Interesting take. This is how I read the above post:
How childish of you to think that your discretionary income is yours to decide what to do with?
How childish of you to think that wanting to be responsible for your money should be allowed?
How childish of you to think that you should be in control of what healthcare policy and services you buy and receive?
How childish of you not to want to be like other western nations where the living standard of two people with college degrees is the same or lower than two people with high school degrees here in the US?
How childish of you not to want be like other western nations where raising two kids is so expensive that there is now declining birth rates in just about every country? (unless, of course, poor people are imported, paid to live there, all in effort to avoid population decline)
How childish of you not to want to be like other western countries where simple amenities, such as air conditioning, are luxuries; where home ownership is much lower; and government tells your family where your kids can go to college and where they cannot?
How childish of you not to understand the importance of command and control?
Well, the above post is the exact reason ACA is going the way of tray heap because the “childish” have reared their heads and has told government it does not know better.
And instead of learning and realizing that more people are being hurt than helped by ACA, the response is to call them “childish.” Oh yeah, I forgot the meme that the childish are too dumb to figure out they are being helped by the law. How much times have I heard that this week on this thread and in the news? Like a broken record. The “childish” decided to give that meme the finger as well.
In good way the above post is instructive, as many have not a clue that this very attitude is why the law is about to disappear. Therefore, let it continue, and it should easier to dismantle a lot of other things, as the “childish” use basic math to calculate their rap costs and have clearly decided that working harder for less should not be an american trait, while others get everything free that you actually have to work for and purchase. Oh yeah, just like those other western nations that suffer from emmigration, as people leave the countries and homes they love. Do you know it is childish not to want to be become like that?
In any event, have a nice Thanksgiving and please be tolerant of the childish, as they might actually say 1 + 1 equals 2 at the dinner table. And you know we cannot have that blasphemy, but they do not know better.
Not all states have the same needs; therefore, it is much more efficient for the states to target and distribute Medicaid based on population needs.
For example, states with huge drug problems (as a percentage of the poor population), such as WV, NH, and OH can target more money to those substance abuse areas, as compared to now where the federal government essentially gives states the similar program allocations relative to population size. A rather stupid set-up given that no two states are alike.
Pre-existing conditions will be converted to high-risk pools. As I pointed out in previous posts, there are many examples of such high-risk pools in the private sector, and these can be enlarged to cover those that need it. However, unlike the block granting of Medicaid per state, the latest plan I reviewed stated the high-risk pools are to be nation-wide in order to better manage the costs and avoid duplicate high cost programs in neighboring states.
Wouldn’t demand for specialists actually decline if you 1) put pre-existing conditions into a high risk pool with presumably more limited benefits and lower max payments and 2) turn Medicare and Medicare private and/or block grants for the states to handle? In both cases, health care becomes more expensive for these groups - sometimes tremendously so - with higher premiums and less covered, thus more out of pocket. Would presume that older Americans (those on Medicare) and pre-existing conditions consume a majority of the specialists’s services and thus may not be able to afford/use these services in the future under these changes. So wouldn’t salaries and demand for specialists services (including some tests, meds, etc.) actually decline with these changes?
@awcntdb
"- How childish of you to think that your discretionary income is yours to decide what to do with?
How childish of you to think that wanting to be responsible for your money should be allowed?"
Not since the beginning of time, have people had full discretion over their own resources under the circumstances of living in a tribe/country/community/family with other human beings.
Some people, like apparently you, have an Ayn Rand view of what the United States should become. Others, possibly now a popular majority of the country, realize that this is not the way of progressive human civilizations. To the latter group, it is indeed a childish selfishness, and a short-sightedness about one’s own health/life/luck, that would drive Randian views.
You are correct on one point: higher female literacy always leads to lower birthrates. While interesting theoretically, as long as we have immigration, it’s not a deal-breaker. (And even if it were, what’s the solution anyone would vote for to reduce female literacy?)
As to the rest of your claims, my sense is that there are not as many very-rich or very-poor people in European countries with a strong social services net, but that the “average” (median or mean income) family does better. In other words, if you were a random baby born into a country with no pick of which parents you want, it’s a much better deal to be born in the EU. Oh, and every baby is born in real life without picking its parents.
It doesn’t seem useful to pine about single payer here. Let’s instead talk about the state of the ACA now, and what would happen if we got proposed changes that have a chance of being enacted.
To that end, I played around with my spreadsheet. If Congress allowed private insurers to charge 5 times as much to the oldest subscribers (64 year olds) as the youngest subscribers (21 year olds), instead of the current 3 times as much, the oldest subscribers would see their insurance premiums increase somewhere around 17%. If the oldest subscribers were charged 6 times as much as the youngest subscribers, their premiums would increase around 23%.
