In Bandera County, nearly 20 percent of the residents lack health insurance, records show. For the estimated one-out-of-five of our county’s population living at 200 percent or less of the federal poverty level, health costs and services can be a serious challenge.
Community health centers such as the Arthur Nagel Community Clinic in Bandera play a large role across Texas serving over 1.3 million low income Texans. These centers are critical as Texas sadly leads the nation in the number of uninsured.
Democratic Party candidates think we can do better for our fellow citizens. The challenge being thrown at the candidates is how to pay for it.
The bottom line for the candidates’ proposals is that the federal government plays a larger role in health care. But what does that do to the federal budget?
Research published in 2016 in the American Journal of Public Health offers some insight.
The authors used data from the Center for Medicare Services’ Office of the Actuary, the Office of Management and Budget, the Census Bureau, and the Internal Revenue Service to come up with a profile of what our tax dollars are currently being used for in health expenditures.
The results were that out of our total national health expenditure, just over 64 percent is being paid by federal, state and local governments. For perspective, this amount exceeds the total paid per capita in every other wealthy nation that has universal health care.
In a “Medicare for All” scenario, if we ignore any lowering of costs due to the immense buying power of a single-payer approach, there is a shortfall of almost 36 percent of our total health expenditure.
The proposals from “Medicare for All” candidates call for tax reform as a primary mechanism (outside of operational savings) where the rich pay more.
Is this fair?
For anyone who is nostalgic for the U.S.A. of the 1950s and 1960s, it is useful to compare that the top marginal tax rates were over 90 percent in the 50s and over 70 percent in the 60s. It is currently 37 percent.
With income inequality peaking again as it did in the 1920s and in2007, it seems inevitable that tax reform will be key to improving our health system. When we consider that from 1978 to 2018, worker pay increased by 12 percent while CEO pay increased 940 percent, there appears to be room to make sensible tax changes toward universal health care.
The differences among the Democratic candidates in reaching universal health care, whether they endorse a government-run system or a system with private options, are actually minimal according to a survey of the candidates by the Washington Post.
All support a public option to buy into a state Medicaid program regardless of income. All support partially expanding Medicare to people aged 50-64. All support giving the federal government the ability to negotiate prices for Medicare. All but three, who are not front runners, support importing drugs.
The Democratic candidates’ proposals to reach universal care are sorely needed. They offer approaches worthy of consideration as opposed to the Republican attempt to abruptly end Obamacare without anything better to offer.