Tim Worstall asks

by on March 22, 2007 at 1:13 pm in Medicine | Permalink

…is a single payer system actually any cheaper, once the deadweight costs of…taxes are taken into account?

More here, this man would warm the heart of Doug Gibbs.  I recall learning that deadweight losses from taxation are about 20 percent of revenue raised, which is just about the size of overhead costs for the private insurance industry.  Don’t ignore this sentence either:

The French system, the one that is generally rated as being number 1 globally, is neither single payer nor single provider.

Keith March 22, 2007 at 1:27 pm

Of course, the taxes and benefits of national health care together need not be distortionary, so long as the taxes’ effect on labor supply counters effect of the health care subsidies on labor supply…

For instance, the French system, like our Social Security, caps the tax rate as a miximum of salary. This regressivity may counterbalance labor supply effects of the national health care subsidy.

mickslam March 22, 2007 at 2:28 pm

Coach,

I don’t get it either. How is shifting payment from one group of parties to another going to add 20% deadweight loss? 20%? It just doesn’t make any sense.

Zubon March 22, 2007 at 3:35 pm

theCoah, mickslam:
All taxes create deadweight loss. When taxes increase, people stop doing some activities because they are no longer worthwhile. Deadweight loss is the loss to society of having forgone those productive activities. Wikipedia has a fair description of it, although the picture does not represent a tax increase.

mpowell March 22, 2007 at 4:32 pm

Mickslam, I do not think you understand deadweight loss in the sense it is being used here. What Worstall is talking about is that for every $1 you raise through taxes, you cost the society $1.20. That would be a 20% loss. Glen Raphael gives a simple example. My understanding of what determines this loss is mostly the marginal tax rate. Increasing a low marginal tax rate incurs less deadweight loss than increasing a high marginal tax rate. Certainly whether it is an extra tax to pay for health care or interstate highways does not matter. Either way, the claim is that in the US right now, the loss is 20% for the total budget. The marginal rate may be higher. So the government can certainly pay those premiums for us, but for every $1 the government spends we lose $1.20. This means that to get the same coverage if the government can’t save 20% on the premiums it pays, we lose overall in the deal.

On the side, there may be some distortion present already due to the subsidization of current insurance premiums that a commentator on Worstall’s site brings up, but I can’t speak to that.

knzn March 22, 2007 at 7:54 pm

Consider the case where both labor supply and the demand for health insurance are perfectly inelastic. In that case, the normal need for health care acts just like a tax, and if you replace that tax with a labor income tax paid to the government to support the same health care, there is no distortion. The subsidy from government provided health care exactly offsets the effect of the tax (assuming that the government provides the same health insurance package that is demanded inelastically in the absence of government coverage). In practice, neither labor supply nor the demand for health insurance are perfectly inelastic, but both are quite a bit more inelastic than your average curve. The 20% figure, I suppose, is derived from a “typical† market (widgets?) and would not be a good estimate in this case. Depending on how the tax is implemented, it could affect the demand for human capital, but I doubt this effect would be large, and it could well offset existing distortions (e.g. signaling).

mickslam March 23, 2007 at 11:07 am

thanks knzn for explaining my point so very well. In this particular case, the deadweight loss will be far less than 20%.

mickslam March 23, 2007 at 3:13 pm

Alex,

We’re not disputing the fact that there is deadweight loss with this thought experiment and that there will be a deadweight loss when this is implemented. We’re only disputing the the size of Tylers estimate. Even in your hypothetical example, the deadweight loss is not as large as it would be if there was a 100% tax and it was spent on things that you would not have purchased. In that case, the deadweight loss would be far larger than in the case you propose in your link. It’s this magnitude that is the debate, not the loss itself.

My claim: The deadweight loss from this tax will be far less than 20%.

mpowell March 23, 2007 at 5:43 pm

Mickslam and knzn, I agree that we are debating the magnitude of this loss but what Tyler and Alex have claimed, and correctly in my opinion, is that this tax will create a deadweight loss just the same as any other income tax. Alex’s post on the 100% tax highlights the problem with the flaw in knzn’s reasoning: when you shift the funding of something from the private sector to the public sector, that is precisely when you incur the deadweight cost (in that case a total loss, of course).

Looking at knzn’s example in particular, it is precisely wrong to assume that the labor supply is inelastic. Right now, we work in order to pay for our own health care. But if the government were going to tax us to pay for it, then what happens? Well, I’ll get the same health care regardless of how much I work. So I’ll work less b/c I’m getting taxed at a higher rate and I’ll still get the same health care!

We can debate the absolute inelasticity of labor supply, but there is no sense in which the response of labor to this tax would be any different than to any other tax. And any thought experiment which does not take into account this elasticity will of course miss the deadweight loss occurred by any tax. But there is a reasonable amount of evidence on the issue of labor elasticity, which is where the 20 percent comes from. Its by no means super-accurate, but it is a good ballpark number.

theCoach March 23, 2007 at 11:04 pm

I can’t read the papers, but they do not really seem to be addressing this directly – of course I have no idea what the 4 parameters are that would get us an answer from less then 10% to 300%.

Is the mechanism by which this would affect this only in disincentive to work? Because if it is, I find that to be a positive – or at least I find using the witholding of health care as a punishment for not working to be morally reprehesible in this day and age. I do not know enough to figure out the details, but I would think that work could be incentivized differently, but perhaps it forever skews the tradeoffs between work and vacation, something I would not consider bad either.

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