# Question regarding Obamacare **URL:** \ **Category:** Politics & Elections\ **Created:** [October 12, 2016, 7:15am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316 "2016-10-12T07:15:21Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [October 18, 2016, 7:21pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/81 "2016-10-18T19:21:01Z")
> [@Orwell](#): > > You seem to think that several of us are lying, which I find incredibly insulting. I also find it bewildering. So, now asking for a \*\*cite \*\*is tantamount to saying you are lying? Not on this board. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [October 18, 2016, 7:26pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/82 "2016-10-18T19:26:58Z")
> [@Bone](#): > > That’s not a cite for what you were claiming. You claimed a person would be exempt. The commissioner said it’d rare. I do not think there is any statutory restriction on auditing an individual annually even if there are no issues. You claim otherwise. Do you have a cite? > > Later on in the article another person mentions complexity as a reason to be selected for audit. You’re not reading the commissioner correctly. Yes, it would be rare for anyone to be “audited every year” since most sane people will change their claims after being audited. But You cant get audited year after year if there are no issues, if the audit is a “no change”: > **[What IRS considers in determining whether an audit is considered Repetitive?](https://www.calt.iastate.edu/what-irs-considers-determining-whether-audit-considered-repetitive)** > > There are limits on the IRS continuing audits year after year. IRS’s scope is limited by Internal Revenue Manual 4.10.2.8.5. If an examination of the same issue(s) in either of the preceding two years resulted in a no-change or a small tax change,... “When the taxpayer provides records identifying the issues examined in prior years: If the issues are the same as in the current year examination, and the I/BMFOLZ print indicates either no change or a small change to the taxpayer’s liability, then the current examination can be closed. Send Letter 2681 (DO), Repetitive Exam Letter, to close the examination.” ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 18, 2016, 8:42pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/83 "2016-10-18T20:42:23Z")
> [@DrDeth](#): > > You’re not reading the commissioner correctly. Yes, it would be rare for anyone to be “audited every year” since most sane people will change their claims after being audited. > > But You cant get audited year after year if there are no issues, if the audit is a “no change”: > [What IRS considers in determining whether an audit is considered Repetitive? | Center for Agricultural Law and Taxation](https://www.calt.iastate.edu/what-irs-considers-determining-whether-audit-considered-repetitive) > > “When the taxpayer provides records identifying the issues examined in prior years: > If the issues are the same as in the current year examination, and the I/BMFOLZ print indicates either no change or a small change to the taxpayer’s liability, then the current examination can be closed. Send Letter 2681 (DO), Repetitive Exam Letter, to close the examination.” I think it is you who is not reading the commissioner correctly. Let’s go to more authoritative source, [IRS code 4.10.2.13](https://www.irs.gov/irm/part4/irm_04-010-002r-cont01.html) : > [@](#): > > 4.10.2.13 (02-11-2016) > Repetitive Audits > > Repetitive audit procedures apply to individual tax returns without a Schedule C or Schedule F, when the following criteria are met: > > An examination of one or both of the two preceding tax years resulted in a no change or a small tax change (deficiency or overassessment), and > > The issues examined in either of the two preceding tax years are the same as the issues selected for examination in the current year. > > Note: > > Prior year surveys do not meet the criteria for repetitive audit procedures. So repetitive audits can be conducted even if there are no issues, if in each of the years different items are identified. In other words, Trump could have items A, B, C, and D in his return. Year 1 could identify item A. Year 2 could identify item B. Year 3 could identify item C and that would not run afoul of the guidance about repetitive audits since the issues selected for examination were different in each year. But even further, the [termination of an examination is completely discretionary](http://www.leagle.com/decision/1983139245litcm1347_11072/TUCKER%20v.%20COMMISSIONER): > [@](#): > > We think petitioners’ reliance on IRM section 4241 is ill-founded for several reasons. First, we have previously held that\*\* the decision to conclude an examination under that section is totally discretionary with respondent\*\*. Chapman v. Commissioner [Dec. 38,783(M)], T.C. Memo. 1982-68. Cf. Cleveland Trust Company v. United States [70-1 USTC ¶ 12,649], 421 F.2d 475, 481-482 (6th Cir. 1970); Luhring v. Glotzbach [62-2 USTC ¶ 9547], 304 F.2d 560, 563-564 (4th Cir. 1962); Collins v. Commissioner [Dec. 32,483], 61 T.C. 693, 701 (1974), **which hold that procedural rules such as those set forth in various Revenue Procedures and the Statement of Procedural Rules are merely directory and not mandatory.** (my bold) ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [October 18, 2016, 8:58pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/84 "2016-10-18T20:58:48Z")
> [@Bone](#): > > I think it is you who is not reading the commissioner correctly. Let’s go to more authoritative source, [IRS code 4.10.2.13](https://www.irs.gov/irm/part4/irm_04-010-002r-cont01.html) : > > So repetitive audits can be conducted even if there are no issues, if in each of the years different items are identified. In other words, Trump could have items A, B, C, and D in his return. Year 1 could identify item A. Year 2 could identify item B. Year 3 could identify item C and that would not run afoul of the guidance about repetitive audits since the issues selected for examination were different in each year. > > But even further, the [termination of an examination is completely discretionary](http://www.leagle.com/decision/1983139245litcm1347_11072/TUCKER%20v.%20COMMISSIONER): > (my bold) That’s not the **Code** , it is the \*\*Manual. \*\* which is what I linked to. Yes, that is\* possible\* but unheard of in practice- for year after year. In any case, rarely does a audit consist of a single item, unless of course, there is only a single item to audit, such as dependents. Technically it is discretionary, but in practice it is not. It’s in the IRM, which of course the IRS can change without Congressional approval. But to change or ignore the IRM for a single individual is just not done. In any case Trumps claim to be audited either is false or was due to the IRS finding significant deficiencies year after year. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 18, 2016, 9:25pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/85 "2016-10-18T21:25:51Z")
_Manual_, not code. I flubbed that one. > [@DrDeth](#): > > Technically it is discretionary, but in practice it is not. It’s in the IRM, which of course the IRS can change without Congressional approval. But to change or ignore the IRM for a single individual is just not done. So it’s not done, except there are 4 court cases cited that support the discretionary nature. It’s not unheard of - it happened and there are court cases for precedent. And when the IRS engages in tactics to penalize non-profits based on the politics of the organization, I’m skeptical of any claim that action by the IRS against an individual is “just not done”. You made the claim that a person would be exempt from audit for two years if they had a clean audit. That was technically incorrect as you acknowledge. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [October 18, 2016, 10:04pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/86 "2016-10-18T22:04:48Z")
> [@Bone](#): > > _Manual_, not code. I flubbed that one. > > So it’s not done, except there are 4 court cases cited that support the discretionary nature. It’s not unheard of - it happened and there are court cases for precedent. > > And when the IRS engages in tactics to penalize non-profits based on the politics of the organization, I’m skeptical of any claim that action by the IRS against an individual is “just not done”. You made the claim that a person would be exempt from audit for two years if they had a clean audit. That was technically incorrect as you acknowledge. Well, two things: 1. This was 1976, before the Taxpayers Bill of Rights, etc. 2. " _Finally, as we shall discuss in the following paragraph, we do not think that this case even comes within the literal language of IRM section 4241._ The IRS did not penalize, and that had nothing whatsover to do with Tax Audits. It was whether or not to grant Non-Profit status without question. And, as they pointed out, it was known for certain types of non-profits to be too politically oriented to qualify. However, indeed, they used incorrect methods for asking more question before approving exempt status. But again, no one was audited, no fines assessed. [IRS targeting controversy - Wikipedia](https://en.wikipedia.org/wiki/IRS_targeting_controversy) This is a red herring. I did make that claim, the commissioner made that claim and that claim is technically correct. There are some exceptions, as with any law. But you likely do not know how returns are _audited._ Neither the Manager nor the auditor has any significant say in initial selection. Returns are run thru the "DIF system to see how different they are from the other returns in the same income bracket- and whether or not those differences will likely result in a significant deficiency. Then those computer selected returns are given to a team of Senior auditors, who cull about half of them. Some few audits are started due to a informants report. No auditor can decide to audit an individual. He cant even look at or request the SSN. Once a audit is completed, the agent can ask to examine the subsequent years return, or even, in rare cases, the priors years return (often, copies of both are included int he file, for comparison purposes). If the audit resulted in a significant deficiency , the Manager will rubber stamp that request. However, unlike the individual agent or auditor, the Manager is rated and bonus is based partially upon “dollars per staff hour”, thus she will want significant tax owed. It is possible for a auditor to make a case that altho 2012 resulted in a no-change, that 2013 has different and juicy looking items. The manager might allow it then. But not for the next year and the next and the next. So, as to the claims that Trump was audited “year after year” that means exactly two possibilities: 1. He is lying or 2. the IRS found significant tax deficiencies in those years, enough so as to commit more staff hours to more audits. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 18, 2016, 10:25pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/87 "2016-10-18T22:25:33Z")
