Which Health Care System do you prefer?

[New confederate ramenia]

Obama model is best.

[Lavochkin]

Obama model is best.

Yup! Causing forcing people to buy something they have no idea on how it works is best!

[New confederate ramenia]

Obama model is best.

Yup! Causing forcing people to buy something they have no idea on how it works is best!

Mandatory out-of-pocket private payer FTW!

[ErVaReAn rEpUbLiC]

Why doesn't the poll allow changing your vote? What if you change your mind? Or made a mistake?
Why doesn't it have an "Other (Please Explain By Post)" type option?

Hmm, it seems adding another option reset the entire voting... I was afraid that might happen.

[Kazarogkai]

That is more or less an inspiration from the barefoot doctors of china more or less, I was thinking it would be a little cheaper having a couple clinics here and there and would guarantee especially in poor rural areas that people have access to atleast basic healthcare services. Typically clinics are not set up in remote places like that requiring the residents to have to travel large distances for even basic services like vaccinations, pregnancies, prescriptions, etc.

I haven't really worked out the details exactly but I was thinking something like $6,000-$12,000 give or take with with a subsidy rate of 100% so that all citizens will be guaranteed that basic amount. For those who make above the threshold It will effectively be a tax write off with only the money made above that being taxed. freeloaders will be an issue but I am willing to accept that.

Sorry for veering your thread into a discussion about taxes. Maybe we should take this to the telegrams if you prefer?

You have a good point about the rural situation. If the situation is very bad with access to healthcare in certain rural areas I'm open to the idea of Beveridge-style clinics, though I'd prefer to avoid it. Though I think there should generally be enough demand for healthcare even in rural areas that privately run clinics should find it profitable to run those.

As for taxes it's ok, I don't really consider it off-topic since welfare policies is a related topic to healthcare. I do wonder though, if the subsidy rate is 100%, isn't it a universal basic income system rather than a negative income tax? I think the subsidy rate has to be below 100% for it to be a negative income tax.

The difference is that under a basic income system everyone regardless of their income would receive a certain amount say $100, whether that guy be Bill gates or Joe poor everyone receives the same amount of money. Under a negative income tax, a variant of guaranteed minimum income, with a 100% subsidy rate the only people who would actually receive money would be those who fall below the threshold, everyone who are above the threshold shall not receive any money instead they will more or less be effectively given a tax write off for the first say $6,000 dollars of their income with the remainder taxed as normal. If we had a progressive tax it would go something like this with tax brackets of: 0%, 10%, 20%, 30%, 40%, and 50%.

Similar effects but slightly different methods. Wikipedia:

"Basic income means the provision of identical payments from a government to all of its citizens. Guaranteed minimum income is a system of payments (perhaps only one) by a government to citizens who fail to meet one or more means tests. While most modern countries have some form of GMI, a basic income is rare."

[Kazarogkai]

No, I haven't. The prebate, I assume you receive even if you earned zero income and paid zero in taxes? And everyone receives the same amount regardless of their income (or lack thereof)? In that case it's basically a universal basic income system, albeit a very limited one.

Yes you would receive it regardless. So it is almost like a basic income but limited to prevent people from eschewing work. Because everyone who buys any item pays tax on that item.

Now personally I would not adopt the Fair Tax exactly. I would keep and estate tax and personal income tax on very high earners as they buy less in proportion to their income. Say 23% on income over one million with capital gains and inheritance counted as income. (23% being the consumption tax). The prebate makes it progressive, as they are still getting taxed on their spending but not benefiting much from the prebate.

But my proposal would further reduce the tax burden on the middle class.

More directly on topic, how would you fund a health care system? Sales tax, income tax, corporate tax etc?

My national insurance system alongside any and social welfare programs that I wold implement in any country I ran would be funded via general taxation. I would make it so that at the minimum 20% of all government income must be spent on social welfare, 20% on education, and 20% on law enforcement. If we run in the red I am okay with that, as a supporter of Keynesian style economics more or less I am fine with running a deficit occasionally.

