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Undecided 44%
Elizabeth Warren22%
Joe Biden14%
Bernie Sanders8%
Pete Buttigieg6%

Thu Aug 1, 2019, 05:54 PM

 

Unless the "public option" is free or inexpensive it's snake oil.. and dangerous snake oil at that.

I'll start this discussion by stating that I consider Biden's and Bennet's debate performances last night as failures. They both insist that adding a "public option" to the ACA is the healthcare system we all should have, but what does that public option actually mean to a consumer? HOW MUCH would my premiums and deductibles be relative to a comparable plan provided by private insurance? THAT'S the most important question, and neither proffered an answer.

So let's address the proposal to keep the ACA:

The ACA should not be a Democratic sacred cow just because it began with the Obama Administration and is better than what we had previously. Even President Obama considered it only a stepping stone (albeit a significant one) on our way to single payer health CARE, as opposed to profit-dominated private health INSURANCE. So, why did he SETTLE for the ACA instead of single payer? Well, because it was constructed upon a Heritage Foundation concept he thought (naively) that he could at least get a few Republicans to agree to the plan, ostensibly unaware that all those Republicans had made a compact among themselves to thwart ANY and all programs that Obama might chalk up as achievements.

Most important in its consideration, in my view, is that the Affordable Care Act is certainly not "affordable" for many Americans... 27 MILLION of us are STILL uninsured. And then there are millions of people such as myself, who barely earned $50k last year but had to fork over $900+ per month, for just myself as a single person, for medical premiums under an ACA-subsidized plan.

Second, "insurance" companies, their executives, and their agents do not wield stethoscopes and scalpels. They don't operate cat-scan machines nor perform operations. They exist to generate PROFITS. And make no mistake about it... they generate ENORMOUS profits. And any and all profits that go to such middlemen could otherwise be directed to health care, itself. We already have real world examples... should I list them? Canada, the UK, France, Scandinavia, Japan, Australia... all of whom have better health CARE delivery than our own, not to mention greater life expectancies.

So, is adding a "public option" to this present mixture a way to reduce overall costs of health care? Please tell me how, because Joe Biden certainly hasn't. How would it eliminate private insurance as the primary element in our health care allocation system? How would it eliminate those PROFITS?

Well, I'll tell you how (again, Biden certainly hasn't) it COULD work. If we're going to have a "public option" on top of the ACA then its premiums must be free or nearly free, in order that employers can eliminate arrangements with private insurers and have their employees move to the public option, or purchase group public option plans themselves. Eventually, private insurance would be replaced as our dominant factor by the sheer weight of its expense to consumers.

So why is the public option "dangerous" at COMPETITIVE rates (i.e. market rates determined by the private insurance companies)? Because unless those rates are actually significantly better they will be perceived as pointless, endangering their very existence, and thus eliminating a movement to government assistance for universal care altogether.

I CAN NOT support your "public option" Joe unless you tell me it's going to be free or inexpensive. Right now you are endangering the future of universal health care.

If I were to vote in a presidential
primary today, I would vote for:
Elizabeth Warren

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Arrow 67 replies Author Time Post
Reply Unless the "public option" is free or inexpensive it's snake oil.. and dangerous snake oil at that. (Original post)
Goodheart Aug 2019 OP
mia Aug 2019 #1
Farmer-Rick Aug 2019 #51
Hoyt Aug 2019 #2
Goodheart Aug 2019 #6
elocs Aug 2019 #9
ehrnst Aug 2019 #16
elocs Aug 2019 #25
Docreed2003 Aug 2019 #26
pangaia Aug 2019 #27
ehrnst Aug 2019 #28
pangaia Aug 2019 #32
LiberalFighter Aug 2019 #40
pangaia Aug 2019 #41
ismnotwasm Aug 2019 #45
Bettie Aug 2019 #63
wasupaloopa Aug 2019 #54
elocs Aug 2019 #8
ehrnst Aug 2019 #29
thesquanderer Aug 2019 #3
emulatorloo Aug 2019 #4
Goodheart Aug 2019 #5
thesquanderer Aug 2019 #12
mia Aug 2019 #7
thesquanderer Aug 2019 #11
mia Aug 2019 #13
thesquanderer Aug 2019 #15
KPN Aug 2019 #31
Goodheart Aug 2019 #35
thesquanderer Aug 2019 #36
uponit7771 Aug 2019 #56
thesquanderer Aug 2019 #57
ehrnst Aug 2019 #37
thesquanderer Aug 2019 #44
ehrnst Aug 2019 #47
thesquanderer Aug 2019 #48
ehrnst Aug 2019 #49
thesquanderer Aug 2019 #55
uponit7771 Aug 2019 #60
ehrnst Aug 2019 #61
Thekaspervote Aug 2019 #10
Act_of_Reparation Aug 2019 #17
BannonsLiver Aug 2019 #22
cynatnite Aug 2019 #24
BannonsLiver Aug 2019 #30
cynatnite Aug 2019 #34
ehrnst Aug 2019 #50
Act_of_Reparation Aug 2019 #62
cynatnite Aug 2019 #20
IronLionZion Aug 2019 #21
UniteFightBack Aug 2019 #14
SouthernProgressive Aug 2019 #18
kcr Aug 2019 #46
Everyman Jackal Aug 2019 #19
ehrnst Aug 2019 #38
Everyman Jackal Aug 2019 #42
uponit7771 Aug 2019 #64
Everyman Jackal Aug 2019 #67
Hortensis Aug 2019 #23
ehrnst Aug 2019 #39
Indygram Aug 2019 #33
Gothmog Aug 2019 #43
wasupaloopa Aug 2019 #52
lark Aug 2019 #53
subterranean Aug 2019 #58
greatauntoftriplets Aug 2019 #59
iwannaknow Aug 2019 #66
Celerity Aug 2019 #65

