Luminous Landscape Forum
Equipment & Techniques => Pro Business Discussion => Topic started by: Schewe on June 30, 2012, 01:51:54 am
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Ellis perhaps wisely locked the thread (http://www.luminous-landscape.com/forum/index.php?topic=68418.0) where he gave a URL for info regarding the impact of the SCOTUS (Supreme Court of the US) decision...but, I was both shocked and pleased at the result...there are some reasons (not for me personally) that give me a motive to hope that healthcare could advance not at the expense of individuals with/without health insurance (I pay a crapload as an independent contractor/artist/author).
Sorry Ellis, I'm happy to keep your thread "informational" and "clean...but there does need "discussion" (ya know?)
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As an American now living in Germany, I am happy to see America move forward with health care reform. I do not believe that Pres. Obama's package is perfect by any means, but it is definitely a step in the right direction. I have lived here in Germany for 2.5 years now. I pay into the German health and retirement system and I have nothing but good things to say about how it works. While I have not been to the doctor since moving here, my wife as well as her parents have been several times and the care is at the least as good as what you get in America and much better in some respects. And, the cost of health care is lower to the individual, whether working for a company, or more relevant to Jeff's post, those that are self-employed. I am self-employed, and I pay the same amount that any other person pays. Here in Germany, we can choose which private company we buy our insurance from. We do not depend on the government for our medical insurance as a lot of people think. We can choose our doctors, dentists etc., and there are not waiting lists or anything for treatment. At least not here in southern Baden-Württemberg. One real positive of our system here is that medicine is amazingly cheap compared to the prices in the USA. The cost of doctor's visits are much lower too.
Before moving here, I was 100% against the thought of such a health-care system, but now, I am a big fan.
But, in the end, the result of the health-care plan depends on the competence of the government running it. The U.S. Congress (Republicans as well as Democratic members) has a less than stellar record on competently managing anything. I think that is what has most people nervous and afraid. Maybe they can get a clue and get it right for a change.
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I too was pleased by the result. As a parent of a child with a chronic condition it means a lot to me personally.
I am puzzled as to what there is to debate.
We all need, and will use health care at some time in our lives.
As the wealthiest nation on the planet, I see scant argument for letting large segments of the population go without protection and care. We are already paying for indigent care but at the highest possible price via emergency room care.
Probably the most instructive precedent is the huge fight that was waged in Congress in opposition to the Social Security Act. Virtually every American today sees SS as the benchmark of Government responsibility to its citizens. Yet at the time it was denounced as Socialism gone wild.
The kerfuffle over the act is really just political posturing. The act will be tweaked over time to smooth out the glitches and extend the coverage. As we become more familiar with the act we will appreciate it for the advance that it is..
There will be unintended consequences for sure but I am sure many will be surprised by the fact that some will be very positive.
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"As the wealthiest nation on the planet,"
not on a per capita basis, size isn't everything. ::)
http://www.npr.org/blogs/money/2012/05/30/153950742/the-worlds-richest-countries-and-biggest-economies-in-2-graphics (http://www.npr.org/blogs/money/2012/05/30/153950742/the-worlds-richest-countries-and-biggest-economies-in-2-graphics)
http://www.huffingtonpost.com/2012/02/15/countries-in-debt_n_1278711.html#s698304&title=7_United_States (http://www.huffingtonpost.com/2012/02/15/countries-in-debt_n_1278711.html#s698304&title=7_United_States)
the NHS is much maligned in the U.K. and while i have not had to use their services much my retired parents have between them had a fair few operations, including a triple bypass and neurosurgery on the spine (twice), thats at least £100,000 worth of care. all you have to do to get this service is pay your income tax.
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The World Health Organization's ranking of the world's health systems (http://www.photius.com/rankings/healthranks.html).
Interesting reading…
Cheers,
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But, in the end, the result of the health-care plan depends on the competence of the government running it. The U.S. Congress (Republicans as well as Democratic members) has a less than stellar record on competently managing anything. I think that is what has most people nervous and afraid. Maybe they can get a clue and get it right for a change.
Both Medicare and Social Security are run quite well, much more efficient than equivalent private programs. Not without problems, of course, but that's not the point.
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Not really. That's from 12 years ago. The Greek health system better than the NHS??? Don't think so...
That reflects the parlous state the Conservatives left the NHS in, and why Labour spent so much sorting it. Remember those waiting lists to get on the waiting lists, which were then some 18 months long? It took quite a lot to get those down to less than 18 weeks, and a matter of two or three in many cases.
Then there was the rampant MRSA as a result of contracting cleaning services to the lowest bidder. It cost millions to literally clean up their act, and millions upon millions to clear out MRSA.
The NHS was on its knees, and poor performance would have been the basis for mass privatisations. It seems as if a similar agenda is on Tory minds today.
In 2010, the UK was set to have overtaken both France & Germany in all metrics by 2013, and was already ahead in most. And the most cost-effective health service in the world.
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Sorry Ellis, I'm happy to keep your thread "informational" and "clean...but there does need "discussion" (ya know?)
Jeff,
I was equally stunned (in a good way!) by the outcome, I was prepared to see it go down in flames. And as Jeff can attest from our discussions about my own situation, I am a prime example of why (in my not so humble opinion!) we need this overhaul. I fall into that previously untouchable category of a " pre-existing condition." Fortunately, I work for a university and have outstanding coverage (and pay a lot for it…). Should I lose that coverage, my life expectancy would be measured in months. But now with this law, I cannot be denied (once it goes into effect).
