One thing I found out during the long discussions on health care is that you can identify the states where the medical care price gougers are strongest when the state government decides to not lift a finger on making or administering the coming exchanges (they also opposed any health reforms); one classic example is Texas, a few quasi monopolistic health care providers are some of the most expensive in the nation and it is very likely that the politicians there are in the pockets of that industry.
They will fund it the same way they fund everything. They will take what they desire by force, threat and extortion and when that is not enough they will push the costs off on the next generation through debt. Don’t they teach about fiscal matters and taxes in civics courses anymore? Ostensibly the tax in question is a 3.8% surtax on investment income for small businesses and investors. But money is fungible so it is not like some revenues can be assigned for this or that… especially when the budget does not even balance. Let’s see, we will assign this 50% to program A, this 50% to program B and this 50% to program C… see it all balances! It is also worth mentioning that the 3.8% does not come close to covering the costs.
Other funding mechanisms include but are not limited to, having the Chinese loan us the money and inflation (in a sense we take what we owe and make each dollar worth less… if not worthless altogether… it is a way of stealing from what people have already saved). Yet other ways include forcing doctors to make less while crossing our fingers and hoping the quality and quantity of services available does not go down in contravention of every principle of economics in a way that has never occurred before in the course of human history but will miraculously happen this time around because… well, just because. This is what Obama means when he says he will bend the cost curve down. He will try to make an end run around the law of supply and demand.
One mechanism for doing that will be the advisory boards that will decide what will be paid for and what will not and what the price will be. Those can either cost money or “save” it depending on which constituent group you belong to and how badly the ruling party needs your vote. And finally they resorted to budgetary gimmicks where 10 years of income was put against 6 years of expenses to make it look revenue neutral while at the same time spending some of the same money twice in the same budget on other things. That is of course not a legitimate source of funding but they are shamelessly claiming it nonetheless so who am I to argue. They certainly don’t need my approval to spend my money… or my grandchildren’s money for that matter.
And those are just the payment mechanisms for the nominal costs and do not include costs to the economy, opportunity costs or the cost of distorting the market and throttling innovation. At the risk of being non-PC there are also very real costs to our liberty. No one ever asks how those that will be paid for but if history tells us anything at all it is that the currency used to pay such a bill will not be in dollars.
I guess we should also mention the fact that the costs of these things are ALWAYS underestimated and that there is always mission creep. So to sum up, not only do the people who passed it not know what is in it, they don’t have the slightest idea what it costs and they intentionally provided less funding than even the estimated costs… which they made sure were lower than what reality dictates. In their defense though, what is really the point of coming up with funding for a new entitlement when the old ones are already completely unsustainable as currently constituted? It is all fantasy financing at that point anyway so what would be the point of the exercise?
While no one can tell you how they will fund it, I can certainly tell you several sources of funding they will not have access to. Those would include the 17 employees we let go from our small business because there was no way to comply with the ACA. Nor will it include the thousands of businesses like mine that will never be started or that will be kept from growing. Other sources there will not be include the larger businesses who had enough clout to get waivers and perhaps even entire states where the senators made special deals so that their citizens would not have to bear the brunt of the funding. I am not sure what happened with those deals. They may not have survived the light of day but who the hell knows since the press is effectively a propaganda arm of one political party. These payoffs have ways of cropping up again in different forms. Whether those bribes survived or not the votes they bought still very much count.
And it is all subject to change anyway. Everything is run by fiat and whimsy these days so tomorrow all of this could be moot depending on how wholeheartedly industries support the ruling party. The government is very much in the business of picking the winners and losers in the economy now. That is what corporatism is and that is how it works. You don’t get exemptions if you don’t play along and whichever constituent group needs to be bribed at the moment will get the benefit of the regulatory interpretations or waivers. This is inevitable when you concentrate all power in a central authority. All power runs through a few people in Washington and everyone comes to them as supplicants to get some allowance or reward, or to punish competing interest groups by using the government’s monopoly on force to their advantage. You can call it socialism, or fascism, or corporatism but there really just isn’t any meaningful difference in those terms except as an exercise in picking teams. They all amount to the same thing in the end.
That doesn’t fully explain everything but the takeaway is that you were foolish to assume they bothered to fully fund the ACA when they haven’t fully funded anything else or that any group of people could restructure 1/6 of the economy of an entire country in their image and have any idea whatsoever of what it would cost to do so.
