Author Topic: What comes after the ACA?  (Read 146525 times)

packlawyer04

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Re: What comes after the ACA?
« Reply #400 on: January 16, 2017, 09:52:16 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.
« Last Edit: January 16, 2017, 09:53:55 AM by packlawyer04 »

packlawyer04

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Re: What comes after the ACA?
« Reply #401 on: January 16, 2017, 09:56:11 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.

nereo

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Re: What comes after the ACA?
« Reply #402 on: January 16, 2017, 09:59:57 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.

Sounds like fear tactics to me.  Let's take SS for an example: currently its running a surplus forecasted to continue until 2019, at which point it'll start drawing from the trust fund.  Under the SST's most conservative model, the fund will be able to pay out full benefits until 2034.  Afterwards, it will be able to pay out at least 79% of proposed benefits for the full 75 year time frame required by law.

Not exactly "pretty soon" in my view, nor even definite.  These models are concervative to begin with and small adjustments and/or better revenue could ensure they never happen.
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Re: What comes after the ACA?
« Reply #403 on: January 16, 2017, 10:01:07 AM »
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.

tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.

What the what? He's literally suggesting that low-to-moderate income people are going to get bigger subsidies. I seriously hope they're not just going to deficit spend this one ...
The first step is acknowledging you have a problem, right?

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packlawyer04

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Re: What comes after the ACA?
« Reply #404 on: January 16, 2017, 10:03:03 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.

Sounds like fear tactics to me.  Let's take SS for an example: currently its running a surplus forecasted to continue until 2019, at which point it'll start drawing from the trust fund.  Under the SST's most conservative model, the fund will be able to pay out full benefits until 2034.  Afterwards, it will be able to pay out at least 79% of proposed benefits for the full 75 year time frame required by law.

Not exactly "pretty soon" in my view, nor even definite.  These models are concervative to begin with and small adjustments and/or better revenue could ensure they never happen.

What scare tactic. You jut admitted it is not going to be able to meet its requirements.  2034 is soon to me.  Less than 20 years.  I'm 35. If someone is 65 now, yeah, you probably don't really care very much.

sol

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Re: What comes after the ACA?
« Reply #405 on: January 16, 2017, 10:03:30 AM »
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'.

Well, the easy way to do that is to raise deductibles.  Insurance premiums gets pretty cheap if everyone has a $20k deductible and gets zero coverage until they spend that much out of pocket in a calendar year.

This sort of plan is usually cheaper for young healthy people, because they just don't go to the doctor.  They get no preventative care at all.  Unfortunately it's not cheaper overall for society, because lots of cheaply preventable problems go untreated until that person shows up at the ER with gangrenous feet.

One way to fix that problem (that the ACA tried, so maybe Republicans hate it) is to make preventative care 100% covered even on high deductible plans.  Like you get one physical per year for free, but if that physical finds anything wrong you are going to be on the hook to pay for it.  Ditto for 100% coverage of twice per year routine dental cleanings, but not any dental work (fillings are 100% out of pocket).  The problem with this plan is that it doesn't really keep costs down if you're paying for the first care and the last care but not the middle care, and it incentivizes people who need routine care to avoid getting it, so that they don't incur any cost for cavities or arthritis drugs or whatever. 

But the high deductible and free preventative care model works well for some people, including my family.  We're on a plan that leans that direction, and it is cheaper for us as long as we avoid any major medical catastrophes, and it will be slightly more expensive than our traditional insurance the first year one of my kids breaks a bone.  As a high income family, we also get way more benefit out of the HSA than do most people because our tax bracket is so high, so I expect Republicans to expand the HSA contribution limits as another tax break for rich people like me. 

bacchi

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Re: What comes after the ACA?
« Reply #406 on: January 16, 2017, 10:03:56 AM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

Forgetting to state that you had your tonsils out when you were 14 was grounds for rescission.

Too many head colds was grounds for denial.

