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Christian Hedonist
Skeptic Friend

92 Posts

Posted - 03/10/2017 :  10:35:52  Show Profile Send Christian Hedonist a Private Message  Reply with Quote
Ok, instead of the bickering what do you think of a plan like this to pay for healthcare for people making less than $50,000/year. Here is a summary of my proposal.




The subsidy would be the maximum they could get paid directly to the healthcare company. If we really want to have healthcare for all people then people are going to have to pay for it. That means increasing taxes. If we did something like this we would not need the mandate and people could get whatever coverage they like. Make sure that if a company wants to get paid with the subsidy they are required to include the protections of the ACA (pre-existing conditions etc.). We could also set up health savings accounts for people who want them.

We need to decide as a society if we want to cover people that cannot afford coverage then some of us are going to have to pay for others to have coverage without getting a benefit for us.















Edited by - Christian Hedonist on 03/10/2017 15:22:23

Dave W.
Info Junkie

USA
25835 Posts

Posted - 03/10/2017 :  22:55:25   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
I appreciate the effort you've put into this, but I think it's based on a few assumptions that need correcting.

Your taxes on electricity, gas and especially the sales tax are regressive. They will impact the poor on a much larger percentage basis than they'll impact the rich. On an average day, the guy making a million bucks a year won't spend a hundred times as much on food as the guy scraping by on ten thousand dollars a year. The rich can also afford to upgrade to LED lights and Energy Star appliances (I know people living with a 40-year-old fridge because they can't afford a new one), and they can afford to spend over $5,000 to get a $1,500 tax credit on a new central air system (thanks, Bush and Obama!), so the electricity tax will impact the rich less than the poor, too.

Any sort of "flat tax" like these will be regressive in reality. The rich will find ways to lower their portion, and so the poor will be stuck paying a larger percentage per capita.

If we raised taxes on everyone in the $75K bracket by 5%; the 100K bracket by 8%; the $150K bracket by 15%, and the $200K bracket by 20%, we'd generate around $800 billion bucks a year. Before you balk at those numbers, remember that the highest tax bracket after WWII was 94%. Perhaps the biggest problem with health care costs right now is that many of the richest of us have an "I got mine, everyone else can fuck off" attitude - they don't actually want to be a part of "society," but they want all the benefits of it anyway (how they got rich, for example). If we - as a country - came together and decided that health care for everyone were as important as defeating Hitler, this discussion wouldn't be required: socialized medicine would be seen by everyone as the only viable option.

You can toy with the numbers, of course, and see how low you can get them. I just did some two-digit estimates.

By "healthcare company," I assume you mean "health insurance company." The majority of the problem is right there, though. If we paid for health care instead of health insurance, the total amount spent would be much lower. Insurance companies are middlemen that demand a profit for their shareholders, but their only value is to "pool the risk." They ensure profits by denying care (if they paid every claim they received, they'd go out of business fast - health insurance companies are the "death panels" people were screeching about in 2008).

On the other hand, if the government paid health care workers directly, then the risk would be pooled at the government level, removing the middlemen and the need for profit (all "government should be run like a business" ideas suffers from this profit flaw). Not only that, but there would be no "claims" to pay, since government employees (doctors) would see you directly. Patient fraud would vanish, and doctor fraud could only exist so far as a doctor could convince his supervisor that he was working on a day when he was really golfing.

Not only that all that, but just think of the savings in HR and other overhead costs! Every health insurance and health care company today has to hire its own HR people, its own accountants, etc. All those costs would vanish.

But enough of the pipe dream...

Except that if we paid for health care instead of health insurance, most of the poorer people wouldn't come anywhere close to spending $11K/year. They only need that much coverage if they're paying for insurance. A couple of check-ups a year with a government doctor would cost a few hundred bucks, at most.

...if we want to cover people that cannot afford coverage...
They're getting covered, one way or another. People without insurance tend to wait until their health problems are critical, and then visit an ER, which is the most expensive way to deliver health care. By law, they can't be turned away from the ER for an inability to pay, so if they can't pay for their ER visit, it's paid by the hospital, which passes its costs along to the other patients. Health care costs go up, and so health insurance premiums and/or deductibles go up, while at the same time, the insurance companies try to figure out more procedures they can decline to keep profits rising instead of just stagnating.

Direct, government-paid health care is the way to avoid all these problems. VA care for everyone. Lots of other countries pull it off, why does the U.S. insist on delivering a lower standard of care for much more money?

Oh, there can still be co-pays or other fees to "discourage" patients from abusing the system. In Japan, a foreigner has to pay about $10/month to get into the national health system. And then there's a $10 visit fee, whether it's a GP or specialist. But an MRI will cost the patient about $250 in Japan (about a tenth what one costs in the U.S.), and prescription drugs are much cheaper. Germany has an 8% flat tax (boo!) to cover everyone, and that includes things like regular home visits from nurses for expectant mothers.

