DawgTalkers.net Forums DawgTalk Palus Politicus Single-payer would tank the US economy

I will try to answer...........



I really don't get this. I'm not being evasive or a jerk, but I really don't know what you are saying. Let me re-read it.

I'm sorry, OCD..............I don't get it. I told you in the PM that I am not a politically-savvy dude. I just don't understand all of the language. That's probably because I am just a "stupid person who works too hard."

However, if you want to clarify what you are saying, I'll give it a shot. I like these types of conversations, as long as your intentions are honest.



Bro, you ask some damn long-ass questions. Ever thought about breaking it down a bit? LOL

Hmmmm..........I thought I asked questions from open-minded people. I want them to educate me. I even asked Eve. I didn't want to hear from the extremists on either side because I already know what y'all will say.

I want information. I want to examine if my "opinions" are correct or if they are misguided.

I don't pretend to have all the answers. I simply gave a real-life example of how competition from other private competitors ensures that I provide better quality and reasonable prices in the goods I produce and the services I render.

Is that hard to understand?

Do you think governmental agencies see things the same way? When was the last time you was at the DOV? Or tried to apply for a permit? Or, dealt w/Unemployment, building a garage, social security, etc?

If you wanna go on the attack to discredit my thoughts, so be it.

Oh, and btw---------------I already answered the one question you had in a PM and I am puzzled why you asked it again. The you and Swish question.

I have no hope for 40, rocky, and Vambo. I have hope for you.

I can agree, but seems I may (wrongly) hitch my wagon to the fact that a few years ago the Govt dictated to Dr offices a lower rate for Medicare patients.

And a lot of Dr offices said they would drop Medicare patients.

But then they didnt.

So I would have to have some hope that if we had "Medicare for all" the Govt monopoly will dictate prices.

That said, there will be a fight between Congressmen paid off by Big Pharma, and Congressmen who want to keep costs down.

Usually the little guy (Us) gets screwed. But on the other hand I dont see how the Dems will ever be in power again unless they can offer a viable solution.

where were the doctors gonna go?

they get paid the most here than most - if not any - other countries. even if the rate gets lowered, they will get paid a crap ton, especially since medicaid/medicare is guaranteed bread for them.

our healthcare isnt even better than some struggling nations.

look at this crap:

http://thepatientfactor.com/canadian-hea...health-systems/

https://www.newsweek.com/united-states-health-care-rated-worst-637114

https://www.usnews.com/news/best-countri...system?slide=10

when my oldest daughter got hurt in Germany, we didn't even take her to the emergency clinic on base. my wife took her to the German hospital, and the only thing we paid was 30 euro for meds.

Exactly. Where the Drs gonna go.

But a very drastic change needs to happen to get us on that path.

I almost feel like the system needs to implode before Americans will be open to that change.

unfortunately you might be right.

we have a knack for having to learn things the hard way before making any meaningful changes.

what is the magic number in terms of dollars that you are willing to pay for health care? Unfortunatley, IMO most peole have an unrealistically LOW starting point. I hear lots say $25 for an office visit at a PCP. But what does that $25 pay for. How many people are involved in your care for that visit not to mention the overhead involved. I know when I see my PCP I see some one that checks me in at the front desk and confirms all of my information and stuff like that. Then I see a nurse who does my vitals and does a quick update on my health history. Then I see the doctor. Once done I see someone to check out out and schedule my follow ups or labs if needed. My guy typical books 5 patients an hour. So for a $25 visit the facility has $125 in one hour time slot to pay the lights, the heat, the cost of the structure, the salaries of the 4 people I saw, their benefits etc. And I left out a lot of stuff that would fall under that visit..So yea $100 for a PCP office visit aint out of the question IMO.

