Can someone logically explain this?

If your math is correct (or close) then why weren't corporations lining up to support him? Sounds like it's a tax break for them!

I see on the Kaiser link they estimated total costs between employee and employer to be over 16000 a year. I dont believe it's that high with a super high deductible plan. I think those numbers are way off. Might be correct for those not working with high deductible plans. So In effect, the plan would be a big drain on workers who almost never use health insurance.

Corporations probably didn't support him because he wanted to tax everyone like crazy. Tax this, tax that. I'm not necessarily saying his plan would save money for corporations since I am assuming an increase in payroll taxes versus a decrease in employer health care expenses would be an additional tax or extra cost in total for employer and employee if you don't used the inflated Kaiser numbers. However I am wondering about all the numbers especially how they would apply to say a single worker in a high deductible plan. I doubt my employer was paying 12000 a year per single employee. However I don't know the numbers for sure.

I was just wondering if anyone here knew the breakdown and if Bernie's numbers made any sense if you didn't add taxes to everything and everyone else other than a payroll tax increase. Other nations pay a lot less per person so I thought what could we do different?

Now if employers do spend 12000 per single employee per year on health care, a 10% tax increase could result in an even bigger pay increase to offset the big tax increase. I'm just asking. Not sure if anyone here knows how much employers pay for a high deductible plan. Probably only a concern if denocrats take over full control in 4 years and it's up for debate again.

^ I say that because I have full faith Repiblicans won't pass anything that useful in reducing costs for average Americans.

However if someone could explain a method to reduce costs that even a congressman or congresswoman could understand it, someone could tell them. A method using valid numbers and lots of examples. Obviously our current congress isn't interested in universal health care. Saving money though, yes they are. I suspect Bernie used fake numbers but I was wondering.

I'm investigating health insurance costs. I will call someone.

I thought the idea of eliminating insurance companies from being in the medical business was on the right track, the theory was pay the tax and everybody gets full coverage no longer having to pay an insurance payment would save money. Just too many of Bernies other ideas were awful.

The main issue for me with a single payer system is that I have amazing medical insurance now and anything else is going to be a huge step down. Also, the idea of Government running anything efficiently and saving money is simply idiotic and without historical precedent. Lastly, while emergency services will be the same I don't see any Government run system having me go from my initial call to my doctor to an appointment with a orthopedic surgeon to 2 mri's to a follow up with him and then a new appointment with a specialist who will determine if surgery can fix my arm or if i fucked myself, all in 32 days. The wait in Canada for a knee scope is 6 months.

My default position is that taxing us more and trusting government to take that money and make good, sound decisions on how to spend it is generation a good idea. It takes quite a bit to convince me otherwise on specific programs.

Concerning healthcare, is it any wonder that Congress exempted themselves from the Obamacare mandates? I don't have the answer, it's very complicated, but I can't imagine the government being the solution.

Bernie Sanders? Is this a time warp?

I agree with most of you that government isn't the solution, but the real predators out there are the insurance companies, I used to have health care through a union plan and it was great coverage, but you need a pool large enough to negotiate with these giant insurance companies, as they steamroll over everyone but the largest of companies. You need to remember insurance was founded on the premise that cost sharing (really Socialism) was a way to lower costs for all and these companies found new ways to stall and otherwise avoid their obligations to the rate payers. One last thought to leave all of you guys with , insurance is really a Socialist concept, where the Socialists are really Predatory Capitalists, not that all Capitalism is predatory but the Socialism practiced by these Capitalists is predatory.

^ not really.

It my simplistic way of looking at it, it comes down to competition vs. no competition. You just have to allow competition to exist.

Also, smaller companies can form a consortium that can negotiate for the larger pool. Insperity is an example of a company that includes this as part of their outsourced HR service offering.

I have read that back in the days before Medicare there were affinity groups that would pool money and cover each other. From what I have read, it was often based on national origin, etc.

I found an interesting comparison on Medi-Share and Samaritan Ministries that are supposed to be kind of like that:

http://samaritanministriesreview.com/sam…

It looks like they both control costs by excluding certain lifestyle-related conditions such as from drugs/alcohol.

I have health and dental from the exchanges now, and really, the only use they have been so far has been their negotiated rates with providers. I think the dental plan might have covered my second cleaning this year, but for the first one, there was a waiting period so they wouldn't pay for anything.

Having lived in Canada and tried to see a doctor there, I would stay away from any Bernie Sanders plan. I remember talking to a guy who was super pissed that his girlfriend had to wait two days for a gallbladder surgery. I looked it up and in Canada it was something like a 4 month wait, and in the UK was 6 months.

@flagooner you need to remember that insurance companies and their lobbyists wrote both Obamacare as well as the new Republican versions. There needs to be some regulatory oversight but our government officials keep abdicating their sworn obligation to represent all of us and just concentrate on where the most money into their personal coffers comes from.
Food for thought why not demand that Congress pass a law that requires them to abide by and live with whatever laws and actions they enact on us.