- Dave W. (Private Msg, EMail)
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Christian Hedonist
Skeptic Friend

92 Posts

Posted - 03/13/2017 :  08:23:26   [Permalink]  Show Profile Send Christian Hedonist a Private Message  Reply with Quote
Originally posted by Dave W.

I appreciate the effort you've put into this, but I think it's based on a few assumptions that need correcting.

Your taxes on electricity, gas and especially the sales tax are regressive. They will impact the poor on a much larger percentage basis than they'll impact the rich. On an average day, the guy making a million bucks a year won't spend a hundred times as much on food as the guy scraping by on ten thousand dollars a year. The rich can also afford to upgrade to LED lights and Energy Star appliances (I know people living with a 40-year-old fridge because they can't afford a new one), and they can afford to spend over $5,000 to get a $1,500 tax credit on a new central air system (thanks, Bush and Obama!), so the electricity tax will impact the rich less than the poor, too.
I agree with this and it is only 5% of the estimated annual cost needed. The gas is less than 2%. It is a way that they can pay into the system some. But maybe it is too much of a burden. Maybe just tax commercial and industrial use?

Any sort of "flat tax" like these will be regressive in reality. The rich will find ways to lower their portion, and so the poor will be stuck paying a larger percentage per capita.
We would need to ensure that the 1% tax increase would be for all income, regardless of its source.

If we raised taxes on everyone in the $75K bracket by 5%; the 100K bracket by 8%; the $150K bracket by 15%, and the $200K bracket by 20%, we'd generate around $800 billion bucks a year.
My 1% tax is across all tax brackets for people that make greater than $50,000. Are you saying the same with these proposed tax increases? Or these increases just in the tax brackets proposed?


Before you balk at those numbers, remember that the highest tax bracket after WWII was 94%.
It doesn't mean it was right.

Perhaps the biggest problem with health care costs right now is that many of the richest of us have an "I got mine, everyone else can fuck off" attitude - they don't actually want to be a part of "society," but they want all the benefits of it anyway (how they got rich, for example). If we - as a country - came together and decided that health care for everyone were as important as defeating Hitler, this discussion wouldn't be required: socialized medicine would be seen by everyone as the only viable option.
I don't disagree with the attitude part, but I am not convinced that socialized medicine won't decrease choice, quality of care and be economically sustainable. What would be the cost of socialized medicine on everyone? How would it be paid for? Doesn't the UK have ~9% tax on everyone?

You can toy with the numbers, of course, and see how low you can get them. I just did some two-digit estimates.
That will pay for it if applied to all the income brackets for someone making over $50,000. You can do 4, 7, 14 and 20% to pay for it. But then this now is just forced robbery in my opinion. If you apply this to all the tax brackets a household will pay $3,333, $8,167, $23,333 and $46,667 respectively. That is a lot of money.

By "healthcare company," I assume you mean "health insurance company."
Yes.

The majority of the problem is right there, though. If we paid for health care instead of health insurance, the total amount spent would be much lower. Insurance companies are middlemen that demand a profit for their shareholders, but their only value is to "pool the risk." They ensure profits by denying care (if they paid every claim they received, they'd go out of business fast - health insurance companies are the "death panels" people were screeching about in 2008).
How is this different than a socialized medicine approach? Don't they also have to pool the risk to pay for the costs?

On the other hand, if the government paid health care workers directly, then the risk would be pooled at the government level, removing the middlemen and the need for profit (all "government should be run like a business" ideas suffers from this profit flaw).
Not really. Decisions will still have to be made to pay for the cost. Maybe not a profit but revenue will still need to be generated and accounted for.

Not only that, but there would be no "claims" to pay, since government employees (doctors) would see you directly. Patient fraud would vanish, and doctor fraud could only exist so far as a doctor could convince his supervisor that he was working on a day when he was really golfing.
A bit of a rosy picture, there will be fraud in any system.

Not only that all that, but just think of the savings in HR and other overhead costs! Every health insurance and health care company today has to hire its own HR people, its own accountants, etc. All those costs would vanish.
So government would not expand at all? There would be a massive increase in government administrators to implement the program. Government offices have HR departments, accountants etc.


Except that if we paid for health care instead of health insurance, most of the poorer people wouldn't come anywhere close to spending $11K/year. They only need that much coverage if they're paying for insurance. A couple of check-ups a year with a government doctor would cost a few hundred bucks, at most.
But what if they have a health care need that is expensive?

They're getting covered, one way or another. People without insurance tend to wait until their health problems are critical, and then visit an ER, which is the most expensive way to deliver health care. By law, they can't be turned away from the ER for an inability to pay, so if they can't pay for their ER visit, it's paid by the hospital, which passes its costs along to the other patients. Health care costs go up, and so health insurance premiums and/or deductibles go up, while at the same time, the insurance companies try to figure out more procedures they can decline to keep profits rising instead of just stagnating.
I agree, my plan would help eliminate this.

