Author Topic: What comes after the ACA?  (Read 241380 times)

waltworks

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Re: What comes after the ACA?
« Reply #450 on: January 16, 2017, 01:09:28 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.

Sounds great to me.

As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

NoStacheOhio

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Re: What comes after the ACA?
« Reply #451 on: January 16, 2017, 01:10:27 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.

FWIW, my hospital employer Family I plan (2-3 dependents) annual costs:
$2993.90 Employee cost
$8957.00 Employer contribution

In-network care is covered 100%, $35 specialist copay, $100 ER copay (waived if you're admitted), reasonable Rx coverage. My premium is discounted 30% because we participate in the wellness program.
« Last Edit: January 16, 2017, 01:13:05 PM by NoStacheOhio »
The first step is acknowledging you have a problem, right?

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jim555

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Re: What comes after the ACA?
« Reply #452 on: January 16, 2017, 01:13:54 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!
Today he was saying he would have insurance for everybody and lower deductibles.  Sounds great!  Trumpcare is awesome.

nereo

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Re: What comes after the ACA?
« Reply #453 on: January 16, 2017, 01:15:04 PM »


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.
"Do not confuse complexity with superiority"

NoStacheOhio

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Re: What comes after the ACA?
« Reply #454 on: January 16, 2017, 01:17:12 PM »


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.

Funny that you mention it, because my department was just working on a piece to explain to international patients (Saudi Arabia in particular) why we weren't going to keep them for six months.
The first step is acknowledging you have a problem, right?

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

accolay

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Re: What comes after the ACA?
« Reply #455 on: January 16, 2017, 01:19:54 PM »
Sounds great to me.

As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

In my experience people want the Hilton, but only want to pay for the HoJo. People don't know what things cost, like they're stuck in 1980s pricing or something.

Schaefer Light

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Re: What comes after the ACA?
« Reply #456 on: January 16, 2017, 01:31:13 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.

I'll take the American health care system over what you've just described any day.

Lorna2287

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Re: What comes after the ACA?
« Reply #457 on: January 16, 2017, 01:36:17 PM »
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

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

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.

GuitarStv

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Re: What comes after the ACA?
« Reply #458 on: January 16, 2017, 01:38:03 PM »


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.

Related side note . . . a couple years ago I was rushing to do some work in the garden early in the morning and managed to slice my right index finger very deeply.  Cleaned the wound, bandaged it up, went on my way to my job.  It was painful but everything seemed fine.  That night I woke up in excruciating pain, noticed bright red streaks on my arms going from where my cut was up my arm, and decided that I needed to go to the ER.

The ER figured out that I had developed blood poisoning.  The stuck me on an IV cocktail of ultra powerful antibiotics and I spent the night there.  The next day I was feeling fine aside from a little throbbing in my hand.  They told me I needed to stay on IV antibiotics for at least a week . . . which really bummed me out that I'd be a prisoner in the hospital.  BUT - then they told me that they had an outpatient program.  I could recover at home, they would show me how/when to swap the IV bags and send a nurse over every day to make sure I was doing everything right.  So that's what I did.

My experience is that it's infinitely better to recover at home where you're comfortable (and it's just a bonus that I managed to save our health care system some cash).

Schaefer Light

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Re: What comes after the ACA?
« Reply #459 on: January 16, 2017, 01:40:00 PM »
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

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

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.

And how many Republicans voted for the ACA?

accolay

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Re: What comes after the ACA?
« Reply #460 on: January 16, 2017, 01:45:48 PM »
My experience is that it's infinitely better to recover at home where you're comfortable (and it's just a bonus that I managed to save our health care system some cash).

This has been studied. There is a sweet spot for hospital stay, don't remember if it's tailored to specific illness. If I recall three days is the magic number. Less or more than that is associated with worse outcomes. I'll find cold hard fact if I have time.

Schaefer Light

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Re: What comes after the ACA?
« Reply #461 on: January 16, 2017, 01:45:48 PM »
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.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

bacchi

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Re: What comes after the ACA?
« Reply #462 on: January 16, 2017, 01:47:06 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.

Americans already pay for it! In fact, we pay more per capita for health care than any other country.