Nope, not charity - craziness. We don’t want to force people to buy insurance of various types , and we don’t want our taxes to go up, but we also don’t want to acknowledge the consequences of those desires. So when some town doesn’t want to raise taxes to pay a nearby city for fire protection and a resident of that town doesn’t want to pay an optional fee to that city for fire protection , the fire department gets blasted for not putting out the fire anyway. Same thing with health insurance- people don’t want socialized health care , they don’t want to be forced to buy insurance, they don’t want their taxes to go up - but I have not yet found one single person (and I’ve asked) who believes hospitals should be permitted to turn people away if they can’t or won’t pay for emergency care.
Boohoo. Businesses have greedily decided to not pay employees properly, and routinely treat them poorly. The rich have sucked all the money out of the economy. The government is just taking the money that people have earned away from the businesses and people that have kept it instead of giving it out as proper compensation.
Do you seriously think such things aren’t already in existence? All health insurance companies have “advisory boards” or departments that, in fact, do make such decisions as to what will and will not be covered, the chief difference is that private companies make such decisions in private, with no public oversight, and no recourse by the public. “Death panels” are already here, they’re in the companies who decide what they will and won’t cover, who use every excuse possible to avoid paying out for customers who do become ill, and who will attempt to retroactively cancel a policy when someone does get sick enabling them to keep years of premium money without having to pay out a dime to someone who now really has need of medical help.
I pay 297.00 a month for individual major medical. ACA is going to subsidize all of us who make less than 40k. Cool, I can finally be a 47%er!
Very true. A friend of mine is a dentist. He has been in practice for decades, and is a great guy and a very good dentist. He used to have a staff of four people just to handle the paperwork for insurance companies. It got to be such a pain that he decided to focus on Medicare and Medicaid. He has as much work as he can handle, he was able to reduce his billing staff to one person and that saves him so much that he makes more money than he did before.
The next step in this argument should be pornographic, I hope you understand.
Who paid the bill when she was born in a hospital - did she? But it was her parents bill, right? No it wasn’t.
In UHC, it’s a fundamental misconception to talk about (a) the individual and (b) a moment in time - like now.
It’s actually about a timeline that begin before the ‘individual’ is born (pre-natal) and extends way beyond the lifetime of the same individual, to generations of family members not yet dreamed of.
Will those generations be born in wealth or in poverty - almost certainly both, will they all be born in good health, does your coworker consider them close family members even though they will never meet? What happens when your coworker loses this job, or the next job?
Fwiw, I thank to God my great grandparents and their generation for throwing out Winston Churchill in the 1945/6 election because he rejected UHC: The National Health Service is the true monument to that generation, and I wish I could thank them for the birth right members of this society have enjoyed since, for my grand children, and for family members I will never know.
See The Olympic Opening Ceremony for a similar sentiment expressed on a national scale.
To think about only now and the self is to misunderstand and/or represent the achievement of UHC.
This is a math fail.
Yes, it is cheaper to pay insurance premiums that hospital bills if you know a particular person will have expenses exceeding insurance premiums.
But to achieve that savings for the thousands of sick you are paying the insurance premiums of a million others who are not going to have medical expenses exceeding premium costs.
So by paying for insurance for the poorest using government tax revenues we collectively are overpaying for medical care for many in order to guarantee saving money on very expensive medical care for the few. That is how insurance works. Insurance companies could not stay in business otherwise.
Does it all balance out in purely dollars and cents terms? Maybe. Perhaps.
Is there a moral good to alleviating illness and suffering? Certainly.
Go with the moral argument.
Our entire economy is feeling the pinch of our health care crisis. Our overpriced health care and the fact that employers have to cover a huge % of the costs is making the US less competitive. Elderly people who want to retire to make way for younger workers can’t retire because they lose their insurance, and employers have to spend several thousand dollars per employee on insurance. Most of our unfunded liabilities are due to health care. Health care is a part of why education costs are growing so fat. All in all, our system is a drain on almost everything about our society we spend 18% of GDP and have less to show for it than nations that spend 8-12%. But sadly America is also a nation of delusions of grandeur and plutocracy so I don’t see it changing on the national level anytime soon.
On another note, if we did have medicare for all it would cost slightly less than our current system (savings of about $400 billion). The bill to create a medicare for all system (HR676) also has a funding mechanism that would cost less for most people. The majority of people, if the HR676 bill was enacted would see their employer and employee payroll taxes go up by an additional 7.8%. But that is less than we spend on insurance right now. The median household income is about 50k, and a family insurance policy is close to 16k now. So instead of you and your employer paying 20-35% of your gross income for health insurance it will only be 7.8% (HR676 has a progressive funding mechanism and cost cutting measures so it is cheaper than our current system).
http://www.healthcare-now.org/whats-single-payer/hr-676
But I don’t see it happening outside of a few liberal states like Vermont. Even CA isn’t truly serious about medicare for all, they just pretend to be when they know it won’t get passed. Back when Schwarzenegger was gov and the dems in the state legislature knew he would veto it they could easily get it passed through the state congress. Now that they have a democratic gov they can’t get the votes in congress. It is like the EFCA on the national level. When Bush was pres and would veto it they could get the votes of the 51 dem senators, when Obama was pres and had 60 senators they couldn’t.
