Monday, October 29, 2018

How Much Single-Payer Health Care Would Really Cost

Poor Man Survival

Self Reliance tools for independent minded people…

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ISSN 2161-5543

A Digest of Urban Survival Resources

Before Obamacare became law, I created an in-depth plan which was better and submitted it to Democrats. It would have included eye care, dental and hearing while eliminating the need for Workers Comp and it would have initiated Tort Reform [we’re the only nation which doesn’t have it in place] and it would have saved a bundle. My plan would have been far simpler and would not require additional bureaucratic levels – Democrats ignored it out of hand and instead, robbed Medicare to subsidize their poorly planned program and today the program is a disaster.

Here is how that plan would play out…

How Much Single-Payer Health Care Would Really Cost

Single-payer health care—something that’s also referred to as “Medicare for All”—has become a hot-button issue across the country. The idea: Instead of the medley of employers, insurers, individuals, charities and federal, state and local agencies that currently pay Americans’ multitrillion-dollar health-care costs, the federal government would open up a national health plan to everyone in the country and pay for essentially all health care.

Health insurance companies would be almost entirely out of the picture. So would employer-sponsored insurance—everyone would have health coverage, employed or not.

Debate about this issue is heating up, and a lot of these discussions include inaccurate information. You might hear single-payer referred to as “free” health care (it would be paid for through higher taxes) or “socialism” (in socialized medicine, the government owns nearly all health-care facilities and employs their workers—that is not what is under discussion for the US).

The government already pays most medical bills for millions of Americans through Medicare, Medicaid and veterans’ health programs, but having it be the single payer for everyone would be a massive change in the American health-care system, which currently makes up nearly 18% of our economy, and would affect everyone in ways that go beyond health care itself. With this such a critical issue in the upcoming midterm elections (and no doubt in the 2020 presidential race), Bottom Line felt it important to provide readers with a better understanding of some of the key financial implications, including…

§ How much would single-payer really cost?

§ How would its cost compare with the cost of our current health-care system?

We reviewed recent analyses by experts who study health-care policy, and we interviewed three experts who have looked carefully at the financial implications of a Medicare-for-All type of plan. Like many Americans across a variety of philosophical viewpoints, these experts disagree among themselves about the wisdom of moving in this direction. But interestingly, they are in closer agreement about the likely costs of such a system.

WHAT EXACTLY IS SINGLE-PAYER HEALTH CARE?

The most detailed single-payer plan that has been put forth so far is the one that Senator Bernie Sanders (Independent-Vermont) introduced in the Senate in 2017. That’s the one being used as a basis for the national debate on single-payer health care.

In a nutshell, it would create one new, national health-care plan that would theoretically replace all of today’s ways of paying for health care. Everyone would be covered, though private plans still could be offered for those who wanted and could afford coverage beyond what the national plan includes. There would be no more separate Medicare just for seniors, no more separate Medicaid and no more Obamacare.

In addition to the traditional medical expenses covered by current Medicare, the proposed plan would cover vision, dental and hearing expenses. There would be no out-of-pocket costs for services—meaning no premiums, deductibles or co-payments. The concept of “preexisting conditions” would not exist because everyone would be covered no matter when an illness began. Taxes would rise to fund the program…but beyond those taxes, Americans generally would no longer have medical expenses. In that sense, this proposal is not like Medicare because Medicare charges premiums, deductibles and co-pays and doesn’t cover vision, dental or hearing. Even so, this proposal often is referred to as Medicare for All, and you’ll hear it called “M4A” for short in the coming months and years.

How expensive would M4A be? A recent working paper published by the Mercatus Center at George Mason University, a think tank that generally advocates market-based approaches to policy, and a separate, previously published analysis by the Urban Institute, a think tank that tends to be less critical of government involvement, came to similar conclusions on that question—we’ll explore them below after a look at the costs of our current system.

WHAT DOES HEALTH CARE COST AMERICA NOW?

One widely respected source of information about the current cost of all health care in the US is the Centers for Medicare and Medicaid Services (CMS), an agency within the US Department of Health and Human Services. Its estimate of the total amount that was spent by everyone for all health care in the US last year (2017) is nearly $3.5 trillion, with that amount projected to rise each year under our current health-care system until it reaches $5.7 trillion for 2026, the last year for which CMS has produced a projection. Total 10-year cost of the current system: $45 trillion.

