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6th November 2019, 10:55 AM | #161 |
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Create a national catastrophic insurance plan. Add the premiums to the income tax. It pays nothing until you have $X in health care costs. You are responsible for paying that $X. X changes based on income. For poverty-level incomes, maybe x=0.
Providers send all bills to the national insurance and when you hit X, the insurance takes over. Providers get real-time updates to see where the patient is at so they know if they have to collect or not. Nice and simple and solves most of the issues we have. |
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6th November 2019, 11:01 AM | #162 |
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6th November 2019, 11:27 AM | #163 |
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6th November 2019, 12:20 PM | #164 |
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But the UK is not a pure 'single payer' system; Private insurance is allowed, and even though it is only a minority of people chose to use it, the resources it provides improve the health care experience for everyone.
This is different than Canada (where typically no such private health insurance is allowed for basic medical care), and it is different than the planned policies of Sanders and Warren (who seem to want to eliminate all private insurance.)
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I found it difficult to dig up information comparing wait times, but I did find this: https://askepticalhuman.com/politics...imes-rationing (Note: This appears to be a private individual's web site, but it looks like he obtained his data from The Commonwealth Fund, a fairly well regarded organization. Normally I wouldn't trust a site like this, but the Commonwealth fund IS trustworthy in my opinion, and the information seems consistent with other data I have seen.) Basically, it says that ~70% of people in the United States were able to get appointments with specialists within 4 weeks. This is better than Canada, Australia, France, New Zealand, Norway and the U.K., and only slightly worse than Switzerland and France.
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6th November 2019, 01:36 PM | #165 |
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6th November 2019, 01:43 PM | #166 |
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I wonder how much those numbers are affected by not only location and insurance type, but also by personal preference. I know I could get in to see a specialist within a day or two (done before with gastro and heart specialist). It was a matter of calling a few offices and seeing which doctor in their office was available the earliest. This trades wait time for openness to whichever doctor has scheduling in the shortest amount of time.
That is also the case with surgeons as some will have longer wait times due to their reputation or length of time practicing. Most people seem content waiting for the specific surgeon they would like to work with as opposed to taking the first available. Are these choices a possibility in these other systems as well? |
6th November 2019, 02:46 PM | #167 |
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I quoted a couple of news articles that referenced the plans of both Warren and Sanders back in post 144.
http://www.internationalskeptics.com...&postcount=144 |
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6th November 2019, 02:58 PM | #168 |
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It very well may be affected by location and insurance type, but the fact that the U.S. has shorter wait times for specialists even with their horrible system of multiple insurance types should be noted.
Not really sure how much personal preference would matter. Yes, it might make a difference on a case-by-case basis, but I can't see any particular country having more of a bias (as in "people in country X are pickier about their specialists").
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It has taken over half a year for me to even get an appointment to see the dermatologists (not even treatment... just the initial consult), and I haven't even gotten a callback to schedule a sleep apnea test. The joys of "single payer" health care.
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6th November 2019, 03:56 PM | #169 |
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Sounds like for people at lower income levels, it would just be "a national insurance plan", and for the wealthier, it would be more of a "catastrophic insurance plan"?
ETA: It sounds like by taking the costs completely off of employers and putting it all on employees, it would be an enormous tax increase for people in the upper 50%? |
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6th November 2019, 04:01 PM | #170 |
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What?? If actually true, that IS surprising. And I suspect it is not due to "single payer" generally but "Health Canada RulesTM".
By way of comparison, in Australia we can choose our own specialist if we like. For example, I need skin cancer treatment also. I have a specialist I prefer to see. And his wait times are a few days to a week without appointment. To initiate the specialist process, I need a referral to him from my regular GP (that's a Medicare-paid-for consult) and then I can go to my specialist for my treatment for as many times as needed. Incidentally, the specialist charges me his fee for services, and some of that (the scheduled fee amount - see previously) is reimbursed by Medicare also. He's not cheap, but that is still about 40% fee paid for. As they say here, better than a poke in the eye with a burnt stick. |
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6th November 2019, 04:05 PM | #171 |
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Imagine a family of 4 who currently make/live on about $50k a year, pay about $5k a year for health insurance, and their employer pays $15k for their insurance.
After the income tax, that family will be making about $30k a year now instead of $50k? If not, show me how the math would pan out... |
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6th November 2019, 04:38 PM | #172 |
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A catastrophic plan that is run by the government would have a very low monthly cost. That $20k currently spent on insurance would be much lower.
So let's say that that young family costs on average $2.5k each per year (I base this on the catastrophic plan I used to have which was about $200 per month for each of us) to insure under a catastrophic plan so about $10k. If employers paid some or even all of that, it would still save them money over the current system. Employers could even contribute some money to a healthcare savings account. The take home pay would certainly not go down and may even go up. |
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6th November 2019, 05:08 PM | #173 |
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How would that highlighted part square with "Add the premiums to the income tax"?