Response to Goodheart (Original post)

Thu Aug 1, 2019, 05:59 PM

1. 'Nothing in this life is free'.

 

This will be funded by the working class. They are so lucky to have a job.
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Response to mia (Reply #1)

Sun Aug 4, 2019, 08:58 AM

51. Actually a lot of things in life are free

 

Air to breath even if it's polluted is still currently free.

If you come out of the correct womb everything can be free for you. Suppose you were born into the Koch Bro family, everything is free. Suppose you were one of Bill Gates' children, everything would be free. Inheritance is just a scam to give the offspring of the filthy rich everything for free. They did nothing to earn it and will probobly do nothing much in their lives.



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Response to Goodheart (Original post)

Thu Aug 1, 2019, 06:05 PM

2. Medicare is not going to be affordable for many Americans either.

 

Healthcare is expensive. There might be some savings under single payer, but picking up uninsured/underinsured, removing coinsurance and deductibles, adding dental, hearing aids, etc., will eat that up.

Biggest problem, M4A will not be enacted anytime soon. Public Option has a better chance. However, Subsidies will have to be increased so everyone is covered and out-of-pocket costs are not an impediment.

Single Payer might be better in many ways, but a lot of people, including Democrats, just donít see the advantage in it for them, for whatever reason. It just wonít pass, and will give trump and GOPers a leg up in general election.
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Response to Hoyt (Reply #2)

Thu Aug 1, 2019, 06:25 PM

6. Medicare is affordable for every Canadian, every Australian, every Brit, every Swede, ....

 

If I were to vote in a presidential
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Response to Goodheart (Reply #6)

Thu Aug 1, 2019, 06:45 PM

9. So, is the U.S., a nation of over 300 million people,

 

the same as much smaller nations such as Canada, Australia, Great Britain, or Sweden?
Why would we believe Medicare for All would work as successfully here as in those countries?
How do we convince Americans who want a choice in their healthcare that we know what's best for them in the healthcare system we impose on them?

The honest answer is that Medicare for All will never become a law anytime soon although those who support it like to hold out that pretense.
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Response to elocs (Reply #9)

Fri Aug 2, 2019, 01:49 PM

16. Especially in two years... None of those countries who have single payer could

 

replicate what they have in TWO YEARS - as Sanders claims it can be done as a POTUS candidate, going from a baked in system that is 18% of the GDP.

His 2016 plan, which claimed it could be done in 8 years was analyzed by an independent health policy think tank, and they didn't agree with the claims in the plan, and determined that taxpayers would pay more, and delivery of care disrupted more than the plan claimed. The think tank was promptly falsely smeared and discredited by Sanders spokespersons, and therefore shortly afterwards,
by his supporters.

Those countries started from scratch generations ago, and their systems grew up with technology as it became more expensive. There was no insurance system to retrofit.

Canada didn't go federally single payer until all the provinces did individually - which took nearly 20 years. Then a very liberal PM was elected in the 60's, and they added a federal layer to what was there. It's still mostly run at the province level, and does not include nearly the perks that Sanders' platinum plan does.

Australia's nearly went under, but they changed it. Their plan is far easier and cheaper to administer with 89% of their population concentrated in a few urban areas, making it more efficient to deliver to more people with fewer facilities. The US is 80% rural. Australia's 10.45% rural population doesn't get very good health care.

It's easy to 'sell "Medicare for All" because that implies that the system is already in place - and you just expand it. The onboarding of hundreds of millions in two years would overwhelm the current infrastructure, and the economic displacement and cost cutting would impact other areas of the economy.

The transfer of billions of dollars from a variety of sources to reroute them to other sources won't happen quickly either.

But during a campaign, it's easy to promise things, and get into a promise competition with opponents.



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Response to ehrnst (Reply #16)

Fri Aug 2, 2019, 03:24 PM

25. It's as if "we'll just flip a switch" and have Medicare for All,

 

but never a realistic explanation of how it would be passed into law and evidently there is the belief there will never again be a Republican president and a Republican Congress that would try and repeal it.
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Response to ehrnst (Reply #16)

Fri Aug 2, 2019, 03:51 PM

26. And not just replicate...

 

Sanders is promising to offer FULL coverage for things like dental and vision which would be much more expansive than any of the current programs in those countries.