The current system is funded primarily from American households (28%), the federal government through taxes (28%), private businesses (20%, mostly consisting of employer-paid health-care premiums) and state and local governments through taxes (17%).

WHAT WOULD SINGLE-PAYER HEALTH CARE COST?

The working paper on Medicare for All by the Mercatus Center got a lot of press when it was released in July 2018. Mercatus concluded that if the assumptions in the proposal are correct, $32.6 trillion in medical expenses would be shifted to the federal government over the next 10 years, but in so doing, they would be taking the place of payments that employers and individuals currently make to insurance companies and to providers.

Federal taxes would go up, but direct health-care costs for individuals and companies, including insurance premiums (and taxes that fund state and local Medicaid), would—assuming the plan were successful as proposed—go away.

This $32.6 trillion shift closely tracked the conclusion of the less heralded 2016 study of M4A by the Urban Institute that was released shortly before Sanders formally introduced his bill. It said that health-care outlays shifted to the federal government would be $32 trillion over the 10 years from 2017 through 2026.

Much of the press coverage of the Mercatus paper mischaracterized the $32.6 trillion as the “cost” of M4A, as if it would add that amount of cost to the US health-care system…when in fact it was not added cost but just a change in who sends money to health-care providers. The Mercatus paper actually found that if the system described in the M4A proposal were successfully implemented, total health-care costs in the country would go down.

However, it is important to understand that focusing on this $32.6 trillion also was potentially misleading in another way—it might be understating the cost of M4A.

That’s because that figure was derived by using certain assumptions about cost savings that are built into the Sanders M4A proposal.

These savings include such things as eliminating $1.6 trillion of administrative costs over 10 years by no longer paying insurance companies to be middlemen in our health-care system…about $846 billion in lower, federally negotiated drug prices…and tremendous savings—$5.3 trillion—from paying for all health care at Medicare payment rates, which are lower than rates currently paid by private insurance companies and higher than Medicaid payments.

The concern, as the Mercatus paper notes, is that such savings assumptions are assumptions. The assumed much lower fees paid to health-care providers would be far less certain than other cost savings and lead to other questions about provider availability and job satisfaction on the part of providers.

To address the uncertainty, the Mercatus paper included two different 10-year scenarios—one in which the M4A proposal’s reduction in provider payment rates was factored in…and one in which it wasn’t (in other words, in which the government is unable to reduce provider payment rates).

Note that in both these scenarios, there also is one area where an M4A cost increase is factored in—increased use of health care from the roughly 30 million Americans who under the current system either can’t afford or choose not to have health insurance…from some people who do have insurance but who would use no-deductible M4A more heavily…and from the inclusion of dental, vision and hearing coverage.

What’s the financial bottom line? Here are the numbers for the five years from 2022 through 2026 based on the Mercatus M4A scenarios and on CMS projections…

§ Under the current health-care system, based on CMS projections, health care would cost the country an average of $5.1 trillion per year.

§ Under Medicare for All, assuming the program reduces fees to providers to Medicare payment rates, health care would cost the country an average of $4.96 trillion per year.

§ Under Medicare for All, assuming the program fails to reduce any fees paid to providers, health care would cost the country an average of $5.4 trillion per year.

It’s important to note that the numbers above are estimates, and no one knows what the exact usage of these services would be. Health-care cost estimates have been wrong before.

In addition, there are financial considerations beyond just America’s total cost of health care…and other considerations beyond just financial ones. Although most current Medicare beneficiaries are satisfied with that system, the quality and availability of care under a much expanded government-managed system are areas of concern. Would there be enough providers? Would patients be able to get in to see providers in a timely manner? If the system didn’t deliver on its promises, would Americans need to purchase additional coverage from private insurers, much as many do now when they buy supplemental Medicare policies?

Another concern is the apportionment of the total cost—Americans would no longer need to pay directly for health insurance or for medical care, but to enable the government to pay our medical costs, taxes would be raised—so whose taxes would rise the most and whose the least? And many employees of health insurance companies (currently totaling about 470,000 people) would have to find new jobs.

