Has U.S. Democracy Been Trumped?

[jogs]

Part of Obamacare was a big expansion of the single-payer share of US healthcare, with about 10.7 million signing up who previously were not eligible before, but also about 3.5 million who were.

 

Ryancare wanted to undo this expansion.

Medicare and medicaid is single-payer like. Seems like most doctors accept medicare and many refuse medicaid. Is anyone here working in the healthcare field? Is the payment schedule for medicaid lower than medicare? Are there fifty different payment schedules in medicaid, one for each state?

Why can't the uninsured enroll into medicaid, only the services are not free?

Meanwhile, the individual market is potentially much more unstable. It is much easier to imagine the exchanges collapsing, followed by a repeal of that part of Obamacare. Meanwhile, the most promising and logical fix to Obamacare exchanges proposed by anyone is an expansion of single payer: Medicare expansion for anyone over 55. It takes the most expensive patients off the exchanges while offering them affordable insurance.

These politicians speak of a family of four receiving tax credits up to an income of $100,000. Give me a break. How many people earning over $100K/yr don't have health insurance from their employer?

[barmar]

Why can't the uninsured enroll into medicaid, only the services are not free?

I have asked you several times to explain this. The whole point of medicaid is that the government pays it. What does it mean to enroll in it if it's not free? How is that different from just paying the doctor out of pocket? And if they can't afford insurance, why would they be able to afford non-free medicaid?

These politicians speak of a family of four receiving tax credits up to an income of $100,000. Give me a break. How many people earning over $100K/yr don't have health insurance from their employer?

Me. BBO is a small enough company that it's not required to provide health insurance. Luckily I have no problem affording individual insurance. Although I decided this year to drop my dental plan -- it was costing $600/year, had a maximum $1,000 payout, and didn't cover expensive procedures (I had to pay about $1500 a couple of years ago for a root canal and implants).

[Vampyr]

actually in a way they do......they send a driver to my house with a ballot and a driver to my house to pick up the ballot. OTOH you are correct it seems I do not yet have the right to a robot driver car or free uber just yet .....give it time.

 

The trouble is registering to vote, not voting. If you are registered you can get a postal,or absentee ballot, I assume everywhere in the US.

[kenberg]

Phase 1, campaign: Trump has a health care plan. It will cover everyone, it will cost much less, it will be really terrific.

 

Phase 2, after the election: Trump has no plan, Ryan does.Trump shows little interest in discussing this or working through problems, he just plans to come after anyone who doesn't vote for it.

 

Phase 3, the bill fails: The new plan is to do nothing to make the ACA work better, do whatever can be done to obstruct it, let it explode. Health care? Past tense.

 

This is not a person who has any interest whatsoever in the well being of individuals in need of care or any interest in the well being of the nation. His basic nature is on full display and, since health care is important to just about everyone, this time it will be difficult for him it just tweet his way out of it.

 

Could we redo the election? After all, the last one had massive voter fraud so it seems there is a case t be made for a do over.

[ggwhiz]

"Voting is a right."

 

Yeah. Some idiot politician here in New York is proposing that failure to vote be made a crime.

 

I like the Australian model. Vote or pay a fine (if I'm not mistaken) and the fine is not a yuge amount. That would put the brakes on the GOP voter suppression tactics once and for all.

[mike777]

The trouble is registering to vote, not voting. If you are registered you can get a postal,or absentee ballot, I assume everywhere in the US.

 

 

I cant speak for the Uk but here in the USA becoming a registered voter is pretty easy...ignore all the crap about voter suppression...it only exists as a talking point for dems.

 

Keep in mind most who don't register don't really want to be bothered...Keep in mind about one third don't bother to vote for President despite being registered....other vote/races are closer to 20% who bother to vote. Again most just don't bother to vote...not because the white man is out to stop them

[mike777]

Could you lay out your reasoning, please. Today looks to me like a defeat of the Republican attempt to mess with Obamacare, leaving it intact. Obamacare is pretty far from a single-payer system.

 

OK for sake of discussion lets call what the UK or Canada or medicare is some version of single payer....again I don't fully understand how singlepayer works and it seems most don't in full understand.

 

So that means over 65 we have single payer today.

IN fact for some under 65 the government pays all or almost all of their health care.

 

Obama care was designed to fail..it has been in failure mode for some time...the only question is when will it implode. My guess is less than ten years from today.

 

However even today America is ...more comfortable with the idea of DC paying for health care f or people under 65 then it was 8 years ago. This is a key, important point. Now America I am willing to bet will never understand single payer...we don't understand medicare...we don't understand who or what the supreme court is...etc

 

However America does understand preexisting conditions...well many of us do...something which no one wants to go back to 8 years ago.

 

Now fast forward ten years...America becomes more and more comfortable with the idea of medicare for all including those under 65..we wont understand in full how it works...we wont understand who pays for it....we wont understand if and how it stifles innovation......but America will become comfortable with the idea of free stuff

 

Now lets talk about voters....about one third don't bother to vote today...about one third today would vote for single payer...whatever that is.....and about one third will not vote for single payer....so I am saying in ten years....dthe number of actuall voters will get to be over 50% for single payer from what ever the number is today.

