Republicans gunning for Medicare... again

[Dikhaut]

You might want to examine how healthcare in other countries works. How they pay less, cover everyone, and have better results.

We may not have the same idea about what constitutes a better outcome. In countries with government paid healthcare it is difficult to access that care due to short supply. I just heard from an acquaintance in the UK who has a skin rash and needs a dermatologist. The wait for a simple appointment is 4 to 6 months. The most basic understanding of economics explains this. When something is free, demand goes way up and supply goes way down. Nobody wants to be in a business where the government is the only customer and they can effectively corner the market.


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[George Jung]

And.... dik.... I don't believe you. Perhaps you're unaware - we have many bilgerats, hailing from around the world. Most of them (non-USA) even have *gasp* excellent, affordable healthcare, and better outcomes, at half the cost, of what we have. And that '6 month waiting period'.... no, it doesn't exist, in most instances. My pt's generally wait 1 - 3 months for many of their specialty appts, most notably since the pandemic.

So..... no.

[Too Little Time]

You might want to examine how healthcare in other countries works. How they pay less, cover everyone, and have better results.

You offered up Medicare for all. Not healthcare in other countries. I would suggest you show some rational path to your goal healthcare plan. Remember that no political party is in favor of a national plan.

But you might remember my previous comments about high deductible healthcare insurance coupled with a health savings account. Many people have such plans - mostly middle class business owners who have the ability to make the decision of which plans are available. Like my experience: after a couple decades of paying a relatively small amount for health insurance many have accumulated enough investments in their HSA to fund their health insurance forever. Unfortunately health insurance is replaced by Medicare at retirement.

High deductible health insurance with an investment account is much better than any healthcare program in any country. If you want to give healthcare to everyone, start with high deductible plans with contributions to a sovereign wealth fund of investments that will pay deductibles.

[John Smith]

We may not have the same idea about what constitutes a better outcome. In countries with government paid healthcare it is difficult to access that care due to short supply. I just heard from an acquaintance in the UK who has a skin rash and needs a dermatologist. The wait for a simple appointment is 4 to 6 months. The most basic understanding of economics explains this. When something is free, demand goes way up and supply goes way down. Nobody wants to be in a business where the government is the only customer and they can effectively corner the market.


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My friend's sister had a stroke; got great care. No waiting. Extensive physical therapy to get speech back: no bill.

It's often pointed out, both, that other countries spend half what we do and GET BETTER RESULTS.

[Osborne Russell]

I would add only that if Republicans try to assure currently retired Americans that their benefits wouldn’t be affected, this promise isn’t feasible — not if they’re serious about balancing the budget within a decade.

But every year, there is a new crop of younger currently retired Americans who worked their whole life for those benefits, and next year's crop, and the next year's after that . . . sooner or later comes the year when retirees of the near future get shafted along with current retirees. To that extent, the political problem never goes away -- it isn't arithmetical, it's equitable.

[UCanoe_2]

But you might remember my previous comments about high deductible healthcare insurance coupled with a health savings account. Many people have such plans - mostly middle class business owners who have the ability to make the decision of which plans are available. Like my experience: after a couple decades of paying a relatively small amount for health insurance many have accumulated enough investments in their HSA to fund their health insurance forever. Unfortunately health insurance is replaced by Medicare at retirement.

High deductible health insurance with an investment account is much better than any healthcare program in any country. If you want to give healthcare to everyone, start with high deductible plans with contributions to a sovereign wealth fund of investments that will pay deductibles.

TLT, you must live on a different planet from the rest of us. Not everyone is a middle class business owner, and few people can afford high deductible insurance plus a medical savings account.

Thanks to the US tax structure, most employed people rely on insurance plans from their jobs. The quality and coverage of those plans varies widely. I was fortunate to work as a Virginia state employee. My salary was not great, but the benefits included excellent insurance (with a choice of plans in some areas), great leave benefits, one of the better public sector pension programs in the US, and a 457 deferred compensation plan to fund an IRA.

Most workers do not have anything like this array of benefits, particularly those who work for small businesses in the private sector. Perhaps their benefits are limited because the middle class business owners send the profits into their own pockets, their high deductible insurance plans, and their medical savings accounts rather than spending on benefits for the employees.

I repeat, not everyone is so fortunate and privileged. You don't seem to have any concept of the difficulties faced by the majority of people who live paycheck-to-paycheck.

