Author Topic: What comes after the ACA?  (Read 386818 times)

Schaefer Light

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Re: What comes after the ACA?
« Reply #1700 on: March 23, 2017, 11:01:22 AM »
My assumption is that Schaefer Light was making the argument (a common one) that "healthcare is not a right".

That is only sort of true legally in the US, though. EMTALA (signed into law by Reagan himself) guarantees you healthcare for life threatening conditions regardless of ability to pay and is widely accepted as just/moral/impossible to repeal. I think that would probably give healthcare (at least life-saving healthcare) enough legal standing to talk about it in terms of "rights", though it's status is a bit uncertain since it's not in the constitution, and it only includes emergency treatment.

Even if you disagree with that assessment, there's no point in arguing that "healthcare isn't a right" because rights are whatever we decide they are. Argue that guaranteeing access to healthcare will collectively hurt our society, or that it's inherently unfair to those who can afford it on their own, or something like that. I may not agree with you but at least the argument can be rationally made. 

Forget the rights argument, because it inherently makes no sense.

-W

Then it's equally nonsensical to say that health care is a right.  After all, there's nothing in the Constitution that says it is a right.

waltworks

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Re: What comes after the ACA?
« Reply #1701 on: March 23, 2017, 11:05:51 AM »
I agree.  I guess what I was getting at was that human rights don't typically require the service of another human being.  Health care requires having people who are capable of administering health care to others.  Free speech, freedom of religion, etc., are rights that anyone can practice and enjoy without the aid of another person.  If we decide that people have a right to something, that implies (at least to my way of thinking) that the government must have the power to force other people to provide that "something".

Agreed. Most existing rights are rights _from_ interference from others. That hasn't always been the case in human history, obviously.

I think we'd all agree that we have the "right" to use public roads to drive/bike around, air/water/food (in descending order of importance) that are at least not actively poisonous (otherwise the "right" to life doesn't mean much) and be defended by our military. All of those things, conversely, require something provided (sometimes unwillingly) by all of us collectively.

And again, established law (EMTALA) already makes health care a de facto right, it just limits it to emergency treatment (arguably the worst way to go about it, really).

-W

Scortius

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Re: What comes after the ACA?
« Reply #1702 on: March 23, 2017, 11:06:04 AM »
I think affordable healthcare should be a human right that is provided to everyone in this great wealthy country, regardless of income or net worth or state in which you live, or age, or gender, or sexual orientation, or race, or anything.

Just out of curiosity, what makes something a human right?

A human right is whatever we collectively decide it is. I mean, free speech, freedom from being enslaved or murdered by those more powerful than you, freedom to practice your religion, etc weren't "human rights" until we collectively created a legal framework that guaranteed those things.

There's nothing stopping us from deciding that free ponies are a human right too (or healthcare in some form). Whether that would be beneficial to society or not could of course be debated.

I guess I don't understand your question. Humans in nature are just animals with no "rights" whatsoever. When we create societies (whether religious or secular) we create a set of ground rules that we sometimes refer to as "rights", but they are inherently made-up moral/ethical constructs. There's no logical way to argue that anything can't be a "right" because a right is whatever we decide it is.

-W

I agree.  I guess what I was getting at was that human rights don't typically require the service of another human being.  Health care requires having people who are capable of administering health care to others.  Free speech, freedom of religion, etc., are rights that anyone can practice and enjoy without the aid of another person.  If we decide that people have a right to something, that implies (at least to my way of thinking) that the government must have the power to force other people to provide that "something".

I believe that within the borders of the USA, access to clean water is a human right.  You may disagree with this.  Access to clean water requires modern infrastructure paid for and maintained by the US government.  So yes, I do believe in the interpretation that certain human rights must be supported and enforced by our government and do require service from our fellow human beings.

Schaefer Light

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Re: What comes after the ACA?
« Reply #1703 on: March 23, 2017, 11:10:40 AM »

I believe that within the borders of the USA, access to clean water is a human right.  You may disagree with this.  Access to clean water requires modern infrastructure paid for and maintained by the US government.  So yes, I do believe in the interpretation that certain human rights must be supported and enforced by our government and do require service from our fellow human beings.

Access to clean water is not a right guaranteed by the federal government.  Some states and municipalities may have statutes on the books, though.

waltworks

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Re: What comes after the ACA?
« Reply #1704 on: March 23, 2017, 11:18:55 AM »

I believe that within the borders of the USA, access to clean water is a human right.  You may disagree with this.  Access to clean water requires modern infrastructure paid for and maintained by the US government.  So yes, I do believe in the interpretation that certain human rights must be supported and enforced by our government and do require service from our fellow human beings.

Access to clean water is not a right guaranteed by the federal government.  Some states and municipalities may have statutes on the books, though.

Federal law requires that employers provide "potable" water to all employees on demand, for free. The feds also require that municipalities/states treat their water supplies in certain ways to ensure safety. It's a right at least in those contexts.

Just FYI.