Quote
Plus Physicians make 20-30% what a U.S. physician makes

No, they don't. PCPs make $185k in the US and $131k in Germany. That's 1/3 less, not 1/3 of.

Stop spreading FUD.

boarder42

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Re: What comes after the ACA?
« Reply #463 on: January 16, 2017, 01:48:15 PM »
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

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

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.

And how many Republicans voted for the ACA?

haha 0... hard to stick it to the "republicans" as their plan when they didnt vote for it... they could have passed whatever they chose to.
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sol

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Re: What comes after the ACA?
« Reply #464 on: January 16, 2017, 01:48:15 PM »
At least one!

Arlen Specter, lifelong Republican from PA, changed his party affiliation specifically for the purpose of giving Democrats a 60 vote filibuster-proof supermajority in the Senate, so that they could pass the ACA.

There were also a whole bunch of Republicans working on subcommittees that drafted the ACA, who not only wrote the text but also then attached amendments.  In the end, they were compelled to vote against the law they helped create by Republican leadership, mostly because Mitch McConnell had a raging hard-on for undermining Obama's agenda in every possible way, democracy be damned.

So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

bacchi

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Re: What comes after the ACA?
« Reply #465 on: January 16, 2017, 01:53:11 PM »
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.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

Cheeseburgers should have a sin tax.

I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

SuperMex

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Re: What comes after the ACA?
« Reply #466 on: January 16, 2017, 01:57:10 PM »
Average Salary for People with Jobs as Physicians / Doctors


People with Jobs as Physicians / Doctors Median Salary by Job
Job
National Salary Data
€0   €50K   €100K   €150K
Physician / Doctor, General Practice
21 salaries
€39,866               
Physician / Doctor, Internal Medicine
13 salaries
€50,083   
Family Physician / Doctor
8 salaries
€50,829   
Physician / Doctor, Neurologist
8 salaries
€60,000   
Physician / Doctor, Radiologist
7 salaries
€39,600   
Physician / Doctor, Plastic Surgeon
6 salaries
€103,846   
Physician / Doctor, Oncologist
4 salaries
€65,000   
Country: Germany | Currency: EUR | Updated: 2 Jan 2017 | Individuals Reporting: 81


People with Jobs as Physicians / Doctors Median Salary by Job
Job
National Salary Data
$0   $100K   $200K   $300K
Family Physician / Doctor
1133 salaries
$167,468               
Physician / Doctor, Internal Medicine
1091 salaries
$181,831   
Physician / Doctor, General Practice
686 salaries
$135,133   
Physician / Doctor, Emergency Room (ER)
551 salaries
$208,256   
Physician / Doctor, Radiologist
460 salaries
$286,989   
Physician / Doctor, Neurologist
364 salaries
$201,899   
Obstetrician / Gynecologist (OB/GYN)
322 salaries
$204,951   
Country: United States | Currency: USD | Updated: 7 Jan 2017 | Individuals Reporting: 7,075

accolay

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Re: What comes after the ACA?
« Reply #467 on: January 16, 2017, 01:59:47 PM »
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.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

I don't know. I wont put a moral equivalence on it all, and I suppose some people have a "food addiction" but I'd bet without even looking up numbers that problems with cigarettes and alcohol cost us more than obesity, and obesity costs a lot. Unsure of stats on car crashes from eating cheeseburgers and driving though.

Some cities have a sugary drink tax. Before we tax cheese burgers though, maybe we should just ditch some agriculture subsidies and stop artificial pricing.

bacchi

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Re: What comes after the ACA?
« Reply #468 on: January 16, 2017, 02:01:45 PM »
Country: Germany | Currency: EUR | Updated: 2 Jan 2017 | Individuals Reporting: 81

Seriously?

SuperMex

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Re: What comes after the ACA?
« Reply #469 on: January 16, 2017, 02:05:38 PM »
OK how about this Bacchi I'll get several German physicians I know to give me their annual pay report and I'll black out their name. If they make more than 33% of what the average U.S. physician makes with similar qualifications you win.

I'll bet you $10,000 are you in?????

bacchi

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Re: What comes after the ACA?
« Reply #470 on: January 16, 2017, 02:11:05 PM »
OK how about this Bacchi I'll get several German physicians I know to give me their annual pay report and I'll black out their name. If they make more than 33% of what the average U.S. physician makes with similar qualifications you win.

