Trumpcare vs Obamacare vs Single Payer

[Jolly_Penguin]

The GOP's bill would get rid of the Obamacare requirement that people have health coverage or face a tax penalty.

I read that your hospitals treat people who can't pay and that this falls onto the tax payer. Is that true? If so, then doesn't this bump up the draw on the tax system and lead to higher taxes? Its like medicare for all, but everybody goes bankrupt first, yes? It seems like a weird mix of socialism and capitalism; enriching insurance companies at the expense of the taxpayer.

It would also eliminate the mandate that employers with at least 50 employees provide health insurance to their workers.

This has always made sense to me and I applaud the move. Why should employers be held responsible to pay for the health insurance of employees beyond health risks that the job itself imposes? I understand an employer paying hazard pay etc, but it seems rather arbitrary for an employer to have to pay for all of your health insurance. It also imposes an even heavier cost on those who lose their jobs and on the unemployed or self employed.

Universal single payer is the answer here (as we've known here in Canuckistan for decades). I'm not sure if Trumpcare takes us closer to that or further from it. It does lift the burden to pay off of the employer, which is a good step forward, and will result in you having to fund more of the medical system with taxpayer dollars (also a step towards single payer if you squint hard enough).

 

[TSwizzle]

I would like to see healthcare uncoupled from the employer. It is ridiculous that health insurance should be part of your compensation for a job.

 

[Jolly_Penguin]

I would like to see healthcare uncoupled from the employer. It is ridiculous that health insurance should be part of your compensation for a job.

I agree. It got that way because the government failed to put universal care in place and employers wanted to offer it as a perk to attract employees, right? But then the government decided to force that on all employers as an expectation. That's pretty messed up.

I have yet to hear a good argument against universal single payer that doesn't involve pointing to Canada with a bunch of false claims, that as a Canadian I plainly see are blatant lies.

 

[ksen]

US employers aren't required to pay for employee health insurance.

 

[Jimmy Higgins]

US employers aren't required to pay for employee health insurance.

Before the ACA, true. After the ACA, plenty of small businesses are exempt from having to provide it, but large corporations* have to.


* definition of "large corporations" isn't exactly what people think

 

[dismal]

The practice of employers providing health insurance is said to have arisen because wage and price controls prevented employers from competing for workers by offering higher salaries but did not count employer-paid benefits as salary.

Although I imagine those whose religion requires them to believe employers don't compete for workers have their own creation myth.

 

[Nice Squirrel]

Single payer now.

 

[dismal]

Single payer now.

Obamacare is here to stay.
- Democrats

 

[Nice Squirrel]

Single payer now.

Obamacare is here to stay.
- Democrats

Single payer now.

 

[ksen]

US employers aren't required to pay for employee health insurance.

Before the ACA, true. After the ACA, plenty of small businesses are exempt from having to provide it, but large corporations* have to.


* definition of "large corporations" isn't exactly what people think

But provide doesn't equal pay for. Most do pay for some of it but that's not a requirement

 

[SimpleDon]

I read that your hospitals treat people who can't pay and that this falls onto the tax payer. Is that true? If so, then doesn't this bump up the draw on the tax system and lead to higher taxes? Its like medicare for all, but everybody goes bankrupt first, yes? It seems like a weird mix of socialism and capitalism; enriching insurance companies at the expense of the taxpayer.

It would also eliminate the mandate that employers with at least 50 employees provide health insurance to their workers.

This has always made sense to me and I applaud the move. Why should employers be held responsible to pay for the health insurance of employees beyond health risks that the job itself imposes? I understand an employer paying hazard pay etc, but it seems rather arbitrary for an employer to have to pay for all of your health insurance. It also imposes an even heavier cost on those who lose their jobs and on the unemployed or self employed.

Universal single payer is the answer here (as we've known here in Canuckistan for decades). I'm not sure if Trumpcare takes us closer to that or further from it. It does lift the burden to pay off of the employer, which is a good step forward, and will result in you having to fund more of the medical system with taxpayer dollars (also a step towards single payer if you squint hard enough).

Most of the costs of treating those who can't pay is recovered through inflated fees for those who can pay.