I firmly believe that health care coverage is a responsibility that must be shared by all members of a society. I paid in for over thirty years before I needed it and now, I can't live with out it. I found it quite ironic in the early debates as politicians made such an issue about "death panels" deciding whether an individual was worthy of care. If denying coverage to someone with low income or a pre-existing condition isn't a "death panel," I don't know what is…
Greg
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I found it quite ironic in the early debates as politicians made such an issue about "death panels" deciding whether an individual was worthy of care. If denying coverage to someone with low income or a pre-existing condition isn't a "death panel," I don't know what is…
Hi Greg,
When politicians stoop so low that only FUD tactics (http://en.wikipedia.org/wiki/Fear,_uncertainty_and_doubt) are left, it should be clear that they do not have sensible/rational arguments to support their case (and are probably in the wrong camp on that issue).
Looking at the situation from a (safe) distance, and basing my view on reports from amongst others the OECD (http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en), it seems that for some people the accessibility and overall cost of healthcare are less important than a dogmatic view on the role of government.
To me, such dogmatic views don't seem to lead to a pragmatic approach aimed at improving the quality/standards of living, unless one of course is one of the few at the excessive money receiving end of the situation and equates that to quality of life.
Cheers,
Bart
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I think it's high time the name was changed...
Health Care.
They don't care... it's all about profit.
The real problem is that prices have simply gone out of control.
Doctors charge ridiculously high fees, drug companies are even worse.
While the economy has slowed down medical costs have gone up.
They will keep on gouging the real economy as much as they can until
it becomes clear to everyone that it is simply racketeering.
Obama Care is a farce. What has it really changed except for forcing people to buy insurance.
Has anything been done to control the cost of the medical services themselves.
Nothing will really change due to Americas political system that is a show really.
There is not really any difference between the repuiblicans and the democrats.
They just make a point in putting up a good show of pretending to really be in opposition to each other, but really
they are just keeping the same old system going. The very rich get richer and the poor become more numerous.
Just look at "our" current president. Gets a Nobel peace Prize before even getting into office and then continues with the wars
and adds a few little ones of his own. Pathetic, just like the rest of them. Clinton kept the war in Iraq warm while he filled the coffers so that
Al Gore could abdicate" and let Bush spend all the money channeling the money to corporate America via a War. Too bad it destroyed
countless lives and most of Iraq.
Now he supports Gay Marriage.... well that was about time. Did he do so because he cares... no he did so because he can't afford to lose the
young vote.
He pretended to be the green president. Then what did he do ... he plowed money into fake green companies that went belly up
just so the green movement would be discredited and that big oil could continue as usual.
He bailed out the American auto industry. Did he tell them to stop making dumb ass gas guzzling big dick SUVs. No.
So now we are stuck with another couple of decades with cars will contribute to high pollution and fuel costs.
Let's go back to the Heath (they don't) Care issue. I'd be willing to bet that one thing that won't go away is
that it will be compulsory to buy heath care insurance from a for profit company. That's what this move is really all about.
It is about shoving compulsory insurance down your throat. The other good stuff will be taken down and the democrats knew it all along.
The last thing they want is the German national heath system.
Incidently Germany is also the most Unionized industrial country.
Seems to be doing very well that way.
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Obama Care is a farce. What has it really changed except for forcing people to buy insurance.
From my understanding (that of a reasonably informed Brit, not an expert USAian), part of the change was to compel insurance companies to sell insurance to everyone. Putting the two together means no one is uninsured, no one is denied healthcare. Clearly there was more, but the change wasn't just about forcing people to spend their money.
What does seem quite clear is that health insurance companies were lobbying hard, trying to convince Republicans (who seemed to need little convincing anyway) to oppose it. Republican politicians were happy to act in the interests of big business rather than in the interests of US citizens. From my perspective this side of the Atlantic, that seems to be the case in all regards, not just healthcare.
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From my understanding (that of a reasonably informed Brit, not an expert USAian), part of the change was to compel insurance companies to sell insurance to everyone. Putting the two together means no one is uninsured, no one is denied healthcare. Clearly there was more, but the change wasn't just about forcing people to spend their money.
That's my perception as well. What's more, allowing more people to join will allow to lower prices for all participants. Looking at the total health related expenditures in the USA, compared to pretty much the rest if the world, there seems to be an imbalance.
What does seem quite clear is that health insurance companies were lobbying hard, trying to convince Republicans (who seemed to need little convincing anyway) to oppose it. Republican politicians were happy to act in the interests of big business rather than in the interests of US citizens. From my perspective this side of the Atlantic, that seems to be the case in all regards, not just healthcare.
Which should raise some questions when seen in relation to excessive cost for essentially not better quality care, and certainly not when seen in relation to denying access to humane care, it's unethical IMHO.
It's also counter productive when large parts of the population cannot participate in society/economy to their full capacity.
Cheers,
Bart
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I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.
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I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.
I wish you a speedy recovery.
I think it also illustrates the difference between having to, quoting Jeff, "pay a crapload as an independent contractor/artist/author" for insurance just in case one might or might not be struck by ill fate, and have a large collective chipping in to purchase the required service at a much more reasonable price only when it is actually needed.
It has more to do with efficiency, and caring for quality of life, than with clinging on to dogmas.
That of course is not an easy message with elections coming up in what is basically a two party system split down the middle which tends to polarize issues and make parties retreat to their trenches.
