A policy lab for the future. Bold solutions for a post-boomer world. Current sprint focus: Reforming American healthcare. Follow/subscribe/donate
United States of America
Joined February 2023
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Cap the ESI tax break. Fund states to cover the uninsured. substack.com/home/post/p-224…
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The Boyd Institute retweeted
$43,117.32 for healthcare coverage for family of four healthy people. If you think that healthcare coverage in the USA is a ok - then you are not paying attention. The healthcare exchange and its providers are so out of touch. In 2026 my healthcare coverage for a very healthy family of four was crazy high. In 2027, the provider is increasing this coverage by 31% year over year. That’s $849.29 more per year above an already insane annual amount. Not signing up for this crap any longer. Our representatives are so out of touch with reality. We need a program based on some common sense. These insurance providers need to be reigned in.
#healthcare #USA #outoftouch #broken #changesneeded
New, by Duke Professor Don Taylor: How to guarantee catastrophic coverage to every American boydinstitute.org/p/how-to-g…
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NEW: When Duke Professor Don Taylor's son turned 26, he lost his answer to a basic question: where would he get health insurance, and what would it cost? Don’s fix caps one tax break to give every American catastrophic coverage. boydinstitute.org/p/how-to-g…
The Boyd Institute retweeted
Bring back catastrophic insurance for people over 30
The Boyd Institute retweeted
What would Medicare for All look like if it were funded through a payroll tax?
CBO’s broadest illustrative coverage scenario requires approximately $3 trillion in additional annual federal funding in 2030, including dental, vision, hearing, and expanded long term care.
On an assumed $14 trillion payroll base, funding that gap would require approximately 21.4% in additional combined employer and employee payroll taxes, while existing federal health funding continues.
Split equally, with no cap on taxable wages, that means 10.7% from you and 10.7% from your employer:
• $50,000 salary: $5,350 more annually from each.
• $100,000 salary: $10,700 more from each.
• $150,000 salary: $16,050 more from each.
• $250,000 salary: $26,750 more from each.
• $500,000 salary: $53,500 more from each—$107,000 combined annually!
Everyone with taxable wages contributes, while coverage extends to children, retirees, and people who aren’t working.
Covered insurance premiums would disappear. Some workers and employers would save overall. Others would pay more. Employer contributions also affect the cost of employing someone and can influence wages and hiring.
This is an illustrative calculation using CBO’s spending estimate, not a CBO-scored tax proposal. Exemptions, changes in wages and employment, and other funding sources would change the required rate.
Replacing premiums with taxes changes how we pay for healthcare. It does not eliminate the cost of providing it.
The Boyd Institute retweeted
There's a lot of talk about universal healthcare, and nothing that shows a person knows less about healthcare policy than when they state, “well the rest of the world has it figured out!”
They haven't.
There is tremendous variety in the healthcare systems of different countries. You've got Canada's dominant government payer. Meanwhile, Switzerland and The Netherlands have no government payer, just a bunch of private insurance plans. England has a government run hospital system while France is mostly private. Singapore uses health savings accounts for routine care and Chile gives vounchers to access private practice.
Some policies are great. Some are awful. All have tradeoffs.
Universal coverage is a worthy goal. We can learn a lot about how to get there from looking at other countries.
Check out my latest below:
The Boyd Institute retweeted
If you have private insurance now, you’re not going to like Medicare for All.
Your taxes will go up to pay for it.
“That’s fine, because I won’t have to pay my private insurance premiums any more!” You might say.
But since we already spend too much on Medicare, even with the tax increases, we won’t be able to fund ample high-quality access for all.
Low-value utilization will go up. We have two very strong studies that show this. So you’ll be waiting even longer for doctor appointments than you do now. You find out you need cataract surgery or a hip replacement and are told the wait is 6 months to a year. The appointments will be even shorter, the doctors more burned out. It’ll take three visits with an NP before you even get to see a doctor.
So you buy private insurance, if you have enough disposable income after the extra taxes. Except now the insurance premium isn’t tax advantaged, so it costs you more than it did previously.
In the end, with the increased taxes and higher priced private insurance, you’re paying more for the same care you have now.
What would Medicare for All look like if it were funded through a payroll tax?
CBO’s broadest illustrative coverage scenario requires approximately $3 trillion in additional annual federal funding in 2030, including dental, vision, hearing, and expanded long term care.
On an assumed $14 trillion payroll base, funding that gap would require approximately 21.4% in additional combined employer and employee payroll taxes, while existing federal health funding continues.
Split equally, with no cap on taxable wages, that means 10.7% from you and 10.7% from your employer:
• $50,000 salary: $5,350 more annually from each.
• $100,000 salary: $10,700 more from each.
• $150,000 salary: $16,050 more from each.
• $250,000 salary: $26,750 more from each.
• $500,000 salary: $53,500 more from each—$107,000 combined annually!
Everyone with taxable wages contributes, while coverage extends to children, retirees, and people who aren’t working.
