The Dismantling of ObamaCare - Ongoing Updates.

[nylife11023]

Insurance and inherent tax advantages shifted payment from people's pocket to insurance. People quit looking at procedure price. They also don't consider price of insurance because they never see it.

If you factor out the human element and just look at healthcare as an economic model, IF there was no insurance... i.e. no huge pile of "never ending money" to pay for health care, some say that something like an appendectomy would cost $1500 and not $5000. The free market would bring costs way down.

Of course we would probably not have any of the lifesaving machinery like CAT/MRI devices. No one would spend the money to develop them because the hospitals would not buy them because it would take too long to break-even on the purchase without being able to bill insurance for $1500 a pop for a scan. Same goes with pharma.

From a political model, it seems to me that eventually we will go to a single-payor system... as only the governments (state/federal) have the ability to collect (or print) the pile of money needed to feed the healthcare beast... or they are the only entities that could control costs and thus the premiums (extra taxes) to pay those costs.

I could see a dual platform such as the UK has, but I don't see any plan that involves ONLY the profit interests of the private sector as being sustainable.

The first steps are being taken with the the idea of letting Medicare negotiate the price they will pay for pharma or perhaps a specific formulary.

The new administration has the best chance in a decade to change the direction of health care delivery and costs. If they can resist the campaign cash from the medical and insurance sectors, maybe we can get something that is sustainable. Otherwise we are going to get screwed again, like we were with ACA.

Time will tell.

 

[somarco]

I have a friend that work at Kroger. He has rich benefits but when asked would prefer cash.

Your friend sounds like a loser.

 

[tonyisme]

Edit: We currently paying for the uninsured by letting them go to the ER and loading the cost onto those with insurance. Switching to a payroll tax would give them better, cheaper access and make them pay something.


Have to agree with this except there's a whole Underground economy where there's no payroll and they're still going to go to ER and go to the hospital and sometimes they even use another name. They in the millions

 

[somarco]

As you noted, payroll taxes allow some to avoid taxation. Consumption taxes touch everyone. Sales taxes. Ad valorem taxes are another form although the compounding effect can super-inflate the final cost, depending on how many steps are in the process.

The problem with giving DC another tax resource is we know they will not use the revenue judiciously. They never do. No accountability.

 

[lukifer]

"Health Spending per person
U.S. $9451
Canada $4609
France $4407
Germany $5,267
U.K. $4,003 but has more problems- Physicians work for govt
Per OECD 2016 data

No co-pays or deductibles."

BS. Canada still has cost shares on Rx and treatment. Prices may be lower on pharmacy, but if I'm getting slapped with a high income tax for "free" healthcare... it better be free. Copays and Coinsurance are still a thing up there.

"Doctors and hospitals don't need large billing staffs and there are no bad debts. Opinion polls show well liked by Canadians. No advertising, no insurance company execs to pay or profit to shareholders. No commissions for sales."

Shocking.... people like stealing other people's money for their own needs? Say it ain't so. People don't like being responsible for their health and expect someone else to fund it, building a societal entitlement? Shocking.

"Health outcomes from most reports are better in Canada and in many countries vs. the U.S."

Explains why rich and powerful Canadians come to the US for treatment. Prime Minister went to Miami for heart surgery few years back... speaks volumes to the access of quality care in the " free" system.

"In most provinces drugs are not covered and many get private Rx insurance. However, drug prices in Canada are far lower than in the U.S. Many U.S. folks order their drugs from Canadian Pharmacies which have controls and standards that many consider as high as in the U.S."

Far lower for certain drugs. Pharma just raises the prices elsewhere to offset these government controls. Econ 101.

"Just as an example, If us older guys need a lift ... I get Sildenafil from Canada, manufactured in Canada under strict Canadian drug manufacturing rules for $3.30 each vs U.S. Walgreens "value priced" at $21.00 each. Exactly the same drug. Fortunately, I don't need any other drugs for medical issues to compare."

I never understood why the weiner meds were such a big deal. Buying from India is even cheaper. Canada isn't the Mecca for cheap meds.

"The biggest negative in Canada is long wait times for non-emergency surgeries. For example, in Toronto, the average wait time for hip replacement surgery is about 200 days. "

A big f'in negative. My brother in laws mom had to go 2 years with a colostomy bag for a service that could have been performed in weeks in the States. Quality of life on the socialized health platform isn't a big deal it seems. She eventually died not too long ago waiting on a list for another "non-emergency" procedure that happened to be needed.

"As one report claims: Health care delivery in Canada is superior to the American market approach in its efficiency of delivery. In the USA, 13.6 per cent of GNP is used on medical care. By contrast, in Canada, only 9.5 percent of GNP is used on the health care system, in part because there is no profit incentive for private insurers. The delivery system eliminates much of the advertising that is prominent in the USA, and the low overall administrative costs. Since there are no means tests and no bad-debt problems for doctors under the Canadian system, doctors billing and collection costs are reduced to almost zero."

One report claims? I can show you a dozen economic books that proves their model is flawed, would people actually care? No. They will end up swallowing this "one report" funded by government propaganda dollars and wave their flag while on a death list.

"On average doctors in Canada earn just slightly less than the U.S. average, but don't have to hire as many administrative folks, Don't pay for employee medical insurance and their E&O cost is much less than in the lawsuit happy U.S."

Yep... I want my doctor to care more about the interests of his employer (the government) rather than my own medical needs. And E&O is less because they carry a high level of immunity to lawsuits as they are glorified state employees.

