Would you pay higher taxes for better government services?
In the US the tax rate on the bottom 78% of earners taxes was less than 7%
England has a tax rate for the same income of 11.5%
The top 6% (Avg Adjusted Gross income 514,000) paid $840 Billion of the income taxes
The Bottom 49.1% (Earning less than 45k AGI) paid $97 Billion of taxes, but 27.4 Million Households filled for $66.7 Billion in EIC tax credits
If the taxes on the bottom 78 percent were increased 6% to a level similar to England the USA could have universal health care
The US Spends 3.4 Trillion on Healthcare.
Just 5% of Americans Account for 50% of U.S. Health Care Spending. So taking away the top 5% means the US spends about 5,500 per person. More than UK, but with a long term approach we can tackle that.
-
Saying no to covering all issues. See above. Total cost down to 1.8T
-
Accepting a tax increase
- Doubling the Medicare withholding will provide 500B
- Down to 1.3T
- Reallocate state spending In 2015, state governments across the country spent a combined $605 billion on health care
- Down to 700 Billion
- Increase taxes 6% across the board, like those of countries that provide healthcare. 600B in Funding
- Down to 100 Billion
- 1/3 of expenses in 2017 was payable for hospital room rentals and 21% was to doctor's office billable hours
- Increase utilization to make hospitals & Doctors more efficient so cost can be cut
- 1% reduction in billable hours and room rates Down 100B
- Adjust pricing based on cost savings
- Repeat
If the US had higher taxes for gas we could have a better Infastructure. Using rough math we in 2017 underfunded the highway dept about $21.5 billion
- 40 Cents per Gallon vs 18.4 cents currently
- 33 Cents vs 17.5 cents for Highway maintenance at fully funded for at least the next 5 years
* 1 Cent vs 0.9 cents Gas Safety and storage. Round it up to a full penny better saftey funds for better clean up
* 4 cents a new Green energy tax for Green projects - 2 Cent New Metro Projects tax
$5.5 Billion annual funding for projects, plus using funding not going to covering the underfunded highway dept means who doesn't want to announce a 10 year $250 Billion Green Deal Project. Get States to match it 40/60 and its a $600 Billion Project
$96 a person more and With this Major Cities can tackle major projects and Rural cities can apply for the Metro Funding. $1.5 Billion each state gets on average can be applied however but that's encouraging moving to a Green plan.
The U.S. combined gas tax rate (State + Federal) is According to data from the OECD, is the second lowest (Mexico is the only country without a gas tax).
The average gas tax rate among the 34 advanced economies is $2.62 per gallon. In fact, the U.S.’s gas tax a rate less than half of that of the next highest country, Canada, which has a rate of $1.25 per gallon.
We want to have the European advanced economy of our peers but we arent wanting to pay for it
You need a real draining of the swamp and more transparent lobbying laws to really have any faith that the taxes would be used for good. The voting system would be a good place to start - removal of the electoral college and the introduction of ranked ballot would help a lot with this process - but unfortunately this seems to be too big of a step for either of your two-party government to consider.
Either way, taxes have proved to be an excellent solution through all phases of the American experiment with continued proof that reductions in taxes DO NOT trickle down economic value to constituents - just the rich getting richer. It's morbidly hilarious that republicans howl on about an elitist class attempting to control their political systems, yet you have Fox News being run as a GOP disinformation platform funded by the Koch brothers. Billionaires paying millionaires to direct the message that "taxes bad" - so much so that the American people voted in a president that screams about the elitist class while continually expressing his "wonderful" business sense - the same man that refuses to release his tax returns citing an imaginary audit.
well, we are sorta-kinda working on rendering the electoral college useless, although it's in a hacky way that's contingent on how electoral votes are allocated to the states and thus its power would shift from decade to decade. so there is that! but yeah, there's pretty much no national movement beyond it for changing the electoral system across the country, just some local ones on a state-by-state basis.
I hadn't read about this - thanks for bringing it to this Canadian's attention! We have a similar problem as you to our south. Gerrymandering continually affects me personally. Last provincial election, lobbying funds were pumped into private Facebook groups like "Ontario-Proud" (I'll let you assume a few ideas on the type of people in this group) - to which used their platform and connection to Progressive Conservatives (PC party = republicans) along with Facebook adsense to manipulate voters to elect a man who lacked a single campaign promise - the brother to the crack head mayor Toronto had a few years ago. Just another rich man taking control of my province who is now cutting my educational funding and university program funding - compromising the education I had signed up for just a couple years ago. The same educational system that would teach me to think critically against Doug Ford's totalitarianism against Toronto.
