OBAMA/TRUMPCARE MEGATHREAD

[cabiness42]

The idea that there are tens of billions of dollars worth of unneeded federal jobs out there is pretty hilarious.

 

You've obviously never worked for a Federal agency.

[southsider2k5]

So I just want to point out, that for a normal pregnancy (2 night stay at hospital, only 1 night with baby since wife didn't deliver until morning...my bill will be in excess of $5K. My last child, obviously different plan, I paid less in insurance premiums and total bill was $100 dollars. Current plan is based upon my wife's company, which due to obama care, reduced benefits to the minimum required or otherwise standard bronze plan. I've already given examples of same situation for clients (when I worked in a different field that allowed me those insights). Obviously hard to differentiate what is driven by increased costs vs. driven by changes and companies changing what they will cover, etc.

 

Long story short...we pay much more in premiums and get far less in benefit protection (have greater out of pocket max's, etc). I literally am dumbfounded at the cost of a standard delivery. I wonder if it was a c-section how much it would have been (clearly in excess of our Out of Pocket individual max). Thankfully we have good positions (and our big time planners), etc, and stable income and have planned for this, but I think vast majority of youth who have major student loans, etc, would be even able to afford the hospital bills (and it isn't like the typical middle class person is qualifying for a bunch of benefit assistance).

 

Out of pocket expenses exploding are also something not being talked about when the premium increases are talked about so glowingly.

[StrangeSox]

You've obviously never worked for a Federal agency.

Based off of the latest CBO estimates, the PPACA will cost roughly $100B per year through 2019. Even if we assume a generous average federal salary of $100k, that means we'd have to cut 1,000,000 "useless" federal jobs. That'd be over 1/3 of the government. Which, A) would screw 1,000,000 middle class people out of a job and B) would screw a whole bunch of the rest of middle class out of services provided by those 1,000,000 employees.

[StrangeSox]

Out of pocket expenses exploding are also something not being talked about when the premium increases are talked about so glowingly.

Yeah, deductibles and co-pays have been increasing for years and that trend unfortunately doesn't show a sign of stopping.

[cabiness42]

Based off of the latest CBO estimates, the PPACA will cost roughly $100B per year through 2019. Even if we assume a generous average federal salary of $100k, that means we'd have to cut 1,000,000 "useless" federal jobs. That'd be over 1/3 of the government. Which, A) would screw 1,000,000 middle class people out of a job and B) would screw a whole bunch of the rest of middle class out of services provided by those 1,000,000 employees.

 

Right, but I'm not talking about funding the entire PPACA, just the portion that is now being covered by the cost being forced upon people who were forced to change plans. More than enough jobs to cut to cover that.

[Balta1701]

Out of pocket expenses exploding are also something not being talked about when the premium increases are talked about so glowingly.

 

 

Yeah, deductibles and co-pays have been increasing for years and that trend unfortunately doesn't show a sign of stopping.

Which remains, again, a thing that businesses are able to do because it's a way to cut payroll expenses without actually cutting their employees' salary. It is one version of an employer response to the near destruction of the global economy in 2008 - weak employment, no upward wage pressure, but actually cutting people's take home pay in response has much higher risk of losing the employee than cutting their benefits.

[StrangeSox]

http://kff.org/health-costs/report/health-...dle-class-more/

 

This analysis paper examines the availability, affordability and stability of the health insurance coverage of the American middle class, defined as those with incomes of $44,000 to $88,000 for a family of four. It also addresses the growing burden of health care costs for the middle class, the adequacy of today’s health insurance plans to protect them from large medical bills, and the difference both make as individuals and families make health care decisions for themselves.

 

Key findings include:

– Nearly a quarter of the nation’s 45 million non-elderly uninsured are middle class;

– Most middle class Americans with insurance get it through their employers, a source of coverage that has been put in jeopardy by the economic recession;

– Health insurance and medical care have become less affordable for the middle class as the growth in insurance premiums and medical costs has far outpaced that of wages.

[farmteam]

No, it's not the entire middle class, but aside from young single people, there are a lot of middle aged self-employed people who got screwed over in this.

