DSA - How Will this Work?

[FLaw47]

I am not saying it cannot be done, it's just that the US is much, much harder (expensive) than other countries that have done this due to population. Also, DSA is proposing much more than just healthcare for all so the costs would be astronomical.

• U.S. population is currently ~343 million.
• Most European countries with universal systems are much smaller: Germany ~84 million, France ~68 million, UK ~68 million, Canada ~41 million, Sweden ~10 million, etc.

Finally I doubt those other countries are spending at the levels of social program spending that the US is today. We wonder why we have deficit spending when we spend the MAJORITY of tax revenues on social programs already today.

Fiscal Year	Social Program Spending (Human Resources)	Total Federal Tax Revenues / Receipts	Social Spending as % of Revenues
2020	$4.34	$3.42	127%
2021	$4.81	$4.05	119%
2022	$4.71	$4.90	96%
2023	$4.16	$4.44	94%
2024	$4.55	$4.92	92%
2025	$4.71	$5.24	90%

Your post is comically misguided. The United States spends less on average on social programs than other developed countries. And it's actually more cost effective to insure a large population than a smaller one, that argument works entirely against you.

 

[Rifler]

it's actually more cost effective to insure a large population than a smaller one...

When the entire insured population is paying insurance premiums....

 

[FLaw47]

When the entire insured population is paying insurance premiums....

It doesn't really matter who is paying as long as it's getting paid.

 

[Rifler]

It doesn't really matter who is paying as long as it's getting paid.

It most certainly matters to those who are actually paying for the program...

 

[Huey Grey 2]

To be fair, single payer is not actually the predominant global solution to universal healthcare.

But they've still figured out universal care. Virtually all developed countries have. I refuse to believe that somehow we can't either.

 

[jimneffer]

But they've still figured out universal care. Virtually all developed countries have. I refuse to believe that somehow we can't either.

but we only pay 1.5X per capita what all those countries pay

HOW COULD WE AFFORD IT?

 

[Rahskie]

Your post is comically misguided. The United States spends less on average on social programs than other developed countries. And it's actually more cost effective to insure a large population than a smaller one, that argument works entirely against you.

My focus is on how much revenue the government brings in versus what we already spend on social programs.

We spend basically ALL of the tax revenues on current social programs. I even explored raising taxes on everyone making $50K or more and raising corporate taxes to 50% and it STILL would not be enough.

Please explain to me like I am 5 how the federal government will raise $2-$4T more dollars annually to support the things the DSA is proposing. My original question was....how will this be paid for. I can 100% get behind helping people, but it is one thing to want that and an entirely different thing to be able to PAY for it.

 

[FLaw47]

But they've still figured out universal care. Virtually all developed countries have. I refuse to believe that somehow we can't either.

I don't disagree with any of that. I just don't want to act like the DSA proposal is synonymous with universal healthcare.

 

[FLaw47]

It most certainly matters to those who are actually paying for the program...

Not for the asinine point of "The USA can't do it because there are too many people".

 

[FLaw47]

but we only pay 1.5X per capita what all those countries pay

HOW COULD WE AFFORD IT?

So you're saying we can't afford to pay for a thing we're already paying for?

 

[Rifler]

Not for the asinine point of "The USA can't do it because there are too many people".

That's because that point should be more accurately written as,... "The USA can't do it because there are too many people who can't or won't financially carry their own weight"...

 

[FLaw47]

My focus is on how much revenue the government brings in versus what we already spend on social programs.

We spend basically ALL of the tax revenues on current social programs. I even explored raising taxes on everyone making $50K or more and raising corporate taxes to 50% and it STILL would not be enough.

Please explain to me like I am 5 how the federal government will raise $2-$4T more dollars annually to support the things the DSA is proposing. My original question was....how will this be paid for. I can 100% get behind helping people, but it is one thing to want that and an entirely different thing to be able to PAY for it.

I brought it up in the post that I believed you quoted and you just ignored it. If we currently generate X in taxes and would cost us (hypothetically) 1.5X to also include this, then multiplying every tax by 1.5 pays for it. Boom, done. Mathematically it's not hard and the fact that you can't make it work out is unsettling.

 

[Moogy]

It doesn't really matter who is paying as long as it's getting paid.

