House COVID relief package supercharges ACA premium support

[Logician Man]

The same damn Democratic lies as last time. It's just another income tax while wrecking healthcare.

How so? Details and links. Or are you simply posting your 'personal opinion'?

 

[joko104]

Have you noticed that whenever politicians talk about healthcare, they actually never talk about healthcare at all. They ONLY talk about MONEY - and argue over how much and from where are they going to get the astronomical sums of money - 1/4th of the entire economy - and then argue over who gets the money. Without a doubt the government itself will take a HUGE cut for itself. Actual healthcare itself is never part of that discussion. It is singularly about money.

This is why we are self pay. We can afford to be self pay, even if major. We do not want our healthcare determined by an insurance company's negotiations with our doctors. We want the doctor singularly focused on our health, not where is s/he going to get his/her money from and will the 3rd party insurance company pay for it? Yet money seems now to dominate the topic of healthcare - rather than healthcare dominating the topic of healthcare.

Whether you have insurance or not, whether you can pay or not, generally healthcare is reducing in quality and availability. Having the government being the final say for virtually all healthcare decisions will NOT improve healthcare. It will be a nightmare in which patients are just endless herds of cattle to be managed economically and accepting that no one lives forever.

 

[Logician Man]

Have you noticed that whenever politicians talk about healthcare, they actually never talk about healthcare at all. They ONLY talk about MONEY - and argue over how much and and from where are they going to get them money - and then argue over who gets the money. Actually healthcare itself is never part of that discussion. It is singularly about money.

This is why we are self pay. We can afford to be self pay, even if major. We do not want our healthcare determined by an insurance company's negotiations with our doctors. We want the doctor singularly focused on our health, not where is s/he going to get his/her money from and will the 3rd party insurance company pay for it? Yet money seems now to dominate the topic of healthcare - rather than healthcare dominating the topic of healthcare.

Whether you have insurance or not, whether you can pay or not, generally healthcare is reducing in quality and availability. Having the government being the final say for virtually all healthcare decisions will NOT improve healthcare. It will be a nightmare in which patients are just endless herds of cattle to be managed economically.

Awfully damned difficult to discuss health care for Americans without discussing 'money.'

 

[joko104]

For example, from what I see nothing will make more doctors, specialists and other skilled medical personnel. With enough of those, no healthcare system can work correctly and it becomes necessary to treat people like a vet going thru the next day's herd of cattle. They is nothing else they can do if there is personnel shortage. How many patients can a doctor see per hour after hour every day? How much time does that leave for actual doctoring?

 

[MaryP]

Decreasing premiums is great. Now if they can do something about $3,000 deductibles, people can really afford to go to the doctor!

 

[Logician Man]

For example, from what I see nothing will make more doctors, specialists and other skilled medical personnel. With enough of those, no healthcare system can work correctly and it becomes necessary to treat people like a vet going thru the next day's herd of cattle. They is nothing else they can do if there is personnel shortage. How many patients can a doctor see per hour after hour every day? How much time does that leave for actual doctoring?

"Seeing patients" IS " actual doctoring."

 

[aociswundumho]

Single-Payer solves that problem:
"...Divorcing capital from operating budgets eliminates the ongoing pressure to reap future capital growth by limiting reimbursement to clinicians. Capital, operating, and educational budgets would be nationally funded, regionally administered, and nonfungible. Applying national planning to regional budgeting would right-size capacity."

Theoretically it solves the problem, but it will not solve the problem in the US healthcare market because it is not politically possible to cut the salaries of doctors, nurses, or even CNAs.

Again, the progessive states of California and Vermont already have the power to "limit reimbursement to clinicians", but they won't. Not now, not ever. If you can't even do it at the state level, why do you think you can do it at the federal level, where special interest groups have even more influence?

 

[Wayne Jr]

Theoretically it solves the problem, but it will not solve the problem in the US healthcare market because it is not politically possible to cut the salaries of doctors, nurses, or even CNAs.

Salaries aren't what needs to be cut. The cost of drugs are what needs to be cut.

 

[JasperL]

What do you want them to do? The problem with healthcare in the US is the sky-high prices caused entirely by government intervention. It's not politically possible for anyone to fix the problem.