I get it. You want things for free. Sadly, nothing is truly free, especially personal responsibility.

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I don't get why this is such a puzzling concept.

Treat health like auto. Class the people based on their risk and write them in standard, nonstandard, and so forth.

When was the last time my auto insurance paid for my preventative maintenance or repairs due to my normal wear and tear? Why should health insurance be any different?

 

[somarco]

Treat health like auto. Class the people based on their risk and write them in standard, nonstandard, and so forth.

When was the last time my auto insurance paid for my preventative maintenance or repairs due to my normal wear and tear? Why should health insurance be any different?

That has been my argument for years, even predating Obamacare.

The problem with that approach is using logic and fact in an attempt to prove your point to the left. Their views are based on emotion and completely void of logical, fact driven opinion.

 

[junkman]

As you noted, payroll taxes allow some to avoid taxation. Consumption taxes touch everyone. Sales taxes. Ad valorem taxes are another form although the compounding effect can super-inflate the final cost, depending on how many steps are in the process.

The problem with giving DC another tax resource is we know they will not use the revenue judiciously. They never do. No accountability.

Those in the underground economy don't file taxes or if they do, are low income many below the ACA cut off and not ACA eligible. My concern is for those that a) don't have access because of underwriting, b) don't have money, access limited and expensive healthcare at the ER and load their cost onto others insurance premium. My concern with b) is that it is expensive and lousy care.

Everyone has to contribute. The left wants to give everything away and the right acts plain mean. A middle road is to teach a person to fish but acknowledge that some have never seen a fishing pole, don't know how to use one, don't own a pole and might not even know that there are fish in the water.

Those with money always have better everything. That's what money buys - more. Greedy self interest is a great motivator that makes us productive. I have an issue when greedy self interest leads the very greedy to do **** that shouldn't be done. Blowing the tops off mountains to get coal is one example. Yes, it can be done but it is wrong on its face.

With healthcare, people need access and need to pay. I was looking at claims for a 800 member group. The top 5% of people had 40% of the claims. Most were single large hits where the people either recovered and claims dropped or they died.

The bottom 60% had claims under $2,500 and 80% were under $5,000. That claims structure is manageable and doesn't necessitate underwriting. It does require participation of both the healthy and sick in 1 pool.

Consumption tax is only collected at the sales counter and avoided by those that don't consume. TN for example uses a gas tax to pay for roads and the geniuses, Republicans in this case, want to penalize those driving fuel efficient cars because they aren't paying enough road tax. So much for smaller government.

Payroll tax is collected when the money comes in (or quarterly) and can be extracted from all who are not under ground. It can also be structured so that it is not avoided by those who don't consume all of their income.

My premium payment limit is $1,000/month. I went to the highest HDHP plan when HSAs first came out and max funded the HSA with the premium difference. This year's premium went to $1,717 for a $6,400 OOP and I bailed to underwritten HDHP and STM. Unless I have an accident, medical claims for the family will be <$1,000. I'd pay the $1,000 under any plan so that isn't a cost consideration. This is the 1st year in 30 that I have what I consider crappy coverage. The alternative was slightly less crappy coverage at much higher premium. We'll see what next year brings. I've seen nothing good on the horizon. Where is the Republican plan? ACA didn't have enough teeth.

Edit: Regardless of what happens, there has never been a decent strategy to reduce trend. It has run at 8-10% for years. PPOs don't stop it, gate keepers don't. Probably nothing will until procedure price is paid by the consumer out of pocket. Then, price matters.

I can find the price of a trip to the moon but not the cost of a hip replacement. WTF!!

 

[somarco]

Everyone has to contribute.

and

Consumption tax is only collected at the sales counter and avoided by those that don't consume.

Are contradictory. Who do you know that does not consume anything at all?

Dead voters don't count.

there has never been a decent strategy to reduce trend.

If you believe this then you really have no clue how health care and health insurance interact.

But then, you prove that with almost every post.

 

[lukifer]

Who do you know that does not consume anything at all?

Dead voters don't count.

"Dead Voters Don't Count"... my new campaign slogan...

The fact is.... those who make more, consume more. Those who make little consume the least. Basic, simple common sense.

You see, Economics is a subject every entitled troglodyte out there failed to either take, understand, or stay awake through. Guess it isn't required in order to get your BA in "HappyFuzzyBunnyAndUnicornFartology" these days.

 

[VolAgent]

"Dead Voters Don't Count"... my new campaign slogan...

The fact is.... those who make more, consume more. Those who make little consume the least. Basic, simple common sense.

You see, Economics is a subject every entitled troglodyte out there failed to either take, understand, or stay awake through. Guess it isn't required in order to get your BA in "HappyFuzzyBunnyAndUnicornFartology" these days.

Yes, but....

Those who make less generally consume a greater percentage of their income while those who make more generally save and avoid any consumption tax. Without exclusions or other alterations, any form of consumption tax tends to fall heaviest on lower income people.

If that isn't a problem, great. If it is a problem, then you have to do something to handle that situation.

I believe Tennessee is one of the few states that charges sales tax on groceries. Until the early 2000s it was the full tax. Slowly it has been reduced to 5% from the state, versus 7% otherwise, plus whatever local tax is charged. 7.25% here locally on groceries. Obviously it is not charged on any type of government assistance.

So that is a bit of a fallacious argument. It all depends on which you want to measure, total taxes paid or taxes paid as a percentage of income.