The Obama Presidency - 2008 & 2012

[Arles]

Originally Posted by Flasch186

Whats wrong is that in FL the servers are crashed from all those people who dont want Obamacare.

A lot of people (like myself here in AZ where the servers crashed) just want to see what the options are. But, it's not going to be that much different from what a normal person could get from a broker:

When Obamacare Exchanges Launch, Premiums Will Be Low, Deductibles High - Forbes

If you want a higher deductible plan now ($1500 to $5000 as in many of the exchanges), you can find one for fairly cheap from a broker. Now, the ACA will probably be slightly cheaper because it's subsidized. But, as many have said here, we will be picking up the bill down the road as citizens. The main improvements for the ACA is in allowing those with pre-existing conditions to apply and giving massive subsidies to small businesses and lower income people. Of course, both of those could have been done independently and without threatening employer coverage.

[Flasch186]

I thought competition drives costs down and is better for the consumer? I bees confused by the philosophy.

/sarcasm because I know its really about not having America become Russia and hating Obama.

[Arles]

Originally Posted by Flasch186

I thought competition drives costs down and is better for the consumer? I bees confused by the philosophy.

/sarcasm because I know its really about not having America become Russia and hating Obama.

There's already a ton of competition for health care. I could call a broker right now and get quotes from 5-6 private health care options here in Arizona. The exchanges aren't bringing in new competition, they are basically doing akin of what China is doing to US businesses. They are heavily subsidized to allow a much cheaper price to certain consumers (esp below a certain income level) and cheaper expenses.

Obamacare to the health industry is essentially the business equivalent of a combo of China and Walmart. It is highly subsidized by the government and can strong arm all suppliers into specific costs (for hospitals) and deductible/premium level (insurers). It's about as anti-capitalism as you can get. All that said, it will probably be effective as long as we (as taxpayers) keep pumping money into it.

[JPhillips]

Originally Posted by Arles

That's because healthcare is a business here. It's not like that in London or Canada. We are going to spend more privately because there is more money to be made for companies

What's interesting about that graph is despite the fact that the US has lower wait times for surgery, higher overall quality of care and lower cost to the consumer (when taxes are figured in), the public cost is roughly on par with that in Europe or Canada. I'd also be interested in factoring the additional tax burden on citizens to have the decreased public cost. If the US increased their tax rate to 45% for everyone like the UK to have a public health system - I'm sure the overall costs would go down. Of course, then a normal fulltime worker making 60K who paid $3.5K pre-tax in yearly premiums and another $1K in pretax expenses would now save that money but be facing a tax increase of between $8 and $10K a year. Not exactly saving them money...especially when you factor in it's doubtful they would have the same quality of care options they do now.

Uhhh, if we spend way more per capita than other OECD countries it isn't a lower cost to the consumer.

You don't want to count the money spent on health insurance by the employer, but you have to for this argument. Where we differ is that you see most government health spending as wrong and I don't care whether health spending is public or private. I don't care if I and my employer spend 5K or if the government and I spend 5K. If my taxes go up, but my private insurance costs go down it's all a wash.

[flere-imsaho]

Originally Posted by Arles

The problem becomes as to whether people think their tax burden going from 25-35% and increasing to 45-50% (Canada/UK/Europe rates) is worth the supposed "improvements" to their individual health care plans. I doubt many people with fulltime jobs ranging from 45K-100K upward would be excited to pay an extra 6K to 20K in taxes every year just to have some form of universal coverage that is likely not going to be as high a quality as the coverage they currently have.

I really don't think that's an assertion you can support with data.

NOTE: I added the bolding to Arles' post.

[Arles]

Originally Posted by flere-imsaho

I really don't think that's an assertion you can support with data.

NOTE: I added the italics to Arles' post.

You think people with fulltime jobs and employer provided coverage would prefer to increase their tax burden by 10-20% to get universal coverage? That seems ridiculous. You are basically saying they would rather pay 4-5K more per year (at the low end) to get, at best, the same coverage they have now.

[Flasch186]

Originally Posted by Arles

There's already a ton of competition for health care. I could call a broker right now and get quotes from 5-6 private health care options here in Arizona. The exchanges aren't bringing in new competition, they are basically doing akin of what China is doing to US businesses. They are heavily subsidized to allow a much cheaper price to certain consumers (esp below a certain income level) and cheaper expenses.

