I don't get why Obama doesn't Just Say it.

[JoeTheJuggler]

I believe that in many European countries the education to become a Doctor is paid for by the State, or at least much cheaper than in the USA. People in the USA are going to think twice about becoming a doctor if they are forced to take pay cuts from current levels and still be saddled with $100,000+ college loans.

Just cutting paychecks without balancing the rest of the system won't work.

I agree. It's really messed up when a new M.D. starts his or her career saddled with a quarter or a half million dollars of debt.

 

[Lurker]

I believe that in many European countries the education to become a Doctor is paid for by the State, or at least much cheaper than in the USA. People in the USA are going to think twice about becoming a doctor if they are forced to take pay cuts from current levels and still be saddled with $100,000+ college loans.

Just cutting paychecks without balancing the rest of the system won't work.

You'll get no disagreement from me. Perhaps government should allow the med schools to open their doors a bit wider to accomodate the increase in demand they will see if UHC passes.

 

[makaya325]

Perhaps our government should have the Higher class pay more taxes to the poor than the Middle class should.

 

[KoihimeNakamura]

No, makaya. Simple solutions like that aren't.

 

[makaya325]

Why do you say that? In your opinion, would my suggestion be a good or bad idea?

 

[Newtons Bit]

You'll get no disagreement from me. Perhaps government should allow the med schools to open their doors a bit wider to accomodate the increase in demand they will see if UHC passes.

I think the doctors themselves, through the AMA, limit the number of people who are allowed to attend medical school, not the government. This is one of the many things that one would hope a health-care reform bill would address.

 

[Lurker]

I think the doctors themselves, through the AMA, limit the number of people who are allowed to attend medical school, not the government. This is one of the many things that one would hope a health-care reform bill would address.

Agreed.

 

[WildCat]

Because people who pay the fine and pay a premium are contributing more money than they'd have to. (You suggested that they can remain uninsured--i.e. pay the fine--but then when they get sick, buy insurance--i.e. pay a premium.)

But if healthy people choose to pay the fine rather than the premium the pool of people paying premiums gets less healthy, and thus more expensive, and less money is coming in.

Which of course is quite a bit higher than the $250 cap you incorrectly said was in the bill.

Yes it is, we're beyond that. I understand the maximum penalty is 2.5% of adjusted income, with an absolute upper limit of the average national insurance premium. You can stop harping on this point now, OK? Note I've been using the $1,250 example for a while now.

So now where are you getting the $5500 premium from?

For the second time now: http://cboblog.cbo.gov/?p=363

Under current law, average premiums for employment-based coverage, the primary source of health insurance for the non-elderly population, are expected to be about $7,500 for a single policy and about $19,000 for a family policy in 2016; average premiums for non-group coverage in 2016 are projected to be about $6,000 for individuals and about $11,000 for family coverage.

 

[WildCat]

You'll get no disagreement from me. Perhaps government should allow the med schools to open their doors a bit wider to accomodate the increase in demand they will see if UHC passes.

It's not the government that decides how many medical schools there are, it's the AMA.

And their interest is keeping doctor numbers down and salaries up. Thus, relatively few and expensive medical schools.

 

[JoeTheJuggler]

But if healthy people choose to pay the fine rather than the premium the pool of people paying premiums gets less healthy, and thus more expensive, and less money is coming in.

I understand that, but I don't agree that the numbers provide an incentive to pay the fine and go uninsured. (Paying the fine does not give you insurance.)

However, you suggested someone could game the system by going uninsured (paying the fine) and then when they get sick buying insurance. If they do that, they don't get the fine back. And they've still got to pay the doctor bills they accrued while they were uninsured. (Money you're not counting.)

For the second time now: http://cboblog.cbo.gov/?p=363

So you're comparing premiums plus "cost-sharing payments" (that is, co-pays) with the fine but not comparing it with the fine plus medical bills.

Again, the way I read this, the fine is just a fine and does not give you any health insurance coverage.

By the way, did you read that last paragraph? Here's a couple of key sentences from it:

Making appropriate comparisons is difficult, however, because insurance premiums can vary under current law—and thus can differ from premiums under a proposal—for many reasons—some of which would tend to make exchange premiums higher than current-law premiums and some of which would tend to make them lower. Differences could be affected by the extent of the coverage that is provided; the rates and methods used to pay providers of health care; the quantity and intensity of services provided; the insurers’ administrative costs; state regulations; the employment status of those insured and employers’ decisions about offering coverage; and the underlying health of the enrollee pool.
<snip>
In light of those complexities, quantifying the net effects of the Chairman’s proposal on the amounts paid by individuals and families to obtain health care is very difficult. CBO has not modeled all of those factors and cannot quantify them or calculate the net effects at this time.

 

[JoeTheJuggler]

Also, you were citing from the section "Comparisons with Arrangements Under Current Law"--projections of premiums in 2016 if the current system continues. That was meant for comparison to the projections of costs under the proposed reform plan.

This is from the section "Subsidies and Payments under the Proposal":

According to the estimate by CBO and JCT, the average premiums for a low-cost “silver” plan for an individual in 2016 would be less than the 13.9 percent cap on premiums as a share of income that would apply in that year for single people with income above roughly 300 percent of the FPL—so no subsidy would be projected for those with income higher than that amount. Our analysis also indicates that families with income equal to 400 percent of the FPL would probably receive some subsidy because the expected family premiums in 2016 would exceed 13.9 percent of their income (about $96,000 in 2016).

