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  #201  
Old 09-24-2019, 04:11 PM
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Let's not get too pissy about it; under a universal health care system, it's likely that the doctors will have less discretion about how they can treat a patient- if they want to get paid, they'll have to adhere to specific treatment guidelines, even when they don't necessarily agree with them.
No. It's exactly the opposite. It's precisely and literally the other way around.

That fact has frequently been noted by the eminent health care economist Uwe Reinhardt, and has come to be known as Reinhardt's Law, or sometimes Reinhardt's irony or paradox. Simply stated, in single payer systems or their functional equivalent, cost control is achieved up front through a negotiated, uniform, and transparent fee schedule, and there is explicitly no meddling at the clinical level between doctor and patient. Whereas with private insurance, every claim is individually adjudicated, so meddling with the doctor's clinical discretion is inherently baked into the system; the intrusion of insurance bureaucracy into clinical decision-making is pretty much the hallmark of US health care. The irony is that physicians opposed to "government involvement" in health care have pretty much brought this situation on themselves; by insisting on their economic freedom from single-payer regulation of their fees, they have sacrificed their clinical freedom to insurance bureaucrats.

From a paper on physician autonomy [PDF]:
It is Reinhardt's assertion that the absence in the United States of an overall program of budgetary control over medical expenditures, as is characteristic of the prominent European systems, results in unparalleled micro-management at the clinical level to achieve cost control unattainable on a larger scale. He writes that "...if the bureaucrats cannot somehow impose upon the healers an overall budget constraint ex ante, then they will sooner or later be driven to control their outlays on an ongoing basis, by monitoring each and every transaction for which they pay -- that is, by second guessing both the providers' clinical and pricing decisions" (Reinhardt, 1988). This appropriation of the clinical dimension of autonomy would be regarded as intolerable by physicians in other medical care systems. He suggests that "European and Canadian physicians would be appalled at the numerous intrusions into clinical decisions now routinely made by these external monitors in the United States. They probably would rise up in arms over that loss in clinical autonomy" (Reinhardt, 1988).

It seems problematic that physicians in the United States would willingly and knowingly sacrifice the clinical element of autonomy that Freidson considered to be the more consequential element of his two-part definition of autonomy. Clinical autonomy, after all, constitutes the primacy of the physician in the health care division of labor and is the basis on which arguments for political and economic autonomy are formed. Reinhardt's answer to this seeming paradox is that physicians in the United States have traded off clinical autonomy "in their tenacious fight to preserve the individual physician's right to price his or her services as they see fit" (Reinhard~ 1988). This observation has been distilled into a formula referred to as Reinhardt's "Law" or "Irony." Reinhardt has summarized his law as follows: "In modern health care systems, the preservation of the healers' economic freedom appears to come at the price of their clinical freedom" (Reinhardt, 1988). The application of Reinhardt's Law to the late-20th-century United States scene would appear to indicate a priority on the part of physicians to pursue economic betterment at the expense of clinical autonomy.
  #202  
Old 09-24-2019, 04:38 PM
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There has to be some sort of fear of it that they have of something besides that.
I think a lot of people have come up with convoluted rationalizations for why the status quo is justified. Who wants to accept that they’ve been exploited by a system that robs us of money, time, energy, and dignity? If you’re a red-blooded American capitalist, that’s a bitter pill to swallow. It violates everything that we’ve been taught to believe about the free market. Better to pretend that the hoops we jump through are necessary evils rather than evil evils.

As a Tricare recipient for the last 16 years, my family and I are living the “nightmare” of socialized medicine. And oh, let me tell you how fucking “scary” it is. Every time I need a physical, I just pick up the phone and schedule an appointment with the clinic. And when I turn up at the receptionist desk, all I have to do is show them my ID; I don’t have to have any tedious conversation about HMOs, PPOs, or any other unintelligible acronyms that I no patience to keep up with. When I need a diagnostic procedure, I don’t have to wonder whether it’s covered by my policy or if I need to get some special approval; if the goddamn doctor says I need it, then I need it. And when I need meds, the docs prescribes them to me and I pick them up at the pharmacy downstairs. And I don’t have to pay a dime for any of it. Not even a $30 copay that...does what exactly? Why don’t people see how crazy it is that they are getting charged chicken shit co-pays for something they are already shelling our expensive premiums for?

When I see people acting as though this “nightmare” is worse than anything you can get from private insurance, I feel like slapping them.
  #203  
Old 09-24-2019, 05:48 PM
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As a Tricare recipient for the last 16 years...
I would guess that makes you active or retired military, or the spouse of one? If thats the case, thank you for all the bullshit you go through for me and my family. Our family respects that sacrifice.

