What comes after the ACA?

[Exflyboy]

We made it to Oct. 1st!  The zombie is temporarily dead. 

I just wanted to add the CSR funding issue makes the Silver plans more expensive.  But the subsidies are hinged to the second lowest cost Silver plan, so it may actually make to non-Silver plans cheaper after the subsidy is applied.  This is why it will cost them more not to fund the CSRs.

Only good zombie is a dead zombie!

[protostache]

We made it to Oct. 1st!  The zombie is temporarily dead. 

I just wanted to add the CSR funding issue makes the Silver plans more expensive.  But the subsidies are hinged to the second lowest cost Silver plan, so it may actually make to non-Silver plans cheaper after the subsidy is applied.  This is why it will cost them more not to fund the CSRs.

Not just after subsidies. In some rating areas in some states the full freight cost of a Silver plan is equal to or more than a gold plan. I know in my area of Michigan it’s going to be a tough call between a higher deductible HSA Silver plan and a lower deductible gold plan because they’ll be only a few dollars apart.

[EnjoyIt]

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

[JLee]

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

[Lance Hiruma]

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

[Exflyboy]

Jump in 2018 insurance rates on the exchange largely a reflection of Trump/GOP sabotage

http://acasignups.net/2018-rate-hikes

Not sure I understand this. The chart shows the full weighted increase in Oregon is to be 15.7%.

I just got a letter from my insurance company saying my unsubsidised rate is going from $847 up to $1102.. i.e a 30% increase!!!!!

Like Holy shit!

[sol]

Like Holy shit!

Are you paying the unsubsidized rate?  If not, then this doesn't impact you at all.  If you are, then it sounds like it's time to let that free market go to work, and you need to shop for different insurance.

[Exflyboy]

Nope getting a significant subsidy which they say will be the same amount next year.. if thats true then I get to pay the full 30%.. for the Bronze HSA plan.

I.e 2017.. cost = $847, subsidy $811.. Net cost $36

2018 .. From Providence, Cost = $1102, subsidy $811, net cost $291.

Not the end of the world but Providence is telling me the subsidy will be the same (assuming the same level of income and I assume the our ages increased by 1 year).

The new plan also has less coverage for out of network.

[DavidAnnArbor]

Nope getting a significant subsidy which they say will be the same amount next year.. if thats true then I get to pay the full 30%.. for the Bronze HSA plan.

I.e 2017.. cost = $847, subsidy $811.. Net cost $36

2018 .. From Providence, Cost = $1102, subsidy $811, net cost $291.

Not the end of the world but Providence is telling me the subsidy will be the same (assuming the same level of income and I assume the our ages increased by 1 year).

The new plan also has less coverage for out of network.

 I would think that your subsidy would go up. It should be based on the cost of the second cheapest silver plan. Presumably that silver plan has gone up in price. And if your income stays the same then your subsidy should go up such that only a certain percentage of your income would go toward paying for the insurance.

[Ocelot]

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.

[former player]

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.

BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.

[protostache]

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.

BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.

What Ocelot is talking about doesn't have anything to do with profitability, it has to do with the "medical loss ratio", which is how much the insurance company pays out for claims. Two programs in ACA transfer funds from plans with low claims to plans with high claims, the "Risk Adjustment" and "Risk Corridor" programs detailed in this helpful explainer. The risk corridor program caused a lot of problems because Senate GOP leadership successfully blocked federal payments into the program which in turn caused many smaller insurance companies to fail due to inaccurate rate setting in the first few years.

The whole idea that an 80% medical loss ratio means your insurance company's profit margin must be 20% is farcical. If they're paying out 80% to providers, then 20% is their gross margin. From that they pay the salaries of everyone involved including customer service, actuaries, and management. They also pay for all of the IT that supports payments sloshing around. They also have to, as Ocelot mentioned, potentially pay into the risk adjustment programs. Insurance company net profit on health insurance, at least for the big players, is like 2-3%. It's basically the same margin as Kroger.

Please don't take the above as me defending the insurance companies or the current system in the US. I am 100% in favor of universal coverage either directly provided by the government or mediated through tightly regulated payers.

[jim555]

New York is still keeping the Essential Plans for 2018 despite the CSR funding question. 
Premium remains at $20 for the 150-200 FPL group, and $0 for the 138-150 FPL group.

The weighted average for the QHPs is a 14.5% increase.

[farmecologist]

For what it's worth...at least some states are doing the best they can to attempt to 'fix' the current situation :

  http://www.twincities.com/2017/10/02/minnesota-health-insurance-rates-stay-stable-or-even-drop-for-2018/

I'm sure there are plenty of holes that can be blown in this...but at least it is not a 100% gloom and doom story like we almost always hear about here.

[protostache]

For what it's worth...at least some states are doing the best they can to attempt to 'fix' the current situation :

  http://www.twincities.com/2017/10/02/minnesota-health-insurance-rates-stay-stable-or-even-drop-for-2018/

I'm sure there are plenty of holes that can be blown in this...but at least it is not a 100% gloom and doom story like we almost always hear about here.