What's the icing on the cake is that the advertising that was done on social media was completely legal - yet had the same contextual advertising occurred in our newspapers or tabloids it would be considered illegal due to campaign finance issues and the wording of law when it comes to print media. I CAN'T MAKE THIS SHIT UP!
https://www.cbc.ca/news/canada/toronto/doug-ford-election-ontario-1.4696565
The electoral college doesn't need abolished - just reapportioned.
Here is an article that describes how and why if anyone is interested: http://www.pewresearch.org/fact-tank/2018/05/31/u-s-population-keeps-growing-but-house-of-representatives-is-same-size-as-in-taft-era/
I definitely agree.
Ranked Choice voting would be a huge positive for the United States.
I’d say no, because I lack faith that those taxes would be allocated with integrity.
i would also say no, but specifically because people would just fall back on other bullshit reasons for why we can't have universal healthcare or the green new deal or whatever else and so the idea of the OP would likely just end up taking more away from people who have less to begin with, with no payoff for them.
perhaps if democrats expressed interest in directing a significant portion of the taxes collected into public systems that are currently lacking in rural republican states - FUCKING EDUCATION PEOPLE! - than maybe they could convince constituents to start thinking critically against GOP messaging against taxes. I doubt it... but it'd be worth a shot. Additionally if this were to succeed, America could begin to educate their youth in the direction of CRITICAL THINKING - a skill that has been washed away by social medias including broadcasters like Fox News.
That seems like a different issue.
It feels like your title and your body are talking about two different things? I'm not exactly sure how higher taxes would lead to better congressional representation. Maybe I'm just misunderstanding.
Regardless, I really disagree with your tax ideas. I don't think we should be increasing taxes on the bottom earners. We should be increasing taxes on the top % earners. As just the first idea that popped into my mind: since we have a progressive tax system, I don't see why we couldn't just add a few more brackets. We could have brackets that extend to something like 50% on income over $1,000,000, etc.
The idea of taxing the lower-income people, the people who are struggling, in order to fund the healthcare program rubs me the wrong way. Much less harm can be caused if we taxed the wealthy instead.
In addition, I'm generally against raising sales taxes, such as a gas tax. This is because it disproportionately effects lower-income people, and I would assume (but I haven't looked into it) it would have a negative impact on the economy.
David Pakman did a recent video on ways to raise over a trillion dollars to fund Medicare for all, among other things. I suggest everyone who's interested watch it here: https://www.youtube.com/watch?v=Rd-MP6pXzuc
I agree with regards to the title. It got me thinking about the implied premise before I read the resulting text, and while I'm afraid that my representation at times leaves a great deal to be desired, it's at least in a region with a healthy set of primaries and contested generals, so the voters are at least getting something which approximates what they collectively want.
I don't know if ranked choice or instant runoff elections would be more expensive per se, but I've certainly heard good things about them and would be willing to modestly pay.
Would a ranked voting system actually cost that much more than what we currently have? I don't know if I've ever seen any estimates. I can't imagine it'd cost too much. With that said, I agree with you.
I think we should work on getting rid of the first-past-the-post voting system in favor of a smarter one, like ranked voting.
I was thinking the cost would be greater than nothing, in that we at the very least would need to obtain different tabitulation software or methods. But yeah, in the long run it would probably be about the same.
I guess recounts would be a bit harder too, so maybe that's something as well.
While the costs (both money and complexity) are something to consider, I don't think it's enough to act as an argument against it. The benefits would be so much greater, I think!
judging by how cost hasn't really come up in the past three years in maine (where there's been an extensive battle over the use of IRV in federal primaries and races that seems to have finally been settled last year) i'd suspect the answer is that it isn't any more expensive than an FPTP-based election.
Wow, I actually found the answer. It cost exactly $441,804. That includes costs for start-up, the primary election, and the general election. The general election by itself cost $340,373.
I don't have enough information to contextualize that number, though. I'm still not sure if it's a lot or a little compared to FPTP.
in the US the answer seems to be "we've got no fucking idea". a few states like colorado offer some snapshots into election costs, but the NCSL has a report which basically suggests that beyond those few snapshots, there's so many things that play a factor or can subsidize costs and so on that it's pretty much impossible to get an accurate number in most places.
EDIT: going off of colorado figures though, it seems like maine is below what a comparable FPTP election might cost. the city and county of denver has a population of about 704,000 and total costs of around 1 million dollars net and 2 million dollars gross for election costs, while maine has a population of 1,341,582 total.