 

Also, no need to increase taxes on anybody (though I am in favor of some combination of a higher taxrate/closing loopholes for the top 1%). Every Senator in favor of Obamacare could have easily found enough unnecessary Executive Branch agency jobs in their home states that could have been cut in order to pay for this, but no, we have to screw over some middle class folks rather than cut the bloated government.

You keep saying this. Part of me thinks you might be right. But you just keep saying it without providing any reasons, much less any support for it. So I can't evaluate whether you are right or not, and what options there might be to fix it.

 

http://kff.org/health-costs/report/health-...dle-class-more/

Is a median income of $44,000-$88,000 for a family of four really considered middle class still? My rough, rough estimate would be something like $75,000-$175,000 for that family size.

[cabiness42]

You keep saying this. Part of me thinks you might be right. But you just keep saying it without providing any reasons, much less any support for it. So I can't evaluate whether you are right or not, and what options there might be to fix it.

 

 

Is a median income of $44,000-$88,000 for a family of four really considered middle class still? My rough, rough estimate would be something like $75,000-$175,000 for that family size.

 

My father-in-law is self-employed, and he, along with all the other self-employed people he knows in his trade had anywhere from 25-60% increases in their premiums from 2013-14 due to their coverages having to be changed to be compliant.

[StrangeSox]

Is a median income of $44,000-$88,000 for a family of four really considered middle class still? My rough, rough estimate would be something like $75,000-$175,000 for that family size.

 

The median income nationally for a family of four is right around $50k. $175k puts you comfortably in the top 10%. $75k would put you in the top 1/3rd of all households. "Middle class" is a constantly shifting political definition which is why it's really a crappy concept, but I think it's fair to exclude the top and bottom quintiles of earners from it at least. That would give you a range between roughly $25k/year and $100k/year for the middle three quintiles, and that represents a huge lifestyle difference in that range.

[Iwritecode]

Is a median income of $44,000-$88,000 for a family of four really considered middle class still?

 

I've been in that range for most of my life with a family of five and consider myself solidly in the middle class.

[bmags]

I totally understand the impulse to think that 44-88 is not middle class, and I have to wonder when sensible housing policy becomes a bigger deal. Breaks across lines in some ways.

[Jenksismyhero]

Student loan debt renders that whole definition useless. If you're making 80k with 100k in student loan payments, you're not living an 80k lifestyle

[farmteam]

Student loan debt renders that whole definition useless. If you're making 80k with 100k in student loan payments, you're not living an 80k lifestyle

That's exactly what I was thinking.

[farmteam]

My father-in-law is self-employed, and he, along with all the other self-employed people he knows in his trade had anywhere from 25-60% increases in their premiums from 2013-14 due to their coverages having to be changed to be compliant.

So your entire argument is based on a minuscule segment of a specific industry?

 

Again, I'm not saying you're wrong, or that it's even probable you're wrong. I have no idea. That's the point. What's the trade?

[Jake]

I'm having a difficult time buying that the government has any business telling me what my health care plan has to cover. If I choose to risk not having something covered, what business is that of anybody else?

 

Even if a person wanted to, they would have a hard time grasping what is and isn't covered. The vast majority just aren't going to go through what is necessary to get the best possible handle on things.

 

More convincing to me, though, is that the entire field of behavioral economics is basically designed to tell us why the government has a justifiable role in the health market. People are terrible at judging individual risk, even when the odds are laid out plainly in front of them. Even when they judge their risk correctly, they tend to make the wrong bet anyway. Personal health is incredibly difficult to judge pre-emptively. People won't get it right. Non-behavioral economics would simply suggest that the private healthcare market is alarmingly inefficient in comparison to largely public-controlled health systems around the globe. Here are a couple charts measuring total (public+private) healthcare spending per capita on the x-axis and estimated years of life lost per 100,000 people. The first is for men, the second is for women.

 

 

 

It's insane that we spend at least 8x as much as Mexico on healthcare and collectively have gained nothing in terms of loss of life for women.

