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> Repeal and Replace ACA, aka Obamacare, The pitfalls and hazards of Healthcare refrom of GOP and the nation
phaedrus
post Feb 25 2017, 04:53 AM
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It's been a good long while since I posted here but there is something bothering me and the other board I post to seems uninterested, thought I would try here. I'm just going to throw out some thoughts on the subject and see where it leads. The subject is the Affordable Healthcare Act and how it gets repealed and replaced. This is going to happen in a few months and I'm sure anyone watching this unfold has seen the protestors yelling, 'do your job', well honestly it's a difficult job.

Consider the fact that the number of people uninsured is at an all time low? In 2010 it spiked at 18.2%, it was 10.5% in 2015. (KFF Org).
In the first quarter of 2016, there were 8.6 percent of Americans or about 27.3 million people who were uninsured, the first time in history that the nation's uninsured rate fell below 9 percent. (CNBC)

I remember Hilary Clinton in the West Wing working on universal health care, the President holding up a plastic card that gives all the same healthcare all the members of Congress enjoy. The obvious question emerges how on earth could we pay for this, Daniel Patrick Moynihan, a solid Democrat, said the financing for this proposed legislation was fantasy, accurate fantasy since it came our of their computer in this way. Well, I suppose the idea of savings from Medicaid and Medicare wasn't the answer. New revenue Obama said was the only way, how did that work out for us?
In reviewing some IRS stats for 2014 returns, I was surprised to see that two taxes added by the Affordable Care Act (Obamacare), generated more revenue in 2014 than was generated from the individual AMT. Here are the stats:

Net Investment Income Tax (NIIT)
(3.8% 1411 tax)

$22.5 billion
Additional .09% Medicare tax
$7.3 billion
Total
$29.8 billion
Alternative Minimum Tax (AMT)
$28.6 billion

For 2013 returns, the AMT generated $4.6 billion more than the two ACA taxes. (ACA taxes generate more revenue than AMT 21st Century Taxation)

I was never all that good at political math but that does seem like a lot of money to me. The Republicans think they have a much better idea, maybe they think they can get the Mexicans to pay for it. I know there were and are a lot of illegal immigrants who draw benefits from it. The numbers again are tricky, but then again they always are:
"Illegal immigration costs our country more than $113 billion a year. And this is what we get," Trump, the Republican presidential nominee, said. "For the money we are going to spend on illegal immigration over the next 10 years, we could provide 1 million at-risk students with a school voucher, which so many people are wanting." (Donald Trump says illegal immigration costs $113 billion a year, Politafact)

I see, we are just going to save money we are just wasting on desperately poor people, why didn't we think of that before. I know, let's take the oil away from the Iraqis, or many we could put the bite on our most important allies in the NATO countries cause they don't have any problems of their own. Or better yet let's raid the existing tax revenue from Social Security, there was a lock box on that at one time, unfortunately they spent that on unilateral action in Iraq. Maybe we could use the $2.5 trillion is held by the Federal Reserve' (CNN Money). It's our own money, that we owe to ourselves, there's nothing confusing or absurd about that is there?

My feeling on this after a mentally and emotionally exhausting campaign and a mildly disturbing first month of Trump. If your not confused, your not paying attention.

An NPR statistic tells us that, '14 percent favor repeal without a replacement plan' (NPR). Perhaps that's how Trump is going to make America great again, repeal ACA and replace it with something terrific!, or maybe nothing at all. As a Democrat I would enjoy the interim elections managed to elect a majority in the Senate or maybe the House again. There is just this one nagging question that is bothering me, how do they intend to pay for all of this.

Bottom line, this is important and well underway. I don't care about Trump's tweets, I care about where this legislation might be taking us.

So, question for debate: What, given the imminent repeal of ACA, aka Obamacare, is the replacement going to be, if any?
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entspeak
post Mar 25 2017, 03:04 PM
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QUOTE(AuthorMusician @ Mar 25 2017, 09:57 AM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

But not as badly as the Republican replacement would have been, and most of us know it.

