palehorse
Lifer
Pssst, you may want to check out Canadian federal and provincial income tax rates...
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People complainign their insurance is going up with the ACA
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werepossum
Elite Member
Here's a hint: When you say someone's post is "just flat out untrue" and post three links addressing none of that post's points, you might want to point out which part of the post you feel you are refuting.
And if you feel that strongly about Canada's health care system, there ARE buses running north every day. You too could be getting free health care!
I agree about the attitude, which is because we've decoupled the entity paying for health care (at least on the surface) from the entity receiving the benefit. But our health care IS rationed. Everything of value which takes time or treasure to provide is inherently rationed. We ration via a variety of methods, primarily by access to health insurance but also by limiting very expensive and/or low percentage procedures and by cutting off care with caps and lifetime limits.
poofyhairguy
Lifer
Agreed, just not in a centralized manner.
In fact the rationing now is the opposite of what one might expect. Obamacare was meant to increase access, but by decreasing reimbursements many doctors have decided to either not take medicare/medicaid or to limit how much they see. This seems to be a huge problem in rural areas where maybe only one or two guys cover the area for certain procedures. When they chose to opt-out it leads to less overall access to healthcare for these patients.
Londo_Jowo
Lifer
So please explain how people that are so happy with their healthcare go to other countries to get procedures and operations at a much greater cost than doing it in their home country?
werepossum
Elite Member
Agreed. I think most people understand that Medicare and Medicaid are losing propositions for doctors, it's just that some people feel entitled to punish doctors because they earn a lot of money. And our rationing developed piecemeal, so it's really not surprising that it's so counter-intuitive, with one person having "free" breast enhancements (great insurance) and another being unable to get basic mid-level care (no insurance.) (Mid-level being between care the patient can afford out of pocket and urgent care the patient can get regardless of ability to pay.)
There are things besides death panels where we'll inevitably have to follow after socialized medicine as well. When I had thyroid cancer, I received a radioactive iodine pill and spent a week in radioactive isolation. Canada can't afford that and has not the infrastructure to support it, so you get your pill and get sent home with an admonition to avoid children and pregnant or child-bearing aged women, not to share utensils, not to share bodily fluids, and generally keep your distance. Most people are perfectly capable of following these instructions, and Canada hardly has an epidemic of radiation poisoning from such practices. Also, at two of the last three specialists I've seen I've actually seen nurse practitioners rather than the doctor, which greatly reduces the overall cost of the visit. While there obviously will be some very small percentage who will sicken and/or die due to this, the overwhelming majority of patients will be served just as well. As we move to provide good health care to everyone, we'll have to adopt such common sense cost cutting measures.
poofyhairguy
Lifer
Sure, everyone wants the doctors to take a financial haircut but provide the same service. If doctors dare to work in their own interest and stop taking on government patients due to cuts well then they are just greedy assholes.
Actually I guess it depends on the region. My dad in a ophthalmologist in a rural Texas community who is transitioning away from taking Medicaid/Medicare. He still takes it, but he follows the scheduling rules (time between procedures) to the letter and he limits his patient load overall. In the past he didn't follow the rules strictly, he just did things on his own schedule and took a cut on the reimbursement to make the patients happy. But with the last round of across the board cuts tied to Obamacare he no longer feels like its worth catering to these patients.
So if you want to get both of your eyes done and you only have medicare/medicaid to pay for it will be something like 6 months compared to two weeks for private insurance patients or cash patients. When people complain about it he says
"Well remember when Fox News said Obamacare would ruin healthcare?"
"Well yeah."
"Well welcome to the new ruined healthcare system."
Luckily he is in a very conservative area so patients accept the reasoning, but I couldn't imagine the situation for doctors in blue states going through the same process.
This is the entitlement mentality among American patients I was talking about. If they are sick they want to see THEIR doctor and not his associate/PA/etc.
Its common sense that we need more PAs and more end-of-life care rationing, but that doesn't make it politically viable unfortunately.
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poofyhairguy
Lifer
Exactly.
And its not just keeping people happy, its liability. American doctors do tons of needless tests just in case granny isn't happy with her result (because you told her to wait 6 months instead of two weeks) and she runs to the medical board.
My dad has already had one patient try to "tattle" on him this way. He got it dismissed but it was a pain in his ass and wasted a lot of his time. Moved him one step closer to not taking any medicare/medicaid patents.
And its not just keeping people happy, its liability. American doctors do tons of needless tests just in case granny isn't happy with her result (because you told her to wait 6 months instead of two weeks) and she runs to the medical board.
My dad has already had one patient try to "tattle" on him this way. He got it dismissed but it was a pain in his ass and wasted a lot of his time. Moved him one step closer to not taking any medicare/medicaid patents.
OutHouse
Lifer
Pssst, you may want to check out Federal, state and local taxes.
OutHouse
Lifer
my doc does not take medicare/medicaid patients.
poofyhairguy
Lifer
Many are moving that direction. Everyone is covered in Obamacare but for some in rural communities there isn't a doctor they can see.