Cheers,
Bart
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I went trough the public health system for a hip joint replacement here in Finland, and the total cost to me was about 220€, including 4 visits for doctor's examinations and several X-rays before the operation, the operation in a specialist hospital and 3 days/2 nights in the hospital. I am now on a 3 month fully paid sick leave, which does not affect my vacations this or next year. All this was provided with the government health insurance, I need not do anything about it. The payment is 2.12% of my salary paid straight by my employer (I do not even see it anywhere in my pay receipt), and all people get the same service, employed or not. For me very simple, and it works.
First your total cost was 2.12 percent of your total earnings (for how long?)plus 220.
Next how well do you think this scales up from 5 million+ to 300 million+ members where 30-45% make little or no contributions?
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I think it also illustrates the difference between having to, quoting Jeff, "pay a crapload as an independent contractor/artist/author" for insurance just in case one might or might not be struck by ill fate, and have a large collective chipping in to purchase the required service at a much more reasonable price only when it is actually needed.
I'm curious, why is this any different that choosing to have car insurance which costs a "crapload" to protect yourself in case you crash your car?
I say this as an independent artist who pays over 12K per year for health insurance. Notice I said insurance. I do not expect "health care". I want financial protection for a bad situation, just like for my car. Just like my car I take care of the maintenance of my body from my own pocket. I surely would never expect the car insurance company to pay for my oil changes and tire rotations.
I make the choice to protect myself financially. I make the choice as to how much of the risk I choose to assume via the deductible.
More importantly I make the choice to structure my personal financial dealings to make sure I can cover the cost of this coverage.
In the end its all about my ability to choose. I would prefer the government not to take away my personal liberty.
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I'm curious, why is this any different that choosing to have car insurance which costs a "crapload" to protect yourself in case you crash your car?
I say this as an independent artist who pays over 12K per year for health insurance. Notice I said insurance.
Hi Craig,
Just to give you an idea, and I know the situation is different in other countries but to provide some reference. In the Netherlands, each individual has a mandatory basic health insurance for hospital bills and visits to the doctor (currently 103 Eur/month, 1236 Eur/year or some USD 1513 at the current exchange rate). That's it. And we have one of the highest expenditures of the OECD countries.
One has the freedom to increase the covered facilities (e.g. physiotherapy, Dental/Orthodontic plans, psychiatric help, additional medication beyond the broad basic coverage, alternative healing, etc.) at an additional fee.
The rest of the health care cost is covered by a percentage of one's income tax, so those who are unfortunate enough to have little or no income, also pay little or none.
In the end its all about my ability to choose. I would prefer the government not to take away my personal liberty.
I can understand that, but that seems to come with an excessively high price tag, and what's more one which makes it much more expensive than it needs be, and only accessible to those who are 'lucky' enough to be able to pay "craploads" because it's so inefficient. There's a reason why the lobbyists for the insurance companies are trying to keep things as they are ...
Cheers,
Bart
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I'm curious, why is this any different than choosing to have car insurance which costs a "crapload" to protect yourself in case you crash your car?
In California, auto insurance is not a choice it's a requirement (http://www.dmv.ca.gov/pubs/brochures/fast_facts/ffvr18.htm).
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In California, auto insurance is not a choice it's a requirement (http://www.dmv.ca.gov/pubs/brochures/fast_facts/ffvr18.htm).
Only if you CHOOSE to own a car.....
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Only if you CHOOSE to own a car...
Your example was "to protect yourself in case you crash your car" which only makes sense as an example if you own a car -- so you seem to be shifting the goal posts, now that your example doesn't show what you want.
How well do you think U.S. health insurance operates with as you said "300 million+ members where 30-45% make little or no contributions"?
"The average U.S. family and their employers paid an extra $1,017 in health care premiums last year to compensate for the uninsured... about 37% of health care costs for people without insurance — or a total of $42.7 billion — went unpaid last year [2008]. That cost eventually was shifted to the insured through higher premiums." USA Today (http://www.usatoday.com/money/industries/insurance/2009-05-28-hiddentax_N.htm)
Incidentally, do you choose to have a body that other organisms use as food and a garbage heap? :-)
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Hi Craig,
Just to give you an idea, and I know the situation is different in other countries but to provide some reference. In the Netherlands, each individual has a mandatory basic health insurance for hospital bills and visits to the doctor (currently 103 Eur/month, 1236 Eur/year or some USD 1513 at the current exchange rate). That's it.
One has the freedom to increase the covered facilities (e.g. physiotherapy, Dental/Orthodontic plans, psychiatric help, additional medication beyond the broad basic coverage, alternative healing, etc.) at an additional fee.
The rest of the health care cost is covered by a percentage of one's income tax, so those who are unfortunate enough to have little or no income, also pay little or none.
I can understand that, but that seems to come with an excessively high price tag, and what's more one which makes it much more expensive than it needs be, and only accessible to those who are 'lucky' enough to be able to pay "craploads" because it's so inefficient. There's a reason why the lobbyists for the insurance companies are trying to keep things as they are ...
Cheers,
Bart
I'll re-ask my original question of another poster, how does this scale up from 16 million to 300 million people where a good percentage make no contributions?
And for the record I'm not against some reforms, and I have no problem with the insurance companies nor the medical profession making a profit. Nor do I believe we have any rights to limit the profit of either an individual or company.
From my perspective, its not a matter of "luck" that I can pay for my insurance, its a matter of choice. It was MY choice to be self employed and forgo an employer provide policy. It is MY choice to structure my financial dealing so I have money to pay for the policy.
Clearly bad things happen and we do have a safety net to provide for those in need. I have no problem with that. We also have people who WILLINGLY provide health service for a lower cost and little or no profit for those in need. Yet another freedom and choice.