> [@DrDeth](#): > > Yes, you can get audited and get a refund or no-change, but then that exempts you from being audited for the next two years. You dont get audited “audited year after year”, if they arent finding some nice deficiencies. > [@DrDeth](#): > > **Technically it is discretionary,** but in practice it is not. > [@Bone](#): > > You made the claim that a person would be exempt from audit for two years if they had a clean audit. That was technically incorrect as you acknowledge. > [@DrDeth](#): > > I did make that claim, the commissioner made that claim and that claim is\*\* technically correct.\*\* There are some exceptions, as with any law. (my bold in each of the above) I am not sure how you are using the term “technically” here. I cited court precedent that demonstrates the discretionary nature of the guidance you referenced. Is it “technically” discretionary, or was your claim “technically” correct that a person would be exempt? Those two things are mutually exclusive. The commissioner said improbable, etc. You however said exempt. His has room for exceptions, yours does not. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [October 18, 2016, 10:35pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/88 "2016-10-18T22:35:32Z")
> [@Bone](#): > > (my bold in each of the above) > > I am not sure how you are using the term “technically” here. I cited court precedent that demonstrates the discretionary nature of the guidance you referenced. Is it “technically” discretionary, or was your claim “technically” correct that a person would be exempt? Those two things are mutually exclusive. The commissioner said improbable, etc. You however said exempt. His has room for exceptions, yours does not. Again, 1976 case, the law has changed since then. Like I said, _Technically it is discretionary, but in practice it is not._ The Commissioner said improbable to being audited year after year without a issue. "But the IRS chief also strongly suggested that the scenario Trump laid out in Thursday’s GOP debate was improbable. “It would be rare for anyone to be audited every year,” Koskinen said in the interview, which will air Sunday. If there were no issues following an audit, Koskinen added, “it’s a number of years — two or three at least — before you hear from us again." \*\*There are two parts to his statement. \*\* The second part confirms what I said _" If there were no issues following an audit…it’s a number of years — two or three at least — before you hear from us again."_ Note the “no issues following an audit”. The Comm also said " It would be rare for anyone to be audited every year". Which is also true. Hoiwever, thsi has nothing to do with Obamacare, so please start a new thread if you wish to continue. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 18, 2016, 11:36pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/89 "2016-10-18T23:36:11Z")
I decline your invitation. I do note that your original claim that a person would be exempt from repeat audits was technically incorrect. Feel free to take it up with the tax court. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 19, 2016, 3:14am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/90 "2016-10-19T03:14:14Z")
> [@Orwell](#): > > Not every government agency and service is “important and needed” True, but some ARE needed and ARE important and they should be funded for the benefit of all of us. > [@](#): > > Boy, you’ve swallowed that illogical Democratic party line, haven’t you? If Trump didn’t pay federal income taxes, and if he’s been audited year after year, then that tells me that he’s been in conformance with the tax code written and passed by politicians of both parties for the past 70 years. Either he has illegally evaded taxes or has legally avoided them. If the latter, which seems to be the case, then he is using the tax code like every citizen and business in the country. And if a poor family doesn’t pay Federal income taxes and audits find no fault because they are in conformance with the tax code they are blasted as parasites - but they are doing nothing different than Trump. If a rich man uses the tax code to his advantage he’s lauded as a hero but if a poor person does so they are regarded as little better than a thief. Poor people using the system to their advantage should be seen as no worse than someone like Trump doing so. > [@](#): > > You make some valid points about pre-existing conditions and lifetime maximums, but you seem to recognize no validity regarding those who complain that we are paying $12k-$20k a year for health insurance policies that are worse than we had five years ago for 1/3 the cost because our former insurance plans “that we liked” are no longer available. That insurance networks are shrinking, so we cannot “keep the doctors we like”. I do recognize the validity but I am also pointing out the hypocrisy of someone complaining about those who take out more than they put into the system when they themselves have just racked up more in medical fees than the total amount of premiums they have paid in over a lifetime. The problem is that the notion that people should be on the hook for their medical care out of their own pockets _does not work_ when you’re confronted by something like cancer or an extensive traumatic injury. Far too many people realize this only after tragedy befalls them and they discover their “good” insurance is not going to save them from bankruptcy or having to beg, hold spaghetti dinners, and start a GoFundMe page in hopes that someone will take pity on them and help them pay their endless costs. > [@](#): > > The dishonesty and deception of those who wrote and passed this monstrosity is appalling. No argument there - I wanted to go straight to single-payer universal coverage, not this bastardized piece of shit. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 19, 2016, 3:18am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/91 "2016-10-19T03:18:48Z")
> [@Orwell](#): > > The “mooches”, as you put it, are getting subsidies and tax credits, reducing their net premiums every month. It’s not just the people who didn’t have insurance before getting the payments, so it’s a lot more than “just” 16 million who do. > > It’s a huge income and wealth transfer program that doing nothing to pare actual health care costs\*\*. It seems like a tremendous boondoggle for the insurance companies\*\*. What industry wouldn’t like a law that required people to buy their product or service, at the same time the government steps in and pays part of the cost? When something is subsidized, let alone mandated, the price goes up. Bolded for emphasis - you hit the nail on the head. This was a bill by and for the insurance companies. Follow the money. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [October 19, 2016, 3:24am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/92 "2016-10-19T03:24:47Z")
> [@Broomstick](#): > > No argument there - I wanted to go straight to single-payer universal coverage, not this bastardized piece of shit. Germany has had universal coverage since the **nineteenth** century - it is multipayer, via non-profit insurance companies. When Bismarck’s 1883 legislation was proposed for the US by Teddy Roosevelt in 1912, it was shouted down as socialism. It is now the **twenty-first** century and we still haven’t learned… ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [October 19, 2016, 12:55pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/93 "2016-10-19T12:55:36Z")
> [@Broomstick](#): > > And if a poor family doesn’t pay Federal income taxes and audits find no fault because they are in conformance with the tax code they are blasted as parasites - but they are doing nothing different than Trump. If a rich man uses the tax code to his advantage he’s lauded as a hero but if a poor person does so they are regarded as little better than a thief. Poor people using the system to their advantage should be seen as no worse than someone like Trump doing so. > I do recognize the validity but I am also pointing out the hypocrisy of someone complaining about those who take out more than they put into the system when they themselves have just racked up more in medical fees than the total amount of premiums they have paid in over a lifetime. I suppose I don’t speak for everyone, but I don’t complain about people honestly using the system (obamacare system, tax code, property tax homestead credits, whatever, etc.) as set up, rich or poor. If you qualify for subsidies because you are poor, or for tax credits because you are middle class, or sheltering income because you are rich - and are doing it legally - then that’s fine. The problem isn’t that people take advantage (legal advantage, not cheating) of a welfare system or the tax code, the problem is the systems are created by politicians, and there are always both intended and unintended flaws, as well as unintended consequences. You mention hypocrisy in some of your posts. It seems to me that you are being unfair to think that it’s OK for a low-income person to legally use the obamacare system to reduce their insurance premiums, but it’s not fair for wealthy people to use the tax code to reduce their income taxes. Correct me if I’m wrong. > [@](#): > > The problem is that the notion that people should be on the hook for their medical care out of their own pockets _does not work_ when you’re confronted by something like cancer or an extensive traumatic injury. Far too many people realize this only after tragedy befalls them and they discover their “good” insurance is not going to save them from bankruptcy or having to beg, hold spaghetti dinners, and start a GoFundMe page in hopes that someone will take pity on them and help them pay their endless costs. I just don’t get how you’ve come to this conclusion. It’s not a straight line from me complaining that my health insurance has tripled in price and that there are now more restrictions on what doctors and hospitals I can use, as a direct result of obamacare, and assuming that I want people to go broke due to medical bills. My complaint is that obamacare was created in a deceitful manner, is far too cumbersome and complex, was passed by congress members who didn’t understand it and failed to listen to warnings, and is not achieving the promised results. And is it really surprising that those of us who are paying the price are the ones complaining, and not those who previously couldn’t get insurance, or who are now getting subsidies? That’s human nature. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 19, 2016, 3:49pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/94 "2016-10-19T15:49:31Z")