The very recent retreat from repeal/replace has a lot of ramifications, but the most obvious one is that the ACA, even with all its problems, is a whole lot better than what we had before. A much more subtle thing is that the ACA can be improved via future legislation. Since Republicans can't get their poo together on this, the improvements will have to come from somewhere else. You know, from some other party that's on the same page regarding health care, one that understands how insurance works, and one that doesn't have a huge faction of ideologues way, way, way over there beyond the edge.

https://www.youtube.com/watch?v=Gq_bjaI0NTo

When that party comes into existence, let me know.
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akaCG
post Mar 25 2017, 05:47 PM
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QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
QUOTE(akaCG @ Mar 24 2017, 01:29 PM) *

...
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
The tax for health insurance is 8.1% in Norway (10.7% for self-employed), this is deducted from paychecks. But, it is fixed. https://www.nav.no/en/Home/Rules+and+regula...e+contributions
...

Yes, the percentage is fixed. But the amounts, obviously, vary with income. So, people making 250K end up paying 5 times more for the very same insurance coverage than people making the average wage (about 50K). Can you imagine the voters' uproar if our government pushed for a policy to do that here?

I know, I know... for all the talk of Christian values, the US doesn't quite have the spirit. ...
...

It would be interesting to test Norwegians' Christian values by way of making their health insurance tax rate progressive, as opposed to flat. I'm guessing such a policy would elicit a response along the lines of "Hell NO!".

QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
QUOTE(akaCG @ Mar 24 2017, 01:29 PM) *

...
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
In the US, the percentage of your income that goes to healthcare varies from place to place and plan to plan. ...
...

Yes, it does. So? What's the problem with different people making different choices regarding what proportion of their income to devote to health care, just like they do regarding what proportion of their income to devote to housing, eating out, transportation, vacation travel, etc.?

You think people "decide" the percentage of their income that will be spent on healthcare like they do these other things? ...
...

I don't think so. I know so. I've been making those choices all of my adult life. So have tens of millions of our fellow citizens, year in year out, month in month out, day in day out. You've never heard of people comparing one plan's premium/deductible combination to another's and picking the one that best fits their needs/wants? You've never heard of people choosing to fill their prescription at Walmart instead of Costco, or CVS instead of Walgreens, etc.? You've never heard of people choosing one Lasik surgeon over another based on cost? You've never heard of people engaging in "medical tourism", whereby they, say, get on a plane to, say, Costa Rica to get their hip replacement on the basis that, even after flight and hotel costs, it's still cheaper for them to do so than getting it done locally? Etc., etc., etc., etc.?

QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctors practice/GPs practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6


This post has been edited by akaCG: Mar 25 2017, 05:48 PM
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entspeak
post Mar 25 2017, 09:26 PM
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QUOTE(akaCG @ Mar 25 2017, 12:47 PM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor€™s practice/GP€™s practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6


And, of course, there is no question asking the people who are uninsured in America this question because... oh, right... they don't have regular doctors. So, grain of salt on this one as a measure of satisfaction with the US healthcare system. I've never said that medical care in the US isn't good when you can afford it - that's not the issue here.

As for the system overall, if they didn't think it worked for them, they would go to a progressive system. It's just a different set of values. No reason for them to "test" anything.

I get insurance through my union... not much choice for me. When I have coverage, it's amazing and I don't need to shop.

This post has been edited by entspeak: Mar 25 2017, 09:28 PM
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akaCG
post Mar 26 2017, 01:40 AM
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QUOTE(entspeak @ Mar 25 2017, 05:26 PM) *
QUOTE(akaCG @ Mar 25 2017, 12:47 PM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor€™s practice/GP€™s practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6


And, of course, there is no question asking the people who are uninsured in America this question because... oh, right... they don't have regular doctors. ...
...