-W

teen persuasion

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Re: What comes after the ACA?
« Reply #1705 on: March 23, 2017, 11:49:49 AM »
You can apparently thank Rep Chris Collins for this piece of idiocy.  NY had pushed a good portion of Medicaid costs down to the county level, and "unfunded mandates" has been a sore spot in NY politics for quite a while.  From what the news mentioned this morning, NY is the only state to do it this way.  As the governor remarked, there us no fairy to suddenly replace the $$$ this new rule would shift away from counties and back to the state level.

  http://www.syracuse.com/politics/index.ssf/2017/03/cuomo_house_gop_health_bill_tells_ny_to_drop_dead.html

http://www.politico.com/story/2017/03/health-care-new-york-medicaid-236328?lo=ap_d1

NYS politics are fucking bonkers. All local taxes get routed through Albany, then sent back to the cities/counties. There's also a truly massive ideological split between the Hudson Valley and the rest of the state. It makes the urban/rural split in Ohio look like slightly different shades of grey. It doesn't surprise me even a little bit that this is a result of that system.

Also, Chris Collins is a gladhanding shitbag.

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iowajes

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Re: What comes after the ACA?
« Reply #1706 on: March 23, 2017, 12:03:49 PM »
My assumption is that Schaefer Light was making the argument (a common one) that "healthcare is not a right".

That is only sort of true legally in the US, though. EMTALA (signed into law by Reagan himself) guarantees you healthcare for life threatening conditions regardless of ability to pay and is widely accepted as just/moral/impossible to repeal. I think that would probably give healthcare (at least life-saving healthcare) enough legal standing to talk about it in terms of "rights", though it's status is a bit uncertain since it's not in the constitution, and it only includes emergency treatment.

Even if you disagree with that assessment, there's no point in arguing that "healthcare isn't a right" because rights are whatever we decide they are. Argue that guaranteeing access to healthcare will collectively hurt our society, or that it's inherently unfair to those who can afford it on their own, or something like that. I may not agree with you but at least the argument can be rationally made. 

Forget the rights argument, because it inherently makes no sense.

-W

Then it's equally nonsensical to say that health care is a right.  After all, there's nothing in the Constitution that says it is a right.

Memorized from 3rd grade:

"We the People of the United States, in order to form a more perfect Union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America."

Seems to me that "promote the general welfare" was one of the main reasons the constitution was established.  Is healthcare not among that?  At the time, welfare was used to mean health; not the current usage of the word. 

The Bill of Rights and all the amendments only lists the things they forgot to put in there in the first place...
« Last Edit: March 23, 2017, 12:07:45 PM by iowajes »

Bumperpuff

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Re: What comes after the ACA?
« Reply #1707 on: March 23, 2017, 12:28:21 PM »
I think affordable healthcare should be a human right that is provided to everyone in this great wealthy country, regardless of income or net worth or state in which you live, or age, or gender, or sexual orientation, or race, or anything.

Just out of curiosity, what makes something a human right?

A human right is whatever we collectively decide it is. I mean, free speech, freedom from being enslaved or murdered by those more powerful than you, freedom to practice your religion, etc weren't "human rights" until we collectively created a legal framework that guaranteed those things.

There's nothing stopping us from deciding that free ponies are a human right too (or healthcare in some form). Whether that would be beneficial to society or not could of course be debated.

I guess I don't understand your question. Humans in nature are just animals with no "rights" whatsoever. When we create societies (whether religious or secular) we create a set of ground rules that we sometimes refer to as "rights", but they are inherently made-up moral/ethical constructs. There's no logical way to argue that anything can't be a "right" because a right is whatever we decide it is.

-W

I agree.  I guess what I was getting at was that human rights don't typically require the service of another human being.  Health care requires having people who are capable of administering health care to others.  Free speech, freedom of religion, etc., are rights that anyone can practice and enjoy without the aid of another person.  If we decide that people have a right to something, that implies (at least to my way of thinking) that the government must have the power to force other people to provide that "something".

You have the right to be represented by an attorney even if you can't afford one.  In that case the government does sometimes conscript practicing attorneys to provide the defense, but that's just part of being an attorney in some states.  In the US you have a right to k-12 education but I have yet to see teachers being conscripted or forced to work without pay. So, when I say you have a right to medical treatment, I mean that in the same way as saying you have the right to an attorney, an education, police protection, or the right to access areas of public accommodation.

The whole "you want to force doctors to work for free?" thing doesn't hold water.  I'm not implying that you meant that, but I have seen it in Facebook posts and figured I'd head it off here.

jim555

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Re: What comes after the ACA?
« Reply #1708 on: March 23, 2017, 02:24:37 PM »
They pulled the bill, they didn't have the votes.  Trump just can't stop winning.

sol

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Re: What comes after the ACA?
« Reply #1709 on: March 23, 2017, 02:44:05 PM »
They pulled the bill, they didn't have the votes.  Trump just can't stop winning.

Whatever.  Part of me WANTS then to pass this piece of garbage, precisely because it is so terrible.  Their constituents will be outraged at the result, and the party will implode when people finally realize their "best" ideas are so harmful to average Americans.

How many rural white republican trump supporters really want to give a giant tax cut to billionaires by giving up their health insurance?  Who in congress seriously thinks that is what their constituents want?

brooklynguy

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Re: What comes after the ACA?
« Reply #1710 on: March 23, 2017, 02:54:25 PM »
It's also not great to be stuck in a state of limbo, given that uncertainty itself will continue to contribute to the decline of the health insurance markets (not to mention the feasibility of early retirement planning...).