I have no problem funding a safety net for those really in need, but lose patience for those spending their cash ( and in many cases government supplied case - from tax payers like me) on booze, smokes, drugs, cable tv, cell phones, high end Nikes, porn etc.
Things are different here. The desire for freedom from government runs high in the US. I'm sure some find it unusual just as some here find the dependance on government in other countries just as unusual. it transcends health care.
No easy answers but government has a very poor record, even worse than prove industry. To use the old saw, just think of health care run like the bureau of motor vehicles...
America is very divided on this issue, pretty much along the percentage lines of the givers and the takers. The law is a mess. Many of the representatives and senators who voted for it had little idea what was in it. The speaker of the house told the world that we had to pass the bill to find out what was in it.
Anyways not going to solve this here, thanks for your thoughts.
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Your example was "to protect yourself in case you crash your car" which only makes sense as an example if you own a car -- so you seem to be shifting the goal posts, now that your example doesn't show what you want.
How well do you think U.S. health insurance operates with as you said "300 million+ members where 30-45% make little or no contributions"?
"The average U.S. family and their employers paid an extra $1,017 in health care premiums last year to compensate for the uninsured... about 37% of health care costs for people without insurance — or a total of $42.7 billion — went unpaid last year [2008]. That cost eventually was shifted to the insured through higher premiums." USA Today (http://www.usatoday.com/money/industries/insurance/2009-05-28-hiddentax_N.htm)
Incidentally, do you choose to have a body that other organisms use as food and a garbage heap? :-)
Not shifting the goal posts at all.
You are shifting them.
You make a CHOICE to have a car, and that CHOICE may require insurance, even though many CHOOSE to disregard the requirement.
And yes I have a body and it should be MY choice in how I use it and how I CHOOSE to insure it, if at all.
I'm not disputing we pay for those who are uninsured, both in increased taxes and increased insurance premiums.
I'm just against putting the government in control of the whole thing.
Your mileage may vary, providing you choose to own a car.
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Obama Care is a farce. What has it really changed except for forcing people to buy insurance.
Has anything been done to control the cost of the medical services themselves.
Well I think one of the big things is that since healthcare will essentially be mandatory, you won't have the drag of uninsured people that must be born by those who are paying for healthcare (as others in this thread have noted).
I have not followed the PPACA legislation in depth, and I know it has been criticized for not doing enough to control costs, but there are some cost control measures in it. These include:
- limiting medical loss ratios to 80%
- tying medicare payments to star ratings
- creating accountable care organizations (to move away from fee for service model)
One might argue that these measures are not enough to control costs, and that they are untested at a national level, but at least it is a start (and I think better than doing nothing and keeping the status quo).
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Do you get to choose how other organisms abuse your body? Do you get to choose a congenital illness?
Talk about shifting the goalposts... I take responsibility for my body and what happens to it in the form of care. Its not the duty of government to decide that for me.
Then be happy because the government is not being put in control of the whole thing.
Please...
What is happening is a response to your repeated question -- "How does this scale up from 16 million to 300 million people where a good percentage make no contributions?"
That response is to get those missing contributions.
Sorry but that's not what is happening. It is MOSTLY increasing the contributions from those already contributing.
Tell us how well that is working out for California.
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Talk about shifting the goalposts...
You're literally correct to say that owning a car is a choice. When you equate that with healthcare, the similar choice is between life and death. Choose life and you have metaphorically chosen to own a car.
Once you've chosen life, once you've chosen to own a car, the running costs you incur will result both from what you choose and what was beyond your freedom to choose.
I take responsibility for my body and what happens to it in the form of care.
Unless you are willing to pay the full cost of all healthcare you receive, you are not taking that responsibility alone.
The very nature of pooled insurance is that other people pay for what you receive.
After 20 thankfully healthy years in the U.S. my health insurance payments have covered a lot of other people's health care (and fat cat luxury).
Please... Sorry but that's not what is happening. It is MOSTLY increasing the contributions from those already contributing.
Please show why you think that.
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The good thing about the Affordable Care Act is that it will create an opportunity for those of us who are self-employed to join larger collective insurance groups. Currently as an owner of a small business, I pay more for myself and for my employees than does a business that has 20 or > employees. And, as a member small group, I cannot get as good of coverage at any cost as bigger businesses do. Bigger groups can self-insure and save a FORTUNE. But that is unchanged by this act.
My hope, and I’m sure the hope of small businesses everywhere is that this Act will provide better coverage for the cost and slow the rate of increase.
I’m not at all thrilled that business owners are the responsible party for collections in this Act, but it’s typical of government to put the responsibility of collection to businesses.
The ideal solution would have been single payer, but that idea was crushed out of existence by the insurance industry and their lap dogs in the right wing.
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You're literally correct to say that owning a car is a choice. When you equate that with healthcare, the similar choice is between life and death. Choose life and you have metaphorically chosen to own a car.
The similar choice is insure or not to insure.
Once you've chosen life, once you've chosen to own a car, the running costs you incur will result both from what you choose and what was beyond your freedom to choose.
You still can CHOOSE how you COVER the running costs of the car. Not the case with the new new healthcare law.
[qoute]
Unless you are willing to pay the full cost of all healthcare you receive, you are not taking that responsibility alone.
The very nature of pooled insurance is that other people pay for what you receive.
[/quote]
Prior to the AHA, it was YOUR choice. No longer the case.
After 20 thankfully healthy years in the U.S. my health insurance payments have covered a lot of other peoples health care (and fat cat luxury).
No your payments have covered your POTENTIAL for risk of expensive medical treatments. You got exactly what you paid for.
Please show why you think that.
