Bemused by the call for "Medicare for All"

This is the calculator but in general the levy is 1.5% to 2% of taxable income. Pensioners and low income people do not pay the levy at all.

Medicare levy calculator | Australian Taxation Office



The medicare levy surcharge is applied to people who can afford private health insurance but choose not to. We are all expected to make some provision for our own health costs if we can afford it rather than expect the government to pay for everything and everyone. It is the reason why private health funds have not been driven out of business. Like most other things in Australia, our health care system is a mix of private enterprise and government. Capitalism and socialism combined.
Do I understand that the highest marginal rate (on taxable earnings of >180K) is 45%? And for this hypothetical person, if they chose to use the public system (Aus Medicare), they'd pay an additional 4K levy?

Again, are Aus Medicare workers public employees?

EDIT:

Ah, here we go:

https://www.commonwealthfund.org/international-health-policy-center/countries/australia

States own and manage service delivery for public hospitals, ambulances, public dental care, community health (primary and preventive care), and mental health care. They contribute their own funding in addition to that provided by federal government. States are also responsible for regulating private hospitals, the location of pharmacies, and the health care workforce.

This sounds like all public hospitals that are a part of the Medicare system are stated-owned, and hence we might suppose that the employees are state employees.

Basically, this how you can control costs in the public system. It requires nationalization of healthcare infrastructure.
 

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HoneyNut

Senior Member
The vision I have of Medicare For All is like Medicare in so much as instead of each private company having to negotiate with the different private health insurers (that gives an advantage to huge companies and employees of those companies), which causes a bit of churn for employees when their company switches insurers and employees have to make sure their current doctor also takes the new insurer or else they have to change doctors), instead with Medicare for All, employees would have the same insurance all the time even as they change companies, and the Medicare for All will have even better leverage than individual private companies do when negotiating prices with the different private health systems.
Maybe with Medicare for All private doctors would be able to exist again instead of being forced into the private health profit making system, but I'm not sure.
It seems to me that the Medicare I prepaid is just hospitalization, so I don't think that type of insurance is very expensive and the savings of having a Medicare for All would more than make up for that amount.
I wish we'd do a national health insurance and get rid of all the stupid multi-million dollar compensated useless CEOs of the private health insurers.
A dream I have is that we might someday have open statistics about how good (or not good) different doctors are.
 

Warrigal

SF VIP
The states were responsible for public schools and hospitals long before Federation (1901) until then there was no federal government.

Before Medicare families paid weekly into hospital and medical benefit funds to be able to cope with health care costs. They were mostly co-operatives and mutual benefit societies. There were also Ambulance and pharmacy funds available. We used to be members of a masonic lodge pharmacy fund as well as a hospital fund and a separate medical benefits fund.

All of that has been replaced by Medicare. Dentistry is not yet included in Medicare but I think it will be soon. Poor people's teeth are rotting in their mouths because there are such long waiting times for free dental treatments.
 

The vision I have of Medicare For All is like Medicare in so much as instead of each private company having to negotiate with the different private health insurers (that gives an advantage to huge companies and employees of those companies), which causes a bit of churn for employees when their company switches insurers and employees have to make sure their current doctor also takes the new insurer or else they have to change doctors), instead with Medicare for All, employees would have the same insurance all the time even as they change companies, and the Medicare for All will have even better leverage than individual private companies do when negotiating prices with the different private health systems.
Maybe with Medicare for All private doctors would be able to exist again instead of being forced into the private health profit making system, but I'm not sure.
It seems to me that the Medicare I prepaid is just hospitalization, so I don't think that type of insurance is very expensive and the savings of having a Medicare for All would more than make up for that amount.
I wish we'd do a national health insurance and get rid of all the stupid multi-million dollar compensated useless CEOs of the private health insurers.
A dream I have is that we might someday have open statistics about how good (or not good) different doctors are.
I just looked at the Aus Medicare system. Here's how it works, as I understand it.

It appears to be one of the things funded by income tax, and there's an income tax surcharge for people making more.

The tax brackets are 0, 19, 32.5, 37, and 45. The top bracket for an individual starts at 180K Aus, or approx 125K US. This is about 60K per year for income tax with a surcharge of 2% on the whole amoubt of taxible income.

The hypothetical person with 125K taxable income in the US woudl therefore pay $64K in taxes.

So apparently a two income family of 125K each would pay 128K per year in combined income and Medicare surcharges.

That's the first part.

The entire Aus Medicare system is state owned and operated. This means all doctors/nurses/etc. are state employees.

I have no real idea of the amounts of coverage, or deductibles, or co-pays this amounts to.

Ask yourself if it seems to you that a tax rate applied that high $60K plus 4K surcharge, to an income of that amount ($125K), plus state takeover of hospitals/clinics/etc., with all employees as state workers will ever get off the ground in the US within your lifetime.
 
