universal health care

[disneysteve]

I don't know how UHC works! Do we still go through the same health insurance companies like Aetna / Cigns / Kaiser etc except the govt pays the premium or we share premium costs (based on income) with the govt?

There's more than one model. Medicare is one example. You pay the government the premiums for Medicare A and B. Then you pay a 3rd party (SilverScripts, Humana) for your Part D prescription plan. Then you pay another 3rd party (AARP, Aetna, Cigna) for your Medicare Advantage plan that covers expenses not covered by the basic Medicare.

[LivingAlmostLarge]

Tort reform and what would happen if we limited dr salaries? Like other countries? And pumped more doctors out not 8 years plus residency but did 4 years of a bachelor's like other countries? We sort of already are transitioning since where I live Nurse Practioners can prescribe medications. So we're increasing our "dr" if have NP and PA. I guess because Dr only want to specialize and make more money. But if I'm not mistaken there are NP in specialities. It's hard to know what to do.

Like2plan I do worry about it not increasing our salary but at the same time if more people get kicked off of employer provided coverage and go on medicaid then we are paying for it through taxes correct? So either way it comes out of people's pockets.

[disneysteve]

I guess because Dr only want to specialize and make more money. But if I'm not mistaken there are NP in specialities.

There are many reasons why doctors don't want to go into family medicine. Income is only one small piece of it but there's a lot more to that story.

That said, I can tell you that I switched from family medicine to urgent care in November 2017. My income is now a little more than double what I made before the switch.

[Like2Plan]

I agree but then it's an across the board paycut to everyone with employer provided coverage. That number will decline steeply if we keep losing jobs and insurance with it. And companies may also drop coverage if times are tough for an extended period. Small businesses might not cover families but just the employee. So if we started by covering those without jobs, above 50, below 18, then natural attrition I think full universal coverage might occur before then. Also if we are talking about instituting extra coverage bought through work that may be how business incentive keep people. Benefit to buy extra or premium coverage.

I think I would dislike this more than anything. Why should the employer get to keep that money that had been part of your compensation package for which you made decisions regarding your salary negotiations? The part I would really dislike is having to pay for the same service twice--once through universal health care coverage (whatever that would look like) and then a second time for extra coverage bought through work--which kind of looks like the health care you are paying for right now. Medicare is a lot like that. You pay for Medicare Part B and Part D and then you have to pay for more insurance because medicare doesn't cover everything. I have mentioned this before--we had insurance when I was growing up and we deferred medical care because we couldn't afford the deductible/copay. Need an operation? without that secondary insurance a 20% copay can be a formidable barrier. So, you are pretty much back to square one.

https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

Like2plan I do worry about it not increasing our salary but at the same time if more people get kicked off of employer provided coverage and go on medicaid then we are paying for it through taxes correct? So either way it comes out of people's pockets.

I don't know what the answer is. But, there are some features that I would not care for with the universal health care--I know there are bureaucrats that I would not care to be making policy decisions regarding my health care. As I mentioned before, ACA was not perfect--but at least it was an attempt to solve the problem.

[Scallywag]

I think I would dislike this more than anything. Why should the employer get to keep that money that had been part of your compensation package for which you made decisions regarding your salary negotiations? The part I would really dislike is having to pay for the same service twice--once through universal health care coverage (whatever that would look like) and then a second time for extra coverage bought through work--which kind of looks like the health care you are paying for right now. Medicare is a lot like that. You pay for Medicare Part B and Part D and then you have to pay for more insurance because medicare doesn't cover everything. I have mentioned this before--we had insurance when I was growing up and we deferred medical care because we couldn't afford the deductible/copay. Need an operation? without that secondary insurance a 20% copay can be a formidable barrier. So, you are pretty much back to square one.

https://www.medicare.gov/your-medica...ts-at-a-glance


I don't know what the answer is. But, there are some features that I would not care for with the universal health care--I know there are bureaucrats that I would not care to be making policy decisions regarding my health care. As I mentioned before, ACA was not perfect--but at least it was an attempt to solve the problem.

My only experience is with MEDI-CAL (that I ironically never wanted to apply for but was coerced into applying by my son's social worker). We have an HMO offered by the employer and nothing else. When he got on Medi-cal problems began in right earnest, because things that would normally have been fully paid for by the main insurance began to be partly billed to my son's Medi-cal. Not good at all. Ultimately, I ended up buying a private child-only plan for him so that we could actually afford his TIMELY services at *high quality hospitals & therapy centers* without waiting for a lifetime. We pay around $600 for his private insurance premiums a month but it's worth it, IMO.