Obamacare to the health industry is essentially the business equivalent of a combo of China and Walmart. It is highly subsidized by the government and can strong arm all suppliers into specific costs (for hospitals) and deductible/premium level (insurers). It's about as anti-capitalism as you can get. All that said, it will probably be effective as long as we (as taxpayers) keep pumping money into it.

So according to all the POL arguments Ive heard for the past 8 years is that get the govt' out and prices go down because the free market and competition is best for the consumer and either drives prices down or quality up. That is complete BS when it comes to the past 40 years of health care in this country and can only be asserted when bastardized by arguments hiding in sheep's clothing. The fact is that some people hate Government on a scale of 1-10 and as that goes up, the will to see facts that dont fit the narrative go down equally.

[Arles]

Originally Posted by JPhillips

Uhhh, if we spend way more per capita than other OECD countries it isn't a lower cost to the consumer.

You don't want to count the money spent on health insurance by the employer, but you have to for this argument. Where we differ is that you see most government health spending as wrong and I don't care whether health spending is public or private. I don't care if I and my employer spend 5K or if the government and I spend 5K. If my taxes go up, but my private insurance costs go down it's all a wash.

Now, I think having companies absorb a big percentage of health care cost so employees don't have to foot the bill in terms of higher premiums or higher taxes is a fine solution at this point.

What everyone is failing to realize is that if all companies put employees in "exchanges" tomorrow and stopped offering coverage - those benefits would be lost to the employees. It's not like the employers are going to give everyone $400-$700 a month raises because their don't have to cover them. They will pocket that savings and the burden will fall back on the employee. If you think that benefit will be somehow realized by an employee if health coverage stops, you are not being realistic. What would happen is a massive outcry by the public for more government subsidies to reduce their now double premium rate.

Now, if it happens at a much slower rate over time, small groups of employees will just simply get screwed and have to pay higher premiums.

[JPhillips]

Originally Posted by Arles

Now, I think having companies absorb a big percentage of health care cost so employees don't have to foot the bill in terms of higher premiums or higher taxes is a fine solution at this point.

What everyone is failing to realize is that if all companies put employees in "exchanges" tomorrow and stopped offering coverage - those benefits would be lost to the employees. It's not like the employers are going to give everyone $400-$700 a month raises because their don't have to cover them. They will pocket that savings and the burden will fall back on the employee. If you think that benefit will be somehow realized by an employee if health coverage stops, you are not being realistic. What would happen is a massive outcry by the public for more government subsidies to reduce their now double premium rate.

Now, if it happens at a much slower rate over time, small groups of employees will just simply get screwed and have to pay higher premiums.

I agree with this, but that doesn't mean we don't count the money spent on healthcare. What I think would happen is that over time salaries would increase to make up that difference when companies begin to compete for employees in a near full employment market, but, yes, initially the money wouldn't all go to the employee.

Of course I think absent the ACA more and more companies are going to stop offering good healthcare. The single best thing we could do for business is get them completely out of healthcare.

[Arles]

Originally Posted by Flasch186

So according to all the POL arguments Ive heard for the past 8 years is that get the govt' out and prices go down because the free market and competition is best for the consumer and either drives prices down or quality up. That is complete BS when it comes to the past 40 years of health care in this country and can only be asserted when bastardized by arguments hiding in sheep's clothing. The fact is that some people hate Government on a scale of 1-10 and as that goes up, the will to see facts that dont fit the narrative go down equally.

I think if you opened up competition across states it would help a bit, but I do think health care is a little different because it's viewed by many as a "right" - not a service. If we had the opinion that everyone should have an affordable option to have catastrophic coverage (ie, $5K deductible) and then our current employer or private provided insurance would be supplemental and knock down the deductible to as low as $250 if people choose to pay the premium - it would be a much different system.

But, as I said earlier, most people feel they have the right to cheap doc visits, prescriptions and specialists. With that in mind, it's a very difficult system to keep costs down given that expectation.

[Arles]

Originally Posted by JPhillips

Of course I think absent the ACA more and more companies are going to stop offering good healthcare. The single best thing we could do for business is get them completely out of healthcare.

Then you need to completely change the system and a lot of people's expectations (esp those with families and over 50) would need to change on what acceptable levels of prescriptions, coverage and deductibles are for what they currently pay.

