Author Topic: What comes after the ACA?  (Read 243280 times)

Jrr85

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Re: What comes after the ACA?
« Reply #2300 on: May 11, 2017, 09:14:37 AM »
As discussed, oh, 40 pages ago I think it's completely unjust that larger plans can negotiate for lower rates on medical coverage.  Sounds great if you are a member of that plan, but its awful if you're not part of a large plan.
The more members a plan has the lower the rates because of the reduction in the overall risk pool. That's not unjust, that's just math. What is unjust is the every individual doesn't have the option to join a very large risk pool.

He's not talking about rates for insurance, he's talking about the rates paid to providers, which are essentially a negotiated "bulk rate" discount.  There's nothing wrong with it per say, but what happens is that providers jack up their "normal" charge so that the insurance companies can pay the "discounted" charges.  Then you end up with uninsured people coming in and being charged the non-discounted charges and having no clue that those charges have very little relation to what the hospital actually needs/expects to be paid. 

As an example, I think the "charge" for the delivery and associated care of the birth of our last child was over $30k.  If we had been uninsured, we probably could have worked with them ahead of time to negotiate an all in cost similar to what the insurance company paid (can't remember what that was other than it being way, way less than the "charge", maybe around $10k?), but lots of people wouldn't know to do that or be comfortable doing that. 

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Re: What comes after the ACA?
« Reply #2301 on: May 11, 2017, 09:24:43 AM »
As discussed, oh, 40 pages ago I think it's completely unjust that larger plans can negotiate for lower rates on medical coverage.  Sounds great if you are a member of that plan, but its awful if you're not part of a large plan.
The more members a plan has the lower the rates because of the reduction in the overall risk pool. That's not unjust, that's just math. What is unjust is the every individual doesn't have the option to join a very large risk pool.

He's not talking about rates for insurance, he's talking about the rates paid to providers, which are essentially a negotiated "bulk rate" discount.  There's nothing wrong with it per say, but what happens is that providers jack up their "normal" charge so that the insurance companies can pay the "discounted" charges.  Then you end up with uninsured people coming in and being charged the non-discounted charges and having no clue that those charges have very little relation to what the hospital actually needs/expects to be paid. 
 
Yes, exactly.  Cost of service, not insurance.  If I break my wrist and need x-rays, the payment amount made to the radiologist will be different depending on how I pay and which insurance company I am covered through.  Different costs for the same service.
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BeanCounter

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Re: What comes after the ACA?
« Reply #2302 on: May 11, 2017, 09:25:23 AM »
As discussed, oh, 40 pages ago I think it's completely unjust that larger plans can negotiate for lower rates on medical coverage.  Sounds great if you are a member of that plan, but its awful if you're not part of a large plan.
The more members a plan has the lower the rates because of the reduction in the overall risk pool. That's not unjust, that's just math. What is unjust is the every individual doesn't have the option to join a very large risk pool.

He's not talking about rates for insurance, he's talking about the rates paid to providers, which are essentially a negotiated "bulk rate" discount.  There's nothing wrong with it per say, but what happens is that providers jack up their "normal" charge so that the insurance companies can pay the "discounted" charges.  Then you end up with uninsured people coming in and being charged the non-discounted charges and having no clue that those charges have very little relation to what the hospital actually needs/expects to be paid. 

As an example, I think the "charge" for the delivery and associated care of the birth of our last child was over $30k.  If we had been uninsured, we probably could have worked with them ahead of time to negotiate an all in cost similar to what the insurance company paid (can't remember what that was other than it being way, way less than the "charge", maybe around $10k?), but lots of people wouldn't know to do that or be comfortable doing that.
Oh! I didn't realize you were talking about the network rates. Yes. Totally agree. Having to negotiate network rates, have separate fee schedules by provider etc, etc. Is a huge administrative drain on the system and a frankly a money maker for the insurers that under a single payor would be eliminated. (but helped pay my salary for many years) It is an additional cost to your individual premium that you are basically forced to have because it's difficult, if not impossible to negotiate rates yourself.

Jrr85

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Re: What comes after the ACA?
« Reply #2303 on: May 11, 2017, 09:31:22 AM »
This has probably been covered elsewhere in the thread, but why does the right get away with framing the young/old cost ratio issue as a moral/fairness issue?  I have had employer-sponsored health care from one employer or another for the past ~20 years.  The young and the old, the sick and the well, all pay exactly the same amount towards their health care under employer plans.  But thereís much squawking about having to subsidize the old or the sick when it comes to the (relatively tiny) individual market.   What gives?  Why isnít whatís good for the goose, good for the gander?  Should we change employer plans to allow them to charge older and/or sicker employees more?  I'd love it the Dem's added THAT as an amendment to a senate bill to highlight the issue.  Why should folks with employer coverage be protected from age/health discrimination?

Because it's not a moral issue when you give people the option to buy in to an insurance pool as part of the benefit of their employment.  Providing favorable tax treatment to make that arrangement work is probably not good policy, but having group rating for the employer pool is not a moral issue. 

