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Old 10-30-2014, 07:46 AM   #61
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The whole 'millionaire subsidy' issue (discussed ad nauseam on this forum) has allowed me to re-evaluate my view on work/life balance and what I used to derisively call 'handouts'.
Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy. There is also no "fair" tax rate the "rich" should pay. There is no reason not to take advantage of any benefits available in the tax code. I have personally decided it's not worth going for the subsidy. I think I'm better off doing Roth conversions aggressively in my pre-RMD years.

Taxpayers are now paying for the tide of new Medicaid and subsidized health plans. People love "free" even if it isn't.
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Old 10-30-2014, 08:01 AM   #62
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Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy.
A few years ago, I would have strongly disagreed.

I've come around.
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Old 10-30-2014, 09:22 AM   #63
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I wonder how the uninsured vs the insured between 2013 and 2014 was affected by the number of immigrants, illegal and otherwise that have insurance now and could not get it before?
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Old 10-30-2014, 09:31 AM   #64
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Immigrants lawfully present in the US are eligible for ACA policies, some assistance is available but restrictions apply.
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Old 10-30-2014, 09:35 AM   #65
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Everyone should take advantage of whatever program is available to them. If you can, I don't see any reason to not suppress taxable income to get the subsidy. There is also no "fair" tax rate the "rich" should pay. There is no reason not to take advantage of any benefits available in the tax code. I have personally decided it's not worth going for the subsidy. I think I'm better off doing Roth conversions aggressively in my pre-RMD years.

Taxpayers are now paying for the tide of new Medicaid and subsidized health plans. People love "free" even if it isn't.

I agree with you and Marko on this.... It is natural, at least to me anyways, to complain about programs or taxes I get hosed on, and then conveniently shrug off any I benefit from. And my beef with getting smacked with a 300% plus increase in premium costs come January would largely go away if they would let me pay my premium with pre-tax dollars like workers through employers are currently afforded.


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Old 10-30-2014, 04:48 PM   #66
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Nope. $55,000
Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.
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Old 10-30-2014, 05:53 PM   #67
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Old 10-30-2014, 05:57 PM   #68
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My nephew came home recently and found his toddler with an open bottle of Tylenol. Taking no chances, he took the kid to ER and they gave the kid a test to see if he had taken any capsules, then kept him overnight for observation. The bill was $55,000.
A little under 10 years ago, I spent a night in the ER due to food poisoning. They did an echocardiogram but basically did nothing but observe. The hospital billed insurance $10k of which they paid $1k.
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Old 10-30-2014, 07:30 PM   #69
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Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.
Under my state's no-fault auto insurance law, if an auto accident occurs the auto insurer must pay full retail rates to the hospitals for medical expenses.

When a patient shows up in an emergency room, they ask quite a few times if an automobile was involved...

-gauss
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Old 10-30-2014, 07:33 PM   #70
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In my state, by law, if an auto accident occurs, the auto insurer must pay full retail rates to the hospitals.

When a patient shows up in an emergency room, they ask quite a few times if an automobile was involved...

-gauss
By law, huh? I guess we know who paid for that legislature.
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Old 10-30-2014, 07:53 PM   #71
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Amazing - where do they come up with these numbers?

Last summer I had a three-day stay in the hospital, two in cardiac care and one in ICU and had two stents put in a heart artery. Bill to the insurance company was $45k.
And a couple years ago dad fell at a resort in Mexico and ended up with a bad concussion in the hospital. He was in a 5 year old hospital which had been built and set up to 5 star international standards with all the latest everything. He spent 2 or 3 days in ICU and a week or more in a regular room. Mom spent the time at an on-site hotel that had everything you could ever ask for. When they finally released him as safe to travel home, the total bill was a mere 18k. I don't know what the equivalent treatment in the US would have cost, but I bet it would have been a six figure bill.
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Old 10-30-2014, 09:37 PM   #72
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Almost all other developed countries seem to be able to afford some form of universal healthcare:....
"The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world."
....
Sheesh! Even the brand-new state of Iraq, of all countries, the one we spent incalculable resources to create, has a constitutional guarantee of universal health care. Yet, oddly enough, from what I could find, not a constitutional right to keep and bear arms.
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Old 10-31-2014, 01:05 AM   #73
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Sheesh! Even the brand-new state of Iraq, of all countries, the one we spent incalculable resources to create, has a constitutional guarantee of universal health care. Yet, oddly enough, from what I could find, not a constitutional right to keep and bear arms.
Interesting point, but I am not sure it was incalculable resources. The estimate I read was $6 trillion dollars:

Iraq war costs U.S. more than $2 trillion: study | Reuters

While the ACA is actually predicted by the Congressional Budget Office to reduce deficits over the next 10 years and in the subsequent decade:

CBO's Estimate of the Net Budgetary Impact of the Affordable Care Act's Health Insurance Coverage Provisions Has Not Changed Much Over Time | Congressional Budget Office
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Old 10-31-2014, 09:07 AM   #74
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.... How can a middle class family making $50K a year, with preACA type faux insurance, afford to pay $40K - $50K in medical costs in one year?
Even pre-ACA maximum out-of-pockets were a lot less than $40-50k, so how could this possibly happen if someone has insurance? especially if they stay within network.
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Old 10-31-2014, 09:20 AM   #75
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The surgery in our family last year was $150K without insurance, and under $50K with insurance company negotiated rates for most of the bills. It is a legalized scam to make the uninsured pay many times over what insurance companies pay.
But the reality you overlook is that the uninsured don't really pay the rack rate. Many of them don't pay at all or negotiate a bill that is much lower than the rack rate. I would agree that the rack rates are ridiculous and should be abolished.

Under my plan in a case like you outline, even if the rack rate was $150k and the negotiated rate was $50k, the insurer would pay $43,750 and I would be billed $6,250. I can often get a 20% discount from the provider for immediate credit card payment and 2% cash back from the credit card company, so my net cost might be as low as $4,900.
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Old 10-31-2014, 09:52 AM   #76
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But the reality you overlook is that the uninsured don't really pay the rack rate. Many of them don't pay at all or negotiate a bill that is much lower than the rack rate. I would agree that the rack rates are ridiculous and should be abolished.



Under my plan in a case like you outline, even if the rack rate was $150k and the negotiated rate was $50k, the insurer would pay $43,750 and I would be billed $6,250. I can often get a 20% discount from the provider for immediate credit card payment and 2% cash back from the credit card company, so my net cost might be as low as $4,900.

The local newspaper here recently had an article about the high rack rate costs. The answers by the local hospitals was long and convoluted, but they all said in unison clearly that no one ever pays anywhere close to those prices for the services whether it be insured or cash payers...


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Old 10-31-2014, 09:54 AM   #77
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DH had surgery over the summer and the only outstanding uncovered item was $185 for "self administered drugs" whatever that was (vs the thousands of $$ in drug costs that were covered--all rightee then). He called the hospital and they said he could resubmit it to his Plan D policy but they were immediately knocking it down to $83 anyway. Nobody has to pay the "rack rate."
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Old 10-31-2014, 10:08 AM   #78
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The possibility that billed rates by hospitals, labs, and other service prividers are not "real" in some way, and may be subject to negotiation or discounting, is a red herring used by them to change the discussion. Those rates are pursued by the providers, when unpaid turned over to collectors, brought to court demanding payment, and still cause bankruptcy. The individua component charges are unrelated to the cost of the component services, and this points to predatory pricing. They are not disclosed upfront, so consumers are not in a position to make informed choice. Discounted prices are considered private information. The fact that cash prices may be 10x greater than preferential insurance prices indicates a badly flawed and abusive delivery system.

It is difficult to see a path to effective cost control of health care while this practice is allowed to continue.
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Old 10-31-2014, 10:48 AM   #79
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Even pre-ACA maximum out-of-pockets were a lot less than $40-50k, so how could this possibly happen if someone has insurance? especially if they stay within network.
Easy. One simply has a medical problem that had been excluded due to it being a pre-existing condition. I guess one could claim that in this case they did not have insurance for practical purposes, and that is really a point in favor of ACA.
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Old 10-31-2014, 11:12 AM   #80
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I agree with you and Marko on this.... It is natural, at least to me anyways, to complain about programs or taxes I get hosed on, and then conveniently shrug off any I benefit from.
I kind of reached a "where's mine?" point in life.
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