Right now, a family of 4 with the husband working at Intel gets a great $250 deductible plan with 90% coinsurance and a monthly family copay of $350. For what you want to have happen, that family would probably have to pay close to $1000 a month to get that same policy without employer subsidies.

[Autumn]

Originally Posted by Arles

You think people with fulltime jobs and employer provided coverage would prefer to increase their tax burden by 10-20% to get universal coverage? That seems ridiculous. You are basically saying they would rather pay 4-5K more per year (at the low end) to get, at best, the same coverage they have now.

If the employer was no longer paying that expense of coverage, though, they would have to entice that worker with higher salary. It's not like salaries would stay static in a U.S. that suddenly had universal care.

[flere-imsaho]

Originally Posted by Arles

You think people with fulltime jobs and employer provided coverage would prefer to increase their tax burden by 10-20% to get universal coverage? That seems ridiculous. You are basically saying they would rather pay 4-5K more per year (at the low end) to get, at best, the same coverage they have now.

Take a look at your last Total Compensation Memo (if your company does one). Add your max out-of-pocket to the amount of premium you pay to the amount of premium your employer pays (and thus pays you less in salary). What does that add up to?

For me, it adds up to about the same tax hike you mention,and for that I'd get a system (if we're talking about good single-payer systems) with no co-pays, no deductibles, no surprise costs, cheap drugs, and no worry that I'll lose coverage for my family if I lose my job.

Sign me up!

[flere-imsaho]

Originally Posted by Autumn

If the employer was no longer paying that expense of coverage, though, they would have to entice that worker with higher salary. It's not like salaries would stay static in a U.S. that suddenly had universal care.

Hahaha, good one.

[sterlingice]

Originally Posted by larrymcg421

Borrowed from Facebook, but I thought this was funny....

GOVERNMENT SHUTDOWN AS COULD BE EXPLAINED TO A CHILD:

GOP: Can I burn down your house?
POTUS: No
GOP: Just the 2nd floor?
POTUS: No
GOP: Garage?
POTUS: No
GOP: Let's talk about what I can burn down.
POTUS: No
GOP: YOU AREN'T COMPROMISING

There are quite a few areas of politics like this. Not that I agree with it, but you could substitute "government shutdown" for abortion and pro-life would be analogous (the phrase "you can't just have a little abortion" comes to mind)

SI

[JPhillips]

Originally Posted by Arles

Then you need to completely change the system and a lot of people's expectations (esp those with families and over 50) would need to change on what acceptable levels of prescriptions, coverage and deductibles are for what they currently pay.

Right now, a family of 4 with the husband working at Intel gets a great $250 deductible plan with 90% coinsurance and a monthly family copay of $350. For what you want to have happen, that family would probably have to pay close to $1000 a month to get that same policy without employer subsidies.

Again, you're ignoring the money from their compensation that goes to healthcare. They may not realize it, but the 350 isn't all they are paying.

[Arles]

Originally Posted by Autumn

If the employer was no longer paying that expense of coverage, though, they would have to entice that worker with higher salary. It's not like salaries would stay static in a U.S. that suddenly had universal care.

Why? if all employers stopped providing health care, why would some have to offer higher salaries? No one would be doing it (esp for middle wage jobs in the 30-60K range) - what would be the point in raising salaries?

I think what would happen is bigger companies that could afford to keep offering these plans would start paying people less. They would simply say "yeah, you could take that 50K offer at the small company over there - but then you have to go on the exchange and that will cost you $400 more a month. So, why not take our 45K offer and have good health care at a cheaper rate."

As the studies show, no one really understands how much employers pay for premiums. So, once the information came out and some companies dropped it, people with families would gladly take a 5% paycut to go to a company that offered it.

If you remove employer-provided health care coverage, the companies do better, the uninsured do better and the out of work do better. Everyone with a fulltime job and employer coverage would do much worse. That's the tradeoff and I'm fairly surprised that people are OK with that. I would rather have a plan that keeps employed people in the middle class where they are, cover a percentage of the uninsured (prob not all, but a lot) and maybe raise state taxes for everyone 1-2% over this ACA poop platter.

