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In an online article entitled "Can Congress Make Health-Care Reform Pay for Itself?" Karen Tumulty brought up the most difficult issue that will face health care reform advocates. Yes, I know the public option will be a tough battle, but Congress figuring out a way to pay for it will be THE biggest issue IMHO in the healthcare debate.

Here's a little background on the problem. Ezra Klein has been reporting for a while that healthcare reform will cost 1.7 trillion dollars over 10 years, a lot more than President Obama's proposed budget figure over 600 billion.
 http://www.prospect.org/...

Given the fact that Congress has already taken President Obama's proposals to pay for healthcare like taxing the charity and mortgage deductions of people making over $250,000 off the table, this is a big problem. It's an even bigger problem b/c Congress has to come up with not the $600 billion which President Obama had budgeted (and paid for in his tax proposals) but $1.7 trillion.

This problem became even more dire when President Obama and Congress came to an agreement last Friday that healthcare had to abide by paygo rules. In other words, healthcare reform has to be budget-neutral and Congress has to find a way to fund healthcare reform without creating a deficit.

Well, as Ezra Klein and now Karen Tumulty are reporting, Congress is looking at taxing employer-provided healthcare benefits:

One of the biggest ways to raise money to pay for health-care reform is also the most politically delicate: taxing employer-provided health benefits. It's an idea that Obama criticized when his opponent John McCain proposed it during last year's presidential campaign, but one that his top White House advisers now say should remain on the table. And it is an approach that Senate Finance Committee chairman Max Baucus says he is considering.

It's easy to see the appeal, if you look at the numbers. The Congressional Budget Office has estimated that fully counting employer-provided health benefits as taxable income could bring as much as $246 billion a year into federal coffers.

http://www.time.com/...

Basically, taxing employer health benefits would pay for healthcare reform.

As both Ezra Klein and Karen Tumulty noted, this idea isn't that popular. I remember when I first posted a diary about this very same topic about a month ago, I got a lot of disbelief and downright anger when I even broached the topic:

http://www.dailykos.com/...

At that time, the New York Times article had a front page story where the administration announced that they were thinking about it. Ezra Klein and even The New Republic's Jon Cohn were reporting that this idea was floated by Congress on their blogs. But like I said before, people didn't want to listen and/or just couldn't believe that President Obama would consent to a proposal like this.

Congress (and probably the White House on the sly) have been negotiating over this matter for months. Max Baucus and the Senate Finance Committee are writing the healthcare reform bill as we speak. The Finance Committee has already finished writing the healthcare delivery system portion of the bill, which you can find here:

http://www.finance.senate.gov/...

Obviously, if Karen Tumulty, someone in the mainstream press, is writing about how to pay for healthcare reform, then it's obvious that they're still working on that part of the legislation now. It's also quite clear from Tumulty's article that they are weighing different options on how to tax employer provided healthcare benefits:

More likely than a total elimination of the favorable tax treatment is the prospect of putting some kind of limit on that deduction — forcing workers to pay taxes, for instance, if their employer offers a particularly lavish plan. Or lawmakers may come at it another way, curbing the tax deduction that companies can take for offering those benefits.

So, here are the options:

1.) Tax all healthcare benefits AKA McCain campaign plan
2.) Tax healthcare benefits if they go over a certain level. I think I remember Ezra Klein talked about this option a couple of months ago and quoted the figure of taxing benefits that went over $12,500 but I'm not sure about that quoted figure.
3.) End the business deduction for employers providing healthcare benefits.

These are the options for coming up with $1.7 trillion in revenues to pay for healthcare reform. If you don't like these proposals, now is the time to call your Congressman and Senators, particularly if they are members of the Senate Finance Committee.

If you don't like these proposals, then I would humbly suggest that you come up with a solution to pay for the $1.7 trillion that will accrue over 10 years for healthcare reform.

My solution would be to impose a VAT (Value Added Tax) to pay for healthcare reform, replace the AMT (alternative minimum tax) and fill the budget deficit gap.

What's your solution to pay for healthcare reform?