^^^ I needed to mention that the laws as written is anti-competitive and they knew that from the beginning, the insurance companies and their agents made sure of that.

+1 for 25. Very few people bitching about the health care system realize that the insurance companies write the law. They just know it's terrible because Fox News says so. Who knew health care could be so complicated?

@SkiBirther wrote: "The main issue for me with a single payer system is that I have amazing medical insurance now and anything else is going to be a huge step down."
-------------------
Probably a valid point. Lady who cuts my hair is from Germany, and she tells me the German healthcare system has both a private insurance market and a government-run component. Everyone must have health insurance and there is something like 8% payroll taxes on every employee. I think the UK also has a private insurance market. Having both allows affluent people to buy their own insurance and have the best doctors and surgeons.

I think MDs should be very highly paid, and having single-payer (only) might push doctors into the middle class. We don't want that. The best doctors and surgeons should have the option to opt out of the government-run system. OTOH, there should be some type of medicare-for-all so that the poor do not end up dying in the emergency room.

We spend way too much of GDP on healthcare. Something has to be done. Obama tried his best to appeal to the GOP with this Romney-like system, and it's not working.

Edit: I'm not all that liberal and I always thought Sanders was proposing shit that can't be paid for. He needs to move to the right if he wants to win in 2020

@Che congress seems to think we are all members of that society. LOL

I think every American should have affordable healthcare. I don't know how to achieve that, and our divided politics is unlikely to find a solution. However, it seems to me that insurance companies only add layers of bureaucracy and unnecessary costs.

^ @25
Your past 2 comments directed towards me... I agree, you are preaching to the choir there.

".....and our divided politics is unlikely to find a solution."

Sixty-eight times Trump has promised to repeal Obamacare:
https://thinkprogress.org/trump-promised…

Sure didn't happen on day one. LOL!

It really is a complicated issue. Just went through the process of finding an orthopedic surgeon for my wife, and having the option to chose a doctor anywhere in the country was wonderful. And he did the surgery within 3 days of arrival. With *only* single-payer, you're not going to have that kind of choice or service.

I checked today what the full cost for medical would be if I paid the full amount, less than 500 per month for medical, a little bit more if I paid full amount for vision and dental.
An extra 10 or 12 % tax taken out of a paycheck if say the pay was 70000 would be minus 7000 in pay, employer could bump up pay by 400 or so a month so that Bernies plan would increase the amount I spend on health care. I thought his numbers didn't make sense. That doesn't even include copays and deductibles I would probably have to pay as well for actual visits.

The problem is insurance costs as charged by insurance companies keeps going up. In the last several years, I probably visited a regular doctor only 3 or 4 times yet I'm spending thousands. Insurance cost is too high in this country. Congress should come up with a plan for everyone legally here and then have an optional plan for everyone to pay extra for better faster care and then congress lives by it as well. They are in charge. They are the plumber on call to fix the problems. They own it. Trump owns it whether he knows it or not. They are being stupid if they think they don't. They need to do the right thing even if it costs more then work on tax cuts that get paid for with extra economic growth. Just my two cents.

"They own it. Trump owns it whether he knows it or not."

Ya got that right, @Shark, exactly. Problem is that Trump only thinks 140 characters at a time and he doesn't know what the fuck he's talking about.

Congress needs to work in August and figure out a workable solution instead of talking about doing away with health care for 22 million people. Republicans are being stupid if they think those 22 million are going to vote for them again without a fix. Democrats won't help fix the mess. They will be political and blame the mess and lack of insurance on the other party laughing all the way until congressional elections or longer. If republicans haven't Figured this out, they aren't too bright. Hmm, if it didn't take a ton of money, I could run for congress and work on a solution. I suspect part of the solution is limiting the amount the government pays health insurance companies.

@Shark wrote: "Democrats won't help fix the mess. "
----------
Last post, and I'll stop dominating the discussion.

I think that's not true. Democrats would be more than willing to fix the failings of Obamacare. But that requires more funding from taxing the top 2% ( a lot of this money comes from taxing certain capital gains). It would make the GOP look incredibly foolish after railing against Obamacare for 7 years.

Sharkhunter, I think you are thinking on the micro-econ scale ignoring the macro scale, perhaps?

U.S. spends, what, 1/6 of GDP on healthcare. That's 16.7%. Senator Sanders was suggesting a a 12% tax for Medicare for all. Which is about 70% of what we spend as a nation, back of the napkin. So it seems "in the ball park." Yeah, we as a nation spend too much.

The low HDHP both you and I see, are probably because we are healthy, young, don't smoke tobacco, don't see the doctor, aren't suffering for 2 or more chronic diseases (i.e., allergies, borderline bloodpressure or cholesterol, depression, diabetes, COPD), nor do we have a BMI of 36 or whatever the typical American has.