I have a regular doctor. I have a regular dentist. I have a regular pharmacy where I get my prescription filled. Yet, ... I have no health insurance. I chose to go the "self-pay" route about 6 years ago, because my yearly out-of-pocket expenses are less than what I'd be paying out in premiums. There are millions like me, who've made the same choice for exactly the same reasons, yet who ("amazingly" enough) do indeed have a regular doctor, a regular dentist, and a regular pharmacy. Reason: doing it that way turns out to be more ... AFFORDABLE ... for us. That's especially true (see link below) of people who are younger than I am (mid-50s). We wouldn't mind at all being able to buy what used to not only be known as a "catastrophic" plan (high deductible in return for low premiums), but actually "behaved" like one. Alas, the Affordable Care Act (i.e. Obamacare) has resulted in such plans quickly becoming LESS AFFORDABLE than going "self-pay". Just another one o' dem "unintended" consequences of "feel good"/"do something" type policies./

Aforepromised link:

"Aetna CEO: Young people pick beer over Obamacare"

QUOTE(entspeak @ Mar 25 2017, 05:26 PM) *
...
As for the system overall, if they didn't think it worked for them, they would go to a progressive system. It's just a different set of values. No reason for them to "test" anything.
...

Nope. They (meaning Norwegians) would not. For the simple reason that they don't have much room left, in terms of the total (25% income tax + 8% health insurance tax + 25% VAT, etc.) tax burden that their average citizen could endure yet more of. If their government dared to propose that their health insurance tax rate should be made progressive instead of flat, even they (who you obviously think of as more Christian-like than your fellow U.S. citizens) would quickly get busy forming a, say, Taxed Enough Already type movement.

Even people who truly think of themselves as "egalitarians", let alone people who just "preen" that way, have a breaking point of the "Are you f***ing serious!!??!!??" type.

This post has been edited by akaCG: Mar 26 2017, 01:53 AM
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entspeak
post Mar 26 2017, 05:01 PM
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QUOTE(akaCG @ Mar 25 2017, 08:40 PM) *
Nope. They (meaning Norwegians) would not. For the simple reason that they don't have much room left, in terms of the total (25% income tax + 8% health insurance tax + 25% VAT, etc.) tax burden that their average citizen could endure yet more of. If their government dared to propose that their health insurance tax rate should be made progressive instead of flat, even they (who you obviously think of as more Christian-like than your fellow U.S. citizens) would quickly get busy forming a, say, Taxed Enough Already type movement.

Even people who truly think of themselves as "egalitarians", let alone people who just "preen" that way, have a breaking point of the "Are you f***ing serious!!??!!??" type.


I owe no allegiance to my "fellow U.S. citizens" when it comes to the hypocrisy of their "Christian" values. I am more patriotic than nationalistic. The thing you are failing to grasp here is that Norwegians view inequality differently than you do. They are willing to pay more to help those less fortunate than themselves. I understand that this may be a difficult concept to grasp.

https://www.citylab.com/work/2017/01/how-no...erently/512852/



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akaCG
post Mar 26 2017, 11:06 PM
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QUOTE(entspeak @ Mar 26 2017, 01:01 PM) *
...
... The thing you are failing to grasp here is that Norwegians view inequality differently than you do. They are willing to pay more to help those less fortunate than themselves. I understand that this may be a difficult concept to grasp.

https://www.citylab.com/work/2017/01/how-no...erently/512852/

1.
Let's see now, ...

In Norway, bank senior executives and neurosurgeons have the same income tax rate and health insurance tax rate as bank clerks and nurses, and they pay no more for their childrens' education than bank clerks and nurses pay for theirs'. And ... there is no inheritance tax.

Yet ... it's the Norwegian system that's supposed to be viewed as the more "Christian" one???

I'm very impressed, I must say. How in the world did the rich in Norway manage to sell that notion to the rest of their fellow citizens, as well as to "egalitarians" elsewhere???

I mean, any time anyone in our country so much as suggests that the federal government should tax everyone's income at the same rate, the howls and screams of the "You hate poor people! You want to throw grandma off the cliff! Your health care policy is just to have people die early! And you call yourself a Christian??!!??" variety, from the very same people who extol the "Christian" virtues of, say, the Norwegian way of going about things, ... oh, boy!