[ErVaReAn rEpUbLiC]

You have a good point about the rural situation. If the situation is very bad with access to healthcare in certain rural areas I'm open to the idea of Beveridge-style clinics, though I'd prefer to avoid it. Though I think there should generally be enough demand for healthcare even in rural areas that privately run clinics should find it profitable to run those.

As for taxes it's ok, I don't really consider it off-topic since welfare policies is a related topic to healthcare. I do wonder though, if the subsidy rate is 100%, isn't it a universal basic income system rather than a negative income tax? I think the subsidy rate has to be below 100% for it to be a negative income tax.

The difference is that under a basic income system everyone regardless of their income would receive a certain amount say $100, whether that guy be Bill gates or Joe poor everyone receives the same amount of money. Under a negative income tax, a variant of guaranteed minimum income, with a 100% subsidy rate the only people who would actually receive money would be those who fall below the threshold, everyone who are above the threshold shall not receive any money instead they will more or less be effectively given a tax write off for the first say $6,000 dollars of their income with the remainder taxed as normal. If we had a progressive tax it would go something like this with tax brackets of: 0%, 10%, 20%, 30%, 40%, and 50%.

Similar effects but slightly different methods. Wikipedia:

"Basic income means the provision of identical payments from a government to all of its citizens. Guaranteed minimum income is a system of payments (perhaps only one) by a government to citizens who fail to meet one or more means tests. While most modern countries have some form of GMI, a basic income is rare."

Wouldn't that mean that once your income exceeds the threshold, your net income actually decreases until a certain point? That's how I imagine things being with a 100% subsidy rate, whilst with a 50% one for every 2 dollar you earn you lose 1 in negative tax income, which continues until you reach the threshold. That used to be my model for the NIT.

[ErVaReAn rEpUbLiC]

Yes you would receive it regardless. So it is almost like a basic income but limited to prevent people from eschewing work. Because everyone who buys any item pays tax on that item.

Now personally I would not adopt the Fair Tax exactly. I would keep and estate tax and personal income tax on very high earners as they buy less in proportion to their income. Say 23% on income over one million with capital gains and inheritance counted as income. (23% being the consumption tax). The prebate makes it progressive, as they are still getting taxed on their spending but not benefiting much from the prebate.

But my proposal would further reduce the tax burden on the middle class.

More directly on topic, how would you fund a health care system? Sales tax, income tax, corporate tax etc?

My national insurance system alongside any and social welfare programs that I wold implement in any country I ran would be funded via general taxation. I would make it so that at the minimum 20% of all government income must be spent on social welfare, 20% on education, and 20% on law enforcement. If we run in the red I am okay with that, as a supporter of Keynesian style economics more or less I am fine with running a deficit occasionally.

Well, today already more than half of US government spending (federal, state, local) is in social expenditures. And the trend can be found for almost all OECD countries, they all tend distribute roughly half of government spending toward social expenditures. By social expenditures I mean welfare+pensions+healthcare. Better look up the data to get a sense of perspective on government spending breakdowns before making policy suggestions regarding spending breakdowns

[Kazarogkai]

The difference is that under a basic income system everyone regardless of their income would receive a certain amount say $100, whether that guy be Bill gates or Joe poor everyone receives the same amount of money. Under a negative income tax, a variant of guaranteed minimum income, with a 100% subsidy rate the only people who would actually receive money would be those who fall below the threshold, everyone who are above the threshold shall not receive any money instead they will more or less be effectively given a tax write off for the first say $6,000 dollars of their income with the remainder taxed as normal. If we had a progressive tax it would go something like this with tax brackets of: 0%, 10%, 20%, 30%, 40%, and 50%.

Similar effects but slightly different methods. Wikipedia:

"Basic income means the provision of identical payments from a government to all of its citizens. Guaranteed minimum income is a system of payments (perhaps only one) by a government to citizens who fail to meet one or more means tests. While most modern countries have some form of GMI, a basic income is rare."

Wouldn't that mean that once your income exceeds the threshold, your net income actually decreases until a certain point? That's how I imagine things being with a 100% subsidy rate, whilst with a 50% one for every 2 dollar you earn you lose 1 in negative tax income, which continues until you reach the threshold. That used to be my model for the NIT.