When you tell young people that they must subsidize older people, who are likely more financially secure than them, that's a moral issue.  Especially when you have older people who did not have to bear the same burden for the generations older than them. 

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2304 on: May 11, 2017, 09:42:16 AM »
What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

This is what the rest of the world does.
In most developed countries the rate hovers around 7-8% of income
then everyone is covered, doesn't matter age, income, pre-existing conditions, where you work, live, whatever

It's as simple as that, and nobody needs worry about switching jobs, getting sick, deductibles, or whatever.

If you only ever lived in the US and don't know by first hand any other health care system, you need to know that this is a non-issue in Europe, Australia, Canada. NOBODY ever needs to worry about access to health care, or going bankrupt because you had an unexpected health issue.

I hear a lot of misconceptions about health care in other countries, things like "but in Canada the doctors are so bad.. " or "you have to wait to see a doctor for so long that you die while waiting or cross the border to get care in the US" . This is complete nonsense, and even if you have to wait a couple of weeks for MRI instead of going in the day after, you will not die, and will not get a $$$$ bill . Everyone who needs care can get it, virtually nobody needs to start a GoFundMe for a breast cancer surgery.
Why would anyone not want to pay ~10% of their income and never worry again about premiums, deductibles,etc. ? Not just for yourself and your immediate family, but for everyone in this country, even the "lazy burger flippers" .

This is also the meaning of 'affordable' - you pay % of your income, not X $s

The HHS secretary said recently that it only makes sense to pay more for health care if you are sick! No it does not! Maybe yes for supplemental health insurance, just like life insurance.
On all fronts it makes sense to pay fixed % . Everybody gets sick, everybody should have access to health care regardless of how much money you have. Nobody thinks "I would keep eating bacon X3/day because the heart surgery is for free"



surfhb

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Re: What comes after the ACA?
« Reply #2305 on: May 11, 2017, 10:00:34 AM »

Happy now, Trump voters?

Yes.  So  far, I'm upbeat.  I'm truly sorry that life went so sideways for you, but it's still not my fault.

"I'm alright Jack...keep your hands off of my stack....".     Lol.... I get it.    I can see why people think in such ways

Reminds me of my ultra conservative friend who's  life went sidewise for him recently.   

It's been amazing watching him transform himself into this tree hugging hippie liberal.   I'm so proud of him!    He's early 60s with some nasty health issues which leave him unable to get a job.   He has retirement but he sure is scared on what this new plan will be bring about.

It could happen to anyone of us


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ZiziPB

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Re: What comes after the ACA?
« Reply #2306 on: May 11, 2017, 10:05:34 AM »
What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

This is what the rest of the world does.
In most developed countries the rate hovers around 7-8% of income
then everyone is covered, doesn't matter age, income, pre-existing conditions, where you work, live, whatever


It's as simple as that, and nobody needs worry about switching jobs, getting sick, deductibles, or whatever.

This ^
This would also mean that we no longer have to pay separate Medicare contributions or health insurance premiums/HSA contributions/out of pocket costs.  So it's not like a totally new tax being imposed on people.  For the vast majority of employed people, the difference in the bottom line would be minimal.



boarder42

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Re: What comes after the ACA?
« Reply #2307 on: May 11, 2017, 10:22:32 AM »
What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

This is what the rest of the world does.
In most developed countries the rate hovers around 7-8% of income
then everyone is covered, doesn't matter age, income, pre-existing conditions, where you work, live, whatever


It's as simple as that, and nobody needs worry about switching jobs, getting sick, deductibles, or whatever.

This ^
This would also mean that we no longer have to pay separate Medicare contributions or health insurance premiums/HSA contributions/out of pocket costs.  So it's not like a totally new tax being imposed on people.  For the vast majority of employed people, the difference in the bottom line would be minimal.

yes we already pay 3% here.  and most employers plus employee contributions to healtcare plans are more than 4% ... make it 8% and we could just have universal healthcare ... kill off the insurance machines. and move on with our lives. 
PM me about how to save 6% on your annual grocery Bill!

There is a 35k starwood bonus right now as well. PM me for the info.

mm1970

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Re: What comes after the ACA?
« Reply #2308 on: May 11, 2017, 10:41:47 AM »
This has probably been covered elsewhere in the thread, but why does the right get away with framing the young/old cost ratio issue as a moral/fairness issue?  I have had employer-sponsored health care from one employer or another for the past ~20 years.  The young and the old, the sick and the well, all pay exactly the same amount towards their health care under employer plans.  But thereís much squawking about having to subsidize the old or the sick when it comes to the (relatively tiny) individual market.   What gives?  Why isnít whatís good for the goose, good for the gander?  Should we change employer plans to allow them to charge older and/or sicker employees more?  I'd love it the Dem's added THAT as an amendment to a senate bill to highlight the issue.  Why should folks with employer coverage be protected from age/health discrimination?