Those were the good ol' days. America! Fuck yeah!

nereo

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Re: What comes after the ACA?
« Reply #407 on: January 16, 2017, 10:07:19 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.
I'm not sure what this has to do with the topic at hand. I made no comment about the efficency of state or local governments; I'm merely trying to explain to non-Americans why there is so much resistance in the US to universal federal health care.  Certainly some will argue that economies of scale favor larger interactions.
Also "the guys who founded this country" also didn't envision a country this large and complex, nor corporations that have the powers and wealth that they do today.
Perhaps that argues for increased local level government, perhaps not - doesn't seem to fit this sub-thread though.
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nereo

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Re: What comes after the ACA?
« Reply #408 on: January 16, 2017, 10:10:02 AM »
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'.

Well, the easy way to do that is to raise deductibles.  Insurance premiums gets pretty cheap if everyone has a $20k deductible and gets zero coverage until they spend that much out of pocket in a calendar year. (snip)


Yeah, except DJT is proposing better & cheaper coverage for everyone "with much lower deductables".
Like many of his promises, I don't see how this is even remotely possible.  To borrow an industry phrase; you can have high quality, fast and cheap, but you only get to pick two.
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Wexler

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Re: What comes after the ACA?
« Reply #409 on: January 16, 2017, 10:11:36 AM »
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.

tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.

Hard to say, because it's not like anyone (including Trump himself) believes anything he says or holds himself to things he said 5 minutes ago.  However, he did complain about drug prices being too high and that he should get to negotiate them.  So...maybe he'll pit himself against the pharmaceutical industry?  It would be hugely popular with everyone except pharmaceutical executives and, you know, the entire Republican congress.  Remember when they passed a law that Medicare wasn't allowed to negotiate drug prices?  For him to act outside of that would require legislative action, and that seems like a non-starter.

nereo

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Re: What comes after the ACA?
« Reply #410 on: January 16, 2017, 10:14:44 AM »

What scare tactic. You jut admitted it is not going to be able to meet its requirements.  2034 is soon to me.  Less than 20 years.  I'm 35. If someone is 65 now, yeah, you probably don't really care very much.
No... I'm not the one doing the analysis here, it's the SS Trustees. You were the one saying "very soon;" my argument is that 19 years is not 'pretty soon' especially when the shortfall is about 20% under the most conservative model.
under most scenarios it will be even longer nad with less of a shortfall, and this is assuming we do nothing for the next two decades.
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Metric Mouse

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Re: What comes after the ACA?
« Reply #411 on: January 16, 2017, 10:16:56 AM »
To provide the defense of what for its citizens?  You mean, like, their health?

It's fucking amazing that there are people in this country more scared of ISIS than they are of cancer.

There are also people more scared of assault rifles than they are of their car... what's the point?
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packlawyer04

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Re: What comes after the ACA?
« Reply #412 on: January 16, 2017, 10:21:06 AM »
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.
I'm not sure what this has to do with the topic at hand. I made no comment about the efficency of state or local governments; I'm merely trying to explain to non-Americans why there is so much resistance in the US to universal federal health care.  Certainly some will argue that economies of scale favor larger interactions.
Also "the guys who founded this country" also didn't envision a country this large and complex, nor corporations that have the powers and wealth that they do today.
Perhaps that argues for increased local level government, perhaps not - doesn't seem to fit this sub-thread though.

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.

I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

I'll wait to see what Trump comes up with but I don't see how he has put together a plan for the the comprehensive changes that would need to be implemented on such short notice.
« Last Edit: January 16, 2017, 10:22:48 AM by packlawyer04 »

nereo

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Re: What comes after the ACA?
« Reply #413 on: January 16, 2017, 10:27:48 AM »

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.

I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.
Fair enough - but I'm not arguing any of these points.
Someone asked why Americans were resistant to universal health care, and I provided my reasoning to why many ideologically disagree with that concept.  A subset of my explanation was that many Americans assume a governmental system will be more wasteful, etc.  You took that portion and re-stated it as fact.