I have a question though. Everyone I have talked to on Tricare or general VA benefits are really happy with their care, but the only gripe is that they have to go to the VA which usually isn't in a place around them.

There seems to be a lot of negative stuff about the VA in the news. Is some of the negative stuff anything you have experienced (if that applies to you at all)?
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  #204  
Old 09-24-2019, 06:44 PM
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I live in the national capital region, where there is no shortage of military treatment facilities. But Tricare recipients can receive care outside MTF if they live far away from one. I don’t know a lot about VA hospitals.
  #205  
Old 09-24-2019, 11:06 PM
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As I understand it, if you had Universal Health care, and a single government insurer, you would not have FREEDOM, and would be in the grip of SOCIALISM. So this would be terrible.
The finance companies that Kip down at the country club invests in would stop paying out the dividends on which he has come to depend. Fewer items would be pawned or sold on Ebay in desperation, slowing the churn of older manufactured goods through society. And all of these economic activities on which the privileged have come to depend would be derided by progressives & labor union members as "the bad old days to which we refuse to return." Can you imagine?!
  #206  
Old 09-24-2019, 11:18 PM
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Oh, also personal injury lawyers. They'd be basically out of work, I guess.
  #207  
Old 09-25-2019, 12:44 AM
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Originally Posted by bump View Post
Let's not get too pissy about it; under a universal health care system, it's likely that the doctors will have less discretion about how they can treat a patient- if they want to get paid, they'll have to adhere to specific treatment guidelines, even when they don't necessarily agree with them.

Or go through the same sort of review process to see why they didn't follow the procedures; the only difference is that it won't involve the patient's pocketbook, but it may well involve the way they're treated and their outcome.

In practical terms, this'll mean that a doctor who's practiced for decades and knows what condition X looks like and that medication Z is most effective for patients of a specific type, will now have to go through the medical theater of trying other medications first, instead of just cutting to the chase and prescribing treatment Z right off the bat. Or they'll make you go through physical therapy and various conservative (and cheap) treatments before finally resorting to surgery, even if they knew it was the right treatment all along.

The good news is that it won't cost the patient anything.
This is just a fantasy, designed to support the idée fixe that gouvernement health care is run by bureaucrats. It's not, at least in the Canadian system. (I'm not claiming any particular virtue about the Canadian system. I'm just mentioning it because it's the UHC system I lived with all my life and am familiar with. )

Doctors are independent contractors. The Medicare system assumes that doctors can. E relied on to give the appropriate treatment that their professional judgment requires. They give that treatment, then get paid. Y the system. They don't have to go to a bureaucrat to get père-clearance for a particular treatment and they don't have their treatment choices scrutinized afterwards and claims denied. That's the significant features of the American private insurance model, designed to cut costs. I guess since that's how your system operate, you just assume that gouvernement run health funding systems run the same way. They don't.
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  #208  
Old 09-25-2019, 12:50 AM
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TIL that the "b" on Northern Piper's keyboard is right next to the period.
  #209  
Old 09-25-2019, 01:05 AM
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Space bar, actually.

Nice reconstructive work, though.
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  #210  
Old 09-25-2019, 01:11 AM
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TIL that TIL is an acronym for "Today I Learnt".
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  #211  
Old 09-25-2019, 01:15 AM
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Oh, also personal injury lawyers. They'd be basically out of work, I guess.
No. We would be fine.
  #212  
Old 09-25-2019, 02:37 AM
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This is just a fantasy, designed to support the idée fixe that gouvernement health care is run by bureaucrats. It's not, at least in the Canadian system. (I'm not claiming any particular virtue about the Canadian system. I'm just mentioning it because it's the UHC system I lived with all my life and am familiar with. )

Doctors are independent contractors. The Medicare system assumes that doctors can. E relied on to give the appropriate treatment that their professional judgment requires. They give that treatment, then get paid. Y the system. They don't have to go to a bureaucrat to get père-clearance for a particular treatment and they don't have their treatment choices scrutinized afterwards and claims denied. That's the significant features of the American private insurance model, designed to cut costs. I guess since that's how your system operate, you just assume that gouvernement run health funding systems run the same way. They don't.
Right. This is an issue that's been well studied, as I described up in my post #201. The clinical autonomy of doctors is in fact an important consequence of the health care systems in Europe and Canada and elsewhere in the world, and the subservience of doctors to insurance bureaucrats is in fact an important consequence of the American health care system. These are fundamental consequences of the way those systems are structured and the way they control costs. The civilized UHC systems do it by negotiating reasonable fee structures for all medical providers and then leaving the doctors alone to do their work according to their professional judgment; the US system does it by scrutinizing every single claim and trying to second-guess the doctor's judgment wherever possible, a system that is barbaric and constitutes unconscionable interference in medical practice. But in return for being barbaric and counterproductive, at least the US system costs twice as much as it needs to!
  #213  
Old 09-25-2019, 04:00 AM
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I think it is always useful to nail down these points before we go any further. Knock them down one by one so to speak, things get messy otherwise.

