The Money Mustache Community
General Discussion => Welcome and General Discussion => Topic started by: dude on June 25, 2015, 09:33:11 AM
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http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf
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I'm so, so happy about this!
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Great! My mom can move out of California now. She was staying in because Ca had an plan to go back to if ACA failed. Now she can move to a cheaper area.
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Big, big relief.
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I'm so, so happy about this!
+1
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“The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner,” said Roberts.
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I think this deserves a 'FUCK YES!!!"
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“The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner,” said Roberts.
"Words no longer have meaning if an Exchange that is not established by a State is 'established by the State.' It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words 'established by the State,'” Scalia said.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
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I am personally against Obamacare but with that said if it is still around when i hit the RE button I will take advantage of the credits since when i RE I will make sure my income needs to be where it has to be to qualify.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
Seriously, are you new?
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Scalia's dissent is pretty hilarious.
I honestly wonder if he has some dementia going on.
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I am personally against Obamacare but with that said if it is still around when i hit the RE button I will take advantage of the credits since when i RE I will make sure my income needs to be where it has to be to qualify.
What would you like instead?
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
Seriously, are you new?
Yes, I actually am quite new to the US. In my lifetime, I have lived in four other countries besides the US, but this is the first time I've been truly befuddled by the local medical system.
All I've gathered in my short time here is that it's pretty messed up - insanely high medical bills, way too many "medical professionals" that at the end of the day do nothing, and a system that heavily favours the medical institutions.
What am I missing?
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Scalia's dissent is pretty hilarious.
I honestly wonder if he has some dementia going on.
Yep, you have to be a few bulbs short of a strand to want to literally rule on the law as it was worded rather than assume the congress really meant to word it another way...
SCOTUSCare - that's a great name!
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
Seriously, are you new?
Yes, I actually am quite new to the US. In my lifetime, I have lived in four other countries besides the US, but this is the first time I've been truly befuddled by the local medical system.
All I've gathered in my short time here is that it's pretty messed up - insanely high medical bills, way too many "medical professionals" that at the end of the day do nothing, and a system that heavily favours the medical institutions.
What am I missing?
That pretty much sums it up. And prior to Obamacare, you also had the ridiculous situation where certain people (like those with pre-existing conditions) couldn't even get insurance, while those who earned too much to qualify for state-funded care, but too little to pay for their own insurance were just shit out of luck. So while we haven't addressed the issues that you brought up, at least the situation has improved in recent years.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
Seriously, are you new?
Yes, I actually am quite new to the US. In my lifetime, I have lived in four other countries besides the US, but this is the first time I've been truly befuddled by the local medical system.
<snip>
What am I missing?
Two sides to the ACA - On the one side, insurance companies can no longer refuse to insure you, and are required to cover certain services.
On the other, you're required to have insurance. To make that insurance "affordable", there are federal subsidies available, depending on your income and the number of people in your family.
So those who object seem to either not want to be required to have insurance (or be required to have insurance that covers services they don't want), or not want others to have a subsidy.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
Seriously, are you new?
Yes, I actually am quite new to the US. In my lifetime, I have lived in four other countries besides the US, but this is the first time I've been truly befuddled by the local medical system.
All I've gathered in my short time here is that it's pretty messed up - insanely high medical bills, way too many "medical professionals" that at the end of the day do nothing, and a system that heavily favours the medical institutions.
What am I missing?
Okay, I will try to summarize as best as I can in the limited time I have, and I may get some details wrong, so others can correct anything I get woefully incorrect. In the US, our system of health care is different than in most of the rest of the world. Basically, there are two big ways of getting health care:
a) you have an insurance company that pays for your medical stuff
b) you are on some kind of government-provided health care--Medicaid for poorer people, Medicare for older people (65+), and Veteran's Administration for vets
Before the Affordable Care Act legislation, the main way that people got insurance plans was via their employer. Most employers only offered insurance plans to full time workers. If you couldn't get coverage via an employer (because you didn't have a full time job), you had to buy coverage for yourself. Insurance rates were individualized, meaning if you had a pre-existing health condition before you applied for insurance coverage, you could be charged more for coverage, or flat out denied coverage totally. The majority of bankruptcies in the US are filed due to medical bills.
After some provisions of the ACA began to go into effect, coverage options changed. Children under the age of 26 can stay on their parents' insurance plans without needing to be full-time students. You can no longer be denied coverage or charged more for an insurance plan if you have a pre-existing condition. Employers over a minimum size (certain number of employees) have to offer coverage to employees working 30 hours a week. There are no longer lifetime limits on medical care with insurance plans (some plans used to cap lifetime coverage at varying levels, like $1 million, but if you had cancer treatment or other expensive care, you'd easily hit this--some premature babies reach this in their first years of life). Insurance plans have to cover minimum levels of things; extremely high deductible plans are outlawed. Insurance plans have to display their information in a specific format to make comparison shopping for plans easier.
Federal law now requires everyone to have insurance coverage. If your income is low and you can't afford it, you can qualify for subsidies (tax credits) to help pay for insurance coverage. This what the Supreme Court reviewed--there was a language issue in the bill that stated tax credits were only available to those who signed up via state insurance exchanges. Except that some states opted not to create state exchanges, and therefore people had to sign up for coverage via the federal insurance exchange. The argument was that these people (about 6.5 million) should not qualify for subsidies because they didn't sign up via a state exchange--except that their state did not create an exchange.
There's more, but this is a brief summary of some of the changes since the ACA.
I'd also recommend these two videos:
https://www.youtube.com/watch?v=qSjGouBmo0M
https://www.youtube.com/watch?v=ql9RVy6FWkg
I, for one, am very glad the ACA went into effect. It's helped me and my family immensely. I have coverage through my state exchange, and my husband will also soon be getting covered via the exchange, as well. My sister and husband both have chronic conditions that are very expensive to manage.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
I'll sum it up for you in 10 words:
"If you like your doctor, you can keep your doctor"
Oh wait...
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I think this deserves a 'FUCK YES!!!"
Close enough?
(http://i0.kym-cdn.com/photos/images/original/000/064/287/1210012807496vq8.jpg)
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(http://agileimpact.org/wp-content/uploads/2014/07/giphy.gif.pagespeed.ce.Q1sHtpXGSM.gif)
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
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I'm only half a fan of the legislation (I'd prefer a pure gov't healthcare OR pure capitalist system rather than this odd mishmash), but I am happy about this ruling. Sowing chaos via lawsuit as political strategy is a terrible way to do things and creating uncertainty for many people in need of medical care is just awful. I can't imagine a more heartless or cynical way to do things and while I am only sort of in favor of the law the Republican party has abjectly disgraced itself in this matter.
Perhaps this will mean we will actually get some reasonable amendments to the law proposed rather than another hundred meaningless votes, or frivolous lawsuits, to repeal it. I'm not holding my breath, though, since those strategies seem to really fire up morons.
-W
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Perhaps this will mean we will actually get some reasonable amendments to the law proposed rather than another hundred meaningless votes, or frivolous lawsuits, to repeal it. I'm not holding my breath, though
Wishful thinking, with a dash of deliberate ignorance thrown in to protect your own sanity.
They have no interest in actually fixing the law, they just want to score political points to raise money from donors so they can run for election again. The whole ACA debacle is about politics and power, not healthcare or insurance.
Republicans had enough votes to make substantive changes to obamacare, and they might have even gotten some democrats to go along with them if the changes actually made sense. But where's the political advantage in that? No, from their perspective it's better to wail about overturning the law, then cry about it when you can't. Both of those things translate into donor dollars.
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Perhaps this will mean we will actually get some reasonable amendments to the law proposed rather than another hundred meaningless votes, or frivolous lawsuits, to repeal it. I'm not holding my breath, though
Wishful thinking, with a dash of deliberate ignorance thrown in to protect your own sanity.
They have no interest in actually fixing the law, they just want to score political points to raise money from donors so they can run for election again. The whole ACA debacle is about politics and power, not healthcare or insurance.
Republicans had enough votes to make substantive changes to obamacare, and they might have even gotten some democrats to go askring with them if the changes actually made sense. But where's the political advantage in that? No, from their perspective it's better to wail about overturning the law, then cry about it when you can't. Both of those things translate into donor dollars.
+1. But the Republicans are lucky that SCOTUS ruled in favor of Obamacare. Imagine the backlash they would have faced if the court had ruled the other way, once tons of people lost their subsidies at once.
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
ACA is not socialized medical care - it's more like socialized medical insurance. One of the complaints about Obamacare on the left is that it's like a band-aid on a spurting jugular. It just requires everyone to have medical insurance, but doesn't do much (if anything) about the high medical costs in this country. I think the most it does in this regard is require insurers to use minimum 80% of costs going to medical costs rather than administrative costs.
That is my understanding, at least. I am glad it survived, but we've got a ways to go until medical care is truly affordable.
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
Not entirely. The ER was required to stabilize you, nothing else. Those without insurance did not get the treatments they needed and likely would have died sooner. For example, my grandmother had a heart attack and got a pace maker and defibrillator. A patient without insurance or the ability to pay would not have gotten those surgeries.
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Glad the legal nonsense is finally over. Now maybe we can move on and look at controlling costs.
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
ACA is not socialized medical care - it's more like socialized medical insurance. One of the complaints about Obamacare on the left is that it's like a band-aid on a spurting jugular. It just requires everyone to have medical insurance, but doesn't do much (if anything) about the high medical costs in this country. I think the most it does in this regard is require insurers to use minimum 80% of costs going to medical costs rather than administrative costs.
That is my understanding, at least. I am glad it survived, but we've got a ways to go until medical care is truly affordable.
Exactly. Quite frankly, it's sad to be so excited about a decision to preserve something that does so little. Thank God for what it does do, though. Without it, my adult stepdaughter could never hope to get medical insurance for herself (pre-existing condition that would bankrupt her if she didn't have insurance).
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
Not entirely. The ER was required to stabilize you, nothing else. Those without insurance did not get the treatments they needed and likely would have died sooner. For example, my grandmother had a heart attack and got a pace maker and defibrillator. A patient without insurance or the ability to pay would not have gotten those surgeries.
So if she did not have insurance and no financial means to cover the bills, she would essentially be left to die?
The hospital would just send her on her merry way?
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
If you didn't have health insurance, this is essentially correct. If you had purchased health insurance prior to the heart attack, bankruptcy would have been unlikely.
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
Before the ACA, insurance was pretty cheap if you were pretty healthy and basically unavailable if you had a poor health history. Now that the ACA requires insurance companies to take everybody, many of the people who already had insurance have seen their costs go up, even after the subsidies, because they're now paying for all the less healthy people to get the care they need. Many of these people are upset about that. Others, for mainly ideological reasons, prefer not to be told that they will owe tax penalties if they choose not to purchase a product from a private corporation. Other people just hate President Obama and want to see anything he supports go down in flames. I think these are three of the biggest objections to the law, but others certainly exist as well.
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So essentially, before the ACA, if I didn't work (for whatever reason), and I got sick (say heart attack), I would go to the ER, and then most likely go bankrupt from the ensuing bills.
ACA = socialized medical care?
The people that are against it are the ones that can afford insurance and don't want to pay for everybody else's I'm guessing?
Not entirely. The ER was required to stabilize you, nothing else. Those without insurance did not get the treatments they needed and likely would have died sooner. For example, my grandmother had a heart attack and got a pace maker and defibrillator. A patient without insurance or the ability to pay would not have gotten those surgeries.
So if she did not have insurance and no financial means to cover the bills, she would essentially be left to die?
The hospital would just send her on her merry way?
As soon as she was considered stable yes and she'd have to pay the ER bill and ambulance bill.
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On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
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Granny would just be back in the ER 10 times with heart problems, which would cost an order of magnitude more than just doing the pacemaker in the first place. Which the taxpayer would pay for. USA! USA!
It's confusing to me how we can have the worst of both capitalism and socialism in one stupid package with US medical care. I'm not sure I could design a more dysfunctional system if I wanted to.
-W
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Granny would just be back in the ER 10 times with heart problems, which would cost an order of magnitude more than just doing the pacemaker in the first place.
GDP for the win!
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On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
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Scalia is the perfect posterboy for the current conservative movement.
Old, white, grumpy, (and irrelevant.)
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But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
You literally just described an activist court under the guise that it was not an activist court...
(http://pphchat.com/resources/images/smileys/emoticon_headinhand.gif)
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But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
You literally just described an activist court under the guise that it was not an activist court...
(http://pphchat.com/resources/images/smileys/emoticon_headinhand.gif)
The only difference between an activist court (or judge) and one that's not is whether you agree with their decision.
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But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
You literally just described an activist court under the guise that it was not an activist court...
(http://pphchat.com/resources/images/smileys/emoticon_headinhand.gif)
The only difference between an activist court (or judge) and one that's not is whether you agree with their decision.
Courts should interpret the law, not make it. Activist courts go beyond interpretation and into lawmaking. Doesn't have anything to due with the side you are on.
Given that this was a 6/3 decision, I would lean against judicial activism in this case but I haven't read the decision.
MW
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But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
You literally just described an activist court under the guise that it was not an activist court...
(http://pphchat.com/resources/images/smileys/emoticon_headinhand.gif)
The only difference between an activist court (or judge) and one that's not is whether you agree with their decision.
Courts should interpret the law, not make it. Activist courts go beyond interpretation and into lawmaking. Doesn't have anything to due with the side you are on.
Given that this was a 6/3 decision, I would lean against judicial activism in this case but I haven't read the decision.
MW
All judges interpret the law. That's their job. All complaints about activist judges are when people don't like the ruling. All of them. That same practice is conveniently ignored when people do like the ruling. It has everything to do with what side you're on. Have you ever seen published material stating that someone is happy with the ruling but not the method to decide the ruling? If so, please present it. However, I'm pretty sure that doesn't exist, for the same reason that complaining about activist judges only happens when you lose. It's a meaningless complaint.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
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Have you ever seen published material stating that someone is happy with the ruling but not the method to decide the ruling? If so, please present it.
Depends on the definition of "published material." See highlighted parts:
On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
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But it is also SCOTUS' job to defer to the legislature as voice of the people. Only an activist court would willfully ignore the intent of the legislature to impose a literal and strained reading of the statute that would effectively unwind the entire system Congress created. God knows, Scalia would never support an activist court! [sarcasm font]
You literally just described an activist court under the guise that it was not an activist court...
(http://pphchat.com/resources/images/smileys/emoticon_headinhand.gif)
The only difference between an activist court (or judge) and one that's not is whether you agree with their decision.
Courts should interpret the law, not make it. Activist courts go beyond interpretation and into lawmaking. Doesn't have anything to due with the side you are on.
Given that this was a 6/3 decision, I would lean against judicial activism in this case but I haven't read the decision.
MW
All judges interpret the law. That's their job. All complaints about activist judges are when people don't like the ruling. All of them. That same practice is conveniently ignored when people do like the ruling. It has everything to do with what side you're on. Have you ever seen published material stating that someone is happy with the ruling but not the method to decide the ruling? If so, please present it. However, I'm pretty sure that doesn't exist, for the same reason that complaining about activist judges only happens when you lose. It's a meaningless complaint.
I'm not complaining about the ruling. I'm not sure it's the decision I would have made, but the process seems sound in this case especially given the 6/3 decision.
Judicial activism occurs with both conservative and liberal judges and it's not a "meaningless issue." There is interpreting the law and then there is stretching interpretation to follow you own beliefs. We have 3 branches of govt for a reason.
If judges would do their job, many of the privacy issues simply wouldn't exist because they would be struck down as unconstitutional. For example, the 4th amendment has been constantly eroded to where we are today. DUI checkpoints, immigration checkpoints.
MW
MW
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
Average is way too difficult to say, because some people have employers who pay for their full coverage or a portion of it, others buy their own coverage, and it depends on your age, status as smoker or non-smoker, family size (usually an option to go with single coverage or family--husband and I don't have kids, so we are on separate plans), which deductible option you select, plus cost varies by state.
And yes, deductible sounds like what you would can an excess. For example, my annual deductible is $2,750 per year. Every January 1, it starts over.
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Courts should interpret the law, not make it. Activist courts go beyond interpretation and into lawmaking.
In a common law system like ours in the U.S., courts do make the law. Every court adds to the body of common law and therefore makes law each time it renders a decision (except for certain limited exceptions of decisions that have no precedential force).
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
Well, I would say under the current system with ACA mandates, they are having to compete, but now they all have to play by the same rules. I can more easily compare my options with my state's insurance exchange, and I went with the cheapest best coverage I could get, so that company is getting my premium money vs. another company.
Also, it's impossible to compare costs when you need health care immediately--there's no calling up of four different ERs when you have a heart attack--ambulance takes you to the nearest hospital. This is another thing that I'd like to see changed, but isn't really addressed with the ACA. And, some things cost what they cost--the drug my husband is on for his chronic condition, for instance, is over $3,500 a month. Lots of factors at play here.
Edited to add: don't confuse the ACA with socialized medicine. The US has that, too--I addressed it in my earlier post. It's called Medicaid, Medicare, and VA care.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I can relate to having gone from free healthcare to having to pay. My very first visit to the doctor in the US was billed incorrectly, resulting in me having to appeal for eight months. If that weren't bad enough, I dealt with multiple parties that seemed to never know what they were doing (even spoke with a rep that could barely speak English), and my bill almost went to collections. The good news is that I finally won the appeal (after the second time) but it is such an exhausting and ridiculous process that I would never ever want to go through again. Before every single visit I make now, I ask them (doctor, dentist, optometrist, whatever) to give me an estimate in writing - I just can't take the chance anymore.
Having said that, "average" healthcare insurance varies.
For example, a friend of mine, who has a job, goes through his employer's health plan and pays $500 a month. When he visits the doctor, he has to pay a co-pay ($5-20). I believe this essentially covers any and all medical issues/visits. But he's a single healthy guy in his 20s, and this is through employer insurance.
I have heard of epipens costing $100-$300 for some people, whereas for others, it may cost $5 if their plan is good.
We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
Sorry, long rant. But to answer your question...it varies, and if you're used to free healthcare, none of the prices here are reasonable.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
It seems to be a community of those who want to maximize their assets, minimize their tax bite and then maximize the social contract with the government. Utopia!
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
Unregulated private health care isn't allowed to happen because it would require allowing people to die if they can't afford care. The only allowable choices are good regulation (i.e., socialism) or corrupt/ineffective/subverted regulation (i.e., what we actually have).
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Judicial activism occurs with both conservative and liberal judges and it's not a "meaningless issue." There is interpreting the law and then there is stretching interpretation to follow you own beliefs. We have 3 branches of govt for a reason.
I don't think that imaginary line between interpretation and stretching exists. Not without some sort of mind reading device. I guess we'll have to agree to disagree.
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Something is fundamentally broken if we have to hope that the supreme court wont screw over millions of people by screwing up their health care options. As a small business owner married to another small business owner, we depended on the rules put in place by the ACA just to have the option of health care coverage. I'm so thankful that reason and common sense prevailed. Now I hope they can see the same way when it comes to allowing marriage for everyone.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
Well, I would say under the current system with ACA mandates, they are having to compete, but now they all have to play by the same rules. I can more easily compare my options with my state's insurance exchange, and I went with the cheapest best coverage I could get, so that company is getting my premium money vs. another company.
Also, it's impossible to compare costs when you need health care immediately--there's no calling up of four different ERs when you have a heart attack--ambulance takes you to the nearest hospital. This is another thing that I'd like to see changed, but isn't really addressed with the ACA. And, some things cost what they cost--the drug my husband is on for his chronic condition, for instance, is over $3,500 a month. Lots of factors at play here.