Because it's not a moral issue when you give people the option to buy in to an insurance pool as part of the benefit of their employment.  Providing favorable tax treatment to make that arrangement work is probably not good policy, but having group rating for the employer pool is not a moral issue. 

When you tell young people that they must subsidize older people, who are likely more financially secure than them, that's a moral issue.  Especially when you have older people who did not have to bear the same burden for the generations older than them.
So...we should also eliminate Medicare?

golden1

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Re: What comes after the ACA?
« Reply #2309 on: May 11, 2017, 10:52:22 AM »
Quote
When you tell young people that they must subsidize older people, who are likely more financially secure than them, that's a moral issue.  Especially when you have older people who did not have to bear the same burden for the generations older than them.

What an odd statement!  As a young person, I was taught that taking care of the elderly was the honorable and MORAL thing to do.  Those older people were the ones that raised the younger generation, yes?  They sacrificed for me and cared for me when I was a defenseless infant who needed it.  But yes, by all means, lets just let the older generations take care of themselves.

I guess I just have a different understanding of what it means to be a decent human in a society. 

AdrianC

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Re: What comes after the ACA?
« Reply #2310 on: May 11, 2017, 10:54:42 AM »
A local rep (not ours, who is even worse) sent an email crowing about the AHCA. In the Q&A section is this:

Can states raise costs for pre-existing conditions?
You won't be charged more as long as you maintain continuous coverage. If you live in a waiver state, have a pre-existing condition, and go without insurance for more than 63 days, only then can an insurer charge you higher premiums based on health status; however, this would only apply during the year following your lapse in coverage and the AHCA provides significant resources at the federal and state level for risk-sharing programs to help lower your premiums.


Is this correct? I was getting the idea that in a waiver state the insurance company could charge higher premiums based on health status even if you had not had a lapse in coverage.

Yes, this is correct, based on my reading of the AHCA bill (which I discussed in more detail in this post), except that I would not characterize the last condition in the italicized text as a requirement that "significant" risk-mitigation resources be dedicated (according to many health care policy experts, the minimum level of resources that need to be dedicated would be better described as "woefully inadequate").

Thanks. I'd read your post but I guess I zoned out when I read "MacArthur amendment (Section 2701(b)(1)(C) of the Public Health Service Act)" :-)

So, we maintain coverage and we're good. Rates just increase for age and we get a tax credit that increases with age. And we get to stash twice as much into an HSA.

I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

rantk81

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Re: What comes after the ACA?
« Reply #2311 on: May 11, 2017, 11:00:36 AM »
Thanks. I'd read your post but I guess I zoned out when I read "MacArthur amendment (Section 2701(b)(1)(C) of the Public Health Service Act)" :-)

So, we maintain coverage and we're good. Rates just increase for age and we get a tax credit that increases with age. And we get to stash twice as much into an HSA.

I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

The part that I think derails FIRE plans is the removal of income-based subsidy.  In my zip code, I just checked the current exchange plans for a couple of age 60, and the lowest cost plan has a $1150/mo premium with $13,300 deductible on a very narrow network.  Paying over $27K out of pocket in a year for a couple before the insurance company kicks in a dime seems kinda contrary to someone who is trying to FIRE.

brooklynguy

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Re: What comes after the ACA?
« Reply #2312 on: May 11, 2017, 11:09:00 AM »
I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

Lots of potential reasons.

One is that certain categories of people, such as frugal low-income mustachians in high-insurance-cost locations, would pay substantially more for robust insurance coverage, on a post-tax-credit/subsidy basis, under this legislation than under the ACA.  So if their plans depended on ACA-based insurance costs, their plans could be derailed.

Another is that the structural design of this legislation (in particular, the weak disincentives for healthy participants to opt out of the insurance market altogether) creates a substantially higher likelihood for the entire individual insurance market to enter a death spiral, with no protection against skyrocketing premiums (since the tax credits no longer increase in tandem with premium costs).

Gin1984

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Re: What comes after the ACA?
« Reply #2313 on: May 11, 2017, 11:21:57 AM »
I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

Lots of potential reasons.

One is that certain categories of people, such as frugal low-income mustachians in high-insurance-cost locations, would pay substantially more for robust insurance coverage, on a post-tax-credit/subsidy basis, under this legislation than under the ACA.  So if their plans depended on ACA-based insurance costs, their plans could be derailed.