The idea that his plan could be implemented in two years and be a panacea for healthcare is nothing more than a "pie crust promise", as Mary poppins would say, easily made and easily broken.
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Response to ehrnst (Reply #16)

Fri Aug 2, 2019, 03:52 PM

27. US is 80% urban and 20% rural in 2017

 


https://www.census.gov/library/stories/2017/08/rural-america.html

About 60 million people, or one in five Americans, live in rural America.

The term ďruralĒ means different things to different people. For many, it evokes images of farmlands and pastoral landscapes. For our purposes, we define rural based on the official Census Bureau classification. What is urban and what is rural is defined after each decennial census using specific criteria related to population thresholds, density, distance and land use.

In general, rural areas are sparsely populated, have low housing density, and are far from urban centers. Urban areas make up only 3 percent of the entire land area of the country but are home to more than 80 percent of the population. Conversely, 97 percent of the countryís land mass is rural but only 19.3 percent of the population lives there.
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Response to pangaia (Reply #27)

Fri Aug 2, 2019, 03:57 PM

28. Thank you for the correction. (nt)

 

If I were to vote in a presidential
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Response to ehrnst (Reply #28)

Fri Aug 2, 2019, 04:01 PM

32. funny isn't it that urbanists are called elite when they are by far far far the majority...

 


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Response to pangaia (Reply #27)

Fri Aug 2, 2019, 06:33 PM

40. There you go...

 

create a program where urban is automatic with opt-out and rural is opt-in.
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Response to LiberalFighter (Reply #40)

Fri Aug 2, 2019, 10:13 PM

41. interesting idea.... what about the suburbs ?

 



or where I live which is a small 'city" about 15,000. not too far from a real city. Rochester, NY
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Response to ehrnst (Reply #16)

Sat Aug 3, 2019, 03:03 PM

45. That's way it's a shit slogan to run on

 

I donít care WHO is using it. Medicare doesnít work the way most people thinks it does.
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Response to elocs (Reply #9)

Mon Aug 5, 2019, 07:46 AM

63. Medicare for All or Universal Health Care

 

rather than the current "insurance for some, but that insurance doesn't want to pay for anything" system, scales.

Here's the thing. In those other countries, smaller populations work because it is a percentage of the taxes collected from each person and business. It scales. Our nation would collect more because there are more of us in the overall pool of "everyone".

Doctors would still get paid, in fact, they would get paid more consistently as insurance companies decide more often than you think to just not pay because....reasons. Hospitals might build fewer large atriums with beautiful fountains and marble floors, but there is a whole lot of waste and a whole lot of profit coming off the top of our system.

Take the profit motive out and the health care system costs a lot less and can give better more comprehensive care as they don't need to find work arounds to deal with things that health insurance companies don't 'like' to cover.

Then there's this: why come to a negotiation with hat in hand begging for the very least you can possibly accept? The only thing that buys is far less than the minimum acceptable. Why is dreaming big, asking for something that would help everyone such a terrible thing? And finally, how would everyone having access to health CARE take choice away from anyone else? All the doctors would be "in network", unless they decided to work outside of the main system in some kind of private concierge system.
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Response to Goodheart (Reply #6)

Sun Aug 4, 2019, 09:06 AM

54. Saying that is a cop out. We need to talk in realistic terms. We need all the facts and truthfully

 

discuss them so we can design a plan that works for us.

If we all were sitting around a table trying to solve the problem of health care in America, someone saying "other countries do it" should be dismissed so that they would not waist the precious time needed to find a fix.
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Response to Hoyt (Reply #2)

Thu Aug 1, 2019, 06:38 PM

8. The elephant in the room: "M4A will not be enacted anytime soon."

 

The candidates who support M4A all know that it will never be enacted soon, or maybe ever, and none of them will even discuss how it realistically can become law.
Pretending that M4A would happen anytime soon is dishonest and holds out false hope for those who need affordable healthcare NOW.

So is it Medicare for All or nothing or is there a Plan B, imperfect as it may be, that has a real chance to be passed?
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Response to elocs (Reply #8)

Fri Aug 2, 2019, 03:58 PM

29. Fixing the damage done to the ACA is going to be the way to get the most people healthcare

 

coverage in the shortest amount of time.
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Response to Goodheart (Original post)

Thu Aug 1, 2019, 06:14 PM

3. Biden did answer this.

 

It's another option on the exchange, with a cost attached, subsidizable based on your income, just like all the other options on the exchange.

From the debate, here's what he said:

provide a public option, meaning every single person in America would be able to buy into that option if they didn't like their employer plan, or if they're on Medicaid, they'd automatically be in the plan.
...
No one has to keep their private insurance. They can buy into this plan. And they can buy into it with $1,000 deductible and never have to pay more than 8.5 percent of their income when they do it. And if they don't have any money, they'll get in free.
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Response to thesquanderer (Reply #3)

Thu Aug 1, 2019, 06:20 PM

4. Thank you for providing the quote

 

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Response to thesquanderer (Reply #3)

Thu Aug 1, 2019, 06:21 PM

5. Where's PRICE in that?

 

Your quote didn't address price relative to private plans, just as I complained.