[Too Little Time]

Eventually, I expect, you'll see doctors more often.

Time is one's best friend. People who have chosen to have high deductible health insurance and invested the difference in premiums have found that it does not take long before income from the invested savings pay for both the annual premiums and out of pocket expenses related to healthcare. While those who have selected higher cost low deductible health insurance continue to pay and complain.

You might want to examine how healthcare in other countries works. How they pay less, cover everyone, and have better results.

I used a technique you claim to use: Ask a question where one is required to defend a position that puts one on the spot.

You have failed to answer the question: How do we get to any of the programs you claim are better?

You are not alone in that. Professionals know that there is not the political will to get there so they offer no substantive path. In past threads about the issue, there were claims that the ACA was a step toward some unspecified goal. Perhaps you could give specifics about who pays the costs. Perhaps you could explain where all the cost savings come from.

Until you do, I and others will have to believe that your claims are just invalid.

[Too Little Time]

TLT, you must live on a different planet from the rest of us. Not everyone is a middle class business owner, and few people can afford high deductible insurance plus a medical savings account.

Thanks to the US tax structure, most employed people rely on insurance plans from their jobs. The quality and coverage of those plans varies widely. I was fortunate to work as a Virginia state employee. My salary was not great, but the benefits included excellent insurance (with a choice of plans in some areas), great leave benefits, one of the better public sector pension programs in the US, and a 457 deferred compensation plan to fund an IRA.

Most workers do not have anything like this array of benefits, particularly those who work for small businesses in the private sector. Perhaps their benefits are limited because the middle class business owners send the profits into their own pockets, their high deductible insurance plans, and their medical savings accounts rather than spending on benefits for the employees.

I repeat, not everyone is so fortunate and privileged. You don't seem to have any concept of the difficulties faced by the majority of people who live paycheck-to-paycheck.

In the past, employees even in non union shops, negotiated for heath insurance that was paid for by their employer. Group policies. Where those who had little risk paid the same premiums as those with high risk. Basically, they insisted that their employer over paid for insurance.

But my point was that employees can negotiate for health insurance that is more suitable than they have negotiated for in the past. One that is more suitable than this Medicare for all that is promoted by some. One that is more suitable than the programs in other countries.

[George Jung]

No, they can't. Owners/employers 'offer' a plan - take it, leave it.

Not sure where you get this crap.

[Dave Gray]

While it is true you can opt out of a company health plan I am somewhat dubious that one person can negotiate something much better.

[Too Little Time]

No, they can't. Owners/employers 'offer' a plan - take it, leave it.

Not sure where you get this crap.

While it is true you can opt out of a company health plan I am somewhat dubious that one person can negotiate something much better.

I suspect most people take what is offered.

My son-in-law works in tech. He frequently changes jobs. When he does so, he insists as part of his contract that his health insurance includes what he wants. In the past, he has had to walk into the human resources office and explain that his contract includes certain health care provisions that the company needs to pay for. He walks out with the company agreeing.

https://www.google.com/search?q=do+b...hrome&ie=UTF-8 indicates that my statement is not as much "crap" as you wish it were.

[CWSmith]

No, they can't. Owners/employers 'offer' a plan - take it, leave it.

Surely Hobby Lobby taught us this!

[CWSmith]

I really do not understand the central tenant of this thread. The GOP gets a lot of its support from older voters. Older voters need, or soon will need, Medicare. Why don't Republican voters recoil over this? Are they so indoctrinated that they think their taxes will be less and then they will buy their own insurance? The wealthy can, but a lot can't. These older voters are voting themselves into the loss of health care.

[UCanoe_2]

I suspect most people take what is offered.

My son-in-law works in tech. He frequently changes jobs. When he does so, he insists as part of his contract that his health insurance includes what he wants. In the past, he has had to walk into the human resources office and explain that his contract includes certain health care provisions that the company needs to pay for. He walks out with the company agreeing.

https://www.google.com/search?q=do+b...hrome&ie=UTF-8 indicates that my statement is not as much "crap" as you wish it were.

TLT, once again you live on a different planet. I point out that your SIL apparently has advanced skills that are much in demand. He is not Joe Average working in a small town tire shop. Your SIL has much more bargaining power than most employees.