Do you think the vast majority who are uninsured are going to be making contributions? The very nature of the program is to offer free care or subsidies to those without, and those most likely to be penalized for not having coverage will be exempted from the penalty.
Who exactly does that leave to provide for most of those "missing contributions" ? Those already contributing. The program is now projected to add 2.9 TRILLION to the federal budget . Somewhere near half of all American households pay no federal income tax.
Who will make up this missing contributions? Those already contributing.
BTW, you passed on telling us how this working out for California.
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The good thing about the Affordable Care Act is that it will create an opportunity for those of us who are self-employed to join larger collective insurance groups. Currently as an owner of a small business, I pay more for myself and for my employees than does a business that has 20 or > employees. And, as a member small group, I cannot get as good of coverage at any cost as bigger businesses do. Bigger groups can self-insure and save a FORTUNE. But that is unchanged by this act.
My hope, and I’m sure the hope of small businesses everywhere is that this Act will provide better coverage for the cost and slow the rate of increase.
I’m not at all thrilled that business owners are the responsible party for collections in this Act, but it’s typical of government to put the responsibility of collection to businesses.
The ideal solution would have been single payer, but that idea was crushed out of existence by the insurance industry and their lap dogs in the right wing.
Will it really do that?
I'm asking because I don't know. It was my understanding that the states were to form the exchanges and many are saying no.
In addition it was also my understanding that self insurance is going away as well.
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First your total cost was 2.12 percent of your total earnings (for how long?)plus 220.
Next how well do you think this scales up from 5 million+ to 300 million+ members where 30-45% make little or no contributions?
My total cost was not 2.12 percent of my total lifetime earnings, that is the amount I have pitched into the common purse so far. If I need more care later on, and I certainly will, everything will be covered until I am dead. There are people who need million dollar cares annually, many handicapped have 5 helpers working on 3 shifts 24/7, all paid by health insurance. As the health insurance is collected from salaries, there is a large percentage of people not paying in also here (children, students, unemployed), but nobody sees that as a problem. Those who earn money support those who do not, those who earn more, pay more. No problems there. As an aside, we do have a tax system which is very efficient and transparent, it is easy to collect taxes, health insurance etc. All tax collection is done by the employer, really no way to avoid it.
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My total cost was not 2.12 percent of my total lifetime earnings, that is the amount I have pitched into the common purse so far.
Just to be clear, what percentage of your income by percentage is collected to pay for health care?
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Just to be clear, what percentage of your income by percentage is collected to pay for health care?
If I get 1000€ salary pre-tax, my employer pays 2.12% = 21.20€ health insurance to a common purse (this money is not earmarked for me), and this happens without me seeing it at all. There are also other payments they have to make on top of the cross salary I see on my pay slip which I do not see either, the total is something around 20% on top of that 1000€. From my 1000€ I pay state tax, local tax, some unemployment taxes etc (taken care by the employer again), which at the moment amount to about 28%, so I get 820€ in the end, and the society gets actually almost 500€.
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Will it really do that?
I'm asking because I don't know. It was my understanding that the states were to form the exchanges and many are saying no.
In addition it was also my understanding that self insurance is going away as well.
I’m no expert on the topic but iirc the private exchanges are supposed to be the center piece of the Act.
For the issue of self-insurance, a quick search with Mr. Google shows nothing of the demise of self-insurance. It’s illogical that this would happen.
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If I get 1000€ salary pre-tax, my employer pays 2.12% = 21.20€ health insurance to a common purse (this money is not earmarked for me), and this happens without me seeing it at all. There are also other payments they have to make on top of the cross salary I see on my pay slip which I do not see either, the total is something around 20% on top of that 1000€. From my 1000€ I pay state tax, local tax, some unemployment taxes etc (taken care by the employer again), which at the moment amount to about 28%, so I get 820€ in the end, and the society gets actually almost 500€.
So actually they are paying you 1320.20, and you do pay that 2.12 percent.
Which brings your total tax burden to about 38%
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Once again, as an American living in Germany, I think the healthcare system in America is terribly broken. Medical costs are way too high. Why are they so high? I believe that it is due to the fact that the insurance companies are able to charge extremely high amounts for their premiums and are able to pick and choose who they insure. Ask a doctor (one that has a perfect record in treatment) how much he has to pay for insurance each year. Ask a hospital administrator how much the hospital has to pay for insurance. The amount will astound you. And who actually pays for this? Everyone. The insured as well as the uninsured. The doctor has to charge very high amounts to pay for the very high insurance costs. Same for the hospitals. So, the insurance companies set the individual insured person's rates very high because the cost of medical care is so high. And the cost of medical care is so high because the cost of insurance is so high. And the wheels on the insurance money bus goes round and round.
Sure, some doctors make a lot of money, but many of them work their asses off....long hours, tremendous stress etc. The insurance companies often decide that they will not pay the full amount of the doctors bill because the price is too high.
The health care system in America is out of control. It needs controlling. The consumer has no power to control it.
Now, having said all of that, I will say this: The Congress of the United States (the guv'ment) has a terrible track record at managing anything except for getting re-elected and spending the taxpayers hard earned money and having basically nothing to show for it in the end. Republicans and Democrats are mostly the same. They will undoubtedly screw the management of ObamaCare up royally as they have most other things they have been in charge of. I think that if the American Government acted in any sort of a responsible and intelligent way, the people would be much more receptive to having them manage healthcare.
Putting the US Congress in charge of such a large amount of taxpayers money is the same as putting a crack head in charge of a Coca Field.
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Yes, I've been goggling as well.