 

In fact some polls say more than 50% support single payer for all today but whatever the actual number is...it seems to be growing...not shrinking..--------------

 

-------------------

 

edit I wanted to add some numbers...HC is around 17-20% of GDP today...for the Swiss it is around 10%...still pretty darn high....DThe usa has the best health care but it is not twice as good as the Swiss...this is a problem in search of some solution...

 

Now if single payer in fact ends up still costing 20% of GDP..then we got a problem....

[mike777]

I like the Australian model. Vote or pay a fine (if I'm not mistaken) and the fine is not a yuge amount. That would put the brakes on the GOP voter suppression tactics once and for all.

 

what happens if they say fyou I am not paying no stinkin fine....jail...they take your house?

[ldrews]

what happens if they say fyou I am not paying no stinkin fine....jail...they take your house?

 

Don't know if they actually would, but they probably have the legal authority to do so.

 

Extreme case in the USA 40 or so years ago: in Utah a father resisted sending his child to public school. He barricaded his family in their house. He was shot and killed during a confrontation with the Sheriff who was sent to enforce the state law that all children above a certain age must be enrolled in school.

[mike777]

One of many problems single payer has is no one seems to fully understand it and how and what it touches.

 

For starters if we define single payer as the central government is the one and only payer of the entire and I want to emphasize the entire health care system from top to bottom, something that is more than what medicare...the UK or Canadian system is.....well no one seems to support that

 

so we get back to square one...exactly what does the government pay for...control...have power over? I assume it is paid by young working folks...not by children not by old folks..not by poor folks..not by those who do not work....in other words it is paid for by less than 50% of us.

 

In any event I would think many many people would vote for single payer as long as others pay for all or most of it.

...

 

edit I note it seems the UK does not have a "true" single payer system but Canada does have a "true" single payer system. It seems in Canada it is paid by taxes on taxable income. Have no idea what taxable income means in detail in Canada or who pays how much of single payer in Canada

At the very least it means we need to define taxable income as similar to Canada to pay for single payer.

 

For starters that means no home mortgage interest deduction and that is just for starters!

[Stephen Tu]

One of many problems single payer has is no one seems to fully understand it and how and what it touches.

 

No one???

How hard is it to read or understand

https://en.wikipedia...ayer_healthcare

?

 

so we get back to square one...exactly what does the government pay for...control...have power over? I assume it is paid by young working folks...not by children not by old folks..not by poor folks..not by those who do not work....in other words it is paid for by less than 50% of us.

 

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.

[awm]

OK for sake of discussion lets call what the UK or Canada or medicare is some version of single payer....again I don't fully understand how singlepayer works and it seems most don't in full understand.

 

So that means over 65 we have single payer today.

IN fact for some under 65 the government pays all or almost all of their health care.

 

Obama care was designed to fail..it has been in failure mode for some time...the only question is when will it implode. My guess is less than ten years from today.

 

However even today America is ...more comfortable with the idea of DC paying for health care f or people under 65 then it was 8 years ago. This is a key, important point. Now America I am willing to bet will never understand single payer...we don't understand medicare...we don't understand who or what the supreme court is...etc

 

However America does understand preexisting conditions...well many of us do...something which no one wants to go back to 8 years ago.

 

Now fast forward ten years...America becomes more and more comfortable with the idea of medicare for all including those under 65..we wont understand in full how it works...we wont understand who pays for it....we wont understand if and how it stifles innovation......but America will become comfortable with the idea of free stuff

 

Now lets talk about voters....about one third don't bother to vote today...about one third today would vote for single payer...whatever that is.....and about one third will not vote for single payer....so I am saying in ten years....dthe number of actuall voters will get to be over 50% for single payer from what ever the number is today.

 

In fact some polls say more than 50% support single payer for all today but whatever the actual number is...it seems to be growing...not shrinking..--------------

 

-------------------

 

edit I wanted to add some numbers...HC is around 17-20% of GDP today...for the Swiss it is around 10%...still pretty darn high....DThe usa has the best health care but it is not twice as good as the Swiss...this is a problem in search of some solution...

 

Now if single payer in fact ends up still costing 20% of GDP..then we got a problem....

 

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).

[mike777]

No one???

How hard is it to read or understand

https://en.wikipedia...ayer_healthcare

?

 

 

 

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.

 

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..

[mike777]

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).

 

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

[kenberg]

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.

[mike777]

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.

 

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/law/help/medical-malpractice-liability/canada.php

[jogs]

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

[jogs]

I have asked you several times to explain this. The whole point of medicaid is that the government pays it. What does it mean to enroll in it if it's not free? How is that different from just paying the doctor out of pocket? And if they can't afford insurance, why would they be able to afford non-free medicaid?

 

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.

[Stephen Tu]

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

 

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.

 

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

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.

 

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

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.

[mike777]

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....

[Stephen Tu]

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 ne.w or shocking.

 

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.

 

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.

 

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*.

 

c

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....

 

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.

[jogs]

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.

[jogs]

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.

 

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.

[Al_U_Card]

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.

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.

[barmar]

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..

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.