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ACA rebate checks coming

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Mxylplyx

Diamond Member
Mar 21, 2007
4,197
100
106
It just seems odd that insurance companies that don't have much of a profit margin (the single digit %'s didn't seem excessive to me) are paying out rebates given healthcare costs that are ever increasing. Something does not seem right here...
Perhaps they don't have much of a profit margin because they blow a large amount of their revenues on excessive executive compensation, inefficiency, and bloated staff. Given that people get healthcare regardless if they pay or not, insurance companies funneling money from one party to the other add NO value to the system. They are merely an inefficiency, a middle man who servers no other purpose but to be a middle man. The entire thing needs to be dismantled and simplified. Yes, I'm talking single payer.
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Yeah, I wanted to ask it there, but that thread was staying on such a nice track, free of that type of debate, I didn't want to spoil it. I shudder to ask what tax increases are going to cover what would seem to me would be massive Gov subsidies...am I better off not knowing?
Well, there is a way to ask that question in an unbiased manner and receive an apolitical answer. After all, the law's the law and it doesn't hurt to say what the law and interpretive regs say.

But here, rather than play coy I'll just do it:

The ACA gives subsidies to certain people (by income) who purchase insurance on an exchange. Where will that subsidy money come from?
Well, a few different sources:
1) Any individual or employer who doesn't conform to the "shared responsibility" (mandate) portion of the ACA will have to pay a fine/penalty. Those monies will ostensibly offset some portion of the subsidy cost;
2) Those fines/penalties won't come close to covering the subsidy costs so to make up for the shortfall the ACA levies ~$200 billion in new taxes on health insurance and pharmaceutical companies, which slowly phase in from 2014 through 2020. This interesting mechanic has the effect of taxing health insurers for funds to pay health insurers. But, rest assured that the health insurers will build those taxes into their premiums so you will be paying them.
3) Even that's not enough to cover the anticipated cost of the subsidies, so more money has to be found. Well, it actually doesn't because the subsidy isn't really a subsidy, it's a refundable tax credit like the Earned Income Tax Credit. Legally, anyone who meets the eligibility criteria is entitled to a refundable tax credit at the end of the year but the government recognized that many people wouldn't be able to afford the up-front premiums even if they knew a large check was coming later. In response, the ACA has an acceleration provision which allows someone who is eligible for the tax credit to apply to the federal government for an acceleration of payment on the credit. For those eligible people the fed will agree to pay the refundable tax credit early but only on the condition that it is paid directly to the insurance company (so the recipient can't take the money and run).
So, from a technical perspective, the subsidies are funded by a combination of direct taxation, indirect taxation, and diverted tax cuts.
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Determining rise in premiums because of the aca is going to be tricky business due to the upward trend in premiums that was happeneing regardless.

I suppose we could do some extrapolation based on the last 10 years however, and that would give a reasonable guess.

But it wont stop these silly "premiums went up because of Obamacare" talking points.
I respectfully disagree. For the insurance industry (and its associated regulators) it's pretty easy to tell which loss cost increases are related to general market conditions and which loss cost increases are related to ACA market reforms and expansions. Please realize that when a rate filing is made it's much more specific than "Average premiums increase 15% with a low of -2% and a high of 47%"; loss costs on the rate filings are very specific as to the categories each dollar tracks to.
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Perhaps they don't have much of a profit margin because they blow a large amount of their revenues on excessive executive compensation, inefficiency, and bloated staff. Given that people get healthcare regardless if they pay or not, insurance companies funneling money from one party to the other add NO value to the system. They are merely an inefficiency, a middle man who servers no other purpose but to be a middle man. The entire thing needs to be dismantled and simplified. Yes, I'm talking single payer.
There's a case to be made that single payor/government health care would be subject to the same inefficiencies and bloat and wouldn't even have the profit motive to control them. It's not like Medicare or the VA is a paragon of efficiency. Hell, Medicare fraud resulting from lack of institutional controls is a multi-billion dollar industry!
 

MooseNSquirrel

Platinum Member
Feb 26, 2009
2,565
294
126
Thats good to hear then, I hate over simplifications.