That article doesn't mention the bit where CMS approved the 1332 waiver necessary to implement the reinsurance program and simultaneously discontinued funding for Minnesota's Basic Health Program, something that they repeatedly promised they wouldn't do. Minnesota is worse off as a whole for implementing that program because of HHS/CMS sabotage.

CMS is effectively stealing $369 million from MinnesotaCare enrollees, giving $208 million of it to unsubsidized MNsure enrollees and...pocketing the $161 million difference?

Put yet another way, CMS just screwed Minnesota residents earning 138% - 200% of the federal poverty line ($16,000 - $24,000/year) in order to help out those earning over 400% FPL ($48,000/yr +). Certainly that help is needed, but it shouldn't have been done by hurting those lower down the income chain.

http://acasignups.net/17/10/03/update-minnesota-avg-rate-drop-2018-thanks-troubled-reinsurance-program

[Bucksandreds]

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

Arguing with the nonsense spewed by the far right gives it legitimacy. Let's let the adults converse about real health care solutions and do our best to ignore the nonsense.

[mm1970]

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

I had a convo on a walk once with a rather conservative woman.  She grew up in my neighborhood and went to the school down the street from me.  But then she went on a rant that she should get a discount on her property taxes because she didn't have children.

Now, this woman was probably in her late 50's or early 60's.

My response:
- This is California.  Prop 13 already insures that you get a discount on your property taxes because you bought your house decades ago.
- You are repaying society for your own education.
- (I didn't even mention the benefits to society from having an educated populace).

My quick math tells me that on average, our district spends $7000 per student per year.
So, for her education, that is $7000x13 = $91,000.  She's married, so double that to add her husband.

Based on that, on Prop 13 capping her prop taxes, and the percentage of property taxes that go to the schools, I estimated that it will take her 75 years until she has paid back the cost of schooling for her and her husband.

So yeah, if you want a discount on prop taxes after 75 years, sure!

[Inaya]

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

But when your taxes go toward healthcare, aren't you really just pre-paying for your own healthcare? Everyone needs it eventually.

[mm1970]

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

But when your taxes go toward healthcare, aren't you really just pre-paying for your own healthcare? Everyone needs it eventually.

Yes, really.  That's a very good way of looking at it. 

[JLee]

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Completely agree. I have no kids but pay a lot.

I think people act like this is an uncharted territory and USA is the first to do this. Oh the sky is falling, the sky is falling. Use fear, because it works for many people.

Property taxes funding schools is a bit different.

When you fund your schools, you aren't actually paying for someone else's kids to go to school.  You are, but in reality you have to think about it as "paying back for your own public education".

I had a convo on a walk once with a rather conservative woman.  She grew up in my neighborhood and went to the school down the street from me.  But then she went on a rant that she should get a discount on her property taxes because she didn't have children.

Now, this woman was probably in her late 50's or early 60's.

My response:
- This is California.  Prop 13 already insures that you get a discount on your property taxes because you bought your house decades ago.
- You are repaying society for your own education.
- (I didn't even mention the benefits to society from having an educated populace).

My quick math tells me that on average, our district spends $7000 per student per year.
So, for her education, that is $7000x13 = $91,000.  She's married, so double that to add her husband.

Based on that, on Prop 13 capping her prop taxes, and the percentage of property taxes that go to the schools, I estimated that it will take her 75 years until she has paid back the cost of schooling for her and her husband.

So yeah, if you want a discount on prop taxes after 75 years, sure!

That's all well and good, but I was homeschooled. Sooooooooo....what am I paying back, exactly?

You're correct - society benefits from having an educated populace, much as society benefits from having a healthy populace.  Do you see where I'm going here?

[EnjoyIt]

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

I do not disagree with either of your comments. I have no problem paying my fair share of taxes and have no problem paying extra to make sure people who can't afford healthcare can have their acute and chronic diseases treated.  I do wonder what the real cost of healthcare would be if we went to a fully government funded system?  Will it increase, decrease or stay the same? I would hope despite some of my listed items, the cost of providing healthcare would go down as a whole.  But by how much?  Even getting healthcare costs down to $8k/person/year is still very expensive. How are we as a country going to pay for it? The general proposition is to increase taxes by what we are currently paying for private healthcare. We assume that those who are subsidized will continue to pay nothing or very little based on their income while those families who don't qualify for subsidies will have to pay more.  If healthcare cost will go down to $8k/person/year then a family of 4 will have to pay $32k/yr for their share as well as cover the subsidies for those who can't afford it. How much more? Am I wrong that for example a family of 4 making $120k/yr would be forking over a significant chunk of their paycheck in this model? 

I will admit I am no expert on what a conversion to a public health plan will look like and interested in seeing how we will fund it. I'm willing to accept my logic above is wrong but would love to understand why/how. I think our biggest issue compared to other countries who have successfully created social healthcare is that they pay half of what the US pays and getting better results.

[JLee]

I think we have a significant math problem if we expect the government to cover everyone's healthcare as we currently have it.  We will need significant cost reductions and massive tax hikes.