I just posted in the POS Joe Walsh thread that the gorilla in the room that no one is talking about is that most of the higher cost of medical care in the US is because we have converted more of the health care sector into for profit businesses. There is no gain in doing this. The magic of competition in health care doesn't produce the lowest cost, and the highest quality health care.

ObamaCare didn't address this point indirectly. It limits the "loss ratio" that the insurance companies can achieve, that is, the amount of money that the insurance companies can keep to pay for their considerable overheads and of course, their profits. Under ObamaCare this is limited to 20% of the premiums that they charge.

I don't know if TrumpCare retains this limit or not. Looking at who is involved in writing TrumpCare I would be surprised if it was retained.

I agree that the Canadian system is far better than either TrumpCare or ObamaCare. I lived in Canada (Montréal) in the 1980's. If I remember correctly the government paid for the premiums out of taxes for insurance that paid for 80% of hospitalization and allowed the insurance companies to make a profit on the supplemental insurance that paid for the other 20%. At the time I was there most companies paid for the supplemental insurance for their employees. The government pays for the insurance with a payroll tax paid for by both the employee and the employer.

This was a long time ago and many things might have changed or my memory might be wrong.

ObamaCare didn't want to disturb the the people who got their insurance through their employers and they didn't want companies to abandon the employer supplied health care insurance when ObamaCare came into force. There fore they put in the requirement for companies with more than fifty full time employees to provide insurance. This requirement wasn't picked at random, most companies with fifty employees or more can self-insure, depending on their financial strength. This means that they take the risk and pay for the medical costs of their employees and their families. This is usually vastly cheaper than buying group insurance from an insurance company that puts the insurance company at risk. Of course, the company can buy insurance for an exceptionally expensive patient that is covered by the self-insurance. Most start paying at the one half to one million dollar lifetime point.

As someone just said recently, who knew that health insurance was so complicated?

 

[Jimmy Higgins]

Before the ACA, true. After the ACA, plenty of small businesses are exempt from having to provide it, but large corporations* have to.


* definition of "large corporations" isn't exactly what people think

But provide doesn't equal pay for. Most do pay for some of it but that's not a requirement

I'm sorry, I missed the qualification you had there. Yeah, provide access, but not fully paid. Though, I'm not certain what the actual requirement is. I'd need to look it up.

 

[Jolly_Penguin]

I just posted in the POS Joe Walsh thread that the gorilla in the room that no one is talking about is that most of the higher cost of medical care in the US is because we have converted more of the health care sector into for profit businesses. There is no gain in doing this. The magic of competition in health care doesn't produce the lowest cost, and the highest quality health care.

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.

I agree that the Canadian system is far better than either TrumpCare or ObamaCare. I lived in Canada (Montréal) in the 1980's. If I remember correctly the government paid for the premiums out of taxes for insurance that paid for 80% of hospitalization and allowed the insurance companies to make a profit on the supplemental insurance that paid for the other 20%. At the time I was there most companies paid for the supplemental insurance for their employees. The government pays for the insurance with a payroll tax paid for by both the employee and the employer.

My OHIP card (government single payer health insurance) pays for all but dental and prescription drugs. Also doesn't pay for cosmetic surgery etc. For dental and prescription drugs, many employers will give health insurance that pays for this, but many don't, and there is no obligation for them to. I've never had any such insurance from an employer myself. I pay that out of pocket. It doesn't amount to a whole lot, as our drugs are considerably cheaper here than they are in the USA.

 

[Jimmy Higgins]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.

The theory is streamlining and perfecting a process so that the cost of operation drops enough, that it can handle the off the top profit. It is an interesting idea, and probably works in some areas. Health care, not so much.

 

[Cheerful Charlie]

I would like to see healthcare uncoupled from the employer. It is ridiculous that health insurance should be part of your compensation for a job.

I agree. It got that way because the government failed to put universal care in place and employers wanted to offer it as a perk to attract employees, right? But then the government decided to force that on all employers as an expectation. That's pretty messed up.

I have yet to hear a good argument against universal single payer that doesn't involve pointing to Canada with a bunch of false claims, that as a Canadian I plainly see are blatant lies.

Decades ago, any attempts to improve how health care was provided in America was met by cries of "Socialized Medicine! Socialized Medicine!", not only from troglodytes on the right, but by the AMA.