[flere-imsaho]

Originally Posted by Arles

What's interesting about that graph is despite the fact that the US has lower wait times for surgery

True, but easily overstated: http://www.commonwealthfund.org/Char...e-Surgery.aspx

higher overall quality of care

Not so much:

http://www.commonwealthfund.org/Publ...or-Update.aspx
http://www.conferenceboard.ca/hcp/details/health.aspx

[Autumn]

Originally Posted by Arles

But, as I said earlier, most people feel they have the right to cheap doc visits, prescriptions and specialists. With that in mind, it's a very difficult system to keep costs down given that expectation.

I think your great health care policy is blinding you to the reality of what it's like for people who do not have one. Do you know what the cost of a doctor's visit is? An ER trip for a kid that split his chin? Do you know how much a minor necessary surgery costs?

People aren't crying in their beer because they don't get cheap doctor visits. People are crying in their beer because they can't possibly afford the combination of premiums, deductible, coinsurance costs and uncovered costs on the cheap high deductible plans. A family like mine would be paying between 700 and 1,200 for a 5K or greater deductible plan, plus a $1,000 deductible for prescriptions. We are a healthy family but just my son's asthma medicine would eat up that deductible every year. In the last five years we've had a vasectomy to pay for, a thyroid surgery, tonsil removals, two ER visits and tons of pediatrician visits for physicals or sick kids. So we're talking about $11K in for sure costs, plus at the least several thousand in expenses. If I hit that deductible I still have a 30% copay.

People who don't have insurance plans aren't being whiny bitches, necessarily. They just don't have $15,000 to spend on health care.

[Autumn]

No, if healthcare was offered by the government already, then I'm not going to pick this 45K job with a health plan over this 55K job without one. Arle's super health plan will no longer be that interesting to him, and employees will look at other companies with better salaries. If his health plan is still better, then it's still worth money.

[sterlingice]

Is part of this problem essentially that a lot of companies really /haven't/ shopped around on insurance pools or that there are such a limited number in state that there's very little competition going on right now for those big company businesses? Basically, the American Airlines, Apples, and Caterpillars of the US only have a couple of places large enough to handle their business so there's the same price fixing oligopolies going on with health insurance as in the rest of business?

Ultimately, isn't part of the idea of this change and the exchanges is to "increase competition" for individuals so they take more care in deciding which insurance to buy?


SI

[Arles]

I'm floored that people think if health care was removed from companies that people would end up recouping that benefit in a higher salary. That is simply never going to happen - especially for people making in the 30-80K range. Maybe it would for the 90K+ crew with very valuable skills. But, there will always be a guy who was making 30K who would be thrilled to take someone's 35K job without insurance. The middle is where people will get screwed by this - as is often the case.

[JonInMiddleGA]

Originally Posted by Autumn

People aren't crying in their beer because they don't get cheap doctor visits.

Honestly, I'd have to call bullshit on that statement. That's the not-so-secret desire for the majority IMO, something for free or next to it.

They just don't have $15,000 to spend on health care.

The question then becomes roughly a) what is the right to have it; and more interestingly perhaps b) what happens to those costs if they had to compete in the real world w/out so much artificial incentive to jack the prices up.

How much is the health care cabal willing to gouge if the current market simply doesn't exist?

[Arles]

Originally Posted by Autumn

I think your great health care policy is blinding you to the reality of what it's like for people who do not have one. Do you know what the cost of a doctor's visit is? An ER trip for a kid that split his chin? Do you know how much a minor necessary surgery costs?

People aren't crying in their beer because they don't get cheap doctor visits. People are crying in their beer because they can't possibly afford the combination of premiums, deductible, coinsurance costs and uncovered costs on the cheap high deductible plans. A family like mine would be paying between 700 and 1,200 for a 5K or greater deductible plan, plus a $1,000 deductible for prescriptions. We are a healthy family but just my son's asthma medicine would eat up that deductible every year. In the last five years we've had a vasectomy to pay for, a thyroid surgery, tonsil removals, two ER visits and tons of pediatrician visits for physicals or sick kids. So we're talking about $11K in for sure costs, plus at the least several thousand in expenses. If I hit that deductible I still have a 30% copay.

People who don't have insurance plans aren't being whiny bitches, necessarily. They just don't have $15,000 to spend on health care.

But I don't understand why you don't have a better plan? If it's pre-existing conditions, I sympathize and think that should be dealt with in some public subsidized way. If that's not the case, there are better options for most people than what you describe. I don't know you situation, but I know for a fact that I could get a family plan for $700 a month out here through United Healthcare as an individual that gives me a $500 deductible. I looked when I was considering doing some consulting.