Originally posted to ademption on Thu Apr 30, 2009 at 07:00 PM PDT.

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Comment Preferences

  •  It will pay for itself. (3+ / 0-)

    Over the whole economy, that is.

    The government will have to get some money, but it will be balanced out by lower health care premiums for very large numbers of people.

    I suggest using the cap-and-trade revenue.  It's going to have to be enormous, because we are going to need a very low cap to avoid catastrophe (see Financial Times today).

    -5.63, -8.10. Learn about Duverger's Law.

    by neroden on Thu Apr 30, 2009 at 07:02:57 PM PDT

    •  to clarify (0+ / 0-)

      cap-and-trade revenue will be enormous.  It'll cover health care, social security, and the budget deficit while leaving room to cut many taxes.

      -5.63, -8.10. Learn about Duverger's Law.

      by neroden on Thu Apr 30, 2009 at 07:03:58 PM PDT

      [ Parent ]

    •  Incorrect (0+ / 0-)

      any cap and trade revenue , according to obama, will go straight to the making work pay payroll credit, so americans will not have to suffer from devastating increases in energy supplies.

      Positions: Expand free trade, remove farm subsidies, balanced budgets, and expanding the death penalty.

      by sensiblecentrist on Thu Apr 30, 2009 at 07:04:09 PM PDT

      [ Parent ]

    •  I cannot think of a more idiotic idea (0+ / 0-)

      We need a gasoline tax but the tax revenue should go right back to the people according James Hansen's formula.  

      Also HR 676 explains how it would funded and that is a hell of alot more sensible than cap and trade with all that extra political baggage.

      I cannot think of anything more stupid then mixing the revenues of both of these politically explosive subjects.  

    •  I thought cap and trade was dead this year (0+ / 0-)

      given that Dems in oil, natural gas and coal rich states were against it? I haven't been following the energy issues as much, so I don't know where we are in the legislative process but I think cap and trade was devoted to paying for something else in the budget if I'm not mistaken....

    •  That isn't paying for itself.. (0+ / 0-)

      If they lower premiums to you, thats more money they have to make up.

      Your costs don't count. They just want to keep you from making noise, and keep you voting for them in 2010 (thanks to the bailout funds, that may be before the shit really hits the fan, economically.)

      Sick people fall off the map.. When you are sick, politics is a low priority. You often dont have a job, or if you still do, you are trying to save it.

      Sick people are basically uninsurable. Nobody wants them. Especially not politicians.

      They will exempt us from having to buy insurance. Thats it.

  •  Cap and trade and tax the rich... (0+ / 0-)
    •  what happened to taxing the rich? (1+ / 0-)
      Recommended by:
      The Crusader

      They only pay into Soc. Security up to $100,000 dollars. Tax 'em for every dollar they make and apply it to health care.  Also, make MANDATORY Pharmaceutical deals, like they do at the V.A.  these pricks have been havin' it their way for 30 years.  How much longer do we hafta put up with the unfathomable GREED of the top 2%?  They got rich on the backs of the poor and have all but made the middle class extinct.  AND STILL WE PAY FOR THEIR LAVISH LIFESTYLE!  (Fuck 'em).

      "The perpetrators must be on the winning side, and never subject to prosecution for anything-by anyone. THAT is a coup d'etat".

      by eddienutzak on Thu Apr 30, 2009 at 07:54:14 PM PDT

      [ Parent ]

      •  Even if you taxed their income by 100% (0+ / 0-)

        you still wouldn't come up with enough revenue to pay the $1.7 trillion for healthcare reform.

        Again, what's your solution for paying for healthcare reform? If you have one, you need to tell your representative in Congress and the Senate now while they are writing the bill....

        •  Adverse Selection: definition from The Economist (0+ / 0-)

          "Adverse selection

          When you do business with people you would be better off avoiding.

          This is one of two main sorts of market failure often associated with insurance. The other is moral hazard. Adverse selection can be a problem when there is asymmetric information between the seller of insurance and the buyer; in particular, insurance will often not be profitable when buyers have better information about their risk of claiming than does the seller.