Exchanges are state run and there is no requirement I can find that makes the states set them up. The feds reserve the rights to run them if the states decline (oh boy).
There is a fear these exchanges will do the opposite of what is intended since the regulation and minimum insurance requirements have increased. And there is also a fear policies in the exchanges will be skewed to higher price point coverage.
Anytime I hear, "I'm from the government and I'm here to help", well lets just say past experience leaves me underwhelmed.
On self insurance it seems from limited study the same applies, much greater restrictions and regulation.
In any case lets just agree to disagree on the value of the ACA. It will get sorted out one way or the other at the ballot box.
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Once again, as an American living in Germany, I think the healthcare system in America is terribly broken. Medical costs are way too high. Why are they so high? I believe that it is due to the fact that the insurance companies are able to charge extremely high amounts for their premiums and are able to pick and choose who they insure. Ask a doctor (one that has a perfect record in treatment) how much he has to pay for insurance each year. Ask a hospital administrator how much the hospital has to pay for insurance. The amount will astound you. And who actually pays for this? Everyone. The insured as well as the uninsured. The doctor has to charge very high amounts to pay for the very high insurance costs. Same for the hospitals. So, the insurance companies set the individual insured person's rates very high because the cost of medical care is so high. And the cost of medical care is so high because the cost of insurance is so high. And the wheels on the insurance money bus goes round and round.
True, but what drives these insurance costs for doctors and other medical care providers?
Litigation. A great place to start but yet another third rail of American politics.
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The similar choice is insure or not to insure.
You now seem to agree that "Only if you CHOOSE to own a car..." isn't a relevant objection -- because we do live and so for your metaphor to work we do own a car.
You still can CHOOSE how you COVER the running costs of the car. Not the case with the new new healthcare law.
For example, in California, you can choose to provide a surety bond, or a cash deposit, or some form of commercial insurance or self-insurance; to establish "financial responsibility" with DMV.
Is your objection that no similar provision exists to deposit $million cash in lieu of insurance within ACA legislation?
No your payments have covered your POTENTIAL for risk of expensive medical treatments. You got exactly what you paid for.
No, my payments covered the health risks for an over-medicated overweight (http://www.bbc.co.uk/news/health-18770328) sedentary population ;-)
Do you think the vast majority who are uninsured are going to be making contributions?
I think more will contribute than do now.
You've already acknowledged that the current situation is -- "we pay for those who are uninsured, both in increased taxes and increased insurance premiums".
One way to pay less, is to lower the health care cost of the currently uninsured.
One way to pay less, is to address the health care need before it reaches Urgent Care.
One way to pay less, is to provide access to basic preventative health care.
BTW, you passed on telling us how this working out for California.
How what is working out?
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You now seem to agree that "Only if you CHOOSE to own a car..." isn't a relevant objection -- because we do live and so for your metaphor to work we do own a car.
sigh, not even close. You can Live and NOT own a car.
For example, in California, you can choose to provide a surety bond, or a cash deposit, or some form of commercial insurance or self-insurance; to establish "financial responsibility" with DMV.
And what does that "fiscal responsibility" protect? Not you but rather anothers property.
Is your objection that no similar provision exists to deposit $million cash in lieu of insurance within ACA legislation?
My objection is quite clear. It's none of the governments business.
No, my payments covered the health risks for an over-medicated overweight sedentary population ;-)
......
I think more will contribute than do now.
Nice attempt at a cop out. The bulk will come form these who already contribute.
You've already acknowledged that the current situation is -- "we pay for those who are uninsured, both in increased taxes and increased insurance premiums".
One way to pay less, is to lower the health care cost of the currently uninsured.
One way to pay less, is to address the health care need before it reaches Urgent Care.
One way to pay less, is to provide access to basic preventative health care.
And ACA will do that how? And if it does are sure it will LOWER costs and not INCREASE them?
How what is working out?
Good question, you have avoided answering it.
I suggest we agree to disagree. And let the ballot box decide.
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You now seem to agree that "Only if you CHOOSE to own a car..." isn't a relevant objection -- because we do live and so for your metaphor to work we do own a car.
sigh, not even close. You can Live and NOT own a car.
Obviously you can live and not own a car - but that wasn't the problem with your metaphor.
I'm sure you agree that by virtue of owning a car we are exposed to various risks. You've told us that we can avoid those risks by choosing not to own a car.
Similarly, by virtue of being alive we are exposed to various risks - including risks to health. To follow your metaphor, we can avoid those risks by choosing not to be alive.
In your metaphor, choosing not to own a car corresponds with choosing not to be alive.
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sigh, not even close. You can Live and NOT own a car.
Obviously you can live and not own a car - but that wasn't the problem with your metaphor.
I'm sure you agree that by virtue of owning a car we are exposed to various risks. You've told us that we can avoid those risks by choosing not to own a car.
Similarly, by virtue of being alive we are exposed to various risks - including risks to health. To follow your metaphor, we can avoid those risks by choosing not to be alive.
In your metaphor, choosing not to own a car corresponds with choosing not to be alive.
I told you you could avoid the mandated purchase of insurance choosing not to own a car. And of course you can avoid the current silly law by choosing to be dead. Both are valid choices.
However in both I'm alive in the first instance. Being alive does not equate to owning a car.
I have a choice to purchase a car.
I'm mandated to purchase insurance if I own. Not if I don't.
I have a choice to purchase healthcare services. I'm mandated to purchase insurance if I use. I'm mandated to purchase insurance if I don't.
