Do you support universal health care? Why or why not?

[Endus]

No your total cost out of pocket was the $30.00 + taxes paid into the system to pay for the services you had.

Seriously? I thought better of you.

When people talk about medical costs, they're talking about costs to the end user. Not about the tax burden.

How many years of Zero services did you go before you had to use the system?

I go to the doctor pretty regularly. It's been a couple years since I moved and lost my GP and I've been dicking around and haven't gotten a new one, but I've still been to a free clinic a few times in that period.

So, loosely speaking, I'm gonna say "zero years". Not on average, mind you, just in general.

For example did you go 5 glorious years without any medical issues that needed treatment paying $8,000 a year in healthcare taxes?

No.

That is the problem when people talk about the Canadian system they forget the real out of pocket.

That's not a "real out of pocket".

1> That others have the care they need is something I'm willing to contribute to. Shocking, I know.
2> The cost is heavily swung towards the wealthy. Those who struggle to make ends meet aren't paying a lot of tax to begin with. The reverse is generally true in the USA, where insurance prices are static and ignore income levels.
3> Everyone understands there's a tax cost. Same as there is for roads, and policing, and all that stuff. That's what taxes are for.
4> "out of pocket" means you're billed at the time of service. Most income tax in Canada is collected directly off your paychecks and was never in your pocket.

The point of a universal tax-funded system is that services aren't withheld from those in poverty, that no one is bankrupted by sudden medical costs, and that being able to pay out of pocket is never a barrier to accessing services.

[Zan15]

As a company I would always gravitate towards the cheaper option. Unless I'm Google or Apple where I have employee's that I must keep happy to not lose them to a competitor.


.

Right so the cheaper option puts 100% of the cost on the employee and the employer get a huge savings unless the Biden plan includes employment taxes to pay for the system.

Considering that the health care industry spends a lot on lobbying, the 2-4% margins must be very profitable. Nothing comes close to the lobbying money of the health care industry. Pharmaceuticals spend $295 million, Hospitals and Nursing homes $106 million, health professionals $95 million, and finally health services at $88 million. That's a total of $584 million in lobby money, and that's not including insurance which is at $155 million and that could imply car insurance as well as house insurance. They clearly have a lot to lose if they can spend this kind of money.

Walmart proved that 2% can make your family the richest family in the world. 2% of a whole lot of money is still a lot of money.

The 2-4% profit margins is for specifically the insurance companies. Pharma runs 15-25%+. Hospitals 2-6%. The few health professionals that report 10-14%. Medical supply and equipment 10-15%.


so lets round up to 1 billion dollars.

United healthcare Revenue: 240 billion dollars. Profit 16 billion Margin 6.62% (10.3b for the insurance division)
Anthem 117b, Profit Margin 4.22%
CIGNA 157b Profit Margin 3.38%
Humana 74.39B Profit Margin 5.58%
Centene 95.75B Profit Margin 2.12%

Just the top few insurance companies have revenue of 683 billion dollars a year (total industry is over 1 trillion dollars). 155 million is a drop in the bucket. Hell its a drop in the bucket in the total profit. Even if you exclude all these companies having huge segments of their companies devoted to non-insurance related businesses its still just a drop.

Throw in the top 10 pharma and you got another 600 billion dollars. Hospital systems a few hundred billion. etc etc

If you look at the relative size of these companies/sectors/industries the amount of money they spend on lobbying is really not excessive vs other industry groups, but it is sure effective.

My concern is that private insurance will pay more for doctors and specialists than Medicare and those Doctors will avoid patients that only have Medicare. I've actually experienced this with a family Doctor who refused to take AAA Medicare because apparently they won a case against Doctors and out of principal he isn't accepting patients with this insurance. He's a terrible Doctor that I ended up having to fix my own health problems because no other Doctor in my area knew what was wrong. He also gets a lot of kickbacks from organizations, which would explain his drug abuse and him needing to be in rehab for a while. Quality of Doctors here in USA are questionable at best. Doctors can refuse patients based on insurance and this can be the method private insurance can use to push out Medicare insured patients.

