- by New Deal democrat
On this Indigenous Peoples/Columbus Day holiday, there is no new economic news, so let me roll out something I have been thinking about for quite a while; namely, how to migrate from out current patchwork health care insurance system to a better, universal system.
Such a migration is very popular. Just last week, the Kaiser Family Foundation reported that 66% of all Americans, including 72% of all self-identified Independents, favor some sort of national health care plan:
The question has always been, how to get there from here, given the many stakeholders with strong financial incentives under the current hodgepodge.
While many observers have issues with Medicare Advantage plans, they are very - and increasingly - popular among Medicare recipients. But they do have several advantages, including that a person enrolled knows up front how much is being paid for by the plan (rather than the uncertain “80%” coverage of regular Medicare). And over the long run, both types of plans seem to cost a similar amount, with the difference being that Medicare Advantage plans are better for relatively younger, healthier seniors, and regular Medicare better for seniors who have costly medical conditions.
Another advantage that “Medicare Advantage for All” would have over “Medicare for All” is that the potent medical insurance lobby would very much be in favor of its passage, removing one very big roadblock to it. And it could easily be employed promptly, since medical insurers already have plenty of experience handling and paying medical claims.
But one big question is, how would it be paid for? Especially if some sort of taxpayers’ revolt from an increased tax burden might be feared.
First of all, there should be no further concern about deficit spending for such a plan. If the GOP can blow a huge hole in the budget and run up $Trillions of debt for a tax giveaway to Billionaires, there is no point in arguing for fiscal prudence on the other side. On top of which, as I’ll lay out below “Medicare Advantage for All” ought to be able to pay for itself.
Here’s how my proposal would work.
1. Everybody not covered by existing Medicare, CHIPs benefits, or Veterans’ benefits, would qualify.
2. The plan would be funded by a FICA withholding tax. Similarly to income tax withholding, at the beginning of each year, every person employed would fill out a form listing the number of persons in their household. Full exemptions would be granted for every household member covered by any other type of medical insurance (including employer-sponsored medical coverage at least equivalent to either an Obamacare silver plan or a Medicare Advantage plan. FICA taxes for the program would be withheld from the person filing the form, as well as any dependent not so covered. In this way, most importantly anyone already covered by an employer’s plan would face no new taxes.
3. Employers with more than 50 employees and $5 million in gross sales would be required to pay their 50% share of the FICA withholding tax starting with the next fiscal quarter more than 60 days after the passage of the act.
4. Employees and smaller employers would not be required to pay their share of the FICA withholding tax until the first fiscal quarter more than one year after the passage of the act.
5. Which means, as per my opening comment, most of the initial year’s outlays for the program would be put right on the general national debt. After that, the FICA taxes would be designed to fund the annual costs of the program, just as FICA taxes have done for, e.g., Social Security and Medicare in the past.
6. Benefits under the act would begin to be paid the first fiscal quarter more than one year after passage of the act as well.
7. The year’s delay in employees’ having to pay the tax would give them a chance to bargain with their employer, formally or informally, about their pay; and if their employer refused to raise their pay to cover their share of the FICA withholding tax, it would give them a chance to find employment elsewhere at a higher rate of pay.
8. Any employer with over 100 employees or over $10 million in gross sales refusing to increase employee wages or salaries to cover their share new FICA taxes would be hit with an income tax surcharge of an equal amount.
9. Just like Medicare Advantage plans, people newly enrolled in the plan would have to compare various plans on offer. If they failed to choose one during the coverage window (the same window of time as with existing Medicare), they would be enrolled in a randomly chosen plan available in their area. Over several years, even lazy consumers who wound up with poorer plans would likely migrate to better plans recommended by relatives and/or friends.
10. The year’s delay in the beginning of payments of benefits would also allow insurers to develop their Medicare Advantage plans for the new influx of younger people (who on average would be in much better health than current Medicare enrollees).
11. Since the program would be funded just like Social Security and existing Medicare, it should withstand any creative Court challenges (with the big caveat that nothing is beyond the majority of the current SCOTUS, but SCOTUS expansion should happen first before anything else anyway).
12. Over time, it’s likely that employers would find it easier and less expensive just to pay their employees’ FICA taxes to join the new Medicare Advantage plans rather than continue with the burdensome paperwork of their own private plans.
13. In addition to being funded by new FICA withholding taxes, the one year hole in the budget would be covered by rescinding the last 3 GOP tax giveaways to the wealthy in 3 stages. For individual taxpayers who earned over $500,000 and corporate taxpayers with gross sales or earnings over $10 million, the 2025 Big Bad Bust-out Bill’s tax cuts would be rescinded immediately. The similar but relatively smaller 2018 tax cuts would be rescinded in two years. And the 2012 extension of the 2002 Bush tax cuts would be rescinded in four years. Further, the rescission would be made retroactive for four years based on income declared then (note there is no “ex post facto” issue as to taxes, which can be made retroactive); and the taxpayers would be given years from the inception of each rescission to pay back the relevant taxes.
The end result would be that every American would be covered by medical insurance at least equal to either Medicare or an Obamacare silver program. Insurers, who suddenly would have a substantially larger pool of relatively healthy new customers, would also be happy. And to the extent necessary (which I doubt it would be), “Medicare Advantage for All” could be a stepping stone, via a subsequent public option if so passed, to “Medicare for All.”