Another is that the structural design of this legislation (in particular, the weak disincentives for healthy participants to opt out of the insurance market altogether) creates a substantially higher likelihood for the entire individual insurance market to enter a death spiral, with no protection against skyrocketing premiums (since the tax credits no longer increase in tandem with premium costs).
Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.   

jim555

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Re: What comes after the ACA?
« Reply #2314 on: May 11, 2017, 11:26:26 AM »
Trump is again threatening the ACA Silver plans cost sharing reductions....

http://thehill.com/policy/healthcare/332953-trump-threatens-to-stop-obamacare-payments

Looks like he is trying to destabilize the insurance markets.  Good luck blaming Obama when you are the one causing the chaos.

nereo

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Re: What comes after the ACA?
« Reply #2315 on: May 11, 2017, 11:26:58 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
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Gin1984

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Re: What comes after the ACA?
« Reply #2316 on: May 11, 2017, 11:34:05 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
I was working as a server and going to school in which I typed my notes.  So since, I was working my way through school I often averaged 15 hours per day in the same arm position.  That caused my trapezius muscle to stop being accustomed to moving and it started being painful to move my neck.  Instead of stopping, going to the doctor and finding out why, I just did not move it until it locked in place and I could not move my jack more than 5 degrees in one direction and 10 in the other.  It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.
So the moral of this story is, if something stops behaving normally, go to the bloody Doctor.
« Last Edit: May 11, 2017, 11:56:16 AM by Gin1984 »

Jrr85

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Re: What comes after the ACA?
« Reply #2317 on: May 11, 2017, 12:18:54 PM »
Quote
When you tell young people that they must subsidize older people, who are likely more financially secure than them, that's a moral issue.  Especially when you have older people who did not have to bear the same burden for the generations older than them.

What an odd statement!  As a young person, I was taught that taking care of the elderly was the honorable and MORAL thing to do.  Those older people were the ones that raised the younger generation, yes?  They sacrificed for me and cared for me when I was a defenseless infant who needed it.  But yes, by all means, lets just let the older generations take care of themselves.

I guess I just have a different understanding of what it means to be a decent human in a society.

A few things wring with this.  First, 57 is not exactly what I would call elderly.  I guess what qualifies as elderly is somewhat of a judgment call/opinion, so not technically wrong, but I think most people would not classify people in their late 50's as elderly. 

Second, the subsidy doesn't go from young people to the older people that sacrificed and cared for you.  If you are in your twenties and have a parent (or somebody else that took care of you) who is in his/her 50's that does need you to help take care of them, the subsidy you're required to pay actually makes it harder for you to help them.  If they have financial trouble, the risk rating related subsidy will mean nothing to them as they will be getting a subsidy to pay their premiums based on their ability to pay.  So you will be paying to subsidize people in their 50's that largely can afford their insurance without the subsidy while the person who actually took care of you that does need your help gets none of it. 

Third, this has nothing to do with letting older generations take care of themselves.  There is still medicare and social security. 

Fourth, I don't see parents in their 50's who are well off demanding that their kids in their 20's or early 30's provide them money or other financial support.  I'm sure it happens, but that seems to be the exception.  If anything, I see parents that are not well off financially that are probably too reluctant to ask for financial help from their kids and who wait until they are facing significant hardship before they ask their kids who are doing well financially for financial help.  So if you were taught that younger people should provide financial support to older people who are in better financial shape than them simply because they are older, I think that's a very small number of people that follow that ethos. 

tyort1

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Re: What comes after the ACA?
« Reply #2318 on: May 11, 2017, 12:51:49 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
Frugalite in training.

ZiziPB

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Re: What comes after the ACA?
« Reply #2319 on: May 11, 2017, 01:12:10 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...



Bucksandreds

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Re: What comes after the ACA?
« Reply #2320 on: May 11, 2017, 04:11:47 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

The 8% could be added to payroll taxes thus made non refundable.  Then everyone would pay the same rate

nereo

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Re: What comes after the ACA?
« Reply #2321 on: May 11, 2017, 04:15:10 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

The 8% could be added to payroll taxes thus made non refundable.  Then everyone would pay the same rate
Yeah, that'll go over well ::eyeroll::
What's 8% of $0?
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AdrianC

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Re: What comes after the ACA?
« Reply #2322 on: May 11, 2017, 04:19:08 PM »
Thanks. I'd read your post but I guess I zoned out when I read "MacArthur amendment (Section 2701(b)(1)(C) of the Public Health Service Act)" :-)

So, we maintain coverage and we're good. Rates just increase for age and we get a tax credit that increases with age. And we get to stash twice as much into an HSA.

I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

The part that I think derails FIRE plans is the removal of income-based subsidy.  In my zip code, I just checked the current exchange plans for a couple of age 60, and the lowest cost plan has a $1150/mo premium with $13,300 deductible on a very narrow network.  Paying over $27K out of pocket in a year for a couple before the insurance company kicks in a dime seems kinda contrary to someone who is trying to FIRE.

Your couple would get $8K in tax credits, so worse case is $19K, assuming same premium. Plus it's not $19K out of pocket before the insurance company kicks in a dime, if they have a plan that includes doctor visits and prescription coverage and such.


AdrianC

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Re: What comes after the ACA?
« Reply #2323 on: May 11, 2017, 04:23:17 PM »
So if their plans depended on ACA-based insurance costs, their plans could be derailed.
Sure, but have they not been listening? The GOP has been saying for 7 years that they will repeal the ACA. Can anyone seriously be basing their FIRE plans on the ACA?

