# So ACA gets repealed. What next for Democrats? **URL:** \ **Category:** Great Debates\ **Created:** [January 6, 2017, 1:40am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438 "2017-01-06T01:40:39Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [January 9, 2017, 10:34pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/81 "2017-01-09T22:34:06Z")
> [@jasg](#): > > My understanding of the Canadian system is that it is funded from income taxes, not a corporate tax. So, if we wave a magic wand and convert the US system to Canada’s - the that 70% employer share goes to your paycheck and then taken back as a tax. > > You are still getting the same take home pay but your tax went up a bunch. Ah…well, I’d be fine if my take home was about the same, if that’s how it works out. i.e. if I’m currently bringing home around $4.5k a month paying $1100 in taxes and it winds up with me bringing home $4.5k a month by paying $1700 in taxes then all well and good. Bring it on. Heck, I’d be ok with bringing home around $4.3k per month for similar health care if it meant basically universal coverage. Bringing home $3.9k a month however would kind of be a bit much for me and probably a lot more folks to swallow. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [January 9, 2017, 11:13pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/82 "2017-01-09T23:13:08Z")
> [@adaher](#): > > It’s also simple to understand. But it certainly has its drawbacks, and there hasn’t been a new single payer system implemented in a long time. I believe Taiwan in the mid-90s. They did a huge project of examining all the healthcare systems out there for cost, efficiency and what kind of problems each might lead to. > [@XT](#): > > Yes, that was my assumption. What else would be the difference since s/he said they were paying $1700+ a month for taxes? Unless the taxes are across the board more for everything I would assume (possibly a bad assumption I admit) that taking my current taxes and including everything I currently pay for healthcare should be fairly close to that figure…and it’s not. Possible differences, as I noted, could be the poster is at the highest tax bracket…which I’m not…so is being taxed the maximum. Other than that, the only difference would seem to be that they are paying for healthcare and it’s all bundled in while mine isn’t. The way I read the post, his taxes pay for everything. Infrastructure, education, healthcare, military defense, welfare, pensions etc. Offhand, I think pensions are generally the biggest outlay of most governments. Canadian public healthcare spending is about 3700 per Canadian. US public healthcare spending is 4500 per American (2014 numbers). So about 18 % below. And that is just the government spending. > [@XT](#): > > If you are an American, look at your own pay stub. It should list all of your local and federal taxes, plus any 401K or retirement deductions AND whatever is being taken out for health insurance. That’s what I did…and my own, including my health care insurance (HC plus vision and dental), retirement (which is 10% of my salary taken out automatically by the organization), SS and Medicare, Fed WH and SIT comes to $1100. Which seems to indicate a $600 gap, all things being equal (again, assuming they are). Feel free to give a ballpark for your own as I’m interested in how this would play out. I always assumed that a single payer system, bundling the costs together would come out with me paying more on my taxes but not a lot more. This would be a 64% increase over my current tax burden for…what? I already have great insurance today. Granted, I’m willing to pay more for folks who aren’t being currently covered…but not sure $600 more a month would work very well. Certainly that’s going to hurt a lot of folks (I’m at the upper end of the tax brackets, so obviously those at the lower end will take less of a hit…but even a hit of a hundred or two is going to hurt middle or lower income folks). I’m not American. I’m from Norway. I make roughly 100 000 $ in Norway, depending on the exchange rate, and pay 25 % tax on that income. Local and national. That covers healthcare, infrastructure, police, a pension, education through university for me and any children, a years total paid leave for each child, any unemployment benefits I might need, military spending, firefighters, snow removal, the lot. (Except water/sewage. Go figure) If he is spending 1700 per month on taxes, that is over 20 000 per year. To me, that seems way way too much money to be going just to healthcare. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [January 9, 2017, 11:34pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/83 "2017-01-09T23:34:04Z")
[QUOTE=Grim Render] The way I read the post, his taxes pay for everything. Infrastructure, education, healthcare, military defense, welfare, pensions etc. Offhand, I think pensions are generally the biggest outlay of most governments. [/QUOTE] Sure. My taxes also pay for everything…that’s my point. If you combined my taxed AND what I’m currently paying for healthcare, plus my social security AND my pension it comes out to $1100 a month right now. That covers both my local And federal tax btw. Plus my own employer actually taked 10% out non-voluntary for our pension retirement package (we still have to pay social security as well). All that combined along with my portion of what I pay for healthcare comes to $1100 a month. Now…if we are taking what my employer also pays for their portion, giving that to me in increased salary then taxing it, and if my take home pay remains essentially unchanged (or even goes down slightly), it’s all good. That might be where the disconnect is for me. My assumption