DSA - How Will this Work?

[bdgan]

Try counting the army of support personnel for those c-suite personnel. And we're talking across the entire industry. What about the physical infrastructure that houses them and all of their competitors. Your premium pays for that glass palace and the overlapping and overlapping and overlapping functions for each of those companies and it buys the corporate jet and the house in Switzerland. And I'm not saying eliminating that fixes the problem, but it isn't some trivial portion of your insurance premium.

It's like people complaining about billionaires. I won't argue that they've accumulated a massive amount of net worth. It would be difficult for you and I to even fathom. But the fact is taking 50% of their net worth would only be enough to run the federal government for about 5 months. Then what?

 

[FLaw47]

I think there might be some administrative savings with single payer. Just not as much as people think. Some look at the low administrative cost for Medicare but they ignore the HHS does plan design/marketing and the SS/IRS collects the money. Somebody is going to have to manage the trust fund and that didn't work out well for SS & Medicare. One guy argues that you wouldn't have to go through open enrollment because everybody would be automatically enrolled at birth. The only way that would be true is if there were no options. Everybody would have to get the same coverage.

I think the insurance companies have become very efficient. That's why the non-profit subsidized co-ops couldn't compete. IMO this would at best save $200 billion per year. That's about 4% which is better than nothing but it's a far cry from cutting costs in half to match many European countries.

I unironically don't see a real problem with having one baseline plan that everyone is covered by with optional private supplemental insurance.

 

[tarheelbybirth1]

It's like people complaining about billionaires. I won't argue that they've accumulated a massive amount of net worth. It would be difficult for you and I to even fathom. But the fact is taking 50% of their net worth would only be enough to run the federal government for about 5 months. Then what?

So we take 50% of their net worth and stop every other avenue for raising revenue? The idea that you could run the entire federal govt for nearly half a year with nothing but 50% of their net worth should be enough to drop your jaw over the amount they control. What if that 50% had instead gone into compensation for their workers... raising their pay... raising their standard of living... and raising their tax contributions year over year over year?

 

[Rifler]

how do you think virtually every other developed country manages to do it?

if "it" is correctly defined as giving their citizens the level and quality of health care that most Americans enjoy,... They don't.

 

[FLaw47]

if "it" is correctly defined as giving their citizens the level and quality of health care that most Americans enjoy,... They don't.

 

[jimneffer]

if "it" is correctly defined as giving their citizens the level and quality of health care that most Americans enjoy,... They don't.

i don't know how to come to the conclusion that "most americans" have a better level and quality of health care than countries that consistently and routinely outperform us in healthcare outcomes

 

[Rifler]

I'm not sure this is the sort of thing that needs to be private, to be honest. I actually agree that actual insurance has been reasonably well solved by the private sector but just having the admin be handled by the government isn't impossible (in single payer).

So the people previously employed by the insurance companies will go to work for the government doing essentially the same thing,.. Private sector works for a profit, while the government generally lacks efficiency,... There's no real savings to be had.

 

[FLaw47]

So the people previously employed by the insurance companies will go to work for the government doing essentially the same thing,.. Private sector works for a profit, while the government generally lacks efficiency,... There's no real savings to be had.

Yeah, I just don't think you're a credible voice on this subject. The government isn't automatically inefficient (though I'm sure that's a nice rhetorical safety blanket to cling to). If you consolidated the 1,000+ insurers in the United States down to 1 insurer, there are massive economies of scale savings to be had (even if we ignore the profit incentives disappearing). Plus you have every health provider in the country set up to interface with only one insurer as well, so you can cut down on the admin on both sides of the ledger.

 

[Rifler]

i don't know how to come to the conclusion that "most americans" have a better level and quality of health care than countries that consistently and routinely outperform us in healthcare outcomes

Personal experience,... Level, quality, and outcome are three different measurements,.. The first two describe the health care product that is being offered,.. The third describes the health care result experienced by the average customer, and takes into account the general health of that customer.

 

[baltimorened]

I'm not sure this is the sort of thing that needs to be private, to be honest. I actually agree that actual insurance has been reasonably well solved by the private sector but just having the admin be handled by the government isn't impossible (in single payer).

ok

 

[Rifler]

The government isn't automatically inefficient (though I'm sure that's a nice rhetorical safety blanket to cling to).

Yes,.. the government is automatically inefficient.

 

[baltimorened]

10 states refused to expand Medicaid. Also, why do you keep circling back to the ACA? Is there anyone on the board who thinks where we are is sufficient? The ACA tried to greatly expand coverage. In some ways it succeeded. Let's do more.

well, I keep bringing up the ACA because that bill was supposed to do exactly what you say you want, healthcare coverage for everyone who doesn't have it. The difference, and admittedly since I don't know what's exactly in your mind, I might be wrong, is that you apparently want the 28 million without insurance to be covered by the government for free...In spite of the fact they can already purchase one of the ACA plans. Given the fact that these 28 million people don't pay for healthcare, it's pretty much a given their taxes/out of pocket expenses will go up once there's a government run plan.

