Author Topic: What comes after the ACA?  (Read 729290 times)

rantk81

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Re: What comes after the ACA?
« Reply #2300 on: May 11, 2017, 11:00:36 AM »
Thanks. I'd read your post but I guess I zoned out when I read "MacArthur amendment (Section 2701(b)(1)(C) of the Public Health Service Act)" :-)

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

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

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

brooklynguy

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Re: What comes after the ACA?
« Reply #2301 on: May 11, 2017, 11:09:00 AM »
I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

Lots of potential reasons.

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

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

Gin1984

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Re: What comes after the ACA?
« Reply #2302 on: May 11, 2017, 11:21:57 AM »
I'm not seeing why this should derail someone's FIRE plans (once it's settled law, that is).

Lots of potential reasons.

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

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

jim555

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Re: What comes after the ACA?
« Reply #2303 on: May 11, 2017, 11:26:26 AM »
Trump is again threatening the ACA Silver plans cost sharing reductions....

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

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

nereo

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Re: What comes after the ACA?
« Reply #2304 on: May 11, 2017, 11:26:58 AM »

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

Gin1984

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Re: What comes after the ACA?
« Reply #2305 on: May 11, 2017, 11:34:05 AM »

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

Jrr85

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Re: What comes after the ACA?
« Reply #2306 on: May 11, 2017, 12:18:54 PM »
Quote
When you tell young people that they must subsidize older people, who are likely more financially secure than them, that's a moral issue.  Especially when you have older people who did not have to bear the same burden for the generations older than them.

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

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

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

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

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

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

tyort1

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Re: What comes after the ACA?
« Reply #2307 on: May 11, 2017, 12:51:49 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.

ZiziPB

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Re: What comes after the ACA?
« Reply #2308 on: May 11, 2017, 01:12:10 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

Bucksandreds

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Re: What comes after the ACA?
« Reply #2309 on: May 11, 2017, 04:11:47 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

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

nereo

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Re: What comes after the ACA?
« Reply #2310 on: May 11, 2017, 04:15:10 PM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

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

AdrianC

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Re: What comes after the ACA?
« Reply #2311 on: May 11, 2017, 04:19:08 PM »
Thanks. I'd read your post but I guess I zoned out when I read "MacArthur amendment (Section 2701(b)(1)(C) of the Public Health Service Act)" :-)

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

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

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

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


AdrianC

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Re: What comes after the ACA?
« Reply #2312 on: May 11, 2017, 04:23:17 PM »
So if their plans depended on ACA-based insurance costs, their plans could be derailed.
Sure, but have they not been listening? The GOP has been saying for 7 years that they will repeal the ACA. Can anyone seriously be basing their FIRE plans on the ACA?

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

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2313 on: May 11, 2017, 07:47:59 PM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

sol

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Re: What comes after the ACA?
« Reply #2314 on: May 11, 2017, 08:54:34 PM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

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

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

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

gerardc

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Re: What comes after the ACA?
« Reply #2315 on: May 12, 2017, 01:16:50 AM »

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

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

Gin1984

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Re: What comes after the ACA?
« Reply #2316 on: May 12, 2017, 06:25:51 AM »

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

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

nereo

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Re: What comes after the ACA?
« Reply #2317 on: May 12, 2017, 07:48:32 AM »

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

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

FrugalToque

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Re: What comes after the ACA?
« Reply #2318 on: May 12, 2017, 07:52:18 AM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

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

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

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

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

Toque.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #2319 on: May 12, 2017, 08:23:06 AM »
The working poor who were depending on Medicaid are going to be very hurt by the AHCA, as Medicaid expansion will be rolled back.

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

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

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

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

Toque.

But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.

wenchsenior

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Re: What comes after the ACA?
« Reply #2320 on: May 12, 2017, 08:28:18 AM »

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

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

Don't be a dick.

the_fixer

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Re: What comes after the ACA?
« Reply #2321 on: May 12, 2017, 08:37:27 AM »
But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.

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

Bucksandreds

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Re: What comes after the ACA?
« Reply #2322 on: May 12, 2017, 09:00:14 AM »
Or we could just do an 8% flat tax, everyone gets covered, period, and we don't have any of thus "us vs them", crap.
I agree that that would be the best solution, but I don't agree that it would stop the "us vs them" arguments.  If anything, that would add fuel to the fire.  You know fully well that all the one percenters would be complaining about the 47% that pay no taxes getting their healthcare for free...

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

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

mm1970

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Re: What comes after the ACA?
« Reply #2323 on: May 12, 2017, 09:13:58 AM »
But, I would guess, most rational people still wonder why any women or legal immigrants voted for Trump.