I'll bet you $10,000 are you in?????

Seriously? Dude, it's not about one physician; it's about the median. Throwing out "this guy I know" means squat.

There is, admittedly, a Euro-USD conversion issue. The Euro used to be much stronger.

nereo

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Re: What comes after the ACA?
« Reply #471 on: January 16, 2017, 02:12:47 PM »


I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

One proposal I'd make is to focus less on taxing individual items and instead levy some sort of penalty on individuals who aren't healthy.  Overweight? you pay more.  Obese? you pay more still.  Maybe people will start taking their health more seriously if there's more of a financial penalty* instead of, you know, just an increased risk of dying and having a poor quality of life.

*yeah, in some regards this is already done by charging smokers and drinkers a higher premium.  And the ADA will probably fight tooth and nail to keep "obesety" from being monitarily penalized.
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bacchi

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Re: What comes after the ACA?
« Reply #472 on: January 16, 2017, 02:15:59 PM »


I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

One proposal I'd make is to focus less on taxing individual items and instead levy some sort of penalty on individuals who aren't healthy.  Overweight? you pay more.  Obese? you pay more still.  Maybe people will start taking their health more seriously if there's more of a financial penalty* instead of, you know, just an increased risk of dying and having a poor quality of life.

*yeah, in some regards this is already done by charging smokers and drinkers a higher premium.  And the ADA will probably fight tooth and nail to keep "obesety" from being monitarily penalized.

That makes sense. It doesn't help those who can't afford it, though. If ya can't afford $200/month, you can't afford $250/month when you're obese and still poor.

SuperMex

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Re: What comes after the ACA?
« Reply #473 on: January 16, 2017, 02:17:02 PM »
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #474 on: January 16, 2017, 02:18:59 PM »
Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

Church tax?  WTF?  Most Germans don't even believe in god any more...
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bacchi

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Re: What comes after the ACA?
« Reply #475 on: January 16, 2017, 02:19:53 PM »
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.

True, it is pre-tax and their taxes are high.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #476 on: January 16, 2017, 02:20:22 PM »
So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

Seriously, you ought to write copy for late-night comedians.  You'd clean up.
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nereo

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Re: What comes after the ACA?
« Reply #477 on: January 16, 2017, 02:22:35 PM »
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.
well that's sort of the thing here... Germany has high taxes and a corresponding high level of services.  In the US you have lower taxes and less services.
Both have their advantages depending on the case and personal preference, but it's not fair to compare post-tax salaries unless you also consider what post-tax services one recieves (or would have to pay for).
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SuperMex

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Re: What comes after the ACA?
« Reply #478 on: January 16, 2017, 02:22:58 PM »
I have 31 German employees only two are Church goers yet they all pay Church tax. I asked them why that is and they said the process is so onerous to get out of it that almost no one does it.

sol

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Re: What comes after the ACA?
« Reply #479 on: January 16, 2017, 02:23:10 PM »
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.

That whole article is a mess of contradictions. 

Trump is promising lower premiums AND lower deductibles, and I don't see any way to do that without
    A)  making insurance crappy, so it doesn't pay for anything, or
    B)  using federal dollars to subsidize insurance companies.  This is what the ACA is already doing. 

Trump is promising "insurance for everybody" and said "There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”   This suggests to me he is either going to offer health care providers (not insurers) federal subsidies for providing emergency medical care to uninsured people, or he is going to increase health insurance subsidies to poor people (which seems contrary to his previous plans to decrease subsidies to the poor and increase subsidies to the elderly).

Trump is promising that nobody who gained access under the ACA will lose coverage.  This seems like an easy fix, just grandfather everyone in and then reinstate the exclusion of people with pre-existing conditions going forward.  He could truthfully claim that no one lost coverage when they repealed the ACA, without the burden of having to provide insurance to any newly sick people. 

Trump is promising not to cut Medicare.  Yay, I guess?  This isn't really surprising because lots of GOP voters are elderly and use Medicare.  What he is doing instead is cutting MedicAID.  Very few young, poor, or disabled people are GOP voters, after all, so the party doesn't lose much by screwing those folks over.



