Our terrible health insurance

[Audrey]

I should also mention that when we had individual health insurance (10+ years ago), we were paying $900/month, had $20-$100 copays (depending), and something like a $5000 deductible.  No prescription coverage and no mental health.  And this was for four people with the adults being well under 50.  Oh, and an autism diagnosis was considered a disqualifying condition (and I was dreading having to change insurance--which we had to do every two years to reduce the premium to an "affordable" level--because my son had just gotten an autism diagnosis).

 

So the OP's insurance seems to be better than that.

 

I realize that your numbers in this post aren't everyone's costs, but I just want to use this as a jumping off point.  I'm just going to use your deductible and premiums for healthcare which add up to $15,800 per year.  Between dh and I together, we make a modestly comfortable income and what we pay combined in federal tax, provincial tax (and we're in a high tax province), CPP (like your social security) and EI (employment insurance), does not add up to $15,800.  And for that, we get healthcare with no co-pays AND all other government services.

[displace]

The problem with one state doing it alone is that they miss out on much of the money that will come from the whole country doing it, such as

Federal tax exemption for employer and employee health insurance premiums

Federal tax exemption for health savings and flexible spending accounts

Administrative costs for the variety of federal programs, including VA, Tricare, Medicaid, Medicare, etc.

 

Plus, if one state isn't getting really adequate funding to implement it because they can't really tap into some of the areas of huge savings, it's likely that the reimbursement rates would be low and might cause doctors to move to another state, thus worsening access to providers.

National healthcare would also hopefully decrease the profit drivin insurance model. Likely not eliminate it, but put more standards on costs and payments for medicines, procedures, etc.

 

Insurance companies are for profit.

[displace]

I realize that your numbers in this post aren't everyone's costs, but I just want to use this as a jumping off point. I'm just going to use your deductible and premiums for healthcare which add up to $15,800 per year. Between dh and I together, we make a modestly comfortable income and what we pay combined in federal tax, provincial tax (and we're in a high tax province), CPP (like your social security) and EI (employment insurance), does not add up to $15,800. And for that, we get healthcare with no co-pays AND all other government services.

Plus we pay national taxes, some of which support Medicaid/Medicare.

[Laura Corin]

 

 

But those of us who rely on good private insurance should not be forced to give that up in the name of universal healthcare.

It's entirely possible to have both.  Many people in the UK have private top-up to their NHS care.

[Melissa in Australia]

It's entirely possible to have both. Many people in the UK have private top-up to their NHS care.

Same in Australia

[Carrie12345]

As an aside, my plan technically has "unlimited mental health" benefits.

My co-pay is higher than our therapists' fees.  Think about that for a second!

[kewb]

I don't want to pay more in taxes for worse healthcare than my family has now.

 

I don't mind paying somewhat more in taxes to expand Medicaid to all low-income folks and to subsidize the reimbursement of deductibles & out-of-pocket maximums for moderate income folks (and not just those on the exchanges). No problem either with only allowing non-profit organizations & member co-ops to sell health insurance to eliminate the profiteering off of insurance.

 

But those of us who rely on good private insurance should not be forced to give that up in the name of universal healthcare.

Ah, yes, the one system for the wealthy and the other system for everyone else. This model is what we have now. Where funding is constantly cut to the poor programs to help the wealthy. If everyone has the same insurance and those with means are no longer able to skip the line then they will be spending their energy and political clout making sure the program is well funded. Right now, Medicaid doesn't serve the wealthy. The payment rates are low and many doctors refuse to see medicaid patients. Efforts to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. When the wealthy skip ahead it makes the waits longer for everyone else. The creation of a private,parallel system for the wealthy or those able to afford it creates a lobby to fight for underfunding public care which results in increases for demand for private care.

[Pawz4me]

I don't want to pay more in taxes for worse healthcare than my family has now.

 

I don't mind paying somewhat more in taxes to expand Medicaid to all low-income folks and to subsidize the reimbursement of deductibles & out-of-pocket maximums for moderate income folks (and not just those on the exchanges). No problem either with only allowing non-profit organizations & member co-ops to sell health insurance to eliminate the profiteering off of insurance.

 

But those of us who rely on good private insurance should not be forced to give that up in the name of universal healthcare.

 

 

I know from prior posts that you strongly identify as a Christian. And I'd sincerely like to understand how you square the above with the teachings of Christ? I'm not trying to start an argument; I don't have the energy for debating right now. I'd just like to understand. Because I totally do not.