You're talking about a total of $10k a year for all 4 people together, too, right? So after the income tax, the take-home pay is $40k instead of $50k? Also, for the family who was making $50k before, what would you suggest the monetary cutoff be for the catastrophic insurance to kick in? |
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6th November 2019, 05:12 PM | #174 |
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I think it does vary quite a bit according to region. Here in Austin, a sleep apnea test or a dermatologist is a matter of days or at the most weeks rather than months. Endocrinologists, on the other hand, are in short supply here, you may have to wait 2 months. You can still get in to see an endo nurse in a shorter time though, so there is no real danger involved.
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6th November 2019, 08:24 PM | #175 |
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7th November 2019, 01:33 AM | #176 |
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7th November 2019, 10:54 AM | #177 |
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7th November 2019, 01:03 PM | #178 |
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Singapore's system doesn't seem to be as simple as you seem to think it is. And Singapore covers everybody, one way or another.
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7th November 2019, 01:49 PM | #179 |
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The major difference is that the US would start out with the resources it has now, which is covering them well enough. One of the main reasons for waiting lists is a lack of resources. For instance here we have just a single neurologist who covers the upper half of the North Island. That means he is able to be seen about one day every four weeks, and if you can't be fitted in on that day, you have to wait another four weeks before he is back in your area. At another point where usually Wellington has four Oncologists, it actually had none and so patients were being flown to Australia for treatment. These aren't entirely issues of having a single payer system, but rather issues of having just 4.4 million people and so we don't have the resources that the US does with 300 million people.
The fact is that those resources that the US has now aren't going to magically disappear because you change who is paying the bill.
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Having said that, in most countries where Governments pay for the healthcare, fiddling too much with the funding of it is a sure way to find yourself exiting out the door come next election. Notice that the GOP wasn't even able to undo the ACA, despite their attacks on it, because they had enough people there that knew that they'd be voted out if they couldn't replace it with something better. At the end of the day however, it is better for your healthcare to be in the hands of a group that has to be transparent about it, and who you can kick out should they try and screw you, rather than being subject to the whims of a company that is really just there to screw as much money out of you as they can so they can give to their shareholders bigger dividends and CEO's bigger bonuses. |
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7th November 2019, 03:22 PM | #180 |
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7th November 2019, 04:11 PM | #181 |
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I've never had to wait longer than a month to get in to see any specialist (cardiologist, endocrinologist, dermatologist, podiatrist). Nor have I ever had to wait more than a few weeks to get a specialized test done (MRI, Echo, etc).
So I'm thinking the wait times in Canada has more to do with where you live in terms of how heavily populated the area is versus the number of specialists/equipment available to service said population. |
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7th November 2019, 04:48 PM | #182 |
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7th November 2019, 05:29 PM | #183 |
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Assuming the employer did not choose to pay it...
For the family of 4 making $50k before, after the income tax, the take-home pay is now $40k instead of $50k? Also, for the family who was making $50k before the new tax, what would you suggest the monetary cutoff be for the catastrophic insurance to kick in? |
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7th November 2019, 06:02 PM | #184 |
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It's not a huge deal, but I do see the (small) problem.
Imagine you work for Company A, and the work is awful, and you're worked to death, all for just $35k a year. The only reason you and your coworkers stay is because it has the best of the best healthcare - basically free to you, and it 100% covers meds, dental, and mental health. Your brother works for Company B, which pays GREAT in comparison, $50k a year, but the catch is, the only "health care" offered is a catastrophic plan with a $30k deductible, which means... no health care/insurance in all reality. Under this plan, nothing changes for you or your company, but your brother and gets free healthcare now, and there's no "perk" to working for your company. People are going to start fleeing your company to work for your brother's. Your brother's company will probably start lowering wages and trying to hire you and your coworkers for $36-40k a year. Not the end of the world, but it's problematic. I like this suggestion: http://cepr.net/publications/op-eds-...dicare-for-all
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7th November 2019, 06:47 PM | #185 |
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Here's a better idea: Make everyone who earns income pay a small percentage before-tax health-care levy. This is the same percentage nation-wide no matter who you work for or how you earn income or where you work. This levy is collected by your employer and passed to the Treasury in the same way they withhold your federal income tax. So it is exactly that same process you know already. Since it is calculated pre-tax, everyone gets to pay it at the same rate - it is an "equal opportunity levy". In exchange, you get basic health care benefits 24x7 (to be defined).
That means there is no disadvantage to changing jobs. You have the same unbroken health cover in your old job, between jobs, and at the new job. As does your family. Sound good? |
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7th November 2019, 07:02 PM | #186 |
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7th November 2019, 07:34 PM | #187 |
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But wait! That's not all!