The states were responsible for public schools and hospitals long before Federation (1901) until then there was no federal government.

Before Medicare families paid weekly into hospital and medical benefit funds to be able to cope with health care costs. They were mostly co-operatives and mutual benefit societies. There were also Ambulance and pharmacy funds available. We used to be members of a masonic lodge pharmacy fund as well as a hospital fund and a separate medical benefits fund.
This part is a lot like co-op insurance plans for social clubs in the US used to be.
All of that has been replaced by Medicare. Dentistry is not yet included in Medicare but I think it will be soon. Poor people's teeth are rotting in their mouths because there are such long waiting times for free dental treatments.
A good argument to earn more money, huh? :)
 

Warrigal

SF VIP
This part is a lot like co-op insurance plans for social clubs in the US used to be.

A good argument to earn more money, huh? :)
Capitalist!

No-one even looks to hire an unemployed man who has a mouth full of rotting teeth, much less a woman. They have a much better chance of getting dental treatment if they throw a brick through a jeweller's window. At least in gaol you get free medical and dental treatment.

Just kidding about the capitalist jibe. Peace?
 
Capitalist!

No-one even looks to hire an unemployed man who has a mouth full of rotting teeth, much less a woman. They have a much better chance of getting dental treatment if they throw a brick through a jeweller's window. At least in gaol you get free medical and dental treatment.
We're way ahead (or behind) you folks here.
People don't go to jail for things like that here.
Just kidding about the capitalist jibe. Peace?
YES!!! :)
 
Recidivists do here

Don't you have a 3 strikes policy in some states?
Boy, with 50 states you can't be sure, but the trend has been a reversal of this for probably 10 years anyway.

The more recent trend has been to do away with requiring monetary bail.

Yes, you read that correctly.

Typically here the sorts of dental problems for the chronically unemployed are a result of prolonged meth use.
 

Warrigal

SF VIP
I understand the doing away with monetary bail to be something to do with the sources of the money?
Yes? No?

As for the chronically unemployed, a large proportion of them are the over 50s with medical/physical problems. I know one such man who wants to work but is unfit for physical labour. He's on a pension but it is not secure and sometimes he has to choose between food and medications. He can do light work, but so can much younger men, so he misses out. As you can imagine, private dental care is out of the question. A bad tooth can be very painful and new dentures very expensive if waiting several years is not an option.

Not everyone on government benefits is a hobo or a druggie.
 
I understand the doing away with monetary bail to be something to do with the sources of the money?
Yes? No?
This is the criterion for the recent Illinois no cash bail law:

"Proponents of the bill argue that the cash bail system disproportionately impacts minority communities, and that eliminating the practice will help to ensure more equitable outcomes."

It's an attempt at equity before the law.
As for the chronically unemployed, a large proportion of them are the over 50s with medical/physical problems. I know one such man who wants to work but is unfit for physical labour. He's on a pension but it is not secure and sometimes he has to choose between food and medications. He can do light work, but so can much younger men, so he misses out. As you can imagine, private dental care is out of the question. A bad tooth can be very painful and new dentures very expensive if waiting several years is not an option.

Not everyone on government benefits is a hobo or a druggie.
This discussion makes me think that the problems most common in Aus and the problems most common here in the US are somewhat different.
 
I understand the doing away with monetary bail to be something to do with the sources of the money?
Yes? No?

As for the chronically unemployed, a large proportion of them are the over 50s with medical/physical problems. I know one such man who wants to work but is unfit for physical labour. He's on a pension but it is not secure and sometimes he has to choose between food and medications. He can do light work, but so can much younger men, so he misses out. As you can imagine, private dental care is out of the question. A bad tooth can be very painful and new dentures very expensive if waiting several years is not an option.

Not everyone on government benefits is a hobo or a druggie.
This is more representative of what it's like here:
 

Happy Heart

Member
The states were responsible for public schools and hospitals long before Federation (1901) until then there was no federal government.

Before Medicare families paid weekly into hospital and medical benefit funds to be able to cope with health care costs. They were mostly co-operatives and mutual benefit societies. There were also Ambulance and pharmacy funds available. We used to be members of a masonic lodge pharmacy fund as well as a hospital fund and a separate medical benefits fund.

All of that has been replaced by Medicare. Dentistry is not yet included in Medicare but I think it will be soon. Poor people's teeth are rotting in their mouths because there are such long waiting times for free dental treatments.
I have mentioned dental care before and the fact that it is the ADA resisting CMS providing care when medically necessary. The ADA is claiming, as recently as last November, that their complaints are financially based since dental equipment is expensive for their members so charges should not be regulated by CMS. Please Google CMS and American Dental Association to read the documents they have online. As I waited with my husband this afternoon for his molds to set up I chatted with our dentist. He said he knows a doctor who is fighting to get dental care paid for by CMS because it is medically necessary. We need to make a lot of noise and be heard to get medically necessary dental work included in Traditional Medicare. You can't count on AARP since they are associated with private insurance companies, as you know. Times have changed and the association between your dental health and general health is well documented, we need the ADA to get out of the way.
I have never had free dental care so I wouldn't even know where to find it. Currently, the cap my husband is getting today costs $1.400 which we will pay for out of our own pocket.
 