I have posted many times that the ACA needs to be fixed, and I've said that the ACA was emasculated by the changes that occurred after passage. But isn't it easier to fix a problem that affects 28 million people without healthcare than blow up a system that covers the other 300 million?

 

[jimneffer]

Personal experience,... Level, quality, and outcome are three different measurements,.. The first two describe the health care product that is being offered,.. The third describes the health care result experienced by the average customer, and takes into account the general health of that customer.

we clearly disagree on the value of personal anecdotes and broad, non-specific/un-referenced statements.

when thinking about something at the scale of a nation's healthcare system, for me, analysis is necessary. you've repeatedly referenced variability in our care. and i'd agree it's there. but it's also there in other countries. maybe not to the degree here, but, to me, that's a bug, not a feature.

we pay significantly more money for significantly worse results. while people can add some context to that statement, said context doesn't make that statement any less true.

 

[Rifler]

we pay significantly more money for significantly worse results. while people can add some context to that statement, said context doesn't make that statement any less true.

The average working American pays a lot towards their health care, has access to quality health care services, and experiences excellent health care outcomes,... Weighing total cost against average outcome on a country by country basis is a useless exercise,.. People care about themselves, not the average.

 

[jimneffer]

The average working American pays a lot towards their health care, has access to quality health care services, and experiences excellent health care outcomes,... Weighing total cost against average outcome on a country by country basis is a useless exercise,.. People care about themselves, not the average.

And the average working Greman/Dane/Swede/etc pays a little less toward their health care, has access to quality health care services, and experiences excellent health care outcomes.

if there's some kind of analysis that shows income stratification and healthcare outcomes in multiple countries...please provide it.

 

[FLaw47]

well, I keep bringing up the ACA because that bill was supposed to do exactly what you say you want, healthcare coverage for everyone who doesn't have it. The difference, and admittedly since I don't know what's exactly in your mind, I might be wrong, is that you apparently want the 28 million without insurance to be covered by the government for free...In spite of the fact they can already purchase one of the ACA plans. Given the fact that these 28 million people don't pay for healthcare, it's pretty much a given their taxes/out of pocket expenses will go up once there's a government run plan.

I have posted many times that the ACA needs to be fixed, and I've said that the ACA was emasculated by the changes that occurred after passage. But isn't it easier to fix a problem that affects 28 million people without healthcare than blow up a system that covers the other 300 million?

I don't know that I've ever said it should be free for people but the ACA plans are pretty expensive still.

I also think it's fundamentally a problem that health insurance is so closely tied to your employer for most working age Americans. From what I can recall, you've never had normal people insurance at any point in your life.

 

[scotchtiger]

i don't know how to come to the conclusion that "most americans" have a better level and quality of health care than countries that consistently and routinely outperform us in healthcare outcomes

What are the obesity rates in those countries?

What are total tax burdens in those countries?


France as an example:

-- US obesity is 2-2.5X France's
-- US severe obesity rate is ~4X France's

-- Taxes per ChatGPT:

France: ~55%
United States: ~33%

That's approximately a 22-percentage-point difference, or a total effective burden roughly 65–70% higher in France.


Generally, those countries have better diet, healthier lifestyles, lower obesity, fewer resulting chronic health conditions and MUCH higher taxes.

 

[baltimorened]

I don't know that I've ever said it should be free for people but the ACA plans are pretty expensive still.

I also think it's fundamentally a problem that health insurance is so closely tied to your employer for most working age Americans. From what I can recall, you've never had normal people insurance at any point in your life.

I did for a short period, ...I planned ahead. It cost me money in the short run - Army doesn't pay as much as civilian jobs...and depending upon your age, that path might still be available to you...

all health insurance is expensive...from reading the papers, so is auto insurance, home insurance....life insurance.
Insurance covers risk. when you buy it you're passing some of that risk from yourself to the insurer. When the government takes over you're passing the risk from yourself and 330 million other people to the government.

 

[FLaw47]

I did for a short period, ...I planned ahead. It cost me money in the short run - Army doesn't pay as much as civilian jobs...and depending upon your age, that path might still be available to you...

all health insurance is expensive...from reading the papers, so is auto insurance, home insurance....life insurance.
Insurance covers risk. when you buy it you're passing some of that risk from yourself to the insurer. When the government takes over you're passing the risk from yourself and 330 million other people to the government.

You're saying that last thing like it's a bad thing instead of "extremely sound economically and moral". Careful, you're talking me into single payer.

Edit: I'll also note that Health Insurance is the most expensive insurance for most Americans and it's the most important one.