          Ideally, insurance premiums should be set according to the risk of a randomly selected person in the insured slice of the population (55-year-old male smokers, say). In practice, this means the average risk of that group. When there is adverse selection, people who know they have a higher risk of claiming than the average of the group will buy the insurance, whereas those who have a below-average risk may decide it is too expensive to be worth buying.

          In this case, premiums set according to the average risk will not be sufficient to cover the claims that eventually arise, because among the people who have bought the policy more will have above-average risk than below-average risk.

          Putting up the premium will not solve this problem, for as the premium rises the insurance policy will become unattractive to more of the people who know they have a lower risk of claiming. One way to reduce adverse selection is to make the purchase of insurance compulsory, so that those for whom insurance priced for average risk is unattractive are not able to opt out.
          "

          •  I know all about adverse selection and (0+ / 0-)

            cherry picking. Again, as I've said in this diary, I've been following the healthcare reform debate very closely. I know about the potential problems with the public option. I agree with you that it could become and most likely will become a dumping ground for people with preexisting conditions and become a new Medicaid for that group.

            But we work with the Congress and the lobbyists that we have not the Congress and the lobbyists that we wish we had. If we can't get Congress to pass cramdown legislation in this environment where banks are pretty popular, how do you expect to get them to pass single payer system, eliminating the jobs of health insurance company employees and billing people at hospitals and doctor offices? They do not want to be responsible for causing these people to lose jobs. Too many people benefit by the system as it exists now including specialists who make too much, hospitals who make a lot of profit from the way our system works etc, etc.

            Insurance companies are a favorite whipping boy here, but they aren't the only villains in our healthcare system. Just one of many....

            •  WHERE will all the money come from? (0+ / 0-)

              I have health problems.

              I am one of the people who can't get insurance now. I'm afraid that people like me will make the price of any underfunded government/private hybrid program unaffordable. I'm also concerned that the ideas put forward so far will fall afoul of WTO regulations on public/private competition. Rules that the Bush administration fought for prevent governments from competing with drug companies and health insurers.

              Single payer avoids the issue, but if we don't,
              that mess will take years to work out in secret WTO tribunals.

              The New York health plan is too expensive for me..
              This is what rates look like when only sick people who are also by necessity the well to do need to/can afford to join:

              April 2009

              New York County

              source http://www.ins.state.ny.us/...

              Monthly family premium rates for Point of Service Plans (POS)

              $4450 - Aetna Health. Inc.
              $3776 - Atlantis Health Plan, Inc.
              $4066 - Empire BlueCross BlueShield HMO
              $6824 - GHI HMO Select, Inc.
              $4187 - Health Insurance Plan of Greater New York, Inc.
              $3816 - Health Net of New York, Inc.
              $3500 - Managed Health, Inc.
              $4208 - Oxford Health Plans (NY), Inc.

              They also have HMOs but they offer substandard care - they often send you to gag-claused doctors who will run you around in circles for years and you never get better.

              http://www.ins.state.ny.us/...

  •  Wait, government has to pay for things? (1+ / 0-)
    Recommended by:
    Alexandra Lynch

    Why don't they just pay for it the way they did the bailouts, our military, and everything else they've ever bought?

    They just push a button on the magic money machine, and it appears out of nowhere. I don't know how it works, but it does, and dammit, it better not stop working while I've got my hand out! Give me some free healthcare already!

  •  I will be happy to contribute some of the 1200.00 (9+ / 0-)

    per month I currently pay for crappy COBRA insurance.

  •  I have some questions. (2+ / 0-)
    Recommended by:
    LI Mike, Katie71

    If we had a single payer wouldn't that end all other health care plans that we pay for now. Medicare, congress and government employees including state and municipal workers V.A medical care, teachers. We the tax payers already pay these benefits. If we went to a single payer wouldn't we save money by decreasing all the various programs we pay for now. I really don't know

    •  My basic understanding is (2+ / 0-)
      Recommended by:
      middleagedhousewife, debbieleft

      that the solution that's getting the most traction now is a publicly financed option for people who do not have access to private insurance through their employers, but people who still have private insurance will keep it, which, from my understanding, is the worst of both worlds.

