This is an interesting analysis of why single payer failed in Vermont. The plan would have cut payments to hospitals and doctors down 16%, so naturally they were not in favor.
The article makes the point that hospitals, doctors and drug companies were in favor of ACA BECAUSE it DID NOT cut costs. It was never supposed to cut costs. If it had, the providers would have lined up against it.
But it wasn’t just that, single payer would have raised payroll taxes in Vermont so much as to be political suicide.
So, people may tell a pollster they want single-payer until they get the details of how much single payer would cost them.
In my area there are several doctors who no longer accept any insurance… you want to see them you pay upfront, $400 for an office visit, $2000 for an annual physical. I have a friend with a longterm chronic condition who is a retired NYC teacher with GHI insurance and that may only be a NYS plan, not certain. It is the longstanding coverage for all NYC employees. Her husband is a retired stockbroker from Merrill Lynch. For awhile they continued with this doctor but at the end of the day it was just too much money and they switched to a new group with a nice young doctor who willing takes GHI.
I have a friend who is a therapist and he no longer takes any insurance after dealing with insurance companies who wanted to know how many sessions it would take to “cure” or solve his patients issues. Another friend is a retired occupational therapist, probably the best known in NYC. She had to take insurance in order to have doctors referrals. On of her favorite stories about dealing with insurance companies is that she was once reimbursed for $.58 for treating a patient for six visits. She actually framed the undeposited check. It probably cost the insurance company more to process and cut the check.
I think the average family has no idea what most of everything costs us, via taxes. The question becomes what the priorities are and should be. And unfortunately, we’e a huge country, with different needs in various regions, different programs requiring fed support.
But rather than platinum, why not something more basic? On Medicare, you can choose a supplemental plan. Or not.
Catastrophic is very dicey, btw. You have to look at what the specifics are, in your state. And plans change annually. But for a person on limited income, Gettng to the deductible is a ball and chain, to begin with.
Single payer (or any other major change) would not necessarily cost more – but it could change who pays the costs. Currently, much of the cost of medical insurance is borne by employers (biased toward larger ones) that offer medical insurance to their employees. Of course, this reduces employment, since hiring an employee costs more due to the expensive medical insurance.
Changing to some other scheme, whether single payer or individual purchase with subsidies or vouchers for poorer people, would be desirable in many ways, but many people would complain about what looks like a giveaway to big business as costs are shifted from employers to the government (taxpayers) and/or individual purchasers. Such political concerns could be alleviated with a payroll tax, but that would have the same disadvantage of reducing employment that employer provided medical insurance costs do now, or a business income tax, but then big businesses would lobby against it.
Of course, cutting costs is desirable, but it is politically difficult, since each interest group in medical care has its own lobby group to protect its share of the costs.
“We promised at the outset that we were going to repeal all of the taxes,” Mick Mulvaney, the White House budget director, said on MSNBC on Tuesday, referring to the Affordable Care Act.
He added, “Who cares if somebody else benefits?”
The European systems were set up before people had their own insurance policies either individually or through their employer, so ANY system that helped pay medical bills was acceptable to them.
Here, many people were already covered with plans they liked so meddling with the previous system created winners and losers. Any new change to the system will create winners and losers. It’s a no-win situation for politicians.
Politicians may want to assure people of that, because many people have a status quo bias, loss aversion, or endowment bias regarding what they already have, meaning that they do not want to put what they already have at risk, even if it means getting something that is likely to be better. Unless something is equal or better in all non-trivial aspects for all people, it may be hard to sell politically. Changing the health care system in terms of access and affordability is pretty much impossible without creating some losers who will complain loudly, and some who may be winners overall may not like losing some aspects of their current situations, even if other aspects get better, so they will also complain.
Of course, politicians may try to devise a plan where the winners are mostly their own supporters and losers are mostly the opposition’s supporters. But that may be a hard task when their own supporters are distributed in a way that makes it hard to keep them all in the winner category (as the GOP is finding with respect to its donors versus voters).
I negotiated contracts for years in my job. When I started, HSA types of policies didn’t exist at all. Folks wanted indemnity plans which really don’t even exist anymore.
We started with no RX coverage at all. No dental either. That changed.
Deductibles and copay amounts changed with each contract.
And the actual providers changed as well. The employer wanted the benefits for the lowest cost to the employer.
Cost share to employees went from 0% to 33%…with premiums higher as well.
The landscape of health insurance e changes…and changes…and changes. It always has.
The CBO analyzes proposed legislation compared to what is now in place, which in this case is the ACA. They write, "CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. " They mean that Ryan’s bill would reduce federal deficits by $337 billion compared to what is now in place, namely the ACA.
One can disagree with what the CBO says, but they say the AHCA would save $337 billion over ten years, as compared to keeping the ACA. No surprise there: the proposed legislation cuts spending on Medicaid by $880 billion. Most of that savings is handed over to people the top 2% of income and large corporations, but some remains as savings.
AHCA/RyanCare/TrumpCare as currently proposed removes two ACA/ObamaCare taxes:
a. 3.8% income tax on investment income over $200,000 (individual), known as the Net Investment Income Tax.
b. 0.9% payroll tax on labor income over $200,000.
Even with the Net Investment Income Tax, investment income in the form of dividends, long term capital gains, and whatever can be put in those categories (e.g. carried interest) is still given favorable income tax rates (though ordinary interest and short term capital gains is taxed at regular income tax rates, but not subject to payroll tax like labor income is). Most taxpayers except the very wealthiest get most of their income from labor, but the top 1% gets a large portion from investment income.
@thumper There was an attempt to shore up the individual market by making group insurance no longer available to small family businesses. Mom and Pop were forced out of very nice group plans and into the individual market. Sole proprietors were forced to do the same. My guess is that since the original ACA architects KNEW the penalty for not purchasing insurance was way way way to small for the young and healthy crowd to care, they grabbed at the easiest targets.
Small family businesses don’t have a whole lot of clout. They are not Apple, or Intel, or GM. They simply go about their daily business as best they can. And so, they were thrown under the bus. A bus that arrived silently (electric and running on green energy no doubt).
Even with these forced new ‘customers’, the IM is still tanking.
Frankly, the individual market needs to crash fast and furious before any real change will happen. And yes, your kids have about the same political clout as the small family business - none.
Are there places in which Anthem is the only insurer in the individual market? If they get out of the individual market, how many people will be without any insurer?
And that’s one of the best arguments against state-only single-payer: Without the federal gov’t getting that money from cash-hoarding, tax-evading corporate interests, the ultra-rich, and (ideally) cuts in military spending, it’s always going to be easy to convince people that it’s against their interests.
I just hope they come up with something. I was no fan of Obamacare but now that it’s here it would be nice if they worked together to fix it.
I hear the typical buzzwords.
-selling across state lines-ins companies can already do that under the ACA. It’s too hard for them to pool doctor groups in different states to make it profitable.
-HSAs-lets see you’ve gotten rid of pensions so I have to save in a 401k, now I have to save in an HSA for health insurance, there’s no money left for college and other things.