You can also avoid the mandated car insurance while owning a car but CHOOSING not to drive it on public roads. In addition unlike health insurance which provides personal financial protection, mandated car insurance only protects the other guy. Choices...just like the choice NOT to seek medical care. Except in your utopia we no longer have the personal choice to not purchase health insurance or face a penalty.
Neither address the issues since most people won't choose to die. And many voluntarily choose not to own a car.
Which begs the question in light of this new law that penalizes every person for the NON purchase of a commercial product. Are non car owning persons being treated differently under the law? A protected class? And what about home owners who don't insure their houses. How about renters who don't insure the contents of their apartment? Lets extend this further. How about those who choose not to purchase chewing gum? Or those who choose not to purchase a Nikon? Can you say slippery slope? Is the ACA discriminatory?
The long and short is I can still choose NOT to purchase car insurance. The option to choose to not purchase health insurance without a incurring penalty is not available.
Maybe that's why we have the legal gymnastics to label the unconstitutional mandate a tax..oh wait, a penalty, no wait a tax....what ever it is.
A great quote that describes the difference between us.
"Free societies allow the citizens to make their choices...even freer ones allow the individual the dignity to incur the consequences of their choices"
It will be sorted out at the ballot box.
BTW, how is the healthcare thing working out for California?
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A great quote that describes the difference between us.
"Free societies allow the citizens to make their choices...even freer ones allow the individual the dignity to incur the consequences of their choices"
Except that if you do choose not to carry health insurance and then have an illness you want treated (because you've made the choice not to die) then the rest of the people in your immediate community have to bear that cost. You are unilaterally imposing a "tax" on the rest of us in your community, especially on the lab techs, hospital orderlies, nurses, doctors, and other healthcare service and materials providers whose expenses you cannot pay and chose not to make prior arrangements for.
No matter what the politicians are saying now to get your money, your voice, and your vote the Affordable Health Care Act isn't going to be repealed or defunded. What GOP does not like is that the Democratic Party got it passed. It has been two years since it was passed, at least fifteen years since the debate about it started in earnest and the one plan the GOP has floated is what was basically enacted in the Affordable Heathcare Act. The GOP has had all that time to come with an alternative and what has been the result? A promse to study alternatives.
As a recent editorial cartoon pointed out: everyone one of the polititicians who have voted to do away with it have so far wasted nearly a billion dollars in the 31 votes the GOP leadership in the House of Representatives has called.
The Republican party has no plan unless you start calling "Obamacare" by its original name: "Romneycare".
This is a fight about money, but what is on the table isn't tax dollars, it's a fundraising war of for both political machines.
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"Free societies allow the citizens to make their choices...even freer ones allow the individual the dignity to incur the consequences of their choices"
Except that if you do choose not to health insurance and then have an illness you want treated (because you've made the choice not to die) then the rest of the people in your immediate community have to bear that cost. You are unilaterally imposing a "tax" on the rest of us in your community, especially on the lab techs, hospital orderlies, nurses, doctors, and other healthcare service and materials providers whose expenses you cannot pay and chose not to make prior arrangements for.
Great point. I would also like to add to this that free societies also allow the citizens to make the choice of place of residence. You CAN choose not to participate in ObamaCare. You can refuse to pay for insurance. You also can choose to move to a different country.
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Also check out http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/13/13-reasons-why-this-is-the-worst-congress-ever/?hpid=z5
Especially item 4.
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Also check out http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/13/13-reasons-why-this-is-the-worst-congress-ever/?hpid=z5
Especially item 4.
Thanks for the link Ellis. Very interesting. Congress is the problem, they run the country, not the president. They are to blame for many of the USA's problems.
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A great quote that describes the difference between us.
"Free societies allow the citizens to make their choices...even freer ones allow the individual the dignity to incur the consequences of their choices"
Except that if you do choose not to carry health insurance and then have an illness you want treated (because you've made the choice not to die) then the rest of the people in your immediate community have to bear that cost. You are unilaterally imposing a "tax" on the rest of us in your community, especially on the lab techs, hospital orderlies, nurses, doctors, and other healthcare service and materials providers whose expenses you cannot pay and chose not to make prior arrangements for.
No matter what the politicians are saying now to get your money, your voice, and your vote the Affordable Health Care Act isn't going to be repealed or defunded. What GOP does not like is that the Democratic Party got it passed. It has been two years since it was passed, at least fifteen years since the debate about it started in earnest and the one plan the GOP has floated is what was basically enacted in the Affordable Heathcare Act. The GOP has had all that time to come with an alternative and what has been the result? A promse to study alternatives.
As a recent editorial cartoon pointed out: everyone one of the polititicians who have voted to do away with it have so far wasted nearly a billion dollars in the 31 votes the GOP leadership in the House of Representatives has called.
The Republican party has no plan unless you start calling "Obamacare" by its original name: "Romneycare".
This is a fight about money, but what is on the table isn't tax dollars, it's a fundraising war of for both political machines.
Time will tell. The majority wants this very bad bill gone. The majority never wanted it in the first place. It's simply very bad law.
You want to cut the cost of healthcare by greatly reducing the amount of extra money you pay in increased taxes and insurance premiums?
The first place to start is to reduce those abusing the system...the ones who are not even Americans. How about we send all the illegals back to where they came from and close the borders? Or is that not as politically comfortable as continuing to soak the taxpayers and legal working folks? Pretty hard for a certain party to pander for votes? How about we do that and then see where we stand?
And, for the record this is not about those who come here LEGALLY. Immigration made this country and it will continue to shape it. If you want to come here, just do it by the front door.
Oh btw, I have no problem at all in denying service to those who choose not to have the ability to pay when they make that choice of their own free will.