Can we predict what effect on costs will having younger healthier members have?

There must be numbers already for age groups.
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Thats good to hear then, I hate over simplifications.

Can we predict what effect on costs will having younger healthier members have?

There must be numbers already for age groups.
Do you mean can we predict what will happen for a group health insurance plan (likely through an employer) with lots of young participants or do you mean something else? I apologize but the bolded statement seems vague to me.
 

lotus503

Diamond Member
Feb 12, 2005
6,502
1
76
Yeah I finally found that, good to know the .gov can legislate how much profit a private company can make....precedent has been set so which company should they go after next?
I'm sure glad they can for basic services.
 

MooseNSquirrel

Platinum Member
Feb 26, 2009
2,565
294
126
The first.

I assume thats why this kind of plan was dreamed up in the first place.

A health care system with only old sick people isnt really sustainable :)
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
The first.

I assume thats why this kind of plan was dreamed up in the first place.

A health care system with only old sick people isnt really sustainable :)
Well, concerning employer-sponsored group coverage, the answer is complex.

First many employers, especially the large ones, are "self insured" and exempt from the ACA.

Those that aren't have three choices: offer a group plan on the exchange, offer a group plan off the exchange, or dump the employees on the individual exchange.

If its the first then there is too much uncertainty to say; too much hinges on your state's exchange composition for reasons I won't get into right now (I'm typing on my phone).

If its the second then the employer plan should still be group rated. A group with lots of young members will pay less than a relatively older group but the younger premiums likely will go up some.

If its the third then young premiums will definitely go up. The ACA requires that for any given individual policy the most expensive person can be more than 300% more expensive (4x) than the least expensive person. Since the high premiums can't come down the low premiums will have to go up.
 

sportage

Diamond Member
Feb 1, 2008
9,184
1,325
126
This is pretty simple. New rules state insurers now have a limit of how much of YOUR premiums they can spend on NON healthcare related stuff.
What is non related healthcare stuff you ask?
Money to hire lobbyist.
Money to contribute to political super packs.
Money spend to buy politicians.
You get the idea.....

Sooooo, if anyone is pissed that their premiums are going to actual healthcare costs, you know, medical equipment and so on, then Im pretty sure your local insurer would welcome a direct check from you with a little note attached that your enclosed check is only meant for buying politicians, employing lobbyist, or better yet just sign it over to Karl Rove.

WTF... Are people F-ing stupid?
People actually object to limiting what insurers can WASTE of your money on non health related expenses?

Oh, and are these the same F-ing people that cry when some union gives money to much the same. Then insists all unions stop and quit wasting membership dues for non union causes?

Yet its just fine and dandy for the insurance company to do what they want with your premiums.
Sounds like a Faux News plan to me.

Oh the poor little insurance for profit folks.
Stop tossing a hissy fit and just write them a direct check if you are really that upset with Obamacare limit rules.
Like I said, Im sure Blue Cross will gladly take your money.
Then give it directly over to any one of Karl Rove's numerous Super packs.
I swear... people are bat shit crazy now a day. To bitch about something so logical, AND in their own best interest.
Crying against better spent healthcare premiums from the poor sap middle class worker.

Just how much of your premium would you prefer Blue Cross waste on hiring lobbyist?
Ten percent? Twenty five percent? Seventy five percent? One hundred percent?
So what happens when Blue Cross needs more lobbyist?
Maybe raise your premiums still higher and higher, while offering you less and less healthcare related coverage... ya think?

I have a little intelligence test for those opposed to better spend healthcare premiums...

One and one equals what?
A. Hell if I know.
B. Eleven.
C. What was that question again.
D. Oh wait a second, I just dropped my weed.
E. None of the above.
.
.
.
 
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DucatiMonster696

Diamond Member
Aug 13, 2009
4,269
1
71
There's a case to be made that single payor/government health care would be subject to the same inefficiencies and bloat and wouldn't even have the profit motive to control them. It's not like Medicare or the VA is a paragon of efficiency. Hell, Medicare fraud resulting from lack of institutional controls is a multi-billion dollar industry!