Direct, government-paid health care is the way to avoid all these problems. VA care for everyone. Lots of other countries pull it off, why does the U.S. insist on delivering a lower standard of care for much more money?
Can you substantiate this claim?

On a personal note, my wife has a disease called achalasia. It is a condition where the muscles in her esophagus do not work. It is a chronic condition that deteriorates as she ages. It was diagnosed 15 years ago and is only found in 1/100,000 people. Through the US health care system we have been able to explore many different options for her treatment and not just the advice of one doctor. We have been free to go to more than one doctor and finally to a specialist. She is going to have an operation to remove her esophagus and replace it with part of her colon due to the severity of her condition. My concern is that in a socialized healthcare system we would not be as free to get the help she needs. We would be bound to a system where going to other doctors would not be covered and would put us in great debt. She has had many operations over the years and because of our health insurance we were able to pay for the procedures. Most hospitals have payment plans if needed. Is this a valid worry?
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Dave W.
Info Junkie

USA
25835 Posts

Posted - 03/13/2017 :  10:24:02   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Originally posted by Christian Hedonist

It is a way that they can pay into the system some.
Are their normal income taxes and sales and use taxes not enough? Why should the poor carry any more of the burden than they already do?

We would need to ensure that the 1% tax increase would be for all income, regardless of its source.
Has that ever happened?

If we raised taxes on everyone in the $75K bracket by 5%; the 100K bracket by 8%; the $150K bracket by 15%, and the $200K bracket by 20%, we'd generate around $800 billion bucks a year.
My 1% tax is across all tax brackets for people that make greater than $50,000. Are you saying the same with these proposed tax increases? Or these increases just in the tax brackets proposed?
I'm saying increase each brackets taxes by that amount.

Before you balk at those numbers, remember that the highest tax bracket after WWII was 94%.
It doesn't mean it was right.
No, it means it's not only possible, but under some conditions it's popular. Don't forget: nobody ever paid 94% of their income in taxes, that was just the bracket rate before deductions and credits.

I don't disagree with the attitude part, but I am not convinced that socialized medicine won't decrease choice, quality of care and be economically sustainable. What would be the cost of socialized medicine on everyone? How would it be paid for? Doesn't the UK have ~9% tax on everyone?
And Germany does all their socialized medicine for an 8% income tax. This is only a problem if you consider taxes to be theft, instead of the normal cost of living in a community in which you expect certain services to be performed by the government. Look at the Scandinavian counties, where actual (not bracket) middle-class income taxes can easily hit 50%. They're not suffering. Nor are they squealing about government theft or "freedom." Ask Dr. Mabuse how many of his government's services he'd be willing to give up for, say, a 10% bump in take-home pay. I doubt he'd trash any of the big ones (health care, college, housing, food) for a little extra cash.

That will pay for it if applied to all the income brackets for someone making over $50,000. You can do 4, 7, 14 and 20% to pay for it. But then this now is just forced robbery in my opinion. If you apply this to all the tax brackets a household will pay $3,333, $8,167, $23,333 and $46,667 respectively. That is a lot of money.
Compared to a $100,000 hospital bill for cancer, it's really quite little. But 4% of 50K is $2,000.

How is this different than a socialized medicine approach? Don't they also have to pool the risk to pay for the costs?
Yes, the question is about where the risk is pooled. With socialized medicine, it's pooled at the government level. In the U.S. system, it's pooled with for-profit insurance companies (and again: they make their profit by denying claims).

On the other hand, if the government paid health care workers directly, then the risk would be pooled at the government level, removing the middlemen and the need for profit (all "government should be run like a business" ideas suffers from this profit flaw).
Not really. Decisions will still have to be made to pay for the cost. Maybe not a profit but revenue will still need to be generated and accounted for.
Yes, and the government has all that machinery already.

A bit of a rosy picture, there will be fraud in any system.
Yes, but in no case will a non-patient be able to file ginned-up paperwork and receive a check. The government won't ever give patients cash for care, the government will pay the doctors. This will drastically reduce the amount of fraud possible.

So government would not expand at all? There would be a massive increase in government administrators to implement the program. Government offices have HR departments, accountants etc.
Government HR departments are tiny compared to private companies with similar numbers of employees. They don't spend time headhunting. With Government Scale, salary negotiations are short. The mechanisms for offering jobs are automated. Most of the work for getting pay increases is done by the employees, and cost-of-living increases are determined by Congress.

Just think of it like the biggest corporate merger in history: even though the final result would be larger, tons of redundancy would be removed, lowering costs.

But what if they have a health care need that is expensive?
Then they'll get that care. What do you think would happen?

