opinion piece, theres a good chart thats worth clicking on the article for but swipe below.

https://www.politico.com/news/agenda/2019/11/25/agenda-can-we-afford-medicare-for-all-071560

We can afford Medicare for All…
… and it could even deliver a huge pay raise to the middle class.

he current debate over "Medicare for All" anxiously asks “ How are we going to afford paying for health care?” But of course, we’re already paying for health care. The true question should be: “ Who should pay for health care?”

Our research shows that when you look at health care costs as a distribution problem, it becomes clear that not only can we afford Medicare for All, but a properly designed transition to Medicare for All could deliver the biggest pay raise in a generation to middle-class workers.

To understand why, it’s worth reviewing how health care is currently funded in the United States. American workers who don’t qualify for Medicare or Medicaid almost always get their insurance through an employer. The average cost of employer-sponsored health insurance is $13,000 a year per covered worker and this cost is growing fast. That adds up to roughly $1 trillion a year.

Since the passage of the Affordable Care Act, it is mandatory for all employers with more than 50 full-time workers to provide health insurance to their full-time employees; employers that don’t provide insurance have to pay a fine. The government has in effect washed its hands of the responsibility of providing health insurance to workers, and instead forces employers to manage this growing cost.

Premiums depress wages
Formally, employers pay about 70 percent of insurance premiums and workers the remaining 30 percent. But in practice, workers are paying the whole thing. The costs might seem invisible to workers, but in fact their health benefits are reducing their take-home pay every week. Why? Because for an employer, what matters is the total cost of employing someone. This cost includes salary but also benefits such as health insurance. If an employer believes your work is worth $50,000 to the company but has to pay $13,000 for your health care, your salary is going to be no more than $37,000.

They also reduce wages in a particularly unfair way: Because health insurance premiums are fixed, the wage penalty is the same for a low-wage secretary as it is for a highly paid executive. This severely depresses wages for tens of millions of moderate-income workers. When you hear that average hourly earnings of (nonsupervisory) American workers have stagnated since the late 1970s in spite of a growing economy, keep in mind that’s in part because growing health care costs are devouring an increasing share of what workers would otherwise be paid. Given the fast growth of health care costs, this situation is not sustainable.

The system is opaque enough that workers can’t see such costs clearly, but they aren’t completely hidden. Health care costs are sometimes visible on your pay slip as the “employer contribution to medical insurance.” The full cost of employer and employee premiums is also usually reported on the W-2 form that you use to file your income taxes. Take a look at box 12, code DD, and see how staggering the amounts are—typically the amount exceeds $10,000 in a year, and it can exceed $20,000 if your insurance covers family members. This is compensation for your work that you never see in your bank account, and you don’t have much choice, let alone the option to take the money as wages rather than health insurance.

Economically, insurance premiums are effectively the same as a tax on labor—a tax administered by employers. What makes this tax stand out is that it’s a so-called head tax, unrelated to ability to pay. It’s the most unfair type of tax: A huge burden for low-wage workers and almost meaningless for the rich. Head taxes (sometimes called poll taxes) used to be popular centuries ago but have long fallen out of fashion. (When Margaret Thatcher tried to impose a head tax in 1988 to replace real estate property taxes in the United Kingdom, she faced an unprecedented revolt and was ousted from office in 1990.)

No government would out-of-the-blue impose a head tax to fund health care; it would be a crushing burden on the working and middle classes. And yet in essence that’s what the U.S. government does today by mandating that employers manage a huge head tax to fund health insurance for workers.

Middle class bearing the burden
If you see the health system this way, it changes how you understand the entire U.S. tax system. Many people believe that the United States has what’s known as a progressive tax system, in which you pay more, as a fraction of your income, as you earn more. It’s true that income taxes are for the most part designed that way, but when you add all the various tax burdens together, the reality is different. And if you add mandatory private health insurance premiums to the official tax take, the U.S. tax system turns out to be highly regressive. Once private health insurance is factored in, the average tax rate rises from a bit less than 30 percent at the bottom of the income distribution, reaches close to 40 percent for the middle class, and collapses to 23 percent for billionaires.

When politicians urgently debate the tax burden on the middle class, they rarely point out that the system is already unfairly built on the backs of the middle class — and it’s our health care premiums that make it that way.

The solution to this mess is simple: The head tax currently paid by workers in the form of mandatory premiums should be replaced by actual, normal taxes based on ability to pay. If employer-sponsored health insurance premiums were transformed into wages, that’s a $13,000 pay increase that each covered worker would get on average, the biggest pay raise in a generation, and one that is long overdue.

Of course, taxes would then have to increase to fund Medicare for All. But they could, and should, look very different than the hidden tax they’re replacing. It would be possible to structure the new taxes so that all workers below a high wage threshold would pay less in taxes than what they would get in extra wages once those were returned to their paychecks – and the government could still raise the same $1 trillion in revenue. Any form of taxation (be it a payroll tax, an individual income tax, a corporate tax, a wealth tax, or a mix of these) would do, since all these taxes are much less regressive than the current health insurance premiums.

Will employers pocket the savings?
One crucial aspect of the transition to Medicare for All has not received enough attention so far: Once employers no longer have to pay for health benefits, how do we make sure they don’t abuse the system, keeping wages the same and pocketing the difference?

To address this problem, the government should legislate the conversion of employer health care premiums into a permanent wage increase at the time of the transition to Medicare for All. From the point of view of employers, this conversion would be neutral: for them, the cost of each worker would not change. Because health insurance premiums are already reported on W-2 forms and pay slips, this wage increase would be easy to enforce and monitor. Firms that try to pocket the premiums instead of boosting wages could be fined.

Even in the case of a slower transition to universal health insurance (such as the creation of a public option) it is essential to legislate that workers who migrate to the public option can take their current health insurance premiums as extra wages. If not, the transition will either never happen (as workers won’t see any upside to migrate), or it will be a boon for employers who will pocket the health care premiums. But if a law mandates that all premiums be added to wages, “Medicare for all who want it” will become “Medicare for All” faster that anyone believes (and the funding equation for both programs will become the same).

The current funding of health care in the U.S., which imposes a mammoth burden on moderate-income workers, is not sustainable. There is broad agreement that everybody should have access to health care—just like all children should have access to education. Given the enormous costs—there’s no cheap way to treat heart attacks, cure cancers, or give birth—low-income families cannot afford health care on their own. The U.S. spends approximately $10,000 on health care per person per year; it is impossible for workers with low salaries to spend $10,000 per family member. Other wealthy countries have understood this basic truth long ago and fund universal health insurance through taxes that are based on ability to pay.

The key question, in the U.S. context, is how to conduct a successful transition to universal public health insurance that redistributes the burden of paying for health care. Do it fast or do it slow, the big picture is this: Fixing the injustice of our current health care funding system is possible and in fact straightforward. And if it came with a law mandating the conversion of premiums into wages, it would deliver the biggest pay raise in a generation to American workers.

bonus
The Army Built to Fight ‘Medicare for All’
https://www.politico.com/news/agenda/2019/11/25/medicare-for-all-lobbying-072110