Quote
Another is that the structural design of this legislation (in particular, the weak disincentives for healthy participants to opt out of the insurance market altogether) creates a substantially higher likelihood for the entire individual insurance market to enter a death spiral, with no protection against skyrocketing premiums (since the tax credits no longer increase in tandem with premium costs).
That is a genuine concern.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2324 on: May 11, 2017, 07:47:59 PM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

sol

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Re: What comes after the ACA?
« Reply #2325 on: May 11, 2017, 08:54:34 PM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

The working poor are going to be very hurt by the republican party's current economic policies.  All of them.   That's kind of the point of the party.

Which is why it's so painful to see a con man like Trump get so many of their votes.  Democracy is a grand idea and I wholly support it, but it does have a potentially fatal flaw in allowing people to choose self destruction.  Trump convinced millions of poor people to vote for their own demise.

I know, lots of them voted for him for reasons other than economics.  They liked that he claimed to hate the same people they hated, and maybe they thought he wouldn't really follow though on all of his "I'm going to screw the poor" campaign promises?  I'll just give them the benefit of the doubt by assuming that they were at least able to recognize those, and weren't just duped.

gerardc

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Re: What comes after the ACA?
« Reply #2326 on: May 12, 2017, 01:16:50 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
I was working as a server and going to school in which I typed my notes.  So since, I was working my way through school I often averaged 15 hours per day in the same arm position.  That caused my trapezius muscle to stop being accustomed to moving and it started being painful to move my neck.  Instead of stopping, going to the doctor and finding out why, I just did not move it until it locked in place and I could not move my jack more than 5 degrees in one direction and 10 in the other.  It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.
So the moral of this story is, if something stops behaving normally, go to the bloody Doctor.

The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people MOD NOTE: It is completely unacceptable and a violation of several forum rules to belittle a fellow forum member for a medical condition.
« Last Edit: May 12, 2017, 07:42:01 PM by swick »

Gin1984

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Re: What comes after the ACA?
« Reply #2327 on: May 12, 2017, 06:25:51 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
I was working as a server and going to school in which I typed my notes.  So since, I was working my way through school I often averaged 15 hours per day in the same arm position.  That caused my trapezius muscle to stop being accustomed to moving and it started being painful to move my neck.  Instead of stopping, going to the doctor and finding out why, I just did not move it until it locked in place and I could not move my jack more than 5 degrees in one direction and 10 in the other.  It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.
So the moral of this story is, if something stops behaving normally, go to the bloody Doctor.

The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people
You do realize that I did that because it was the only way I could afford to go to school?  Thanks for laughing at me.

nereo

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Re: What comes after the ACA?
« Reply #2328 on: May 12, 2017, 07:48:32 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
I was working as a server and going to school in which I typed my notes.  So since, I was working my way through school I often averaged 15 hours per day in the same arm position.  That caused my trapezius muscle to stop being accustomed to moving and it started being painful to move my neck.  Instead of stopping, going to the doctor and finding out why, I just did not move it until it locked in place and I could not move my jack more than 5 degrees in one direction and 10 in the other.  It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.
So the moral of this story is, if something stops behaving normally, go to the bloody Doctor.

The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people
You do realize that I did that because it was the only way I could afford to go to school?  Thanks for laughing at me.
Didn't mean to open you up to criticism Gin - my apologies if its caused you angst. I just never made the connection that 'traps = trapezus muscle'.  I've worked quite a few jobs (mostly on ships and at field stations) where I'm put in a positions that have caused lingering spasms and loss of mobility, but thankfully nothing permanent.  It's easy for others to take pop-shots adn say things like 'just don't do that'. Ironically it's given me a new appreciation for OSHA and workplace rules for proper posture... something i once thought was laughably bureaucratic.
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FrugalToque

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Re: What comes after the ACA?
« Reply #2329 on: May 12, 2017, 07:52:18 AM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

The working poor are going to be very hurt by the republican party's current economic policies.  All of them.   That's kind of the point of the party.

Which is why it's so painful to see a con man like Trump get so many of their votes.

http://www.theglobeandmail.com/news/world/us-politics/the-average-trump-supporter-is-not-an-economic-loser/article32746323/

I don't disagree with your other points, but Trump's voters did tend to be slightly richer people, compared to Clinton's voters.  The notion that Trump somehow attracted unusual amounts of poor people away from the Democrats is one of the more confusing ideas to come out of that election.

Toque.

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Re: What comes after the ACA?
« Reply #2330 on: May 12, 2017, 08:23:06 AM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

The working poor are going to be very hurt by the republican party's current economic policies.  All of them.   That's kind of the point of the party.

Which is why it's so painful to see a con man like Trump get so many of their votes.

http://www.theglobeandmail.com/news/world/us-politics/the-average-trump-supporter-is-not-an-economic-loser/article32746323/

I don't disagree with your other points, but Trump's voters did tend to be slightly richer people, compared to Clinton's voters.  The notion that Trump somehow attracted unusual amounts of poor people away from the Democrats is one of the more confusing ideas to come out of that election.