And what you said in your first sentence already exists under the ACA.
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Response to Goodheart (Reply #5)

Thu Aug 1, 2019, 07:12 PM

12. re: "And what you said in your first sentence already exists under the ACA"

 

Of course it does... because the whole POINT of Biden's plan is basically that is *IS* the ACA, except with another option. Which brings me to your other comment...

Your quote didn't address price relative to private plans, just as I complained.

Obviously it is supposed to be cheaper, since it removes the for-profit motive of private insurance companies, and otherwise there would be no point. But you know, if it doesn't save you money, don't pick it! In Biden's plan, the current options are still there as well.

As for how much cheaper to expect, Inslee's public option plan in Washington was estimated to save people between 5 and 10 percent on their premiums.
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Response to thesquanderer (Reply #3)

Thu Aug 1, 2019, 06:28 PM

7. The rest will pay up to 8.5 % of their incomes until they, too, are also broke.

 

Who will be left to pay for it then?
The billionaires? Just like Mexico is going to pay or the wall.
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Response to mia (Reply #7)

Thu Aug 1, 2019, 06:55 PM

11. There's no plan for free healthcare for everyone, from ANYONE.

 

Everyone will require either a premium to be paid, or a tax increase. But it will be scaled so that people who can afford less will also pay less. SOME will end up getting it for free. But those who can afford to pay something will be paying something, whether in premiums or taxes.
If I were to vote in a presidential
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Response to thesquanderer (Reply #11)

Thu Aug 1, 2019, 07:23 PM

13. Is that the same as:

 

"From each according to his ability, to each according to his needs"?

Even though that will benefit all who are poor, no matter which party they favor, I doubt that those who are working now, or hope to get a job, will want to have less take home pay in order to subsidize the rest.

What about retired folks who have done with less during their working lives in order to save money for their old ages. Will they have to spend down their savings to pay the extra taxes and premiums?

In Florida, when people get down to $2000 in the bank, they "end up getting it for free".

What's the use of saving money, if the government is going to take it away, anyway?




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Response to mia (Reply #13)

Thu Aug 1, 2019, 07:57 PM

15. Biden's plan works exactly the way the ACA works, why is anyone confused/surprised?

 

That's Biden's whole sell. Don't throw out ACA, add a public option to it. How different from the ACA does anyone expect it to be? (Yes, he makes some other changes, too, but it's fundamentally the same, and that sameness is what's he's pushing, i.e. that it would not be overly disruptive or overly expensive to implement.)

Even though that will benefit all who are poor, no matter which party they favor, I doubt that those who are working now, or hope to get a job, will want to have less take home pay in order to subsidize the rest.

Just like the ACA. You don't pay enough even to cover your OWN coverage (much less anyone else's) until you make a certain income... below that point, the government subsidizes you.

What about retired folks who have done with less during their working lives in order to save money for their old ages. Will they have to spend down their savings to pay the extra taxes and premiums? .

Just like today, your premiums/subsidies/taxes are based on how much you make in a given year, not how much you've saved from prior years. You can have a million in the bank, but if your income this year is only $10k, your premiums/taxes are based on having earned $10k.

What's the use of saving money, if the government is going to take it away, anyway?

Even today, once your health deteriorates, it is common that having saved money only gets you into a *better* nursing home, but ultimately, it still bleeds you dry and then medicaid kicks in because they've made you broke. That's the system as it is today. Unless you stay healthy enough to maintain your own living space to the end, or have so much money that you can afford having private care come to you.

Now, if you're talking about plans OTHER than Biden's, there are other variations. Everyone's is a little different. But none of them are "free for everyone" because someone has to pay for it. How much comes from "taxing the rich," how much comes from individual tax increases (progressively, like the income tax), how much comes from premiums (also a sliding scale), these details may differ. But the concept is always, anyone who can afford to pay SOMETHING into the system is going to pay something into the system; and the system will take care of those who can't pay anything. Though there is wiggle room on that last part, as one of the criticisms of Biden's ACA-based plan is that it doesn't immediately cover absolutely everyone as some other plans do.
If I were to vote in a presidential
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Response to thesquanderer (Reply #3)

Fri Aug 2, 2019, 03:59 PM

31. No he didn't. He didn't speak to what the

 

premium will be whatsoever. Itís a legitimate question and concern. I agree with the OP. In fact, Bidenís proposal will only harden the current opposition to the ACA. An option that only effectively reduces costs for those who canít afford whatís available in the current ACA marketplace will do nothing to reduce the cost for the majority of Americans. It will perpetuate the profiteering that dominates our health industry instead.

Incrementalism is what created the economy, income inequality, and health care costs we have now. Iím done with it.