Hm, yeah. I looked at some of the data and was going to try to make a comparisson, but it seems like there are too many factors. For example, California seems to include the cost of poll workers, but those costs seem to be absent from the pdf of Maine I linked.
Edit for your edit: I was literally doing those exact same calculations! Except, I was using the three Colorado counties because Maine apparently has an active voting population of a little over a million.
Therefore: Denver + El Paso + Douglas =
409591 + 394100 + 214593=1018284active votersMaine has
1028602active voters.The 2016 gross general election cost for those three Colorado counties =
4002578or $4,002,578The 2018 (state, not federal) general election cost for Maine =
340373or $340,373Surely this isn't a fair comparison and not an accurate representation, right? Also, I'm not sure if I was supposed to use net or gross.
Why is it that the US and Canada have the lowest sales taxes and gas taxes and we worry about affecting the poorest people while other countries have much higher taxes to pay for an entire country to have social services
2 People each making 32,000
In England you'll end up paying
In America
The gas tax avg among our peers is $2.62 including that one of those is 0 and the other 0.18
If we were to increase the taxes on the current top 50% to pay for the healthcare it only further makes us unlike our peers. IN England the top 50% pay 90% of tax revenue which is 33% of Total revenues for the UK.
As whole dollars, $1 in total funding received
is 0.33 from taxes
the top 50% pay 0.27
The US currently is the same nearly top 50% pay 96% of tax revenue which is 50% of Total revenues for the US.
As whole dollars, $1 in total funding received
is 0.50 from taxes
the top 50% pay 0.48
The UK has a 20% VAT that provides funding for much of the government (42%) in cities instead of Property/Sales Taxes
I agree. I read this post, and couldn't see the connection between the title and the issue that @semideclared is actually discussing in the body of the post. So, I've fixed the title to better represent the post.
Hmm. Understandable.
The 99 percent club thinks that Congress only represents the 1%, and especially the top 10 percent.
Since the top 6 percent pays 56 percent of the bill while the next 28% pay 30% would making it more equal help representing the country fairly?
If nothing changes but the bottom 60 percent pays for the major initiatives they/the people of today want that would make it more balanced.
The problem with that idea is that the reason the rich pay a disproportionate amount of taxes is because they control a similarly disproportionate share of the country's wealth. The bottom 60% controls less than 5% of the country's wealth, and receives less than a quarter of its income. Trying to get them to pay the same share as the richest people in the country is like trying to get blood from a stone, and moreover punishes the working class by taking money out of the hands of people who can least afford it.
That, and the reason why the interests of the rich are disproportionately represented in congress isn't because they pay most of the taxes, it's because they can afford lobbyists and they finance political campaigns. If you want a government that represents the interests of the people, ban political donations and make elections publicly funded, don't take money from the hands of the poor.
Not paying the same share as wealthy. Paying a share of the costs that now include major social serervices for everyone.
The UK has a 20% VAT that provides funding for much of the government (42%). In cities instead of Property/Sales Taxes the central gov't provides funding
2 People each making 32,000
In England you'll end up paying
In America
The gas tax avg among our peers is $2.62 including that one of those is 0 and the other 0.18
If we were to increase the taxes on the current top 50% to pay for the healthcare it only further makes us unlike our peers. IN England the top 50% pay 90% of tax revenue which is 33% of Total revenues for the UK.
As whole dollars, $1 in total funding received
is 0.33 from taxes
the top 50% pay 0.27
The US currently is the same nearly top 50% pay 96% of tax revenue which is 50% of Total revenues for the US.
As whole dollars, $1 in total funding received
is 0.50 from taxes
the top 50% pay 0.48
What is Wealth?
Other facts from wealth in 2017
I get the distinct impression I'm being argued past. At any rate, the poorest half of Americans consists largely of people living paycheck to paycheck. Why would you ever want to go to them for revenue? It's a lot of work and suffering for not a lot of money. It's inefficient.
And a VAT is a regressive tax that disproportionately affects low income people, and isn't a good idea just because other counties do it. Frankly, the only taxes the poor should be paying are those intended to change behaviors, like tobacco or carbon taxes.
I have no idea what point you're trying to make here. Sorry.
They're saying that if poor people funded the government at a higher rate, the government would cater to them more as a result. If the poor people just banded together to fund their healthcare initiative they could afford it themselves.
The entire idea of a progressive tax system like the one we have in the U.S. is that you pay an amount that is proportional to your means. For example, a $500 tax bill will absolutely crush someone at or beneath poverty level, but will hardly go noticed by someone making millions of dollars a year. So, rather than expecting both parties to shell out the same amount, it makes more sense to lower the tax burden on the impoverished and increase the tax burden on the wealthy.