[Arles]

As an addendum, I just went to Individual Health Insurance Quotes | UnitedHealthcare and put in for a quote for myself, wife and two sons. I got a ton of $1K deductible plans ranging from $300 to $630 based on the level of coinsurance and out-of-pocket maxes you want. I also know that you can do even better than the site if you use a broker or are a small business owner. And this is independent of the ACA.

[RainMaker]

Originally Posted by Arles

Why? if all employers stopped providing health care, why would some have to offer higher salaries? No one would be doing it (esp for middle wage jobs in the 30-60K range) - what would be the point in raising salaries?

Your argument here is that companies have been providing health insurance to employees out of the goodness of their heart. That if they eliminated health insurance coverage, no employee would complain or request more money. That's just not how the labor market works. You're acting like there is no competition for labor.

[JonInMiddleGA]

Originally Posted by RainMaker

You're acting like there is no competition for labor.

Just be careful not to overstate how much competition there is in the majority of fields. The vast majority of "players" are simply replacement value at this point anyway.

[Arles]

Originally Posted by RainMaker

Your argument here is that companies have been providing health insurance to employees out of the goodness of their heart. That if they eliminated health insurance coverage, no employee would complain or request more money. That's just not how the labor market works. You're acting like there is no competition for labor.

No, they do it as a competitive necessity - much like a 401K. But they know that the specific coverage plan isn't key to most employee's decisions to accept a job. Heck, most don't even learn about a company's plan until after they accept and go through orientation.

If most employers dropped coverage, there would no longer be that need for that competitive necessity as most people would be in the same boat. And, again, the few that did still offer it would have a huge competitive advantage to the point they could offer much lower salaries. In the end, the employees would not make out any better. Most salaries would stay the same as they are now and people would just be paying more out of pocket for premiums offered through these exchanges.

[RainMaker]

Originally Posted by JonInMiddleGA

Just be careful not to overstate how much competition there is in the majority of fields. The vast majority of "players" are simply replacement value at this point anyway.

Then they would all be making minimum wage. If you are paying more than that, it is due to competition.

[Arles]

Originally Posted by RainMaker

Your argument here is that companies have been providing health insurance to employees out of the goodness of their heart. That if they eliminated health insurance coverage, no employee would complain or request more money. That's just not how the labor market works. You're acting like there is no competition for labor.

So, by your argument, small businesses that offer no health insurance right now pay a much higher wage than larger businesses having similar positions with benefits - correct?

[RainMaker]

Originally Posted by Arles

No, they do it as a competitive necessity - much like a 401K. But they know that the specific coverage plan isn't key to most employee's decisions to accept a job. Heck, most don't even learn about a company's plan until after they accept and go through orientation.

If most employers dropped coverage, there would no longer be that need for that competitive necessity as most people would be in the same boat. And, again, the few that did still offer it would have a huge competitive advantage to the point they could offer much lower salaries. In the end, the employees would not make out any better. Most salaries would stay the same as they are now and people would just be paying more out of pocket for premiums offered through these exchanges.

Your points contradict each other. On one hand you say they do it because of competition, then say it doesn't matter and employees don't care. If employees didn't care and didn't factor it into their salary, companies wouldn't provide it. Companies are not in the business of giving out benefits out of the goodness of their heart.

[RainMaker]

Originally Posted by Arles

So, by your argument, small businesses that offer no health insurance right now pay a much higher wage than larger businesses having similar positions with benefits - correct?

I'm sure some do and I'm sure some don't. What does small vs big business have to do with anything? There are a lot of other variables at play.

My argument is that benefits given to employees are valued by the employees otherwise the company wouldn't be providing it. Companies don't give away money for free.

[Arles]

Originally Posted by RainMaker

Your points contradict each other. On one hand you say they do it because of competition, then say it doesn't matter and employees don't care. If employees didn't care and didn't factor it into their salary, companies wouldn't provide it. Companies are not in the business of giving out benefits out of the goodness of their heart.

No, they do it because people expect it from all fulltime positions. If most didn't have it, then people wouldn't expect it and the ones that did could underbid the ones that didn't. But when everyone has it - it's almost the same as no one having it. How many jobs have you seen offer their health insurance plans to you before accepting? There may be some that do it for higher salary positions, but I've never seen one.