Well Respected Man

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Re: What comes after the ACA?
« Reply #1711 on: March 23, 2017, 06:56:12 PM »
From the U.N. Universal Declaration of Human Rights:

http://www.un.org/en/universal-declaration-human-rights/

Article 25.
 
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

The U.S. voted in favor of the document. So yes, society has an obligation to other humans.

jim555

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Re: What comes after the ACA?
« Reply #1712 on: March 23, 2017, 07:21:36 PM »
So Trump wants a vote up or down on Friday.  He wants this out of the way so he can go golfing.  Then they can blame the Democrats for not helping them.
The Dems should help them by suggesting Medicaid for up to 200% FPL for all 50 states and Medicare buy in for everyone else.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1713 on: March 23, 2017, 07:23:29 PM »
From the U.N. Universal Declaration of Human Rights:

http://www.un.org/en/universal-declaration-human-rights/

Article 25.
 
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

The U.S. voted in favor of the document. So yes, society has an obligation to other humans.
But is it legally binding? Has anyone ever brought a lawsuit in a US court?

Exflyboy

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Re: What comes after the ACA?
« Reply #1714 on: March 23, 2017, 09:18:10 PM »
So Trump wants a vote up or down on Friday.  He wants this out of the way so he can go golfing.  Then they can blame the Democrats for not helping them.
The Dems should help them by suggesting Medicaid for up to 200% FPL for all 50 states and Medicare buy in for everyone else.

These clowns can't even agree amongst themselves.. I love it.. I actually feel more confident we might KEEP the ACA now..:)

Bateaux

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Re: What comes after the ACA?
« Reply #1715 on: March 23, 2017, 10:18:55 PM »
The GOP has big problems.  Trump promised a lot of people, desperate people he was going to deliver them from evil Obamacare.   I'm surprised how many thought they'd get cheaper if not almost free health-care. There is no Republican proposal for that.  I'm with Sol.  Part of me wish that the garbage offered by Ryan would pass.  Let them suffer and seek out who to blame.
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Schaefer Light

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Re: What comes after the ACA?
« Reply #1716 on: March 24, 2017, 09:11:46 AM »
I hope the bill doesn't pass.  Much like the "Affordable" Care Act, it does nothing to make health care more affordable.

Schaefer Light

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Re: What comes after the ACA?
« Reply #1717 on: March 24, 2017, 09:24:25 AM »
My assumption is that Schaefer Light was making the argument (a common one) that "healthcare is not a right".

That is only sort of true legally in the US, though. EMTALA (signed into law by Reagan himself) guarantees you healthcare for life threatening conditions regardless of ability to pay and is widely accepted as just/moral/impossible to repeal. I think that would probably give healthcare (at least life-saving healthcare) enough legal standing to talk about it in terms of "rights", though it's status is a bit uncertain since it's not in the constitution, and it only includes emergency treatment.

Even if you disagree with that assessment, there's no point in arguing that "healthcare isn't a right" because rights are whatever we decide they are. Argue that guaranteeing access to healthcare will collectively hurt our society, or that it's inherently unfair to those who can afford it on their own, or something like that. I may not agree with you but at least the argument can be rationally made. 

Forget the rights argument, because it inherently makes no sense.

-W

Then it's equally nonsensical to say that health care is a right.  After all, there's nothing in the Constitution that says it is a right.

Memorized from 3rd grade:

"We the People of the United States, in order to form a more perfect Union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America."

Seems to me that "promote the general welfare" was one of the main reasons the constitution was established.  Is healthcare not among that?  At the time, welfare was used to mean health; not the current usage of the word. 

The Bill of Rights and all the amendments only lists the things they forgot to put in there in the first place...

I don't think so, but it's just about impossible to win an argument involving "general welfare" (no matter which side you're on).

sol

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Re: What comes after the ACA?
« Reply #1718 on: March 24, 2017, 10:12:46 AM »
I hope the bill doesn't pass.  Much like the "Affordable" Care Act, it does nothing to make health care more affordable.

Technically, the affordable care act was suppose to limit healthcare costs to 10% of your income, unless you were above 400% of the FPL.  It does some (but arguably not enough) to control the retail list price of care, but it does a whole lot more to control the cost to consumers, by capping your maximum out of pocket expenses for comprehensive insurance.

This is why the premium increases that republicans complain about are mostly meaningless.  For anyone on an individual ACA plan, your costs don't change at all when premiums go up because your subsidies go up by the same amount.  Your costs are fixed regardless of the cost of care, and the burden then falls on the government instead of the consumer to find ways to reduce those costs, for example by using Medicaid's fixed pricing model.

The new republican plan disassembles all parts of this structure.  Your costs would no longer be capped.  Price controls would be removed.  Your subsidies may go up our down, depending on your relative income, but your max out of pocket expenses would no longer be a fixed budget item you could accurately predict.  It's a disaster on all fronts, as far as I can tell:  fewer people with health insurance, and everyone pays more for worse care.  This is not the fixing the ACA needs.

I don't have a lot of faith in the republican party's ability to govern, but I'm confident they could have come up with something better than their current plan.  They floated like four alternative options that were all better than this stinking pile of legislation, so I'm not sure how they ended up with such a loser.

