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Proponents of a national, single-payer health care system, like one favored by presidential candidates Elizabeth Warren and Bernie Sanders, have long argued it would make medical care accessible to millions of Americans who currently can’t afford it and potentially drive down national health care spending overall.

Opponents, on the other hand, tend to focus on how it would rework the economy: 2 million jobs lost, higher taxes to pay for it, the concentration of market power in the government.

The United States is facing an economic crisis that is predicted to result, not only in much higher unemployment, but also in a significant decrease in personal wealth. Large corporations as well as small businesses are shedding employees in order to survive. 276 As we well know from the sorry sight of the CEOs of the big three automobile companies coming hat-in-hand to plead with Congress for a bailout, the cost of health care as well as other employment benefits is part of the reason that U.S. companies are not only unprofitable and uncompetitive, but perhaps also unsustainable. 277 As the saying goes, we are all feeling the pain. Is the pain sufficiently universal to create empathy for the less fortunate by the more fortunate; the kind of empathy that might support a redistribution of wealth? With the health care system an acknowledged mess, the economic system shaky enough to scare even those who currently have affordable health insurance, a terrible economy, and a new administration that believes in the power of government to solve problems, is the time right for systemic health care reform? In other words, has the policy window for health reform opened?278

Currently there are many reasons to believe that federal health care reform is an idea whose time has come. The President is a Democrat, and Democrats control both houses of Congress, but this does not guarantee a policy outcome. A recent Gallup poll on Americans' perception of the health care system versus their own health care demonstrates what seems to be an inexplicable attitude: while seventy-three percent of respondents believe that the health care system is in crisis or has major problems, eightythree percent rank the quality of their own health care as excellent or good and sixty-seven percent rank their own health care coverage as excellent or good. 279 Is there a coherent take-away message about what the electorate wants from this administration in the way of health care reform?

Small businesses are independent establishments wholly owned by an individual, a family, or business partners. Small businesses are vital to local and national economies. In the aggregate, they have a very large impact on the nation, but individually, they are truly small.1 As such, the influence of small businesses could easily be overlooked, especially when health insurance legislation's focus is on individuals and large businesses.

The current American health insurance system is not sustainable because it increases the burden on large employers while providing a potentially untenable situation for small employers, does nothing to control rising medical costs, and does not provide universal insurance coverage. Specifically, the way the health insurance system works for small employers highlights these problems by providing optional guidelines with little assistance and no standardization for coverages among employers. Employers are then left to choose between providing potentially unaffordable coverage or forcing themselves and employees to find insurance on the individual exchange, which might not be any more affordable.

The evidence abounds: A “Medicare for All” single-payer system would guarantee comprehensive coverage to everyone in America and save money.

Christopher Cai and colleagues at three University of California campuses examined 22 studies on the projected cost impact for single-payer health insurance in the United States and reported their findings in a recent paper in PLOS Medicine. Every single study predicted that it would yield net savings over several years. In fact, it’s the only way to rein in health care spending significantly in the U.S.

Fundamental reforms like M4A could greatly aid labor market outcomes for U.S. workers. The most obvious benefits would be higher wages and salaries, increased availability of good jobs, reduced stress during spells of job loss, better “matches” between workers and employers, and greater opportunity to start small businesses.

Higher cash wages and salaries

The United States spends significantly more on healthcare compared to other nations, but we don’t have better healthcare outcomes. What’s more, rising healthcare spending is a key driver of America’s unsustainable national debt and high healthcare costs also make it harder to respond to public health crises like the COVID-19 pandemic. Below is a look at the increasing healthcare costs in the United States, what is causing that rapid growth, and why it matters for public health and our fiscal outlook.

HOW MUCH DOES THE UNITED STATES SPEND ON HEALTHCARE?

America is doing better than most countries, thanks to the vast amount of money it spends on health care and the excess capacity this funds. But it is not doing well. Average hospital-occupancy rates recently exceeded 80% for the first time. Even in the darkest days of the pandemic few states reported paediatric wards under stress (which we define as 90% or more beds being occupied). In early November fully 17 states were in this position, the result of a rise in all sorts of bugs in kids.

Every kind of sickness and disaster

A recent NBC/Wall Street Journal poll again demonstrated that health care is the top government priority among voters. So how are our political leaders tackling the question? For Democratic presidential candidates, the debate is mostly about a new “Medicare for All”—somehow expanding government coverage for every American (alas, with little discussion about how to fund it). Republican leaders have focused primarily on dismantling Obamacare, though President Trump last week called for bi-partisan legislation to reform provider billing practices. Yet such issues are only a fraction of the tangle of healthcare challenges that, as Mr. Trump once noted, “nobody knew could be so complicated.”