Of course that's the point you miss when you read the quote.
"...even freer ones allow the individual the dignity to incur the consequences of their choices" "
You seem quite happy a democratic controlled House, Senate and executive branch passed this mess since that's the way the system works.
I hope you are just as happy that the system works when a republican controlled House, Senate and executive branch toss it in the trash.
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Also check out http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/13/13-reasons-why-this-is-the-worst-congress-ever/?hpid=z5
Especially item 4.
ROFLMAO!
If that's the true reason for number four, please explain the current job creation numbers. (which like the others are a bit of fantasy)
(btw if you want to turn this into a strictly political discussion, and we can take this to a more suitable venue and I'll be very happy to continue)
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Great point. I would also like to add to this that free societies also allow the citizens to make the choice of place of residence. You CAN choose not to participate in ObamaCare. You can refuse to pay for insurance. You also can choose to move to a different country.
Ah yes, the if you don't like it...move...defense. I'm more inclined to use the political system instead.
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Yes, I've been goggling as well.
Exchanges are state run and there is no requirement I can find that makes the states set them up. The feds reserve the rights to run them if the states decline (oh boy).
There is a fear these exchanges will do the opposite of what is intended since the regulation and minimum insurance requirements have increased. And there is also a fear policies in the exchanges will be skewed to higher price point coverage.
On self insurance it seems from limited study the same applies, much greater restrictions and regulation.
In any case lets just agree to disagree on the value of the ACA. It will get sorted out one way or the other at the ballot box.
You made assertions. You can produce no facts to back your assertions up, and so you state 2x you are fearful of what *might* happen.
Thanks for sharing that. I’m fearful too, but can provide facts as to why.
Having paid into a system that has gone up over 135% in the last 10 years, while offering reduced services for my added expense, I shudder to see what the next 10 years could bring, without MAJOR changes to the system. Can you imagine a system that requires a typical healthy adult to pay over $1,000 per month, every month just for health insurance? That is where we are headed, without a major change.
Meanwhile, many of our local “non-profit” health providers have stock piled billions of dollars. They too claim being fearful. http://seattletimes.nwsource.com/html/localnews/2017460805_surplus09m.html I’m pretty sure the same phenomena can be found across the country.
The insurance and medical industry is wealthy nearly beyond the ability to count largely because some people are just too fearful to think for themselves. These same people will believe anything these greedy groups tell them to believe.
As far as self-insurance, greater oversight of self-insurance plans is a good thing. I know of some groups who use self-insurance, and they’ve done extremely well as a consequence. The $$$ that would otherwise go into the coffers of insurance companies stays with the company and lets them re-invest it. That permits the company to grow more readily. That’s fine with me.
Any company that is big enough to self-insure, probably will, unless, their employee population puts them at risk for losing $$ due to being self-insured. That kind of risk is why strict oversight is important and the risk is why insurance exists in the first place.
The real tragedy is that that health care has become nearly guaranteed path to ruin for anyone who really needs it, especially without insurance. Heck, the cost of delivering a baby is over $30K per the WSJ. http://online.wsj.com/article/SB124165279035493687.html
How about the cost of a trip to the ER to fix a simple broken arm? Accordingly that can be anywhere between $2.5K to over $16K. http://health.costhelper.com/broken-arm.html.
Now let’s look at some fairly common life events. Roughly 80% of men will have serious lower back problems in their lives. Typical cost to repair a herniated disk can be between $8K and $150K. http://www.herniateddiscbacksurgery.com/spine-surgery-cost.shtml
Typical cost of some forms of cancer treatment: Lung cancer treatment: over $40K. Prostate cancer: over $18K. Recurrent breast cancer: around $55K. http://www.washingtonpost.com/wp-dyn/content/article/2008/06/10/AR2008061001987.html
There are endless examples. The point is if one doesn’t have health insurance, entirely predictable life maladies can financially destroy nearly anyone. If people can’t afford insurance, then ultimately the cost falls to the tax payers.
You really want this trend to continue unchanged? A political party that encourages that is what I fear.
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You made assertions. You can produce no facts to back your assertions up, and so you state 2x you are fearful of what *might* happen.
Thanks for sharing that. I’m fearful too, but can provide facts as to why.
snip....
You really want this trend to continue unchanged? A political party that encourages that is what I fear.
You really CAN'T read can you Justan?
I suggest to go back upthread and do just that, and then climb on your high horse and ride off into the sunset.
I can supply all the "dueling" facts you can ever want to back my assertions and I'll be happy to do just that. Lets just move this to a more suitable venue. If the mods permits, coffee corner works just fine for me.
Then we can dance....
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Yes, and by virtue of being alive, we are exposed to health risks - it comes with the territory.
In contrast, as you have repeatedly stated, owning a car, and being exposed to various risks as a consequence, is a choice we make.
LOL! you really don't deal with losing well do you? And choosing to use healthcare being exposed to various risks as a consequence, is a choice we make.
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That's a good point - is there property of others that should be protected?
Yes there is - you've already agreed that "we pay for those who are uninsured, both in increased taxes and increased insurance premiums".
There's $42.7 billion in health care costs for people without insurance that is shifted onto higher premiums for the insured.
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We CHOOSE to accept those costs, we and also choose otherwise.
You presume you know my opinion - you don't know my opinion.
Fair enough. So lets find out what your opinion really is. Do you agree with the quote or not?
Which "healthcare thing"?
Why Isaac, its the same one why have avoided answering for four posts now....
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I've started a new thread in the coffee corner. I'll comment there and leave this thread.