was that if I go from paying $1100 in taxes to $1700 that would be $600 a month less in my pocket. But if I am given a ‘raise’ of, say, $500 a month then my taxes go up $600, I’m only out $100 a month for my take home…and, at least for me, that’s do-able. > [@](#): > > If he is spending 1700 per month on taxes, that is over 20 000 per year. To me, that seems way way too much money to be going just to healthcare. I think we are talking past each other here. I don’t think either s/he thinks that all $1700 of their taxes go to healthcare, nor do I. Taxes go to a variety of things. The comparison, however, was between what the poster is paying for taxes including healthcare and what I’m paying for taxes, which also include healthcare (and in my case I bundled in everything basically, including my pension and SS/medicare which I pay on top of what I pay for all the rest). ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [January 10, 2017, 12:00am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/84 "2017-01-10T00:00:43Z")
> [@iiandyiiii](#): > > I started a thread about it, but I think another possibility is that the Republicans essentially abandon their principles and fashion a Trumpcare which is largely similar to the ACA but rebranded, and find out that most of their voters don’t actually care about the conservative principle that the government shouldn’t be involved heavily in helping people get health care and insurance. Such a thing might be politically very successful, but I think in the long run most progressives would be incredibly pleased by such a development. Yep. Just keep the ACA text verbatim, and call it the Totally Responsible Universal Medical Provision Act. Or, the TRUMP Act. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [January 10, 2017, 12:24am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/85 "2017-01-10T00:24:33Z")
> [@XT](#): > > If you are an American, look at your own pay stub. It should list all of your local and federal taxes, plus any 401K or retirement deductions AND whatever is being taken out for health insurance. That’s what I did…and my own, including my health care insurance (HC plus vision and dental), retirement (which is 10% of my salary taken out automatically by the organization), SS and Medicare, Fed WH and SIT comes to $1100. Which seems to indicate a $600 gap, all things being equal (again, assuming they are). Feel free to give a ballpark for your own as I’m interested in how this would play out. I always assumed that a single payer system, bundling the costs together would come out with me paying more on my taxes but not a lot more. This would be a 64% increase over my current tax burden for…what? I already have great insurance today. Granted, I’m willing to pay more for folks who aren’t being currently covered…but not sure $600 more a month would work very well. Certainly that’s going to hurt a lot of folks (I’m at the upper end of the tax brackets, so obviously those at the lower end will take less of a hit…but even a hit of a hundred or two is going to hurt middle or lower income folks). > > If I’m making wrong assumptions here or missing something then let me know…I WANT to be, so I’m receptive to missing something where I can come back with a :smack: and concede I was wrong or didn’t think of something. But remember your paystub doesn’t list all of the taxes you pay. Different jurisdictions have different taxing schemes and also provide different services, and that makes it difficult to compare. I live in the US and checked my paystub - $947 income taxes and $323 for SS and medicare and another $208 for my health insurance - for a total of $1478 _per pay period_( and I don’t overwithhold to get a big refund). That doesn’t include the at least $12K my employer pays for my health insurance. Or my deferred compensation contributions. And BTW, that’s on a barely six-figure income, not a high six-figure income. But my city has an income tax in addition to the state income tax , low real estate tax, no school tax ,no personal property tax and I do not pay separately for services that some jurisdictions don’t include in their taxes (like trash pickup or firefighters). So for you to compare my taxes to yours, it would take more than just looking at our paystubs (is your property tax higher than mine, do you have to pay separate school or library taxes, or subscribe to a volunteer fire department or trash pickup service, etc)- and the same is true when comparing one country’s taxes to another’s. Between my taxes and my share of my health insurance- I’m paying more than **Grim Render** - but just going by what he mentioned in his post, mine don’t pay for a college education or a year’s paid leave for each child. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [January 10, 2017, 12:58am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/86 "2017-01-10T00:58:05Z")
> [@doreen](#): > > Between my taxes and my share of my health insurance- I’m paying more than **Grim Render** - but just going by what he mentioned in his post, mine don’t pay for a college education or a year’s paid leave for each child. As others have noted though, our taxes in the US pay for what is doubtless a slightly larger military than Norway… ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [January 10, 2017, 1:02am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/87 "2017-01-10T01:02:34Z")
> [@jasg](#): > > As others have noted though, our taxes in the US pay for what is doubtless a slightly larger military than Norway… They do- but that’s also part of what I meant by it’s not enough just to look at the paystubs. ---