I'm honestly not sure what in my argument you are disagreeing with or why - if anything you seem to be saying that these perceptions are facts.  I wasn't providing an opinion about whether they are true or not because the validity isn't important to the original question about why many in the US resist universal coverage programs.
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bacchi

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Re: What comes after the ACA?
« Reply #414 on: January 16, 2017, 10:33:09 AM »
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

What are the real problems and the solutions? I'll start.

Problems:
1) Everything costs a lot.
2) We're unhealthy.
3) End of life care is yuge for some people.

Solutions:
1) Regulate costs.
2) Promote healthy living. How?
3) Death panels (95 year olds don't get heart-lung transplants)?


nereo

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Re: What comes after the ACA?
« Reply #415 on: January 16, 2017, 10:45:51 AM »
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

What are the real problems and the solutions? I'll start.


Modifying what Bacchi wrote...
Problems:
1) Health Care costs more in the US than most other countries
2) We're unhealthy.
3) End of life care is yuge for some people.
4) Too many people don't have coverage and/or won't be able to afford coverage without assistance
5) ER visits by uninsured billed to hospitals which never collect

Solutions:
1) Regulate costs.
more preventative medicine, including vaccines and health care during developmental years. Reduce over-treatment/tests which is largely an effort to cover one's ass or appease patients. Control costs of prescription drugs. Reduce overprescription of drugs in first place.
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.
3) Death panels (95 year olds don't get heart-lung transplants)?
We need a paradigm shift on how the elderly are cared for, including more personal responsibility for family members and keeping the elderly engaged in the community vs walling them off to die expensive protracted deaths in assisted senior living stations. 'Right to die" needs to be available for terminally ill patients.  Mostly though better health in your 60s will ensure MUCH cheaper health adn better quality of life in your 70s/80s/90s.
4) extend a minimum level of coverage for everyone which includes annual checkups & vaccines.
5) dunno - but reducing the use of ERs for medical treatment (detecting/treating before it becomes a serious problem) also seems like a 'win-win', and gets back to some level of coverage for everyone.
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GuitarStv

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Re: What comes after the ACA?
« Reply #416 on: January 16, 2017, 10:53:18 AM »
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

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Re: What comes after the ACA?
« Reply #417 on: January 16, 2017, 10:58:37 AM »
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

To some extent this is already being done - there are taxes on cigarettes/cigars/tobacco, and in most places non-processed groceries have no sales tax.  Some places have started taxes and limitations on sodas and other sugary drinks (like NYC).  Personally I think this is one weapon we should use, but tehy alone probably won't do the trick.
One argument against is that it's monkeying with 'free-trade' and that people ought to be free to make their own decisions. 
Also, these taxes have had some effect but it's far from perfect, as evidenced by the number of overweight and obese in both the US and Canada.
My guess is people would still buy super-grande double-caramel frappachinnos at 900 calories every morning even if we instilled a $1 tax/drink on them.

ETA:
I don't want the government deciding what's bad for me.
This is a pervasive and legitimate concern for many.
« Last Edit: January 16, 2017, 11:01:35 AM by nereo »
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Re: What comes after the ACA?
« Reply #418 on: January 16, 2017, 10:59:28 AM »
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

I don't want the government deciding what's bad for me.

bacchi

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Re: What comes after the ACA?
« Reply #419 on: January 16, 2017, 11:05:30 AM »
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

To some extent this is already being done - there are taxes on cigarettes/cigars/tobacco, and in most places non-processed groceries have no sales tax.  Some places have started taxes and limitations on sodas and other sugary drinks (like NYC).  Personally I think this is one weapon we should use, but tehy alone probably won't do the trick.
One argument against is that it's monkeying with 'free-trade' and that people ought to be free to make their own decisions. 
Also, these taxes have had some effect but it's far from perfect, as evidenced by the number of overweight and obese in both the US and Canada.
My guess is people would still buy super-grande double-caramel frappachinnos at 900 calories every morning even if we instilled a $1 tax/drink on them.

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.

nereo

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Re: What comes after the ACA?
« Reply #420 on: January 16, 2017, 11:09:59 AM »

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.

