Bradley's Health Care Proposal (RE: West on Bradley's Gravitas

[Ken Hanly]

The great advantage of universality in health care with a one tier system is that
the rich are in the system too. It is to their advantage to see to it that it is
well funded. In a means tested health care system those who are not in the system
are naturally not too concerned if the "public:" system is well funded or not. They
do not get their health care through that system. Also, most of the better doctors
will migrate to private health care where their income will be higher. Also, means
testing involves bureaucracy and bureaucrats probing into people's incomes etc. It
also involves greater administrative costs. To find a Kafkaesque bureaucratic horror
show, don't look in the archives for Soviet Socialised Medicine. Look at health care
delivery today in the US of A. There is just no question that the US has much higher
administrative costs than any universal system.

   Cheers, Ken Hanly

Nathan Newman wrote:


> > -----Original Message-----
> > From: owner-lbo-talk at lists.panix.com
> > [mailto:owner-lbo-talk at lists.panix.com]On Behalf Of JKSCHW at aol.com
> > Sent: Thursday, January 20, 2000 2:44 PM
> >
> > Social Security isn't means tested. Is that throwing away money?
> > Neither is national health in most countries. Or maybe you are not
> > advocating means testing, or think the Bradley plan wouldn't. But why
> > then would they need to know your income? Maybe to find out if they
> > were serving the low income population?  --jks
>
> Social Security is means tested in the sense that benefits are determined by how
> much you made in your lifetime, although it is a regressive means testing in
> that the more you made, the more you are paid by the government. Not that social
> security overall is regressive since richer people pay in more over their
> lifetime, but there is a reasonable debate over whether purely universal
> programs are always better than means tested programs.
>
> Universal benefits often use of a lot government funds on middle class and
> wealthier citizens, often essentially redistributing from middle class tax
> payers to middle class recipients with little economic redistribution.  Social
> security is a good program, but for all its universality, the rich pay very
> little into it proportionate to their income.  The argument for universal
> programs is that they are politically bulletproof, but social security is partly
> bulletproof because the wealthy are not taxed to pay for it, so they don't
> mobilize against it. National health care in a number of countries is funded
> heavily by national VAT (sales-type) taxes that are not particularly
> progressive.
>
> The advantage of means tested programs is that the money spent is almost pure
> redistribution, largely at the federal level from progressive income taxes paid
> overwhelmingly by the wealthy directly to those most in need.  For the same
> reason, those programs are under continual political assault.
>
> Obviously, the ideal is a broad-based progressive tax where the wealthy
> contribute for universal coverage.  But that still requires means testing on the
> tax payment side.
>
> There are more serious policy downsides to means-testing, largely due to the
> "phase-out" of benefits which operates like a high marginal tax on additional
> income on those receiving those benefits.  I think that is far bigger problem
> with means tested programs than the worries over paperwork.
>
> -- Nathan Newman