    •  You only need to be covered once (1+ / 0-)
      Recommended by:
      ferg

      This is the key point.  If someone is already in Medicare or under the VA, they are covered.  Medicare is relatively cheap once you take into account what population they cover (i.e., if they cost money, it's because people are relatively old, not because alternative provision would be cheaper).  And the VA is very efficient.

      To the extent that public health care spending goes up, private spending will fall more.  Administrative spending will fall substantially, as our spending on admin drops from its current ridiculous level down to what it costs in countries like Canada or France.  Taxes might rise, but payments insurance companies would fall more.

      Financing is not going to be the kind of problem the diarist may be worrying about.

      "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

      by mbayrob on Thu Apr 30, 2009 at 07:40:10 PM PDT

      [ Parent ]

      •  Would all plans be rolled into one? (0+ / 0-)

        If it was single payer wouldn't they all be rolled into one. Like one big Medicare program. I would also love to see the lap-o-lux-o plan the congress gets  rolled into the single payer plan.

        •  Statements suggest incrementalism (2+ / 0-)
          Recommended by:
          ferg, The Crusader

          No, Obama's statements make it pretty clear they intend to create programs that cover classes of people who are not well served right now, but that as much as possible, they want to keep most people who are well covered right now in the same systems they are in now.

          So consolidation of systems is not on the table right now.  Which is fine, really.

          The key thing to watch is the availability of a public option that is outside of insurance company control.  This is where we can get real savings, and where we can get effective leverage on the insurance rackets.

          The alternative to that availability is a government subsidy of the insurance companies, which will at best make insurance more available, but which probably won't be cheaper.  And if we let the insurance companies continue to deny coverage under the modified system, it will be a very expensive, craptastic mess.

          "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

          by mbayrob on Thu Apr 30, 2009 at 07:51:50 PM PDT

          [ Parent ]

  •  health care reform is cheaper not not reforming (1+ / 0-)
    Recommended by:
    Katie71

    it's just u have to think long term, like 30 year

  •  payroll tax (2+ / 0-)
    Recommended by:
    middleagedhousewife, eddienutzak

    Increase the Medicare payroll tax and enroll everyone in Medicare.

    Problem solved.

    •  if we (2+ / 0-)
      Recommended by:
      ferg, eddienutzak

      take all the Federal health care funding, including Federal civilian and military employee benefits and aid to the states and put this into a single pot along with the Medicare payroll tax and use this to pay for a single payer program, I think we'd have a good start towards the $170B/year Klein estimates. (though this would be front-loaded for obvious reasons)

      We can also add an employer tax (lower than the average per-employee contribution) and provide no exemptions for providing employee health care.

      Looking for intelligent energy policy alternatives? Try here.

      by alizard on Thu Apr 30, 2009 at 07:36:41 PM PDT

      [ Parent ]

      •  yep (1+ / 0-)
        Recommended by:
        alizard

        I think we're basically saying the same thing.

        I'm just suggesting we think of the medicare payroll tax as our health care premium.  It probably needs to rise a bit, but nowhere near as much as a current health care premium, so most people and businesses would save tremendously.

  •  There may be ways to finesse the tax exclusion (3+ / 0-)
    Recommended by:
    The Crusader, ademption, Pris from LA

    In the campaign, Senator Clinton suggested capping the exclusion from taxation of employer-sponsored health benefits for people with high incomes.  Here is a link to testimony last summer from the Congressional Joint Committee on Taxation (click on the download button to get the .PDF file) that estimates that current savings from eliminating the exclusion for people with incomes over $200k would be roughly $13-16 billion per year.  Under JCT's baseline the tax expenditure (that's what they call certain tax breaks like the exclusion for employer-paid health benefits) grows rapidly, the same pace as projected health costs, about 5-7 percent per year.  Thus the 10-year cumulative savings would be considerable.  Of course, to prevent a tax rate "cliff," the exclusion would have to be phased-out as annual income rose over a certain range, perhaps $175-250k.   (These figures are sort of averages for illustration, and don't consider tax filing status.  So the phase out range might be lower for single taxpayers, a little higher for head of household filers, and higher again for taxpayers filing married joint returns.)