Mr. Green

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Re: What comes after the ACA?
« Reply #1719 on: March 24, 2017, 11:17:41 AM »
I was just having a conversation with a colleague from the UK yesterday and he was saying that when a Brit is sent to the States to work, his HR department assumes, based on past bills, that a simple birth, with no extra anything, will cost $60,000. If it's a C-section, or involves complications of any kind, he said the bills approach $250,000. This is the "retail price" of course but I guess the way his company handles healthcare for employees in the US is that they just pay the bill, since they're not using American insurance networks.

He also mentioned how drugs can be 10x-100x more expensive here for the same drug. He mentioned another colleague who needed cancer treatment drugs and the company was prepared to fly him back to the UK, had he not been returning for a family visit, because a single treatment in the US was ~$3,000 and in the UK it was ~50 pounds.

I imagine Brits pay higher taxes but he also mentioned the UK spends about 6% of it's GDP on healthcare, whereas the US spends over 17% of its GDP on healthcare. It was an interesting conversation to hear what it's like somewhere else.
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PathtoFIRE

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Re: What comes after the ACA?
« Reply #1720 on: March 24, 2017, 11:25:35 AM »
Looks like the AHCA is dead for now
https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?action=Click&contentCollection=BreakingNews&contentID=65073116&pgtype=article

I don't know if I'm hoping Trump will grow bored and leave healthcare alone, and risk meddling in some area, or buckle down and get bogged down in trying to make something out of this bad situation.

rantk81

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Re: What comes after the ACA?
« Reply #1721 on: March 24, 2017, 01:14:22 PM »
I am genuinely interested in knowing details about the single-payer systems in other countries (like in Canada, or or the NHS in the UK, or others.)

Specifically, is there a "separate tax" that is supposed to specifically pay for these single-payer plans? Like some line-item out of your payroll checks? Or is it included from the general tax amount collected from paychecks?  Or part of some VAT/sales tax?  Or just part of the overall government budget?

Are there annual costs/payments you make directly to participate in these plans (e.g. like how we pay "insurance premiums" in the United States)?

When you receive care, what do you have to pay (if anything?) out of pocket? Do you have things like deductibles, co-pays, co-insurance, out-of-pocket-maximums, etc?  What are these numbers? And are they the same for everyone? Or different based on what your income is, or based on what plan level(s) you have?

Basically, I'm completely ignorant about how those single payer plans are paid for and how the cost-sharing works... and I'm actually really interested to know.


Paul der Krake

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Re: What comes after the ACA?
« Reply #1722 on: March 24, 2017, 01:24:36 PM »
I am genuinely interested in knowing details about the single-payer systems in other countries (like in Canada, or or the NHS in the UK, or others.)

Specifically, is there a "separate tax" that is supposed to specifically pay for these single-payer plans? Like some line-item out of your payroll checks? Or is it included from the general tax amount collected from paychecks?  Or part of some VAT/sales tax?  Or just part of the overall government budget?

Are there annual costs/payments you make directly to participate in these plans (e.g. like how we pay "insurance premiums" in the United States)?

When you receive care, what do you have to pay (if anything?) out of pocket? Do you have things like deductibles, co-pays, co-insurance, out-of-pocket-maximums, etc?  What are these numbers? And are they the same for everyone? Or different based on what your income is, or based on what plan level(s) you have?

Basically, I'm completely ignorant about how those single payer plans are paid for and how the cost-sharing works... and I'm actually really interested to know.
Each country does it differently, but yeah it's usually a combination of payroll taxes and general funds. The labels differ but the end result is the same.

Classical_Liberal

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Re: What comes after the ACA?
« Reply #1723 on: March 24, 2017, 01:32:44 PM »
I was just having a conversation with a colleague from the UK yesterday and he was saying that when a Brit is sent to the States to work, his HR department assumes, based on past bills, that a simple birth, with no extra anything, will cost $60,000. If it's a C-section, or involves complications of any kind, he said the bills approach $250,000. This is the "retail price" of course but I guess the way his company handles healthcare for employees in the US is that they just pay the bill, since they're not using American insurance networks.

He also mentioned how drugs can be 10x-100x more expensive here for the same drug. He mentioned another colleague who needed cancer treatment drugs and the company was prepared to fly him back to the UK, had he not been returning for a family visit, because a single treatment in the US was ~$3,000 and in the UK it was ~50 pounds.

I imagine Brits pay higher taxes but he also mentioned the UK spends about 6% of it's GDP on healthcare, whereas the US spends over 17% of its GDP on healthcare. It was an interesting conversation to hear what it's like somewhere else.

This is interesting and very consistent with anecdotes I have heard from friends who work in and consume healthcare in other developed nations.  Part* of the problem here is the macroeconomics of an increasing intertwined world economy.  A simplified explanation of this situation is as follows. Medical instrument manufacturers and pharmaceutical companies know well the price controls other developed nations place on their products.  This means that the "free market" of health care in the US is by far the best profit center for their products.  Those of us in the US then pay a premium for these products to offset the reduced profits  these companies take in other similarly economically developed nations. IOW, since the US refuses to cap prices we are subsidizing all of the nations that do cap costs.

