Health Care Thread

frqkjt_sl said:

For premium costs, I always compared premium pre-ACA of a middle class citizen with the premium post-ACA (no subsidies) of the same middle class person. Median income gets subsidy, but they are not middle class. I have defended this position with evidence - see my NYtimes article, and discussion. You never responded.

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You posted an opinion - followed by a supporting OPINION piece - that is one person's opinion that you're using to trump up a nonsensical argument using that nonsense as a foundation, which only serves to support a nonsensical argument.Middle class - Wikipedia, the free encyclopediais an example of the standard definition of the term. I can find examples of redefinitions of almost anything to try to trump up an argument, it doesn't mean that they are valid. (And note, in some areas you can have up to around $120k in family income and still qualify for the subsidy - and you clearly don't really understand social strata, there's absolute differences in my lifestyle with with around $60k [$32k disability/~$30k average on investment income - assuming no cashouts since I try not to do any] than my low-income clients I volunteer to help with resumes, and again from my family that own businesses running from $200k up to a $1m a year in the case of the advertising VP - theirs aren't too distinguishable from each other however even though my uncle at $200k makes a fraction of what she does their lifestyles are basically the same [and note, mine although lesser - isn't that far off - thus why "middle class" is still a thing at this strata contrary to your nonsensical rambling])

+70 to -100: I took into account the positive cases.

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You went on a tangent and put "if it even does" at the end - that's not acknowledging it when you mention the worst case scenario a dozen times absent of it's opposite nadir.

As the middle class shrinks, the base of people who can pay for the subsidies through higher insurance premiums and through existing taxes falls. I further argue that the ACA, by targeting middle class/entrepreneurs, accelerates this process. You have not responded.

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Which you again repeat while ignoring the fact that there's only two places that fund the ACA subsidies:
a) The insurance companies which are using a portion of their profits to apply that way, which will of course scale with the number of clients.
b) The number of working people, and the numbers are set up such that it's 1:1 - no one is subsidizing someone else's plan out of FICA, FICA is not allowed to be used on ANYONE ELSE OTHER THAN THE DEPOSITOR under Federal law since FICA started. They can use your FICA to subsidize you and no one else, that's the law on the matter.

So your hypothetical "running out of people" scenario can never happen - the only thing is that can possibly happen is insurance rates slip upwards in scale with the subsidy increase. But then again, if they start getting too oppressive or off, the numbers can be easily revised to change the top and bottom rates for subsidy or the portion of subsidy that is given - it's amazing that laws can actually be fucking revised - it's something I learned even before Schoolhouse Rock ran being nearly 40, but I'd hope to think some degree of Civics is still being covered in schools even if not as early as it was in my day (4th grade for the beginnings).

I'll start providing evidence to contradict yours when it's either a) On Topic or b) NOT A FUCKING OPINION PIECE - just because it's in the NYTimes doesn't mean shit when it comes from the OpEd page when you're looking for something factual. 2/3 of the time I'm on my tablet responding anyhow, so linking is a huge pain in the ass.

PS - You might want to look up what strawmanning is, because I'm not the one setting them up. Additionally most of the background data I've provided multiple times in the past in this very thread. In fact every point besides the stuff directly relative to your shitty insurance plan are all in here, including multiple copies of the CBO links - again, if you actually cared to educate yourself rather than foaming at the mouth with whatever pundit you allowed to program you.

When I brought up passing 100 billion in costs to future generation, it was in response to your incredible arrogance that we should not be concerned with such a minor issue this. I did not inply that this is the only possible result of the ACA, as you accuse.
If the actual number turns out different, fine.

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When you have a big debt personally - do you start looking at the $5-10 items that make you go $1000 in debt every month or do you start with the $500 items and start seeing how you can parse those down? Or even more accurately do you take an investment account with a brokerage fee that fluxes between gaining you $70 a month or losing $100 a month while giving you numerous other benefits and toss it aside before you start looking at seeing if you can trim down those $500+/mo bills?

A sane person starts with the big stuff and then works down to the small - and certainly doesn't cut out things with potential REVENUE GENERATION before they actually have the time to tell where they're at revenue or cost wise unless the cost is extreme. (Which $100b in out budget is not - the worst case is teensy in the scale of our budget)

I deal with some degree of debt counseling in my volunteer work (it's getting homeless guys back to work [theoretically women too, but not had a female client yet] - obvious why I try to educate them some on finances) - top down is always how I teach them when it comes up, being mostly on resume and interviewing it's only offered when they ask for advice on it though. [Although since stuff like getting suited up and personal care come up - it's not THAT rare however]

There is also the issue that a great part of our wealth is based on the dollar being the world reserve currency, although increasingly less so. An interesting topic is, how does maint. of the dollar as reserve currency relate to our military capabilities.

