Health Care Thread

$349 ACA plan I'm sure is presubsidy, and there's far more to it than just that one bullet point for their differences. For a median earning individual, the plans would be almost identical in cost assuming you don't have the subsidy in there, which from the ZIPs for Ohio I used, it absolutely isn't. Lower than yours from $30-50k and a little more up to the subsidy cutoff.

Vaclav_sl said:

$349 ACA plan I'm sure is presubsidy, and there's far more to it than just that one bullet point for their differences. For a median earning individual, the plans would be almost identical in cost assuming you don't have the subsidy in there, which from the ZIPs for Ohio I used, it absolutely isn't. Lower than yours from $30-50k and a little more up to the subsidy cutoff.

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Who pays the subsidy? Not those receiving the subsidy, so not median income earners. Not large corporations, and not the top 1%. Process of elimination leaves pretty much only the remaining true middle class and wealthy business owners(i.e. employers). How are these important groups doing right now?
America's Sinking Middle Class - NYTimes.com
http://data.bls.gov/timeseries/LNS11300000- labor force participation rate is down during this 'recovery'

What does it tell you that a median earning individual needs a government handout in order to afford healthcare? Doesn't sound middle class to me. Median income is no longer enough in the United States - the middle class disappears from the bottom up.

I never argued that the ACA plan isn't more affordable with the subsidy, of course it is. But someone has to pay that, as our government is already adding over 1 trillion in debt per year since 2008. Those someones might just be tapped out.

Subsidy is largely footed by the insurance companies themselves if you actually bothered to read the ACA. The rest of it comes out of the part of FICA that used to go to hospitals to cover defaulted care costs that should now be mostly irrelevant.

Even if you're too lazy to read the ACA, it is quite long, you could read the CBO reports that show it as close to revenue neutral for EVERYTHING CONTAINED IN IT - it's fluxed between costing a max of around $100b a year to actually generating up to $70b or so depending on the report you use (there's been a few) - with the average being only a minimal annual cost - and even $100b in the scale of our budget is laughably small and that's about the worst it's ever been. [Commonly bandied around by those against the ACA as "$1T in new taxes" except they neglect to mention that was a TWENTY YEAR cost estimate, so only actually $50b a year in reality when they were quoting that...]

Fucking jack ass keeps acting like people skimmed his post and or took his words out of context, keep trying dumb ass only person buying it is you.

I prefer my sutures done with sterile adhesive rather than maple syrup, thanks. (Kidding, but supposedly it does work as one and is antiseptic not that I'd ever try)

Vaclav_sl said:

Subsidy is largely footed by the insurance companies themselves if you actually bothered to read the ACA. The rest of it comes out of the part of FICA that used to go to hospitals to cover defaulted care costs that should now be mostly irrelevant.
... and even $100b in the scale of our budget is laughably small and that's about the worst it's ever been.

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Given the influence insurance companies had in drafting the ACA, they are going to have protection against loss of profits built in. If the insurance companies are paying the subsidies, then they are paying either out of their profits, or out of increased revenue. They will not pay subsidies and lower their profits; the ACA protects this from this.

How does an insurance company increase revenues? -By charging more. Who pays more? -Those who can afford to pay. Who can afford to pay? - not net subsidy recipients. Who will pay? The remaining middle class, and wealthy business owners (employers).

This is really simple: business pass on overhead costs to paying customers. If the insurance companies are paying part of the subsidies, the cost of the subsidies gets passed on to .. guess who? We're bleeding those who create wealth dry.

As for the part coming out of FICA - that's tax money. Let's assume no net increases in straight taxes due to ACA. Assume the US government maintains current spending levels only.

IMF report: "Who Will Pay and How"
http://www.imf.org/external/pubs/ft/wp/2011/wp1172.pdf

The United States is facing an untenable fiscal situation due to the combination of high fiscal deficits, an aging population and rapid growth in government-provided healthcare benefits. (pg4) ... closing the fiscal gap requires a permanent annual fiscal adjustment equal to over 15 percent of U.S. GDP. (pg.5) ... The fiscal gap measures, as a present value, a country's excessof total expenditures(including those arising from its commitments tospend in the future)over available current and future resources.(pg.6) the U.S. fiscal structure is not equitable across generations:future generationsare expected to subsidize the entirety ofcurrent generations' huge fiscal shortfall.(pg.24) ...

the federal government can restore fiscal balance by raising all taxes and cutting all transfer payments immediately and for the indefinite future by 35 percent. ...
and were the IPAB to succeed in curbing healthcare spending growth as provided in the IPAB mandate, reining in the fiscal gap would still require an immediate and permanent increase in all taxes and cut in all transfers of 26 percent.