Yah, its kind of hard to force them to accept patients they don't want to. Medicare forces them only to accept Medicare's rates +% when they do not participate, but they do not have to accept the patient if they do not want to. Would require major changes in the law though not impossible since they did it with Emergency Rooms through the EMTALA, even the EMTALA only provides limited treatment during the ER visit not continuing treatment.

That's where price controls come into play. You can regulated prices.

Of course when you take into account you might be paying/receiving 25% less for services under a Medicare system, you are saving that much and more by not having to staff up to deal with 600 insurance companies as you try to find the one the patient really belongs too.
Straight up Canadian system you would save even more since you would have very little need for additional staff since things like eligibility, authorizations and contact with an insurance company is all but nil. You'll have to deal with backend reviews, but its minimal cost for physicians more expense on facilities.

- - - Updated - - -

Seriously? I thought better of you.

When people talk about medical costs, they're talking about costs to the end user. Not about the tax burden.

When you talk about medical cost you include the premiums paid each year for the insurance. In Canada you do not have premiums you have taxes. Its just replacing one word with another. They mean the same thing.
Medical cost out of pocket.

Your taxes specifically to pay for your health services is a cost to the end user, unless you magically have a fairy paying your taxes for you each year? Can i have the fairy pay my premiums too?

That's not a "real out of pocket".

1> That others have the care they need is something I'm willing to contribute to. Shocking, I know.
2> The cost is heavily swung towards the wealthy. Those who struggle to make ends meet aren't paying a lot of tax to begin with. The reverse is generally true in the USA, where insurance prices are static and ignore income levels.
3> Everyone understands there's a tax cost. Same as there is for roads, and policing, and all that stuff. That's what taxes are for.
4> "out of pocket" means you're billed at the time of service. Most income tax in Canada is collected directly off your paychecks and was never in your pocket.

The point of a universal tax-funded system is that services aren't withheld from those in poverty, that no one is bankrupted by sudden medical costs, and that being able to pay out of pocket is never a barrier to accessing services.

It is a real "out of pocket". All in cost. total cost. Whatever you want to call it.
Having a plan with only a 500 dollar "out of pocket/cost sharing" is not a great thing when the premium is $30,000 a year vs a plan that has a 10,000 out of pocket but the premium is only $5000 a year. Total out of pocket starts at $5,000 vs $30,000. If you use services the max out of pocket for one plan is 30,500 vs 15,000 for the other.



Still a huge savings over the premium/tax system we have in the united states.

In the US not only do we pay on average almost 20k for family to have insurance, the average plan has thousands in cost sharing if you have services rendered. The average family also pays $2000 in Medicare taxes to pay for insurance.... that you do not even get to use for decades but its still a yearly cost.

So your all in cost "out of your pocket" each year is my Premium + Medicare Tax + Out of pocket / Cost sharing if I paid any that year.


#2 is technically not correct as insurance cost more in higher income states to people with higher average incomes. Poor people in these states pay higher premiums then poor people in other states. NY insurance premiums are way higher then those in Alabama. Also those in lower income ranges get subsidies and qualify for Medicaid where they have zero premiums and no out of pocket.

Also the "wealthy" do pay more in taxes to support Medicare and ACA though its nowhere near realistic levels they should be at to support the system and help the poor.



Do you confuse me with someone that does not support this system? Just the opposite I have supported the Canadian type system for decades since i got into insurance decades ago. i am willing to pay more out of my pocket than I am now just so more people in this country can afford healthcare services and not go bankrupt or go without care. Even if that includes paying more in direct taxes or new taxes. Hell i would even pay more than my current premiums and cost sharing. It would benefit me and the national economy in the long run and it would be a net gain for most people and businesses.

the problem is we are not communicating the real yearly "out of pocket" in the US. If we did, these numskulls would realize how much cheaper it would be if we went to a nationalized health care system like in Canada.
Hell most people think they are "only paying" $500.00 a month for insurance out of their paycheck. They forget that their employer is picking up the other $1200 a month which is a direct impact on their salaries, raises and benefits. They don't even realize they are actually paying the $1200 indirectly as well since this is factored into their total compensation.