Some numbers from my co. and cos I know:
add:~35%, for tobacco numbers
Employer contribution:
HDHP(HSA eligible), single: 4600-5700/yr (less this year)
same, but family: 12300-13000/yr (less this year)
Employee contribution:
HDHP, single, $32/bi-week(was $70 more, last year)
HDHP, family. $70/bi-week(Was $70 more, last year)
$3200 deductible single, $6500 deducible, family
new for 2017, employee will make employer contribution to HSA, half in may, half in nov:
$750/single, $1500 family.
my contribution is still $35/bi-weekly (the price difference to me between HDHP and PPO 2 years ago).
Employer contribution:
PPO, single: 6000/yr
PPO, plus spouse, 12000-14000/yr
PPO, family, 14000-17000/yr
Employee contribution:
PPO, single, $64/bi-weekly
PPO plus spouse, 129/bi-weekly
PPO, family, $194/bi-weekly

tobacco numbers are ~35% more.

I put $35/week into my HSA.

4 years later I'm still trying to think how I might come up with the est. $7K costs my wife's knee surgery might be. I can't get any good ideas what it might cost (she was hit year ago why a car before I met her, when she was out running one afternoon). She already spent through her settlement costs with her earlier surgery and followup care.

Politically, I think Democrats would like to fix the system, but I don't think they know really how in a way that would, culturally, be acceptable to the American people. I don't think the British NHS would work here, there are details about it that would horrify Americans. Even the Canadian centralized system would have problems here. On the other end, Republicans and Libertarians are in a fantasy land where the magic-of-the-market will fix all of the problems.

The ACA was the Democrats attempt to implement the Republican system (Romneycare), but without the public option, to get 60 votes. But if Democrats could get credit for implementing the republican's best ideas, why would anyone vote republican, lol (*ducks*).

Medicare, for a government run system, is rather popular, culturally acceptable to most Americans, and already in place. We could, if we wanted to, roll the other federal programs into it (Congress, Medicaid, *maybe* the VA), raise taxes ~12% to pay for it. Even with the increased tax bill, most Americans would probably come out ahead, including the $70,000/yr income example Sharkhunter gave. Of course, the system would still allow for the Tuscl $350K club with Money, who want better care to be able to buy it, much like today where those over 65 with money can pay for better care if they want it. Avoiding the "Why can't I buy what I want with my own money?" cultural problem that just about every other nationalized (socialized) healthcare problem would have if implemented in here. :)

Real problem is the insurance companies, there isn't a business that they are in involved with that hasn't seen costs skyrocket, and they make dubious promises constantly that they renege on. Lets look at some of the other businesses they have dropped their heavy hand in and examine the results.
Workers Compensation Insurance, closely related to health care costs are astronomical that are imposed on businesses large and small, they pay out only if forced too and there is a legal component to this which is rife with fraud and so many abuses its disgusting.
Auto Insurance rates skyrocketed in the last 14 years, if you have the audacity to make a claim for a loss that you have paid for they hit you with additional costs, damn they pull credit reports and cherry pick customers, redlining as needed to suit their profits.
Home owners Insurance, one of the worst offenders of all, you paid for the coverage the amounts are spelled out in your contract that won't prevent them from denying a claim on a technicality, if perchance you get lucky and they offer you a settlement for your loss the amount offered is usually not enough to cover the loss incurred, most home owners when pursuing a claim need to hire an adjuster just to get a fair shake from the Insurer that has already pocketed their money.
There are many more types of insurance and I don't have the patience or energy to go into more detail than I have so let me just wrap this up and make my point, the Congress of the United States , the Senate and most of the other branches of government has been purchased lock stock and barrel by the consortium of insurance companies that have been stealing premiums from the ratepayers for years and until we get a real sheriff in the White House and some Honest Representatives, this is going to continue unabated and our health care system will never be available to help American citizens wholeheartedly until these thieves are run out on a rail !

Even a 6 month wait is better than the alternative for the typically american. I can't imagine a reality where I can get orthopedic surgery diagnosed and booked in 32 days let alone 3 days, including air travel. Must be nice. :) (j/k)

Good luck to your wife, @Dominc. Terrific and informed post!!

specialists here want $60 co pays plus I know I get a bill for coinsurance for $440 within 60 days. MRIs are 935-$3500 ea (I know from experience). MRIs are probably 1/3 of that from MRIs-R-us, in the 'hood. Which I also now know. Don't forget to ask for "The cash discount." It's usually at least 25% off the top. And with co-insurance at 80% or 100% on HDHP, the cash discount makes more sense that billing through insurance, some times.

The hospital or clinic "chargemaster" must be an evil person, who was bullied in school. To make up rates like those most get billed ...