Edited to add: don't confuse the ACA with socialized medicine. The US has that, too--I addressed it in my earlier post. It's called Medicaid, Medicare, and VA care.
i'll grant that obamacare isn't true socialized medicine, in that the govt runs everything(currently); but its going to be a system of greater control of the govt over you; that's never a good thing.
there's going to be cases where some medicines and procedures are held in check on rising costs but that's going to be few or healthcare corporations wouldn't be favoring obamacare so much.
just give it some time.
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Judicial activism occurs with both conservative and liberal judges and it's not a "meaningless issue." There is interpreting the law and then there is stretching interpretation to follow you own beliefs. We have 3 branches of govt for a reason.
I don't think that imaginary line between interpretation and stretching exists. Not without some sort of mind reading device. I guess we'll have to agree to disagree.
We can agree to disagree, but putting public good (DUI checkpoints for example) above the constitution is the definition of judicial activism in my opinion. I don't think the line was "imaginary" there. Certain justices didn't like the result, so they ignored the constitution and allowed arbitrary stops.
We continue to go that direction because a judge felt compelled to over reach. Now we are faced with huge privacy issue in our country.
MW
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"its going to be a system of greater control of the govt over you; that's never a good thing."
What evidence do you have for this grand statement? This appears to be an article of faith on your part.
"there's going to be cases where some medicines and procedures are held in check on rising costs but that's going to be few or healthcare corporations wouldn't be favoring obamacare so much."
Not sure what you are trying to expresss here, but rationing of care far predated the ACA. At least now when you are insured the insurance company is required to actually insure you to minimum sstandards. Oh and there is also the small side benefit of a 35% drop in the uninsured rate since obamacares inception.
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"its going to be a system of greater control of the govt over you; that's never a good thing."
What evidence do you have for this grand statement? This appears to be an article of faith on your part.
"there's going to be cases where some medicines and procedures are held in check on rising costs but that's going to be few or healthcare corporations wouldn't be favoring obamacare so much."
Not sure what you are trying to expresss here, but rationing of care far predated the ACA. At least now when you are insured the insurance company is required to actually insure you to minimum sstandards. Oh and there is also the small side benefit of a 35% drop in the uninsured rate since obamacares inception.
Careful using your fancy facts and statistics. We prefer fear-mongering and "slippery slope" analogies around these parts.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I completely agree, but the bottom line is that the voting public will no way, no how go for a repeal of EMTALA (or of Medicare) - and without getting rid of those, you can't set up such a system. Given the realities, it would arguably be better to go full socialized rather than the half-and-half mess we have now.
I would love to see some libertarians/conservatives in the congress stand up and call for EMTALA to be repealed. They'd be out of office in a heartbeat, because nobody likes dead babies or old folks. If there's someone dying at the doors of the hospital (or in the middle of the wilderness, and a chopper can get there), pretty much everyone ends up saying, "we should save that person."
That means you probably have to just give away the health care, but you should do it in the smartest possible way. The ACA is probably not that way but it's very incrementally smarter than what it replaced.
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Something is fundamentally broken if we have to hope that the supreme court wont screw over millions of people by screwing up their health care options.
The Supreme Court can't ever screw anyone over. Only Congress can screw people over; the Supreme Court can only hold Congress accountable for it.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine.
*blink*
Which country are you talking about?
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There has been some discussion on how Obamacare does not deal with limiting the cost of healthcare in the US. Ideally it would in these two ways:
- Newly insured persons would visit their doctors and receive more preventative care. This should lower costs for everyone due to fewer (expensive) ER visits and emergency procedures.
- Now that (mostly) everyone is properly insured, private insurance companies have the clout to battle with healthcare providers over cost. You can see this happening as some blockbuster drugs (i.e. Sovaldi) are not being covered under insurance due to cost. My employer subsidized insurer also provides a web portal to help direct us to lower cost hospitals and doctors. Although we individual users often cannot comparison shop, hopefully our insurance providers are doing it for us.
Obviously this is a capitalist system so we are going to see an arms race between insurers and hospitals/provider groups over who holds the power in setting prices. In many smaller towns a hospital chain may operate ALL of the hospitals in a large geographic area. Guess who is going to have the upper-hand in determining the negotiated rates for a hospital stay?
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Elevating "Legislative Intent" over "Plain Language" statutory interpretation leads to sloppy future rulings & general unpredictability in statutory interpretation.
Like its earlier pro-ACA ruling (built on a similarly shaky legal premise), I expect we will see this court quickly back away from the rationale that it used to settle this controversy.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
When I aged out of my mother's plan, I could get no insurance for ANY amount of money except for COBRA. And the reason I was denied was a locked up traps. I could not even find a insurance company that would exclude that and cover me. If not for COBRA, I would not have had health insurance. And my mother retired because ACA, she would never have been able to retire early without it, but because of being worried it would be removed by the Supreme Court she stayed in California on COBRA and then CAL-COBRA so that if it was canceled she could go on the uninsurable plan the state had put together. Now she can move out of California into a low tax area and/or lower COLA which will allow her to stretch her money farther.
The increases in health insurance premiums have increase less once the ACA was passed, than before because of the 80% cap. I am so grateful for the ACA because now, I don't have to worry about not having insurance. It means we took the HSA plan which costs us less but when you COBRA it, it is higher than their other plan. The ACA gives many people health care they otherwise would not get and that means it saving lives. Oh, and I have more plans I have access to now than I did before, not less.
And btw, the per-curser to ACA was RomneyCare not Medicaid.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
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but its going to be a system of greater control of the govt over you; that's never a good thing.
Newsflash: that is the way everything in the US has been going for years. In no way is this restricted to healthcare.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
Does this cover preventive services (immunizations for kids, yearly physical, etc.)?
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
*snip*
And btw, the per-curser to ACA was RomneyCare not Medicaid.
Indeed. And it's worth pointing out that the main concepts of RomneyCare (and later Obamacare), such as the individual mandate and exchanges, were developed in Conservative think tanks in the early 90s.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
Does this cover preventive services (immunizations for kids, yearly physical, etc.)?
Yes, most real insurance plans (I.e. not rip off plans) covered preventative care before, and they are all required to cover it now under the ACA.
For comparison purposes, FEHB insures federal employees and all of their pricing information is available online. $600 biweekly ($1300/month) is about average for good family coverage with no deductible, but the employer pays most of that and the cost to employees is more like $320/month.
This is why it was so important to have employer sponsored health insurance prior to the ACA. Costs were outrageous to buy it on your own. Lots of people who would have preferred to quit their corporate jobs and start their own businesses were unable to do so because of the high costs of private health insurance.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
Does this cover preventive services (immunizations for kids, yearly physical, etc.)?
Yearly physical and kid shots are covered free of charge. If you need literally anything else, get out your wallet.
I should mention that we are paying up for skinny coverage because this is a high income year. Last year we were heavily subsidized with a premium under $100/month and a deductible of $200/year. The loss of subsidy on making more is effectively a new edition to the tax code that penalizes you for making money. The marginal tax rate at some income points (up to 400% FPL) is extremely steep now.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
Does this cover preventive services (immunizations for kids, yearly physical, etc.)?
Yearly physical and kid shots are covered free of charge. If you need literally anything else, get out your wallet.
I should mention that we are paying up for skinny coverage because this is a high income year. Last year we were heavily subsidized with a premium under $100/month and a deductible of $200/year. The loss of subsidy on making more is effectively a new edition to the tax code that penalizes you for making money. The marginal tax rate at some income points (up to 400% FPL) is extremely steep now.
If this is a nongrandfathered private plan, then there are actually over 100 preventive services that are covered. A lot of those are probably not recommended for your family (like you might be too young for colorectal cancer screening). But for kids, the list is really long.
www.cdc.gov/prevention for personalized lists and more info.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
Does this cover preventive services (immunizations for kids, yearly physical, etc.)?
Yearly physical and kid shots are covered free of charge. If you need literally anything else, get out your wallet.
I should mention that we are paying up for skinny coverage because this is a high income year. Last year we were heavily subsidized with a premium under $100/month and a deductible of $200/year. The loss of subsidy on making more is effectively a new edition to the tax code that penalizes you for making money. The marginal tax rate at some income points (up to 400% FPL) is extremely steep now.
If this is a nongrandfathered private plan, then there are actually over 100 preventive services that are covered. A lot of those are probably not recommended for your family (like you might be too young for colorectal cancer screening). But for kids, the list is really long.
www.cdc.gov/prevention for personalized lists and more info.
It is an exchange policy. Practically speaking, any other healthcare we would use besides a physical and shots would run us hundreds to thousands of dollars in out of pocket costs. It is what it is.
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So much depends on the plan you pick. We looked at the 3 dozen offered to us, and picked one that our doctors participate in and that has a reasonable copays for visits and Rx. If we need big stuff (hospital or imaging) we do have a hefty deductible. For the usual stuff, though, it's great.
Two adults, mid 50's, $1150/month before any subsidies. This year anyway. Next year, it'll go up, I'm told.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
Good question.
See http://www.supremecourt.gov/opinions/14pdf/14-114_qol1.pdf for the full opinion, but the short answer to your question is "no."
Excerpt from that opinion (highlight added):
"Second, we must determine whether a Federal Exchange is “established by the State” for purposes of Section 36B. At the outset, it might seem that a Federal Exchange cannot fulfill this requirement. After all, the Act defines “State” to mean “each of the 50 States and the District of Columbia”—a definition that does not include the Federal Government."
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
A lot of the research and discovery that results in drugs is actually paid for by the government and is conducted at universities by faculty, staff, and students. The pharmaceutical companies often come in later and do the rest of the work, like the testing and clinical trials and bringing the drug to market. Pharma spends more money on advertising than on actual research. And much of that research is just to create a "me too" drug that copies what another company's drug does. Viagra comes out, so another firm rushes to create another drug that does the same thing.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
My question of what is in it was rhetorical.
Regardless of the amount of research and development, I'm pretty sure the prices are hyperinflated. I have less issues with companies making huge profits off consumable goods (i.e. Apple products), but this is medicine we're talking about.
What if my insurance company didn't cover any portion of the ointment?
Epipens for $300? This is an extra $300-$900 mandatory expense every year that some people have to pony up.
Might as well start billing people for ER before rolling them into the OR: "Sir, you'll have to pay before I can use the defibrillator on you."
Nobody should ever have to consciously choose to accept or reject basic treatment.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
u
We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing anBd testing it.
No, in the U.S., the term state means one of the 50 states that make up the United States. The Supreme Court wasn't debating the meaning of the word state in that context but rather if the placement of the phrase meant that people in states without a healthcare exchange could get subsidies. It seems like such a small thing to debate over but really our Supreme Court is in place for precisely that sort of finetoothed comb analysis of our laws.
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I was bought a lot of expensive meals as a cardiac fellow by drug/device companies. The opportunities still abound, but are frankly not worth it. But a lot of money is "invested' to influence docs to use specific non generic drugs for non evidence based reasons.
If you want the "freedom" to pay for such practices and in so doing to pay more than twice as much for health care as the citizens of any other developed nation (and for worse outcomes) than you should root for repeal of the ACA.
You should also root against medicare being given the opportunity to competitively bid for drug prices.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
In my part of California, the cheapest Obamacare plan is about $225/mo with no subsidies. That plan starts paying when your health costs reach $5000 for the year and covers everything once your costs exceed $6350.
Sound flawed? This is 100x better than the previous status quo.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
The entire case was contrived by opponents of the law that want to see it removed at any cost. Their entire motivation was to get rid of the law and they didn't care how. They had lots of conferences and organizations working to find a way--any way--that the law could be struck down through the courts. They even manufactured plaintiffs (i.e. the people theoretically suing) by finding people who either weren't really harmed or didn't even seem to realize they were part of a lawsuit.
So is that bad?
I don't know. Our judicial system isn't setup to see "what's the most efficient use of people's time?" or "which party is the most ethical?" or "are these lawsuits filed in good faith?".
It's setup to ask "which side does the law agree with?"
So it could be that people would be harmed by the law but not have the resources to do all of this litigating, and these brave and true warriors are fighting the good fight for it all. But "justice is blind" (theoretically) so it doesn't matter what the facts outside the courtroom are.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
When I aged out of my mother's plan, I could get no insurance for ANY amount of money except for COBRA. And the reason I was denied was a locked up traps. I could not even find a insurance company that would exclude that and cover me. If not for COBRA, I would not have had health insurance. And my mother retired because ACA, she would never have been able to retire early without it, but because of being worried it would be removed by the Supreme Court she stayed in California on COBRA and then CAL-COBRA so that if it was canceled she could go on the uninsurable plan the state had put together. Now she can move out of California into a low tax area and/or lower COLA which will allow her to stretch her money farther.
The increases in health insurance premiums have increase less once the ACA was passed, than before because of the 80% cap. I am so grateful for the ACA because now, I don't have to worry about not having insurance. It means we took the HSA plan which costs us less but when you COBRA it, it is higher than their other plan. The ACA gives many people health care they otherwise would not get and that means it saving lives. Oh, and I have more plans I have access to now than I did before, not less.
And btw, the per-curser to ACA was RomneyCare not Medicaid.
I have pretty good insurance. I also had really good medical care when I was in the Navy. So, you know, government.
Right now I have dual coverage by my work and my husband's work. I have found that over the last 10 years, my insurance costs (deductibles and premiums) have only gone up and up. Mostly the first 7 of those years. They haven't changed recently. My husband's insurance costs went DOWN when the ACA took effect because of the max overhead.
But let me move on, to my friend John, who moved to CA from the East Coast, and could not get insurance from Blue Cross, because of a pre-existing condition. Note: he had Blue Cross insurance in MD, and he was just asking to transfer it to a CA plan. But now he was not insurable. Then there is his wife Kathy. Who covered the insurance for both of them through work (he does not get insurance at work). Except she got laid off, and it took 2.5 years to get a new job. Well, with a mortgage payment, can you REALLY afford COBRA for 2.5 years? Um, no. ACA saved their bacon, literally.
And this is just one example. I know too many people who were unable to get coverage because of pre-existing conditions after working and having insurance for THIRTY YEARS. So then in their 50's they should go bankrupt from cancer? No.
I consider providing some level of medical insurance or medical care at a reasonable cost to be 'civilized'. I don't think the ACA is perfect, but you have to start somewhere. I also am not a fan of the system where my friend's brother DIED because he didn't have insurance and couldn't afford it.
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Thankyou to all of those that answered my query about average cost of Insurance. I was only a little
appalled gobsmacked as i frequent forums like this so had an idea it wasn't cheap.
I was fucking appalled more surprised by the level of the deductibles to be honest. Given that many non mustachians don't seem to have two pennies to rub together how do they pay these? CC, finance? If you don't pay do you get chased by the healthcare provider or your insurance company?
As someone who is Early retired due to a life changing medical condition i can only thank my lucky stars that i wasn't in the US, as i guess i'd still be early retired but possibly homeless and living on fresh air.
(oh and just triple shocked by the medicine prices!! I'm guessing these aren't covered by insurance unless you have the absolute gold plated insurance policy? What happens if you can't pay them. I'm on a ton of medication, i'm guessing i'd be dead?)
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On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
You have 3 hands and you can still get insurance?
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if you do not have the money then state(s) insure it. most of the states I know have (had?) their own insurance programs for least privileged, plus federal government would pay for your medicine if it comes to it. if you happen to have nothing at all and no insurance whatsoever , they will still treat you. so a lot of this 'dying on the doorsteps' BS is just that - BS.
I came from the system that was 'free' (Soviet Union). I also have family and friends in Europe and Israel and would have hard time arguing that is free in any form (you just pay for it in taxes up front vs per need).
As for ACA - I am glad that we now have options we did not have before. I am not sure if there was a better way to pass it.. I am also not sure if we as society can pay for it without massive explosion of our debt which would come back to be paid one way or another...
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if you do not have the money then state(s) insure it. most of the states I know have (had?) their own insurance programs for least privileged, plus federal government would pay for your medicine if it comes to it. if you happen to have nothing at all and no insurance whatsoever , they will still treat you. so a lot of this 'dying on the doorsteps' BS is just that - BS.
I came from the system that was 'free' (Soviet Union). I also have family and friends in Europe and Israel and would have hard time arguing that is free in any form (you just pay for it in taxes up front vs per need).
As for ACA - I am glad that we now have options we did not have before. I am not sure if there was a better way to pass it.. I am also not sure if we as society can pay for it without massive explosion of our debt which would come back to be paid one way or another...
This criticism ignores that our pre ACA healthcare system was the most expensive in the world, and healthcare inflation has markedly slowed since its passage.
It also ignores that non partisan scoring of the ACA has fond that it will decrease the federal deficit, and thaqt repealing it would increase the deficit.
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if you do not have the money then state(s) insure it. most of the states I know have (had?) their own insurance programs for least privileged, plus federal government would pay for your medicine if it comes to it. if you happen to have nothing at all and no insurance whatsoever , they will still treat you. so a lot of this 'dying on the doorsteps' BS is just that - BS.
"They" (I assume you mean doctors/hospitals) treat you because there is a law that specifically requires them to treat you. It is called EMTALA and was signed into law by Ronald Reagan in the 80s.
So it's not "BS", it's "socialized" healthcare at work.
-W
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...and healthcare inflation has markedly slowed since its passage.
And so has overall inflation. One can debate which is the dog and which the tail. It would be much easier to defend the quoted phrase if the attached graph showed noticeably negative values since ACA passage.
From http://www.forbes.com/sites/theapothecary/2015/03/09/has-obamacare-fixed-u-s-healthcare-inflation/:
(http://s23.postimg.org/5jzeyiuzb/screenshot_74.jpg) (http://postimg.org/image/5jzeyiuzb/)
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From a totally selfish perspective , at least a few of the authors and artists I love have been able to quit day jobs that they were holding on to for healthcare benefits and that ability to quit is a direct result of the ACA. I'm grateful for the increased art-work/opportunities for the self-employed that the ACA provided.
So....Yay for this decision!
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A self-employed friend with a preexisting condition who had to get his meds from China now is able to have health insurance through the ACA.
Also, I love that the Republican slur "Obamacare" has stuck so much, so that now people will always know which president finally was able to make a dent or two in our dysfunctional mess of a health care system.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
They mean the individual states (i.e. Alaska, Calif, etc...) not the nation as a whole. Each state is allowed autonomy to make it's own laws as long as they abide by federal laws as well as constitutional laws/rights. That's why you'll see each state will have different gun laws, marriage laws, property and tax laws, etc... What's legal in one state can be illegal in another.
Not really. Disabled people are covered by Medicaid or Medicare I believe.
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Probably someone else answered this already but basically for people who pay for their own medical insurance, the Obamacare/ACA has 3 plans - Bronze, Silver and Gold level plans.
There's also catastrophic coverage (for those under 30 or with a hardship exemption) which is cheaper than bronze usually and platinum (more expensive than gold usually). Bronze covers 60% of actuarial value, silver 70%, gold 80%, and platinum 90%.
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Eric,
I don't have a citation for you to published material but I know in the legal world Roe v. Wade is commonly cited as a case where we approve of the result but not how the court got there. I actually posted about that at one point on here if you search the archives.
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As an outsider looking in, I find it utterly mad that you lot would tie up your Supreme Court debating what the meaning of the word "state" is.
When one refers to "The State", is not one automatically referring to Government, being either state or federal level interchangeably?
They mean the individual states (i.e. Alaska, Calif, etc...) not the nation as a whole. Each state is allowed autonomy to make it's own laws as long as they abide by federal laws as well as constitutional laws/rights. That's why you'll see each state will have different gun laws, marriage laws, property and tax laws, etc... What's legal in one state can be illegal in another.
Not really. Disabled people are covered by Medicaid or Medicare I believe.
You have to be disabled (as in on social security) for 2 years before you qualify for Medicare. You need someway to protect yourself those two years.