Toque.

But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.
Transitioning to FIRE'd albeit somewhat cautiously...

wenchsenior

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Re: What comes after the ACA?
« Reply #2331 on: May 12, 2017, 08:28:18 AM »

Or people like me who could find NO insurance, for ANY amount of money because of a small pre-existing condition.  Seriously, all I did was lock my traps and no insurance.  I cannot retire with the risk of losing my stash to one incident.
...I'm not even sure what this means... explain?
I was working as a server and going to school in which I typed my notes.  So since, I was working my way through school I often averaged 15 hours per day in the same arm position.  That caused my trapezius muscle to stop being accustomed to moving and it started being painful to move my neck.  Instead of stopping, going to the doctor and finding out why, I just did not move it until it locked in place and I could not move my jack more than 5 degrees in one direction and 10 in the other.  It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.
So the moral of this story is, if something stops behaving normally, go to the bloody Doctor.

The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people

Don't be a dick.

the_fixer

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Re: What comes after the ACA?
« Reply #2332 on: May 12, 2017, 08:37:27 AM »
But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.

I know several immigrants that came here legally and they feel it is a slap in the face that they worked so hard, put in the time and effort to do it the right way when others are breaking the law, getting away with it. I do not ask people who they vote for but it would not surprise me if they voted Trump.

Bucksandreds

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Re: What comes after the ACA?
« Reply #2333 on: May 12, 2017, 09:00:14 AM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

The 8% could be added to payroll taxes thus made non refundable.  Then everyone would pay the same rate
Yeah, that'll go over well ::eyeroll::
What's 8% of $0?

The majority of those on "welfare" in the United states are working. Right now they're paying $0 for Medicaid. A payroll tax to pay for Universal Healthcare means that the majority of those who currently receive Medicaid for free would have to start paying for their health insurance. That sounds like an idea that the right should get behind.

mm1970

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Re: What comes after the ACA?
« Reply #2334 on: May 12, 2017, 09:13:58 AM »
But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.

I know several immigrants that came here legally and they feel it is a slap in the face that they worked so hard, put in the time and effort to do it the right way when others are breaking the law, getting away with it. I do not ask people who they vote for but it would not surprise me if they voted Trump.
I know at least one of my sisters voted for Trump.  But, I've been at enough family dinners to know that half my family has a not-very-hidden undercurrent of flat out racism.

And, you know. Obamacare, bad.  Let me just sit back using my Medicare.

And, Benghazi!

Luck12

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Re: What comes after the ACA?
« Reply #2335 on: May 12, 2017, 09:22:14 AM »
The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people

I don't even care if this gets me a temp banning.  Fuck you, you are an asshole.   Pretty easy to tell what your political affiliation is. 

dividendman

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Re: What comes after the ACA?
« Reply #2336 on: May 12, 2017, 10:24:43 AM »
  Democracy is a grand idea and I wholly support it, but it does have a potentially fatal flaw in allowing people to choose self destruction. 

The fatal flaw in democracy, as Jefferson told us, is that it required an informed electorate. That's why I think we should have tests in the voting booth that quiz you on an issue an if you get the quiz wrong your vote for that issue/candidate is nullified.

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Re: What comes after the ACA?
« Reply #2337 on: May 12, 2017, 10:28:39 AM »

The 8% could be added to payroll taxes thus made non refundable.  Then everyone would pay the same rate
Yeah, that'll go over well ::eyeroll::
What's 8% of $0?

The majority of those on "welfare" in the United states are working. Right now they're paying $0 for Medicaid. A payroll tax to pay for Universal Healthcare means that the majority of those who currently receive Medicaid for free would have to start paying for their health insurance. That sounds like an idea that the right should get behind.
I wrote that late last night and could have been more explicit.
On record I live in a country with a single-payer system and I'm not against it for the US (where I've spent most of my life) - I just think it's hard to get from here to there.

My response was to an earlier comment that a payroll tax would eliminate the "us-vs-them" argument.  I think that approach would do the exact opposite - anyone that wasn't working would not be paying into the system, including the old, the young, students, etc.  A payroll tax would mean that high-earners support the system, while the poor, the retired and unemployed get benefits.  Again - I'm not arguing against this, but this would be the absolute mega-storm of "us-vs-them."  It should be noted that ERs would benefit the most from such an arrangement.

Looking at other similar taxes (e.g. the FICA taxes for SS and Medicare) as well as the Income Adjustment Tax ("Obamacare tax") - the GOP angrily talks about how unfair these are..."a handout to the poor"; "the welfare state"; "a vast transfer of wealth" etc.  Payroll taxing the entire medical system would be orders-of-magnitude greater, because we're talking about a system that currently requries >$3T.  I just don't see that ever getting off the ground in the US, politically speaking.
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Gin1984

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Re: What comes after the ACA?
« Reply #2338 on: May 12, 2017, 11:07:08 AM »

The 8% could be added to payroll taxes thus made non refundable.  Then everyone would pay the same rate
Yeah, that'll go over well ::eyeroll::
What's 8% of $0?