Direct, government-paid health care is the way to avoid all these problems. VA care for everyone. Lots of other countries pull it off, why does the U.S. insist on delivering a lower standard of care for much more money?
Can you substantiate this claim?
Which claim? That health care is more expensive in the U.S. than elsewhere? Or that health care is less effective in the U.S. than elsewhere? This report addresses both.

My concern is that in a socialized healthcare system we would not be as free to get the help she needs. We would be bound to a system where going to other doctors would not be covered and would put us in great debt. She has had many operations over the years and because of our health insurance we were able to pay for the procedures. Most hospitals have payment plans if needed. Is this a valid worry?
If we socialized medicine here in the U.S., all doctors would be "covered" because they'd get paid by the government. You would be able to shop around for procedures with complete freedom, unlike today where most people's insurance limits your choices to in-plan doctors (or at least makes out-of-plan doctors and services costly).

Imagine your predicament if your family income was, say, 20% of whatever it is. Would your insurance still be affordable, given that its premiums, co-pays and deductibles wouldn't be any less?

Coincidentally, I read Poor People Need BETTER Health Insurance than the Rest of Us, Not Worse just before seeing your reply here.

- Dave W. (Private Msg, EMail)
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Christian Hedonist
Skeptic Friend

92 Posts

Posted - 03/15/2017 :  13:15:05   [Permalink]  Show Profile Send Christian Hedonist a Private Message  Reply with Quote
Originally posted by Dave W.

Why should the poor carry any more of the burden than they already do?
How do they pay more of the burden when in my plan they only pay the 1% sales tax like everyone else? I took out the electric and gas consumption taxes.

If we raised taxes on everyone in the $75K bracket by 5%; the 100K bracket by 8%; the $150K bracket by 15%, and the $200K bracket by 20%, we'd generate around $800 billion bucks a year.
My 1% tax is across all tax brackets for people that make greater than $50,000. Are you saying the same with these proposed tax increases? Or these increases just in the tax brackets proposed?
I'm saying increase each brackets taxes by that amount.
Ok. That is too much in my opinion. Here is a new plan that I have based on some of your comments.



I Increase the tax burden on the wealthier and decreases the national sales tax to 1%. This would include traditionally tax exempt entities.
And Germany does all their socialized medicine for an 8% income tax. This is only a problem if you consider taxes to be theft, instead of the normal cost of living in a community in which you expect certain services to be performed by the government. Look at the Scandinavian counties, where actual (not bracket) middle-class income taxes can easily hit 50%. They're not suffering. Nor are they squealing about government theft or "freedom." Ask Dr. Mabuse how many of his government's services he'd be willing to give up for, say, a 10% bump in take-home pay. I doubt he'd trash any of the big ones (health care, college, housing, food) for a little extra cash.
I don’t know many people that could pay daily expenses and plan for the future if 50% of their money was confiscated. I have an below average salary for married filing jointly status and modest home with three kids. If the rules were suddenly changed dramatically I could no longer support my family as we planned. I would rather have my money and be able to have the freedom to do what I like with it and then have the government help those that need it. That is what my plan is trying to do.

Compared to a $100,000 hospital bill for cancer, it's really quite little. But 4% of 50K is $2,000.
My calculation is not on the bottom of the bracket but takes a third of the range and adds it to the bottom of the bracket. And not all people get cancer. In my plan everyone could get insurance and be covered for $100,000 cancer.

In the U.S. system, it's pooled with for-profit insurance companies (and again: they make their profit by denying claims).
But they cannot deny claims that are in your contract. They make money by not paying claims because they are not submitted not by denying them. If they pay too many claims they lose money. You seem to think all companies are run by ruthless bastards. That is not the case.




Government HR departments are tiny compared to private companies with similar numbers of employees. They don't spend time headhunting. With Government Scale, salary negotiations are short. The mechanisms for offering jobs are automated. Most of the work for getting pay increases is done by the employees, and cost-of-living increases are determined by Congress.
Government HR departments are large and do headhunt. They have many regulations to comply with. Private HR departments are just as large as they need to be.


Which claim? That health care is more expensive in the U.S. than elsewhere? Or that health care is less effective in the U.S. than elsewhere? This report addresses both.
This report only talks about Cancer, Heart disease and diabetes where Cancer deaths are low in the US as compared to the other countries. It also says that one reason for the studies outcome is that we spend less on social care than the other countries, not specifically due to the healthcare system.

If we socialized medicine here in the U.S., all doctors would be "covered" because they'd get paid by the government. You would be able to shop around for procedures with complete freedom, unlike today where most people's insurance limits your choices to in-plan doctors (or at least makes out-of-plan doctors and services costly).
Sorry if I don’t take your word for it. The government lied to get the ACA passed, THE CBO overestimated the enrollment by 100% and underestimated the cost by 50%. The government still has to make money through taxes or other revenue just like private companies.

Imagine your predicament if your family income was, say, 20% of whatever it is. Would your insurance still be affordable, given that its premiums, co-pays and deductibles wouldn't be any less?
Yes it would be.