This is all assuming some reasonable assumptions about the actual cost and age breakdown of the people now in the insurance market. But changing the assumptions doesn’t change the numbers much. Charging the oldest subscribers 6 times as much as the youngest subscribers isn’t going to double the older people’s premiums.
Also, despite what a lot of people say, bringing in new healthy young subscribers doesn’t lower rates for everyone very much. To really lower rates, you need to bring in OLD healthy subscribers. It’s not the 25 year old Uber driver. What you really want is to entice 55 year old marathoners and 60 year old bicyclists into the pool.
Well…this year…my young subscriber…age 32…saw his premium go up from $173 a month to $375 a month…and that is WITH a subsidy. More than a 100% increase in costs.
My other kid has an individual plan, not purchased on the exchange, no subsidy…28 years old. Premium went from $275 to $375 a month. Again…a huge %age increase.
Personally I think this is an equalization because I think their premiums for 2016 were actually low.
But that doesn’t help when your income really isn’t increasing…at all…and you now have to come up with $2000 more a year for health insurance. Kid one. Or $1200 a year more for kid 2.
Can you explain how this worked? 'Cause it confuses me still.
A lower-income health insurance buyer is subsidized down to a certain payment. That is, the law calculates how much the person can pay according to their income, and then they have to pay that premium and no more, no matter how much their insurance costs. That was true last year and it is still true this year. It doesn’t matter how old they are. All this assumes the person buys the reference Silver plan, the second cheapest Silver plan.
So, if your 32 year old had the same income in 2016 as he will in 2017, and he bought the reference Silver plan last year and this year, his premium wouldn’t have changed one penny. Did your son buy a cheap Bronze plan last year, but this year that cheap plan’s price went up more than the reference Silver plan? Did he buy an expensive Gold plan, and its price went up more than the reference Silver plan? Is he buying a “better” plan this year than last year?
Unsubsidized buyers’ premiums went way up. Most subsidized buyers should have seen no change.
@“Cardinal Fang” I just sent your post to my kid. I’m totally hoping you are right…and that even if his income goes up a little (it won’t be over $40,000 for the year), that his actual premium won’t go up $200 a month!
And before someone brings up the example of Norway and says “see, this is what a social service net should look like”, you cannot compare a country in Europe with a population of a midsize state in the United States to the United States as whole. You need to compare populations of roughly similar size, such as the European Union as a whole compared to the US as a whole.
The median household income in the United States for 2013 was about $52,000. This is considerably higher than the European Union as a whole. The average European has a standard of living roughly equivalent to an American in Louisiana or Mississippi.
And the other big elephants in the room that nobody seems to bring up are 1) Europe cannot afford its social services either, and 2) Europe as a whole free-rides on the US for defense. If they had to pay for their own defense, Europe would have drastically cut its social services.
CF - So as a healthy person in my 60’s, my insurance would go up 23% according to your calculations. I’m assuming that’s on top of the 43% increase my insurance company wants to charge me. It’s still ridiculously expensive, but DH and I are in the very small group of people who are getting individual insurance but don’t qualify for subsidies. Nobody involved in health insurance/government seems to care how much we have to pay.
What is your point, shellfell? Health insurance is ridiculously expensive in the US because health care is ridiculously expensive in the US. All the tricks to shift the cost to the other guy don’t change that.
I’ll pay $11,500 for my insurance next year, just for me, so I’m sympathetic. But reducing health care costs in the US is a very, very hard problem. As ucbalumnus and I have discussed here, there are no simple fixes, because everything in health care in the US costs more than in other countries. Single payer, by the way, wouldn’t change that. If we adopted a single payer plan for the US for people under 65, health care would still be ridiculously expensive because we really don’t understand how to limit costs.
As someone who spends a lot of time in Europe, I beg to differ.
European salaries are very low, that is true. And I agree comparing the US to a European country doesn’t make sense, so comparing a US State to one country, or the EU+ EEA to the US would be more valid.
But standard of living in most of Western Europe is similar on average, and in some cases, much better, than what it is in the US, due in part to lower costs for health and education (+ low cell phone/cable plans). Eastern Europe still hasn’t recovered from the civil wars from 20 years ago and even not from communism that plagued their economy for decades and could be compared to struggling US states.
So, Mississippi or Louisiana can be compared to Bulgaria, Romania, Slovakia, or Latvia, but can’t be compared to Spain, Britain, France, Scandinavia, Luxemburg, Switzerland, Germany, Belgium, etc.
