While the United States is a low-tax country compared to most industrialized nations, for a majority of Americans it doesn’t feel this way. That’s largely because private health insurance companies receive a large portion of our income every month. If we sent our money to a publicly run health insurance plan (e.g. Medicare) instead, almost all of us would save thousands of dollars each year while guaranteeing comprehensive health coverage for everyone.
The United States is unique in that we pay for a large part of our health care costs through an employer-based system. It is a creature of World War II, when we had price controls on wages and everything else to stamp down on inflation. Instead of increasing wages, employers offered health insurance. No other modern industrialized nation finances most of its health care system this way, because it does a terrible job of controlling costs, it’s highly regressive and it causes job lock, where people stay with a job just to receive health insurance.
For private-sector workers in West Virginia, the average health insurance premium was nearly $21,000 for family coverage in 2018. While employers typically cover most of these payments, it is widely recognized that employers consider the payments as part of an employee’s total compensation. Large increases in health insurance premiums have downward effects on workers’ wages.
The Economic Policy Institute finds that the rapid growth in employer-sponsored insurance premiums since 1979 had crowded out almost $390 billion in potential cash-wage increases for American workers by 2016, with employer-based family premiums now comprising over half of most worker’s wages.
A 2019 University of Pennsylvania study found that workers in West Virginia had the fourth-highest health care cost burden (family premiums as a share of median household income) in the nation in 2016. So employee compensation is going up, due to health insurance getting more expensive, but the money is going to private health insurance companies, leaving employers less likely to increase wages.
Since paying health insurance premiums is basically mandatory for most workers (employers with 50 or more full-time workers must enroll them in a health insurance plan), insurance premiums paid by employers act just like a tax — but a tax paid to private insurance companies, instead of the government.
If you include these payments as a tax on labor, U.S. workers are taxed higher than those living in most European countries. The insurance premium payments are also highly regressive, falling harder on those with smaller incomes. And this doesn’t even take into consideration out-of-pocket spending, such as co-pays or deductibles, which have also grown considerably over the years.
This is a terrible to way to fund health care. Setting up a universal system, such as Medicare for All, would give the vast majority of workers the biggest take-home pay raise they’ve ever seen. Instead of paying private health insurance companies, it would be financed publicly by enacting a combination of higher taxes on the wealthy and big corporations, implementing costs savings (e.g. lower prescription drug prices and administration costs) along with a flat payroll tax similar to Social Security and Medicare.
While the naysayers of universal health care like to talk about Medicare for All being a huge tax increase, it’s actually a massive tax cut for most Americans. Here’s an illustrative example. Suppose we have a privately owned and poorly run water utility in Kanawha County that charges everyone $50 a month despite frequent leaks and boil water advisories. One day, this utility shuts down and the county decides to take it over and charge everyone an annual “tax” of $500. Would you be outraged that you have to pay $500 in a new tax or be happy that you will now save $100 on your water bill each year?
(Hint: Ask a resident in Morgantown if they would prefer to pay Charleston rates for water or the lower amount to their publicly owned water utility).
While opponents of Medicare for All like to scare people with big numbers, saying it will cost $32.6 trillion over the next 10 years, this is actually about $2 trillion less in total national projected health spending over this period. Estimates show Medicare for All would reduce total U.S. health expenditures by $5.1 trillion over 10 years relative to current projections under our existing system.
The moral of this story is do not let people mislead you by focusing just on taxes, leaving out the services those taxes pay for and the other costs those taxes replace. Like clean water, we all need affordable health care coverage and today our premiums are taxing us harder than ever. Solutions like Medicare for All can reduce overall health spending while ensuring we all have access to health care anytime we need it. Untying health premiums from overall compensation gives us not only more money in our pockets, but the freedom to start a new business, avoid bankruptcy, lower stress, improve productivity and live longer and healthier lives.
Ted Boettner is executive director of the West Virginia Center on Budget & Policy.