The majority of those on "welfare" in the United states are working. Right now they're paying $0 for Medicaid. A payroll tax to pay for Universal Healthcare means that the majority of those who currently receive Medicaid for free would have to start paying for their health insurance. That sounds like an idea that the right should get behind.
I wrote that late last night and could have been more explicit.
On record I live in a country with a single-payer system and I'm not against it for the US (where I've spent most of my life) - I just think it's hard to get from here to there.

My response was to an earlier comment that a payroll tax would eliminate the "us-vs-them" argument.  I think that approach would do the exact opposite - anyone that wasn't working would not be paying into the system, including the old, the young, students, etc.  A payroll tax would mean that high-earners support the system, while the poor, the retired and unemployed get benefits.  Again - I'm not arguing against this, but this would be the absolute mega-storm of "us-vs-them."  It should be noted that ERs would benefit the most from such an arrangement.

Looking at other similar taxes (e.g. the FICA taxes for SS and Medicare) as well as the Income Adjustment Tax ("Obamacare tax") - the GOP angrily talks about how unfair these are..."a handout to the poor"; "the welfare state"; "a vast transfer of wealth" etc.  Payroll taxing the entire medical system would be orders-of-magnitude greater, because we're talking about a system that currently requries >$3T.  I just don't see that ever getting off the ground in the US, politically speaking.
I've heard regular taxes spoken like that, but not FICA.  Everyone pays FICA, and actually if you earn over the cap, you end up paying less than the poor.

Paul der Krake

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Re: What comes after the ACA?
« Reply #2339 on: May 12, 2017, 11:20:07 AM »
I've heard regular taxes spoken like that, but not FICA.  Everyone pays FICA, and actually if you earn over the cap, you end up paying less than the poor.
No, you end up paying less *in percentage terms* than the poor. You still pay more than the poor. And you get very little added benefit in return, because the bend points in the Social Security payout calculations are very steep.

nereo

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Re: What comes after the ACA?
« Reply #2340 on: May 12, 2017, 01:55:56 PM »
I've heard regular taxes spoken like that, but not FICA.  Everyone pays FICA, and actually if you earn over the cap, you end up paying less than the poor.
No, you end up paying less *in percentage terms* than the poor. You still pay more than the poor. And you get very little added benefit in return, because the bend points in the Social Security payout calculations are very steep.
First, only people with earned income pay FICA.  That means (broadly speaking) the elderly, students, unemployed etc. aren't paying FICA in any given year. The ER crowd could not pay for the last 4+ decades of their life, for example.  With the SS portion of FICA your benefits are based on your contributions over your top 35 years.

Second - hang around Bogleheads and you'll hear lots about how "unfair" (their terms) FICA can be.  Sometimes here too.  Paul is right though - it's about percentage/absolute terms.  Someone earning $125k pays way more in absolute terms than someone earning $25k in FICA (5x more!), even though they both pay the same percentage.
Again, I'm not saying it's a bad way of doing it, just that I think it's a political non-starter in the US.  You'd have to convince a large block of mostly high earners that they are going to support health care for the elderly, all children, the unemployed, etc.  In that regard we're a pretty selfish lot.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2341 on: May 12, 2017, 07:02:48 PM »
It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.


Yes massage therapy is very effective for back muscle tension. I also recommend yoga too.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2342 on: May 12, 2017, 07:26:47 PM »
In this NY Times piece it's clear that many who hated the ACA made too much money to qualify for the subsidies and found that they were paying more for health insurance in the marketplace than what they used to pay. It seems like many of these individuals could have qualified for subsidies if they made an effort to lower the AGI through retirement plans.

https://www.nytimes.com/2017/05/12/health/affordable-care-act-repeal.html?module=WatchingPortal&region=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=9&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2017%2F05%2F12%2Fhealth%2Faffordable-care-act-repeal.html&eventName=Watching-article-click&_r=0

badassprof

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Re: What comes after the ACA?
« Reply #2343 on: May 12, 2017, 10:10:14 PM »
I am one of those people working for insurance. I have a consulting gig that would cover my bills, but I had cancer when I was in my late 30s (late 40s now). Pre Obamacare, no one would insure me for any price.  We are ready to pull the trigger and would happily give our well-compensated jobs to some younger folks, but don't dare exit before this insurance business is settled.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2344 on: May 13, 2017, 04:42:24 PM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

Assume that as a county we decided to implement universal health care by offering something similar/identical to the current Medicare program, but offering it to people of all ages, instead of just folks 65 years old. Assume that the cost of it would be funded by a payroll tax, similar to the FICA taxes. What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