I'm with sharkhunter, in the near term, I see HDHP+HSA at he only viable way for the individual to have a say.

Lest we forget the last recession was triggered by AIGs insolvency to cover the debentures on the packaged home loans no one has ever paid the price or even been charged criminally for forcing the taxpayers to bail out an insurance company that wrote insurance policies on those knowingly fraudulent loans and this is the state of affairs that allows those companies to get away with criminal behavior repeatedly.

@twentyfive, yes, we need get rid of the corrupt (bought and paid for with lobby money) politicians in the Whitehouse and Congress. I think that was a half of the appeal of "protest" candidates, like Trump and Sanders.

Most of Senator Sanders' "free stuff" for millennials wouldn't have passed Congress. I don't think free college and free healthcare is possible, but I at least the guy might have had our backs. Too many of the young people think that socialism is some happy hippy version of sharing rather than the dark reality.

Too bad we can't send corrupt, bought'n'paid politicians to jails or death row. It might send a message. Ditto for corrupt corporate executives. Martha Stewart seems to have a better attitude after going to Camp Cupcake for 9 mos.

Here are some older PPO numbers, employer contributions, just as Obamacare was passing Congress:
Employer contributions, $1500 deductible family, 2 million lifetime max, 9 month grace period each year for pre-existing conditions w/e we switched plans to 'save' money
PPO, family, 8000-12,000/yr, healthy, typically employee
PPO family, for pre-existing conditions: 24,000/yr (typical), some 48,000/yr or 54,000/yr (!!).
PPO family, for "uninsurable" persons: one was $180,000 (60+ yo male, active but health problems, one of our 5 founders of the company). another was $240,000/yr, 60+ yo male, cancer survivor, one lung removed and only 2/3 of other lung left, lung issues unrelated to cancer, another one of our 5 founders.

I did not misplace the decimal point.

We were happy to had the two highest premium candidates off to medicare, when we could. Back then, I doubt an insurance co would insure them outside of a group plan (pre-Obamacare).

For the 180,000/yr and the 240,000/yr guy, the employee contributions were the same as everyone else.

Wasn't it Margret Thatcher (and TiredTraveler) who said, "The problem with socialism is you eventually run out of other people's money."

We need a system that can handle cancer treatments. Not sure what to do about the "pre-existing conditions" people. We used to pre-Obamacare, pay like 24K-54K/yr for some of these people. It was insane. I think "pre-existing conditions" might just be a euphemism for "I need someone else to pay for my healthcare for me."

Most of those people, when I would chat with them, had at least one chronic condition that required ongoing care or medications. Many, themselves, often got to the 7-8% MAGI where they could start to deduct healthcare expenses on IRS 1040 long form. So, they would grateful for any assistance they got from us. They knew any help was a blessing.

Shark,

My worry with single payer (Bernie's medicare for all) is if I pay my 12% tax on my $60,300. Does that mean I get *unlimited* healthcare for that 12%? If so, people are going to opt for surgery as Plan A (and a magic cure) maybe a lot of Opiods and skip past "cost effective" Plan B things like physical therapy, personal strength exercises, and leaning to survive with a little pain?

Although it was fiction, recall the A&E television show "Breaking Bad" was about a HS Chemistry teacher who starting selling meth in order to pay for his cancer chemo treatments. Sort of funny, if that's the solution to spiraling costs.

Shark, what did you pay for your last Dr.'s visit? Mine was a clinic, where I finally gave in after 5 weeks with a nagging cough. It was a viral infection (no antibiotics), but I did get a steroid Rx. That helped. $50 copay, visit was $230, I got a kick back 8 weeks later saying I owed $130 more. So ins only covered $50 of the $230 bill. I should have just paid the cash price: $172.50, would have been slightly cheaper that way. Live and learn!

This just in...latest attempt to repeal Obamacare fails in Senate. So what else is new?

https://www.vox.com/policy-and-politics/…

Insurance is the one purchase where you prefer not to get your money's worth.

Can we stop with the fake news bullshit that repealing Obamacare throws 22 million people off their insurance. Its a blatant lie and a misstatement of what the CBO said. Those 22 million people will CHOOSE to not buy insurance because the fucking government won't be able to penalize them by increasing their taxes. If Obamacare was the solution the left wouldn't have to lie. While we're discussing AIG lets not pretend that Obama didn't use our taxpayer money to bail out that piece of shit Warren Buffet. Lastly you folks have awful co-pays. My max co-pay is $15 and that was for an emergency appointment with a Harvard med School orthopedic surgeon.

http://www.politifact.com/truth-o-meter/…

We spend more on health care than the other industrialized countries do, with their Universal Health Care, covering everyone. Emergency Room care is universal, it is reactive and inefficient, it is expensive, and it is medicine designed to prevent litigation.