**Author:** ![Horatius](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/horatius/32/3572_2.png) [@Horatius](https://boards.straightdope.com/u/Horatius)\ **Post date:** [January 10, 2017, 3:20am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/88 "2017-01-10T03:20:31Z")
> [@XT](#): > > I knew Canadian’s paid more in taxes than we did, but I am having a hard time grasping that sort of difference. Hopefully Horatius is going to come back and say s/he made a typo or perhaps that s/he is at the very top of the tax brackets and paying the maximum for his or her high 6 figure salary…otherwise I guess I won’t be retiring to Canada as I had hoped and I am not seeing how such a system would work in the US, assuming it would cost something similar. > [@Grim\_Render](#): > > I’m not American. I’m from Norway. I make roughly 100 000 $ in Norway, depending on the exchange rate, and pay 25 % tax on that income. Local and national. That covers healthcare, infrastructure, police, a pension, education through university for me and any children, a years total paid leave for each child, any unemployment benefits I might need, military spending, firefighters, snow removal, the lot. (Except water/sewage. Go figure) > > If he is spending 1700 per month on taxes, that is over 20 000 per year. To me, that seems way way too much money to be going just to healthcare. I’m in the second highest tax bracket, and have very few deductions, being single with no kids. And that $1700 a month is for all my income taxes, not just health care. Yeah, Canadian taxes are higher than the US on average, but I’m probably at an extreme compared to most people. You also have to consider that a person with a family that has the same overall income as I do actually gets a double bonus: lowered taxes due to additional benefits, plus, their healthcare cost isn’t scaled according to the size of their family. A single person in the US might be able to get away with a minimum-cost, minimum-benefit plan, but would that work out so well with the typical 2.3 kids type family? Looking around, [I found this](http://kff.org/health-costs/report/2016-employer-health-benefits-survey/): > [@](#): > > Annual premiums for employer-sponsored family health coverage reached $18,142 this year, up 3 percent from last year, with workers on average paying $5,277 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Education Trust 2016 Employer Health Benefits Survey. So the average cost to the workers directly is about $440 a month. That’s an average, so of course lots of people would pay more. So if I was paying that out of my pocket, my taxes would likely be about $1250 a month or so. Higher, but not ridiculously higher. Add in the Employer costs, and health care alone is almost the same as all of my current tax burden. But this also doesn’t take into account deductibles and co-pays. My deductible is $0 for doctor, emergency room and hospital visits, as well as for blood tests, ultrasounds, X-rays, CT scans and basically every other test I’ve ever had done. I’ve got a co-pay on my prescriptions, but for most drugs that’s less than $10, often less than $5, for a two to three month supply. I do have one drug that is $80 per month, but that’s an unusual case. On the whole, I suspect I’m getting better value for my money than the vast majority of Americans. I had an emergency room visit this past summer, while visiting a friend’s campground. I had pain that I thought might be a kidney stone. Literally, my only concern was if I could find the hospital in a town I’d never visited before. No worries about costs, or if the doctor/hospital was in my network. No debating if I should get the tests the doctor wanted. No bills for the drugs they gave me at the hospital. Show up, deal with it, go back to the campsite. That was the whole day. How much extra is that worth? ---
**Author:** ![Fiveyearlurker](https://avatars.discourse-cdn.com/v4/letter/f/da6949/32.png) [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)\ **Post date:** [January 10, 2017, 3:49am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/89 "2017-01-10T03:49:00Z")
The dog that caught the bus [might not actually have the votes](http://nymag.com/daily/intelligencer/2017/01/obamacare-repeal-might-have-just-died-tonight.html) now that it’s real, and not just for headlines. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 10, 2017, 4:19am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/90 "2017-01-10T04:19:03Z")
Not enough votes for Repeal and Delay, but that’s a good thing, since it was always a terrible idea. ---
**Author:** ![Fiveyearlurker](https://avatars.discourse-cdn.com/v4/letter/f/da6949/32.png) [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)\ **Post date:** [January 10, 2017, 4:33am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/91 "2017-01-10T04:33:32Z")
> [@adaher](#): > > Not enough votes for Repeal and Delay, but that’s a good thing, since it was always a terrible idea. But, that’s going to require bipartisanship, unlike repeal and delay. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 10, 2017, 4:48am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/92 "2017-01-10T04:48:36Z")
If you want to pass it with 60, sure. But they can do a lot through reconciliation too. BTw, one smart move is that they are keeping the Medicare cuts. Since those are just “savings” and do not impact benefits at all, honest to goodness, there’s no reason not to keep them. ---
**Author:** ![Fiveyearlurker](https://avatars.discourse-cdn.com/v4/letter/f/da6949/32.png) [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)\ **Post date:** [January 10, 2017, 4:51pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/93 "2017-01-10T16:51:19Z")
You can’t create a new law without 60 votes. ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [January 10, 2017, 6:01pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/94 "2017-01-10T18:01:08Z")
