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So now we got health care

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Guest erpi

Um, Im very confused. We have our own private health care. Yet the nation will be gearing up with Obama care. There will be a 'tax' I keep hearing about. Will my check now be reduced even more by supporting others? Anyone out there know about this? I can't have MORE taken out. I'd love to hear from anyone knowledgeable about this. Thanks.

Erpi

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Basically, in order for the policy to be constitutional, it has to be declared a tax. So, you're now forced to pay for the tax... ahem, I mean healthcare policy, or be subject to a federal penalty. I could have sworn I heard free health care not too long ago too.... hummm, lets just forget that never happened and be happy little teamster lemmings though ok ::) .

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If you already have health insurance, nothing changes. You only pay the "tax" penalty if you do not have health insurance.

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If you already have health insurance, nothing changes. You only pay the "tax" penalty if you do not have health insurance.

Over 2000 pages in this law. Does anyone really know the answer?

Um, Im very confused. We have our own private health care.

I wonder for how long? Private health insurance will most likely be driven out of business by having to compete with the government. WIthin a few short years there will only be one health insurance provider. Universal health coverage will be the de facto condition.

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There is something in all this that could lead to universal access to basic healthcare for every US citizen regardless of money or existing conditions. Who knows if that would ever happen here. I think he biggest obstacle is that this is the only 1st world country where people have tons of money and no universal health care. The health care industry has had it pretty good for the last 200 years, and it will be hard to pull that money back.

How things stand right now, somebody with health care won't change. No taxes, nothing. If anything the costs of insurance should be less, because they will have 5 times as many clients (so hopefully the union passes on those savings). That's how things worked out in Massachusetts when Romney started this. I know people that made about $20k/year and freelance engineers that made about $100k. They all said as out of pocket insurance buyers they found it to make things way cheaper. My brother is an engineer that gets insurance as part of his compensation from work, and said it doesn't effect him personally. He is quick to point out that his freelancer friends all say they are better off because of it. We'll see how it translates to the national level.

I'm not union, so I pay for health insurance out of pocket. Hopefully throwing 5x as many people in the pool will make companies fight for our business. I'm furious at how they increase my monthly payments ever year and drop services and add things like $1000/year deductible instead of a $20 co-pay.

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Lets be clear though, this in now way (currently) "gives away" free health care to every US citizen. Kind of the opposite.... if you do not buy health insurance, you pay a penalty/tax/whatever. That tax will ramp up for the first few years.

If you care enough, this is the current proposed tax for being uninsured:

http://abcnews.go.com/blogs/politics/2012/06/health-care-law-mandate-tax-how-much-is-it/

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The Supreme Court struck down the justification for ACA by way of a Mandate and the Commerce Clause (basically, Gov argued it had the right to regulate interstate commerce, purchasing health care, and the Court said no). But, the Court did say that the Law is basically a tax and if it's a tax, then it's constitutional.

Right now, there's a lot of focus on "tax". The ruling did not impose a new tax, it merely confirmed Congress' right to taxation. The "Tax" comes to people individually if they choose not to buy health insurance. The Government's argument, I believe, when it viewed this as a Mandate was that everyone is already within commercial system of health care: there are people who buy health insurance and the pooling together of their payments helps keeps the cost down when someone needs health care, but there are also people who either can't afford health care or who choose not to buy health insurance, but we as a society incur those costs when people go to the emergency rooms or let illnesses develop into much more serious situations than they could have been if found earlier through a regular checkup.

Here is a simplified breakdown of the ACA - I found this online, I did not write this so it's certainly not my hard work. Also, here is a cartoon that breaks down the arrangement under the law between people, insurance companies and the government (also not my work, just copying and pasting here): http://i.imgur.com/ZkHCP.jpg

Josh

Already in effect:


  • It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices) ( Citation: An entire section of the bill, called Title VII, is devoted to this, starting on page 747 )

  • It increases the rebates on drugs people get through Medicare (so drugs cost less) ( Citation: Page 216, sec. 2501 )

  • It establishes a non-profit group, that the government doesn't directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 665, sec. 1181)

  • It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 499, sec. 4205 )

  • It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether. For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them. ( Citation: Page 30, sec. 1101, Page 45, sec. 2704, and Page 46, sec. 2702 )

  • It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) ( Citation: Page 47, sec. 2705 )

  • It renews some old policies, and calls for the appointment of various positions.

