Maybe this is why I have been feeling yucky. Tax changes that will effect me and mine.

Discussion in 'Controversial' started by Scooby_Snax, Nov 17, 2017.

  1. RabbiKnife

    RabbiKnife Open the pod bay door, please HAL.

    No.

    Private insurance only. No employer sponsored insurance. Let wages and health care prices be determined by the market. Let doctors compete for my health care dollars. Let employer's compete for my labor in real dollars, not in tax deductible insurance dollars.

    Create a high-risk pool for the high-risk and a safety net for the extremely poor, although personally I think the safety net should be provided by the churches and not the government.
     
  2. RabbiKnife

    RabbiKnife Open the pod bay door, please HAL.

    Well said. My care is 12 years old and has 150K miles on it. I'd like to get government subsidies for a new engine replacement insurance plan, please.
     
  3. teddyv

    teddyv The horse is in the barn. Staff Member

    That is a complete pipe dream.
     
  4. RabbiKnife

    RabbiKnife Open the pod bay door, please HAL.

    Politically, probably so.

    Economically, constitutionally, and morally, it should be the goal.
     
  5. tango

    tango ... and you shall live ... Staff Member

    I'd like to see a blend between the UK and the US systems.

    If someone goes to the doctor with a headache and the doctor says they need to take an aspirin and lie down, I think they should be paying the doctor's fees themselves. If the doctor says they have brain cancer and it will cost $500,000 to treat it, that's something I'd say needs to be treated more like the UK way than the US way.

    The trouble with the UK system is that there is too much abuse of a system that is free at the point of use and little to nothing by way of sanctions against those who abuse it. The trouble with the US system is when healthcare is a for-profit industry and people end up struggling to pay for treatment if they are diagnosed with something particularly ugly.
     
  6. tango

    tango ... and you shall live ... Staff Member

    Further to my earlier comments about the effective tax rate imposed by the (un)affordable care act. Today I had the fun task of choosing a plan for myself and my wife and found some figures that are truly depressing.

    These figures are based on a married couple with no dependent children, living in Pennsylvania. Just out of curiosity I fiddled with projected income to see what kind of effective marginal tax rates are created by the tax credits and "extra savings" associated with a silver plan at lower levels of income.

    A couple making $24,000pa signed up for a silver plan would see their premiums reduced from $1,766 to $292, a saving of $1,474 per month (yes, the government hands out nearly $18,000 to put towards health insurance). The extra savings from choosing a silver plan mean the deductibles and copays are reduced - the out of pocket maximum for this hypothetical couple would be $2,500 for the year. If their income were to increase to $27,500 their tax credit would reduce to $1,440 per month (a difference of $408pa) which creates an effective tax of 11.6% on top of other federal and state income taxes. The real kicker is if that couple maxes out their insurance limits - at $27,500 annual income the out of pocket maximum rises to $4,900. If that couple incurs as little as $5,000 in medical costs distributed such that the policy is maxed out the increase of $3,500 in income is offset by slightly over $2,800 in final medical costs (the differences in out of pocket maximum figures, tax credits etc). That means that an unhealthy couple seeing their income rise by $3,500 would only get to keep approximately $700 of it after medical costs were considered (an effective 80% tax rate). Add in 10% federal income tax and 3% PA personal income tax and the tax rate rises to an effective 93%. If they are unfortunate enough to be self-employed and subject to the additional 15% self-employment tax the chances are they are better off not bothering. (It's not quite that simple as part of self-employment tax can be deducted from income, and health insurance premiums can be deducted from self-employment income, but the figures remain depressing)

    Interestingly, if that same couple saw their income rise from $60,000 to $65,000 their eligibility for tax credits would drop from $1,074/month to zero. That means the marginal $5,000 in annual increase would cost $12,888 in lost tax credits, creating an effective marginal tax rate of 258% on top of direct tax rates and turning an apparent gain of $5,000pa into a loss of $7,888pa, again before income taxes are levied. Admittedly at this point the couple would benefit from itemising their deductions rather than taking the standard deduction but it does raise the question of why people would bother working extra hard in the hope of a modest pay raise when it creates this kind of situation.

    As before, if my figures are wrong please point out where and why. It's kinda depressing looking at figures like this and wondering if there is really any point in working at all.
     
