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Take It From Me: Tweaks Won't Fix Healthcare


Take It From Me: Tweaks Won't Fix Healthcare

Wendell Potter

Democrats have secured a 40-seat flip of the House of Representatives, based largely on a nationwide call for health care reform. Many Democrats, led by Brian Higgins of New York, are planning to use their newfound control of the House to work on a Medicare buy-in bill.


The underlying principle of insurance is organically good. The MARKET has made it EVIL.


I suppose progressives are expected to be impressed by a former corporate elitist (who is a guaranteed to live the rest of his life under the protection of a golden parachute) and his heart-felt mea culpa.

But if you are impressed, we are worse off than even I thought.

The “debate” in the U.S. progressive world has moved from the utility of private insurance to what “Medicare for All” actually means.

Bernie Sanders, Pramila Jaypal and many Blue Wavers are trying to convince us that S. 1804 and HR 676 are the same (or should be made the same under the weaker Senate version).

The millionaire senator and great compromiser Jayapal seem to be winning. They clearly understand the Power of the Tweet. If it says “Medicare for All.” it must be.

(Jaypal, by the way is one of 68% of Dims who does not pay her interns and she was part of a Dim faction that worked to undermine the $15 Now fight in Seattle, where under the leadership of the Social Alternative one of the strongest $15 Now ordinances in the nation was passed in 2014.

In any case, it’s all good because we have just been educated by a former CIGNA CEO, so we too, now have the “inside scoop.”

Mea culpa, mea culpa, mea maxima culpa…


I am. I’ve heard him being interviewed several times, read a few essays, and would take any more like him who have a ‘crisis of conscience’ in this and many other fields happily.

The new thing I’m thinking about now is when he wrote

while doing less than the bare minimum to help struggling businesses, workers, families and patients.

I’ve been thinking primarily about individuals, not businesses. @KC2669 has listed some payroll tax numbers in reply to my comments that we need to be upfront and simple about the change in financing so that individuals and families can figure out if they are going to benefit or have to be ready for a greater cost outlay (which will surely be true for many rich people and some not so rich people - I think it will be a wash for me and I might even pay slightly more which I’m willing to, but I’d like to know the numbers). So whether it is payroll tax only (I’m not that keen on payroll taxes myself - seems like a dumb way to raise money) or payroll + other taxes (e.g. https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all?inline=file), it would be effective for our side to do the outreach to many of these small businesses that Wendell Potter is referring to and do the same before/after cost analysts for them, and assuming it is a benefit to them (it’s been advertised this way in the past - e.g. GM in Canada vs GM in the US and how much health care costs affect the price of a car made here), then we can press the business angle which is sure to get a better pick up from much of the US press - maybe we can even get a few business publications to come it in favor.

I didn’t know about Jaypal was against a $15 minimum wage - that is very surprising (and disappointing). I’m less surprised about the intern problem - that has been going on for a while and is so widespread that I don’t doubt many progressive politicians are caught on the wrong side of that one. AOC deserves credit for pushing that issue into the light.

Since I am one of the people that has been clamoring for a unification of HR 676 and SB 5102, I will have to do some more reading and maybe writing letters to politicians on the topic. When I skimmed through both documents in the past, it seemed like HR 676 was pretty thin on a lot of details of how we get there which SB 5102 at least addressed partially (maybe in a way you don’t like). This effort should really be coordinated with PNHP and economists like Robert Pollin who have been studying the issue for a long time.


Jaypal, wasn’t "against $15/hr (eventually), but she and a large majority of the Dim establishment in Seattle and Washington pushed a watered-down version exempting various businesses and stretching out the timeline.


I think too many Democrats are still thinking about the Tea Party attacks on Obamacare and are thinking that tweaking is the best way to go. Democrats in safe districts can push for a single payer plan but can the others who face tough electoral contexts in their home districts. Getting these Democrats to accept some risk rather than playing it safe is the challenge for the progressive wing of the Democratic Party.


Great points. The one thing about a payroll tax, despite its regressive elements, is it gives everyone buy-in into the system. This is one reason why New Dealers used it to finance Social Security. It is also a relatively stable source of income. Just food for thought.

