Can someone explain in a nutshell EXACTLY what the Republicans object to re Obamacare

[ITR_champion]

@slash2k

Your own cite says that these new regulations and fees and mandates will cost $4,800 to $5,900 per employee over ten years. That’s $480-590 per employee. The average cost of family coverage this year is over $17K per employee, so we’re talking less than ten percent, AND this amount includes the cost to employers who never previously provided health insurance and now have to. In the grand scheme of things, this isn’t “a lot more.”

True, I suppose. Then again, those numbers were projections from 2014 about costs far into the future. It’s been a theme of Obamacare that costs are higher than expected, often a lot higher. That’s why the Co-Ops failed, why insurers may leave the exchanges entirely, and so forth. If costs to employers end up being far higher than projected, that could hardly be a surprise.

From your cite: “Eventually, large employers may opt to pay the fine for not providing health insurance and leave their workers to get coverage in the exchanges. Doing so might even save them money.” Um, this was going on for years before Obama ever took office; the percentage of employers offering health benefits declined every single year from 2000 to 2010, and most likely peaked sometime during the Reagan administration How is that the fault of the ACA?

The OP’s question was why Republicans oppose Obamacare. A doper (who, like me, is not a Republican) gave his own experience as an example. Because of the ACA, his employer was financially forced to move to higher deductibles in his plans. It’s happened at my employer too. It’s happened to many employers. And of course higher deductibles are just one way that employers share the government-imposed burden with their employees. There are many others.

In response to that, defenders of the law point out that costs were rising and employers had to respond even before the law was passed. This is true, but not likely to comfort those who are getting screwed now. When promoting the law, Obama and company explicitly promised lower prices and higher quality of coverage.

There are, of course, plenty of other reasons why people Republican and otherwise would oppose the law, ranging from enormous paperwork requirements to job losses.

[slash2k]

@ITR_champion

A doper (who, like me, is not a Republican) gave his own experience as an example. Because of the ACA, his employer was financially forced to move to higher deductibles in his plans.

I’d like to see some evidence that his employer, or yours, was “financially forced” to do so, as opposed to having made a strategic decision to reduce labor costs by paying less.

See, e.g., Bloomberg:

Employer efforts to limit spending can be found in two measures tracked by Mercer: how much firms are actually paying, and how much they’d have to pay if they didn’t make any changes to their health plans by doing things like increasing the costs shared by workers. In 2016, actual spending is projected to rise by 4.2 percent, while without changes like higher deductibles, totals costs would grow by an average of 6.4 percent. The 2.2 percentage point gap shows how employers are changing health benefits to limit spending.

An increase of 6.4% would be slightly below the average of the past two decades. If both employers and employees were paying 6.4% more, there’d be complaints, but it would be more muted. However, what we’ve seen is employers deciding to shift costs onto employees. (And since employers typically pick up more than two-thirds of the cost of employee health benefits, that extra 2.2% not being paid by employers, coupled with the 6.4% increase on the employee share, actually translates into an employee increase more in the range of 11-12 percent. In other words, employees are seeing costs going up at close to three times the rate their employers are. That’s not employers “shar[ing] the government-imposed burden”; that’s employers shifting the burden.

For example, here in Kansas the state government is considering a proposal to eliminate the “regular” state employee health plan and move everybody onto a high-deductible plan, solely as a cost-saving measure. Note that this is not intended merely to reduce the rate of growth in health-care spending; it is intended to reduce the absolute amount the state spends. If the proposal is adopted, the state thinks it will spend $12-15 million less in fiscal year 2017 than it will this year. Since it is state government, the proposal is being discussed publicly; in how many boardrooms are similar discussions taking place out of public view?

Some of your other points:

Yes, many of the co-op plans are failures. However, the plans were brand-new business ventures, funded almost exclusively with federal loans, and subject to bizarre requirements (for example, they were legally prohibited from hiring anybody who had ever held an executive position at a for-profit health insurance company). You give some novices a bunch of federal money to play with in a new and uncertain market, and the results aren’t exactly unexpected.