> [@Orwell](#): > > I suppose I don’t speak for everyone, but I don’t complain about people honestly using the system (obamacare system, tax code, property tax homestead credits, whatever, etc.) as set up, rich or poor. No, you personally do not, however there are a number of participants in this forum who do make such complaints. It’s even more repulsive/hilarious when they themselves are the beneficiaries of such or similar programs. > [@](#): > > If you qualify for subsidies because you are poor, or for tax credits because you are middle class, or sheltering income because you are rich - and are doing it legally - then that’s fine. The problem isn’t that people take advantage (legal advantage, not cheating) of a welfare system or the tax code, the problem is the systems are created by politicians, and there are always both intended and unintended flaws, as well as unintended consequences. Agreed. However, I think we can agree that castigating one group of people for working within the law to their benefit while celebrating another group doing the exact same thing is very much hypocritical. > [@](#): > > You mention hypocrisy in some of your posts. It seems to me that you are being unfair to think that it’s OK for a low-income person to legally use the obamacare system to reduce their insurance premiums, but it’s not fair for wealthy people to use the tax code to reduce their income taxes. Correct me if I’m wrong. You are wrong and here’s the correction: it’s fine to either applaud or condemn all who do such things, but unfair to applaud one group for doing so while condemning another. There are many, many things wrong with the ACA, but blaming those in poverty who can now get healthy insurance and those who receive subsidies for somehow breaking the back of poor, innocent middle class people is wrong - those folks are getting the best benefit they can under the current system. If the system is causing pain then it’s because the _system_ is deeply flawed, not because some poor person can now see a doctor on an annual basis with breaking _his_ finances. > [@](#): > > My complaint is that obamacare was created in a deceitful manner, is far too cumbersome and complex, was passed by congress members who didn’t understand it and failed to listen to warnings, and is not achieving the promised results. I understand that and largely agree. > [@](#): > > And is it really surprising that those of us who are paying the price are the ones complaining, and not those who previously couldn’t get insurance, or who are now getting subsidies? That’s human nature. Actually I know quite a few subsidy receivers who are _also_ complaining. Not as loudly, but many of the same complaints - lack of choice, unable to keep doctors, ruinous out-of-pocket payments, and so forth. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [October 24, 2016, 3:11pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/95 "2016-10-24T15:11:26Z")
[Major hikes in marketplace plan rates](http://www.post-gazette.com/business/healthcare-business/2016/10/17/Marketplace-health-plans-see-sharp-increase-for-2017/stories/201610170135) > [@](#): > > Insurers seeking rate increases for their 2017 Affordable Care Act health plan offerings got that and more, as the Pennsylvania Insurance Department announced Monday it had approved rate hikes averaging 32.5 percent for individual plans and 7.1 percent for small group plans. > > 16 Pennsylvania counties — including 11 in the western region — have only one insurer offering plans through the marketplace, she said. > > In some instances, the state has approved higher increases than insurers requested. For one individual marketplace plan, Pittsburgh-based insurer Highmark asked for a 48.1 percent increase and the state approved a 55.07 percent increase; for another, Highmark’s 38.4 percent increase has been bumped up to 45.42 percent by the state. Highmark is one of the companies I need to consider for 2017. I had Highmark in 2015, but switched to Aetna because Highmark’s rates went up too much in 2016. Aetna has left the exchange for 2017. If Highmark’s already high rates are going up another 50%+ on top of last year’s 30%+, I don’t know what I’m going to do. ---
**Author:** ![Peanut50](https://avatars.discourse-cdn.com/v4/letter/p/8491ac/32.png) [@Peanut50](https://boards.straightdope.com/u/Peanut50)\ **Post date:** [October 27, 2016, 9:30am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/96 "2016-10-27T09:30:17Z")
I’d considered just dropping this entire thread–as the subject of health insurance is now excruciating (yes, folks, I live in that lovely state where premiums are going up 50% and MORE), but…I just can’t. The “bump” and learning that BCBS, my insurer, is leaving the state…this is partly why I cannot support ACA. Well, down to it. [QUOTE=Kimstu] The type of “insurance servitude” that you’re recommending, where people have to cling desperately to any job that provides decent health insurance because otherwise they can’t get reliable coverage, is a stupid and inefficient way to run a workforce. [/Quote] Oh, so, _that’s_ horrible, but the indentured servitude **I** have to live with to pay not only for my own health insurance, but everybody else’s that cannot afford their own–that’s _perfectly okay?_ I’m sitting here, facing a reality in which my coverage for 2017 will be a mind-blowing $2500-$2600/month. Or more. JUST for health insurance. That doesn’t include everything else that isn’t covered, like some of my prescriptions, and so on. Wow, you guys sure are right. ACA is just WONDERFUL. \ > [@Broomstick](#): > > For several years my spouse and I had NO insurance - and he’s diabetic, and has long-standing issues due to his birth defect. We were denied over and over. _We had no insurance and we had no access_. There’s a thread on this forum about the bullshit I had to go through just to get a goddamned tetanus booster. FYI–not that this is the business of anyone here–I was without insurance for about 12 years. Between the time, in '89, that I became self-employed, and the time I was able to buy my own insurance. Moreover, I needed relatively minor surgery during that time. What did I do? _I saved up my money,_ and I negotiated pricing with the doctors, anesthesiologist and the medical center, and I ended up paying about $9800 for surgery that was to have been billed at around $20K. I further paid for any/all meds for myself during those 12 years, and the annual physicals that my spouse required. If you think that I live in some magic bubble, in which I have NO idea what it’s like to not have insurance, you are dead wrong. I DID, however, make a real effort to ensure that I obtained insurance as soon as my income was steady enough to cover the payments. And, by the way–I bought that coverage BEFORE I bought any other things, including cars, appliances, etc. > [@](#): > > And WTF does it matter if someone received insurance through sufferance or not? Is _anyone_ less deserving of health care than another? I really hope that was not what you intended to say but it could be read that way. The comment _was_ essentially stating that I should be _grateful_ that we had the insurance, as if Santy Claus had brought it to me. You may (and seem to) take offense at the term sufferance, but my point was about ME, and whether _I_ should be “grateful” that I have the damned insurance. Why the hell should I be grateful, when I’ve certainly paid more than $200K toward that self-same insurance in my lifetime, if not more than that? > [@](#): > > Comparing the VA to a national health service like the UK’s or Canada’s or Germany’s is apples to oranges, or at least apples to pears. They aren’t the same thing. Sure, we can omit the live military medical services, because those are, as someone else mentioned, brilliant. But the VA damn sure isn’t. And you want to argue that that’s not a real “national health service,” like the UK, etc., with single payer? Ok, great, then. How about Medicare and Medicaid, and how efficient and wonderful and cost-saving THOSE are? Those are, absolutely and undeniably, single-payer. Those are EXACTLY what single-payer advocates want. Let’s see: in 2014, Medicare, _alone_, **lost more than 60 BILLION** , with a B, dollars. And that’s for what percentage of the population? In 2010, it was a mere **48billion.** Those are GAO figures. Look 'em up yourself. \*\*The 60B was more than 10% of Medicare’s entire budget. \*\*Yeah, boy, \*I can see how single payer is such an improvement. \* For those that don’t read all the National budgeting documents, 49% of all–ALL–our government spending (this includes defense) goes to Social Security, Medicaid and Medicare. Period. That was BEFORE the buffoons decided that we had plenty of dough to pay for Obamacare. Medicare is the FASTEST-growing expenditure in the national budget. Or, at least, it was prior to Obamacare, which should outstrip it shortly in gross inflation of figures. Aka, MONEY required to bloody well pay for it. > [@](#): > > Nevermind that the Republican anti-government types have been repeatedly cutting funding to the VA, just like they’ve cut, or tried to cut, funding to every other important and needed government service for decades. BTW: I’m a Libertarian. However, that’s also Democratic Bullspeak. Just like all the other nonsense that they spew. Honestly, the amount of crap that gets spun from the DNC is truly appalling these days. > [@](#): > > It’s not, but it sure as hell beats being locked out of the system entirely. Or what you’re going through. YES, which I would _not_ have gone through, to this horrible level of expense, when we were still on my perfect great Aetna plan. It would have been significantly less expensive. BTW: for the person that seems to think that those of us bitching about the horrible costs are making this up, I’m in Arizona. I have BCBS. I used to have a PPO plan, but they don’t allow small businesses with under 30 employees or self-employeds to buy PPO plans any longer. So _now_ I have an HMO plan. Everyday Health Alliance. Go ahead. Look it up. > [@](#): > > Insurance companies have NO motive to keep costs down because they want _their_ profits to go up. Sure, they squeeze the folks actually providing the services but _they_ never trim _their_ costs. Government has zero incentive to trim costs. All they do is go back to Congress, hands out, and ask for what? TAX DOLLARS. Ours. Or mine, at least. I can’t speak for the rest of you. > [@](#): > > Why shouldn’t corporations