Single-payer healthcare would save $450B and 68k lives a year: study

First labor isn't perfectly fungible between sectors and firms. Moving workers will result in significant productivity lowering frictions. The clearest example of this is that the group most likely to have low insurance outlays relative to wages are high income workers. When the denominator's larger, the fraction's smaller

For example a worker making $500,000 a year, even with a platinum plan $25,000 a year plan is only outlaying the equivalent of a 5% payroll tax. They'd get hit very hard under single-player payroll tax. In contrast a worker making $25,000 with a $6000 employer-insurance is paying 20%. Unfortunately the typical $500k/year high skilled job can't easily be replaced with twenty $25k/year workers.

Second, you have to consider not just the reshuffling of demand between employers. You all also have to consider the tradeoffs potential workers make between paid labor and leisure. Universal single-payer will cause some workers to drop out of the labor force, scale back their hours worked, or take less stressful but lower productivity jobs. When everyone has access to the same healthcare regardless, the incentives between those options becomes less differentiated. People retiring early or spending more time as homemakers could be a good thing or a bad thing. But without a doubt it lowers economic output, and therefore the tax base.

Finally raising payroll taxes creates incentives for workers to reclassify in a way that shields their income. One form is outright evasion. More jobs will pay cash under the table, more "employee leasing" schemes, or just simply not declaring income. The higher taxes are the more incentive there is to take the risk. But there's also many perfectly legal ways to dodge payroll taxes. Cash compensation can be shifted to exempt benefits like life insurance, employee discounts, and meals. Employee compensation can be reclassified as director fees. American Workers can relocated to foreign offices, where they're exempt from payroll taxes. Self-employed people can re-incorporate as an S-corp.

This just scratches the surface. Once you double the effective payroll tax, expect a lot more effort and money invested in strategies to evade it. This not only means the proposed payroll tax rate captures less revenue than projected. It also means the pre-existing payroll tax now collects less revenue.

Depending on your risk tolerance, it could pay off for people to do this... But it’s certainly not for everyone.

- Every visit to a doctor is a game of cat and mouse. I am never sure what bill to expect and how many bills to expect.

- Price is always inflated due to the fact that insurance company has to make money on every visit to the doctor.

- Every visit requires a Claim. Claims get filed incorrectly. Fun and games trying to call a bunch of different "departments" trying to understand the claim and why am I being charged ?

- In network/out of network game. Ohh, I am sick and unconscious but I have to make sure that the person seeing me is "in network" so that I don't get a million dollar bill. Sorry, bad luck. While you were unconscious, we called a doctor who was "out of network" and not our problem. Have fun fighting wit the insurance company.

- Why does every visit require me to show insurance ? I just wanna talk to my damn doctor. Can I not just give you some money directly ?

- I visited the doctor. Doctor has to file a claim for $x while the insurance company only allows $y. So the doctor inflates the amount of initial claim knowing that they will be reduced anyway by the insurance company. Cat and mouse game continues and finally, poor me is left with a bill that I now have to figure out. Have I already paid enough (copay, deductible, out of pocket limit) ? Lucky me.

- My employer changes my insurance company. Oh, I have to redo the entire paperwork with al my doctors. Ok I did it. Oops the doctor office still filed a claim with my previous company. I am now fighting to get that sorted.

It's (supposedly) CHEAPER. That's right in the title. If you want to argue whether it's actually cheaper or not, that's another thing, but this kind of feigned ignorance is really not helping the debate.

> I would like to pay my doctor, and my hospital, and my pharmacy for my healthcare costs not some borg.

In South Korea, with its universal healthcare system, I always visited a hospital and paid them directly right there. Usually a few to a dozen bucks for common cold, inflamed ears, that kind of stuff. Here in the free world of America, I go to hospital and three weeks later a faceless insurance company sends me a ridiculous bill and I don't even understand how they arrived at such a price.