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Medicare for All?

Taxes for All?

[By Rick Kakler CFP®]

As the recent debates among the Democratic presidential candidates emphasized, the idea of government-managed health care is gaining popularity. “Medicare for all” or some form of “free” universal health care is certainly an appealing idea. Who among us wouldn’t appreciate someone else paying our medical bills?

I certainly would. My family’s personal health care costs, including premiums and out-of-pocket expenses, run just over $3,000 a month. If my health care were free, I could find a lot of uses for the savings.

But my skeptical side, and probably yours as well, knows that there is no such thing as a free medical procedure. Someone, by some means, has to pay for insurance coverage, doctor visits, hospitalizations, and other medical costs.

The tax tab for providing “Medicare for all,” as envisioned by Sen. Bernie Sanders, is $3 trillion a year, according to several analysts. Currently, the cost for Medicare is about one-sixth that amount, or $583 billion a year.

Sanders and other presidential candidates tell us the wealthy will pay this tab. The reality is that when we look at other countries that have similar universal health care plans, it isn’t just the wealthy that are paying for it.

Raising the more than $3 trillion needed annually to fund “Medicare for all” would require doubling all personal and corporate income taxes or tripling payroll taxes. This analysis comes from Marc Goldwein, a senior vice president at the non-partisan Committee for a Responsible Federal Budget. He was cited in a May 9, 2019, Bloomberg article by Laura Davison, “Tax hikes on wealthy alone can’t pay for Medicare for all plan.” “There is a lot of money out there, but there isn’t $30 trillion [over 10 years] sitting around from high earners,” Goldwein said. “It just doesn’t exist.”

I did a little investigating of the tax rates of European countries that have universal health care and found Goldwein’s statement to be true. For example, Denmark taxes income over $7,000, with rates starting at 40%. The US rate starts at 10%. This would indicate a doubling or tripling of income taxes or payroll taxes on the lowest earners is not a politically-skewed scare tactic, but an economic reality.

The top rate in Denmark is 56%, while the top rate in the US is 50% (37% federal and 13% state). This is just one of many examples I found in my searching that strongly indicate other countries that have universal health care haven’t found much room left to tax the wealthy. Based on their experience, the majority of the cost will need to come from lower income earners.

Sadly, this message is not being disseminated to voters by proponents of universal health care. While I am not advocating for or against universal health care here, I am advocating for full disclosure and transparency.

A topic as significant as this deserves a great deal of discussion based on clear, complete disclosure of facts and educated analysis. It requires the best available answers to questions like who will be covered, what will be covered, how much the program will cost, and who will pay for it.

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Assessment

Raising six times what we are currently spending for Medicare would be a huge task. Transferring one-eighth of the US economy from the private sector pocket to the public sector one would not be easy or painless. Making the transition to some form of tax-funded universal health care would be a major shift in direction for this country that would have a significant impact on all Americans. It is not a decision to make based on inadequate information, political rhetoric, or unreasonably optimistic assumptions.

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More Changes to Medicare for Doctors

More Changes to Medicare

By Ira Nash MD

Conclusion

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On Medicare Bureaucratization

Isn’t limited to governments

By Rick Kahler MS CFP®

A client recently told me about her first medical checkup after becoming eligible for Medicare. “The doctor said things like, ‘They require us to fill out this form,’ and ‘This test is covered every three years, so we can’t do it this year,’ and ‘Medicare will pay for a baseline EKG even though you have no history of heart disease.’ I’ve gone to this doctor for ten years. I’m the same person I was a year ago. Yet it felt as if I had moved to a category where the appointment was all about the paperwork instead of my health. ”

A situation like this, where the paperwork seems more important than the person, demonstrates something I call the Principle of Bureaucratization: the idea that the more layers of decision-making are added to an organization, the less efficient it becomes in delivering its goods or services.

While this phenomenon affects organizations and governments of all sizes, the negative outcomes seem to increase the larger a company becomes or the further away the seat of government is from its constituents. Municipal services seem to be delivered more efficiently than state services. State services tend to be more efficient that those coming from the federal government. There are some exceptions, but not many.

One reason is that the further removed from you the decision-maker is, the less personal the services will be. Moving from the private health care system to the government-run health care system called Medicare is just one example. The same principle seems to apply in other countries. I have visited the UK numerous times, and it seems that every time I’ve read a newspaper article about some specific failing of the NHS (National Health Service). Just recently, at a workshop in Europe, a participant from the UK told me that the waiting list to see a psychiatrist was one year. “The NHS simply works against you,” she said with exasperation.