pay taxes? If anything, industries with inherent hazards (which would include most involved in resource extraction) should be paying to support health care. _WHAT_ about what I said, makes you think I said that? I said that in Canada, a great deal of tax income is collected, not from the individual taxpayer, but from corporations and companies that work with natural resources. That’s what I said. And again: folks, please _pay attention_. Those rich 1%ers–all those horrible people that you all think are getting over on you–are paying 49% of ALL the taxes paid in this country. Then, the other half of us are paying the rest. That leaves Mitt Romney’s infamous 47%. Infamous, yes, but also factual. The 47% that get more out of the government than they put in, whether that’s unemployment, medicare, medicaid, social security, welfare, and so on. So, the working middle class and the 1%ers are footing the bills. That’s inarguable. Those 1%ers are paying for \*ANYONE \*reading this post, who got more out of their taxes than they paid in; those who have subsidized health care, and so forth. Those one-percenters are paying for YOU. > [@](#): > > A good slice of it is completely unnecessary middle-men, i.e. “private insurance companies”. Right. Because you really believe that they are EVIL. Out of curiosity, do you happen to know what percentage of insurance claims, from doctors and hospitals, are paid on the first submission? Second? Ever? Do you? And in contrast, what percentage of Medicare and Medicaid claims are not paid on the first pass? Second? Third? What percentage of private insurance claims are fraudulent, like the fraudulent Medicare claims? What was it? **$60B? Sixty Billion dollars?** According to the GAO. Think that private insurers have \*those \*type of MIA money losses? And who PAYS for those losses? I DO. And for anyone reading this that pays taxes, YOU do. And we will continue paying that for “single payer ACA,” when that comes. That–Medicare–IS the largest single-payer health care system in the US. Right? So, there you are. $60B in losses, reported just last year. Single-payer healthcare. > [@](#): > > There is an oversupply of expensive technology - for example, the average US city has more MRI machines than some entire countries. Those who have the machines have to pay for them, which leads to an incentive to use them even when not really needed, which drives up costs. Right. All those fraudulent MRIs. What’s your cite for these statistics? I don’t know about you, but ANYtime I need a test, the request gets sent to BCBS, first, and they analyze my medical records, other tests, etc., to decide whether or no they will pay for it. That’s part of them controlling costs. So, the idea that Doctors are sending patients left and right to pay for expensive machinery seems absurd on its face. I’m perfectly happy to see your cites on that, though. I’m always open to changing my mind about something when I see factual data. > [@](#): > > He must have been pretty flush with cash to pull that off - is he aware that there are very competent doctors in India willing to do a hip replacement for cash for a fraction of what a US surgeon charges? If Canadians were _that_ desparate for treatment they’d be going to India for such things and not the US, because India is a crapload cheaper, but the quality of the treatment is just as good in their top-end hospitals. You missed what I said. He’s simply one Canadian. In Arizona, we are flooded with them, in the winter, many of them here for various surgeries. Some other person here asserted their opinion that obviously, they were all having frivolous (as if there is such a thing) surgeries, like plastic surgery. They’re not. The one gentleman I mentioned was simply an example. Last study/info I read, 52,000 Canadians travelled abroad to obtain healthcare, in 2014. ( [Breaking News, Headlines and Stories | National Post](http://news.nationalpost.com/news/canada/number-of-canadian-patients-travelling-abroad-for-treatment-increased-by-25-study-finds) ) Now, they have 30M people. So, what, 2%, give or take? Not bajillions; but still… > [@](#): > > It sure as hell is better for those who DON’T get coverage under the old system! I guess it was OK 40 million people just didn’t have access to regular health care at all. If such a person needed a hip replacement they’d NEVER get it - because they don’t have the money and it’s not a life-or-death requirement. Purportedly, it was 30 million. Now, here’s my question for you. We all know–even the Prez admitted–that there were ~7 million of us that lost our existing plans, due to the advent of Obamacare. So, you can hardly count those people in those who’ve been “liberated” due to Obamacare. If indeed 11 million people have “signed up,” that’s total. That _includes_ those 7 million people like me, who were replacing plans that they lost, plus people signing up–like you–AND, people who signed up through Obamacare, who were signing up for, or renewing, Medicaid. (Also single payer, in case anyone’s forgotten.) So, here’s a question–because NOBODY seems to be able to get the “most transparent administration in history” to pony up the real-live numbers: of the purported 11 million, how many are people replacing their plans that were lost due to ACA? How many are new enrollees to Medicaid, going through the “Exchange?” How many are actually people who are PAYING for their ACA coverage? I suspect that the number of “newly insured” who are actually paying 100% of their own insurance coverage, without any subsidies, tax breaks, and so forth, is actually a dismally low number, of the 11 million. > [@](#): > > To start: > > - Eliminate the necessity of private insurance (having it as an adjunct, like in Germany, would be OK) > - Eliminate the oversupply of high-end, very expensive medical technology (the more MRI machines than any one city needs issue) > - Get malpractice \*premiums \*under control (private insurance company woes again) > > That’s just to start. Ah, yes, tort reform. You’ve obviously never had someone in your family killed by medical incompetence. I have. We did not sue, mind you, but we had EVERY reason to do so. > [@](#): > > Of course it’s not that simple, the devil is in the detail - but if you’re willing to throw millions of people needing healthcare under the bus to keep your premiums low why do you balk at putting insurance company employees out of work? I don’t balk at putting insurance company employees out of work. However, I know magical thinking when I see it. This government already cannot run Medicare and Medicaid. OR the VA. Those are EXACTLY what you and others here are proposing. Single-payer. Why on earth would I think that the Feds would run a regular health-care system any better? > [@](#): > > Hey - wouldn’t the new bureaucracy need people with experience in health care administration…? Yeah–at the IRS. Ever dealt with them? \*\*I have. \*\* > [@](#): > > I used to work for the health insurance industry. Now I work in a different industry. Why can’t those other people do the same? They can. I simply don’t believe that the “government” does ANYTHING better than private business. (Other than its assigned role, National Defense.) The cost overruns, screw-ups, lost money…the list is endless. The government has grown and encroached, increasingly, my entire life. > [@](#): > > Are you referring to the people who pay no Federal taxes? Like Mr. Trump, who apparently went 20 years without paying any? I take it that you don’t really understand the Tax Code, and why businesses can write off losses. Even assuming that Hillary’s rhetoric is true–that he didn’t pay any PERSONAL taxes–he was legally entitled not to. I take every single tax deduction that I can. Are you trying to say that you don’t? That you pay more taxes than you have to? > [@](#): > > Or are you saying the only people who deserve healthcare are those who can afford to pay and if you’re sick and poor to hell with you, suffer and die? > > You ARE aware, aren’t you, that you are now in the category of people who, not that long ago, would simply _not be covered_ at all? That if they roll back the “no denial on pre-existing conditions” clause you are now screwed? Oh, yes, and if you’d taken the time _to actually read_ my initial post, you’d see that I mentioned that. As far as “only people who can afford healthcare” question goes, yes, to some extent, I think that’s true. The inequities of life _aren’t_ going to be compensated for, by taxing the holy shit out of those who do work and pay their own way. Or this absurd fascination with the 1% that seems to have gripped the left. Or those folks with the “us versus them” mindset; those people who think that the rich pulled some trick, cheated someone, got over on them, who deem them EVIL, and want to take all their money…while at the same time worshipping at the altar of Steve Jobs, or sitting on Facebook all day, putting yet more money into the pocket of Zuckerberg. Did you use Google today? Did you? Do you think that those corporations DON’T pay taxes? Trust me, all those people out there bitching about how “big companies don’t pay taxes” are talking out of their asses. They pay taxes, all right, and they pay a lot of them. Anyone who wants to know can pick up information on those companies from the SEC. They ain’t secret. > [@](#): > > Also, like a lot of people, you don’t seem to have a clue how insurance works. You HAVE TO HAVE a pool of people who pay more in premiums than they collect in order to cover those that cost more than they pay in - which category, by the way, you fell into as soon as the amount the insurance company paid out exceeded how much you paid in premiums. In fact, between a heart attack and cancer you’ve cost the insurance company a crapload more than, say, a 20 year old unemployed jerk with appendicitis or a single mom intermittently employed who needed her gall bladder out. Actually, I truly DO have a “clue” as to how insurance works. That’s why it boggles me that you think that ACA is so wonderful. Or did I miss the stampede of young people that ran me over, on their way to sign up, and PAY for the plan, as part of their obligation to do so? What? What’d you say? So, since that _didn’t_ work, how is it you see Single Payer working? What, the Government doesn’t worry about all those pesky things like stockholders, etc., so, when they run out of money, they’ll just do what? Increase our taxes. AGAIN. You really think that single-payer is somehow magically going to cost ME less? That somehow, Uncle Sam won’t find a way to get those thousands out of me, that I’m currently paying out to BCBS? This is all great for you. You got health insurance, because yu couldn’t afford it, before. Well, guess