  • It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )

  • It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending. ( Citation: Page 14, sec. 2711 )

  • Kids can continue to be covered by their parents' health insurance until they're 26. ( Citation: Page 15, sec. 2714 )

  • No more "pre-existing conditions" for kids under the age of 19. ( Citation: Page 45, sec. 2704 and Page 57, sec. 1255 )

  • Insurers have less ability to change the amount customers have to pay for their plans. ( Citation: Page 47, sec. 2794 )

  • People in a "Medicare Gap" get a rebate to make up for the extra money they would otherwise have to spend. ( Citation: Page 379, sec. 3301 )

  • Insurers can't just drop customers once they get sick. ( Citation: Page 14, sec. 2712 )

  • Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific).

  • Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down. ( Citation: Page 42, sec. 2719 )

  • Anti-fraud funding is increased and new ways to stop fraud are created. ( Citation: Page 699, sec. 6402 )

  • Medicare extends to smaller hospitals. ( Citation: Starting on page 344, the entire section "Part II" seems to deal with this )

  • Medicare patients with chronic illnesses must be monitored more thoroughly.

  • Reduces the costs for some companies that handle benefits for the elderly. ( Citation: Page 492, sec. 4202)

  • A new website is made to give people insurance and health information. (I think this is it:http://www.healthcare.gov/ ). ( Citation: Page 36, sec. 1103 )

  • A credit program is made that will make it easier for business to invest in new ways to treat illness by paying half the cost of the investment. (Note - this program was temporary. It already ended) ( Citation: Page 830, sec. 9023 )

  • A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers. ( Citation: Page 22, sec. 1101 )

  • A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn't paying for the Aspirin you bought for that hangover. ( Citation: Page 800, sec. 9003 )

  • Employers need to list the benefits they provided to employees on their tax forms. ( Citation: Page 800, sec. 9002 )

  • Any new health plans must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge. ( Citation: Page 14, sec. 2713 )

1/1/2013

  • If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word "tiny", a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we're talking about people in the top 5% of earners. ( Citation: Page 818, sec. 9015 )

1/1/2014

This is when a lot of the really big changes happen.


  • No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history. ( Citation: Page 45, sec. 2704, Page 46, sec. 2701, and Page 57, sec. 1255 )

  • If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead, unless of course you're not buying insurance because you just can't afford it. (Note: On 6/28/12, the Supreme Court ruled that this is Constitutional, as long as it's considered a tax on the uninsured and not a penalty for not buying insurance... nitpicking about wording, mostly, but the long and short of it is, it looks like this is accepted by the courts) ( Citation: Page 145, sec. 5000A, and here is the actual court ruling for those who wish to read it. )

Question: What determines whether or not I can afford the mandate? Will I be forced to pay for insurance I can't afford?

Answer: There are all kinds of checks in place to keep you from getting screwed. Kaiser actually has a webpage with a pretty good rundown on it, if you're worried about it. You can see it here.

Okay, have we got that settled? Okay, moving on...


  • Small businesses get some tax credits for two years. (It looks like this is specifically for businesses with 25 or fewer employees) ( Citation: Page 138, sec. 1421 )

  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.

  • Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need. ( Citation: Page 14, sec. 2711 )

  • Limits how high of an annual deductible insurers can charge customers. ( Citation: Page 62, sec. 1302 )

  • Cut some Medicare spending

  • Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. ( Citation: Page 801, sec. 9005 )

  • Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.

  • Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen. ( Citation: Page 81, sec. 1312 )

  • A new tax on pharmaceutical companies.

  • A new tax on the purchase of medical devices.

  • A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they'll get taxed.

  • The amount you can deduct from your taxes for medical expenses increases.

1/1/2015

  • Doctors' pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in this post. If you're looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.

1/1/2017

  • If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). ( Citation: Page 98, sec. 1332 )

2018


  • All health care plans must now cover preventative care (not just the new ones).

  • A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).

2020

  • The elimination of the "Medicare gap"

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John Paul paints a rosy picture of the effects of "Romney-care" in Massachusetts despite studies showing it to be an extremely costly government run plan.

If this is indeed the "model" for "Obama-care" then it will be a costlier plan that we cannot afford, considering the massive deficit the country has.

Here are two links: http://www.cato.org/pubs/policy_report/v30n1/cpr30n1-1.html

http://www.nytimes.com/2011/09/28/business/health-insurance-costs-rise-sharply-this-year-study-shows.html?pagewanted=all

This November will not only be a referendum on Barack Obama, but on the so called "Affordable Health Care Act"

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Just to add on:

Single Payer Health Care was dropped from the ACA during the negotiations prior to the passing of the law by Congress. There was the opinion that if the Supreme Court struck down ACA that the next incarnation of Health Care reform would definitely be a single payer system, but that is now moot. Perhaps Medicare will eventually be expanded to everyone. But that would probably be way down the line.