Do opponents of UHC now accept that a doctors clinical freedom is enhanced, rather than diminished by how UHC is organised? (certainly in the UK)

straight question, would appreciate a response.
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  #214  
Old 09-25-2019, 01:40 PM
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No. We would be fine.
You're sure?

Between UHC and no-fault auto insurance, the personal injury bar is almost non-existent in my province.
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  #215  
Old 09-25-2019, 01:42 PM
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Do opponents of UHC now accept that a doctors clinical freedom is enhanced, rather than diminished by how UHC is organised? (certainly in the UK).

But, but, DEATH PANELS!!!!




(Okay not a straight response. )
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  #216  
Old 09-25-2019, 02:03 PM
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This is just a fantasy, designed to support the idée fixe that gouvernement health care is run by bureaucrats. It's not, at least in the Canadian system. (I'm not claiming any particular virtue about the Canadian system. I'm just mentioning it because it's the UHC system I lived with all my life and am familiar with. )
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Originally Posted by Novelty Bobble View Post
Do opponents of UHC now accept that a doctors clinical freedom is enhanced, rather than diminished by how UHC is organised? (certainly in the UK)

straight question, would appreciate a response.


To further point out the difference, it's instructive to look at the differences between the UHC system in Canada, which usually doesn't cover dental care, and the private insurance a lot of people use to cover dental care.

I get my dental care insurance via work, so it's actually quite similar to how all medical insurance works in the US.

For all non-dental care I've ever received, I've never had a bureaucrat try to refuse to cover the procedure. There was one operation I had, where they did have to make a decision about putting me on a wait list* for having it done in Toronto, or paying for me to travel to the US to have it done. They eventually paid for the US option, which was the one my doctor preferred.

Compare that to my dental plan. Routine coverage is pretty automatic, but the first time I had to have a crown put in, they initially denied coverage for it. My dentist spent some time arguing with them, and I eventually had it done on my own dime, and then re-submitted the claim as a fait accompli. They eventually did pay the 75% or so that they were supposed to cover, but had I not had the money to pay for the crown upfront, I might have been completely out of luck. I'm now currently waiting to hear if they'll cover another crown that I need.

Seems like a bit of a difference to me.




*As for the wait list, not long after, they added more money to cut down on the list, so that within a year, it was no longer necessary to send people out of country for this sort of procedure. So, in fact, the bureaucrats actually listened to the doctors and changed their policies, not the other way around.
  #217  
Old 09-25-2019, 05:28 PM
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But, but, DEATH PANELS!!!!
(Okay not a straight response. )
But in contrast to most criticisms of UHC at least it has the virtue of clarity
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  #218  
Old 09-26-2019, 02:16 AM
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agree with Horatius: the only time I've had to fight to get coverage for treatment was the private dental plan, which wasn't going to provide something at full cost. Never had such an issue with medicare.
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  #219  
Old 09-26-2019, 06:51 PM
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I've gone throughtbtg thread and it looks like the OP has gone. That's too bad, because I have a genuine question: what is so good about the OP's plan that he doesn't want to give it up? And I mean details, not a vague "choice" issue. And as others have pointed out, I'm curious if it's an employer plan, chosen by the employer?
It is really inexpensive.

Since Medicare payroll taxes pay for all of Medicare I know that my taxes would more than double to pay for the 120 million people that would need to be added to Medicare rolls.

About 160 million are on private insurance now and 50 million are on Medicare that I also pay for via the 2.9% payroll tax. That leaves 120 million that would need to have their premiums paid by us working stiffs.

I expect my taxes would more than double what I pay for in private + Medicare now.

Senator Warren is straight out lying when she claims my "cost" would go down.

Last edited by Linden Arden; 09-26-2019 at 06:52 PM.
  #220  
Old 09-26-2019, 06:58 PM
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I expect my taxes would more than double what I pay for in private + Medicare now.

Senator Warren is straight out lying when she claims my "cost" would go down.
How are you accounting for what businesses pay for employee insurance?

