BBO Discussion Forums: Has U.S. Democracy Been Trumped? - BBO Discussion Forums

mike777, on 2017-March-25, 19:44, said:

No one???
How hard is it to read or understand
https://en.wikipedia...ayer_healthcare
?

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Single payer would be funded by taxation of course. Money that employers and employees currently pay to private insurance companies would presumably get funneled to the medicare for all plan instead. Medicare is more efficient than private insurance, being non-profit, so theoretically most employees ought to be able to have slightly bigger paychecks and still be covered. Essentially your Medicare tax goes up but it gets more than offset by what you aren't paying private insurance. For most folks anyway. Probably the wealthy have to pay more if we want the poor to be covered, and for the middle class to not to be paying too much.

The difference between the Canadian and UK system is basically who is running the hospitals and paying the doctors. In Canada the hospitals are privately run. In the UK the government runs the hospitals, somewhat analogous to the VA veteran's system here. The U.S. is basically an ungodly hybrid of a lot of different systems for different population segments due to accidents of history and what was politically achievable at various times.

mike777, on 2017-March-25, 17:53, said:

Switzerland may not be the best example here. Unusual among European nations, Switzerland has only private insurance. It's sort of like a better version of Obamacare -- all insurance is private, everyone is on the individual market, it is heavily regulated (in particular they must accept all applicants and cost cannot vary by person, and a certain set of treatments must be covered by all basic plans), and anyone who does not sign up for a plan will be assigned one at random. There are subsidies available for the poor. The result is a quite expensive system (2nd to US) but also one of the best in outcomes (life expectancy significantly longer than US, most other measurables also better; they are not afflicted by the occasional long wait times of some single payer systems nor the complexity of the many US systems; other than through blind patriotism it's hard to argue anything about US healthcare is better than Swiss).

Stephen Tu, on 2017-March-25, 22:19, said:

How hard is it to understand...very hard....all you quote is some general stuff....the hard part is the details....geez come on


For example you say taxation...but what taxation...what are you taxing....if taxable income....do you know defining taxable income is very difficult...

You seem to have no understanding of just how difficult medicare is to understand in full.

Your entire post is evidence you don't understand this stuff in full...just a bunch of general stuff..

awm, on 2017-March-25, 23:07, said:

OK... you make some good points, if nothing else your posts proves my point about my lack of fully understanding the details of single payer.

.as far as better...well we seem to be better at innovation but if you believe the swiss are better at innovation in health care..ok...
For example it seems in the future innovation in..computers...robots...AI will become a more important element in healthcare

In any case size matters ..it creates bias when I compare a country of 320 million to a tiny country such asthe Swiss which is what 7 million?

-----


btw it seems a bit weird that costs do not vary by person ....so a twenty year old pays just as much as a 70 year old

I appreciate some of the references, I might try to work through some of it. But, as near as I can see, we are struggling with whether children should be vaccinated. Any broader health care change is completely off the table.

I agree with Stephen Tu that "The U.S. is basically an ungodly hybrid of a lot of different systems for different population segments". Unless there is someone who, to my great surprise, disagrees with that I won't elaborate.

But I am not at all sure that I want a single payer system either.

Back in post 5160 Helene spoke of "However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:".
In post 5168 I spoke of why this, as I understood what she was saying, would be completely unacceptable to me. Of course maybe we could work things out since both Helene and I are far more reasonable than your typical member of Congress. Talk about your low bar.

Which is probably supporting Mike's notion that the basic concept is easy, the details are hard.

But we have a president who has no interest along these lines. His interest lies in what to do about the fake news reports that the crowd size at his inauguration fell short of 5 million. Or whatever figure his twitter based mind is claiming these days.

kenberg, on 2017-March-26, 06:56, said:

Ken you make good points.

btw I just wonder how law suits work in single payer..the good news is if we sue the govt...they have a lot of money and may be willing to settle out of court...the plaintiff lawyers only get paid if they win. Correction the defending lawyer gets paid..win or lose.... I mention this because I married into a large family of lawyers who work both sides


https://www.loc.gov/...lity/canada.php

Why is the claims fraud rate so high with medicare and medicaid? How does private health insurers keep their claims fraud low?

barmar, on 2017-March-25, 08:24, said:

Nothing should be set in stone.

San Francisco has a health program for the poor. It is means tested. Each member is subsidized. This subsidy amount is dependent on the member's income and finances. Any money paid by the members goes to paying for the service provided, not to a health insurer.

http://healthysanfrancisco.org/

Seems like most doctors refuse to see uninsured independent persons. HSF provides a network which connects patients to doctors.

mike777, on 2017-March-26, 06:16, said:

Why do you need more than general stuff to understand the gist of the concept and whether you support the idea or not? That's all you need as a voter, you aren't being asked to write the details of the legislation! That's why we have a bunch of congressmen with an army of staffers, plus the IRS and Medicare bureaucracies, to work out the details if this ever comes to pass.