That complexity, besides being mind-numbing, has also blocked more serious strategic thinking in our public debate. Expanding access and reducing costs are important for many voters—but nobody’s talking about a bigger strategic monster: our need to ramp up healthcare innovation. How will we accelerate growth of new knowledge so our overall system can actually perform better long term—to achieve higher quality and financially sustainable patient care? What are the breakthroughs to turn around today’s losing battle: we’re spending on healthcare faster than we can afford, even as positive outcomes per dollar keep sinking versus those of other developed nations?

Federal Reserve officials are widely expected to announce on Wednesday a pause in their regimen of rate hikes.

After 10 consecutive hikes, investors are pricing in a 94% chance that the Fed will leave rates unchanged for the first time since January 2022, according to the CME’s FedWatch Tool.

Moving to Medicare for All will involve dramatic reductions in current spending for health insurance premiums and out-of-pocket healthcare, balanced by net savings and increased taxes. As critics have noted, over the ten years 2019 to 2028, Medicare for All would cost nearly $36 trillion, which would require an increase in federal revenues of nearly $9 trillion over the same period.26

This tax increase, however, would be more than offset for Americans by the reduction in health insurance premiums and out-of-pocket spending on healthcare.27 Current insurance premiums are already nearly 22% of taxable payroll and are projected to rise to nearly 24% over the next decade, well above the cost of Medicare for All at 14% of taxable payroll, falling to 10% over the next decade (see Figure 8). If the total cost of the Medicare for All system was put on wages, it would still lower the share of wages going to healthcare by a third, saving the average worker over $4000 in 2019, rising to nearly $8000 by 2028 (see Figure 8). The savings for the average worker would be even greater to the extent that Medicare for All is financed with progressive taxation, which would shift some of the cost onto those with more ability to pay, and onto profits. Health insurance premiums currently are the same for all regardless of income: a CEO who is paid $20 million pays the same premium as a sales agent on $50,000. By shifting the burden to ability to pay, tax finance would give even greater savings to the middle class and to workers.

Every dollar spent on medical care is a dollar that comes out of someone’s income, taken from a worker or a business owner or a shareholder or a family. So it’s not quite right to say that “insurance companies” or “the government” pays our healthcare bills. We pay the premiums or the taxes— and usually both. Insurance companies and the government are the intermediaries that collect the money and send it where it needs to go. But the money comes from us, no matter the healthcare system. The American people fund our healthcare system today, and the American people would fund our healthcare system under Medicare for All. What changes under Medicare for All is the size of the national healthcare bill, where we send the money, who keeps some of it for profit (and how much they keep), and which people pay how much.

That last question—who pays how much—is also a question of social values. How much should the rich pay for healthcare compared to the middle class and the poor? How much should the healthy pay compared to the sick? Our current healthcare system takes an implicit stand on these questions, but the answers often remain hidden beneath a fog of complexity. M4A brings these ethical issues out of the shadows, forcing us to decide collectively which values should be embedded into a system that consumes nearly a fifth of our economy and takes care of us at our most fragile moments.

Fundamental health reform like “Medicare for All” would be a hugely ambitious policy undertaking with profound effects on the economy and the economic security of households in America. But despite oft-repeated claims of large-scale job losses, a national program that would guarantee health insurance for every American would not profoundly affect the total number of jobs in the U.S. economy. In fact, such reform could boost wages and jobs and lead to more efficient labor markets that better match jobs and workers. Specifically, it could:

Boost wages and salaries by allowing employers to redirect money they are spending on health care costs to their workers’ wages.

Secondly, note that this existential risk Kuznets curve appears in the transition dynamics of the optimal allocation. Considering that existential risk mitigation is a global public good, it is unlikely resources are allocated to safety optimally in the real world. As such, this should not be taken to be a prediction of what a particular country with a particular set of institutions will do with regard to existential risk.

Nevertheless, there are a number of reasons why we might still be interested in the transition dynamics under the (impatient) optimal allocation. For one, since there are very long timescales involved here, it is very hard to know (and thus model) what government and societal institutions will evolve to deal with existential risk. However, the ideal these institutions will likely aim at is the optimal allocation. The optimal allocation might thus be a rough proxy for the real-world allocation.

Significantly higher healthcare spending in the United States will continue a damaging ripple effect across the economy, crunching public sector budgets and those of businesses and households as well. That's according to a new report from Moody's Investor Service.

