No. It’s what could I do if I wasn’t paying the “poll tax” on my health care.
intercst
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This is an unknown statement about the future.
It could just be effectively unavailable because it has gotten so expensive, ACA for example, or plans available to small biz.
No one is expecting to pay zero or even a low amount.
We know that we already pay 18% of gdp, so no one expects free.
There are many opportunities for cost savings.
But we all agree there are strong vested interests grabbing the 18%.
It is unreasonable to think that the lack of something as important as healthcare in some jobs but not others is not a constraint on better economic opportunities.
Those economic opportunities can grow gdp and cover the incremental healthcare costs - because the economic opportunity set is made larger.
Have you heard Oscar’s story?
I’m sorry but this is just flat wrong.
You are laboring under the impression that everyone has to pay for healthcare with x% of their salary . That’s not true. Yes, eventually the bill must be paid, but your are mistaken that I must pay “X%” for that service. I don’t pay X% for the Army, there are a tremendous number of people who don’t pay anything (low income people who end up paying nothing in income tax) and the higher income people pay more via the graduated tax. This is also true of many government services - almost all of them which are supported by the income tax.
This is also true in other countries which have universal coverage. Not everybody goes through the same toll booth when getting coverage. Some people with no income still get coverage. Some people with very low income still get coverage (and pay nothing.) Some people with very high income get coverage (they may choose to supplement it with private plans in some countries.)
It’s NOT your simple “Well, you still have to pay the same amou nt”. That’s not how it works.
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You may actually pay more as Lower or middle income taxpayers. All of these other nations have much higher individual tax rates at the lower end and then much higher sales/vat taxes that disproportionately hit anyone as their income decreases.
Iten Kenya life expectancy 57.5 and 62 year.
Why? And what’s it like without care? On this board we think of end of life. The problem is also beginning of life.
The lower regional life expectancy in Elgeyo-Marakwet County (where Iten is located) is primarily driven by socio-economic challenges, healthcare infrastructure gaps, and high rates of preventable childhood diseases. [1, 2]
Life expectancy is a statistical average heavily skewed by deaths that occur early in life. The local numbers are driven down by several distinct factors: [3]
High Maternal and Child Mortality
- Home Deliveries: Local health data indicates that roughly 35% to 63% of births in the county take place outside of professional medical facilities without skilled attendants. This sharply increases the risk of fatal complications for both mothers and newborns. [2, 4, 5]
- Preventable Childhood Diseases: The majority of outpatient hospital visits in the county are due to respiratory infections, pneumonia, diarrhea, and intestinal worms. When untreated, these are leading causes of death for children under five. [1, 6]
Economic and Geographic Disparities
- High Poverty Rates: While Iten itself is a bustling athletic hub, county data reveals that 57% of the overall population lives below the poverty line—with rates climbing to 67% along the nearby Kerio Valley and Escarpment. Poverty severely limits families’ ability to afford medical care and proper sanitation. [7, 8]
- Malnutrition: Food insecurity and nutrient deficiencies cause significant levels of childhood stunting. Local nutrition studies show this weakens immune systems from an early age, leaving children highly vulnerable to common infections. [9, 10, 11]
Healthcare Access Gaps
- Long Distances to Care: About half of the county’s residents must travel more than 5 kilometers (over 3 miles) to reach the nearest health facility. In a medical emergency, this lack of proximity can be fatal.
- Staff and Resource Shortages: The region has historically faced low doctor-to-patient ratios, meaning public clinics are frequently understaffed and prone to medicine stock-outs. [1, 2, 5]
Localized Border Conflicts
- Insecurity: Parts of Elgeyo-Marakwet (particularly along the Marakwet–Pokot border) suffer from perennial tribal conflicts and cattle rustling. The resulting violence causes premature deaths, predominantly among young males, which suppresses male life expectancy statistics. [12]
I can provide more context on these issues if you let me know what you are focusing on:
- Are you looking into how local health programs or NGOs are addressing these statistics?
- Do you want to see how these numbers compare to neighboring Kenyan counties?
- Are you researching how the elite runners in Iten defy these regional health trends?
[2] https://www.elgeyomarakwet.go.ke
[3] https://www.firstlinks.com.au
[4] https://www.elgeyomarakwet.go.ke
[7] https://www.elgeyomarakwet.go.ke
I think you may have identified my concern with albaby’s increasingly complicated arguments that still felt wrong. I have a loved one (in full remission and healthy now) who was diagnosed with an aggressive, fast growing stage 3 tumor that had migrated to two lymph nodes when she was a youthful, athletic, healthy eating 38 year old.