Actually no that would not be the case for in a progressive system only the money you made above the threshold will start to be taxed, the money made at or below will be taxed at only 0%. Let me explain. Say we have a Progressive taxation system with a negative income tax and as such the tax brackets are as such:

00% 0-10,000
10% 10,001-20,000
20% 20,001-30,000
30% +30,001

Example A:
John's Income: 5,000
Tax bracket: 00%
Tax: 0
Subsidy: 5,000
Total Income: $10,000

Example B:
Sam's income: 8,000
Tax bracket: 00%
Tax: 0
Subsidy: 2,000
Total Income: 10,000

No matter what they always make $10,000 dollars in total regardless of how low or high their income goes. Now let us see how this would work if ones income was above the threshold:

Example C:
Adam's income: 60,000
Tax bracket(s):
00% 10,000/00
10% 10,000/1,000
20% 10,000/2,000
30% 30,000/9,000
Tax: 12,000
Subsidy: 0
Total Income: 48,000

In effect the first $10,000 is not taxed at all, the next $10,000 you make is taxed at 10%, the next at 20%, and any remaining you have is taxed at 30$. Only the money you make above the threshold is taxed at all. Say you made $10,100 the first $10,000 will be taxed at 0% with the remainder(in this case $100) being taxed at 10% which means your taxes amount to $10 in total. Unlike most Guaranteed minimum incomes like say welfare which gives a flat rate so long as you make below a certain amount and immediately cuts off once you make above that, in this case there is no poverty trap(make more money on welfare than off it).

[ErVaReAn rEpUbLiC]

Actually no that would not be the case for in a progressive system only the money you made above the threshold will start to be taxed, the money made at or below will be taxed at only 0%. Let me explain. Say we have a Progressive taxation system with a negative income tax and as such the tax brackets are as such:

00% 0-10,000
10% 10,001-20,000
20% 20,001-30,000
30% +30,001

Example A:
John's Income: 5,000
Tax bracket: 00%
Tax: 0
Subsidy: 5,000
Total Income: $10,000

Example B:
Sam's income: 8,000
Tax bracket: 00%
Tax: 0
Subsidy: 2,000
Total Income: 10,000

No matter what they always make $10,000 dollars in total regardless of how low or high their income goes. Now let us see how this would work if ones income was above the threshold:

Example C:
Adam's income: 60,000
Tax bracket(s):
00% 10,000/00
10% 10,000/1,000
20% 10,000/2,000
30% 30,000/9,000
Tax: 12,000
Subsidy: 0
Total Income: 48,000

In effect the first $10,000 is not taxed at all, the next $10,000 you make is taxed at 10%, the next at 20%, and any remaining you have is taxed at 30$. Only the money you make above the threshold is taxed at all. Say you made $10,100 the first $10,000 will be taxed at 0% with the remainder(in this case $100) being taxed at 10% which means your taxes amount to $10 in total. Unlike most Guaranteed minimum incomes like say welfare which gives a flat rate so long as you make below a certain amount and immediately cuts off once you make above that, in this case there is no poverty trap(make more money on welfare than off it).

Oh, but that's actually a subsidy rate of 0%, and for every 1 dollar that is earned an equal amount is deducted from your negative tax income. So in essence you can earn up to $10,000 (in this example) in gross income without seeing any increase in your net income. I suppose that's cost-effective, instead of the standard model where the subsidy rate is 50% and for every 1 dollar you earn only 50 cents are deducted.

It is possible that I got the concept of the subsidy rate backwards, though.

[Adab]

Personally, I prefer the National Health Insurance model.

[ErVaReAn rEpUbLiC]

No, I haven't. The prebate, I assume you receive even if you earned zero income and paid zero in taxes? And everyone receives the same amount regardless of their income (or lack thereof)? In that case it's basically a universal basic income system, albeit a very limited one.

Yes you would receive it regardless. So it is almost like a basic income but limited to prevent people from eschewing work. Because everyone who buys any item pays tax on that item.

