The Reverse Mandate of the Senate Bill

jaeger19 · Jul 17, 2017

Helix said:
only during the stimulus was my COBRA even close to affordable while on unemployment (i think the cost in 2009 was $247 a month.) last time, it was a grand a month, and even when i got my new job, i had to wait an extra month for coverage. before you ask, i lost my job because my boss lost his grant.

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Sure.. but that's not that hard a fix. The affordability will get fixed when you are able to stay on your plan. Your Cobra was extremely expensive in part because your employer was purchasing your healthcare prior to your losing your job.. and the insurance companies could gouge the employer way more. thus when you lost your job.. your cobra was way more expensive. If you had been on an individual plan prior.. as most people should be.. then the cost of insurance would not have been that high.

When Obamacare was being bandied about.. we looks at what it would cost for us to ditch healthcare insurance for our employees.. and what it would cost if each and other one of them bought an individual policy. As individuals.. the cost of their healthcare insurance.. would be 1/3 but it cost me as an employer.. for the same coverage.

And that's because 1. the insurance company knows that I can afford more and that my workers expect good healthcare insurance from me.. so the insurance company can jack my prices up. 2. The insurance companies states that they have more unknowns.. which probably is a point.

but for example.. my ton of my employees are getting coverage as if their spouse is primary.. but.. their spouse is actually secondary because they have coverage through their work. but I pay as if they are on my policy as if they are primary.
Since they COULD be primary on my policy.

some outcomes are better here. however, we pay a LOT more, and access to that level of care is situational.

And access is situational there as well. Our outcomes tend to be better as well as timeliness of care etc. And if you want costs to go down.l. hang onto your butt when the economy crashes.

Helix · Jul 17, 2017

jaeger19 said:
Well.. you have to recognize what you are seeing. You are seeing percentage of GDP. which is basically your income. So.. as our population has aged.. you see more GDP growth in this sector. Also as companies outsource, move overseas etc, or simply stop production in the US.. a greater percentage of GDP will come from healthcare which can't outsource.

Lets say you were running a company that had multiple division. healthcare division, computers/cell phone division, clothing manufacture, and agriculture. Over the years.. you have lost marketshare in computers/cell phones, and clothing manufacture as competitors have taken marketshare... but you are still making profit in these division but not as much as before.. your healthcare division has been going gangbusters and producing a larger portion of your income than before.. and agriculture has made slow steady gains.

Would you decide.. gosh.. healthcare is producing a greater percentage of my income.. I better cut it.? would that make sense?

the system can't bear the rising costs forever. we need a more sustainable system that's more similar to the rest of the first world. it's not like every other country that isn't paying out the nose for health care has a horrible economy. it's often quite the opposite.

jaeger19 said:
If you want to hurt the economy.. increase the inequity between the middle class and poor and the rich... then we have to bring those costs down. But bringing those costs down will hurt the wages of the poor and middle class.

i don't see people starving on the streets in other first world countries due to not overpaying for health care.

jaeger19 said:
Absolutely.. but understand what is working and what isn;t working. Your solution of single payer would make things worse.

though single payer is my preference and makes the most sense, i'd consider supporting a custom fit solution based on the best parts of other health care systems that are working more efficiently than ours.

Helix · Jul 17, 2017

jaeger19 said:
Sure.. but that's not that hard a fix. The affordability will get fixed when you are able to stay on your plan. Your Cobra was extremely expensive in part because your employer was purchasing your healthcare prior to your losing your job.. and the insurance companies could gouge the employer way more. thus when you lost your job.. your cobra was way more expensive. If you had been on an individual plan prior.. as most people should be.. then the cost of insurance would not have been that high.

COBRA is a good idea on paper, but in practice, it's just not feasible for many people.

jaeger19 said:
When Obamacare was being bandied about.. we looks at what it would cost for us to ditch healthcare insurance for our employees.. and what it would cost if each and other one of them bought an individual policy. As individuals.. the cost of their healthcare insurance.. would be 1/3 but it cost me as an employer.. for the same coverage.