You've totally missed the point.  The "massive tax hikes" required to pay for all of that health insurance are already being paid by you and me and everyone else.  We just pay it to for-profit health insurance companies instead.  The taxes would only go up by the same amount that our health insurance costs would go down.  Without a profit motive involved, we'd arguably SAVE money in the process by paying less in increased taxes than we currently pay for health insurance.

It's not like taxes would go up to cover the cost of healthcare and we'd have to find that much more money.  We're already paying for it.  Single payer shouldn't cost one penny more than our current health care system costs. 

So don't fall for that conservative line about how it will cost the government trillions.  They only say that because under the current system, we pay for health insurance with a regressive fixed tax (everybody pays the same regardless of income) and rich people LOVE regressive fixed taxes.  If we went to federal single payer health insurance, total healthcare cost would stay the same (or go down) but rich people would probably pay more than poor people.  That's the real Republican argument against single payer.  Not that it will cost more, but that it will cost the country the same while costing rich people more and poor people less.

A few points on your comment:
1) Yes I agree that we are currently paying that amount so if we convert it from paying insurance premiums and deductibles to taxes it should technically make no difference in the final amount paid. Except, those who make enough money will find their taxes go up not just to cover their own $10.5k/yr, but also their families.  So a family of 4 would see their taxes go up by $42k/yr right?  Then the healthcare cost of those who can't afford their share of $10.5k/yr.  If a large portion of the country will be paying nothing or a tiny fraction of that $10.5k, then Sol, how much will you and I have to cover? Will this same higher income upper middle class family have to shell out $50-$60k/yr to cover those costs?  I honestly don't know the answer to this math problem, but it does concern me. 

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

3) There will be some savings in regards to decreased paperwork since healthcare providers will have to deal with only 1 payer.  I have no way of calculating those savings, but I'm sure they are not insignificant.

4) We can also assume that those who currently pay out of pocket or have high deductibles may utilize more health resources since everything will be fully covered by the government and expenditures would likely go up.

5) Will expenditures in total go up or go down I believe is very tough to predict based on just those simple points.

6) If all 320 million people are covered by the government, will the government be more or less efficient than the private sector? It depends.  Medicare seams to be relatively efficient based on the number they claim (There is a whole discussing how they neglect to calculate the inefficiencies they force unto the hospitals, offices and health care providers but that is a whole other topic.) Can they be more efficient than the private sector and will they be able to continue that when responsible for the entire US?

So once again Sol, I seam to agree with some of your points, but it does lead to more questions.

Re: 1)  People with kids use the school system at a cost - does that mean people with kids pay more in property and income taxes to offset their usage? My paycheck says no. Quite the opposite, actually.

Re: 4) Or, people with access to preventative health care might catch problems earlier and end up saving the entire health care system money in the end -
 Further info.

I do not disagree with either of your comments. I have no problem paying my fair share of taxes and have no problem paying extra to make sure people who can't afford healthcare can have their acute and chronic diseases treated.  I do wonder what the real cost of healthcare would be if we went to a fully government funded system?  Will it increase, decrease or stay the same? I would hope despite some of my listed items, the cost of providing healthcare would go down as a whole.  But by how much? Even getting healthcare costs down to $8k/person/year is still very expensive. How are we as a country going to pay for it? The general proposition is to increase taxes by what we are currently paying for private healthcare. We assume that those who are subsidized will continue to pay nothing or very little based on their income while those families who don't qualify for subsidies will have to pay more.  If healthcare cost will go down to $8k/person/year then a family of 4 will have to pay $32k/yr for their share as well as cover the subsidies for those who can't afford it. How much more? Am I wrong that for example a family of 4 making $120k/yr would be forking over a significant chunk of their paycheck in this model? 

I will admit I am no expert on what a conversion to a public health plan will look like and interested in seeing how we will fund it. I'm willing to accept my logic above is wrong but would love to understand why/how. I think our biggest issue compared to other countries who have successfully created social healthcare is that they pay half of what the US pays and getting better results.

We are already paying for it.

[EnjoyIt]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

[JLee]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math. I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

[Paul der Krake]

It's pretty simple: public health spending comes from your taxes. As a high earner, you, EnjoyIt, pay a disproportionately large share of all Medicare, Medicaid, and the funny accounting that goes on when hospitals write off unpaid bills.

[Mr Mark]

There are many ways so-called single payer could work. It could be a gov regulated (and paid) super basic catastrophic style plan with some thresholds before it pays, waitlists for non critical treatments and capped copays. If people want higher levels of coverage they can purchase in the market.

[Ocelot]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Don't forget you are also paying through your general taxes, thanks to the very generous tax breaks given to employer-provided healthcare spending, which adds up to a huge amount of lost revenue that must be made up somewhere. Also remember that everybody pays to offset those tax breaks while not everybody is lucky enough to have the benefit of health insurance via their employer, ironically meaning that poorer people are in a way paying for a benefit that mostly only middleclass and up enjoys.

[Ocelot]

2) We can assume/hope that taking the "for profit" insurance motive out of the system by eliminating for profit health insurance, the cost should go down.  I believe their profit is capped to 20% so maybe costs will go down by ~20%.  If the government outsources its healthcare coverage to private industries as they do now to companies like Novitas Solutions then the for profit motive still exists and that 20% savings may be much lower or non-existent.

