Author Topic: What comes after the ACA?  (Read 689649 times)

TrudgingAlong

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Re: What comes after the ACA?
« Reply #4350 on: June 12, 2018, 01:40:37 PM »
To be fair, the VA did have some significant issues with providing adequate care for a while. Most of that was due to massive underfunding and has largely been corrected however. I use them primarily now and am just as pleased as when I used my private care.
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.
The VA actually works quite well overall. That's why it's such a sensation when there are reports of corruption.

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Glad to hear that!

Yes! Drives me crazy the VA has such a bad rep just because our news slant is always so negative. If itís working, they donít bother to report. Shulkin was fired because he resisted privatization, and my understanding is people thought he was doing a good job. We get healthcare from the active duty side, and itís fantastic. Itís a huge reason I support single payer because I think everyone should get good healthcare, not just those who sign their lives away to the government.

jim555

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Re: What comes after the ACA?
« Reply #4351 on: June 12, 2018, 02:10:44 PM »
I don't see how single payer ever gets to the US.  Both parties would need to be on board, and that is not happening.  Even if it happened it would be constantly sabotaged until it would fail by a thousand cuts.

If you look at European and Canadian politics the conservatives are not gunning to get rid of their national health systems.  Though the Tories have massively underfunded the NHS that are not overtly advocating for its removal.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4352 on: June 12, 2018, 02:18:05 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.




DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4353 on: June 12, 2018, 08:06:28 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.


Thank you for this information it's invaluable in helping people figure out what to expect for health care costs.

Mr. Green

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Re: What comes after the ACA?
« Reply #4354 on: June 12, 2018, 09:28:26 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year. Since you've bought medigap coverage you're not paying anything more out of pocket besides any drugs Part D might consider higher tier drugs.

We know that Medicare works very well, so when you consider that in many states the cost of premiums alone for two people only in their mid-30s is already more than $10,000 a year, that just shows you how broken the private insurance system is without any cost controls.
RE in June 2016. Wife is joining me at the end of June!

maizeman

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Re: What comes after the ACA?
« Reply #4355 on: June 12, 2018, 09:34:11 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year. Since you've bought medigap coverage you're not paying anything more out of pocket besides any drugs Part D might consider higher tier drugs.

We know that Medicare works very well, so when you consider that in many states the cost of premiums alone for two people only in their mid-30s is already more than $10,000 a year, that just shows you how broken the private insurance system is without any cost controls.

I'm not arguing medicare's cost controls aren't also valuable, but do keep in mind that government spending in medicare is also about $10,000/enrollee, so we're really talking about $30,000 in total costs for two people in their mid-60s for essentially complete coverage of healthcare for a year.

Roadrunner53, I'll echo the thanks for being willing to share your numbers, as this is a part of long term FIRE expenses which had been essentially opaque to me previously.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4356 on: June 13, 2018, 06:13:21 AM »
You are welcome on sharing my numbers. I live in CT so the cost of Part F varies in each state. CT is one of the most expensive so Part F could be substantially lower in another state. I checked a bunch of other states and here is what I found Plan F costs:

Ypsilanti, MI $137.28
Peachtree City, Ga $194.50
Tucson, AZ $145.12
Pine Bluff, Arkansas $206.75
The Villages, FL $184.07
Myrtle Beach, SC $145.92
Kingsport, TN $143.20
Ancorage, AK $133.28
Honolulu, HI $138.72
Springfield, MA $191.00
Kittery, Maine $224.75
Manhattan, Ny $294.50
Virgin Islands, ST Thomas $154.50



Roadrunner53

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Re: What comes after the ACA?
« Reply #4357 on: June 13, 2018, 06:55:21 AM »
Plan F supplement to Medicare is really good but there are cheaper options.

When you are hospitalized under Medicare Part A the deductible for 'each benefit period' is $1,340. The benefit period is a bit confusing but if you were very sick you could be faced with paying it more than one time a year. Here is an example: https://www.medicaremadeclear.com/basics/medicare-coverage-and-costs/medicare-part-a/meet-margaret?utm_source=blog&utm_medium=social&utm_campaign=post&utm_content=2017_blog_kcE

Then with Medicare Part B which is doctors visits and testing requires a $183 deductible per year.

Plan F Medicare Supplement will pay these deductibles and when you go to the doctor's office you pay no deductibles.

I am not promoting Plan F but for us it give us some relief from worry from out of sight medical bills and charges. That is why there are choices. What is good for me may not be good for you. Some people chose not to buy any supplement plans and can't afford to do so. It is a personal choice.