 

[Rifler]

Insurance covers risk. when you buy it you're passing some of that risk from yourself to the insurer. When the government takes over you're passing the risk from yourself and 330 million other people to the government.

Actually when everything is working correctly the risk is primarily shared across all of the policy holders,... While the carrier pockets enough to cover operating expenses and overhead.

 

[baltimorened]

You're saying that last thing like it's a bad thing instead of "extremely sound economically and moral". Careful, you're talking me into single payer.

taking you to single payer...you've been there for a long time...

Just consider, when you pass the risk to the government, since lots of folks aren't extremely happy about deficits and debt. risk means potentially higher cost to taxpayer.

Now you believe that the government can do healthcare better and cheaper. So for you, no problem. I don't think you're right. I haven't seen the government do much better or cheaper...remember the government runs the Pentagon..do you think that rune efficiently?

Old economic expression, when something is free, demand is infinite. I can see large overruns in government projection of cost....you don't. But, that's what makes the world go around, different well meaning people see things differently.

 

[FLaw47]

taking you to single payer...you've been there for a long time...

Just consider, when you pass the risk to the government, since lots of folks aren't extremely happy about deficits and debt. risk means potentially higher cost to taxpayer.

Now you believe that the government can do healthcare better and cheaper. So for you, no problem. I don't think you're right. I haven't seen the government do much better or cheaper...remember the government runs the Pentagon..do you think that rune efficiently?

Old economic expression, when something is free, demand is infinite. I can see large overruns in government projection of cost....you don't. But, that's what makes the world go around, different well meaning people see things differently.

My man, I'd really appreciate it if you'd stop telling me what policies I support and otherwise putting words in my mouth (I'll apologize for deliberately making one of your arguments seem worse earlier).

• I don't want Single Payer. I've repeatedly stated that I prefer a public option though a fully German style system could work well for us.
• I've never said that I want "free" healthcare and I've explicitly said that I specifically don't want healthcare free at the point of service sans preventative treatments (eg physicals, colonoscopies, birth control). I think there should be a modest co-pay (income adjusted, perhaps) for all non-preventative services because the data overwhelmingly supports the idea. In fact, the VA should do that too.
• I've also never said that I want the government to run hospitals (though they do that now with the VA and do a bang up job, and are better than the community on most metrics), in case you were worried about that.

If the government was insuring everyone, the year to year volatility is going to be pretty small. That's an enormous risk pool. If private insurers are able to stay solvent with profoundly smaller risk pools, the government should be able to as well.

 

[Rifler]

If the government was insuring everyone, that's an enormous risk pool. If private insurers are able to stay solvent with profoundly smaller risk pools, the government should be able to as well.

It's not the size of the risk pool,.. It's the percentage of paying participants in the risk pool.

 

[FLaw47]

It's not the size of the risk pool,.. It's the percentage of paying participants in the risk pool.

Again, all of these "takers" or whatever pejorative you prefer are being paid for by everyone else now (in a variety of ways). Unless your contention is that all of these people suddenly become more expensive (you haven't articulated that point so I don't know), I fail to see how your point is relevant.

If we funded it through payroll taxes then you'd have more people paying in.

 

[TC_Nole_OX]

DSA Oliver Larkin speaking with Scott Hannity


Talking about Taxing the Rich with Scott Hannity

 

[Rifler]

Again, all of these "takers" or whatever pejorative you prefer are being paid for by everyone else now (in a variety of ways). Unless your contention is that all of these people suddenly become more expensive (you haven't articulated that point so I don't know), I fail to see how your point is relevant.

If we funded it through payroll taxes then you'd have more people paying in.

If all of these individuals are already being taken care of, (and in a fashion, they are), then everything is already good, so no need to do anything,.. Yes, my contention is that these people will become more expensive when they begin to use services that they feel they are now owed,... Working people paying payroll taxes are in most cases already contributing towards their health care,.. Where will these "more" people suddenly come from?

 

[FLaw47]

If all of these individuals are already being taken care of, (and in a fashion, they are), then everything is already good, so no need to do anything,.. Yes, my contention is that these people will become more expensive when they begin to use services that they feel they are now owed,... Working people paying payroll taxes are in most cases already contributing towards their health care,.. Where will these "more" people suddenly come from?

Were you not aware that there are some people with jobs but without health insurance? There are 23 million uninsured Americans who are part of working families. 60% of uninsured working Americans have employers who don't offer healthcare.

I'm not saying things should be free for them but I think they should be able to get an annual physical and not have to go to the ER for everything. The only payroll taxes these people currently pay that might be going towards healthcare is the Medicaid portion and we should all know that not every state expanded Medicaid and it's very difficult to get on in South Carolina.