Like you, I would likely pay more depending on the payroll tax split. I am fortunate that my employer has a fairly generous healthcare package so, at best, I expect things to be a wash for me. Still worth doing though since tying healthcare to employers is dumb.


Maybe I will rethink my opposition to payroll taxes. My main reservation comes from a conservative talking point I heard many years ago but it made sense (unlike most of their points). Why would you want a tax that discourages an additional worker from being hired? I’d rather have a VAT. Maybe it isn’t really that different than income tax (aside from the flat rate) as the money going from employer to employee is taxed before or after and so maybe it doesn’t affect hiring decisions like I’ve been told by this talking point.


Canada just uses general tax revenues. There no separate tax for our Universal Care. All taxes raised go into a pool. If the USA can use general tax revenues to fund a 1 trillion dollar a year Military then can do the same with health care.

Businesses in Canada do not pay a percentage of these revenues other then their own Corporate taxes paid. Rather they are freed up to offer employees supplementary benefits. This alows small family owned businesses much greater flexibility.


Correction. Just a CIGNA Veep, not CEO. His parachute may be less shiny, but megacorp veeps don’t retire poor.


Canada has a bit of a different political culture than here. Like it or not, this country has a storied history of aversion to taxes and a do-it-yourself type independence mythos. That is one of the main reasons New Dealers worked to create buy-in via a payroll tax. A program that you pay for–or “earn”–is not a giveaway, welfare, and is harder to cut. Republicans basically cut income taxes every time they get power, so a more sure-fire financing mechanism will be needed.

That does not mean a payroll tax is the only way or ought to be the sole way of funding a Canadian-type system, just that there is a very real conservative tilt in this country when it comes to social spending that policy makers, even at the height of the New Deal, had to be wary of.


Well I think the political culture in the USA , where all Political parties tapped into those funds raised by FICA for spending on other things and where benefits received from the same continously eroded demonstrates that monies rate from payrill taxes are NOT harder to cut.

Again , with Democrats or Republicans in power , US Military spending always a “Sure thing” and that the US Military remains the most respected Government institution in the USA , does not suggest a culture that is against taxes. It suggests one that has been sold on the idea that taxes used to kill other people a good thing and taxes used to help other people bad.


That is basically a myth perpetuated by conservatives, that is that the Social Security trust fund is being “drained” (I think that is what you mean). Social Security is funded through a dedicated payroll tax that functions as a pass-through, basically younger people are taxed to pay directly for the care of their elders. The two trust funds exist for surplus revenues which are invested in treasury bonds. The bonds are sold when payroll taxes are not sufficient to cover outgoing benefits.

That is a simplification of how it works, but I just want to clarify because the “Social Security is dying myth” is one of the most pernicious. It is mainly other programs, those funded via the general fund, that are under constant pressure. Conservatives cut income taxes on the premise these will get trimmed next, then put things like work requirements in them while under financing agencies that oversee them. Then, we get the headlines about programs “dying,” not enough money, etc.


The fact remains that with things like COLA adjustments not made properly, The Government changing how inflation measured and Medicare recipients having to pay monies over and above what they already paid in FICA taxes for their health Care , the promised money is rather easy to “cut”.

My Parents saw all of their health care costs covered. There was no co-pays and deductibles that drained their bank accounts. In the USA these co-pays and deductibles and added premiums have been climbing over the years.

When you say FICA taxes you paid all your life will no longer cover X , y and Z it the same as stealing it back.


I would think it would have to be part of the income tax and not payroll tax. There are many out there who make their money aside from a payroll.


Totally understand. Payroll tax is regressive and not ideal, but the New Dealers were not inaccurate in their assumption about buy-in either. HR 676 contemplates a “modest” one—though it doesn’t define it.


You know what the excrementalists say, “let the mediocre be the enemy of the good”.


Did you say something insightful?


You should ask your employer how much your share of the insurance is. Virtually all companies now take money from your paycheck as your contribution to your apparent company sponsored health insurance.


Exactly. Insurance is a concrete form of socialism: from each according to ability - to each according to need. You don’t need to understand Marx to get this quite basic principle of a decent humanity.