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No its not - even the worst doom and gloom economists expect any pain from it would be minimal even even noticeable. Especially since there's no currency to replace us, seen China recently? And they were the only serious competition to replace us.

Hoss_sl said:

You mean when you could get a doctor to make an emergency house call for like ... a chicken? Yeah bro

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You do realize that the AMA and insurance industry killed that idea, right? If you're talking about the same world with insurance and the AMA like we are in today, he was 100% correct to talk about it never really being cheap.

Trollface_sl said:

is it possible that frqk is hodj.

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I considered this with hope in my heart, but it is not possible. Hodj was much more articulate, if also verbose, and does/did not adhere to the same guiding principles.

He was also way more of a smug asshole for no reason.

Chanur_sl said:

I would be willing to pay an additional 5-10% in taxes if it meant comprehensive universal healthcare. This would be good for businesses and pretty much everyone not rich.

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I think you're grossly underestimating how much it would cost. We're only able to sustain ourcurrentform of "public" healthcare via massive borrowing. Expanding it to everyone and actually paying for it rather than borrowing money would be far, far more than 10%.

I invite you to look at Germany, and see what lengths they had to go through to afford their social safety net and maintain their balanced budget amendment. Germany is a decent comparison because their health care system is in fact very similar to Obamacare. Their per-capita health costs are a lot lower than ours, but the actual system is structured very similarly. Health insurance is not provided by the government in Germany, it's provided by nonprofit sickness funds that are not run by the government. Enrolling in one is mandatory but you can pay an annual fee to opt out and either go without or buy US-style insurance. Their old-age social insurance program is also very similar to Social Security.

So, what kind of tax burden do they have over there to afford it?

- 30.5% income tax on income up to ?52,000, 42% thereafter. Technically, it's 18.9% tax on the first Euro earned with a linear increase to 42% at ?52,000, but it's effectively 30.5% for that first 52k as long as you make at least that much.
- 9% payroll tax for the social insurance/pension scheme. Just like in the US, your employer has to match this.
- If you live in West Germany, you also pay a 5.5% "solidarity tax" to fund handouts to East Germany.
- 19% federal sales tax (VAT) on everything you buy. This is in addition to the state sales tax.
- 28% capital gains tax. There are no brackets involved here and virtually no exemptions at all, even retirement accounts of the poor/lower middle classes have to pay this rate.
- Mortgage interest and property taxes are not tax-deductible like they are here.

So, if you live in Dusseldorf, have an annual gross income of ?100,000, and spend 66% of your post-tax income on things subject to sales tax/VAT, the government keeps about 60 cents for each Euro you earn. That's if you rent. If you own your own place, that goes up to 65-70 cents per Euro due to property tax. Then you have stuff like the equivalent of $8/gallon gas and ?2,500 driver's licenses. At the end of the day, it's not unreasonable to claim you end up giving 75% of your gross income to the government, especially if you consider your employer's portion of your social insurance taxes as income lost to taxation.

That's the kind of tax burden they had to implement to balance their budget. Now take into account that their per-capita health care and pension costs are much lower than ours are, and that their military is a barely-funded joke, while we spend $600 billion/year on ours. What part of this do you want to bring over here?

Chanur_sl said:

I would be willing to pay an additional 5-10% in taxes if it meant comprehensive universal healthcare. This would be good for businesses and pretty much everyone not rich.

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5-10% in addition to what you already pay for healthcare? Because 5-10% of your income is probably less than what 75% of the American population pays for healthcare right now.

X: Your starting number for Germany is too high 14% on first Euro. And you are ignoring that 25-40% are the average deduction range that most people see since they allow. Solidarity tax is multiplicative not additive so adding the solidarity tax to say 50% nets to 52.75%. Additionally their cap gains is just shy of 27% with the solidarity tax, 25% flat in East - and there's even a minimum deduction for cap gains they get there. (Frankly, to me with as much invested as I do, researching it makes me consider talking to someone about shifting my money - it seems obvious why they're considered a tax haven)

I'm sure there's other errors you made there too - and their system isn't one we'd likely adopt anyhow for healthcare. Singapore is the best fit if we want to adapt our system with a tried method (and about those Singapore taxes....) or we'd go a full blown UHC system. No logical person is promoting Germany's system.