Wages are not etched in stone, but nor do they appear out of a vacuum. They are negotiated in a competitive market place. Now taxes can be applied in various manners, but the wages will be renegotiated to accommodate this.

So taxes on employers are usually really taxes on employees. Taxes on employees reduce their numerical pay, but they also take market pressures off of housing costs and the costs of keeping up with the Joneses. And then when the government gets money, it does not use it to inflate the stock market or deposit it into tax free havens. It spends it. And this creates jobs and market demand for goods and service. Likewise any increase in the money in the hands of poor people, also gets spent.

The real issue is just what portion of the GDP is the government.

This is the Keynes issue.

https://en.wikipedia.org/wiki/Keynesian_…

And then once you have decided on such matters, then how the taxes are applied and how the post tax pay is distributed, can then be decided.

So if you say that a guy getting $70k of gross pay will now be paying an additional 10% tax, this does not mean that his market adjusted disposable income or his standard of living will be reduced by that much. It may even be improved. Most of these things are set up as downwards wealth transfers.

And then, what kind of a world do you want to be living in, one where things might be okay for you, but where lots of people have nothing, except the sight of cops and civilians with guns, keeping them in their places?

SJG

News Flash: Steve Bannon was influenced by the notorious fascist occultists Julius Evola and Rene Guenon, and related groups of reactionary Catholics.

https://www.democracynow.org/2017/7/26/j…

Horseshit, SkiBirther. 22M people will not be able to afford insurance.

@Skibum it's great that you have such a wonderful insurance policy didn't you see @Dominic's cost break down he can't afford to pay for his doctors visits even with Insurance, he can only buy what is available at his workplace, now you want to take even that away from millions of folks that's, sadistic.I would bet that your insurance is a product of your wife's employer or a trade association, because as you described your practice you couldn't get offered that level of insurance on your own or it would cost you for concierge level care as you describe an extremely high price.
I had great insurance as a union member and continued to pay union dues until I was no longer able to be covered in Florida by the union, I do have a quality health plan but still nowhere as cheap as what you are stating.

"Insurance Companies Hit Record Setting Profits at the Expense of the Consumer"
Health should be a right, not a privilege.
Everyone can see Health Insurance is a scam.
The health industry should not be a for profit industry, where 90% of the money is profit and administration, and only 10% goes to dealing with the health issues...

Senate has now rejected THREE Obamacare repeal bills. John McCain voted with two other female senators to reject even the watered-down repeal bill:

https://www.vox.com/2017/7/28/16054694/s…

LOL!

@CH. If the margins are that big, the industry would be ripe for new players to enter and drive down the cost. A big part of the answer is to drop restrictions and allow competition.

Throughout this healthcare debate, republican senator Susan Collins has been a real hero -- one of the only republican senator with balls. She's was recorded on a hot mike saying "I'm worried" and stating that Trump is "Crazy!"

http://www.cbsnews.com/news/senators-rec…

@ I'm just waiting to hear @Skibum reply to my question and I just want to remind everyone that this is not fake news. If you can't afford your health care than you won't be getting it, as a result 22 million people will be effectively thrown off, that's true news.
One last point this president promised us cheaper and better health care he has not delivered on either, cheaper, or better, that isn't fake news either.

^ That's not true.

It's well known that we have to pass bills so that we can find out what is in it.
Just ask Nancy Pelosi.

^^^Fuck Nancy Pelosi these idiots just don't want to do their job. The whole group of them are as corrupt as ever.

Don't a very large portion of Obamacare people have it because they are penalized if they don't?

I thought i read 75% would drop it if they could. I think there should be something but penalizing people with fines forcing them to take it seems a bad idea.

^^^If the risk pool is not spread out amongst all health regimes the pool will only contain sick people, I know the argument I'm healthy why should I have to pay for the sick. The answer to that is you already do, by the most inefficient system possible providing Basic care at ERs, because these people use the emergency system, and don't pay, forcing the taxes expected to be spent to provide for regular expenses, ( police, roads, schools, etc. )to divert to health care because ERs are closing all over the country due to lack of funding.

Still just sounds like insurance except with penalties, not really just care for people who need it.

As government expands, liberty contracts.

@ime, I understand what you are saying, but with the private insurance model, how would the market account for: propitious selection (ins. co.s cherry picking), asymmetric information, adverse selection, and moral hazard?

Generally functioning market clearing prices require information free flowing from both sides (informed seller and informed buyer).

@ime, though from a libertarian sense, I get what you are saying about fines and forced participation. Do you agree with the EMTALA, Reagan signed? If you think, and I think you do, is it because it doesn't confiscate any of your property. Fair point, plus no one forces anyone to really go to the ER. Do agree with Medicaid expansion? (funded giant axes on capitals gains)

Is madating the 3X pricing cap, madating coverage cor pre-existing conditions, children until 26 on parent's plan, charging the sexes the same prices, mandatory maternity care, mental health coverage, no annual or lifetime maximums, ... or these in the minds of those for limited government ... are these too much regulation?

