Author Topic: What comes after the ACA?  (Read 387523 times)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1950 on: April 14, 2017, 10:51:58 AM »
I simply don't understand what you mean.

PiobStache

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Re: What comes after the ACA?
« Reply #1951 on: April 14, 2017, 11:01:13 AM »
I simply don't understand what you mean.

"The mandate" was a dishonest piece of legislation and those tend to be doomed to failure for a number or reasons, not least of which is, people hate being lied to by politicians and this was an epic lie. 

Remember, one of the many ACA pledges, was no new taxes?  So the ACA trundles down the tracks, gets signed into law, and we have this mandate that individuals must purchase health insurance or pay a penalty but that this isn't a tax.  What we're told is that Congress is exercising its power under the Commerce Clause.  This goes all the way to the SCOTUS and what does the SCOTUS find?  They struck that down as unconstitutional. 

So why do we still have the mandate?  Well the Court ruled that the mandate is indeed a tax, and obviously, Congress is 100% within its rights to pass a tax. 

So to get the ACA passed the mandate was not a tax, but to keep it constitutional...it's a tax.  Very dishonest.  Then Jonathan Gruber comes along, gets stupid, and opens his mouth on video about how "low information voters" were fooled by this and how it got the ACA done.  In case you don't know, Gruber was Romney's main health economist to get Romneycare done in MA and then he moved onto the ACA.

So the problem with the mandate is that if folks had just been honest, and created a forthright and workable tax to pay for healthcare, we could have used that as another tool to dismantle the current, fatally flawed system we have.  Instead the mandate does nothing more than give the force of law to everyone having to actually support the current system by forcing them to buy coverage. 

See the important distinction here?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1952 on: April 14, 2017, 12:16:47 PM »
Yes I see your point. I don't actually think the ACA is fatally flawed though. I am fine with a health insurance system that has mandates.

PiobStache

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Re: What comes after the ACA?
« Reply #1953 on: April 14, 2017, 12:27:44 PM »
Yes I see your point. I don't actually think the ACA is fatally flawed though. I am fine with a health insurance system that has mandates.

I'm fine with a well constructed and rational tax to provide healthcare, so I'm sorry, I don't think you see my point.  Also, the mandate was just one problem with the ACA package, as I've indicated.  ACOs are not the panacea policy makers made them out to be (I think only about 40% of the Pioneer ACOs are still running!) and BPCI is having very mixed results.  Part of that, of course, is that not every patient encounter can be in the 15th percentile for spend (as that's how math works) but this is apparently the goal and how budgets get set.  The Medicaid exchanges were poorly constructed and have imploded around the country (I mean, really?  Policy makers didn't understand there would be horrendous adverse case mix?)

I could go on but everyone already has their opinion and facts rarely change an opinion. 

Gin1984

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Re: What comes after the ACA?
« Reply #1954 on: April 14, 2017, 12:31:21 PM »
Yes I see your point. I don't actually think the ACA is fatally flawed though. I am fine with a health insurance system that has mandates.

I'm fine with a well constructed and rational tax to provide healthcare, so I'm sorry, I don't think you see my point.  Also, the mandate was just one problem with the ACA package, as I've indicated.  ACOs are not the panacea policy makers made them out to be (I think only about 40% of the Pioneer ACOs are still running!) and BPCI is having very mixed results.  Part of that, of course, is that not every patient encounter can be in the 15th percentile for spend (as that's how math works) but this is apparently the goal and how budgets get set.  The Medicaid exchanges were poorly constructed and have imploded around the country (I mean, really?  Policy makers didn't understand there would be horrendous adverse case mix?)

I could go on but everyone already has their opinion and facts rarely change an opinion.
That is not true.  In places where governors actually tried to set them up well, they worked well.  When they were set up to fail because the GOP wanted to say they could not work, well yes, they failed.  You can't expect to set up a law to avoid human tampering. 

PiobStache

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Re: What comes after the ACA?
« Reply #1955 on: April 14, 2017, 12:45:12 PM »
That is not true.  In places where governors actually tried to set them up well, they worked well.  When they were set up to fail because the GOP wanted to say they could not work, well yes, they failed.  You can't expect to set up a law to avoid human tampering.

Two replies to this:

1)  My claim above the ACA was written in an echo chamber?  When you write legislation that clearly doesn't take into account the fact not everyone is going to agree with you.  There should never have been any choice for the state level politicians to participate or not.  Then remember the series of cases to massage things to allow the Feds to set them up?  An ad hoc rescue due to the same.

2)  Even states that were early adopters are seeing major players exist the market and the remainders jacking rates up substantially.  Why?  As I said above, horrendous adverse case mix.  Anyone with half a brain knew this was going to happen.  Here's Maryland, a reliably blue state and early adopter:

Quote
2017 rates and carriers

Maryland is one of many states where UnitedHealthcare is exiting the individual market at the end of 2016. And Evergreen Health is not selling or renewing individual market plans for 2017 (details below).

The remaining carriers that offered plans through Maryland Health Connection in 2016 are continuing to do so in 2017, with the following average rate increases:

CareFirst Blue Choice (HMO): 23.7 percent
CareFirst Blue Cross Blue Shield: 31.4 percent
Cigna: 29.8 percent
Kaiser Permanente: 26.6 percent

Source: https://www.healthinsurance.org/maryland-state-health-insurance-exchange/

Pretty sure poor people are not happy about 25-30% rate hikes.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1956 on: April 14, 2017, 01:23:38 PM »
LOL, you really hate "conservatives," don't you?  But glad to hear you're not for unlimited healthcare all the time.

Specifically, I really hate people who are actively trying make our broken healthcare system even worse.  I was briefly hopeful that Donald Trump was actually going to try to improve things, based on his campaign rhetoric, but then all of the republican plans that were put forward seemed like steps backwards. 

Rationed care is but one of the few ways that must be instituted.

Can we start by giving doctors the authority to ration that care, instead of insurance companies? 

Quote
You work for the federal government and therefor your income depends on taxes.

I work for the federal government because it's the place I feel like I can do the most good in the world with my skill set.  I assure you that this decision came with a considerable pay cut compared to doing the same work in the private sector.  And as an aside, I find your casual judgment of my moral sensibilities to be condescending and offensive.  You're entitled to be both of those things, though, so you go right ahead and judge me and I'll go right ahead and judge you for it.  Deal?