  7. teddyv

    teddyv The horse is in the barn. Staff Member

    "Too much abuse" - how much abuse? Can you quantify that (or has the NHS)? Too often these things are given these vague, non-quantifiable costs. What the percentage of the total NHS budget? And what is your cutoff for what you consider a level of unacceptable abuse? 1%, 5%, 10%? For the record, I have no idea what this may be in the Canadian healthcare system, and is complicated because its administered at the provincial level.

    This is similar to claims of abuse of other social services. While we of course would strive to limit abuse, it's simply going to happen within any society. Society needs to ask how much are we willing to put up with so that we don't marginalize those legitimate users acting in good faith.
     
  8. tango

    tango ... and you shall live ... Staff Member

    Of course abuse is hard to quantify, especially when it's unlikely that people will agree on just what counts as "abuse" in the first place. But a combination of inefficiencies, ineptitude, and a total lack of desire to curb waste within the NHS itself is at least part of the problem.

    A family friend used to work as a doctor's receptionist before she retired. One thing she observed was that every time the UK introduced universal free prescriptions was a massive influx of people coming to see the doctor with trivial concerns. Perhaps they had a headache and if the doctor prescribed them an aspirin they wouldn't have to pay for aspirin at the pharmacist. When universal free prescriptions ended the demand for the doctor's time dropped off.

    From my own experience, between the time I graduated and the time I got my first job I got free prescriptions. One time when I went to see the doctor with a persistent cough (I'm usually the kind of guy who typically goes to see the doctor when I'm one step away from being pronounced dead) he offered me two prescriptions. Since I wouldn't have to pay for either I accepted them both. Years later when I had a similar condition but would have to pay for both prescriptions I took the one that offered the most benefit and figured I didn't need the other so declined it. Again, there's wastage because those with no skin in the game have no incentive to reduce waste.

    When I took my wife to casualty with a suspected broken foot she had to wait a while (which is to be expected) and then told to go to the X-ray, which was at the far end of the hospital. Thankfully I was there to take the weight off her bad foot because no assistance of any kind was offered - she was expected to walk, on a suspected broken foot, across the hospital. As it turned out she didn't have a break, just a nasty sprain, so they gave her some painkillers and loaned her a crutch to help keep the weight off her bad foot, merely asking that we returned the crutch when we were finished with it. So a couple of weeks later I went back to return the crutch, given we didn't need it any more. The receptionist was visibly stunned that I'd actually bothered to return it, she clearly wasn't sure what to do in such a situation. I can only guess at how much medical equipment is handed out with nothing more than "bring it back when you're done with it" and then written off because there's no expectation of ever seeing it again. A simple solution would be to take a refundable deposit so that there's a clear incentive to return things.

    Some years ago I was visiting a family member in hospital. He had been involved in a road traffic accident and was being put back together again. In the bed next to him was a guy who was having cosmetic surgery on his nose, courtesy of the NHS. He openly admitted that he wouldn't have bothered with it, had he known just how much was going to be involved. But the NHS rode to the rescue - he wasn't happy with the shape of his nose so it was reshaped, at no cost to him, thanks to the UK taxpayer. I'm not sure this is a good use of public money.

    As with so much else there comes a point when it costs more to actively hunt down and eliminate the last traces of abuse than it costs to just accept that no system can ever be 100% efficient. But when the NHS can pay staggering sums for very little service, when it can provide cosmetic surgery at no cost to the user (and I'm talking entirely elective surgery here, not reconstructive/restorative surgery after an assault or an accident), when swathes of the population pay absolutely nothing however much they use/abuse the system, and when there are no sanctions available for people who clearly are just taking advantage of the generosity of the NHS, it seems there is plenty of scope to improve.

    You make a good point about not marginalizing users who act in good faith but turn out to have a complaint that is not serious. If someone fears they may be having a heart attack but proves to have nothing more than severe indigestion (this exact scenario happened to a family friend) there is arguably a case to be made that they shouldn't just wait and see for fear of what the ambulance bill will be if they are wrong. It's not much of a choice for an older person of limited means to choose between calling for an ambulance and risking a huge bill, or not calling for an ambulance and risking death. Here there's an obvious "in" for a discussion on the inefficiencies introduced by the US-style system of individual insurance. That said there's a big difference between someone who visits the doctor with a persistent headache and a concern that it's something serious, and the person who visits the doctor at 10am because they woke up that morning with a headache.
     
  9. devilslayer365

    devilslayer365 Wazzup?!