@ime, do you feel the republican model of: unless you opt for continuous coverage, insurance co.s can charge you 35% rate hike for failing to provide continuous coverage? Do you see this as a mandated fine? Or rather do you see it as a personal choice and personal responsibility with consequences? I am thinking the latter. I just want your thoughts.

Right now 1/6 of GDP is paying for all this. I don't think one can get that level of spending in line with other countries because nothing exists in a vacuum. I do suspect -- as many physicians have -- the at the United States subsidizes much of he rest of the world. If we tried to gets our costs way down it possible the costs in other counties would go up or medicine would stagnate.

The days of your doctor saying, take two asprin and call me in the morning are long gone.

Does anyone else read Jonathan Chait?

Obamacare lives:
http://nymag.com/daily/intelligencer/201…

"While elections swing back and forth between right and left, there is a reason that the United States is a more humane place today than it was 25 or 50 years ago. Social Security, civil rights, Medicare, Medicaid, and Obamacare have survived. Legalized child labor, supply-side economics, and unlimited pollution have withered. Ideas that bring real improvement to peoples’ lives have more staying power than ideas that do not."

In the beginning, there was major medical insurance with a reasonable deductible. Maybe $2,000 in today's dollars. If you broke an arm or had an infection, you went to a kindly General Practitioner who treated you for a modest fee. The insurance company only got involved if you went to the hospital for something major. Overall, the system worked pretty well.

Then, first dollar coverage became the norm, partly because it was tax advantaged. Suddenly, insurance company bureaucrats were involved in every treatment. Insurance clerks told doctors how to practice medicine. Doctors fought back by hiring their own bureaucrats. Patients got caught in the middle.

In some countries, single payer systems were implemented instead. That means bureaucrats make all the medical decisions for you. They ration care and literally decide who lives and dies. This is what the VA health system has become.

Over a long life, I much preferred the major medical approach. I found a doctor I liked, decided how often to see him, and paid modestly for service. Every decade or so, I ended up in the hospital and reconciled the bill with my insurer when I was discharged.

@dominic i was just pointing out how you keep hearing 22 million people will lose it. I would be more interested in hearing the different opinions from people who have it, i doubt they all love it.

I don't know the answer I have always worked and bought insurance and not always the cheapest plan. I don't pretend to know what is best for other people.I don't see the government as very efficient, partially based on my first hand experience working for the Federal Govt a few years ago.

We have crooked politicians, greedy insurance companies and an industry with few players. I think if given the chance the free market could come up with better and new alternatives.

@ime, a lot of those 22M who live in Ohio, have Medicaid, especially red 'R' voters in rural areas. I cannot over emphasize that. They love-love-LOVE Medicaid. Even my 73 yo mother in law wants to switch from Medicare to Medicaid because the benefits, in clouding dental, are there.

You guys might get rid of the mandate, maybe. But Medicaid and cap-gains taxes are very popular with rural Trump supporters.

I have always had my own health insurance. Since I was 18 in college, my mom said I was on my own, so I bought a plan and have paid my own way ever since (I'm 39 now).

@ime do you honestly think someone earning $12-15/hr can budget enough money to pay my plan?

Like it or not the govt is in healthcare (Medicare, Medicaid, VA). I agree it is ineffective the. But how can the working class afford the rates doctors and hospitals charge? Are you honestly proposing the 'skibum plan' of 'I worked and got mine, so f-u?" If your wife or daughter needed surgery (like mine does) do you just have $7K in savings lying around? Maybe you all do and that's my problem (I have no savings). Just curious. Twice I had money in savings: once $4K and once $1K. Gone both times. Medical bills.

I'd like a different way, ideals aside, we need to work with what we have.

Medicaid along at lot of those 22M is VERY popular. Everyone I know who got coverage under Obamacare is on Medicaid.

@ime, ideally I'd like a voluntary system was is conservative, where I only run things like true accidents: broken bones, car accidents, cancer through insurance. Then I pay cash for regular visits: yearly physical, sick with a cough, etc. But it's hard to do that with the rates they charge, even on my salary.

My (single) mom used to do that when we were kids in the '80s when she worked as a retail sales associate. When we got sick, she took us, and wrote them a check and when we needed a Rx at the pharmacy, she paid cash from her purse. It's hard to do that now. Seems almost quaint.

What is your idea of a conservative bill to replace Obamacare? Or have you thought it through?

I think the hard pill to swallow is that Obamacare IS already a moderately conservative bill, that uses the privat market, with subsidies, and expands Medicaid for the working poor, with some insurance market regulations. Moderately conservative. Passed by a Democrat.