I sat down and did some back of napkin calculations and want people to weigh in. Currently Medicare tax rates are 1.45% (times 2) to cover 60 million of the 300+ million US citizens. Would you be willing to have that tax rate increased to 7.25% to start a Medicare for all type plan? I would then say that since medical expenditures are 18% of the GDP, that we use that number as a basis for what a family should expect to pony up for health care costs in a year. They are already paying 7.25% in medicare taxes so I propose that an individual or family (doesnt matter size) will be expected to pay the 10.75% of their MAGI to cover the first $$ of their bill like a deductible. This 10.75% will be mandated to be put into a HSA via mechanisms like payroll deduction, 941 quarterly reporting or withholding from your annual tax refund. As with any HSA it is yours to keep.. it is not use it or lose it. Employers are free to pay any portion of the HSA contribution that they see fit...once your 10.75% is met the federal government will pick up 100% of the remaining costs. If you wish to buy private insurance to cover the cost of the 10.75% you are free to do so but will lose the tax advanatges of the HSA. Under this scenario, the rich will pay significantly higher deductibles then the poor based on income. But it also makes even the poor put some skin in the game. As far as employers go their payroll taxes will go up significantly but they will no longer be paying insurance premiums and would have the ability to shift the balance of the costs of insurance over to salary increases or contributions into the mandatory 10.75%.

Granted all of this is quick back of the napkin stuff. I could be convinced to be on board with this, but I am still betting members of the FSA will see the costs to users being to high.

Hey Tee, hope it's ok if I just reply once and reply from posts on the last page too

First off, sorry for having that many outpatient surgeries, that doesn't sound like fun. I'm well aware that in the end what matters is the "patient responsibility" number. That demonstrates the highly inflated nature of medical prices in the United States, and both the Hospitals and Insurance Companies attempt to hide the true cost of healthcare. The true cost is close to the patient responsibility amount. I just think both the hospital and insurance company are operating under a veil, and it's hard to argue that a system is fair and just if that system feels compelled to fake prices to make it appear like you're getting a deal. In the end what I care about is how much out of pocket is costs for a patient to get services. The cost in the US is significantly higher than other developed countries, even ones with lower populations than ours. This doesn't seem to make sense.

While I wouldn't put it past someone to file bankruptcy over $500, I don't think that's a typical use case. It takes a lot of time and effort to file for bankruptcy and it completely destroys your credit. Just because someone has existing debt does not mean that an unforeseen medical bill can't push them over the edge. Debt has a snowball effect and once you can't maintain your debt repayments it falls apart pretty quickly. The best way to avoid debt is to never get it. However, sometimes you can't help it. I didn't ask my wife to split her egg so we'd have twins, therefore all but making sure they'd spend time in the NICU. I also couldn't help that it took them 3 weeks to learn how to eat properly. It's hard for me to think I should blame myself for a situation like that. I had no credit card debt until a few days ago when I put some of the medical bills on a 0% repayment plan on my amex. Sometimes you have no choice.

I agree with you on the wage freezes. In Europe you actually don't make a ton of money by being a doctor. However, they don't pay the college tuition either. To get your PhD in computer science in France for instance is something stupidly small like 500 euro. I never worked with PhD people until working for a french company. Too expensive in the US for too little gain. Now we're ending up with Doctors who owe so much debt they are on PSLF. That's stupid and a sign of a broken system if there is one: source

I only half agree on the better eating. The most expensive medical bills are for many non-preventable issues like cancer. Some would be lifestyle choice (smoking and lung) but many aren't. That said, we have a weight problem in the US that is driving up our general medical expenses.

I would be willing to start with your back of the napkin argument actually. I make pretty good money and it would still be cheaper for me to spend the amount you're saying, especially if it's taxfree. Paying $8300 just on out of pocket on taxable income this year blows. Add my premium into that and 10.75% MAGI would be like 70-80% of my current costs. I'm not ignorant enough to think healthcare should be free. I do think it should be universal though.

You have to do more than just charge people a fee based on income. You have to regulate pricing.

Right now we have a systems that is run by a corporate conglomerate of big pharma. They buy out the major hospital boards, have their drugs prescribed as policy, then they pressure private doctors who also use those hospitals to follow the same policies when it comes to prescribing meds and charging for services.

The cost is then passed on to the insurance companies who will then just charge you an exorbitant amount to have insurance. Of course you don't pay that ridiculous amount yourself but share the cost with your place of employment. Even then most insurance forces you to pay a certain percentage of costs like 20% co-pay at least unless you work for a really great company.

You won't realize what is being paid till you lose your job and you have to pay the full price. Then you start to understand that there is no way a normal person could ever afford insurance on their own. People who are self employed or run a small business already understand the extreme hardship that paying for insurance is. It's the single largest expense to hiring employees and the number one factor that prevents a business from hiring employees.