Quote
In the US the answer is not as simple as single payer.

Definitely not!  Have I somewhere suggested that single payer was a panacea for American healthcare?  There are a whole host of associate issues that would have be simultaneously addressed if we tried to institute a single payer option.  I'm also fine with private healthcare existing as a supplement to guaranteed basic services for everyone, and I'm even fine with corporations profiting off of being the middle man between people who need care and the government that ultimately pays for it.  What I'm not fine with, and what pisses me off the most, is how the current American system deliberately exploits some groups of people while denying necessary and life saving care to others.  Can we talk about ways to address some of those problems?

Sol,
Thank you for responding.  Sorry for the delay, but my work and life take precedence over forum replies.  Either way, here is my response.

1) Doctors can attempt to ration the care, but todays climate makes it very difficult due to some regulations such as:
   a) Patient satisfaction which is tied with reimbursement.  If patients don't get what they want, your scores suffer and so does your wallet.  Family wants their decrepit with no quality of life great great grandfather to have their colon cancer treated with surgery, radiation, and a feeding tube. 
   b) Fear of missing something right away and the patient having a worse outcome as well as the physician getting sued in the process. When we ration care we need to also accept misses.  For example, not every headache or abdominal pain needs a CT, but it may delay catching the appendicitis or the brain bleed on someone in the future.  We need to decide if this is acceptable to our population and make the necessary changes to allow for it.

2) Regarding judging, I get judged on a regular basis and have no qualms of being judged by you or anyone else.  My comment was intended to invoke a response which it did. Although you may be different, or maybe not different at all, most people who are paid by taxes are equally eager to make sure those taxes are collected, and as much as possible.  It is a bit of self interest at play which may be conscious or subconscious.  It is no different that myself being concerned about trying to fix healthcare costs by simply paying physicians less as opposed to fixing the inefficiencies of medical care today.

3) Actually I believe and may be wrong that you are a big proponent of single payer and have even written scenarios of how do accomplish that.  Again, we currently have a single payer system for about 1/3 of the US population with private insurance covering almost everyone else.  Yes there still exists a significant population who is not insured and has poor access to healthcare.  This current single payer system is failing considering the cost of healthcare for Medicare/Medicaid patients continues to rise and the reason why this is such a hot topic.  I also strongly disagree that we need an insurance middleman for the majority of our health expenditures.  There is no need for the insurance middle man to take a cut on every inexpensive medication and doctors visit. It is just one additional item that increases the cost for those patients. 

4)
Quote
What I'm not fine with, and what pisses me off the most, is how the current American system deliberately exploits some groups of people while denying necessary and life saving care to others.  Can we talk about ways to address some of those problems?

Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table. What pisses me off is that we are stuck talking about who will pay for healthcare instead of discussing how to decrease cost. Because at the end of the day not everyone can receive healthcare the way it is currenlty expected/demanded.  We simply need to cut costs and only then can we talk about making sure every person in the US can afford healthcare because currently it is unafordable.  Just like on this forum both Democrats and Republicans are having the wrong discussion and it is the problem. 

5) You mentioned that republicans want to cut taxes on the richest people.  Yes, it is true but a little disingenuous for 2 reasons. 
   a) It removes the Obamacare surtax which was an added tax on higher income Americans.  Obviously removing Obamacare will affect that tax.
   b) Cutting taxes will always affect the wealthiest people because they pay the most taxes.  Cutting 1% on someone who makes $1 million/yr vs cutting 1% on someone making $100k/year will affect both people differently.

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Re: What comes after the ACA?
« Reply #1957 on: April 14, 2017, 04:33:51 PM »

1) Doctors can attempt to ration the care, but todays climate makes it very difficult due to some regulations such as:
   a) Patient satisfaction which is tied with reimbursement.  If patients don't get what they want, your scores suffer and so does your wallet.  Family wants their decrepit with no quality of life great great grandfather to have their colon cancer treated with surgery, radiation, and a feeding tube. 
   b) Fear of missing something right away and the patient having a worse outcome as well as the physician getting sued in the process. When we ration care we need to also accept misses.  For example, not every headache or abdominal pain needs a CT, but it may delay catching the appendicitis or the brain bleed on someone in the future.  We need to decide if this is acceptable to our population and make the necessary changes to allow for it.

2) ) Actually I believe and may be wrong that you are a big proponent of single payer and have even written scenarios of how do accomplish that.  Again, we currently have a single payer system for about 1/3 of the US middle man to take a cut on every inexpensive medication and doctors visit. It is just one additional item that increases the cost for those patients. 
 

Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table. What pisses me off is that we are stuck talking about who will pay for healthcare instead of discussing how to decrease cost. Because at the end of the day not everyone can receive healthcare the way it is currenlty expected/demanded.  We simply need to cut costs and only then can we talk about making sure every person in the US can afford healthcare because currently it is unafordable.  Just like on this forum both Democrats and Republicans are having the wrong discussion and it is the problem. 

5) You mentioned that republicans want to cut taxes on the richest people.  Yes, it is true but a little disingenuous for 2 reasons. 
   a) It removes the Obamacare surtax which was an added tax on higher income Americans.  Obviously removing Obamacare will affect that tax.
   b) Cutting taxes will always affect the wealthiest people because they pay the most taxes.  Cutting 1% on someone who makes $1 million/yr vs cutting 1% on someone making $100k/year will affect both people differently.

1) True. Very difficult to fix. I've attended a job orientation where nurses are taught how to tell patients their discharge instructions in a way so the patients don't mark them lower for not giving their discharge instructions. Patients are frequently very unreliable.
Satisfaction scores should be tied to outcomes, not a survey on whether your room was cleaned promptly at 8:15 am every morning and if you were happy with your shitty restricted diet food.

Not everyone receives life saving care in the ER. If I show up there with cancer, they will not provide me my chemo, they will stabilize me and send me home to arrange for the actual life saving treatment on my own dime.

