I follow the Fray on each health-related article and can only note a dearth of supporters' explanations for how a public option would be paid for (that is, work or succeed). Supporters say single-payer, Medicare-for-all is the way to go. OK. I can understand the desire because people are familiar with Medicare, they see it work for the elderly and disabled, and they feel entitled to future benefits because money comes out of their pay for every hour worked. If you like Medicare, you call it a social contract between generations, where the young (ages 14-64) pay for the old (65+) and disabled. If you don't like it, you call it a Ponzi scheme where a large generational cohort (Baby Boomers) are going to leave everyone else holding the bag in the form of large, unfunded, projected benefit obligations. In any case, it seems the most logical path, if it can be sold politically.

I happen to one of those lucky, employed and insured (through Wellmark) individuals that may be suspicious of sweeping change. I'm fairly young and in good health. The few times I've submitted insurance claims, I've been treated fairly and my co-pays are low. I'm happy now. However, I realize that costs will increase and my situation may be less favorable in the future, so I can be sold on reform, perhaps.

Then, if folks had my coverage, everyone would likely be happy. If 300M Americans had my coverage, it'd cost $1.44 Trillion ($400/mo x 12 X 300M) each year. Reuters says that all the big insurers only bring in $404 Billion and change, and that includes their investment income, in addition to premiums. Forget about big profits and greedy CEOs. If we just grabbed ALL their money every year and didn't let them pay any claims, we're still a Trillion short each year. Of course, people might be upset to pay $4800 per year for nothing. We'd need to tax certain people that were paying premiums, say $4800 per year, to get them to hand over the cash. That gets us to $404 Billion. To get the other missing Trillion, each of our 300M will need to also pony up $3,333.

These are simple assumptions. If everyone was covered, costs should be less, per person. However, we're also bringing many new people into the system and not setting aside $ for new docs, nurses, medical equipment and infrastructure. We're also not accounting for the annual premium increases that inevitably come, although hopefully less steep if everyone was kicking in.

Say annual median income is $50,000. Current Medicare tax is 2.9% (1/2 employer, 1/2 employee, currently). I'd no longer have to pay premiums but (if I'm median income) my new Universal Medicare rate would be 16.3% [X = ($4800+3333)/50000], because we need to replace the premium money and the extra Trillion needed to get everyone else in the system.

Let's review my new world in Universal Medicare: My tax rate went up 13.4% for each hour worked and millions more people (pick your favorite number) are now in line in front of me for health care.

I'm not screaming "Obama wants to kill granny!" I'm not hyperventilating over "death panels." It can be reasonably argued, however, that I'm significantly poorer and that my care got worse.

The failure of universal access/care supporters to address the cost issue reveals a lack of seriousness. It makes it appear that you want something for nothing (or something so long as someone else pays for it) and also that you don't value the efforts that people have to put forth to finance their health care, currently.

Sell me.

<link>

(I'm using the HCOMP 2007 number)

All your math is pointless because the health care reform bill is about more than just insuring everyone--it's about making changes to the entire health care industry, not just insurance. You can address the cost of insuring everyone in concrete numbers if we were talking about providing private insurance or medicare to everyone within the current system. However, it's not even close to being that simple.

So sorry, no one can sell you on the cost until we know how the system itself will be reformed and what those reforms will do to the overall cost of health care. Then, when the administration figures out the best way to provide "insurance"--whether to expand medicare, create a separate public option, or simply legislate and mandate private insurance, or do nothing in this regard, then perhaps your math will be worth something.

Sorry guy, you have questions and of course those questions should be answered, but you're just going to have to WAIT.

Thanks for your thoughtful post. I'd like to challenge a couple of underlying assumptions, however. First, the raison d'etre of health insurers is to make money, not provide access to health care. Therefore, the issue of health insurance premiums has absolutely nothing to do with the cost of provision of health care. This leads, secondly, to the fact that the US has the highest cost per capita for actual delivery of health care in the industrialized world but does not have the "best" health outcomes if measured, .e.g in terms of life expectancy link link , because, for example, short term cost considersations drive poor health-related decisions. Would it be cheaper to provide everyone with subsidized health club memberships or wait until everyone has Type II Diabetes and then pay for treatment of that disease? The bottom line is the tension between underlying ethos of private health insurers - profit and accountability to shareholders - versus that of a government-sponsored or -provided program - actual delivery of health care and accountability to the public - along the lines of Medicare and Medicaid.