We have a system in place for the poor and elderly already. It's not great but it functions. Medicare and medicaid. It regulates pricing already. It has strict guidelines on what doctors can charge them and strict guidelines on what is paid out for medicine. The doctors already know and they just get it done that way.

That's the thing. You don't need to invent ANYTHING. It's already there. You just have to open it up to everyone and charge them a fee based on income. Then you offer supplemental insurance to fill the gaps just like is ALREADY DONE.

To pay for it I would have a flat tax of 10% to all business's income and 10% to all citizens. The only exception I would make is for those at poverty level. Why? Because in a civilized nation it is the responsibility of its people to look after those who are less fortunate and need help to get back on their feet.

For certain things you need to take out the profit motive and have a human decency motive. Education, healthcare, basic food, and public safety are the three things I find the most essential to be the responsibility of of the government. The government doesn't need it's fingers in everything we do but on those four things I think it's essential to give all citizens a fair chance at life. A healthier and more meaningful life.

Somewhere the line gets crossed between socialism and common decency.

I agree. I don't really want the government involved with business ownership or having them overtax everything. Still the way you can judge any country is by the how well the people live even when they are poor. Being educated, fed, healthy, and safe are the core of what it means to have a successful country.

It's no benefit to say your country has the best doctors and healthcare if it's so expensive that more than half the citizens can't afford it or go bankrupt if they do. Capitalism on basic needs doesn't work because all it does is enslave you to poverty. That is why there is a balance that needs to be maintained. Otherwise countries fall into ruin. History shows us that over and over again.

I am sorry...I just cannot get on board with government mandated prices controls in any sector. Once you allow the government have control of prices and wages in one sector it will only be a matter of time till they move on to the next sector and the next and the next. I have no idea what your career is but how would you feel if it was decided that for the good of the country you could only make $30,000 a year because keeping your income low makes the price of your goods or service cheaper for your fellow man. Why wont you let the market decide what your value is? if the populace wants your product and service and allows you to make $200K what is wrong with that? If they dont and you only earn $15k then whats wrong with that?

You control prices in the medical field by refusing to have services done at a price you do not accept. If a $2000 procedure is not worth it to the masses then they should pass on having it done. once noone is paying $2000 for said procedure then the market for that dries up and drives prices down...the problem is we have an insatiable appetite for medical services. Demand drives cost. It is a cold hard fact.

but America will never see eye to eye or even come to a modicum of common ground on this issue so we might as well just move on to issues we can come to a agreeable consensus on.

A majority of Americans think we should have universal coverage. That majority is a plurality of single payer and multi payer, but that majority is definitely for universal care source

Heck, even in the group that is against universal care, a third of all respondents felt we should keep medicare and medicaid!

I work closely with our HR department and budgets. It costs my employer approx $7000 a year to provide insurance to an employee. It cost my employer about $7200 a year in employee payroll taxes. It cost my employer about $5000 a year in bonuses and incentive pay per employee. My employer spends about $3000 in OT per employee. Then add in $6000 in retirement plan payments per employee. Then the employer has the biggest cost to hiring an employee which is the $40,000 a year salary.

Health insurance/care makes up about 10% of our costs to hire an employee. double digit number yes but not crippling as some will have you to believe

They are for it right up until they have to come up with a fiscally sound funding mechanism

Where is the source data to support that claim?

so 7000 for insurance plus 7200 in taxes for which I am sure is the matching contribution towards social security. SS covers medicare and medicaid when your older. So for a wage of 40,000 your company is spending an extra 14,000 towards healthcare for present and future. That is a LOT more than 10%. Hell even the 7000 is a lot more than 10% to have that employee earning 40,000.

There are plenty of people who work 40 hours a week and will earn less than what your paying for insurance but yet you think they have a fair opportunity at being able to have their health looked after.

Now look at it this way. Your company will pay a flat 10% towards national health care costs no matter how many employees it has. It would actually benefit them to grow and have more employees because as they grow the percentage cost per employee goes down because if I have 200 employees and I pay 10% it's a lower cost than paying 10% for 100 employees. However more people are working now and paying more into the national health insurance fund so it still works out great.

