Speaking of ACA

[NW-Bound]

People often think of "universal healthcare" as "single payer", and also as "free". But universal healthcare is usually funded by a tax. How else the government gets the money?

In Germany, it's 15.5% of your income, but that includes 7.3% from your employer. In addition you also pay 2.55% for long-term disability care.

If you make above a certain threshold, or fit certain criteria such as being a freelancer, you can buy private insurance. Private insurance premium varies, and may be higher for pre-existing conditions.

I have not been able to find info on healthcare for retirees. Logically, it is the same as that for workers, but I don't know what happens to the employer matching portion.

[joeea]

Quote:

Originally Posted by youbet But Medicare isn't working all that well financially. It's in a horrible financial state destined to go broke before SS if I recall correctly.

It doesn't work that way.

Medicare is funded by Congress. It could only go "broke" if Congress chooses not to fund it any given year.

Social Security cannot go broke. At minimum, it will run on the SS taxes collected each year. It could only go "broke" if no SS taxes were collected.

[Rianne]

Is Healthcare a privilege, a right or business? Who is healthcare serving? Who profits (by dollars or by services)?

-Shareholders
-Patients
-Providers
-Pharma research
-Medical staff
-Medical equipment
-Medical research


How are we defining The Healthcare Industry? What is the Mission Statement? I consider this the end of this discussion for obvious reasons. We have to get the Mission Statement right. That's all.

[NW-Bound]

Healthcare is more and more regarded as a right.

Even so, most (all?) countries still implement some restrictions, as it is a limited resource.

And people with money can usually get more. It's the same as people with money have better housing than Section 8, and eat caviar and lobster that people on SNAP (foodstamp) cannot afford.

[Montecfo]

Quote:

Originally Posted by copyright1997reloaded Here's the net: Those of you who are getting discounted ACA coverage are doing so on the backs of young healthy individuals and the US taxpayer. Your subsidized costs do not come close to reflecting the actuarial costs (age adjusted) for your plan. .

I agree with most of your post but this stood out. All insurance is healthy subsidizing sick. That is how it works.

Our tax system is all about high earners subsidizing low. That is how it works.

We have an income tax, not a net worth tax.

I do understand your point, but it actually is quite complicated and cuts several ways, as I see it.

[MichaelB]

Quote:

Originally Posted by NW-Bound Healthcare is more and more regarded as a right.

More like a need that every person has for their entire life.

[NW-Bound]

Healthcare is a bit more than a need.

We all need love, recreation, and entertainment, but nobody has suggested that these be provided universally.

[ziggy29]

Quote:

Originally Posted by NW-Bound Healthcare is a bit more than a need. We all need love, recreation, and entertainment, but nobody has suggested that these be provided universally.

Maslow would say it's a "safety need" -- more basic than love, recreation or entertainment, but not as basic as, say, food, water or oxygen.

[NW-Bound]

And whether we call it a right or a need, how much should be shared?

Do we force RobbieB to share his caviar and wagyu beef with SNAP recipients?

Hey, I want to share his wagyu beef too. Not the caviar because I do not care for it. I will take double the beef portion to make up for it, thank you.

[flintnational]

We also have the ability to build Ferraris. But, we cannot afford to provide them to everyone. I am fairly certain our ability to provide unlimited top shelf healthcare to everyone also exceeds our ability to pay for it. We will need to work out a gatekeeper, someone that says "no". The government, an insurance company or the consumer are all candidates. I don't know that anyone currently has this role.

[MichaelB]

Quote:

Originally Posted by flintnational We also have the ability to build Ferraris. But, we cannot afford to provide them to everyone. I am fairly certain our ability to provide unlimited top shelf healthcare to everyone also exceeds our ability to pay for it. We will need to work out a gatekeeper, someone that says "no". The government, an insurance company or the consumer are all candidates. I don't know that anyone currently has this role.

Of course, no one suggested ferraris or unlimited top shelf healthcare.

Quote:

Originally Posted by NW-Bound And whether we call it a right or a need, how much should be shared? Do we force RobbieB to share his caviar and wagyu beef with SNAP recipients? Hey, I want to share his wagyu beef too. Not the caviar because I do not care for it. I will take double the beef portion to make up for it, thank you.

Are you going to an extreme to make a point or avoid one? Do you disagree that health care is something each of us needs for our entire life, and also the life of the mother before birth?