    The problem with basing a cap or elimination of the exclusion on the "lavishness" of the benefit is that it's hard to judge what's lavish or what's just expensive because the group has more older, sicker workers.  For example, a business with a very high-deductible or bare-bones coverage but with workers with average age 55 might have higher premiums than a business with younger workers but richer benefits.  Expected health costs rise at least 3 or 4 (or even 5 or 6 times) as people age from 20 to 65.

    I hope President Obama's proposal to cap the tax rate applicable to certain deductions is brought back on the table.  That, plus phasing out the exclusion for people with higher incomes, plus some very sensible Medicare payment changes could go a long way toward paying for a decent health reform package.  Eliminating the business deduction, I believe, is a bad idea, which would cause a real erosion of employer coverage.  (Capping the exclusion for people with high incomes, I think, would cause much less of a problem with that.)

    Sorry for the long comment, but one more thing.  I think a lot of us who went through the health reform disaster in 1993 and 1994 think of this year as a "do or die" for health reform.  I agree, sort of.  I think we MUST pass something this year to get the ball rolling.  But I also think the president has a new philosophy, which hasn't been tried before.  I think he's going to get his big agenda items, like health reform, energy and climate, education, started this year, even if he has to compromise quite a bit for budgetary reasons.  But then, I think he's going to keep coming back in subsequent years for incremental add-ons and improvements or mid-course corrections.  After all, the economy will eventually recover, and the budget picture will look better.  This Administration is able to multi-task on domestic policy, and he'll challenge Congress to do the same.  He has spoken about his intent to be persistent, and I believe that.

    Thank you for posting a thoughtful diary, and, again, I apologize for rambling.  It's a very important topic.

    •  Thanks for the link (0+ / 0-)

      I want to look at that as I'm not only interested in healthcare policy, but tax policy as well.

      The problem with basing a cap or elimination of the exclusion on the "lavishness" of the benefit is that it's hard to judge what's lavish or what's just expensive because the group has more older, sicker workers.  For example, a business with a very high-deductible or bare-bones coverage but with workers with average age 55 might have higher premiums than a business with younger workers but richer benefits.  Expected health costs rise at least 3 or 4 (or even 5 or 6 times) as people age from 20 to 65.

      I think this is one of the reasons why unions are so against this tax. They have a lot of older workers including retirees who would be affected by this tax change. I didn't mention it in this diary but Baucus also extends Medicare down to 55 year olds. I guess employers would stop providing health care insurance or just offer health care supplemental to 55 year olds and above to reduce their costs.

      I really think it depends upon how Congress envisions healthcare in the future. Should it be employer-based or not? Or should it be an individual responsibility? I can see both sides of the issue....

  •  We pay more for health care, and get less health (8+ / 0-)

    The issue isn't how we're going to pay for it -- we pay the most of any developed country per capita for health care, and we get less for our money than places like France or Germany.  Hell, the UK pays something like half of what we pay, and people live longer in better health.

    The issue is how we cut the insurance companies out of the loop, since money that goes to them is going right down the toilet: they make money by leaching off the system, and forcing everyone else to cover for the dead weight of their admin costs, and the costs imposed on patients and doctors as the insurance companies attempt to avoid paying claims, avoid covering people, and avoid proactive and preventative care of the kind that saves money in systems better run than ours.

    Mostly, we're talking about shifting the money we already pay to the insurance rackets to the government instead, either as health fees or taxes.  It's a good deal for everybody who makes an honest living.  If the insurance companies have a problem with that, well, they need to start making an honest living for a change.

    "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

    by mbayrob on Thu Apr 30, 2009 at 07:35:08 PM PDT

    •  Simple (0+ / 0-)

      Repeal the Constitution, pass the program, reinstate the Constitution.