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ACA saved their bacon, literally.
Why were they insuring their bacon?
(Hey, you did say "literally!")
On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
You have 3 hands and you can still get insurance?
Who said I only have three?
I'm an Edosian (http://en.memory-alpha.wikia.com/wiki/Edosian), you insensitive clod!
It didn't count as a pre-existing condition because I just had it grafted on.
Ah, never mind.
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And now for a more serious comment:
I was bought a lot of expensive meals as a cardiac fellow by drug/device companies. The opportunities still abound, but are frankly not worth it. But a lot of money is "invested' to influence docs to use specific non generic drugs for non evidence based reasons.
If you want the "freedom" to pay for such practices and in so doing to pay more than twice as much for health care as the citizens of any other developed nation (and for worse outcomes) than you should root for repeal of the ACA.
You should also root against medicare being given the opportunity to competitively bid for drug prices.
I'm sure the ACA was an improvement in this regard, but it wasn't nearly enough of one. Marketing of prescription medications should simply be banned entirely. (And I have my doubts whether marketing of OTC stuff should be permitted either.)
Our judicial system isn't setup to see "what's the most efficient use of people's time?" or "which party is the most ethical?" or "are these lawsuits filed in good faith?".
This in itself is almost as big a problem as the health system, too.
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On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
You have 3 hands and you can still get insurance?
Who said I only have three?
I'm an Edosian (http://en.memory-alpha.wikia.com/wiki/Edosian), you insensitive clod!
It didn't count as a pre-existing condition because I just had it grafted on.
Ah, never mind.
Zaphod? Is that you? Hmmm...I wonder if the ACA would insure 2 heads instead of one? Maybe double the premiums?
Towels cost $638 each when buying from a doctor/hospital. Guaranteed that you'd never forget yours!
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On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
You have 3 hands and you can still get insurance?
Who said I only have three?
I'm an Edosian (http://en.memory-alpha.wikia.com/wiki/Edosian), you insensitive clod!
It didn't count as a pre-existing condition because I just had it grafted on.
Ah, never mind.
Zaphod? Is that you? Hmmm...I wonder if the ACA would insure 2 heads instead of one? Maybe double the premiums?
For a hoopy frood like him, I'm sure they'd waive charges altogether =)
(off-topic we used to have a cat called Zaphod, he was an insane manx who sadly had only one head)
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This is a very big day for my future. Thank you SCOTUS!
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Thankyou to all of those that answered my query about average cost of Insurance. I was only a little appalled gobsmacked as i frequent forums like this so had an idea it wasn't cheap.
I was fucking appalled more surprised by the level of the deductibles to be honest. Given that many non mustachians don't seem to have two pennies to rub together how do they pay these? CC, finance? If you don't pay do you get chased by the healthcare provider or your insurance company?
As someone who is Early retired due to a life changing medical condition i can only thank my lucky stars that i wasn't in the US, as i guess i'd still be early retired but possibly homeless and living on fresh air.
(oh and just triple shocked by the medicine prices!! I'm guessing these aren't covered by insurance unless you have the absolute gold plated insurance policy? What happens if you can't pay them. I'm on a ton of medication, i'm guessing i'd be dead?)
Well, if you're truly poor and couldn't afford medical insurance coverage, depending on which state you lived in, you may have qualified for very reduced cost or free health coverage via Medicaid, but state vary wildly. In Minnesota, where I live, which is known for being somewhat more progressive than other states, there was an option for something called MinnesotaCare if you were denied coverage or asked to pay a higher premium due to a pre-existing condition. I will admit that I was on this coverage for a couple years because I was denied private insurance. I had quit a full-time job in another state and moved back home to Minnesota, where I got two part-time jobs with no benefits. I applied for health insurance and was denied because I have allergies and was treated for acne as a teenager. Literally, those were my pre-existing conditions. So after my denial, in the mail a couple days letter, I was offered MinnesotaCare. It was reasonably priced, and run by one of the big name insurance companies in the state (Medica). I was on it for many years until I got a full-time job.
As for medical bills, it's complicated. It's my understanding that they can't charge interest on this debt, but if you were uninsured, one trip to the ER would be pretty financially catastrophic, hence the number of bankruptcies due to medical bills. My deductible being $2,750 for a year isn't too bad, actually--I could have gone with a lower deductible, but had to pay more for my monthly premium. You weigh the options when enrollment comes. I have a spreadsheet where I compare the overall costs, adding up the premium and the deductible and seeing if I feel comfortable being on the hook for that much (or making sure I will have enough saved in case I land in the ER). For DH, with his medication being $3,500/month, he will reach his deductible in less than a month, and then the rest will be covered. This is one reason we are on separate plans, because he will easily reach a lower deductible, whereas I have few health issues and almost never reach my deductible, so it saves us money to be on separate plans.
Also, one thing that hasn't been mentioned is that there are two kinds of plans: High Deductible Health Plans (or HDHPs) and co-pay plans (I forget the official name of these plans). My parents' coverage was a co-pay plan, where every time you visited a doctor or filled a prescription, you just paid a reasonable amount--say $20 or $30. But I'm on a HDHP, so I would pay the full cost of the doctor visit (getting a bill in the mail a couple weeks after the visit) for the full cost--let's say $150. The co-pay plans tend to be a lot more expensive, for good reason. But a HDHP has advantages, too, the main one being that if you have one, you can contribute pre-tax money to a Health Savings Account (or HSA). I do this via my employer, as does my DH, and we contribute the maximum amount we can--$3,350 per person. And then I have the option of investing this money, so it can grow. We have a nice little cushion in our HSAs that will cover our deductibles--it's like an emergency fund specifically for medical stuff (and it can be used on other costs, but then taxes must be paid on it). The other advantage of HDHP is that you don't pay as much for coverage you won't use--so I could have opted for a much higher deductible, like $6,500, and paid even less per month, but I elected the $2,750 deductible because it was closest to the deductible my employer offered.
Okay, this is long. :)
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if you do not have the money then state(s) insure it. most of the states I know have (had?) their own insurance programs for least privileged, plus federal government would pay for your medicine if it comes to it. if you happen to have nothing at all and no insurance whatsoever , they will still treat you. so a lot of this 'dying on the doorsteps' BS is just that - BS.
I came from the system that was 'free' (Soviet Union). I also have family and friends in Europe and Israel and would have hard time arguing that is free in any form (you just pay for it in taxes up front vs per need).
As for ACA - I am glad that we now have options we did not have before. I am not sure if there was a better way to pass it.. I am also not sure if we as society can pay for it without massive explosion of our debt which would come back to be paid one way or another...
This criticism ignores that our pre ACA healthcare system was the most expensive in the world, and healthcare inflation has markedly slowed since its passage.
It also ignores that non partisan scoring of the ACA has fond that it will decrease the federal deficit, and thaqt repealing it would increase the deficit.
Exactly. See here (with links):
http://www.bloombergview.com/articles/2015-06-25/scotuscare-survives-again
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I generally agree with you but that would require doctors to be more proactive than they currently are. For many people with chronic medical conditions, their doctor gets them as stable as possible with what is currently available and you just wait for a new drug to come out that might work better. For those people, when the new drug comes out, their doctor doesn't usually call them up and say "hey, make an appointment, we have a new treatment option." Instead, the patient sees it on TV, makes an appointment with their doc and asks if A would be better than B. For my condition, I only see my doctor every other year so long as it remains the same and he keeps prescribing my maintenance medication in that time. That was true even when I was't in remission but was just as good as I could get. If something came out that was likely to put me fully in remission, I would want to know about it. Preferably by my doctor and not an ad but if the doc isn't going to tell me, then I do want to hear about it one way or another.
I'm a member of a national support group for my condition so maybe they could be in charge of emailing members about new meds rather than ads.
I'm generally against ads but I'm for awareness and I'm not sure how to accomplish the latter since no one wants to spend the money and time on it unless they are profiting which basically boils down to ads.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
I'll bite also. We have Federal coverage, considered by many Americans to be among the best coverage out there. It's what Congresspeople and Senators are covered by, too.
For 2 adults, our cost is $460/month, with no deductible and a 10-20$ copay per visit. This covers a large portion of cost of many visits, procedures, and drugs, but by no means all. For example, I've had both CAT scans and MRIs, and those both ran me 500-700$ after insurance payments, annual physical lab work runs about 150-200$, and some antibiotics are essentially free whereas single rounds of others cost 150$. Technically, this policy covers dental, but in practice it really doesn't...cuts about 5-10% off our dental bills. My husband just got a broken tooth capped for around 800$ after insurance paid.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I have the benefit of having a good insurance plan because I work for state government. To cover my family, I pay a net of $244/mo to cover medical, dental and vision (technically I pay $1130 and receive a credit of $886). When I visit the doctor I pay $20 up front if in network and $50 if out of network. I have to cover the first $750 of costs in my year (deductible) and then have pay 30% after that as long as its a covered activity. If its not a covered activity I would pay 100%.
Some activities are covered 100% such as well-baby checks for my kids and an annual physical.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
I'll bite also. We have Federal coverage, considered by many Americans to be among the best coverage out there. It's what Congresspeople and Senators are covered by, too.
For 2 adults, our cost is $460/month, with no deductible and a 10-20$ copay per visit. This covers a large portion of cost of many visits, procedures, and drugs, but by no means all. For example, I've had both CAT scans and MRIs, and those both ran me 500-700$ after insurance payments, annual physical lab work runs about 150-200$, and some antibiotics are essentially free whereas single rounds of others cost 150$. Technically, this policy covers dental, but in practice it really doesn't...cuts about 5-10% off our dental bills. My husband just got a broken tooth capped for around 800$ after insurance paid.
By "Federal coverage", do you mean FEHB or the Marketplace? Members of Congress and Senate buy through the Marketplace now. They no longer receive FEHB plans.
If FEHB, does "your cost" omit the portion (if any) paid by your employer? It could be as much as 75% subsidized.
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Thanks again to everyone who answered my questions, easpecially Rubybeth who gave a wonderfully detailed answer. I understand the whole thing much more now. Cheers.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
I'll bite. For family coverage of 2 adults and 2 children, we pay about $600/month for a policy where we are on the hook for the first $10,000 of costs per year. This was our least expensive realistic option.
I'll bite also. We have Federal coverage, considered by many Americans to be among the best coverage out there. It's what Congresspeople and Senators are covered by, too.
For 2 adults, our cost is $460/month, with no deductible and a 10-20$ copay per visit. This covers a large portion of cost of many visits, procedures, and drugs, but by no means all. For example, I've had both CAT scans and MRIs, and those both ran me 500-700$ after insurance payments, annual physical lab work runs about 150-200$, and some antibiotics are essentially free whereas single rounds of others cost 150$. Technically, this policy covers dental, but in practice it really doesn't...cuts about 5-10% off our dental bills. My husband just got a broken tooth capped for around 800$ after insurance paid.
By "Federal coverage", do you mean FEHB or the Marketplace? Members of Congress and Senate buy through the Marketplace now. They no longer receive FEHB plans.
If FEHB, does "your cost" omit the portion (if any) paid by your employer? It could be as much as 75% subsidized.
Oh, yes, I forgot Congress just switched off FEHB...we are on FEHB. And yes, our cost is subsidized about $970/month. So the total monthly cost for good insurance is ~$1430/month.
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The Supreme Court decided to ignore a technicality. It's like the plaintiffs were trying to say that the law should be struck down because Simon didn't Say. It was a stupid argument and the Justices were right to laugh it out of Court.
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Thanks again to everyone who answered my questions, easpecially Rubybeth who gave a wonderfully detailed answer. I understand the whole thing much more now. Cheers.
I don't think you do, because if you understood American health care we would all be able hear you banging your head against a wall.
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Thanks again to everyone who answered my questions, easpecially Rubybeth who gave a wonderfully detailed answer. I understand the whole thing much more now. Cheers.
I don't think you do, because if you understood American health care we would all be able hear you banging your head against a wall.
Gillstone, thank you for this response, you made me laugh out loud. People are staring at me now.
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I'm so thankful that reason and common sense prevailed. Now I hope they can see the same way when it comes to allowing marriage for everyone.
Two for two! The SCOTUS is on a roll.
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Thanks again to everyone who answered my questions, easpecially Rubybeth who gave a wonderfully detailed answer. I understand the whole thing much more now. Cheers.
I don't think you do, because if you understood American health care we would all be able hear you banging your head against a wall.
I thought it prudent to keep my thoughts to myself. Not my circus, not my monkeys.
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I don't need obamacare at all, but I gladly pay slightly more in taxes / insurance to make sure people don't end up dead due to perfectly treatable conditions but no coverage.
Among other things, dead people can't buy the stuff that pays my salary.
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I don't need obamacare at all, but I gladly pay slightly more in taxes / insurance to make sure people don't end up dead due to perfectly treatable conditions but no coverage.
Among other things, dead people can't buy the stuff that pays my salary.
If you want to retire before 65 and aren't mega millionaire, you probably do need the ACA eventually.
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I don't need obamacare at all, but I gladly pay slightly more in taxes / insurance to make sure people don't end up dead due to perfectly treatable conditions but no coverage.
Among other things, dead people can't buy the stuff that pays my salary.
Pinko!
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Would so much rather self-insure than be forced to buy an insurance product...
Lots of people think that way. The problem is that not all of them will successfully self insure, and so will end up being supported by the rest of us when they eventually get sick or injured. Your envisioned utopia of self reliance is really the worst kind of socialist state.
Someone else already pointed out that you can't keep EMTALA, which basically forces hospitals to treat people, if you don't also force people to pay for that care. Your ideal world of self insurance only works out if we as a society are okay with letting poor uninsured people die in hospital parking lots.
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Would so much rather self-insure than be forced to buy an insurance product... not that what we have today is really insurance anyhow in the traditional sense (protection against really bad things happening with a premium priced based on the likelihood of that happening to you so based on your own health or lack thereof).
For me, it seems like a blow against FI now that more time is required to have the funds to cover either the forced insurance or forced penalties for not buying a policy. Probably comes out to working a good full year or so just to cover that.
The benefits of health insurance far exceed the costs of it. It's far easier than you think to get a condition that you have no way of paying for the care of. And when you are uninsured, multiply that bill by literally 10, because hospitals literally just make up large numbers and call those "prices". And they won't tell you what they are before you get the service. Insurers negotiate those down to a reasonable (but still highly profitable) price because of the volume of business they control. You have no such leverage.
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I am personally against Obamacare but with that said if it is still around when i hit the RE button I will take advantage of the credits since when i RE I will make sure my income needs to be where it has to be to qualify.
What would you like instead?
I'm not Davids, but for starters I would like:
*The ability to buy high deductible insurance. I think I am capable of deciding my risk tolerance, don't need the Prez to do that for me
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others wish to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
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Would so much rather self-insure than be forced to buy an insurance product...
Lots of people think that way. The problem is that not all of them will successfully self insure, and so will end up being supported by the rest of us when they eventually get sick or injured. Your envisioned utopia of self reliance is really the worst kind of socialist state.
Someone else already pointed out that you can't keep EMTALA, which basically forces hospitals to treat people, if you don't also force people to pay for that care. Your ideal world of self insurance only works out if we as a society are okay with letting poor uninsured people die in hospital parking lots.
At some point, yes, people will need to die in hospital parking lots. Don't pay for you insurance and you are able? hmmmm. not much sympathy here.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
If you want an explanation in comic form, there is one here: http://economixcomix.com/home/obamacare./
I find that the author tends to inject a bit of editorial slant in the comics, but very well done and an informative and fun read.
..I would like:
...
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others with to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
For anyone whose interested in a personal story of someone who took that route, there is this recent story: http://www.reddit.com/r/personalfinance/comments/3azqh6/wife_has_rare_type_of_cancer_no_medical_insurance/
It looks like it worked out ok for them in the end.
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I am personally against Obamacare but with that said if it is still around when i hit the RE button I will take advantage of the credits since when i RE I will make sure my income needs to be where it has to be to qualify.
What would you like instead?
I'm not Davids, but for starters I would like:
*The ability to buy high deductible insurance. I think I am capable of deciding my risk tolerance, don't need the Prez to do that for me
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others wish to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
Define a *high* deductible. I fine a 10k family deductible to be plenty spicy.
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Even though I doubt I will ever benefit since at 61 on former employer insurance until medicare age I am happy that it passed. I would prefer a single payer system but this is better then nothing.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
No change like this will come without a fight because there are definite winners and losers. Most of the FIREs in this community plan to live on pretty modest yearly incomes to they will reap the advantages of the expanded aid. The more consumer focused healthy population just sees an increased cost, sometimes significant. Costs were already high so it is understandable that they would be unhappy.
I think we can almost all agree insurance companies for health are mostly fucking awful and have been free to fuck people over for a long time. Reasonably intelligent people can disagree on whether the ACA will make the overall system more or less stable in the future.
In the end I think most people on the left would prefer to see a more radical shift to a socialized health care like the rest of the western world. While more right leaning people would have liked to see insurance companies forced to compete at the national level to drive rates down and enhance coverage through competition.
Either way I think we have to do something for people with pre-existing conditions because we cant ask the average person to go bankrupt from medical bills because they were unlucky. I am happy the law wasn't gutted for those people. The ACA has little effect on me because Engineers are pretty much always full time and always get benefits. It would likely hurt me now if I became an independent contractor.
If politicians and the medical community can come up with a better system I would like to see them drive for that rather than waste money on frivolous law suits to gut our system and bring us back to the status quo... I am not optimistic that it will happen.
The entire concept of a medical system based on paying for treatments is broken and medical spending in general is out of control. We need to reward hospitals and practices that keep people the most healthy not those that provide the most costly treatments. There are those in the medical community that have made that last statement but I don't think anyone has clear plan of how you get from where we are to there.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
If you want an explanation in comic form, there is one here: http://economixcomix.com/home/obamacare./
I find that the author tends to inject a bit of editorial slant in the comics, but very well done and an informative and fun read.
Great, fun read; thanks for the link.
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Ok so as someone who lives in a country with free healthcare can i ask roughly how much do you pay for a average healthcare insurance?
And is a deductible what we would call an excess, i.e. if i smash my car up i have to pay the first £250 of any bill.
Thanks.
In my part of California, the cheapest Obamacare plan is about $225/mo with no subsidies. That plan starts paying when your health costs reach $5000 for the year and covers everything once your costs exceed $6350.
Sound flawed? This is 100x better than the previous status quo.
Thats actually a pretty good plan. Can you couple that with an HSA? Deductibles I don't find to be that big a deal. The number that puts you at risk and hurts you is the max out of pocket. Care cost skyrocket so much in an emergency, even a 20% copay often wont keep you from running up to the max out of pocket in a bad year.
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ACA saved their bacon, literally.
Why were they insuring their bacon?
(Hey, you did say "literally!")
On one hand, I don't think the ACA solved the real problem, which is costs. On the other hand, I think it's an improvement compared to the previous (appalling) status quo, and thus mostly support it.
On the third hand, I agree with Scalia that Congress fucked up the language and that the law should have been struck down on those grounds -- regardless of the havoc that would ensue. It is the SCOTUS's job to uphold the Constitution and legal principle, not to disregard it just because it's inconvenient.
Also, I would have enjoyed the schadenfreude of seeing the Republicans get what they wanted, then get pilloried for it once their their base suddenly realized how screwed they were.
You have 3 hands and you can still get insurance?
Who said I only have three?
I'm an Edosian (http://en.memory-alpha.wikia.com/wiki/Edosian), you insensitive clod!
It didn't count as a pre-existing condition because I just had it grafted on.
Ah, never mind.
Hey, because they didn't have to pay the high costs of COBRA, they had enough money to go in on a free-range pig (I went in on it with them). Lots of delicious bacon.