The way I read this, the subsidies are dependent on the the premiums otherwise available, thus guaranteeing an incentive to get insured.

 

[WildCat]

However, you suggested someone could game the system by going uninsured (paying the fine) and then when they get sick buying insurance. If they do that, they don't get the fine back.

They never have to pay it in the first place, because the tax penalty is prorated:

‘‘(2) PRORATION FOR PART YEAR FAILURES.—

The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as— ‘‘(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to ‘‘(B) the entire taxable year.

So if you buy insurance in July, your penalty is 2.5% of your income accrued until the insurance was purchased in July.

And they've still got to pay the doctor bills they accrued while they were uninsured. (Money you're not counting.)

What doctor bills? All you need is a diagnosis, then you can forgo treatment for a few minutes while you sign up for an insurance plan. The rest is paid by the insurance company, and they can't refuse.

Again, the way I read this, the fine is just a fine and does not give you any health insurance coverage.

Nope, but there's no need to as explained above.

By the way, did you read that last paragraph? Here's a couple of key sentences from it:

Yep. I interpret it as "expect higher rates".

 

[WildCat]

The way I read this, the subsidies are dependent on the the premiums otherwise available, thus guaranteeing an incentive to get insured.

Seems to me they're just pointing out that subsidies will increase as premiums rise (assuming they rise faster than income).

I don't see how this is an incentive to buy insurance, unless your income is low enough to where the subsidy equals or exceeds the fine.

 

[McHrozni]

Of course the economies are not 1:1 either. Neither is the cost to get those medical degrees. Yes, doctor salaries in the US may have to come down.

Glad you agree. Obviously, it will be problematic to sell such problems to US doctors, correct?

It is not my contention that we can or should be paying what Spain is paying per person for health care. I submit the numbers not pretending to know the answers to the many questions they bring up. But the national debate about health care currently ignores what is going on abroad and they should definitely be examining it and asking these questions.

You certainly shouldn't focus on only one aspect. Yes, certainly, US is paying a whole lot more. That's one aspect. I have presented a few others, which also shouldn't be exactly dismissed.

LOL. You don't think there are questionable results about the US system? As many go bankrupt due to medical bills and many die due to not being able to afford treatment for cancer?

One of the possible effects could be that the costs per person will decrease marginally, but the quality of care will drop substantially. That would be a bad thing, even if it were temporary, for a few years, agreed?

Do we get what we pay for? We pay over twice what many other countries pay, do we get twice better results? I think not.

No, that's too difficult to measure.

Of all the foreigners I have talked to that currently live in the US, not a single one prefers the US health care system. These are co-workers of mine.

Not exactly a representative sample. It's not so much a question of what you perfer, but what the individual results are. To say the US system is only more expensive for no result is not true.

McHrozni

 

[Bob Blaylock]

Ah, you also believe that these programs are unconsitutional, right?

Unemployment Insurance
Social Security
Medicare..

Yes, absolutely. Nowhere does the Constitution contain any language authorizing the federal government to operate these programs, therefore, per the Tenth Amendment, the federal government has no such authority.

 

[gambling_cruiser]

Here in Vienna, I pay 3.95% of my income for health care insurance.
How much do you US guys/gals pay?

 

[McHrozni]

Here in Vienna, I pay 3.95% of my income for health care insurance.
How much do you US guys/gals pay?

Juding from a nice stick graph on Wikipedia, they pay about 50% more than you. Healthcare spending in Austra is about 10% of GDP, and about 15% in USA.

This is interesting, also from Wikipedia:
Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories (diagnostic laboratory services, pharmacies, medical device manufacturers, etc.)

Which of these categories would be inherently reduced with a single payer system?

McHrozni

 

[eeyore1954]

Are a great deal of the people who will be leaving the ranks of the uninsured according to this bill the same people who choose to be uninsured now because but will be forced to buy insurance under the bill (or pay a penalty)?

 

[eeyore1954]

I agree with the idea that it is a moral imperative to cover everyone even if we have to pay more for it. I am willing to pay more.

However, there is a fly in the ointment here:

Total spending on health care, per person, 2007
United States: $7290
United Kingdom: $2992
Italy: $2686
Spain: $2671
Japan: $2581 (2006)


If we went to a single payer system like they have overseas, is it unreasonable to think we might pay less consider the statistics above?

I am wondering what is the average earnings in each of these countries and how much is spent on end of life care.

 

[Lurker]

Glad you agree. Obviously, it will be problematic to sell such problems to US doctors, correct?

I think it is of only minor relevance to sell the plan to doctors. I'm not sure we should be catering to the needs of the few here.

One of the possible effects could be that the costs per person will decrease marginally, but the quality of care will drop substantially. That would be a bad thing, even if it were temporary, for a few years, agreed?

Quality will drop? Why would you think that?

Not exactly a representative sample. It's not so much a question of what you perfer, but what the individual results are. To say the US system is only more expensive for no result is not true.

Your opinion is noted. I would say that we pay 2x to 3x as much as other modern industrialized nations and receive marginal returns.