Most employer-sponsored health plans are heavily subsidized by the employer, who then takes a tax deduction for the amount paid to the insurance company. Are you ignoring these sums in your calculations, or are they figured in somewhere that you haven't mentioned?
  #221  
Old 09-26-2019, 08:18 PM
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Right, you don't want your taxes to go up, but that's not what I'm curious about. I'm wondering what your insurance coverage is , that you do 'tbwantbto give up for UHC, which is his I read your thread title?
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  #222  
Old 09-26-2019, 09:16 PM
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It is really inexpensive.

Since Medicare payroll taxes pay for all of Medicare I know that my taxes would more than double to pay for the 120 million people that would need to be added to Medicare rolls.

About 160 million are on private insurance now and 50 million are on Medicare that I also pay for via the 2.9% payroll tax. That leaves 120 million that would need to have their premiums paid by us working stiffs.

I expect my taxes would more than double what I pay for in private + Medicare now.

Senator Warren is straight out lying when she claims my "cost" would go down.
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<<snip>> For a slightly higher tax rate, I don't have to worry when changing jobs, or between jobs, or whatever - I'm covered. When the doc says "you should have that test done", I'm covered. I can go to pretty much any doc I choose; I don't have to go by a list provided by some company who's trying to maximize profits, to a doctor who's trying to maximize profits, or just get paid by the insurance companies. The longest wait I've had for medical care was for a spot in a private hospital, for a dental procedure not covered by UHC, for which I waited two months. Everything I've done in the public part has been within a week.

Oh, and that slightly higher tax rate? I pay about 10.6% more income tax than I would pay for the same income if I lived in the States. I don't pay any insurance premiums over and above that income tax. Nothing but income tax and some retirement contributions are being taken from my paycheck. I'm pretty sure I come out ahead on the deal, along with never, ever, having to worry about it.
<<snip>>
{emphasis added}

Linden Arden, are you spending more than 10.6% of your gross income on healthcare?
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Old 09-26-2019, 09:25 PM
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It is really inexpensive.
You had best pray that you don't ever lose your job, or you'll find out exactly how much your health insurance actually costs when you try to get COBRA and pay the full amount that your employer's been paying for you. You're very lucky they're paying as much as they are, but don't fool yourself into thinking it's not costing a lot of money. You just don't see it. Expect it to be costing between $750 to $1000 per month, per member, for a silver-level policy. More for a gold or platinum policy. And more the older you are.
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Old 09-26-2019, 09:34 PM
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Man, my auto-correct is going crazy. Let's try that again.

Right, you don't want your taxes to go up, but that's not what I'm curious about. I'm wondering what your insurance coverage is, that you don't want to give up for UHC, which is how I read your thread title?
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  #225  
Old 09-26-2019, 10:06 PM
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How are you accounting for what businesses pay for employee insurance?

Most employer-sponsored health plans are heavily subsidized by the employer, who then takes a tax deduction for the amount paid to the insurance company. Are you ignoring these sums in your calculations, or are they figured in somewhere that you haven't mentioned?
And also, don’t forget that most of the expensive patients ( people over 65 ,people on disability and people that are too sick to work) are getting their healthcare via a government program anyway ( or a possibly subsidized ACA policy) Employer based insurance is frequently cheaper because they can exclude people that are too sick to work. I guess you get COBRA for a year before you have to find a private plan ( probably an ACA plan ,the other ones won’t take you ) or go on government assistance.)

I’m not saying private plans get out of covering serious illnesses - they do end up covering family members of insured and they cover a lot of patients during the first year of a serious illness, if the patient can afford to buy it via COBRA. But the ability to throw someone that can’t work off their health insurance and onto the government dime is another the way the public sector subsidizes private industry.

And the insurance companies really do care. Our insurer used to audit the payroll at my workplace pretty much every year ( they were a small business with a lot of unhealthy employees and several people with seriously ill family members).

I lost my insurance after their auditor determined I didn’t meet their definition of an employee ( I was a contract worker but I had self-incorporated). No warning, no grace period. Which was kind of funny because I was the one person in the place that never used my insurance, I hadn’t filed a claim in 2 years. My premiums were pure profit to them.

Last edited by Ann Hedonia; 09-26-2019 at 10:08 PM.
  #226  
Old 09-27-2019, 03:10 AM
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{emphasis added}

Linden Arden, are you spending more than 10.6% of your gross income on healthcare?
The additonal question to ask is "whatever that percentage is, does the cover continue indefintely if you find yourself out of work?" because that's a key feature.
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  #227  
Old 09-27-2019, 07:19 AM
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I think it is always useful to nail down these points before we go any further. Knock them down one by one so to speak, things get messy otherwise.