And that's because 1. the insurance company knows that I can afford more and that my workers expect good healthcare insurance from me.. so the insurance company can jack my prices up. 2. The insurance companies states that they have more unknowns.. which probably is a point.

but for example.. my ton of my employees are getting coverage as if their spouse is primary.. but.. their spouse is actually secondary because they have coverage through their work. but I pay as if they are on my policy as if they are primary.
Since they COULD be primary on my policy.

i just don't see a good reason to link access to healthcare to specific employment at all. how many potential entrepreneurs have just stayed at their jobs instead of starting a new business because they couldn't afford to lose their health care? seems like that alone would be a real drag on the economy, and it can certainly be a drag on both employers and employees. when you leave a job for whatever reason, you haven't just lost a paycheck; you've often lost your access point to the entire health care system unless you're able to pay exorbitant COBRA prices.

jaeger19 said:
And access is situational there as well. Our outcomes tend to be better as well as timeliness of care etc. And if you want costs to go down.l. hang onto your butt when the economy crashes.

we pay twice as much for similar results in most cases. other countries have found a balance. we can, too.

jaeger19 · Jul 17, 2017

Helix said:
the system can't bear the rising costs forever. we need a more sustainable system that's more similar to the rest of the first world. it's not like every other country that isn't paying out the nose for health care has a horrible economy. it's often quite the opposite.
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Sure it can.. it fact its a good thing Helix. Those costs feed right back into the community. All those non profit hospitals providing care that PEOPLE NEED.. and why? because for now our population is getting older and sicker. And we have probably the strongest economy in the world Helix.. and we are so wealthy as a nation that our poor basically live at a level that in most countries is considered middle class.

However, look at it a little more closely in relation to other countries. We're often told that to be poor in the US is much worse than being poor in the social democracies of Europe. And the bottom 10% in the US are indeed worse off than the bottom 10% in Sweden. But they're better off than the bottom 10% in Germany or France: places where we are told that there is indeed that social democracy

https://www.forbes.com/sites/timworstall/2013/06/01/astonishing-numbers-americas-poor-still-live-better-than-most-of-the-rest-of-humanity/#2d5dfd9d54ef

So what do you think happens when you tear all those salaries out of people who are x ray techs, nurses, therapists, social workers, billing specialists,.. not to mention the construction guys building hospitals and outpatient clinic so on and so forth. Go out in your community and see who is building and for what.. a lot of medical buildings are being built.

i

don't see people starving on the streets in other first world countries due to not overpaying for health care.

And our bottom 10% are considered middle class in most European countries.

though single payer is my preference and makes the most sense, i'd consider supporting a custom fit solution based on the best parts of other health care systems that are working more efficiently than ours.

single payer makes little to no sense.

jaeger19 · Jul 17, 2017

Helix said:
COBRA is a good idea on paper, but in practice, it's just not feasible for many people.

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Because its based on what the employer pays for healthcare insurance which is an inflated price for the reasons listed by me.

i

just don't see a good reason to link access to healthcare to specific employment at all

I agree.. as I already posted. That's why it makes more sense for individuals to purchase their own healthcare.. and allow their employer to help pay in toward it. Then the policy is the individuals and goes with them when they change jobs or if they decide to go out on their own and start a business.

we pay twice as much for similar results in most cases. other countries have found a balance. we can, too.

Honestly. this gets tiresome.. yes.. we pay more. You don't want to deal with the reasons why.. you want to ignore that we do because our economy is different. Our cultures are different. These countries insurance COVERS LESS THAN WE DO.

Sure.. we can strike "a balance" like other countries using single payer. . .. if you want a smaller economy,, more out of work people, Less healthcare coverage for the majority of americans, more inequity, and less timeliness of care.

Helix · Jul 17, 2017

jaeger19 said:
Sure it can.. it fact its a good thing Helix. Those costs feed right back into the community. All those non profit hospitals providing care that PEOPLE NEED.. and why? because for now our population is getting older and sicker. And we have probably the strongest economy in the world Helix.. and we are so wealthy as a nation that our poor basically live at a level that in most countries is considered middle class.

and our system of granting access to health care needs serious work. i could lose my job, get sick, and go broke if i don't COBRA.

jaeger19 said:
https://www.forbes.com/sites/timworstall/2013/06/01/astonishing-numbers-americas-poor-still-live-better-than-most-of-the-rest-of-humanity/#2d5dfd9d54ef

So what do you think happens when you tear all those salaries out of people who are x ray techs, nurses, therapists, social workers, billing specialists,.. not to mention the construction guys building hospitals and outpatient clinic so on and so forth. Go out in your community and see who is building and for what.. a lot of medical buildings are being built.

other first world countries are doing fine without significantly overpaying for health care. we'll do fine, as well.

jaeger19 said:
And our bottom 10% are considered middle class in most European countries.

single payer makes little to no sense.

tying access to health care to specific employment makes no sense. what's our compromise position here?

Helix · Jul 17, 2017

jaeger19 said:
Because its based on what the employer pays for healthcare insurance which is an inflated price for the reasons listed by me.