As far as job losses in the medical device industry, even the industry analysts haven’t been able to determine what, if any, effect the medical device tax is having on industry employment. Your own cite quotes one:

The long and the short of it is that it’s nearly impossible to determine if the tax alone was the cause of layoffs, or if the company used the tax as a good cover for layoffs that were going to happen to begin with. The medical device industry is facing some pretty substantial headwinds that have nothing to do with the excise tax.

The job losses are allegedly due to the 2.3% excise tax on devices ranging from hip implants to imaging machinery. However, it is difficult to see how a tax in that range will greatly impact necessary personal equipment (if you need a coronary stent, 2.3% of the cost of the stent is but a minute fraction of the total cost of the procedure anyway), and to the extent that it impacts unnecessary procedures, well, that’s what cost control is supposed to do. Similarly, facilities that really need a new MRI machine will still need it even if the cost is 2.3% higher than it otherwise would be, and the fact that medical inflation is below historical averages doesn’t show an industry reeling from devastating price increases.

[Quartz]

@sleestak

If, and this is a giant if, I believed that the U.S. could implement single payer and not end up like Greece I might be ok with single payer even though I do not believe it is the governments job to provide health care.

Why look at Greece when you could look closer to home, to Canada, or the UK, or Australia? All of which have UHC is one form or another and aren’t the basket-case that is Greece.

And don’t mix welfare with UHC.

[Fear_Itself]

@sleestak

If, and this is a giant if, I believed that the U.S. could implement single payer and not end up like Greece I might be ok with single payer even though I do not believe it is the governments job to provide health care.

Whose job is it to provide health care?

[SmartAlecCat]

@Quartz

Why look at Greece when you could look closer to home, to Canada, or the UK, or Australia? All of which have UHC is one form or another and aren’t the basket-case that is Greece.

And don’t mix welfare with UHC.

Are there any first world countries (other than the U.S.) that don’t have UHC?

[Grim_Render]

@sleestak

Well, Portugal, Italy and Spain aren’t out of the woods yet either. And the root cause is debt. And that debt is largely social programs and taxes that lead to tax evasion. All four have big problems is this area.

Slee

I don’t think you have fully grasped just how much cheaper single payer is than the US current mess of a system, or the economics of the issue.

[Northern_Piper]

If the root cause for those three countries is debt caused by social programs and taxes triggering tax evasion, then you would see the same problems in any country with a strong social net including health care. But you don’t. Countries like Germany, the U.K., France, Canada, Australia and New Zealand have strong social programs with health care included, but don’t have the problems of Greece in particular.

Greece has a huge number of problems in its government finances. Blaming it all on UHC is a kind of perverse cherry-picking.

[ITR_champion]

@slash2k

I’d like to see some evidence that his employer, or yours, was “financially forced” to do so, as opposed to having made a strategic decision to reduce labor costs by paying less.

I’m not sure what the difference is.

You have a household budget, I assume. In other words, there’s a maximum amount that you can pay per year. If the price of something necessary, like food, were to rise, you would have to cut something in your budget. You might buy less food, or buy cheaper food, or keep food the same and cut costs elsewhere in your budget. Somewhere, somehow, you would have to cut something to make up for those higher food costs.

An employer also has a budget, a maximum amount they can pay each year. If a new law pushes the cost of health care up, they have to cut something. As the links that I’ve already posted show, employers have found many responses. Some have stopped buying health insurance entirely, some have made their employees pay more for insurance, some have switched to cheaper insurance with higher deductibles and smaller networks, some have kicked spouses out of their health care plans, and some have cut costs elsewhere. But when the government raises what employers must pay for health care, something has to get cut somewhere, barring the employer being lucky enough to get a big windfall that covers the costs.

[slash2k]

@ITR_champion

I’m not sure what the difference is.

You have a household budget, I assume. In other words, there’s a maximum amount that you can pay per year. If the price of something necessary, like food, were to rise, you would have to cut something in your budget. You might buy less food, or buy cheaper food, or keep food the same and cut costs elsewhere in your budget. Somewhere, somehow, you would have to cut something to make up for those higher food costs.

However, if my household budget went up 20% (say, I got a big raise) and food prices went up 5%, but I decided i wanted to buy a Ferrari instead of a Honda, was I “financially forced” to buy less food or cheaper food in order to pay the bill for the Ferrari? or did I simply make a strategic decision that I wanted something else more than food?