[QueenCat]

I should also mention that when we had individual health insurance (10+ years ago), we were paying $900/month, had $20-$100 copays (depending), and something like a $5000 deductible.  No prescription coverage and no mental health.  And this was for four people with the adults being well under 50.  Oh, and an autism diagnosis was considered a disqualifying condition (and I was dreading having to change insurance--which we had to do every two years to reduce the premium to an "affordable" level--because my son had just gotten an autism diagnosis).

 

So the OP's insurance seems to be better than that.

 

I think that was before the mental health parity laws went into effect. And now, with ACA, autism wouldn't be a disqualifying condition.

[Twolittleboys]

Okay, I just don't get this. I was looking at the spin-off thread about deductibles and it just is crazy! I am not going to say that our health care system in Europe is perfect - I am sure it could be improved on. But surely anyone can see that the US style is horrible and needs more than a bit of tweaking? How difficult could it be to have a group of politicians and experts sit down, look at what works in other countries and what doesn't, adjust for cultural differences, and come up with a decent alternative? Obviously, it is a complex issue so that alternative likely wouldn't be perfect but then would be time for tweaking it.

 

 

I don't want to pay more in taxes for worse healthcare than my family has now.

 

I don't mind paying somewhat more in taxes to expand Medicaid to all low-income folks and to subsidize the reimbursement of deductibles & out-of-pocket maximums for moderate income folks (and not just those on the exchanges). No problem either with only allowing non-profit organizations & member co-ops to sell health insurance to eliminate the profiteering off of insurance.

 

But those of us who rely on good private insurance should not be forced to give that up in the name of universal healthcare.

That is not how it works. Yes, obviously with universal healthcare the healthy and wealthy subsidize the rest of the population. But a) these population groups are not fixed (i.e. healthy people get unwell, poor people can get rich etc.), b) it is the Christian/ethical/right thing to do and c) overall costs are much lower (based on what I hear the costs for simple procedures in the US are).

 

But at least in Germany (and probably most countries) there are private alternatives. If you make over a certain amount of money you can leave the public insurance and join a private insurance plan (which provides some additional benefits and lower cost for some but higher cost for others). And of course there are various additional insurance policies that you can take out to cover stuff (e.g. a single room at the hospital, some fancy doctors etc.).

 

Here, employees pay about 8% of their income for health insurance (the employer matches the amount). Self-employed workers pay twice that (so around 16 %). However, there is an upper limit so no employee pays more than around $350 (self-employed $700). Spouses without income and minor children are covered without extra pay. So for a family with two adults (one empoyed by a company, the other has no income) and three kids the total cost per month would be no more than $350. There are no deductibles and little co-pays (I think §15 or so for medicines, a small amount for hospital stays etc.).

 

I am not saying the US should (or could) use the exact same system (which does have problems as well) but surely something similar could be developed? I would say benefits / medical services are probably comparable to the US. And if you need better insurance you could always supplement with additional coverage.

[EKS]

I think that was before the mental health parity laws went into effect. And now, with ACA, autism wouldn't be a disqualifying condition.

 

Yes--it was before all of that.

[Guest]

Okay, I just don't get this. I was looking at the spin-off thread about deductibles and it just is crazy! I am not going to say that our health care system in Europe is perfect - I am sure it could be improved on. But surely anyone can see that the US style is horrible and needs more than a bit of tweaking? How difficult could it be to have a group of politicians and experts sit down, look at what works in other countries and what doesn't, adjust for cultural differences, and come up with a decent alternative? Obviously, it is a complex issue so that alternative likely wouldn't be perfect but then would be time for tweaking it.

 

 

That is not how it works. Yes, obviously with universal healthcare the healthy and wealthy subsidize the rest of the population. But a) these population groups are not fixed (i.e. healthy people get unwell, poor people can get rich etc.), b) it is the Christian/ethical/right thing to do and c) overall costs are much lower (based on what I hear the costs for simple procedures in the US are).

 

But at least in Germany (and probably most countries) there are private alternatives. If you make over a certain amount of money you can leave the public insurance and join a private insurance plan (which provides some additional benefits and lower cost for some but higher cost for others). And of course there are various additional insurance policies that you can take out to cover stuff (e.g. a single room at the hospital, some fancy doctors etc.).

 

Here, employees pay about 8% of their income for health insurance (the employer matches the amount). Self-employed workers pay twice that (so around 16 %). However, there is an upper limit so no employee pays more than around $350 (self-employed $700). Spouses without income and minor children are covered without extra pay. So for a family with two adults (one empoyed by a company, the other has no income) and three kids the total cost per month would be no more than $350. There are no deductibles and little co-pays (I think §15 or so for medicines, a small amount for hospital stays etc.).

