Thread: How will the POTUS healthcare law decision effect manufacturing?

Originally Posted by dp

What would the situation be if Dad had not bought that insurance even though he could afford it?

The reason that there is a problem hinges on this exact question.
It turns out that the outcome is often that Mom gets sick, the money is gone, and the Fed picks up the tab...
but not until AFTER Mom and Dad lose the house and file for bankruptcy. It's even better when Dad gets sick, then he loses his job too. Now we have Dad, Mom and the Kid out on the streets.
And that's assuming he DIDN'T get insurance...until recently the insurance company could have taken his premiums until the oncology report came back, then dumped the family. Same result...even WITH responsibility.

Here's the real kicker.
The moral hazard argument is only vaguely associated with this behavior.
It turns out that unless you see enough poor sick people to be scared of being poor and sick you won't be scared enough to adjust your behavior.
Then, of course, there's Kiddo...should Kiddo be forced to pay for Dad's bad call?

I understand the communication issue here...it took a second.
There is a narrow definition of 'cost' called 'accounting cost'.
As we might expect, narrow is how DP would interpret things.

I am thinking of the broader 'economic cost'.
Economic cost - Wikipedia, the free encyclopedia

It's a little like latent versus sensible heat...
something you don't understand unless you do...
and something QwickBooks nor Wikipedia will teach you.

Here I go sticking my neck out again. Reading dp's post #309 makes for horific reading if it's even close to the truth.

From what I understand then it's insurance companies in the USA that run the American health care system. Government, through taxes, tries to patch the holes that invariably crop up.

Doesn't it worry enough people that insurance companies don't give a damn as to who live or dies? Their only concern is that they don't lose money. In fact they like it best when they make as big a profit as possible.

That pharmaceutical companies need to make profit is understandable as research costs. It's when pharmaceutical companies and insurance companies get together and involved with health care the "fun" starts.

If a person is unhappy with the political party in power then a vote can (perhaps) change things when the time comes. Insurance companies seem to be an invisable yet very powerful party. You certainly don't get a vote on the matter.

The purpose of a police force is to ensure law and order. What's the purpose of insurance companies?

Originally Posted by Gordon B. Clarke

The purpose of a police force is to ensure law and order. What's the purpose of insurance companies?

To make their shareholders rich. Duh. If that means people missing out on treatment then that's literally the cost of doing business.

OTOH systems like the UK one as I (poorly) understand it make me very nervous as well. I like the hybrid system we have in Australia, and I speak from the POV of just having had a basal cell carcinoma chopped out of my cheek, going to cost me a few hundred out of pocket at most, no waiting time, private surgeon, all done in 3 days from diagnosis to local surgery operation. Part covered by insurance, part Govt health system.

Wonder how much this would have cost in the USA?

PDW

Originally Posted by PDW

To make their shareholders rich. Duh. If that means people missing out on treatment then that's literally the cost of doing business.

OTOH systems like the UK one as I (poorly) understand it make me very nervous as well. I like the hybrid system we have in Australia, and I speak from the POV of just having had a basal cell carcinoma chopped out of my cheek, going to cost me a few hundred out of pocket at most, no waiting time, private surgeon, all done in 3 days from diagnosis to local surgery operation. Part covered by insurance, part Govt health system.

Wonder how much this would have cost in the USA?

PDW

It could be a never ending discussion as to which country had the best system and there certainly isn't one that doesn't have flaws. I find it easier to point out the ones I don't like and a person would have to be very, very rich to want the US system. I guess to most ignorance is bliss and brain washing successful.

About 20 years ago I was operated for double sided hernia. 3 days in hospital and 3 weeks off work on sick leave. Hospital cost me nothing (had already paid through taxes) and got full pay during my sick leave. Everything went as it should and never had a problem with it since.

As you write, wonder what that've had cost me in the USA?

Originally Posted by Gordon B. Clarke

It could be a never ending discussion as to which country had the best system and there certainly isn't one that doesn't have flaws.

People in this country have insurance so ingrained into their skulls they don't realize it doesn't solve a problem - it is the problem. Once we get a crop of politicians that put the needs of the people first we may get a proposal for a public health system that does not include this unneeded layer. That would mean ignoring a very powerful lobby and a lot of campaign donations and so is very unlikely. If more people understand what the true cost of insurance vs health care costs they may start to vote intelligently. I'm being crazy here, now.

Something to notice in that scenario I played out is that insurance is at the beginning and ending of the process. People whose livelihoods are dependent upon insurance payouts buy insurance with that income. That is how tightly it is woven into our society.

Originally Posted by PDW

Wonder how much this would have cost in the USA?

PDW

We can guesstimate that from your experience and the earlier figures I used. Insurance cost: $18,000/year. 20% deductible, assuming from your "few hundred", if we say that $300 is 20% then the total price of the procedure is $1500. This is pretty close to what Medicare allows. The insured is out $18,500 if that is the only medical care received in the covered year.

