You are going to tax my health benefits and I get what in return? Oh, yeah, I'm really going to sign on to that! Corporations will simply allow higher earners to choose another form of compensation. Sure, you may kill employer paid insurance but then where do you get your revenue? We have absolutely zero commitment to a universal system so we give up our employer paid benefits, there is no revenue, then where do we go for healthcare? What's really happening here is that we've gone clear past the center and we're begining to make Republican arguments. Get rid of all that employer paid insurance that costs corporations. Compensate high earners extremely well. Let them self-insure or give them a tax credit which will be particularly helpful to them because they have a lot of income that needs sheltering and give the midde class a coupon for the Target Minute Clinic (or they may choose Walmart if they prefer).

What we should have is a commitment to a progressive tax system that taxes income, including investment income to provide for a comprehensive safety net including truly universal healthcare. But that would require at least one progressive political party.

Should we have to pay taxes on our vacation days? Think of all the stuff we could fund with that! Maybe we could start paying taxes on the money our employer spends to heat our workplace. Put those last two babies together and we could go start another war!

OK, I know I'm being snarky, but do you really want to INCREASE taxes on the middle class when Obama expressly stated he would NOT do it? And your reasoning is that Democrats in Congress wouldn't let him tax the wealthy, which he EXPRESSLY said he WOULD do?

I am with Oleeb and Miguel, and it really is a no-brainer. Spend all health care money on health care and fund it that way. People who cannot afford insurance now would be able to, and that money would also go into the pot. Take away advertising, stockholder's profits, myriad layers of people functioning either as gatekeepers (or beggars at the door of the gatekeepers), the mountains of paper, and the current inability to get deals with providers (and more and more) --- what have you got? A system that spends health dollars on health care.

And to all those people who say the Canadian system is so bad that they all come here for health care, I ask: How many times have you had to wait extra long hours at the doctor's office because of all the Canadians who got there before you? It is a ludicrous argument. There is no excuse for not doing the right thing, and the right thing is single-payer, universal health care.

Quick question. If Gov't healthcare is all that great, why would employers keep paying for regular health plans?
They wouldn't, ergo no taxes to pay for healthcare.

Why would we be taxing workers' (at least, those making under $100,000/year) and/or small employers' benefits, rather than wealthy persons' tax deductions? I understand, too, that the administration's proposal originally suggesting removing some of those rich people's tax deductions proposed paying some of the $600+ billion start-up costs by "trimming" Medicare/Medicaid reimbursement for "unnecessary" tests etc. (bringing the "intensity" of medical care down to that of the "average" hospital/region), a proposal claimed to not harm beneficiaries. . .on the basis of the Dartmouth Health Atlas reports--which, however, are not outcome studies and thus cannot prove such harmlessness. (I have read these reports--wonder if anyone else has.) In short, this proposal would pay for expanding workers' coverage by "trimming" that (Medicare/Medicaid) provided to the old, disabled, and poor; the proposal to tax employer-paid health benefits would tax the middle- and working-class; no one seems ready to stand up to the rich and say "You've been having it good the past 30 years--now pay your share, which is very big." We need single-payer healthcare and a seriously progressive tax system again, and if this requires considerably more "revolution" than the Obama/Clinton administration can do, then let's move on with it.

We won't gave a single-payer health system because the insurance companies and all the others who have inserted themselves into the "market" to make money won't allow it. I put quotation marks around market for a reason. Health care is no "market" in the Economics 101 sense of the word. Sick people have no choice whether or not to buy medical treatment. It's not like choosing between a Ford and a bicycle. What we have is a form of legal extortion. The more you need health care, that is, if it is life threatening, the more it costs. The more you need medicine, the more it costs. If you have a regular headache, take aspirin. If you have a migraine sumatriptan costs ten bucks a tab. This accounts for the crazed prices of pills for heart problem and people who are HIV positive. So it's not that single payer won't work, it's that the extortionists don't want to give up their racket.

Single payer system is as mythical as the Unicorn. The entrenched interest in the multiplayer system will fight tooth and nail to keep it from happening.

Insurance companies are a parasite on the American health system. Doctors hate them for the excessive hassle to treat their patients. Hospital and service providers tolerate them because they payout marginally higher reimbursements compared to medicare and certainly better than medicaid.

I am certainly no fan of the current system but I also distrust the government when it comes to single payer. Monopolies have never been in the best interest of the country. They can stifle innovation and development of new therapies.

The purpose of a single payer system is to control cost and growth. It will pursue this goal in bureaucratic fashion with no regard for changes as they become necessary.

I expect though that in the end it would be better than the present system. We would trade one set of headaches for another. Its just that there will be aspirin for everyone, but no head MRI's unless you meet the prespecified criteria as set forth in the only "CMS approved" therapeutics guideline book, even if your Doctor suspects something beyond what is not listed in the regulatory manual.

