood why the NFIB or national Chamber of Commerce or any other business organization isn't asking for single payer or some other way to get healthcare cost and responsibility away from employers. I'm guessing potential tax increase is the only reason I can think of.

Joe K wrote: ↑Tue Jan 28, 2020 7:15 am

Johnnie wrote: ↑Tue Jan 28, 2020 6:56 am Gotta love this article from Politics about an existential breakdown in the Democratic party:

‘They let him get away with murder’: Dems tormented over how to stop Bernie

Love the phrasing.

And it shows just how pathetic Democrats truly are that their lack of a spine to stand up to Republicans has forced the base farther left than they liked. Oh well.

Maybe Obama should've forced through judges and Merrick Garland when he had the opportunity instead of playing a game only he followed the rules for?

What a bunch of absolute whiners. Also amazing how many Democratic operatives don’t understand the simple facts that: 1.) there is a big unmet need for a political movement that actually tries to help poor and working class people; and 2.) politics is a lot more appealing to people when it’s framed in moral terms rather than technical terms. Those two principles get you like 90% of the way to understanding Sanders’ appeal. But the Democratic professional class just doesn’t get it because they view politics as a puzzle game for affluent, well-educated technocrats.

Many of the people quoted in that article are DLC retreads. They've spent their entire political careers catering to Big Money and trying to split the difference on policy matters... Pragmatism reigns supreme for those folks.

I'm so over that shit. I'm basically on board for Bernie or Warren at this point. Very tired of everyone who isn't an expert with years of looking at poll data trying to be pundits.

I endorse the above message

mister d wrote: ↑Wed Jan 29, 2020 12:04 am There will be a massive across the board tax increase. It will pay for itself with a massive across the board health care cost decrease. This feels like saying “how can you buy a house knowing there will be a massive increase to your mortgage expenses” without acknowledging rent expenses will disappear.

I don't think that analogy works. When you buy a house, it's the same person who used to pay rent and is now paying a mortgage. But that is not what would happen under a switch to single-payer.

With a switch to single-payer, there is no good way to achieve that, to ensure that each individual person who would be paying $X for health care under the current system will now pay $X in increased taxes under single payer.

There are millions of people paying either all or a large chunk of their own health insurance premium. There are millions of people who are paying none or almost none of their own health insurance premium. There are millions of people who are paying for *other people's* health insurance premiums. I've reviewed proposals, and none of them appear to me to be effective to ensure that a vast majority of those individual people will pay the same amount or less if we switch to single payer.

Still, though, why single payer? Why put all your eggs in a plan that requires (i) approval from at least 50 senators, not in some theoretical world but in a 2021 world where at least 48% of the Senate will be to the right of Joe Manchin, (ii) a leap toward liberalism that has never been seen in this country, (iii) millions of people to vote to put their own financial/emotional security at risk, and (iv) our government to smoothly accomplish, for 300 million people, what no other government has even tried (the transition, not the ultimate single payer plan)? There are other ways to get to universal coverage that face far fewer hurdles.

Steve of phpBB wrote: ↑Wed Jan 29, 2020 11:50 amWith a switch to single-payer, there is no good way to achieve that, to ensure that each individual person who would be paying $X for health care under the current system will now pay $X in increased taxes under single payer.

I don't understand why status quo is the goal versus properly spreading out the costs. I was the same person in 2011 and 2015 paying vastly different amounts for the same healthcare.

mister d wrote: ↑Wed Jan 29, 2020 11:58 am

Steve of phpBB wrote: ↑Wed Jan 29, 2020 11:50 amWith a switch to single-payer, there is no good way to achieve that, to ensure that each individual person who would be paying $X for health care under the current system will now pay $X in increased taxes under single payer.

I don't understand why status quo is the goal versus properly spreading out the costs. I was the same person in 2011 and 2015 paying vastly different amounts for the same healthcare.

Right. The goal should not be status quo. Some will pay more; some will pay less. But hopefully we get to a system where unexpected medical issues don’t result in bankruptcy or worse, and people don’t have to decide between paying for needed care and putting food on the table. It’s completely unacceptable that people are dying in this country because they are rationing insulin or too afraid of the costs associated with going to the hospital.

mister d wrote: ↑Wed Jan 29, 2020 11:58 am

Steve of phpBB wrote: ↑Wed Jan 29, 2020 11:50 amWith a switch to single-payer, there is no good way to achieve that, to ensure that each individual person who would be paying $X for health care under the current system will now pay $X in increased taxes under single payer.

I don't understand why status quo is the goal versus properly spreading out the costs. I was the same person in 2011 and 2015 paying vastly different amounts for the same healthcare.

If millions of people believe single payer will mean their taxes will go way up, they will not support single payer or vote for a candidate who makes it a big part of their platform. So that means (i) single payer wouldn't happen, and (ii) if the Dem nominee is one such person, Trump is more likely to win.

So to avoid having millions of people believing single payer will raise their taxes, you need to come up with a system that, for the most part, allocates the necessary massive tax increases to the people who are otherwise saving money from the transition.