Germany that we all love to quote as one of the best examples of a 1 payer system taxes all it's employees a little over 15% About 7% is paid by the employer.  There is also a cap in Germany at about $5500 on the tax making it regressive, but having every person who works front the bill.  A few other interesting points.  Germany pays about 40% less per person compared to America for healthcare.  1/3 of hospitals in Germany are losing money.  Just some facts to think about.  Basically if brought to the US we would need a higher tax with a higher cap and it would replace medicare tax of 2.9% that we have today.  I obviously have not calculated the actual math to know the taxes required, but we spend a little over $10,000/yr per person for healthcare in this country.

starguru

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Re: What comes after the ACA?
« Reply #2345 on: May 13, 2017, 05:14:31 PM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

Assume that as a county we decided to implement universal health care by offering something similar/identical to the current Medicare program, but offering it to people of all ages, instead of just folks 65 years old. Assume that the cost of it would be funded by a payroll tax, similar to the FICA taxes. What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

Germany that we all love to quote as one of the best examples of a 1 payer system taxes all it's employees a little over 15% About 7% is paid by the employer.  There is also a cap in Germany at about $5500 on the tax making it regressive, but having every person who works front the bill.  A few other interesting points.  Germany pays about 40% less per person compared to America for healthcare.  1/3 of hospitals in Germany are losing money.  Just some facts to think about.  Basically if brought to the US we would need a higher tax with a higher cap and it would replace medicare tax of 2.9% that we have today.  I obviously have not calculated the actual math to know the taxes required, but we spend a little over $10,000/yr per person for healthcare in this country.

I wonder if we taxed all income (not just earned) at 10-15% if we could cover all the entitlement programs, including a single payer health care system.  And if so, would a majority go for it.  If so, then the only problem would be preventing the never ending expansion of entitlements. 

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2346 on: May 15, 2017, 07:24:57 AM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

Assume that as a county we decided to implement universal health care by offering something similar/identical to the current Medicare program, but offering it to people of all ages, instead of just folks 65 years old. Assume that the cost of it would be funded by a payroll tax, similar to the FICA taxes. What percentage of a tax on payrolls would be required to fund this type of program?  3%?  5%? 10%? 15? Would it even be higher than 15%?  (This amount could even be somewhat "hidden" by splitting it between "employer" and "employee" tax -- in a similar manner that the FICA taxes are done.)

Even at 15%, wouldn't that be a palatable thing for the public at large, considering that employers would no longer be paying large sums of money to a group policy... and employees wouldn't be on the hook for payroll deductions for the group plans? 

I'd accept that, and I say that as someone who who earns a high income, and would be paying a significantly disproportionately higher amount than lower income folks.

Germany that we all love to quote as one of the best examples of a 1 payer system taxes all it's employees a little over 15% About 7% is paid by the employer.  There is also a cap in Germany at about $5500 on the tax making it regressive, but having every person who works front the bill.  A few other interesting points.  Germany pays about 40% less per person compared to America for healthcare.  1/3 of hospitals in Germany are losing money.  Just some facts to think about.  Basically if brought to the US we would need a higher tax with a higher cap and it would replace medicare tax of 2.9% that we have today.  I obviously have not calculated the actual math to know the taxes required, but we spend a little over $10,000/yr per person for healthcare in this country.

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.

nereo

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Re: What comes after the ACA?
« Reply #2347 on: May 15, 2017, 07:36:15 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
It IS a lot of money.  It's also what we in the U.S. are spending annually on our health care (personal + employer + medicare/medicaid/all-governments). One way or another that's what gets paid, and its more per person than any other nation.

when people say health care ought to be paid for through payroll taxes I'm not sure many appreciate just how huge a change that would be.  160MM workers means the median payroll tax would need to be over $18,500/year. Higher earners will pay a LOT more simply because someone earning minimum wage can't pay $18k in health-care taxes. 
Again, we're paying this already in various forms, but for a country where a large portion is actively fighting to lower taxes I'm not sure how this could gain traction. Most people are clueless about the real cost of healthcare.
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TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2348 on: May 15, 2017, 09:06:45 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals

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Re: What comes after the ACA?
« Reply #2349 on: May 15, 2017, 09:22:10 AM »

$10k per year per person is $3 trillion dollars per year.   That is a lot of money.
Most people are clueless about the real cost of healthcare.


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals

Though you have a point, you can't just take that money out of the system. That overpriced pill goes to investment in new pills or employee's salaries. Insurance premiums support thousands of employees who would presumably need a job elsewhere, and someone would need profits to pay their salaries. It also pays for admin work, some of which will still need to be done at some level. "Exorbitant" hospital bills pay for doctors, equipment, and new hospitals; we would still need this right?

In my opinion single-payer is probably more efficient, but it's not just flicking a switch and getting health-care nirvana and saving billions. Especially not with an ingrown system like this. I don't think for a second it's a cut and dry as the Sanders crowd make it out to be. Like Trump, simple, feel-good answers to complex problems is his thing..