Oh, and on another note, Plan F will be disappearing as a choice in 2020. Those who have it will be grandfathered from what I have heard. Plan G would be the one I would choose if Plan F didn't exist. It is identical but you have to pay the Part B deductible of $183 once a year.

The Hub retired at age 63 and a year later found out he had prostate cancer. We were on Obamacare at the time. He had surgery and the insurance paid pretty good but we did have maybe $5,000 in various bills to pay on our own. Then about 7 months later we found out that he still had high PSA levels and had to go thru radiation. At that point he was on Medicare and Part F. We didn't receive one bill which was quite a relief. I did see the bills and was over $200K. This is a guy who was never sick except with colds in his life. You just never know about these things.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4358 on: June 13, 2018, 07:35:27 AM »
I hope he recovers

Roadrunner53

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Re: What comes after the ACA?
« Reply #4359 on: June 13, 2018, 07:43:07 AM »
Thank you DavidAnnArbor! He has had several PSA tests since the radiation and results have been wonderful! It was a long haul for sure! That is how we spent last summer. Started just before July 4th. So we are coming up on a year now. It is amazing when you get a certain illness all of a sudden you find a ton of people with the same thing. You think you are alone in this situation but there are so many others.

BTDretire

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Re: What comes after the ACA?
« Reply #4360 on: June 13, 2018, 08:35:13 AM »
 Ya, I remember the ACA, when the rules started in 2012 I had an 18.4% increase in the premium on my families health insurance policy. The next year  the increase was 19.2%, and the year after that a 24% increase.
  But if that helped somebody here with $1M NW  get cheap or free health insurance, I guess it was worth it...  /s/

  I recall posting about a family getting over $30,000 as a health insurance subsidy with an income over $90k.
I think the percentage of the population on the ACA, is still under 12% and too many of that 12% could pay for their own policy, but took advantage of free money from other taxpayers. /end rant/
   Have a happy day :-)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4361 on: June 13, 2018, 08:41:55 AM »
Ya, I remember the ACA, when the rules started in 2012 I had an 18.4% increase in the premium on my families health insurance policy. The next year  the increase was 19.2%, and the year after that a 24% increase.
  But if that helped somebody here with $1M NW  get cheap or free health insurance, I guess it was worth it...  /s/

  I recall posting about a family getting over $30,000 as a health insurance subsidy with an income over $90k.
I think the percentage of the population on the ACA, is still under 12% and too many of that 12% could pay for their own policy, but took advantage of free money from other taxpayers. /end rant/
   Have a happy day :-)

That's the beauty of living simply without extravagance, much of the income is saved  in tax shelters toward a future retirement which is the responsible thing to do. Consequently this high savings lowers the AGI, and thereby qualifies one for subsidies.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4362 on: June 13, 2018, 08:47:26 AM »
Ya, I remember the ACA, when the rules started in 2012 I had an 18.4% increase in the premium on my families health insurance policy. The next year  the increase was 19.2%, and the year after that a 24% increase.
  But if that helped somebody here with $1M NW  get cheap or free health insurance, I guess it was worth it...  /s/

  I recall posting about a family getting over $30,000 as a health insurance subsidy with an income over $90k.
I think the percentage of the population on the ACA, is still under 12% and too many of that 12% could pay for their own policy, but took advantage of free money from other taxpayers. /end rant/
   Have a happy day :-)

Yes, what you say is true but the Federal Government made up the guidelines on the Federal Poverty levels as seen in this chart: https://obamacare.net/2018-federal-poverty-level/

The guidelines do not take into account savings, only earnings which include: Social Security income, Pensions, IRA withdrawals, Investment income (interest, dividends) and wages from a job.

jim555

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Re: What comes after the ACA?
« Reply #4363 on: June 13, 2018, 09:11:59 AM »
If someone can't manage their MAGI down to the juicy subsidy territory they must have a lot of money and can afford to pay up.

Exflyboy

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Re: What comes after the ACA?
« Reply #4364 on: June 13, 2018, 09:20:45 AM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year. Since you've bought medigap coverage you're not paying anything more out of pocket besides any drugs Part D might consider higher tier drugs.

We know that Medicare works very well, so when you consider that in many states the cost of premiums alone for two people only in their mid-30s is already more than $10,000 a year, that just shows you how broken the private insurance system is without any cost controls.