5) I would argue that the person making $100k will receive more need based benefit from getting an extra $1k back much more than a person making $1 mill would from getting an extra $10k back. Both are equally likely to waste that amount, but the middle class person is much more likely to actually need it to live off of.
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obstinate

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Re: What comes after the ACA?
« Reply #1958 on: April 14, 2017, 09:32:53 PM »
Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table.
I'm about 90% sure this isn't true. You can't just turn up and demand chemotherapy, gamma knife, etc. You can't get aids drug cocktails for free, or the drugs needed to manage debilitating rheumatoid arthritis, crohn's disease, or any number of other conditions. You can't turn up and order a quadruple bypass, a kidney transplant, etc.

You can turn up and get stabilized. That's very different from getting all the necessary treatment to live out your years. It's disingenuous to claim that everyone can turn up and receive high quality treatment without regard to ability to pay.

It is also disingenuous to claim that "not everybody can receive healthcare" under the current cost structure. Sure they can! We'd just have to pay a bit more for it. But the U.S. has low taxes compared to many countries, so there's plenty of room to move the revenue side of the equation. Now whether that will actually happen, or whether you want it to happen, may be another question. But it is definitely possible, and I don't mean the same sense that it's possible for pigs to fly. I mean it has been done elsewhere.
« Last Edit: April 14, 2017, 09:40:40 PM by obstinate »

EnjoyIt

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Re: What comes after the ACA?
« Reply #1959 on: April 14, 2017, 09:59:58 PM »
Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table.
I'm about 90% sure this isn't true. You can't just turn up and demand chemotherapy, gamma knife, etc. You can't get aids drug cocktails for free, or the drugs needed to manage debilitating rheumatoid arthritis, crohn's disease, or any number of other conditions. You can't turn up and order a quadruple bypass, a kidney transplant, etc.

You can turn up and get stabilized. That's very different from getting all the necessary treatment to live out your years. It's disingenuous to claim that everyone can turn up and receive high quality treatment without regard to ability to pay.

I will concede that the ED will stabilize you, and depending on your situation and the type of disease you may get help setting up medicaid to help pay for your chronic disease.  If you are debilitated via arthritis or Chron's you get on disability and get medicaid.  If you are in renal failure you auto qualify for medicaid and can be placed on a transplant list if you qualify.  If you need a bypass then definitely you will get it regardless of your ability to pay.  But you are correct if you are diagnosed with lung cancer for example, you are given options on where to get care and assistance in trying to set up medicaid if you can't afford the medication.  How do I know?  I am an ED doc who sees it happen all the time. 

Quote
It is also disingenuous to claim that "not everybody can receive healthcare" under the current cost structure. Sure they can! We'd just have to pay a bit more for it. But the U.S. has low taxes compared to many countries, so there's plenty of room to move the revenue side of the equation. Now whether that will actually happen, or whether you want it to happen, may be another question. But it is definitely possible, and I don't mean the same sense that it's possible for pigs to fly. I mean it has been done elsewhere.

See, that is where you are mistaken.  The desire and need of this country is very different than others. The cost of our healthcare is high for reasons that other countries do not have.  We, Americans demand everything, immediately, using only the latest and greatest tech, and the newest drugs.  Add on top of that the cost of development, the cost of complying with regulations, and the cost of collecting from the government, and prices will continue to rise, rise, rise.  You can not tax your way out of this mess.  Look, we just increased medicare tax but the cost of healthcare rises.  That is my point the cost will keep rising until we actually decide to address the huge elephant in the room.  Instead we keep arguing about who will pay.

Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

beltim

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Re: What comes after the ACA?
« Reply #1960 on: April 15, 2017, 02:00:51 AM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

EnjoyIt

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Re: What comes after the ACA?
« Reply #1961 on: April 15, 2017, 07:35:59 AM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1962 on: April 17, 2017, 10:16:56 AM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

Gin1984

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Re: What comes after the ACA?
« Reply #1963 on: April 17, 2017, 10:35:58 AM »
Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table.
I'm about 90% sure this isn't true. You can't just turn up and demand chemotherapy, gamma knife, etc. You can't get aids drug cocktails for free, or the drugs needed to manage debilitating rheumatoid arthritis, crohn's disease, or any number of other conditions. You can't turn up and order a quadruple bypass, a kidney transplant, etc.

You can turn up and get stabilized. That's very different from getting all the necessary treatment to live out your years. It's disingenuous to claim that everyone can turn up and receive high quality treatment without regard to ability to pay.

I will concede that the ED will stabilize you, and depending on your situation and the type of disease you may get help setting up medicaid to help pay for your chronic disease.  If you are debilitated via arthritis or Chron's you get on disability and get medicaid.  If you are in renal failure you auto qualify for medicaid and can be placed on a transplant list if you qualify.  If you need a bypass then definitely you will get it regardless of your ability to pay.  But you are correct if you are diagnosed with lung cancer for example, you are given options on where to get care and assistance in trying to set up medicaid if you can't afford the medication.  How do I know?  I am an ED doc who sees it happen all the time. 

Quote
It is also disingenuous to claim that "not everybody can receive healthcare" under the current cost structure. Sure they can! We'd just have to pay a bit more for it. But the U.S. has low taxes compared to many countries, so there's plenty of room to move the revenue side of the equation. Now whether that will actually happen, or whether you want it to happen, may be another question. But it is definitely possible, and I don't mean the same sense that it's possible for pigs to fly. I mean it has been done elsewhere.

See, that is where you are mistaken.  The desire and need of this country is very different than others. The cost of our healthcare is high for reasons that other countries do not have.  We, Americans demand everything, immediately, using only the latest and greatest tech, and the newest drugs.  Add on top of that the cost of development, the cost of complying with regulations, and the cost of collecting from the government, and prices will continue to rise, rise, rise.  You can not tax your way out of this mess.  Look, we just increased medicare tax but the cost of healthcare rises.  That is my point the cost will keep rising until we actually decide to address the huge elephant in the room.  Instead we keep arguing about who will pay.

Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.
You do NOT in many states get automatically enrolled or hell even the ability to enroll in Medicaid because having the diseases you stated.  That may happen in your state but in many states, those people just die from lack of  care. 
You really need to look up the data on this.

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EnjoyIt

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Re: What comes after the ACA?
« Reply #1964 on: April 17, 2017, 10:50:37 AM »
Currently each and every person who shows up at the hospital will receive life saving care regardless of ability to pay so that discussion is off the table.
I'm about 90% sure this isn't true. You can't just turn up and demand chemotherapy, gamma knife, etc. You can't get aids drug cocktails for free, or the drugs needed to manage debilitating rheumatoid arthritis, crohn's disease, or any number of other conditions. You can't turn up and order a quadruple bypass, a kidney transplant, etc.

