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Medicare for All could also provide pay increases for workers

February 12, 2020

Topics: Quote of the Day

Financing Medicare for All

By Gabriel Zucman
January 24, 2020

  • Full private funding of health care is impossible because of its high costs
  • Premiums for employer-sponsored plans are a privatized poll tax
  • A tax because it’s mandatory (over 50 employees) and reduces wages
  • A poll tax because all pay the same regardless of income
  • A privatized tax because it is managed by employers
  • For the middle class, health insurance is the biggest tax they pay
  • Solution: replace insurance premiums (poll tax) by taxes based on ability to pay
  • Convert current premiums to additional employee wages
  • Broad-base flat tax on all income. 6% rate enough to replace all private premiums.
  • Can be supplemented with progressive taxes
  • Biggest take-home pay increase in a generation for working families

22 minute video, with PPT:


By Don McCanne, M.D.

Gabriel Zucman, along with his colleagues Emmanuel Saez and Thomas Piketty, have demonstrated the injustices of income and wealth inequality and have suggested ways to remedy these injustices. The profound inequities of health care financing in the United States provide an opportunity to use tax policies to painlessly move in the direction of improving equity in both income and in health care. Here Gabriel Zucman provides one example of how that could be done.

If employers converted their current health insurance premiums to employee pay increases, there would be no net cost to the employers. Zucman estimates that a six percent tax on income would be enough to pay for the additional costs of single payer Medicare for All. That six percent tax would be considerably less than the premiums currently paid by payroll deductions and forgone wage increases. Thus the net result would be the biggest take-home pay increase in a generation for working families, helping to favorably reset the current inequities in income.

This is only one example of how tax policy can be used to make health care affordable for each and everyone of us. Most importantly we can refute those who say that we cannot afford single payer Medicare for All. On the contrary, we cannot afford not to enact and implement it.

There is a message here for those union executives who are fighting single-payer Medicare for All. You can help by seeing that this message is delivered to them.

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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