Thirty years ago, health insurance was very affordable. Why is it expensive now ?
1. It's free for many. Medicaid is largely $0 out-of-pocket so there is no patient incentive to control cost and no Doctor incentive. I read that 30% of Medicaid patients have prescriptions for opiod pain pills. Patients are happy, doctors are happy, and the taxpayer pays.
2. Bureaucrats. A huge percent of the premium cost goes toward insurance company administrators watching doctors and medical clinic staff justifying procedures.
3. Lawyers. It is estimated that 25% of medical procedures are unnecessary but performed defensively to keep from getting sued.
4. Technology. Hospitals and clinics buy state of the art technology to attract doctors and patients, then must find a way to pay for the equipment.

@mark94 I don't know how old you are I'll take a guess and say mid forties to early fifties, let me ask you a question thirty years ago how much was a gallon of milk ? I think it was around $.50 Now its $3.75 and a gallon of milk is still the same product that it was in 1987. Medicine is a totally different product you expect much more from medicine than you did in 1987, research costs money, medicines cost money, doctors need money to live.
As far as insurance companies go you are preaching to the choir we realize that over 20% of every dollar spent for healthcare ends up in the coffers of an Insurance company, but the folks that vote for these corrupt politicians, over and again think that it's going to be different when they vote for a blowhard like Trump, guess what the joke is on you, he ain't any different than advertised.
Don't really know what the solution is but what we got now ain't working for everybody, I'm OK Random is OK Skibum is OK, I don't know about the rest of you, but at my age 63, I wish good outcomes for you younger people.
My politics are not liberal, but I am progressive, I think you people that are so anti-progressive are ignoring the facts, that is the real problem.

When I say it was affordable, I mean on a dollar adjusted basis. Health care used to take a much smaller portion of the typical person's budget than it does now. Clothing and food were bigger costs than health care.

There's a book, can't remember it, that describes how, over a period of 100 years, the government tried to fix the eco-system of Yellowstone Park. Too many deer ? Add wolves. Too many wolves ? Issue hunting passes. On and on, it just kept getting worse.
I think that's our Health Care system in a nutshell.

^^^ Great so you think an insurance company is the way to go because the government fucked up a hundred years ago, that's too simplistic I think we need better government, not more government, but we need to get rid of the money handed out like lollipops to legislators that do the bidding of the lobbies. I think that the basic medical system needs to be administered by an entity that recognizes that we are headed to the twentysecond century and the world Iwe knew is getting smarter exponentially, if we don't adapt we are going to be left on the ash heap of history.

BTW the only time clothing and food were cheaper than health care was when you weren't sick, and the average life expectancy was 50 something so you didn't live long enough to get diseases like cancer and if you were a diabetic you died even younger sorry health care has always been quite costly.

under obamacare is it too late for san_jose_guy's mother to abort him? i'd pay for it if it's an issue of money

^^^I think we're past that now maybe it's time for euthanasia

We have to make our society work. Advocating things which are irresponsible will only lead to disorder and violence.

SJG

well san_jose_guy there is nothing irresponsible about advocating for your removal from the gene pool. just the opposite

Ah yes, we need to have the government run health care because they are sooooooo much smarter than we are.
Given a choice between making a medical decision with my doctor, an insurance company, or the federal government, I'll take the doctor every time.

No they aren't smarter, but we need to have a one tier society, not a two tier, and health care is such a basic need that it has to be publicly managed.

And you doctor has been government run ever since he first applied for his medial license.

SJG

Deconstructing Gurdjieff, Tobias Churton
https://www.youtube.com/watch?v=o2cSaBCb…

@mark94 the government is not so much smarter than us, it is us! We Americans, are a lazy entitled bunch of folks that think that we can get what ever we want without working hard for it, case in point this last election I believe less than 60% of eligible voters cast a ballot for any candidate the turnout of the younger groups of voters was abysmally even less. Over the last 50 years the work ethic has been trending down, people expect to get paid for just showing up, but that is a topic for another thread .
SJG isn't often right but even a broken clock is right twice a day, medical decisions that you make with your doctor follow strict government guidelines so yeah the government is influencing your medical care like it or not

Sounds like they may try a fix after the August recess with input from democrats. May lose republicans on that though. Reducing premiums for average wage Americans would be nice. Sounds like a setup for failure. The last time democrats and republicans worked together probably only shadowcat and older posters here remember.

In effect all these high premiums and penalties if you can't afford it were ruled to be constitutional because congress has the right to tax the people and all these premiums are very taxing. First step towards tax relief in my opinion if congress can actually get anything done .

^^^Not that long ago Clinton and Gingrich made welfare reform work and a bunch of other things Reagan worked well with Tip O Neil on a bunch of stuff, before Bush 2 lots of times it was bipartisan, the real loss to bi-partisanship was the rise of the Tea Party which really started the crash and burn win at all cost shit that we see taking place now.