HoneyNut

Senior Member
The tax brackets are 0, 19, 32.5, 37, and 45. The top bracket for an individual starts at 180K Aus, or approx 125K US. This is about 60K per year for income tax with a surcharge of 2% on the whole amoubt of taxible income.

The hypothetical person with 125K taxable income in the US woudl therefore pay $64K in taxes.
I don't know anything about Australia's medical system. I do know that in the USA, Medicare does not use state employees for either doctors or insurers. With Medicare I still choose between Blue Cross/Blue Shield or UnitedHealthcare or several others, and with Medicare I still see doctors that either work for themselves (getting rare) or are employed at some private for-profit health facility. So Medicare-for-All would probably be the same I'd expect.

Also, I don't know about Australian tax rates and brackets, but I suspect that you might have interpreted them incorrectly. In the USA tax rates only apply to the dollar amount that is above the bracket level, not applied to the lower bracket dollars (so the real rate is less).

I think there have been many studies that have found that Medicare for All would be less expensive than the current system.
 
I don't know anything about Australia's medical system. I do know that in the USA, Medicare does not use state employees for either doctors or insurers. With Medicare I still choose between Blue Cross/Blue Shield or UnitedHealthcare or several others, and with Medicare I still see doctors that either work for themselves (getting rare) or are employed at some private for-profit health facility. So Medicare-for-All would probably be the same I'd expect.

Also, I don't know about Australian tax rates and brackets, but I suspect that you might have interpreted them incorrectly.
Nope, I used these:
https://www.ato.gov.au/rates/individual-income-tax-rates/
https://moneysmart.gov.au/income-tax/income-tax-calculator
In the USA tax rates only apply to the dollar amount that is above the bracket level, not applied to the lower bracket dollars (so the real rate is less).
Right. And it's the same in Aus but the brackets are different.
And the 2% levy for Aus Medicare applies to the entire taxable amount.

https://moneysmart.gov.au/income-tax/income-tax-calculator#!focus=1

I think there have been many studies that have found that Medicare for All would be less expensive than the current system.
 

HoneyNut

Senior Member
Right. And it's the same in Aus but the brackets are different.
And the 2% levy for Aus Medicare applies to the entire taxable amount.
So then that sounds like the Australians and Americans are paying approximately the same in taxes -- tho note that when I ran the $180k in the Aus calc it only mentioned generic income tax, whereas when I did the equivalent 124k in the US tax calc I had to add my location and it included state and local tax - the results were Aus keeping 69% of income and US keeping 68% of income, but the Australians get health care for their money but in the US we have to pay quite a lot more in addition in order to have health insurance (and also our employers pay too).

Two thumbs up for Australia!
 

Warrigal

SF VIP
I don't know anything about Australia's medical system. I do know that in the USA, Medicare does not use state employees for either doctors or insurers. With Medicare I still choose between Blue Cross/Blue Shield or UnitedHealthcare or several others, and with Medicare I still see doctors that either work for themselves (getting rare) or are employed at some private for-profit health facility. So Medicare-for-All would probably be the same I'd expect.
Medicare in Australia does not preclude fee for service from private practitioners. My GP and all of the specialists I see are in all private practices. It is only in government hospitals (we do have private hospitals as well) that the staff are government employees.

Also, I don't know about Australian tax rates and brackets, but I suspect that you might have interpreted them incorrectly. In the USA tax rates only apply to the dollar amount that is above the bracket level, not applied to the lower bracket dollars (so the real rate is less).
Same here. There is a tax free threshold for very small incomes, then the next tax bracket is at a relatively low rate. The rate goes up as each new tax bracket is reached. Recent taxation legislated has meant that the highest incomes are paying a lot less tax than before, if they pay tax at all that is, because they would rather pay the money to the taxation lawyers and accountants than to the common purse.

I think there have been many studies that have found that Medicare for All would be less expensive than the current system. Economy of scale is part of it. It does require a rather large bureaucracy to run it and a tight rein on costs is also necessary to avoid bloating over time.
 
So then that sounds like the Australians and Americans are paying approximately the same in taxes -- tho note that when I ran the $180k in the Aus calc it only mentioned generic income tax, whereas when I did the equivalent 124k in the US tax calc I had to add my location and it included state and local tax - the results were Aus keeping 69% of income and US keeping 68% of income, but the Australians get health care for their money but in the US we have to pay quite a lot more in addition in order to have health insurance (and also our employers pay too).