    Congress FINALLY got rid of Obummercare’s individual mandate for health insurance! Yes! Miracles DO occasionally still happen! ;)
     
  10. RabbiKnife

    RabbiKnife Open the pod bay door, please HAL.

    That's because Trump has been such an ineffective President in this first year.
     
  11. devilslayer365

    devilslayer365 Wazzup?!

    Call it what you want. I’m too high with gratitude to care. LOL! By the way, Congress, who has more power than the President in many ways, is pretty ineffective, too. They had a shot at undoing the mandate earlier this year and blew it. Remember? They couldn’t get enough votes to do it. But, they did it. Finally...
     
    Last edited: Dec 21, 2017
  12. tango

    tango ... and you shall live ... Staff Member

    Hopefully losing the individual mandate will result in insurance companies having to be a little more competitive, knowing there's a choice to simply not buy an ACA-compliant policy if their prices continue to be ridiculous.

    Some people say that the individual mandate keeps healthy people in the risk pool and therefore keeps premiums down, but I'm not sure what part of a 70% annual increase and an annual premium of nearly $20,000 counts as "keeping premiums down". A comparable plan only three years ago was 1/3 the price it is now.
     
  13. RabbiKnife

    RabbiKnife Open the pod bay door, please HAL.

    Chief Justice John Roberts has demonstrated his keen understanding of economics and politics .

    He rightly called it a tax.
    He predicted that the political reaction once people knew what it was would result in Congress taking action.

    If you need a linear formula, you can thank Harry Reid, Nancy Pelosi, and Barak Obama for the election of Donald Trump and the passage of a phenomenal tax reform law.
     
    devilslayer365 likes this.
  14. devilslayer365

    devilslayer365 Wazzup?!

    Obamacare was a SICK JOKE. I’m sure President Obama, and all the Democrats in Congress that passed it, knew the individual mandate was NOT going to keep premiums down. But, they wanted it passed anyway...:rolleyes:
     
  15. tango

    tango ... and you shall live ... Staff Member

    I think the Affordable Care Act would be better named the Unaffordable Votes Act. By forcing people to buy something they all but guaranteed the price would rocket, and adding generous tax credits to help people pay for it (I mean, seriously, handing out $12,000 a year to someone making $60k, to help towards health insurance premiums?) would only fuel the fire. Then they could start the scaremongering because the Nasty Republicans might stop the tax credits, encouraging people to vote Democrat to keep the premiums "affordable". And by twisting the numbers at the bottom end of the economic spectrum, where workers are likely to have a strong degree of pride and not want to game the system, means they were less likely to lose out to people gaming the system. For good measure the people at the bottom end of the economic spectrum usually aren't the most economically literate, so probably wouldn't even realise what was being done to them. They'd just know that however hard they struggled nothing seemed to help, and be worried that the Nasty Republicans would do nothing except make it worse.
     
  16. IMINXTC

    IMINXTC Time Bandit

    Maybe this will subdue the innumerable crass marketing schemes playing on threats of penalties and a general sense of confusion.
    Being 65, i have the advantage of Medicare payments taken out of my Social Security retirement and will settle shortly on a supplemental policy, having left Kaiser Cal. And i also work, putting in while also recieving ss benefits.
    Still the marketers call several times a week.
     
  17. tango

    tango ... and you shall live ... Staff Member

    I must admit before I chose my plan I wondered just how many times they were going to contact me to remind me to choose a plan.

    Aside from getting at least one email every day warning me of the deadline I also got text messages and recorded telephone calls. I wish there was some way of telling them to stop bugging me because I knew very well what the deadline was, but their user interface is so catastrophically bad I need to be in the right frame of mind to even attempt to navigate it.

    The bit that is truly mind boggling is when you try to report a life change. Maybe you need to change your projected income for the year, or your address or something. It should be a simple process but no, you have to go through Every. Single. Thing. on your profile, one question at a time, confirming it didn't change. No, my name is still the same. No, my date of birth didn't change. No, my gender didn't change. No, my marital status didn't change. No, my ethnicity hasn't changed. Nobody is in prison, nobody was recently released from prison, I just want to revise my guess at my annual income.

    For an address change I suppose you have to go through the hassle (but even then they still refuse to accept my street address and mailing address aren't the same, despite trying several times to get it to work). I certainly wouldn't go through the process to update my guess as to what my annual income will be unless it was wildly different to my last guess.
     

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