Imagine paying that if you only had social security and had to make rent every month.. Damn!

Mind you, thinking about the $200k bill... If I understand it right then Medicare has a 20% deductible.. so for a $200k bill that would be $40k. So in effect you are paying $10k per year to insure against a bill of $200k.. if so then assuming a sufficiently high NW you might consider it better to take the out of pocket cost which may never happen.

I'm sure I am way over simplifying this?

Roadrunner53

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Re: What comes after the ACA?
« Reply #4365 on: June 13, 2018, 09:21:34 AM »
We are a family of two and had to stay at the 400% income level to receive the subsidy. No way I was going to jeopardize getting the subsidy. When we needed extra money we pulled from savings, not IRA's which would have had to been added to income. One more month and off ACA to Medicare. Still have to keep income low for the rest of the year to keep in check with income level for year. Come January, we can pull out more money from IRA's and stop pulling from savings.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4366 on: June 13, 2018, 09:28:34 AM »
The scary thing is that Medicare has no out of pocket maximum on that 20% coinsurance. No wonder people buy supplemental  coverage.

radram

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Re: What comes after the ACA?
« Reply #4367 on: June 13, 2018, 09:51:55 AM »
Ya, I remember the ACA, when the rules started in 2012 I had an 18.4% increase in the premium on my families health insurance policy. The next year  the increase was 19.2%, and the year after that a 24% increase.
  But if that helped somebody here with $1M NW  get cheap or free health insurance, I guess it was worth it...  /s/

  I recall posting about a family getting over $30,000 as a health insurance subsidy with an income over $90k.
I think the percentage of the population on the ACA, is still under 12% and too many of that 12% could pay for their own policy, but took advantage of free money from other taxpayers. /end rant/
   Have a happy day :-)

Yes, what you say is true but the Federal Government made up the guidelines on the Federal Poverty levels as seen in this chart: https://obamacare.net/2018-federal-poverty-level/

The guidelines do not take into account savings, only earnings which include: Social Security income, Pensions, IRA withdrawals, Investment income (interest, dividends) and wages from a job.

I believe BTD just wants everyone else to do what he does..... you know, forgo legal tax and credit rules for the sake of morality and the country. I am sure he sent in an extra payment to the feds because he gets tens of thousands in income that is not taxed in the form of an employee health plan. Probably sends in another check to pay taxes on unrealized gains, since the feds incorrectly allowed him to exclude those gains as income. And another from earnings in his 401k. And of course he made up the difference between the long term gains rate and his income rate. I hear even billionaires do this one with regularity on moral grounds.

It is fine to disagree with a policy, and I fully encourage all to voice their opinion and work to get these policies changed. But to try to shame people into not taking advantage of rules and policy they qualify for all the while taking full advantage of other policies yourself just doesn't sit right with me. Are you proposing means testing as a way to make ACA better? If you are, then say so, so we can discuss that. I would add I would be in favor of means testing, for ALL policies discussed in this post (radram waits as BTD calculates whether means testing EVERY rule he takes advantage of will save him, or cost a SHIT TON more so he knows whether or not he supports the idea).

Full disclosure: I am taking full advantage of every policy I have mentioned to the fullest extent allowed by policy and law, as well as probably a dozen other credits, deductions and other rules I did not even bother to mention yet. I fully expect everyone else to do the same.

I think I will end my rant and sarcasm as well.

You also have a wonderful day.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4368 on: June 13, 2018, 10:06:35 AM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year. Since you've bought medigap coverage you're not paying anything more out of pocket besides any drugs Part D might consider higher tier drugs.

We know that Medicare works very well, so when you consider that in many states the cost of premiums alone for two people only in their mid-30s is already more than $10,000 a year, that just shows you how broken the private insurance system is without any cost controls.

Imagine paying that if you only had social security and had to make rent every month.. Damn!

Mind you, thinking about the $200k bill... If I understand it right then Medicare has a 20% deductible.. so for a $200k bill that would be $40k. So in effect you are paying $10k per year to insure against a bill of $200k.. if so then assuming a sufficiently high NW you might consider it better to take the out of pocket cost which may never happen.

I'm sure I am way over simplifying this?

Actually Plan F is $241.50 per month per person so $5,796 per year for two people. This is where the 20% comes in.
Plan B you have to pay $134.00 per month to even buy a supplement. You need Plan B to see doctors and get tests done. Plan D (prescriptions) really doesn't factor in for medical treatments.