Do opponents of UHC now accept that a doctors clinical freedom is enhanced, rather than diminished by how UHC is organised? (certainly in the UK)

straight question, would appreciate a response.
I'm not sure how that would play out in the US, because we'd have to see what type of UHC plan we get. I'm more interested in knowing what % of doctors would stop their practices if we went to single-payer vs if we used another way to get to UHC. It's well-known that in the US, Medicare & Medicaid don't pay as much as private insurance. If we went to Single Payer, some doctors would see a decrease in payments (likely, anyway). Would they accept that?
  #228  
Old 09-27-2019, 07:38 AM
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I'm not sure how that would play out in the US, because we'd have to see what type of UHC plan we get. I'm more interested in knowing what % of doctors would stop their practices if we went to single-payer vs if we used another way to get to UHC. It's well-known that in the US, Medicare & Medicaid don't pay as much as private insurance. If we went to Single Payer, some doctors would see a decrease in payments (likely, anyway). Would they accept that?
Like any service or commercial concern the equation comes down to income v outgoings. Would a switch to UHC also make it cheaper to run their practices?

As for "accepting" it, why would it matter? In all UHC systems in the first world that I know of, Doctors are paid, at least, a solid middle class wage. There is no reason to imagine that the USA would be any different and I can't imagine why there'd be a shortage of people lining up to train and work as doctors.
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  #229  
Old 09-27-2019, 07:47 AM
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How are you accounting for what businesses pay for employee insurance?

Most employer-sponsored health plans are heavily subsidized by the employer, who then takes a tax deduction for the amount paid to the insurance company. Are you ignoring these sums in your calculations, or are they figured in somewhere that you haven't mentioned?
Yes.

The employer portion is paid by me since it is part of my compensation package. The fact that my employer withholds it for tax purposes doesn't change the fact that "benefits" are part of my total compensation just as "salary" is.
  #230  
Old 09-27-2019, 07:49 AM
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It is really inexpensive.
Do you mean "inexpensive" as in the total costs are low? Because if so, I'd be interested in how much your employer is actually paying on it, and how much the government is chipping in in tax breaks.
Or do you mean inexpensive to you personally? Because I really doubt it is as inexpensive to you as the healthcare of the UK, which is free at the point of delivery or Norway where a persons maximum medical costs are capped at $ 300 per year.

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Since Medicare payroll taxes pay for all of Medicare I know that my taxes would more than double to pay for the 120 million people that would need to be added to Medicare rolls.

About 160 million are on private insurance now and 50 million are on Medicare that I also pay for via the 2.9% payroll tax. That leaves 120 million that would need to have their premiums paid by us working stiffs.
As others have pointed out, the over-65s who are currently on medicare cost far more than the average person. Bodies fall apart as we age, sadly. I once calculated that they cost roughly 4x that of under-65s. The group of people who are uninsured and still alive is probably marginally healthier than the others as they don't include people who are kept alive through medical care. For long.

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I expect my taxes would more than double what I pay for in private + Medicare now.

Senator Warren is straight out lying when she claims my "cost" would go down.
Why do you think the laws of economics work differently for you? Healthcare in the UK costs 25 % less in taxes than the current setup costs you in taxes, and they cover everyone and do not charge people for it. Your current system means you pay more in taxes, to the government, for healthcare than most other developed nations. Unlike them, the tax-payers in the US are not in the group that receive any healthcare for their money.

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Originally Posted by survinga View Post
I'm not sure how that would play out in the US, because we'd have to see what type of UHC plan we get. I'm more interested in knowing what % of doctors would stop their practices if we went to single-payer vs if we used another way to get to UHC. It's well-known that in the US, Medicare & Medicaid don't pay as much as private insurance. If we went to Single Payer, some doctors would see a decrease in payments (likely, anyway). Would they accept that?
What are they going to do, drive a bus?

For starters, their pay could end up going up to the level of some UHC nations, but even if not, what is the alternative to medical practice once you spent all those years in college on a medical degree?

A national system would also make it easier to certify physicians from abroad, easing the shortage of doctors in the US

Last edited by Grim Render; 09-27-2019 at 07:52 AM.
  #231  
Old 09-27-2019, 08:02 AM
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Originally Posted by galen ubal View Post
{emphasis added}

Linden Arden, are you spending more than 10.6% of your gross income on healthcare?
By adding 120 million people onto my tax burden my costs will skyrocket. I want to keep this as a macro discussion.

As a middle income working stiff I pay for 100% of my health insurance (remember "benefits" are part of my compensation package) and we (workers) pay 100% of current Medicare taxes.

