The Affect on artists by the Supreme Court's ruling on the Affordable Care Act-2

[Craig Lamson]

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.

[Craig Lamson]

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

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.

[sbay]

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).

[Craig Lamson]

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.

[Isaac]

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.

[Justan]

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.

[Craig Lamson]

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.

[Craig Lamson]

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.

[Petrus]

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.

[Craig Lamson]

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?

[Petrus]

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€.

[Justan]

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.

[Craig Lamson]

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%

[Bryan Conner]

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.

[Craig Lamson]

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.

[Craig Lamson]

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.

[Isaac]

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 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?

[Craig Lamson]

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.

[Isaac]

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.

[Craig Lamson]

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?