 

I am not saying the US should (or could) use the exact same system (which does have problems as well) but surely something similar could be developed? I would say benefits / medical services are probably comparable to the US. And if you need better insurance you could always supplement with additional coverage.

Regarding the first paragraph, no, not everyone sees the need for change. There are those lucky few who, momentarily, have good insurance through their employer. I used to be one of those lucky people. But that number is shrinking. Even big companies are cutting back on benefits. Unfortunately, politicians will continue to vote themselves amazing benefits so they will not be the ones to lead the change. It is going to take more of the have-nots rising up and demanding change.

[displace]

I would anticipate costs of a national health care system (ETA - in the US) would be higher than any one country in Europe. Just logistically with more people and more rural areas, costs could skyrocket. But I'm not well versed in the finances involved personally. Experts think total personal costs would be reduced from current rates.

Edited July 27, 2017 by displace

[displace]

Regarding the first paragraph, no, not everyone sees the need for change. There are those lucky few who, momentarily, have good insurance through their employer. I used to be one of those lucky people. But that number is shrinking. Even big companies are cutting back on benefits. Unfortunately, politicians will continue to vote themselves amazing benefits so they will not be the ones to lead the change. It is going to take more of the have-nots rising up and demanding change.

Also, health insurance lobbies to politicians as well. So, if a politician is getting a ton of free perks from Insurance company A, why not vote to help them out a bit?

[justasque]

I would anticipate costs of a national health care system (ETA - in the US) would be higher than any one country in Europe. Just logistically with more people and more rural areas, costs could skyrocket. But I'm not well versed in the finances involved personally. Experts think total personal costs would be reduced from current rates.

 

We are not more rural than Canada, which has an excellent national health care system, in my extended family's experience.

And while we have more people needing treatment, we also have more people paying in to the system.  While the US has worse health outcomes in some categories than other Western countries, some (most?) of that is due to the inability to afford to see a doctor or to buy needed medicines due to lack of health insurance.

[AmandaVT]

The State of Vermont was on the way to Universal Health care a few years ago. When they discovered the true budget for that they dropped the idea. Now California is trying for a way to do that. If and when one of the states can do that successfully the Federal Gov. might use their model for a national plan. Having expensive insurance and not being able to afford medical care is sad.

 

Sent from my SM-G355M using Tapatalk

 

Vermont is really close to universal coverage now. We have about 97% of people covered. Still hoping we implement single payer at some point. Our new governor has been contacting other governors about a New England Health Care Coalition and I hope they work together to figure something out.

[goldberry]

I would anticipate costs of a national health care system (ETA - in the US) would be higher than any one country in Europe. Just logistically with more people and more rural areas, costs could skyrocket. But I'm not well versed in the finances involved personally. Experts think total personal costs would be reduced from current rates.

 

I think we would most certainly see some outrageous costs at the beginning.  They would finally have to address the doctor shortage, schooling bottlenecks, lack of access in rural areas.  I would imagine at least five years, and maybe five to ten as an adjustment period before it leveled out.

 

Which is why cynical me thinks it probably would never work. There would be people screaming the first year, and the next set of politicians would probably be elected specifically to intervene.  There would be a whole set of people who wouldn't take time to educate themselves about it.   It wouldn't matter that it was part of a plan, there would be another set of people willing to exploit it so they could to get elected, to get power, to make gains for themselves.  We have a problem in America with short-sightedness.  I actually heard one person say the only time they pay attention to politics is when gas prices go up. ??  

 

I still maintain it's about priorities.  Honestly, when I look at what is proposed to add to our defense budget, which not everyone believes is underfunded, that amount seems "outrageous" to me.  Not many people are too concerned though. Similar amounts spent on a healthcare system for all Americans? People are horrified!  It's about how much we value something.  (No, I am not saying defense should not be a priority.  I am saying healthcare should be.)  What qualifies as "outrageous" is most certainly subjective.

[Twolittleboys]

Regarding the first paragraph, no, not everyone sees the need for change. There are those lucky few who, momentarily, have good insurance through their employer. I used to be one of those lucky people. But that number is shrinking. Even big companies are cutting back on benefits. Unfortunately, politicians will continue to vote themselves amazing benefits so they will not be the ones to lead the change. It is going to take more of the have-nots rising up and demanding change.