MFA will ADD 120 million people to our payroll tax burden. I expect my cost to double based on current law. Yet I have a lying politician who claims my "cost" will go down by adding those 120 million people. And she won't provide any detail to support such an outlandish claim.

Trump has lied some 12,000 times according to the Washington Post. But he hasn't told one that big yet.
  #232  
Old 09-27-2019, 08:07 AM
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I have spent some time trying to get into the heads of Americans on this subject, and try to understand how they see things. Like thos who automatically assume that there is a bureaucratic layer between doctors and patients who must approve things because that is the only way they know.

Look:

A) is the costs of delivering healthcare. Surgery, drugs, bandages, MRIs, doctors hours, nurses, etc, etc, etc.

B) is the cost of gatekeeping, filtering out people who are not to get healthcare, get reduced healthcare or do not get everything covered. Rationing it. It induces insurance agents, stock dividends, billing, chasing down payments, credit-checking, liaising and negotiating between hospitals and insurers, arbitration, appeals, time spent on forms, etc, etc, etc, etc. Things that are non-existent or more rudimentary in most other first world nations.

US healthcare costs are the total costs of A + B

I think people are looking a bit too hard on the costs of A, and don't really realize how much B totals up to. They assume that B is so much smaller than A that its negligible in the total costs.

Thats not true. B is about equal to A. In other words, the cost of the US rationing measures in healthcare are now as large as the costs of delivering healthcare. People believe A is so large that they are desperately afraid of the extra costs they think they would get if B was relaxed even slightly.

Whereas when you consider that most people in the US have healthcare of some sort, the actual costs of rationing have grown much larger than what it'd cost to just treat everyone.
  #233  
Old 09-27-2019, 08:14 AM
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Originally Posted by Linden Arden View Post
By adding 120 million people onto my tax burden my costs will skyrocket. I want to keep this as a macro discussion.
Why do you think other nations have less of a tax burden towards health care, when everyone is on health care?
  #234  
Old 09-27-2019, 08:36 AM
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Originally Posted by Linden Arden View Post
By adding 120 million people onto my tax burden my costs will skyrocket. I want to keep this as a macro discussion.

As a middle income working stiff I pay for 100% of my health insurance (remember "benefits" are part of my compensation package) and we (workers) pay 100% of current Medicare taxes.

MFA will ADD 120 million people to our payroll tax burden. I expect my cost to double based on current law. Yet I have a lying politician who claims my "cost" will go down by adding those 120 million people. And she won't provide any detail to support such an outlandish claim.

Trump has lied some 12,000 times according to the Washington Post. But he hasn't told one that big yet.
Maybe you should ask Sen. Warrren if her plan includes raising or rescinding the current $132,900 wage limit for FICA tax. Betcha it does. If you add in the additional contributions, that changes your arithmetic considerably. And the wage market will inevitably adjust to new conditions "on the ground;" that's how the Invisible Hand functions.

Or maybe you should look at how .... gee, literally every other wealthy, developed nation has managed to both reduce costs and improve outcomes with a single-payer system. If you want to take a "macro" view.

If a picture's worth a thousand words, this cartoon should cover whatever else I had to say: It Could Happen Here! (Matt Bors)
  #235  
Old 09-27-2019, 08:39 AM
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Originally Posted by Grim Render View Post
Why do you think other nations have less of a tax burden towards health care, when everyone is on health care?
Services cost much more here in the USA.



Quote:
Specialists, nurses and primary care doctors all earn significantly more in the U.S. compared to other countries. General physicians in America made an average of $218,173 in 2016, the report notes, which was double the average of generalists in the other countries, where pay ranged from $86,607 in Sweden to $154,126 in Germany.

Individual services cost a lot more, too. In 2013, “the average cost in the U.S. was $75,345 for a coronary artery bypass graft surgery, whereas the costs in the Netherlands and Switzerland were $15,742 and $36,509, respectively,” the report states. “Computed tomography was also much higher in the United States, with an average payment of $896 per scan compared with $97 in Canada, $279 in the Netherlands, $432 in Switzerland and $500 in Australia in 2013.
https://www.cnbc.com/2018/03/22/the-...in-the-us.html

And cutting the salaries/costs for those services is electoral doom.
  #236  
Old 09-27-2019, 08:47 AM
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Maybe you should ask Sen. Warrren if her plan includes raising or rescinding the current $132,900 wage limit for FICA tax.



It Could Happen Here! (Matt Bors)
That limit does not apply to Medicare taxes today.