More over the cost of healthcare currently works against married people with families because the healthcare premium is much higher for a family than it is for a single employee. It can be a strong contributing factor for NOT hiring someone in their 40s even though they might have great experience because they can hire a 26 year old and potentially save thousands of dollars just on healthcare premiums. As someone who hired and fired people I can tell you it's a fact that many businesses weigh this factor into who they hire.

Furthermore it's been publicly stated by many, many, many business owners that the single greatest factor they decide before hiring new employees is the cost of insurance especially on jobs that earn less than $20 an hour. It literally stops them from hiring ANY new employee in many cases. That is not my opinion but fact.

The +6% of portion payroll taxes know as FICA finances Social Security not Medicare/aid so you are mistaken to say that is a health care expense.

The inability of an employers workforce to meet demand drives hiring not having extra money in the company coffers....at best having extra money in company coffers will drive wages higher in companies that value the employee.

And I am confused....flat 10% of what??? Profits??? Payroll??? Gross receipts? Growing a company with more employees will increase your healthcare costs under any plan.

10% is 10%. 1 employee, or a million employees.

Pit, as you know, my wife is in the medical field. She is an anesthetist. Thus, she has more knowledge of such things than guys like us. I asked her about it and she says that hospitals do not turn away the poor. They don't want to advertise that for obvious reasons, but if people need medical attention, they get it.

Furthermore, the number of people who DON'T pay raises the cost for those of us who do pay.

He implied that a flat 10% of 200 employees is cheaper the a flat 10% of 100.....that only works if the salaries of the 200 (in total) is less then what the 100 make in total....in other words the 200 are earning less money....

So again what is the flat 10% based off of????

I don't even know what the discussion is about. 10% is 10%.

To further back this up my mom spent several years as the head of the local OB unit...they delivered any where from 50 to 75 babies in a given month...they routinely “wrote off” $250,000 of actual bills in a given month...and by “writing off” I mean passing that $250,000 on to the bills of patients that paid.

Yes they get medical treatment at the expense of the hospital who then passes it onto those who can pay. Meanwhile they bill the poor and ruin their credit for not being able to pay, unless they have a program that writes a percentage off.

I honestly don't know what is so hard to understand.

Company X earns 1 million and pays 10% of that towards national insurance. Their rate won't go up or down no matter how many employees they have. They pay the same whether they have 100 or 200 employees. Therefore it frees them up to hire more employees because the cost of insurance is no longer a factor in hiring people.

Actually it gets cheaper to hire more employees because the cost per employee would go down the more they hire from the standpoint of how much they payout for insurance. They will pay $100,000 for healthcare cost whether they have 100 employees or 200. It doesn't have to be 10% by the way. I am just using that number for easier math ...

The State still makes out because now they have more people working and paying taxes vs people unemployed and paying no taxes. As the company hire more people chances are they are doing it because they are earning more money and if they earn more money they the 10% they pay will also go up.

It's a very simple system that works to make sure all companies pay a fair amount the same as all regular people pay the same amount based on income.

So company X earns $1,000,000 with 100 employees and you say a flat 10% cost on that million will encourage them to hire 200 employees (doubling the companies employee salary cost) all while making the same $1,000,0000.....if a company X is growing to support hiring, then earnings are increasing, which means the 10% dollar amount will change too......

Unless...oh wait....the governments says company X can only make $1,000,000 via price controls (that you said you support in some sectors)...so the only options President of company X has is either not hire extra employees to maintain the million dollar earnings or deflate the wages of all employees to keep earnings the same in a growing labor pool...

I am in a similar situation with my personal consulting business....I can’t pick up anymore clients because my schedule is full. I had to turn away 2 clients in the last year because if I took them on I woukd have to hire a person to do the work and all of the income from those clients woukd go strait to the new hire and I woukd not be any better off while taking on more responsibility and liability....no thanks....I grow to a point to support me and my family....I don’t grow to soley support another employee...it does not make sense...I am happy where I am at...but I digress.

There won't ever be an earned income cap because the rich will never allow themselves to lose their lobbyist power so that is not even a real point.

The simple reality is that health insurance is THE most given reason employers give for not hiring new employees because it's the straw that breaks the camel's back.

Your free to stay a small company all you like. There is nothing wrong with that. Nothing at all. For others though, that have the ambition/desire to grow their company they have to hire new employees. IF they don't hire more people then they can't grow as you so aptly mentioned. Since insurance cost is the number one reason given why companies say they can't afford to hire more people and expand then it stands to reason that something needs to be done because what we have now is NOT working. Especially small businesses.