> [@Fiveyearlurker](#): > > You can’t create a new law without 60 votes. Harry Reid demonstrated that those sort of requirements aren’t set in stone. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [January 10, 2017, 6:59pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/95 "2017-01-10T18:59:59Z")
> [@HurricaneDitka](#): > > Harry Reid demonstrated that those sort of requirements aren’t set in stone. What did Harry Reid do that created a new law? Reconciliation can be used to change budget outlays or other matters affecting the federal budget. For example, increasing tax credits to buy health insurance on the exchanges, closing the ‘donut hole’ in Medicare prescriptions, and committing the federal government to cover the full costs of Medicaid expansion through 2016 were all changes wrought by Reid’s use of budget reconciliation, but none of these created new programs. Medicare, Medicaid, and the exchanges were all in existing law (ok, the exchanges were in a law that had only existed for a week, but it still existed), and reconciliation merely changed the amounts allocated, or how the amounts were to be determined. To create an entirely new program, though, how would you use budgetary reconciliation? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 10, 2017, 8:13pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/96 "2017-01-10T20:13:06Z")
ACA exists, you just alter the parts that have budgetary impact to make what is almost an entirely new law. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [January 10, 2017, 10:28pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/97 "2017-01-10T22:28:20Z")
> [@adaher](#): > > ACA exists, you just alter the parts that have budgetary impact to make what is almost an entirely new law. That doesn’t get you a “we repealed the ACA” checkmark, though–that’s just tinkering with the hated Obamacare instead of getting rid of it. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [January 10, 2017, 10:48pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/98 "2017-01-10T22:48:53Z")
> [@adaher](#): > > The second part is true. Medical bankruptcies are unheard of in UHC countries. > > However, denial of medical care is not even a bug of single payer systems, it’s the whole point. Costs are kept down because it’s easier for the government to say no than private corporations. Are you fucking shitting me? You’ve got to be fucking shitting me. Have you ever needed medical care, or had a family member who needed medical care? Because that must have never happened, if you can believe what you just wrote. > [@](#): > > One of the other neat features of single payer is that often, you’ll never know if you were denied treatment, because doctors know to only offer treatment that will be paid for. In the US, where coverage levels vary, doctors prescribe whatever tests or treatments or drugs make medical sense. In Canada and Britain, they stay within the limits of the system. And since drug advertising is often illegal in UHC countries, consumers have no idea whether there’s a treatment for their condition or not. Again, have you ever had to navigate the so-called “system” here in the United States? Because a wonderful feature of our system is you can never, ever, ever be sure what something will cost, and who will be stuck with the bill, until after you spin the wheel. Oh, that’s a pre-existing condition. You needed approval for that. That was out of network. Not covered under the silver plan, you should have got the platinum plan. You didn’t fill in the correct form, and now you have to pay the whole bill. We reviewed the files from three years ago and you actually owe us for that procedure you had that you thought would be covered. > [@](#): > > One of the hilarious in a sad way aspects of denial of coverage in the US, is that in many cases newspapers will report on these cruel insurance companies, only to find that if you did a little research, the NHS nor Canada’s Medicare would have approved the treatment either! Sometimes doctors want to throw Hail Marys and try questionable stuff to save a life. Doesn’t mean taxpayers or insurance companies are obligated to pay hundreds of thousands for that 1% chance. Again, we already have Death Panels, they’re just insurance company bureaucrats. Try negotiating with them, and see how fucking far you’re going to fucking get. ---
**Author:** ![Fiveyearlurker](https://avatars.discourse-cdn.com/v4/letter/f/da6949/32.png) [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)\ **Post date:** [January 10, 2017, 11:52pm UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/99 "2017-01-10T23:52:52Z")
> [@HurricaneDitka](#): > > Harry Reid demonstrated that those sort of requirements aren’t set in stone. ACA passed 60 to 39. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 11, 2017, 12:37am UTC](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438/100 "2017-01-11T00:37:59Z")
> [@slash2k](#): > > That doesn’t get you a “we repealed the ACA” checkmark, though–that’s just tinkering with the hated Obamacare instead of getting rid of it. If that’s how you want to spin it, you can certainly do it that way. However, repealing ACA in its entirety has never been realistic due to the 60 vote rule. But Republicans and Democrats alike still consider it effectively repealed if everything that it does that has to do with federal dollars is erased. [Previous page](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438.md?page=4) [Next page](https://boards.straightdope.com/t/so-aca-gets-repealed-what-next-for-democrats/776438.md?page=6)