You can turn up and get stabilized. That's very different from getting all the necessary treatment to live out your years. It's disingenuous to claim that everyone can turn up and receive high quality treatment without regard to ability to pay.

I will concede that the ED will stabilize you, and depending on your situation and the type of disease you may get help setting up medicaid to help pay for your chronic disease.  If you are debilitated via arthritis or Chron's you get on disability and get medicaid.  If you are in renal failure you auto qualify for medicaid and can be placed on a transplant list if you qualify.  If you need a bypass then definitely you will get it regardless of your ability to pay.  But you are correct if you are diagnosed with lung cancer for example, you are given options on where to get care and assistance in trying to set up medicaid if you can't afford the medication.  How do I know?  I am an ED doc who sees it happen all the time. 

Quote
It is also disingenuous to claim that "not everybody can receive healthcare" under the current cost structure. Sure they can! We'd just have to pay a bit more for it. But the U.S. has low taxes compared to many countries, so there's plenty of room to move the revenue side of the equation. Now whether that will actually happen, or whether you want it to happen, may be another question. But it is definitely possible, and I don't mean the same sense that it's possible for pigs to fly. I mean it has been done elsewhere.

See, that is where you are mistaken.  The desire and need of this country is very different than others. The cost of our healthcare is high for reasons that other countries do not have.  We, Americans demand everything, immediately, using only the latest and greatest tech, and the newest drugs.  Add on top of that the cost of development, the cost of complying with regulations, and the cost of collecting from the government, and prices will continue to rise, rise, rise.  You can not tax your way out of this mess.  Look, we just increased medicare tax but the cost of healthcare rises.  That is my point the cost will keep rising until we actually decide to address the huge elephant in the room.  Instead we keep arguing about who will pay.

Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.
You do NOT in many states get automatically enrolled or hell even the ability to enroll in Medicaid because having the diseases you stated.  That may happen in your state but in many states, those people just die from lack of  care. 
You really need to look up the data on this.

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BTW, I live in Texas which has horrible medicare enrollment.  You can tell me to look up facts, but I see it every day.  Either way you look at it, you can not tax your way out of this problem. This is a spending problem and not an income problem.  I would be fine being taxed more if I thought it made even an ounce of good, but the reality is that our hunger for medical care can not be satiated with a few billion extra dollars.  Prices will continue to go up until we accept the fundamentals of keeping costs down.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1965 on: April 17, 2017, 10:56:18 AM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

You are right about one thing.  We, Americans are a selfish bunch that want everything NOW!.  We don't care who pays for it or how it happens, we want it, we deserve it, and who cares if my lifestyle makes it more expensive or more difficult. I still want and deserve it.  It is easy to keep taxing the guy above you and hope something useful happens to that money.  It is much harder to fix the actual problem of the cost of healthcare.  We can tax ourselves to oblivion, but nothing will change until we fix the fundamentals.  it currently costs the US government more money for each individual on Medicare than anywhere else in the world.  We need to fix that before we talk about increasing our taxes. 

As Mustachians we learn to be more efficient in our expenditures to provide financial security.  The US government is the exact opposite when it comes to healthcare.  Instead we keep arguing about taxes and losing the bigger picture which is expenses.  It is not who will pay, but how much we will pay which needs addressing.

obstinate

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Re: What comes after the ACA?
« Reply #1966 on: April 17, 2017, 11:20:23 AM »
You are right about one thing. ...
Instead of changing the subject, how about admitting you were wrong about Americans' relative tax burden and the feasibility of paying for our medical costs by growing government revenue?

Bucksandreds

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Re: What comes after the ACA?
« Reply #1967 on: April 17, 2017, 12:12:53 PM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

You are right about one thing.  We, Americans are a selfish bunch that want everything NOW!.  We don't care who pays for it or how it happens, we want it, we deserve it, and who cares if my lifestyle makes it more expensive or more difficult. I still want and deserve it.  It is easy to keep taxing the guy above you and hope something useful happens to that money.  It is much harder to fix the actual problem of the cost of healthcare.  We can tax ourselves to oblivion, but nothing will change until we fix the fundamentals.  it currently costs the US government more money for each individual on Medicare than anywhere else in the world.  We need to fix that before we talk about increasing our taxes. 

As Mustachians we learn to be more efficient in our expenditures to provide financial security.  The US government is the exact opposite when it comes to healthcare.  Instead we keep arguing about taxes and losing the bigger picture which is expenses.  It is not who will pay, but how much we will pay which needs addressing.

Why should anyone listen to the opinions of someone who could so easily be proved wrong on an issue that they were so sure of?

Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1968 on: April 17, 2017, 12:23:34 PM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

You are right about one thing.  We, Americans are a selfish bunch that want everything NOW!.  We don't care who pays for it or how it happens, we want it, we deserve it, and who cares if my lifestyle makes it more expensive or more difficult. I still want and deserve it.  It is easy to keep taxing the guy above you and hope something useful happens to that money.  It is much harder to fix the actual problem of the cost of healthcare.  We can tax ourselves to oblivion, but nothing will change until we fix the fundamentals.  it currently costs the US government more money for each individual on Medicare than anywhere else in the world.  We need to fix that before we talk about increasing our taxes. 

As Mustachians we learn to be more efficient in our expenditures to provide financial security.  The US government is the exact opposite when it comes to healthcare.  Instead we keep arguing about taxes and losing the bigger picture which is expenses.  It is not who will pay, but how much we will pay which needs addressing.

Why should anyone listen to the opinions of someone who could so easily be proved wrong on an issue that they were so sure of?

Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

That was a dick response by you.  I have never insulted you and would expect similar treatment from you.

We have a 1 payer system for about 1/3 of our population and the costs continue to rise year over year.  Costs have nowhere else to go but up because there are no solutions currently on the table to decrease those costs.  It is a shame that you would rather use insults instead of discussing the issue regarding cost.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1969 on: April 17, 2017, 12:29:16 PM »
You are right about one thing. ...
Instead of changing the subject, how about admitting you were wrong about Americans' relative tax burden and the feasibility of paying for our medical costs by growing government revenue?