Yikes.

 

[FLaw47]

That's because that point should more accurately read, "The USA can't do it because there are too many people who can't or won't financially carry their own weight"...

That would have been a better argument that would still not be true.

 

[Rifler]

That would have been a better argument that would still not be true.

No, it's most definitely true,... Too many non-contributors.

 

[FLaw47]

No, it's most definitely true,... Too many non-contributors.

It's too many non-contributors for you to be interested. It doesn't make the system unworkable, you just don't want it (which is your prerogative). At the end of the day, all of those people who aren't "pulling their weight" aren't "pulling their weight" now and are still consuming healthcare. Moving healthcare spending toward a more public model (where we'd have some taxes on most of those "non-contributors") would have them contributing at least some (and ideally getting preventative care and driving down overall costs).

Do you think the United States is unique in this way? Are we the only country with "non-contributors"?

 

[Moogy]

I brought it up in the post that I believed you quoted and you just ignored it. If we currently generate X in taxes and would cost us (hypothetically) 1.5X to also include this, then multiplying every tax by 1.5 pays for it. Boom, done. Mathematically it's not hard and the fact that you can't make it work out is unsettling.

And (hypothetically) when we look at all the programs that DSA wants to implement, and the cost of the above mentioned mathematical term (multiplier x current tax rate) eventually exceeds 1.00 ... what do we do? Keep spending? Ignore the numbers?

The salient point is, we need a plan. We need actual planned actions and actual numbers to determine if something is feasible. Vermont tried to go single payer ... full steam ahead ... and then they saw it was going to kill them under the weight of taxes and an economic slow down, so they abandoned it.

This is real money and real lives at stake. A real country with a real economy.

We can't just have intellectual infants screaming "I want" and "other parents give their kids these things" and then say "OK, Veruca ... we'll do it."

It MAY be fully and entirely workable ... and that would be AWESOME. If you can get the entire population effective and efficient healthcare at a cost our population can reasonably handle ... let's do this thing. And, certainly, if you're in a position where you're pushing for a leadership role and your platform is assuring us this will happen ... you have done the analysis and have the plan and numbers that show it is workable ... so let's see it. And, surely, your backers have seen this plan and determined the numbers look good, and have gone beyond "Joey's parents always take him to the Maldives, so why can't we go?" in their support of the plan.

It's one thing to scream from the sidelines that beating the Hawkeyes is easy, and if you just had a chance, you'd beat them, like so many other teams have, even though you've personally never played college football (and either has your entire team). It's another to see that Iowa is now on your schedule and you have to make good on your tough talk. And when someone asks you how you're going to do it, you can only come up with "well, we're going to score more points than they do," as pee drips down your leg. When they follow up with asking you what your plan is, you say you'll figure it out when you get out there. Folks aren't going to have much confidence that it's going to work out.

 

[Rifler]

It's too many non-contributors for you to be interested.

Correct, and when you don't have a funding source you can't accomplish anything,... Those of us footing the bill for healthcare don't have unlimited dollars to spend on that line item,... When you price us out of the market we move from being contributors waving dollar bills, to being non-contributors with our hand out.

 

[baltimorened]

My focus is on how much revenue the government brings in versus what we already spend on social programs.

We spend basically ALL of the tax revenues on current social programs. I even explored raising taxes on everyone making $50K or more and raising corporate taxes to 50% and it STILL would not be enough.

Please explain to me like I am 5 how the federal government will raise $2-$4T more dollars annually to support the things the DSA is proposing. My original question was....how will this be paid for. I can 100% get behind helping people, but it is one thing to want that and an entirely different thing to be able to PAY for it.

aren't the billionaires going to pay for it

 

[FLaw47]

And (hypothetically) when we look at all the programs that DSA wants to implement, and the cost of the above mentioned mathematical term (multiplier x current tax rate) eventually exceeds 1.00 ... what do we do? Keep spending? Ignore the numbers?

The salient point is, we need a plan. We need actual planned actions and actual numbers to determine if something is feasible. Vermont tried to go single payer ... full steam ahead ... and then they saw it was going to kill them under the weight of taxes and an economic slow down, so they abandoned it.

This is real money and real lives at stake. A real country with a real economy.