[RaoBurning]

What did the insurance company pay? Or was the contracted rate $1000? If it was $1000 in total then I think its a fair rate for the cost.

The total cost (double checked for more accurate numbers) was $9,200. Insurance covered all but $1,000.62, which is now my out of pocket problem.

So you are talking about a half dozen professionals serviced you. How much did you expect it to cost?

Honestly, about $5,000 more, based on prior experience and adjusting for the different hospital I went to; total cost, I mean, not after insurance. If it'd happened earlier in the day I just would have gone to urgent care and been out a hundred bucks or so, but hey here we are.

- - - Updated - - -

Just to offer a comparison to a universal health care system.

I've seen your tell these adventures a couple of times over the years now, and it always makes me absolutely livid at how we run things. I've probably told this other one before, too, but one good turn deserves another:

My relative worked tech support for a while, but came down with a nasty infection before his insurance kicked in. Three month probationary periods aren't uncommon; the job I have now took from August to October for the insurance to kick in, and it's a state job no less. Because of not having the insurance, he tried to power through the infection, which naturally didn't work, so he ended up hospitalized, which cost him his job.

The infection had progressed to a point where it required a particular type of strong antibiotic—bugger if I remember the name, it was years ago now—to fight. Which, surprise! He was one of the people who have the reaction to it that shuts down his kidneys. So that was more time in the hospital getting renal function back to mostly normal.

Six-figure medical bill and freshly unemployed. Hurray.

Fast forward a year. Small infection in the big toe. But surprise, no insurance again, and fearing another six-figure bill, he waits it out. It crawls through his foot up into his leg. Store bought topical treatments do nothing. The flesh is necrotic. The house smells like death. Finally, it's eaten away enough of the skin and muscle to expose bone, and we force him to the ER.

We can finally stop putting out coffee grounds to suppress the smell.

He lost most of that foot and part of his calf muscle, and most of his kidney function because surprise again that same antibiotic from before is what they had to use to save the rest of his leg. The hyperbaric treatments (stick the patient in a glass tube of pure, compressed oxygen for hours on end, several days a week. Good thing I was unemployed for that stretch since the closest treatment center was a 30 mile round trip) messed with his already sketchy vision and now he's on dialysis until/if we find a kidney donor.

This wouldn't have happened anywhere else in the developed world, best I can tell. He could have just gone in, had shit sorted early before the infections became hospitalization worthy, and he'd still be a somewhat productive member of society instead of a funeral waiting to happen.

For want of a fucking nail, indeed.

[ThatsOurEric]

they actually charge the same amount

No they don't, and you'd know that if you educated yourself a little.

Also what is criminal levels of money?

Maybe going to a hospital, waiting 6 hours, only getting your blood drawn, and then getting hit
with a $3,000 bill?

I mean if that's not fucking criminal robbery for literally nothing being done (and no, having
your blood drawn, in no way shape or form, can ever JUSTIFIABLY cost $,3000) I don't know
what is.

[Felya]

I mean if that's not fucking criminal robbery for literally nothing being done (and no, having
your blood drawn, in no way shape or form, can ever JUSTIFIABLY cost $,3000) I don't know
what is.

Why was your blood drawn? Do you have porphyria?

[ThatsOurEric]

Why was your blood drawn? Do you have porphyria?

It wasn't mine. I had a friend who had an stomach ache (it was just gas) but the pain for that
person was so crazy high that they panicked, as they'd never had a stomach ache of that kind
before.

We rushed to the hospital at midnight, and didn't leave until 6am. All they did was take my friend
in for tests (which was just a blood test) and when we left, my friend got hit with a bill that was
$3,000, which is fucking horseshit.

Just to add, this event took place 3 years ago.

[Zan15]

No they don't, and you'd know that if you educated yourself a little.

Worked in the industry for over 25 years i think i am educated way farther than you'd like to believe. You are confusing charges with allowances. they charge the uninsured 150 dollars he owes 150 dollars. They charge BCBS 150 dollars but the contract allowance is 110. the most the patient will owe is 110.

