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Tags Elizabeth Warren , health care reform , Medicare For All , presidential candidates

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Old 6th November 2019, 10:55 AM   #161
xjx388
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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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Old 6th November 2019, 11:01 AM   #162
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Originally Posted by xjx388 View Post
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.
No it doesn't.
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Old 6th November 2019, 11:27 AM   #163
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Originally Posted by acbytesla View Post
No it doesn't.


Yes it does:

Coverage for the poor.
No more medical bankruptcy.
Reduced administrative burden.
Access to medical care for all.

What’s the problem?
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Old 6th November 2019, 12:20 PM   #164
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Originally Posted by ponderingturtle View Post
Quote:
Canada has been attempting to deal with the issue of how to allocate health care resources in a 'single payer' system (for basic medical services) for decades, and yet we are stuck with long waiting lists.
Yet it is better in the UK with the NHS...
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.)
Quote:
and in general the US has longer wait times to see specialists than other nations that have universal care.
Do you have any proof that that is the case?

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.
Quote:
It seems waits are remarkably bad in canada but that is not a universal feature of universal systems.
Keep in mind that there is a difference between 'universal systems' and 'single payer' systems. Single payer systems are universal, but not all universal systems are single payer.
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Old 6th November 2019, 01:36 PM   #165
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Originally Posted by Segnosaur View Post
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.)

Do you have any proof that that is the case?

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.

Keep in mind that there is a difference between 'universal systems' and 'single payer' systems. Single payer systems are universal, but not all universal systems are single payer.
Given that medicare has private options it seems really weird for it to suddenly outlaw private insurance under the name of medicare for all. Got a source for that claim of banning private insurance?
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Old 6th November 2019, 01:43 PM   #166
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Originally Posted by Segnosaur View Post

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.
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?
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Old 6th November 2019, 02:46 PM   #167
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Originally Posted by ponderingturtle View Post
Given that medicare has private options it seems really weird for it to suddenly outlaw private insurance under the name of medicare for all. Got a source for that claim of banning private insurance?
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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Old 6th November 2019, 02:58 PM   #168
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Originally Posted by rdwight View Post
Quote:
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.
I wonder how much those numbers are affected by not only location and insurance type, but also by personal preference.
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").

Quote:
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.
I am in Canada. Last time I saw my doctor (early spring) I mentioned the need for 1) a sleep apnea test, and 2) a need to see a dermatologist regarding a skin growth that might be cancerous.

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.
Quote:
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?
I have no idea. But in my experience in the Canadian system, the patient does not select the specialist (but the general practictioner may have preferred specialists to work with). So I get whatever is offered. (Which I don't mind.... I think doctors are trained well enough that any doctor will have the needed skills. But there are still waiting lists.)
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Old 6th November 2019, 03:56 PM   #169
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Originally Posted by xjx388 View Post
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.
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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Old 6th November 2019, 04:01 PM   #170
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Originally Posted by Segnosaur View Post
But in my experience in the Canadian system, the patient does not select the specialist (but the general practictioner may have preferred specialists to work with). So I get whatever is offered. (Which I don't mind.... I think doctors are trained well enough that any doctor will have the needed skills. But there are still waiting lists.)
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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Old 6th November 2019, 04:05 PM   #171
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Originally Posted by xjx388 View Post
Yes it does:

Coverage for the poor.
No more medical bankruptcy.
Reduced administrative burden.
Access to medical care for all.

What’s the problem?
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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Old 6th November 2019, 04:38 PM   #172
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Originally Posted by kellyb View Post
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...
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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Old 6th November 2019, 05:08 PM   #173
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Originally Posted by xjx388 View Post
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.
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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Old 6th November 2019, 05:12 PM   #174
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Originally Posted by Segnosaur View Post
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").


I am in Canada. Last time I saw my doctor (early spring) I mentioned the need for 1) a sleep apnea test, and 2) a need to see a dermatologist regarding a skin growth that might be cancerous.

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.

I have no idea. But in my experience in the Canadian system, the patient does not select the specialist (but the general practictioner may have preferred specialists to work with). So I get whatever is offered. (Which I don't mind.... I think doctors are trained well enough that any doctor will have the needed skills. But there are still waiting lists.)
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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Old 6th November 2019, 08:24 PM   #175
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Originally Posted by kellyb View Post
How would that highlighted part square with "Add the premiums to the income tax"?
Well, if I'm understanding the proposal correctly, the employers will still be paying into it because businesses have income tax too.
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Old 7th November 2019, 01:33 AM   #176
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Originally Posted by Silly Green Monkey View Post
Well, if I'm understanding the proposal correctly, the employers will still be paying into it because businesses have income tax too.
I'd be curious to know if that' what xjx is proposing - funding it through business/corporate income taxes as opposed to personal income taxes.
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Old 7th November 2019, 10:54 AM   #177
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Originally Posted by kellyb View Post
I'd be curious to know if that' what xjx is proposing - funding it through business/corporate income taxes as opposed to personal income taxes.