Conversely, the current health-care system has serious faults that are proven—including relentlessly skyrocketing costs (far higher per person than in any other country)…continued lack of coverage for tens of millions even under Obamacare and ongoing fear of losing coverage for others…and the need for employers and providers to devote vast resources to managing health coverage for their employees and patients, respectively.

Under single-payer health care, instead of being able to reduce today’s private payment rates to current Medicare rates, as is noted in the Mercatus paper, the more likely scenario would be “payment rates being set higher than they are under current Medicare law and lower than those now paid by private insurance.” In other words, a system in which health care costs the country more than what the Sanders M4A proposal suggests…but less than what the country will be paying for health care if no change is made to the system…and with everyone covered.

Grand irony: Considering the two M4A scenarios above—one with significant payment cuts for providers and one with no payment cuts for providers—the midpoint of those two possibilities comes out to a total health-care cost of $5.18 trillion per year, almost exactly the projected cost to the country if our current health-care system is retained—one difference being, of course, universal coverage. So it may be that the cost of health care in America is not the biggest issue in this important debate.

Questions for everyone to consider include these…

How much value do you place on having everyone covered?

And who do you trust more to manage the health care you receive—the government or insurance companies?

For a big swath of insurance-beleaguered Americans, not to mention their sandbagged employers, the price of health coverage just keeps going up.

The annual family premium for employer-sponsored health insurance rose 5% over the past year to an average of $19,616 for 2018, according to a survey by the Kaiser Family Foundation.

That may not seem like too much of a jump. But the increase is double the inflation rate, which was just 2.5% over the past year, Kaiser points out, and it’s nearly double the rise in workers’ wages, which gained 2.6% on average over the past year.

In most workplaces, the employer and employees share the cost of health insurance premiums in some way…and then, of course, the employees pay any deductibles and copays for services used. That makes it all the more important for people covered by employer-based health insurance to study the available options during the open enrollment period. For instance, if you and your spouse both have employers that offer health insurance, compare the cost of obtaining coverage separately versus covering both of you at one employer. Also compare the costs of coverage for dependent children if you have any.

The health-care insurance burden falling on employees is weighty. According to the Kaiser survey, workers’ contribution to the premiums alone is, on average, $5,547 for family coverage, with employers picking up the tab for the balance.

While that dollar figure is similar to last year’s, according to the foundation, the long-term numbers are more sobering. The average worker contribution for family coverage has increased 21% over the past five years and 65% over 10 years.

Another growing burden—deductibles. Over the past decade, deductibles have soared, rising 212%, according to the foundation. Inflation totaled just 17% over that span, and workers’ earnings grew just 26%. In other words, health care costs have been and still are an out-of-control skyrocket that is claiming a larger and larger portion of what people earn.

“Health costs don’t rise in a vacuum,” the Kaiser Family Foundation said. “As long as out-of-pocket costs for deductibles, drugs, surprise bills and more continue to outpace wage growth, people will be frustrated by their medical bills and see health costs as huge pocketbook and political issues.”

Employer-sponsored health insurance is in many ways the cornerstone of nationwide coverage. Such insurance covers more than half of the non-elderly population—about 152 million people.

There are some numbers in the Kaiser survey that may, just may, suggest the trend of digging into workers’ disposable income is slowing.

Premiums for family coverage increased 78% in the six years from 2000 to 2006…and then increased 37% in the six years between 2006 and 2012…and then increased 25% in the six years between 2012 and 2018.

However, bear in mind that all of those premium increases far outstripped gains in workers’ earnings, which rose just 20% between 2000 and 2006, 18% between 2006 and 2012, and an anemic 14% between 2012 and 2018, according to the Kaiser Family Foundation.

Source: The Kaiser Family Foundation, a non-profit organization based in San Francisco focused on health care issues and the US role in global health policy, has produced the survey since 1999. National Research LLC conducted telephone interviews for the survey with human resource and benefits managers at 2,160 firms between January and July 2018. Date: October 23, 2018 Publication:Bottom Line Personal

Have you noticed ridiculously high increases in the price of your health care? If you have private health insurance, whether through your employer or a policy you bought directly, the answer is probably yes. A study by the Kaiser Family Foundation has found that the cost of health care in the US is much higher and has grown much more rapidly in the past two decades for people with private insurance than for those on Medicare or Medicaid. Even if your insurance starts to cover much of the cost each year at some point, the deductibles that have to be paid first are skyrocketing and can be crushing. And health-care costs are significantly outpacing the inflation rate—meaning that many Americans who have been able to pay for medical care in the past are, simply put, on a collision course with not being able to afford the care they need.