Insurance is a gamble. You buy it to protect yourself but you hope you NEVER use it! Hahaha, funny, something you buy but you never want to use it. What in your life have you bought that was so expensive but never use it?

Cassie

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Re: What comes after the ACA?
« Reply #4369 on: June 13, 2018, 01:10:11 PM »
Road, my DH was diagnosed with prostrate cancer at 49. 10 years later he is fine. He did the radiation seeds and it worked well. Also has less side effects than the surgery for others that may face this in the future. You still have side effects but not as many and not as severe.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4370 on: June 13, 2018, 01:30:20 PM »
Cassie, that is good your husband is doing well! 10 years is fantastic!

SugarMountain

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Re: What comes after the ACA?
« Reply #4371 on: June 13, 2018, 01:36:42 PM »
I haven't been following this thread that closely, but this is making me nervous with potentially only a month to go.  Both DW & I have pre-existing conditions, neither extremely serious but could be used to keep us from getting insurance if the ACA truly does die.

https://talkingpointsmemo.com/dc/the-domino-effect-of-the-trump-admin-gutting-pre-existing-conditions-protections

Mr. Green

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Re: What comes after the ACA?
« Reply #4372 on: June 13, 2018, 02:03:36 PM »
I haven't been following this thread that closely, but this is making me nervous with potentially only a month to go.  Both DW & I have pre-existing conditions, neither extremely serious but could be used to keep us from getting insurance if the ACA truly does die.

https://talkingpointsmemo.com/dc/the-domino-effect-of-the-trump-admin-gutting-pre-existing-conditions-protections
Even if a court were to rule in the DOJ's favor, there would be an appeal. Hell, it likely would drag into the next administration, and if Democrats take over both the Legislative and Executive branches they could turn around and drop the case. It will be years before this issue would see a permanent resolution, and I imagine the ACA will have to stay in place until a final resolution is reached.
RE in June 2016. Wife is joining me at the end of June!

DreamFIRE

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Re: What comes after the ACA?
« Reply #4373 on: June 13, 2018, 04:19:32 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year.

That's $10,000 out of pocket per year.   That seems incredibly high to me.  I'm paying about $900/yr net out of pocket now (including premiums and co-pay/deductibles, not employer's contribution).  I hate to see seniors paying that high of total cost out of pocket after paying into Medicare all of their working careers.  They're getting screwed in other ways as well.

hydra

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Re: What comes after the ACA?
« Reply #4374 on: June 13, 2018, 04:46:47 PM »
Quote
Earnings include: Social Security income, Pensions, IRA withdrawals, Investment income (interest, dividends) and wages from a job

Does this include investment income from retirement accounts or only from non-retirement (taxable) accounts?

DreamFIRE

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Re: What comes after the ACA?
« Reply #4375 on: June 13, 2018, 05:20:47 PM »
Quote
Earnings include: Social Security income, Pensions, IRA withdrawals, Investment income (interest, dividends) and wages from a job

Does this include investment income from retirement accounts or only from non-retirement (taxable) accounts?

It does include any distributions from traditional retirement accounts and IRAs, but Roth distributions are not included in MAGI.

For non-retirement accounts, the interest, dividends, capital gains all count towards your MAGI.

For SS, both taxable and non-taxable portions of SS benefits count toward MAGI.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4376 on: June 13, 2018, 05:43:48 PM »
Are you proposing means testing as a way to make ACA better? If you are, then say so, so we can discuss that. I would add I would be in favor of means testing, for ALL policies discussed in this post (radram waits as BTD calculates whether means testing EVERY rule he takes advantage of will save him, or cost a SHIT TON more so he knows whether or not he supports the idea).

??  ACA already uses means testing based on MAGI in regards to Medicaid, PTC, and CSR.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4377 on: June 13, 2018, 05:48:05 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year.

That's $10,000 out of pocket per year.   That seems incredibly high to me.  I'm paying about $900/yr net out of pocket now (including premiums and co-pay/deductibles, not employer's contribution).  I hate to see seniors paying that high of total cost out of pocket after paying into Medicare all of their working careers.  They're getting screwed in other ways as well.