 

And this isn't like many other sorts of choices people might make that include risk. When you buy spotty insurance, you've put yourself in a position where if any of a certain set of things happen to you, you're automatically either going bankrupt or going to die before you otherwise would (so in this set of choices, if they let you take enough debt to go bankrupt, you've benefited!). The stakes are really high. Remember, upwards of 65% of bankruptcies in the USA are driven by medical debt. Of those with medical debt-induced bankruptcy, 75% have insurance. Between 800k and 1.5 million people file for bankruptcy every year.

[Y2HH]

Even if a person wanted to, they would have a hard time grasping what is and isn't covered. The vast majority just aren't going to go through what is necessary to get the best possible handle on things.

 

More convincing to me, though, is that the entire field of behavioral economics is basically designed to tell us why the government has a justifiable role in the health market. People are terrible at judging individual risk, even when the odds are laid out plainly in front of them. Even when they judge their risk correctly, they tend to make the wrong bet anyway. Personal health is incredibly difficult to judge pre-emptively. People won't get it right. Non-behavioral economics would simply suggest that the private healthcare market is alarmingly inefficient in comparison to largely public-controlled health systems around the globe. Here are a couple charts measuring total (public+private) healthcare spending per capita on the x-axis and estimated years of life lost per 100,000 people. The first is for men, the second is for women.

 

 

 

It's insane that we spend at least 8x as much as Mexico on healthcare and collectively have gained nothing in terms of loss of life for women.

 

And this isn't like many other sorts of choices people might make that include risk. When you buy spotty insurance, you've put yourself in a position where if any of a certain set of things happen to you, you're automatically either going bankrupt or going to die before you otherwise would (so in this set of choices, if they let you take enough debt to go bankrupt, you've benefited!). The stakes are really high. Remember, upwards of 65% of bankruptcies in the USA are driven by medical debt. Of those with medical debt-induced bankruptcy, 75% have insurance. Between 800k and 1.5 million people file for bankruptcy every year.

 

I hear people repeat stuff like this all the time...insert Mexico, Cuba, or some other 2nd/3rd world nation, and compare them to the US.

 

I don't, for a single second, believe statistics coming out of corrupt ass countries like that, and if you've ever gone to any of these places, and actually left a protected tourist zones, you'd quickly realize that's a load of crap. Hell, get pulled over by a cop there (off the reservation), and you'll quickly realize it's nothing more than a shakedown where you have two choices, you either give them all the money you have, or you get to go to Mexican jail for a day and see how that works out.

 

They're great at reporting stats from the areas they want to report them from, but ignoring poor/troubled areas, and then showing "their healthcare is as good as any other countries". That'd be like Chicago ignoring the south side gun violence "because it's just poor people killing poor people", and reporting there were just 15 murders for all of 2014, and then proclaiming, "Look, Chicago is just as safe as Sweden!"

Edited April 20, 2015 by Y2HH

[Jenksismyhero]

Do those statistics include end-of-life care? As a nation we spend an obscene amount of money on the that. I'm guessing most other countries don't do that and don't do that to the same degree.

[StrangeSox]

ARE YOU ADVOCATING FOR DEATH PANELS?!!!?!?!?!!!11

[Jenksismyhero]

No, but if those costs are included in general health care spending, and you're comparing those figures to basic death figures, it's not really an apples to apples comparison.

[Chisoxfn]

Which remains, again, a thing that businesses are able to do because it's a way to cut payroll expenses without actually cutting their employees' salary. It is one version of an employer response to the near destruction of the global economy in 2008 - weak employment, no upward wage pressure, but actually cutting people's take home pay in response has much higher risk of losing the employee than cutting their benefits.

In one case of my example that is true, but for all other companies, the amount the company would match and pay stayed flat and/or increased (as a relative percentage), however, to keep things from going crazy, other adjustments had to be made. For example, this current year at my current employer, premiums went up 10% (and coverage went down...hard to quantify exact percentage because a lot depends on how much you go out of pocket, but it was a pretty big overall reduction in coverage vs. the previous gold plated caddy coverage). Had the Company kept everything the same, premiums would have went up in excess of 40% (both to the company and the employee), whose % match was going to remain consistent). They opted to go with the version with lower premiums (and subsequently lower coverage) as the perception is the employee (and I'd generally say this is true) is more focused on the premiums paid vs. total cost (as you usually have to put some estimates in up front when analyzing that).