      Any idiot knows what needs done, in a thousand different emergencies. What takes rocket science is getting it done in the United States of America.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Thu Apr 30, 2009 at 07:39:16 PM PDT

      [ Parent ]

      •  What's the Constitution got to do with it? (4+ / 0-)

        Really.  What does it have to do with it?

        The politics may be hard, but the problem isn't legal, except to the extent that bribing politicians is legal in the US -- which it certainly is.

        "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

        by mbayrob on Thu Apr 30, 2009 at 07:42:03 PM PDT

        [ Parent ]

    •  I wish I could rec this coment more than once.n/t (2+ / 0-)
      Recommended by:
      salmo, txlosthorn

      "The perpetrators must be on the winning side, and never subject to prosecution for anything-by anyone. THAT is a coup d'etat".

      by eddienutzak on Thu Apr 30, 2009 at 08:00:49 PM PDT

      [ Parent ]

    •  Well getting rid of insurance companies (1+ / 0-)
      Recommended by:
      Pris from LA

      is not on the table. I've been following this issue very closely. Last week, Max Baucus said that single payer was not on the table. He has often said that we are looking for a "uniquely American" solution to healthcare. When asked at the virtual townhall meeting last month about single payer, President Obama took it off the table. Hoyer conducted a townhall meeting and he was honest said there just aren't enough votes to support single payer.

      Single payer supporters had a hard time even getting a seat at the table for the White House Healthcare Summit a month ago and that was with a lot of coaxing. The healthcare bill is being written now behind closed doors. Baucus et al have invited the lobbyists a seat at the table during negotiations and single payer supporters aren't invited. That's the reality, ok?

      We'll be very lucky if we can get the public option. VERY LUCKY. In the meantime, no matter if we go to single payer or just have a public option, we've got to figure out how we're going to pay for it. We've got to pay for electronic IT, the agency governing comparative effectiveness studies, bonus payment financial incentives for primary care doctors/nurse practitioners etc.

      So again, what are your suggestions for paying for healthcare reform? If you've got any suggestions, I would suggest you call your Senators and tell them since they are writing the bill as we speak....

      •  Public option will cost more than $4k/month (0+ / 0-)

        It will be very expensive.. because all ths sick people who are uninsurable will gather there. Really, that will doom any public program.

        Google "adverse selection" in the context of healthcare.

        •  This is, well, crap (0+ / 0-)

          No, adverse selection is not the problem unless the public option is designed to be undesirable.

          You not what you are speaking of.

          A public option can be something as simple as a health cooperative that is not run by the insurance companies.

          "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

          by mbayrob on Fri May 01, 2009 at 02:16:50 AM PDT

          [ Parent ]

          •  it is designed to be undesirable (0+ / 0-)

            because of the fact that it will be the only option that will accept (or is supposed to accept) the huge percentage of people who can't get nongroup coverage. (everybody who is not covered through their jobs, most of whom can't get insurance now for an affordable price)

            If costing more than what most people can pay, or offering limited coverage in cases of chronic illness is failing, and it is, it is designed to fail.Thats what many experts have been saying for 2+ years.

            PNHP blog has a good explanation of why this happens.

            For example, in MA, around 5-10% (most of them are those people who dont get insurance throuh jobs, for example, self employed or unemployed, and who either themselves or have a family member with health issues) still can't find insurance they can afford.. so they exempt them from having to pay fines for not having insurance. And they remain uninsured, with the added burden of not being able to get free healthcare like they used to.

            People keep saying Obama promised this and Obama promised that but often, they are confusing things that other people said with Obama. Obama said no such thing. The reason he avoids a mandate is because its going to be too expensive for many people.

            For example, the plans that Senators have cost the government around $40k/yr.

            (even if the Senators get them for free or very cheap, its subsidized)

            Read the fine print.

      •  WTF is your problem? (0+ / 0-)

        Since you are misrepresenting what is going on.

        Yes, the insurance companies are fighting a public option, since they want the kind of deal from Obama that the banks and AIG have gotten.