what? It’s NOT great for ME. I’m paying out the wazoo, which I would NOT have had to do, before. Folks, “single-payer” is simply code-speak for taking yet MORE money from those of us who are actually earning it, in TAXES. It’s not going to magically fix everything. The payments that I make now, to BCBS, will be paid to the Feds in taxes. Sure, it may fix something for YOU, but it won’t for ME. And as far as the insurer paying out more than we paid in–yes, _NOW,_ that’s true, because I was forced to switch insurers. If I hadn’t been forced to do so, Aetna had a nice chunk of money from me, over the years, that _WOULD HAVE_ , more than covered my husband’s medical bills. And now, for those very reasons, all the insurers but ONE are leaving my state. There will be NO choice for me, in a few days. I will have NO options. > [@](#): > > If you’re whining about those who collect more than they pay in YOU are now in that category. No. I’m in that category at the insurer’s. I was talking about those who take more out of the “government” (aka, their fellow taxpayers) than they put in. Again: there is NO such thing as “government” money. All the money, all the subsidies, etc., are paid by the people you see around you. Your inlaws, your sister, your mother, your Dad…all the taxpayers are paying for those plans, those subsidies, etc. > [@](#): > > At one point my spouse hit a lifetime maximum on his insurance policy, was cut, and then _blacklisted_ and told that company would NEVER cover him again, at ANY price. Then he went years _unable_ to get insurance. Is that preferable? Keep in mind, that used to be done _routinely_ to people who had cancer so before you answer consider that YOU are now in that category of people. Yes, thank you, I am aware of insurance practices. I’m pretty sure that most people are. However, if you’ve been paying attention, the inability of the insurance companies to limit their losses, has resulted in what’s happened this year–everyone pulling OUT of the marketplace. Now, only the people working for companies, getting their insurance through their employer, will have “affordable” health care coverage. The rest of us? We’re simply screwed. So, you should be DELIGHTED. After all–the evil insurance companies are bailing out (gosh, they musta really been makign a profit, eh?). We’ll all be on “single-payer,” all right, the last insurance company standing. All my choices and options are GONE NOW. All thanks to the left’s incredible power of magical thinking, that all the young people would sign up and cheerfully pay, and that somehow, it would “all work out.” Yeah, right. > [@](#): > > Maybe if billionaires like Donald Trump were required to actually pay Federal Taxes like the middle class that wouldn’t be such a problem? Let me guess: you really believe that Warren Buffett’s secretary paid MORE in taxes than he did, right? n.b.: not so. His percentage bracket was lower, but of course…there’s a massive difference in what was paid. So, if the Trumps and Buffetts, etc., aren’t paying taxes, then what one-percenter is out there, paying that 49%, Broomstick? Paying that HALF of all taxes? > [@](#): > > Got a harsh truth for you - those who are healthy and in power don’t give a damn about people with “broken backs” - or those who have had heart problems or cancer. Apparently neither do you, despite now being in that group, with you’re talk about who does and doesn’t “deserve” medical treatment. No, they don’t. That’s why we used to have health insurance companies, that could bet on who would, and wouldn’t, become ill. Who would have group insurance plans, that amortized costs, that included young people who had little or no costs, to cover the increased costs for those who are older. That has worked for 100+ years. And now, the idiots on Capital Hill have created penury, for those of us who WORK for a living. I don’t qualify for some tax credit, or tax break, or subsidy, not unless I do what a bunch of people I know have done, which is LIE about my income, on my taxes. If I do that, then, of course, I’ll pay for that lie, vis-a-vis Social Security. As far as my life? We are SERIOUSLY looking at expat locations, and expat health insurance. Otherwise, as things are going here, I may have to sacrifice my (modest) home, or go without health insurance. I’m not sure I can afford both. My home’s mortgage pyment is $1500/month (we put $100K cash money into this house, as the down, when we bought it, precisely to keep the payments lower), and my health insurance WAS $1479, now going up 50-60% in 2017. So, that’ll be $2250, at the lowest, maybe more. That means I have to NET $3750/month–again, that’s after taxes–just to pay for healthcare and my home. That doesn’t include a penny for food, cars, electricity, etc. We don’t live high on the hog, by ANY means. I pay cash for everything, I don’t charge. We’re both drving old cars–and when I say, “old,” I mean OLD. Mine is 19 years, and my husband’s truck is 18yrs. We keep them maintained and running. We’re not squandering money. I guess you’ll be happy when I have to give up my home. Yeah, boy, \*that’ll show ME. \* I suspect that more and more people who at least have a few resources left to hand will do the same thing that we’re going to do…expatriate, so we’re not stuck here, in “insurance payment servitude,” paying not only for ourselves but everyone else, when we cannot afford it. Yes, that means I won’t get to keep my house here, and I’ll end up living someplace that I didn’t really want to go to…but at least I won’t be HERE. A country that I \*served, \*gladly…and now I’m ready to leave it. Whatever. Read the federal budgets. Read where all those idealized countries in Europe spend their money, where they get it, what the TAX rates are. Compare our federal spending, by category, to the UK, to Sweden, to Denmark, etc. I’m genuinely glad that you and your husband have insurance. I hope you keep it. But I do NOT think it’s right that my insurance payments have DOUBLED, in 3 years, to help you pay for it. I’m sorry, I just don’t. And if YOU were faced with the possibility of losing _YOUR_ house, to finance this absurdly Pollyannaish venture into “Obamacare,” to pay for MY insurance, I don’t think you’d like it, either. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [October 27, 2016, 10:31am UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/97 "2016-10-27T10:31:29Z")
The feds run an amazing, first class single player health care system in the active duty military health care system. Unnecessary medical tests are not a problem, at least in my understanding and experience. So it’s a fact that it’s possible for the feds to run a great health care system. They also can run crappy systems. But this is an indictment of the details of the particular system, not of the feds. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [October 27, 2016, 1:08pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/98 "2016-10-27T13:08:28Z")
> [@](#): > > My home’s mortgage pyment is $1500/month (we put $100K cash money into this house, as the down, when we bought it, precisely to keep the payments lower), and my health insurance WAS $1479, now going up 50-60% in 2017. So, that’ll be $2250, at the lowest, maybe more. Bravo, Peanut50. Epic rant that is painfully honest and truthful. As I posted, Aetna is leaving PA, too, and with BCBS getting approval for a 50%+ increase, I expect my health insurance to cost more than my mortgage payment next year. And my $1,900 mortgage payment includes property taxes and insurance. And that doesn’t include copays, deductibles and drugs, of course. So, I’m wondering how many of the ACA supporters out there pay more for health insurance than they do for their rent or mortgage payment. I suspect it’s fairly low, yet those of us who have seen our health insurance premiums double or triple are not supposed to gripe about it. Like you, Peanut50, I’m a libertarian, and don’t see much that the government does efficiently or cost-effectively. But Obamacare is SO BAD, frankly, I just don’t know where we go from here. I’m not sure that nationalized, single-payer wouldn’t be better. Perhaps not, but the “Affordable” Care Act is so unaffordable, both for those of us who are paying premiums and for the nation as a whole, that it has to collapse. As predicted five or so years ago, of course. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 27, 2016, 4:34pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/99 "2016-10-27T16:34:06Z")
Part One: > [@Peanut50](#): > > Oh, so, _that’s_ horrible, but the indentured servitude **I** have to live with to pay not only for my own health insurance, but everybody else’s that cannot afford their own–that’s _perfectly okay?_ No, it’s not OK. Would you prefer a system where you were simply left out of the system entirely? Because that’s where you’ll be if the ACA is rolled back and insurance companies can ban people for pre-existing conditions again. > [@](#): > > I’m sitting here, facing a reality in which my coverage for 2017 will be a mind-blowing $2500-$2600/month. Or more. Yep. My spouse and I were quoted those prices _back in the 1980’s_. “Oh, were not _denying_ you.” Right, you’re just requiring more per month in premiums than the household brings in gross. That’s why I went to work for the health insurance industry, it was the only way to get my spouse covered. > [@](#): > > FYI–not that this is the business of anyone here–I was without insurance for about 12 years. Between the time, in '89, that I became self-employed, and the time I was able to buy my own insurance. Moreover, I needed relatively minor surgery during that time. What did I do? _I saved up my money,_ and I negotiated pricing with the doctors, anesthesiologist and the medical center, and I ended up paying about $9800 for surgery that was to have been billed at around $20K. I further paid for any/all meds for myself during those 12 years, and the annual physicals that my spouse required. If you think that I live in some magic bubble, in which I have NO idea what it’s like to not have insurance, you are dead wrong. My spouse’s current medical care is running about $2,000-3,000 a month right now at retail prices. How the _hell_ could we save money if we’re paying that much out every month? Yeah, I understand the whole negotiating thing, I usually mange to get down to 40% of the list price, but when someone has a _chronic_ condition that, without treatment, will rapidly become life-threatening you don’t have months were you can skip and build up reserves. When my spouse was _able_ to work he did so, and among other things, spent 10 years paying off the surgery that saved his leg from amputation out of his own pocket. Problem is he’s older and sicker and is