My two cents.

Too much change, too fast. We are being bulldogged by Democrats because they fear the next election cycle. This may be the best health care package to come toward us in a hundred years, but it's going to take time to sell it, lots of time.

If the government can explain the details of this reform package so that a junior high kid can understand it, we will be in the ballpark. As it is, mostly we have confusion, and that's not getting any better simply because our government honestly expects us to follow their "lead" when they can't prove they even understand the package they are selling. Again, we are being bulldogged...

Wrong, the government does not expect us to "follow their lead" anymore than we usually do, given that we live in a Representational Democracy/Federal Republic (which in its very definition requires the public to follow the lead of their elected officials...you do live in America, right? You understand what an electoral system is and how it functions?)

The government has not explained its package because it does not have a package yet. They aren't selling a package because, as of right now, there IS no package.

No one is bulldogging you, but you DO seem to be paranoid. Perhaps if your insurance covers it, you can seek counseling for that.

Dr. Houser,

Assigning motives to others, such as paranoia and ignorance of the electoral system only serve to put clamps on honest discussion. My point of view does not come from irrational fear of the government. In fact, it's quite the opposite.

And by the way, your reply included this gem, "Wrong, the government does not expect..." Please prove that. Are you responding factually, or is this your opinion, wrapped in an unwillingness to consider any other idea on the subject? You defend representative democracy with a very broad brush. Maybe you could be more specific.

The next time I need someone to serve as my Dad, I'll let you know...

Oh I'm sorry, have you proven any of your paranoid statements? Can you prove that the government is currently expecting you to follow their lead in any way that isn't a product of the fact that you live in a system that requires you, the citizen, to follow the lead of the officials that you elect? Are you going to prove that there is some backdoor way into the system that allows the people more power than they actually have and that this administration is somehow inhibiting the public from access to that backdoor?

I can prove *all* of my statements. Firstly, here is the definition of representative democracy:

Representative democracy is a form of government founded on the principle of elected individuals representing the people, as opposed to either autocracy or direct democracy.

Simple definition, provided by wikipedia. I'm not defending it in as much as I'm simply stating that that is the governmental system of the country that you live in (you know...the USA....you live here right?). What else would you like me to say about it?

Proof that there is more than one bill being bandied about by the government:

This is a link to the bill that was voted on by the house: <link>
Here is a link to an LATimes article that discusses the VARIOUS bills being considered at the moment: <link>

And here are the definitions of paranoid (both provided by dictionary.com):

1. Psychiatry. a mental disorder characterized by systematized delusions and the projection of personal conflicts, which are ascribed to the supposed hostility of others, sometimes progressing to disturbances of consciousness and aggressive acts believed to be performed in self-defense or as a mission

or more simply

2. baseless or excessive suspicion of the motives of others."

So there you go! Again, if your insurance covers it, perhaps you should check that out.

Doogie, you have (unwittingly) highlighted the very problem healthcare reform advocates have in convincing the public. In response to Iowa City's legitimate question about costs, your response is "you have to WAIT."

For a lot of people that is not good enough. It's like being asked to agree to buy a house without knowing what it looks like or how much it costs. Having the realtor say, "You'll have to wait to find those things out, now sign the damn papers!" is not very comforting.

Cost is a fundamental concern. Every bit as fundamental as the position that healthcare coverage is a right. Rights are not worth anything if the system cannot afford to enforce those rights in a sustainable manner.

You'll notice that no one has answered your question. Every response has been some form of distraction or counter-attack - "well, it's not that simple!"

The fact is, insuring everyone would mean adding insurance for 40-50 people. No one has comptetently demonstrated how this could be done without massive expenditures. The non-partisan Congressional Budget Office came in with a price tag fo rthe Public Option that was incredibly high - one of the things that drove opposition to the plan. Without using actual numbers, some supporters have said that cutting inefficiency will pay for it, which is impossible. Even if the entire insurance industry were done away with, no more than 20% of the current cost of health care would be eliminated.