The actual charges are the same for most places regardless of the patient. Most facilities do not have seperate charge masters for different kind of patients. This would run afoul of CMS rules not to mention violate a bunch of state "favored nation" laws/regulations.

Non insured patients can negotiate down the allowance with discounts and charity care but the charges are still 150.00.

NJ is a fun place to visit hospitals.
I used to spend a lot of time with Valley Hospital doing audits on them, oh the good times. They always tried to "bribe" me with great lunches

Maybe going to a hospital, waiting 6 hours, only getting your blood drawn, and then getting hit
with a $3,000 bill?

I mean if that's not fucking criminal robbery for literally nothing being done (and no, having
your blood drawn, in no way shape or form, can ever JUSTIFIABLY cost $,3000) I don't know
what is.

You didn't "just get your blood drawn". You had an ER doctor either come see you or review your test results. You had a nurse draw the blood. You had a lab tech process the blood and the results.

Then there is the cost for the facility. You think its cheap to keep an ER open 24/7/365? Guess what, its not. Guess who pays for it? Everyone whom comes into the ER. What happens those nights they have full staff and only have 10 patients? Oh right that cost is spread over the year so they don't go bankrupt.

Might i ask why you went to the ER with what condition that they would "only draw blood"?

- - - Updated - - -

It wasn't mine. I had a friend who had an stomach ache (it was just gas) but the pain for that
person was so crazy high that they panicked, as they'd never had a stomach ache of that kind
before.

We rushed to the hospital at midnight, and didn't leave until 6am. All they did was take my friend
in for tests (which was just a blood test) and when we left, my friend got hit with a bill that was
$3,000, which is fucking horseshit.

Just to add, this event took place 3 years ago.

Just saw the second part.

i am going to have to call bullshit.
No one is drawing blood in the ER without first a visit or an order by an ER doc.

Also the test results must be reviewed by said doctor as well so there would be professional facility charges.


BTW how do you think 6 hours of electricity, heat, salaries, liability, benefits, etc etc are being paid?

[Ivanstone]

the problem is we are not communicating the real yearly "out of pocket" in the US. If we did, these numskulls would realize how much cheaper it would be if we went to a nationalized health care system like in Canada.
Hell most people think they are "only paying" $500.00 a month for insurance out of their paycheck. They forget that their employer is picking up the other $1200 a month which is a direct impact on their salaries, raises and benefits. They don't even realize they are actually paying the $1200 indirectly as well since this is factored into their total compensation.

I'm pretty sure that its been pointed out to the usual suspects the relative costs numerous times over the years. Assuming you're believed (not guaranteed), they'll usually counter-argue that the government shouldn't be doing it for some reason or another. Sometimes with a side-order of this is coerced through threat of violence.

[Felya]

It wasn't mine. I had a friend who had an stomach ache (it was just gas) but the pain for that
person was so crazy high that they panicked, as they'd never had a stomach ache of that kind
before.

We rushed to the hospital at midnight, and didn't leave until 6am. All they did was take my friend
in for tests (which was just a blood test) and when we left, my friend got hit with a bill that was
$3,000, which is fucking horseshit.

Just to add, this event took place 3 years ago.

No, that’s not how shit works. What made the stomach ache so unique?

[muto]

No I don’t feel like getting taxed into the floor, because someone has to pay for it, and that someone is the people.

[Endus]

No I don’t feel like getting taxed into the floor, because someone has to pay for it, and that someone is the people.

See, this stuff is just silly.

Americans pay as much in tax for healthcare, per capita, as Canadians do, more or less. Some variance based on differences in tax brackets and the like, to be sure, but more or less, pretty much the same.

You then pay even more, on top of that. And your care isn't any better overall.

Where did you get the idea that you'd be taxed a lot more?

[TigTone]

See, this stuff is just silly.

Americans pay as much in tax for healthcare, per capita, as Canadians do, more or less. Some variance based on differences in tax brackets and the like, to be sure, but more or less, pretty much the same.

You then pay even more, on top of that. And your care isn't any better overall.