Again because text doesn't express tone let me be clear. I am not insulting or looking down on ANYONE who runs a small business and is happy to stay that way. I run one myself. I am quite comfortable with it myself. That is not the situation for most small businesses though because they want to grow and get bigger. Many businesses take pride in the fact they employ a large amount of people. The cost of insurance should not be preventing hardworking people from going to work. We have to fix that problem because it's just not right.

I have no issue with the idea of national healthcare but, it can't simply be turned on without major changes.

As mentioned, #1 is cost. We have to control the costs first or else the government will just continually raise taxes to pay for increased expenses to the point we are all working just to pay for the national healthcare bills.

#2 is the populace. We as a country are extremely unhealthy, and that needs to change for the national system to work even semi-fairly.

Rather than just turning the system over to a national system, how about we create options. Start by building (or buying up) healthcare facilities that become part of the national network. These facilities can be used by anyone for minimal, if any, out-of-pocket expenses.
They are staffed by some full-time paid staff and interning doctors and nurses (Who's college tuition is assisted by them interning in the national system for a specified number of years before they can go private.)
And put in place a system for other privatized Doctors and nurses to volunteer in the national facilities, who in return can earn tax breaks or something to make it worth their time and effort.

Then you would still have the private sector for those willing to pay, low-cost option for those that don't want to pay for private, and free for those that are currently under government assistance and cannot afford to pay.

It still comes down to #1 though, controlling the escalating costs.

Actually, that will not be happening that much longer

There is a FICO model now that excludes medical collections from factoring into your score, and lenders now do not even count them toward a derog count.

I have a feeling this is going to be the way of the future here soon when it comes to FICO scores and Credit reports.

My institution already has adopted this, before it goes into effect. our thought process is, that a medical bill is not something you planned to have, or agreed to take out on your own accord like a loan or credit card. So we do not hold them against you.

Which is the exact same reasoning that caused auto insurance to be mandated. Because the insured were paying the cost for the uninsured. Making sure everyone has healthcare actually makes perfect sense.

What people seem to promote is allowing a total lack of financial responsibility for some so that others end up covering their expenses. I'm just not sure how any of that makes sense.

The irony of that is dumbfounding. I live in Florida, where auto-insurance, like most places, is mandatory to registering a vehicle, yet include in my policy is a required "uninsured motorist coverage". /smh

I don't know about Florida, but when I lived in Ohio and now here in Tennessee, they mandate that you have insurance yet do not require you show proof of insurance when you register your vehicle. Makes zero sense. Yet as a rider uninsured motorist insurance is very cheap. At least both here and in Ohio.

I certainly carry one as well since the state I live in doesn't actually require proof of insurance when registering a vehicle. I believe I would anyway because so many people drive under a suspended license.

So does that stop medical bills from bankrupting people? Are they advocating bankrupting the medical professionals by telling people it's cool if you don't pay them because you didn't plan for it? Just more slippery slope. Hospitals won't fold over that, they pass those losses on to others just like any business would.

The only way to fix this mess is Single payer, take our lumps and cover everyone.

I agree with you OCD. It's also much cheaper to enact preventative medicine and catch problems early than it is to have people coming in after it's too late. I mean what's the point of knowing what could have stopped a problem from starting if the poor are never going to be able to see a doctor anyways.

To me it's just a matter of being civilized and having human decency. I consider any country who can't take care of its people a failure in my book. If we wanted to go it alone we would all be in the woods avoiding each other. We come together as a society so we can be there for each other during hard times. That is called being a community.

Fixed.

I consider you agreeing with me a victory for us coming together on something! Thanks Razor.

Ridiculous. Some people you just can't reach.

Sounds like a perfect job for Sashi Brown!

You keep ignoring the issue on cost. You live in some fantasy world where you believe healthcare will really be "free". Fact is, the US government is the most inefficient and bloated entity to ever exist. All you're going to do is replace insurance profit markups and replace it with paying for government bloat. The cost will continue to go up and up and our taxes will go up and up to pay for it. I mentioned it before, Colorado had a 10% tax increase to pay for single payer just to cover 1.5% of the country population.