We can't just have intellectual infants screaming "I want" and "other parents give their kids these things" and then say "OK, Veruca ... we'll do it."

It MAY be fully and entirely workable ... and that would be AWESOME. If you can get the entire population effective and efficient healthcare at a cost our population can reasonably handle ... let's do this thing. And, certainly, if you're in a position where you're pushing for a leadership role and your platform is assuring us this will happen ... you have done the analysis and have the plan and numbers that show it is workable ... so let's see it. And, surely, your backers have seen this plan and determined the numbers look good, and have gone beyond "Joey's parents always take him to the Maldives, so why can't we go?" in their support of the plan.

It's one thing to scream from the sidelines that beating the Hawkeyes is easy, and if you just had a chance, you'd beat them, like so many other teams have, even though you've personally never played college football (and either has your entire team). It's another to see that Iowa is now on your schedule and you have to make good on your tough talk. And when someone asks you how you're going to do it, you can only come up with "well, we're going to score more points than they do," as pee drips down your leg. When they follow up with asking you what your plan is, you say you'll figure it out when you get out there. Folks aren't going to have much confidence that it's going to work out.

I think you misunderstand me. I don't actually want single payer healthcare. I'm just pushing back against the idea that it's somehow impossible to pay for because I don't like lies or bad arguments.

I think you are correct that we'd need all of those details ironed out before passing a single payer bill into law (obviously) but I find it very suspicious how single payer is supposed to have a fully fleshed out policy ready to go before anyone will even talk about it when (and I don't think I'm exaggerating much here) that's not the standard for any other high level policy proposal.

 

[baltimorened]

So you're saying we can't afford to pay for a thing we're already paying for?

we could go back and forth forever on this. One thing I have not seen is a breakout of exactly how DSA would pay for all this. It shouldn't be enough to just say, "well we can afford it" We know how much revenue we take in, we know how much we currently pay for social programs, a good cost accountant could extrapolate costs for the programs minus potential savings from existing program elimination. That would give us a good feel for the new total cost of our DSA platform and then we can back out way into proposals for how we pay for it.

In my mind, I don't see how we expect the "rich to fund everything" unless we totally redefine what we call rich.

 

[jimneffer]

It's too many non-contributors for you to be interested. It doesn't make the system unworkable, you just don't want it (which is your prerogative). At the end of the day, all of those people who aren't "pulling their weight" aren't "pulling their weight" now and are still consuming healthcare. Moving healthcare spending toward a more public model (where we'd have some taxes on most of those "non-contributors") would have them contributing at least some (and ideally getting preventative care and driving down overall costs).

Do you think the United States is unique in this way? Are we the only country with "non-contributors"?

we have no choice but to pay 1.5X what other countries pay for a system with generally worse outcomes

it's the only way

 

[FLaw47]

Correct, and when you don't have a funding source you can't accomplish anything,... Those of us footing the bill for healthcare don't have unlimited dollars to spend on that line item,... When you price us out of the market we move from being contributors waving dollar bills, to being non-contributors with our hand out.

You know that you're already footing the bill, right? All of these "non-contributors" are going to the ER because they ER has to see them and all of that gets passed back to us in the form of higher costs.

 

[FLaw47]

we could go back and forth forever on this. One thing I have not seen is a breakout of exactly how DSA would pay for all this. It shouldn't be enough to just say, "well we can afford it" We know how much revenue we take in, we know how much we currently pay for social programs, a good cost accountant could extrapolate costs for the programs minus potential savings from existing program elimination. That would give us a good feel for the new total cost of our DSA platform and then we can back out way into proposals for how we pay for it.

In my mind, I don't see how we expect the "rich to fund everything" unless we totally redefine what we call rich.

Here's what I said to Moogy:

I think you are correct that we'd need all of those details ironed out before passing a single payer bill into law (obviously) but I find it very suspicious how single payer is supposed to have a fully fleshed out policy ready to go before anyone will even talk about it when (and I don't think I'm exaggerating much here) that's not the standard for any other high level policy proposal.

 

[Rifler]

You know that you're already footing the bill, right? All of these "non-contributors" are going to the ER because they ER has to see them and all of that gets passed back to us in the form of higher costs.