To use your earlier analogy, you have to make sure you are imposing the monthly mortgage payment on the guy who used to pay rent. If that mortgage payment is instead being imposed on the rest of the neighborhood, many of whom are paying their own rent or mortgages, people aren't going to go for it.

Joe K wrote: ↑Wed Jan 29, 2020 12:05 pmRight. The goal should not be status quo. Some will pay more; some will pay less. But hopefully we get to a system where unexpected medical issues don’t result in bankruptcy or worse, and people don’t have to decide between paying for needed care and putting food on the table. It’s completely unacceptable that people are dying in this country because they are rationing insulin or too afraid of the costs associated with going to the hospital.

Yes. That is why people should be supporting plans to fix that problem, plans that can actually be enacted in 2021.

Expand eligibility for and amount of subsidies, impose stricter regulations on insurers in both coverage, and acceptance, and maximum out of pocket costs, add a public option, allow Medicare to negotiate drug prices, allow drug imports from Canada and the EU, allow people to buy into Medicare or Medicaid, require the fucking red states to expand Medicaid like they were supposed to originally, ban surprise hospital costs.

But its not a reallocation among the people on your block, its raising taxes on people in the super rich part of town who, up until now, have been paying the same as you.

mister d wrote: ↑Wed Jan 29, 2020 12:17 pm But its not a reallocation among the people on your block, its raising taxes on people in the super rich part of town who, up until now, have been paying the same as you.

Unfortunately, raising taxes on the super-rich won't bring in nearly enough money. Especially if you were already planning to raise taxes on the super-rich to pay for a host of other things.

So there's basically no way a nation with a $23+ Trillion dollar GDP can pay for anything. America's the best.

Steve of phpBB wrote: ↑Wed Jan 29, 2020 12:26 pmUnfortunately, raising taxes on the super-rich won't bring in nearly enough money. Especially if you were already planning to raise taxes on the super-rich to pay for a host of other things.

In 2016, average market income was $15,600 for the lowest quintile and $280,300 for the highest quintile. The degree of inequality accelerated within the top quintile, with the top 1% at $1.8 million, approximately 30 times the $59,300 income of the middle quintile.

Don't even worry about the 1% here, just the top 20%. Why does that math not work?

mister d wrote: ↑Wed Jan 29, 2020 12:46 pm

Steve of phpBB wrote: ↑Wed Jan 29, 2020 12:26 pmUnfortunately, raising taxes on the super-rich won't bring in nearly enough money. Especially if you were already planning to raise taxes on the super-rich to pay for a host of other things.

In 2016, average market income was $15,600 for the lowest quintile and $280,300 for the highest quintile. The degree of inequality accelerated within the top quintile, with the top 1% at $1.8 million, approximately 30 times the $59,300 income of the middle quintile.

Don't even worry about the 1% here, just the top 20%. Why does that math not work?

I can't pinpoint a source now, but my understanding has always been that it just doesn't. That is just isn't enough. We're talking about undoing the recent massive tax cut, times thirty. (Probably only twenty to account for efficiencies and other ways that tax revenues would naturally rise from a switch.)

Does that source you quoted that from indicate how much the aggregate taxable income was of that top quintile?

I assume $280K times 1/5 of the US households.

mister d wrote: ↑Wed Jan 29, 2020 1:53 pm I assume $280K times 1/5 of the US households.

Do you have a link to the place you got that from?

Edit: Google tells me there are 128 million households in the US. So if 1/5 of those make an average of $280,000. Or 25.6 million households.

If you confiscate every dollar each of those households makes over $200,000, that's an average of $80,000 per household. Multiply that by 25.6 million households, and you get a total of $2 trillion.

So complete confiscation of every dollar over $200K covers two-thirds the annual cost of single payer.

Steve of phpBB wrote: ↑Wed Jan 29, 2020 1:57 pmIf you confiscate every dollar each of those households makes over $200,000, that's an average of $80,000 per household. Multiply that by 25.6 million households, and you get a total of $2 trillion.

Like in the same way you could say "if you confiscate every dollar over $250K you could pay the military budget"?

mister d wrote: ↑Wed Jan 29, 2020 2:01 pm https://en.wikipedia.org/wiki/Income_in ... ted_States

Thanks.

That Wiki article cited a CBO report addressing income in 2016. According to that CBO report, once you take into account taxes they are already paying, that top quintile makes an average of $214,000.

So assuming you still need those folks to keep paying taxes for the rest of the federal budget, complete confiscation of every dollar over $200,000 gets you $358 billion. That figure is about 1/8 of the cost of single payer.

If you really did switch to single payer, you'd have a more efficient system, and you'd also free up part of the money these guys are already paying in federal taxes. But still, confiscation of every dollar over $200K wouldn't come even close to covering single payer.

mister d wrote: ↑Wed Jan 29, 2020 2:13 pm

Steve of phpBB wrote: ↑Wed Jan 29, 2020 1:57 pmIf you confiscate every dollar each of those households makes over $200,000, that's an average of $80,000 per household. Multiply that by 25.6 million households, and you get a total of $2 trillion.

Like in the same way you could say "if you confiscate every dollar over $250K you could pay the military budget"?