And Sen Warren doesn't have a MFA plan - just a vague promise.
  #237  
Old 09-27-2019, 08:49 AM
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Yes.

The employer portion is paid by me since it is part of my compensation package. The fact that my employer withholds it for tax purposes doesn't change the fact that "benefits" are part of my total compensation just as "salary" is.
Wait, screech to a halt, record scratch..... That withholding is NOT the employer-paid portion of the insurance premium. That is YOUR portion. Your employer also pays an equal or higher amount IN ADDITION to what they pull out of your checks.
  #238  
Old 09-27-2019, 09:00 AM
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Originally Posted by Linden Arden View Post
Services cost much more here in the USA.

https://www.cnbc.com/2018/03/22/the-...in-the-us.html

And cutting the salaries/costs for those services is electoral doom.
Services cost more because you are paying for the whole system. The wages of healthcare insurance people, hospital employees who deal with insurers, people who work in billing... all of that is rolled into the bills.

And physicians or specialists actually get paid more than in the US in Australia, Switzerland, and the Nederlands. They still cover everyone on far less money than the US spends.

Whats more, there is about 1 million physicians in the US. At $ 218 k per year, the total costs are 218 billion. Maybe a 100 billion above average, and 50 billion less than the high salaries nations, adjusted for population. US overspending on medical care is about 1.6 trillion. Salary differences are far too small to make up the difference.

The US gets charged more across the board not because you pay people more, but because you pay more people. You simply have a lot of people in gatekeeping doing jobs that other nations don't see the point of.
  #239  
Old 09-27-2019, 09:09 AM
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Originally Posted by JcWoman View Post
Wait, screech to a halt, record scratch..... That withholding is NOT the employer-paid portion of the insurance premium. That is YOUR portion. Your employer also pays an equal or higher amount IN ADDITION to what they pull out of your checks.
Both portions are MY portions. The EMPLOYER withholding is part of my compensation package and that is how it works for everyone.
  #240  
Old 09-27-2019, 09:13 AM
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Originally Posted by Grim Render View Post
For starters, their pay could end up going up to the level of some UHC nations, but even if not, what is the alternative to medical practice once you spent all those years in college on a medical degree?
Since there is less total medical care being performed than we need, if we instituted UHC the demand for it would go up rather than down, so not only would we need to entice otherwise capable people to enter the field with good pay, we'd need to increase the output of doctor's colleges as well.

Furthermore, probably because of the current lack of physicians, we currently import a lot of them from abroad. If they only got paid as much as they do in other UHC nations, some of them would choose to go to one of the other ones instead.

But these are small details compared to the huge wastefulness of the current American system. We could easily pay doctors more than they're currently making and come out ahead since every doctor's office could lay off one or more clerical staff, and that's before you count the insurance companies themselves.
  #241  
Old 09-27-2019, 09:17 AM
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Originally Posted by Linden Arden View Post
Services cost much more here in the USA.
And why you do suppose this is?
  #242  
Old 09-27-2019, 09:38 AM
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Originally Posted by Linden Arden View Post
Both portions are MY portions. The EMPLOYER withholding is part of my compensation package and that is how it works for everyone.
Yes, but while it's "part of your compensation package," you likely never see how much your employer is paying for their share of your health insurance coverage (unless your employer is a lot more transparent than most are). Your coverage, which you really like, is currently inexpensive (to you), but if you had to foot the entire premium bill out of your own pocket (if you lost your job, and had to continue buying it via COBRA), you very likely would *not* think that it's inexpensive.
  #243  
Old 09-27-2019, 09:52 AM
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Originally Posted by kenobi 65 View Post
Yes, but while it's "part of your compensation package," you likely never see how much your employer is paying for their share of your health insurance coverage (unless your employer is a lot more transparent than most are). Your coverage, which you really like, is currently inexpensive (to you), but if you had to foot the entire premium bill out of your own pocket (if you lost your job, and had to continue buying it via COBRA), you very likely would *not* think that it's inexpensive.
I agree with this but I ask you -

How can my (or any worker) cost be LESS when you add 120 million people to those of us who currently pay all the Medicare taxes?

I need to go to work now so I won't be around for the rest of the day.

Last edited by Linden Arden; 09-27-2019 at 09:54 AM.
  #244  
Old 09-27-2019, 12:00 PM
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Originally Posted by Linden Arden View Post
Yes.

The employer portion is paid by me since it is part of my compensation package. The fact that my employer withholds it for tax purposes doesn't change the fact that "benefits" are part of my total compensation just as "salary" is.
Ok, let's see your accounting then.