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

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

And, Benghazi!

Luck12

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Re: What comes after the ACA?
« Reply #2324 on: May 12, 2017, 09:22:14 AM »
The real moral of the story is don't work 15 hours a day in a position that hurts you. You know the Doctor is just going to tell you to rest and take it easy, right? Maybe some painkillers. They're notoriously clueless for postural problems. You gotta take care of your own health, can't solve everything with a check. Lol @ people

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

dividendman

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Re: What comes after the ACA?
« Reply #2325 on: May 12, 2017, 10:24:43 AM »
  Democracy is a grand idea and I wholly support it, but it does have a potentially fatal flaw in allowing people to choose self destruction. 

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

nereo

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Re: What comes after the ACA?
« Reply #2326 on: May 12, 2017, 10:28:39 AM »

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

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

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

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

Gin1984

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Re: What comes after the ACA?
« Reply #2327 on: May 12, 2017, 11:07:08 AM »

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

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

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

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

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Re: What comes after the ACA?
« Reply #2328 on: May 12, 2017, 11:20:07 AM »
I've heard regular taxes spoken like that, but not FICA.  Everyone pays FICA, and actually if you earn over the cap, you end up paying less than the poor.
No, you end up paying less *in percentage terms* than the poor. You still pay more than the poor. And you get very little added benefit in return, because the bend points in the Social Security payout calculations are very steep.

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Re: What comes after the ACA?
« Reply #2329 on: May 12, 2017, 01:55:56 PM »
I've heard regular taxes spoken like that, but not FICA.  Everyone pays FICA, and actually if you earn over the cap, you end up paying less than the poor.
No, you end up paying less *in percentage terms* than the poor. You still pay more than the poor. And you get very little added benefit in return, because the bend points in the Social Security payout calculations are very steep.
First, only people with earned income pay FICA.  That means (broadly speaking) the elderly, students, unemployed etc. aren't paying FICA in any given year. The ER crowd could not pay for the last 4+ decades of their life, for example.  With the SS portion of FICA your benefits are based on your contributions over your top 35 years.

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

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2330 on: May 12, 2017, 07:02:48 PM »
It had extreme pain that made me get anti-inflammitories, muscle relaxants and still barely was able to work.  I now get massages of a frequent basis so it will not relock in place.


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

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Re: What comes after the ACA?
« Reply #2331 on: May 12, 2017, 07:26:47 PM »
In this NY Times piece it's clear that many who hated the ACA made too much money to qualify for the subsidies and found that they were paying more for health insurance in the marketplace than what they used to pay. It seems like many of these individuals could have qualified for subsidies if they made an effort to lower the AGI through retirement plans.

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

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Re: What comes after the ACA?
« Reply #2332 on: May 12, 2017, 10:10:14 PM »
I am one of those people working for insurance. I have a consulting gig that would cover my bills, but I had cancer when I was in my late 30s (late 40s now). Pre Obamacare, no one would insure me for any price.  We are ready to pull the trigger and would happily give our well-compensated jobs to some younger folks, but don't dare exit before this insurance business is settled.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2333 on: May 13, 2017, 04:42:24 PM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

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

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

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

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

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Re: What comes after the ACA?
« Reply #2334 on: May 13, 2017, 05:14:31 PM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

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

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

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

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

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

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Re: What comes after the ACA?
« Reply #2335 on: May 15, 2017, 07:24:57 AM »
I know this is ignoring a lot of big issues... but as I read many discussions on the topic of universal health care, this thought keeps going around in my mind:

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

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

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

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

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

nereo

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Re: What comes after the ACA?
« Reply #2336 on: May 15, 2017, 07:36:15 AM »

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

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

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Re: What comes after the ACA?
« Reply #2337 on: May 15, 2017, 09:06:45 AM »

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


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

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Re: What comes after the ACA?
« Reply #2338 on: May 15, 2017, 09:22:10 AM »

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


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

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

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

nereo

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Re: What comes after the ACA?
« Reply #2339 on: May 15, 2017, 09:30:56 AM »

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


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals
Interesting question. 
Here's a quick breakdown according to cms.gov

Health Spending by Type

Total 2015 health care spending = $3.2T (up 5.8% y/y)

Hospital care: $1.0T (32%)
Physician/Clinical $634.9B (20%)
Professional Services: $87.7B (3%) *
Dental Services: $117.5B (4%)
"Other" Health Services: $163.3B (5%)**
Home Health Care: $88.8B (3%)
Nursing Care: $156.8B (5%)
Prescription Drugs: $324.6B (20%)
Durable Medical Equipment: $48.5B (2%) ***
Non-durable Medical Equipment: $59B (2%) ****

* independent health-care practitioners like physical therapists, optometry, podiatry etc.
**services generally delivered in non-traditional settings (schools, community centers, workplace) as well as ambulance care and substance abuce/mental heath
*** retail spending, includes eye-glasses, hearing aids, etc.
**** retail spending, includes OTC medicines, surgical dressings, etc.