I agree.. as I already posted. That's why it makes more sense for individuals to purchase their own healthcare.. and allow their employer to help pay in toward it. Then the policy is the individuals and goes with them when they change jobs or if they decide to go out on their own and start a business.

so if my job is cut, who covers my employer's part?

jaeger19 said:
Honestly. this gets tiresome.. yes.. we pay more. You don't want to deal with the reasons why.. you want to ignore that we do because our economy is different. Our cultures are different. These countries insurance COVERS LESS THAN WE DO.

which plan? and yeah, it's getting tiresome. as i've pointed out before, American employer provided plans run the gambit from useless to awesome.

jaeger19 said:
Sure.. we can strike "a balance" like other countries using single payer. . .. if you want a smaller economy,, more out of work people, Less healthcare coverage for the majority of americans, more inequity, and less timeliness of care.

i don't agree with your overview. also, this same argument can be used to argue against replacing workers with technology. countries with more efficient healthcare systems still manage to have decent economies, and most of them don't take health care coverage away when someone is downsized by his or her employer.

jaeger19 · Jul 18, 2017

Helix said:
and our system of granting access to health care needs serious work. i could lose my job, get sick, and go broke if i don't COBRA.

Yep.. like I already stated and gave a solution.

other first world countries are doing fine without significantly overpaying for health care. we'll do fine, as well.

If you define "doing fine" as their lower 10% doing significantly worse than our poorest 10%..

tying access to health care to specific employment makes no sense. what's our compromise position here?

I already presented a solution that does not tie healthcare insurance to specific employment.

jaeger19 · Jul 18, 2017

Helix said:
so if my job is cut, who covers my employer's part?

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Your unemployment insurance. With prices being lower.. you will be able to afford it. and in the system..

but its a good point. The unemployment pay should be based on not only your take home salary.. but also what your employer is giving to your HSA.

which plan? and yeah, it's getting tiresome. as i've pointed out before, American employer provided plans run the gambit from useless to awesome.

Just about any. Medicaid, Medicare.. even the VA cover more than most single payer plans in other countries. All healthcare insurance companies cover more than single payer in most countries. Especially when you consider essential health benefits under Obamacare.

i don't agree with your overview

Of course.. and that's because you don't want to listen to facts and reality. Face it.. you have never even really considered the economic impact of hurting 18% of GDP and what that would do.

also, this same argument can be used to argue against replacing workers with technology

Well.. would you not argue against the government mandating that companies replace 30% of their workforce with technology?
Maybe you would agree with the right wing that the government should stop being a major employer.. Government spending accounts for about 36% of GDP. If you think healthcare spending is unsustainable ..; you must hate government spending. So would you agree with the right wing that we should cut government spending down to 15%?

Germany;s government spending accounts for 19.7% of GDP.. so lets cut cut cut... and no effects on the economy in the US right? Because Germany can do it and no one is "starving in the streets".

Helix · Jul 18, 2017

jaeger19 said:
Yep.. like I already stated and gave a solution.

If you define "doing fine" as their lower 10% doing significantly worse than our poorest 10%..

I already presented a solution that does not tie healthcare insurance to specific employment.

i don't agree that it's a feasible solution. private individual plans, especially if you don't put everyone in the same pool, are going to have high deductibles and high premiums.

Helix · Jul 18, 2017

jaeger19 said:
Your unemployment insurance. With prices being lower.. you will be able to afford it. and in the system..

but its a good point. The unemployment pay should be based on not only your take home salary.. but also what your employer is giving to your HSA.

HSAs don't solve the problem of prohibitively high access costs. most people will just avoid treatment until it's unavoidable.

jaeger19 said:
Just about any. Medicaid, Medicare.. even the VA cover more than most single payer plans in other countries. All healthcare insurance companies cover more than single payer in most countries. Especially when you consider essential health benefits under Obamacare.

Medicaid is pretty good in most states. employer specific plans, which most people have, range from awesome to nearly useless.

jaeger19 said:
Of course.. and that's because you don't want to listen to facts and reality. Face it.. you have never even really considered the economic impact of hurting 18% of GDP and what that would do.

like i said, other first world countries are not overpaying for healthcare, and their economies and quality of life are pretty good.

jaeger19 said:
Well.. would you not argue against the government mandating that companies replace 30% of their workforce with technology?
Maybe you would agree with the right wing that the government should stop being a major employer.. Government spending accounts for about 36% of GDP. If you think healthcare spending is unsustainable ..; you must hate government spending. So would you agree with the right wing that we should cut government spending down to 15%?

as we eliminate sectors of our economy with technology, our choice is eventually going to be to use the public sector to keep people working or to have a guaranteed wage. it's pretty much pay people to work or pay them not to. which would you prefer?

jaeger19 said:
Germany;s government spending accounts for 19.7% of GDP.. so lets cut cut cut... and no effects on the economy in the US right? Because Germany can do it and no one is "starving in the streets".

what's your opinion of Germany's health care system? i haven't studied that one as closely.

https://en.wikipedia.org/wiki/Healthcare_in_Germany

jaeger19 · Jul 19, 2017

Helix said:
HSAs don't solve the problem of prohibitively high access costs. most people will just avoid treatment until it's unavoidable.