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Uh, wages? Plus investment income on high earners like the ACA does now?

It's not hard to define wages. It's a box on a W-2. Taxable income is difficult because that's after a maze of deductions and exemptions that have been lobbied in by various interests over the years. But payroll taxes for SS and Medicare are off of gross pay, before any deductions. It would be simple to increase the rate on these, and make it similar/less than what currently employers and employees are shelling out to private insurance. Tax credits can offset this for low earners, the max could perhaps be capped for high earners like SS is now.

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What crucial details are you trying to figure out? The only thing most people really need to know to support is:
- how much more am I going to be taxed, and/or how much in monthly premiums would I have to pay?
- is my net take home pay after all of this going to be more or less than it is now, and by about how much?
- how would single-payer government compare to what I have now, in terms of deductibles, co-pays, what services are covered, what kind of choices do I have with regards to doctors, hospital networks?

Sure details and exact numbers would have to be worked out, but that's what the legislative process is for. Voters can wait until proposed legislation comes out and if the details are way out of wack from what they initially envisioned/supported they can change their mind and rally against it. But I don't see why you need more than general concepts to be for or against the idea of expansion to lower age groups, or eventually to everyone.

Stephen as I stated before no one understands fully how single payer works....you now seem to agree...great.

As I stated before when people hear, what people understand about single payer, what they hear is free stuff...a bunch of free stuff and people like getting free stuff people vote in favor of free stuff....none of what I am saying is new or shocking.

Please refer to the first post of mine that you quoted. I simply said that if you count everyone..I mean everyone who will be covered by single payer..kids...old folks....poor people...everyone....that more than 50% pay something close to zero in taxed income. I don't know how old you are but if you are young...you will be the one paying for this....thank you Stephen but please pay a lot. It will be good, smart hard working young folks such as yourself who are paying for all of this....thank you.


But please understand it is people such as myself...my wife who will be using this single payer health care..it would be nice to figure out what single payer pays for and if not enough....how to get it to pay more....

To use a real life example....will single payer pay to fly my wife to MDAnderson in Houston.. how much, everything? will they pay for at Anderson? What about after care...etc....so many questions....

mike777, on 2017-March-26, 11:40, said:

Only idiots think it's all free stuff. Granted there are a ton of idiots in this country. But really anyone with a functioning brain should realize that *someone* has to pay the doctors, hospitals, etc., that it can't be free for everyone. We can make it free for some low income households, but only by making other people (e.g. raise taxes on the extremely wealthy) pay more to cover the people not paying. Some segment of the population is fundamentally against this moderate amount of wealth redistribution, I guess they prefer the if you are poor and get sick, tough luck I guess you die plan, we won't pay to save you. But most of us aren't this heartless, I thought this was settled under Reagan when legislation mandated emergency care without verifying ability to pay. These costs get passed on to the rest of us regardless through higher premiums, and it ends up more expensive than covering these poor people to manage their health before it becomes an emergency situation.

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There are a lot of low income people who currently don't pay *income* taxes, the stuff you calculate on your 1040 after deductions, exemptions, etc. But a lot of those people are still paying *payroll taxes*, for SS and Medicare, and their employers are paying these taxes also. Most people get health coverage through their employer. The premiums the employers are paying private insurance companies could go to the government for single payer instead. Since single payer systems are non-profit and more efficient than private insurance, in theory the government should be able to collect somewhat *less* than what is currently going to private insurance, and companies could afford to pay many workers *more*.

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Do most people know the answers for these for their private insurance carrier? Do they even have any control over this, given that many employers don't give much choice of plan at all?

How much is covered would be a negotiation between the public at large and their legislative representatives. At some point there is a choice between more coverage + higher taxes, vs. less coverage + lower taxes forcing people to chip in more on their own for specialist care or whatever. But at least there wouldn't be a profit motive like there is in private insurance where they are incentivized to cover as little as legally allowed to.

Every health insurer takes in more in premiums than it pays out in claims. That statement must be true else insurers will go bankrupt. Therefore in the individual healthcare insurance market healthy persons are paying more than they are receiving. It would be much cheaper to pay ordinary medical needs out of pocket. Just have insurance for an unexpected catastrophic event. If you were allowed to enroll into your state's medicaid, you would be in a network. It would be easier to navigate the healthcare maze than doing it alone. You would just pay for your services. For all healthy people this would a cheaper alternative than buying insurance.
Catastrophic health insurance makes no sense for the health insurer. When a person has a pre-existing chronic condition which clearly cost over $10K/yr to treat, how can the health insurer make a profit. America must decide how much money the treasury is willing to allocate to help those with pre-existing conditions. There are also 500,000 to 600,000 homeless. This group can't afford to contribute to their healthcare.
Any health plan by a politician which doesn't start with a non insurer model is a loser out of the gate.