Sure, but how do we get past the fungibility of money concept? Raise a bunch of money for health-care through taxes on cigs and sugary drinks and within a few years other funding for health care will be diverted to schools or roads or higher-speed internet access.
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Re: What comes after the ACA?
« Reply #421 on: January 16, 2017, 11:11:40 AM »

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.

Sure, but how do we get past the fungibility of money concept? Raise a bunch of money for health-care through taxes on cigs and sugary drinks and within a few years other funding for health care will be diverted to schools or roads or higher-speed internet access.

Revenue neutrality is an important concept for such a tax to allay these types of fears.

accolay

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Re: What comes after the ACA?
« Reply #422 on: January 16, 2017, 11:14:06 AM »
Which is why the guys who founded this country left most powers with the states.
I disagree that is why the Founders left power or "most power" to states.

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.
I don't understand this argument.

Quote from: packlawyer04
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.
A lot of the ACA tried to address these problems and control costs. Healthcare in our country can have good outcomes, but overall stats are shit in the United States. I didn't understand arguments for our Great American Healthcare System (since Canadians were coming here for treatment or whatever) because it was never that great. I'll argue that instead of our system being broken, we had no system.

Getting rid of the system that attempted to fix things and replacing it with nothing is not a good idea. (just by saying that it's going to be the best is not a plan). And over the last seven eight years it's been a waste of time. Instead, why not attempt to fix the problems with the current system? Unfortunately for those that hate the individual mandate, there can be no system without that. There is no logical argument for having a working or good system without the individual mandate. People are going to have to contribute to the pool. Just like taxes.

sol

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Re: What comes after the ACA?
« Reply #423 on: January 16, 2017, 11:18:07 AM »
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread.


accolay

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Re: What comes after the ACA?
« Reply #424 on: January 16, 2017, 11:20:42 AM »
I don't want the government deciding what's bad for me.

We'll then I'll fucking tell you: Cigarettes, too much alcohol, too much sugar are bad for you. Everything in moderation. Eat vegetables and fruits. Exercise.

accolay

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Re: What comes after the ACA?
« Reply #425 on: January 16, 2017, 11:24:11 AM »
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread.

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!

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Re: What comes after the ACA?
« Reply #426 on: January 16, 2017, 11:33:09 AM »
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

sol

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Re: What comes after the ACA?
« Reply #427 on: January 16, 2017, 11:34:27 AM »
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread.

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!

Even if the extra taxes you might pay are less than you're currently paying for health insurance which you wouldn't need to buy anymore?

Besides, the way Republicans are talking I'm not sure they really care about balanced budgets anymore.  They could fund the whole thing with deficit spending up front, then worry about phasing in the taxes over the next ten years.  Or maybe cancel a trillion dollar war to help pay for it?

packlawyer04

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Re: What comes after the ACA?
« Reply #428 on: January 16, 2017, 11:38:42 AM »
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Nobody needs to wake up. Some in this country want to have a tax, regulatory and overall system similar to our European brethren.  I think they are crazy, but you are not going to change their view. Fortunately, they are still the minority.
« Last Edit: January 16, 2017, 11:41:05 AM by packlawyer04 »

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Re: What comes after the ACA?
« Reply #429 on: January 16, 2017, 11:45:46 AM »
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

This is an extremely disingenuous argument. The VA is but one example of a domestic single payer system, as Sol has noted repeatedly. As you say, it's also at a very small scale, comparable to national healthcare systems in other small countries, which several posters have argued is an integral part of their success. Thus the VA itself might be poorly executed (although I need more info to be convinced of that. Anyone have a good source here?) but it's ridiculous to claim that disproves the entire concept of single payer.

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Re: What comes after the ACA?
« Reply #430 on: January 16, 2017, 11:47:38 AM »
As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Do you NOT READ the responses to your own posts?

Ask anyone in the military whether they would rather have free lifetime health coverage through the VA or be forced to buy insurance on the private individual market.  Go ahead, I'll wait.