]

Actually they do if done right. and that's because individuals all buying what insurance they need and being able to hop insurances creates more competition and lowers prices by making the insurance companies beholden to their customers using the insurance rather than a corporation that buys it for them.

Medicaid is pretty good in most states. employer specific plans, which most people have, range from awesome to nearly useless.

Medicaid is generally regarded as THE WORST insurance that you can have. (other than perhaps the VA). It has the most barriers to care.. and much fewer providers that accept it. And its still better than Canada.

Employer based plans are in general way better than Medicaid and especially after the ACA with its requirements

like i said, other first world countries are not overpaying for healthcare, and their economies and quality of life are pretty good. .

very true,.,.IF and you mean by pretty good that their middle class lives at or close the level of our lower 10%. that's for most European countries.

as we eliminate sectors of our economy with technology, our choice is eventually going to be to use the public sector to keep people working or to have a guaranteed wage. it's pretty much pay people to work or pay them not to. which would you prefer

?

OR.. we experience growth in sectors of our economy where we have lots of demand (aging people) and where technology actually INCREASES the number of people working.. not decreases it. And coincidently pays a better wage.

Why do you want to hurt this sector of our economy?

As far as Germany. When I was there recently I saw two systems. A private one for the wealthy and upper middle class.. and a public one for everyone else. What I saw.. the public system did not provide the care that our system provides on average.. while the private system did.
It appeared to me that the access to seeing a GP was better than ours.. much like in other single payer countries and that's a good thing we should adopt.

However you cannot separate out the German system or any of the systems really without considering things like the Size of Germany and its rural vs urban areas, compared with the US rural vs urban areas. You cannot separate out their other systems for retirement, and safety nets and demographics..and how that affects their health.

Helix · Jul 19, 2017

jaeger19 said:
Actually they do if done right. and that's because individuals all buying what insurance they need and being able to hop insurances creates more competition and lowers prices by making the insurance companies beholden to their customers using the insurance rather than a corporation that buys it for them.

Medicaid is generally regarded as THE WORST insurance that you can have. (other than perhaps the VA). It has the most barriers to care.. and much fewer providers that accept it. And its still better than Canada.

Employer based plans are in general way better than Medicaid and especially after the ACA with its requirements

very true,.,.IF and you mean by pretty good that their middle class lives at or close the level of our lower 10%. that's for most European countries.

?

OR.. we experience growth in sectors of our economy where we have lots of demand (aging people) and where technology actually INCREASES the number of people working.. not decreases it. And coincidently pays a better wage.

Why do you want to hurt this sector of our economy?

Please. That would be like me asking you why you want to bankrupt hard working Americans just because they had the misfortune of getting sick while having substandard insurance. I know that you don't want that. I think that we both want to fix our health care system. We just disagree about the best way to do it.

Anyway, we'll probably have to table this discussion. I'm getting ready to travel overseas, and quote farming on a phone or tablet is cumbersome at best.

jaeger19 · Jul 19, 2017

Helix said:
Please. That would be like me asking you why you want to bankrupt hard working Americans just because they had the misfortune of getting sick while having substandard insurance. I know that you don't want that. I think that we both want to fix our health care system. We just disagree about the best way to do it.

Anyway, we'll probably have to table this discussion. I'm getting ready to travel overseas, and quote farming on a phone or tablet is cumbersome at best.

First it would not be like" asking you why you want to bankrupt hard working Americans just because they had the misfortune of getting sick while having substandard insurance.".

The reason is that hard working americans by and large are not going bankrupt because of substandard insurance and medical bills. Studies show that medical bills are only a small portion of the overall debt that people in bankruptcy declare. Studies that compare Canada with single payer and the US and bankruptcy during periods where its an apple to apple comparison (similar rules and similar economic times) fine that Canada has a similar rate of medical bankruptcy as the US.

Medical bills are not what push people into medical bankruptcy. That's largely a myth. FAce it.. why would any hospital EVER want to push someone into bankruptcy and guarantee that they don't get paid? It would make no sense. and that's why counties pay for indigent care.. facilities right off large amounts as free care.. hospitals bend over backwards with payment plans etc.

Its not large medical bills that create bankruptcy when you get sick.. its the LOSS OF INCOME that is associated with being sick that causes bankruptcy. That's why bankruptcy for medical reasons happens in Canada and other countries.

And single payer didn;t fix it there nor will it fix it here, since its not the cause.

Have fun on your overseas trip.. and be safe,