Maybe I misread the graph, but it appears the US is right in the middle

https://data.oecd.org/chart/4ObH

Ohh, and I am not changing the subject.  The subject is "what comes after the ACA?" The answer is higher cost for healthcare which is exactly what I have been answering.  It is higher cost with the ACA, it is higher cost with Trump Care, and it would be higher cost with Bernie Sanders Care, or whatever crap our government keeps throwing at us. All because we are unwilling to address cost.

obstinate

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Re: What comes after the ACA?
« Reply #1970 on: April 17, 2017, 01:40:54 PM »
EnjoyIt: as the person you were responding to already pointed out to you, the absolute numbers are almost totally meaningless. You need to look at percentage of GDP, in which case we are an outlier near the bottom, above only South Korea and Mexico, IIRC.

This is relevant because your claims that we must focus on cost exclusively presumes that there is insufficient money to pay for medical services at the relatively high costs we face here. That is simply not true. There is plenty of money, should the government choose to begin taxing people more heavily.

It would be great to reduce costs (and single payer or a much more strict regulatory situation is likely the best way to do it), but it is a bald-faced lie to say that we must do that and cannot spend more than we do on the problem.
« Last Edit: April 17, 2017, 01:48:20 PM by obstinate »

Bucksandreds

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Re: What comes after the ACA?
« Reply #1971 on: April 17, 2017, 01:51:00 PM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

You are right about one thing.  We, Americans are a selfish bunch that want everything NOW!.  We don't care who pays for it or how it happens, we want it, we deserve it, and who cares if my lifestyle makes it more expensive or more difficult. I still want and deserve it.  It is easy to keep taxing the guy above you and hope something useful happens to that money.  It is much harder to fix the actual problem of the cost of healthcare.  We can tax ourselves to oblivion, but nothing will change until we fix the fundamentals.  it currently costs the US government more money for each individual on Medicare than anywhere else in the world.  We need to fix that before we talk about increasing our taxes. 

As Mustachians we learn to be more efficient in our expenditures to provide financial security.  The US government is the exact opposite when it comes to healthcare.  Instead we keep arguing about taxes and losing the bigger picture which is expenses.  It is not who will pay, but how much we will pay which needs addressing.

Why should anyone listen to the opinions of someone who could so easily be proved wrong on an issue that they were so sure of?

Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

That was a dick response by you.  I have never insulted you and would expect similar treatment from you.

We have a 1 payer system for about 1/3 of our population and the costs continue to rise year over year.  Costs have nowhere else to go but up because there are no solutions currently on the table to decrease those costs.  It is a shame that you would rather use insults instead of discussing the issue regarding cost.

And avoiding the subject I so easily disproved you on with your initial response to me is not a "dick move?" Your non sequitor response was not conducive to a rational argument.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1972 on: April 17, 2017, 02:04:34 PM »
Lastly, the US does not have low taxes, especially when you add in property tax, state tax, sales tax, gasoline tax, toll roads, alcohol and tobacco tax, and I'm sure I am missing much much more.  Just looking at federal tax is not fully accurate.  Also, our corporate tax is one of the highest in the world.  Again, more taxes will not fix the real problem.

Yes, the US really does have lower taxes than many countries: https://data.oecd.org/tax/tax-revenue.htm
This includes all income taxes, state and federal, social security taxes, business taxes, property taxes, etc. The OECD average is 34.3% of GDP.  The US is at 26.4% of GDP, markedly lower than countries like France (45.5%), Germany (36.9%), or the Netherlands (37.7%).

Based on your graph the US is somewhere in the middle. You know this does not need to be a race to have the highest taxes. And it does not change my point that the problem regarding healthcare is not who pays for it, but how much it costs. Check out our healthcare expenditures as a percent of GDP and compare it to those same countries.

Not when you sort by % of GDP that is taxed. Were 4th lowest of 35 countries in the OECD. The U.S. has a problem of not taxing it's rich enough. We have worse health (life expectancy, obesity, etc), educational, poverty outcomes than many/most of our peers because we have an obsession with a get whatever you can at everyone else's expense attitude.

You are right about one thing.  We, Americans are a selfish bunch that want everything NOW!.  We don't care who pays for it or how it happens, we want it, we deserve it, and who cares if my lifestyle makes it more expensive or more difficult. I still want and deserve it.  It is easy to keep taxing the guy above you and hope something useful happens to that money.  It is much harder to fix the actual problem of the cost of healthcare.  We can tax ourselves to oblivion, but nothing will change until we fix the fundamentals.  it currently costs the US government more money for each individual on Medicare than anywhere else in the world.  We need to fix that before we talk about increasing our taxes. 

As Mustachians we learn to be more efficient in our expenditures to provide financial security.  The US government is the exact opposite when it comes to healthcare.  Instead we keep arguing about taxes and losing the bigger picture which is expenses.  It is not who will pay, but how much we will pay which needs addressing.

Why should anyone listen to the opinions of someone who could so easily be proved wrong on an issue that they were so sure of?

Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

That was a dick response by you.  I have never insulted you and would expect similar treatment from you.

We have a 1 payer system for about 1/3 of our population and the costs continue to rise year over year.  Costs have nowhere else to go but up because there are no solutions currently on the table to decrease those costs.  It is a shame that you would rather use insults instead of discussing the issue regarding cost.

And avoiding the subject I so easily disproved you on with your initial response to me is not a "dick move?" Your non sequitor response was not conducive to a rational argument.
EnjoyIt: as the person you were responding to already pointed out to you, the absolute numbers are almost totally meaningless. You need to look at percentage of GDP, in which case we are an outlier near the bottom, above only South Korea and Mexico, IIRC.

You are correct as a percentage of GDP we are lower on the list.  Is it because a large percentage of the US pays no taxes or is it because the rich are not paying enough?  I do not think those charts show that.  Does that chart also include corporate taxes?  I believe it does not.