Also, just because in theory a small business may offer a variety of insurance plans, this does not mean that they must. If Joe Average insists on a different health insurance plan from everyone else, it will be an administrative headache for his boss that will require deducting a different premium from Joe's paycheck, as well as negotiating a contract with a different insurance company.

The administrative headache will cost the boss money. Unless Joe can make the boss a whole lot more money, it will not be worthwhile to hire him. Tough luck, Joe, go apply at the next tire shop down the road.

I highly recommend that you come to Earth and go to work changing tires...or flippin' burgers....or working the production line in a toothpaste tube factory....or shoveling dirt on a construction site. Talk to us again after you have experienced the reality that most working people live in.

[Too Little Time]

TLT, once again you live on a different planet. I point out that your SIL apparently has advanced skills that are much in demand. He is not Joe Average working in a small town tire shop. Your SIL has much more bargaining power than most employees.

Also, just because in theory a small business may offer a variety of insurance plans, this does not mean that they must. If Joe Average insists on a different health insurance plan from everyone else, it will be an administrative headache for his boss that will require deducting a different premium from Joe's paycheck, as well as negotiating a contract with a different insurance company.

The administrative headache will cost the boss money. Unless Joe can make the boss a whole lot more money, it will not be worthwhile to hire him. Tough luck, Joe, go apply at the next tire shop down the road.

I highly recommend that you come to Earth and go to work changing tires...or flippin' burgers....or working the production line in a toothpaste tube factory....or shoveling dirt on a construction site. Talk to us again after you have experienced the reality that most working people live in.

My wife never had an issue with doing payroll. She used a computer with a spreadsheet. Larger, but still small businesses, often use a payroll service. They seldom have problems.

We don't negotiate an insurance contract with any insurance company. We call an insurance broker who looks for an appropriate ACA compatible plan.

Any business that is large enough to have an HR department has enough employees who can negotiate their health insurance benefits, can offer custom benefits to anyone who asks at no administrative cost to the business. Any business smaller than that can do what I have suggested.

I think the demographics here run a bit above changing tires or flipping burgers. Most probably have the skills to get the health insurance they want.

[Dikhaut]

And.... dik.... I don't believe you. Perhaps you're unaware - we have many bilgerats, hailing from around the world. Most of them (non-USA) even have *gasp* excellent, affordable healthcare, and better outcomes, at half the cost, of what we have. And that '6 month waiting period'.... no, it doesn't exist, in most instances. My pt's generally wait 1 - 3 months for many of their specialty appts, most notably since the pandemic.

So..... no.

https://www.cnn.com/2023/01/23/uk/uk...apart-gbr-intl


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[JayInOz]

The system in Australia works. There are lengthy waiting times for some elective procedures under medicare. If you are prepared to wait it isn't a problem. If you're not prepared to wait then you can join a private health system and jump the queue. One of the great things about our system is that everybody is covered. You don't need to be highly educated and in a position which gives you bargaining power to get coverage. The feller with the brain injury at the garbage recycling plant gets the same coverage as the foreman. Republicans seem to be afraid to even look at it because it's the only thing worse than communism to them- socialism! It's like being sick but being too afraid to say the C word just in case. From the outside looking in, it's sad and frustrating and fairly stupid. JayInOz

[Too Little Time]

I highly recommend that you come to Earth and go to work changing tires...or flippin' burgers....or working the production line in a toothpaste tube factory....or shoveling dirt on a construction site. Talk to us again after you have experienced the reality that most working people live in.

Most of our lives my wife and I spent without health insurance. The only reason we had health insurance and an HSA was because the economics worked out for us.

In the past I have said: I am all in favor of giving those below the median free health care. (Not just free at the point of service.) That is a much better deal than the ACA gave them. What do you offer? What does your political party offer?

Perhaps you could focus your argument on those who had the ability to negotiate their healthcare benefits, got what they were happy with, and are now unhappy. I see a lot of people in that group who see an opportunity to get someone else to pay for their health care. Perhaps you see something else.

[Too Little Time]

The system in Australia works. There are lengthy waiting times for some elective procedures under medicare. If you are prepared to wait it isn't a problem. If you're not prepared to wait then you can join a private health system and jump the queue. One of the great things about our system is that everybody is covered.

I have been reading about the issues that the UK is currently having. Any comments on their issues?

[John Smith]

I've a suggestion. Let anyone who wishes opt out of Medicare. Let those who wish opt in. It would be interesting to see how many are foolish enough to opt out.