DreamFire Medicare, Plan B is $134 a month. If you choose, you do not have to pay for any other thing, you don't even have to buy into Plan B if you don't want to. However, if you get no supplement, you will pay $1,340 if you are hospitalized as a deductible and can be more than one time a year depending on each benefit period. With Part B you will pay $183 a year as a deductible to see doctors. If you don't buy Plan B you will pay for all your doctor visits and all testing done. If you don't buy a Prescription plan you will pay out the butt for prescriptions. Each person has to identify needs, cost and affordability. A lot of people cannot afford anything. But if you don't buy into this crap, you will be inundated with huge bills. Hub and I chose to pay thru the nose with the different plans as I have written about to ward off medical costs if they should happen. There are lots of choice that are less costly but like the old saying goes, you get what you pay for. Never in my wildest dreams did I think we would pay this kind of money per year for health insurance.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4378 on: June 13, 2018, 06:26:38 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.
I feel like $10,000 is a reasonable amount of money for two people in their mid-60s to spend on healthcare for the year.

That's $10,000 out of pocket per year.   That seems incredibly high to me.  I'm paying about $900/yr net out of pocket now (including premiums and co-pay/deductibles, not employer's contribution).  I hate to see seniors paying that high of total cost out of pocket after paying into Medicare all of their working careers.  They're getting screwed in other ways as well.

DreamFire Medicare, Plan B is $134 a month. If you choose, you do not have to pay for any other thing, you don't even have to buy into Plan B if you don't want to. However, if you get no supplement, you will pay $1,340 if you are hospitalized as a deductible and can be more than one time a year depending on each benefit period. With Part B you will pay $183 a year as a deductible to see doctors. If you don't buy Plan B you will pay for all your doctor visits and all testing done. If you don't buy a Prescription plan you will pay out the butt for prescriptions. Each person has to identify needs, cost and affordability. A lot of people cannot afford anything. But if you don't buy into this crap, you will be inundated with huge bills. Hub and I chose to pay thru the nose with the different plans as I have written about to ward off medical costs if they should happen. There are lots of choice that are less costly but like the old saying goes, you get what you pay for. Never in my wildest dreams did I think we would pay this kind of money per year for health insurance.

Yep, I'm following.  You can cut some of the upfront costs by not buying in to the plans/supplementals but are taking a risk of greater out of pocket costs for health care and prescriptions you might actually need to use.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4379 on: June 14, 2018, 06:07:50 AM »
When you get your Medicare card, it is printed with Medicare A (Hospital) and Medicare B (doctors/tests). The letter says if you choose not to take Medicare B you are to notify them and they will reissue the Medicare card with just Medicare A printed on the card. The card in my opinion is totally useless unless you are hospitalized. Then you still have to pay the $1,340 deductible for each benefit period. That could be several per year if you need to be hospitalized more than one time. You are almost forced into buying into Medicare B for doctor visits and tests. At that point you will be stuck for 20% of what is left over that Medicare doesn't pay. With the drug program you are forced into buying prescriptions at a 'preferred' pharmacy where your copays are less than a nonpreferred pharmacy. Or you can choose to use the warehouse option where most generic drugs cost you zero and you get a three month supply. However, all the drugs are listed in tiers. Tier 1 being generic and as you go up the totem pole of tiers, the drugs get more expensive on top of the monthly premiums.

It always seemed when I heard of Medicare, I assumed it was pretty much a 'free' program. Hahaha, nothing could be farther from the truth! Medicare A is free in the sense if you have worked 10 years you qualify for Medicare A with no monthly fees or premiums. Getting admitted to a hospital when on Medicare isn't easy. They keep you most of the time under 'observation status' which means you are not formally admitted. You have to be admitted on paper, and stay 3 nights for Medicare to pay for rehab in a nursing home if needed later. They try their darndest to not admit you. I had a family member under observation status and they kicked her to the curb and didn't even know what was wrong with her. Here is a scary article on it: https://newoldage.blogs.nytimes.com/2014/01/10/fighting-observation-status/

radram

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Re: What comes after the ACA?
« Reply #4380 on: June 15, 2018, 08:23:39 AM »
Are you proposing means testing as a way to make ACA better? If you are, then say so, so we can discuss that. I would add I would be in favor of means testing, for ALL policies discussed in this post (radram waits as BTD calculates whether means testing EVERY rule he takes advantage of will save him, or cost a SHIT TON more so he knows whether or not he supports the idea).

??  ACA already uses means testing based on MAGI in regards to Medicaid, PTC, and CSR.

Yes, you are correct.

I meant using assets as a condition of utilization. As an example, if you own a billion dollars worth of Berkshire Hathaway stock(and no other assets), it increased 23% in 2017, or $230,000,000. 2017 income would be $0 for MAGI purposes, since MAGI does not take into account either assets nor unrealized gains. You would qualify for ACA subsidies. Compare this to qualifying for college grants and loans. The FAFSA makes you report your assets, which disqualifies you in my Berkshire example( unless you own it in a retirement account... then you would still qualify).