Coincidentally, I read Poor People Need BETTER Health Insurance than the Rest of Us, Not Worse just before seeing your reply here.
In my plan they would have a better plan. They would not have to pay for it. The ACA protections could still be implemented, the difference is all could get care that cannot get under the ACA or the new GOP plan.
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Dave W.
Info Junkie

USA
25835 Posts

Posted - 03/16/2017 :  12:42:24   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Originally posted by Christian Hedonist

How do they pay more of the burden when in my plan they only pay the 1% sales tax like everyone else?
In Texas, the poor are already paying a 6.25% state sales tax; a $0.20/gal state gasoline tax; an $0.184/gal national gasoline tax, etc.

Adding any more taxes to the taxes the poor already pay is adding to their burden.

More later.

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Christian Hedonist
Skeptic Friend

92 Posts

Posted - 03/16/2017 :  14:05:22   [Permalink]  Show Profile Send Christian Hedonist a Private Message  Reply with Quote
Originally posted by Dave W.

Originally posted by Christian Hedonist

How do they pay more of the burden when in my plan they only pay the 1% sales tax like everyone else?
In Texas, the poor are already paying a 6.25% state sales tax; a $0.20/gal state gasoline tax; an $0.184/gal national gasoline tax, etc.

Adding any more taxes to the taxes the poor already pay is adding to their burden.

More later.
So someone pays in a couple hundred dollars a year and gets back $11,000 for healthcare for the year is unacceptable? That is less than the ACA.
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Dave W.
Info Junkie

USA
25835 Posts

Posted - 03/16/2017 :  19:15:07   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Originally posted by Christian Hedonist

So someone pays in a couple hundred dollars a year and gets back $11,000 for healthcare for the year is unacceptable?
Allow me to quote:
Whoever oppresses a poor man insults his Maker, but he who is generous to the needy honors him. Proverbs 14:31
The real problem is that poor people can't spare a couple hundred bucks a year.

These are people who've worked out a balancing act between rent, utilities, food and other necessities. They don't have an extra dollar, generally, much less 1% of whatever you'd impose that tax upon. The USDA said in 2015 it cost a "thrifty" family of four about $140/week for food. I'd guess mom and/or dad would have to go with a buck forty less in food per week, 'cause I know you wouldn't want to starve the children for the 1% tax.

That is less than the ACA.
What is? The ACA imposed a tax on poor people of more than 1%? Do tell.

I don’t know many people that could pay daily expenses and plan for the future if 50% of their money was confiscated.
Yet you wish to confiscate one more percent from poor people?

I have an below average salary for married filing jointly status and modest home with three kids. If the rules were suddenly changed dramatically I could no longer support my family as we planned. I would rather have my money and be able to have the freedom to do what I like with it and then have the government help those that need it. That is what my plan is trying to do.
So you don't think that the governments where taxes are very high are help those that need it? I certainly do. They're helping much more than our governments help us, which is why the taxes are high.

And not all people get cancer. In my plan everyone could get insurance and be covered for $100,000 cancer.
In "my" plan, everyone gets the health care that they need, without insurance companies getting in the middle and taking a slice of the pie (which drives up costs).

But they cannot deny claims that are in your contract.
They do, on a regular basis. Then you're forced to delay the care you need to "dispute" their decision, hoping you've gotten the wording right (other private services make money writing health insurance dispute letters on your behalf!), while the insurance company hopes that they can at least delay payment for the care you need until the next quarter to keep the stockholders happier.

Of course, it depends upon the care needed. Heart-attack victims aren't going to find their care delayed due to insurance denials, but plenty of people needing orthopedic surgery (for example) do. Victims of workplace accidents get care delayed all the time because the insurance company argues with the employer about who's going to pay. Slip-and-fall victims in stores need lawyers because then it's two insurance companies and their lawyers going after each other. Etc.

They make money by not paying claims because they are not submitted not by denying them. If they pay too many claims they lose money. You seem to think all companies are run by ruthless bastards. That is not the case.
Most claims are submitted by the providers, these days. I'd find a different doctor if mine weren't submitting claims like he says he does. The ruthlessness is demanded by the stockholders. I wouldn't pin it on any executive, or even all the executives. They need to make the company turn a profit, or else the stockholders abandon them and the company will shut down. And the stockholders sure aren't thinking "oh, I'd better not sell my shares of XYZ Insurance Co, because then someone might find their policy isn't any good any longer." Hell, many people who own stock don't know what's in their portfolio, they have that handled by someone else.

So what looks like ruthlessness on the part of the insurance companies is merely the regular demands of the investments markets. If we didn't have insurance companies for health care, things would be much more rosy.