Private health insurers are huge companies with very good accountants. Just like you or I would do with our income tax, they can successfully minimize their profit on paper while still stashing it away in investments/facilities, especially with the heavy incentive to do so that the profit cap provides. Recently the small local health insurer my work uses went out of business - the problem, as I understand it, was that they were excessively profitable, and subsequently were forced to pay compensation to another firm that wasn't profitable, a demand that effectively put them out of business. The "non-profitable" firm was BlueCross BlueShield. I find it very hard to believe that company is not profitable.

Let's also consider the huge costs of legal action between insurers. We all pay for that via premiums, and it would be absolutely unnecessary in a single-payer system.

BiB: huh?

(I suspect that you don't have a free market health system in the USA at all, you have a "deliberately rigged to profit the people who give politicians the most money" health system.

What Ocelot is talking about doesn't have anything to do with profitability, it has to do with the "medical loss ratio", which is how much the insurance company pays out for claims. Two programs in ACA transfer funds from plans with low claims to plans with high claims, the "Risk Adjustment" and "Risk Corridor" programs detailed in this helpful explainer. The risk corridor program caused a lot of problems because Senate GOP leadership successfully blocked federal payments into the program which in turn caused many smaller insurance companies to fail due to inaccurate rate setting in the first few years.

The whole idea that an 80% medical loss ratio means your insurance company's profit margin must be 20% is farcical. If they're paying out 80% to providers, then 20% is their gross margin. From that they pay the salaries of everyone involved including customer service, actuaries, and management. They also pay for all of the IT that supports payments sloshing around. They also have to, as Ocelot mentioned, potentially pay into the risk adjustment programs. Insurance company net profit on health insurance, at least for the big players, is like 2-3%. It's basically the same margin as Kroger.

Please don't take the above as me defending the insurance companies or the current system in the US. I am 100% in favor of universal coverage either directly provided by the government or mediated through tightly regulated payers.

Thanks for the explanation.

[talltexan]

Various media sources (through interviews with former ACA administrator Andy Slavitt) are now touting something called "Synthetic Repeal". It basically refers to undercutting the law through

1. Executive Orders that allow insurers to offer "barebones" health insurance plans across state lines, (I recognize that this might actually benefit a lot of people who are Mustachians)
2. Budgets that shrink Medicaid and deny resources to insurers in the exchanges, and
3. Sabatoge of the ACA through website downtime, lack of advertising, etc., to shrink the total risk pool

Without demonstrating the consensus of elected officials against this law, it will basically be a programme of actions through which the President and Congress are able to make Health Coverage much less accessible to poor and those with pre-existing conditions, while allowing them the ability to campaign in 2018 by claiming that ACA was flawed from the start, and--but for a few Centrist Republican holdouts--we could have fixed it and avoided the mess that we're now in.

[Exflyboy]

In other words .. Act like assholes!

[OurTown]

In other words .. Act like assholes!

I don't think they are acting.

[nereo]

Well since repeal hasn't worked the GOP is plowing ahead with the 'sabotage' strategy:

GOP cuts federal support for ACA enrollment

GOP widens definition for which employers can deny coverage of birth control under their health care plan.

[Exflyboy]

From that article..

“The American people know a bad deal when they see one, and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.”

Umm.... If your a total Dump F GOP voter, no I don't think you do know a bad deal when you see one!

[nereo]

From that article..

“The American people know a bad deal when they see one, and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.”

Umm.... If your a total Dump F GOP voter, no I don't think you do know a bad deal when you see one!

For context it's important to cite who was speaking - in this case the HSS spokesman Matt Lloyd via email.
Amazing. The spokesman for the very federal bureau that is supposed to be overseeing the ACA is publicly trashing it instead.

[Monkey Uncle]

Apparently there is an E.O. in the works to allow individuals to form associations to purchase group health insurance. 

http://www.msn.com/en-us/news/politics/trump-poised-to-sign-order-opening-new-paths-to-health-insurance/ar-AAt34K9

It isn't clear from the article whether the plans would have to meet ACA exchange plan standards.  If not, such plans could skim off the healthy people who don't qualify for subsidies.  Perhaps an opportunity for higher income early retirees to reduce their insurance costs, but likely not for typical mustachian FIREees with low taxable incomes.

[nereo]

The more this kind of crap happens the more I wonder whether these collective actions couldn't be contested in federal court.
As I understand it, the federal government has a legal obligation to faithfully uphold the laws passed by congress. I'm not a legal expert, but it seems this current congress and executive branch long ago crossed the line of "good faith" towards teh ACA (still the law of the land).

Open question: Can the HHS be sued for actively sabotaging a law such as the ACA?  Can the courts compel these offices to act in good faith of the law?

[DavidAnnArbor]

The more this kind of crap happens the more I wonder whether these collective actions couldn't be contested in federal court.
As I understand it, the federal government has a legal obligation to faithfully uphold the laws passed by congress. I'm not a legal expert, but it seems this current congress and executive branch long ago crossed the line of "good faith" towards teh ACA (still the law of the land).