Speaking of fraud and inefficiency.


Alleged pill ring cost taxpayers $500 million

Four dozen people have been charged in one of the largest drug-diversion schemes ever, a federal prosecutor said Tuesday. The alleged Medicaid fraud is estimated to have cost taxpayers a half-billion dollars.

"The defendants worked a fraud on Medicaid, a fraud on pharmaceutical companies, a fraud on legitimate pharmacies, a fraud on patients who unwittingly bought second-hand drugs and ultimately a fraud on the entire health care system," said Preet Bharara, U.S. Attorney for the Southern District of New York. The FBI seized more than $16 million worth of second-hand prescription drugs, comprised of more than 33,000 bottles and more than 250,000 loose pills.

The fraud started on the streets of New York City, where AIDS patients sold pricey drugs they received for free through Medicaid. "People with real ailments were induced to sell their medications on the cheap rather than take them as prescribed," said Janice Fedarcyk, Assistant Special Agent in Charge of the FBI field office in New York.

Buyers would pay $50 for medicine that cost Medicaid $650 per bottle.

"In any population there may be people who, notwithstanding the fact that they need to take medication, are willing to sell that medication if they're in dire straits," Bharara said. Over seven years, according to court documents, the criminals exploited the difference between the cost to the patient of obtaining the prescription drugs through Medicaid, which was usually nothing, and the hundreds of dollars per bottle that pharmacies paid to purchase those drugs to sell to their customers. Authorities said they dismantled a "national, underground market" for some of the most expensive drugs available to treat HIV, schizophrenia and asthma. The pills ended up in Texas, Florida, Nevada, Utah and Alabama. From there they were resold to pharmacies across the country. The pills were kept in uncontrolled and sometimes egregious conditions.

"End users of the diverted drugs were getting second-hand medication that may have been mishandled, adulterated, improperly stored, repackaged and expired," Fedarcyk said. Among the medicines allegedly resold by Medicaid patients were Zyprexa, an antipsychotic, and the HIV drugs Atripla, Trizivir, Prezista, Reyataz, Isentress, Intelence, Kaletra, Sustiva and Truvada. The FBI has asked anyone who may have purchased second-hand prescription drugs to call an FBI hotline at 212-384-3555.
http://news.yahoo.com/feds-bust-alleged-pill-ring-cost-taxpayers-500-210336430--abc-news-topstories.html
 
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Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,879
4,210
126
This is pretty simple. New rules state insurers now have a limit of how much of YOUR premiums they can spend on NON healthcare related stuff.
What is non related healthcare stuff you ask?
Money to hire lobbyist.
Money to contribute to political super packs.
Money spend to buy politicians.
You get the idea.....

Sooooo, if anyone is pissed that their premiums are going to actual healthcare costs, you know, medical equipment and so on, then Im pretty sure your local insurer would welcome a direct check from you with a little note attached that your enclosed check is only meant for buying politicians, employing lobbyist, or better yet just sign it over to Karl Rove.

WTF... Are people F-ing stupid?
People actually object to limiting what insurers can WASTE of your money on non health related expenses?

Oh, and are these the same F-ing people that cry when some union gives money to much the same. Then insists all unions stop and quit wasting membership dues for non union causes?

Yet its just fine and dandy for the insurance company to do what they want with your premiums.
Sounds like a Faux News plan to me.

Oh the poor little insurance for profit folks.
Stop tossing a hissy fit and just write them a direct check if you are really that upset with Obamacare limit rules.
Like I said, Im sure Blue Cross will gladly take your money.
Then give it directly over to any one of Karl Rove's numerous Super packs.
I swear... people are bat shit crazy now a day. To bitch about something so logical, AND in their own best interest.
Crying against better spent healthcare premiums from the poor sap middle class worker.

Just how much of your premium would you prefer Blue Cross waste on hiring lobbyist?
Ten percent? Twenty five percent? Seventy five percent? One hundred percent?
So what happens when Blue Cross needs more lobbyist?
Maybe raise your premiums still higher and higher, while offering you less and less healthcare related coverage... ya think?