Maybe I just missed it in skimming through that description of the ACA, but one of the benefits of the ACA that is already in effect is that insurance companies have to spend at least a certain percentage of their intake on health care. That recognizes that the insurance companies are for profit business that want to make money but that these are companies that are in the business of people's lives and so CEO pay and administration fees can't detract from the service they are supposed to be providing.

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...I wonder for how long? Private health insurance will most likely be driven out of business by having to compete with the government. WIthin a few short years there will only be one health insurance provider. Universal health coverage will be the de facto condition.

I see your point, but if history is any indication, this may not necessarily be the case... when put up against the "competition" found in the private sector, the government rarely, if ever, does it better or cheaper -- that's not to say they won't be stupid enough to mandate it anyhow.

I foresee a "tax credit" or exemption for those able to show (receipts, etc.) as proof of an existing policy. Then, of course that paves the way for the government to eventually decide which policies actually "qualify"... so I can see a person having a policy, but still being told they're responsible to pay the "tax" because they're particular policy isn't accepted (or is no longer accepted) by the government.

It's a slippery slope for sure : (

The government doesn't have to adhere to any practical business model though -- if it did, it would have been bankrupt and bought out decades ago.

~tt

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About six months ago Spike Dolomite Ward wrote an article for the Los Angeles Times about her experiences with Obamacare.

There is a follow-up article in The Times today that talks about her continued therapy for breast cancer. Currently an independent artist and the head of a non-profit arts education organization, Spike used to be the receptionist for Mike Denecke. The iconic image of "Father Time" is her work.

Here is a link to the article:

http://www.latimes.c...0,7451497.story

David

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Great article, thanks David...

I think it quite accurately shows the conflict we face as a nation between our humanitarian spirit (and emotional connection to even complete strangers) and our own sense of self-preservation and practicality. There doesn't seem to be an immediately obvious fix. I do like this response to the article:

limitgovt at 8:42 AM June 29, 2012

"As a conservative republican, I have great sympathy for the writers ordeal and wish her the best in fighting her illness.  She is showing courage and compassion in trying to help other people understand her difficulties and trying to help everyone understand the Law.  However, I differ with her views on the impact of the law and also do not agree that the law saved her life.  The doctors providing the care saved her life.  From the article, it appears that she elected to stop paying insurance premiums to save money and then qualified for a cheaper govt alternative program that is subsidized by the rest of us.  Her treatments are substantially more than the premiums she pays, so all of us make up the difference through tax dollars while we continue to pay our own premiums.  For instance my monthly premium for a healthy family is $1600 per month that I elect to pay instead of going uninsured.  

The law has some good provisions related to preexisting conditions, and other issues, but it will expand healthcare costs and ballon the deficit.   The dhhs has way too much power in this law and is already making poor decisions like requiring mandatory free contraceptions to all.  To control Overall costs the patient needs to have some incentive to only use what is absolutely necessary or pay for it.   Again I hope for a full recovery for Ms Ward and to disagree is not to hate "

We're obviously a long way from any sort of "ideal" solution for all, but if we lose our sense of compassion, we're all fucked -- you can bank on that.

~tt

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John Paul paints a rosy picture of the effects of "Romney-care" in Massachusetts despite studies showing it to be an extremely costly government run plan.

When my daughter was living in Massachusetts after college she got a very nice heath insurance plan under the RomneyCare system for a little over $200/month, Blue Cross/Vision/Dental. It's an excellent system and the national one we'll have available starting in 2014 should be excellent too. Neither is a good as a single-payer system would be (Medicare-For-All), but they're a start.

Don't forget that the Affordable Health Care Bill also gives us things like a right to health insurance if you have a pre-existing condition, no lifetime caps on health insurance pay-outs (so that you insurer can't call you up one day and say, "You know that chemo-therapy you've been having? Sorry, but you've reached your lifetime limit so don't bother showing up for any more."), increased health insurance portability, preventative health care and the ability to keep your kids on your health insurance plan until they're 26.

In the long run it will save lots of money because more people will have insurance and be able to go to their doctor for a simple treatment instead of having to go to an emergency room when things get worse. It should also cut way down on the huge numbers of people that have to declare bankruptcy because of medical bills (currently the biggest reason for bankruptcies in the US).

I just had three X-Rays on a shoulder and I had to pay $84 because that's the negotiated price between my health plan and the clinic. If I didn't have any health insurance (so, oh, that I couldn't afford it AND rent) my bill for the X-Rays would have been $380. So the way the system works (or doesn't) is that the people least able to pay are charged the most.

P.S. One of the founders of the Cato Institute, and a heavy backer, is one of those marvelous Koch Brothers...