It could be part of payroll taxes and employers could choose to pay it. It could be implemented any number of ways, but the basic idea is mandatory catastrophic health insurance and maybe mandatory healthcare savings accounts.

Sort of like they do in Singapore.
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Old 7th November 2019, 01:03 PM   #178
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Originally Posted by xjx388 View Post
It could be part of payroll taxes and employers could choose to pay it. It could be implemented any number of ways, but the basic idea is mandatory catastrophic health insurance and maybe mandatory healthcare savings accounts.

Sort of like they do in Singapore.

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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Healthcare in Singapore is supervised by the Ministry of Health of the Singapore Government. It largely consists of a government-run universal healthcare system with a significant private healthcare sector. In addition, financing of healthcare costs is done through a mixture of direct government subsidies, compulsory savings, national healthcare insurance, and cost sharing.

Singapore generally has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000.[1] Bloomberg ranked Singapore's healthcare system the most efficient in the world in 2014.[2] The Economist Intelligence Unit placed Singapore 2nd out of 166 countries for health-care outcomes. [3]
https://en.wikipedia.org/wiki/Healthcare_in_Singapore
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Old 7th November 2019, 01:49 PM   #179
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Originally Posted by Segnosaur View Post
Canada has been attempting to deal with the issue of how to allocate health care resources in a 'single payer' system (for basic medical services) for decades, and yet we are stuck with long waiting lists.

Why exactly do you think the U.S. will somehow be magically different? That somehow the U.S. will be able to somehow solve the problems that Canada (a pretty normal western country with no major corruption issues) has been unable to?
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.

Quote:
Its a little bit more complex than that I think.

Governments will have to budget for whatever health care costs are expected, and plan for any expected infrastructure upgrades that are needed. (After all, you probably don't want to give private hospitals and clinics free reign to decide "We want to buy X and the government will pay".) That means health care will be subject to the actions of a government that will have multiple competing priorities.
You are proposing a false dichotomy here. The system I was proposing is one where the hospitals are paid an amount of money per year, based on their patient loads and services, and then they get to spend that as they have need. If they want to buy new equipment or upgrade things then it would come out of their operating budget, just as it does now. The only time they would have to go back to the Government and plead a case for extra assistance would be when they encounter an unplanned situation that they cannot cover via normal operating, for instance say there was a high contagious disease outbreak that suddenly spiked their patient numbers well beyond what was originally budgeted for.

Quote:
Keep in mind that I am not saying single payer makes the system worse overall... I am saying it will probably make the system worse for certain people.
And I'm noting that it doesn't need to do so.

Quote:
Whatever levels of government bureaucracy are implemented to lobby politicians and negotiate costs, ultimately the decisions about how much to fund health care will come down to the president and congress critters.

Would you really feel confident putting complete control of your health care funding in the hands of a President Paul Ryan a decade from now?

I can just imagine the conversation at the GOP headquarters:
"We need to give the rich another tax cut"
"But that will increase the deficit"
"Maybe we can cut down on defense spending."
"Ha ha! good joke"
"I thought you would think that was funny"
"Lets just cut a few extra billion out of health care. After all, by the time waiting lists get too long the Democrats will be back in power."
This is going to be an issue with any government funding. One would hope that no one in the US is stupid enough to elect Paul Ryan to the Presidency, though I'd have said the same about Trump too, so....

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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Old 7th November 2019, 03:22 PM   #180
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Originally Posted by Bob001 View Post
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.



https://en.wikipedia.org/wiki/Healthcare_in_Singapore


I’m not saying that we adopt it wholesale but it definitely has some great things about it. Chiefly, it has a huge cost sharing component but subsidizes care for lower income people. There’s a lot there we could make work without adopting a single-payer system.
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Old 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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Old 7th November 2019, 04:48 PM   #182
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Originally Posted by Bob001 View Post
A thoughtful critique of the Warren plan:

Another, deeper issue—which a number of writers, not to mention Warren’s primary rival Bernie Sanders, have pointed out—is that the centerpiece of her proposal is fundamentally unfair to many businesses and workers. It’s specifically a raw deal for companies that already offer their employees generous insurance, as well as for low-wage workers, who would somewhat indirectly shoulder a disproportionate share of the burden from the tax scheme she has concocted.