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Response to KPN (Reply #31)

Fri Aug 2, 2019, 04:09 PM

35. Bravo.

 

If I were to vote in a presidential
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Elizabeth Warren

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Response to KPN (Reply #31)

Fri Aug 2, 2019, 04:29 PM

36. re: "He didn't speak to what the View profile premium will be whatsoever."

 

He did to some extent, when he said it would not exceed 8.5% of your income, that the deductible would be $1,000, that those who cannot afford it will get it free and that those on medicaid will be rolled over into it. That information tells most people roughly what it will cost them. It's impossible to give a hard figure, because just was with the ACA today, there are many different amounts you could pay, based on what plan you choose and based on your income.

And I'd say it is assumed that anyway coming into the conversation has a certain basic knowledge of the issue, i.e. that the point of a public option is to lower costs by offering a plan that does not have profit for an insurance company built into it. So that's the other piece of info... if you're on the ACA today, the public option should be lower than what you're now paying, because that's it's raison d'etre. The one missing piece is how much cheaper. I'd assume worst case, 5% cheaper, which is the lowest estimate I've read. The best estimate I read was that it could be in the range of 20% cheaper. I wouldn't count on that. But I don't think anyone has the hard numbers yet.
If I were to vote in a presidential
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Response to thesquanderer (Reply #36)

Sun Aug 4, 2019, 09:51 AM

56. If he's capping deductable then it's more than 5% cheaper

 

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Response to uponit7771 (Reply #56)

Sun Aug 4, 2019, 10:11 AM

57. I guess, if you tend to spend at least $1k of your deductible.

 

Lots of people don't.

But also, maybe some of the variation in estimates of the savings that could come with a public option plan depends on what you're comparing it to... i.e. a high deductible bronze plan vs. a low deductible gold plan.
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Response to thesquanderer (Reply #3)

Fri Aug 2, 2019, 04:31 PM

37. That has some consequences. There have to be limits to who gets that public option,

 

unless premiums are charged on a sliding scale, charging more for those who make more. That adds another layer to the administration, and therefore costs, however.

Why would employers even bother offering any subsidies or hr administration of health care coverage if they can just tell people to go get the public option. That would effectively kill any incentive for employers to provide an alternative to the public option - which would then kill any incentive for private insurance to participate, leading to accusations of "YOU SAID WE WOULD BE ABLE TO CHOOSE A PRIVATE OPTION!"

Most countries with UHC require employers to handle some of the subsidizing and administration of coverage, just to spread the labor and costs a bit. People who are employed go through their employer to register for their coverage.

The ACA limited subsidies for people on exchanges to those with lower incomes - that were still too high according to the ACA determined income level for individual state expanded medicaid programs - which several red states refused to implement, and therefore cut people out of help with insurance on the exchanges, but also didn't provide them with medicaid.

Long story short- unless there are conditions limiting people to get the public option (such as the restrictions on Medicare and Medicaid), any employer provided options that include private insurance will go away. Private insurance will pull out of the health care market.

The public "option" will be a misnomer, because it will be the only choice. Which is not what is being promised.









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Response to ehrnst (Reply #37)

Sat Aug 3, 2019, 02:21 PM

44. re: "unless premiums are charged on a sliding scale, charging more for those who make more"

 

Yes, that's exactly how it works, just like today. Remember, it's building on the ACA infrastructure, which already has that sliding scale (i.e. the less you make, the more of a government subsidy you get). So "that adds another layer to the administration, and therefore costs, however" is not really an issue.

Private insurance will pull out of the health care market.

The public "option" will be a misnomer, because it will be the only choice


Maybe, but some would say that's a feature, not a bug. The idea is that a single-payer option is the ideal, but rather than force everyone into it, people will transition into it gradually over time, as the market prompts people to voluntarily decide to sign up for the public option, which in turn prompts the private health care industry to radically change or leave the market. That may not be Biden's plan (I don't know), but it is a common one, seen as more moderate than the ones that are mandating a full transition over 4 years or whatever.
If I were to vote in a presidential
primary today, I would vote for:
Elizabeth Warren

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Response to thesquanderer (Reply #44)

Sun Aug 4, 2019, 07:32 AM

47. First, no, the ACA subsidies aren't just a sliding scale - it involves more than income.

 

The ACA relies on Employer participation.

There will also be the issue of determining what income really is. If you've ever filled out the FAPSA for student aid, you know how problematic those metrics are.

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Response to ehrnst (Reply #47)

Sun Aug 4, 2019, 07:58 AM

48. Employers today can choose the plan they want to offer.

 

I assume that if there is a government run non-profit plan ("public option", the employer will be able to choose that if they want to.

This is the big flaw in the talking point about letting consumers have choice. Most people are insured through their employment, and they have little or no choice, because they can only choose what the employer lets them choose. Plus if they lose that job, they can lose that plan. (Not all plans offered to businesses are also available to individuals.) Today's "choice" is an illusion for most people. They're worried about losing something they don't actually have.