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It's sure easy to scoff at that 100 billion when you can pass the bill off to the unborn. We're already spending far more than we can afford - what happens as the middle class continues to shrink, and those who were net contributers become net receivers of subsidies?

Our old system needed reform badly. Poor and disabled were getting fucked. However, we cannot afford the ACA. We're already going broke. Even if the ACA doesn't increase spending, we're still adding debt to the tune of $1 trillion annually.

Hard choices are coming - as the report says, even if ACA reduces costs.

You're not completely unreasonable but you need to avoid using loose logic trains to explain aca and where the money comes from.

frqkjt_sl said:

This is really simple: business pass on overhead costs to paying customers. If the insurance companies are paying part of the subsidies, the cost of the subsidies gets passed on to .. guess who? We're bleeding those who create wealth dry.

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a) I know what the MF in IMF stands for.
b) So...single payer for you too?
c) You seem to be confusing those who amass wealth with those who "create" it.

Picasso_sl said:

You're not completely unreasonable but you need to avoid using loose logic trains to explain aca and where the money comes from.

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Loose logic trains?

I say the remaining middle class will partly pay subsidies. Response I get: no, insurance co. and federal government (taxes) will pay subsidies. As if there is no link between insurance company revenue, tax revenue, and those who can afford to pay insurance co and taxes!

Who is guily of loose logic again?

BoldW_sl said:

a) I know what the MF in IMF stands for.
b) So...single payer for you too?
c) You seem to be confusing those who amass wealth with those who "create" it.

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c) No, I am not. Those top 1% fucks on wall street are the wealth amassers. Middle class and entrepreneurs (wealthy business owners) create wealth. Don't believe the socialist propaganda.

b) I do not know how the US can solve fiscal gap. We seem fucked. I say healthcare reform should have been limited to expanded Medicaid for poor and those with pre-existing conditions, along with some plan to make healthcare a more competitive market. Who knows if we could even afford that.
-- If anything, I believe single payer is a worse choice than the ACA.

a) O.K. ...

So entrepreneurs are wealth creators, but we don't want the option that decouples healthcare from working for a medium to large business? Yeah, having more entrepreneurs sure would be shitty.

wormie_sl said:

It really is a shame that the obvious solution to the health care costs, the one for which we have evidence that shows it being highly effective and superior to anything we have, leads to slavery.

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I claim we can't afford ACA; I provide evidence and deduction. You either can't comprehend, or have no counter-argument.

Better brush off the logical fallacy (ad hominem). But remember, I am the one with logic problems.

**edit: the trolls are trollish

BurnemWizfyre_sl said:

All this from the guy who originally claimed countries with single payer were socialist slaves.

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frqkjt_sl said:

I claim we can't afford ACA; I provide evidence and deduction. You either can't comprehend, or have no counter-argument.

Better brush off the logical fallacy (ad hominem). But remember, I am the one with logic problems.

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All this from the guy who originally claimed countries with single payer were socialist slaves.

I'm curious then, why single payer would be a worse choice? In what regards? Those in countries with single-payer systems seem to love them. Survey after survey shows this (ask any of the candians or brits on the board). Administrative costs and per capita healthcare costs are lower in those countries as well. Longer wait times and death panels have been debunked so many times. The main countries we look at as examples of socialized healthcare also have a smaller income gap (not saying causation, but do want to show the correlation), and overall those citizens are much happier with their lives in general.

Quality of care I suppose is really the only debatable metric, though not much of one to me.

Ishad_sl said:

So entrepreneurs are wealth creators, but we don't want the option that decouples healthcare from working for a medium to large business? Yeah, having more entrepreneurs sure would be shitty.

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Very good point. I worked with someone who had owned a food truck, but had to shut down and get a government job because she could not buy individual health insurance at any price. It is a benefit of the ACA that the self-emloyed with pre-existing conditions can now access healthcare. I never said the ACA is without benefits. I said we can't afford the ACA.