getting more expensive to keep going. I suppose we could just stop taking care of him - he’ll go blind and his kidneys will fail and he’ll take a few months, probably to die a miserable death. Except he doesn’t want to die. I don’t want him to die either. So, yes, I’ll _gladly_ take the subsidies no matter how much you scream about your taxes because my spouse’s life means more to me than your howling about matters. > [@](#): > > I DID, however, make a real effort to ensure that I obtained insurance as soon as my income was steady enough to cover the payments. And, by the way–I bought that coverage BEFORE I bought any other things, including cars, appliances, etc. So did we - I found a way to get want I want and what we need in our current system. Yes, it involves subsidies for us because otherwise we could never pay our premiums, they would be more than the household is bring in right now. And I’m not going to apologize for being one of those families currently getting more than we’re giving because back when I was giving more than I was getting I understood that paying into the system when I didn’t need it was the only hope of the system being there when I did need it. > [@](#): > > The comment _was_ essentially stating that I should be _grateful_ that we had the insurance, as if Santy Claus had brought it to me. You may (and seem to) take offense at the term sufferance, but my point was about ME, and whether _I_ should be “grateful” that I have the damned insurance. Why the hell should I be grateful, when I’ve certainly paid more than $200K toward that self-same insurance in my lifetime, if not more than that? If your family has dealt with a heart attack and then cancer then it’s most likely you’ve cost the system more than a million dollars. Unless you’re claiming you’ve paid more than a million in premiums in your lifetime you are, in fact, now among those getting more than giving. Remember that when you’re outraged and whining about the freeloaders. If you had not had any insurance what do you think the outcome would have been? Let me tell you, just in case you’re not clear: without insurance your spouse would have had his heart attack treatment to the point he was no longer in danger of imminent death, then he would have been sent home. And if you could not have coughed up money at that point he would have had no follow-up - no additional procedures, no cardiac rehab, no drugs other than what you could afford to pay for in a given month, and that’s assuming you could have got him in to see a doctor to prescribe them. When the cancer was found, if you had not had insurance and could not pay out of pocket he would have simply been sent home without treatment - because cancer isn’t _immediately_ life threatening. He would have been sent home to die, with no appeal possible. This is the point at which people start to beg, and hope they can find someone else to foot the bill (i.e. charity) so their loved one doesn’t die sooner than necessary. But he actually got medical treatment, right? Of course, the result may still be crushing poverty for the two of you for the rest of your days. You might lose your house? Yes, you might - lots of other people have lost their homes due to such problems. You aren’t unique. You aren’t special. Your story has played out across this country over and over for decades. Your situation isn’t even the worst I’ve known of. That’s why after a couple years I got out of the claims administration part of health care, it was just too fucking depressing. > [@](#): > > Sure, we can omit the live military medical services, because those are, as someone else mentioned, brilliant. But the VA damn sure isn’t. And you want to argue that that’s not a real “national health service,” like the UK, etc., with single payer? Ok, great, then. How about Medicare and Medicaid, and how efficient and wonderful and cost-saving THOSE are? Those are, absolutely and undeniably, single-payer. Those are EXACTLY what single-payer advocates want. Well, no, they are not exactly what we want. What I want is a system where everyone pays in according to their ability and receives according to their need - which, yes, IS socialist but experience in many other countries shows that it works better than our capitalist model where you either pay as little as you can get away with (even nothing at all) and propose that those most needful, who are often those least capable, pay and pay and still not have enough to get what they need. And no, the VA, Medicaid, and Medicare are NOT “national health service” because _they do not include the entire nation_. Medicare is for old people, a demographic that tends to be sicker and less able than the younger folks. Medicaid is for poor people - another demographic that tends to be sicker and more disabled not the least of which because of situations like yours, where medical debt/costs dump them from the middle class into poverty. The VA is heavily populated, again, by the older and many of the younger have chronic health issues/disabilities. The one that works - the active military healthcare, Tricare - works in no small part because it’s “customer” base is largely young, healthy, and able-bodied. If we’re going to do a NATIONAL health service then it has to include _everyone_ both sick and well. The larger the pool the smaller the risk per individual. We have a potential pool of 300,000,000, larger than any European nation’s, and should be able to do health care at least as efficiently as the UK or France or Germany or Canada. Yes, that means the healthy and the wealthy will be paying in more than the sick and the poor. But since _anyone_ can become sick or disabled it’s the only way to make the system work and have it be there when/if any particular person needs it. And 99% of us risk becoming poor, so that, too. > [@](#): > > Let’s see: in 2014, Medicare, _alone_, **lost more than 60 BILLION** , with a B, dollars. And that’s for what percentage of the population? In 2010, it was a mere **48billion.** Those are GAO figures. Look 'em up yourself. \*\*The 60B was more than 10% of Medicare’s entire budget. \*\*Yeah, boy, \*I can see how single payer is such an improvement. \* Again, you’re looking at the pool of people who are among the sickest in the nation - the elderly. Most of those costs are for the last few months or years of life. That’s why you need the young and healthy paying into the system, too - which the young and healthy will benefit from when they’re old and sick. Or become young and sick or disabled. Slicing out the sickest groups for government coverage will always make government look more expensive than private coverage because the private coverage gets to cherry-pick the young and healthy then dump them on the public system when they get too expensive and start to impact profits. Putting everyone in the same group will, yes, increase costs for those who, due to youth, health, and a little luck, can go years without paying anything at all, only to demand entrance to the system later when something bad happens. Well, hell, I my taxes pay for the fire department even if my house has never burned down, and for the cops even if I’ve never needed to call them. I don’t see anything particularly unjust in demanding _everyone_ pay into a system that provides coverage for everyone. Right now, it’s the equivalent of trying to fund the fire department by only charging those who have had their houses burn down and have lost everything. Or trying to fund the police by charging those who have been robbed of everything for “police services”. No, it doesn’t work well. > [@](#): > > For those that don’t read all the National budgeting documents, 49% of all–ALL–our government spending (this includes defense) goes to Social Security, Medicaid and Medicare. Period. So? Why is taking care of the sick and disabled a bad thing? Oh, and by the way - social security is NOT part of health care. Those on social security who need health coverage are covered by Medicare, and sometimes Medicaid. They’re two different things. So re-run that calculation using JUST Medicaid and Medicare. > [@](#): > > Medicare is the FASTEST-growing expenditure in the national budget. Or, at least, it was prior to Obamacare, which should outstrip it shortly in gross inflation of figures. Aka, MONEY required to bloody well pay for it. So… what do you suggest we do? Simply not pay for any medicine for anyone over 65 and if they can’t pay out of pocket we just watch them die? Fine, let’s abolish Medicaid and Medicare… and when your spouse reaches 65 (if he hasn’t already) don’t whine when he’s sent home to die and you get to watch it happen. We started Medicare and Medicaid because that’s what _did_ happen to people who didn’t have money or insurance back in the bad old days. Most people alive now aren’t old enough to remember that time, but it was pretty horrible. That’s why a staunch Republican capitalist like Richard Nixon tried to get universal coverage for the US back in the early 1970’s, and please don’t try to claim Nixon was a leftist, a liberal, or a softie. > [@](#): > > YES, which I would _not_ have gone through, to this horrible level of expense, when we were still on my perfect great Aetna plan. It would have been significantly less expensive. No, it wouldn’t. Either your premiums would have gone up, or you would have been dropped entirely before the ACA. > [@](#): > > BTW: for the person that seems to think that those of us bitching about the horrible costs are making this up, I’m in Arizona. I have BCBS. I used to have a PPO plan, but they don’t allow small businesses with under 30 employees or self-employeds to buy PPO plans any longer. Yes, because it’s usually sick/disabled/chronic problem people that go for PPO’s (on average) while the healthy and able-bodied when for lower cost plans that cost less (although they were much less useful if you did have a catastrophic problem). It costs the insurance companies too damn much for a PPO to fill up with sickly people. If they’re insuring large companies there will be a minority of sick/disabled to cover for those that cost more, but not so much for small companies and not at all for individuals. Stop and think - how long would a business last if they sold policies that wound up paying out more than they bring in? Because that’s where you’ve been these last few year - you’ve received more in services than you’ve paid in premiums. _Obviously_ the money of other people is making up the difference, if it wasn’t, the insurance company wouldn’t stay in business. Again, the larger the pool of healthy people paying in the more feasible covering the sick becomes. > [@](#): > > So _now_ I have an HMO plan. Everyday Health Alliance. Go ahead. Look it up. Yep, because cost