Not dragged in is the annual deductible because the amount of the deductible varies. Insurance doesn't pay anything until you've paid the deductible. If your annual deductible is $400 then you are out $900 for the above treatment and $18,900 for insurance and health costs.

Here is a difference between the US system and other systems. We know where our money is going and how much it costs us. I think in tax-based systems in Europe and other places the exact figure isn't known to the payer. If that is a wrong view I'd love to be corrected.

Edit: Since we're doing some calculating we can make some other assumptions to discover the guesstimate for the actuarial root of the insurance premium. Recalling that the insurer gets about 20% of the pie, backing that out we have $14,400 left from the premium they can pay out before losing money. That figure is the amount they have calculated their insured demographic for the family of 5 is likely to spend each year on health care (less the annual deductible and the 20% co-pay). That 20% is meant to be a deterrent, btw, from actually using the entire balance, and it amounts to $3600 annually if expenses are maxed out to even. This also is complex because there is a maximum out of pocket for the insured for very expensive medical care.

What this gives us is a picture of what any tax-based system will cost the tax payers if only tax payers were covered. That of course is not the case, so you have to count tax payer noses, non-tax payer noses, and see what the excess costs are when distributed to all tax payers. These figures are based on actuarial data when done formally and represent real costs to tax payers. Then there's the administrative overhead to toss in.

Health care is not cheap when the entire population of covered people is counted.

Originally Posted by Miguels244

I understand the communication issue here...it took a second.
There is a narrow definition of 'cost' called 'accounting cost'.
As we might expect, narrow is how DP would interpret things.

I am thinking of the broader 'economic cost'.
Economic cost - Wikipedia, the free encyclopedia

It's a little like latent versus sensible heat...
something you don't understand unless you do...
and something QwickBooks nor Wikipedia will teach you.

Your point is understood, but cost, in your terms, is what the CURRENT taxrate is versus some arbitrary baseline. If you decided that baseline is taxation at 100%, then our current tax system costs something like 11 trillion a year! But, if I decided that an effective tax rate of 5%, for example, should be the baseline, then we are in tall clover with our current system. Those figures for "the cost of tax cuts" are complete horseshit because they're based on some arbitrary baseline, which is irrelevant.

Originally Posted by dp

We can guesstimate that from your experience and the earlier figures I used. Insurance cost: $18,000/year. 20% deductible, assuming from your "few hundred", if we say that $300 is 20% then the total price of the procedure is $1500. This is pretty close to what Medicare allows. The insured is out $18,500 if that is the only medical care received in the covered year.

In point of fact it's the only medical treatment I've had since 2008 when I had a couple other BCCs removed.

The money I'm out of pocket is partly due to what you call 'co-pays' and partly sheer laziness on my part. If I went to a general practioner and got a referral to the specialist, I'd get more of the cost of the procedure back. I'd rather just pay the extra, not like it's going to send me broke. I think the theory is that it cuts down on wasting expensive specialist time, however it wastes *my* time to do it that way so I don't.

Another example: daughter had severe abdominal pain, went to hospital, was operated on 2 days later as an emergency patient, cost to her $0.00 even though she has private health insurance because it was in a public (ie taxpayer funded) hospital. Actual cost of course is the pooled amount of tax paid over time, TANSTAAFL after all.

My point is, our system *works* and nobody need worry about going bankrupt under it. We, on a demographic basis, have better population outcomes than the USA at a greatly reduced cost. Hell, you people don't even do screening of infants for treatable disorders when the cost of *not* treating them can be huge. I think your attitude of letting poor peoples' kids die instead is appalling, frankly.

From my POV your insurance companies are a big part of the problem not part of the solution. I don't really care what you do provided you don't try to export a severely broken system to us in search of greater profits for your leeches - and they do try!

PDW

Originally Posted by PDW

My point is, our system *works* and nobody need worry about going bankrupt under it. We, on a demographic basis, have better population outcomes than the USA at a greatly reduced cost. Hell, you people don't even do screening of infants for treatable disorders when the cost of *not* treating them can be huge. I think your attitude of letting poor peoples' kids die instead is appalling, frankly.

From my POV your insurance companies are a big part of the problem not part of the solution. I don't really care what you do provided you don't try to export a severely broken system to us in search of greater profits for your leeches - and they do try!

PDW

Coupla things - and I not sure you meant it that way, but I don't have an attitude of letting poor kids die. I'm advocating a true tax-based system close to what you have and with no insurance companies anywhere in sight and where everyone has the right to quality medical care. And I'm not advocating exporting our system - it sux - that's why we hate it. Obamacare is only an mandated extension of what we already have and it is absurd. Being against Obamacare does not automatically translate to I don't want public health care. Nutters like Welden assume that but it isn't realistic or true.