I don't want them to do anything. If the GOP just stay out of the way, that's all we can ask.

And it's weird that in countries with more government intervention than here - pretty much everywhere - prices are FAR LOWER than here. How do you explain that if government both causes high prices and prices in many places half what we pay.

 

[aociswundumho]

Salaries aren't what needs to be cut. The cost of drugs are what needs to be cut.

1. Why did you post a paragraph about the ability of a single payer system to reduce "reimbursement to clinicians" and now state that salaries don't need to be cut?

2. Drugs are only about 10% of healthcare spending. Reducing drug prices will not even make a dent in problem.

FastStats

FastStats is an official application from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) and puts access to topic-specific statistics at your fingertips.

www.cdc.gov

 

[JasperL]

Theoretically it solves the problem, but it will not solve the problem in the US healthcare market because it is not politically possible to cut the salaries of doctors, nurses, or even CNAs.

Again, the progessive states of California and Vermont already have the power to "limit reimbursement to clinicians", but they won't. Not now, not ever. If you can't even do it at the state level, why do you think you can do it at the federal level, where special interest groups have even more influence?

If you're looked at it at all, you know there are huge logistical problems doing 'single payer' on a state by state basis.

 

[aociswundumho]

I don't want them to do anything. If the GOP just stay out of the way, that's all we can ask.

And it's weird that in countries with more government intervention than here - pretty much everywhere - prices are FAR LOWER than here. How do you explain that if government both causes high prices and prices in many places half what we pay.

1. Stupid, corrupt, government can intervene in different ways, which yields different outcomes.

2. Someone who dies on a waiting list, or simply isn't treated, doesn't cost the government anything. Also, you'll notice all of the countries with single payer all offer private insurance. Why would anyone need to pay for private health insurance in a country with free healthcare?

 

[aociswundumho]

If you're looked at it at all, you know there are huge logistical problems doing 'single payer' on a state by state basis.

That's funny, because neither Vermont nor California cited "logistical problems" as the reason they didn't pass single payer. The reason it failed in both cases was because the tax increases necessary to fund it were so high they even made progressives sick.

 

[JasperL]

1. Stupid, corrupt, government can intervene in different ways, which yields different outcomes.

So government intervention doesn't cause high prices, since big government can and does result in prices half the costs here. In other words, if we change government policies, we can lower prices, because it's been done all over the world, literally. But you don't have any ideas how to change government policies, which makes your ideas as worthless as those of the GOP. Any moron can throw rocks and bitch and whine about how someone else did a job. It is only meaningful if your ideas are better or you can do the job better. This seems obvious to me.

If you bitch about how your wife or girlfriend cooks dinner, and are useless if she hands you the frying pan, then who cares what you think? The GOP and right wing on healthcare is like that asshole at the dinner table bitching at his wife for cooking it all wrong, but is incompetent to do the job better. It's just noise.

2. Someone who dies on a waiting list, or simply isn't treated, doesn't cost the government anything. Also, you'll notice all of the countries with single payer all offer private insurance. Why would anyone need to pay for private health insurance in a country with free healthcare?

Sure, and if you're uninsured in this country, you don't get on a waiting list at all, because you can't afford treatment.

The bottom line is healthcare is a scarce resource and it's rationed, like all other scarce resources. So the question is how best to 'ration' care. It's not whether to ration, since providing 100% of the population 100% of the care they might want isn't possible. Whatever insurance you have 'rations' care. Some things it won't cover and it limits payments for nearly everything. That's the same in every country. Medicare doesn't pay 100% of anything any person wants.

So when you bring up dumb talking points about 'waiting lists' you're not really saying anything. First of all, the assertion that all countries with UHC have long waiting lists is simply false, a lie. Some have longer waiting lists for some things than the U.S. and some don't. It varies by country. Second, again, if you want to compare waiting lists you have to account for the uninsured in this country who simply won't ever get surgery for e.g. a torn ACL, etc. because they can't afford it and the ER/ED won't provide it. So they live in pain and never get on a list for ACL surgery. Well, when you say to 40 million - you can't get this, ever, that shortens the wait lists, since 40 million cannot get on the list, ever. Or, you could say they stay on the 'wait list' forever. Add the uninsured and compare that wait list to e.g. France and you're comparing apples to apples. If not, let France cut its list by some huge number because they don't let the poor on it at all, and you've got another apples to apples comp.

