Every other economically advanced country has a form of universal healthcare. And, though the systems vary, they all spend less while achieving better outcomes.
Compared to every country on that list, the United States has lower life expectancy at birth, higher infant mortality, and higher obesity. And more American seniors have two or more chronic conditions (68%). Canada (56%) and Australia (54%) are the only others above 50%.
This statement is easily misunderstood. The US achieves the same or better outcomes as all other OECD (economically advanced) nations if the individual is covered by insurance. For those who are not covered, their outcomes are so bad that it lowers the statistical average down for the entire country.
So, the important point here is that our poorer outcomes is not due to our inability to deliver; it’s due to our inability to provide universal access to care.
With other advanced economies clamping down on the profit motive, the United States effectively subsidizes research and development of drugs and medical devices for the rest of the world.
One cannot emphasize how important this point is. If (for example) the US starts to negotiate drug prices, the well of “miracle” drugs will dry up in a hurry, as the pharmas place their bets on fewer and universally applicable medications. If you have a rare disease, forget about it; they’re going to invest in better pills for men to achieve an erection. So, assuming the OECD nations WANT the pharmas to continue researching in the treatment of rare(er) diseases, some sort of accomodation with the pharmas (public funding) would have to be made.
However, it’s fair to say a single-payer system with private health providers (like Canada), a publicly run system (like the UK), or strict price controls and required insurance (like Japan) could plausibly give the United States better care for less money.
But it’s politically impossible. That’s obviously true now, with Republicans in charge, but it’s probably true for the foreseeable future.
Very true. However, it should be pointed out that Americans wouldn’t like any of those systems, other than the part that lowers cost. The UK system survives on the back of immigrant doctors from India; my Brit friends think it’s amusing that we want to see the same doctor again and again; they are not in the habit of doing so. Japan uses extremely high copays and deductibles (You thought Obamacare was bad? LOL.) to control costs.
We could probably go universal with a system like the Swiss, where the feds simply dictate that everyone has to be covered with some kind of barebones plan (the kind the ACA made illegal) and then let the states solve the problem for themselves. In Switzerland, each state (canton) runs their own system, I believe.
The AHCA eliminates taxes that fund ACA subsidies, about $60 billion per year, almost all of which will go to the richest Americans. Members of the top 0.1% would save almost $200,000 annually. This will also set a new baseline for upcoming tax reform, helping Republicans game Congressional scoring systems to make larger cuts permanent, instead of needing them to expire after 10 years like the Bush tax cuts.
Probably a good time here to talk about funding mechanisms and politics. The misused concept “tax breaks for the rich” is starting to appear.
Democrats love to milk the rich for social programs. Republicans don’t oppose reasonable progressive taxation and means-testing, but consider the reality of capital flight. IOW, you can only milk them so far, before you hit the law of diminishing returns that harms more than it helps.
Capital flight occurs when the owner of the capital (here, the rich person) realizes that their money can be more efficiently invested overseas rather than domestically. This used to not be a problem, back when you actually physically had to move your capital overseas; but now, since we just push a button to move money, it’s a major problem.
(It is my observation that liberals deny the existence of capital flight as a problem, recognizing it only when (a) they want to pillory a Republican candidate for having accounts in the Cayman Islands, and (b) when a corporation moves their HQ overseas via inversion. Which means they’re ignoring about 98% of the capital flight that exists. This is not good tactics, in my view.)
Back to the ACA taxes. Yes, the AHCA would eliminate about $60B of taxes mostly paid by the rich. That’s less money than was spent on Superstorm Sandy cleanup. That tells you how few people (and how little money there is to gained) by going back to the top .1% well again and again.
Be aware that for the top .1%, 200K a year is chickenfeed. There’s no lobby of ultrarich people out there telling the GOP to “get rid of this tax or else.” The GOP isn’t getting rid of it because of pressure from their rich megadonors; they’re getting rid of it because it is bad funding p0licy that can lead to capital flight, not from the top .1%, but up and down the rest of the upper quintile. (You don’t want to incent somebody with 250K of annual income and a million in net worth to buy rental property in Romania, in other words. They might start doing it. :-) )
So, let’s talk about funding: You’ll recall that when the ACA debate was going down, the Democrats were rather manic about getting a score from the CBO which was under a “trillion dollars over ten years”, and ended up playing games with incremental implementation which pushed costs outside of that 10-year window.
Medicare and Medicaid are funded with a payroll tax of 3.2%, half paid by the individual, half paid by the employer. How much does a percent of payroll tax take in? Anyone? Bueller?
Well, by my math, a 1% payroll tax, paid half by the individual, half by the employer, takes in…….just under a trillion dollars over 10 years.
Yes folks, you read that right. The reason why we’ve spent the last eight years squabbling with each other about health care is because our politicians (that’s all of them) are too cowardly to suggest that we (and our employers) cough up an extra half a percent of wages, which together with existing funding mechanisms that the AHCA will leave in place, not only funds the system, but easily funds the shortfall at the low-income end that the AHCA is being criticized for.
So, raise your hands. How many of you will cough up an extra half percent of your income to solve the biggest social problem we have in America?
I suspect that about 90% of Americans will raise their hands, if for nothing else but to get the politicians to shut up about it and go to work screwing something else up.