And yet, the effective tax rates of the wealthy and of corporations is typically comparable to or lower than those of the middle class. That stands contrary to the ideals presented above where those of greater means take on a greater share of the tax burden. Furthermore, increasing the effective tax rates on those with less means further widens the gulf, ensuring that the middle class is paying a substantially higher amount than wealthy earners.
Also note that wealthy earners are able to earn their wealth largely due to public services and infrastructure that are funded by taxpayers. Things like public education to provide a skilled workforce, roads and bridges to allow for transporting goods, laws and law enforcement to protect businesses from criminals and broken contracts, etc., all of which are necessary for business to operate efficiently. They utilize these things to a much higher degree than your average taxpayer, so they have an obligation to pay a greater share to maintain them.
Additionally, wages for the average taxpayer have been fairly stagnant for a long time, while rents and house prices continue to skyrocket and inflation grows ever higher, which means your average taxpayer has an increasingly lower purchasing power every single year. They become less and less capable of shouldering the tax burden over time.
Finally, there's the fact that a significant portion of those in the "bottom 78%" don't even pay any healthcare costs, instead relying on state-provided healthcare, and wouldn't be able to afford the $5 for a school field trip for their kid, let alone an increase in their taxes. I know, I grew up in those conditions. So the tax increase would either crush the bottom-most earners completely, or it would significantly impact the middle class.
With all of the above in mind, it makes absolutely no sense to insist that those with lesser means should be the ones to take on a greater tax burden. Instead, we should be focusing on getting those with greater means who are paying less than their fair share to pay a more equitable amount. Once that happens, we can discuss adjusting the tax brackets according to the new level of need.
That doesn't quite answer the (seemingly rhetorical) question you posed, however, so I'll end by addressing it:
Would I pay higher taxes? Yes, absolutely. We should have single payer. The taxes I would pay would very likely be substantially less than my insurance premiums alone. The amount we pay for privatized health care is stupid. But I want to see the jackasses at the top pay their fair share like the rest of us who break their backs every day to funnel more wealth into their pockets. Our society depends on everyone pitching in, and the fact that the wealthy elite, who will never ever have to worry about whether or not they will be able to pay rent next month, get to pay an effective tax rate that is lower than my own is fucking insulting. Make them pitch in an equitable amount, then I'll happily contribute more.
On housing, Who regulates them?
The issue is the Dr/Lawyer/etc who can buy a depressed home for 100k and drop 100k on it to sell it for 250k.
I've often heard that American government spending per capita on healthcare is higher than in many comparable countries with universal healthcare systems (e.g. the chart on this page that shows the private/public breakdown of spending per capita). The lack of universal healthcare in the US seems like a problem of political will rather than an issue of funding. And, even if it were an issue of funding, it certainly doesn't follow that the way to raise those funds is to increase the tax burden on those at the bottom.
The USA doesn't say no to healthcare, this means the US spends 3.4 Trillion on healthcare, but
The fact that our taxes are not high enough to pay for everything they should is a symptom of the real problem: our legislative representatives are very poor at representing their constituents. There are many reasons for this, but you can see from the very highest level that the biggest one is that instead of electing a person who is a part of the community and knows what everyone wants, we select from a list of names of people we do not know, who each have their own ideas, and we hope that their values align with ours.
But heck, let's get down into details.
Political Parties Poison the Well
As long as there are two political parties in this country, we will not have true representation. Political parties do not help anyone except politicians who are looking to stay in power. And because that is their true purpose, there is no way to get rid of them outside of extreme countrywide efforts.
Because of political parties, political issues are a matter of party loyalty, not of merit. They are the reason why facts don't matter in today's political climate. They are the reason why we still have first-past-the-post voting and why many states have winner-takes-all results for federal elections. They are the reason why the Electoral College still stands in spite of being obviously unfair and favored by the population since at least 1968](https://news.gallup.com/poll/159881/americans-call-term-limits-end-electoral-college.aspx) - that's more than half a century.
Poor Options Depress the Votes
Let's say you are an independent voter who is in favor of small government but is permissive and progressive as far as social issues go. Who do you vote for?
Take a minute and think about your answer. The people talking about small government are Republicans, so they seem like a good answer, but they are absolutely horrible on social issues. Why would you vote for them if it means more repression of your gay and immigrant friends? Democrats are certainly out, because they have a reputation for spending the big bucks. Third party candidates aren't even on the table - it's like throwing your vote away. Naturally, throwing the vote away is what people tend to do. That's why we don't have that much participation at the polls.