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Since when was a government-run plan NOT extremely costly?

How about the VA? They do a fine job that their patients generally like and its overhead (cost of administration) is 3% of their budget. The average overhead in for-profit health care systems in the US is 15%.

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How about the VA? They do a fine job that their patients generally like and its overhead (cost of administration) is 3% of their budget. The average overhead in for-profit health care systems in the US is 15%.

I'm a Vet and use the VA, and I'll say that there has been some recent federal government changes that are raising the cost of treatment and prescriptions. The level of quality at the VA is not on par with what you'd get at a privately owned facility either..... trust me I can give you personal examples.

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At the time I couldn't afford the "premium care" (unemployed), so I had to settle with what I could afford, not because I didn't have a "right" for care .

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A friend and fellow mixer up here in Kanuckistan just blew out his knee. He will be out of commission for 4-5 weeks after his surgery. He probably won't be able to work for that period, thankfully, he won't incur a $100 000 bill as well.

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Ironic that Romney is shaking his fist at "Obama-care".

In the long term, universal health care can only help the middle class, which in turn can only help the economy. It might take time to reap the benfits of this essential humanitarian plan, but it's the right thing to do. Isn't that what should be important? People shook their their fists at all kinds of things over the years, but in the end it's always the right thing to do the right thing.

People are so short-sighted when it comes to the "economy". California has chosen to lessen the number of required hours and days for children to attend school, in order to save money. It seems crazy to me that politics has become a career and no longer public service. It is ruining the country, and the world.

Robert

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A friend and fellow mixer up here in Kanuckistan just blew out his knee. He will be out of commission for 4-5 weeks after his surgery. He probably won't be able to work for that period, thankfully, he won't incur a $100 000 bill as well.

That's great, and in a similar situation, I dare anyone not to be thankful -- it doesn't make the $100,000.00 go away though... someone pays that -- and more, because now you've got this extremely inefficient government-run system controlling everything -- and every person's hands through which that particular "account" passes will also be reaching in for a paycheck.

Jim, I'm sorry but If you think the VA is some kind of shining example of a properly run business, or of the government enriching the lives of its citizens, I think you should spend some more time in the VA hospitals around the country. Ask around -- I suspect you'll discover Zack's story to be more in step with reality.

Keep in mind that statistics can be manipulated to "prove" anything from "we are causing global warming" to "beaver anal glands taste good" (Google "castoreum") ... and just about anything in between.

~tt

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That's great, and in a similar situation, I dare anyone not to be thankful -- it doesn't make the $100,000.00 go away though... someone pays that -- and more, because now you've got this extremely inefficient government-run system controlling everything -- and every person's hands through which that particular "account" passes will also be reaching in for a paycheck.

In fact the Canadian (I assume that's what's meant by Kanuckistan) health care system (single payer) is a very efficient system, and it's government run.

The whole idea of health insurance is that lots of people contribute small amounts of money so they the small percentage of them that need big bucks spent on an operation or whatever can get it without going bankrupt or dying. Spreading the risk is the basis for any kind of insurance and the bigger the spread the less each has to contribute. The big mistake historically is in letting insurance be provided by for-profit companies instead of mutual associations (as it was originally).

Jim, I'm sorry but If you think the VA is some kind of shining example of a properly run business, or of the government enriching the lives of its citizens, I think you should spend some more time in the VA hospitals around the country. Ask around -- I suspect you'll discover Zack's story to be more in step with reality.

It is a very good example of a well-run health care system, at least as well run as most for-profit systems in this country and far better than a lot of for-profit systems. I know quite a few people in the health care field, including many involved in health care policy , research and analysis and, in general, they think the VA does a very good job. Most researchers in the field think that the French system is the best world wide.

…statistics can be manipulated to "prove" anything from "we are causing global warming" to "beaver anal glands taste good"

The only people that use the term "cause" in that case is Fox News. Serious researchers and news organizations say, rightly, that we (humans) are doing things that are contributing to a long term increase to global temperature that will have injurious effects on our species. The planet will survive, we might not.

What you do with a beaver's anal gland is up to you.

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As a Canadian, Im also very happy with our health system to date. Sure, there are waiting times and inefficiencies, but overall I think the idea of universal health care is very important!!

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Did they fix you?

No actually. They gave me pain killers (after I declined them) so I was puking on top of my other issues. I had to remind them a few times to check my feet, which turned out I had 6 broken toes. I went in there busted up, and left worse off technically. All I got was a back brace to help me out. What did fix me was my physical therapist that I paid for outside of my VA benefits, because they weren't going to provide one.

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