Paul der Krake

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Re: What comes after the ACA?
« Reply #4381 on: June 15, 2018, 08:32:26 AM »
Yes, using income as a proxy for means is imperfect. But until someone comes up with a way to fairly establish taxpayers' means that doesn't require adding millions of pages to the tax code and the hiring of millions of inspectors, we're going to stick with that.

iris lily

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Re: What comes after the ACA?
« Reply #4382 on: June 15, 2018, 08:34:54 AM »
Are you proposing means testing as a way to make ACA better? If you are, then say so, so we can discuss that. I would add I would be in favor of means testing, for ALL policies discussed in this post (radram waits as BTD calculates whether means testing EVERY rule he takes advantage of will save him, or cost a SHIT TON more so he knows whether or not he supports the idea).

??  ACA already uses means testing based on MAGI in regards to Medicaid, PTC, and CSR.


Exactly why we arent cashing out  gains of the stock market. We are keeping our MAGi low until we slide into Medicare, 11 months from now. Countdown  time, 10...9...8...months.
« Last Edit: June 17, 2018, 10:09:14 PM by iris lily »

radram

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Re: What comes after the ACA?
« Reply #4383 on: June 15, 2018, 08:41:35 AM »
Are you proposing means testing as a way to make ACA better? If you are, then say so, so we can discuss that. I would add I would be in favor of means testing, for ALL policies discussed in this post (radram waits as BTD calculates whether means testing EVERY rule he takes advantage of will save him, or cost a SHIT TON more so he knows whether or not he supports the idea).

??  ACA already uses means testing based on MAGI in regards to Medicaid, PTC, and CSR.

Exactly why we arent cashing out  gains of the stock market. We are keeping our MAGi low until we slide into Medicare, 11 months from now. Countsown time, 10...9...8...months.

Yes, you are correct.

I meant using assets as a condition of utilization. As an example, if you own a billion dollars worth of Berkshire Hathaway stock(and no other assets), it increased 23% in 2017, or $230,000,000. 2017 income would be $0 for MAGI purposes, since MAGI does not take into account either assets nor unrealized gains. You would qualify for ACA subsidies. Compare this to qualifying for college grants and loans. The FAFSA makes you report your assets, which disqualifies you in my Berkshire example( unless you own it in a retirement account... then you would still qualify).


I'm not only the MAGI president.....I'm also a client.  :)


radram

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Re: What comes after the ACA?
« Reply #4384 on: June 15, 2018, 08:47:33 AM »
Yes, using income as a proxy for means is imperfect. But until someone comes up with a way to fairly establish taxpayers' means that doesn't require adding millions of pages to the tax code and the hiring of millions of inspectors, we're going to stick with that.

I agree any system will have imperfections to exploit. I only ask that people keep these exploitation's in mind while attacking others they can not benefit from. Seems to be the very definition of a hypocrite.

desert_phoenix

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Re: What comes after the ACA?
« Reply #4385 on: June 15, 2018, 12:38:41 PM »
I am going on Medicare August 1st. Hub has been on it for a year and a half. The Hub and I chose Traditional Medicare Part A (covers hospital costs) no cost if you work 10 years, Part B (covers doctors/tests) $134 a month, Plan D (covers prescriptions) $78 a month and Plan F supplement (covers the 20% Medicare doesn't pay) $241.50 a month.

No one has to buy Part B, Plan D or Plan F. However, Medicare Part A only covers hospital. So you will have to either buy these other plans or pay out of your pocket for everything else.

So, between the two of us we will be paying $907 a month, $10,884 a year for health insurance for two people.

Yes, we could have made other cheaper choices but the Hub has had some serious health issues and the Medicare choices we made were good because we didn't receive one bill. His treatments were over $200K.

Are Medicare parts B, D, and F a one-time and irrevocable choice?  Or could you opt-in and out each year?

Roadrunner53

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Re: What comes after the ACA?
« Reply #4386 on: June 15, 2018, 12:53:58 PM »
desert_phoenix

Part B I am guessing you can opt out but if you opt out from the beginning there are penalties you must pay to get back in. The monthly rate is jacked up and you will pay more than normal prices. It isn't a good idea to opt out of Part B. If have a job at age 65 you can continue to keep your employer plan and delay Part B till you retire then you best go on Part B at that point or penalties will occur when you decide you want in later on.