« Last Edit: January 16, 2017, 08:22:17 PM by sol »

nereo

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Re: What comes after the ACA?
« Reply #480 on: January 16, 2017, 02:23:51 PM »
So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

Seriously, you ought to write copy for late-night comedians.  You'd clean up.

Reading some of Sol's posts, the voice of John Oliver occasionally takes over in my head...
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waltworks

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Re: What comes after the ACA?
« Reply #481 on: January 16, 2017, 02:26:12 PM »
SuperMex, you need to back up your numbers. You are digging yourself a quick credibility hole.

I will eat my hat if German physicians (GPs, no cherrypicking plastic surgeons or something) make 33% of what US physicians do.

I'm assuming you googled this and misinterpreted the NPR quote at the top of the results page:
http://www.npr.org/templates/story/story.php?storyId=91931036
"In some parts of Germany, doctors are going on strike over what they get paid. It's not that German doctors live in poverty. The average German primary-care doctor makes around $123,000 a year before taxes. That's about one-third less than the U.S. average."

That means they make 66% of what a US physician does, not 33%.

-W

SuperMex

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Re: What comes after the ACA?
« Reply #482 on: January 16, 2017, 02:27:01 PM »
Nereo I totally agree and that was my point Americans have to come to terms with which they prefer.

However politicians saying they are going to give you something for free is total bull.


bacchi

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Re: What comes after the ACA?
« Reply #483 on: January 16, 2017, 02:28:15 PM »
I'm assuming you googled this and misinterpreted the NPR quote at the top of the results page:
http://www.npr.org/templates/story/story.php?storyId=91931036


An interesting part of that story,

Quote
On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered.

SuperMex

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Re: What comes after the ACA?
« Reply #484 on: January 16, 2017, 02:29:28 PM »
your right if you are counting pre-tax wages and don't take into account the difference in taxes.

nereo

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Re: What comes after the ACA?
« Reply #485 on: January 16, 2017, 02:37:13 PM »
Nereo I totally agree and that was my point Americans have to come to terms with which they prefer.

However politicians saying they are going to give you something for free is total bull.

I agree on both points emboldened above.
In general the US population sucks at understanding their level of service is tied to the amount we pay.  A stupidly large percentage of people seem to think we can increase services while decreasing taxes, all while paying down the deficit.
Partly I blame this drum-beat of "fraud and waste are to blame for everything!" as well as "increased growth will more than make up for loss in tax revenue when we cut taxes."
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waltworks

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Re: What comes after the ACA?
« Reply #486 on: January 16, 2017, 02:38:51 PM »
your right if you are counting pre-tax wages and don't take into account the difference in taxes.

At $180k income (roughly) a US single doctor not doing any clever tax-avoidance (ie pretax retirement/health accounts) would pay (roughly) $70k in total taxes (state taxes vary a lot, but that's probably close). So $110k.

German taxes on $123k would break down as roughly:
First $8k = $0
Next $45k = $8k
Last $70k = $29k

The Euro is close enough to the dollar right now that I'm just going to ignore doing any careful converting back and forth.

That leaves us with a total compensation after income tax of about $86k. Even if you tack on some of the other taxes you mention (which I know nothing about) you are not going to get to $55k after tax, let alone ~$36k (which would be one third of US after-tax money).

You may have misunderstood how marginal tax rates work.

-W
« Last Edit: January 16, 2017, 02:43:41 PM by waltworks »

Gal2016

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Re: What comes after the ACA?
« Reply #487 on: January 16, 2017, 02:59:59 PM »
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.

You've had people come from Russia and complain about our healthcare?

How about we ask natives of China and India  (the only two countries with higher populations than the US) how they're managing "universal healthcare" for ALL of their many citizens? -- Yeah. Comparing the US to any other country regarding "universal healthcare" is disingenuous. We're kind of unique and some cookie cutter, "well it worked for Canada" proposal just isn't going to work.

I work in healthcare (RN and then in management, which is where I am currently).  The ACA has made a mess of things. It didn't fix the things that were previously broken and things that were running relatively smoothly (those who already had insurance) it royally screwed up.

And Trump's promises sound an awful lot like Obama's "you can choose your own doctor and you don't have to change providers" line.  bleh.