The private insurance is a PPO and a secondary on the plan, with Medi-cal now a tertiary and 100% out of the picture. But i know people who cannot afford a private plan so I get its an issue. State insurance has many pit falls including timely access so I am wary of going Universal it it's just glorified Medi-cal that would be offered to all regardless of age & health

PS: I actually warn parenrs with a newly diagnosed kid from giving up employer insurance and getting on Medi-cal, despite any coercion by their child's social worker / case manager to do so. DON'T DO IT!

[annibe11e]

I just want to point out that "Medicare for All" is not just putting everyone on the current Medicare program. It would be a new program designed for a universal plan.

[Scallywag]

I just want to point out that "Medicare for All" is not just putting everyone on the current Medicare program. It would be a new program designed for a universal plan.

As long as *timely* access to top hospitals & providers are guaranteed, i am fine with whatever you call it.

[disneysteve]

As long as *timely* access to top hospitals & providers are guaranteed, i am fine with whatever you call it.

A great many people don't have that now with whatever their current insurance is. Access to care is a huge problem across the board. When I was in private practice, it often took my patients 3 months or more to get appointments with specialists. I doubt that would be any different under a universal health plan.

[Scallywag]

A great many people don't have that now with whatever their current insurance is. Access to care is a huge problem across the board. When I was in private practice, it often took my patients 3 months or more to get appointments with specialists. I doubt that would be any different under a universal health plan.

Which is my real fear. I have diabetes & asthma, so access to timely care is a must for me.

[LivingAlmostLarge]

Obamacare I hate to say it stabilized a bad market. Instead it helped keep us on the path. I think truly we should have let it fail because obamacare was trying to make the health insurance market "pseudo free market" instead of pushing either single payer or true free market. I think we should uncouple insurance and go to totally free market. CUT off everyone not on medicare and then force everyone not on medicare onto buying their own. Level playing ground. Even faster we'll just let those with medicare buy medicare and stop paying for it. Run the money out and then see how people like a true free market buy your own health insurance. Medicaid too. Let everyone have to negotiate and pay for care themselves.

Prices will come way down without insurance or with insurance you truly have to pay for. Make for an efficient market. We'll see what happens when young and healthy refuse to buy insurance. Leaving only the sickest people and older and pre-exisiting conditions to pay. It really goes well with the US mentality of I am fine, I don't take handouts until I DO and need it. Everyone else is the problem. None of this social good crap.

I don't think people in the US will come around to single payer until they are forced to acknowledge the do it yourself plan won't work.

[Like2Plan]

Prices will come way down without insurance or with insurance you truly have to pay for. Make for an efficient market. We'll see what happens when young and healthy refuse to buy insurance. Leaving only the sickest people and older and pre-exisiting conditions to pay. It really goes well with the US mentality of I am fine, I don't take handouts until I DO and need it. Everyone else is the problem. None of this social good crap.

One of the features of ACA that I liked--everybody had to pay something. I mentioned in another post that I had some young friends who didn't sign up for health care (this was back when I was in that cohort--so, this goes back a ways ) It wasn't because they couldn't afford the health care, it was because they didn't see the need for it and they saw it as a waste of money. It is hard to convince a young, healthy 30 something that there are health issues you can't predict. Also, I think a lot of folks view insurance as a pay as you go kind of thing. When the premiums are more than what you would pay out of pocket to see the Dr, it doesn't necessarily make sense to them (forgetting about that occasional broken leg from skiing or intensive care from a global pandemic or whatever).

[disneysteve]

It is hard to convince a young, healthy 30 something that there are health issues you can't predict.

Being a doctor, this drives me crazy. I can understand a teen thinking they're invincible, but by the time you've reached your 30s, you should have enough life experience to understand that crap happens. Surely you must know someone who had to have their appendix out, or gall bladder, or a kidney stone. Somebody in your life must have fallen and broken a bone or two. You've got to be aware that it isn't just old people who get hurt, sick, and injured. Perhaps you don't fully appreciate the cost of incidents like that, but to think you just don't need insurance because you're healthy is baffling.