What I am against is such a system being used for electives such as breast implants where the health (mental or otherwise) of the patient is not affected, and other cosmetic surgeries with similar circumstances. I don't think the public health trough is an open door to any medical treatment people might want. No liver transplants for death row prisoners, for another example. And even then I'd consider an exception for cases under judicial review for wrongful detention.

Originally Posted by Cornilsn

Your point is understood, but cost, in your terms, is what the CURRENT taxrate is versus some arbitrary baseline. If you decided that baseline is taxation at 100%, then our current tax system costs something like 11 trillion a year! But, if I decided that an effective tax rate of 5%, for example, should be the baseline, then we are in tall clover with our current system. Those figures for "the cost of tax cuts" are complete horseshit because they're based on some arbitrary baseline, which is irrelevant.

I base those assertions on ratio to GDP.

Originally Posted by dp

Coupla things - and I not sure you meant it that way, but I don't have an attitude of letting poor kids die. I'm advocating a true tax-based system close to what you have and with no insurance companies anywhere in sight and where everyone has the right to quality medical care. And I'm not advocating exporting our system - it sux - that's why we hate it. Obamacare is only an mandated extension of what we already have and it is absurd. Being against Obamacare does not automatically translate to I don't want public health care. Nutters like Welden assume that but it isn't realistic or true.

What I am against is such a system being used for electives such as breast implants where the health (mental or otherwise) of the patient is not affected, and other cosmetic surgeries with similar circumstances. I don't think the public health trough is an open door to any medical treatment people might want. No liver transplants for death row prisoners, for another example. And even then I'd consider an exception for cases under judicial review for wrongful detention.

No, I didn't think you had that opinion WRT letting kids die, but SRT Mike does. He's a fan of the current system - if you can't pay, screw you *and* your kids.

I also agree WRT cosmetic surgery and repairing the foreseeable results of abuse - I'd not give a liver transplant to an alcoholic for example, if there was someone else with an acceptable tissue match who could use it and *hadn't* willfully wrecked their original.

So I don't think our positions differ much. The Australian system isn't perfect by any means and there's a culture of entitlement I don't care for, but it does deliver reasonable to very good results in the vast majority of cases and with nobody living in fear of medically induced bankruptcy or industrial peonage for fear of losing employer-provided cover.

From what I have read Obamacare is merely outsourcing tax collection to insurance companies with no effective means of controlling their rapacity. I predict that it's going to fail badly in its current form, assuming the aim is to actually improve health outcomes in the USA and not to improve wealth outcomes for the insurance industry at the expense of health outcomes. I know which way I'd be betting given the record to date.

PDW

Would I be right or wrong in assuming, apart from the very rich, that Americans don't like the system they have at present? They just can't agree on what system they should have.

I don't hear any members from countries comparable to the USA complaining or bitching a fraction as much

Isn't there anyone or any organization in the USA with enough clout to find a system that benefits and can be approved by a majority of the population? I can't help but think back to the Soviet Union. Less than 2% decided what was best for the other 98%. Strange that it always seemed to work out most beneficial to the 2%.

Nope, I'm not opening a discussion on communism vs. capitalism - just that power is concentrated and, more often than not, misused.

Gordon

Originally Posted by PDW

. . . From what I have read Obamacare is merely outsourcing tax collection to insurance companies with no effective means of controlling their rapacity. I predict that it's going to fail badly in its current form, assuming the aim is to actually improve health outcomes in the USA and not to improve wealth outcomes for the insurance industry at the expense of health outcomes. I know which way I'd be betting given the record to date.

PDW

It's not quite that bad. As the legislation unfolded, there were some who argued for single payer. It quickly became apparent that there was so much insurance industry opposition to that, along with cries of "socialism," that it wouldn't fly. The next approach, favored by more, was to have a "public option." That basically meant that people could choose either to join the Medicare payment system earlier than retirement or keep using a private insurer. That's about when we had those uninformed "conservatives" with signs to the effect "keep government out of my Medicare."

The insurance company response to talk of a public option was talking out of two sides of its mouth. On one side it said the government couldn't do anything right, that this was government taking over peoples' lives, it was socialism, emulating those dastardly French, creating "death panels" and the like. On the other side it said that the government (remember the guys who couldn't do anything right) would put them out of business. So, the Democrats ended up giving up on that as well -- no doubt fearing insurance company PAC money and the like in the next election. It's a shame more of our elected officials didn't have the courage to act on this.

What's left, however, is state-run "exchanges." These essentially allow any state to set up insurance funds in competition with the incumbents. It gives the insurance companies a bit more trouble, since they have to play Whack-a-Mole with 50 states. One or two of them, say Vermont as an example, might actually begin to demonstrate how poorly the American public is being served by a middleman that rakes 20% or more off the top. Others might follow.

