morpeth

While I do think if there was control on health care costs, and government subsidizing insurance costs, perhaps the system could be modified to work perhaps the only solution is a single payer system similar to that in other countries. At least Sanders stood up for that.

Giantaxe

We all agree on medical costs and the inability of politicians to take on vested interests in that area.

You do realize that "Europe or UK" have some form of mandate to reach universal coverage, be it through the requirement to pay taxes (centrally-funded systems such as the NHS) or through a requirement to buy insurance (most European countries)?

Who is saying that? Californians vote overwhelmingly for a party that wanted Medicaid expanded in all 50 states. A Supreme Court decision allowed states to refuse the expansion, and guess who refused to expand? It certainly wasn't Democratic-controlled states.

morpeth

-My opinion the mandate is actually pretty simple. It is absurd and immoral to charge someone a penalty for being poor ! I understand why it was done, it was just wrong.

- I have no problem with income or sales taxes paid to fund a medicare care system, but if you are not making money in UK you dont have to pay national insurance !

- I have already stated that while I think the Democrats are just as cowardly as the Republicans in finding an overall real solution to the health care system in the USA, at least on this issue the Democrat party's heart was in the right place and Obama did something rather than nothing.

Giantaxe

The NHS is funded almost entirely out of general taxation, not National Insurance. That includes all forms of taxes including income tax, capital gains tax, VAT, excise taxes etc. Unless you're a self sufficient hermit, you are contributing to the NHS.

But you are right that there is a relationship between income and size of NHS contribution. That is what ACA subsidies try to replicate - imperfectly - in that the poorest don't pay anything (Medicaid) and subsidies reduce until they are eliminated at 400% of the federal poverty level. And just as with the ACA, the wealthiest and healthiest end up subsidizing health costs of the poorest and sickest.

morpeth

The ACA doesn't work for many because even with the subsidy the premium or deductible it can be unaffordable. It did a wonder job for millions, but there are still many without insurance OR doing without the basics to pay their premiums or deductibles.

There is still private insurance in the UK and from what little I am aware quite affordable. Only someone drugged with Washington DC idiocy would dream up charging people for being too poor to afford insurance.

If I understand correctly the NHS accountants for 10% of British GDP,in US health care at 16% of American GDP. So issue is an economic competitive one as well.

Giantaxe

And excludes pre-existing conditions. Which isn't much of an issue given that everyone has access to the NHS.

What do you think is a reasonable proportion of one's income to spend on healthcare? Additionally, do you think people should be able to go to the emergency room without contributing anything to the system?

Agreed.

morpeth

One policy I know about excluded pre existing conditions for 18 months but as you say having NHS no big deal.

Those are good questions. My answer would be a global solution needs to be in place rather than just tinker here or there.

As far as emergency room visits, at least in states I am familiar with, they have to attend to people, but that doesn't stop them billing! My daughter had to go to an emergency room in NYC in December, saw a doctor for grand total of 15 minutes, dealing with receptionist ( who barely spoke English or any other language we know), and for 30 minutes labor time and bill was $900. So really unless costs are controlled, how does one determine a reasonable percentage of income ?

I do know it is a perverse regressive evil to penalize people just for being poor. Or for companies over a certain number of employees to be required to OFFER medical insurance - but then company charges so much for premiums employees cant afford the insurance,

Giantaxe

I agree. As I pointed out before, having a multitude of differing programs is one reason why reform is so difficult.

It doesn't stop them billing you, but the reality is that poorer people tend to have few, if any, assets. So the cost will likely get written off.

The reason I asked is that the maximum fine is $695 or 2.5% of household income, whichever is larger. Personally, I think the mandate is way too weak and that is one reason that the ACA is floundering in some states, namely too many younger and healthier people are paying (or avoding paying) the penalty rather than getting insurance.

They are being penalized for not having insurance but still having emergency room access whose cost will likely end up being written off and passed on to everyone else.

Giantaxe

I see that Trump's budget released today proposing cutting $800bn from Medicaid over the next decade and $192bn from nutritional programs, $72bn from disability programs and eliminate loan programs for the poor to help their children go to college. Meanwhile, it proposes tax cuts that will overwhelmingly benefit the richest Americans. If the poor voted for Trump, he is well and truly selling them down the river.

morpeth

Emergency rooms only cover so much. If I recall one of the justifications of the ACA, was that people could visit a doctor for non emergency issues, so therefore that money would be saved from less emergency room visits. That seems logical, I haven't seen what the results have been.

I quite agree hospitals " write-off" costs, but don't the hospitals still make money billing those written off costs ( which of course they include their overhead and profit in the total "written off") ?

I quite agree the complexity of having so many different programs is part of the problem.

$695 is simply too high for the poor and working poor, both in practical terms, and morally. Then there is harassing by collection agencies, and often disrespect to those without insurance by hospital staff. On top of all this, people who avoid doctors because of the cost letting conditions go untreated - developing more serious conditions that cost society even more.

carcajou

Please put away your DNC talking points. While I don't like Trump, 8 years of Barack Obama showed us that the Democrats do not care about the working classes either, and perhaps care even less.

MidAtlantic

Adding to that the US outcomes are among the worst of developed countries.

Giantaxe

Huh? Those are actual facts from Trump's proposed budget releases yesterday.

Giantaxe

Emergency rooms legally have to "medically stablilize" you regardless of ability to pay. Go to any emergency room and it's not hard to deduce that many use it as their access to the health system as opposed to using it purely for emergencies.

If 100% of a bill is written off (which is what happened with a $27k bill for one of my children, btw) then the hospital (and doctors) make a loss. Those losses are made up by charging others (or the taxpayer) more.

MidAtlantic

That's how I assumed it worked as well, but reading this gives a different perspective:

https://insight.kellogg.northwestern...ofit-hospitals