*The other parts being the the Cadillac, private hotel suite expectations of US healthcare consumers (ie speedy-pants, spoiled rich folks) & the costs of human capital in the system here.

Taken to extremes in developing (ie poor) countries, these companies sometimes even provide drugs and devices at a significant loss.  They do this because they are fully aware their patents will simply be reverse engineered by companies in these countries to provide for their citizens.  One can hardly blame those countries from an ethical standpoint.

Even as a fiscally conservative & free market perspective like mine, it is in the best interest of the US to cap medical costs in some way (the ACA did not go far enough this realm, capping only for consumers, not total costs).  Even if this means single payer.  If we do not, the US will continue to lose this game.  Capping medical costs  may have the short term effect of reducing private investment in R&D, but will provide more equally distributed care for US citizens with existing technology.  This will allow the US to play a "fair" game on a macro-scale with the rest of the developed world. The money saved from managing the ever increasing  costs, from a GDP perspective, could later be directed towards R&D.  Even a libertarian has to conclude that the gov't intervention needed when a fair market for private industry cannot be effectively established.  At this point in time, a global fair market is simply not possible since we cannot force the rest of the world to play by our rules.

#libertarian for US single payer

jim555

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Re: What comes after the ACA?
« Reply #1724 on: March 24, 2017, 01:44:20 PM »
I am genuinely interested in knowing details about the single-payer systems in other countries (like in Canada, or or the NHS in the UK, or others.)

Specifically, is there a "separate tax" that is supposed to specifically pay for these single-payer plans? Like some line-item out of your payroll checks? Or is it included from the general tax amount collected from paychecks?  Or part of some VAT/sales tax?  Or just part of the overall government budget?

Are there annual costs/payments you make directly to participate in these plans (e.g. like how we pay "insurance premiums" in the United States)?

When you receive care, what do you have to pay (if anything?) out of pocket? Do you have things like deductibles, co-pays, co-insurance, out-of-pocket-maximums, etc?  What are these numbers? And are they the same for everyone? Or different based on what your income is, or based on what plan level(s) you have?

Basically, I'm completely ignorant about how those single payer plans are paid for and how the cost-sharing works... and I'm actually really interested to know.


http://www.nhs.uk
"With the exception of some charges, such as prescriptions, optical services and dental services, the NHS in England remains free at the point of use for all UK residents."
"Funding for the NHS comes directly from taxation. "

I looked into how to qualify.  The only qualification is to be "ordinarily resident".  It is not based on how much has been paid in or having a job.

rantk81

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Re: What comes after the ACA?
« Reply #1725 on: March 24, 2017, 01:50:46 PM »
Paul Ryan and Trump have pulled the bill. There will be no vote today.

jim555

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Re: What comes after the ACA?
« Reply #1726 on: March 24, 2017, 01:52:35 PM »
They had to be way short to pull it again.

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Re: What comes after the ACA?
« Reply #1727 on: March 24, 2017, 02:23:32 PM »
I am genuinely interested in knowing details about the single-payer systems in other countries (like in Canada, or or the NHS in the UK, or others.)

Specifically, is there a "separate tax" that is supposed to specifically pay for these single-payer plans? Like some line-item out of your payroll checks? Or is it included from the general tax amount collected from paychecks?  Or part of some VAT/sales tax?  Or just part of the overall government budget?

Are there annual costs/payments you make directly to participate in these plans (e.g. like how we pay "insurance premiums" in the United States)?

When you receive care, what do you have to pay (if anything?) out of pocket? Do you have things like deductibles, co-pays, co-insurance, out-of-pocket-maximums, etc?  What are these numbers? And are they the same for everyone? Or different based on what your income is, or based on what plan level(s) you have?

Basically, I'm completely ignorant about how those single payer plans are paid for and how the cost-sharing works... and I'm actually really interested to know.

Well, here in the UK your health care is just covered. 100%.  Period. Is there some extra tax like you ask?  Let's do the math: if you earn £80,000 ($100,000) in the UK, your take-home pay (after tax and National Insurance, which is the UK version of social security) is £54178 ($67723).  If you earn $100,000 a year as a single person in the SF Bay Area, your take home pay (after federal, state and social security) will be $67923.  In other words, in the UK you are taxed just like you would be in California except that your health care is completely free.  As I hope you can see, my fellow Americans, you are being screwed over by the system in the US and the Republicans just tried to screw you over even more!  I hope someday the USA can join the rest of the civilised world....

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Re: What comes after the ACA?
« Reply #1728 on: March 24, 2017, 02:26:00 PM »
At this point in time, a global fair market is simply not possible since we cannot force the rest of the world to play by our rules.

Which sucks, but it's true.  I wish we could force them to.

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Re: What comes after the ACA?
« Reply #1729 on: March 24, 2017, 02:27:46 PM »

4.  Expand access to HSAs by making them available to everyone regardless of plan type, giving them higher contribution limits, and allowing more more costs (like OTC medications) to be deductible. 

This is a plan I could maybe get behind!  We have an HSA, and we love it.  It's a great tax shelter for rich folks like me, though I admit it is totally worthless to the majority of Americans who already pay little or no taxes and who don't have any surplus income to sock away in a tax shelter.  This bullet point is effectively just another tax cut for the rich.  Hey I'm rich, sign me up!  The GOP thinks that all you poor folks can suck it, apparently.