 

Either way, my point is, it isn't employers driving this change. In some cases sure, but in general, all I see is absurd price increases and they have gotten crazy post Obamacare. I am not actually correlating the two because insurance costs have been crazy prior to, but lets not just look at premiums as an indicator. I could be on a plan that cost $50 / month and ultimately cost me thousands more than a plan that cost 500 a month depending on coverage & my use of insurance.

[Texsox]

I hear people repeat stuff like this all the time...insert Mexico, Cuba, or some other 2nd/3rd world nation, and compare them to the US.

 

I don't, for a single second, believe statistics coming out of corrupt ass countries like that, and if you've ever gone to any of these places, and actually left a protected tourist zones, you'd quickly realize that's a load of crap. Hell, get pulled over by a cop there (off the reservation), and you'll quickly realize it's nothing more than a shakedown where you have two choices, you either give them all the money you have, or you get to go to Mexican jail for a day and see how that works out.

 

They're great at reporting stats from the areas they want to report them from, but ignoring poor/troubled areas, and then showing "their healthcare is as good as any other countries". That'd be like Chicago ignoring the south side gun violence "because it's just poor people killing poor people", and reporting there were just 15 murders for all of 2014, and then proclaiming, "Look, Chicago is just as safe as Sweden!"

 

I worked in Mexico for three years. I've been pulled over by cops in Mexico and in the US. The experiences were about the same.

 

As a large employer we were required to provide a doctor on staff to treat the employee and their families. Much cheaper than providing insurance and more convenient for the workers, less so for the families. I spoke with the doctor a number of times, he was educated in the Caribbean. Seemed like the employees were well cared for.

[Texsox]

In one case of my example that is true, but for all other companies, the amount the company would match and pay stayed flat and/or increased (as a relative percentage), however, to keep things from going crazy, other adjustments had to be made. For example, this current year at my current employer, premiums went up 10% (and coverage went down...hard to quantify exact percentage because a lot depends on how much you go out of pocket, but it was a pretty big overall reduction in coverage vs. the previous gold plated caddy coverage). Had the Company kept everything the same, premiums would have went up in excess of 40% (both to the company and the employee), whose % match was going to remain consistent). They opted to go with the version with lower premiums (and subsequently lower coverage) as the perception is the employee (and I'd generally say this is true) is more focused on the premiums paid vs. total cost (as you usually have to put some estimates in up front when analyzing that).

 

Either way, my point is, it isn't employers driving this change. In some cases sure, but in general, all I see is absurd price increases and they have gotten crazy post Obamacare. I am not actually correlating the two because insurance costs have been crazy prior to, but lets not just look at premiums as an indicator. I could be on a plan that cost $50 / month and ultimately cost me thousands more than a plan that cost 500 a month depending on coverage & my use of insurance.

 

The cost increases have been horrible since the mid 1980s.

[Y2HH]

I worked in Mexico for three years. I've been pulled over by cops in Mexico and in the US. The experiences were about the same.

 

As a large employer we were required to provide a doctor on staff to treat the employee and their families. Much cheaper than providing insurance and more convenient for the workers, less so for the families. I spoke with the doctor a number of times, he was educated in the Caribbean. Seemed like the employees were well cared for.

 

That's like saying health care is perfectly fine in the US because I work for Blue Cross Blue Shield, and we have a number of doctors/nurses on staff and a clinic in the basement of our offices.

 

That doesn't mean everyone else does.

 

Unfortunately, MOST people don't work for large employers, not the US, and not in Mexico.

 

And one doctor for an entire "large company and their families" doesn't sound all that amazing, to be perfectly honest.

Edited April 20, 2015 by Y2HH

[Y2HH]

The cost increases have been horrible since the mid 1980s.

 

The education and certifications required to become a doctor in the US carry significant cost, as well as the malpractice insurance they carry, as well as how much they end up making 10 years after they're "established".

 

Those things, in combination, put an automatic upward pressure on cost.

 

I don't know many doctors, but I do know one and he makes over 280k per year, NOT counting perks/401k/vacation/benefits/etc.