The percentage levy on your pre-tax earnings is noticeably less than what you pay now in post-tax insurance for the same cover. PLUS! You don't have to fight with insurance companies to pay for medical care any more. It is all covered for you. Just go see your doctor and try to stay healthy. Do I have to throw in a set of whitewalls too?? |
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7th November 2019, 07:49 PM | #188 |
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7th November 2019, 08:10 PM | #189 |
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7th November 2019, 08:18 PM | #190 |
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7th November 2019, 08:35 PM | #191 |
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Employers who pay for insurance now would save money so it’s a no brainer to cover it. I would leave the actual calculations to others but I would think a $3000 deductible would not be unreasonable. And yeah, if healthcare is so important, I’m not so concerned with a reduction in take home pay in exchange for access to healthcare in the event of a catastrophic illness. I and my employer currently pay a lot more than $10k a year for the three people in my family’s coverage (my son is ineligible as of next August) not including current copays and deductibles so I would end up saving money. One side effect of this plan would be that doctors would have to compete more on price because patients would be paying cash for most of our services. Pricing would have to become transparent for most of the healthcare that most people encounter. Hospitals, imaging centers, labs, etc. would have to be more price conscious too. I think it would encourage innovation. It would surprise you to learn the prices we have been able to negotiate for cash paying patients for labs, imaging, etc. The medical industry’s pricing scheme is the way it is now because the true price and cost is hidden behind fee schedules that are designed to maximize revenue from government and private payers, not actual consumers of the “product.” So I think any reduction in take home pay would be minimal, medical costs would have to come down and people would end up with way more affordable access to medical care. And no one would be bankrupted by an unexpected catastrophic illness. |
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8th November 2019, 02:59 AM | #192 |
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Next you'll be saying things like how it would allow you to change doctors or go to any hospital in the country without worrying about going out of network or having to change plans. Or even worse, that you could keep your doctor and never have to worry about your plan being changed to make them out of network!
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8th November 2019, 03:30 AM | #194 |
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8th November 2019, 03:45 PM | #195 |
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Sounds exactly like exactly what I'm proposing except you've left out the definition of basic health care benefits. Clearly, you are saying that the US should do what the UK does and have an NHS-style single payer plan. The barriers to such a plan in the US are many. First of all, you'd have to convince doctors to close up their private practices and start working directly for the government at government salaries. That ain't gonna fly.
Or we could have the government be the insurer for everyone but not directly employ doctors: So-called Medicare for all. I can tell you that's another huge barrier. Doctors in my community who currently rely on government payers for the bulk of their revenue are struggling. Doctors have to see more and more patients per day -volume is how they make ends meet. The administrative burden is huge, especially now with the whole "Value Based Care" thing. So you can't have "Medicare" for all, you'll have to totally redefine the program into something else. The thing is, we hear this a lot: Just do what Canada/UK/Utopia does! The problem is that we are not those places. We have our own issues and established socioeconomic culture. You can't just plop your VHS tape into our Betamax player. |
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8th November 2019, 04:23 PM | #196 |
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You need to do a bit more research into the UK's NHSs if you think that "convince doctors to close up their private practices and start working directly for the government at government salaries."
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8th November 2019, 04:29 PM | #197 |
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You are confusing single-payer, comparable to our Medicare now, and government-run, comparable to the NHS or our VA. In our current Medicare system, doctors and hospitals maintain their own businesses and accept Medicare payments. There's no obvious reason why Medicare couldn't be expanded, especially starting on a voluntary "public option" basis. If current payment schedules are too low, that is subject to adjustment. And I'm not sure every doctor dreams of getting rich running his own business. Many doctors choose to work for HMOs or VA facilities, and earn good salaries with job security, regular work schedules, substantial administrative support and reduced administrative burdens. Once again, a summary of the four basic models to provide universal health care. Note that some rely on closely regulated private insurance companies. The choice is not single-payer or government-run. https://www.pbs.org/wgbh/pages/front...es/models.html https://www.pbs.org/wgbh/pages/front...rld/countries/ |
8th November 2019, 06:29 PM | #198 |
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I have long argued that representative is not a job and voters are not their boss. People say I'm wrong about that. So let's assume it is true.
It seems fairly intuitive that she made assumptions about the numbers that make her plan feasible. While within reason, they are rosy. And they are all less conservative that the UI numbers What to do about it? I would not tolerate that in a team member or in an interview candidate I expect best estimates, not favorable estimates. |
8th November 2019, 06:44 PM | #199 |
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9th November 2019, 02:08 AM | #200 |
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The reason Warren's financial advisers (and Dean Baker) are going with putting the tax completely on employers, is because there are "a lot" (not sure what the exact % is, but it's over 10%...might be closer to 30%) of middle class people for whom the current "post-tax insurance" costs are extremely low, because their employer pays almost all of it.
That's why the Sanders campaign has been tweeting out articles like this to support it: https://www.theguardian.com/commenti...es-saez-zucman
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All those middle class people who currently have fantastic coverage through their employer will only "win" under the Sanders financing scheme if their employer gives all of that money the employer currently has to spend on healthcare directly to the employee as a raise. |
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