I'm fully aware of that,.. What you don't seem to understand is that in the ultimate single payer scenario those non-contributors will both expect and receive 100% the same level of care that the contributors are now receiving,... One of two things will have to happen,.. Either my currently acceptable cost for excellent healthcare goes up so that everyone can receive that product, or the quality of my healthcare goes down to a level that's deemed to be marginally acceptable to the average,... Neither are acceptable to me.

 

[FLaw47]

I'm fully aware of that,.. What you don't seem to understand is that in the ultimate single payer scenario those non-contributors will both expect and receive 100% the same level of care that the contributors are now receiving,... One of two things will have to happen,.. Either my currently acceptable cost for excellent healthcare goes up so that everyone can receive that product, or the quality of my healthcare goes down to a level that's deemed to be marginally acceptable to the average,... Neither are acceptable to me.

I feel like you're tilting at windmills here. You've conjured up your own version of what you think this would look like and have decided to be pissed about it.

 

[Rifler]

I feel like you're tilting at windmills here. You've conjured up your own version of what you think this would look like and have decided to be pissed about it.

What we have been discussing is the traditional single payer approach,... What I think we should be looking at is more of a hybrid, where a single payer system covers "basic" healthcare, and then supplemental private insurance picks up services above and beyond what has been defined as "basic",.. The category of "basic" would be limited to what we as a society are willing to pay for.

 

[FLaw47]

What we have been discussing is the traditional single payer approach,... What I think we should be looking at is more of a hybrid, where a single payer system covers "basic" healthcare, and then supplemental private insurance picks up services above and beyond what has been defined as "basic",.. The category of "basic" would be limited to what we as a society are willing to pay for.

And I think a hybrid model could be fine! "Traditional single payer approach" isn't really a thing, is all I'm saying. Bernie's proposed Single Payer from back in the day would have been the most generous healthcare plan in the world, if I'm remembering correctly (and more generous than Medicare) and I think that was probably far too much. I actually don't think we want "free at the point of service" at all for anything that isn't preventative care.

My point is I don't think it's productive to gin up your least favorite hypothetical version of a thing that doesn't exist and then get mad about it.

 

[Willence]

Government is too large. It shouldn't provide anything in terms of services for Americans. Everything it touches gets more expensive and less efficient. It's not hard to solve this issue. Also, using some of the same principles as we have in Trump accounts with healthcare would allow us to solve the vast majority of our healthcare issues. We have to stop thinking that government is the answer. This fundamental shift in this country has been devastating and it won't get better until we come to the realization that government is a necessary evil but at its core, it is just not a good thing.

All these folks that advocate for single payer options should be more considerate of the level of care provided by these institutions in other countries. We can get rid of employer provided insurance plans and have a system that is patient to doctor and nothing more in between. Suffice it to say, employer provided health insurance HAS to go in all this. It is a yoke around the neck of pay in this country.

 

[FLaw47]

Government is too large. It shouldn't provide anything in terms of services for Americans. Everything it touches gets more expensive and less efficient. It's not hard to solve this issue. Also, using some of the same principles as we have in Trump accounts with healthcare would allow us to solve the vast majority of our healthcare issues. We have to stop thinking that government is the answer. This fundamental shift in this country has been devastating and it won't get better until we come to the realization that government is a necessary evil but at its core, it is just not a good thing.

All these folks that advocate for single payer options should be more considerate of the level of care provided by these institutions in other countries. We can get rid of employer provided insurance plans and have a system that is patient to doctor and nothing more in between. Suffice it to say, employer provided health insurance HAS to go in all this. It is a yoke around the neck of pay in this country.

Ah yes the "this hasn't been done anywhere that I'd like to live but it can be done here!" solution.

 

[Moogy]

I think you misunderstand me. I don't actually want single payer healthcare. I'm just pushing back against the idea that it's somehow impossible to pay for because I don't like lies or bad arguments.

I think you are correct that we'd need all of those details ironed out before passing a single payer bill into law (obviously) but I find it very suspicious how single payer is supposed to have a fully fleshed out policy ready to go before anyone will even talk about it when (and I don't think I'm exaggerating much here) that's not the standard for any other high level policy proposal.