https://slate.com/business/2019/11/e...er-unfair.html
The problem with this critique is that the tax would replace the exorbitant cost of insurance, it would not be an addition to the cost of insurance. The raw deal is not so raw when that basic fact is not ignored.
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Old 7th November 2019, 05:29 PM   #183
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Originally Posted by xjx388 View Post
It could be part of payroll taxes and employers could choose to pay it.
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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Old 7th November 2019, 06:02 PM   #184
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Originally Posted by fishbob View Post
The problem with this critique is that the tax would replace the exorbitant cost of insurance, it would not be an addition to the cost of insurance. The raw deal is not so raw when that basic fact is not ignored.
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
Quote:
Elizabeth Warren's Excellent Opening Gambit on Medicare for All
Quote:
There are issues with the planned funding mechanisms. It makes more sense just to charge employers a set percentage of wages rather than base payments on historic insurance premiums.
Quote:
However, we should realize this is an opening gambit, not a finished product. The final version of the Affordable Care Act was 2,300 pages when it went to a vote. It is unlikely that a Medicare for All bill will be any shorter.

Warren's proposal is not the final word. But it is an excellent first draft that provides a basis for future debate.
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Old 7th November 2019, 06:47 PM   #185
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Originally Posted by kellyb View Post
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
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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Old 7th November 2019, 07:02 PM   #186
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Originally Posted by Norman Alexander View Post
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?

That sounds utterly ridiculous. How could anything like that possibly work?

Pfft.
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Old 7th November 2019, 07:34 PM   #187
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Originally Posted by AnonyMoose View Post
That sounds utterly ridiculous. How could anything like that possibly work?

Pfft.
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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Old 7th November 2019, 07:49 PM   #188
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Originally Posted by Norman Alexander View Post
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??
Impossible! Pants on fire!

You must be from Planet X.

Uh... can I have the whitewalls still though?
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Old 7th November 2019, 08:10 PM   #189
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Originally Posted by AnonyMoose View Post
Impossible! Pants on fire!

You must be from Planet X.

Uh... can I have the whitewalls still though?
Planet X whitewalls.
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Old 7th November 2019, 08:18 PM   #190
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Originally Posted by kellyb View Post
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.
I think more problematic is the way it penalizes companies with less than 50 workers. Those that currently provide insurance to their employees, without the need to do so, would continue to have to contribute in this scheme, but not those that aren't presently.
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Old 7th November 2019, 08:35 PM   #191
xjx388
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Originally Posted by kellyb View Post
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?


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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Old 8th November 2019, 02:59 AM   #192
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Originally Posted by Norman Alexander View Post
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?
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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Old 8th November 2019, 03:25 AM   #193
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Originally Posted by Ladewig View Post
Blaspheme! Blaspheme!
Apostasy!

I’m kidding, but that is pretty close to the reaction one will get when one makes that proposal. And in age of Trump, one will most certainly be accused of hating America and trying to make America fail.

Actually, I emphatically agree with your suggestion but military spending is a juggernaut.

Well, you wouldn't want to make the US less safe, what with it's long and storied history of people being killed on US soil by invading military forces.
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Old 8th November 2019, 03:30 AM   #194
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Originally Posted by 3point14 View Post
Well, you wouldn't want to make the US less safe, what with it's long and storied history of people being killed on US soil by invading military forces.
Remember the Alamo!
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Old 8th November 2019, 03:45 PM   #195
xjx388
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Originally Posted by Norman Alexander View Post
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?
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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Old 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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Old 8th November 2019, 04:29 PM   #197
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Originally Posted by xjx388 View Post
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.
.....

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/
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Old 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.
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Old 8th November 2019, 06:44 PM   #199
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Originally Posted by rdwight View Post
I think more problematic is the way it penalizes companies with less than 50 workers. Those that currently provide insurance to their employees, without the need to do so, would continue to have to contribute in this scheme, but not those that aren't presently.
All 4 of them? Unfair!!!!
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Old 9th November 2019, 02:08 AM   #200
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Originally Posted by Norman Alexander View Post
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??
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

Quote:
Take a secretary earning $50,000 a year, who has employer-sponsored health insurance at a total cost of $15,000. In reality her labor compensation is $65,000 (that’s what her employer pays in exchange of her work), but the secretary only gets $50,000.
Quote:
Take again the case of a secretary earning $50,000 in wage and currently contributing $15,000 through her employer to an insurance company. With universal health insurance, her wage would rise to $65,000 – her full labor compensation. With an income tax of 6% – which, if applied to a base large enough, would be enough to fund universal health insurance – she would have to pay about $4,000 more in tax. But the net gain would be enormous: $11,000. Instead of taking home $50,000, the secretary would take home $61,000.
See the bad (really bad) assumption there?

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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