Open question: Can the HHS be sued for actively sabotaging a law such as the ACA?  Can the courts compel these offices to act in good faith of the law?

Yes I believe so. Just like the EPA or Department of Defense can be sued for not upholding various laws like the Clean Water Act, etc. I would believe that is the case.

[protostache]

The more this kind of crap happens the more I wonder whether these collective actions couldn't be contested in federal court.
As I understand it, the federal government has a legal obligation to faithfully uphold the laws passed by congress. I'm not a legal expert, but it seems this current congress and executive branch long ago crossed the line of "good faith" towards teh ACA (still the law of the land).

Open question: Can the HHS be sued for actively sabotaging a law such as the ACA?  Can the courts compel these offices to act in good faith of the law?

Some group like ACLU would have to find a test case of someone who is directly harmed by this sabotage. Then, they have to take it all the way through the appeals process to the Supreme Court. Then the Supreme Court, itself a somewhat conservative institution these days due to the Gorsuch nomination, would have to agree to take up the case and find in favor of the plaintiff. Finding the right test case is extremely important.

After that whole years-long process you still have the problem of the administration actually abiding by the decision. With everything else that's going on that's actually somewhat of an open question.

[nereo]

The more this kind of crap happens the more I wonder whether these collective actions couldn't be contested in federal court.
As I understand it, the federal government has a legal obligation to faithfully uphold the laws passed by congress. I'm not a legal expert, but it seems this current congress and executive branch long ago crossed the line of "good faith" towards teh ACA (still the law of the land).

Open question: Can the HHS be sued for actively sabotaging a law such as the ACA?  Can the courts compel these offices to act in good faith of the law?

Some group like ACLU would have to find a test case of someone who is directly harmed by this sabotage. Then, they have to take it all the way through the appeals process to the Supreme Court. Then the Supreme Court, itself a somewhat conservative institution these days due to the Gorsuch nomination, would have to agree to take up the case and find in favor of the plaintiff. Finding the right test case is extremely important.

After that whole years-long process you still have the problem of the administration actually abiding by the decision. With everything else that's going on that's actually somewhat of an open question.

yeah, the whole "duty/breach/cause/harm" paradigm.  I understand that relying on the courts could take years and that the upper courts may refuse to hear it - especially if the law gets changed during the interium, under the argument that any decision no longer holds relevance (under a new hypothetical law).
Shouldn't be too hard to find a good test case though; active sabotage is going to leave thousands without insurance, and certainly some of them will experience physical and financial harm from being uninsured when they ought to have been covered.

[Monkey Uncle]

The more this kind of crap happens the more I wonder whether these collective actions couldn't be contested in federal court.
As I understand it, the federal government has a legal obligation to faithfully uphold the laws passed by congress. I'm not a legal expert, but it seems this current congress and executive branch long ago crossed the line of "good faith" towards teh ACA (still the law of the land).

Open question: Can the HHS be sued for actively sabotaging a law such as the ACA?  Can the courts compel these offices to act in good faith of the law?

Some group like ACLU would have to find a test case of someone who is directly harmed by this sabotage. Then, they have to take it all the way through the appeals process to the Supreme Court. Then the Supreme Court, itself a somewhat conservative institution these days due to the Gorsuch nomination, would have to agree to take up the case and find in favor of the plaintiff. Finding the right test case is extremely important.

After that whole years-long process you still have the problem of the administration actually abiding by the decision. With everything else that's going on that's actually somewhat of an open question.

yeah, the whole "duty/breach/cause/harm" paradigm.  I understand that relying on the courts could take years and that the upper courts may refuse to hear it - especially if the law gets changed during the interium, under the argument that any decision no longer holds relevance (under a new hypothetical law).
Shouldn't be too hard to find a good test case though; active sabotage is going to leave thousands without insurance, and certainly some of them will experience physical and financial harm from being uninsured when they ought to have been covered.

I don't know, the muslim ban didn't take very long to work its way through the courts.  Although it isn't resolved yet, the supremes did lift part of the lower court injunction until it comes up in their queue for a final decision.  Seems like things can move pretty fast when they involve a hot enough political issue.

[EnjoyIt]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Don't forget you are also paying through your general taxes, thanks to the very generous tax breaks given to employer-provided healthcare spending, which adds up to a huge amount of lost revenue that must be made up somewhere. Also remember that everybody pays to offset those tax breaks while not everybody is lucky enough to have the benefit of health insurance via their employer, ironically meaning that poorer people are in a way paying for a benefit that mostly only middleclass and up enjoys.

Thanks for the information Ocelot, the above as well as your explanation about insurance profits are actually less than 20%.  The does lead me into more questions.  Since under a universal healthcare plan business will not be offering health insurance as a benefit.  Do you think we will get raises to help offset some of the tax hike on healthcare or will businesses just take the decreased expense for themselves? 

I am not a fan of our current healthcare system but as a higher income earner very concerned about my taxes going up "significantly" in a universal healthcare plan.  I can afford paying a bit more and would not mind it too much if it had a worthwhile benefit. More importantly I am very concerned for middle class Americans who currently pay for healthcare will find their taxes go up significantly to help fund universal healthcare. I think this is the same group of people who are getting squeezed by the ACA.  They make too much money for subsidies and now also need to pay higher premiums and deductibles as compared to before the ACA. 