per person is less in an HMO - but I’m sure you can entertain us with how much worse the HMO is vs. the PPO. Even so, the insurance companies would love to kick your family to the curb because even with higher premiums and lower coverage your family is still a high risk to become a net loss the company. And that’s why capitalism doesn’t work for health care - those most in need are nearly always those least able to pay. Pure capitalism and free market practices mean you convince people to purchase insurance when they’re healthy and drop them as soon as they have a major illness or accident, and the companies actually used to do that until public outrage led to the government stepping in. > [@](#): > > Government has zero incentive to trim costs. And private corporation have all too much incentive to cut costs regardless of the human suffering and death that might result. > [@](#): > > All they do is go back to Congress, hands out, and ask for what? TAX DOLLARS. Ours. Or mine, at least. I can’t speak for the rest of you. Trust me, I paid taxes this year. I’ve been paying them for nearly 40 years now. > [@](#): > > And again: folks, please _pay attention_. Those rich 1%ers–all those horrible people that you all think are getting over on you–are paying 49% of ALL the taxes paid in this country. Yep. And they own more than 40% of all the wealth in the nation so I really don’t see this as horribly inequitable. > [@](#): > > Then, the other half of us are paying the rest. That leaves Mitt Romney’s infamous 47%. Infamous, yes, but also factual. The 47% that get more out of the government than they put in, whether that’s unemployment, medicare, medicaid, social security, welfare, and so on. You forgot the tax breaks for mortgage owners. Why do we do that? Why should you get a tax break for going into significant debt? I’m always surprised libertarians don’t insist that if you can’t pay for a house yourself you shouldn’t have one, or at least the government shouldn’t be involved in encouraging people to go into debt. > [@](#): > > So, the working middle class and the 1%ers are footing the bills. That’s inarguable. Contrary to rumor the working poor pay taxes, too. I don’t know where you get this notion that they’re receiving everything for free. I’ve been both middle class and working poor and I feel that being in the bottom 1% I busted my ass a LOT harder than at any time in my middle-class life. > [@](#): > > Those 1%ers are paying for \*ANYONE \*reading this post, who got more out of their taxes than they paid in; those who have subsidized health care, and so forth. Those one-percenters are paying for YOU. They’re also paying for YOU. You have a house? You take the mortgage deduction? Then other peoples’ money is covering the difference you’d pay if you didn’t have the mortgage deduction. You still have health insurance? It paid for all that expensive treatment your spouse needed? (Minus your co-pays, but I’m assuming that’s still easily into the 6 figures) Then someone else’s’ money is covering the difference between what you received and what you paid. You seem upset that someone, somewhere, somehow, might be getting more than their fair share… yet other people have been covering the difference between what you pay in and what you’ve received. Look in the mirror. > [@](#): > > Right. Because you really believe that they are EVIL. Out of curiosity, do you happen to know what percentage of insurance claims, from doctors and hospitals, are paid on the first submission? Second? Ever? Do you? You know, if we had a SANE system we wouldn’t be using insurance claims - we’d treat people, submit a bill (which wouldn’t go up and down wildly varying between patients depending on the card in their wallet), and the providers would get paid. And yeah, I used to know - but it is now more than a decade since I worked in that area so I don’t know anymore, and certainly don’t have up to date information. It’s irrelevant, because the way prices are set (or aren’t) and services are paid for in our jacked-up system is stupid. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 27, 2016, 4:48pm UTC](https://boards.straightdope.com/t/question-regarding-obamacare/768316/100 "2016-10-27T16:48:08Z")
Part Two > [@](#): > > Think that private insurers have \*those \*type of MIA money losses? Yep. That’s why some of them go out of business. You’re waving around $60 BILLION like “b” on the front of the unit somehow makes it more horrible. I’m more interested in the percentage represented. Also how you define “fraud” - there’s inefficiencies in any large system, vs. actual criminal intent. Also, I’m totally OK with enforcing the law and jailing those who jack the system. > [@](#): > > And who PAYS for those losses? I DO. And for anyone reading this that pays taxes, YOU do. And we will continue paying that for “single payer ACA,” when that comes. You have ALWAYS paid for those losses. Back when you had your “perfect” Aetna plan your premium dollars were set in part to cover whatever losses Aetna experienced, either paying out legitimate claims or fraud in regards to Aetna. You think private insurance doesn’t experience fraud losses? Of course it does. > [@](#): > > That–Medicare–IS the largest single-payer health care system in the US. Right? So, there you are. $60B in losses, reported just last year. Single-payer healthcare. No, it’s not - it’s a carve out of the sick, elderly, and disabled. Single-payer healthcare would cover EVERYONE IN THE COUNTRY. > [@](#): > > Right. All those fraudulent MRIs. What’s your cite for these statistics? This is why I want you to define “fraud”. Because I did not say “fraud”, I said “unnecessary”. There is a definite difference. > [@](#): > > I don’t know about you, but ANYtime I need a test, the request gets sent to BCBS, first, and they analyze my medical records, other tests, etc., to decide whether or no they will pay for it. That’s part of them controlling costs. So, the idea that Doctors are sending patients left and right to pay for expensive machinery seems absurd on its face. I’m perfectly happy to see your cites on that, though. I’m always open to changing my mind about something when I see factual data. [Journal of the American Medical Association on the overuse of MRI](http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1672286) [Consumer Reports on over use of CT scans](http://www.consumerreports.org/cro/magazine/2015/01/the-surprising-dangers-of-ct-sans-and-x-rays/index.htm) > [@](#): > > You missed what I said. He’s simply one Canadian. In Arizona, we are flooded with them, in the winter, many of them here for various surgeries. Some other person here asserted their opinion that obviously, they were all having frivolous (as if there is such a thing) surgeries, like plastic surgery. They’re not. The one gentleman I mentioned was simply an example. Last study/info I read, 52,000 Canadians travelled abroad to obtain healthcare, in 2014. ( [Breaking News, Headlines and Stories | National Post](http://news.nationalpost.com/news/canada/number-of-canadian-patients-travelling-abroad-for-treatment-increased-by-25-study-finds) ) Now, they have 30M people. So, what, 2%, give or take? Not bajillions; but still… In 2007, the most recent year I could get stats on, 750,000 Americans left the US to get medical care elsewhere, despite our having such a wonderful system. :rolleyes: I see a lot of estimates that since 2010 that number is a million plus. So… what’s your point? It seems Americans go aboard for medical care as a similar percentage of the population. I don’t think all those Canadians are coming south for “frivolous” reason. If you’re on a 16 week waiting list for hip surgery and have the means to travel to Arizona and get it done in 2 weeks instead more power to you. And if you’re living in Arizona and want to travel to Mexico to have major dental surgery and have the means to do so more power to you. In the case of the Canadian, though, that’s a choice to pay more to wait less. In the case of the American it’s often either go to Mexico or don’t get it done. > [@](#): > > Purportedly, it was 30 million. Now, here’s my question for you. We all know–even the Prez admitted–that there were ~7 million of us that lost our existing plans, due to the advent of Obamacare. So, you can hardly count those people in those who’ve been “liberated” due to Obamacare. If indeed 11 million people have “signed up,” that’s total. That _includes_ those 7 million people like me, who were replacing plans that they lost, plus people signing up–like you–AND, people who signed up through Obamacare, who were signing up for, or renewing, Medicaid. (Also single payer, in case anyone’s forgotten.) Nope, it didn’t include me - I have a health insurance program that pre-dates the ACA and is not part of “Obamacare”. In fact, the Federal government wanted us to abolish the program and convert entirely to ACA but Indiana went to court and successfully argued to keep a modified form of it as yet another alternative. So no, I don’t have an ACA policy. For full disclosure: the state government has set my portion of the premium as a set percentage of my monthly income. Which means every time over the past 8 years I’ve received a raise or gotten a better job my healthcare premiums have gone up in absolute terms. The state pays (yes, out of tax money) the remainder of the premiums. We have a very limited number of doctors from which to choose. It’s not an ideal situation but it is one we can afford and I have no objections to paying our share as defined under the program. And, by the way _Medicaid is NOT single-payer!