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At some point, yes, people will need to die in hospital parking lots. Don't pay for you insurance and you are able? hmmmm. not much sympathy here.
That is exactly what was happening, and the public outcry caused congress (and president Reagan) to pass EMTALA.
How many damn times do I have to say it? Unless you can explain how you will repeal EMTALA, there is no point in complaining about socialized medicine, because we have it. We have a really, really shitty version of it. So you can try to fix that, or you can rail against big gubmint without bothering to read your own damn (recent!) history.
-W
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A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
My bias - I'm non American who probably would have died in my 20s if I had been, either that or my parents would have lost their house to pay for my care. My main medication at one stage was $3000 plus a day in hospital each month - lets say $50000 over the year just for the treatment, plus whatever bimonthly consultant visits would be. I paid almost nothing (there may have been a $21 co pay for the meds, I don't remember now). Without treatment, life expectancy was about 4 years, with treatment, life expectancy is same as the regular population (so maybe 60 more years). Because I was treated, I got well, and finished Uni, got a good job and have been a happy little tax payer for a decade, rather than being too ill to work and getting disability until I died. My taxes + the benefits I didn't get have more than paid for the health care costs already with many earning years to go, so it seems like it was a good deal for the government and for me.
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I am personally against Obamacare but with that said if it is still around when i hit the RE button I will take advantage of the credits since when i RE I will make sure my income needs to be where it has to be to qualify.
What would you like instead?
I'm not Davids, but for starters I would like:
*The ability to buy high deductible insurance. I think I am capable of deciding my risk tolerance, don't need the Prez to do that for me
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others wish to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
Define a *high* deductible. I fine a 10k family deductible to be plenty spicy.
$10,000 is where I'd start. maybe go as high as $20,000.
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At some point, yes, people will need to die in hospital parking lots. Don't pay for you insurance and you are able? hmmmm. not much sympathy here.
That is exactly what was happening, and the public outcry caused congress (and president Reagan) to pass EMTALA.
How many damn times do I have to say it? Unless you can explain how you will repeal EMTALA, there is no point in complaining about socialized medicine, because we have it. We have a really, really shitty version of it. So you can try to fix that, or you can rail against big gubmint without bothering to read your own damn (recent!) history.
-W
Honestly, if it would not effect kids, I'd be fine with keeping what we have but exempting hospitals of treating American patients without insurance. You want to be an idiot, remove yourself from the gene pool.
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At some point, yes, people will need to die in hospital parking lots. Don't pay for you insurance and you are able? hmmmm. not much sympathy here.
That is exactly what was happening, and the public outcry caused congress (and president Reagan) to pass EMTALA.
How many damn times do I have to say it? Unless you can explain how you will repeal EMTALA, there is no point in complaining about socialized medicine, because we have it. We have a really, really shitty version of it. So you can try to fix that, or you can rail against big gubmint without bothering to read your own damn (recent!) history.
-W
Honestly, if it would not effect kids, I'd be fine with keeping what we have but exempting hospitals of treating American patients without insurance. You want to be an idiot, remove yourself from the gene pool.
This is the fatal flaw of libertarianism. It assumes a universe of rational actors who make either bad or good decisions.
As an example, What about the complete idiots? What about those with IQ's in the 70 range? Should they be allowed to die in the streets because they have no access to employment and are a bad bet for insurance companies? Will that make for a more ideal society in your eyes?
I try to hold myself to a libertarian level of personal responsibility, but it does not follow that because I am a lucky, lucky guy, that noone should be cared for by the communal whole.
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Somebody please explain Obamacare...all I've heard is people whining about it and now everybody here is all happy that it's "survived."
What's the deal anyway?
If you want an explanation in comic form, there is one here: http://economixcomix.com/home/obamacare./
I find that the author tends to inject a bit of editorial slant in the comics, but very well done and an informative and fun read.
..I would like:
...
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others with to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
For anyone whose interested in a personal story of someone who took that route, there is this recent story: http://www.reddit.com/r/personalfinance/comments/3azqh6/wife_has_rare_type_of_cancer_no_medical_insurance/
It looks like it worked out ok for them in the end.
That was a very interesting read. The couple is in my state. Yep, lots of people like them aren't buying the ACA mandated insurance and they've got the funds to do so.
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..I would like:
...
* No mandate to buy insurance. Believe me, I will buy insurance to protect my stash, but if others with to risk their stash, so be it. And believe me, I know many household who are not buying it anyway, mandate or not. These households all vote Democratic, by the way.
For anyone whose interested in a personal story of someone who took that route, there is this recent story: http://www.reddit.com/r/personalfinance/comments/3azqh6/wife_has_rare_type_of_cancer_no_medical_insurance/
It looks like it worked out ok for them in the end.
That was a very interesting read. The couple is in my state. Yep, lots of people like them aren't buying the ACA mandated insurance and they've got the funds to do so.
So "work[ing] out ok for them in the end" actually meant getting an ACA plan after all:
I just got off the phone with someone very kind on the ACA helpline. We figured out together that losing my unemployment insurance in August counts as a life changing event and therefore as of August 1 I am able to enroll myself and my wife into a plan. She is eligible for the full subsidy and will have almost 100% coverage for $40 per month. I am so happy that I'm crying.
This is not an example of people refusing to participate in the ACA and winning; this is an example of people refusing to participate in the ACA and then eating crow.
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A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
A lot of people are ignorant and gullible. The word has been widely used as propaganda for decades in the US by conservative politicians. It's been equated with the great evils of the Nazis and the USSR. Through the long Cold War in particular, it has taken on a whole new meaning in the minds of many Americans. It's associated with a visceral revulsion. People who don't even know what the word means are reflexively against it. I doubt more than a small percentage of Americans could accurately define it, let alone articulate the pros and cons of such a system.
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A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
My bias - I'm non American who probably would have died in my 20s if I had been, either that or my parents would have lost their house to pay for my care. My main medication at one stage was $3000 plus a day in hospital each month - lets say $50000 over the year just for the treatment, plus whatever bimonthly consultant visits would be. I paid almost nothing (there may have been a $21 co pay for the meds, I don't remember now). Without treatment, life expectancy was about 4 years, with treatment, life expectancy is same as the regular population (so maybe 60 more years). Because I was treated, I got well, and finished Uni, got a good job and have been a happy little tax payer for a decade, rather than being too ill to work and getting disability until I died. My taxes + the benefits I didn't get have more than paid for the health care costs already with many earning years to go, so it seems like it was a good deal for the government and for me.
I don't understand why so many people defend such a broken system. No one else in dozens of developed countries around the world with universal government health care want the US system. It's not likely that everyone else wrong and the US is the lone voice of reason.
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A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
My bias - I'm non American who probably would have died in my 20s if I had been, either that or my parents would have lost their house to pay for my care. My main medication at one stage was $3000 plus a day in hospital each month - lets say $50000 over the year just for the treatment, plus whatever bimonthly consultant visits would be. I paid almost nothing (there may have been a $21 co pay for the meds, I don't remember now). Without treatment, life expectancy was about 4 years, with treatment, life expectancy is same as the regular population (so maybe 60 more years). Because I was treated, I got well, and finished Uni, got a good job and have been a happy little tax payer for a decade, rather than being too ill to work and getting disability until I died. My taxes + the benefits I didn't get have more than paid for the health care costs already with many earning years to go, so it seems like it was a good deal for the government and for me.
I don't understand why so many people defend such a broken system. No one else in dozens of developed countries around the world with universal government health care want the US system. It's not likely that everyone else wrong and the US is the lone voice of reason.
Because "WE'RE #1!!!!!" and "USA! USA! USA!"
There's an attitude in the country that we're the best at everything. This is fed by the fact that we are very good at many things. And people literally believe that we have the best healthcare system in the world. It is absolutely incomprehensible to the vast majority of Americans that we are actually somewhat near the bottom in terms of industrialized nations. They literally would not believe it.
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At some point, yes, people will need to die in hospital parking lots. Don't pay for you insurance and you are able? hmmmm. not much sympathy here.
That is exactly what was happening, and the public outcry caused congress (and president Reagan) to pass EMTALA.
How many damn times do I have to say it? Unless you can explain how you will repeal EMTALA, there is no point in complaining about socialized medicine, because we have it. We have a really, really shitty version of it. So you can try to fix that, or you can rail against big gubmint without bothering to read your own damn (recent!) history.
-W
Honestly, if it would not effect kids, I'd be fine with keeping what we have but exempting hospitals of treating American patients without insurance. You want to be an idiot, remove yourself from the gene pool.
This is the fatal flaw of libertarianism. It assumes a universe of rational actors who make either bad or good decisions.
As an example, What about the complete idiots? What about those with IQ's in the 70 range? Should they be allowed to die in the streets because they have no access to employment and are a bad bet for insurance companies? Will that make for a more ideal society in your eyes?
I try to hold myself to a libertarian level of personal responsibility, but it does not follow that because I am a lucky, lucky guy, that noone should be cared for by the communal whole.
Shhhhh....don't try to use reason with them. It's a waste of time and energy.
-
A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
My bias - I'm non American who probably would have died in my 20s if I had been, either that or my parents would have lost their house to pay for my care. My main medication at one stage was $3000 plus a day in hospital each month - lets say $50000 over the year just for the treatment, plus whatever bimonthly consultant visits would be. I paid almost nothing (there may have been a $21 co pay for the meds, I don't remember now). Without treatment, life expectancy was about 4 years, with treatment, life expectancy is same as the regular population (so maybe 60 more years). Because I was treated, I got well, and finished Uni, got a good job and have been a happy little tax payer for a decade, rather than being too ill to work and getting disability until I died. My taxes + the benefits I didn't get have more than paid for the health care costs already with many earning years to go, so it seems like it was a good deal for the government and for me.
I don't understand why so many people defend such a broken system. No one else in dozens of developed countries around the world with universal government health care want the US system. It's not likely that everyone else wrong and the US is the lone voice of reason.
Because "WE'RE #1!!!!!" and "USA! USA! USA!"
There's an attitude in the country that we're the best at everything. This is fed by the fact that we are very good at many things. And people literally believe that we have the best healthcare system in the world. It is absolutely incomprehensible to the vast majority of Americans that we are actually somewhat near the bottom in terms of industrialized nations. They literally would not believe it.
You also have to remember that the world is quite American-focused, and the average American has no particular impetus to visit or learn about any other system. And unlike in other developed countries, which tend to cover American news in more detail than we cover news in any other country, there is a lack of basic knowledge in America about how the rest of the world lives. Recently, I participated in a casual discussion of the American healthcare system and its flaws and good points, etc., with a group of people that included residents of Great Britain, China, Italy, and Israel (along with a bunch of Americans). One American grad student, whose husband was med student, ranted on and on against Obamacare, and how doctors were underpaid in America, and if they were paid less there would be rationing and quality of care would collapse, and health outcomes would be worse. Eventually, I asked mildly how it was that health outcomes in all these other nations that truly have socialized medicine (not Obamacare) was superior to American outcomes. She flat out denied it. Then she started talking about how terrible health care was in all these socialized systems WHILE RESIDENTS OF THE OTHER COUNTRIES SAT RIGHT THERE GAPING. Finally I said, "Have you ever visited these countries?" "Well, no" "Has your husband visited these countries?" "No." And I gestured around at all the people at the table and asked her if she'd ever considered asking actual users of those systems what they thought? That shut her up quick.
Americans are just bone-ignorant of what's happening elsewhere, that's all.
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I always wondered how come the US who have a bigger population than my country (Canada) couldn't find a way to make healthcare work when in Canada, we have had it since the late 60's? You ask every canadian the one thing that we are proud to have that the US doesn't have, everyone of them including myself will tell you it's healthcare. As much as the US have everything else in alot of categories (ex: lower prices on food, better place to make money, etc...), healthcare is the only thing, we canadians wouldn't trade anything for with the US. I hope the US make this work, because it sucks when you have to declare yourself bankrupt over a medical issue. And I am sure, every other country in the world who have a healthcare system would say the samething.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
You're just describing the mechanism for paying for research & development (patents), you're not actually correcting Marty.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
A lot of the research and discovery that results in drugs is actually paid for by the government and is conducted at universities by faculty, staff, and students. The pharmaceutical companies often come in later and do the rest of the work, like the testing and clinical trials and bringing the drug to market. Pharma spends more money on advertising than on actual research. And much of that research is just to create a "me too" drug that copies what another company's drug does. Viagra comes out, so another firm rushes to create another drug that does the same thing.
Mostly true. But don't forget small biotech companies, which tend to be the most common place for new drug development - though they are usually formed out of research at universities, and most wind up acquired by big pharma or large biotech companies.
-
A somewhat philosophical question here - why do so many people in this debate use the word "socialised" as if it is obviously synonymous with "evil"?
My bias - I'm non American who probably would have died in my 20s if I had been, either that or my parents would have lost their house to pay for my care. My main medication at one stage was $3000 plus a day in hospital each month - lets say $50000 over the year just for the treatment, plus whatever bimonthly consultant visits would be. I paid almost nothing (there may have been a $21 co pay for the meds, I don't remember now). Without treatment, life expectancy was about 4 years, with treatment, life expectancy is same as the regular population (so maybe 60 more years). Because I was treated, I got well, and finished Uni, got a good job and have been a happy little tax payer for a decade, rather than being too ill to work and getting disability until I died. My taxes + the benefits I didn't get have more than paid for the health care costs already with many earning years to go, so it seems like it was a good deal for the government and for me.
I don't understand why so many people defend such a broken system. No one else in dozens of developed countries around the world with universal government health care want the US system. It's not likely that everyone else wrong and the US is the lone voice of reason.
Because "WE'RE #1!!!!!" and "USA! USA! USA!"
There's an attitude in the country that we're the best at everything. This is fed by the fact that we are very good at many things. And people literally believe that we have the best healthcare system in the world. It is absolutely incomprehensible to the vast majority of Americans that we are actually somewhat near the bottom in terms of industrialized nations. They literally would not believe it.
You also have to remember that the world is quite American-focused, and the average American has no particular impetus to visit or learn about any other system. And unlike in other developed countries, which tend to cover American news in more detail than we cover news in any other country, there is a lack of basic knowledge in America about how the rest of the world lives. Recently, I participated in a casual discussion of the American healthcare system and its flaws and good points, etc., with a group of people that included residents of Great Britain, China, Italy, and Israel (along with a bunch of Americans). One American grad student, whose husband was med student, ranted on and on against Obamacare, and how doctors were underpaid in America, and if they were paid less there would be rationing and quality of care would collapse, and health outcomes would be worse. Eventually, I asked mildly how it was that health outcomes in all these other nations that truly have socialized medicine (not Obamacare) was superior to American outcomes. She flat out denied it. Then she started talking about how terrible health care was in all these socialized systems WHILE RESIDENTS OF THE OTHER COUNTRIES SAT RIGHT THERE GAPING. Finally I said, "Have you ever visited these countries?" "Well, no" "Has your husband visited these countries?" "No." And I gestured around at all the people at the table and asked her if she'd ever considered asking actual users of those systems what they thought? That shut her up quick.
Americans are just bone-ignorant of what's happening elsewhere, that's all.
Very true.
I always wondered how come the US who have a bigger population than my country (Canada) couldn't find a way to make healthcare work when in Canada, we have had it since the late 60's? You ask every canadian the one thing that we are proud to have that the US doesn't have, everyone of them including myself will tell you it's healthcare. As much as the US have everything else in alot of categories (ex: lower prices on food, better place to make money, etc...), healthcare is the only thing, we canadians wouldn't trade anything for with the US. I hope the US make this work, because it sucks when you have to declare yourself bankrupt over a medical issue. And I am sure, every other country in the world who have a healthcare system would say the samething.
It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
It's also because there's an irrational aversion among many people to having the government do anything, and a belief (despite evidence to the contrary) that the private sector does everything better always. There are some things where the private sector does do a better job. There are some things where it does a much worse job--and healthcare is one of those.
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We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
My question of what is in it was rhetorical.
Regardless of the amount of research and development, I'm pretty sure the prices are hyperinflated. I have less issues with companies making huge profits off consumable goods (i.e. Apple products), but this is medicine we're talking about.
What if my insurance company didn't cover any portion of the ointment?
Epipens for $300? This is an extra $300-$900 mandatory expense every year that some people have to pony up.
Might as well start billing people for ER before rolling them into the OR: "Sir, you'll have to pay before I can use the defibrillator on you."
Nobody should ever have to consciously choose to accept or reject basic treatment.
You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
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There are some things where it does a much worse job--and healthcare is one of those.
I don't agree with this, unless by "worse job" you mean only "costs less." Public systems provide care at a lower costs than comparable private systems, but I don't think there's enough data to say whether comparable public or provide health care systems provide better care - though my suspicion is that private systems provide better quality care (at a higher cost).
See for example Switzerland and the Netherlands versus France or Germany.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
A lot of the research and discovery that results in drugs is actually paid for by the government and is conducted at universities by faculty, staff, and students. The pharmaceutical companies often come in later and do the rest of the work, like the testing and clinical trials and bringing the drug to market. Pharma spends more money on advertising than on actual research. And much of that research is just to create a "me too" drug that copies what another company's drug does. Viagra comes out, so another firm rushes to create another drug that does the same thing.
MostlyVery true. But don't forget small biotech companies, which tend to be the most common place for new drug development - though they are usually formed out of research at universities, and most wind up acquired by big pharma or large biotech companies.
Fixed that for you :)
I said "A lot" and "much" and other qualifiers that make my statement accurate without having to dig up the specific numbers.
Your point is of course a good one as well.
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There are some things where it does a much worse job--and healthcare is one of those.
I don't agree with this, unless by "worse job" you mean only "costs less." Public systems provide care at a lower costs than comparable private systems, but I don't think there's enough data to say whether comparable public or provide health care systems provide better care - though my suspicion is that private systems provide better quality care (at a higher cost).
See for example Switzerland and the Netherlands versus France or Germany.
On a population level, we spend far more per capita (so yes, more costly) and have results that are sub-par (WHO ranks the US close to the bottom among industrialized nations). I think that supports my point.
It's entirely possible that if you are able to spend huge sums of money you can get much better care than the average Swede or Brit. But that's not apples to apples. When you include everyone in society, those on the bottom of the scale are so much worse off than the comparable people in the other industrialized nations, they bring down overall the numbers below other nations.
What I've seen are that if you are a white, educated, upper income individual with private insurance in the US your health outcomes are on par with the average person in other industrialized nations.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
A lot of the research and discovery that results in drugs is actually paid for by the government and is conducted at universities by faculty, staff, and students. The pharmaceutical companies often come in later and do the rest of the work, like the testing and clinical trials and bringing the drug to market. Pharma spends more money on advertising than on actual research. And much of that research is just to create a "me too" drug that copies what another company's drug does. Viagra comes out, so another firm rushes to create another drug that does the same thing.
MostlyVery true. But don't forget small biotech companies, which tend to be the most common place for new drug development - though they are usually formed out of research at universities, and most wind up acquired by big pharma or large biotech companies.
Fixed that for you :)
I said "A lot" and "much" and other qualifiers that make my statement accurate without having to dig up the specific numbers.
Your point is of course a good one as well.
Well, okay. But I think the "me too" drug downside is overstated. Sure, there might not be a clinical need for another Viagra. But there are absolutely clinical uses for additional statins, or birth control, or anti-inflammatories, or anti-depressants. Very rarely is the first drug on the market to treat a given condition the "best," and even when it is there are almost always cases where a portion of the population is better off using a different drug.
And then there are whole classes of drugs where constant innovation is needed because of the environment adapts. Penicillin used to be a miracle drug capable of destroying almost every bacterial infection known to man. Now we've had like 5 additional classes of antibacterials, and there are still bacteria that have resistance to every drug we've invented.