[Keith Wilson]

One more time: EVERY other developed country spends much less on health care than the US, for roughly comparable results by every reasonable measure. And they cover everybody, all the time. The US system of paying for health care is utterly idiotic, although it's gotten somewhat better in recent years - not significantly in cost, but in access..

[Norman Bernstein]

Most of our lives my wife and I spent without health insurance. The only reason we had health insurance and an HSA was because the economics worked out for us.

Was the fact that you didn't happen to suffer a catastrophic medical crisis, a result of your economic decision making?

My wife is recovering from a fractured hip. About a year ago, she broke the other hip, and got a hip replacement. That time, the total bill was over $47,000.... This time, I expect the bill to be higher. My out of pocket cost, last time, was just about $1700.

Now, explain to me exactly how somebody making minimum wage can be expected to buy a high deductible health insurance plan, pay for the premiums, pay the deductible if THEY break their hip, and all at the same time, invest in an HSA?

DSE

[Norman Bernstein]

https://www.cnn.com/2023/01/23/uk/uk...apart-gbr-intl

Try reading the whole article, and not just the headlines:

“When the Labour government came in in 1997, they injected considerably more money into the NHS. It enabled us to appoint an adequate number of staff and get on top of our waiting lists,” Neville told CNN.

But this level of investment did not last. In response to the 2007-2008 financial crisis, the Conservatives elected in the coalition government in 2010 embarked on a program of austerity. Budgets were cut and staff salaries frozen. For Neville, the ensuing decade saw a gradual “erosion” of the system: “Slow, subtle, but nonetheless happening.”

The 'liberal' gov't adequately funded the NHS. The 'conservative' gov't cut back on the spending.

Now, exactly whose fault is the problem?

[sandtown]

The reason why no major US political party supports M4A

is because of the legalized bribery of elected officials.

Common Dreams today . ..
During his own campaign last year, Barnes refused to take money from corporate PACs, and raised more than $40 million from grassroots supporters, breaking fundraising records in Wisconsin. Barnes is a supporter of Medicare for All and focused heavily on workers' rights and strengthening unions during his Senate campaign.In recent years corporate Democrats have shown hostility toward progressive candidates and lawmakers, warning that pushing for government-run healthcare will harm the party despite the proposal's popularity with Democratic voters. Political pundits have also claimed that support for progressive policies will hurt Democratic candidates' chances at the ballot box.

[Too Little Time]

Was the fact that you didn't happen to suffer a catastrophic medical crisis, a result of your economic decision making?

My wife is recovering from a fractured hip. About a year ago, she broke the other hip, and got a hip replacement. That time, the total bill was over $47,000.... This time, I expect the bill to be higher. My out of pocket cost, last time, was just about $1700.

Now, explain to me exactly how somebody making minimum wage can be expected to buy a high deductible health insurance plan, pay for the premiums, pay the deductible if THEY break their hip, and all at the same time, invest in an HSA?

I said those below the median should get free health care. I think that includes those who are making minimum wage. They would not need an HSA. But you might also ask: How would a person making minimum wage handle the broken hip problem with low deducible insurance? $1700 is a lot of money for those making minimum wage - especially if they lose their job due to to the incident whether directly or indirectly.

You seem to be saying a middle class guy like you cannot afford a $47K medical bill. We paid into our HSA while we were middle class. And only for a decade. Despite having a $100K medical expense and paying $10K deductible, we have $300K in an HSA. (Our net worth at the time of the medical expense was about $300K - by coincidence. So we had enough funds to pay without insurance.)

https://www.healthsystemtracker.org/...ending,%202019 has a realist analysis of health care expenses. https://www.statista.com/statistics/...care-spending/ has a similar analysis. Your $47K of expense is unusual. In any given year only 5% of the population has an annual expense over $25K. For most high deductible policy would be a much better deal than the policies most want.

[Too Little Time]

One more time: EVERY other developed country spends much less on health care than the US, for roughly comparable results by every reasonable measure. And they cover everybody, all the time. The US system of paying for health care is utterly idiotic, although it's gotten somewhat better in recent years - not significantly in cost, but in access.

It is the system that the middle class and unions for the working class wanted. Now, they are unhappy.

I am happy with the costs I have paid and the services I have received.

[George Jung]

Just mulling.... but has anyone else 'wondered' if tlt is actually a bot?