When polled on political issues, the majority of people tend to agree with the liberal side of the issue. Only about 18% of people think that abortion should be outlawed, versus 29% who think that it should be legal regardless of situation. What's unique about that particular poll is that when they phrased it to only offer two choices - pro-life or pro-choice - it's neck and neck. It's the same phenomenon that happens when you force people into two broad choices instead of having actual nuanced positions.
Lack of Oversight and Accountability.
Congressional votes are public record, as are the discussions on the floor. Congress even has it's own newspaper, and C-SPAN even offers video recordings. That being said, what is said on the floor is often pre-written speeches designed for posterity rather than real discussion on the merits of a law. The actual decisions get made behind closed doors in each politician's offices.
The real issue is that their reasoning is not well represented to the public which they serve. Those official records are extremely cryptic if you are not constantly involved in congress on a regular basis. Local news doesn't usually do much to cover what their federal representatives are doing, and when they do, they typically talk about politicians who are representing other states and districts.
To be honest, there's probably quite a lot that I'm forgetting about right now, but these are just the ones that I've been thinking about the most lately.
I have a few reasons why I might not agree with this proposal in it's current state.
The first is on the funding side, in the sense that the funding comparisons made are not showing the whole picture. You say in your comments that you neglect state and local taxes, which I would be very hesitant to neglect, especially since these taxes will not be deductible from federal taxes in the future. Additionally, I think that the population you propose to tax has proportionally less wealth in the United States than they do in the United Kingdom. From the images and data here, the top 1% of people own more than twice as much wealth proportionally in the US compared to the UK. I don't know where the money should come from, but I would argue that in many ways the United States needs to tighten loopholes in its personal and corporate tax codes, since these tax codes end up very regressive in practice, though they are designed as progressive taxes.
The second is a more emotional argument. My significant other is or likely will become one of those people who accounts for an outsized portion of medical expenses. For them, its necessary to visit several medical specialists who often further specialize in the relevant conditions, as well as undergo costly tests, to even fully understand the medical issues at play. This is rather expensive, and in the end still leaves them with a quality of life that is likely lower than that of a healthy person. Though I think the United States could benefit from a universal healthcare program as many other nations have, I hope it's understandable that I am reticent to sacrifice the care of those close to me for that to happen.
As for the changes to the electoral system that this post is maybe also about, I do think we need to overhaul it. The electoral college is silly, and First Past the Post leads to a biennial choice between bad and worse, at least in the minds of many voters. Plus there's Gerrymandering in many states. The problem here is that I don't feel it is likely that politicians elected under the current system are likely to change to a system that would threaten their reelection. I'll keep complaining about it just in case, though.
This is something that unfortunately universal healthcare advocates often ignore. In no way is the US a good place for those of us with chronic conditions (my specialist is 6 hours away and not covered by my insurance), but other places are not necessarily better for us. I know of folks in Canada who are unable to access the tests or medication they need through their system, and I know that if I lived in the UK I'd be stuck in a system that treats my illness as psychological. (This is despite the fact that there is biomedical research being done in the states which shows immune and autonomic nervous system dysfunction, and those of use who have it know from our experiences that we're not just "scared of exercise.")
I'm strongly in favour of the UK system, imperfect though it is, so I'm always interested to hear a dissenting opinion. Do you think the funding model specifically contributes to the US care being better for your specific condition? I'm trying to figure out if there's something that could be systematically improved, or whether it's more a case of different decision making unrelated to the payment structure.
I'm honestly not against the NHS; I'm a dual citizen, and I was brought up by parents who hate the US system and talked warmly about the NHS. I think if I wasn't chronically ill I'd be fairly happy with the idea of living there and getting care from the NHS. My issue is when folks here in the US overlook the issues that disabled and chronically ill people face in countries like the UK and Canada.
Sure, we have similar issues in the US, but switching to another system won't fix these issues. If insurance tries to get out of covering something because it's expensive, the government won't want to pay either, even if it's the only treatment to significantly slow the progress of cystic fibrosis, for example. Those cost/benefit analyses just get shifted to a different overseer, and by treating a UK system (or others) like the perfect model, US folks advocating for universal healthcare won't be able to make things work better for those of us with rarer, poorly understood, and/or more expensive conditions. They won't even know it's a potential problem.