Europe doesn’t “free ride”. If you’ve ever witnessed July 14 parade or heard of wars against alQaida in Africa, you know military power is big, strong, and very much an alive ally, especially France and Britain. Not all countries are in NATO but they coordinate with it. In addition, even if they were free riding, would it justify putting the US at risk by cutting that investment? Because if growing powers such as China, a revnge-bent Russia, and enemies such as AQMI or other terrorist groups, grow due to American cuts, everyone suffers. In addition, US influence stabilizes the world for all of us but also maintains American interests - if we become isolationist, other countries will rush to fill the void, and they won’t be kind to us.
My point isn’t to shift the burden to someone else. DH has been self-employed almost his entire career so paying fully for health insurance is something we are very used to. My complaint is that there isn’t the political will to do anything for the small group of people who pay for their own health insurance but don’t qualify for subsidies. We fall through the cracks.
The data disagrees with you regarding freeriding. NATO countries are expected to spend 2% of GDP on defense. If you review the chart on page 2, you will see that ~80% of the countries fall short of that mark, some of them considerably.
The only countries that are above 2% are the US, Greece, the UK, Estonia and Poland. France is close at 1.8%. Major economies that are free-riding on the US defense umbrella include Germany (1.2%), and Spain (0.9%). You would at least think that countries formerly controlled by the USSR would know better (and Poland does), but the Slovak Republic lazes along at 1.2%. Canada is also at 1.0%, but it is unlikely to get invaded.
I am not a fan of American isolationism, but a warning to countries that NATO support is only available to countries meeting the expected financial obligations would be a very useful kick in the butt for some of these countries.
The data also disagrees with you about Europe’s income being about the same as the US. Here is one datapoint where Politifact evaluated Romney’s statements that said that American incomes were 50% higher than Europe’s as being “Mostly True”. The article says that if we are talking about median incomes in OECD countries, the number drops to the US worker’s income being about 30% higher than a European’s income.
There’s talk of making health insurance premiums tax deductible, which would be something I guess. But I don’t much like the idea of adding a tax deduction which would benefit the 60-year-old person making $250,000 a year much more than the person making $50,000 a year.
It sounds like your point IS to shift the burden to someone else. You “fall through the cracks,” where in this case falling through the cracks is defined as paying the actual cost of someone your age. You wish you could pay less. If you paid less, someone else would have to pick up part of your actual costs.
#575 actually I said incomes are lower, but standard of living isn’t.
When a doctor’s visit costs $1 or an MRI $150; when your additional insurance costs $200 a year; when private schools cost $1,000-4,000 a year and there are plenty of decent public schools; when you have unlimited calls, texts, pictures, and internet access for $25/mo; when you’re guaranteed 50-60% of your salary as a pension even if you don’t have retirement savings; when a year of college costs less than 12k a year and can even be tuition free… your income may be lower but your standard of living is good.
Honestly I think salaries are too low, and if they increased there’d be more discretionary spending this mire growth.
Numbers are often understood as ‘indicative’ there - see how many are within their 3% deficit rate … Which they decided on by themselves. As long as they inch toward the numbers Europeans are fine. And yes it’s very irritating but it’s worse elsewhere (where numbers are not even seen as 'indicative '!) The one country I’m surprised about is Canada because they are North American in their use of numbers. But, as you say, they’re not worried about an invasion.
I also suspect that the countries don’t contribute as much as they’re supposed to due to the financial crisis they’re still in.
Because I am self-employed, my premium is already fully deductible, as a direct write off from my income. (self employed health insurance deduction). But the problem is that I don’t earn enough from self-employment to be able to afford to pay 20% or more of my income on health insurance, and also pay for my housing and other expenses. And as I get older, I have less flexibility to earn more, simply because I don’t have the same reserves of energy and stamina that I did when I was younger. It simply isn’t feasible for a $50K earner to turn around and become an $60 or $70K earner just to keep up payments on health insurance.
The problem is that those who are on the spectrum of needing more health services because of age-related decline are experiencing declining earning ability. The beauty of medicare is that we all have been paying into the system through the tax system since our youth – it is an entitlement because my tax dollars have been going into that system since I had my first job as a teenager.
However, everyone gets older over time. So when we look at is as a question of young people being unfairly burdened to
pay for the needs of old people, that is ignoring the fact that those young people will someday be old themselves.
I agree that the raw (unsubsidized) costs of premiums are too damn high for everyone. But it doesn’t really work to try to push the burden of the highest premiums on the demographic group most likely to be sickest, because health is directly related to earning capacity. So costs need to be spread in a different way.
Actually we do. Any health economist will tell you that one can ration on price or ration on services – or both. But collectively, we choose just the opposite; for example, we increase mandatory coverage (which many on cc support). Mandating nice-to-haves, but not medically necessary, is the opposite of a cost reduction feature.