[Arles]

Again, people are arguing in circles here. I see three camps:

1. Health care should be de-linked and taxes/premiums will go up for most people but that's for the better good. More people will have better access to coverage and that's worth the pain for the middle class
2. Health care should be de-linked and employers will now pay their employees more money to compensate. More people will have better access to coverage and there really won't be much pain for the middle class.
3. Health care should stay linked to employment for now because the cost to the individual is much lower than any alternative for their level of plan. It's not a great system for the uninsured, part time or self-employed, but any change should focus only on those three areas.

I am in option 3 and most of the people arguing seem to be in option 2 - but I just don't see that as a feasible alternative and think 1 is more likely.

[RainMaker]

Originally Posted by Arles

No, they do it because people expect it from all fulltime positions. If most didn't have it, then people wouldn't expect it and the ones that did could underbid the ones that didn't. But when everyone has it - it's almost the same as no one having it. How many jobs have you seen offer their health insurance plans to you before accepting? There may be some that do it for higher salary positions, but I've never seen one.

Companies don't work together to keep salaries down. They are competing for labor. If they all received a $5000 reprieve per employee, companies would use that $5000 to out-price their competition. It's how our economy works.

Same for any product on the marketplace. If the cost of goods was cut in half for all soda makers, they all wouldn't maintain the same price because the public isn't aware. They'd be cutting prices trying to beat out their competition.

[ISiddiqui]

Originally Posted by Arles

Again, people are arguing in circles here. I see three camps:

1. Health care should be de-linked and taxes/premiums will go up for most people but that's for the better good. More people will have better access to coverage and that's worth the pain for the middle class
2. Health care should be de-linked and employers will now pay their employees more money to compensate. More people will have better access to coverage and there really won't be much pain for the middle class.
3. Health care should stay linked to employment for now because the cost to the individual is much lower than any alternative for their level of plan. It's not a great system for the uninsured, part time or self-employed, but any change should focus only on those three areas.

I am in option 3 and most of the people arguing seem to be in option 2 - but I just don't see that as a feasible alternative and think 1 is more likely.

I think you are overly generalizing point 2. I think with a more comprehensive health plan, a lot of middle class will have less pain due to having less out of pocket expenses for health care. As people have pointed out, Middle Class folks have employer health care - but in a lot of cases its crap coverage, leading to a lot of out of pocket expenses.

I do think that fact does make it evident that other countries have better coverage than the US does.

[JonInMiddleGA]

Originally Posted by RainMaker

Then they would all be making minimum wage. If you are paying more than that, it is due to competition.

Not sure earnings entirely relates to the point I was making. Maybe it's clearer if I had said "replacement value within fields".

[Arles]

Originally Posted by ISiddiqui

I think you are overly generalizing point 2. I think with a more comprehensive health plan, a lot of middle class will have less pain due to having less out of pocket expenses for health care. As people have pointed out, Middle Class folks have employer health care - but in a lot of cases its crap coverage, leading to a lot of out of pocket expenses.

I do think that fact does make it evident that other countries have better coverage than the US does.

I think other countries have consistent care across the population while many people here have access to better or similar care for less out of pocket (when you factor premiums, taxes and coinsurance) and others have worse access. If I had confidence that a plan could be implemented that didn't negatively impact those with the better/cheaper plan - I would certainly consider it a more viable option. My fear, though, is that to have a similar system as other countries - a lot of people will be paying more in taxes than they did with employer based coverage for potentially worse care.

Instead of bringing everyone to a median line that hurts many and helps others, I'd rather focus on getting better options to those with poor ones and leave those with good plans alone. Maybe that isn't feasible, I don't know. But I'd rather try than risk having a significant number of people with good plans moved over to more expensive for less benefit/higher deductible "exchanges".

[Autumn]

Originally Posted by Arles

But I don't understand why you don't have a better plan? If it's pre-existing conditions, I sympathize and think that should be dealt with in some public subsidized way. If that's not the case, there are better options for most people than what you describe. I don't know you situation, but I know for a fact that I could get a family plan for $700 a month out here through United Healthcare as an individual that gives me a $500 deductible. I looked when I was considering doing some consulting.

Because you live in a different place than me? This is exactly my issue -- you're assuming your experience is that of the rest of the world. There are only two health companies that offer high deductible plans in Maine, basically. They cost $800 or $1,200 alternately for a 5K deductible, and differ in coverage obviously. If I wanted a regular HMO, I would have to pay between $2,600 and $6,400 a month.