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We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
My question of what is in it was rhetorical.
Regardless of the amount of research and development, I'm pretty sure the prices are hyperinflated. I have less issues with companies making huge profits off consumable goods (i.e. Apple products), but this is medicine we're talking about.
What if my insurance company didn't cover any portion of the ointment?
Epipens for $300? This is an extra $300-$900 mandatory expense every year that some people have to pony up.
Might as well start billing people for ER before rolling them into the OR: "Sir, you'll have to pay before I can use the defibrillator on you."
Nobody should ever have to consciously choose to accept or reject basic treatment.
You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
I think another important question to address is why drugs in the US are about twice as expensive as drugs in other industrialized nations. People in the US are subsidizing people in Germany, France, and Japan--to the tune of about 100%. Sure there are patents and sure that pays for the costs of R&D. But clearly the other rich countries are able to negotiate much more reasonable prices. I think it's unreasonable for us to subsidize them in this manner. Let's bring our drug prices way down and allow the rest of the first world to bear more of the cost.
We should do the same thing with global military budgets, but that's another topic.
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What's in it doesn't actually matter or costs a couple of cents. You are paying for the 10-15 years of research and development that big pharma and various biotech firms have spent inventing and testing it.
No, you're paying for the monopoly power granted to someone as a substitute for paying for the research through other means.
http://www.cepr.net/publications/reports/financing-drug-research-what-are-the-issues
The existing system also has other costs beyond the sticker price:
http://www.cepr.net/press-center/press-releases/patent-monopolies-mismarketing-drugs
A lot of the research and discovery that results in drugs is actually paid for by the government and is conducted at universities by faculty, staff, and students. The pharmaceutical companies often come in later and do the rest of the work, like the testing and clinical trials and bringing the drug to market. Pharma spends more money on advertising than on actual research. And much of that research is just to create a "me too" drug that copies what another company's drug does. Viagra comes out, so another firm rushes to create another drug that does the same thing.
MostlyVery true. But don't forget small biotech companies, which tend to be the most common place for new drug development - though they are usually formed out of research at universities, and most wind up acquired by big pharma or large biotech companies.
Fixed that for you :)
I said "A lot" and "much" and other qualifiers that make my statement accurate without having to dig up the specific numbers.
Your point is of course a good one as well.
Well, okay. But I think the "me too" drug downside is overstated. Sure, there might not be a clinical need for another Viagra. But there are absolutely clinical uses for additional statins, or birth control, or anti-inflammatories, or anti-depressants. Very rarely is the first drug on the market to treat a given condition the "best," and even when it is there are almost always cases where a portion of the population is better off using a different drug.
And then there are whole classes of drugs where constant innovation is needed because of the environment adapts. Penicillin used to be a miracle drug capable of destroying almost every bacterial infection known to man. Now we've had like 5 additional classes of antibacterials, and there are still bacteria that have resistance to every drug we've invented.
You are correct as usual. "Me too" drugs do have some benefit.
My point was that the big pharma firms like to make it seem like they are charging insane amounts of money for their cheap chemicals because all that money is going to new cures for currently uncured diseases ("tomorrow's miracles" to quote the ad). When the reality is that it's just another way for us to raise certain anatomy or to lower cholesterol (instead of just eating better). And the "me too" drugs are often not better than the first to market drug, and are often not even tested against the first to market drug (or at least the results are not published)--just another option.
One real benefit is that the copycat drug can bring the cost of both drugs down. However, there has been an awful lot of lockstep pricing in the industry, where both firms raise their drug costs on the same day or so, with matching price increases. There really isn't that much competition.
And almost no one is actually researching new antibiotics. It's unfortunate. But they don't work as well anymore do to overuse. And new ones would start to have the same problems quickly.
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There are some things where it does a much worse job--and healthcare is one of those.
I don't agree with this, unless by "worse job" you mean only "costs less." Public systems provide care at a lower costs than comparable private systems, but I don't think there's enough data to say whether comparable public or provide health care systems provide better care - though my suspicion is that private systems provide better quality care (at a higher cost).
See for example Switzerland and the Netherlands versus France or Germany.
On a population level, we spend far more per capita (so yes, more costly) and have results that are sub-par (WHO ranks the US close to the bottom among industrialized nations). I think that supports my point.
But the US is one data point with a mixture of systems - public, private, and an uninsured population that dwarfs any of the comparison countries. Much of the reason the US ranks so poorly in international rankings is access to care, i.e. so many people don't have health insurance. The ACA is changing this. But in the meantime, using the US to say that private health care systems are worse than public doesn't make any sense at all.
The fair comparison is countries that have universal coverage, but different implementations. Hence my Switzerland and the Netherlands versus France or Germany.
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It's entirely possible that if you are able to spend huge sums of money you can get much better care than the average Swede or Brit. But that's not apples to apples. When you include everyone in society, those on the bottom of the scale are so much worse off than the comparable people in the other industrialized nations, they bring down overall the numbers below other nations.
But that's not what I'm saying. I'm talking about the average person in the Netherlands or Switzerland, compared to the average person in France or Germany. And yes, I know that these aren't perfect comparisons either, but they're a heck of a lot better than using the US as an example for anything other than "if more people have health insurance than more people have better health care."
What I've seen are that if you are a white, educated, upper income individual with private insurance in the US your health outcomes are on par with the average person in other industrialized nations.
I think this only supports my point.
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
That's never stopped us from retiring entire industries before, or pushing for other industries to be outlawed. Nobody is going to be raising money for the homeless insurance adjusters or paper pushers outside your local grocery store.
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This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
How is this any different from saying that some mutual funds charge crazy high fees, and so we definitely shouldn't use Vanguard instead because then the employees of those high-fee companies will be out of work? The lower cost more efficient option is a job killer in every sense. Just like a single-payer health care system would be. I'm still in favor of both.
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
I'm not sure how much employment loss there would be. A lot of the excess is profits (e.g. pharmaceutical firms are perennially in the top 3 most profitable industries) or unreasonably high salaries or subsidizing rich foreign countries (see higher drug price post above). So that doesn't do much to the number of jobs here. You would still need similar amounts of care to be provided, so the actual care delivery jobs are still needed.
Typically when an industry evolves and gets more efficient, the workers get jobs elsewhere. See the buggy whip cliche.
But I think the economy would actually improve and create more jobs than were lost. Healthcare is an enormous hidden tax on the economy. It makes hiring someone so much more expensive. If we cut out all that inefficiency, employers and employees around the country suddenly have an extra $1-1.5 trillion jangling in their pockets--each year! That could do a lot of buying and hiring in other industries.
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But I think the economy would actually improve and create more jobs than were lost. Healthcare is an enormous hidden tax on the economy. It makes hiring someone so much more expensive. If we cut out all that inefficiency, employers and employees around the country suddenly have an extra $1-1.5 trillion jangling in their pockets--each year! That could do a lot of buying and hiring in other industries.
How many mustachians would love to have the extra few thousand dollars every year in their pockets instead of paying an insurance company?
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
I'm not sure how much employment loss there would be. A lot of the excess is profits (e.g. pharmaceutical firms are perennially in the top 3 most profitable industries) or unreasonably high salaries or subsidizing rich foreign countries (see higher drug price post above). So that doesn't do much to the number of jobs here. You would still need similar amounts of care to be provided, so the actual care delivery jobs are still needed.
Typically when an industry evolves and gets more efficient, the workers get jobs elsewhere. See the buggy whip cliche.
But I think the economy would actually improve and create more jobs than were lost. Healthcare is an enormous hidden tax on the economy. It makes hiring someone so much more expensive. If we cut out all that inefficiency, employers and employees around the country suddenly have an extra $1-1.5 trillion jangling in their pockets--each year! That could do a lot of buying and hiring in other industries.
Blonde lawyer was only talking about health insurance companies - which are in one of the least profitable industries. There is substantially more overhead than government-run health insurance plans, however, which would account for where the savings - and job losses - would come from.
Also, I tend to agree that the net result of offering single-payer universal health care would be an increase in the number of jobs thanks to reduced drag on the economy. I'm not sure how universal private insurance would compare on that axis (increased efficiency on one large organizations versus competitive pressures of different insurance companies). However, there would inevitably be a transition period that would have higher unemployment due to the very nature of people needing to find new jobs, in necessarily different industries.
Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
I'm not sure how much employment loss there would be. A lot of the excess is profits (e.g. pharmaceutical firms are perennially in the top 3 most profitable industries) or unreasonably high salaries or subsidizing rich foreign countries (see higher drug price post above). So that doesn't do much to the number of jobs here. You would still need similar amounts of care to be provided, so the actual care delivery jobs are still needed.
Typically when an industry evolves and gets more efficient, the workers get jobs elsewhere. See the buggy whip cliche.
But I think the economy would actually improve and create more jobs than were lost. Healthcare is an enormous hidden tax on the economy. It makes hiring someone so much more expensive. If we cut out all that inefficiency, employers and employees around the country suddenly have an extra $1-1.5 trillion jangling in their pockets--each year! That could do a lot of buying and hiring in other industries.
Blonde lawyer was only talking about health insurance companies - which are in one of the least profitable industries. There is substantially more overhead than government-run health insurance plans, however, which would account for where the savings - and job losses - would come from.
Also, I tend to agree that the net result of offering single-payer universal health care would be an increase in the number of jobs thanks to reduced drag on the economy. I'm not sure how universal private insurance would compare on that axis (increased efficiency on one large organizations versus competitive pressures of different insurance companies). However, there would inevitably be a transition period that would have higher unemployment due to the very nature of people needing to find new jobs, in necessarily different industries.
Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
In addition to cutting out insurance provider overhead, there could be savings on the costs of medical devices, drugs (both much higher in the US than abroad), incomes for certain providers (also much higher here), hospitals, etc, etc. There's way more fat than the 2008 study you pointed to (and even the 2014 update to it published in HA).
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Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
Yeah, you're ignoring the point I made earlier, that I bolded this time. Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/
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Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
Yeah, you're ignoring the point I made earlier, that I bolded this time. Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/
I see the point you were making, which is a good thing that people overlook. But our GDP *per capita* is pretty close to many (and even lower than some) of those EU countries. If you sort by the "Total health expenditure % of GDP" on that Wikipedia link I provided, you can see that we're still about double (some above and some below) the rate of other industrialized nations in terms of expenditures as a % of GDP. So, as I was saying, if we brought our spending down to a level on par with other nations, we could save half or even more of our current expenditure. And by providing a range of 33% to 50% savings, I was being on the conservative end of that estimate--although admittedly the whole idea of cutting our spending like that is highly unlikely for many reasons other than this fun speculative exercise.
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I think I overestimated the number of people employed by health insurance companies. This fortune article says "more than 240,000." I would have expected that many at just one company so I guess I was way off.
http://fortune.com/2014/10/20/health-insurance-future/
This article is also pretty interesting. I didn't read the whole thing yet but it addresses a lot of the problems with our current model.
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I think I overestimated the number of people employed by health insurance companies. This fortune article says "more than 240,000." I would have expected that many at just one company so I guess I was way off.
http://fortune.com/2014/10/20/health-insurance-future/
This article is also pretty interesting. I didn't read the whole thing yet but it addresses a lot of the problems with our current model.
And not all those jobs would go away. Some would be moved to other locations.
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Sorry, this is a little long, but it goes through what has happened to my premium since Obamacare regs started.
NOTE; No Obamacare regs, first two years.
BLUE CROSS Policy Family of 4, $2,500 Deductible
2-01-09 $720
Yearly Premium
To $8,640
7-01-09 $720
I received notice my premium was increasing to $825 per month.
This is $9,900 per year. I needed to do something.
To lower my premium I raised my deductible to $10,000.
This decreased my premium to $376 per month.
Saving my $5,388 per year. (crazy reduction)
8-01-09 $376
TO Yearly Premium
$4,512
5-01-10 $376
Received a 7.7% premium increase
6-10-10 $405
TO Yearly Premium
$4,860
5-01-11 $405
Received a 8.1% premium increase
6-01-11 $438
To Yearly Premium
$5,256
5-01-12 $438
OBAMACARE REGULATIONS START---Received a 19.4% increase
6-01-12 $523
TO Yearly Premium
$6,276
5-01-13 $523
MORE OBAMACARE POLICIES---Received 21% increase
6-01-13 $633
TO Yearly Premium
$7,596
3-01-14 $633
Dropped my daughter off policy, Premium reduction of $89
4-01-14 $544 Policy is now for 3 people
5-01-14 $544
6-01-14 $544
7-01-14 $544
MORE OBAMACARE POLICIES---Received 18.8% increase
8-01-14 $646
Yearly Premium
$7,752
Note if my daughter was still included premium would be
$8,952
At this time BLUE CROSS wants me to choose an Obamacare policy.
The cheapest ObamaCare premium is $1,142 per month or $13,700 a year.
Just 25 months ago I was paying $438 per month or $ 5,256 a year.
My policy has a $10,000 deductible. Obamacare has a $12,500 deductible.
After I pay my $10,000 almost everything is covered 100%.
I wrote all of the above in July of 2014.
Today I did a check on Healthcare.gov, a policy equivalent to what I have is $13,500.
The generous hardworking Taxpayers will subsidize me with $9,360 to reduce my cost to $4140.
This would save me $4,308 a year.
I have not went on Obamacare, my doctor doesn't accept it, I don't want the wellfare check,
I don't want it to succeed, and I think the subsidies will rise over time.
I have a price were I will be bought, but I'm not there yet. If I was retired and dropped my income to $40,000,
my ACA premium would cost me $41 per month.
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
Regarding the subsidy, If half of US families took Obamacare, 62 million with an average subsidy of $10,000
That would be a cost to the hardworking taxpayers of $620,000,000,000 or 17.7% of the Federal tax revenue.
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Sorry, you're just wrong in some places here. Healthcare expenses have been going up like crazy for decades. There was no regulatory change that happened near many of your "OBAMACARE POLICIES" denotations--just medical cost inflation or BCBS raising your premiums because they could. And the older plans are exempt from most of the policy changes anyway, unless the insurer chooses to adopt them.
Those premiums sound very high. I'm guessing because you're getting somewhat older. Which explains some of the increase in premiums you've seen as well. The policies get much more expensive as you get near 60--because older people cost so much more.
And your back of the envelope math is assuming the average American is in your exact situation (ages, lower incomes, etc). Which obviously isn't the case. And the ACA was designed so that people would continue to have insurance through work, and are only available to those with a lower income, so that the subsidies wouldn't be for half of the US.
The ACA actually *decreases* the federal budget deficit.
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Today I did a check on Healthcare.gov, a policy equivalent to what I have is $13,500.
The generous hardworking Taxpayers will subsidize me with $9,360 to reduce my cost to $4140.
This would save me $4,308 a year.
I have not went on Obamacare, my doctor doesn't accept it, I don't want the wellfare check,
I don't want it to succeed, and I think the subsidies will rise over time.
I have a price were I will be bought, but I'm not there yet. If I was retired and dropped my income to $40,000,
my ACA premium would cost me $41 per month.
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
Regarding the subsidy, If half of US families took Obamacare, 62 million with an average subsidy of $10,000
That would be a cost to the hardworking taxpayers of $620,000,000,000 or 17.7% of the Federal tax revenue.
Your statements in bold directly contradict each other.
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
^^^^^THIS 100%^^^^^^^
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It always gets me how a financially responsible community like MMM can have such a majority of it support essentially socialized, government run medicine. I would think the majority would be against and for the competition of the private industry that brings about the greatest responsibility and forces hospitals and insurers to compete for patients. You car insurance competes for you like crazy, imagine if health insurance had to do the same.
I know most here think obamacare is the greatest thing that ever came out of DC, but if that were true; then why did all the stocks of big hospitals and insurers soar after the ruling; because obamacare is making them more profitable and making your opitions less and less.
If Obamacare were so good, doctors wouldn't be quitting, Medicaid(essentially obamacare's prerunner) wouldn't be denied at some of the finest hospitals, doctors clinics that are run by fee for service wouldn't be popping up all over.
obamacare essentially increased the costs and put healthcare services on a permanent decline of 320 million for 10 million that the govt could have taken care of without throwing the healthcare system under the bus. it still looks good now, give it 10 years or read the stories on british healthcare.
^^^^^THIS 100%^^^^^^^
None of this makes any sense at all.
The ACA is in no way a socialist, government run healthcare system. That's just false on its face. It's private insurance--which is why hospital and insurer stocks have tripled.
And the ACA *increases* competition by creating the Marketplaces.
Fee for service has been the standard for decades. But, in significant part due to the ACA, it's actually in rapid decline. The target is for 80% of Medicare to be value-based (not just FFS) and 80% of 1/3 of the states to be entirely value-based in the next 4 years.
You also have to understand nuance. I think the ACA is better than the hideously terrible system we had before. I think the ACA is less terrible--not sunshine and rainbows. By comparison, it's great. By comparison to <pick just about any other industrialized nation> it's crap. But many of those other industrialized nations have actual socialist, government run healthcare systems. And it's much cheaper (like half the cost per capita, even adjusting for GDP differences), and the outcomes are better in most cases.
It would be hard for your statements to be less reflective of reality.
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
Hey, all that money is paying for the hospital CEO's new yacht! How dare you call that waste!
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We once got an ointment prescribed by the doctor. 60g of the ointment retailed for $630. How is this even possible? What's even in it?
My question of what is in it was rhetorical.
Regardless of the amount of research and development, I'm pretty sure the prices are hyperinflated. I have less issues with companies making huge profits off consumable goods (i.e. Apple products), but this is medicine we're talking about.
What if my insurance company didn't cover any portion of the ointment?
Epipens for $300? This is an extra $300-$900 mandatory expense every year that some people have to pony up.
Might as well start billing people for ER before rolling them into the OR: "Sir, you'll have to pay before I can use the defibrillator on you."
Nobody should ever have to consciously choose to accept or reject basic treatment.
You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
Actually, pharmaceutical companies have the highest profit margin in the health care industry (more like 20-30%). Another problem is outrageous executive compensation, which gets subtracted from revenue before earnings are calculated. Total executive compensation at the big 5 pharma companies ranges $38 - $66 million.
http://www.forbes.com/sites/danmunro/2015/05/26/pharma-trumps-all-healthcare-sectors-in-executive-compensation/ (http://www.forbes.com/sites/danmunro/2015/05/26/pharma-trumps-all-healthcare-sectors-in-executive-compensation/)
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Sorry, you're just wrong in some places here. Healthcare expenses have been going up like crazy for decades.
Yes as I posted, I had a 7.2% increase and a 8.1% increase before 2012 when Obamacare policies started. Not the 18% to 21%
after Obamacare policies started.
There was no regulatory change that happened near many of your "OBAMACARE POLICIES" denotations--just medical cost inflation or BCBS raising your premiums because they could. And the older plans are exempt from most of the policy changes anyway, unless the insurer chooses to adopt them.
Obamacare polices started in 2012, but only some, they affected me since I'm self employed and buy my own policy. All increases waited until the anniversary date of my policy.
I think they have recently went after employer supplied policies, but haven't touched their union buddy Cadillac policies, yet. It is coming.
Those premiums sound very high. I'm guessing because you're getting somewhat older. Which explains some of the increase in premiums you've seen as well. The policies get much more expensive as you get near 60--because older people cost so much more.
Yep, 60 years old.
And your back of the envelope math is assuming the average American is in your exact situation (ages, lower incomes, etc).
I think you are right about the Average American, because younger people have a lower premium, their premium will be lower and they will get less subsidy amount. On the other hand the average American has a lower MAGI than I used for the calculation. I used $65k, the average US family earns around $53k with an even lower MAGI.