If we talk about the rich well their highest tax bracket can be as high as 39.6% federal, 13.3% state, 2.35% medicare with surtax, and that does not include property tax and sales tax.  You can say that most rich people avoid all of that through tax avoidance scheming, but the reality is that if you have earned income, you can avoid only so much in paying taxes.  Capital gains tax is lower which helps the effective tax rate. Also, the US has the second highest corporate tax rate of 35% second to Cameroon at 39%. 
https://en.wikipedia.org/wiki/List_of_countries_by_tax_rates

I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.  This needs to be our biggest priority.  It makes no difference who pays for it if those costs keep rising year over year.  The result will always be unsustainable. I am really surprised that no one on this board thinks this.  Is it because they are afraid of rationed care, and doing the hard work that needs to be done? Or is it because it is just easier to yell to increase taxes today ignoring the future?

PiobStache

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Re: What comes after the ACA?
« Reply #1973 on: April 17, 2017, 02:06:57 PM »
Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

Where is the logic or the real world example to support the claim in the bolded?  I ask as so many countries with universal healthcare have VATS to help fund government spending, and those are regressive, not progressive taxes.

More taxes?  Agreed.
All of them progressive?  Real world says different.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1974 on: April 17, 2017, 02:13:41 PM »


And avoiding the subject I so easily disproved you on with your initial response to me is not a "dick move?" Your non sequitor response was not conducive to a rational argument.

Please read my post above.  Changing the statistics to a % vs actual dollar amount and then calling me dumb does not make your argument any stronger.  I am trying to have a civil discussion to the best of my ability with the knowledge I have.  I nor you know everything and every fact available.  If you supply a fact for me I am more than happy to review it and add it to my knowledge base.  It may or may not skew my views.  In this instance the US being a lower % of taxation on population vs GDP does not change the fact that the cost of healthcare is unsustainable in this country.  It also does not negate the fact that we already have a single payer system for 1/3 of our population and this system will fail of cost are not contained.  Raising taxes another few percentage points will temporize the situation but still does not address the problem that the cost of healthcare in the US is much higher than the rest of the world.  The graph does not go to 2016.  It is believed that we spent more than $10,000 per person on healthcare in the US in 2016.  Increased taxes will not keep up with this.


obstinate

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Re: What comes after the ACA?
« Reply #1975 on: April 17, 2017, 02:42:47 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1976 on: April 17, 2017, 02:53:31 PM »
Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

Where is the logic or the real world example to support the claim in the bolded?  I ask as so many countries with universal healthcare have VATS to help fund government spending, and those are regressive, not progressive taxes.

More taxes?  Agreed.
All of them progressive?  Real world says different.

Where did anyone comment on how progressive any other countries health care taxes are collected? The US already progressively taxes for healthcare with the Medicare surcharge that is a part of the ACA. These types of taxes combined with raising the current Medicare payroll tax can fund healthcare for all.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1977 on: April 17, 2017, 02:55:44 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

I was just about to type this. Top marginal rate is totally different from effective rate or tax burden. This is either intellectually dishonest on his part or he doesn't understand the basics of taxation.

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Re: What comes after the ACA?
« Reply #1978 on: April 17, 2017, 02:59:56 PM »
Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

Where is the logic or the real world example to support the claim in the bolded?  I ask as so many countries with universal healthcare have VATS to help fund government spending, and those are regressive, not progressive taxes.

More taxes?  Agreed.
All of them progressive?  Real world says different.

Where did anyone comment on how progressive any other countries health care taxes are collected? The US already progressively taxes for healthcare with the Medicare surcharge that is a part of the ACA. These types of taxes combined with raising the current Medicare payroll tax can fund healthcare for all.

Well, let's examine this.

Does the US have progressive taxes for healthcare vis a vis the Medicare tax?  Not really.  Everyone pays the same percent up until the cap, so it's a flat tax, not a progressive tax by definition.  Now, there is a bit of a progressive nature in the surtax, as one has to have a certain income to trigger it, but again it's flat and not progressive.

So not really.

As to the bolded and taxes in other countries...typical American thinking.  The whole world makes something work in a certain way but in American we can do it differently!  A rational person would look at how countries that have already succeeded at what America has failed at do things and then work from there.  As I think we can all agree healthcare in the US is mess why do we think just more of the same will make things work?  Because 'Murica?
« Last Edit: April 17, 2017, 03:01:30 PM by PiobStache »

EnjoyIt

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Re: What comes after the ACA?
« Reply #1979 on: April 17, 2017, 03:05:13 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

Unfortunately increasing taxes will only temporize the situation until costs exceed those taxes as well.  Do you not agree that the cost of healthcare in the US is much higher than the rest of the world?  Do you not think if we can cut the cost by 25% it would be enough to get access to care by everyone who is missing it in the US and then some?

BTW, if we cut cost by 25% we would still be spending more than every other country.  As you can see the cost really does matter, and cutting costs will go a lot further than increasing taxes.  BTW, taxes have increased on the higher earning Americans with Obamacare, but the cost of healthcare today is still almost 25% higher than it was in 2010.  You have to agree that cutting costs will go a lot further than increasing taxes.

I am not okay with increasing taxes just to continue the same bureaucratic low efficiency healthcare that we provide today. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #1980 on: April 17, 2017, 03:12:44 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

I was just about to type this. Top marginal rate is totally different from effective rate or tax burden. This is either intellectually dishonest on his part or he doesn't understand the basics of taxation.

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1981 on: April 17, 2017, 04:16:41 PM »
Universal rationed care paid for by taxing everyone more, in a progressive manner, is the only viable long term solution to our health care problems. You ranting on and on doesn't mean you know anything. Often the dumbest amongst us are the loudest.

Where is the logic or the real world example to support the claim in the bolded?  I ask as so many countries with universal healthcare have VATS to help fund government spending, and those are regressive, not progressive taxes.

More taxes?  Agreed.
All of them progressive?  Real world says different.

Where did anyone comment on how progressive any other countries health care taxes are collected? The US already progressively taxes for healthcare with the Medicare surcharge that is a part of the ACA. These types of taxes combined with raising the current Medicare payroll tax can fund healthcare for all.

Well, let's examine this.

Does the US have progressive taxes for healthcare vis a vis the Medicare tax?  Not really.  Everyone pays the same percent up until the cap, so it's a flat tax, not a progressive tax by definition.  Now, there is a bit of a progressive nature in the surtax, as one has to have a certain income to trigger it, but again it's flat and not progressive.

So not really.