The study will be done anyway but the hospital will not get reimbursed. This obviously cuts into the hospital's sole profit margin and source of income. They will follow this back to the doctor that ordered the study and it will be noted on their hospital physician profile. This information will be used to calculate a productivity score for that physician. Any doctors beyond the designated standard deviation will be assessed and invited to obtain employment elsewhere.

The next doctor will think twice about confirming the diagnosis. Eventually someone will get misdiagnosed and possibly hurt.

Again, one set of problems for another.

By and by, I do not have a solution either, but I am certainly taking more notice of this than ever before...

Re: Every single other developed country has what you term as a "unicorn."

This is not true. Single-payer systems are rare (though the fact that we have one such next door in Canada makes it seem as if they are common). Most countries have a mixed public-private system, but one in which the private part is regulated to a fare-thee-well, becoming in effect a public (but not government-owned) utility. That's probably where this will go, and it does work well (e.g, France, Germany), but the problem will be to get there.

Democrats don't have spines.
They have donors.

Of course I agree with all the commenters that a single payer system is what we need. What I don't understand is why the money for it is an issue. How much have we spent over the past what, seven or eight years?, on the wars in Iraq and Afghanistan? Were taxes raised to pay for these wars? Not at all. Where did the money come from? From debt, I assume. If we could incur zillions of dollars of debt for unnecessary and immoral wars, why can't we incur billions of dollars of debt to ensure proper single payer health care for all Americans? Or proper private insurer health care for that matter? Are the wars in Iraq and Afghanistan really more important than health care for Americans? Do they really provide more benefit to Americans? If Obama wants health care for all now and thinks he can't afford it without more money, stop tomorrow every penny on the wars and put that money into health care, where it will do some good. The hypocrisy of saying we can't afford health care when we don't even think twice about the cost of war would be astounding if it weren't so normal. To move the ball along, require Congress, the Supremes, and all political appointees and elected officials of the Executive Branch to find and pay for their own health care in the private marketplace. How many of the folks in those groups are insurable? Believe me, we'd have single payer health care in no time if we did that.

I'm not crazy about this idea, either. It's like saying the only one sure way to get out of a bear trap is to cut off your leg.

If a universal health ultimately reins in costs, most people won't care about deductibility limitations.

The key is the inclusion of a bona fide public healthcare option.

Without it, no deal.

Send Kathleen Sebelius to the land of Finlandia composer Jean Sebelius. She could see a working healthcare system, used as a model in many countries now, of a universal health care system that 1) provides better outcomes and service, 2) allows doctors to have successful private practices, 3) costs the country as a whole about 40% less on a per capita basis, and 4) embraces biomedical innovation. The Finnish system is far from perfect, but it is practical and eminently transplantable to the US.

As someone who doesn't care much for economics, I attend to two classes of said community. I read posts like this Reich piece that wear beltway-colored glasses, and the creative 'why didn't anyone else consider that?' kind of freakonomic articles. Where I stand now, the Reich/entrenched commentary needs to take it's place in the hallway with the naysayers and lobbyists.

Speaking on funding single-payer insurance, one fiscal fact is clear and obvious. Simply put, the insurance industry thrives on duplicity. Having private corporations covering health insurance requires any potential risk to insure itself for any litigation. That said, every man, woman, child, and otherwise valuable pet or inanimate possession are subject to massively redundant coverage.

In a commonplace example, ponder a morning where you pick up a friend and go put for coffee. We'll assume the actor in the story already has employee-funded coverage, so that's one layer of insurance on our tally. Then actor gets into his car, which covers supplemetary (if not completely redundant) coverage as a minimum requirement in all state jurisdictions. When actor leaves his driveway, each vehicle he passes gives a moment's redundant coverage. Unless he hits a pole unprovoked, we're up to three blankets of coverage and he's only been awake for 45 minutes.

Heaven forbid he picks up his friend. Renter's insurance provides layer 4 of coverage while the landowner's policy offers a 5th. The drive to the coffee shop repeats the same redundant motorist coverage, until the coffee shop covers him twice more, by propietor and landlord. That's 7.

I know I'm exaggerating the case, but the task at hand is to describe that each tier of insurance is paid in fear that each insurance company is paying the raw medical bills. In a single-payer system, that's all gone. The insurance industry loses it's 'what if' liability, and the bottom falls out of the industry.

Writers like Reich and other industry insiders see this as a weakness of the model, but, in the age of skinflint teabaggers, I can't think of a better persuasive discussion. Task someone from the Freakonomics school to evaluate the benefit of one-blanket coverage and insurance companies will be eternally apologetic at worst and absolutely obsolete at best.

It has to be single payer or nothing will change in our health insurance mess we now have. I can see a scenario where a compromise is reached and some reforms implemented. The growth in costs being passed on to the consumer will be slowed for a few years and after that it will continue to eat up more and more of the American people's income and slow any growth in our economy as nations where there is universal coverage do better.

