Post on 01-Jul-2015
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Strong opinions voiced on
single-payer health
insurance system
LAS VEGAS REVIEW-JOURNAL
By JENNIFER ROBISON
If our email inbox is any indication, Las
Vegans feel strongly about starting up a
single-payer health insurance system.
After we wrote on Jan. 19 about a
Vermont lawmaker’s federal proposal to
mandate that states set up one-payer
systems that would operate like
Medicaid and guarantee coverage for
all, the feedback rolled in.
We’ve selected two letters with
opposing takes on the issue to keep the
discussion going.
Once you’ve finished reading up on the
debate, check out how a local consumer
got a pleasant surprise when he recently
Al Popp reached out with a novel
idea. He writes: Let’s just expand
Medicaid to everyone. How do we pay
for this system? We pay for it by taxing
all food and beverages at 10 percent.
Just add it to the price of the product
before the sale, like we do with gasoline
excise taxes. If a person spends $200 a
week for food and beverages, whether it
be in a grocery store, convenience
store, restaurant or catering business,
one would be paying $20 a week for
their health care, which equates to
$1,040 a year. That, to me, is affordable
health care. The more you spend on
Well, Al, I’m a reporter, so I’m completely
flexible and I have no opinions.
In the interest of public debate, though,
your plan is definitely worth sharing.
One common criticism of this kind of
funding source is that poor Americans
spend an above-average share of their
income on groceries, so it becomes a
regressive tax that penalizes lower-
income earners more than wealthier
households. This is why Nevada’s sales
tax exempts food bought inside grocery
stores.
So although you’re correct that people
would pay less if they spent less, a plan
Plus, low-income households already
face higher food costs because their
neighborhoods might have fewer
supermarkets and pricier food as a
result.
As you note, Al, your idea does have
upsides. No one would be mandated to
use Medicaid; they could still buy a
private plan for more coverage, the way
some affluent households pay both
local property taxes and private-school
tuition. International tourists who buy
pricey meals on vacation also would
feed into the system. And
undocumented residents would pay as
On the other side, Las Vegas insurance
broker Patrick Casale chimed in on
single-payer with this: There are five
reasons single-payer can never work for
the United States: immigration; taxation;
capping doctors’ and hospitals’ earnings;
capping Big Pharma; and medical access.
Part of Patrick’s concern is that our
country already is strapped
financially, and a plan that opens free
health care access to all (Medicaid
doesn’t charge copays or premiums)
would be unsustainable given current
immigration rates. What’s more, he
said, countries with one payer “have a tax
rate that exceeds 50 percent, and
Making a single-payer system work
also might require limiting hospital
charges and incomes, and that
would in turn hurt access as
providers perform fewer procedures
to control costs, Patrick said. And
tangling with the major
pharmaceutical companies on what
they charge would be a Herculean
task in what he called “the most
overdrugged nation worldwide.”
Patrick said he also would like to
see the federal government
eliminate fraud in Medicare and
Medicaid before the programs
Steve Selbrede wrote in with praise
for a little-known provision of
Obamacare: There have been many
recent stories and letters about the
absurdly high deductibles of
Obamacare insurance plans. When I
first began to investigate the Nevada
Health Link website to choose my own
plan, I was distressed to see very high
deductibles. After about 30 hours of
studying my options, I found that these
deductibles are not always so high.
Steve discovered Cost Sharing
Reduction, a little-known discount in
the Affordable Care Act that lowers
You do need to meet a few guidelines
to benefit. For starters, you have to buy
your plan through Nevada Health Link,
the state exchange’s website. Plus, the
discount is good only on silver plans,
the federal law’s benchmark coverage.
And you have to make less than 250
percent of the federal poverty level.
That’s $59,625 for a family of four, or
$29,175 for a single.
Steve qualified, and after he chose
Nevada Health CO-OP’s Southern Star
Silver Plan, here’s what he found: His
calendar-year deductible dropped from
$4,250 to $750, while his out-of-pocket
You do need to complete the sign-up
process at nevadahealthlink.com to
determine whether you’ll get the
break. So Steve offered some tips on
how to make it through, if you have
issues with the site.
First, forget about browsing for a plan
without creating an account, because
you won’t get a full reckoning of the
cost unless you put in your details.
Start an account at the site with a user
name and a password, or you won’t
be able to get back into your account.
Do not provide your e-mail address,
or you might not be able to return to
your account. Make sure you know