 

[JasperL]

That's funny, because neither Vermont nor California cited "logistical problems" as the reason they didn't pass single payer. The reason it failed in both cases was because the tax increases necessary to fund it were so high they even made progressives sick.

For the record, I've never supported "single payer" as an option and that's part of the reason. If we'd started with that decades ago, we'd have adjusted to paying for healthcare through taxes versus insurance premiums. Doing it now is a shock, even if overall the change is a wash. Those changes to single payer will have lots of winners and losers, even if on 'average' there's no change in costs. It's worse if only one or a few states impose the high taxes on individuals and companies. The losers from those high taxes, whose taxes are higher than what they're now paying in premiums, have a big incentive to leave or avoid CA. If it's nationwide the problem is far less.

I also don't really believe the taxes should be limited to income taxes. If you fund broad based benefits, the taxes are appropriately in my view broad based taxes. It's why in part that Europe and many other places have high VAT or consumption taxes - to fund things like UHC, and I'm fine with using consumption taxes to do that. Everyone pays part of the cost, and everyone gets a benefit. But, again, there are serious competitive issues when a VAT or RST is 20% in CA, and only 8% in Nevada.

And the promise is lower costs, because a single payer can drive down those costs. But in a national economy and national healthcare system, it's incredibly difficult to have one hospital getting paid $400 for X and across the road or across the state line a different hospital is getting paid $650 or $1,200 for X. Same thing for doctors. My brother is a doctor in CA. He's paid a bit less than he could make elsewhere, but it's in the ballpark. If we really controlled costs, maybe his pay is half what it is now. Well, if he can make 100X in CA and 200X in Washington state, that's a pretty big incentive to leave CA for Washington.

Anyway, the only possible way we'll get "single payer" is if it's done nationally, and I don't think it can be done nationally, not realistically. So I don't support it, and IMO most politicians who say they do are just using support for 'single payer' either dishonestly, or as a marker for UHC which is entirely different. Worldwide, "single payer" like Canada or a government healthcare plan like the UK are the exceptions, but every other country has UHC, and they get there dozens of ways. Most places have mixed funding, like we do here. A large government role, and with employers and employees paying for lots of the total costs with taxes or premiums, some private providers, some government facilities. I can't envision a scenario where we put private insurers out of business and convert to a nationwide Medicare for all system. The transition is too great, the disruption to so many relationships, such as employer/employee too great. It's why I support the ACA as the least bad of the options I've seen.

 

[Greenbeard]

I wonder if having fixed this some employers will look at intentionally paying the ESRP, hiking pay a bit and letting employees go to the marketplace for coverage. Any thoughts on that?

Employers have proven pretty resistant to giving up offering health benefits thus far, it's hard to imagine the calculation is going to fundamentally shift for them now. The optics of dropping coverage in the wake of the pandemic may well push the other way.

What happens to those who cannot afford to pay for any insurance?

Well, as passed by the House, it not only makes the premium subsidies more generous, it gives anyone receiving unemployment benefits access to the most generous subsidy, i.e. zero premium coverage:

Second, the Ways and Means proposal would allow someone who received (or was approved to receive) unemployment benefits at any time during 2021 to receive tax credits and have their income treated as no higher than 133 percent FPL. Those who receive unemployment benefits would receive maximal subsidies for ACA coverage, meaning no-premium coverage. This would apply for 2021 only. (Based on the CBO’s reading, premium tax credits would only be available for those who receive unemployment and are otherwise eligible for premium tax credits, meaning their income is between 100 and 400 percent FPL. Another way to read this provision is that anyone who receives unemployment benefits is deemed an applicable taxpayer, meaning they would qualify for premium tax credits even if their income is below 100 percent FPL. That reading would extend subsidies to at least some people in states that have not yet expanded their Medicaid program.)