Government HR departments are large and do headhunt. They have many regulations to comply with. Private HR departments are just as large as they need to be.
I don't know where you've worked, but I've never seen a government HR department as large (per employee) as a private company's HR department (not including, of course, mom-and-pop shops and other tiny companies). And I've never seen them headhunt, since the job postings are - as you say - regulated to be fair. They may send people to job fairs and the like, but I've never heard of a government HR department cold-calling someone and offering them (specifically that person) a job. I think it'd be illegal.

This report only talks about Cancer, Heart disease and diabetes where Cancer deaths are low in the US as compared to the other countries.
Also longevity and obesity and a few other things.
It also says that one reason for the studies outcome is that we spend less on social care than the other countries, not specifically due to the healthcare system.
It's all interconnected, anyway.

Sorry if I don’t take your word for it. The government lied to get the ACA passed...
So if the government has lied, then all our discussions are moot? Okay, but it's a double-egded sword. Every time you suggest an improvement, I'll just reply, "sorry if I don't take your word for it, the government lied once."

The government still has to make money through taxes or other revenue just like private companies.
Uh, yeah, but private companies don't get to generate revenue by fiat. And the government does get to pull money out of its butt, if need be.

Imagine your predicament if your family income was, say, 20% of whatever it is. Would your insurance still be affordable, given that its premiums, co-pays and deductibles wouldn't be any less?
Yes it would be.
Wow! Lucky you! I've got run-of-the-mill insurance through the company I work for, but if they dropped my pay by 80%, my premiums would go from 10% of my paycheck to 50%! And the deductible would shoot up to being a double-digit percentage of my annual take-home pay. No way I could afford my current insurance under those conditions. I'd have to settle for less health care, or using the ER for coverage, since lowering the premiums would just increase the deductibles and my family - like yours - uses health care. I am envious of your awesome insurance, with its tiny costs and never-deny-a-claim attitude.

In my plan they would have a better plan. They would not have to pay for it.
Okay, let's talk about that $11,000 some more. Does that include deductible and co-pays? If so, the poor will wind up with shitty insurance. They need better insurance than rich people have, because the poor can't afford high-deductible policies.

- Dave W. (Private Msg, EMail)
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Why not question something for a change?
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Christian Hedonist
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92 Posts

Posted - 03/22/2017 :  14:10:38   [Permalink]  Show Profile Send Christian Hedonist a Private Message  Reply with Quote
Originally posted by Dave W.

Allow me to quote:
Whoever oppresses a poor man insults his Maker, but he who is generous to the needy honors him. Proverbs 14:31
The real problem is that poor people can't spare a couple hundred bucks a year.
So the people under the ACA pay less than $300/year for health coverage?

These are people who've worked out a balancing act between rent, utilities, food and other necessities. They don't have an extra dollar, generally, much less 1% of whatever you'd impose that tax upon. The USDA said in 2015 it cost a "thrifty" family of four about $140/week for food. I'd guess mom and/or dad would have to go with a buck forty less in food per week, 'cause I know you wouldn't want to starve the children for the 1% tax.
But aren’t they paying at least this under the ACA currently?

Yet you wish to confiscate one more percent from poor people?
No, from everyone. I could see your point of people are paying nothing for healthcare now. It is my understanding that mo one gets a 100% subsidy. Even if they did, they would have copays and such. They would have none of that under my plan.

In "my" plan, everyone gets the health care that they need, without insurance companies getting in the middle and taking a slice of the pie (which drives up costs).
You just move the pie from the private to the public sector where there is no competition. What do the private companies do that the government wouldn’t have to do?

They do, on a regular basis. Then you're forced to delay the care you need to "dispute" their decision, hoping you've gotten the wording right (other private services make money writing health insurance dispute letters on your behalf!), while the insurance company hopes that they can at least delay payment for the care you need until the next quarter to keep the stockholders happier.
Why would this be different under a government run system?

I don't know where you've worked, but I've never seen a government HR department as large (per employee) as a private company's HR department (not including, of course, mom-and-pop shops and other tiny companies). And I've never seen them headhunt, since the job postings are - as you say - regulated to be fair. They may send people to job fairs and the like, but I've never heard of a government HR department cold-calling someone and offering them (specifically that person) a job. I think it'd be illegal.
So you think all job in the government are filled by people applying to a posting on the internet or something? I work for a state government school. The HR department can and does help departments find qualified people for positions.

Uh, yeah, but private companies don't get to generate revenue by fiat. And the government does get to pull money out of its butt, if need be.
That is not a good thing unless you think our national debt will never have any negative consequences.

Wow! Lucky you! I've got run-of-the-mill insurance through the company I work for, but if they dropped my pay by 80%, my premiums would go from 10% of my paycheck to 50%! And the deductible would shoot up to being a double-digit percentage of my annual take-home pay. No way I could afford my current insurance under those conditions. I'd have to settle for less health care, or using the ER for coverage, since lowering the premiums would just increase the deductibles and my family - like yours - uses health care. I am envious of your awesome insurance, with its tiny costs and never-deny-a-claim attitude.
I said I could still afford it, not that I have the money lying around. I would have to adjust my budget and take the money from somewhere else, get another job etc. It is my wife’s and my responsibility to have health insurance for our family. We would probably have to stop giving. I bet you would find a way to pay for it as well.