To your other points, when it comes to individual insurance plan purchases at least, ACA subsidies are based on a sliding scale of income, and it's not hard to determine what your income is for purposes of subsidy. Just use number on your tax return. It's not like financial aid packages where some individual is reviewing each application to confirm eligibility. It's all automated.
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Response to thesquanderer (Reply #48)

Sun Aug 4, 2019, 08:37 AM

49. I will assume nothing before I see Biden's public option plan.

 

This is the big flaw in the talking point about letting consumers have choice.


That is not one of my talking points. I cringed when Obama said, "If you like your insurance, you can keep your insurance." That was used against his credibility by those opposing the ACA. Making grand promises might "inspire" us, but they often raise expectations that backfire when those promises aren't delivered.

To your other points, when it comes to individual insurance plan purchases at least, ACA subsidies are based on a sliding scale of income.


That's only after they qualify to purchase on the exchanges at all. Those who make too much, according to the ACA medicaid expansion projections, but live in states that didn't participate in the expansion, don't qualify for any subsidy.

So, someone in a state that says a single person making $13,000 is making too much to qualify for Medicaid (under $12,000), and the ACA stated that the state was to expand Medicaid to single person making $19,000, that person will be ineligible for both Medicaid and subsidies on the exchanges.

So, it's more complicated than sliding scale based on income - the person making $19,100 a year will get subsidies, but that same person would not get any subsidies, nor Medicaid if they made $13,000.

That led to a lot of people becoming infuriated at the ACA.
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Elizabeth Warren

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Response to ehrnst (Reply #49)

Sun Aug 4, 2019, 09:49 AM

55. That's an issue of states choosing not to participate.

 

That wasn't a flaw in how they tried to set up the ACA, it was the result of a court ruling against them that essentially permitted states to prevent their residents from being fully covered by the ACA as intended. Yes, that somehow needs to be addressed, but it an issue that is separate from the fact that the ACA subsidies are still based on income.
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Response to ehrnst (Reply #49)

Sun Aug 4, 2019, 11:21 AM

60. That's the states not using substitute that's not the ACA

 

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Undecided

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Response to uponit7771 (Reply #60)

Sun Aug 4, 2019, 02:29 PM

61. I have no idea what that sentence means. (nt)

 

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Response to Goodheart (Original post)

Thu Aug 1, 2019, 06:53 PM

10. TheBrits and others enacted govt funded hlth care post WWII. We missed the boat

 

Most Americans...not all but most are really very poor stewards of their health and their bodies, then when the time comes to pay the piper of course itís going to be very high tech and very costly.

If you want to cut your own personal health care costs, take better care of yourself. If everyone did, it would be easier.

There are no easy answers, and nothing is free. But again, just take better care of yourself
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Response to Thekaspervote (Reply #10)

Fri Aug 2, 2019, 02:33 PM

17. "If you want to cut your own personal health care costs, take better care of yourself"

 

You're kidding, right?
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Response to Act_of_Reparation (Reply #17)

Fri Aug 2, 2019, 03:05 PM

22. Seems pretty obvious to me.

 

Are you making the case the preventive measures like a good diet, not smoking and physical activity arenít relevant to an individualís costs? Seems to me if youíve got an illness caused by an unhealthy lifestyle thatís eventually going to cost that individual in the end, whether thatís copays for treatment for heart disease, diabetes or cancer.

Some people are predisposed to illness for a variety of factors outside their control. Others get there by making bad choices.
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Response to BannonsLiver (Reply #22)

Fri Aug 2, 2019, 03:17 PM

24. So those who make bad choices in your eyes should pay more?

 

Having affordable access to health care in the first place makes it easier to get on the path to a healthier lifestyle.

Plus, have you seen our world lately? There is so much misinformation and outright lies that exist aisle by aisle in a supermarket. With deceptive advertising, misleading claims about what's good for you, it's hard to navigate.

I've been researching the keto diet and watched "the magic pill" on netflix. That'll give you a wakeup call.

I'm not completely sold on the keto diet. The coconut oil is going back to the store.
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Response to cynatnite (Reply #24)

Fri Aug 2, 2019, 03:58 PM

30. No.

 

My point was they WILL pay more. Reading is fundamental.
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Response to BannonsLiver (Reply #30)

Fri Aug 2, 2019, 04:09 PM

34. Got it.

 

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Joe Biden

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Response to cynatnite (Reply #24)

Sun Aug 4, 2019, 08:45 AM

50. In some countries with UHC, people are bumped down the list for

 

organ transplants if they are not following guidelines for healthy living, like smoking, eating a diet high in junk food, etc.

You do pay more on the ACA state exchanges as you age, because of higher health care costs. There is a cap, but there are higher premiums.

Taking care of your health does more do keep down health care costs in general, and health care coverage does reflect that.

Yes, one will pay in general if one doesn't exercise, eat well, get sleep, etc.

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Response to BannonsLiver (Reply #22)

Mon Aug 5, 2019, 07:26 AM

62. The operative word being "seems"

 

Geography and epigenetics are probably far more important factors.