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2340 on: May 15, 2017, 09:54:51 AM »

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


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

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

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

there are many reasons why health care costs in the US are about double the cost per capita compared to the rest of the developed world ( and the outcomes are worse in the US)
Of course there is no  simple solution, and it's no health-care nirvana in any of those other countries, but there is no reason why what has been proven to work in Europe, Canada, Australia, etc. would not work in the US

I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system



rantk81

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Re: What comes after the ACA?
« Reply #2341 on: May 15, 2017, 09:59:28 AM »
I would shed zero tears for all the folks who would become unemployed from their jobs at private health insurance companies.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2342 on: May 15, 2017, 10:00:33 AM »

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


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

Great question. And I have some opinions on this being a physician and seeing a lot of waste. The US pays almost twice as much for healthcare as compared to other developed countries.  Where does that money go?

1) Physicians: I hate saying this, but physicians make more money in the US compared to other countries.  I will add that in other countries physicians don't come out $350k in debt, as well as have a shorter track to practice allowing them to start their career earlier.  Also in many of those countries physicians are not subject to frivolous law suits. 

2) Regulations: Go to any hospital and doctors office and add up all the non patient care personnel in that facility. These people do not add any value to the patient but are required to meet regulatory standards as well as billing/coding needs.

3) End of life care: Families of patients with no quality of life, severe dementia, bed bound, half paralyzed will receive medical treatment to prolong their agony. Some suspect this accounts for 20% of medicare cost.

4) Insurance company profits:  There should be no need to have an insurance middle man skimming their piece off of every transaction. Insurance should exist for catastrophic expenses not for refilling your blood pressure medication or seeing your primary care doctor for a cold.

5) Shortage of primary care physicians forcing patients into emergency departments for primary care needs.

Today if someone with insurance goes to see their doctor with a cough the process is as follows after showing up at the office:
a) give insurance info
b) insurance info must be processed
c) a person is required to fill out regulatory information regarding your lifestyle and habits
d) all that info must be placed into expensive computer software that requires IT to manage
e) physician finally sees you, examines you and gives you a recommendation and may write a prescription all of which takes about 5 minutes
f) physician spends another 5-10 minutes documenting your care
g) coder must take that documentation and turn it into something billable
h) billing process must take affect and the insurance company must agree to pay for the visit.  If rejected that bill can be requested to be re-evaluated.
i) for brevity I will not go into detail at the hoops that must be jumped through at the pharmacy when you deliver your script. But that also is filled with regulatory and insurance burdens.

or

The patient goes to see their doctor, there is a nurse/secretary at the front desk that asks you to sign in and swipe a credit card.  Basic info is documented in a much less expensive computer system. You see your doctor for 5 minutes who documents for 1 minute regarding your visit (less documentation is needed since there is no need to send to a coder/biller and there is less regulatory demand.) You get your prescription and finalize your bill through your credit card.

As you can see the second process requires less personnel and takes up less time allowing the physician to see more patients per day.  The total cost of the visit drops dramatically.

The thing is, there are hundreds of thousands of people employed by healthcare that would lose their jobs if we instantly fixed the problem. It really isn't as simple as flip a switch, increase medicare tax to 15% and everyone gets medicare. I honestly do not see any legitimate improvement for a very long time. Previous and current administrations do not show any desire to fix the problems I just laid out. I suspect future administrations will have similar attitudes.
« Last Edit: May 15, 2017, 10:28:15 AM by EnjoyIt »

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2343 on: May 15, 2017, 10:00:48 AM »

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


what is the break down of the costs?
How much of that is insurance premiums, profits,  100$ overpriced ibuprofen pills and bandaids at hospitals
Interesting question. 
Here's a quick breakdown according to cms.gov

Health Spending by Type

Total 2015 health care spending = $3.2T (up 5.8% y/y)

Hospital care: $1.0T (32%)
Physician/Clinical $634.9B (20%)
Professional Services: $87.7B (3%) *
Dental Services: $117.5B (4%)
"Other" Health Services: $163.3B (5%)**
Home Health Care: $88.8B (3%)
Nursing Care: $156.8B (5%)
Prescription Drugs: $324.6B (20%)
Durable Medical Equipment: $48.5B (2%) ***
Non-durable Medical Equipment: $59B (2%) ****

* independent health-care practitioners like physical therapists, optometry, podiatry etc.
**services generally delivered in non-traditional settings (schools, community centers, workplace) as well as ambulance care and substance abuce/mental heath
*** retail spending, includes eye-glasses, hearing aids, etc.
**** retail spending, includes OTC medicines, surgical dressings, etc.