2.
As far as the matter of "help[ing] those less fortunate than themselves" goes, it never ceases to amaze me that oh so many among us judge the generosity of a country's people solely on the basis of what proportion of its citizens' income that country's government takes and then redistributes. Which, of course, is only one part of the story. The other part of the story, courtesy of the Charities Aid Foundation 2015 Global Giving Index Survey, being ..

CAF World Giving Index Ranking:

1. Myanmar, with a score of 66
2. U.S.A., with a score of 61
3. New Zealand, with a score of 61
4. Canada, with a score of 60
5. Australia, with a score of 59
6. U.K., with a score of 57
...
...
...
...
...
...
...
14. United Arab Emirates, with a score of 50
15. Norway, with a score of 49
16. Guatemala, with a score of 49
17. Bhutan, with a score of 49
18. Kyrgyzstan, with a score of 49
19. Thailand, with a score of 48
20. Germany, with a score of 47

Link (Table 1, page 10; PDF): http://www.cafamerica.org/wp-content/uploa...EB_V2_FINAL.pdf

This post has been edited by akaCG: Mar 26 2017, 11:12 PM
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entspeak
post Mar 27 2017, 04:44 AM
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As I said, I get how it would be difficult concept for you to grasp.

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LoneWisdom
post Mar 27 2017, 10:19 AM
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QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.


Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? Norway also has a 'Dutch disease' dependency on oil exports while attempting to hedge a downturn in oil with investments in the stock market, weighted toward a growing Chinese economy. A false prosperity will not benefit Norway when it suddenly loses its foundation combined with high young adult unemployment. Socialists depend heavily on others doing the heavy lifting. It has already been forced to withdraw from its investments to sustain its overly generous socialist safety net due to oil prices falling to $30 a barrel in 2016.

Norway seeks to diversify its economy as oil earnings plunge

Norway's Oil Shock

Risks Mount for World's Biggest Wealth Fund


Repeal ACA, don't replace. Have AMA doctors commit to pro bono work for those that can't afford health care. Insurance is for catastrophes, not for preexisting conditions. Cooperatives will provide better health care than creating multiple layers of collectors and claims 'managers.' Unwind other agencies that lead the U.S. down these unsustainable socialist tendencies. Stop depending on others to do the heavy lifting. It's unrealistic.




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akaCG
post Mar 29 2017, 01:00 AM
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QUOTE(LoneWisdom @ Mar 27 2017, 06:19 AM) *
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.

Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? ...
...

Unfortunately, the answer to your question, I'm afraid, is: Nope.

On either side of the ideological/political/such "isle", it bears mentioning.

Both "Look at Norway!" type advocates, as well as "Look at Singapore!" type advocates shall, alas, always be with us.

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entspeak
post Mar 29 2017, 04:23 PM
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QUOTE(akaCG @ Mar 28 2017, 08:00 PM) *
QUOTE(LoneWisdom @ Mar 27 2017, 06:19 AM) *
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.

Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? ...
...

Unfortunately, the answer to your question, I'm afraid, is: Nope.

On either side of the ideological/political/such "isle", it bears mentioning.

Both "Look at Norway!" type advocates, as well as "Look at Singapore!" type advocates shall, alas, always be with us.

You were the one who said "Look at Norway!"
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akaCG
post Mar 29 2017, 09:14 PM
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QUOTE(entspeak @ Mar 29 2017, 12:23 PM) *
QUOTE(akaCG @ Mar 28 2017, 08:00 PM) *
QUOTE(LoneWisdom @ Mar 27 2017, 06:19 AM) *
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.

Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? ...
...

Unfortunately, the answer to your question, I'm afraid, is: Nope.

On either side of the ideological/political/such "isle", it bears mentioning.

Both "Look at Norway!" type advocates, as well as "Look at Singapore!" type advocates shall, alas, always be with us.

You were the one who said "Look at Norway!"

Please don't pretend that you don't understand that I was referring to "Look at [how much better/fairer/more "Christian"/etc.] Norway['s health care system is than that in the U.S.]!" people such as ... yourself. Especially since I immediately followed said phrase with the phrase "type advocates" (now highlighted).

C'mon.

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