[flintnational]

Quote:

Originally Posted by MichaelB Of course, no one suggested ferraris or unlimited top shelf healthcare. ...........

But, I think that is what we currently have in many cases. I have not seen a lot of evidence that cost benefit analysis is being conducted. And in some situations, total cost is not even an issue. I agree these are tough decisions.

[ShokWaveRider]

Some form of basic affordable healthcare should be available to all. Suppliments should be avialable for those who want more. The basic care should not be so basic, as it allows anyone to go bankrupt.

I believe Australia works on that principle, maybe other countries also.

[NW-Bound]

Quote:

Originally Posted by MichaelB Of course, no one suggested ferraris or unlimited top shelf healthcare. Are you going to an extreme to make a point or avoid one? Do you disagree that health care is something each of us needs for our entire life, and also the life of the mother before birth?

I made a joke to point out that defining the basic level of need is not simple. I don't think we have been able to do that with healthcare.

For example, can we really afford to spend an unlimited amount of money to extend a human life? But that's what ACA no lifetime coverage limit means.

If we say that, yes, a human life is so precious that there should be no limit in health care for a single person, then why are we letting homeless people die in the street? Why are wrongful death awards not even higher?

It is never that simple. I do not have an answer, and just tried to raise the point.

[Aerides]

A lot of the problem with lifetime caps is not because of the craziness that can happen with end of life care, but the start.

Imagine having a child who is born with a defect, that's fixed in surgeries and premie care, who finally leaves hospital at say 3 months old... and they've already burned off their lifetime cap?

I was the recipient of a surgical error decades ago that left my insurance covering above $300k. So, before 30, having burned off a quarter of my cap, wasn't a fun prospect. I always looked for employer plans with providers that didn't have a cap. I'm personally glad they all have to, now.

Obviously anecdotes shouldn't drive policy, but there is something to envy in the idea that, in some countries, no one has to ever worry that a catastrophic illness could result in financial devastation.

[ziggy29]

Clearly we can't afford an unlimited, all-you-can-eat system without any incremental cost to anyone.

And just as clearly, IMO, I can't morally justify a system where people can die, or get a lot more sick than need be, because they lack basic coverage or, even if they have insurance, have a deductible so high that going to the doctor would pose a significant financial hardship.

So there are a couple of "limit lines", so to speak. We can't afford the former of these two statements, and a compassionate and affluent society needs to be better than the latter. At that point, the debate, so to speak, is coloring within those lines.

[Breedlove]

This is a highly political string and should be cancelled or deleted .

[MichaelB]

Quote:

Originally Posted by NW-Bound It is never that simple. I do not have an answer, and just tried to raise the point.

Same here. We agree.

[MichaelB]

Quote:

Originally Posted by Breedlove This is a highly political string and should be cancelled or deleted .

To me it looks like a civil conversation among respectful forum members.

[NW-Bound]

For lack of better things to do while hiding from the outdoor heat, I spent a bit of time reading about Germany healthcare system.

Why Germany? Because as Wikipedia says, "Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it".

Also, "Germany has the world's oldest national social health insurance system, with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889."

But I found something a bit disturbing to me.

Insurers have to accept people with income below 60750€ per year, who pay a premium of 7.3-8.3% of their income but with a cap at about 400€ a month. The employers pay another 7.3%. This is "compulsive insurance".

If you make more than the above threshold, or if you are a freelancer, or if you have a "minijob", plus some other categories, then you have "voluntary insurance". It is not really voluntary on your part, because everyone must have insurance. Rather, the insurers can refuse you, or demand underwriting, and raise premium based on existing conditions.

The "voluntary" or private insurance is really cheap for young persons even when they get no employer matching, but becomes more expensive when people get older. And when they get to 55 when the premium gets to about 1500€/month, it is said that going back to compulsive insurance is virtually impossible.

Hey, no "minijob" means no goofing off. No ER. You are deadmeat. It appears that to fit in the system, you have to do your part, meaning pay more as you are young and healthy so that you can get subsidized when you are old. And work till your retirement age. No cheating allowed!


PS. Readers of this forum will remember what FIREd said about trying to get health insurance in France when he moved back from the US. There was no such thing as ER in France, so he had to create a "minijob" to qualify. It seems the same here with Germany.

I could not help smiling when I realized that if I were not in the US, I would be working my butt off right now instead of doing ER and studying healthcare systems in other countries.