I also never said the old system didn't need reform. Look at my last post:

I say healthcare reform should have been limited to expanded Medicaid for poor and those with pre-existing conditions

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I'm not in this industry; I am not an expert. But here's a suggestion, short of the ACA, to fix this problem.

Let's say you are self-employed, earn $90k per year with a pre-existing condition, thuscannot get individual health insurance in the old system. Let these people buy in to medicaid. What is wrong with this?

BoldW_sl said:

Longer wait times and death panels have been debunked so many times. ... Quality of care I suppose is really the only debatable metric, though not much of one to me.

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I was not aware the longer wait times had been debunked at all. My research indicates much longer wait times to see a specialist in the UK vs the USA, for example. However, in the UK, you will get to see a primary care physican faster, on average.

There may be good reason for longer wait time primary care in the US that has nothing to do with quality of our doctors or facilities. The US is experiencing, and will continue to experience, a shortage of primary care physicians. --edit: especially as ACA does not address the fact that primary care doctors are underpaid relative to specialists.

Quality of care - Eomer linked a document on this. It's a minefield topic, and very complicated. I will say only this: I believe I have access to high quality healthcare in the US with health insurance, and I believe those in the UK also do.

The question with healthcare anywhere, is how to expand access without diminishing quality, and critically, without going bankrupt. Now, look at the income gap in the US and UK, and the debt levels of the US and the UK, for example. It is working just fine in either case?

In response to wait times, I found this a while back and found it pretty awesome.
http://www.gov.nl.ca/HaveYouHeard/wta.pdf

I was actually unfair. The true outlier is still Canada for wait times. They do in fact have longer wait times (cited reason being funding cuts by conservative local governments), but here's the awesome part: They're fixing it.

The fact that Canada has public healthcare allows them to make changes to it when necessary, rather than letting private corporation make those decisions (privates would not lower wait times unless it somehow meant more money for them) just makes sense across the board.

For a broader overall view of wait times:
Universal Healthcare Doesn't Mean Waiting Longer to See a Doctor - Olga Khazan - The Atlantic

So much of the uproar over the recent insurance plan cancellation notices has been prompted by fears that the affected people will no longer be able to see the doctors they prefer or to get treated as quickly as they'd like. But compared to the rest of the Western world, that's already the reality for many Americans. This report is just a sign that some countries have found a way to not only insure more people, but to get them the care they need faster.

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BoldW_sl said:

In response to wait times, I found this a while back and found it pretty awesome.

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Re: Atlantic link:

But other countries have less of a disparity between specialist and primary care salaries ...
The one access measure the U.S. performed slightly better on was in the ability to get specialist appointments within two months. ...
This is not to say that America's healthcare reform will alleviate wait times for primary care (in fact, just the opposite may occur. ...
But other countries have less of a disparity between specialist and primary care salaries, much cheaper medical school, and less paperwork requirements for doctors in GP positions-all factors that help incentivize more primary care physicians and, sadly, extend beyond the scope of the Affordable Care Act.)

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This does not support you case. It supports mine. The US falls behind on measures of wait time due to a shortage of primary care physicians, but you get specialist appointments sooner in the US on average. This is because primary care physicians get paid poorly relative to say, a cosmetic surgeon. You're a med school student - which do you choose? Furthermore, ACA does not address this problem.

edit: leading again to the conclusion that ACA is not the reform we needed.

People in many countries that spend far less on healthcare than the U.S. are more likely to say they can usually get a same-day or next-day appointment when they need it, and to say they can get after-hours treatment without going to the ER. This is true for countries that have single-payer systems, like the U.K. (though not Canada), andfor many Western European countries that have multi-payer systems like ours.

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For those who think single-payer is the only real solution.

The current Medicaid expansion is where all the loss if any the ACA is causing the rest of it is neutral or better. Research more, talk less, than come back speaking as an informed person.

Right now your proposed idea when it was floated in 04 was shot down for having a projected cost of $300b a year. If a worst case scenario of $100b is terrible what is three times that? Christ, man.

PS the more sick an infirm there are the worse our productivity will be, a healthy nation is an economically stronger nation which of course generates more taxes in the end... you see the point I hope.