It also gives the states that have declined the Medicaid expansion so far a carrot to do so:

States that newly expand Medicaid would receive an additional five percentage point increase in their regular federal Medicaid matching rate (FMAP) for two years, no matter when they newly expand. This increase would be in addition to the temporary 6.2 percentage point FMAP increase enacted as part of the Families First COVID-19 relief legislation (P.L. 116-127) that is available through the duration of the COVID-19 public health emergency. (The matching rate for the expansion itself would remain at 90 percent).

Trash the whole thing and replace it with Single-Payer.

A key difference between the American Rescue Plan and single-payer is that the former is going to be law in a week.

 

[Greenbeard]

The same damn Democratic lies as last time. It's just another income tax while wrecking healthcare.

Yes, we all remember rightwingers predicting the ACA would wreck health care a decade ago. We're owed some mea culpas.

• Since Obamacare Became Law, 20 Million More Americans Have Gained Health Insurance
• Name the much-criticized federal program that has saved the U.S. $2.3 trillion. Hint: it starts with Affordable
• Medicare’s cost surprise: It’s going down
• Health Spending Growth Slowing, More on Pace with Economic Growth
• Employers’ Health Care Cost Growth Has Plateaued
• Medicare ACO Results for 2018: More Downside Risk Adoption, More Savings, and All ACO Types Now Averaging Savings
• How the Affordable Care Act Drove Down Personal Bankruptcy: Expanded health insurance helped cut the number of filings by half
• Obamacare, in Its First Big Test as Safety Net, Is Holding Up So Far
• The Affordable Care Act Reduced Income Inequality In The US
• Baby Survival Rates Improved in States With Affordable Care Act, Data Show
• Out-of-hospital cardiac arrests fell under the Affordable Care Act
• Medical care, health have improved for low-income adults under ACA
• ACA linked to reduced racial disparities, earlier diagnosis and treatment in cancer care
• Affordable Care Act Increased Rate of Early Cancer Diagnoses
• Uninsured cancer patients saw increased coverage for care following Medicaid expansion
• ACA credited with earlier diagnosis of gynecologic cancers in young women
• Fewer Patients Have Been Dying From Hospital Errors Since Obamacare Started

 

[Neomalthusian]

Employers have proven pretty resistant to giving up offering health benefits thus far, it's hard to imagine the calculation is going to fundamentally shift for them now. The optics of dropping coverage in the wake of the pandemic may well push the other way.

I don't doubt you. As I probably said in the past though, I used to live in AK, where this possibility was interesting to me from the beginning, because our organization had employees making between $30,000 and $50,000 a year and the cost of family coverage the employer incurred was $35,000 year or more. Referencing their latest rates, in some of these cases the employer could raise the employee's pay by almost the amount of their in-network OOP maximum, pay the corresponding taxes and retirement contributions on it, and the ESRP, and still end up ahead. And unless the employee was maxing out, they'd end up ahead too. The main barrier to this previously was the employees whose household income was >400% FPL, i.e. a household of four could pay 25% of their >$120k household income on premiums, and a household of two in their late 50s could pay over 40% of their income (over ~$82k) in premiums.

 

[Wayne Jr]

1. Why did you post a paragraph about the ability of a single payer system to reduce "reimbursement to clinicians" and now state that salaries don't need to be cut?

The point was to show how revenue to pay the bill's changes. Clinician's pay is just one of the bills. You focused on the wrong thing.

 

[Wayne Jr]

A key difference between the American Rescue Plan and single-payer is that the former is going to be law in a week.

Huge waste of time. We need to stop electing politicians to political offices and only elect businessmen.

 

[Greenbeard]

Huge waste of time. We need to stop electing politicians to political offices and only elect businessmen.

We've had both an MBA president and a "businessman" in the White House so far this century. Both left the economy in ruins on their way out the door and neither pursued single-payer health care.

 

[VySky]

Majority of bill has nothing in common with Covid.

 

[Greenbeard]

Majority of bill has nothing in common with Covid.

With 70%+ public approval, seems like no one cares!

 

[VySky]

With 70%+ public approval, seems like no one cares!

It’s the $1400 that people care about. Screw everything else.

 

[Wayne Jr]

We've had both an MBA president and a "businessman" in the White House so far this century. Both left the economy in ruins on their way out the door and neither pursued single-payer health care.

Yeah, 1 office. We need to replace at least half of Congress.