        The concept here is called public-private competition, and it's not new.  Perhaps new to you.  But not new to the folks who are not shilling for the insurance companies.

        "If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what's our problem? "

        by mbayrob on Fri May 01, 2009 at 02:19:26 AM PDT

        [ Parent ]

        •  They don't have unlimited money for subsidies.. (0+ / 0-)

          In fact, the recent talk has been about making it "revenue neutral" which means NO, zero, none- subsidies at all.

          That means that if you are sick, or if you NEED it for some reason, you will be forced to pay its full cost, so this program will be very, very expensive. Only the sick and well to do will have that option.

          I don't know how you can sit there and tell yourselves that Obama will pull money, trillions of dollars, out of a hat..

          His victory repudiated the whole idea of universal healthcare. He is on the record saying that single payer, the only solution that could actually work, is "off the table".

          The probablity is that we will have a several year diversion into somethng that fails, and eventually, we will realize that we screwed up but by then unemployment among the working class will be so high we wont be able to afford anything of the kind.

          That is my guess at what the insurance companies and drug manufacturers hope.

  •  We're Already Paying More Than Single Payer Costs (1+ / 0-)
    Recommended by:
    ferg

    And the National Health we already run already has the most expensive customers, the elderly and veterans.

    We're already spending all we need to.

    Of course, since we're not going to adopt single payer, the program we're going to implement WILL cost a lot more.

    We need to generate a LOT more profits than we're doing now.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Apr 30, 2009 at 07:38:11 PM PDT

  •  We are already paying for health care (4+ / 0-)

    The problem is not how to pay for it but how to get rid of the private health insurance companies.  The profits and expenses of these private health insurance companies do not go to health care.

    •  Exactly (2+ / 0-)
      Recommended by:
      ferg, Pris from LA

      Without the money-changers the bill would go from your doctor to DC where the doc knows exactly what they will be paid.

      Docs can reduce costs by retiring 90% of their billing staff.

      Med insurance middle men and payment denial experts go to the unemployment office in hope of finding an honest living.

      Health Ins. Companies are the fat to be cut. They add no value to the health equation. They must be kicked out of the Health Care Temple.

      Now.

      "Be yourself; everyone else is already taken." - Oscar Wilde

      by greendem on Thu Apr 30, 2009 at 08:16:40 PM PDT

      [ Parent ]

  •  wait a minute... (0+ / 0-)

    $634B is what's in the current budget for a national health program.

    $1.7T averaged over the 10 years Klein calls for is $170B/year, though I would expect this to be front loaded. If Klein's numbers are any good, what is the problem?

    As for what I think we should be doing... see below. Though I may actually be calling for more money than is really needed.

    I would very much like to know where Klein is getting his numbers. (the spreadsheet available for download would do) They seem too good to be true.

    Looking for intelligent energy policy alternatives? Try here.

    by alizard on Thu Apr 30, 2009 at 07:44:19 PM PDT

    •  The problem is as I stated in the diary (0+ / 0-)

      is that every proposal that President Obama stated in his budget to pay for health care reform has been rejected by Congress. They don't want to reduce the charity or mortgage deductions for people making $250,000 or above. Where's the money going to come from?

  •  1) Single payer, no more overhead. We're done. (5+ / 0-)

    You're trying an ass-backward approach to prying the fingers of for-profit insurers from America's throat. This is a really bad idea which provides a perverse incentive for employers to drop health insurance at the speed of light. There will surely be a substantial gap between loss of employer-provided insurance and any public plan picking up the slack; the number of Americans lacking health insurance will explode.

    Instead, attack the problem head-on. Set up a public health insurance option that is simply open-enrollment Medicare. Overhead is zero, everyone already understands the system, infrastructure is already in place. Then provide a positive incentive for employers to support/subsidize it- not a negative incentive driving them to abandon their current coverage.