Now personally I would not adopt the Fair Tax exactly. I would keep and estate tax and personal income tax on very high earners as they buy less in proportion to their income. Say 23% on income over one million with capital gains and inheritance counted as income. (23% being the consumption tax). The prebate makes it progressive, as they are still getting taxed on their spending but not benefiting much from the prebate.

But my proposal would further reduce the tax burden on the middle class.

More directly on topic, how would you fund a health care system? Sales tax, income tax, corporate tax etc?

It is funded through general government revenue. There's no need to make a distinction where the source of revenue comes from, or earmark specific tax revenues for the funding, in the end all that matters is that there is a balance between spending and revenue. Just like there is no actual need to fund road infrastructure spending specifically through fuel taxes...

On a side note, it's funny how the estate tax is being accepted as self-evident in the US, while in Sweden not even the Social Democrats want it back (it was abolished a while ago).

Also, regarding tax policy, US tax revenues are artificially lower than they should be (have you ever wondered why tax revenue as a % of GDP is 25%, while actual government revenue is more like 31-34%?) (depending on source) because about 5% of GDP in government revenue comes from other sources like fines, fees etc. This is a much larger percentage than in other countries, where the difference between tax revenue and government revenue is smaller.

[The Rossinite Empire]

Ideally national insurance but practically out of pocket/free market health insurance

[Novus America]

Ideally national insurance but practically out of pocket/free market health insurance

Why not use the Swiss/Dutch/German model? You get the best of both.

[Greed and Death]

Out of pocket lets people take their own chances.

[Fanosolia]

Honestly though Canada's current system will always have a special place in my heart I have to go with Australia's system. It's still universal but they allow for private insurers (more so than canada at least) and there's more co-op payment, and there's a levy of 1% if you can pay for the private but you choose not to. I don't know why, but I've always found that bit funny.

[Threlizdun]

Out of pocket lets people take their own chances.

Or you know, prevent some people from having a chance at all.

[ErVaReAn rEpUbLiC]

Honestly though Canada's current system will always have a special place in my heart I have to go with Australia's system. It's still universal but they allow for private insurers (more so than canada at least) and there's more co-op payment, and there's a levy of 1% if you can pay for the private but you choose not to. I don't know why, but I've always found that bit funny.

Yeah, the Canadian system is sometimes said to be the second worst healthcare system in the developed world except for the US (going by their rankings in the WHO and the Commonwealth Fund), while Australia is seen as a better-functioning example of the NHI model.

[Grave_n_idle]

I well and truly prefer the NHI model.

We have the Beveridge model here in New Zealand and, frankly, it doesn't work - the hospitals are underfunded, waiting lists can literally last for years, nurses aren't paid what they deserve to be paid (and so frequently have to go on strike) - and this is true of other health systems such as the NHS in Britain.

None of that is a problem in the model - that's all down to the political system starving the beast.

[ErVaReAn rEpUbLiC]

I well and truly prefer the NHI model.

We have the Beveridge model here in New Zealand and, frankly, it doesn't work - the hospitals are underfunded, waiting lists can literally last for years, nurses aren't paid what they deserve to be paid (and so frequently have to go on strike) - and this is true of other health systems such as the NHS in Britain.

None of that is a problem in the model - that's all down to the political system starving the beast.

Can you empirically prove that a free-market healthcare system performs better with regards to this?

[Fanosolia]

Honestly though Canada's current system will always have a special place in my heart I have to go with Australia's system. It's still universal but they allow for private insurers (more so than canada at least) and there's more co-op payment, and there's a levy of 1% if you can pay for the private but you choose not to. I don't know why, but I've always found that bit funny.

Yeah, the Canadian system is sometimes said to be the second worst healthcare system in the developed world except for the US (going by their rankings in the WHO and the Commonwealth Fund), while Australia is seen as a better-functioning example of the NHI model.

I wouldn't go that far, but it would be wrong of me not to bring up the fact Canada has some pretty bad wait times with in the Healthcare, while Australia is like sixth in the world when it comes to efficiency. The only problem I have with that knowledge is the same reason I have problems of some people pointing to Hong Kong for healthcare. The pop is smaller than us, though I'm more way more willing to accept trying Australia's method since it closer than that of that small city state.