There was no reason for her to pay exorbitant insurance rates until the cancer diagnosis. She is now in good health, living life fully and caring for her family thanks in no small part to her employment insurance which paid for hundreds of thousands (if not millions) of dollars worth of chemotherapy, radiation treatments, and surgeries over a two year period and now pays $20,000 per month for drugs to prevent recurrence.
Universal healthcare pays for everybody but nobody wants to pay for it till they discover they need it.
It is a lot like climate change where we collectively minimize the risk until it is too late.
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…and like fire and police departments (originally in chaotic ‘free market’ competition), and zillions of other “natural public goods” that are best funded by society as a whole….like public health.
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And yet, the get “free” (or highly subsidized and universal) health care. They get “free” (or highly subsidized higher education). They get longer and more comprehensive family leave. There are a lot of other benefits that the low and middle-income citizen gets in Europe that a comparable USian does not. Do they pay for them? Of course they do.
So the question is: are these benefits a “societal good”? I would argue that universal health care is; it is “good” for the individual, but it is also good for the group, as it keeps communicable disease at bay, makes people more productive, and promotes longer lives. Is higher education (without the attendant loan-drag) good? I would argue yes, although the US has certainly made more of it during this technological era than Europe. Is family leave a good thing? I think so; opinions can vary.
How about subsidized mass transit? Childcare? Social safety net?
(I would finally just note that the US is funding infrastructure nd other things because of its world-class currency and ability to conjure wealth out of thin air. This is not an advantage that can last forever; it never does. The EU is also doing deficit spending, but at half or less than the US rate. If they were to bump up to that of the US economy I’m sure they could all sorts of new and swell bells and whistles that they now must forgo. Defense, spending, for instance.
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Not at all. It won’t be exactly some fixed percentage, and it won’t be that specific.
But to a first approximation, health insurance for the working-age person costs about $7K per year. That’s true of both employer based group rate insurance and individual policies now that we have Obamacare. There is of course a ton of variation based on geography and the specifics of the policies, but that’s roughly what it costs for non-elderly adults.
Functionally, that means that the job with health insurance just pays you about $7K more than your nominal salary. It’s in the form of health insurance because that’s tax advantaged. But that’s what it is. And the other job without health insurance just pays you the nominal compensation.
In a world with a national health unsurance program, the government is going to be collecting about $7K per working age adult to cover the cost of providing that insurance. And that’s going to have to be paid by almost everyone, because it’s just too huge a number to be paid by just rich folks. Every country on earth that had these systems fund them by having broad based VAT or payroll taxes that everyone ends up paying.
What that means is that in practice, and very broadly speaking, the economic factors that keep you from switching jobs due to health insurance won’t change if the system changes. The core reason you can’t switch to the other job isn’t because it doesn’t have health insurance, but because it pays too little for you to take that job and pay about $7K to cover an individual market policy.
That “pays too little” dilemma doesn’t disappear if you switch health care systems, because even though paying for your own policy isn’t done any more, everyone in the work force is going to end up having to kick in about $7K for the new system. Yes, there will be some degree of variation and whatnot - but for most people, if you couldn’t afford the de facto pay cut before the health care switch, you’re not going to be able to afford it after.
This mismatch in expectations is why no states have implemented single payer systems, even though many blue states have seriously tried. A lot of constituents conceptualize it as “I’ll be liberated from health care insurance costs,” when in reality it just means “Everyone will still have to pay for their health insurance, just through taxes rather than policy premiums.” And in that world, any job you couldn’t take because health insurance costs weren’t included in compensation will stillbe a job you can’t take because it doesn’t pay enough to cover the health insurance costs you pay through taxes.
Yes, they are societal goods. The problem is that the public seems to know no end to what is a societal good they are willing to have others pay for. I would be totally for universal healthcare, if the US were in better financial shape and or the public is willing to cut elsewhere and or raise the necessary taxes to pay for it.
They are not and Europe is our future, if we continue down this path. Get our fiscal house in order, then let’s talk. In the interim, let’s scrap the ACA and do everything possible to alleviate the cost of healthcare and insurance, including broad price transparency.
Why are we modeling everyone as the same (average)?
That’s a mistake (people are not economic clones).
There will be people that can handle the $7k.
They have saved up.
Or they LBYM.
Or just downsized house.
Or moved in with partner and cut housing costs in half.
Or kids now off and on their own, so no kids costs.
Or their side gig is taking off.
This is the very point: unlock the varied employment opportunity set to those who can use it, according to their varied skillset and economic situation.
Not different than free vs restricted trade and how it unlocks the varied economic positions and resources of various nations.
Increase the employment opportunity set.
And this is a win without even attacking health costs per se, and we all know those costs are there to be tackled.
The costs probably cannot be tackled all at once and/or fast, but they can and should be tackled, even if incrementally.
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Of course there will be. But those aren’t the folks we’re talking in this thread, for the most part. Those are people who have jobs with health care, but can’t afford to switch to a job without healthcare - by definition, they can’t handle the $7K.