So what do you think?  How much will a family of 4 making lets say $120k/yr have to pay in taxes to pay for healthcare for themselves and also help fund it for all Americans taking into account that we spend $10,500/person/yr and you expect US citizens to pay a little less if we remove the insurance profit? 

[EnjoyIt]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math. I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

Exactly, now I think you are getting to the real problem of healthcare in the US.  We pay toooooo much and very few talk about how to decrease costs. We spend lots of time talking about who will pay.  The rich, the poor, or the middle class.  But who is talking about decreasing cost? Who is talking about letting CMS negotiate prices? Who is talking about decreasing some of the bureaucracy involved in delivering healthcare in the US?

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay. 

BTW, your link above was very cool, but I do not think it addresses my question on how much will upper middle class Americans have to pay for universal healthcare?

[Monkey Uncle]

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay.

LOL, I used to think we were close to that point back in the '90s.  Little did I know.

[DavidAnnArbor]

"The White House is finalizing an executive order that would expand health plans offered by associations to allow individuals to pool together and buy insurance outside their states..."

"Under the president's executive action, membership groups could sponsor insurance plans that cost less because — for example — they wouldn't have to offer the full menu of benefits required under the Affordable Care Act, also called "Obamacare." It's unclear how the White House plans to overcome opposition from state insurance regulators, who see that as an end-run to avoid standards."

http://www.sfgate.com/news/politics/article/White-House-to-order-expansion-of-health-care-12262303.php

[Malloy]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math. I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

Exactly, now I think you are getting to the real problem of healthcare in the US.  We pay toooooo much and very few talk about how to decrease costs. We spend lots of time talking about who will pay.  The rich, the poor, or the middle class.  But who is talking about decreasing cost? Who is talking about letting CMS negotiate prices? Who is talking about decreasing some of the bureaucracy involved in delivering healthcare in the US?

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay. 

BTW, your link above was very cool, but I do not think it addresses my question on how much will upper middle class Americans have to pay for universal healthcare?

Agree 100%.  But a lot of different groups of people benefit from our high costs (doctors, pharma, hospitals, medical suppliers, insurance companies) and they have no interest in seeing things change. 
EnjoyIt-health care economists have found that a tiny percentage of patients drive 50% of all health care costs.  Also, much preventative medicine, even if people followed advice to implement, wouldn't really help that remaining 50% go down much.  What do you think can be done to reduce costs?  I'd like to see out-of-network balance billing abuse laws passed everywhere, but that is only a small part of the problem.

https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html

[nereo]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

Exactly, now I think you are getting to the real problem of healthcare in the US.  We pay toooooo much and very few talk about how to decrease costs. We spend lots of time talking about who will pay.  The rich, the poor, or the middle class.  But who is talking about decreasing cost? Who is talking about letting CMS negotiate prices? Who is talking about decreasing some of the bureaucracy involved in delivering healthcare in the US?

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay. 

BTW, your link above was very cool, but I do not think it addresses my question on how much will upper middle class Americans have to pay for universal healthcare?

...you mean other than us here in 74 pages-and-counting of discussion about US health care laws?
As Wexler pointed out, health care benefits so many people and a plethora of diverse groups that there's an enormous constituency that doesn't want to see [their] slice of the pie get any smaller. How many times have the headline monthly jobs report been followed by teh sentence "...led by large gains in the health care sector..." For me that's the single biggest argument for single-payer health care and a potential response to your repeated query about whether or not single-payer would reduce costs.  It certainly could, and based on other countries if done right it could cut costs by 50% or more.
Here's where I think the GOP has hit the height of hypocracy in the last decade or so.  Many of these ideas they used to champion, and they used to howl about how expensive the entire system was becoming. Now... they want the opposite, and want all price limiting restrictions stripped from legislation.  Seemly because when the other side does it, it must be "bad"

There is of course the seldom talked about downside, that reducing costs will almost by definition result in the loss of hundreds of thousands (if not millions) of jobs. The Kaiser foundation estimates there are 12.5MM people in the health care sector, and that excludes all of the people in the insurance market.

[EnjoyIt]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math. I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

Exactly, now I think you are getting to the real problem of healthcare in the US.  We pay toooooo much and very few talk about how to decrease costs. We spend lots of time talking about who will pay.  The rich, the poor, or the middle class.  But who is talking about decreasing cost? Who is talking about letting CMS negotiate prices? Who is talking about decreasing some of the bureaucracy involved in delivering healthcare in the US?

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay. 

BTW, your link above was very cool, but I do not think it addresses my question on how much will upper middle class Americans have to pay for universal healthcare?

