Re: “Reform Medicare by raising eligibility age”
Let me again try to understand this proposal. Your idea will result in healthcare costs declining from 1/6 of GNP to 1/9 of GNP a 1/3 decrease). By healthcare costs you re including medicare, medicaid, and the VA.
For some reason you fail to close the loop by not telling readers the VAT percentage, nor mention any CO pays or deductibles, nor any impact ( if any) to provider reimbursement rates, nor the impact of a VAT on the poor. I am guessing your case would be better made by including such in your proposal.
As for me, I am quite skeptical. Some may even describe your proposal as getting the camel’s nose into the tent.
EDITOR: Our neighbor to the north, Canada, finances health care via the Value Added Tax. You are correct that it tends to be regressive, since it is a tax on all levels of production. But then again the current funding of the non-governmental portion of health care is also regressive. For example, the highest paid executive pays the same as the lowest ‘blue’ or ‘gray collar’ worker in most firms.
The important thing is when you do away with health care companies in exchange for the ’single payment’ via a governmental agency, then at least 25% of the cost of health care in the USA, consumed by administration costs, evaporates.
Of course huge and profitable institutions will fight reform tooth and nail. Moreover, some doctors and dentists who are able earn much more than say $250,000 a year they otherwise would be paid, will also resist any reform.
Keep in mind that physicians start in practice owing a huge amount of debt. As part of health care reform, we advocate providing full tuition for post graduate studies in the fields of medicine.
If you study the attitude of the bulk of professionals who work under a single payer system, they are happy not to have to worry about what they are earning and able to devote themselves solely to the practice of their profession.
“The healing of America” by T. R. Reid is a New York Times Bestseller and is a pleasant and easy read. One becomes acquainted with various approaches to health care through the developed world. They are all better than what we have.
Lastly, given that what we advocate is far more universal than what we now have, it would be more accurate to say we are only leaving the camel’s nose outside the tent.
The Canadian VAT, called GST, is 5%. A 5% VAT cannot pay for US Healthcare. I calculate somewhere in the 18.5% range is required.
My VAT estimate may be low because economists tell me taxing consumption causes less consumption. My VAT may be lower if a 25% savings in administration is possible but you are not specific about how the savings materialize, i.e. what jobs would be cut, financial services no longer needed, record keeping no longer needed etc.
If any co pays or deductibles are needed, financial records and billing administration cannot stop. I also offer the fact that the ACA (Obamacare) has increased administration costs and record keeping substantially.
Training a doctor costs in the range of 250K to 300K for a GP. Since you propose taxpayer funding you need to add that cost to a VAT. According to The United States Physician Workforce and International Medical Graduates: Trends and Characteristics, I estimate the US accepts 250,000 doctors each year (foreign and domestic trained doctors). This is an additional 69 billion dollars in doctor education costs to be borne by the VAT. You also imply a need to limit doctors wages. Doctors are paid well because most are on call 24/7.
I imagine if doctors earn 9 – 5 wages they will work 9 – 5 hours. I am sure there are many people, especially in the Washington DC area, who are paid much more for doing much less. You proposal is more like “let’s put the camel in the tent and we will figure it out later.” Didn’t I hear something like that before?
I have read T.R. Reid’s book. As I recall he was not specific about US restructuring costs either.
EDITOR: With all due respect, the fact is that Canadian health care, alone with France which is rated the best of the world, costs about 2/3rds as much as the USA’s.
There is nothing that exceptional about the population of the USA If we do the same, we should obtain the same results.
For those of us who work on salaries rather than paid by the hour, the concept that we only work 40 hours a week is absurd.
Those who choose careers in medicine would do so not to become multi-millionaires but rather to enjoy an upper-middle class life and to perform their chosen careers by helping others.
(Some physicians who practice in the worse paying fields such as social diseases would actually end up earning more.)