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palehorse
Lifer
I sincerely hope you're not trying to say that US tax rates are equal to, or greater than, Canadian tax rates...?
Canadians pay an arm and a leg for their socialized healthcare, and most of that is reflected in their exceedingly high tax rates... and God help you if you're middle class and living in Saskatchewan, Quebec, or Manitoba!!
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Svnla
Lifer
I saw on NPR/Nightly Business tonight and it said for a single person, 27 years old, makes about $25K/year will pay about $125 or so (after all the subsidize and help) per month for the silver plan healthcare.
How the heck a guy/gal that makes $25K before taxes will have the money ($1,500 per year) to pay for the required health care?
How the heck a guy/gal that makes $25K before taxes will have the money ($1,500 per year) to pay for the required health care?
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werepossum
Elite Member
That's one of the worst things about our system. Doctors should be punished proportionately when they have screwed up. Instead we have doctors being punished proportionately to a lawyer's ability to convince a jury that they have screwed up, not at all the same thing. So they prescribe a lot of expensive tests that the vast majority don't need because otherwise anything bad that happens to the patient will be seen as the doctor's fault.
sactoking
Diamond Member
Technically, a single person making $25,000 will have a monthly premium of (about) $99.63, or an annual premium of $1,195.50 (4.782% of income).
Federal Poverty Level for an individual in 2013 is $11,490. The tax credit chart is:
Income (As % FPL) Max % Of Income
133% 2.0%
150% 3.0%
200% 4.0%
250% 6.3%
300% 8.05%
400% 9.5%
In between those numbers it increases linearly.
Someone with an income of $25k is at 217% FPL. From 200% to 250%, the max premium increases 2.3% over 50 points, or 0.046% per point. At 217% you've got 17 extra points, so 0.782% above 4.0%. 4.782% of $25,000 is $1,195.50 per year or $99.63 per month.
Svnla
Lifer
Are you sure you are talking about the SILVER plan and not bronze/other cheaper plan? The $125 (or so) amount I cited earlier was about the silver plan for 1 single person, 20 something, with no dependent.
boomerang
Lifer
These figures have got to be averages or worse, guesstimated averages. Rates are varying by state and sometimes widely.
Which brings me to my question. Was I wrong in thinking that one of the facets of Obamacare was portability? With premiums varying so widely and more importantly, insurers picking and choosing where they will offer plans, I see no means for portability. Maybe my recollection is wrong.
palehorse
Lifer
When I looked at the recently released Kaiser Family Foundation study of 18 markets, anything over 400% of FPL showed "no cap"... is that true, or did I read it wrong? I thought you had previously stated that the max is 9.5% for anything 400% or higher...?
(PDF found here, see the chart in Figure 6 on page 7):
http://kaiserfamilyfoundation.files...remiums-and-participation-in-marketplaces.pdf
...and the rub.
The 27 year old will still be on the hook for thousands of dollars of out of pocket expenses if they do get significantly sick... and would still potentially be burdened with a shit ton of debt...
ACA does very little to prevent medical bill induced bankruptcy.
Are you kidding?
He comes from the mindset that most if not all business owners are swimming in cash, and that simply isn't true. Not even close to being true.
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Pray To Jesus
Diamond Member
How to stop increases in the underlying cost of medical care?
Total health care spending in the United States is expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970. To put it in context, this means that health care spending will account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021
Why is U.S. health care spending so high?
According to National Health Expenditure data, the growth in premiums tracked directly with the underlying cost of medical care from 2000-2010 a trend that has been consistent for decades.9
Compared to other Organization of Economic Cooperation and Development (OECD) nations, hospital spending in the U.S. is more than 60 percent higher.
Spending on physicians, specialists and dentists is almost 2 ½-times higher than in other OECD countries.10
Hospital cost increases
The newly formed Health Care Cost Institute has found that rising prices for care were the chief driver of health care costs for privately insured Americans in 2011. Spending on health care services climbed 4.6 percent in 2011, well above the 3.8 percent growth rate found for 2010 and higher than expected for 2011. Prices rose for all major categories of health care, such as hospital stays and surgical procedures, but rose fastest for outpatient care.
An increasingly important factor driving hospital price increases is consolidation of the hospital industry. Hospital mergers and acquisitions jumped by 33 percent between 2009 and 2010. Research shows that hospital market concentration leads to increases in the price of hospital care. In fact, price increases exceeded 20 percent when mergers occurred in concentrated markets.
Data show that after hospital spending the next biggest contributor to overall spending growth between 2005 and 2009 was the increase in physician and clinical service costs. These costs accounted for 18 percent of total growth or $229 per person over the five-year period.14
Medical technology
The increasing cost of medical technology is a significant contributor to higher health care spending. The implementation of new medical technology accounts for between 38 percent and 65 percent of health care spending increases. New technology expands the range of treatment options available to patients, but it does by replacing lower-cost options with higher-cost services.