[LivingAlmostLarge]

One of the features of ACA that I liked--everybody had to pay something. I mentioned in another post that I had some young friends who didn't sign up for health care (this was back when I was in that cohort--so, this goes back a ways ) It wasn't because they couldn't afford the health care, it was because they didn't see the need for it and they saw it as a waste of money. It is hard to convince a young, healthy 30 something that there are health issues you can't predict. Also, I think a lot of folks view insurance as a pay as you go kind of thing. When the premiums are more than what you would pay out of pocket to see the Dr, it doesn't necessarily make sense to them (forgetting about that occasional broken leg from skiing or intensive care from a global pandemic or whatever).

Um I had a ton of clients who did not pay and were 30-60 and who couldn't afford ACA but could afford $695 penalty. So the rates of insurance had to go up because they refuse to pay it. I can't blame them when they told me the cost. Do we recall what TexasHusker said? How much it was for his family? He was paying a religious one but was a little unsure what they would cover? It was a risk but better than nothing.

Let's say you make $75k for single and it's $6k/year for medical or $695 penalty. Penalty is cheaper because "I never go to the dr."

So the ACA did NOT have everyone paying. $695 penalty is peanuts. IF you made it a % of your income for not having insurance (something like a single payer) like 10% then you would have people signing up. But otherwise it was more cost efficient to not sign up then go in an emergency and declare BK or something else.

I'm not saying you are wrong to like Obamacare but it was never going to work and didn't work because it was trying to stabilize a bad market that was artificially stabilized by employer provided insurance. And the repercussions were not severe. I think we could go the true free market as long as we decouple insurance to employment. Then many people would be looking for health care. Or maybe everyone would go without and then it would cause prices to fall. Who knows? But we don't have a true free market health insurance market. And you can't do Obamacare without a real one.

[LivingAlmostLarge]

Being a doctor, this drives me crazy. I can understand a teen thinking they're invincible, but by the time you've reached your 30s, you should have enough life experience to understand that crap happens. Surely you must know someone who had to have their appendix out, or gall bladder, or a kidney stone. Somebody in your life must have fallen and broken a bone or two. You've got to be aware that it isn't just old people who get hurt, sick, and injured. Perhaps you don't fully appreciate the cost of incidents like that, but to think you just don't need insurance because you're healthy is baffling.

right but you have to tax them to sign up for insurance like auto insurance. And there will still be people driving/living without insurance. Health insurance for obamacare to work has to be like auto insurance and it's not.

[Like2Plan]

Um I had a ton of clients who did not pay and were 30-60 and who couldn't afford ACA but could afford $695 penalty. So the rates of insurance had to go up because they refuse to pay it. I can't blame them when they told me the cost. Do we recall what TexasHusker said? How much it was for his family? He was paying a religious one but was a little unsure what they would cover? It was a risk but better than nothing.

Let's say you make $75k for single and it's $6k/year for medical or $695 penalty. Penalty is cheaper because "I never go to the dr."

So the ACA did NOT have everyone paying. $695 penalty is peanuts. IF you made it a % of your income for not having insurance (something like a single payer) like 10% then you would have people signing up. But otherwise it was more cost efficient to not sign up then go in an emergency and declare BK or something else.

I'm not saying you are wrong to like Obamacare but it was never going to work and didn't work because it was trying to stabilize a bad market that was artificially stabilized by employer provided insurance. And the repercussions were not severe. I think we could go the true free market as long as we decouple insurance to employment. Then many people would be looking for health care. Or maybe everyone would go without and then it would cause prices to fall. Who knows? But we don't have a true free market health insurance market. And you can't do Obamacare without a real one.

Um, I'm pretty sure I said I didn't think ACA was perfect. I didn't like everything about it. It definitely needed some tweaks. (But, at least someone tried to do something about this problem.)

I believe the penalty phase was just being phased in before it was turned off. And, IIRC it was a higher penalty--this is what I found on google-- "2016-18: 2.5% of total annual income or $695 per adult; $162.50 per each child under 18, whichever is higher. Maximum of $2085 per family. 2019: The penalty will be removed starting in 2019. Those that were uninsured in 2018 must still pay the penalty on 2018 tax form, however."

There are also some loopholes that you could drive a truck through. (Such as folks qualifying for the subsidy while still having quite a bit of resources).