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Twenty years ago I would not have written this, but I have grown less naive.
Consider human nature…when thinking about paying for healthcare and generating retirement income
We have tried countless schemes to manage health care costs, and expand coverage. Similarly we provide incentives to get people to save for their retirement. The evidence shows only modest progress, but nothing has really solved the basic problems.
We humans are just short-term thinkers.
Over 20 million Americans still have no health insurance. In October of 2024, there were 72.1 million people enrolled in Medicaid, and 7.2 million people enrolled in CHIP – all subsidized by taxpayers.
So, isn’t it time to accept that we are not planners, that we have difficulty with money and implement a universal health care system – no, not socialized medicine – and greatly enhanced Social Security – and pay for both?
Higher taxes? Absolutely, but that does not mean higher individual spending. What do people spend now on health care? What do taxpayers spend on things like Medicaid and CHIPS and various health related subsidies? All that is replaced, not added to.
How many Americans are adequately saving for their retirement? How many will rely mostly on Social Security? How many seniors receive taxpayer funded assistance of various types at both the state and federal level because they don’t have adequate income?
A 2024 study by AARP found that 20% of Americans over the age of 50 have no retirement savings at all. Information from USA facts states that in 2022, 54% of families had a retirement account, this means that potentially 46% of families did not. Isn’t it clear that incentives to save, even avoid taxes are not enough? Now the initiative seems to be auto enrollment, that is grasping at straws.
Sure, in theory we are adults, we should be able to handle our finances, act prudently, plan for the future, take responsibility for our lives. It’s a nice theory and many people do just that, but many more do not and many can’t because of what life has thrown at them.
Simply saying we don’t want higher taxes, we don’t want more government is a red herring- between Medicare, Medicaid, CHIPS and the VA over 40% of Americans are already covered by a government health plan.
Looking the other way doesn’t mean we don’t eventually pay for the significant gaps in our social structure.
Human nature is our greatest challenge and we are not going to overcome that one person at a time.
Alternative practical ideas are welcome.
Might I suggest that anyone who thinks the US medical “system” is fine read this?
There are several different, functional, systems in use in other countries, some with more government involvement and some with less. The problems with changing the US system are political dysfunction and the money spent on lobbying on the on hand, and people and companies benefiting from the excess costs on the other.
I managed the IT dept for a large local govt. Our agency began matching 401k contributions up to 5%. I mentioned this in a staff meeting, telling people this was like a free lunch. A number of staff said they could not afford it. BS! We had a lot of highly paid techs who could afford it. Many were not that far from retirement.
A classic case of short term thinking.
Today’s headline on the main page of HumbleDollar.
“You could fail to contribute to your 401(k) with the employer match—or you could refuse your year-end bonus. Same thing.”
I will definitely be using that comparison with my coworkers. That gets the point across perfectly!
“So, isn’t it time to accept that we are not planners, that we have difficulty with money and implement a universal health care system – no, not socialized medicine”
yes, socialized medicine. As proven by the guy who just died up in Canada waiting twelve hours for medical care in the ER, socialized medicine does not work.
Rather than anecdotes, here is data on US emergency room deaths.
Conclusion: “Patients with sepsis and acute respiratory failure die after a long stay in the ER, and the risk increases with overcrowding. A fast-track pathway should be considered for hospital admission of critical patients.”
I grew up with what I imagine you are calling “socialized” medicine. It worked well. The US system costs a lot more for worse results than the system in any other industrialized country. Presumably you are using “socialized” as an insult. That is not helpful.
Medicare or something like it is not socialized medicine. That is when government runs hospitals and other providers are employed by government agencies. We have been using Medicare for over 15 years and our access to and receipt of care has been no different than the previous 65 years.
if you want horror stories, you don’t have to look to Canada or anywhere else, but right here in the US.
However, the folks in Canada, the UK and other countries would disagree with you. They like their systems and can’t understand why the US doesn’t fix theirs.
i guess this never happens in America…
Is the reason some Americans don’t save for retirement and don’t have health insurance the fact that under our capitalist system, they can’t afford it?
The solution for retirement systems I read about most recently was a joint program to increase social security funding, and to introduce a government sponsored pension plan available to all Americans called a Guaranteed Retirement Account. The joint system ensures income stability, and the pension system ensures access to highest quality long and mid term investments which are only available to large, managed asset pools. It even promises to be revenue neutral. It seemed like a well researched proposal, if anyone is interested.