And you've complete ignored the other two single-payer systems in America, Medicaid and Medicare.  Medicare in particular is wildly popular, nationwide, despite all of these complaints about how American is too big for it to work.

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Re: What comes after the ACA?
« Reply #431 on: January 16, 2017, 11:51:07 AM »
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

What specific problems do you mean? I mean, you get treated the same for lung cancer (in theory) whether you're of Norwegian origin or African or whatever. There are some subtle differences (sickle cell anemia, some genetic stuff that exists in small populations) but it's not like we're treating vastly different things - these are all people. What about the size of the country makes health care hard to deliver?

If I go to the doctor for an infected toe in Louisiana or in Utah, what sort of problems would I/we run into if both doctors were part of the same large system? I mean, specific problems that would result in my treatment being really expensive or ineffective or both?

I mean, people generally like Medicare, which covers the whole country and is an enormous thing. It works. It could probably work better, but so could Aetna or BC/BS.

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Re: What comes after the ACA?
« Reply #432 on: January 16, 2017, 11:52:05 AM »
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA.

I don't agree that the VA is necessarily a harbinger of what health care must look like, or even a good example to compare it to.  The VA is tasked with treating a very select subset of the population that's has as high-risk occupations as you can get and is burdened by a very high number of chronic and sometimes catastrophic injuries. Its members can leave the service but are still covered for many years afterwards (sometimes for their entire lives). Unlike most any other proposed system it's funding source doesn't come primarily from the people it's treating, but from an outside group (namely non-military citizens), so it becomes a political football.
While federal in nature, the VA's membership pool is relatively small - a few million active plus several million retired but still under care.

There is no apples-to-apples comparison, but one could look at state-mandated health care systems, or other federal systems (including our own medicare) and learn from them what works and what doesn't work.
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Re: What comes after the ACA?
« Reply #433 on: January 16, 2017, 11:55:00 AM »
As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Do you NOT READ the responses to your own posts?

Ask anyone in the military whether they would rather have free lifetime health coverage through the VA or be forced to buy insurance on the private individual market.  Go ahead, I'll wait.

And you've complete ignored the other two single-payer systems in America, Medicaid and Medicare.  Medicare in particular is wildly popular, nationwide, despite all of these complaints about how American is too big for it to work.

Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.

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Re: What comes after the ACA?
« Reply #434 on: January 16, 2017, 11:58:30 AM »
You know who also is a large country that has simpler healthcare than us, fucking Russia... They are about half our size, yet we have about 18x the GDP...

I have yet to meet a single person who has come to the US from another major nation that isn't absolutely baffled by our health care system and the staggering costs to the individual.

There is no doubt that having state governments and a fairly large population ensures that creating our system will bear some extra degree of complexity and uncertainty but it is far from impossible to improve on what we have.


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Re: What comes after the ACA?
« Reply #435 on: January 16, 2017, 11:59:27 AM »
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread.

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!

Even if the extra taxes you might pay are less than you're currently paying for health insurance which you wouldn't need to buy anymore?

Besides, the way Republicans are talking I'm not sure they really care about balanced budgets anymore.  They could fund the whole thing with deficit spending up front, then worry about phasing in the taxes over the next ten years.  Or maybe cancel a trillion dollar war to help pay for it?

I was kidding about the socialism and taxes. Honestly I pay about 45 bucks a month for both health and dental. 30$ copay out of network, $0 if I go to the care system where I work.

Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!

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Re: What comes after the ACA?
« Reply #436 on: January 16, 2017, 12:05:45 PM »
Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!

While I can't actually speak for the republican party, I imagine they do care about balanced budgets. But like politicians across the spectrum, they are willing to spend money to help the people in their districts (which is what they were elected for). So there are complex, conflicting interests, across both political parties, which is why the federal debt has been increasing massively.
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Re: What comes after the ACA?
« Reply #437 on: January 16, 2017, 12:06:22 PM »
Look, I get it. You guys like big government.

What does this mean to you? I have never understood the talking point. Please, I'm honestly interested in your take on what Big Government means and why it applies to only some areas of government and not to others?

