Matt Bruenig, founder of the People’s Policy Project—a rare progressive think tank, funded by small donations instead of corporations—has a smart piece in the New York Times today in which he makes the point that when Americans calculate how much they pay in taxes, they should be factoring in healthcare premiums. While we have what is nominally a progressive tax code, the addition of these premiums makes it look more like a flat tax:
What this data shows is that lower-income workers, higher-income workers, single workers, and married workers with children all contribute around 40 percent of their pay toward taxes and health premiums. And when those health care costs are taken into account, the less well off no longer pay less than high-earners, as they do in taxes alone.
Those numbers for middle and lower-income Americans actually compare unfavorably with places like the U.K. and Canada and Finland.
Bruenig’s math is aimed at making a bigger point: A Medicare for All program is going to save most people money in the long run, because the increase in taxes will be offset by the fact that premiums no longer exist. When he checked the numbers from a single-payer proposal from New York state, this is what he found:
...the plan would cut health care costs dramatically for the lowest income group, while increasing them by about 50 percent for the highest income group. Middle-class people would also experience net savings on health care equal to around 10 percent of their income, with only those earning 10 times the federal poverty line or above — that’s $134,000 for an individual or $276,000 for a family of four — paying more than they do now.
Bruenig’s piece is necessary, and well-conceived, but I couldn’t help feeling a little frustrated that his point had to be made in the first place. I keep going back to one of the top reader comments on the op-ed:
Wow. As a Canadian who has lived in our version of universal healthcare all my life, I find the “insight’ that individual healthcare premiums should be factored into a comparison of the costs of the current system with a universal system so obvious that it scarcely needs stating. Has the debate in the United States become so artificial and slanted that you actually have to argue that fundamental starting point?
It’s flabbergasting to me, too, but the truth is that we haven’t gotten past this simple starting point in the U.S—not even close. Every time we see a Medicare for All proposal discussed in mainstream media—not even right-wing media!—the same question comes up: “Won’t it increase taxes?” (Ditto for any conversation you have with someone who doesn’t quite understand the concept of Medicare for All in the first place.) It’s gotten to the point that I can’t tell if the media actually doesn’t get it, or if they’re operating in bad faith as a collective.
This should be really simple, and it should be something every American can understand: A Medicare for All program is going to save you money unless you’re rich. It is going to save you money because the increase in taxes will be less than what you’re already paying in healthcare premiums.
Of course, this broad truth doesn’t even begin to get into deductibles and co-pays and coinsurance, not to mention the exorbitant, life-ruining, debt-spiraling cartel costs for services that aren’t covered, or for individuals themselves who lack insurance. Bruenig doesn’t broach those topics, wisely focusing instead on the simple issue of “no, even when we’re only talking about premiums, you are not going to have pay more money in taxes unless you’re raking in $134,000 as an individual or $276,000 as a family.”
But those other costs are important, too—they make the absence of a single-payer system look even more egregious from a financial and moral standpoint.
If we’re ever going to overcome insurance company and pharmaceutical propaganda in this country and have a fighting chance to institute a single payer system, we need to make people understand the easy math: If you wipe out premiums (and all the other delightful costs of private healthcare), and the tax increase of a single-payer system is less than you were paying for those premiums, you’re coming out ahead.