Then again you also have japan at rank 4 with a pop 4 times the size of Canada's I'm just like "HOW DO YOU EVEN!?"

[ErVaReAn rEpUbLiC]

Yeah, the Canadian system is sometimes said to be the second worst healthcare system in the developed world except for the US (going by their rankings in the WHO and the Commonwealth Fund), while Australia is seen as a better-functioning example of the NHI model.

I wouldn't go that far, but it would be wrong of me not to bring up the fact Canada has some pretty bad wait times with in the Healthcare, while Australia is like sixth in the world when it comes to efficiency. The only problem I have with that knowledge is the same reason I have problems of some people pointing to Hong Kong for healthcare. The pop is smaller than us, though I'm more way more willing to accept trying Australia's method since it closer than that of that small city state.

Then again you also have japan at rank 4 with a pop 4 times the size of Canada's I'm just like "HOW DO YOU EVEN!?"

I'm confused, are you saying that Japan is over-performing given their large population?

[Fanosolia]

I wouldn't go that far, but it would be wrong of me not to bring up the fact Canada has some pretty bad wait times with in the Healthcare, while Australia is like sixth in the world when it comes to efficiency. The only problem I have with that knowledge is the same reason I have problems of some people pointing to Hong Kong for healthcare. The pop is smaller than us, though I'm more way more willing to accept trying Australia's method since it closer than that of that small city state.

Then again you also have japan at rank 4 with a pop 4 times the size of Canada's I'm just like "HOW DO YOU EVEN!?"

I'm confused, are you saying that Japan is over-performing given their large population?

No, just that makes my link to population and efficiency of healthcare fictitious at best since until at least Italy you have honk and Singapore at the top (which a lot of people like to point out make a case for free market systems) then you have japan that has very high population (comparatively speaking) ranked at 4. I'm just really shocked that it's 4th in world to be honest.

[Novus America]

Yeah, the Canadian system is sometimes said to be the second worst healthcare system in the developed world except for the US (going by their rankings in the WHO and the Commonwealth Fund), while Australia is seen as a better-functioning example of the NHI model.

I wouldn't go that far, but it would be wrong of me not to bring up the fact Canada has some pretty bad wait times with in the Healthcare, while Australia is like sixth in the world when it comes to efficiency. The only problem I have with that knowledge is the same reason I have problems of some people pointing to Hong Kong for healthcare. The pop is smaller than us, though I'm more way more willing to accept trying Australia's method since it closer than that of that small city state.

Then again you also have japan at rank 4 with a pop 4 times the size of Canada's I'm just like "HOW DO YOU EVEN!?"

Because the Bismark model simply seems to work better.

[ErVaReAn rEpUbLiC]

I'm confused, are you saying that Japan is over-performing given their large population?

No, just that makes my link to population and efficiency of healthcare fictitious at best since until at least Italy you have honk and Singapore at the top (which a lot of people like to point out make a case for free market systems) then you have japan that has very high population (comparatively speaking) ranked at 4. I'm just really shocked that it's 4th in world to be honest.

There are too many factors at play that determines the quality of healthcare, although I mostly agree with the assessment that wealthy city-states might have an easier time in creating a high-quality healthcare system. This is probably also true with cities inside countries, there is a well-known rural-urban gap in life expectancy. Cities tend to have superior economies of agglomeration in general, so they also end up with higher per capita income, superior infrastructure and transportation networks in general.

In short, Hong Kong and Singapore likely don't have high-quality and cost effective healthcare systems because their populations are small (in truth I suspect small populations and low population density might in itself worsen healthcare performance) but rather because of the structure of an urban economy, with superior economies of scale and network effects. The Nordic countries, which are generally known as perhaps the most well-run societies in the world, do not perform better than larger countries like France or Japan with regards to healthcare.

And, as others have pointed out, Japan has the Bismarck Model

In truth I believe it's hard to compare Japan to Western countries with regards to healthcare, because there are many factors, including a different culture of organization, that might partly explain the differences in performance. This could apply to Hong Kong and Singapore as well, who are known for their effective and efficient governments.