I think most Americans can agree that our healthcare system is badly flawed. We may disagree on the causes and cures. I see as one major problem that our federal government has created a regulatory structure which allows a select number of health insurance and pharmaceutical companies control over the health care system. These regulations have sent insurance costs soaring by almost eliminating competition. Third-party payment of medical bills means those receiving the services don’t have any incentive to even ask about costs.

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Bureaucratization isn’t limited to governments. It also affects large companies where the policies are made by people many layers away from the customers, and the employees dealing with customers don’t have the authority to make decisions or solve problems. Who hasn’t experienced having a seemingly easy problem to solve with a service provider, calling a customer service representative, and ending up on the phone for 45 minutes being passed from department to department and supervisor to supervisor?

Many employees of large firms and governments are equally frustrated by the bureaucracy created in their organizations. Bureaucratic organizations stagnate innovation and responsiveness. They are especially inefficient when those dealing directly with consumers don’t have any significant consequences riding on the quality of the goods or services provided. This is one reason why many, like Brian Robertson in his book Holacracy, believe the “best practices” governance model for organizations is a self-organizing structure that empowers employees closest to consumers to make decisions.

What’s the bottom line?

You’re ultimately responsible for your own well-being. Ask questions, be the squeaky wheel, and, above all, make connections with those working in the bureaucracies you deal with. Help them keep in mind that their purpose is to serve people, not paperwork. 

Conclusion

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Hospital Re-Admissions Trends

For Medicare

By http://www.MCOL.com

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Conclusion

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Financial “Planning” versus “Preparing”

Understanding the Difference

By Rick Kahler CFP®

Retirement planning is one of the issues that commonly lead clients to consult financial advisers.

One of its essential aspects is creating a plan to save and invest in order to provide a comfortable retirement income. Ideally, this starts many years ahead of retirement, even as early as your first paycheck.

As retirement comes closer, planning for it expands to take in a host of other considerations, such as deciding when to retire, where to live, and what kind of lifestyle you hope to have. When retirement becomes a reality, the focus shifts to carrying out the plan.

Preparing

All of this planning is crucial. Yet, for both financial advisers and clients, it’s good to keep in mind that planning has its limits. In the post-retirement years, it may be helpful to think in terms of preparing for old age rather than planning for it.

The older we get, the more important this distinction between planning and preparing becomes. Too many life-changing things can happen without regard to our best-laid plans. Often they occur unexpectedly, resulting in emergency situations where urgent decisions have to be made. A stroke or a fall, a diagnosis of terminal illness, a broken hip that leaves someone unable to go back to independent living—and suddenly, right now, the family needs to find an assisted living facility, arrange for live-in help, or sell a home.

What are some of the ways to prepare for these contingencies?

  1. Explore housing options well ahead of time. Find out what assisted living, home care, and nursing home services and facilities are available where you live and whether they have waiting lists. Have family conversations about possibilities like relocating or sharing households:
  2. Research the financial side of these options. Investigate the cost of hiring help at home, assisted living facilities, and nursing care centers. Find out what is and is not covered by Medicare and long-term care insurance. For example, people are sometimes surprised to learn that Medicare does not pay for nursing home care other than short-term medical stays.
  3. Designate someone to take over decision-making, and do the paperwork. Execute documents like a living will, medical power of attorney, and contingent power of attorney. Update them as necessary, and give copies to your doctors, your financial planner, and appropriate family members.
  4. Start relatively early to downsize. Well before you’re ready to let go of possessions or move into smaller housing, start considering what to do with your “stuff.” Focus on the decisions rather than the distribution. There’s no need to get rid of possessions prematurely, but decide what you want to do with them—and put in writing. Do this while it’s still your choice, rather than something your family members do while you’re in the hospital or nursing home
  5. Do your best to practice flexibility and acceptance. No matter how strongly you want to live in your own home until the end of your life, for example, it may not be possible. The physical limitations of aging can limit our choices, and even the best options available may not be what we would like them to be. It is a profound gift to yourself and your family members to accept these realities with as much grace as you can muster.

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Assessment

Finally, please don’t underestimate the importance of planning financially for retirement. Because the bottom line is that you can’t plan for all the things that might happen as you age, but you can prepare to deal with them. One of the most useful tools to cope with those contingencies is having enough money.

Conclusion

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PP-ACA Change or Repeal for 2017?

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Potential Component Changes

By http://www.MCOL.com

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MORE: Podcast: Third Quarter Health Plan Financial Reports

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Tom Price for HHS Secretary & Seema Verma for CMMS

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Obamacare critic for HHS 

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Trump nominates Rep. Tom Price for HHS secretary

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Trump picks Seema Verma to head Centers for Medicare and Medicaid Services

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