I have a little intelligence test for those opposed to better spend healthcare premiums...

One and one equals what?
A. Hell if I know.
B. Eleven.
C. What was that question again.
D. Oh wait a second, I just dropped my weed.
E. None of the above.
.
.
.
I think this poster is a bot. The "savings" fallacy has been effectively shot down by demonstrating that taxes will more than offset those. It's a given when requiring coverage for very expensive patients. One can argue from a moral point they should be covered, but "affordable" isn't inclusive. In fact it's quite the reverse, although it appears those costs will be hidden by the financing mechanism of taxes.
 

techs

Lifer
Sep 26, 2000
28,567
3
0
There's a case to be made that single payor/government health care would be subject to the same inefficiencies and bloat and wouldn't even have the profit motive to control them. It's not like Medicare or the VA is a paragon of efficiency. Hell, Medicare fraud resulting from lack of institutional controls is a multi-billion dollar industry!
Holy shit that can't be more wrong.
Medicare IS a paragon of efficiency! Medicare uses between 2-3 percent of premiums as overhead to process claims. Private health insurance companies use up to 30 percent.

Health insurance is like a supermarket that sells a very high dollar amount of goods and makes a very small percentage of profit. That is the nature of the business. If health insurance companies made the same percentage of profit as is common in most other industries they would be the worlds most profitable companies.

Yet, paying health claims is a very simple matter. Its almost all computerized. Processing costs have plummeted since the 1990's as they have gone computerized while the overhead health insurance companies charge has skyrocketed.

Call it what you want, but like charities which have to spend a certain amount of donations on actual charity in order to get tax exemptions and call themselves a charity, that is what is happening with ACA. It requires companies that want to sell a product called health insurance actually spend a certain percentage of their sales on actual health care.

Lastly, the "fraud" in Medicare, Medicaid, etc is actually a tiny amount of the total in health care reimbursement. Unlike private insurance which never reveals the amount of fraudelent claims they pay out, public health plans do.

I would venture a guess, on my actual experience as a health care executive who was involved in finding fraud in a private health care company that Medicare and Medicaid have far less fraud than private plans.


Just as an aside, did you know that large self insured companies that use private health care companies to process their claims have to hire other companies to watch over the health care companies because they not only don't try and combat fraud, they actually encourage it. The reasoning is simple. The health care company makes more money the more claims it pays out.
 

cubby1223

Lifer
May 24, 2004
13,525
42
86
This is pretty simple. New rules state insurers now have a limit of how much of YOUR premiums they can spend on NON healthcare related stuff.
How about the federal government creating television ads informing us how wonderful Obamacare is, is that acceptable healthcare related stuff?


Spending on "NON healthcare related stuff" is not the massive behemoth of a problem we have. This is more of a temporary feel-good story. The problem is the money that is spent on healthcare.

Does Obamacare tackle the monopolistic practices of drug manufacturers? Of device manufacturers? Tort reform? Obamacare is little more than a grab by the government, with a few convenient scapegoats to appease the masses.
 
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Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,879
4,210
126
Holy shit that can't be more wrong.
Medicare IS a paragon of efficiency! Medicare uses between 2-3 percent of premiums as overhead to process claims. Private health insurance companies use up to 30 percent.

Health insurance is like a supermarket that sells a very high dollar amount of goods and makes a very small percentage of profit. That is the nature of the business. If health insurance companies made the same percentage of profit as is common in most other industries they would be the worlds most profitable companies.

Yet, paying health claims is a very simple matter. Its almost all computerized. Processing costs have plummeted since the 1990's as they have gone computerized while the overhead health insurance companies charge has skyrocketed.

Call it what you want, but like charities which have to spend a certain amount of donations on actual charity in order to get tax exemptions and call themselves a charity, that is what is happening with ACA. It requires companies that want to sell a product called health insurance actually spend a certain percentage of their sales on actual health care.

Lastly, the "fraud" in Medicare, Medicaid, etc is actually a tiny amount of the total in health care reimbursement. Unlike private insurance which never reveals the amount of fraudelent claims they pay out, public health plans do.