There does not exist a plan like you describe in my state, nor in many, many other states. That's the problem.

[ISiddiqui]

Originally Posted by Arles

I think other countries have consistent care across the population while many people here have access to better or similar care for less out of pocket (when you factor premiums, taxes and coinsurance) and others have worse access. If I had confidence that a plan could be implemented that didn't negatively impact those with the better/cheaper plan - I would certainly consider it a more viable option. My fear, though, is that to have a similar system as other countries - a lot of people will be paying more in taxes than they did with employer based coverage for potentially worse care.

Instead of bringing everyone to a median line that hurts many and helps others, I'd rather focus on getting better options to those with poor ones and leave those with good plans alone. Maybe that isn't feasible, I don't know. But I'd rather try than risk having a significant number of people with good plans moved over to more expensive for less benefit/higher deductible "exchanges".

So basically your solution is (for lack of a better phrase) "More Government". Ie, expand Medicare to those who are poor, but under the poverty level, those who have pre-ex and can't get coverage due to it, those who have massive deductibles for any insurance whatsoever?

How wouldn't that increase taxes? Hell, how could you get any increased coverage for the poor and needy without increased taxes or throwing everyone on exchanges with individual subsidies?

Basically, you are advocating for a unicorn. You want your good coverage, but want the poor to be covered more, but don't want your taxes raised. Welcome to utopia.

Btw, I disagree with your view of different country health care - lot of people paying more for substantially better health care (single payer tends to allow for people to be no to little out of pocket costs - and you can get a private plan on top of it for non-essential stuff - which isn't covered in most US private plans).

[Passacaglia]

Maybe we should leave this issue to the states? *ducks*

[Autumn]

As long as it's not to my state, that's fine, lol.

[TRO]

Originally Posted by Passacaglia

Maybe we should leave this issue to the states? *ducks*

Why stop there. Counties deserve a voice too.

But screw municipalities, they don't need to be heard.

[Dutch]

You know, the one thing I do look forward to with Obamacare is the % of people who pass their annual checkup with flying colors that are still on welfare. And during that annual checkup, as a free service, we should provide those folks with ID cards so they can vote. And if you are illegal, you have to leave the country. And if you are unemployed, you have to take the job the hard-working illegal immigrant just gave up. Sounds like a win-win for everybody.

[flere-imsaho]

Originally Posted by Arles

I think other countries have consistent care across the population while many people here have access to better or similar care for less out of pocket (when you factor premiums, taxes and coinsurance)

If I make $100,000/year as the husband (or wife) in a family of four and file jointly, I'm in the 25% tax bracket in the United States.

If I make the equivalent of $100,000/year as the husband (or wife) in a family of four and file jointly (or however it's done), I'm in the 40% tax bracket in the United Kingdom.

(NOTE: This is back of the napkin math, not real math. So, tally-ho, nitpickers!)

So, a $15K difference.

But, in the U.S. I will also pay, on average, a premium contribution on my employer-sponsored plan of $4,565/year. (2013 Summary of Findings | The Henry J. Kaiser Family Foundation)

I will also pay, on average, out of pocket expenses of $3,301/year (http://www.bankrate.com/finance/insu...e-cost-1.aspx).

So, of that $15K difference, almost $8K is money I'm paying anyway.

Now, does the $7K delta represent the discount in my salary my employer pays me because of this? If they were to dump my coverage, would they pay me that extra? Hard to say.

I agree with Jon that it's probably more likely something like this would happen higher up on the spectrum with people who have in-demand and/or unique skills or are otherwise in demand. And while people on the lower end of the spectrum might not benefit from this wage jump, they're more likely to benefit from either the ACA premium subsidy for exchange plans which goes up to 400% of the Federal Poverty Level, ( which is $88,200 for our hypothetical family of four) or qualify for Medicaid, of course.

[ISiddiqui]

Well, mind - the UK has more benefits than just NHS for the extra taxes . Very cheap tuition for university is well worth increased taxes in itself.

[Arles]

Originally Posted by flere-imsaho

If I make $100,000/year as the husband (or wife) in a family of four and file jointly, I'm in the 25% tax bracket in the United States.