Waste
Wasteful spending likely accounts for between one-third and one-half of all U.S. health care spending. PricewaterhouseCoopers calculates that up to $1.2 trillion, or half of all health care spending, is the result of waste.16
An Institute of Medicine (IOM) report estimated unnecessary health spending totaled $750 billion in 2009 alone.17
The biggest area of excess is defensive medicine, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to wasteful spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity.
Unhealthy lifestyles
The growing burden of chronic diseases adds significantly to escalating health care costs. Researchers predict a 42 percent increase in chronic disease cases by 2023.
Much of this cost is preventable, since many chronic conditions are linked to unhealthy lifestyles. For example, obesity accounts for an estimated 12 percent of the health spending growth in recent years.
Aging population
Life expectancy in the U.S. reached 77.9 years in 2007, up significantly from 62.9 years in 1940.20
Individuals who are age 65 or older, who spend much more on health care services than younger people, will comprise nearly one-fifth of the population by 2050.
Profits
Insurance industry profits are not a significant driver of health insurance premiums. A Yahoo Finance analysis places the health insurance sectors average profit margin in 2012 at just 4.5 percent.
Average profit margin
major drug manufacturers, 16.7 percent;
medical instrument and supply companies, 13.6 percent; biotechnology, 11.9 percent;
medical appliance and equipment companies, 13.7 percent.
Administrative costs represent less than 2 percent of health care spending growth. Private insurance administrative costs are actually comparable to Medicares administrative costs when comparing similar services. In 2009, private payers expended $12.51 per member per month versus $13.19 for Medicare.
Total health care spending in the United States is expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970. To put it in context, this means that health care spending will account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021
Why is U.S. health care spending so high?
According to National Health Expenditure data, the growth in premiums tracked directly with the underlying cost of medical care from 2000-2010 a trend that has been consistent for decades.9
Compared to other Organization of Economic Cooperation and Development (OECD) nations, hospital spending in the U.S. is more than 60 percent higher.
Spending on physicians, specialists and dentists is almost 2 ½-times higher than in other OECD countries.10
Hospital cost increases
The newly formed Health Care Cost Institute has found that rising prices for care were the chief driver of health care costs for privately insured Americans in 2011. Spending on health care services climbed 4.6 percent in 2011, well above the 3.8 percent growth rate found for 2010 and higher than expected for 2011. Prices rose for all major categories of health care, such as hospital stays and surgical procedures, but rose fastest for outpatient care.
An increasingly important factor driving hospital price increases is consolidation of the hospital industry. Hospital mergers and acquisitions jumped by 33 percent between 2009 and 2010. Research shows that hospital market concentration leads to increases in the price of hospital care. In fact, price increases exceeded 20 percent when mergers occurred in concentrated markets.
Data show that after hospital spending the next biggest contributor to overall spending growth between 2005 and 2009 was the increase in physician and clinical service costs. These costs accounted for 18 percent of total growth or $229 per person over the five-year period.14
Medical technology
The increasing cost of medical technology is a significant contributor to higher health care spending. The implementation of new medical technology accounts for between 38 percent and 65 percent of health care spending increases. New technology expands the range of treatment options available to patients, but it does by replacing lower-cost options with higher-cost services.
Waste
Wasteful spending likely accounts for between one-third and one-half of all U.S. health care spending. PricewaterhouseCoopers calculates that up to $1.2 trillion, or half of all health care spending, is the result of waste.16
An Institute of Medicine (IOM) report estimated unnecessary health spending totaled $750 billion in 2009 alone.17
The biggest area of excess is defensive medicine, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to wasteful spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity.
Unhealthy lifestyles
The growing burden of chronic diseases adds significantly to escalating health care costs. Researchers predict a 42 percent increase in chronic disease cases by 2023.
Much of this cost is preventable, since many chronic conditions are linked to unhealthy lifestyles. For example, obesity accounts for an estimated 12 percent of the health spending growth in recent years.
Aging population
Life expectancy in the U.S. reached 77.9 years in 2007, up significantly from 62.9 years in 1940.20
Individuals who are age 65 or older, who spend much more on health care services than younger people, will comprise nearly one-fifth of the population by 2050.
Profits
Insurance industry profits are not a significant driver of health insurance premiums. A Yahoo Finance analysis places the health insurance sectors average profit margin in 2012 at just 4.5 percent.
Average profit margin
major drug manufacturers, 16.7 percent;
medical instrument and supply companies, 13.6 percent; biotechnology, 11.9 percent;
medical appliance and equipment companies, 13.7 percent.
Administrative costs represent less than 2 percent of health care spending growth. Private insurance administrative costs are actually comparable to Medicares administrative costs when comparing similar services. In 2009, private payers expended $12.51 per member per month versus $13.19 for Medicare.
OverVolt
Lifer
Is this true? What is the point of health insurance then.
I got the "pun". The working middle class is going to take it up the butt. In third world countries there is not a middle class, only lower and upper class. The USA is heading toward the majority serving their kings.
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