Corporate profits in the U.S. remain at or near record levels. cite, cite. After-tax profits as a percentage of GDP are at levels higher than they’ve ever been since the U.S. government starting keeping records in the late 1920s. Corporations are devoting a greater percentage of their budget to profits, which is great for shareholders, but it’s the equivalent of a household spending more money on an expensive car and less on food. That’s a choice, not something being imposed from without.

[Northern_Piper]

@Grim_Render

I don’t think you have fully grasped just how much cheaper single payer is than the US current mess of a system, or the economics of the issue.

Indeed. Here’s a post I made over in this thread (Why isn’t anyone actually looking to cut healthcare costs?), in response to a poster involved in the US insurance system who was explaining the need for administrative costs. My response was that most of those costs were solely the result of the unusual US system, and would be greatly reduced under a single-payer system:

@Northern_Piper

[Quote=RingsOfPylon]

We have to report to at least 100 different federal and state agencies. Then we have to satisfy audits (I specialize in explaining the automated processes to auditors and producing software to provide data and validate the numbers).

In the single payer system where I live (Canada), medical offices only have to report claims to two different agencies: the provincial health insurance commission for the great majority of patients, and to the Workers’ Compensation Board, a different provincial agency, for treatment for work-related injuries. In practice, WCB is not a large portion of payments for medical care in the province. There is therefore only one set of codes needed, not over 100.

[Quote=RingsOfPylon]
If no one is doing an audit, how does the consumer or client know if they are being overcharged or if mistakes are being made or if someone is engaging in various forms of fraud?
[/QUOTE]

Here, the [del]consumer[/del] patient does not have any involvement in payment, since there are no co-pays or deductibles. The two clients (insurance commission and WCB) can and do conduct audits.

[Quote=RingsOfPylon]

There are drug rebates to various states. Many entities work out rebate agreements between drug manufacturers and clients. They, usually government entities, recoup some of their expenditures on drugs directly from manufacturers. These are processed and billed quarterly, with invoices going to various manufacturers, payments being collected, and disputes being resolved.
[/QUOTE]

The provincial governments have worked out a system for uniform drug costs across the country, for drugs used in the hospitals, by using their combined purchasing power, just like WalMart.

[Quote=RingsOfPylon]

You need to have people who interface with customers to answer questions about policies and charges, or provide information about constantly changing plans and coverages.
[/QUOTE]

Since coverage of medical matters is uniform and universal within a province, there is no need for that function in our system. [del]Customers[/del] Patients never have to ask those questions, since payment is made by the medical commission directly to the doctor or the hospital.

[Quote=RingsOfPylon]
You need to have the same thing for providers who call with questions.
[/QUOTE]

The provincial insurance commission is the one that sets the terms, so there is no need for this function in our system.

[Quote=RingsOfPylon]
I don’t see how you get out of administrative overhead. You can move it around a bit, but it can’t be eliminated entirely as long as some measures of accountability, review, and dealing with customers are required. It’s a sub-business within itself. A necessary one.
[/QUOTE]

Every system has administrative overhead. But the amount of administrative overhead multiplies the more complex your system. Administrative overhead in a single-payer system is much lower than a multi-payer, private insurance system.

[Quote=RingsOfPylon]
I can’t even imagine how, regardless of design or government, there isn’t a conscientious and detailed review of spending, payments, rebates, who is spending how much on what, and the like. You can’t get rid of that and still have a system that is accountable to the customer and to the taxpayer.
[/QUOTE]

Agreed, any system needs an effective audit system. However, the more complicated your payment system, and the more payors there are, the more complex and expensive the audit function becomes. Here, the medical insurance commission performs regular audits within the medical system, and has the statutory power to claw back over-payments. Because there is only one payer and one payment structure, audits will be much simpler and less expensive than what you are describing.

[/QUOTE]

[DorkVader]

nm

[RingsOfPylon]

@Northern_Piper

The provincial governments have worked out a system for uniform drug costs across the country, for drugs used in the hospitals, by using their combined purchasing power, just like WalMart.

I think you might be overlooking a big component in prescription drugs with private insurance, prices notwithstanding.

Most folks in Canada have some sort of private prescription coverage, assuming they don’t fall under the exceptional categories where drugs are covered. When the customer walks into a pharmacy and hands their prescription over to the pharmacy assistant and the prescription is filled, it’s submitted to an automated system for pricing and approval.