Which high level policy proposals were not held to those standards?

Repeal and replace? That worked out so well. Or something else?

This is near and dear to me because, as I stated earlier, I know someone who was a diehard progressive, heavily involved as part of Bernie's team (and other progressives before him), and was largely responsible for the strategy and communication of Bernie's platform ... and they eventually got so sick of the nonsense (the fact that it wasn't realistic ... it was just for show) that they bailed and got a job in the strategy/consulting arena in the private sector.

Personally, I've had enough of idiots (like Trump) who overpromise and underperform, and you knew, beforehand, that it was destined for failure because there wasn't a well thought out plan.

So, if all this has progressed beyond the idealistic, and not realistic ... I'd like to see it.

 

[Willence]

Ah yes the "this hasn't been done anywhere that I'd like to live but it can be done here!" solution.

No idea what you're talking about. I'm saying it can't be done here....and it shouldn't be.

 

[Moogy]

I feel like you're tilting at windmills here. You've conjured up your own version of what you think this would look like and have decided to be pissed about it.

That's what happens when people you don't agree with talk about changing things, but don't provide a realistic framework of what they're going to do. Do you think he's going to imagine a scenario where progressives swoop in and stick the landing? Maybe assuage the fears of those who doubt you with something other than "other people do it, how hard can it be?"

 

[jimneffer]

No idea what you're talking about. I'm saying it can't be done here....and it shouldn't be.

exactly...

you can have our healthcare system that costs more for worse results when you pry it from my cold dead hands!

 

[FLaw47]

Which high level policy proposals were not held to those standards?

Repeal and replace? That worked out so well. Or something else?

This is near and dear to me because, as I stated earlier, I know someone who was a diehard progressive, heavily involved as part of Bernie's team (and other progressives before him), and was largely responsible for the strategy and communication of Bernie's platform ... and they eventually got so sick of the nonsense (the fact that it wasn't realistic ... it was just for show) that they bailed and got a job in the strategy/consulting arena in the private sector.

Personally, I've had enough of idiots (like Trump) who overpromise and underperform, and you knew, beforehand, that it was destined for failure because there wasn't a well thought out plan.

So, if all this has progressed beyond the idealistic, and not realistic ... I'd like to see it.

Any GOP tax cut, what would eventually become the ACA, TCJA, Big Beautiful Bill, Green New Deal, I'd wager Medicare/Medicaid, etc etc etc.

All of those were things that were high level talking points and had the details ironed out (well or not) when it came time to draft the bill.

I don't want Single Payer, but I don't think every conceivable question about it needs to be answered on the campaign trail. And, for what it's worth, it's much harder for an individual state to implement single payer because of a myriad of federal rules that make it more expensive and the profoundly smaller risk pools.

 

[FLaw47]

No idea what you're talking about. I'm saying it can't be done here....and it shouldn't be.

I'm referring to your plan to get out of government and employer based healthcare entirely.

 

[dpic73]

For those who claim no DSA candidates have explained how to make Medicare for All work, El-Sayed literally wrote a book about it - though he claims not to be DSA, he advocates for many of the same policies.

No, I haven't read it.

Medicare for All

Abdul's running for U.S. Senate to get money out of politics, put money in your pocket, and pass Medicare for All.

abdulforsenate.com

 

[BelemNole]

While certainly expensive, our healthcare system works quite well for a majority of working Americans,... Replacing it with a single payer system covering everyone that provides the same level of services to those same working Americans will be difficult and likely even more expensive,... It will become a choice between cutting services or spending more.

Works quite well - so long as you don't use it.

Medial bills are the #1 cause of bankruptcy in the country.

 

[Rifler]

Works quite well - so long as you don't use it.

Medial bills are the #1 cause of bankruptcy in the country.

Works well,.. I've used it, incurred medical bills, and haven't gone bankrupt.

 

[Willence]

I'm referring to your plan to get out of government and employer based healthcare entirely.

For any solution that has a chance to improve the situation getting employer and government provided healthcare out of play is essential. There are really two solutions, government provided or single-payer systems or a system that is funded by people and in necessary cases added to by the government and then used as a forward facing funding means of healthcare between patient and doctor/medical practice. That's the only way to fix this mess that I have seen.