Plan D (prescriptions) they tell you to review it each year to determine your needs. You can plug in your prescriptions to see what your yearly costs will be thru a preferred pharmacy or thru ordering thru the warehouse deal of 3 months prescriptions at a time. You can switch from one plan to another.

Plan F (supplements to Medicare) or any other supplement you are supposed to be able to change from one to another, but if you have health issues they may require a physical and then they could deny coverage if you are a risk. Once you are in, you can stay in. If the plan is eliminated, like Plan F will be in 2020, you can stay on it grandfathered.
« Last Edit: June 15, 2018, 02:48:56 PM by Roadrunner53 »

hydra

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Re: What comes after the ACA?
« Reply #4387 on: June 15, 2018, 02:38:00 PM »
For early retirees who are willing and able to travel, is medical tourism the answer to our woes?

http://www.medicaltourismmag.com/top-10-medical-tourism-destinations-world/

RedwoodDreams

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Re: What comes after the ACA?
« Reply #4388 on: June 18, 2018, 09:07:44 PM »
When you get your Medicare card, it is printed with Medicare A (Hospital) and Medicare B (doctors/tests). The letter says if you choose not to take Medicare B you are to notify them and they will reissue the Medicare card with just Medicare A printed on the card. The card in my opinion is totally useless unless you are hospitalized. Then you still have to pay the $1,340 deductible for each benefit period. That could be several per year if you need to be hospitalized more than one time. You are almost forced into buying into Medicare B for doctor visits and tests. At that point you will be stuck for 20% of what is left over that Medicare doesn't pay. With the drug program you are forced into buying prescriptions at a 'preferred' pharmacy where your copays are less than a nonpreferred pharmacy. Or you can choose to use the warehouse option where most generic drugs cost you zero and you get a three month supply. However, all the drugs are listed in tiers. Tier 1 being generic and as you go up the totem pole of tiers, the drugs get more expensive on top of the monthly premiums.

It always seemed when I heard of Medicare, I assumed it was pretty much a 'free' program. Hahaha, nothing could be farther from the truth! Medicare A is free in the sense if you have worked 10 years you qualify for Medicare A with no monthly fees or premiums. Getting admitted to a hospital when on Medicare isn't easy. They keep you most of the time under 'observation status' which means you are not formally admitted. You have to be admitted on paper, and stay 3 nights for Medicare to pay for rehab in a nursing home if needed later. They try their darndest to not admit you. I had a family member under observation status and they kicked her to the curb and didn't even know what was wrong with her. Here is a scary article on it: https://newoldage.blogs.nytimes.com/2014/01/10/fighting-observation-status/

Roadrunner, thanks for adding your insights into this discussion. I'm newly eligible for Medicare as of July 1, but due to disability rather than age. I also had been under the impression that if I could just make it to Medicare (after two years on SSDI), I'd have free to low cost health insurance after my 35 years of working and paying into the system. Em, nope! The thing that alarms me most is that it seems like unlike traditional health insurance programs there's no concept of out of annual pocket max, especially when it comes to prescriptions... I totally get why you chose the plans you did to cover yourselves 100% for parts A & B... 10k might seem like a lot but is also almost nothing when your alternative is hundreds of thousands of dollars in medical bills. I was also chagrined to learn that the Part B policies (medigap only) available to those on SSDI are more limited and more expensive than those available to those ages 65 and older. Go figure.

RedwoodDreams

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Re: What comes after the ACA?
« Reply #4389 on: June 18, 2018, 09:12:28 PM »
desert_phoenix

Part B I am guessing you can opt out but if you opt out from the beginning there are penalties you must pay to get back in. The monthly rate is jacked up and you will pay more than normal prices. It isn't a good idea to opt out of Part B. If have a job at age 65 you can continue to keep your employer plan and delay Part B till you retire then you best go on Part B at that point or penalties will occur when you decide you want in later on.

Plan D (prescriptions) they tell you to review it each year to determine your needs. You can plug in your prescriptions to see what your yearly costs will be thru a preferred pharmacy or thru ordering thru the warehouse deal of 3 months prescriptions at a time. You can switch from one plan to another.

Plan F (supplements to Medicare) or any other supplement you are supposed to be able to change from one to another, but if you have health issues they may require a physical and then they could deny coverage if you are a risk. Once you are in, you can stay in. If the plan is eliminated, like Plan F will be in 2020, you can stay on it grandfathered.

