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Strong opinions voiced on

single-payer health

insurance system

LAS VEGAS REVIEW-JOURNAL

By JENNIFER ROBISON

If our email inbox is any indication, Las

Vegans feel strongly about starting up a

single-payer health insurance system.

After we wrote on Jan. 19 about a

Vermont lawmaker’s federal proposal to

mandate that states set up one-payer

systems that would operate like

Medicaid and guarantee coverage for

all, the feedback rolled in.

We’ve selected two letters with

opposing takes on the issue to keep the

discussion going.

Once you’ve finished reading up on the

debate, check out how a local consumer

got a pleasant surprise when he recently

 Al Popp reached out with a novel

idea. He writes: Let’s just expand

Medicaid to everyone. How do we pay

for this system? We pay for it by taxing

all food and beverages at 10 percent.

Just add it to the price of the product

before the sale, like we do with gasoline

excise taxes. If a person spends $200 a

week for food and beverages, whether it

be in a grocery store, convenience

store, restaurant or catering business,

one would be paying $20 a week for

their health care, which equates to

$1,040 a year. That, to me, is affordable

health care. The more you spend on

Well, Al, I’m a reporter, so I’m completely

flexible and I have no opinions.

In the interest of public debate, though,

your plan is definitely worth sharing.

One common criticism of this kind of

funding source is that poor Americans

spend an above-average share of their

income on groceries, so it becomes a

regressive tax that penalizes lower-

income earners more than wealthier

households. This is why Nevada’s sales

tax exempts food bought inside grocery

stores.

So although you’re correct that people

would pay less if they spent less, a plan

Plus, low-income households already

face higher food costs because their

neighborhoods might have fewer

supermarkets and pricier food as a

result.

As you note, Al, your idea does have

upsides. No one would be mandated to

use Medicaid; they could still buy a

private plan for more coverage, the way

some affluent households pay both

local property taxes and private-school

tuition. International tourists who buy

pricey meals on vacation also would

feed into the system. And

undocumented residents would pay as

 On the other side, Las Vegas insurance

broker Patrick Casale chimed in on

single-payer with this: There are five

reasons single-payer can never work for

the United States: immigration; taxation;

capping doctors’ and hospitals’ earnings;

capping Big Pharma; and medical access.

Part of Patrick’s concern is that our

country already is strapped

financially, and a plan that opens free

health care access to all (Medicaid

doesn’t charge copays or premiums)

would be unsustainable given current

immigration rates. What’s more, he

said, countries with one payer “have a tax

rate that exceeds 50 percent, and

Making a single-payer system work

also might require limiting hospital

charges and incomes, and that

would in turn hurt access as

providers perform fewer procedures

to control costs, Patrick said. And

tangling with the major

pharmaceutical companies on what

they charge would be a Herculean

task in what he called “the most

overdrugged nation worldwide.”

Patrick said he also would like to

see the federal government

eliminate fraud in Medicare and

Medicaid before the programs

 Steve Selbrede wrote in with praise

for a little-known provision of

Obamacare: There have been many

recent stories and letters about the

absurdly high deductibles of

Obamacare insurance plans. When I

first began to investigate the Nevada

Health Link website to choose my own

plan, I was distressed to see very high

deductibles. After about 30 hours of

studying my options, I found that these

deductibles are not always so high.

Steve discovered Cost Sharing

Reduction, a little-known discount in

the Affordable Care Act that lowers

You do need to meet a few guidelines

to benefit. For starters, you have to buy

your plan through Nevada Health Link,

the state exchange’s website. Plus, the

discount is good only on silver plans,

the federal law’s benchmark coverage.

And you have to make less than 250

percent of the federal poverty level.

That’s $59,625 for a family of four, or

$29,175 for a single.

Steve qualified, and after he chose

Nevada Health CO-OP’s Southern Star

Silver Plan, here’s what he found: His

calendar-year deductible dropped from

$4,250 to $750, while his out-of-pocket

You do need to complete the sign-up

process at nevadahealthlink.com to

determine whether you’ll get the

break. So Steve offered some tips on

how to make it through, if you have

issues with the site.

First, forget about browsing for a plan

without creating an account, because

you won’t get a full reckoning of the

cost unless you put in your details.

Start an account at the site with a user

name and a password, or you won’t

be able to get back into your account.

Do not provide your e-mail address,

or you might not be able to return to

your account. Make sure you know