Stephen Tu, on 2017-March-26, 12:58, said:

With Obamacare the democrats thought the healthy poor would be willing to subsidize those with pre-existing conditions. Many choose to pay the penalty and still received no healthcare.

jogs, on 2017-March-26, 18:25, said:

A caveat concerning "bloating". A medical condition that affects health-care systems here (in Canada). The administration and supervision of care-giving provides employment opportunities for the politically connected. Since overall budgets get gross approval, these non-practitioners suck up a lot of the $ available for patient care. RAMQ in Quebec is much worse than OHIP in Ontario. One of the reasons for long waits in emergencies and old or lacking diagnostic and treatment machinery in hospitals.

mike777, on 2017-March-26, 06:16, said:

How important is it for people to "understand" this stuff in any detail? The taxation thing is no different from the income taxes that everyone already pays -- if you can't understand it you go to H&R Block.

Most people don't understand how a car engine works, but they still have no problem driving one.

Hardly anyone understands how computers and the Internet works, but they can Google and play Kandy Krush, that's all that matters.

barmar, on 2017-March-26, 19:27, said:

The analogy gets tricky, analogies usually do. Cars: In 1980 I bought an Isuzu diesel. I don't need to know how a diesel works. but I do need to know how easy it will be to get diesel fuel whan I need it. I need to know if I might have problems with it in the winter if I move from Maryland to northern Minnesota.

Medical care has changed greatly during my lifetime, The possibilities for treatment have changed immensely, the mode of paying for it has changed immensely. I have seen enough variation, each with its own pluses and minuses, to be more than a little skeptical when I hear of how well it all would work if we would just do this or just do that.

The current system works well, very well, for me. I recognize that it does not work well for everyone. So I see the question as how to make it work better for others without screwing it up for myself. I am pretty sure that it is not easy.

mike777, on 2017-March-26, 06:23, said:

The 70 year old has, in a way, paid for her care by the premiums she paid between the ages of 20 and 69. I know this is over-simplified, but it is one way to think about the matter.

There are two more things that you might need to understand

1. The mindset of a person who believes that health care is a basic human rights not a commodity.

2. Empathy. Seeing a man suffering catastrophic injuries from a terrorist attack in a the heart of your city, a child born with cystic fibrosis, a woman diagnosed with breast cancer, and thinking, that could be me, that could be my child, that could be my wife.

As someone mentioned above, insurance companies are not going broke. In fact, they are among richest companies on the planet. Vast sums of money are being skimmed off rather than being used for medical treatment. A single-payer system is like an insurance company that does not intend to make a profit, and will in fact operate at a loss if necessary. There could be other models with this characteristic which might be more palatable for Americans, seeing as how they are so deathly afraid of socialised medicine. On the other hand I have not heard of large numbers of, or in fact one, senior refusing Medicare. There might be a few, but not enough to deny the fact that the majority of Americans are unwilling to put their money where their mouth is.

kenberg, on 2017-March-26, 20:24, said:

I've never been able to fully understand my healthcare options. Whether I've had employer-supplied insurance or I've been self-insured, they've always given me a menu of different plans to choose from. Employers generally just have a few options (HMO versus PPO, high or low deductibles), while the market place has lots of options. The websites have options to compare them, but figuring out the priority between feature A, feature B, and price is difficult. In the end I just guess.

As a Dane (i.e. used to a single-payer system) living for a long time in the Netherlands, it astonished me how anybody in the Netherlands who is not on the pay list of the insurance lobby could support the insurance system.

The only argument I have heard is that it gives you choice. You can choose high or low co-payments, coverage of certain things are not in the basic package (like complementary medicine). In Denmark, you can of course also decide to pay for an extra insurance that lowers or eliminates co-payments so that's hardly an argument. But with respect to alternative treatments I suppose the insurance system has the advantage that if you take insurance for the more expensive options, you don't have to pay everybody else's cheaper options through the taxes at the same time.

Even in the Netherlands, you still have to pay for other people's chemotherapy even if you'd always chose Chinese herbs yourself if you got cancer. That's because standard cancer treatment is in the basic package. But I suppose one could find examples where the insurance system saves you from paying for the standard treatment which you don't get because you have chosen a more expensive alternative.

I find it difficult to believe that there are many people for whom that saving would be big enough to cancel out the extra costs of the expensive insurance system, compared to single-payer. I suppose I could be wrong.

mike777, on 2017-March-25, 17:53, said:

You are joking right? Surely noone who has any idea about international healthcare can really believe something like this.