Okay, let's talk about that $11,000 some more. Does that include deductible and co-pays? If so, the poor will wind up with shitty insurance. They need better insurance than rich people have, because the poor can't afford high-deductible policies.
They would have $11,000/ year for anything they want for healthcare. You want everyone to have the same best level of healthcare available and that is not going to happen. We cannot afford as a nation free healthcare for everyone without making some hard decisions. I know you want the rich to pay for healthcare, food etc. for everyone else, that is not going to happen.
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Dave W.
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USA
25835 Posts

Posted - 03/23/2017 :  13:34:52   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Originally posted by Christian Hedonist

So the people under the ACA pay less than $300/year for health coverage?

...

But aren’t they paying at least this under the ACA currently?
If you're poor enough, you get Medicaid. But if you make less than 400% of the poverty level, you get subsidies for premiums and deductibles. The less you make, the greater the subsidy. People just above the Medicaid line, for example, have paid as little as $12/year in premiums.

Yet you wish to confiscate one more percent from poor people?
No, from everyone.
Yes, everyone includes the poor. The fact that you're taking 1% from everyone doesn't make it fair, because rich people can lose 1% of their take-home pay and not blink. Especially people who are so rich that they take a salary of $1/year to make their company's bottom line look better (so they'd pay an extra penny in your plan), while getting millions of bucks a year in stock options and other deferred tax shelters.

I could see your point of people are paying nothing for healthcare now. It is my understanding that mo one gets a 100% subsidy. Even if they did, they would have copays and such. They would have none of that under my plan.
Medicaid costs to patients:
Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children. Generally, out of pocket costs apply to all Medicaid enrollees except those specifically exempted by law and most are limited to nominal amounts. Exempted groups include children, terminally ill individuals, and individuals residing in an institution. Because Medicaid covers particularly low-income and often very sick patients, services cannot be withheld for failure to pay, but enrollees may be held liable for unpaid copayments.
In 2013, the maximum Medicaid deductible was $2.65 (not a typo) and their co-pays for non-exempt services were $4. But even that tiny amount means many poor people go without an annual check-up (even while their kids get them for free).

You just move the pie from the private to the public sector where there is no competition. What do the private companies do that the government wouldn’t have to do?
Insure people. Do you really not get that I'm talking about removing the whole middle layer of costs?

They do, on a regular basis. Then you're forced to delay the care you need to "dispute" their decision, hoping you've gotten the wording right (other private services make money writing health insurance dispute letters on your behalf!), while the insurance company hopes that they can at least delay payment for the care you need until the next quarter to keep the stockholders happier.
Why would this be different under a government run system?
Why would the government deny care that your government doctor says you need?

So you think all job in the government are filled by people applying to a posting on the internet or something?
I know that there are lots of government jobs filled by a manager calling up an old college friend and saying, "come work with us," but that's not HR doing that.

That is not a good thing unless you think our national debt will never have any negative consequences.
This again? Our debt won't be a problem until we get to the point where we can't pay the interest (about twice the size it is now).

I bet you would find a way to pay for it as well.
Perhaps by allowing the bank to foreclose on my home, sure.

They would have $11,000/ year for anything they want for healthcare.
The average cost of a benchmark "Silver" plan through ACA exchanges in 2017 is $1,019/month in premiums for a family of four with no smokers, and a $12,500 out-of-pocket maximum. Under your plan, the premiums wouldn't even be fully covered.

You want everyone to have the same best level of healthcare available and that is not going to happen.
Why not? Other countries do it. Are you saying that the U.S. cannot raise its performance goals to match them?

We cannot afford as a nation free healthcare for everyone without making some hard decisions.
I know. I've made my decision.

I know you want the rich to pay for healthcare, food etc. for everyone else, that is not going to happen.
Neither is your plan, so long as Republicans rule the roost. They're never going to agree to any plan that includes tax increases on themselves.

The U.S. is the only industrialized nation in the world in which a major political party will not even consider tax increases. We're also the only country in which a major political party denies scientific conclusions, and opposes universal health care.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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The Rat
SFN Regular

Canada
1342 Posts

Posted - 04/02/2017 :  12:14:22   [Permalink]  Show Profile  Visit The Rat's Homepage Send The Rat a Private Message  Reply with Quote
Basically, you're re-inventing the wheel. Just find a country with a system that works (there are many), and copy that.

Bailey's second law; There is no relationship between the three virtues of intelligence, education, and wisdom.