To answer your question, I don't really know. I don't think it's necessarily the different funding model that contributes to my care in the US potentially being better (unlike the cystic fibrosis case I linked above). It could be fixed within the system; the main issue is that the NHS NICE guidelines (while slowly changing) have long recommended "treatments" that often exacerbate people's symptoms and are based on a psychological hypothesis not borne out by current research. There was a highly flawed study used as evidence for these treatments; I don't know how monetary concerns might have factored into that (cognitive behavioral therapy and graded exercises therapy are cheaper to implement than biomedical research, I imagine).
In practice, the UK and US systems might not look that different to me, assuming there are private practitioners in the UK treating people. Either way I'd have to go out of the system to find a doctor taking patients and doing research, pay out of pocket, and deal with doctors within the system who doubt that it's a real medical illness. But in the NHS that doubt is systemic, rather than something that can be easily avoided by switching a doctor, so it's scarier.
Thank you, I appreciate the insight. It totally makes sense that a key risk of having a single system is that any top-down mistake or doubt is magnified, and it's not something that I have any immediate solution to. It's always easy to point to the averages, but I can quite see that being little comfort to you as an individual!
Thanks for "listening"! :)
That is very unfortunate. For my SO, I think the care would be largely equivalent under either system. Several tests have been denied on a past insurance plan for falling under preexisting conditions, which didn't really reflect the medical reality. It's hard to get away from that sort of thing when your condition begins in childhood, unfortunately.
Ooph, yeah. Insurance companies are definitely not better. They try anything to weasel out of paying for necessities. I hope your SO is able to get the care they need.
Although the original post suggests otherwise, the strong likelihood is that you wouldn't have to. The NHS generally provides excellent care for long term or chronic conditions, and removes the risk of care lapsing due to disability-induced job (and insurance) loss. The implication that taxes would need to rise to accommodate this is also dubious, since you're already paying more per capita in healthcare taxes than the UK total spend on the NHS. You could stop paying insurance altogether, keep the exact same tax distribution, and still have a UK-standard universal system.
To my understanding, you analysis is correct, though I could easily see there being people in the US that would balk at paying the same money to the federal government that they now pay to a private company.
As for the quality of care point in the other comment, some of that comes from having to wait long periods of time to see specialists, and sometimes having to settle for a less expensive procedure instead of what might be best medically. That said, this has already happened to my SO under private insurance, though switching plans has helped somewhat. Even so, I don't think there's any system that makes the wait for specialists short, since not many people focus on rarer conditions.
That's a very good point - even if a change will benefit the vast majority, there might be a few individuals left worse off, and if someone you care about is one of them then all the positive statistics in the world will be cold comfort. Whether or not it applies to your partner's situation specifically (and I sincerely hope that it does not), it's something that's important for me to remember in discussions like this.
At risk of belabouring the point, switching to a UK-identical system wouldn't need anything extra to go to the government. You guys already pay £3,742 in taxes (and another £3,875 in insurance), we pay £2,892 total [all numbers annual per-capita averages]. That's how stark the difference is.
Of course switching an entrenched system wouldn't be anything like that simple, but I do think it's valuable to see what's possible.
To control cost NHS, reviews large or ongoing health care costs. The US doesn't. There are plenty of ways to save money in bringing downs costs, but to reduce cost overall we would have to limit care
The costs incurred by those high spenders aren't frivolous, though; we're talking about things like drugs that literally keep people alive or able to function. When you target those costs in particular and limit that medical care, people will suffer and die.
Are you advocating denying care to people with complex and expensive medical conditions, when there are no less-expensive alternatives that will help them? Or am I missing your point?
That's a big statement to make without backup. The spend difference between countries doesn't necessarily imply a different standard of care - it could be that, it could be a difference in efficiency for the same care, it could be a mix of both.
As for the top heavy distribution, I don't really see what that adds to the conversation. The healthcare outcomes and the average spend are both important, but if you're covering those two bases I don't really see that it matters if some people need a lot more care than others.
A gamechanging immunotherapy drug that can extend the life of patients with advanced head and neck cancer has been turned down for use in the NHS because of its high cost.
Nice will not approve drugs that cost more than its threshold of £20,000 to £30,000 per year of quality life, except for an end-of-life treatment – as this drug is – in which case the threshold rises to £50,000. But Nice believes nivolumab would cost between £66,000 to £75,000 per year of quality life.
He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider. If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment. About 8% of the population has some private health insurance from an employer or trade association and 2% pay from their own resources.
Can I see the source for this? Does this include state and local taxes as well? Also let's not forget that Americans pay a lot more out of pocket for services that the UK provides its citizens, still the de facto earning is lower regardless of the tax rate. As for spending on healthcare - I think it is an unfair comparison. The UK's single payer HMO system has a lot more bargaining power and gets considerably more for their money than the US.