Not that it will happen, but to follow up on @rickdugan's comment in another thread about the PPACA exchanges. I would like to see if there is 'voter will' to make Congress "eat its own dog food", as Microsoft calls it. I'd like to see Congress remove its own exemption status and be required to either use Medicaid or (ideally) buy insurance on the exchanges.

I think if they had the use the product they are foisting upon the rest of us, I have a hunch, a pretty strong hunch, Congress would fix most of the problems if they had to live with them too.

So Congress exempting themselves is complete and total B.S., IMO.

^^^I thought I had made that point earlier in this thread.

The most terrifying words in the English language are: I'm from the government and I'm here to help.

The cost of any program is equal to the benefits paid less any expenses incurred. The only way for health care to be cheaper is to reduce administrative expenses or reduce benefits paid. If we reduce benefits paid, it means either someone is not getting adequate care or the providers are earning less.

All it takes is one grandma getting high quality care in and out of hospitals for what turns out to be the final year of her life to break the system. How many 20-somethings have to buy coverage and pay premiums for care they do not wind up using to pay for the care delivered to one such grandma? 10? 15?

I cannot imagine anyone advocates withholding care to their own grandma. The question is, how are we going to pay for it when she cannot? Have the gub-ment pay?? WE ARE the government. Everything they spend was once ours.

If we demand pharma become not-for-profit, we will likely stifle innovation. If we demand doctors accept pay cuts, we will wind up with mediocre doctors. If we demand tort reform, we risk reckless behavior without meaningful consequence.

I cannot see any way out of the morass. If we, as American citizens are going to demand the best health care in the world, we are going to pay more than the rest of the world -- one way (premiums, copays, etc.) or the other (taxes). It is a zero sum game. Every dollar goes somewhere.

^^^You are still giving up that 20-25% to the insurance companies, figure out a way to eliminate them and the cost comes down substantially!

Ah, you did Twentyfive. I must have a short memory, sorry about that.

I agree about the insurance companies. All they seem to do is, look at the annual medical billing codes from Medicare, then say, "nope, that's too complex," and they try to do their own. Realize it's a ton of work and they'll have to do it year, after year. Then they see Medicare does it each on schedule. So like that sitting beside you in class, he copies your homework, except he just marks up the prices 1.4X if not higher (since the hospitals and physicians won't accept Medicare reimbursement rates from the rest of us)

So it's not like the insurance companies are doing much to justify being in the middle of it. The best way to reduce consumption is not through a bean-counter but at the Physician-->Patient interface. But too many patients don't want to take the time or effort or they don't want to question their doctors. But it's the only way it will get done. But the insurance cos. have to go.

It's easy, "Say Doc, this treatment here, this is only marginally more effective that this other one here. Let's not do it." :)

@pensionking, not entirely true. Some treatments are vastly more effective but only have marginal or negligibly better outcomes, yet are not substandard. I'm not sure if the word is tragedy of the commons or prisoners dilemma or what.

I get what you are saying. I would like high performing medical, that is prudent, yet thrifty, but not cutting corners. You know, the Ben Franklin 'Poor Richards wisdom' version of Blue Cross/Blue Shield.

Bernie's plan is a 2.2% tax on his income and a 6.7% employer tax.

Looking at the typical employer and employee contributions for a PPO plan at the Kaiser foundation the rates for a family of four are:

PPO 5570 / year Worker, 13433 employer.
High deductible 4289/ year worker, 12865 employer.

These rates seem a bit low compared to the prevailing costs where I live. It's closer to $8000 to $10000 for a family plan adding in the HSA. Which seem to be the biggest rip offs.

A person earning $80,000 per year at 2.2% tax. His rates under Bernie's plan would be 1760 per year, with 5360 for the employer. If his wife makes the same as him that comes to 3520, and 10,720 split among two employers. So both end up being less.

Now for a single young person making the same amount, his rates will go up, although the employers expense rate will drop slightly.

Here's another thing to consider:
I remember doing analysis of HMO's, Regular Insuring in the US vs single payer in Europe in manufacturing and office jobs in Economics in College back in the early 90's.

European companies typically had an advantage to the their U.S. counterparts, in medical costs than, in some industries it was over a 2 for one advantage.

Intelligent post from @PensionKing, as usual.

Obamacare has survived because it's working. Yes, it will need some additional legislation to stabilize the exchanges. It preserves some of the best features of the free-market and allows doctors to make a very good living. The only losers under Obamacare are some young, healthy people and the top 2% who see some of their investment income taxed. Warts and all, it's probably a better system than single-payer which would push doctors into the middle class and stifle innovation by pharma companies.

Some of the rants against Obamacare represent thinly-veiled racism. Hard-core Libertarian types who resent having their taxes going to lazy parasites who don't look like them. And the fact that Obama is not white feeds into that racism.

Obama will go down in history as a great and consequential president for Obamacare and for stabilizing our financial system after the housing crash in 2008.