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Re: What comes after the ACA?
« Reply #438 on: January 16, 2017, 12:09:06 PM »
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

In theory, the only people who wouldn't come out ahead in this deal are the super wealthy.  And those folks will still be super wealthy, even with slightly higher tax rates.

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Re: What comes after the ACA?
« Reply #439 on: January 16, 2017, 12:14:57 PM »
Everyone likes big government. They just like different parts. I'd rather spend more of my tax money on keeping people healthy than on big new whiz-bang fighter jets. If you feel that the world is a very threatening place, you might feel the opposite way, I guess.

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Re: What comes after the ACA?
« Reply #440 on: January 16, 2017, 12:16:06 PM »
Lets also not forget that a large part of the Republican rallying cry against the ACA has just been partisan rhetoric design to help win elections against Democrats by drumming up sentiment against the law.

The ACA is the perfect opportunity to do this because absolutely some people have seen their premiums go way up, and the cost of insurance is as always has been disgusting. So all the attention on health care is the perfect opportunity to make people upset and stir passions.

I am not saying the Repubs are uniquely disgusting for doing this I am just noting that most of the "repeal the ACA" rallying cry is political theater.

The reality is the Repubs know that tweaking healthcare is a hornets nest filled with pitfalls open for their political opponents to jump on. They also know while their base may be happy to hate the ACA and side with them now, the opposite effect is likely to occur if they if they do a true repeal and start letting insurance companies boot millions sick people off of their insurance plans. The Repubs and Dems are all pretty cowardly about going after a system like Medicare, Social Security or now the ACA in a transparent way because they know if their cuts could hurt them in the next election.

So they will keep railing against the ACA, and at some point after enough tweaking has occurred the news outlets and the Repubs will declare that they have repealed the ACA, but the reality will be that we have remnant pieces of it floating trying to keep certain things like pre-existing condition coverage with a bunch of new confusing rules added in. What we end up with will be better for some and worse for others, but they will declare some form of political victory against the ACA and maybe re-brand it.

accolay

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Re: What comes after the ACA?
« Reply #441 on: January 16, 2017, 12:17:05 PM »
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

Yeah. For the record, I'm not too worried about my taxes going up a bit if it benefits the country as a whole and definitely not worried about increasing taxes for the wealthy.

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Re: What comes after the ACA?
« Reply #442 on: January 16, 2017, 12:23:33 PM »
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

In theory, the only people who wouldn't come out ahead in this deal are the super wealthy.  And those folks will still be super wealthy, even with slightly higher tax rates.

I think people who work at hospitals would probably end up a little worse off, mostly because our health plans are insanely good, and there's little to no profit motive for a health system covering its own people (especially if it's 501c3). On the whole, I'm willing to accept that trade-off for a better macro system. For one thing, it gives non-clinical workers like me more employment options outside of healthcare. Currently, most employers would have to pull up to my house with a dump truck full of money for me to jump ship (and I'm not particularly well-paid).
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Re: What comes after the ACA?
« Reply #443 on: January 16, 2017, 12:25:04 PM »
Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!

While I can't actually speak for the republican party, I imagine they do care about balanced budgets. But like politicians across the spectrum, they are willing to spend money to help the people in their districts (which is what they were elected for). So there are complex, conflicting interests, across both political parties, which is why the federal debt has been increasing massively.

I am not sure that is the case. It may be popular to attack the opposing sides plans to expand spending in an area you don't approve of with ideal talk about balancing the budget. But things seem to be the opposite with every President in my short lifetime.

The last major opportunity the Repubs had to "balance the budget" was when Bush took office after Clinton. Clinton having raised some taxes left Repubs with a surplus of cash. The new administration could have easily pay down a bit of the deficit and attempted to continue to run in a surplus. Instead they passed budgets that put us back into a deficit. I don't recall Obama ever running a surplus.