This isn’t a question of whether it would be good if people had more freedom to switch jobs without worrying about compensation levels. I’m just pointing out that switching the health care system isn’t going to let very many people who can’t switch jobs now because of health care suddenly be able to switch jobs. Because for the most part, switching health care systems doesn’t make the health care expense for most people go away. It just switches from being something you have to pay for as a health care premium to something you have to pay for through a combination of VAT and payroll taxes. And if you couldn’t afford to swap a higher-paying job for a lower-paying job (or self-employment) before, you’re not especially likely to be able to after.
I’m not saying everyone’s an economic clone, of course. In a country with 330 million people, there will be unusual cases, and at the margins there may be some folks who this might change the circumstances. I think I mentioned upthread that folks in public sector union jobs might be among them, given the role that health care benefits plays in their compensation. No doubt there are other groups. But for the most part, folks who couldn’t afford to leave their jobs to take one with lower compensation when part of their comp took the form of health care still aren’t going to be able to do that once health care moves out of premiums into taxes.
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I am talking about those people.
I’m talking about all people considering an “eo” (economic opportunity).
Not the specific question I am addressing, I am talking about EOh vs EO and how that affects all people seeking “eo’s”.
I wouldn’t marginalize this population by size or economic relevance without more data (and the article doesn’t say much - or anything - about variation in individual circumstances).
Also, mean cost of $7k is not the only consideration on a health benefit.
There are at least two more elements.
There is an uncertainty element: people may feel that there is more certainty about the near future of their employer plan (the bird in the hand) relative to an alternative like the ACA which has a lot of uncertainty swirling around it. I would not discount this uncertainty effect.
There could be a benefit-value element as well, again variable by person, in which the $7k gets you better care in the employer plan, or you pay below the $7k average. We also have the impact of recent policy changes weakening the cost-benefit for ACA plans (more cost, less benefit and reducing enrollment and the reduction in economies of scale and health of the insured population).
If we equalize health care benefits (keeping cost the same) over the big set, EO, the set of all employment opportunities (“eo’s”), then we remove these frictions in the economy.
We make the economic opportunity set bigger and unlock more economic output.
It’s not different than free trade unlocking more economic value over a group of nations relative to those nations doing less international trade.
Why wouldn’t we do it?
Same cost for health care, but more economic output.
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Sure, but not by very much. If someone isn’t changing a job because of health care coverage, most of them won’t be able to change jobs in a universal system anyway.
I know you’re labeling it as a “friction,” but there’s tons of people that stay in their jobs even if it’s not their preferred employment because their dream job does not pay enough. That’s not really friction. People make choices. If there’s a job that they would prefer to take but choose not to because it doesn’t pay as well as their current job, that’s not something we would consider ‘friction’ in the economy.
So when you write:
I don’t think it will remove very many frictions at all - because what you’re labelling “frictions” in this scenario is largely differences in compensation that will remain after you switch health care systems. Again, maybe at the margins who this would change their decision-making - but certainly not “1 in 4 Americans.” Most of those folks will still be “locked” in their jobs in the new system as they are in the current system.
Again, this is not debating whether it would be good to remove “friction” in the economy. Rather, just to point out that most of the folks who are sticking in their job for the health coverage today would likely still be sticking in their jobs under a universal health system as well.
It’s probably not a huge population, but I bet it’s nontrivial.
And it being not huge is not a reason to not pursue a more optimal economic outcome.
We need incremental change. A few steps of incremental changes leads to broadly impactful change.
Suppose nationally it’s 2 million people, who, because of their particular economic situation, could pursue a better economic outcome were it not for the constraint of substantially unequal health care among their “eo’s”.
That’s several decent-size metro areas.
And that’s just the population number, made up for sake of argument.
More importantly, we don’t know the dollar economic impact of the better economic outcomes of that 2 (or unknown X) million, including multiplier effects, like for Oscar:
And marginal effects are important in economics - they set the terms at the point at which decisions are made for the larger population: salary negotiations, housing prices, migration decisions, education decisions, etc.
I agree.
But I didn’t label it as a friction.
You did, just now.
I labeled substantially unequal health care across the set of “eo’s” as a friction, which it is.
It’s a financial penalty (and maybe health or mortality risk penalty) on economic activity that could potentially be reduced to achieve a better economic outcome, similar to a tariff as a trade barrier is a friction.
You also keep focusing on averages in pay and health costs while dismissing variation among individuals and among “eo’s” with respect to pay, health benefits and economic situation.
That variation is what drives better outcomes in economies.
I addressed this many times already.
The scenario I proposed equalizes health care across the total set of “eo’s” and emphasizes that people are not economic clones.