Agree 100%.  But a lot of different groups of people benefit from our high costs (doctors, pharma, hospitals, medical suppliers, insurance companies) and they have no interest in seeing things change. 
EnjoyIt-health care economists have found that a tiny percentage of patients drive 50% of all health care costs.  Also, much preventative medicine, even if people followed advice to implement, wouldn't really help that remaining 50% go down much.  What do you think can be done to reduce costs?  I'd like to see out-of-network balance billing abuse laws passed everywhere, but that is only a small part of the problem.

https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html

Everyone in the medical industry has incentive to keep certain pieces of todays structure and change others.  Insurance, pharma, and suppliers love the system we have now. Insurance in particular has has record high profits the last few years. Hospitals are hit or miss depending on the location they are in, but they do spend significant capital to meet regulation or benchmarks that have not shown to statistically impact or improve patient care. They also spend significant amounts of capital on dealing with the insurance industry as well as CMS. A singer payer system would definitely decrease the later. Although most physicians make good money, I have yet to meet a doctor who is happy with the current system. Most physicians, myself included are concerned about single payer because they worry wages will go down and bureaucracy will go up.

Regarding your quoted article. Balance billing is a byproduct of poor reimbursement.  For example a general surgeon will get paid $300 to remove a gallbladder.  That doesn't just include the surgery but also includes post op in hospital re-eval, office re-eval, pre-op evaluation as well as treating any potential complications that may arise from the surgery. From that money the physician has to pay the staff required to bill/collect as well any office staff for pre-op and post of visits.  It doesn't matter if the procedure takes 1.5 hours on an easy patient, or 3 hours on a highly inflamed and scared up organ which also increases the risk of complications. I will let you decide if $300 is enough. Every surgeon obviously thinks it is not and therefor some will balance bill when possible.  I don't think balance billing for another $200-300 bucks is that big of a deal if explained/negotiated prior to the procedure.  I am appalled at how some unscrupulous physicians will balance bill for thousands. The article you linked does not describe every physician but a small fraction of asshats that make the rest of us look bad.  And yes it is just one of the things that needs to change in order to decrease the cost of healthcare in the US.

[EnjoyIt]

Who is "we?"  Currently we (My wife and I) pay our medicare tax, our insurance premiums, and any healthcare we incur which so far has been below our yearly deductible. Last couple of years, roughly our family spent $13k/yr which is pretty damn low since we are young and healthy.  How much more will we have to pay to help cover the rest of the US?  Maybe I am just not getting the math.  I'm sure you will agree that we will have to pay more.  How much more?

If the cost of healthcare on average is $10,500/person we are definitely underpaying our share of the average.  Someone else must be covering our share as well as covering all those people who pay less or nothing at all. Who are these people? I have to be missing something, what is it?

Why are you sure of this?  The fundamental problem is we, as a collective nation, spend FAR more money than should be necessary on health care. If we lower what we pay as a collective, why do you insist that individual costs are going to skyrocket?

US Health Care Spending: Who Pays?

Exactly, now I think you are getting to the real problem of healthcare in the US.  We pay toooooo much and very few talk about how to decrease costs. We spend lots of time talking about who will pay.  The rich, the poor, or the middle class.  But who is talking about decreasing cost? Who is talking about letting CMS negotiate prices? Who is talking about decreasing some of the bureaucracy involved in delivering healthcare in the US?

My personal opinion is that we will be seeing very little change in the US until costs becomes so astronomical that we will have no choice but to ignore the lobbyists and actually make laws that decrease how much we pay. 

BTW, your link above was very cool, but I do not think it addresses my question on how much will upper middle class Americans have to pay for universal healthcare?

...you mean other than us here in 74 pages-and-counting of discussion about US health care laws?
As Wexler pointed out, health care benefits so many people and a plethora of diverse groups that there's an enormous constituency that doesn't want to see [their] slice of the pie get any smaller. How many times have the headline monthly jobs report been followed by teh sentence "...led by large gains in the health care sector..." For me that's the single biggest argument for single-payer health care and a potential response to your repeated query about whether or not single-payer would reduce costs.  It certainly could, and based on other countries if done right it could cut costs by 50% or more.
Here's where I think the GOP has hit the height of hypocracy in the last decade or so.  Many of these ideas they used to champion, and they used to howl about how expensive the entire system was becoming. Now... they want the opposite, and want all price limiting restrictions stripped from legislation.  Seemly because when the other side does it, it must be "bad"

There is of course the seldom talked about downside, that reducing costs will almost by definition result in the loss of hundreds of thousands (if not millions) of jobs. The Kaiser foundation estimates there are 12.5MM people in the health care sector, and that excludes all of the people in the insurance market.

To be honest with you, other than my rhetoric and a few comments the 74 pages here talk about how republicans are morons and the poor will suffer. Much of the talk here is about who will be paying for our expensive healthcare.  The Republicans want the poor to pay which is idiotic since they are poor and can't afford it.  The democrats want the rich and middle class to pay.  They say mostly the rich, but the reality is that the middle and upper middle class take a significant hit as well.  We did have some nice discussions about CMS negotiating with pharma and we talked about death panels.  Outside of this 74 pages the conversation in the political arena is about cost shifting and not cost reduction.  That is why I am so pessimistic regarding any real change to our healthcare system.

