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d-usa wrote: If the free market doesn't have total and absolute control to do what it wants and there is even a shred of regulation = socialism.
Which is the same as communism am I doing it right?
Pretty much. Socialism is just a word we use instead of communism to avoid scaring old ladies and so that we don't give guys who fought in World War 2 a hard attack when they realize that the Russians won.
Doctors would be apposed their paychecks will be slimmer and they'd deal with drunks more.
It's only fair that the poor get the same treatment, if everyone was middle class then it would be a silly idea for the majority, even though it screws with unlucky situations.
Evilledz wrote: Can someone explain to me exactly what Obamacare is? Is it essentially the same as the NHS that we have over here?
Because if it, I think it'll be a huge step forwards for the healthcare system in the US. By catering for everyone and giving an equal opportunity to be treated rather than having to choose between medical care and eating...
It's NOT universal healthcare like NHS. It's the same system, only that you're now required to purchase healthcare insurance (private or public exchange) or pay a tax/fine.
Azazel sort of alluded to this in another thread... the best thing that could happen is to convince the Electorates to demand a single payer system.
Reposted if you want to see a portion of the gooey details:
These are just taxes:
Spoiler:
Taxes that took effect in 2010:
1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.
2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.
3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.
4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.
5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.
6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.
Taxes that took effect in 2011:
7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.
8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.
Taxes that took effect in 2012:
9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.
Taxes that take effect in 2013:
10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.
Capital Gains Dividends Other*
2012 15% 15% 35%
2013+ 23.8% 43.4% 43.4%
*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.
11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:
First $200,000
($250,000 Married)
Employer/Employee All Remaining Wages
Employer/Employee
Current Law 1.45%/1.45%
2.9% self-employed 1.45%/1.45%
2.9% self-employed
Obamacare Tax Hike 1.45%/1.45%
2.9% self-employed 1.45%/2.35%
3.8% self-employed
12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986
13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI ($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995
14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389
15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994
16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000
Taxes that take effect in 2014:
17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following
1 Adult 2 Adults 3+ Adults
2014 1% AGI/$95 1% AGI/$190 1% AGI/$285
2015 2% AGI/$325 2% AGI/$650 2% AGI/$975
2016 + 2.5% AGI/$695 2.5% AGI/$1390 2.5% AGI/$2085
Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337
18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346
Combined score of individual and employer mandate tax penalty: $65 billion/10 years
19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993
Taxes that take effect in 2018:
20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956
That's not including any regulatory changes...
Here's a nice summary:
Spoiler:
The Employer Mandate
ObamaCare’s employer mandate is among the new laws most anti-growth provisions. When implemented, it will force most American businesses to offer government-approved health insurance to their employees or else pay new federal taxes for not doing so. This costly new requirement will make it more expensive for firms to hire workers in the future. Consequently, it will destroy jobs, and many firms are likely to slow down on hiring in anticipation of its implementation.
“Free-Rider” Provision
ObamaCare does not impose a straight-forward requirement that employers offer health insurance to workers. Proponents of the new law wanted to avoid the charge that the new law was directly imposing new costs on American business. So, instead, they created a back-door mandate, what they call the “free-rider” provision.
If a firm with at least 50 workers has a full-time employee who is getting federally-subsided insurance through an ”exchange,” then that employer must pay a penalty for failing to offer that worker acceptable insurance on the job. (Workers that are offered qualified coverage by an employer are ineligible for the new insurance subsidies provided in the exchanges.)
The tax is scheduled to begin in 2014 and the Congressional Budget Office estimates it will bring in approximately $10 billion in annual revenue once it’s fully implemented.
Penalties For Failure To Insure
For firms which do not offer insurance any insurance, have more than 50 employees, and have at least one employee receiving insurance subsidies, they must pay a tax of $2000 per subsidized employee. The tax is applied to all of a firm’s employees (after excluding the first 30), not just those that are subsidized. For example a firm with 51 employees would pay $42,000 in new annual taxes, and an additional $2,000 tax for every new hire.
For firms that do offer insurance, the penalty is the lesser of $2,000 for every employee (after exempting the first 30) or $3,000) for every employee receiving a subsidy.
The National Federation of Independent Business has a clear and informative table which examines the taxes assessed under different scenarios here.
Disincentives to Hire
ObamaCare’s employer mandate will discourage business development and growth. Small firms with 50 or fewer workers will have very strong disincentives to expand. These businesses can avoid the new penalties by staying small; growth will simply add new costs and burdens. Many businesses with low profit margins are unable to pay the substantial cost of providing comprehensive insurance to all of their employees or the new taxes under ObamaCare’s employer mandate. Once companies reach 50 employees, they are likely to turn to contractors and outsource work to evade the new mandate, even if such arrangements are less efficient than directly hiring new workers.