Note all the above corrections were made with a simple wiki check.

And of course there's that too but the core of his numbers are mishandled even.

You mean as a source of funding? Any savings would have to recouped elsewhere via taxes or something.

Vaclav_sl said:

X: Your starting number for Germany is too high 14% on first Euro. And you are ignoring that 25-40% are the average deduction range that most people see since they allow. Solidarity tax is multiplicative not additive so adding the solidarity tax to say 50% nets to 52.75%. Additionally their cap gains is just shy of 27% with the solidarity tax, 25% flat in East - and there's even a minimum deduction for cap gains they get there. (Frankly, to me with as much invested as I do, researching it makes me consider talking to someone about shifting my money - it seems obvious why they're considered a tax haven)

I'm sure there's other errors you made there too - and their system isn't one we'd likely adopt anyhow for healthcare. Singapore is the best fit if we want to adapt our system with a tried method (and about those Singapore taxes....) or we'd go a full blown UHC system. No logical person is promoting Germany's system.

Note all the above corrections were made with a simple wiki check.

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I read the wiki page, it's four years out of date. They've had to rapidly increase taxes to meet the demands of the balanced budget amendment, even the capital gains tax was only implemented in 2009. They had no capital gains tax before that.

http://www.expatica.com/de/finance_b...ny-_18488.html

I missed the part about the multiplicative solidarity tax, but I actually underestimated the payroll tax. According to that link, the maximum contribution is ?998 per month, or 12% of the gross income of someone making 100k.

If I'd really wanted to skew the numbers, I'd have included the 9% church tax too. Of course you can opt out of that, but if you're going to talk about deductions and the "average person" you kind of have to include it.

fanaskin_sl said:

how about the billions of dollars of wastethat the aca seems to help expand, that would pay for the healthcare expansion by itself, instead 1/2 the future middle class has to "boot strap it" for everyone.


How the U.S. Health-Care System Wastes $750 Billion Annually - Brian Fung - The Atlantic

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How does the ACA expand any of the types of waste your posted article describes?

fanaskin_sl said:

How the U.S. Health-Care System Wastes $750 Billion Annually - Brian Fung - The Atlantic

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By far the biggest black hole when it comes to waste has to do with how we practice medicine -- over half of it is accounted for by unnecessary services, inefficient care, or the failure to prevent problems that require expensive intervention.

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I don't disagree that there's a lot of waste in the system, but that's completely independent of the ACA. The problem there is that a service may have been unnecessary with hindsight, but could have been useful in "prevent[ing] problems that require expensive intervention." It's a bit like saying the last 3 months of someone's life are the most expensive. Certainly true, but you don't know when those 3 months start until the person has died. There are a lot of expensive interventions that end up saving most patient's life and, presumably, that's something we want to spend money on.

By the way: there's actually surprisingly little evidence that preventive care -- except for vaccines -- reduces overall costs. Doesn't mean it's a bad idea or shouldn't be done (outcomes matter, too), but it's not going to make health care any cheaper.

Funny even your own link says the first 8300 and change is tax free amongst other oopsies. Additionally checking other 2014 sources they're showing 14% minimum rate as well (from the EU website itself, more likely to be reputable compared to whatever expatica is).

And regardless it's moot because their rates aren't exclusively once source nor are they a system anyone has ever suggested emulating. Singapore would be the example of one it has been suggested often we adapt into. (And my personal fave, FYI)

Also note, even with all those "scary big numbers" that's $800 a year more per capita on average. While being only about $1k behind in average income. Remember that extra 5-10% you were responding to? That's 4% roughly as an aggregate which it would technically be slightly lower. Game, Set, Match.

fanaskin_sl said:

I imagine ralph nader is correct, the Canadian healthcare bill is 13 pages, the american one is 2,700 pages, it's filled with complexities, trapdoors and special interest hooks.

Ralph Nader on Obamacare - YouTube

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So "it seems" like the ACA expands waste and "you imagine" that this is hidden somewhere in its 2,700 pages.

Okay.

Look, I don't think the ACA is a perfect answer. But the ACA isn't really the problem, either. The problem is the health care system itself, but the argument is never about fixing a broken health care system. Instead, the argument is about paying for a broken system.