This trend will be catastrophic for many if it continues, but if you’re privately insured, some of the results of the Kaiser study could help you budget and manage your medical costs in ways that minimize financial harm…or help you understand what you stand to save when it’s time to enroll in Medicare. Study findings that could help you…

Inpatient hospital care costs have soared the most. The increase in health-care costs has been particularly steep for patients with private insurance who require inpatient hospital care. Those costs spiked a full 13% between 2014 and the first quarter of 2018, according to the study, compared with an increase of just 3% for inpatient care received by patients on Medicaid and Medicare. For perspective, overall inflation totaled about 6% during the same period—more than half of the increased cost of inpatient care for the privately insured. As measured in 2015, hospital inpatient prices were 68% higher for private patients than for Medicare patients.

Price increases have been especially sharp for some procedures. The average cost under private insurance of an inpatient laparoscopic appendectomy jumped 136% from 2003 to 2016, reaching an average of more than $20,000, with some topping $35,000.

What to do: Keep this in mind when deciding when to switch from private insurance to Medicare.

Prices of procedures vary widely by market. Where you receive care has a huge impact on what you can expect to pay. For example, the average price of a full knee replacement in the New York City area was $50,000 in 2016. Around Louisville, Kentucky, the same procedure would run you $23,000—less than half. The national average was $34,063. And the average price increase between 2003 and 2016 was a lofty 74%, compared with the overall inflation rate of 28%.

What to do: If you are relocating, be sure to ask about and factor in the cost of medical care in your area. And for some people, it might even make sense to move because you want to be in an area with lower medical costs—the difference to your overall finances can be that significant.

Even office visits skyrocketed in price. The average price of a common office visit rose 69% from 2003 to 2016, from $60 to $101 (and in some parts of the country, office visits topped $150).

What to do: When choosing doctors, especially those you expect to see frequently for follow-up care, ask about charges for simple office visits, and make that information one of the factors you consider. This is something that very few people do but that could save you a lot of money.

Source: Robert Graboyes, PhD, senior research fellow and health-care scholar at Mercatus Center at George Mason University, Arlington, Virginia…Jonathan Oberlander, PhD, professor and chair of social medicine and professor of health policy and management at University of North Carolina at Chapel Hill…and Jodi L. Liu, PhD, associate policy researcher specializing in health-care financing and payment at Rand Corporation, a nonprofit research and policy organization in Santa Monica, California. Date: November 1, 2018

Source: A report from the Peterson-Kaiser Health System Tracker titled “How have healthcare prices grown in the US over time?” Authored by Gary Claxton, Matthew Rae, Larry Levitt and Cynthia Cox of the Kaiser Family Foundation, the report analyzed a subset of claims filed by large employers from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database (MarketScan).

Yours for better living,

Bruce ‘the Poor Man’

Additional News Items

Nearly half the world lives on less than $5.50 a day: World Bank (Adam)

"Particularly distressing findings are that extreme poverty is becoming entrenched in a handful of countries and that the pace of poverty reduction will soon decelerate significantly," the report said.

At the $5.50-a-day threshold, global poverty fell to 46 percent from 67 percent between 1990 and 2015. The bank reported last month that extreme poverty had fallen to 10 percent in 2015.

Jim Rogers: Worst Crisis In My Lifetime (Herman J.)

While gold and silver have held up well during the sell-off over the last couple days, Rogers says the precious metals’ could fall.

Lastly, Rogers talks commodities other than precious metals. He says sugar is 80 percent below its all time high.

6 Ways to Plan for Healthcare in Early Retirement (Consumerism Commentary)
Early retirement has become a growing movement in the past few years, particularly with the nine-year bull market in stocks. But one critical aspect of early retirement--that’s commonly ignored--is how to pay for healthcare.

These Americans Fled the Country to Escape their Giant Student Debt (CNBC)

Defeated by their student debt, some borrowers are packing their bags and fleeing from the U.S. to other countries, where the cost of living is often lower and debt collectors wield less power over them.