But if that doesn't convince you, maybe stop and consider how similar your position on personal health mirrors the Republican position on personal wealth.
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Response to Thekaspervote (Reply #10)

Fri Aug 2, 2019, 02:49 PM

20. That's what my daughter told my grandson while she was pregnant...

 

Then he was born with a birth defect.

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Response to Thekaspervote (Reply #10)

Fri Aug 2, 2019, 02:55 PM

21. Europe had a lot of wounded to take care of because of the war

 

the US found a new enemy instead: communism. So there was strong opposition to these programs because people thought they'd lose freedoms or something. Employer-based health insurance came about in the US during the postwar years as other countries went for national health insurance. The US established programs for the large number of wounded veterans but not regular civilians.
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Response to Goodheart (Original post)

Thu Aug 1, 2019, 07:28 PM

14. The ACA Mend it don't end it. nt

 

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Joe Biden

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Response to Goodheart (Original post)

Fri Aug 2, 2019, 02:36 PM

18. Calling these things "free" is snake oil. NT

 

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Undecided

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Response to SouthernProgressive (Reply #18)

Sun Aug 4, 2019, 12:45 AM

46. Pretending that government doesn't exists to help people

 

and acting like that isn't a disingenuous right-wing tactic is snake oil
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Response to Goodheart (Original post)

Fri Aug 2, 2019, 02:46 PM

19. My usual post.

 

I am 100% service-connected disabled and ALL of my medical is free. I could get a paid-for insurance policy if I felt the VA wasn't enough, but I am perfectly satisfied with the VA. I am for single-payer healthcare with private insurance on top of that for whoever wants it.
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Response to Everyman Jackal (Reply #19)

Fri Aug 2, 2019, 04:36 PM

38. There will be no private insurance option if the public option is open to "anyone who wants it"

 

regardless of income, and the price is the same, regardless of income.

There is a reason that your service-connected care is restricted to certain people- to keep it affordable, and that is what creates the market for private insurance. That private option would disappear if the public option was universal.

If employers are not required to provide insurance subsidies and administration, they will simply tell employees to go get the public option.

Unless the private option is limited by income or employment status, anyone who is wealthy would have no incentive to pay more for a private option.




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Response to ehrnst (Reply #38)

Fri Aug 2, 2019, 10:43 PM

42. I don't want a public option.

 

I want everyone to have the same healthcare I get for the same price I pay, nothing. If people want to pay for some type of health insurance say for getting a colonoscopy every 2 years let them. I am 100% service-connected disabled but it has nothing to do with me being in the military. If I never joined the army I would still have a schizotypal personality disorder, which is as close as any of my psychiatrists have been able to figure.
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Response to Everyman Jackal (Reply #19)

Mon Aug 5, 2019, 07:59 AM

64. +1, We already have a single payer system and a lot of VAs work pretty good from what I've heard...

 

...it's nearly 50/50 on opinion of VA.

Open up VA's to public, that will help drive down the cost of these overtly expensive hospital groups.
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Response to uponit7771 (Reply #64)

Mon Aug 5, 2019, 02:58 PM

67. A VA type system for everyone is fine but not the same system.

 

From the reactions I see in restaurants and stores in non-military towns many civilians would not feel comfortable in a VA hospital waiting room. That is why you will see outside the Fayetteville NC VA hospital the sign "Where the price of freedom can be seen.". This is not the case where I live just a few miles from Camp LeJeune.
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Response to Goodheart (Original post)

Fri Aug 2, 2019, 03:12 PM

23. Nonsense premise, including the RW "free" smear that has no

 

basis in reality.

The ACA was meant to include a public option, and those costs were worked out and found to be affordable by the GAO and a bunch of other analysts before its passage in 2009. It would have been included in the ACA if conservative, anti-tax opposition that included Joe Lieberman hadn't managed to block it.

I call it nonsense, btw, because that it can be funded and would be, and how, is extremely well documented. And all relevant arguments that it would be too expensive refuted.

All of those here who've spent the past 10 years without it, don't forget to also thank Bernie Sanders for his efforts. He would be glad if he could to delay all improvements to the ACA for at very least another 7 years while a his own giant but unwritten program that also depended on free market, for-profit providers was written and implemented. Without development of inexplicable LW opposition to the ACA (!) in 2015-2016, a probable Hillary Clinton administration would have added the public option already.
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Response to Hortensis (Reply #23)

Fri Aug 2, 2019, 04:42 PM

39. +1000.(nt)

 

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Response to Goodheart (Original post)

Fri Aug 2, 2019, 04:08 PM

33. Medicare for America (the plan Beto O'Rourke endorses)

 

https://www.congress.gov/bill/116th-congress/house-bill/2452/text

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Response to Goodheart (Original post)

Sat Aug 3, 2019, 10:46 AM

43. Fighting over the details of their healthcare proposals won't help them beat Donald Trump

 


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Response to Goodheart (Original post)

Sun Aug 4, 2019, 09:00 AM

52. Nothing is free! Somebody has to pay. We need to make it vey clear that there will be no free

 

medical care period.