Covered insurance premiums would disappear. Some workers and employers would save overall. Others would pay more. Employer contributions also affect the cost of employing someone and can influence wages and hiring.
This is an illustrative calculation using CBO’s spending estimate, not a CBO-scored tax proposal. Exemptions, changes in wages and employment, and other funding sources would change the required rate.
Replacing premiums with taxes changes how we pay for healthcare. It does not eliminate the cost of providing it.
The Boyd Institute retweeted
Excellent post from @boydinst
Highly recommend for my friends @awgaffney and @ajlamesa
open.substack.com/pub/boydin…
A teen’s injuries from a tragic car accident and an 88-year-old’s fifth specialist are not the same kind of healthcare, and pretending they are is why the system is broken. @PeterIBanks notes the difference between catastrophe and managed decay. boydinstitute.org/p/whatever…
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The Boyd Institute retweeted
This is from my Virginia Obamacare plan choices.
Who is buying this plan? Comes out to $67,000 per year in premiums!
Ask me what the cheapest Carefirst plan costs.
The Boyd Institute retweeted
I'm still fighting an $8,500 out of pocket bill from the birth of my child.
There is something perverse and insidious about how healthcare is handled in America.
No, this isn't a “Medicare for all” or “mah freedom” thing. Its something else.
The out of pocket price for a standard baby delivery at my hospital is about $11k.
That means, if I showed up with my wailing wife, uninsured, I would have been billed up to $11k.
But I am insured. So what was my bill: $8,500--- AFTER INSURANCE PAID $22K!!!!
Now think about that for a moment. The hospital was already paid more than TWICE the cash price.
And they still are coming after me for more.
Seriously though, what is the insurance company doing?!
You mean to tell me that the insurance company, with 80 million subscribers, has less negotiating power than a bloke off the street?
Something is deeply wrong with the incentive structure that will only be fixed by dismantling the whole system and starting over.
Biggest "the kids are fucked" moment I've had recently was at the dentist.
Walked in with a cracked tooth and dental insurance I'd paid for all year.
Thought that meant I was covered.
Instead, the front desk quoted me $1,900 for a crown, then explained my plan only pays up to $1,500 total per year, and I'd already used part of it on a cleaning.
Got home and started reading about how dental insurance works.
Turns out the yearly maximum on a lot of plans has barely moved in decades, while the cost of the work kept climbing.
I was naive enough to think insurance meant the bill got handled.
Apparently, I was just paying for a coupon that runs out.
NEW: A few weeks ago, Peter Banks was told his unborn daughter might be in mortal danger. In that moment he would have paid anything. That’s why he thinks “whatever it costs” is no way to run healthcare policy. A weekend read. boydinstitute.org/p/whatever…
The Boyd Institute retweeted
Biggest "the kids are fucked" moment I've had recently was at the dentist.
Walked in with a cracked tooth and dental insurance I'd paid for all year.
Thought that meant I was covered.
Instead, the front desk quoted me $1,900 for a crown, then explained my plan only pays up to $1,500 total per year, and I'd already used part of it on a cleaning.
Got home and started reading about how dental insurance works.
Turns out the yearly maximum on a lot of plans has barely moved in decades, while the cost of the work kept climbing.
I was naive enough to think insurance meant the bill got handled.
Apparently, I was just paying for a coupon that runs out.
The Boyd Institute retweeted
Healthcare costs an employer $10,000 per year for an employee making $40k
And we still can’t complete with large chains and negotiated plans
People think Obamacare is taxing billionaires to provide healthcare
It’s actually killing small business competition to help conglomerates
Now that midterms are over, let's focus on solving problems in a bipartisan fashion. Like healthcare. nitter.cf/unusual_whales/status/…
The average US family health insurance premium, per KFF’s annual survey:
1999: $6,000
2002: $8,000
2005: $11,000
2008: $13,000
2011: $15,000
2014: $17,000
2017: $19,000
2020: $21,000
2023: $24,000
2026: $28,000
That’s up 387% since 1999, about 6% a year.
Inflation over the same period: about 2.6% a year.
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The Boyd Institute retweeted
Couldn’t agree more with Nathan Smith’s passionate, dogmatic insistence on price transparency in healthcare. Inspired by him, I’ve already been agitating for it in my own medical visits.
More solutions like this, please! via @boydinst
boydinstitute.org/p/path-to-…
NEW: Last month Nathan Smith diagnosed American healthcare as “rent-seeking paternalism.” In this piece, he offers a path out of it through price transparency and help for those who can’t pay. boydinstitute.org/p/path-to-…
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The Boyd Institute retweeted
US healthcare costs are rising at an alarming rate:
Medical care prices have surged +132% since 2000, the largest increase among major consumer spending categories.
Over the same period, shelter costs have risen +127%, while food prices have soared +112%.
Price increases across all these spending categories have outpaced overall CPI, which is up +99% since 2000.
As a result, ~30% of insured US adults have skipped or delayed getting healthcare they needed due to costs over the last 12 months, according to a KFF survey.
Healthcare costs have never been higher.
