A Properly Structured Single Payer: Financing

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Finance a single payer with a federal sales tax. There will be a lot of debate over whether this kind of tax for health care is equitable. http://www.debate.org/opinions/would-a-federal-sales-tax-be-more-equitable-than-the-current-federal-income-tax I think it is equitable because then everyone, including the poor, would be contributing to the payment for their own health care. In the past, I have avoided the concept of national sales tax because I thought it would be unfair to the poor, believing that there is a big difference in living when you don’t have to worry about how much money is in your pocket when you go grocery shopping. However, I now believe that the quite large number of people receiving food stamps weakens this argument considerably.

http://www.cnsnews.com/news/article/ali-meyer/food-stamp-beneficiaries-exceed-46000000-38-straight-months Thus a national sales tax to pay for funding a single payer health care system seems the right way to proceed.

How much federal sales tax would be necessary? I don’t know. Part of the answer is how much do we need. Estimates of current national health care expenditure are published.

http://www.cdc.gov/nchs/fastats/health-expenditures.htm

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

Does it really take 2.9 trillion dollars to run our health care system (as of 2013)? Note the health care spending reported for 2007 was $2.2 trillion.

http://content.healthaffairs.org/content/28/1/246.abstract

So, in six years, health care spending increased by 700 billion dollars? Why? I’m sure there are many ‘experts’ who can rattle off reasons for this. To me, it sounds like a whole lot of waste and bureaucracy. I bet I could run a single payer in an equitable manner for a whole lot less, while maintaining healthy profit for necessary health care businesses.

What percentage federal sales tax would be necessary to accumulate 2 trillion dollars? One estimate reports that 1% would equal 445 billion dollars. http://www.quora.com/Concerning-federal-sales-taxes-how-much-revenue-would-a-1-2-sales-tax-collect-and-how-much-backlash-would-this-have  I really don’t know if this number is valid. That’s what tax gurus and mathematical economists are for.

Just remember this would mean no more Medicare, Medicaid, other publicly funded health programs, private health insurance premiums, deductibles, co-pays, etc. and the expense to various sectors that go to pay for all that. It would also mean no more bad debt for hospitals and doctors, that anyone when they feel ill could get up and go to the doctor without financial fear, and that doctors could welcome all people into their office regardless of financial status without the resentment that they won’t get paid. And all employers would be out of the health care benefits business.

I would also mention that the words indigent, poor, unable to afford health insurance define a large number of people and lead to financial discrimination in the health care sector. First, these people are frustrated and angry. They have difficulty finding doctors who will see them. Thus they go to the emergency room for a lot of illness which could and should be managed in the doctors’ offices. Second, the doctors are frustrated and angry. Anyone who has been in private practice knows that  non-reimbursed visits quickly lead to a severe strain on cash flow. They don’t want to and are not putting up with it. In my view, both sides are right. How about we solve the problem with a well financed single payer, paid for by everybody? Then the words indigent, poor, unable to pay for medical care could be forever removed from our health care lexicon.

R. Garth Kirkwood,MD

doctork@equalhealthcare.org

 

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