Part-Time and Seasonal Employees
Fines to employers under the employer mandate also are imposed on workers who are not full-time employees, where a combination of employees working 120 hours per month (around 30 hours per week) count as one employee. This provision in the bill especially hurts seasonal businesses, where it is frequently not cost effective to provide insurance benefits to an employee who will only be with the firm for a short period of time.
Penalizing Low Income Households
ObamaCare provides strong incentives for firms to avoid hiring workers from low-income households. Eligibility for subsidized insurance in the exchanges is based on household income, and firms can be penalized if one of their workers gets subsidized coverage in an exchange. Thus, firms have a strong incentive to find workers who won’t qualify for subsidized coverage, which may also lead to invasions of privacy. For instance, a restaurant might find it better to hire young waiters from upper-income neighborhoods, as opposed to low-income areas, because they would be less likely to qualify for subsidized insurance in the exchanges. ObamaCare therefore is penalizing the very households it was supposedly passed to help.
While it does create a more challenging environment, we'll adapt. We always do.
The ACA has such an impact that 3% of our doctors felt strongly enough to participate in an online survey about it, 60% of which said they would leave.
So we should repeal the ACA because roughly 1.5% of physicians contacted don't like it.
d-usa wrote: So summarizing the whole point of this thread:
The ACA has such an impact that 3% of our doctors felt strongly enough to participate in an online survey about it, 60% of which said they would leave.
So we should repeal the ACA because roughly 1.5% of physicians contacted don't like it.
Let's try something else...
Do you know any doctor that has enough time to read/fillout a survey?
d-usa wrote: I always figured you would just strap them to a kangaroo and watch them hop over the horizon...
That's way better than what I could think of.
Frazzled wrote: I know my doctor has already dumped Medicare patients and specifically had a note with "thank Obama" up for six months. I'm just waiting to see if our Bank will dump coverage for everyone. I'm giving it 50/50. Its cheaper for them just to pay the fine.
And before that it was cheaper for them to just not cover healthcare at all. And even cheaper to still to pay no more than minimum wage for every single position in the bank. Except, you know, if they want skilled, qualified staff then you have to offer the price that kind of labour can command.
And so it only makes sense to offer a decent package, including healthcare.
But you know that already. But you made the decision that if something sounds like a good way to boo ACA, then you ain't gonna let thinking and common sense get in they of that.
Automatically Appended Next Post:
Frazzled wrote: The Medicare bureaucracy disagrees with you.
Reality disagrees with you.
Private insurance administration costs between 11 and 14%. Medicare administration costs 6%.
Frazzled wrote: Cool. I like that. I'm actually ok with a good single payer system if thats the case.
Here's another question, why do they still have private systems? Doesn't that set up: 1) crappy system for the worker drones; 2) a good system for the wealthy?
Well, it isn't so much worker drones vs the wealthy, with the tax incentives in place it makes good sense to join a private plan once the highest income earner goes over $80,000, which is a lot of people. 53% of people have private health insurance.
A private system allows for variety, and allows the consumer to go and talk to different plans and pick the one that works best for him. So some plans might deliver better results in some areas, others elsewhere. I originally chose my plan because it was a little cheaper than the alternatives, and had great coverage for the kinds of treatment I was likely to need - being a young guy in my 20s that was basically sporting injuries and good coverage of doctor's trips. When I married I visited different providers with my wife, and we chose the provider that offered the best coverage for the stuff we were likely to need in the next few years - obstetric care, basically.
Automatically Appended Next Post:
Frazzled wrote: That doesn't mean less care. That means more care for that group.
math, its a wonder.
No, this conversation isn't happening in a bubble. There's a whole world out there, and it's been studying healthcare systems around the world for decades, and the causes of the high cost of US healthcare are very well documented, and have nothing to do with 'we get more care'. Because you don't.
Instead, you get more care that doesn't do anything. The pay for procedure rather than pay per the illness system you have no actually encourages unecessary processes. And then you double down on that waste by repeating the same system with your prescription drugs. The very high admin costs of your private insurers are another issue - having invoices travel between patient, hospital and insurer over and over again is far more costly than most people realise - and that's before you add in the costs of individuals defaulting on their payments. Having private insurers with a profit incentive to deny treatment, and then having an entire legal establishment to mediate what is and what isn't covered treatment is a whole other level of waste.
And finally, and perhaps worst of all, despite all the free market everywhere, you have no actual consumer choice. I can go and ask different private insurers about their plans, and move freely between them based on who is best meeting my health needs. In the US, people directly paying for their own insurance are a tiny market, and they pay a massive premium. Most coverage is provided by the employer, who has no ability to determine the health needs of each of his employees.
This message was edited 4 times. Last update was at 2012/11/16 03:36:21
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
That means more care for that group.