It's still at least 50-50 likely that the insurance companies will game the exchanges as well. But, this option could move ever so slightly in a better direction.

Originally Posted by PeteM

It's not quite that bad.

Once we get past the heat and light show, the reality is there are a number of good features no matter WHAT one's point of view is.

But even those are not ready for their mandated implementation dates - some of which have already passed.

Just to take a case in point - the legislation requires an insurance company to explain their policy coverage in no more than FOUR PAGES of essentially 'Peter-Rabbit-English' and not of too-damned-small typeface, thanks.

Most folk would be glad of such clarity in ANY insurance policy.

So the Gumment publishes a template. A sample as to how it can be done to make sure Big Insurance has no excuse to not comply.

The template is SIX pages.

Bottom line is that whether Dem-led, Rep-led, consensus, or outright war, there WILL have to be changes.

The Income tax was thrown out on the first go as well. Even when they finally got it past the courts, they had another fatal flaw in a so-called 'voluntary' system that took around 20 years to correct. Originally, one wasn't required to file a return on one's GROSS income being above a minimum, only on one's NET income after allowable expenses and deductions being above a minimum.

Which effectively blinded the IRS to even the calculations. Nor could they directly compel sight of them in those early days.

Obamacare will need far more rework than the dirt-simple tax code of the 1920's.

Bill

Originally Posted by Cornilsn

Your point is understood, but cost, in your terms, is what the CURRENT taxrate is versus some arbitrary baseline. If you decided that baseline is taxation at 100%, then our current tax system costs something like 11 trillion a year! But, if I decided that an effective tax rate of 5%, for example, should be the baseline, then we are in tall clover with our current system. Those figures for "the cost of tax cuts" are complete horseshit because they're based on some arbitrary baseline, which is irrelevant.

I base my cost on whether or not it will increase the debt...that's my base line.
In this case the debt increased several trillion dollars.
In general it takes about 30% of the GDP to run a Western democracy.
Since we spend 4% of our GDP on the military, as much as everyone else combined, we need to add that in as an exceptional cost.

Originally Posted by smalltime

I wonder if I can get one of these:

Obama administration keeps giving out Obamacare waivers, despite new Republican spotlight | The Daily Caller

Go to work for the government, join a union.

Originally Posted by Miguels244

Since we spend 4% of our GDP on the military, as much as everyone else combined, we need to add that in as an exceptional cost.

Better recalculate that percentage Miguel. If you take the DOD budget and add all the other defense costs that are hidden in the budgets of other departments, primarily State and Homeland Security, the total easily hits $1.2 trillion. Last year's GDP was $15.09 trillion, so the number works out right at 8%.

If it was 4% we'd be a hell of a lot better off fiscally than we are now.

Munchr

Unless you have a solution as to how to become a country with a do-nothing / do no harm entity, some of those expenditures are necessary.
Unfortunately, so are the HSA and other security related expenditures.
On the bright side tough, if you remove the expenditures on wars and DOD funded giveaways to other countries, the defense budget is the best example of
a true trickle down economics. And the best part of it is that it is well spread throughout the various sectors with a sizable part going to the the real value creating manufacturing sector.
While I have no actual figures, I'd guess the majority of the monies spent are not outsourced, meaning it is also a reasonable "stimulus" for the US economy. Certainly far better
than the one we've passed a few years ago.

Now, is there waste, fraud and unfair practices in the system? You bet!
Can the amount be reduced and re-allocated to somewhere else for a better purpose? You bet!
But just where would it be better spent? Please Please please do not say education!
Our education spending vs GDP is on-par with the majority of the EU nations and almost twice that of Japan, yet we suck and suck major league in comparison.
Also, please don't say we should spend it on healthcare. We're already spending a boatload of it on that as well, yet it still sucks ( as a system, not as care!!! for those who like to believe otherwise )
Infrastructure? Yup, but need the plans first before we start buying shovels.
Paying down debt? Yup, but ask some of our elected monkeys on one side what they think of that!
Handing it out in the form of welfare checks and foodstamps? We're already doing that, see what it got us.

So what are we going to do with the freed up amount? I sure as shiit don't know.

"Last year's GDP was $15.09 trillion, so the number works out right at 8%."

Hold on there just a moment. What about the debt service on the 3 trillion we BORROWED to run the war in iraq?
You need to include that amount in there on top of the 8 percent.

What do we do with "all that extra money" if we pull out of afghanistan? I dunno, but seeing as we already
owe that three trillion, we could put a start at "stop loss."

First thing ya do when yer in a hole: STOP DIGGING.

We could fund medicare at an expanded level.
We could increase SS benefits.
We could send some kids into college to study math, science, and engineering.