Its off topic but I think that is wrong, I don’t think it ever got past the filibuster. My point though was that when politicians know something has no chance of truly passing they have an easier time promoting the bill. They get to appease their base by pretending to care about solving problem X w/o pissing off powerful interests or doing anything controversial.
That won’t sway disgusting people. But you might tell her that she will end up paying less to provide minimal health insurance for poor people than she will pay to have them treated by emergency rooms, which was Willard’s plan.
Well, I suppose there may be very unusual cases where someone is healthy all his life, and then gets hit by a bus and dies instantly, so we can’t know about a particular person.
But the stats are so overwhelmingly clear, and the difference in cost between ER/hospital care and minimal insurance that allows preventive care is so huge, that you only need to increase the sample size to 100 or so to be very confident that insurance is cheaper in the long run.
And when you’re talking about millions of people, it’s really pretty silly to say insurance won’t save money.
The idea that the savings from fewer ER visits because of universal health insurance will be enough to pay for the cost is not supported by the evidence. In Massachusetts they found that ER visits went up slightly after the state government payed for expanded health insurance.http://www.reuters.com/article/2011/06/02/us-health-reform-er-idUSTRE7514VX20110602
Likewise the idea that preventative care will lower costs has been found to not be true.
The experience of states trying to increase coverage has shown that mandates to increase coverage increase costs. Massachusetts, Tennesee, and Oregon.
The reality is that when people are given health insurance they use more health care which increases the costs. There is no free lunch, you can not give health insurance available to more people without a corresponding increase in the cost of health care.
Ya know, expensive is not just defined by the amount of dollars paid. It’s what those dollars buy. Factor in things like immediate availability. md2000 explains rationing (AKA waiting lists) in Canada far better than I could. I needed knee surgery. I got it on my time table (yes, I have insurance). Canda could offer that, too. It would just cost more money.
Also consider research and innovation. Those cost money. There is no doubt that lowering the dollars paid to doctors, hospitals and pahrm companies will result in less dollars spent on research and MAY slow down the rate of innovation. It’s a real risk.
This is not as simple as per capita spending.
Once the insurance mandate kicks in I’m going to be in the doctor’s office for every cough and sniffle, minor ache, or discomfort.
I don’t have faith in modern medicine. Modern Medical Doctors are highly trained and many of them are quite good at what they do. Yet, more of what docs do can be attributed to the placebo effect than most would be willing to admit. They are able to heal because our society and culture expect that they will be able to. However, I’m not such and atheist over it that I think having an appendectomy is nothing but placebo. I’m just not buying until I need something like that.
I rarely go to the doctor. The last time I went, a few years back now, was because my employer wouldn’t allow me to continue to work without authorization from a doctor. So I had to go in and convince a doctor to let me go back to fucking work. They didn’t treat a goddamn thing just confirmed my diagnosis (with a fucking biopsy that cost me hundreds) which I had already correctly guessed and had already began treating myself.
The days where I am allowed to make my own health care decisions are over. The nanny state has won. Perhaps I can rack up enough medical history that I will quality to be on disability then I should become eligible for foodstamps and govt. subsidized housing and energy assistance. I should be able to find work under the table for cash here and there, actually once I start thinking about it that doesn’t sound too bad. I’ll probably have more disposable income not working. What the fuck is the point in being a productive member of society when you’re just going to be told that you’re immoral for wanting to keep what you earn and make your own decisions on how it gets spent?
Can anyone tell me?
Your employer paid for that doctor. What the hell are you whining about?
In practice, government run healthcare systems are incredibly efficient - at least compared to the mishmash of duplicative administration we have now. The UK NHS - hardly an economist’s dream - covers every UK citizen and legal resident for less than we spend on administration alone.
I love it when people who don’t understand anything about the health insurance industry start pretending they do. How do you think healthcare providers get paid now? I’ll give you a hint: it’s not an arm’s length bargain, it’s a rate set by an advisory board at an insurance carrier.
Colibri noted that this sort of comment was not appropriate for General Questions and, while not directed at a particular poster, it also does nothing to help promote discussion, here.
[ /Moderating ]