I know for a fact that there is at least one Canadian drug insurance company that uses the same software that we do for adjudicating pharmacy claims. There may be others.

Now, maybe the Canadian government stays out of those private transactions, but I doubt it, if for no other reason than to track drug utilization from a population health point of view.

Those private insurance companies are adjudicating pharmacy claims for Canadian citizens based on their private insurance policies (perhaps the public ones do as well). As such, I’m sure they have to report income and outgo to at least taxing agencies in addition to any central authority that collects drug utilization information. It would also be safe to say that both the insurance company and the government are interested in whether or not there’s, say, an over-prescribing of opioids going on.

There might data exchanges to validate eligibility (is the person eligible for private insurance, is their income too low and they should be getting public coverage, are they Canadian citizens?) - most insurance companies will let a customer know if that customer might be eligible for additional help.

There are probably also other accountability mechanisms. Is the insurance company honoring its contract with the consumer in regards to service? Who monitors that? Are there insurance boards or attorneys who can conduct inquiries and demand data for investigations and the like?

I bet the overheads are not that dissimilar. The volume may be lower because it only involves pharmacy claims and/or long term care that is not covered by the government, but there is probably a lot of reporting, data exchanges, and auditing going on.

There is a lot that goes on behind the scenes. It was quite the education for me when I started working in Healthcare IT in 2007. I didn’t know the half of it; I’m not sure anyone outside of the industry even realizes what goes on behind the scenes.

[Fiddle_Peghead]

@John_Mace

The pre-amble has never been used as a source of government authority, except where that authority is mentioned elsewhere in the constitution. Otherwise, that would provide a blank check of federal powers since anything can fall under “the general welfare”.

Ah. Thanks, John.

[Fiddle_Peghead]

@Bone

You’re missing a word in the second clause here in a way i can’t tell what your question is. Should, could, would? I’m not sure. If you clarify your question I can answer it.

“Should”.

[Bone]

@Fiddle_Peghead

Do you then agree that if someone who doesn’t buy health insurance and has no means to pay for health care, **[should] **be denied emergency room services, whether in case of an accident or just general care?

@Fiddle_Peghead

“Should”.

I’m inserting that word where I think it goes. Let me know if I got that wrong.

If that person who doesn’t buy health insurance and has no means to pay for health care, they should not be denied the services mandated by the EMTLA if they are subject to it by accepting Medicare payments. If these people are denied at this type of facility, then that would be in violation of the EMTLA.

If your question is more broadly construed as to whether the EMTLA is good policy, I do not think it is. I am opposed to unfunded mandates in general, though the policy goals may be worthwhile. I would prefer an entitlement be established for care/insurance if we as a society deem it appropriate to provide this type of safety net.

[T.M]

I live in the U.K. and know nothing about health care in America. the Question I would ask myself is. Should a person be left to die because they cannot afford medical treatment? I personally believe that any country that believes themselves to be a civilised country must have a Medicare system that is free at the point of delivery for its citizens. What would I do to make this come about? Support a political party that was near to my political ideology and campaign with them for the Medicare system that I wished to have in my country

[Really_Not_All_That_Bright]

What do you think we do?

[septimus]

@Really_Not_All_That_Bright

What do you think we do?

Since you may care about three issues but only can get only vote for one candidate, I think a large portion of Americans vote based on candidate’s position on

Guns!!Among remaining voters, many are most concerned about

Gays!!
or
Abortion
Fiscal or secular humanistic issues? Not so much.

[T.M]

@Really_Not_All_That_Bright

What do you think we do?

I do not know but from the outside looking in it seems that the political parties are more interested in point scoring than anything else. I some tomes think that none party action can get things moving

[lance_strongarm]

@T.M

I live in the U.K. and know nothing about health care in America. the Question I would ask myself is. Should a person be left to die because they cannot afford medical treatment?

Of course not, and we don’t do that.

We just pretend like everyone is paying for their own care and then shift the costs through a patchwork of government programs and “cost-shifting” in which hospitals charge the insured more to make up for what they lose from those who can’t pay.

It’s complicated enough for any politician to turn it into whatever he/she wants without many people actually understanding it.