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Yours for smarter living,

Bruce ‘the Poor Man’

Additional FREE Resources

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Other notes of interest…

Living Frugally In Suburbia
You live differently than your neighbors.

14 Frugal Food-Rescuing Tips from Grandma
These depression-era frugal tips still work today!

8 Simple Ways to Put More Money in Your Pocket
Have more money without working harder!

Knowing When and How to Stockpile Groceries
Stocking up could save your grocery budget!

Emergency Preparedness on a Budget
Affordable ways to prepare for an emergency.

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Monday, October 22, 2018

Why our Middle Class is Screwed

Poor Man Survival

Self Reliance tools for independent minded people…

www.poormansurvivor.net

ISSN 2161-5543

A Digest of Urban Survival Resources

Why our Middle Class is Screwed

According to the Social Security Administration, the median yearly wage in the United States is just $30,533 at this point. That means 50 percent of all American workers make at least that much per year, but that also means that 50 percent of all American workers make that much or less per year. When you divide $30,533 by 12, you get a median monthly wage of just over $2,500. But of course nobody can provide a middle class standard of living for a family of four for just $2,500 a month.

Here are just a few examples from their official website…

-34 percent of all American workers made less than $20,000 last year.

-48 percent of all American workers made less than $30,000 last year.

-59 percent of all American workers made less than $40,000 last year.

-68 percent of all American workers made less than $50,000 last year.

At this moment, the federal poverty level for a family of five is $29,420, and yet about half the workers in the entire country don’t even make that much on a yearly basis.

Why the Middle Class Is Screwed

By Robert Kiyosaki

Last December, Congress passed the largest U.S. tax system overhaul in more than 30 years—a $1.5 trillion tax cut, but America’s middle class will see less than a quarter of the savings under the legislation.

In 2018, middle-income households—those earning $20,000-$100,000—will see a tax cut of about $930 on average. Just about half of American adults live in middle-class households, down from 61% in 1971 according to the Pew Research Center. For a while now, I’ve been predicting that the middle class would disappear and that we would have only two classes of people in the U.S., the poor and the ultra-rich.

The middle class is made up of people who work for a living, earning wages doing carpentry, plumbing, factory work, and all types of services. They live paycheck to paycheck with very little in savings or investing in retirement.

Those earning more than $500,000 a year will get $61 billion in cuts in 2019. This includes income earned by pass-through businesses such as partnerships and S-corporations that pay taxes on individual returns. This is because tax cuts for small businesses will help boost the economy—helping job growth.

This isn’t a story of economic gloom, it’s a financial education that you won’t hear through mainstream media. There are four financial forces that cause most people to work hard and yet struggle financially:

1. Taxes

2. Debt

3. Inflation

4. Retirement

Which one of these four affects you personally?

If he were alive today, my poor dad would have struggled financially even without his bad investments. He most likely would not have been comfortable. Today, the middle class is quickly disappearing. But it’s a different sort of disappearance than people think. As Jim Rickards writes, “The middle-class numbers are not necessarily getting smaller. The problem is that middle class doesn’t mean what it used to mean.” I believe the population is actually dwindling, but this is an important understanding. There is still a population living and breathing in the 40-60% mid range of earnings. But because all the ways my poor dad achieved a level of financial comfort no longer work in today’s economy, that distinction doesn’t entitle you to the security you would have had even twenty years ago.

Today, savers are losers, houses are worth less and less, there are no pensions, and essential goods for life are more and more expensive. Today, inequality is higher than it’s ever been.

How the Rich Get Richer

Here’s the kicker. The rich know how to use these forces to make more money rather than have them steal their wealth.

The rich know how to make investments and run businesses that allow them to pay little to no taxes.

The rich know how to use debt and other people’s money to make investments that provide constant cash flow while paying that debt off.

The rich know how to make investments that hedge against inflation and make them money while others are falling behind.

The rich know how to utilize all these forces to have a secure retirement provided by cash-flowing assets.

The rich can do all of this because they understand how money works and have a high financial IQ.

How So-Called Experts Keep People Poor by Limiting Their Mindset

The problem with conventional advice about money is that it’s not only conventional but also often wrong. In fact, much of the money advice out there is designed to keep you from becoming poor rather than to inspire a mindset to grow rich.