I just ran a 20 year younger family, with a $45k MAGI, the subsidy is only $399/mo as you expected, the premium is also lower $185/mo after the subsidy. Much lower than I expected.
Which obviously isn't the case. And the ACA was designed so that people would continue to have insurance through work, and are only available to those with a lower income, so that the subsidies wouldn't be for half of the US.
I have plenty of people that tell me they are either paying more or the staff was trimmed so the company doesn't have to buy employees insurance. Two companies within a block of where I sit trimmed their staff. (restaurants) All employees must buy their own insurance or pay the penalty.
The ACA actually *decreases* the federal budget deficit.
We'll see, a lot more people on Medicaid, the cost of insurance is up, a lot, the government is paying the subsidies to insurance companies. The only way it decreases the Federal budget is because it was loaded with tax increases.
I guess any boondoggle legislation could decrease the deficit, if you put enough tax increases in it.
In the end Obamacare won, and it won't be long and I suspect I'll be on it.
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You are already on it.
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Your statements in bold directly contradict each other.
I have not went on Obamacare, my doctor doesn't accept it
and
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
I don't see the confusion, I have not bought an Obamacare policy, I have looked on the Healthcare.Gov website, the cost of a policy equivalent to the $7,752 policy I have now, is $13,500. Same company. Why? Who gets the extra money? For what?
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You are already on it.
Who are you referencing in your reply?
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Sorry, you're just wrong in some places here. Healthcare expenses have been going up like crazy for decades.
Yes as I posted, I had a 7.2% increase and a 8.1% increase before 2012 when Obamacare policies started. Not the 18% to 21%
after Obamacare policies started.
There was no regulatory change that happened near many of your "OBAMACARE POLICIES" denotations--just medical cost inflation or BCBS raising your premiums because they could. And the older plans are exempt from most of the policy changes anyway, unless the insurer chooses to adopt them.
Obamacare polices started in 2012, but only some, they affected me since I'm self employed and buy my own policy. All increases waited until the anniversary date of my policy.
I think they have recently went after employer supplied policies, but haven't touched their union buddy Cadillac policies, yet. It is coming.
Those premiums sound very high. I'm guessing because you're getting somewhat older. Which explains some of the increase in premiums you've seen as well. The policies get much more expensive as you get near 60--because older people cost so much more.
Yep, 60 years old.
And your back of the envelope math is assuming the average American is in your exact situation (ages, lower incomes, etc).
I think you are right about the Average American, because younger people have a lower premium, their premium will be lower and they will get less subsidy amount. On the other hand the average American has a lower MAGI than I used for the calculation. I used $65k, the average US family earns around $53k with an even lower MAGI.
I just ran a 20 year younger family, with a $45k MAGI, the subsidy is only $399/mo as you expected, the premium is also lower $185/mo after the subsidy. Much lower than I expected.
Which obviously isn't the case. And the ACA was designed so that people would continue to have insurance through work, and are only available to those with a lower income, so that the subsidies wouldn't be for half of the US.
I have plenty of people that tell me they are either paying more or the staff was trimmed so the company doesn't have to buy employees insurance. Two companies within a block of where I sit trimmed their staff. (restaurants) All employees must buy their own insurance or pay the penalty.
The ACA actually *decreases* the federal budget deficit.
We'll see, a lot more people on Medicaid, the cost of insurance is up, a lot, the government is paying the subsidies to insurance companies. The only way it decreases the Federal budget is because it was loaded with tax increases.
I guess any boondoggle legislation could decrease the deficit, if you put enough tax increases in it.
In the end Obamacare won, and it won't be long and I suspect I'll be on it.
I'm telling you that you had a grandfathered policy (from pre-ACA) and there was almost nothing that changed for grandfathered individual market policies. That's why they were "grandfathered" because you could keep them almost entirely the way it was. Some insurers decided to stop offering them for business reasons. Some insurers used the ACA as a dishonest excuse to move people to more expensive plans. BCBS may have decided to change things of their own accord. They may have decided to charge you more because you got older. They may have decided to charge you more because your individual market risk pool was so small. They may have decided to charge you more because your alternative was to get an ACA-compliant plan (which costs more because it covers more).
Employers have been dropping health insurance coverage for the past couple decades because health care costs so much. I'm sure this will continue even with the ACA. Fortunately, workers without job-based coverage can get covered through the Marketplace now.
The ACA was primarily paid for by overpaying less to private insurers for Medicare Advantage plans. They were paying private insurers something like 15-20% (forget the exact number) more per person for Medicare Advantage plans as compared to the cost of traditional Medicare. Now they overpay them less than before, which saves about $70 billion per year. More than the tax credits cost.
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Speaking of ACA - does it make a sticky thread for those of us in US and are considering FIRE? links to definitions (MAGI, federal poverty level by family size, list of States with expanded Medicare ,etc.) I think gootofgood have an excellent post on it but I am not sure who else is tracking this or how easy it is to reference http://rootofgood.com/affordable-care-act-subsidy/
what do you think?
Mod note: put something together and we'll take a look. As of now no informative thread exists to sticky.
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I'm telling you that you had a grandfathered policy (from pre-ACA) and there was almost nothing that changed for grandfathered individual market policies. That's why they were "grandfathered" because you could keep them almost entirely the way it was.
Yes, I do have a grandfathered policy. You did qualify your response with "almost nothing" and "almost entirely". So I guess you do realize the even my grandfathered policy had changes because of Obamacare. I don't know them all, but I now get a free physical each year, but I pay heavily for that. I get a free colonoscopy every 5 years, but I pay heavily for that. I now have unlimited lifetime cost cap, it was capped at 5 million, but I pay heavily for that. I have some additional mental health care coverage, but I pay heavily for that. I think there was some additional sustance abuse coverage also. So I got a lot of free stuff, but I'm charged for it.
Some insurers decided to stop offering them for business reasons. Some insurers used the ACA as a dishonest excuse to move people to more expensive plans. BCBS may have decided to change things of their own accord. They may have decided to charge you more because you got older. They may have decided to charge you more because your individual market risk pool was so small. They may have decided to charge you more because your alternative was to get an ACA-compliant plan (which costs more because it covers more).
All of those are probably true, but the last one, they raised my premium so I would move to the ACA where they would get even more money because of the subsidy, sticks with me.
As to, (which costs more because it covers more), my policy covers 100% after the 10k deductible, except for mental health and sustance abuse and a limit on ambulace service.
Employers have been dropping health insurance coverage for the past couple decades because health care costs so much. I'm sure this will continue even with the ACA. Fortunately, workers without job-based coverage can get covered through the Marketplace now.
Just be sure to note that health insurance was available before the Market place, I've been buying it for at 30 years.
The ACA was primarily paid for by overpaying less to private insurers for Medicare Advantage plans. They were paying private insurers something like 15-20% (forget the exact number) more per person for Medicare Advantage plans as compared to the cost of traditional Medicare. Now they overpay them less than before, which saves about $70 billion per year. More than the tax credits cost.
Don't have any information about that, but if the government is paying I'm sure there is waste.
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I'm telling you that you had a grandfathered policy (from pre-ACA) and there was almost nothing that changed for grandfathered individual market policies. That's why they were "grandfathered" because you could keep them almost entirely the way it was.
Yes, I do have a grandfathered policy. You did qualify your response with "almost nothing" and "almost entirely". So I guess you do realize the even my grandfathered policy had changes because of Obamacare. I don't know them all, but I now get a free physical each year, but I pay heavily for that. I get a free colonoscopy every 5 years, but I pay heavily for that. I now have unlimited lifetime cost cap, it was capped at 5 million, but I pay heavily for that. I have some additional mental health care coverage, but I pay heavily for that. I think there was some additional sustance abuse coverage also. So I got a lot of free stuff, but I'm charged for it.
Some insurers decided to stop offering them for business reasons. Some insurers used the ACA as a dishonest excuse to move people to more expensive plans. BCBS may have decided to change things of their own accord. They may have decided to charge you more because you got older. They may have decided to charge you more because your individual market risk pool was so small. They may have decided to charge you more because your alternative was to get an ACA-compliant plan (which costs more because it covers more).
All of those are probably true, but the last one, they raised my premium so I would move to the ACA where they would get even more money because of the subsidy, sticks with me.
As to, (which costs more because it covers more), my policy covers 100% after the 10k deductible, except for mental health and sustance abuse and a limit on ambulace service.
Employers have been dropping health insurance coverage for the past couple decades because health care costs so much. I'm sure this will continue even with the ACA. Fortunately, workers without job-based coverage can get covered through the Marketplace now.
Just be sure to note that health insurance was available before the Market place, I've been buying it for at 30 years.
The ACA was primarily paid for by overpaying less to private insurers for Medicare Advantage plans. They were paying private insurers something like 15-20% (forget the exact number) more per person for Medicare Advantage plans as compared to the cost of traditional Medicare. Now they overpay them less than before, which saves about $70 billion per year. More than the tax credits cost.
Don't have any information about that, but if the government is paying I'm sure there is waste.
If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention. Before the Marketplace, many people could not by any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc. It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.
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Your statements in bold directly contradict each other.
I have not went on Obamacare, my doctor doesn't accept it
and
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
I don't see the confusion, I have not bought an Obamacare policy, I have looked on the Healthcare.Gov website, the cost of a policy equivalent to the $7,752 policy I have now, is $13,500. Same company. Why? Who gets the extra money? For what?
My point was that it can't be an equivalent policy - if nothing else, your doctor doesn't accept it and therefore it's not the same policy. The fact that the price is so different I think also indicates they're not equivalent. I can't give you more details than that because I don't have the information, but I'm sure that you'd find differences when you looked at the actual plan documents.
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You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
Where is the 10-20% figure from?
When my dentist charges $290 for a regular teeth cleaning, but offers it year-round at a special discounted price of $59, it makes me inclined to believe that their profit margins, at a MSRP of $290, are much much higher than 20%.
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However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
Actually, pharmaceutical companies have the highest profit margin in the health care industry (more like 20-30%). Another problem is outrageous executive compensation, which gets subtracted from revenue before earnings are calculated. Total executive compensation at the big 5 pharma companies ranges $38 - $66 million.
http://www.forbes.com/sites/danmunro/2015/05/26/pharma-trumps-all-healthcare-sectors-in-executive-compensation/ (http://www.forbes.com/sites/danmunro/2015/05/26/pharma-trumps-all-healthcare-sectors-in-executive-compensation/)
Branded pharma companies have profit margins that high, yes. But generic pharmaceuticals are sold at much lower margins, and account for 84% of all drugs sold in the US.
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You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
Where is the 10-20% figure from?
When my dentist charges $290 for a regular teeth cleaning, but offers it year-round at a special discounted price of $59, it makes me inclined to believe that their profit margins, at a MSRP of $290, are much much higher than 20%.
It was an estimate - as Monkey Uncle pointed out, branded non-generic pharma companies can have 30% profit margins, but generics have much lower margins, and account for the vast majority of drugs sold in the US and worldwide.
I'm not sure what relevance your teeth cleaning cost has on pharma profit margins.
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If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention.
It may have been optional, but it's a moot point, it wasn't optional for me.
Before the Marketplace, many people could not buy any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc.
I'm sure that's true of some, but many, have their new car, eat out three times a week, take a two week vacation, buy coffee at the mall, and buy their kids the latest electronics, but they can't afford insurance.
It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.
I suggest that is just ignorance if they bought a policy that didn't fit their need.
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If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention.
It may have been optional, but it's a moot point, it wasn't optional for me.
Before the Marketplace, many people could not buy any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc.
I'm sure that's true of some, but many, have their new car, eat out three times a week, take a two week vacation, buy coffee at the mall, and buy their kids the latest electronics, but they can't afford insurance.
It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.
I suggest that is just ignorance if they bought a policy that didn't fit their need.
You asserted the changes to your policy were because the ACA required them. I was pointing out that this assertion is incorrect. Your costs went up because BCBS decided that they should.
Pre-ACA, you were only able to purchase whatever an insurance company said you could purchase, and the benefits were very limited. This point is not related to whether someone was good with their money otherwise. Or someone's ability to understand what they were buying. Before the law was passed, the comprehensive coverage available post-ACA was not available to many, regardless of the price or their intelligence.
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Your statements in bold directly contradict each other.
I have not went on Obamacare, my doctor doesn't accept it
and
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
I don't see the confusion, I have not bought an Obamacare policy, I have looked on the Healthcare.Gov website, the cost of a policy equivalent to the $7,752 policy I have now, is $13,500. Same company. Why? Who gets the extra money? For what?
My point was that it can't be an equivalent policy - if nothing else, your doctor doesn't accept it and therefore it's not the same policy. The fact that the price is so different I think also indicates they're not equivalent. I can't give you more details than that because I don't have the information, but I'm sure that you'd find differences when you looked at the actual plan documents.
Equivalent in that once I pay my deductible, everything is 100% covered. Except, mental healthcare, substance abuse and ambulance
have additional costs.
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Your statements in bold directly contradict each other.
I have not went on Obamacare, my doctor doesn't accept it
and
Why should an ACA policy cost $13,500 when an equivalent private policy from the same company costs me $7,752.
I don't see the confusion, I have not bought an Obamacare policy, I have looked on the Healthcare.Gov website, the cost of a policy equivalent to the $7,752 policy I have now, is $13,500. Same company. Why? Who gets the extra money? For what?
My point was that it can't be an equivalent policy - if nothing else, your doctor doesn't accept it and therefore it's not the same policy. The fact that the price is so different I think also indicates they're not equivalent. I can't give you more details than that because I don't have the information, but I'm sure that you'd find differences when you looked at the actual plan documents.
Equivalent in that once I pay my deductible, everything is 100% covered. Except, mental healthcare, substance abuse and ambulance
have additional costs.
And your doctor doesn't accept it. Thus, it's not the same policy.
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I'm telling you that you had a grandfathered policy (from pre-ACA) and there was almost nothing that changed for grandfathered individual market policies. That's why they were "grandfathered" because you could keep them almost entirely the way it was.
Yes, I do have a grandfathered policy. You did qualify your response with "almost nothing" and "almost entirely". So I guess you do realize the even my grandfathered policy had changes because of Obamacare. I don't know them all, but I now get a free physical each year, but I pay heavily for that. I get a free colonoscopy every 5 years, but I pay heavily for that. I now have unlimited lifetime cost cap, it was capped at 5 million, but I pay heavily for that. I have some additional mental health care coverage, but I pay heavily for that. I think there was some additional sustance abuse coverage also. So I got a lot of free stuff, but I'm charged for it.
Some insurers decided to stop offering them for business reasons. Some insurers used the ACA as a dishonest excuse to move people to more expensive plans. BCBS may have decided to change things of their own accord. They may have decided to charge you more because you got older. They may have decided to charge you more because your individual market risk pool was so small. They may have decided to charge you more because your alternative was to get an ACA-compliant plan (which costs more because it covers more).
All of those are probably true, but the last one, they raised my premium so I would move to the ACA where they would get even more money because of the subsidy, sticks with me.
As to, (which costs more because it covers more), my policy covers 100% after the 10k deductible, except for mental health and sustance abuse and a limit on ambulace service.
Employers have been dropping health insurance coverage for the past couple decades because health care costs so much. I'm sure this will continue even with the ACA. Fortunately, workers without job-based coverage can get covered through the Marketplace now.
Just be sure to note that health insurance was available before the Market place, I've been buying it for at 30 years.
The ACA was primarily paid for by overpaying less to private insurers for Medicare Advantage plans. They were paying private insurers something like 15-20% (forget the exact number) more per person for Medicare Advantage plans as compared to the cost of traditional Medicare. Now they overpay them less than before, which saves about $70 billion per year. More than the tax credits cost.
Don't have any information about that, but if the government is paying I'm sure there is waste.
It was available for you, it was not available for all Americans.
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You just made an argument for the ACA - that everyone should have insurance that covers essentials like epipens.
However, you shouldn't ask a question (even rhetorical) and then just disregard the answer. You might think that drugs are hyperinflated, but if you completely removed profits from drug companies you'd only reduce prices by 10-20% (removing superfluous advertising would add a bit more). And then you wouldn't have any new drugs because no one would bring them to market. Projekt provided a link that discusses other ways to pay for research and development of new drugs, but that just shifts the cost - instead of paying an extra 20% on current drugs to fund research, maybe your taxes would go up a corresponding amount to fund research.
Where is the 10-20% figure from?
When my dentist charges $290 for a regular teeth cleaning, but offers it year-round at a special discounted price of $59, it makes me inclined to believe that their profit margins, at a MSRP of $290, are much much higher than 20%.
It was an estimate - as Monkey Uncle pointed out, branded non-generic pharma companies can have 30% profit margins, but generics have much lower margins, and account for the vast majority of drugs sold in the US and worldwide.
I'm not sure what relevance your teeth cleaning cost has on pharma profit margins.
I'm lumping the ridiculousness that is the American medical system all together.
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I'm not sure what relevance your teeth cleaning cost has on pharma profit margins.
I'm lumping the ridiculousness that is the American medical system all together.
So no relevance at all to the discussion at hand. Got it.
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I'm not sure what relevance your teeth cleaning cost has on pharma profit margins.
I'm lumping the ridiculousness that is the American medical system all together.
So no relevance at all to the discussion at hand. Got it.
Actually it is relevant.
You are estimating that pharma companies profit 10-20% (apparently 30% for some and who knows how much for others).
I am estimating that based on what I've seen (the dentist example was the first thing that came to mind), I'm inclined to believe that the profits in the medical industry as a whole are much higher than 10-30%.
It's just my personal observation though, I could be wrong.
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I'm not sure what relevance your teeth cleaning cost has on pharma profit margins.
I'm lumping the ridiculousness that is the American medical system all together.
So no relevance at all to the discussion at hand. Got it.
Actually it is relevant.
You are estimating that pharma companies profit 10-20% (apparently 30% for some and who knows how much for others).
I am estimating that based on what I've seen (the dentist example was the first thing that came to mind), I'm inclined to believe that the profits in the medical industry as a whole are much higher than 10-30%.
It's just my personal observation though, I could be wrong.
If you think that one anecdote about discounting at a dentist is at all relevant to the profit margins of pharma, or provides any pedagogical value to the larger question of profits in the medical industry, then this conversation isn't going anywhere.
I will point out, though, that total US drug sales are about $300 billion. The total US spending on health care is something like $3 trillion. So even if all drugs were free forever, the total savings to US consumers is a maximum of 10%.
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Ideologically I'm for a free market in medical care.
Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
But realistically, I realize this will never happen. So at least ACA is a step towards smart laws. Hopefully.
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It's because of the $$$. All that money we spend (about 16% of GDP) on healthcare is someone's income. Judging from other nations, about half of that or more is wasted. All those people are going to fight to keep their income from being cut in half.
This is a very real issue. While I would love to see the US have socialized medicine and get rid of for profit health insurance companies, I can't help to think about how many people are employed by health insurance companies. Blue Cross Blue Shield alone for example. There would be a very real crisis if all of those people were suddenly out of work.
I don't think socialized medicine would provide enough jobs to employ all those people. I'm not sure how we could make the transition without causing a huge economic issue from all of the suddenly unemployed people.
That's never stopped us from retiring entire industries before, or pushing for other industries to be outlawed. Nobody is going to be raising money for the homeless insurance adjusters or paper pushers outside your local grocery store.
I agree that a whole legion of unemployed health insurance agents need to be considered in any industry change, but that's not enough reason to not make a change.
I think about this same issues with tax experts. Think of all of the people inthe income tax industry who sell their expertise, and what happens to them in a flat tax scenario? I am in favor of flat tax, but I always hate to see acvountants screwed over. Insurance agents, not so much.
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Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
Perhaps prices would be less. Your private health care cost is double that of other countries with government paid health care, many of which have a higher standard of care.