The military budget is a crazy $700 billion (including a bunch of stuff like payment to veterans benefits and their health care). If you cut it in half, you'd get one-eighth of the way to single payer.

If you cut the military budget in half *and* confiscated every dollar of household income over $200K, you are still only one-fourth of the way there.

And again, who are the 50 senators who are going to vote to cut our military spending in half?

Ultimately, that's the fundamental problem.

It's not simply that single payer "is expensive."

It's that single payer for our country would cost *so much* that it would require a fundamental reshaping of our tax structure and our federal budget. It would require white people as a whole to say "I am okay giving a huge chunk of my money to people I don't know and have no affinity with instead of using it for my own kids' college or my own retirement."

Which, yay, but again, are all those folks in Orange County who elected an all-Dem Congressional slate in 2018 going to go for that?

Who is currently paying for healthcare?

(If we want to leave it at "current funding is dependent on personal financial disaster and bankruptcies and that's too complicated to unwind", so be it I guess? Its hard and different, but its being paid and then some right now and can be paid but a little less to massive benefit if we actually cared to.)

mister d wrote: ↑Wed Jan 29, 2020 3:11 pm (If we want to leave it at "current funding is dependent on personal financial disaster and bankruptcies and that's too complicated to unwind", so be it I guess? Its hard and different, but its being paid and then some right now and can be paid but a little less to massive benefit if we actually cared to.)

It's not that healthcare-related personal financial disaster and bankruptcy are "too complicated" to address. It's that there are other ways to address those with much less political, social, and fiscal difficulty than single payer. Those steps I suggested a few posts ago would result in massive benefits - as the ACA did.

I'm not saying people should be left to die without insulin. I'm saying let's solve that problem in a way that doesn't require a politically unlikely remaking of our economy.

BIG NEWS!

John Delaney is out!

So his 0.5 percent will probably go to Biden!

Killer Mike bringing it for Bernie.

Where's Corn Pop's video for Biden? Did you know Joe Biden was also a vice president to a black man once? He knows the urban community!

Jokes aside, Killer Mike is phenomenal. And I think there's a new Run The Jewels album coming soon.

Steve of phpBB wrote: ↑Wed Jan 29, 2020 3:41 pm

mister d wrote: ↑Wed Jan 29, 2020 3:11 pm (If we want to leave it at "current funding is dependent on personal financial disaster and bankruptcies and that's too complicated to unwind", so be it I guess? Its hard and different, but its being paid and then some right now and can be paid but a little less to massive benefit if we actually cared to.)

It's not that healthcare-related personal financial disaster and bankruptcy are "too complicated" to address. It's that there are other ways to address those with much less political, social, and fiscal difficulty than single payer. Those steps I suggested a few posts ago would result in massive benefits - as the ACA did.

I'm not saying people should be left to die without insulin. I'm saying let's solve that problem in a way that doesn't require a politically unlikely remaking of our economy.

ding ding ding

I don't have an issue voting for Bernie or Liz, but single payer is more of a negotiating point to get us to universal coverage. There's no reason to do on that hill.

Nonlinear FC wrote: ↑Fri Jan 31, 2020 2:39 pm

Steve of phpBB wrote: ↑Wed Jan 29, 2020 3:41 pm

mister d wrote: ↑Wed Jan 29, 2020 3:11 pm (If we want to leave it at "current funding is dependent on personal financial disaster and bankruptcies and that's too complicated to unwind", so be it I guess? Its hard and different, but its being paid and then some right now and can be paid but a little less to massive benefit if we actually cared to.)

It's not that healthcare-related personal financial disaster and bankruptcy are "too complicated" to address. It's that there are other ways to address those with much less political, social, and fiscal difficulty than single payer. Those steps I suggested a few posts ago would result in massive benefits - as the ACA did.

I'm not saying people should be left to die without insulin. I'm saying let's solve that problem in a way that doesn't require a politically unlikely remaking of our economy.

ding ding ding

I don't have an issue voting for Bernie or Liz, but single payer is more of a negotiating point to get us to universal coverage. There's no reason to do on that hill.

I think it’s fair to say that the GOP will vigorously oppose any Democratic proposals on health care. So rather than pre-comprise, I’d rather see the Dems stake out a very aggressive starting point. No reason for them to negotiate against themselves. And at this point there’s really no empirical evidence that a watered down proposal is necessary to be competitive in the general election.

Johnnie wrote: ↑Fri Jan 31, 2020 2:34 pm Where's Corn Pop's video for Biden? Did you know Joe Biden was also a vice president to a black man once? He knows the urban community!

Jokes aside, Killer Mike is phenomenal. And I think there's a new Run The Jewels album coming soon.

Bernie definitely has the best musician endorsements. Wish I still lived in Boston so I could drive up for this:

Well, this is fucking gross.

Mike Bloomberg Gave the DNC $300K Two Days Before He Entered the 2020 Race

And now the DNC is changing its rules in a way very favorable to ... Mike Bloomberg.

So the DNC is cool with 4 more years of Trump. This is so nakedly obvious that progress is bullshit to them. All that matters is money.