Re: Plan F ... In case you aren't already dizzy from details, yes, there's this whole notion of "age attained" and "issue age" rated policies:

https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx#;return%20false;

I'm in the position of needing to choose a medigap policy for the first time and I'm somewhat petrified at choosing the wrong type and being stuck with something subpar or that becomes astronomically expensive over time.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4390 on: June 19, 2018, 04:42:20 AM »
desert_phoenix

Part B I am guessing you can opt out but if you opt out from the beginning there are penalties you must pay to get back in. The monthly rate is jacked up and you will pay more than normal prices. It isn't a good idea to opt out of Part B. If have a job at age 65 you can continue to keep your employer plan and delay Part B till you retire then you best go on Part B at that point or penalties will occur when you decide you want in later on.

Plan D (prescriptions) they tell you to review it each year to determine your needs. You can plug in your prescriptions to see what your yearly costs will be thru a preferred pharmacy or thru ordering thru the warehouse deal of 3 months prescriptions at a time. You can switch from one plan to another.

Plan F (supplements to Medicare) or any other supplement you are supposed to be able to change from one to another, but if you have health issues they may require a physical and then they could deny coverage if you are a risk. Once you are in, you can stay in. If the plan is eliminated, like Plan F will be in 2020, you can stay on it grandfathered.

Re: Plan F ... In case you aren't already dizzy from details, yes, there's this whole notion of "age attained" and "issue age" rated policies:

https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx#;return%20false;

I'm in the position of needing to choose a medigap policy for the first time and I'm somewhat petrified at choosing the wrong type and being stuck with something subpar or that becomes astronomically expensive over time.

Did not know this. Thanks for pointing that out!

LaineyAZ

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Re: What comes after the ACA?
« Reply #4391 on: June 19, 2018, 08:16:38 AM »
Heard someone say that Part D/Prescriptions is what also covers the drugs for any chemotherapy. 
So in deciding on whether to opt in on that, just realize that, of course, cancer can strike anyone and so Part D coverage goes beyond what your typical prescriptions needs may be. 

Roadrunner53

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Re: What comes after the ACA?
« Reply #4392 on: June 19, 2018, 08:23:36 AM »
Heard someone say that Part D/Prescriptions is what also covers the drugs for any chemotherapy. 
So in deciding on whether to opt in on that, just realize that, of course, cancer can strike anyone and so Part D coverage goes beyond what your typical prescriptions needs may be. 

LaineyAZ I am not a Medicare expert but I don't think Part D pays for Chemo. See this: https://www.medicare.gov/coverage/chemotherapy.html

LaineyAZ

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Re: What comes after the ACA?
« Reply #4393 on: June 19, 2018, 08:56:52 AM »
Thanks, looks like my info was wrong on Part D. 

Paul der Krake

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Re: What comes after the ACA?
« Reply #4394 on: June 19, 2018, 09:38:29 PM »

Mr. Green

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Re: What comes after the ACA?
« Reply #4395 on: June 20, 2018, 11:20:31 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/
The article said the cut to social security would be paid by disallowing someone to collect unemployment while also clecting social security disability insurance money. At first thought that seemed strange to me because how would you be disabled and still working in order to lose a job but then I remembered the fact that there is partial disability.
RE in June 2016. Wife is joining me at the end of June!

DreamFIRE

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Re: What comes after the ACA?
« Reply #4396 on: June 20, 2018, 07:01:58 PM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

protostache

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Re: What comes after the ACA?
« Reply #4397 on: June 21, 2018, 05:37:57 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

toganet

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Re: What comes after the ACA?
« Reply #4398 on: June 21, 2018, 06:53:08 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

What I don't get is why.  What goal is served by making life worse for millions of people?  Is it just pure greed and cronyism, or do they have some notion that "the market" will magically fix everything?  If so, what would that look like?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4399 on: June 21, 2018, 07:56:22 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

What I don't get is why.  What goal is served by making life worse for millions of people?  Is it just pure greed and cronyism, or do they have some notion that "the market" will magically fix everything?  If so, what would that look like?

Yep, that's all there is to it.  They think, "I got mine, why couldn't you get yours?  You've just been lazy, or you have some other character deficiency or made some other bad choice that caused you to not be able to afford astronomically expensive health care.  Therefore, I'm not going to reward your bad behavior by paying taxes to support you."
Took that job and shoved it - January 6, 2018