    •  well put (2+ / 0-)
      Recommended by:
      Ralphdog, Pris from LA

      Pass a bill that says this:

      1. Any citizen of the United States may now enroll in Medicare.
      1. It costs this _ much.
      1. The plan may be purchased by a third party for any individual.
      1. The cost is tax deductible for the payer.

      The big taxpayer savings may come from local and state governments switching to it if they will.

    •  Umm, it's not me (0+ / 0-)

      I'm not the one that came up with the idea of taxing employer provided health care benefits. That's Congress, particularly Max Baucus of the Senate Finance Committee. I am trying to convey to you that this is how Congress plans to pay for healthcare reform if they don't reach an agreement to find an alternative tax solution.

      If they can't come to an agreement that abides by the paygo rules, healthcare reform isn't happening this year.  

      Again, if you don't like this idea, what's your solution (other than single payer which isn't happening) to pay for healthcare reform?

  •  let me put it this way (0+ / 0-)

    I capped out with Obama by credit card 1 minute and 15 seconds after McCain mentioned his "plan" to tax employer provided healthcare.  

    •  Well think about it this way (0+ / 0-)

      If the Senate Finance Committee adopts this proposal, President Obama can argue that he accepted a Republican offer proposed by his campaign rival in the spirit of bipartisanship. That's how his press office would try to spin it.....

  •  Raise My Taxes Please (1+ / 0-)
    Recommended by:
    txlosthorn

    Seriously. I won't miss 2 or 3% off the top.
    It's worth it to me personally if Americans
    can live without the constant fear of medical
    bills or lack of care ruining their lives, or worse,
    a premature death.
    We can't "serve the general welfare"
    without paying for it.

    The truth of who we are exists outside of and prior to time..

    by post rational on Thu Apr 30, 2009 at 08:30:55 PM PDT

  •  Efficacy is the standard (2+ / 0-)
    Recommended by:
    Alexandra Lynch, txlosthorn

    Aren't we told regularly that the question of whether or not to prosecute torture should be settled based on whether or not it was "effective."  Never mind the law, Republicans say.  Well, I can think of a whole bunch of really effective ways to pay for health care - do you suppose Republicans would agree to apply the same rule?

  •  They want to make healthcare revenue neutral (0+ / 0-)

    The first thing that we need to understand is that Obama's priorities are with healthy people in corporate jobs. He wants to make it cheaper for businesses to buy health insurance for their employees, and he doesn't want to abolish the system that locks many workers to their jobs out of fear of losing health insurance. Any changes to those fundamentals seem off the table. That doesn't leave much to work with. Every change that lowers the rate of increase for healthy workers will probably increase costs or decrease access for the sick, or god forbid, chronically ill. And during this first round, we aren't talking about drugs, just hositalization. The end result will probably be a system that offers plans like New York State's - at comparable costs.. $4-5k a month take it or leave it. Only the very affluent sick will be able to afford it. The other alternative Ive seen discussed asks people to pick what diseseases they want covered in a sort of cafeteria style way, basically asking them to predict the future, what diseases they might get sick from. That way, if I have lung cancer insurance and get lung cancer, I am covered, but if I end up with lupus, its my fault, I'm on my own.. I didn't want that.

    This will keep costs down, but a lot of people will fall through the cracks.

    I really dont see any option for many people apart from emigration. Otherwise, each "gift" from the government comes with strings that make it much less workable. For example, if they expand Medicaid, eerybody who makes claims will lose their assets to the government.. no houses or savngs to give children.. poof...

  •  Employers already shun those over 35-40 (1+ / 0-)
    Recommended by:
    Pris from LA

    Its because of health insurance.

    There are millions of Americans who can't get any job because of the cost of insuring them.

    People who should be in their prime working years but because of the cost of health insurance nobody wants to touch them.

    The average job lasts 3 years on the west coast.. we are still stuck in the 20th century mindset about "jobs".

    Those good jobs may never come back. Machines and software do more and more. Taxing health benefits will be like pouring gasoline on a fire.

    Business can often function on very few people. Many still dont realize this, but they will, if we make them take on a responsibility that is really not theirs.

    Other countries deal with these changes much more honestly.

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