_ It doesn’t cover everyone in a state or in the nation. It covers a subset of people and therefore is competing alongside the private system that can still cherry-pick the wealthier members of society and ignore the poorest and sickest. > [@](#): > > So, here’s a question–because NOBODY seems to be able to get the “most transparent administration in history” to pony up the real-live numbers: of the purported 11 million, how many are people replacing their plans that were lost due to ACA? Those plans were lost due to decisions by _health insurance companies_, not the government. The private health insurance companies are _happy_ to blame the government while they increase their own profits. > [@](#): > > I suspect that the number of “newly insured” who are actually paying 100% of their own insurance coverage, without any subsidies, tax breaks, and so forth, is actually a dismally low number, of the 11 million. So? Are the poor less deserving of health care than you are? Are you saying we should only save those above a certain economic level? > [@](#): > > Ah, yes, tort reform. You’ve obviously never had someone in your family killed by medical incompetence. I have. We did not sue, mind you, but we had EVERY reason to do so. Then why didn’t you? And why is the threshold “killed”, why not simply maimed? My spouse almost lost his leg to surgical incompetence at 20, his walking will be impaired for the rest of his life. He had to pay out of pocket for the surgery to save his leg and it took him 10 years to pay it off even while making six figures as an engineer. > [@](#): > > Why on earth would I think that the Feds would run a regular health-care system any better? Because every other first world nation’s government manages to do so, with less cost per person and better outcomes than what we have? > [@](#): > > Yeah–at the IRS. Ever dealt with them? \*\*I have. \*\* Me, too - again, you’re nothing special or exceptional. Every situation you’ve outlined (except for possibly losing a house) my family has been through. A lot of other families have been through the same thing. In my case, I realized our “system” is broken and cruel. I looked around and found out other countries do things better. Now I advocate we follow their example. > [@](#): > > They can. I simply don’t believe that the “government” does ANYTHING better than private business. (Other than its assigned role, National Defense.) OK, let’s go back to private fire coverage - if you don’t pay your monthly bill to the fire department your house can just burn. And if your house is on fire be sure you call the correct fire company because the others (if there is any competition in your area, there might not be) won’t come when you call because you’re not their customer. Yes, that’s really how it used to be done. Let’s do private police coverage, too - if you can’t pay for police coverage you’ll just have to do without. Someone kicks down your door, rapes the women, and steals all your stuff? Too bad, you didn’t plan ahead and purchase a police coverage policy. Let’s have competing sewer companies! Yes, that’s a _great_ idea - multiple sewer lines everywhere! Let’s do away with municipal trash pickup - in fact, that is the case where I live. My landlord has to pay a private company to haul away the building trash. We have a _lock_ on our dumpster to keep folks from dumping their garbage in our dumpster and making us pay to haul their trash. It’s actually a common feature of dumpsters and trash cans around here. And there is _still_ a problem with people just dumping trash because either they won’t or can’t pay to have their hauled. Let’s charge for every foot of every road - yes, forget public roads, make every road private. Hope you don’t mind paying tolls every time you go somewhere. The problem with people with your stance is that you conveniently ignore what the government does actually do for us. You ignore _why_ we moved to public fire coverage, and public policing, and government involvement with utilities and roads. We take something like the interstate highway system for granted. > [@](#): > > The cost overruns, screw-ups, lost money…the list is endless. The government has grown and encroached, increasingly, my entire life. So you want to go back to the days when if you fell on hard times you really could starve to death, when if you didn’t have the money to pay for medical treatment up front you simply suffered and died, when the local “police” were whatever posse of men the local sheriff could call up, when if you didn’t “subscribe” to a fire company your house would just simply burn down? The government has “encroached” because the majority of people have decided they want government services. Unfortunately, a lot of people don’t want to grasp that if you want the government to do more yes, you’ll have to pay taxes. Don’t want taxes and less government? Then don’t complain if getting medical care for your family means losing your house due to debt. > [@](#): > > I take it that you don’t really understand the Tax Code, and why businesses can write off losses. I take it that you don’t really understand the Tax Code and why people poor enough to be excused from paying X category of taxes are doing nothing more or less than what those businesses are doing - using the system to their own advantage. Yet you rant about those poor people receiving subsidies for their health coverage as if they’re doing something wrong or cheating - they aren’t, any more than Trump writing off a huge loss to avoid Federal taxes for 20 years was doing something wrong or cheating. I may not like certain aspects of the system, but I don’t feel I can blame someone who is operating within the law for using the system to their benefit. > [@](#): > > Are you trying to say that you don’t? That you pay more taxes than you have to? Nope. In fact, despite being poor I use a professional to do my taxes to maximize benefit to me. Which has been the case, it’s been well worth the money. > [@](#): > > Oh, yes, and if you’d taken the time _to actually read_ my initial post, you’d see that I mentioned that. As far as “only people who can afford healthcare” question goes, yes, to some extent, I think that’s true. The inequities of life _aren’t_ going to be compensated for, by taxing the holy shit out of those who do work and pay their own way. You seem to have missed that point that _based on what many other nations have done over decades_ if you truly get EVERYONE into the system you _don’t_ have to tax the “holy shit” out of anyone. When they passed the ACA it was stated VERY CLEARLY that if the young and healthy didn’t get on board it wouldn’t work. The young and healthy are doing everything they can to avoid paying so _of course_ the ACA isn’t working very well and will eventually collapse under it’s own weight. Which I why I hated it from the get-go. It wasn’t going to work long term. > [@](#): > > Or this absurd fascination with the 1% that seems to have gripped the left. Or those folks with the “us versus them” mindset; those people who think that the rich pulled some trick, cheated someone, got over on them, who deem them EVIL, and want to take all their money… Oddly enough, my family _does_ know someone in the 1%. Actually, the upper 5% of the 1%. In fact, we just spent a week at his house which was, of course, _extremely_ nice and full of creature comforts, and in fact he loaned me his driver to take me out for a very touristy afternoon in a neighboring state. The purpose of the visit was for my spouse and him to work on a mutual business interest which was pretty damn minor for the billionaire but of great impact to us. So we weren’t asking for a handout and didn’t get one, it was strictly payment for work (well, he was nice enough to put us up at his house instead of a hotel). We’ve known him for over 20 years now. No, I don’t think the 1% are evil, quite a few of them are very nice, generous people and help others by employing them or helping them find work or helping to fund new business ventures. Funny thing, though - he used to work in the insurance industry, too (not healthcare, but another areas). And we talked a bit about healthcare in the US and how the current system doesn’t work well and how other countries mange to do the same things better. He’s got the advantage over me because he’s a trained actuary, sort of wish he was here to explain the math as he would do so much better than I could. > [@](#): > > …while at the same time worshipping at the altar of Steve Jobs, or sitting on Facebook all day, putting yet more money into the pocket of Zuckerberg. Did you use Google today? Did you? Yes, I did use google today - specifically to get the cites you requested. I am not and never have been on Facebook. I think I’ve purchased exactly one Apple product in my entire lifetime - not that there’s much difference in buying Microsoft. Except the Gates family now seems to be using some of their wealth to better the world, like working to provide vaccination, and reduce (and eventually eliminate) malaria and polio. In addition to various other initiatives intended to benefit poor people _worldwide_. Wealth is a tool. Wealth is neither good nor evil, what matters is what you do with it. > [@](#): > > Actually, I truly DO have a “clue” as to how insurance works. That’s why it boggles me that you think that ACA is so wonderful. Except _I never claimed that_. Go back and read my posts - I’ve been anti-ACA all along. I want _single payer universal health coverage_ which is a very different animal. > [@](#): > > Or did I miss the stampede of young people that ran me over, on their way to sign up, and PAY for the plan, as part of their obligation to do so? That IS a big part of the problem - there wasn’t any such stampeded, which doomed the ACA from the start. You can’t allow people to opt-out, otherwise the young and healthy will, and that will not work. > [@](#): > > So, since that _didn’t_ work, how is it you see Single Payer working? Because it works in so many other places. Why should it be impossible to implement here? Or are we Americans just that stupid and cruel? > [@](#): > > You really think that single-payer is somehow magically going to cost ME less? I don’t know, not having full access to your financial information (nor would I want it). But it WILL cost you less than having to pay for a heart attack and cancer treatment entirely out of pocket. > [@](#): > > That somehow, Uncle Sam won’t find a way to get those thousands out of me, that I’m currently paying out to BCBS? Yes. The money you would otherwise be paying to a private company would then be going to the government to pay for your healthcare. You prefer to pay those thousands to a private company? Why? How would paying those thousands to the government in return for at least the same, and possibly better, coverage be any worse? > [@](#): > > This is all great for you. You got health insurance, because yu couldn’t afford it, before. Uh… no. Until 2007, when I was laid off, I paid for health insurance with no subsidy or break on the premiums. Then for 18 months we had no insurance at all. During which time, by the way, my spouse’s vision, kidney, and liver function all suffered permanent damage because we simply didn’t have the money to purchase all his maintenance medications, much less anything else. Then my state government started a program that we joined up with because it was to our benefit. Why do you have a problem with any of the above? Or would you have prefered we amble along with no coverage and insufficient funds to pay for needed maintenance medications until my spouse needed a kidney transplant or lifetime dialysis? Would THAT have saved the public money? [Previous page](https://boards.straightdope.com/t/question-regarding-obamacare/768316.md?page=4) [Next page](https://boards.straightdope.com/t/question-regarding-obamacare/768316.md?page=6)