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Illustration: Rebecca Zisser/Axios

People focus on the health costs that are most tangible and sometimes outrageous to them: their deductibles, and drug costs, and surprise medical bills, and the annual increase in the share of the premium they pay. But there's more that gets less attention because it's not as visible to them.

Why it matters: To really understand how Medicare for All or any other big change in health care financing would affect them, people need to understand how they would impact their overall family health budgets. Few people think about the other health costs they pay: their taxes to support health care, or what their employers are paying towards premiums (which is depressing their wages).

Between the lines: Consider this hypothetical example of a total family health “budget”:

  • The Browns, a family of four with at least one member in poor health and a $50,000 income, have standard employer coverage much like 156 million other Americans. They spend $9,250 per year (19% of their income) on health.
  • This includes $3,950 (8% of their income) in out-of-pocket health spending, $3,900 (8% of their income) in health insurance premiums, and, although they are almost certainly not aware of it, approximately $1,400 (3% of their income) in state and federal taxes that fund health programs.
  • The Browns are not taxed on the contributions their employer makes toward health insurance premiums, which economists generally say offset wages. Their employer is contributing an additional $13,050 to their health insurance premiums, as well as $750 in Medicare payroll taxes.
  • When combined, the Brown’s spending on health care and the money spent by their employer on their behalf totals a considerable $23,050. And remember, they make $50,000.

A few ideas that could help people learn more about their health total care spending and how reform proposals might affect their health spending:  

  • The IRS and states could include a simple pie chart on everyone’s tax forms, showing taxpayers where their tax dollars go today.
  • Along with estimating the impact of health reform legislation on the federal budget, or the number of uninsured, the CBO could estimate its impact on typical family budgets, taking into account all of the forms of health spending families have today. Organizations like ours could do this as well.

What to watch: This could be particularly important when analyzing Medicare for All proposals, since they would so significantly alter the financing of health care by shifting it from premiums and out-of-pocket costs to taxes.

  • A Medicare for All plan would likely reduce what the nation spends on health care by lowering payment rates to providers and creating administrative efficiencies. The average family would likely pay less, but how much is hard to say without more details.
  • However, by changing the financing so significantly, there would likely be both winners and losers. Low-income people and sick people might pay less, and higher-income people and those who are healthy could pay more.

The bottom line: We can only get a clear picture of how family finances would be affected by Medicare for All, or any other significant overhaul of the health care system, by looking at the totality of what they pay now.

Go deeper

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Global press freedom deteriorates amid pandemic

Data: Reporters Without Borders; Chart: Axios Visuals

Journalism is seriously restricted in 132 of 180 countries included in Reporters without Borders' annual Press Freedom Index — a particularly dangerous state of affairs during the pandemic.

Breaking it down: Nordic countries are ranked high on the list for having "good" press freedoms, while China, Turkmenistan, North Korea and Eritrea are at the bottom. The U.S. is ranked 44th.

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40 mins ago - Economy & Business

How anti-greed backlash killed the European Super League

Photo: David Cliff/Anadolu Agency via Getty Images

The 48-hour rise and fall of the European Super League is the perfect encapsulation of how anti-greed sentiment has changed the rules of capitalism.

Why it matters: The highly-complex structures of capitalism are built from the mostly base motivations of individuals chasing money. That's been condemned and celebrated in equal measure — but has also largely been accepted.

Senate Republicans unveil $568 billion infrastructure counterproposal

Sens. John Barasso and Shelley Moore Capito. Photo: Caroline Brehman/CQ Roll Call/Bloomberg via Getty Images

Senate Republicans formally rolled out the framework for their $568 billion counterproposal to President Biden's $2.5 trillion infrastructure plan on Thursday.

Why it matters: The package is far narrower than anything congressional Democrats or the White House would agree to, but it serves as a marker for what Republicans want out of a potential bipartisan deal.