Well, I do understand that you may not want change if you have great coverage via an employer. Actually, when I lived in the US, my insurance coverage was similar to what I have in Europe and the monthly payments were much lower. However, I would hope that a good portion of these people would understand the basic need and be willing to pay a bit more. But more importantly, when looking at the other thread about deductibles, it seems that very few have insurance plans that are better (or even similar) to what we have. Not sure if this board is too dissimilar to the general population to base any conclusions on though. I mean I do understand self-interest, but how many people really have a great, inexpensive plan (50%, 20%, 10%?)

 

 

 

I would anticipate costs of a national health care system (ETA - in the US) would be higher than any one country in Europe. Just logistically with more people and more rural areas, costs could skyrocket. But I'm not well versed in the finances involved personally. Experts think total personal costs would be reduced from current rates.

I am not expert on health care (at all) but I am not sure this is true. The total number of people shouldn't make a difference. The important question would be more how ages (i.e. how many pay and how many are too young or old to pay & obviously older people as a whole have higher health costs) and income (e.g. just 1% rich people having to pay for 40% poor people is more difficult than 30% rich paying for 10% poor) are distributed. I am also not sure whether rural areas would have much of an impact?

 

I do think a huge problem must be the cost structure in the US. Sometimes, people post on Facebook what their medical bills would have been without insurance and the amounts are just crazy. I remember someone getting their appendix out and the cost was about three or four times as much as hospitals in Germany would get from insurance.

 

Again, our system isn't perfect (I am just using it for comparison as I am most familiar with it). But surely a group of experts should be able to come up with some sort of plan that would cover at least the more basic insurance needs of everyone at a cost that is reasonable as it clearly gets done in many other countries.

[caedmyn]

One thing I have not seen discussed here, for those who consider themselves Christians, are the Christian healthcare-sharing plans.  There are a a few different ones, ranging from essential ly catastrophic care that's super cheap (I think it would be $135/mo for our family) to what I consider great coverage for under $500/mo.  They do exclude pre-existing conditions (at least the one we're on does) and have no mental health coverage or coverage for something like OT or speech therapy, and there's not a lot of prescription coverage.  Ours has worked well for us.  It's got a $300 per incident deductible.  So a regular doctor's visit like a well-check wouldn't be covered at all, but everything after the first $300 for my 4 YO's reflux (including the original visits to the pediatrician, labs, medical procedures, and specialist visits) is eligible, plus any self-pay discounts apply to that $300.  We'd be paying something like $1000/mo for the cheapest catastrophic coverage I can find, with something like a $10,000 deductible (DH is self-employed).  You do have to self-pay and submit the forms yourself.

Something like that isn't a viable option for everyone, but might be for some who aren't happy with or can't afford their current healthcare plans.

[goldberry]

One thing I have not seen discussed here, for those who consider themselves Christians, are the Christian healthcare-sharing plans.  There are a a few different ones, ranging from essential ly catastrophic care that's super cheap (I think it would be $135/mo for our family) to what I consider great coverage for under $500/mo.  They do exclude pre-existing conditions (at least the one we're on does) and have no mental health coverage or coverage for something like OT or speech therapy, and there's not a lot of prescription coverage.  Ours has worked well for us.  It's got a $300 per incident deductible.  So a regular doctor's visit like a well-check wouldn't be covered at all, but everything after the first $300 for my 4 YO's reflux (including the original visits to the pediatrician, labs, medical procedures, and specialist visits) is eligible, plus any self-pay discounts apply to that $300.  We'd be paying something like $1000/mo for the cheapest catastrophic coverage I can find, with something like a $10,000 deductible (DH is self-employed).  You do have to self-pay and submit the forms yourself.

 

Something like that isn't a viable option for everyone, but might be for some who aren't happy with or can't afford their current healthcare plans.

 

We are in one right now, because it is all we can afford.  It has worked okay for us.  But I recognize that while it is working for us right now, it has some concerning gaps, and doesn't help all those who don't qualify for whatever reasons.  Part of the reason it is affordable is because of the people it can exclude.  

 

It is time there was an affordable option for everyone.  Not just low income, not just middle class, not just Christian, not just healthy people.  The current plan to go back to allowing insurance to exclude certain groups of people or entire conditions, just so it can be affordable for other healthy people, doesn't solve the problem.  It just shifts it to a more vulnerable population.

 

I agree the healthshares are a good solution for some people on an individual level.  

[goldberry]

Which is just one more reason why tethering health insurance to employment is untenable. It stifles innovation and ties people to jobs that are no longer a good fit for them.

 

Yes, there is a current attitude of "If you don't have good health insurance, just find a job that has it!"