So one of the main blocks to a more comprehensive system came from the doctrinaire medical provider system itself.
In large part this was successful since there was no big movement to proceed to something better. And for many, health care provided in the workplace sufficed.

In the era of the cold war, "Socialized Medicine!" resonated with most people even thought it was all baloney. For many years, Canada was not the boogy man, England was. Any perceived failure in England was pointed to as the results of "Socialized Medicine!"

 

[coloradoatheist]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.

I agree that the Canadian system is far better than either TrumpCare or ObamaCare. I lived in Canada (Montréal) in the 1980's. If I remember correctly the government paid for the premiums out of taxes for insurance that paid for 80% of hospitalization and allowed the insurance companies to make a profit on the supplemental insurance that paid for the other 20%. At the time I was there most companies paid for the supplemental insurance for their employees. The government pays for the insurance with a payroll tax paid for by both the employee and the employer.

My OHIP card (government single payer health insurance) pays for all but dental and prescription drugs. Also doesn't pay for cosmetic surgery etc. For dental and prescription drugs, many employers will give health insurance that pays for this, but many don't, and there is no obligation for them to. I've never had any such insurance from an employer myself. I pay that out of pocket. It doesn't amount to a whole lot, as our drugs are considerably cheaper here than they are in the USA.

Huh? If you are an insurance company and it costs $20 to prevent something compared to the $10K to fix it then there is definitely an incentive for prevntative care. I see the opposite, with socialized medicine there is no incentive to improve.

 

[LordKiran]

Yes. This exactly. I never understood how anybody could believe that adding a profit motive to health care insurance could make it cheaper. I also don't see how it could encourage preventative care.



My OHIP card (government single payer health insurance) pays for all but dental and prescription drugs. Also doesn't pay for cosmetic surgery etc. For dental and prescription drugs, many employers will give health insurance that pays for this, but many don't, and there is no obligation for them to. I've never had any such insurance from an employer myself. I pay that out of pocket. It doesn't amount to a whole lot, as our drugs are considerably cheaper here than they are in the USA.

Huh? If you are an insurance company and it costs $20 to prevent something compared to the $10K to fix it then there is definitely an incentive for prevntative care. I see the opposite, with socialized medicine there is no incentive to improve.

Utterly assinine.

The state has about as much incentive to not waste money it doesn't have to as an individual person does. Furthermore, in an privatized market those same 20 dollar prevention methods can often be price hiked to maximize profits.

 

[coloradoatheist]

Huh? If you are an insurance company and it costs $20 to prevent something compared to the $10K to fix it then there is definitely an incentive for prevntative care. I see the opposite, with socialized medicine there is no incentive to improve.

Utterly assinine.

The state has about as much incentive to not waste money it doesn't have to as an individual person does. Furthermore, in an privatized market those same 20 dollar prevention methods can often be price hiked to maximize profits.

Huh? Congressmen aren't paid on how much they save a tax payer, and many cases they are incentivized to become very inefficient. A CEO gets paid on how well he/she can drive down costs to improve performance.

 

[none]

Um performance? Didn't even mention profits

 

[Cheerful Charlie]

I read that your hospitals treat people who can't pay and that this falls onto the tax payer. Is that true? If so, then doesn't this bump up the draw on the tax system and lead to higher taxes? Its like medicare for all, but everybody goes bankrupt first, yes? It seems like a weird mix of socialism and capitalism; enriching insurance companies at the expense of the taxpayer.

Emergency care will take care of emergencies, but little more. It does not mean if you turn up at the local emergency room with pain that turns out to be cancer, that you get free cancer care. You may get pain medications and a referral to a doctor.

Here in Houston, we have the Harris County Health System that picks up from there, offering help on a sliding scale for uninsured or indigent patients referred from the Emergency Room.

Thanks to the incompetence of our state government, this system has it's had funding cut and is now $85 million in debt.
Texas also did not set up a AHCA exchange to help low income persons afford insurance.

But no, emergency room health care does not in any way substitute for comprehensive health care. Here in Harris County, we actually had one of the best health support systems for poor patients, many who had pre-existing conditions and no hope pf getting insurance pre-ACA. Partly because we have the amazing Houston Medical Center, one of the world's best medical centers that offers a lot of amazing expertise for many through Harris Health.