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Comment by herge | Hacker News Reader

I wonder how much money is wasted in the US in government bureaucracy between making sure people who claim social security benefits are due social security, that medicaid claimants are not medicare claimants, that food stamps physically go out to those in need, and that the foods stamps themselves are just spent on food, etc. Probably much more than checking how many people over 18 live in each address.

Also, the whole economy benefits by simply giving out money that people can choose to spend as they wish, instead of in limited categories (like food stamps).

Finally, people who work (legally) already pay taxes and are managed by the IRS, so taking this basic income back from them in taxes wouldn't be that much overhead.

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The SSA's budget is like $12 billion to oversee over $750 billion in social security payments (1.6%). Medicaid's administrative overhead is about $16.5 billion to oversee $288 billion in payments (5.7%). See page 69 of this PDF: http://www.hhs.gov/budget/fy2014/fy-2014-budget-in-brief.pdf.

Medicare in particular is famous/notorious for low administrative overhead. Not sure how other social services perform

Yes, but that comes from it being available to everyone (of a certain age), which is the same advantage a basic income has.

Unfortunately Medicare runs headlong into the other point the comment above was making: Medicare forces you to spend a very large income grant on a very particular category of consumer good. And that effectively forces huge spending on healthcare when society would be better off if they could spend it on other things.

Healthcare is not a consumer good and people would still need it regardless of whether or not it's paid for by Medicare.

Suppose the money was spent on better nutrition, exercise, good heating/insulation for seniors, instead of on curative medical care after something goes wrong?

> better nutrition, exercise

In the states. Really.

Healthcare is absolutely a consumer good. I don't even know how to begin to try and understand your claim.

Not that health economics is my area of expertise so feel free to contradict me, but I believe the US per-capita healthcare spending on Medicare, Medicaid et al is actually higher than comparable nations with universal healthcare. The rationing, measuring and paying is really very expensive to administer.

>the US per-capita healthcare spending on Medicare, Medicaid et al is actually higher than comparable nations with universal healthcare.

This is true.

>The rationing, measuring and paying is really very expensive to administer.

This is not.

We have written legislation that prevents us from negotiating for healthcare goods and services; we protect US doctors from foreign competition and allow the profession to artificially constrain the supply. We also prevent Americans from importing drugs, or buying into other countries' health care systems - also shielding the domestic market from competition. Also, patents and reformulations.

Administration is actually a very small overhead. Rent-seeking is the problem.

Yeah, one of these is not like the others. Medicare at least acts a bit like a single-payer, and drives other efficiencies in health care. Too bad there isn't a medicare-for-all option in Obamacare.

The medicare-for-all is the end game of what's happening now. All the key architects of ACA have voiced their support for single-payer as the ultimate goal.

I've been confused for years as to why that wasn't the proposed solution. We already have medicare and medicaid in place, and they are working (how well... up for debate).

"We have 17 million uninsured americans in this country!" (or whatever the number was. Well... just expand medicaid eligibility (or even allow people to pay for medicaid coverage on their own, regardless of pre-existing conditions). Problem solved (or solved a lot more broadly than this force-everyone-to-buy-private-insurance-and-make-the-insurance-companies-change-their-underwriting-practices).

> I've been confused for years as to why that wasn't the proposed solution.

It wasn't because a political concern was to get something that could pass without beign scuttled by pushback from the industry and resistance Congressional Republicans and even from conservative Democrats that met and scuttled Clinton's reform efforts (why Clinton didn't seek a simple single-payer solution is another question), and so pretty much all the proposals from the major Democratic candidates in 2008 were variations on the mandatory/subsidized insurance purchase idea that had been being pushed by the insurance industry since, IIRC, the early 00's, and had been frequently floated in Republican circles -- including being a signature accomplish for Mitt Romney in Massachussettes.)

> Medicare at least acts a bit like a single-payer

Well, several decades ago it did, before the shift to encourage purchase of private managed care plans with government subsidies through what (after several name changes) is now called "Medicare Advantage".

Medicare now is more like the ACA model plus a public option than it is like single-payer.

Enforcement costs can easily outstrip the revenue collected.

One example might be public transit where the cost of printing tickets, tokens and passes, plus paying fare collectors and maintaining the equipment to prevent people from jumping gates is way more expensive than just letting people on for free.

This is something that shocked me when I went on the UTA Trax trains in Salt Lake: there were no tickets.

Or, to be precise, there were tickets, but they weren't enforced. No turnstiles were present anywhere in the system.

Coming from previous transit systems like MARTA and the DC METRO, this was a shocking turn of events.

Supposedly officials come around and ensure everyone has a ticket, but I never saw that happen.

The buses, on the other hand, require payment to board.

Plenty of places have turnstile-free transit systems. Berlin, Germany and Oslo, Norway come to mind.

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