 

First, there are less and less companies offering it period.  Second, companies that do offer are cutting back, offering higher deductible plans with higher copays.  And third, isn't GROWTH OF NEW BUSINESS what we want in our economy??  Isn't small business supposed to be good for America?  We're supposedly cutting taxes and regulation to ENCOURAGE businesses, remove the burden that keeps small businesses from opening and growing.  But at the same time, we have a system where healthcare is only affordable for those who work for large companies?  

 

Nope, don't buy it.  If the government wants to encourage entrepreneurship, it needs to get serious about healthcare.

[TechWife]

I think that was before the mental health parity laws went into effect. And now, with ACA, autism wouldn't be a disqualifying condition.

 

Mental health parity laws only mean that if a policy covers mental health issues, they must be covered under the same deductible and at the same rate of other covered services. Since ACA now requires mental health coverage, the provision that it must be covered at the same rate is the important part that kicks in. Prior to ACA, our policy covered mental health at 50%, now it is covered at 80% like all other medical services. 

[Twolittleboys]

As far as tethering health care to jobs, this clearly leads to different risk pools which is good for some (e.g. I am pretty sure that was why my cost was so low 15+ years ago as almost everyone in the company was young (under 35) and educated) but not for others. As soon as you have more older workers you are in trouble, not to mention any professions that either are riskier or just wear on the body more.

 

The best way to make costs affordable for everyone is to spread it over as many people as possible.

 

I do think this is an urgent problem and I think to make it work, everyone will have to give a bit. It might be best to exclude some areas in the beginning to lower costs and stay off touchy areas. Sure, this would still mean that people had out of pocket costs but at least everyone would have some basic coverage. And once the system works, there is no reason it couldn't be adjusted slowly.

[Frances]

Regarding the first paragraph, no, not everyone sees the need for change. There are those lucky few who, momentarily, have good insurance through their employer. I used to be one of those lucky people. But that number is shrinking. Even big companies are cutting back on benefits. Unfortunately, politicians will continue to vote themselves amazing benefits so they will not be the ones to lead the change. It is going to take more of the have-nots rising up and demanding change.

Many of the "haves" are also demanding change.

[goldberry]

Many of the "haves" are also demanding change.

 

It's like the civil rights movement in that way.  A good portion of the people who are not being directly affected have to stand up for the rights of everyone.  It's harder with this, though, because that means an actual hit in the pocketbook for some, not just standing up in principle!  In other words, having to put your money where your mouth is! ;)

[QueenCat]

Mental health parity laws only mean that if a policy covers mental health issues, they must be covered under the same deductible and at the same rate of other covered services. Since ACA now requires mental health coverage, the provision that it must be covered at the same rate is the important part that kicks in. Prior to ACA, our policy covered mental health at 50%, now it is covered at 80% like all other medical services. 

 

Thank you for clarifying that..... we've never had a policy that didn't cover mental health so I guess I missed that part of it. That's actually pretty significant. And scary, as that could easily go away.

[Guest]

I think we would most certainly see some outrageous costs at the beginning. They would finally have to address the doctor shortage, schooling bottlenecks, lack of access in rural areas. I would imagine at least five years, and maybe five to ten as an adjustment period before it leveled out.

 

Which is why cynical me thinks it probably would never work. There would be people screaming the first year, and the next set of politicians would probably be elected specifically to intervene. There would be a whole set of people who wouldn't take time to educate themselves about it. It wouldn't matter that it was part of a plan, there would be another set of people willing to exploit it so they could to get elected, to get power, to make gains for themselves. We have a problem in America with short-sightedness. I actually heard one person say the only time they pay attention to politics is when gas prices go up. ??

 

I still maintain it's about priorities. Honestly, when I look at what is proposed to add to our defense budget, which not everyone believes is underfunded, that amount seems "outrageous" to me. Not many people are too concerned though. Similar amounts spent on a healthcare system for all Americans? People are horrified! It's about how much we value something. (No, I am not saying defense should not be a priority. I am saying healthcare should be.) What qualifies as "outrageous" is most certainly subjective.

Oh we can cut out defense budget and make it work. I bet Japan and Germany would just love that - sorry guys, we wanted to mirror you and spend less on defense and more on healthcare. Have fun maintaining your own militaries again. Sayonara NATO and foreign bases.

 

That's about the only way to do it without increasing the fee burden, we will have to shift it from one tax designation to another or costs will far exceed what you see in NHS and such. I suppose I'm fine leaving a bunch of places to fend for themselves on some level, but the consequences won't be pretty if that much of a power vacuum is created in the name of US healthcare. It's a lot more fair for our populations, though.