If I make the equivalent of $100,000/year as the husband (or wife) in a family of four and file jointly (or however it's done), I'm in the 40% tax bracket in the United Kingdom.

(NOTE: This is back of the napkin math, not real math. So, tally-ho, nitpickers!)

So, a $15K difference.

But, in the U.S. I will also pay, on average, a premium contribution on my employer-sponsored plan of $4,565/year. (2013 Summary of Findings | The Henry J. Kaiser Family Foundation)

I will also pay, on average, out of pocket expenses of $3,301/year (http://www.bankrate.com/finance/insu...e-cost-1.aspx).

So, of that $15K difference, almost $8K is money I'm paying anyway.

So you're saying I would have zero out of pocket with a national plan? And remember, that $3K out of pocket is often pretax for people with medical savings accounts - as are their premiums. So, you aren't paying taxes on that 8K difference. So, in terms of lost money, it's closer to 6K (it would be 8K before taxes anyway). But we are splitting hairs a bit so I will use your numbers. The point remains that person is now paying $7K more for virtually no person gain for their family. That's losing almost $600 a month for the privilege of providing better health care to other people. That's kind of a tough sell, isn't it? I don't think a lot of people have that kind of money to just throw around for the greater good.

Now, does the $7K delta represent the discount in my salary my employer pays me because of this? If they were to dump my coverage, would they pay me that extra? Hard to say.

This is a key question. My guess is the high end positions would get some kind of concessions for the loss of coverage while the middle class would just eat most of it as a loss as they are deemed fairly replaceable. We have guys in our factory with the same health plan that Execs have access to and they make between 30 and 50K. I'm fairly sure that we wouldn't bump their salary 7-9K to make up that lost benefit if we dropped coverage. That's between a 18-25% raise for those guys.

I agree with Jon that it's probably more likely something like this would happen higher up on the spectrum with people who have in-demand and/or unique skills or are otherwise in demand. And while people on the lower end of the spectrum might not benefit from this wage jump, they're more likely to benefit from either the ACA premium subsidy for exchange plans which goes up to 400% of the Federal Poverty Level, ( which is $88,200 for our hypothetical family of four) or qualify for Medicaid, of course.

The subsidy scales though. So, if you are two parents making 35K each, you are not saving much from the ACA. Certainly not enough to makeup for the increase premium cost and you will probably end up with a higher deductible (unless you want to pay over triple your old premiums).

Again, not to sound like a broken record, but no matter how you slice it - separating employers from health care will result in a pretty massive crapburger for most of the middle class workforce. Maybe that's worth it over time, but let's atleast be honest that it would happen.

[Arles]

Originally Posted by ISiddiqui

Well, mind - the UK has more benefits than just NHS for the extra taxes . Very cheap tuition for university is well worth increased taxes in itself.

I'm pretty sure what I would pay in 18 years of a VAT tax would more than cover the instate tuition here in Arizona for my son. There are a lot of taxes in the UK (up to 12% payroll tax, 40-45% income tax, VAT) to where they are not getting quite the deal people think. Hey, it works for them but we don't even know if their plan would scale to the US given our population, expectations of the public and other issues like illegal immigration (no way to ever cover them).

To assume that we could get cheap tuition for college, full health coverage and the other benefits for the UK without raising our tax burden into the 60% range after it's said it done is - as you say - advocating for a unicorn.

[SirFozzie]

And in more washington based insanity news, apparently a man set himself on fire on the national mall and danced around.

[Arles]

Originally Posted by Autumn

Because you live in a different place than me? This is exactly my issue -- you're assuming your experience is that of the rest of the world. There are only two health companies that offer high deductible plans in Maine, basically. They cost $800 or $1,200 alternately for a 5K deductible, and differ in coverage obviously. If I wanted a regular HMO, I would have to pay between $2,600 and $6,400 a month.

There does not exist a plan like you describe in my state, nor in many, many other states. That's the problem.

I don't see that at all. I went to Anthem (Blue Cross) and chose Maine:
https://www.anthem.com/health-insurance/home/overview

There's a healthchoice plus $2K deductible plan that costs $830 a month. In network, you have a 20% co-insurance with no lifetime max. It's not a great plan, but it's not $1200 for a 5K deductible. Given Maine costs about 15-20% more to live in than Phoenix, that seems close to on par - but certainly a little higher.

This is another example of where if we can open up health options across state lines a lot of people could benefit that way as well.