You fiend! Never have I encountered such corrupt and foul-minded perversity! Have you ever considered a career in the Church? - The Bishop of Bath and Wells, Blackadder II

Baculum's page: http://www.bebo.com/Profile.jsp?MemberId=3947338590
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Valiant Dancer
Forum Goalie

USA
4823 Posts

Posted - 05/06/2017 :  09:11:19   [Permalink]  Show Profile  Visit Valiant Dancer's Homepage Send Valiant Dancer a Private Message  Reply with Quote
I'm sorry I stepped away for business for so long.

When the ACA went into effect there were 7 major insurers. I worked for the seventh largest. Through too high MLRs (where ancillary departments who had myriad state regulations to code for were not included in the MLR) those major insurers started a major effort to merge. My employer was bought by the third major insurer and brought the number to 6. Another company was bought by Anthem. So now we are down to 5 insurers.
Minor insurance companies ceased to exist or were gobbled up by the major insurers. (Even though they kept the minor insurer's name on products to appear as if there was more competition than there actually is.)

Then Anthem made a play for Cigna and Aetna made a play to acquire Humana. That would reduce the number of insurers to 3. BCBS cannot buy anyone due to anti-trust issues. Anthem and Aetna were stopped because of the anti-trust issues (for which Anthem has sued DOJ and Aetna pulled out of competing markets with Humana trying to solve the anti-trust issues and to punish the DOJ for daring to stand in their way.)

As Dave says, any sales tax is regressive against the poor. The poor end up shouldering an unreasonable burden. Because it takes a lot of money to be poor. In Cook County, IL (where Chicago is AKA Crook County), the sales tax (state + local) is 10.5%. (7.5% state sales tax and 3% Cook County tax) Chicago is also proposing (again) an employee head tax (which the last time they did that, businesses fled Chicago). The poor have added expenses for being unbanked (money orders for bills, check cashing fees, etc) I have been unbanked before and I have experienced first hand how much it sucks. And I was not particularly poor (bad ex. Had to divorce her and promise banks I would not add her to the account ever.)

Obamacare was an OK start. But at this point, the system is so broken that the Feds (who would not have to deal with state whims on prompt payment guidelines or, like Texas, bizarre ways that prompt payment penalties are assessed, or providers who know that they are the only game in town to serve a population and hold out for scads of cash.) have to step in. Medicare for all seems like a reasonable program. Funded with an income tax increase on the top 10% of earners heavier on the top 1% of earners. Now this will impact me with higher taxes, but slashes my healthcare costs (and ensures no bad debt to providers through medical bankruptcies or the uninsured). This allows the government to put in price controls and make unreasonable providers accept reasonable rates. The existing healthcare companies already have life insurance, fire and hazard insurance, and other insurance products they can focus on as well as supplementary health insurance to cover deductibles and the like. Employers would no longer have the burden of health insurance premiums (for those that offer health insurance subsidies for their employees) so they have more money to put towards salaries, building business, and hiring more people. Employees would be appropriately taxed at their ability to pay.

While this might not sound like it is fair, it is better than how cost sharing through bad debt (due to EMTALA and medical bankruptcies) is working now. Now rural areas will need more compensation than urban areas and there is stuff there for them in current Medicare law.

This will reduce fraud because if you lose your ability to bill the government due to fraud, likely you are not a niche doctor for the rich and probably aren't that good anyway. That is a huge disincentive to committing fraud.

Now for the prescription drug issue. There was a recent article which mentions such things as the inefficient drug supply chain that adds cost at every time the drug changes hands.

The drug manufacturer sets a price for a drug which represents a healthy profit, the cost of manufacturing, and R&D. Say, $100.
The drug wholesaler buys the drug in bulk and buys the drug at 80% of the set price, so they acquire it for $80.
They then sell it to a pharmacy for the list price and pocket $20.
The pharmacy takes a copay (say 10%) so they get $10 from the parient and then bill the insurance company.
The insurance company pays $90 to the pharmacy and sends the prescription to a Pharmacy Benefit Manager (PBM). Since there are only 3 PBMs and one of those is about to fail, the PBM goes back to the wholesaler and demands they get a refund of $15. The wholesaler still is net $5 so they agree. The PBM keeps $14 and returns $1 to the insurance company.

With the Feds, the PBM's go away. Price controls for drugs get placed on the wholesalers (and limit what the drug manufacturers can charge). And the process becomes more fair to the consumer.

https://www.usatoday.com/story/news/2016/10/03/how-prescription-drug-middlemen-make-their-money/91461918/


Cthulhu/Asmodeus when you're tired of voting for the lesser of two evils

Brother Cutlass of Reasoned Discussion
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Dave W.
Info Junkie

USA
25835 Posts

Posted - 05/06/2017 :  19:38:43   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Welcome back, Val!

Originally posted by Valiant Dancer

While this might not sound like it is fair...
It is fair. Those who don't think it sounds fair assume that everyone starts life on equal footing, which is itself an unfair assumption to make.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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