[regentrude]

Oh we can cut out defense budget and make it work. I bet Japan and Germany would just love that - sorry guys, we wanted to mirror you and spend less on defense and more on healthcare. Have fun maintaining your own militaries again. Sayonara NATO and foreign bases.

 

That's about the only way to do it without increasing the fee burden, we will have to shift it from one tax designation to another or costs will far exceed what you see in NHS and such. I suppose I'm fine leaving a bunch of places to fend for themselves on some level, but the consequences won't be pretty if that much of a power vacuum is created in the name of US healthcare. It's a lot more fair for our populations, though.

 

I don't buy the argument that going to a universal coverage inevitably has to increase price. In the current dysfunctional system, the US health care spending per capita is much higher than that of other developed countries. Somehow, the others manage to have universal coverage and spend significantly less.

 

http://www.pgpf.org/chart-archive/0006_health-care-oecd

http://www.kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/

 

and we have much less to show for it in terms of life expectancy

https://www.forbes.com/sites/danmunro/2017/07/04/single-payer-healthcare-isnt-necessary-but-single-pricing-is/#29297225e0e3

Edited July 27, 2017 by regentrude

[scholastica]

As far as tethering health care to jobs, this clearly leads to different risk pools which is good for some (e.g. I am pretty sure that was why my cost was so low 15+ years ago as almost everyone in the company was young (under 35) and educated) but not for others. As soon as you have more older workers you are in trouble, not to mention any professions that either are riskier or just wear on the body more.

 

The best way to make costs affordable for everyone is to spread it over as many people as possible.

 

I do think this is an urgent problem and I think to make it work, everyone will have to give a bit. It might be best to exclude some areas in the beginning to lower costs and stay off touchy areas. Sure, this would still mean that people had out of pocket costs but at least everyone would have some basic coverage. And once the system works, there is no reason it couldn't be adjusted slowly.

Yes it does create bigger risk pools which helps. Wouldn't it be better if we had a 300 million + person risk pool? Yes, one would pay for more than one use if one is young and healthy, but one won't always be and one will benefit later. We could have the biggest risk pool in the world and share the burden.

[ChocolateReignRemix]

I don't buy the argument that going to a universal coverage inevitably has to increase price. In the current dysfunctional system, the US health care spending per capita is much higher than that of other developed countries. Somehow, the others manage to have universal coverage and spend significantly less.

 

http://www.pgpf.org/chart-archive/0006_health-care-oecd

http://www.kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/

+1

There will be a reallocation of costs from insurance premiums to taxes to support a national healthcare model, but there is no reason to believe the total per capital expenditure needs to be higher than it is now.

[Carol in Cal.]

+1

There will be a reallocation of costs from insurance premiums to taxes to support a national healthcare model, but there is no reason to believe the total per capital expenditure needs to be higher than it is now.

It might not need to be, but it would be.  Because any excuse will do.  And because there is nothing in any of these proposals to go after the cost issue, except care rationing.

Edited July 27, 2017 by Carol in Cal.

[LucyStoner]

It is interesting that you have had such trouble filling out paperwork for Medicaid.....I live in OK and dh and I qualified for a form of Medicaid (for low income adults) earlier in the year when he was out of work.....It was an on line application that took about 15 minutes total.  I didn't even have to send any documentation in.  

 

 

Given the attitudes in Texas, I wonder if all the paperwork is in place to discourage applicants?

 

Yes, Texas does make it intentionally difficult.  I was born there, have family there.  It's frustrating by design.  

[Laura Corin]

It might not need to be, but it would be. Because any excuse will do. And because there is nothing in any of these proposals to go after the cost issue, except care rationing.

You can substantially reduce drug costs by bargaining if you are a big buyer, like a state or a country.

[scholastica]

You can substantially reduce drug costs by bargaining if you are a big buyer, like a state or a country.

Except that the pharmaceutical companies have it written into Medicare laws here that the federal government can't negotiate on behalf of its beneficiaries.

[Crimson Wife]

National healthcare would also hopefully decrease the profit drivin insurance model. Likely not eliminate it, but put more standards on costs and payments for medicines, procedures, etc.

 

Insurance companies are for profit.

 

You don't get "cost control" without rationing. Right now we've got rationing by high pricetags (not a good situation) but single payer rations by denying care outright. My daughter would not have been eligible for her cochlear implant under the very strict eligibility criteria in place in countries with single payer like the UK. I don't like the deductible and cost share of our current private insurance but at least we can get the care that has really benefited our child.