This has been pointed out several times already, yet some just can't be convinced.
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Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
Perhaps prices would be less. Your private health care cost is double that of other countries with government paid health care, many of which have a higher standard of care.
When was the last time health care was truly a free market? I don't know. Probably not in the last 60-100 years? Medical technology has come a long way in that time.
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Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
Perhaps prices would be less. Your private health care cost is double that of other countries with government paid health care, many of which have a higher standard of care.
When was the last time health care was truly a free market? I don't know. Probably not in the last 60-100 years? Medical technology has come a long way in that time.
Well, it's much more "free" here than basically every other industrialized country, and it sucks. I would, as a person who holds himself to a libertarian-ish standard for personal resposibility, love to see a true free market for healthcare. But I also know that in reality,
A) it's politically impossible. Nobody likes to see a pregnant lady/handicapped veteran/child die because she can't pay, or worse because she's unconscious and nobody can figure out who she is/if she's insured quickly. See my earlier posts about EMTALA.
B) It would require some way of ensuring very transparent information for all parties on costs/benefits/outcomes. There is currently no such thing (and it's unlikely there ever will be) and as such consumers of health care can't really negotiate on an equal footing.
-W
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Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
Perhaps prices would be less. Your private health care cost is double that of other countries with government paid health care, many of which have a higher standard of care.
When was the last time health care was truly a free market? I don't know. Probably not in the last 60-100 years? Medical technology has come a long way in that time.
Health care cannot be a properly functioning free market. For a properly functioning free market you need things like full transparency of current pricing to everyone. You also need fully informed participants on both sides of the transaction. There's no way (in most cases) you are going to know as much about your healthcare needs as the physician does. Healthcare market failure is the reason why we have the situation we have now.
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I will add the current model of insurance-driven payments could never be a truly free market option. When insurance companies view their purpose as generating returns for their owners, patients become liabilities and their treatments are costs that offset the revenue from premiums. In particular, for-profit insurers in a radically free market have every incentive to delay and deny payment for as long as possible to ensure the greatest return per client. In the pre-ACA market that allowed recision, retroactive cancellations and pre-existing condition exclusions, this was the practice of companies that placed the bottom line over basic ethics.
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Speaking of ACA - does it make a sticky thread for those of us in US and are considering FIRE? links to definitions (MAGI, federal poverty level by family size, list of States with expanded Medicare ,etc.) I think gootofgood have an excellent post on it but I am not sure who else is tracking this or how easy it is to reference http://rootofgood.com/affordable-care-act-subsidy/
what do you think?
Mod note: put something together and we'll take a look. As of now no informative thread exists to sticky.
I started a thread that could serve this purpose. I'll add more to it as I have time or think of important things to know. Feel free to submit your questions.
http://forum.mrmoneymustache.com/welcome-to-the-forum/information-on-the-affordable-care-act-with-a-focus-on-early-retirees/
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Just about every industry I can think of that doesn't have massive government involvement, efficiency goes up and costs go down over time. I wonder where medical prices would be if the government had it's hands out of it. (Same thing applies to education, and more recently housing.)
Perhaps prices would be less. Your private health care cost is double that of other countries with government paid health care, many of which have a higher standard of care.
When was the last time health care was truly a free market? I don't know. Probably not in the last 60-100 years? Medical technology has come a long way in that time.
Well, it's much more "free" here than basically every other industrialized country, and it sucks. I would, as a person who holds himself to a libertarian-ish standard for personal resposibility, love to see a true free market for healthcare. But I also know that in reality,
A) it's politically impossible. Nobody likes to see a pregnant lady/handicapped veteran/child die because she can't pay, or worse because she's unconscious and nobody can figure out who she is/if she's insured quickly. See my earlier posts about EMTALA.
B) It would require some way of ensuring very transparent information for all parties on costs/benefits/outcomes. There is currently no such thing (and it's unlikely there ever will be) and as such consumers of health care can't really negotiate on an equal footing.
-W
I agree completely. I think it's -possible- to solve problem B, but we all can agree it's not going to happen.
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Speaking of ACA - does it make a sticky thread for those of us in US and are considering FIRE? links to definitions (MAGI, federal poverty level by family size, list of States with expanded Medicare ,etc.) I think gootofgood have an excellent post on it but I am not sure who else is tracking this or how easy it is to reference http://rootofgood.com/affordable-care-act-subsidy/
what do you think?
Mod note: put something together and we'll take a look. As of now no informative thread exists to sticky.
I started a thread that could serve this purpose. I'll add more to it as I have time or think of important things to know. Feel free to submit your questions.
http://forum.mrmoneymustache.com/welcome-to-the-forum/information-on-the-affordable-care-act-with-a-focus-on-early-retirees/
How very timely. I was just thinking of posting a question related to this. Thanks, Forummm!
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Regarding the poster with the $59 dental cleaning special - that is very likely a loss leader. Get a new patient in, they are more likely to come back. Attorneys offer free consultations for this very reason. It is also why we accept some legal insurance plans. We will absolutely lose money on some of the cases but make it back up when that person gets in a car accident and hires us as their personal injury lawyer. That's how groupon and all those other social networking coupon things work.
As for free market healthcare - my problem with it is health care is generally a need not a want. I take medication because I need it, not because it is fun. If I lost my insurance, I would continue taking it so long as I could afford to pay for it. If I stopped taking it, it isn't because I decided the cost wasn't worth it. It is because I decided it was more important to feed my family and pay my mortgage - to the major detriment to my health. It's not really a choice if you will.
One plan I heard about that does work on free market principals is where the insurance company shares with the insured when they save the company money. If two pharmacies are in network and one is $50 cheaper than the other, and you show them you did your homework and switched, they give you 50% of the savings. That same program was also sharing with the insured when they caught and reported medical billing errors.
I will admit that for my uninsured pet meds, I call around and go to the cheapest pharmacy. For my meds, I go to the most convenient one either right next to my house or work. If it was easier to get the answer though, I'd consider going to the cheaper one. There is no quick online database and some pharmacies won't even give you a quote over the phone unless they have your prescription in their system. It's ridiculous.
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Regarding the poster with the $59 dental cleaning special - that is very likely a loss leader. Get a new patient in, they are more likely to come back. Attorneys offer free consultations for this very reason. It is also why we accept some legal insurance plans. We will absolutely lose money on some of the cases but make it back up when that person gets in a car accident and hires us as their personal injury lawyer. That's how groupon and all those other social networking coupon things work.
I doubt they are straight up losing money on it, but I can believe that it's a "loss leader."
What I mean by that is if I'm a dentist I (generally) own my own practice. I buy a building, equipment, etc. Most of my costs are going to be fixed. Regardless of how many patients I have it's going to cost me $X per month to keep this place open.
There are a few costs, however, that are variable. The hygienists, front desk lady, power to run the equipment, etc. Do I think that those cost $118 per chair per hour (I'm assuming two cleanings an hour)? Doubtful, so it's better to have someone paying $59 in the chair then it being empty, but I'm betting he won't be able to afford his overhead (and pay himself) on only $59 per cleaning, which is why it costs the regular patients $250.
Edit: Bottom Line is that most costs for stuff in the medical field are fixed. They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)
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One plan I heard about that does work on free market principals is where the insurance company shares with the insured when they save the company money. If two pharmacies are in network and one is $50 cheaper than the other, and you show them you did your homework and switched, they give you 50% of the savings. That same program was also sharing with the insured when they caught and reported medical billing errors.
Nice idea. But limited in possible scope. As a patient you 1) generally don't know what your choices are for anything that's expensive and 2) generally don't have pricing info for those choices. It might be easy to pick a cheaper pharmacy. But the pharmacy costs are all pretty close to each other. It's the multi thousand dollar tests and surgeries that rack up the bucks. And you have no idea what those will cost in advance. Even an estimate from your insurance company or the provider is often substantially wrong. And you are probably more worried about which is the best doctor to do the surgery, or are incapacitated and can't make the choice (say if it's an emergency).
The movement towards patient directed care is very fraught with these complications and limitations.
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Edit: Bottom Line is that most costs for stuff in the medical field are fixed. They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)
Isn't the overhead supposed to be covered by what they charge for the hospital room itself? But I think you're on to something about the overhead in the US health care system, which is far higher than anywhere else in the developed world. Part of that is due to the ridiculous complexity in our system, which tends to create positions that don't exist in single-payer systems. But a big part of it is that administrators and executives in the medical business are very highly compensated. I.e., they're gouging us because they can. Why? To pay themselves a lot of money.
http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0 (http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0)
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Edit: Bottom Line is that most costs for stuff in the medical field are fixed. They charge you $50 for a Band-Aid, not because the Band-Aid costs $50, but because the overhead for that Band-Aid costs $50. (The nurse that puts it on, the front desk staff, the back office staff purchasing the Band-Aid, etc.)
Isn't the overhead supposed to be covered by what they charge for the hospital room itself? But I think you're on to something about the overhead in the US health care system, which is far higher than anywhere else in the developed world. Part of that is due to the ridiculous complexity in our system, which tends to create positions that don't exist in single-payer systems. But a big part of it is that administrators and executives in the medical business are very highly compensated. I.e., they're gouging us because they can. Why? To pay themselves a lot of money.
http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0 (http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0)
Yeah, the overhead for the band-aid doesn't cost $50. That's just what they are trying to get away with charging. Because they can. The charges on their chargemaster are literally just made up. Totally pretend numbers. If you look at the Medicare rates for stuff, it includes no allowances for $50 band-aids and other BS like that. It's a bundled payment for the procedure and the stay. And it will be much less than a private insurer pays. And much, much less than what an uninsured person would be billed. But the hospital *makes money* from the Medicare bill. Hospitals advertise for Medicare patients in Florida. Clearly it's profitable. They just make much more money from everyone else.
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Hospital chargemasters inflate the overall numbers and then when insurance, Medicare and Medicaid come in to actually pay they have t make the adjustments. Go look at the audited financials for a hospital and you'll see a line item for "Gross Patient Service Revenue" followed by a significant adjustment that reflects the negotiated payments of insurance and mandated payments of Medicare and Medicaid. Those who have to pay full price (the uninsured) eventually pay a fraction of what they are charged as well and that is reflected a bad debt write-off. The accounting of hospitals is one of those flags that show exactly how messed up healthcare was and still is.
The dysfunction of pre-ACA healthcare has severely altered the operations of insurers, hospitals, pharmaceuticals, doctors and patients. The mix of adverse incentives to seeking treatment and perverse incentives to deny critical care are deeply engrained in our system and any reform package is going to be incredibly difficult to write and enact because there are guaranteed to be winners and losers in the change.
The deep systemic problems of our healthcare is why the GOP has struggled to actually provide an alternative for the ACA they hate so much. There are no simple fixes that can be explained in less than 10 words and compromises have to be made to make sure one reform doesn't destroy the entire system. For example, getting rid of pre-existing condition exclusions on its own could drive up prices since people won't seek insurance until they need it (after the diagnosis) so to keep the prices relatively stable there has to be a mandate for everyone to buy insurance so the actuarial pool has more healthy people than unhealthy people. You can't get rid of something people don't like (mandates) without getting rid of something they love (pre-existing condition protection)
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My point was that it can't be an equivalent policy - if nothing else, your doctor doesn't accept it and therefore it's not the same policy. The fact that the price is so different I think also indicates they're not equivalent. I can't give you more details than that because I don't have the information, but I'm sure that you'd find differences when you looked at the actual plan documents.
Equivalent in that once I pay my deductible, everything is 100% covered. Except, mental healthcare, substance abuse and ambulance
have additional costs.
[/quote]
And your doctor doesn't accept it. Thus, it's not the same policy.
[/quote]
I didn't say it was the same policy I said it was equivalent.
Both policies do the same, they pay 100% after I pay my deductible. (A few minor exceptions)
Now, I have no idea what the reimbursment rates to the doctors are. I suspect they are less
and that is why my doctor (and many others) don't accept ACA policies.
This is another reason that the higher cost for an ACA policy seems wrong. (lower reimbursment)
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I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.
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I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.
Congratulations, it essentially does just that. The ACA actually decreases the deficit by using Medicare dollars more efficiently (over-paying private Medicare Advantage plans by less--but still overpaying), penalties for those who have affordable coverage available but choose not to buy, a small tax on medical device manufacturers (an insanely profitable industry), and extending the Medicare tax to higher income household investment income.
And the Cadillac tax. Well, not so much. That is estimated to only bring in about $5 billion per year when it starts in 2018 because hardly anyone is affected by it, and those who are affected are affected very little. Anyone significantly worried about it may not understand what it actually is. It's a 40% tax on the employer's cost of the plan that's above a very high threshold ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). So if your individual coverage plan costs $10,300 (an incredibly expensive plan), the tax would be $40 for the year ($10,300 - $10,200 * 40%). My plan costs something like $6k/year and has no deductible, a huge nationwide network, is going to cost us just a few hundred dollars to have a baby, etc. So a plan over $10k is a really lavish plan.
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99
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I am all for health insurance for everyone.
My concern is the cost will be drawn from those who have employee provided insurance.
My employer is already bracing itself for the "Cadillac tax" which will, most likely, be passed on to us, the employee through increased share of premiums.
My other concern is that insurance companies have already asked for premium increases to cover the expenses of the very sick people the ACA covers. A cost that will be passed on to me as well.
Great plan, I just wish the Govt. could pay for the ACA with the tax dollars I already give them.
Congratulations, it essentially does just that. The ACA actually decreases the deficit by using Medicare dollars more efficiently (over-paying private Medicare Advantage plans by less--but still overpaying), penalties for those who have affordable coverage available but choose not to buy, a small tax on medical device manufacturers (an insanely profitable industry), and extending the Medicare tax to higher income household investment income.
And the Cadillac tax. Well, not so much. That is estimated to only bring in about $5 billion per year when it starts in 2018 because hardly anyone is affected by it, and those who are affected are affected very little. Anyone significantly worried about it may not understand what it actually is. It's a 40% tax on the employer's cost of the plan that's above a very high threshold ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). So if your individual coverage plan costs $10,300 (an incredibly expensive plan), the tax would be $40 for the year ($10,300 - $10,200 * 40%). My plan costs something like $6k/year and has no deductible, a huge nationwide network, is going to cost us just a few hundred dollars to have a baby, etc. So a plan over $10k is a really lavish plan.
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=99
i guess I will see what happens in 2018. I like my Kaiser for me and my wife at $13.00 per 2 week pay period. I sure would like to keep it that way
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I guess I will see what happens in 2018. I like my Kaiser for me and my wife at $13.00 per 2 week pay period. I sure would like to keep it that way
Do I have that right $312 a year?
I'm at $8,448 a year for a family of 3.
No pregnancy, no preexcisting, $10,000 deductible.
Ages 60, 55, 22.
Then again, an Obamacare policy is $13,508.
Almost enough to make me want to retire, so I can
let the system subsidize me!
Against all my conservative values though.
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I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)
I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.
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I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)
I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.
Well if it's $1k/mo, then you must be making at least $130k/year. $1k isn't so bad for a large income like that (at least 2.5 x the national average). It's not "cheap", but you could "afford" it.
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I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)
I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.
how much domyou think that you should pay?
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I've been thinking of leaving the corp world and starting my own business. Then I priced out what I'd need to get a lot worse insurance than I currently have for my family and I. $1k a month. Affordable care my ass. :)
I'll have to wait till my wife can go back to work and get a job with decent employer subsidized healthcare, then I can stop working for the man. Our healthcare system is a joke in many ways, a national embarrassment.
Well if it's $1k/mo, then you must be making at least $130k/year. $1k isn't so bad for a large income like that (at least 2.5 x the national average). It's not "cheap", but you could "afford" it.
And it is better than not being able to get any at all.
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This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:
Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?
In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.
It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.
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This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:
Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?
In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.
It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.
Given that you are not paying $140 because your employer is paying the rest, yes that amount seems reasonable.
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This forum could use an easy multi quote. :) To answer the comments, and take this more as a frustrated rant rather than a debate:
Yes, income is above $130k currently. Does that make that number (which is for a high deductible plan BTW) any less batshit crazy? Does it make any kind of sense to try to launch a business with that hanging over your head and possibly sucking you dry every month? Especially considering I could work a day job without having to drum up customers, do my own financials and processes, pay more self employment tax and only pay $140/month for much better coverage? Is this how we as Americans want the deck stacked?
In terms of how much I think I should pay, can I answer that with a real life tale of healthcare from another country? I took a trip with my wife and kid back to the old country. A few days before our son gets some kind of weird cold thing that gets really bad on the flight over with his mouth stinking, fever, vomiting, etc. Bad stuff, we get off the plane and have to go to the pediatric ER. I'm cursing my luck knowing this is gonna cost me $1k+ like it would in the US. It was $40, and BTW just as professional, maybe moreso, than in the states. I've also gotten dental work done over there, and it's exactly the same quality and experience wise as here. Except I paid $120 for a root canal, filling and tooth extraction instead of what would surely have been over $1k here. Yes I have bad luck on trips, FML. This is the former eastern bloc FFS, and we can't get our shit together in the US of A???? To answer the original question, a lot f'in less.
It seems we're at the point where it's such a disaster than any small bandaid to the massively screwed system is met with a resigned, "Oh well, it could be a little bit worse." As a drill instructor friend of mine was very fond of saying: Unsat.
The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much. And is worse IMO than what the other industrialized nations have. I think we should have just moved to "Medicare for all" and paid for it however (there are many ways to pay for it). Medicare would be much, much cheaper than the private system we have now. And it would be uniform around the nation so it would save people a lot of confusion and worry about being balance billed with astronomical (and made up) charges (like $20 bandaids at a hospital) and all the other unacceptable crap we have to put up with by having this hodge podge of payers. And Medicare itself could more easily continue to drive down the cost of care through coordinated innovation programs like they are in the process of doing now (via ACA). But that was never on the table because of the lobbying power of the industry that likes to continue to leech off of the rest of us and provide no value.
One of the good things the ACA does is to adjust the cost of your health insurance to correspond with your income. It actually makes it much easier to start your own business. For one, because you can actually get insurance on your own. And that insurance has to cover your kid's and your wife's health problems now--when before it would explicitly exclude coverage for them. So not only can you get care, but it's de facto affordable for you. If your small business is struggling and you only make $50k the first year, the tax credit will mean that you may only be paying a $100/mo for a low-deductible plan depending on your family size. But if you are successful at the $150k level, it might be $1k/mo for the plan because you can afford that.
If you're paying $140/mo for you insurance via work, your employer is paying something like $1k/mo for you. That money is coming from the salary they would otherwise be paying you if health care cost something more reasonable in this country.
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I agree that we should have put everyone on Medicare. The first year we retired & just collected our pensions we had to pay $10,000/year for health insurance from my former employer when we only made $40,000. Now they we both consult p.t. our income is up to around $70,000 so paying that much is a lot easier to swallow. Because my hubby is 5 years younger then me even when I go on Medicare we will continue to be [ripped off] by the state because even with me off it only goes down by 200/month & then I will need to buy a supplement. So no break in health insurance costs until I am 70. Most other countries have accomplished what we can't seem too. My DIL is from Poland & she gets all her good quality cheap care when she goes back home.
[MOD EDIT - please use another metaphor, thank you]
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The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much.
Yes, the ACA has rewarded the health insurance industry, the Health Care Select Sector SPDR ETF (XLV)
is up 113% since ACA regs started in 2012.
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The cost of care in the US is crazy high. Almost no one disagrees with that. The ACA is an improvement on the terrible system we had. So it's now much less terrible but still the system costs too much.
Yes, the ACA has rewarded the health insurance industry, the Health Care Select Sector SPDR ETF (XLV)
is up 113% since ACA regs started in 2012.