SuperMex

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Re: What comes after the ACA?
« Reply #488 on: January 16, 2017, 03:01:06 PM »
I think your 86K is right before they take out the rest of the taxes. I picked my number of in the 50's based on the fact that all of the people I work with pay about 50% of their income in taxes. I also know that the more you make the higher rate you end up paying.

waltworks

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Re: What comes after the ACA?
« Reply #489 on: January 16, 2017, 03:12:48 PM »
I think your 86K is right before they take out the rest of the taxes. I picked my number of in the 50's based on the fact that all of the people I work with pay about 50% of their income in taxes. I also know that the more you make the higher rate you end up paying.

Ah, you "picked" a number.

Again, your picked number is very obviously wrong. And you'd need to tax your $86k (after tax) money by more than another 50% before you'd get to the $36k you need to get to 33% of US physician income.

Even if you use your 50% in taxes number, you're at $61k. That's 55% of what a US physician would make after taxes (as I showed) not 33%.

Don't make shit up, please.

-W

mm1970

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Re: What comes after the ACA?
« Reply #490 on: January 16, 2017, 05:56:46 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.

Sounds great to me.

As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Ha ha funny.  When I had my second kid, I had him in the new wing of the hospital.  The birthing rooms and the patient rooms after were a VAST improvement.  Twice the size, soaking tubs for the labor and delivery rooms, a large couch that opened to a bed for the spouse.

But the doctors and staff are SO GOOD at saving you some dough.  After one night in the hospital, literally being woken every 1.5 hours (half by the baby wanting to nurse, the other half by...someone taking my blood pressure, or taking out the trash, or checking the baby's vitals)... it all came to a head at 8:20 am the next morning, when I had FOUR people in there in the space of 10 minutes (custodian, breakfast, pediatrician, nurse to take the vitals)...when the OB came in 5 minutes later (two people still there!) and asked if I wanted the option to leave that day (baby was not even 24 hours old), I said YES!!

I got better sleep at home with a newborn right next to me.

mm1970

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Re: What comes after the ACA?
« Reply #491 on: January 16, 2017, 06:07:01 PM »
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.

You've had people come from Russia and complain about our healthcare?

How about we ask natives of China and India  (the only two countries with higher populations than the US) how they're managing "universal healthcare" for ALL of their many citizens? -- Yeah. Comparing the US to any other country regarding "universal healthcare" is disingenuous. We're kind of unique and some cookie cutter, "well it worked for Canada" proposal just isn't going to work.

I work in healthcare (RN and then in management, which is where I am currently).  The ACA has made a mess of things. It didn't fix the things that were previously broken and things that were running relatively smoothly (those who already had insurance) it royally screwed up.

And Trump's promises sound an awful lot like Obama's "you can choose your own doctor and you don't have to change providers" line.  bleh.
Honestly reading this makes me cringe.

Everyone says this like it's truth, it's truth!  Or when people say that the ACA made their costs go up, and it's horrible.

Do people not understand that it DEPENDS??

it depends on where you live
it depends on how your state implemented the ACA
it depends on how much money you make
it depends on whether or not you were even insurable before.

I have a very good friend who is a NP and has done a LOT of work in public health.  For her, in her city in her state, she's been thrilled because FINALLY a lot of hard working people have access to care, are getting checkups, and are able to afford necessary medications (these are NOT people living in poverty - they were already covered).  "It's been a slog seeing a lot of new patients but has been SO WORTH IT."

And my neighbor, self employed and middle class who requires a fair bit of medication due to a genetic disease - ACA is literally the best insurance she's had as an adult.  Better than any employer sponsored insurance she had before becoming self employed.

And my friends who were uninsurable due to preexisting conditions - saved their bacon.

My husband's insurance costs went down, mine went up.

IT DEPENDS PEOPLE!!

waltworks

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Re: What comes after the ACA?
« Reply #492 on: January 16, 2017, 06:27:12 PM »
Yeah, we had to do c-sections for both kids - but my wife is a former professional athlete and all-around badass, so we managed to get discharged ASAP in both cases. 2 nights both times, they "recommended" 4 or something but... no way. Everyone did better at home.

-W

Lance Burkhart

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Re: What comes after the ACA?
« Reply #493 on: January 16, 2017, 09:47:12 PM »
Quote
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.

I recommend you read Bill Lind and Martin Van Creveld.