 

[Crimson Wife]

I know from prior posts that you strongly identify as a Christian. And I'd sincerely like to understand how you square the above with the teachings of Christ? I'm not trying to start an argument; I don't have the energy for debating right now. I'd just like to understand. Because I totally do not.

 

I strongly believe in helping the poor, which is why I would be fine with paying somewhat higher taxes in order to expand Medicaid. I would be strongly in favor of a junk food tax with the profits dedicated to health care. But please show me where in the Bible it says that Christians have to believe in socialized medicine run by the government.

 

[Jen500]

You don't get "cost control" without rationing. Right now we've got rationing by high pricetags (not a good situation) but single payer rations by denying care outright. My daughter would not have been eligible for her cochlear implant under the very strict eligibility criteria in place in countries with single payer like the UK. I don't like the deductible and cost share of our current private insurance but at least we can get the care that has really benefited our child.

 

I understand that you have good health insurance/medical care now...(so you don't seem to care about those others who don't), but what about the future of your children? Don't you worry about them getting medical care when they are adults and on their own, without your insurance?

[Crimson Wife]

I understand that you have good health insurance/medical care now...(so you don't seem to care about those others who don't), but what about the future of your children? Don't you worry about them getting medical care when they are adults and on their own, without your insurance?

 

I definitely DO care. I just think that we can improve the situation without dumping private health insurance entirely. I am in favor of expanding Medicaid to all low-income citizens and subsidizing the reimbursement of deductibles and out-of-pocket costs for moderate income folks. I would support raising taxes for that purpose. I would start with a junk food tax since poor diet causes a lot of health problems and unlike cigarettes and alcohol, there is no "sin tax" on it.

[ChocolateReignRemix]

 My daughter would not have been eligible for her cochlear implant under the very strict eligibility criteria in place in countries with single payer like the UK.

 

 

Wait, so you are saying you researched the criteria for CIs in single payer countries well enough that you know all of their criteria?  Or are you going off of a summery put together by someone else?

[scholastica]

We don't have to dump private health insurance to make it more fair for everyone. If the insurance companies were forced to consider the entire population the risk pool and everyone were required to purchase it and the government could subsidize low income families, it would be a lot more fair. You could probably eliminate Medicaid entirely. The government would just pick up the entire tab for that family.Instead we have huge corporations getting a tax break for providing great insurance at a great rate to their employees. Meanwhile, small businesses get higher and higher premiums if one of their employees gets sick. Individuals have huge premiums and low benefits because they don't happen to have the privilege of working for a big corporation or they own their own businesses.

[Guest]

That harmless little word 'subsidizing' is exactly what jacked the premiums on so many people to begin with. Even those on here with excellent insurance and low costs are seeing it taken out elsewhere in their paycheck. Not to mention the government tends to add twice the cost and half the efficiency to everything from energy to education, and is a poor admin of the existing healthcare they already oversee.

 

There are indeed solutions to the medical access and cost issue. But you're not going to see them coming from the least efficient and least accountable among us.

[Pawz4me]

I strongly believe in helping the poor, which is why I would be fine with paying somewhat higher taxes in order to expand Medicaid. I would be strongly in favor of a junk food tax with the profits dedicated to health care. But please show me where in the Bible it says that Christians have to believe in socialized medicine run by the government.

 

 

I think you very well know that wasn't what I was referring to in my question.

 

But that's okay. I said I wasn't trying to start a debate, and I do appreciate your replying. The attempted deflection/non-answer actually answered my question a lot more than you probably realize.

[LucyStoner]

That harmless little word 'subsidizing' is exactly what jacked the premiums on so many people to begin with. Even those on here with excellent insurance and low costs are seeing it taken out elsewhere in their paycheck. Not to mention the government tends to add twice the cost and half the efficiency to everything from energy to education, and is a poor admin of the existing healthcare they already oversee.

 

 

 

You have a strong bias, and it's showing through in the rhetoric of your post.  Can you offer any specific examples to back up your generalizations?  

[EmilyGF]

I definitely DO care. I just think that we can improve the situation without dumping private health insurance entirely. I am in favor of expanding Medicaid to all low-income citizens and subsidizing the reimbursement of deductibles and out-of-pocket costs for moderate income folks. I would support raising taxes for that purpose. I would start with a junk food tax since poor diet causes a lot of health problems and unlike cigarettes and alcohol, there is no "sin tax" on it.

Hear hear!

 

We were buying milk and ice cream the other day and for some reason the cashier asked me what type of cigarettes I wanted to buy. Just being asked that made my skin crawl, and then my 5-year-old son made some really judgemental comments about people who buy cigarettes. BUT I WAS BUYING JUNK FOOD. â€‹Which we know causes all sorts of health problems. And we talked about that on the walk home.