No just federal.
For the UK https://www.gov.uk/guidance/rates-and-thresholds-for-employers-2017-to-2018
Tax thresholds, rates and codes
The amount of Income Tax you deduct from your employees depends on their tax code and how much of their taxable income is above their Personal Allowance.
Employee personal allowance
£11,500 per year
UK Basic tax rate 20% on annual earnings above the PAYE tax threshold and up to £33,500
UK Higher tax rate 40% on annual earnings from £33,501 to £150,000
UK Additional tax rate 45% on annual earnings above £150,000
For us taxes https://www.irs.gov/statistics/soi-tax-stats-individual-income-tax-returns-publication-1304-complete-report
Table 1.x
I think it was table 1.3
2016 income filed in 2017
Yea we are no where near UK levels but I think a 10 year plan... Or any long term plan could get us there
I think comparing only federal tax will bias you. In my state we pay 10% for state taxes and a considerable amount for local taxes as well. In other states, you have low state taxes but very high sales tax. You really need to compare the total take-home pay (including healthcare costs) to really compare the two countries. I suspect that doing so will show that Americans pay far higher de-facto taxes and yet have nothing to show for it
The UK has a 20% VAT which isnt included in those numbers and provides 42% of Govt funding
If I could wave a wand and have it happen, with some sort of magic bond that prevented it from being misused, certainly. The problem is, however, we have a pretty high tax rate in the US (former US Government professor/somewhat known consultant Peter Mathews cited it at ~45% for the middle class) that is comparable to more socialized countries, with none of the socialist benefits (I'm a part-time worker/student, so I'm well below that, but still lose 1/3 of my paychecks). We got screwed hard by Obamacare (not Obama's fault, I think, he did what he could and had his balls handed back to him by an adversarial Republican-majority Congress), and it was just somewhat fixed (no penalty for not being insured, and at least in California, we still have the gov't subsidized marketplace, according to my tax advisor).
I don't want to say where I think the money could be taken from, exactly, but we have a lot of corporate tax loopholes, culturally harmful subsidies (corn, and oil, for example), and a massive defense budget for a country with no other country actively attacking it. If we can cut that spending, we could divert funds to some "socialist" policies (nationwide healthcare marketplace, if not just a totally socialized healthcare system, nationwide eduaction funding to help with local deficits caused by low property tax income from low land values, for example), a "Green New Deal" not just for the future, but for the coming economic recesssion. If, and only if we can make inroads towards re-appropriating taxes already taken, would I support paying more. But as of today I could not trust that the money would be going to a good place.
Not sure where you would get 45% tax rate. Someone making 50k in the middle class is subject to a income tax rate of 6%-7%. Depending on the state somewhere between 50%-20% is subject to Sales tax of 4% and 10%
As an Example Nevada in the high side has ~half your income subject to 8% sales tax. Nevada has lower Property Taxes at 0.68% And no income or Corporate taxes
I did read up on him I saw he supported a 14% Corporate tax rate, but higher taxes on OIl industry
No, I would not. USG needs to appropriately use the revenue it is already obtaining from taxes. I firmly believe that proper management of current healthcare budgets could result in high quality universal healthcare, for instance. In order to do this, however, there must be political will to railroad the BS from lobbyists and make rational executive decisions. Similar idea for schools--the quality of American education vs. spend per student is INSANE, and ought to result in firing & blacklisting everyone responsible.
I have no problem paying more in taxes, but I want to see adult management of what I'm already paying before I'd be okay with a tax hike.
How do you define appropriately, is it
Just 5% of Americans Account for 50% of U.S. Health Care Spending.
The top 1%, 3,257,000 people receive on Average $209,000 annually in medical care
The Next 4%, 13,028,000 people receive on Average $104,000 annually in medical care
The bottom 95% 309,400,000 receive on Average $5,500 annually in medical care
325,415,000 receive on average $10,500 per person in medical costs
Is it how are funded
0.33 from taxes
the top 50% pay 0.27
*As whole dollars, $1 in total funding for the USA received
0.50 from taxes
the top 50% pay 0.48
As for education most of the budget ~78% is personnel. of that budget 56% is teachers 39% is student support services. 5% is back office
Now where do you make cuts, In Nashville A director Level is 150,000 for a Top 30 size district. I would love to find a report on the amount of necessary oversight. Avg Teacher salary is 56,000 Principles make 134,000. School counselors part of that support expense are 72,000. Add in an Admin for 58,000 and a secretary for 35,000.