The key word is “available” There are many saving opportunities already available. Putting them to use for a working life is the problem IMO.
You have to decide what level of healthcare is universal and what must be privately insured. Without doing that you’re entering a consumption spiral that will bankrupt any system.
That’s what happened with Medicare, it basically went bankrupt and then decided to embrace cost shifting to the non-Medicare part of the population.
But that’s the first hurdle, not the nuts and bolts of the payer system, rather what’s universal and what’s individual.
Did anyone mention the effect insurance industry and other special interests would have on negotiations to effect changes to health-care?
Yes, i acknowledged private insurance would have a role. That’s why there is Medicare Advantage – which costs taxpayers extra – and the ACA.
All Americans are required to buy health insurance under the widely known PPACA aka Obamacare. The Supreme Court even rejected 3 challenges to it. It’s illegal to not have health insurance. That’s how that works.
That’s not true any longer, the individual mandate was repealed years ago. Some states, however, do maintain tax penalties for those who go without health insurance coverage.
The penalty (which the Supreme Court called a tax) was repealed, but not the requirement. You may have noticed that you have to file a form with your tax return proving that you have health insurance.
The reason for the insurance mandate as the “uninsured” are in reality insured by those who do have health insurance. There is no free ride. The cost of treating the uninsured is reflected in increased premiums for those who do have insurance.
While I don’t have the expertise to address the myriad of details, your overall view makes sense to me.
While I think that this is a direction we need to go, the devil is in the details.
If you could get the coverage and cost agreements done, the way I would design the system is:
When someone says the easy way to do this kind of thing is via expanding Medicare, the reason is that Medicare contains a coverage plan, administration and billing, amounts to be paid providers and has a funding plan.
Absent beginning with Medicare as a design base, I don’t think that there is any way to get the needed agreements done.
“So each zone would have a single payer plan.”
I think that a Medicare type system where 80% of costs are covered based on federal taxation, then with a required supplement to cover the 20% would be better. This way it gives people some skin in the game, and different options for covering their 20% cost. You could allow any number of insurance companies to provide coverage with different deductibles, and copays, or none. Using the lettered supplement plans which all have the same coverage is a good feature of the Medicare supplement program is a good feature.
Yes to all except there is really only one funding source and that is citizens through taxes, premiums and out of pocket costs. Even employer contributions actually come from workers pockets.
The plan would be based on Medicare, but with modifications such as coverage for pediatric care and obstetrics. I envision a transition period starting by adding new borns and then gradually by age groups and Geographic regions.
Insurers would have to be involved in some way.
Every citizen would be covered automatically and tax paying non-citizens would be eligible.
Out of pocket costs and premiums would be income based. Employers on average pay 8% of payroll today to provide health benefits. They would welcome say 5-6% and no admin costs, no labor related issues.
To start, benefits would be medical and limited Rx only, after the actual experience costs were determined, expanded Rx, vision and dental could be added as long as taxpayers were willing to pay to fully fund them.
No services would be free except perhaps immunizations.
Costs would be adjusted annually to keep it fully funded, that means payroll taxes go up as do deductibles and copays consistent with health care spending.
The system would use pre-certification, concurrent and retroactive review with some services limited. People don’t like that, but it won’t work without it. That is a major flaw of Medicare, people and providers have a virtually a blank check.
Provider payments would be a bit higher than current Medicare.
I have been thinking about this for very long time. During the Clinton era I lobbied Congress and was invited to the White House to provide input and ideas. Unfortunately, after I did that for about 20 minutes, they didn’t like the questions I was asking and didn’t call on me again. 😢
Dick your stab at the problem is much appreciated, and certainly something needs to change. But one problem I see in your plan is the division in the country regarding treatments such as abortion, and transgender care.
Are these covered? Are they not? Who gets to decide? Does it bounce back and forth from term to term based on who is in control of congress, or which party controls the White House?
One of many details to be decided. Hey, we still have people calling Obamacare socialized medicine.
But yet KFF reported in January it has a 64% approval rating.
Yup
I wish it weren’t true but I also find myself coming to the same conclusion. What we’re currently doing, however well it might work for some of us, simply doesn’t work for a significant percentage of the people. I think it’s time for us as a society to accept the data and move towards something that has a chance of working. Planning and saving simply isn’t a realistic expectation for everyone.