5.  Provide "refundable advanced tax credits" for people without employer insurance, regardless of income.

This is just like the ACA plan except they're calling them "credits" instead of "subsidies" but the idea is the same.  Uncle Sam will foot the bill for some portion of your insurance coverage (though they would shutter the exchanges that currently allow you to shop for insurance, so get used to calling around for rate quotes).  The key difference here is that under the GOP plan, Uncle Sam will provide that subsidy to everyone, instead of just for poor people.  This bullet point is effectively just another tax cut for the rich.  Hey I'm rich, sign me up!  The GOP thinks that all you poor folks can suck it, apparently.

7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

8.  Change Medicaid to block-grant funding.  This fundamentally alter the nature of this program from an entitlement, available as a social safety net to anyone who meets the criteria, to a blank check for each state to spend as they see fit.  Maybe they'll expand coverage to pregnant women and children (WIC), or maybe they'll cancel medicaid entirely and use the money on tax breaks for rich people.  Each state would get to decide.  Red states have been pushing hard to reduce medicaid eligibility, because they don't like helping poor people.

Medicaid is currently the country's largest single insurer, providing low-cost insurance to tens of millions of low-income families and people with disabilities.  It's also one of the most expensive things our government does.

Most Democrats strongly oppose ending this 54 year old program, in part because the GOP plan to dismantle medicaid (which benefits the poor and disabled) is just the first step in their plan to also dismantle medicare and social security (programs that benefit senior citizens).  The GOP hates all of the entitlement programs, and medicaid is the easiest one to attack because poor people and the disabled don't vote with quite the same power that senior citizens do. 

If they successfully kill medicaid, everyone's retirement plans are about to get a lot more complicated.

These were some of the points that resonated with me the most, although I found it most enlightening when I first read it some time ago. I had to laugh when Trump was asked about giving the rich a tax break and he totally blustered .. .Does he really think that people don't know or understand what he is doing?
Oh man, interesting times we live in.

So Trump couldn't make it happen - over promised - under delivered. 
He'll find a way to blame Obama or Ryan or someone ...

As a country, this is bad news for everyone. I do wish reps and dems would hash out a palatable bill together. Lord knows ACA could be improved, but the crux is the stranglehold the insurance companies seem to have on America Inc. and uber conservatives.

You know one would think that a master negotiator would blossom in an environment of opposite ideals that must be congealed into a plan to benefit everyone needing health care in America. Instead, he fumes and blusters and showed me at least, for the first time, how little he really cares about this bill. He should have started with taxes and infrastructure and built some momentum first.

No system is ever perfect, but growing up in Europe it all seemed to work just fine, why the US is fighting to keep medications at 10 to 100 times the price what they are in other countries or insist on inflated premiums I will never understand. This health care plan is supposed to be for the good of all the people - not to fatten the pockets of the pharmaceutical industry!

Sure, the rich have always had private insurance and better treatment - regardless of the country. My girlfriend in Germany mentioned that when she went to a heart/stroke rehab facility in the mountains that they had a separate dining room just for the rich Saudis who came there for treatment.
Yet, she said their food was excellent, on par with any gourmet restaurant. She loved the spa and the massage and one on one sessions, not to mention the music and art ...

Quote by Sol: If they successfully kill medicaid, everyone's retirement plans are about to get a lot more complicated.

Agreed, it will be interesting to see how the next round turns out.
 


stoaX

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Re: What comes after the ACA?
« Reply #1730 on: March 24, 2017, 02:29:15 PM »
I am genuinely interested in knowing details about the single-payer systems in other countries (like in Canada, or or the NHS in the UK, or others.)

Specifically, is there a "separate tax" that is supposed to specifically pay for these single-payer plans? Like some line-item out of your payroll checks? Or is it included from the general tax amount collected from paychecks?  Or part of some VAT/sales tax?  Or just part of the overall government budget?

Are there annual costs/payments you make directly to participate in these plans (e.g. like how we pay "insurance premiums" in the United States)?

When you receive care, what do you have to pay (if anything?) out of pocket? Do you have things like deductibles, co-pays, co-insurance, out-of-pocket-maximums, etc?  What are these numbers? And are they the same for everyone? Or different based on what your income is, or based on what plan level(s) you have?

Basically, I'm completely ignorant about how those single payer plans are paid for and how the cost-sharing works... and I'm actually really interested to know.

Well, here in the UK your health care is just covered. 100%.  Period. Is there some extra tax like you ask?  Let's do the math: if you earn £80,000 ($100,000) in the UK, your take-home pay (after tax and National Insurance, which is the UK version of social security) is £54178 ($67723).  If you earn $100,000 a year as a single person in the SF Bay Area, your take home pay (after federal, state and social security) will be $67923.  In other words, in the UK you are taxed just like you would be in California except that your health care is completely free.  As I hope you can see, my fellow Americans, you are being screwed over by the system in the US and the Republicans just tried to screw you over even more!  I hope someday the USA can join the rest of the civilised world....