I would venture a guess, on my actual experience as a health care executive who was involved in finding fraud in a private health care company that Medicare and Medicaid have far less fraud than private plans.


Just as an aside, did you know that large self insured companies that use private health care companies to process their claims have to hire other companies to watch over the health care companies because they not only don't try and combat fraud, they actually encourage it. The reasoning is simple. The health care company makes more money the more claims it pays out.
Holy crap, did you know the reason that the it costs so little? Because they have terrible service and offload work to providers who do less of what they are supposed to? That what takes hours under private insurance takes days or weeks because people who work for it are drowning in regs and work overloads? Do you know that Medicare D is handled by private corporations because they can do the work better than they can? That in spite of this sometimes they haven't the authority to move things along because it has to be reviewed by the govt employees who just put things in a big pile until they are able to get to it?

You never worked with any of this have you?
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Holy shit that can't be more wrong.
Medicare IS a paragon of efficiency! Medicare uses between 2-3 percent of premiums as overhead to process claims. Private health insurance companies use up to 30 percent.

Health insurance is like a supermarket that sells a very high dollar amount of goods and makes a very small percentage of profit. That is the nature of the business. If health insurance companies made the same percentage of profit as is common in most other industries they would be the worlds most profitable companies.

Yet, paying health claims is a very simple matter. Its almost all computerized. Processing costs have plummeted since the 1990's as they have gone computerized while the overhead health insurance companies charge has skyrocketed.

Call it what you want, but like charities which have to spend a certain amount of donations on actual charity in order to get tax exemptions and call themselves a charity, that is what is happening with ACA. It requires companies that want to sell a product called health insurance actually spend a certain percentage of their sales on actual health care.

Lastly, the "fraud" in Medicare, Medicaid, etc is actually a tiny amount of the total in health care reimbursement. Unlike private insurance which never reveals the amount of fraudelent claims they pay out, public health plans do.

I would venture a guess, on my actual experience as a health care executive who was involved in finding fraud in a private health care company that Medicare and Medicaid have far less fraud than private plans.


Just as an aside, did you know that large self insured companies that use private health care companies to process their claims have to hire other companies to watch over the health care companies because they not only don't try and combat fraud, they actually encourage it. The reasoning is simple. The health care company makes more money the more claims it pays out.
No, just no.
 

MooseNSquirrel

Platinum Member
Feb 26, 2009
2,565
294
126
Well, concerning employer-sponsored group coverage, the answer is complex.

First many employers, especially the large ones, are "self insured" and exempt from the ACA.

Those that aren't have three choices: offer a group plan on the exchange, offer a group plan off the exchange, or dump the employees on the individual exchange.

If its the first then there is too much uncertainty to say; too much hinges on your state's exchange composition for reasons I won't get into right now (I'm typing on my phone).

If its the second then the employer plan should still be group rated. A group with lots of young members will pay less than a relatively older group but the younger premiums likely will go up some.

If its the third then young premiums will definitely go up. The ACA requires that for any given individual policy the most expensive person can be more than 300% more expensive (4x) than the least expensive person. Since the high premiums can't come down the low premiums will have to go up.
Have you seen a study showing if these mandates will help moderate or worsen the rises?

Here is a great take on the larger debate:

http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Have you seen a study showing if these mandates will help moderate or worsen the rises?

Here is a great take on the larger debate:

http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/
No offense intended, but I don't really need a study; I'm seeing it in action.

(Now that I'm at a computer and not on my phone...)
For example, take scenario #1 in my prior post, the one I said was too complex. What happens is each state exchange has the ability to mandate how insurers offer health plans on the SHOP exchange. There are six main options:
1) An employer picks one plan from one insurer
2) An employer picks one insurer and the employees may choose any plan from that insurer
3) An employer picks a metal tier and the employees may choose a plan from any insurer offering that metal tier
4) An employer picks one insurer and the employees may choose a plan from a package offered by that insurer (employees do not get all choices)
5) An employer picks a partnership among multiple insurers and the employees may choose a plan from a package offered by those insurers (employees do not get all choices)
6) Open market, whereby an employee may choose any plan from any insurer at any tier

Group health insurance is generally less expensive than individual health insurance because the group rating mechanism keeps premiums down. Traditionally, for an employer to qualify for group rating they had to have a certain participation ratio among their employees, say 75% of employees had to participate in the group plan. This is why some employers wouldn't let employees opt out of coverage.