Where did you get the idea that you'd be taxed a lot more?

Muto maybe from a group of Americans that believes any form taxation is theft.

[ThatsOurEric]

No, that’s not how shit works. What made the stomach ache so unique?

Are you a doctor? No? Then how the hell should I know? I'm only telling you what the doctors there told us.
That it was just gas. He had no problems after the visit and needed no medication or anything, other than
your typical over the counter gas medicine.

[Felya]

Are you a doctor? No? Then how the hell should I know? I'm only telling you what the doctors there told us.
That it was just gas. He had no problems after the visit and needed no medication or anything, other than
your typical over the counter gas medicine.

I’m not a doctor, I’ve simply been to emergency room before and have donated blood... it doesn’t make any sense for your friend to have blood drawn immediately... not to mention receiving the results immediately. A complete metabolic blood test, takes 1-3 days for results.

Edit: I realized the next day... you are describing an episode of Big Bang Theory...

[Zan15]

No I don’t feel like getting taxed into the floor, because someone has to pay for it, and that someone is the people.

being taxed while then not having to pay a premium every year. How far into the floor do you think you are going to go? For most people it will probably be a wash and for those whom its not, they had 40 years of not paying their fair share of taxes and won't even really have much of an impact when a little extra is taken out of their 400k+ incomes.

[Twdft]

No I don’t feel like getting taxed into the floor, because someone has to pay for it, and that someone is the people.

The beauty of everyone paying into the system is that it's financable.

To give a comparison rough numbers for Germany: we pay about 8% of our gross wages into health insurance, employers pay about the same amount. Up until €58.000 per year gross wages, meaning if you earn more you still only pay 8% of 58k. We have co-pay for certain things like €20 per day spent in a hospital and €5-10 for drugs, that's limited to 2% of gross wages or less if you're poor. (There is a private insurance system for self employed and civil servants, premiums should be comparable)

I think about 10% of gross wage for universal healthcare is perfectly fine.

[Zan15]

The beauty of everyone paying into the system is that it's financable.

To give a comparison rough numbers for Germany: we pay about 8% of our gross wages into health insurance, employers pay about the same amount. Up until €58.000 per year gross wages, meaning if you earn more you still only pay 8% of 58k. We have co-pay for certain things like €20 per day spent in a hospital and €5-10 for drugs, that's limited to 2% of gross wages or less if you're poor. (There is a private insurance system for self employed and civil servants, premiums should be comparable)

I think about 10% of gross wage for universal healthcare is perfectly fine.

it should be % of gross income, regardless of income. That way the weathly cannot play games with their "wages" by being compensated by other means like they do today.

[nonameelf]

No I don’t feel like getting taxed into the floor, because someone has to pay for it, and that someone is the people.

We already pay more in taxes for healthcare than any country with universal healthcare. We just get far, far less than what they get.

[Endus]

it should be % of gross income, regardless of income. That way the weathly cannot play games with their "wages" by being compensated by other means like they do today.

That doesn't work for pretty obvious reasons.

Picture a guy running a local big grocery store as a non-profit. He's community-focused, and only takes a salary of $50,000, pushing profits into employee wages rather than his own pocket. He doesn't incorporate because he's not into that stuff.

His gross revenue over a year is gonna be over a million. I've seen estimates for starting a medium-size grocery store at around $250k for the first three months; you need to be making more than that to turn profit.

If you tax his income at the $1 million gross revenue, rather than his salary income, he's not gonna be able to keep the store afloat.

I definitely agree that loopholes need to be closed, and a good way to do so would be to do things like add income caps to qualify for exceptions on things like home ownership, and to greater control what counts as "charitable donations"; donating to your kids' university or to the local opera that you frequent shouldn't qualify as "charity", because you'll reap benefits yourself. I'm just disagreeing with the idea that taxing gross income rather than net is really workable; better to tweak how you can "hide" net income.

[Rene Bascos Sarabia Jr]

Coming from a country with Astronomicaly High mostly privitized medical costs despite being a 3rd World Poverty stricken nation. I absolutely am jealous of people who enjoy universal healthcare.