HR Dept for employees is 6.9 Million
Of course a small proportion of the risk pool utilizes an outsized amount of healthcare spend. That shouldn't surprise anybody. My burning question is what proportion of the quoted healthcare spend figures are billing inflation/out of control pricing? If we say that healthcare ought to be accessible for everyone, I find it intellectually dishonest to claim that healthcare is an sector capable of setting its own prices. Eliminate fee-for-service, centrally and aggressively set prices by region like a utility, and eliminate the vast archipelago of rent seeking bullshit in the healthcare space.
Re education, salaries aren't the problem, and if anything ought to have upward pressure applied to them to attract more talent to the profession. I believe that all government pensions (and pensions generally..), explicitly including military pensions, ought to be eliminated as they are mathematically untenable. [0] suggests that these monies are enough to make a difference and could be redirected toward proper wages for teachers. [ 56k/year average for such a critical function is pretty abysmal in my view. ] If I think about it later I will try to find hard numbers, but a perfunctory search isn't turning up the data I'm looking for. The nation ought to go the way of private industry and eliminate unrealistic benefits--and yes, I realize this isn't a politically viable solution at this time.
[0] https://www.teacherpensions.org/blog/10-states-spend-more-employee-retirement-costs-higher-education
As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options. Choices must be made as to how this limited budget is spent. Economic evaluations are carried out within a health technology assessment framework to compare the cost-effectiveness of alternative activities and to consider the opportunity cost associated with their decisions.[23] By choosing to spend the finite NHS budget upon those treatment options that provide the most efficient results, society can ensure it does not lose out on possible health gains through spending on inefficient treatments and neglecting those that are more efficient.
NICE attempts to assess the cost–effectiveness of potential expenditures within the NHS to assess whether or not they represent 'better value' for money than treatments that would be neglected if the expenditure took place
He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider. If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment. About 8% of the population has some private health insurance from an employer or trade association and 2% pay from their own resources.
What do you mean by this? You can't just refuse to cover more expensive, long-term conditions as part of universal healthcare; that's what insurance used to do, and the ACA was passed in part to fix that because people suffered and died. (They still do, but to a lesser extent.)
The article you linked suggests options like: separating high-cost people into a separate pool (bad) or reducing the issue with more preventative care (not going to work for many conditions). Another option that's touted as a way to supposedly reduce costs is drug formularies, which in practice mean that patients with complex needs are unable to access the drugs that their doctors deem are most appropriate for them.
If you have an expensive surgery or longterm care that is above average, NHS will review it at your local Clinical Commissioning Group and it's cost Benefit effectiveness is reviewed to be covered.
To control cost NHS, reviews large or ongoing health care costs.
Yeah, sorry, I wasn't clear - I know this is done in other systems, and I don't want to replace the current US system of care being denied by insurance with care being denied by the government.
Yea... Then there is no way to fairly compare Healthcare costs and the idea of having a similar experience in the USA is much different.
With Medicare for all and better cost management we could see reduced costs of 5-10 percent. But we're still $9000 per person
I mean, one can make the decision that quality of life/length of life isn't worth it for certain people based on cost - but it's important to be clear and honest about what that means. People with cystic fibrosis who could slow their decline significantly will instead get sicker and die younger. People with developmental disabilities will be denied transplants because of DALY/QALY considerations and the idea that they won't be able to handle aftercare/medications. Etc.
Heck yes I would, happily. The crazy thing is that with a few tweaks we could have much better services without even spending more. First, close tax loopholes and beef up the IRS, then start going after rich tax avoiders. Every dollar they store away on a rock in the Bahamas is a dollar we don't get to invest in the country. Second, end the volunteer army and institute a draft. Now we won't be in perpetual war, especially since men and women are now eligible. There is still a ton of debt from our terrible spending following 9-11 and med bills/bennies for people in the armed forces but it would still free up a big chunk of the budget.
While we're on a roll, stronger democracy and not lower spending is the best way to make sure funds continue to be used well. Bringing our system into the modern world would help greatly in that regard.
Can you elaborate a bit on this? Why would a draft stop the perpetual wars?
After Vietnam the military-industrial complex realized that draft wars wouldn't let them wage perpetual wars around the world. It's a mix of people not wanting to send their sons (now daughters too) to war, and most importantly the activism that being conscripted inspires. That's why they moved to a volunteer army model and gave the military an advertising budget. That advertising budget has contributed towards the jingoization of society and for example pays for the national anthem display before football games.
I do pay high taxes for government services where I live and like the system. Currently I am happy with how my tax money is being distributed, and the services I and fellow residents around me get in return.