As to the bolded and taxes in other countries...typical American thinking.  The whole world makes something work in a certain way but in American we can do it differently!  A rational person would look at how countries that have already succeeded at what America has failed at do things and then work from there.  As I think we can all agree healthcare in the US is mess why do we think just more of the same will make things work?  Because 'Murica?

Well, let's examine this.

Medicare tax 1.45% of employee income levees against all.
Medicare sur tax 3.8% of income leveed against income over $200,000-$250,000.

What definition of progressive taxation makes this a not really other than that it is inconvenient for the fight you are trying to pick against an argument that no one made?

Edit: it took 3 seconds to find an example of "foreign progressive taxation" that pays for healthcare.  Canada. At least partly funded by Canadian income tax which is definitively a progressive form of taxation. So just stop. You started an argument with me about something that I wasn't arguing and still failed.


http://www.canadian-healthcare.org/page8.html
« Last Edit: April 17, 2017, 04:36:50 PM by Bucksandreds »

Bucksandreds

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Re: What comes after the ACA?
« Reply #1982 on: April 17, 2017, 04:19:44 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

I was just about to type this. Top marginal rate is totally different from effective rate or tax burden. This is either intellectually dishonest on his part or he doesn't understand the basics of taxation.

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

Im in favor of rationed care. No one (Except the taxpayer) financially benefits from rationed care. Time to try to find a new angle to fail on.

rpr

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Re: What comes after the ACA?
« Reply #1983 on: April 17, 2017, 04:23:07 PM »

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

I just wanted to make a small correction. Only the *working* rich pay high taxes. The *non working* rich who get most of their income from capital gains and dividends pay very low taxes.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1984 on: April 17, 2017, 04:49:29 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

I was just about to type this. Top marginal rate is totally different from effective rate or tax burden. This is either intellectually dishonest on his part or he doesn't understand the basics of taxation.

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

Im in favor of rationed care. No one (Except the taxpayer) financially benefits from rationed care. Time to try to find a new angle to fail on.

It is not an angle.  We sit and keep arguing here in the forums and on the news and in congress who will pay for healthcare. That is the wrong argument.  We can not proceed without touching the real problem and one of the solutions is rationing care.  There are plenty more which I have alluded to several times.  Just increasing taxes will solve nothing.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1985 on: April 17, 2017, 04:59:05 PM »
I do not think that graph is totally fair for example Denmark which is at the top of that list only has a 22% corporate tax rate. Or Greece which is slightly higher up on the list only pays 15-22% on corporate taxes.
Why does it matter what the corporate tax rate is? The graph is displaying total government tax revenues as %GDP. It's not making a comment on what segment of the economy or population the revenues are coming from.

BTW, the question of whether the rich or poor pay enough is interesting, but not germane to this discussion. The question at hand is whether there are solutions other than decreasing cost, and the answer is yes, full stop.

I may be misunderstanding some of these graphs and willing to have them explained better.  I am not necessarily saying to not increase taxes, what I am saying is that we will get much better results on making healthcare affordable by actually addressing the cost of healthcare in this country.
OK, that is not what you actually said earlier, but if you're stepping back from your earlier claims that that was the only solution, then I feel I've accomplished my goal in this part of the discussion.

I was just about to type this. Top marginal rate is totally different from effective rate or tax burden. This is either intellectually dishonest on his part or he doesn't understand the basics of taxation.

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

Im in favor of rationed care. No one (Except the taxpayer) financially benefits from rationed care. Time to try to find a new angle to fail on.

It is not an angle.  We sit and keep arguing here in the forums and on the news and in congress who will pay for healthcare. That is the wrong argument.  We can not proceed without touching the real problem and one of the solutions is rationing care.  There are plenty more which I have alluded to several times.  Just increasing taxes will solve nothing.

Who is arguing with you about need to lower costs? You said that we were a high tax country but effectively we are in the bottom 10-15% in terms of effective taxation for OECD countries. We are a first world very low tax country. Health care costs are lowered through universal care that is rationed with negotiated prescription prices and the government setting the rates for each procedure. No one is arguing that prices are too high. You have just been informed that we are a low tax country for the first world. PERIOD. Argue with the air, now.

obstinate

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Re: What comes after the ACA?
« Reply #1986 on: April 17, 2017, 07:46:55 PM »

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

I just wanted to make a small correction. Only the *working* rich pay high taxes. The *non working* rich who get most of their income from capital gains and dividends pay very low taxes.
Even working rich do not pay particularly high taxes here. In France, my marginal rate would be nearly sixty percent, from what I can tell. Here, in New York City, it is only around 50%.

rpr

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Re: What comes after the ACA?
« Reply #1987 on: April 17, 2017, 07:50:52 PM »

I was just trying to point out that the rich pay a lot in taxes and the highest tax brackets are indeed very high.  How high is too much or too little is very tough to say.  I also realize that effective tax rate is not the marginal tax rate. Personally I think I pay a lot in taxes.  I would prefer to pay less but accept what is handed to me. I would be upset if my taxes went up again just as they did through Obama.  I can tell you this much, it sure is easy to increase taxes on someone else.  It is definitely easier than realizing we have a real problem regarding cost of healthcare and fixing that instead. It is as if you have a stake in keeping costs high and will look for any source possible to continue to fund it.

I just wanted to make a small correction. Only the *working* rich pay high taxes. The *non working* rich who get most of their income from capital gains and dividends pay very low taxes.
Even working rich do not pay particularly high taxes here. In France, my marginal rate would be nearly sixty percent, from what I can tell. Here, in New York City, it is only around 50%.
In comparison, the *non working* rich have effective tax rates of around 15%-20%. 

Schaefer Light

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Re: What comes after the ACA?
« Reply #1988 on: April 18, 2017, 06:02:21 AM »
I'm not willing to vote for a candidate who would ask me to pay a penny more in taxes for any benefit for any person.  I refuse to support making our already bloated government any bigger.

Bucksandreds

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Re: What comes after the ACA?
« Reply #1989 on: April 18, 2017, 06:57:12 AM »
I'm not willing to vote for a candidate who would ask me to pay a penny more in taxes for any benefit for any person.  I refuse to support making our already bloated government any bigger.