The following advice is most often peddled to the middle class:

1. Live below your means

2. Limit takeaways

3. Cash over credit

4. DIY projects

5. Talk to your family about budgeting

6. Set an example

7. Write it down

Broadly, these can be condensed into three broad categories of bad budgeting advice that are foundational to members of the middle class.

Bad Advice #1: Live in a world of scarcity

The classic mantra to “live below your means” is one of the most destructive things you can teach someone about money. It teaches people to think in terms of scarcity. “You only have so much, so you must be careful not to run out.” It kills drive to create more.

Bad Advice #2: Set Limits

When you live in a world of scarcity, you must find ways to conserve what you have. So, naturally you set limits. Not going out to eat, creating systems to limit spending, and doing everything yourself instead of hiring an expert; all are ways those with a scarcity mindset set limits to “save” money. Unfortunately, they sometimes don’t save money, and even when they do, they feel unfulfilled, stressed, and don’t get to enjoy the things they want to.

Bad Advice #3: Set the wrong example

Ultimately, if you follow the advice of conventional money experts and model this behavior for your family, you’ll continue to raise generations who struggle to make ends meet financially. Worse yet, you’ll teach them to see the world as one of scarcity, limiting their mindset and potential in the process.

What Can You Do?

When I do any sort of interview, whether for a news outlet or a blogger, the first question I usually get asked is about why I wrote Rich Dad Poor Dad. I always answer that it was because I saw the financial crisis of today coming and I wanted to help as many people as possible to get out of the rat race.

The second question is usually about my relationship with Donald Trump. They want to know if I believe that Trump is a great President and will save America. Even though I have great respect for Donald, I don’t think it matters who is in the White House. It is the banks and Wall Street that control our money—and ensures money control your life.

Today, the middle class has exchanged its wealth for handouts. One explanation is that handouts feel securer than self-reliance. This is a fine sentiment until one day you wake up and realize that you’re poor. It’s even more frightening when you realize the government you rely on is poor too.

If you want to be rich, the choice is clear. You must be fiercely independent. You must take your future and your money into your own hands through financial education—something the government will never hand out.

Today, your tomorrow can be better than your present. But it will take hard work, discipline, and independence, something often in short supply today.

Increasingly, which class you belong to will be a function of the choices you make on how you’ll live your life. Will you be independent? Or will you rely on government handouts?

Now, more than ever, it is imperative to stop playing by the old rules of money. The middle class is dying, and the government won’t save it. The rules have changed, and the cards are stacked.

If you want to not only survive but also thrive financially, it’s time to take matters into your own hands, to educate yourself financially, and to play by the new rules of money.

Robert Kiyosaki

Editor, Rich Dad Poor Dad Daily

Yours for better living,

Bruce ‘the Poor Man’

Additional New Items

Nearly half the world lives on less than $5.50 a day: World Bank (Adam)

At the $5.50-a-day threshold, global poverty fell to 46 percent from 67 percent between 1990 and 2015. The bank reported last month that extreme poverty had fallen to 10 percent in 2015.

America’s $1.5 trillion student debt is a ‘failed social experiment’

But ask many borrowers in this generation whether they worry about how the loans will affect their future and you’ll get a slew of bleak replies: It’s stopped them from getting their car fixed, switching jobs, buying a home and having children. Even a tax credit aimed at helping working low- and moderate-income Americans can be seized to repay defaulted student loans.

Entire Federal Budget Now National Security Secret – Dr. Mark Skidmore (yogmonster)

In closing, Dr. Skidmore says, “How can you have a democracy if you don’t have any transparency whatsoever? Having integrity and confidence is so essential to the whole system, and this just puts everything in question. . . . We should clean this up and show we are legitimate. If we don’t, we are just shooting ourselves in the foot.”

Red Cross suffers own damage from Hurricane Michael (Thomas R.)

"We're watching what people are going through," Smith said. "We've been through this with Matthew and Irma, but this is a little bit different. This is catastrophic, but it's a reminder for all of us that this could have been our community, and in some ways, it is our community. Please continue to be diligent. Make sure you have your disaster supply kit in place, as well as a plan."