Conservatives may be for balancing the budget but the Repubs and Dems rarely chose to run a balanced budget for long before the desire to spend more money on their respective private interests takes over. Repubs do tend to make cuts, but they also increase spending in other areas like defense and decrease taxes/revenues in ways that aren't helpful to most of us.

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Re: What comes after the ACA?
« Reply #444 on: January 16, 2017, 12:42:28 PM »
Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.

Why not make it more local, like at the city or county level? States are hugely inefficient.

The problem is that would it create a death spiral in those states that provided universal care. This could be ameliorated somewhat by cutting the funding to the moocher states but the costs would eventually catch up.


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Re: What comes after the ACA?
« Reply #445 on: January 16, 2017, 12:54:01 PM »

Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.

I certainly would not count myself in the camp of people who "like big government."  I'd favor seeing the size and scope of the government shrink a fair bit at a gradual rate, but of course the devil is in the details. I'd rather we not spend money on the military like we have over the past 15 years. I'd like us to step-up educational spending, particularly at the university level before more of our universiteis fall out of the "top 100 in the world" rankings. Our infrastructure needs investment dollars, but I don't think the solution should always be bigger, newer roads.

Also - not sure how the west coast (currrently composed of just California, Oregon and Washington) could be "littered with states that pass [state healthcare]." If your argument is that smaller entities are more efficient than larger ones, many of the southern states should be as well (or even better) equipped to run their own state healthcare systems.
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Re: What comes after the ACA?
« Reply #446 on: January 16, 2017, 12:59:58 PM »
Also - not sure how the west coast (currrently composed of just California, Oregon and Washington) could be "littered with states that pass [state healthcare]." If your argument is that smaller entities are more efficient than larger ones, many of the southern states should be as well (or even better) equipped to run their own state healthcare systems.

I think he was implying that those states wouldn't pass their own state-run healthcare system because of freedom.

sol

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Re: What comes after the ACA?
« Reply #447 on: January 16, 2017, 01:01:38 PM »
Everyone likes big government. They just like different parts.

It's okay to admit that we ALL like big government.  Even the most conservative among us recognize that the US military is superior to every alternative on the planet.  It is a lumbering behemoth, hugely inefficient and wasteful, and yet it enjoys bipartisan support for the sole reason that it is better than the privately-operated alternative, despite all of its flaws.  Highlighting those flaws doesn't change the fact that is still better than the alternative.

It is more efficient than the private alternative, because it pays less to its staff.  It is more effective than the private alternative, because it has access to classified information and technologies that are not publicly available.  It is more accountable than the private alternative, because it reports directly to our elected officials and is backed by the full credit of the US economy.  When I try to envision a private company doing the job of the US armed forces, I have nightmares about Bond villains.

The same reasoning applies to lots of other "big government" programs, like the CDC and the FCC and a thousand other agencies with acronyms.  Lots of people complain about "big government" but they really like having beef without any e. coli in it, and functional internet/radio/tv, and widely available vaccines and outbreak response teams.  The interstate highway system is universally better than any state highway system.  The post office provides service to places that UPS and FedEx don't go.  And Medicare is enormously successful at providing affordable health insurance to the elderly, and could easily be expanded just by lowering the eligibility age.

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Re: What comes after the ACA?
« Reply #448 on: January 16, 2017, 01:03:05 PM »
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Germany individual income tax rates, 2016

Tax %   Tax Base (EUR)
0           Up to 8,652
14%           8,653-53,665
42%           53,666-254,446
45%           254,447 and over

Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

19% flat vat tax on almost all purchases, TV tax, radio tax, dog tax, road tax, and a ton I haven't thought of.

Plus Physicians make 20-30% what a U.S. physician makes and you get worse access to care and it is no frills care. After you have a surgery they roll you into the hall and leave you with your family to recover, 2-3 patients to a room, there is a cost benifits analysis on care when you are older.

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Re: What comes after the ACA?
« Reply #449 on: January 16, 2017, 01:07:08 PM »
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Thanks to Trump, we won't have to!  Coverage for all Americans that's going to be 'much better, much cheaper, [with]... much smaller deductibles!'
It's almost like magic!
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