Does Biden have a health care plan or a realistic method of getting it passed

Politics & Elections
41

We don’t have that.

We have some specific programs like Medicare and Medicaid which are not available to everyone. We have a private marketplace that is available to everyone but does not accomplish everything a government-run healthcare program could. Namely, when the insurance companies are not able to make a profit, they are not obliged to be on the exchange offering competitive prices and when they are able to make a profit there isn’t a public program competing with them to necessitate that their prices remain competitive.

The gap in coverage issue is actually separate from that one IMO (although that is a huge problem as well). Of course subsidies help with that but I don’t think it’s likely that any particular issue with our current system can actually be eliminated purely through increasing subsidies alone.

I am in the camp that doesn’t think single-payer is necessary. A multi-payer system where healthcare funding/insurance through a government mechanism is available for everyone. However, that is not what we currently have.

42

I’m in the same camp. I think that Switzerland has a good system that relies on something like…“the ACA done right”. It’s regulated plans on exchanges, but it’s better subsidized so that it’s more affordable, and the individual mandate in Switzerland really has teeth. Switzerland and the Netherlands have both achieved UHC using an ACA-on-steroids approach.

The key to UHC is a government that’s committed to a system that achieves UHC, that provides regulation that forces the issue. It can be single-payer or multi-payer. In the US, if we ever achieve UHC, I think it will be via multi-payer, mainly because of politics.

43

I actually also agree with that a Swiss/Dutch approach can be effective. Unfortunately I think in the US the level of income and wealth inequality is so huge that I think even without the political problems it would be really tough for us to get this one right. Our huge income/wealth disparity and the regional differences add more obstacles for us than exist in Switzerland and the Netherlands. It’s a weird problem for us because what you want to do is extend the max cost as a percent of income up to the point where the market is offering plans below the percentage of income - basically to let the market decide where the subsidy should kick in. This of course wouldn’t work in practice because the market could just arbitrarily raise prices and have the government pick up the tab. Failing that, it needs to just be high enough that in at least moderately high COL areas there isn’t an income gap, or there needs to be a formula based on cost of living. I think San Francisco and the like might be able to survive in any system, but there’s a level of COL where there aren’t enough local/state resources to help people out but the cost of living would lead to people who make a high income but need the subsidy to afford healthcare.

We also have the problem that the federal government actually having a hard mandate for healthcare would get struck down by the SCOTUS, so all that remains is the tax penalty. There is the option of raising the penalty but I think this would be a problem because it would compound any other issue with people who are unable to get private healthcare but don’t qualify for medicare into a bigger problem. It is I guess a positive sign that the tax penalty was completely removed and participation in the system stayed high, which shows that most Americans really want health insurance as long as there is any way to afford it.

This is a point that really needs emphasis. A lot of things can work. But they if enough of our political system is actively invested in not having UHC work completely. Especially with how complicated and patchworked it is now, and the fact that some things rely on federal/state cooperation, there’s always going to be someone who figures out how to create a loophole somewhere.

It’s a bit paradoxical because the closer you get to single-payer the harder it is for conservatives and special interests to stick their claws into the system, but of course the tougher it is to achieve in the first place. I think the first step involves both giving people the best we can in the confines of the current system to fight off Trumpian zero-sum politics as well as a combination of political campaigning for real as well as organizing and pressure.

44

I am above the cut-off income for Medicaid, and below the age for Medicare, and I did not serve in the military or have a govt job.

Could you tell me how I could get health insurance from the federal government?

Or are you for some reason thinking that buying private insurance through the ACA exchanges is the same thing? If so, then I think that we have found the root of your confusion on this topic.

45

No, we don’t have “the ability for every American to get health insurance from the federal government.”

We have various federal programs. Medicare, Medicaid, the VA, and there are probably some more I can’t think of right now.

We have the ACA, which, as I pointed out above, is not “health insurance from the federal government,” but rather a set of regulations for private health insurance, coupled with a subsidy for (some) low-income purchasers.

Even with all of those, there are plenty of holes through which someone can fall.

Just for kicks, I went on my state’s exchange and looked up what it would cost me to purchase insurance for my family of five, given my income.

To purchase even what they call a “bronze” level policy, given the deductibles and out-of-pocket cost limits, allowing for the (trivial) subsidies given at my income level, is simply not possible. Not if I want to keep on housing and feeding my children, never mind saving for their educations, or my retirement. And since I have three small children, I can’t buy a lower-level policy (a catastrophic-only policy). I cannot have my children unable to see a doctor regularly, even the few doctors who accept the bronze-level plans (which seem, at least here in NY, to be in-network only, and have very small networks).

So it is not true that every American has the ability to get health insurance from the federal government. It’s not even true that every American has the ability to get health insurance, period, full stop.

46

It basically comes to the same thing. Those are government regulated and often govt subsidized.

Is there some benefit to getting it direct from the feds? Assuming there is the same cost. I mean, if you send a check to the Feds and they send that $ on to the insurer, it just adds a level.

47

You have the ability, you have made a choice not to. I understand your choice, But you seem to say " I can’t buy a lower-level policy (a catastrophic-only policy). I cannot have my children unable to see a doctor regularly,…" So which is it? You cant afford insurance, yet you have your kids seeing a doctor on a regular basis. What choice did you make, then? I am confused.

Now, yes, Bidens reforms for the ACA and Medicare are critical. Lower income people will have their ACA free, more elderly will be covered by Medicare, and struggling people will get more subsidies. This is badly needed.

48

Allow me to alleviate your confusion.

As I said, I went to my state’s exchange “just for kicks.” Perhaps I should not have been so flippant. I wanted to see what it would cost me to purchase health insurance for a family of five, given my income.

I do not have to purchase insurance on the exchange because fortunately I have a health insurance policy through my employer. It’s a pretty good one, and they pick up most of the cost. It’s still quite expensive for me. Not surprising, since it covers me, my wife and our three children.

Spoken like a disciple of Milton Friedman. Yes, people have the choice to, say, forego saving for their children’s higher education so that they can get health insurance for those children now. Or they can choose to have those children go without regular health care and purchase a more affordable catastrophic coverage policy.

I suppose those are choices, so I guess I have to concede your point, in part.

That said, it’s simply not true that every American has the ability to get health insurance from the federal government.

49

Cool, that’s great. And I get mine forever as a retired Fed (I do pay a small amount, mind you, it comes out of retirement).

We still need Bidens reforms, for everyone else, at least.

50

I agree with both of these responses.

Millions fall through these cracks, which are really Grand Canyons. Eat or buy a ACA policy? That’s the “choice” the way is exists now. It’s basically “let them eat cake”.

One other action that would help is for the federal to require every single state to adopt the Medicaid Expansion. That would cover some millions of people currently uninsured.

51

It’s not the same thing, as you yourself point out:

And why does the Fed have to send a check to an insurer, rather than to the healthcare providers themselves?

It is that unnecessary level that you are admitting is added in that I am talking about.

That is not a valid assumption to be made, if you remove the parasite that takes 30% of every health care dollar for itself.

And keep in mind that you don’t just get that 30% savings. Since they are by law only allowed to keep 30% of the premiums, and must spend the rest on healthcare, they are actually incentivized to push the increase in the cost of healthcare, as that means that they get to raise premiums and take more money. It’s a bit like “expenses plus” govt contracts, where the contractor has no incentive to keep costs down.

So, yes, there is a benefit from getting it direct from the feds.

52

It’s actually 20% under the ACA. Public insurance overhead is likely much less, probably under 5%, so your point stands. But it’s not 30%.

53

Thanks, I misremembered. I should have double checked before posting.