For starters, what is the dollar value of the taxes foregone by the federal government in having your employer provide health coverage, and what would be the effect on the federal health care budget if that amount was paid by your employer to the feds instead of to an insurance company? (Remember, that would not change the amount your employer puts into your weekly paycheck, because you never see it anyway.)

Last edited by slash2k; 09-27-2019 at 12:02 PM. Reason: added final parenthetical
  #245  
Old 09-27-2019, 12:47 PM
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That limit does not apply to Medicare taxes today.
You are correct; it does not. I learned something today; thank you.
  #246  
Old 09-27-2019, 12:54 PM
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Can you help me understand this in a little bit of an easier way? They way I took it is that its "your doctor vs. the doctor that the insurance company has"?

It would seem to me that there is one of these doctors in this scenario that would have your medical interests in mind, because, um, he is your doctor and is looking at you in person? The other doctor is the "doctor of your insurance company's money"?
The trick lies in the "third party review". So in reality, it's more like "your doctor vs. the insurance company, and they send it out to an impartial third party to make the decision.

In the case of the company I worked for, we ran a huge network(500+) of urgent care and occ health clinics, and this was something our docs did in their spare time. We did have a few full-time review drs though, and a relatively large network of specialists and state-specific docs when regulations required them.

So what would happen is that an insurance company would think some sort of workers' comp claim was medically unnecessary, but they weren't sure, so they'd throw it over to our docs who would take a look and based on various medical industry treatment guidelines(sometimes state-mandated ones), they'd make a determination of whether the treating doctor was right or not.

More often than not, these were things like unnecessary surgeries or janky pain management- like say prescribing oxycontin initially for stuff like back pain without going through more conservative treatments and/or medications first.
  #247  
Old 09-27-2019, 01:01 PM
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Anecdotes != Data and all that...

As y'all know, I work in the health insurance field, specifically group health insurance - the health insurance you get from your employer, in other words, the subject of this thread.

Part of the process is we give in-person enrollment meetings, where we present the plans, explain the differences, talk about premiums, etc. This happens once a year when the benefits get renewed and people make their annual selections.

Yesterday, I was in a physical therapy office, meeting with about 18 people (we focus on the small business space). I'm standing up, giving my spiel, explaining how the AFLAC products can help pay the high deductibles when I paused, turned to the audience, and said

To be honest, we all... every one of us in the agency... wishes this shit would just get nationalized. (gasps) We'd lose a lot of money, sure, but we'll just go do something else and the country will be the better for it.

They applauded.

Last edited by JohnT; 09-27-2019 at 01:03 PM.
  #248  
Old 09-27-2019, 01:29 PM
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Originally Posted by Linden Arden View Post
How can my (or any worker) cost be LESS when you add 120 million people to those of us who currently pay all the Medicare taxes.
This has been repeated ad nauseum but why do you think the per capita costs of healthcare in the USA are sooooooooooo much bigger than in any other equivalent nation? What accounts for that big difference?
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  #249  
Old 09-27-2019, 01:50 PM
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Originally Posted by bump View Post
The trick lies in the "third party review". So in reality, it's more like "your doctor vs. the insurance company, and they send it out to an impartial third party to make the decision.

In the case of the company I worked for, we ran a huge network(500+) of urgent care and occ health clinics, and this was something our docs did in their spare time. We did have a few full-time review drs though, and a relatively large network of specialists and state-specific docs when regulations required them.

So what would happen is that an insurance company would think some sort of workers' comp claim was medically unnecessary, but they weren't sure, so they'd throw it over to our docs who would take a look and based on various medical industry treatment guidelines(sometimes state-mandated ones), they'd make a determination of whether the treating doctor was right or not.

More often than not, these were things like unnecessary surgeries or janky pain management- like say prescribing oxycontin initially for stuff like back pain without going through more conservative treatments and/or medications first.
Question about how that all played out.

I assume that the doctors were not doing this out of the goodness of their hearts, that they were getting paid, correct?

And the insurance company gets to choose what doctors that they want to use to get a third party opinion on a procedure correct?

Do you think that insurance companies would send it to doctors who have a higher or a lower rate of approving suspect procedures?

Do you think that the doctors would feel any pressure to err on the side of denying claims in order to continue getting these referrals?
  #250  
Old 09-27-2019, 01:52 PM
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Originally Posted by Linden Arden View Post
I agree with this but I ask you -

How can my (or any worker) cost be LESS when you add 120 million people to those of us who currently pay all the Medicare taxes?

I need to go to work now so I won't be around for the rest of the day.
Are you thinking that you total taxes will double, or that your medicare payroll tax would double?
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