And since correlation always equals causation, I guess there's nothing else to be said.
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If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention. Before the Marketplace, many people could not by any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc. It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.
Yes, I have a grandfather policy.
it was entirely optional for your plan to add all the preventive care you mention.
Yes, you are correct, I can only find a few things that were mandatory.
The preventive healthcare was not one of them.
These are the mandated items as I find them.
Insurers cannot place lifetime limits on coverage for plans (i.e., plans cannot set a
maximum they will cover on a person over the life of the insurance plan).
Plans cannot deny coverage for a patient due to illness or unintentional mistakes on
insurance applications.
Dependents under 26 years of age who do not have insurance coverage can be
included on the employer plan of their parent(s).
Insurers cannot deny coverage to minors with pre-existing conditions.
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Was going to start a thread, but this is probably a better place to ask.
We are planning on sponsoring my mother in law for citizenship in the near future. She is 58 yrs old, and has a reasonable nest egg in retirement accounts. We will be taking care of her financially above what she can afford, but I am worried mostly about health insurance.
From my limited research, she would not be eligible for medicaid as a new immigrant. She will most likely gift us a good chunk of her savings before, so when she is here she will have no income. This is where I am confused. If you are below the federal poverty level (which 0 most certainly will be), then medicaid is how you insure, correct?
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If you have a grandfathered policy, it was entirely optional for your plan to add all the preventive care you mention. Before the Marketplace, many people could not by any "real" coverage because of pre-existing conditions, annual limits, lifetime limits, recissions, etc. It looked like insurance, but wasn't really truly insurance in many cases if you needed to actually use it for anything substantive.
Yes, I have a grandfather policy.
it was entirely optional for your plan to add all the preventive care you mention.
Yes, you are correct, I can only find a few things that were mandatory.
The preventive healthcare was not one of them.
These are the mandated items as I find them.
Insurers cannot place lifetime limits on coverage for plans (i.e., plans cannot set a
maximum they will cover on a person over the life of the insurance plan).
Plans cannot deny coverage for a patient due to illness or unintentional mistakes on
insurance applications.
Dependents under 26 years of age who do not have insurance coverage can be
included on the employer plan of their parent(s).
Insurers cannot deny coverage to minors with pre-existing conditions.
Yes, those are the 4 things that changed for grandfathered individual market policies.
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My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA insurance but does not get any $ off based on their incomes because she has a green card.
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My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA insurance but does not get any $ off based on their incomes because she has a green card.
Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.
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I agree that we should have put everyone on Medicare. The first year we retired & just collected our pensions we had to pay $10,000/year for health insurance from my former employer when we only made $40,000. Now they we both consult p.t. our income is up to around $70,000 so paying that much is a lot easier to swallow. Because my hubby is 5 years younger then me even when I go on Medicare we will continue to be [------] by the state because even with me off it only goes down by 200/month & then I will need to buy a supplement. So no break in health insurance costs until I am 70. Most other countries have accomplished what we can't seem too. My DIL is from Poland & she gets all her good quality cheap care when she goes back home.
"------ by the state?" [MOD NOTE: No kidding]
ok.
You can afford it, you have it, and I assume it works decently. That's a pretty sweet place to be, but ok.
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My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA insurance but does not get any $ off based on their incomes because she has a green card.
Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.
So my MIL would be able to buy a plan on the exchange with a subsidy if she doesn't have any income?
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My DIL is Polish & before she could get her fiancee visa we had to sign that we could support her if need be. She can't get Medicaid but can buy ACA insurance but does not get any $ off based on their incomes because she has a green card.
Non-citizen legal residents with incomes in the 0%-400% of FPL ranges who don't qualify for Medicaid are eligible for premium tax credits. There's a special provision for legal residents because they don't always qualify for Medicaid that extends the tax credits to 0% FPL.
So my MIL would be able to buy a plan on the exchange with a subsidy if she doesn't have any income?
If she's a non-citizen legal resident who is ineligible for Medicaid, and ineligible for any other source of affordable health insurance, then most likely, yes.
https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
Lawfully present immigrants and Marketplace savings
If you’re a lawfully present immigrant, you can buy private health insurance on the Marketplace. You may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income.
•If your annual income is 400% of the federal poverty level or below: You may be eligible for premium tax credits and other savings on Marketplace insurance.
•If your annual household income is below 100% federal poverty level: If you’re not otherwise eligible for Medicaid you’ll be eligible for premium tax credits and other savings on Marketplace insurance, if you meet all other eligibility requirements.
https://www.healthcare.gov/blog/10-things-immigrant-families-need-to-know-about-the-marketplace/
https://www.healthcare.gov/immigrants/immigration-status/
https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
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Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.
IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't. It really, really isn't.]
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Not surprised at all that your family has gotten wrong information with regards to immigration status and ACA eligibility. I tried signing up the first time around through in excahnge (from October 2013 until January) and after hours on the phone it became clear that training the support staff to the intricacies of the immigration-related paperwork was a very distant afterthought.
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Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.
IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't. It really, really isn't.]
The call center staff are not experts. They just read scripts--like most other call centers. And they probably don't have a great script for this topic. They aren't even dedicated to healthcare.gov. The next call they get is probably about tires or something.
The links I posted above are accurate and if you fill out the online application you should have a correct result. If you don't, please PM me the details. I know someone who works there and can get it straightened out.
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Thanks forummm, very good info. I have just one more question that I can't seem to find.
When considering ACA subsidies, would my MIL apply by herself or would she be considered part of our household? I know that I have to sign an affidavit of support, but I am not sure about this question. This would obviously mean the difference between a significant subsidy and none as I believe as a household of 3 we would fall out of the income range.
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Also it seems like a reasonable option would be to pay her for childcare when we do have kids. Seems like you could plan the amount to get the maximum subsidy and eventually qualify for medicare.
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Perhaps my son & DIL were given wrong information but together they make $40,000 which qualifies them for a subsidy. However, they were told that only my son was eligible and not her.
IL: yes we can afford it now because we are choosing to keep working to supplement our pensions. However, once we quit working we would still pay a fourth of our gross income for health insurance. Yes that is being [MOD EDIT: Nope, it isn't. It really, really isn't.]
oh gee, I really did not intend to have your post moderated. That's a little heavy handed, I think. Sorry about that. (but moderators, do what you think best, I'm not challenging it.)
Back on topic, our outside income is $28,000 plus some change that DH will make this year in occasional jobs. We pay out $12,000 in health insurance. I'm ok with that, it was a conscious decision to retire early, I wasn't forced out. We do have income from investments but it varies from year to year, I never know how much it will be.
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Thanks forummm, very good info. I have just one more question that I can't seem to find.
When considering ACA subsidies, would my MIL apply by herself or would she be considered part of our household? I know that I have to sign an affidavit of support, but I am not sure about this question. This would obviously mean the difference between a significant subsidy and none as I believe as a household of 3 we would fall out of the income range.
It's based on how you file your taxes. I can't advise you on what's the right way for you to file your taxes (talk to a tax professional). But if you claim your MIL as a dependent, she's included in your household. If you don't, then she's not.
https://www.healthcare.gov/income-and-household-information/household-size/
Also it seems like a reasonable option would be to pay her for childcare when we do have kids. Seems like you could plan the amount to get the maximum subsidy and eventually qualify for medicare.
If money changes hands then SE tax is due. Include that in your thinking.
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Thanks! I can't even imagine how an immigrant would figure all this out.
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Thanks! I can't even imagine how an immigrant would figure all this out.
It's too complicated for even people with graduate degrees. I can't stand having to pick between plans at work--and they are all easy to get and have pretty clear premiums associated with them. The whole system has so much confusion and non-transparency built into it. Single payer would be worth it just to make everything easy to figure out. The potential to save $1 trillion per year is just a bonus :)
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Thanks! I can't even imagine how an immigrant would figure all this out.
It's selection bias at its finest: people who made it through the heaps of BS that immigration authorities have thrown at them to get here tend to have a much higher tolerance for bureaucratic nightmares and fact-finding missions.
Laws are not written with immigrants in mind, at all.
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Ya, after going through the process of getting my wife here, (first fiance visa, then residency) I can understand why so many ppl come here illegally. I bet I have spent 5k and spent many countless hours doing paperwork to get everything we needed.
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Ya, after going through the process of getting my wife here, (first fiance visa, then residency) I can understand why so many ppl come here illegally. I bet I have spent 5k and spent many countless hours doing paperwork to get everything we needed.
Most people come illegally because even if they did all this work, they still couldn't get in because of quotas or other barriers to legal immigration. Even if you are willing to spend money and do paperwork, you just can't get in if you're from a country where everyone wants to leave and come to the US.
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IL: I think that you are spending a ridiculous amount of $ for your healthcare too. I wasn't trying to offend people either. I guess I was insensitive and at least the mods have a sense of humor about it. It cost my son a lot of $ to get his fiancee here too. They were approved the first time but had proof that for 3 years they had been visiting each other in Europe so it was a real relationship. I think because of all the cheating in the past that is the reason that it is so difficult now to get fiancee visas & expensive.
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Ya, that was the strangest part. Having to create a timeline proof of our relationship. The thing that really bugged me was paying ~600 to send in a form, and have it take months to get approved. You would think for that kind of money they could do business in a timely fashion. LOL Gov't I guess.
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Ya, that was the strangest part. Having to create a timeline proof of our relationship. The thing that really bugged me was paying ~600 to send in a form, and have it take months to get approved. You would think for that kind of money they could do business in a timely fashion. LOL Gov't I guess.
Getting OT, but my wife and sister in law are from PL (Dzien dobry BTW!) and my wife did it the easy way. Green card lottery winner, next to nothing in terms of paperwork. Just waiting for enough time to pass and getting her citizenship. Sister not so much. She was on a J1 and fell in love. Got married and had to deal with the typical slog through the process. My memory of the timeline isn't perfect but it was under a decade to get citizenship the legal way. But not that much under a decade, lol!
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I'm staggered at the amount that people pay for insurance over there in the States. $1000+ a month, yet still with a $5000+ excess? That's just ridiculous.
I'll do a quick comparison to show that public healthcare isn't quite as bad as some of you lot think it is. Here in Australia universal healthcare was introduced in 1975. At the time, the average life expectancy from birth in Australia and the United States was about the same.
By 2011, the average Australian has a life expectancy of over three years longer than the average American. Sure, correlation doesn't mean causation, yada yada, but maybe just a little bit of that is due to our public healthcare system, which by the way costs us just over half as much as a percentage of GDP.
We have a private system as well as the public healthcare system (and private hospitals as well as public ones), and lots and lots of us have private insurance too (there's incentives via the tax system once your income is above a certain level). My health insurance is $110 a month which partially covers dental and optical and the like and covers my hospital visits (with a $500 excess), so I don't have to go on a waiting list for non-emergency surgery. Doctors visits are partially subsidised (and fully subsidised for some people), about half of a $70 doctors visit for me is subsidised. Many prescription medicines are partially subsidised too.
It's not perfect, but geez it's better than the clusterfuck the American system seems to be. I'm sure Obama would have liked to introduce something similar, but he wouldn't have been able to get it through.
Sources are as below, I didn't use Wikipedia. :)
http://www.cdc.gov/nchs/data/hus/2011/022.pdf
http://www.aga.gov.au/publications/life_tables_2005-07/downloads/australian_life_tables_2005-07.pdf
http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3105.0.65.001
http://www.cdc.gov/nchs/data/databriefs/db115.pdf
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
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I'm staggered at the amount that people pay for insurance over there in the States. $1000+ a month, yet still with a $5000+ excess? That's just ridiculous.
I'll do a quick comparison to show that public healthcare isn't quite as bad as some of you lot think it is.
Intelligent and educated people in the US know that the healthcare systems in other industrialized nations are far superior in many respects. But that doesn't stop jingoistic cries of "We have the best healthcare system in the world!!!!" from politicians and other dolts. We think we're the best at everything.
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Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
Yeah, you're ignoring the point I made earlier, that I bolded this time. Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/
Please notice that in your link, Norway and Luxembourg have higher GDP and substantially lower health care cost. The main difference between the Norwegian and Swedish health care (Sweden at 12th place, Norway at second place in the above mentioned wikipedia list), is the salary costs. A doctor might make more in the US, but we pay our cleaning staff, administrators, nursing aids etc substantially more. So I would guess you would end up closer to Sweden. I have talked to people who have tried the US health system, typically on holidays or while working a year or two in the US, and they say that the main difference is luxury: They get better food, nurses that have time to talk to them, freshly renovated rooms, etc. Also, a lot of time, doctors here will tell you to take a painkiller and see if it gets better by it self. MRIs, X-rays, and extended blood tests are reserved for when it doesn't get better. Antibiotics are strictly regulated, and only given if they are sure it is bacterial (and that it won't get better anywhy if you just wait a bit). There have been serious discussions the last years about how much money should be spent on treatments that only increase life span by a few months, or if there should be an age limit. It sounds horrid when you first hear it, but a lot of medical experts claim that a lot of the most expensive and intensive treatments for the sickest people only increase the length of time they are suffering.
I pay 8.2 % of my salary to the "Social security fund". This covers health care, unemployment, sick leave (1 year at 100 % pay, 3 years at 60 %), public pension, unemployment benefits (2 years at 60 %), etc. For most people, the cost of this is less than $500/month.
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Lastly, your estimate of the inefficiencies in US health care is way off. The total health care spending in the US is something like $3.0 trillion. If we paid the amount corresponding to our GDP in line with other countries (remember the US has a very high GDP and health care spending as a percentage of GDP goes up as a function of GDP) we'd save something like $600 billion or 20%.
http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?_r=0
I was scaling our ~$3 trillion expenditures down to a per capita level similar to other industrialized nations. We spend about twice as much per capita as many other industrialized nations. And about 1/2 of about $3 trillion is in the $1-1.5T ballpark. If we were to have a Japan or Finland level of expenditure we could maybe even save as much as $2T per year.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
Yeah, you're ignoring the point I made earlier, that I bolded this time. Here's a reference showing that we should be spending more than other OECD countries, because we're richer than other OECD countries: http://theincidentaleconomist.com/wordpress/sure-its-got-to-go-up-but-how-much/
Please notice that in your link, Norway and Luxembourg have higher GDP and substantially lower health care cost. The main difference between the Norwegian and Swedish health care (Sweden at 12th place, Norway at second place in the above mentioned wikipedia list), is the salary costs. A doctor might make more in the US, but we pay our cleaning staff, administrators, nursing aids etc substantially more. So I would guess you would end up closer to Sweden.
Yes, those data suggest that there's a point at which spending more on health care solely because you live in a wealthier country doesn't make sense. But that point is closer to Norway and Luxembourg, and not, say, Portugal or Poland. So you could argue that the US should be spending ~1/3 less on health care to bring it in line with the other richest countries in the world.
Also, a lot of time, doctors here will tell you to take a painkiller and see if it gets better by it self. MRIs, X-rays, and extended blood tests are reserved for when it doesn't get better. Antibiotics are strictly regulated, and only given if they are sure it is bacterial (and that it won't get better anywhy if you just wait a bit). There have been serious discussions the last years about how much money should be spent on treatments that only increase life span by a few months, or if there should be an age limit. It sounds horrid when you first hear it, but a lot of medical experts claim that a lot of the most expensive and intensive treatments for the sickest people only increase the length of time they are suffering.
I pay 8.2 % of my salary to the "Social security fund". This covers health care, unemployment, sick leave (1 year at 100 % pay, 3 years at 60 %), public pension, unemployment benefits (2 years at 60 %), etc. For most people, the cost of this is less than $500/month.
This is a great illustration of a philosophical difference in health care systems. Public health care systems are set up to reduce type 1 errors - that is, false positives. The US health care system, especially the most expensive private insurance plans, are set up to minimize type 2 errors - that is, false negatives. Reducing type 1 errors is much cheaper.
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Most European countries seem to realize that universal-single payor health care is the way to go. My DIL is from Poland & she gets all her health care very cheaply when she goes to visit & Poland is not a rich country.
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Most European countries seem to realize that universal-single payor health care is the way to go. My DIL is from Poland & she gets all her health care very cheaply when she goes to visit & Poland is not a rich country.
The main reason she gets her health care cheaply is because Poland is not a rich country. She probably also gets food, housing, and transportation pretty cheaply there too.
Which isn't to say that the US wouldn't reduce costs with a single-payer system (they would). But most of the difference between the cost of health care in Poland and the US is the relative cost of living.
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Poland is not cheap for the people that live there. Even though everything costs less then for us in the states they also make a lot less. My DIL does not live there but gets her medical care on visits home.
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The main reason she gets her health care cheaply is because Poland is not a rich country. She probably also gets food, housing, and transportation pretty cheaply there too.
Poland is not cheap for the people that live there. Even though everything costs less then for us in the states they also make a lot less. My DIL does not live there but gets her medical care on visits home.
Appears that you agree with each other on this.
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Poland is a beautiful country to visit & really cheap for Americans. They have their own currency so are not on the Euro. To give you an idea eating in a really, really fancy restaurant lasagna is 8 American dollars & Filet Mignon is 24 ( the most expensive thing on the menu). Duck was somewhere in the middle. I could live like a King if I retired there:))
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Poland is a beautiful country to visit & really cheap for Americans. They have their own currency so are not on the Euro. To give you an idea eating in a really, really fancy restaurant lasagna is 8 American dollars & Filet Mignon is 24 ( the most expensive thing on the menu). Duck was somewhere in the middle. I could live like a King if I retired there:))
How well could a person get around if they only spoke English?
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The main reason she gets her health care cheaply is because Poland is not a rich country. She probably also gets food, housing, and transportation pretty cheaply there too.
Poland is not cheap for the people that live there. Even though everything costs less then for us in the states they also make a lot less. My DIL does not live there but gets her medical care on visits home.
Appears that you agree with each other on this.
Yup! I was about to say that everything Cassie said fits with what I said, and vice versa.
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Not a ton of people in Poland speak English. Also the bigger the town the more likely to hear some English but in smaller towns not much at all. When we went to Italy many people spoke English but the cost of living was also much higher. Also I read that Polish is very difficult to learn. They like Americans. Both times we went with my son & DIL so not that big of an issue. Also when traveling without her she would tell us what buses to take, etc. If we got into a dilemma we would just call her.
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This is interesting. Looks like 3 separate studies, including one by a conservative think tank, are saying that the employer mandate to provide coverage has not had any appreciable effect on employment. There was a lot of political noise around this provision, but it looks like the dire warnings didn't come to pass.
President Obama's health-care reform hasn't meant less time on the job for American workers, according to three newly published studies that challenge one of the main arguments raised by critics of the Affordable Care Act.
One provision of the law, which is widely known as Obamacare, requires businesses with more than 50 employees to offer health insurance to those working at least 30 hours a week. That mandate took effect this year.
Republicans, and some Democrats, worried that employers would look for ways to get around the mandate, either by giving their employees fewer than 30 hours, or by hiring fewer people.
Either result would be bad for workers, one reason that Republican nominee Mitt Romney called Obamacare a "job-killer" during the last presidential campaign. Other Republicans issued similarly bleak warnings.
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So far, though, researchers say employers have not changed how they hire and schedule their workers in response to the law.
"The data, to date, basically say that that hasn't happened, at least on aggregate basis -- that there really hasn't been nearly the change that some people were expecting," said Chris Ryan, a vice president at the payroll-management firm ADP.
http://www.washingtonpost.com/news/wonkblog/wp/2015/08/12/no-obamacare-isnt-killing-full-time-jobs-new-evidence-shows/
I guess it's similar to where the economic theory would say that raising the minimum wage would decrease the supply of minimum wage employment, however in practice the evidence suggests that this is not the case in the real world (for levels similar to today's minimum wage).