IS NO FREE HEALTH CARE:
Health care reforms are often promoted as having no
But this is an illusion: Every doctor and nurse must be paid.
The fact that most health-care dollars pass thru back-channels
sometimes gives the illusion that the consumer does not pay.
But we do pay: thru
our employers, thru our local taxes,
thru our state taxes, and thru our federal taxes.
Much of the controversy about health-care costs
amounts to arguing about which
box on our pay-stubs
will include the cost of our health care.
Politicians like to blame others
for health-care costs:
Each level of government wants other levels to bear more
of the expenses.
This does not reduce
the total cost;
it merely alleviates the criticism for whichever level of government
has been able to shift the costs of health care to some other level of
HEALTH-CARE PAID BY EMPLOYERS.
2. MEDICARE: HEALTH-CARE SUPPORTED BY FEDERAL TAXES.
MEDICAID: HEALTH CARE PAID FOR BY STATE AND FEDERAL TAXES.
PUBLIC HOSPITALS: HEALTH-CARE PAID BY LOCAL TAXES.
5. 2010 HEALTH-CARE REFORM.
IS NO FREE HEALTH CARE:
James Leonard Park
1. HEALTH-CARE PAID BY
In the United States of America most health-care
flow from employers to health-insurance companies,
then to the health-care providers.
Because the employees never see these specific
their pay statements,
they sometimes operate under the misconception
that such health-care is FREE.
But employers know better:
Every company that provides health-care benefits
knows that a significant amount of money must be paid each month
to cover the health-insurance of each employee.
In round numbers, this is about $10,000 per year
for each employee covered.
When a whole family must be covered by one employee,
then the cost is obvious higher,
depending on the number of people in the insured family.
Employees never touch this money,
since it is paid directly by the employer to the health-insurance
And since they never see it, they might forget that this stream of
But if the same employees were required to pay for
their own health-care,
they would be much more aware of exactly how much it costs each year.
And when an employer adds or removes health-care as a fringe benefit,
there is usually a corresponding adjustment
in the amount paid to the employee for the work performed.
In other words, the employer must consider the cost
as a part of the cost of having each employee on the payroll.
And because health insurance is paid by the employer,
it is not taxed as income to the employee.
The worker never sees this stream of money
and the worker does not have to pay taxes on this $10,000 (or more) per
When the employer pays most of the health-care
costs, it is not free.
2. MEDICARE: HEALTH-CARE SUPPORTED
BY FEDERAL TAXES.
In the United States of America, everyone who
reaches the age of 65
is eligible for tax-supported health-care called Medicare.
Enrollment is easy and almost automatic when we reach that age.
We are never told how much it costs the federal government
to provide this heath care.
So we might assume that it is free
But in the background huge sums of money are passing around.
Medicare is supported by a special tax on income,
which is part of the Social Security tax.
During all of our working lives, we pay money into Medicare.
And when we reach age 65,
most of our health-care needs will by paid by the Medicare
Once again, we the tax-payers and the beneficiaries
never see this money.
And we do not know how much
we have paid into the Medicare fund
nor how much Medicare pays
each month for our health-care after age 65.
Medicare pays billions in heath care for senior
citizens every year.
This is not free health care:
Everyone with earned income pays into the Medicare fund,
which pays the doctors, nurses, and hospitals that care for Medicare
Here are the details of the Medicare tax:
For each worker in the USA, 2.9% of income is paid into the Medicare
Half is paid by the employer, half by the employee.
But since all is withheld and paid directly by the employer.
this also is money never seen or touched by the worker.
Beginning in 2013, high-income employees will paid an even higher
3. MEDICAID: HEALTH CARE PAID FOR BY STATE AND FEDERAL TAXES.
There are well-known gaps in Medicare coverage,
which can be filled in by payments out of patients' pockets.
And for the very poor, these gaps in payment are filled by other levels
The largest of these programs is called "Medicaid" on the national
The money behind the scenes here is a combination
of money paid in state taxes
and money paid in federal
Each state has a different name of this health-care for the poor.
Neither medicare nor medicaid is free.
Both are supported by taxes paid by the people who are working.
Thus, these could be called "tax-supported health-care".
During all of the years of our working lives,
we have money deducted from each pay-check
in order to keep both of these programs operating.
And our employers have also paid specific amounts each month for each
into the various state and federal funds that support medicaid.
4. PUBLIC HOSPITALS: HEALTH-CARE
PAID BY LOCAL TAXES.
On the local level, in the United States, we have
tax-supported local health-care systems.
These are supported by another hidden tax to which most of us pay
Property taxes due on all real estate in any taxing district
are collected for roads, schools, & public health.
We would have to read deep into the details of our property-tax
to determine just how much of our money is going into health-care at
the local level.
And since most people pay their property taxes
an item included in their monthly mortgage statement—
this cost is even more hidden
than other taxes.
We generally think of these costs as just a part of owning a home.
People who get health-care at public hospitals
do not have to pay if they cannot afford to pay.
Anything not directly paid by the patient
is paid by local property taxes:
There is no free health care.
5. 2010 HEALTH-CARE REFORM.
In 2010 a new federal law was adopted in the United
which makes more shifts on the ways money will flow
from the tax-payers, wage-earners, & their employers into
Millions of additional people will be included for the first time.
But basically the means of paying for health-care will remain in the
It will still be very difficult to calculate how much money
is going for the health-care of any individual.
Because this health-care reform included few
to control costs,
the total cost of health-care for each individual is likely to climb
When enacted in 2010, this total cost per person was about $8,300.
And within a few months, the cost is likely to reach $10,000 per person.
This could amount to 20% of the economy of the United States of
Some of the provisions of the 2010 health-care
reform are likely to be changed.
And the huge increased costs to the tax-payers and employers
are likely to be a major factor in such future changes.
The illusion of free health-care will disappear as the money is
Each and every dollar spent in providing health-care
must be collected from someone, somewhere in our complicated money-flow
There is no free health-care,
only hidden ways of
collecting and paying each dollar.
As we uncover the hidden rivers of cash, we will ask:
Is this the best way to pay for our health-care?
James Park is an existential philosopher living on
All of his health-care costs are paid for by a combination of Medicare
and various state and federal programs to fill the gaps in Medicare.
He does not know how much is paid out each year for his health-care.
And he does not know the various pathways this money takes
as it makes it convoluted ways from the tax-payers
to his ultimate health-care providers.
Much more about him will be discovered on his
An Existential Philosopher's Museum, linked below.
This museum now has more than 1,100 rooms.
Some related cyber-sermons are listed here:
Nine Ways to
Reduce Health-Care Costs
Rationing of Health-Care
Million Dollar Death
3-4-2010; Revised 4-3-2010; 11-3-2010; 2-24-2011; 4-13-2011; 4-22-2012