Indeed I and many others use a 3% overhead estimate as valid for a universal single payer system and get there by including anticipated start up costs - The 3% may well be high because the uncomplicated claims for young folks are so cheap to process, plus the costs for start may be overestimated. Medicare actual costs - including the cost of the contracted out claims paying service - was $2.92 Billion in 2006. It paid actual claims to providers of $180.01 billion. That makes the overhead 1.6%.
As to the GOP variation of the Swiss national health plan which is the Giuliani proposal praised in the Wall Street Journal and discussed in a NY Sun article http://www.nysun.com/article/56131, it is not even universal coverage because Mr. Giuliani's proposal does not include a mandated purchase of a policy. His slogan "It's your health — you should own your health insurance" is the usual GOP slogan rather than solution approach which he of course justifies by saying he wants no solution that is an infringement on individual liberty - as if the civil rights we lost in the Patriot Act and the Military Commissions Act are not "an infringement on individual liberty"!
Guiliani's "health plan" is a $15,000 tax deduction (taken as with IRA deductions as part of the calculations of "adjusted income) - and while that covers the actual insurance company premium cost, how does the FIT tax deduction help the family making $30,000 whose main or sole income tax is the Social Security payroll tax? Indeed how does the average family fit the initial $15,000 into their budget?
Guiliani in effect is relying on continuing the poor heath care that makes use rank 37th in quality of care among the industrialized nations of this world, making poor and lower middle class rely on the ER and never get preventive care. Since the ER usage is passed on to the public as the government covers the major portion of the care that is never paid for, he is for continuing our current system where our taxes pay for half the health cost in America each year. I do not like the proposals for the government giving money to the insurance companies directly to cover policies for the poor and middleclass because of the 30% markup, but at least subsidized purchase of health insurance policies is an "honest giveaway" to the insurance companies as it is transparen - a contrast to Guiliani's tax deduction gift to the rich that hides the give away as a "health plan for all Americans".
The health care professional's consensus is that our extremely low ranking in health care is influenced by our not encouraging preventative measures so people don't get sick in the first place. Guiliani's thought to solve this problem is that greed - individual greed - will force folks to spend money on preventive care so that they will not later have a larger cost that must be paid from their tax-deductible health savings account (HSA) - an account most American do not make enough to have the surplus funds to set up - and if set up most Americans would roll the dice and hope for no sickness period so as to keep all the money rather than pay for preventive care. I do not see American finances and attitudes changing so that Guiliani's HSA account reliance would actually work.
Is there an economic difference to society between WSJ's Sally Pipes' Democrats "will raise tax" and Guiliani's demand that folks contribute to HSA's, beyond the obvious fact of mandate required payment versus voluntary - with real cost being the poorer health, less productivity due to illness, and shorter life span of the population? I suggest the Guiliani approach is actually more costly to society.
Indeed, is there an ounce of difference between a government bureaucrat cutting you a check for coverage of a list of conditions approved by a politician, and an insurance company owner trying to deny you a check so as to make a larger profit via the employee who is trained to search for reasons to not pay? Well yes, there is a differance - but Guiliani's approach is not the better of the two.
But Guiliani is selling FREEDOM - as if our forefathers fought for our FREEDOM TO GET ILL when we lack funds for HSAs and insurance company health policies. The GOP want us to thank Guiliani for suggesting a way to increase freedom and choice for an employee - "freedom to choose a health plan that fits an individual's needs and the freedom to keep it should he change jobs" - whenever he has the extra money to pay for the policy and is not just going to have to hope he does not get sick - those being the conditions attached to the above that are not mentioned.
Edwards does not just leave private health insurance in place, he mandates coverage, throws in government funds to offset cost for the poor, and sets up a competition with a Medicare alternative. Obama does not mandate, but he does toss in rules that allow the sick to get insurance. Hillary's plan is coming out in the fall. Richardson wants Medicare beginning at 55 with policies below 55 that can not exclude the sick. Indeed no exclusion of the sick in coverage - no pre-existing denials - is in Hillary's cost saving proposal and appears common to all Dem plans. So where is Guiliani on ending pre-existing exclusions? - Why it seems he will not say.
The GOP cover for tax deductions for the rich is now "Income adjustable premiums" - and indeed in effect the tax deduction does produce a difference in the net outlay between the fellow making $75,000 and the fellow making a million - it means the higher tax rate person pays less - so I guess Guiliani is now in favor the rich paying less than the middle class for health care? Interesting....
No one who knows the facts is into "not trusting the Canadian system" - or "not supporting a universal system". There are a lot of questions that the GOP plants in the Media and which flow back to be answered - but I do not take those questions to mean the GOP war on the non rich is actually winning a few converts..
The point Guiliani makes that the health system rationing that we have now will continue under universal health is true- we agree. But I am in favor of not rationing based on wealth, which is the current system, and rather rationing in a basic health coverage plan that pushes money toward prevention and care of the problems that are doing the most harming to society. That means the boob job will not be paid for under a universal health care plan that only covers basic needs - but then the better off can always save via that tax deductible HSA account, or buy a supplemental insurance policy from an insurance company so as to fund the next face lift/nose job or medical care that is really not critical or preventive.