Not a 'smart' bot - but one, maybe, programed differently? As in 'give contrary, oppositional responses' to all threads?

[Paul Pless]

broken arrow. . .

[George Jung]

Yeah. That too.

dumb-bot.

[Nicholas Carey]

Was the fact that you didn't happen to suffer a catastrophic medical crisis, a result of your economic decision making?

My wife is recovering from a fractured hip. About a year ago, she broke the other hip, and got a hip replacement. That time, the total bill was over $47,000.... This time, I expect the bill to be higher. My out of pocket cost, last time, was just about $1700.

Now, explain to me exactly how somebody making minimum wage can be expected to buy a high deductible health insurance plan, pay for the premiums, pay the deductible if THEY break their hip, and all at the same time, invest in an HSA?

DSE

A couple years ago, Number Two Son had a tricky, very hard to diagnose case of appendicitis. Including the surgery, a week in hospital, and another minor surgery to get rid of the catheter that went from his arm to his heart for IV drugs (it had gotten "stuck"), the total bill was north of $120,000. Our out-of-pocket was IIRC c. $800.

The high-deductible+HSA plan that my employer offers — for employee+dependents — costs the employee $384/month ($4,604/year). The deductible is $2,500 per person, or $5,000 per family, whichever gets hit first. Out-of-pocket maximum is $6,900 per person, or $13,500 for the family, whichever gets hit first. And, after the deductible, you're liable for 30% of treatment costs and lab fees (50% if it's an ER visit the insurance company deems "not an emergency").

For the HSA, my employer contributes $1,060 to the HSA. The employee can contribute up to a maximum of $7,750 per year (plus an additional $1,000 if the employee is of age 55 or older).

One might make the observation that the above would seemingly imply that the employee has a not-insignificant amount of discretionary cash to put into the HSA. Not a lot of lower-wage people going to have the spare scratch to put several thousand a year into an HSA that they can't then get at for decades, unless its a "qualified" health care expense, without the IRS levying a 20% penalty on top of the income tax owed on the withdrawal.

And if one is, as many lower wage families are, working paycheck to paycheck, getting hit with $13,000 worth of out-of-pocket medical costs is likely to drive them into bankruptcy (A 2019 study suggests that some 2/3 of all personal bankruptcies cite unexpected medical expenses/problems as a (or the) contributing cause of the bankruptcy — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366487/ — and that that hasn't changed significantly since the advent of the Affordable Care Act, aka ObamaCare). IIRC, a previous study found that the average amount of the unexpected medical expenses plunging people into bankruptcy was rather small, about $4,000.

High-deductible health insurance with an HSA is designed to discourage use of healthcare. For the most part, it makes sense for young, generally healthy people, who don't consume much in the way of medical care.

[Too Little Time]

The high-deductible+HSA plan that my employer offers — for employee+dependents — costs the employee $384/month ($4,604/year). The deductible is $2,500 per person, or $5,000 per family, whichever gets hit first. Out-of-pocket maximum is $6,900 per person, or $13,500 for the family, whichever gets hit first. And, after the deductible, you're liable for 30% of treatment costs and lab fees (50% if it's an ER visit the insurance company deems "not an emergency").

https://www.irs.gov/pub/irs-drop/rp-22-24.pdf

High deductible health plan. For calendar year 2023, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that isnot less than $1,500 for self-only coverage or $3,000 for family coverage, and for whichthe annual out-of-pocket expenses (deductibles, co-payments, and other amounts, butnot premiums) do not exceed $7,500 for self-only coverage or $15,000 for familycoverage.

If you think the out of pocket amounts are out of line, you should tell your employer. There are certainly better options.

If I were an employer, I would reimburse any amount an employee had to pay over the $3000 minimum out of pocket for family coverage. That is what my wife does.

[Dikhaut]

Try reading the whole article, and not just the headlines:



The 'liberal' gov't adequately funded the NHS. The 'conservative' gov't cut back on the spending.

Now, exactly whose fault is the problem?

It seems it is you who did not read the whole article.


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[leikec]

Just mulling.... but has anyone else 'wondered' if tlt is actually a bot?

Not a 'smart' bot - but one, maybe, programed differently? As in 'give contrary, oppositional responses' to all threads?

Don’t let him near your dog…

Jeff C

[Canoeyawl]

Don’t let him near your dog…

Jeff C

or your museum grade kayak