Under the ACA the participation ratio will be calculated by employees on the exchange, not employees on a particular plan. If the state allows options 3, 5, or 6 this causes huge problems. Now a company might meet the participation ratio for the exchange but not meet the participation ratio of any particular plan. This will force the insurers to go to individual rating which will be defaulted to higher premiums than group rating.

Example: An employer has 100 employees. The exchange has a participation ratio of 80%. In order to use the exchange at least 80 employees must elect to use the exchange. The exchange allows option 6 and there are a total of 10 insurers offering plans on the exchange. 80 employees elect coverage on the exchange with an equal distribution among insurers (8 people per insurer). While the group of employees has met the participation ratio requirement of 80% each individual insurer will only pick up 8 employees. 8 employees constitutes a "microgroup" and can't be effectively group rated. Premiums will more closely resemble individual premiums, which are higher than group premiums, so the employees will see higher average premiums as a result of purchasing on the exchange.
 

bfdd

Lifer
Feb 3, 2007
13,312
1
0
rebate is less than the increase i saw for a single month of insurance. lols.
 

Phokus

Lifer
Nov 20, 1999
22,995
745
126
Canada should just take over our healthcare system, they have a 1% overhead versus the 30% overhead we have in private care.
 

sactoking

Diamond Member
Sep 24, 2007
6,763
1,495
136
Nice chart.

A note: only people with individual insurance policies that qualify for a rebate should expect a check. If you have insurance through an employer, trade association, or other group ("employer") and qualify for the rebate the rebate check will go to the employer and not to you. I believe the employer is required to use it for your benefit, but it is likely that it will be used to offset future premium payment(s).
 

Tom

Lifer
Oct 9, 1999
13,294
1
76
+1

Who the hell gets rebates under this bullshit act anyway? People who don't pay for their healthcare anyway? Is it like the good old earned income credit?
I pay 100% of my individual healthcare insurance premium, about $900 a month. And I got a rebate check.
 

techs

Lifer
Sep 26, 2000
28,567
3
0
Holy crap, did you know the reason that the it costs so little? Because they have terrible service and offload work to providers who do less of what they are supposed to? That what takes hours under private insurance takes days or weeks because people who work for it are drowning in regs and work overloads? Do you know that Medicare D is handled by private corporations because they can do the work better than they can? That in spite of this sometimes they haven't the authority to move things along because it has to be reviewed by the govt employees who just put things in a big pile until they are able to get to it?

You never worked with any of this have you?

Wow. Some seriously wrong shit.

Medicare uses private companies to do ALL thier claims processing.

Medicare claims are paid faster than private health insurance claims since under their contracts with the private health insurance companies the companies get penalized if they don't pay a certain proportion of claims within a certain amount of time. Private health insurance companies have no such restrictions. Check your private health insurance contract. There is no set time limit to pay a claim. In fact, many health insurance companies pay claims at staggered intervals that are determined by the investments of your health insurance premiums that they hold until a claim is made.

As to your last claim that somehow Medicare employees are involved in holding up claims, thats complete and utter bullshit. The only time Medicare gets involved is with new and/or experimental procedures. And in comparison, private health insurance companies have been known to sit on the same types of claims since they can more easily deny payment if a subscriber has died.

You really know nothing of health insurance and the health insurance industry, do you?
 

WackyDan

Diamond Member
Jan 26, 2004
4,794
68
91
Canada should just take over our healthcare system, they have a 1% overhead versus the 30% overhead we have in private care.
They can mandate whatever overhead they want under single payer. Explain why 46,000 canadians came to the US last year for health care because the care they needed wasn't available in their province or because they were put on a terribly long waiting list?

I can have low overhead too...If I ration the care. Nobody should deny that rationing happens with single payer - it has to... But don't point to Canada or England as some crown jewel of nationalized health care.
 

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