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google


EnjoyIt

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Re: What comes after the ACA?
« Reply #2344 on: May 15, 2017, 10:06:43 AM »
I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system

I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

nereo

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Re: What comes after the ACA?
« Reply #2345 on: May 15, 2017, 10:15:11 AM »
I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system

I'm sorry you had to go through all that. It is sad adn embarrassing how convoluted and complex the system is. For many years I have been against a single payer system.  My tune has changed as I study it further, but I also realize that a single payer system is not enough.  We still have the same hoops to jump through when dealing with Medicare and Medicaid that you described above.  Look at the single payer system in Germany who everybody loves so much.  There are 130 organizations that manage this insurance, all employees in the country of Germany pay ~15% in healthcare tax.  That includes those working for minimal wage, and still 1/3 of the hospitals in Germany are losing money.  Single payer is not necessarily the panacea we all hope for.

I'll add that I've been having my own frustrations here in Canada with our health-care system in Quebec (Canada does not have a national health-care system).
I'm not certain that people in the US would be comfortable with the same system, and I'm unclear what is meant when people just brandish terms around like "for worse outcomes".
Most of the data I've seen still shows outcomes for insured patients within the US to be at or near the top in nearly every category.  The problem is that we're paying through the nose for our system, when other developed countries get nearly as good results for half to a third the cost.  And of course in the US we also have millions of uninsured or under-insured.

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Re: What comes after the ACA?
« Reply #2346 on: May 15, 2017, 10:15:57 AM »
there are many reasons why health care costs in the US are about double the cost per capita compared to the rest of the developed world ( and the outcomes are worse in the US)
Of course there is no  simple solution, and it's no health-care nirvana in any of those other countries, but there is no reason why what has been proven to work in Europe, Canada, Australia, etc. would not work in the US

I just wasted an hour on the phone back and forth with  the Dr. office and the insurance company to figure out if my spouse's colonoscopy would be covered , and how much  we would have to pay.
Could not get passed "if the Dr. bills it in a certain way, then we would cover 90% after deductible" 90% of what? no one knows, and we are the lucky ones with awesome health insurance coverage from a large employer.
It doesn't have to be this way. Single payer just means no insurance middle-man, and nobody needs to worry about going into huge debt over medical issues. This is the real inefficiency of the system.
We need to move on from health insurance system to a real health CARE system


I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the root cause of high health care costs in the US.

beltim

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Re: What comes after the ACA?
« Reply #2347 on: May 15, 2017, 10:17:42 AM »

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google

See bolded.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2348 on: May 15, 2017, 10:30:11 AM »

I copied your whole post, but am only responding to the bolded part.  You're describing a problem of regulation, not of system design.  Switzerland has mandatory private insurance but does not have people worrying about going into huge debt over medical issues because of regulation of the private insurers.  Germany has more or less single-payer system, but it is administered through over 1,000 separate intermediates.  So insurance (or other) middle-men are not the only root cause of high health care costs in the US.

Made slight change to your response that makes it a bit more factual I believe.

TheBeeKeeper

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Re: What comes after the ACA?
« Reply #2349 on: May 15, 2017, 10:39:23 AM »

Health Spending by Major sources of funds:
Medicare $646,2B (20%)
Medicaid (17%)
Private Health insurance: $1.1T (33%)
Out of Pocket: $338.1B (11%)

Health Spending by Type of Sponsor
Federal Government (29%)
Households (28%)
Private Businesses (20%)
State/Local G'vment (17%)

Source (opens PDF)

Where is how much we spend on insurance premiums?
and another question would be what % of people in the country have true access to health care.
People who cannot afford insurance, or people with catastrophic plans (or maybe just bad coverage) would skip the Dr. and rely on luck or Dr. Google

See bolded.

it looked to me like "health spending" meant cost of care, and  33% of that was funded by private  insurance
I still don't see in these numbers how much money is spent on premiums, and how much of that the insurance company pay to providers, so how much profit or loss overall for private insurance.