Yeah, but at least in California we get lousy public schools, leaking water pipes and lousy roads in exchange for our high taxes.

sol

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Re: What comes after the ACA?
« Reply #1731 on: March 24, 2017, 02:44:17 PM »
As of this afternoon, it looks like the republican's repeal and replace plan is dead and gone.   Does this mean we keep Obamacare for the next four years?

SomedayStache

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Re: What comes after the ACA?
« Reply #1732 on: March 24, 2017, 02:51:09 PM »
So the master deal maker couldn't make his deal.

PathtoFIRE

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Re: What comes after the ACA?
« Reply #1733 on: March 24, 2017, 02:55:15 PM »
Does this mean we keep Obamacare for the next four years?

Or do they just resort to further subtle sabotage, and then swoop in like heroes next year?

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Re: What comes after the ACA?
« Reply #1734 on: March 24, 2017, 03:46:50 PM »
I found this article from David Frum interesting given today's events.
https://www.theatlantic.com/politics/archive/2017/03/the-republican-waterloo/520833/
A good quote from the closing:
Quote
I take no pride or pleasure in saying “I told you so.” We’ve all been wrong about enough things to teach us humility about our rare bursts of foresight. What I would urge is that those conservatives and Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.

Do you think the vote was scheduled for a Friday so that the shame of the failure could be blunted by at least a couple of days of weekend for the American electorate to have moved on to something else? Maybe Trump will tweet something inane and provocative on Sunday evening so that the news cycle has something else to chew on early next week.

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Re: What comes after the ACA?
« Reply #1735 on: March 24, 2017, 03:59:47 PM »
This whole "Obamacare will explode" stuff is laughable.  The spin machine never stops. 
CBO states ACA markets are viable.  Do they believe their own BS?

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Re: What comes after the ACA?
« Reply #1736 on: March 24, 2017, 04:29:01 PM »
I almost never watch the news anymore because I'm doing the whole 'low information diet' thing.  But I tuned in today because my parents are visiting and were talking about it. 

OMG, the R's with control of the House, the Senate, the White House and the Supreme Court could not repeal Obamacare????? They've been carping about it for 6 years.  6 years!!!!  Now that they have the power to change it, they have this epic fail on a massive public stage?  ZOMG, I can't actually believe it.  It feels like I'm in some weird alternate universe or on a crazy political TV show.  I'm still in shock!  Albeit a delightfully delirious shock.  Hahaha.
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Re: What comes after the ACA?
« Reply #1737 on: March 24, 2017, 04:49:52 PM »
The rhetoric certainly seems like Obamacare will be around for a few years now. It will be interesting to see what happens. Now that the Republicans healthcare alternative is dead, the Aetna/Humana merger is dead, and the Anthem/Cigna merger will probably die for the same reasons as Aetna/Humana, will insurance companies return to markets they've left? In markets that have a healthy number of choices, it seems like rates are starting to stabilize (losses are becoming smaller) now that insurance companies know what to expect of their markets. If markets do become profitable as they smooth out, an Obamacare repeal will probably become an impossibility as it will come to be viewed as effective.
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Re: What comes after the ACA?
« Reply #1738 on: March 24, 2017, 05:42:21 PM »
Trump and Ryan have picked up the ball and gone home.  Without doing anything to help ACA succeed they will also do all they can to make it fail.  I kind of wish they would have succeeded in passing their piece of crap bill and let their supporters reap what they sowed....

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Re: What comes after the ACA?
« Reply #1739 on: March 24, 2017, 05:54:12 PM »
The problem with sabotage is it may backfire.  After all the Rs are the ones in power so it will be hard to blame the Ds who will be out of power for the next several years.  Trump and Co. are not the brightest bulbs in the pack.  They will end up owning O-care whether they want it or not and they will be blamed.

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Re: What comes after the ACA?
« Reply #1740 on: March 24, 2017, 07:13:41 PM »
As of this afternoon, it looks like the republican's repeal and replace plan is dead and gone.   Does this mean we keep Obamacare for the next four years?

Hopefully 2 more years. Hopefully you crazy Americans vote in an opposition congress (or at least one house), though it's very difficult with the seats that are up in the Senate and the gerrymandering in the house.

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Re: What comes after the ACA?
« Reply #1741 on: March 24, 2017, 08:23:03 PM »
As of this afternoon, it looks like the republican's repeal and replace plan is dead and gone.   Does this mean we keep Obamacare for the next four years?

Hopefully 2 more years. Hopefully you crazy Americans vote in an opposition congress (or at least one house), though it's very difficult with the seats that are up in the Senate and the gerrymandering in the house.

I think the house will turn democrat in 2018. The senate will remain republican since only 8 of the 33 seats up for reelection are Republican.

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Re: What comes after the ACA?
« Reply #1742 on: March 24, 2017, 11:25:18 PM »
House v Burwell (16-5202) is on hold.  This is the case against the Silver plans cost sharing reductions.  Will Trump quash the money for them is the next question to be answered.

Interestingly loss of CSRs would increase premiums.  The premium increase would require higher APTC payments and the net result would cost the government more money than if they left the CSRs in place.
http://www.coveredca.com/news/pdfs/CoveredCA_Consequences_of_Terminating_CSR.pdf
« Last Edit: March 25, 2017, 12:11:12 AM by jim555 »

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Re: What comes after the ACA?
« Reply #1743 on: March 25, 2017, 08:20:28 AM »
House v Burwell (16-5202) is on hold.  This is the case against the Silver plans cost sharing reductions.  Will Trump quash the money for them is the next question to be answered.

