rom [EMAIL PROTECTED] Wed Apr 6 18:45:59 1994
Date: Wed, 06 Apr 1994 11:03:12 -0700
From: Elaine Bernard <[EMAIL PROTECTED]>
Reply to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Subject: RE: Economists for a California Single-Payer Plan?
Elaine Bernard in quotes:
"Let me explain. For single payer to work it needs to
capture all of the moneys that currently go into the
health care system. [deletia] The single payer advocates mostly
argue for separating funding the health care system from employment
by funding the system with taxes more or less equivalent
to the amount that people already pay. Further it will be
a graduated tax (and therefore much more progressive)."
"Anyway, as I understand it (this may have changed as many of
the single payer advocates are very much aware of this problem)
the Clinton plan precludes (explicitly) a more progressive
funding formula. In other words, he's keen to hobble any
chance of a single payer system, while posing that he would
permit it."
Elaine makes an excellent point about the Clinton plan's treatment of
single payer system and his explicit rejection of
alternative/progressive funding sources [Title I, section 1223.d.1 of
Clinton's Health Security Act].
However, I think her conclusion that a payroll funding source
"hobbles" single-payer programs is too strong. It is possible to run
a non-progressive funded single-payer program. McDermott's Single
Payer Bill [HR 1200] is funded by a FLAT payroll tax (at least
Clinton's payroll tax and the California proposal's payroll tax
posted by Nathan Newman have sliding scales to help poor and small
employers respectively). It is a bad way of funding a single-payer
system but that has not stopped it's main proponents from adopting it.
I agree with Elaine's point of severing the employer funding
connection wholeheartedly, but of all the proposal's before Congress
you have to support the Stearns/Nickles [i.e., Heritage Foundation]
proposal to stop employer ties.
On a related note, I have been perusing the Clinton Proposal and have
found many interesting irregularities (some of these can be a result of
a misreading because I am not a lawyer but I have tried to be careful):
If a state (or region!) adopts single-payer status they are exempted
rightly from a number of requirements that other states must follow
but one of them is "assuring adequate access to a choice of health
plans [i.e., a health plan cannot setup shop exclusively in wealthy
areas if poor people are closeby]. Indulge me further, if a large
state had a poor region (downturn in a key industry, for example)
they could "let them" go single-payer and the single-payer system
would have fewer guarantees to provide quality and access.
Also, the single-payer region COULD opt to let large employers
continue to offer their own set of plans and the Medicare population
could also remain separate. This is an admittedly extreme example but
it is possible that "Single-payer" will be used as a reduced quality
provider under the Clinton shoehorn.
One other note, the fine for corporate alliances not providing their
employees with comprehensive benefits is explicitly capped in the
Clinton proposal ($100,000). It is entirely possible for a large
employer to attempt to "shave" moderate to expensive benefits rationally
(and hope not to get caught of course).
Jim Westrich // [EMAIL PROTECTED]
Marxman say: "Nine to Five slavery or a twenty-four seven
Most slaves tricked by a promise of a heaven
Controlled by the sound of a whip that goes "Sack!"
Mind-forged manacles make sure there is no slack"