I would love to see easier accessibility to cheap generic medications, double and quadruple patient rooms for the non resourced patients, removal of benchmarks and regulations that provide no benefit to patient outcomes. I would love to see the insurance middle man eliminated from low cost medical expenses for those with the resources to afford it.  Something as simple as refilling a chronic medication involves several people when it should involve the patient, the pharmacist and maybe once or twice a year the doctor who prescribed it.  Everyone else is just inefficient waste. There is tons more out there for cost reduction but I have yet to hear a politician discussing them.

BTW, lately I have been seeing examples of medications, or studies actually cost more with insurance as compared to cash payment.  Just the other day I saw an MRI cost a patient $750 with insurance, $500 without.  The thing is the $500 would not go towards meeting the deductible for the year. Just one more thing to think about in our convoluted health system.

[farmecologist]

I would love to see easier accessibility to cheap generic medications, double and quadruple patient rooms for the non resourced patients, removal of benchmarks and regulations that provide no benefit to patient outcomes. I would love to see the insurance middle man eliminated from low cost medical expenses for those with the resources to afford it.  Something as simple as refilling a chronic medication involves several people when it should involve the patient, the pharmacist and maybe once or twice a year the doctor who prescribed it.  Everyone else is just inefficient waste. There is tons more out there for cost reduction but I have yet to hear a politician discussing them.

BTW, lately I have been seeing examples of medications, or studies actually cost more with insurance as compared to cash payment.  Just the other day I saw an MRI cost a patient $750 with insurance, $500 without.  The thing is the $500 would not go towards meeting the deductible for the year. Just one more thing to think about in our convoluted health system.

Regarding drugs, lets do a case study.  One very disturbing trend I see firsthand is the ridiculous price trends of insulin...which millions of people are dependent on and absolutely cannot live without.

   https://www.vox.com/science-and-health/2017/5/12/15621952/insulin-price-increases

This is a blatant attempt at controlling the market under the name of 'incremental progress' ( i.e. - keeping patents active ).  And there are currently no 'generic' versions of older formulations.   

And from this recent article :

   https://www.wfyi.org/news/articles/diabetics-protest-rising-insulin-prices-at-drug-company-headquarters

"According to the lawsuit, the list price of Lilly’s drug, called Humalog, has doubled in the past five years. In the mid-‘90s, when the drug was first launched, it cost $21 a vial. Now, list price for that same amount is $274."

Now multiply that by millions of people who are totally dependent on it...and you get the idea of the big money involved. And again there are no 'generic' forms of insulin at all.

We see this firsthand as we have a family member that uses Humalog.  The price increases have been outrageous but at least it is covered well if you have insurance.   These are the sorts of things that have to be dealt with if we ever want to see healthcare costs 'trend down'.

As an aside, I can see why some drugs are expensive...as it does cost a tremendous amount to create niche cancer drugs and such.  However, it really does seem proper to somehow regulate drugs that have been established for decades where an equivalent generic doesn't exist ( insulin being a prime example )
 

[JLee]

I would love to see easier accessibility to cheap generic medications, double and quadruple patient rooms for the non resourced patients, removal of benchmarks and regulations that provide no benefit to patient outcomes. I would love to see the insurance middle man eliminated from low cost medical expenses for those with the resources to afford it.  Something as simple as refilling a chronic medication involves several people when it should involve the patient, the pharmacist and maybe once or twice a year the doctor who prescribed it.  Everyone else is just inefficient waste. There is tons more out there for cost reduction but I have yet to hear a politician discussing them.

BTW, lately I have been seeing examples of medications, or studies actually cost more with insurance as compared to cash payment.  Just the other day I saw an MRI cost a patient $750 with insurance, $500 without.  The thing is the $500 would not go towards meeting the deductible for the year. Just one more thing to think about in our convoluted health system.

Regarding drugs, lets do a case study.  One very disturbing trend I see firsthand is the ridiculous price trends of insulin...which millions of people are dependent on and absolutely cannot live without.

   https://www.vox.com/science-and-health/2017/5/12/15621952/insulin-price-increases

This is a blatant attempt at controlling the market under the name of 'incremental progress' ( i.e. - keeping patents active ).  And there are currently no 'generic' versions of older formulations.   

And from this recent article :

   https://www.wfyi.org/news/articles/diabetics-protest-rising-insulin-prices-at-drug-company-headquarters

"According to the lawsuit, the list price of Lilly’s drug, called Humalog, has doubled in the past five years. In the mid-‘90s, when the drug was first launched, it cost $21 a vial. Now, list price for that same amount is $274."

Now multiply that by millions of people who are totally dependent on it...and you get the idea of the big money involved. And again there are no 'generic' forms of insulin at all.

We see this firsthand as we have a family member that uses Humalog.  The price increases have been outrageous but at least it is covered well if you have insurance.   These are the sorts of things that have to be dealt with if we ever want to see healthcare costs 'trend down'.

As an aside, I can see why some drugs are expensive...as it does cost a tremendous amount to create niche cancer drugs and such.  However, it really does seem proper to somehow regulate drugs that have been established for decades where an equivalent generic doesn't exist ( insulin being a prime example )

Just look at what Mylan did when they acquired rights to EpiPen in 2007.