Because people are not economic clones and their is greater variety of “eo’s” in the bigger set, EO, if we keep health care cost and value the same, but expand access to care from the smaller set EOh to the larger set EO, we get a better economic outcome.
A more optimal outcome is almost always found in the larger set, and nearly certain in economics with large variation in agents and decision sets.
Explained here:
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Not necessarily. The problem with this model is that you’re only looking at “EO’s” and making certain assumptions about the effect of a national health care system on the participants that are likely to be untrue.
First, and perhaps most importantly, switching to a national health care system doesn’t just unlock more employment opportunities. It also unlocks lots of non-employment opportunities. You’ll have people using this change in order to FIRE, or to work part-time instead of full-time, or to work in economically less productive endeavors. There is no reason to assume you’ll get a better economic outcome from all this. That’s consistent with what we’ve seen with UBI experiments, BTW - you see a small but statistically significant reduction in work and labor force participation.
Second, you can’t assume you’ll keep health care cost the same. One of the reasons our national health care outcomes aren’t significantly better than they are is because about 10% of our working age population is uninsured. Those folks don’t consume as much healthcare as insured people (occasional visits to the ER notwithstanding). Change the system so they all have access to health care, and health care consumption will rise. Whether that increases health care costs depends on whether there are other changes to the system - but ceteris paribus health care expenses go up.
And finally, the system of paying for all of this will introduce new frictions - which may equal or outweigh the old frictions. High payroll taxes discourage employment in taxed jobs, at the margins; high VAT or sales taxes discourage consumption, at the margins. Forcing every job to provide health insurance and every person to pay for health insurance (indirectly through taxation) will open up some opportunities, but it will foreclose others.
I am strongly biased against our present system because of this:
Uninsured people with catastrophic injuries and or life threatening illnesses, facing life saving treatment costing from several hundred thousand to millions of dollars, are legally responsible for the full bill and can only receive help from Medicaid after they have spent down all of heir assets.
And that system is woefully underfunded because healthy people don’t want to pay for a system that they don’t think they will need. Maybe that is the will of the majority and will live with it because Ispouse will not leave her family behind and therefore neither will I.
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Not true.
I stated to include all flavors of employment, including part-time and not working (but everyone still must pay, I do not assume something for nothing):
But I do have an inconsistency in my thought experiment.
I wrote about individuals making choices to “maximize economic output,” but that was unrealistic.
Some individuals may indeed max economic output: work long hours, pursue the highest compensation and give up time spent on other activities, such as leisure time (including family time) to focus on ”work”.
On the other hand, there will be individuals that forgo the highest compensation to instead pursue other activities which we could bucket as ”leisure”.
In general, there will be a continuum of preferences among individuals that pursue some mix of time spent in work vs leisure that meets each individual’s personal utility - the economic manifestation of “life, liberty and the pursuit of happiness”.
So instead of individuals maximizing some dollar economic output, they seek to maximize some individual-specific personal utility (and choose “eo’s” accordingly).
Sure I can.
It’s a thought experiment.
I am trying to isolate the effects of two different effects on individual decisions:
- Unequal costs, certainty and value per dollar betweenEOh and EOu.
- Health care costs.
The premise of the thought experiment is to isolate (1) from (2).
Now anyone can say, “oh, but the real world is so much more complicated, what about factors A, B, C, … and you can’t isolate A from B and etc …“
Well, no one begins to understand a complex world by considering many factors at once.
No one.
Of course, the thought experiment is some model (abstraction/caricature) of the real world (as all of our discussions here are).
But that doesn’t mean it cannot be instructive.
Einstein and peers found thought experiments useful for understanding complex systems.
Now, we may not have Einstein-level thought experiment here, but we can try.
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Medicare Buy-In and Health Care Stabilization Act was proposed in 2017
Courtney-Larson-Higgins plan would allow Americans age 50-64 to buy-in to Medicare
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That is not true. The majority of Americans want it. Perhaps over 70% of us as adults. The profit motive and lobbying are shutting it down. We are opting for evil to make a few bucks. We have that habit, and we know better.
I had a friend who was warm and kind until about three months ago. He was a Vietnam protester, very adamant. Part of the legend in his head about how great a guy he is. That friend was a medical equipment and pharma rep regional manager. He is worth millions. His real MO is to milk it. Underneath that kindness is a very angry guy because of his own greedy actions. He had open-heart surgery at age 52. He is now 76. The expense account, alcohol, and food caught up with his wife as well. She went in for open-heart surgery around the same age. Living high! Very dishonest. He would never face it. I want taxes to go up. He’s a staunch liberal who wants taxes extremely low. He called me every name in the book. I gave up on him. He is a medical know-it-all who knows zero about medicine and thinks he is smarter than all the doctors. Milk it.