In fact, a "health care for all" push does come with a price tag. The question is, who would pay for it. Those who believe health care to be a right would say, I don't care how, just pay for it. Raise taxes or borrow money, but whatever you do, just "think of the po' chilluns."

The fact that no one has answered your question is quite telling.

Yes, you have to wait. Sorry. You're not buying a house, you're watching the formation of legislation. To use your strange analogy, you already bought the house in the election and now you're watching to see what the house you bought will do. You can buy a new house in a year, but right now, you already bought your house.

Sorry our political system is not very comforting--perhaps you can advocate to change our representative democracy/federalist republic into a direct democracy. Unfortunately, that's not the neighborhood you're shopping for your house in.

And of course costs are a fundamental concern, and the elected administration has stated, on multiple occasions, that it agrees with that and that one of health care reform's main purposes is to control costs in our broken system.

You can want more than this...but your desires, while human, aren't supported by our system. So....sorry, thems the breaks. You have to wait for legislation to be shaped in order for it to be sold. You can raise your voice in regards to what you hope that legislation looks like, but if you want it sold to you, you have to wait for it to be in its final form.

Wow, your post was pretty telling (telling that you're a misinformed racist idiot).

Thanks for that.

Munich:

You'll notice that no one has answered your question. Every response has been some form of distraction or counter-attack - "well, it's not that simple!"

The fact is, insuring everyone would mean adding insurance for 40-50 people. No one has comptetently demonstrated how this could be done without massive expenditures. The non-partisan Congressional Budget Office came in with a price tag fo rthe Public Option that was incredibly high - one of the things that drove opposition to the plan. Without using actual numbers, some supporters have said that cutting inefficiency will pay for it, which is impossible. Even if the entire insurance industry were done away with, no more than 20% of the current cost of health care would be eliminated.

In fact, a "health care for all" push does come with a price tag. The question is, who would pay for it. Those who believe health care to be a right would say, I don't care how, just pay for it. Raise taxes or borrow money, but whatever you do, just "think of the po' chilluns."

The fact that no one has answered your question is quite telling.

As I said, I don't buy in to the underlying assumptions, which is why I "didn't answer the question." If we assume, as I posited, that preventive health care is less expensive than corrective health care, then considerations about cost must also change. It may be true that to simply insure everyone within the given system would be massively expensive. The whole point, however, is not to simply extend a broken system to everyone but to change the system altogether. That response may not fit on a bumper sticker but it doesn't mean that it's wrong or not addressing the issue.

Exactly, and Munich's ridiculous claim that the ABSOLUTELY TRUE phrase "well, it's not that simple" is somehow a distraction or a counter-attack is telling as well. He's used to simple ideas and simple concepts being forced down his throat and considers the idea that something might actually be complex to be out of the question. Hmmmm...I wonder why.....

Doogie67:

Exactly, and Munich's ridiculous claim that the ABSOLUTELY TRUE phrase "well, it's not that simple" is somehow a distraction or a counter-attack is telling as well. He's used to simple ideas and simple concepts being forced down his throat and considers the idea that something might actually be complex to be out of the question. Hmmmm...I wonder why.....

Right. It's *not* simple. If it were, the problem would have been sorted by now. Duh. The fact that this issue is hugely complex is the reason we're having this conversation. Or screaming at our respresentatives in town halls meetings. Whichever floats your boat.

You can call me names all you want. I'm a grown man, it doesn't bother me. I don't see how calling me a racist (?) disproves anything I wrote.

Leveraging the purchasing power of a large entity (such as the federal government) and cutting out inefficiencies (such as insurance companies) can have an effect on costs. However, even if the BEST outlook on this is assumed, this would be no more than 20% of the total cost of providing health care. And it would very possibly be much less.

The mathematics, as Iowa City pointed them out, are simple. Adding ~50 million people to the pool, adding guaranteed coverage for pre-existing conditions, and then subtracting 20% from the total cost (again, best possible estimate for those who believe in publicly-provided health care), still leaves a huge overall cost increase. Probably close to half a trillion dollars per year. The non-partisan CBO found as much.

Do you have any numbers to counter-act this estimate? How much will "preventive care" save? Yeah, I know ... "a lot." But how much?

Please tell me you have something more to buttress your arguments than accusations of racism.