What evidence do you have that our government is bloated? Do you possess any data that suggests that countries with smaller governments and less social expenditure have better outcomes for it's citizens?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1990 on: April 18, 2017, 07:17:02 AM »
I'm not willing to vote for a candidate who would ask me to pay a penny more in taxes for any benefit for any person.  I refuse to support making our already bloated government any bigger.

The idea that Medicare or Medicaid is a bloated bureaucracy is false. Virtually every dollar collected for these programs is dispensed toward health care spending.

Regarding how to make health care cheaper:
The ACA/Obamacare law has been providing research into finding out what standards of care are the most effective for a given medical condition. This is vital research that will help us win the battle against cost.

That Medicare can't negotiate the prices of prescriptions drugs should be changed, we're giving away billions of money to the pharmaceutical industry. You can thank the Republicans for this one.

Pilot studies show a small percentage of patients consume the vast quantity of care, trying to get those patients to adhere to medications is shown to reduce the amount of care they need and lower costs.

And moreover the cost curve for Medicare has been lowered. The Congressional Budget Office has lowered future projections for Medicare spending precisely because of the changes made by the ACA to Medicare and the way reimbursement is provided.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1991 on: April 18, 2017, 07:26:20 AM »
That Medicare can't negotiate the prices of prescriptions drugs should be changed, we're giving away billions of money to the pharmaceutical industry. You can thank the Republicans ALL OF THE POLITICIANS for this one.

Plenty of blame to go around on that score ;-)
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

Gin1984

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Re: What comes after the ACA?
« Reply #1992 on: April 18, 2017, 08:30:15 AM »
That Medicare can't negotiate the prices of prescriptions drugs should be changed, we're giving away billions of money to the pharmaceutical industry. You can thank the Republicans ALL OF THE POLITICIANS for this one.

Plenty of blame to go around on that score
;-)
No, not really.  This came from the GOP and the dems had nothing to do with it.  In fact many dems have fought for the idea that we should be negotiating.

sol

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Re: What comes after the ACA?
« Reply #1993 on: April 18, 2017, 08:42:59 AM »
No, not really.  This came from the GOP and the dems had nothing to do with it.  In fact many dems have fought for the idea that we should be negotiating.

To be fair, Trump supported that idea during the campaign too, before becoming President and doing the exact opposite.  Like most of his policy positions, he says whatever he thinks will be popular and then has no qualms about completely ignoring his stated positions and doing something else.  Negotiating drug prices is a wildly popular idea, blocked by the pharma lobby because they can buy politicians.  They apparently bought Trump, because he now opposes it.
« Last Edit: April 18, 2017, 08:44:59 AM by sol »

Schaefer Light

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Re: What comes after the ACA?
« Reply #1994 on: April 18, 2017, 10:25:04 AM »
I'm not willing to vote for a candidate who would ask me to pay a penny more in taxes for any benefit for any person.  I refuse to support making our already bloated government any bigger.

What evidence do you have that our government is bloated? Do you possess any data that suggests that countries with smaller governments and less social expenditure have better outcomes for it's citizens?

Here's my evidence - www.usdebtclock.org - all $19.8 trillion of it. 

Surely people on these forums wouldn't approve of spending more than their income year after year.  And people on this forum nearly always approach things from the spending side (i.e. cut expenses) versus the revenue side (i.e. bring in more money).  I happen to think our government should take the same approach.

sol

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Re: What comes after the ACA?
« Reply #1995 on: April 18, 2017, 10:52:58 AM »
Surely people on these forums wouldn't approve of spending more than their income year after year.

Please don't tell me you've made the obvious mistake of equating a household's budget with the US government's budget. 

Those two situations are only similar if the household can manufacture unlimited amounts of money, which they can not only spend but also sell to other households at a premium.

PathtoFIRE

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Re: What comes after the ACA?
« Reply #1996 on: April 18, 2017, 11:02:00 AM »
Here's my evidence - www.usdebtclock.org - all $19.8 trillion of it. 

Surely people on these forums wouldn't approve of spending more than their income year after year.  And people on this forum nearly always approach things from the spending side (i.e. cut expenses) versus the revenue side (i.e. bring in more money).  I happen to think our government should take the same approach.

You are totally ignoring the other side of the balance sheet for the United States Government. It's assets (land, mineral rights, other property, taxing authority) far outstrip the comparatively small "debt".

Schaefer Light

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Re: What comes after the ACA?
« Reply #1997 on: April 18, 2017, 11:17:29 AM »
Surely people on these forums wouldn't approve of spending more than their income year after year.

Please don't tell me you've made the obvious mistake of equating a household's budget with the US government's budget. 

Those two situations are only similar if the household can manufacture unlimited amounts of money, which they can not only spend but also sell to other households at a premium.

I wish the same were true of the government.  Taking away its ability to print as many dollars as it wants/needs would be a huge step in the right direction.

Schaefer Light

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Re: What comes after the ACA?
« Reply #1998 on: April 18, 2017, 11:18:28 AM »
Here's my evidence - www.usdebtclock.org - all $19.8 trillion of it. 

Surely people on these forums wouldn't approve of spending more than their income year after year.  And people on this forum nearly always approach things from the spending side (i.e. cut expenses) versus the revenue side (i.e. bring in more money).  I happen to think our government should take the same approach.

You are totally ignoring the other side of the balance sheet for the United States Government. It's assets (land, mineral rights, other property, taxing authority) far outstrip the comparatively small "debt".

That's a fair point, but I don't think we're prepared to sell off Alaska to pay down our debt ;).

Bucksandreds

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Re: What comes after the ACA?
« Reply #1999 on: April 18, 2017, 11:27:40 AM »
Surely people on these forums wouldn't approve of spending more than their income year after year.

Please don't tell me you've made the obvious mistake of equating a household's budget with the US government's budget. 

Those two situations are only similar if the household can manufacture unlimited amounts of money, which they can not only spend but also sell to other households at a premium.

I wish the same were true of the government.  Taking away its ability to print as many dollars as it wants/needs would be a huge step in the right direction.

Raising taxes to pay for healthcare does not need to raise and could actually lower debt.  Fully funding Medicare for all through taxes eliminates the paid for by debt Medicaid and CHIP programs. I'm sure you'd still be against this as your true concern is likely the desire to not pay taxes and changing the subject to government debt levels is a convenient way for you to shift the discussion.