The U.S. spends almost double what other high-income countries spend as a share of their economies, Moody's said, totaling $3.3 billion in 2016 or 18 percent of GDP. Households and businesses made up nearly half of the spending.

To assess the long-term effects of domestic income inequality in developed countries, we assume a zero discount rate. Our contention is that inequality reduction is more likely to decrease rather than increase existential risk. Our somewhat preliminary conclusion is thus that longtermists should favour inequality reduction.

We discuss several reasons for why inequality might have negative effects and one reason why it might have positive effects. The negative effects we discuss are climate change, the effect of inequality on public institutions, conflict and polarisation, and differential progress. The potential positive effect we discuss is that if inequality lowers growth rates, and if growth increases existential risk, then inequality could lower existential risk.

When the coronavirus came crashing through the United States, it brought with it mass layoffs. By April 2020, unemployment was up to 14.7%, the highest rate in the last few decades. With the healthcare system in the U.S. almost entirely tied to employers, the flaws of such a system have never been more clear. Unemployment causes loss of healthcare, and amid a pandemic, arguably little is more important than access to quality medical assistance.

Before the pandemic had even emerged, however, the trend in national discourse towards a single-payer healthcare system made significant headway. Often referred to by names like Medicare for All, such reform would ensure that every American, regardless of status and employment, would be entitled to health coverage funded by tax dollars. With nearly every Democratic presidential candidate proposing some form of healthcare reform and some pushing a single-payer system exclusively, a reassessment of the way the United States manages healthcare appears all but inevitable.

Yet, as 17 million people have lost their jobs because of Coronavirus related closings, many have also lost their health insurance. The reason is simple. In the U.S., the majority of working age Americans get their health insurance from an employer. Either their employer, or their spouse’s.

And just in case you think that this result is somehow intentional, the podcast below should dissuade you. Basically, we have employer-sponsored insurance first and foremost because it’s cheap to insure workers (you know, because they ain’t usually sick). Then, during WWII, when employers couldn’t raise wages because of price ceilings, employers instead attracted workers through benefits like health insurance. Then, employers got a tax break for offering this kind of benefit. The rest is history.

From the earliest days of the COVID-19 pandemic in 2020, a disturbing pattern was clear: the new disease was hitting some groups of Americans much harder than others. It wasn’t just people 65 and older who were more susceptible. Black and Hispanic people, and other racial and ethnic groups had significantly higher rates of severe illness, hospitalization, and death than white Americans.

Statistics compiled by the COVID Tracking Project, for example, showed that Black people were dying at 1.7 times the rate of white people, and a study by the Centers for Disease Control and Prevention found that Latinx, Hispanic, and American Indian or Alaska native people were nearly twice as likely as non-Hispanic white people to seek emergency room care for the disease.

First, the prevalence of those underlying conditions which exacerbate COVID-19 severity would be reduced via equitable access to care. For example, uninsured adults are significantly more likely than insured adults to be unaware of their hypertension (33, 34), much less likely to be receiving treatment (35), and much less likely to have their hypertension under control (36). Hypertension specifically increases the risk of COVID-19 mortality by 188% (37). Additionally, uninsured women were found to have a higher prevalence of obesity (35), which is another risk factor for severe COVID-19. Diabetes has similarly been associated with significantly increased COVID-19 severity and mortality (38). Uninsured adults with diabetes were half as likely to be aware of their condition as their insured counterparts (39).

Early diagnosis and access to life-saving medical care.

Cutting the Prevention and Public Health Fund, which deals directly with planning for bioterror attacks and pandemics, was only the most obvious way in which the House bill attempted to undermine American security. Over the long term, there is also a movement afoot to put basic health care out of reach of many Americans. Simply making healthcare unaffordable may seem less dramatic than slashing an emergency-preparedness budget, but doing so also undermines national security.

As the Congressional Budget Office report suggests, the American Health Care Act would make healthcare essentially unaffordable for people with pre-existing conditions, because it would allow insurance companies to dramatically increase their premiums. Ten years ago, I wrote about the security impact of the uninsured during the George W. Bush presidency. In 2005, almost 47 million people (about 16 percent of the total US population) were uninsured. Thanks to the Affordable Care Act passed under the Obama administration, that number dropped to a low of 11 percent, according to a Gallup poll taken during the first quarter of 2016. The Affordable Care Act was a big step in the right direction, but it didn’t close the gap, and the national security and public health challenges of having a large fraction of the population uninsured remain as relevant today as they were a decade ago.