 

I've pondered how much of a sin tax there would have to be to get me to stop buying junk food. Maybe 5-10 cents/gram of sugar? I think that would make a big difference for me.

 

Emily

[Noreen Claire]

This discussion of whether single-payer will cost more or less than what is already 1/6 of the U.S. economy fails to mention that the reason insurance costs are so high is NOT due to the actual cost of medical services, but due to the fact that insurance companies, many hospitals, drug companies, etc are all FOR PROFIT BUSINESSES. Having a for-profit health care system is an abomination.

[LucyStoner]

A couple of issues with "sin taxes" on junk food.  

 

Let's tax the cheapest food per calorie to pay for...health care for the poor.  Disproportionately tax poor people to fund healthcare for poor people.   :blink:

 

If these sorts of taxes "succeed", revenue from them drops.  Ask states who pinned their state budgets to cigarette taxes how THAT'S working for them these days.  

 

Edited July 27, 2017 by LucyStoner

[MistyMountain]

Vermont is really close to universal coverage now. We have about 97% of people covered. Still hoping we implement single payer at some point. Our new governor has been contacting other governors about a New England Health Care Coalition and I hope they work together to figure something out.

I have been wanting move to New England anyway but I will be packing the bags if they implement a single payer system in New England.

Edited July 27, 2017 by MistyMountain

[goldberry]

Oh we can cut out defense budget and make it work. I bet Japan and Germany would just love that - sorry guys, we wanted to mirror you and spend less on defense and more on healthcare. Have fun maintaining your own militaries again. Sayonara NATO and foreign bases.

 

That's about the only way to do it without increasing the fee burden, we will have to shift it from one tax designation to another or costs will far exceed what you see in NHS and such. I suppose I'm fine leaving a bunch of places to fend for themselves on some level, but the consequences won't be pretty if that much of a power vacuum is created in the name of US healthcare. It's a lot more fair for our populations, though.

 

I'm sorry, can you show me where I suggested cutting our defense budget?  As so many people have pointed out in the Medicare discussions, slowing the rate of growth for something is not the same as cutting it.  :)  But actually I didn't even recommend that.  I merely drew a comparison between what one might consider outrageous versus what one might consider necessary or worth the value.

 

Also, just to clarify regarding the cost of single payer being more expensive, I do think it will be less expensive in the long run.  I was stating that I think there will be a transition period where some necessary things will have to be addressed, and that during that time, there will likely be higher prices before it leveling off.  I don't think saying "it will cost less!" but then we don't see that for a few years will actually prepare people well.  We need to realize it will take a bit, but it will be worth it. 

 

 

[winterbaby]

Hear hear!

 

We were buying milk and ice cream the other day and for some reason the cashier asked me what type of cigarettes I wanted to buy. Just being asked that made my skin crawl, and then my 5-year-old son made some really judgemental comments about people who buy cigarettes. BUT I WAS BUYING JUNK FOOD. â€‹Which we know causes all sorts of health problems. And we talked about that on the walk home.

 

I've pondered how much of a sin tax there would have to be to get me to stop buying junk food. Maybe 5-10 cents/gram of sugar? I think that would make a big difference for me.

 

Emily

 

Five cents per gram of sugar? That would be over eight dollars on a gallon of whole milk. You can't be serious.

 

The problem with taxing "junk food" is one of definition, which in turn is a problem of resources. Everybody thinks they know what it means, but making a scientific definition that the government can enforce, and then vetting every new food product (or every recipe change on existing products) would take a lot of work and money. And the definition would not be uncontroversial. Some people feel that sugar is the bad guy, some people carbs in general, others fat. Whose definition of a healthy diet would be chosen for the foods that would be tax-free? The government has made mistakes about this in the past, recommending a very high carb diet which turned out to be not so great after all. And that was just recommendations - not a penalty for failing to follow them. An attempt to tax people for eating the "wrong" kind of diet would be a bureaucratic and political nightmare.

 

Besides, even foods that we agree are less than ideal can be OK in moderation in the context of a balanced diet. Ice cream is not as harmful as cigarettes. The idea of living in a country where poor children go their whole lives without a bite of ice cream because it's been taxed to the point of effective prohibition sounds nightmarish.

[goldberry]

I have been wants I move to New England anyway but I will be packing the bags if they implement a single payer system in New England.

 

It's nice you have those options.  Most of the people who are in need don't have an option of moving elsewhere for a healthcare system they prefer.