I am afraid that many who call for single payer think they will get free medical care and that's why they want it.

If you are indigent and can't pay for care the cost is passed onto someone else. There is always a cost. There are providers and medical supplies and drugs and rent and building maintenance and admin salaries.

There is no free lunch. And yes I'll say it. Some here want free stuff. And wanting free stuff will get us 4 more years of trump.
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Response to Goodheart (Original post)

Sun Aug 4, 2019, 09:02 AM

53. I loved the idea of single payer, but one concern bothers me.

 

What would happen to Medicaid, it is the ultimate single payer because the enrollee pays nothing or at most a small co-pay for services. I don't see how both could function in the same space when they'd be competing for the same people. Qualifying for Medicaid is hard for adults, what would be the qualifications for single payer and would single payer be able to negotiate like Medicaid and Tricare with pharmaceutical companies? Then there's the issue of supply. I can tell you that the number of hospitals and doctors that accept Medicaid is small. I'm sure single payer will have even worse access issues since it won't have the volumes of Medicaid.

I think Medicare for all who want it may be the best way to go. The people who have poverty or near levels of income would also qualify for Medicaid which would cover up to 200% of the FPL. Now that I'm retired, I'm a lot more cognizant of the cost of things and how everything interacts, so am now not so sold on adding a single payer option onto the ACA. If I'm wrong about this, please let me know where I've erred.


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Response to lark (Reply #53)

Sun Aug 4, 2019, 10:24 AM

58. I'm not sure I understand what you're saying.

 

A single-payer plan, like the one proposed by Bernie Sanders, would likely replace Medicaid. The only qualification would be being a legal resident of the United States. Everyone would be covered automatically.

Would it be able to negotiate prices with pharmaceutical companies? Every country with a single-payer system does that, so I assume we could, too.

As for supply, I don't know why you think a single-payer would have fewer hospitals and doctors that accept it than Medicaid. The opposite is true. Since most of the population would be covered by the single-payer system, most providers would have the choice of either accepting it or going out of business.
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Response to Goodheart (Original post)

Sun Aug 4, 2019, 11:05 AM

59. Despite the fact that I'm on Medicare, last year's out-of-pocket medical expenses totaled $9,000.

 

Yes, I have an autoimmune disease and other medical issues, but that's still a lot of money. IMO, Medicare needs to work better before it's expanded.
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Response to greatauntoftriplets (Reply #59)

Mon Aug 5, 2019, 10:41 AM

66. Medicare Needs Fixing

 

There is no out-of-pocket spending cap on simple/government Medicare, which means you can easily go broke if you get a serious illness. But you can pay an additional premium (and it's expensive on a fixed SS income) to a private company to supplement your costs and provide an out-of-pocket cap. Then there's the issue of pre-existing conditions. Most people don't realize that these private supplemental insurance companies can still refuse to insure applicants with certain pre-existing conditions, unless those applicants apply within 6 months of their eligibility date (65th birthday). In addition, there is no dental, vision, or hearing coverage; and you've gotta pay an additional premium for drug coverage.

Medicare Advantage, run by private companies, comes with: drug coverage; a reasonable out-of-pocket-cap; no pre-existing condition limitation; dental/vision/hearing coverage; and requires no additional premium (i.e., you just pay the $135 or whatever it is). However, co-payments are high for specialists. And of course you lose the freedom to select any Medicare provider you want.

Hopefully, MFA will fix these deficiencies, and I believe Bernie's plan does. Candidates who support keeping the ACA, and reforming it, should address these issues in their campaigns.
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Response to Goodheart (Original post)

Mon Aug 5, 2019, 08:22 AM

65. I do not see a public option being passed (let alone MFA)

 

Too many trillions at stake (at present rates of increase, our nation will be spending 5 to 6 trillion USD per year on healthcare 10 years from now), and big healthcare (hospitals and doctors), big pharma, and big insurance will spend hundreds of millions to crush it. They are already starting, and have vowed for years to do so. It is going to be painted as a GIANT socialist take-over, and it does (rightly so IMHO) put the rentier for-profit healthcare leeches directly in the target sights, so they will look at it as a battle for their very existence, a battle to keep their rapacious gravy trains a rollin'.

We have 108 (almost half of entire total) House members in centrist caucuses, ie The New Democrat Coalition, The Blue Dog Caucus, and the truly problematic No Labels bi-partisan Problem Solvers Caucus. Right now it only takes less than 20 defections to scupper the public option. Even if we gain back the Senate, we have to deal with people like Manchin, Sinema, Doug Jones (if he wins in 2020), Carper, Cooms, Tester, Angus King, etc., who may not support a public option when the rubber meets the road.

I am only being realistic in my pessimism. Hell, the SCOTUS may strike down the ACA. If that happens we will be lucky to get remotely back to where we are now (which is far from a good place atm.)
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