Interestingly loss of CSRs would increase premiums.  The premium increase would require higher APTC payments and the net result would cost the government more money than if they left the CSRs in place.
http://www.coveredca.com/news/pdfs/CoveredCA_Consequences_of_Terminating_CSR.pdf

Now that Ryan and Trump appear to have shrugged their shoulders and walked away from health care "reform," what are the next things we should watch out for to give an indication of ACA plan stability going forward?  The CSR case noted above is one big thing.  I think we should also be watching closely in May when the insurers have to make their proposals for next year. 

And I have to think that the repubs will be looking for every way possible to sabotage the ACA so that their "death spiral" myth becomes fact.  What are some of the ways they might do that without Democratic support?  I suspect more court challenges will be the preferred method, now that it's clear that they can't actually legislate the ACA's demise. 

Or maybe they just repeal the subsidies and cost-sharing outright without putting anything else in their place.  They could do that under reconciliation, right?  They probably could get the Freedom Caucus nutcases to go along with that.  The only thing stopping them would be the consciences of a handful of R moderates.
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Re: What comes after the ACA?
« Reply #1744 on: March 25, 2017, 09:24:57 AM »
Now that Ryan and Trump appear to have shrugged their shoulders and walked away from health care "reform," what are the next things we should watch out for to give an indication of ACA plan stability going forward?  The CSR case noted above is one big thing.  I think we should also be watching closely in May when the insurers have to make their proposals for next year. 

And I have to think that the repubs will be looking for every way possible to sabotage the ACA so that their "death spiral" myth becomes fact.  What are some of the ways they might do that without Democratic support? I suspect more court challenges will be the preferred method, now that it's clear that they can't actually legislate the ACA's demise. 

Or maybe they just repeal the subsidies and cost-sharing outright without putting anything else in their place.  They could do that under reconciliation, right?  They probably could get the Freedom Caucus nutcases to go along with that.  The only thing stopping them would be the consciences of a handful of R moderates.

I don't know how many more challengeable things there are in ACA, but if they're there the GOP will use them. One thing the administration could do without legislation is pull all advertising about enrollment periods in the name of "cost cutting" which would dampen the number of new enrollments. DHHS also has the power to change when open enrollment actually occurs and how long it lasts, and if they chop that down they will also limit new enrollments.

About passing another reconciliation bill, they only get one per budget year and it has to be pre-declared in that year's budget resolution, and they can only be considered one at a time. They never passed a budget resolution for FY2017, which should have been done last year, so they used that one for AHCA. They say they want to do business tax reform as another one sometime this year, so they'll be using their FY2018 budget resolution slot for that.

They could of course write those tax cuts into the tax reform package, but it will be a lot harder to get them through reconciliation without the Medicaid and subsidy cuts that were in AHCA. They'll have to be passed with a 10 year sunset because those cuts will drive up the deficit like crazy.

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Re: What comes after the ACA?
« Reply #1745 on: March 25, 2017, 09:30:17 AM »

 In other words, in the UK you are taxed just like you would be in California except that your health care is completely free.  As I hope you can see, my fellow Americans, you are being screwed over by the system in the US and the Republicans just tried to screw you over even more!  I hope someday the USA can join the rest of the civilised world....

So do I...so do many of us
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liberty53

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Re: What comes after the ACA?
« Reply #1746 on: March 25, 2017, 09:53:49 AM »

 In other words, in the UK you are taxed just like you would be in California except that your health care is completely free.  As I hope you can see, my fellow Americans, you are being screwed over by the system in the US and the Republicans just tried to screw you over even more!  I hope someday the USA can join the rest of the civilised world....

So do I...so do many of us

I don't - this report by the OECD doesn't shine a very positive light on healthcare in the UK:

http://www.oecd.org/unitedkingdom/Health-at-a-Glance-2015-Key-Findings-UK.pdf

Comparisons to other countries are here:

http://www.oecd.org/health/health-at-a-glance-19991312.htm

I remember having to find treatment for an ear infection when I lived in England - yeah it was free, but had to take the morning off, drive a few towns over,  and wait a few hours to see someone. Of course this was a number of years ago.

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Re: What comes after the ACA?
« Reply #1747 on: March 25, 2017, 09:58:07 AM »
I remember having to find treatment for an ear infection when I lived in England - yeah it was free, but had to take the morning off, drive a few towns over,  and wait a few hours to see someone. Of course this was a number of years ago.
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Re: What comes after the ACA?
« Reply #1748 on: March 25, 2017, 10:05:25 AM »
What are some of the ways they might do that [i.e., sabotage the ACA] without Democratic support?

Today's NY Times outlines some of the available options on the menu:  "Trump's Choice on Obamacare: Sabotage or Co-opt?"

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Re: What comes after the ACA?
« Reply #1749 on: March 25, 2017, 10:28:57 AM »
Kansas (of all places) has approved expanded Medicaid, but looks like a veto might happen.  Deep red Kansas is caving in?  Socialism, nooooo.