CDP45

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Re: What comes after the ACA?
« Reply #494 on: January 17, 2017, 12:00:00 AM »
So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

Seriously, you ought to write copy for late-night comedians.  You'd clean up.

Reading some of Sol's posts, the voice of John Oliver occasionally takes over in my head...

This must be a case where it's funny because it's not true.
Not 1 republican senator voted for Obamacare
Not 1 republican congressman voted for Obamacare

It was passed only on partisan lines by Dem party controlling house, senate, and white house....hmm...

Here's the facts that Sol thinks everyone is to dumb to find, or he's such a partisan hack he's ignoring reality now:
http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=111&session=1&vote=00396
http://clerk.house.gov/evs/2010/roll165.xml

Erica

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Re: What comes after the ACA?
« Reply #495 on: January 17, 2017, 12:32:10 AM »
Younger middle class here, and I feel the pinch of ACA very hard.  31 years old. 
You may want to check into one of the healthcare sharing ministries. They satisfy the ACA mandate but are much less expensive.



Alps

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Re: What comes after the ACA?
« Reply #496 on: January 17, 2017, 04:57:09 AM »
I have 31 German employees only two are Church goers yet they all pay Church tax. I asked them why that is and they said the process is so onerous to get out of it that almost no one does it.

Well apparently they're stupid. I did it when I was 14 (legal adult regarding religion) and it absolutely was not more complicated than going to the local municipal office with your ID and signing some forms.

I will say that I know a bunch of folks who don't consider themselves religious, yet feel that their church tax is being put to good use and are content still paying it.

boarder42

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Re: What comes after the ACA?
« Reply #497 on: January 17, 2017, 05:23:23 AM »


I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

One proposal I'd make is to focus less on taxing individual items and instead levy some sort of penalty on individuals who aren't healthy.  Overweight? you pay more.  Obese? you pay more still.  Maybe people will start taking their health more seriously if there's more of a financial penalty* instead of, you know, just an increased risk of dying and having a poor quality of life.

*yeah, in some regards this is already done by charging smokers and drinkers a higher premium.  And the ADA will probably fight tooth and nail to keep "obesety" from being monitarily penalized.

That makes sense. It doesn't help those who can't afford it, though. If ya can't afford $200/month, you can't afford $250/month when you're obese and still poor.

well and multiple studies done have shown the obese and smokers actually cost the system less than healthy people on a per year basis due to the costs to take care of a person who was healthy when they get really old
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Schaefer Light

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Re: What comes after the ACA?
« Reply #498 on: January 17, 2017, 06:29:38 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.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

Cheeseburgers should have a sin tax.

I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

In its purest form, the free market solution would be no insurance.  Each person would pay the full cost of his own health care with no help from anyone else.  That would surely discourage a person from eating, drinking, or smoking too much.  I realize this is a step too far for most people, as they aren't going to be okay with not having any form of health insurance.  In my opinion, the next best thing is for people who are out of shape to pay higher premiums.  The insurance companies would have to decide what "out of shape" means to them.  They should know which health indicators typically lead to higher costs better than anyone.

I also believe that people should be allowed to have no insurance.  They should have to sign some sort of waiver indicating that they understand the risk - from both a health and financial perspective.  They should not get a taxpayer bailout.  If they get sick, they'll be relying on their own resources and the charity of others to help them out.  If they can't get the help they need, then they'll pass away the same way people have died for most of human history (i.e. without insurance).

GuitarStv

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Re: What comes after the ACA?
« Reply #499 on: January 17, 2017, 06:56:53 AM »
I also believe that people should be allowed to have no insurance.  They should have to sign some sort of waiver indicating that they understand the risk - from both a health and financial perspective.  They should not get a taxpayer bailout.  If they get sick, they'll be relying on their own resources and the charity of others to help them out.  If they can't get the help they need, then they'll pass away the same way people have died for most of human history (i.e. without insurance).

This idea is great in theory, the problem is when it comes to application.

You're effectively saying that health care workers and family have to sit by and watch someone die, knowing full well that there is a cure . . . but simply not being able to pay the money for the cure.  It will never happen.  Regardless of the documents and forms signed, most people will see it as patently unfair to make someone suffer/die in this manner and will lobby to change the system.