/ Westhill Consulting Insurance/ Strong opinions voiced on single - payer health insurance system - Westhill Consulting Insurance
/ Westhill Consulting Insurance/ Strong opinions voiced on single - payer health insurance system - Westhill Consulting Insurance
Start a New Topic » « Back to the Westhill Consulting Insurance group
By JENNIFER ROBISON
LAS VEGAS REVIEW-JOURNAL
If our email inbox is any indication, Las Vegans feel strongly about starting up a single-payer health insurance system.
After we wrote on Jan. 19 about a Vermont lawmaker's federal proposal to mandate that states set up one-payer systems that would operate like Medicaid and guarantee coverage for all, the feedback rolled in.
We've selected two letters with opposing takes on the issue to keep the discussion going.
Once you've finished reading up on the debate, check out how a local consumer got a pleasant surprise when he recently signed up for new coverage.
■ Al Popp reached out with a novel idea. He writes: Let's just expand Medicaid to everyone. How do we pay for this system? We pay for it by taxing all food and beverages at 10 percent. Just add it to the price of the product before the sale, like we do with gasoline excise taxes. If a person spends $200 a week for food and beverages, whether it be in a grocery store, convenience store, restaurant or catering business, one would be paying $20 a week for their health care, which equates to $1,040 a year. That, to me, is affordable health care. The more you spend on food and beverages, the more you will contribute to health care. I'm curious what your thoughts are on this plan.
Well, Al, I'm a reporter, so I'm completely flexible and I have no opinions.
In the interest of public debate, though, your plan is definitely worth sharing.
One common criticism of this kind of funding source is that poor Americans spend an above-average share of their income on groceries, so it becomes a regressive tax that penalizes lower-income earners more than wealthier households. This is why Nevada's sales tax exempts food bought inside grocery stores.
So although you're correct that people would pay less if they spent less, a plan to tax food and drink would disproportionately hurt discretionary income among working-class households.
Plus, low-income households already face higher food costs because their neighborhoods might have fewer supermarkets and pricier food as a result.
As you note, Al, your idea does have upsides. No one would be mandated to use Medicaid; they could still buy a private plan for more coverage, the way some affluent households pay both local property taxes and private-school tuition. International tourists who buy pricey meals on vacation also would feed into the system. And undocumented residents would pay as well, anytime they visit the grocery store. So would "panhandlers, the underground market and cash-paid workers," as you said.
So, readers: Add what you'd like to Al's suggestion.
■ On the other side, Las Vegas insurance broker Patrick Casale chimed in on single-payer with this: There are five reasons single-payer can never work for the United States: immigration; taxation; capping doctors' and hospitals' earnings; capping Big Pharma; and medical access.
Part of Patrick's concern is that our country already is strapped financially, and a plan that opens free health care access to all (Medicaid doesn't charge copays or premiums) would be unsustainable given current immigration rates. What's more, he said, countries with one payer "have a tax rate that exceeds 50 percent, and numerous other taxes," including sales taxes. Accounting firm KPMG backed that up with a 2012 study that pegged top marginal income-tax rates at 56.6 percent in Sweden, 55.4 percent in Denmark and 48 percent in Canada. The marginal U.S. rate is 39.6 percent.
Making a single-payer system work also might require limiting hospital charges and incomes, and that would in turn hurt access as providers perform fewer procedures to control costs, Patrick said. And tangling with the major pharmaceutical companies on what they charge would be a Herculean task in what he called "the most overdrugged nation worldwide."
Patrick said he also would like to see the federal government eliminate fraud in Medicare and Medicaid before the programs expand to all Americans. Curbing malpractice lawsuits might make a difference in costs, too.
Anything else you can think of, readers?
■ Steve Selbrede wrote in with praise for a little-known provision of Obamacare: There have been many recent stories and letters about the absurdly high deductibles of Obamacare insurance plans. When I first began to investigate the Nevada Health Link website to choose my own plan, I was distressed to see very high deductibles. After about 30 hours of studying my options, I found that these deductibles are not always so high.
Steve discovered Cost Sharing Reduction, a little-known discount in the Affordable Care Act that lowers what you owe out of pocket for deductibles, coinsurance and copayments. It's above and beyond the tax credit that helps cut premiums for lower-income earners.
You do need to meet a few guidelines to benefit. For starters, you have to buy your plan through Nevada Health Link, the state exchange's website. Plus, the discount is good only on silver plans, the federal law's benchmark coverage. And you have to make less than 250 percent of the federal poverty level. That's $59,625 for a family of four, or $29,175 for a single.
Steve qualified, and after he chose Nevada Health CO-OP's Southern Star Silver Plan, here's what he found: His calendar-year deductible dropped from $4,250 to $750, while his out-of-pocket maximum fell from $6,350 to $1,500. His office visits went from $15 or $45, depending on network level, to $5 or $30. Specialist copays were reduced from $50 or $150 to $10 or $50.
You do need to complete the sign-up process at nevadahealthlink.com to determine whether you'll get the break. So Steve offered some tips on how to make it through, if you have issues with the site.
First, forget about browsing for a plan without creating an account, because you won't get a full reckoning of the cost unless you put in your details. Start an account at the site with a user name and a password, or you won't be able to get back into your account. Do not provide your e-mail address, or you might not be able to return to your account. Make sure you know exactly what your adjusted gross income is before you get started. And check your insurer's website for a provider list because the state exchange's site doesn't always match, he said.
"Don't wait for a bill. Send a check in right away," he added.