Two thumbs up for Australia!
So let's see...

You're essentially saying that in the US if you add state and local taxes to the federal income tax, it comes out that it's 1% *less* than national Australian income tax, alone?

Do you know if there are Australian taxes that are the counterparts of our state and local taxes? Wouldn't it be more honest to add these in, also?

BTW, when you say:

when I did the equivalent 124k in the US tax calc

How did you get the US brackets (10%, 12%, 22%, 24%, 32%, 35% and 37%) to approximate the Aus brackets (19%, 32.5%, 37%, 45% +2% Medicare levy)?

Let's do apples to apples before doing a premature endzone dance and blowing on a didgeridoo. Let's see about other taxes the states/localities might levy:

https://en.wikipedia.org/wiki/Taxation_in_Australia#:~:text=State governments do not levy,the sale prices it charges.

At this age, and for a very long time now, I have no need to be right; all I'm interested in is getting it right. There's a big difference.

For all I know, the Australian system may well be superior to ours and cost about the same, but from what you've shown it's not been demonstrated.

All we really know for sure is that you don't like the present US system.
 

JimBob1952

Senior Member
I once had to write something about the German system, which is highly regarded.

It's not "single payer" per se; patients see private doctors and there is a degree of choice.

Everyone pays an 8 percent dedicated tax to cover the costs of healthcare, no matter how much you make. That's in addition to other taxes, which are high by US standards.

Quality is high and healthcare costs represent about 12 percent of GDP (it's closing in on 20 percent here.)

I guess my point is that healthcare isn't really free anywhere. It's just a question of who pays, and how.
 

ShaRe

New Member
If you do some research, you quickly find that we pay twice as much for healthcare in the US than most other nations.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

However in terms of overall quality of care, the US ranks in the mid-30's, compared to other nations.
https://www.numbeo.com/health-care/rankings_by_country.jsp

Most other nations have some form of Universal Healthcare, and they pay far less by Not having to support all the "corporate" plans that we are saddled with.....and they get better overall care.

We used to have a "Medical Profession"....but that has been replaced by a "Health Care Industry"....and the Primary purpose of Any industry is to Make Money.
"primary"...only fits better I think...
 

Remy

Well-known Member
Location
California, USA
I don't hear of countries with national health trying to get rid of it. I'm grateful to have Covered California. I still cringe when I've had something done and that bill comes for me to pay what wasn't covered.
 

Dr. Jekyll

New Member
Location
Florida
I think someone should collect the headlines from the national health care countries and publish them widely over here. That might tone down the clamoring a little bit. I have a long standing connection with some folks in Ireland so I pay attention to news from there. Here are some recent headlines from the Irish press.

Damning report into mental health services for children and teens highlights a profound crisis and a national scandal
'Horrendous conditions' - thousands march on streets over 'dystopian nightmare' at University Hospital Limerick
Hospitals were Covid hotspots during Christmas, says CMO Breda Smyth, as trolley numbers still rising
Patients told by HSE chief to brace themselves for more years of hospital trolley gridlock
Free GP care for all in 2026 would cut patients’ bills significantly but lead to longer waits – ESRI report
Senior HSE exec says he was ‘absolutely horrified’ by hospital overcrowding as he resigns
Trolley Count: 482 patients waiting for a bed in Irish hospitals
Full list of Ireland's most overcrowded hospitals as hundreds wait on trolleys for beds

They also have an ongoing problem with staffing medical professionals. The government pay is low (comparatively) and they have lots of people who get their medical training and then take off for other places like Australia, Canada or the US.

National health care is not the panacea that some folks think it is.
 
Medicare for all? What will they do when all these younger working people are hit with IRMAA?
If you exchange with them at length, as I have on various forums, you quickly find out that they think a) we don't pay anything at all as recipients (no premiums); b) everything is completely covered.

In short, they think that they are the only ones paying into the system and that we (Boomers and beyond) are yet again screwing them.
 

TabbyAnn

Southern Indiana, U.S.A.
I mean, it clearly won't be Medicare as we know it, so they must mean a national healthcare system, but what would it be? Single payer? Nationalization of all healthcare facilities? Something that has a chance of happening would be a good discussion.
Yes. it would be a good discussion. I've never studied the national healthcare systems of other countries but the current corporate business structure that healthcare in the United States has morphed into is unfortunate, unhealthy, and unpleasant. Some short, factual, accurate essays on national healthcare in other countries would be interesting. I think you are right that when most people say Medicare for all, they mean something more like the socialized medicine of a national healthcare system. I've found Medicare to be quite good in paying the bills for senior patients promptly with little or no paperwork on the part of the patient. It's the corporate medical facilities that Medicare has to pay that have become undesirable.
 


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