Health insurers, corporate health providers, big Pharma and trial attorneys all need to be taken on...head on...if we want any change. Too many have come to rely on the system which provides health care to us as a cash cow. So much so that is an unsustainable system.

No taxing of benefits for high income people who are provided insurance through their employer. It needs to be a universal single payer system that provides the same level of coverage for every single American regardless of their socioeconomic position. Raise taxes. Raise them on corporations and the wealthy most and don't be afraid to fight the 'Tax and spend socialists' strawmen which will inevitably be erected.

"Many in Congress and in the White House are convinced it’s the only good option."

Sure many in Congress are convinced, they don't have to live by the rules they place on us unwashed masses. What say they get taxed, contribute to SSI, have to live with Medicaid after they retire and then tell us what's good for us.

How much revenue is likely to be generated specifically by taxing the health benefits of those earning over $100K? That seems to be the key question in this policy and should be answered with at least some kind of estimate -- although the general idea sounds good.

Several other sources of money from taxation both to finance a full-throated health insurance program as well as the eco-industrialization (and fast, especially in the area of energy) that the country and the world need. (also whatever education proposals the Obama Administration plans on pursuing, which necessarily must involve spending big bucks one way or another). Of these three, I would insist that the Greenhouse Gas issue -- underestimated in its urgency not only by most Americans, including most Democratic politicians and voters, but (at least judging by the movement demands) most activists in the field as well -- is paramount.

See, on the urgency of GHGs: http://www.guardian.co.uk/commentisfree/2009/mar/17/monbiot-copenhagen-emission-cuts

At any rate, generating revenue could come from a variety of sources, all of which should be discussed together, as it is not necessary to compartmentalize revenue sources and expenditures -- taxing health care to pay for a health program, for example. The 'compartmentalization' approach can lead to attempts to gain too much (or too little) politically from a given source. Of the tax benefits to the rich that would be eliminated, how much would be in tax benefits for giving to nonprofits? Other than that, many of the other loopholes might be closable without generating a firestorm of effective opposition. (Clinton often proposed reforms that could only fail politically, as they generated more opposition than support in the political arena. I would add that when politicians REALLY want something, like corporate globalization/"free trade" they are able to overcome ALL KINDS of opposition, but not to protect the environment, etc.)

Here are a bunch of other politically feasible taxes that I have mentioned at times in the past at TPM Cafe:

The STET (Securities Transaction Exchange Tax) which apparently could have side-benefits as well as being a politically palatable revenue-generator. The same goes for similarly marginal taxes on arbitrage and derivatives, something Reich would better know how to craft (or know who knows it) in the particulars.

There's also taxing pollution, including pollution within regulated limits. I understand that a carbon tax, straight up, would be politically difficult, and failed in the 90s politically. But taxing mercury emissions and basically every other kind that people don't want being emitted near them (NIMBY pollution), and then devoting a good portion of that to the areas that suffer from these emissions, while also putting some towards health care makes good sense.

Taxing scarce resources, at least in some instances, is another eco-tax that could be politically palatable if adroitly formulated. One example I have been advocating for over 20 years is a VERY HIGH tax on redwood wood as well as on other old-growth forest wood, but especially redwood (to make it economically unfeasible to use for picnic tables, eg). This revenue could be used not only to buy up virgin forests, but to hire unemployed lumber workers to restore devasted forest and other land, in 'green employment', and provide a revenue stream (especially in CA) where desperately needed. And most redwood is exported. Similarly, the use of nonrecycled content of disposable paper, eg toilet paper, could be taxed in such a way to promote paper products made out of recycled (and where feasible, as in packaging and newspapers) readily recyclable paper. The tax should be sufficient to make paper recycling very much economically feasible. Some of these policies could be offset by particular benefits to industries, like an urgently needed bailout for the newspaper industry. (These two could be worked together nicely).

If possible, other types of activity one seeks to discourage, like the export of jobs, could not only not be subsidized but also subject to tax. And so could particular luxury items (though it was claimed that taxing yachts would cost too many jobs for working class stiffs, a classical paradigm). Again, much of it lies in the particular approach taken, and whether it is specifically designed with POLITICS first as well as economics in mind.

I would be interested in particular suggestions that people have along these lines (I have myself proposed a complicated tax-and-subsidy system for new vehicles based on their expected mileage/carbon energy-based consumption, which would subsidize many cars while heavily taxing new SUVs. This would obviously have to be delayed long enough for the auto industry to prepare for it. But there are many other such ideas

I would like some proof:

"Most middle class American families rely on it and won’t want to give it up even if a new universal system becomes available."

If given the choice of fully portable, comprehensive coverage for the wager earner and dependents? Of course, that's precisely the choice that cannot speak its name on either end of Pennsylvania Avenue.