 

[bdgan]

Let's not overstate what this program was - it was $2.4 Billion in funding to start up the co-ops (so almost nothing), the enrollees where much more sick (expensive) than typical, and congress immediately cut funding to them.

I understand that funding was cut but the fact remains it was still non profit and there were no cost savings. I was buying my own insurance back then and the premiums charged by co-ops were no less expensive than private insurers.

 

[bdgan]

Try counting the army of support personnel for those c-suite personnel. And we're talking across the entire industry. What about the physical infrastructure that houses them and all of their competitors. Your premium pays for that glass palace and the overlapping and overlapping and overlapping functions for each of those companies and it buys the corporate jet and the house in Switzerland. And I'm not saying eliminating that fixes the problem, but it isn't some trivial portion of your insurance premium.

Do you think there are limited number of administrative people working in D.C.? Do you think all the government buildings are bare bones?

Do you realize that by law insurance companies must spend 85% of their revenues (premiums) to pay providers?

UNH is the largest private insurer that a lot of people love to hate. All of their administrative expenses add up to roughly 13% of revenues. So how do you think we would cut $15k premiums in half to equal UK, Germany, France, etc. by eliminating overhead?

 

[bdgan]

So we take 50% of their net worth and stop every other avenue for raising revenue? The idea that you could run the entire federal govt for nearly half a year with nothing but 50% of their net worth should be enough to drop your jaw over the amount they control. What if that 50% had instead gone into compensation for their workers... raising their pay... raising their standard of living... and raising their tax contributions year over year over year?

Those companies would be much smaller.
The stock market would take a huge dip.
Investment would go way down.
A lot of jobs would be lost.

 

[bdgan]

So we take 50% of their net worth and stop every other avenue for raising revenue? The idea that you could run the entire federal govt for nearly half a year with nothing but 50% of their net worth should be enough to drop your jaw over the amount they control. What if that 50% had instead gone into compensation for their workers... raising their pay... raising their standard of living... and raising their tax contributions year over year over year?

Musk’s wealth is tied up in companies like Tesla and SpaceX, making it difficult to liquidate. “If the government took all of Elon Musk’s Tesla and all of Elon Musk’s SpaceX and dumped it into the market to get cash, they’d be lucky to get $200 billion. Forget a trillion,” Schiff said on the podcast. By his math, Adam Schiff’s promised $7,500-per-household payout would shrink to roughly $1,500 per household once the assets were force-sold.

 

[scotchtiger]

Were you not aware that there are some people with jobs but without health insurance? There are 23 million uninsured Americans who are part of working families. 60% of uninsured working Americans have employers who don't offer healthcare.

I'm not saying things should be free for them but I think they should be able to get an annual physical and not have to go to the ER for everything. The only payroll taxes these people currently pay that might be going towards healthcare is the Medicaid portion and we should all know that not every state expanded Medicaid and it's very difficult to get on in South Carolina.

The 23M is a problem no doubt, but I don’t think we need even a public option to address it. Heck, bring back the individual mandate. Age adjustment on premiums already accounts for both lower risk and lower income in your younger years making things more affordable as you’re starting out. Allow insurers to reward healthy, fit people with premium rebates for avoiding smoking and obesity. That allows people to have some control over their premiums. Offer inexpensive, basic plans that cover what you suggest and not all of the 10 essential health benefits

Honestly a lot of what the ACA attempted to do. I would just factor in penalties to those dragging down the risk pool or reward for those doing the opposite - whichever way you want to look at it. While still covering unpreventable preexisting conditions.

The government forces us to have auto insurance. Mortgage companies force us to have homeowners insurance. I have no issue forcing people to carry insurance so the rest of us don’t have to pay for them. Subsidies based on income already exist, so we’re helping the poor. If you don’t carry insurance, then add penalties, withhold benefits or garnish wages.

But everyone should know that the responsibility falls on them. And everyone should have some incentive or penalty associated with healthier living. That’s the only way we’re going to get the country to reverse the obesity epidemic plaguing our healthcare system and driving up costs for everyone.

 

[FLaw47]

The 23M is a problem no doubt, but I don’t think we need even a public option to address it. Heck, bring back the individual mandate. Age adjustment on premiums already accounts for both lower risk and lower income in your younger years making things more affordable as you’re starting out. Allow insurers to reward healthy, fit people with premium rebates for avoiding smoking and obesity. That allows people to have some control over their premiums. Offer inexpensive, basic plans that cover what you suggest and not all of the 10 essential health benefits

Honestly a lot of what the ACA attempted to do. I would just factor in penalties to those dragging down the risk pool or reward for those doing the opposite - whichever way you want to look at it. While still covering unpreventable preexisting conditions.

The government forces us to have auto insurance. Mortgage companies force us to have homeowners insurance. I have no issue forcing people to carry insurance so the rest of us don’t have to pay for them. Subsidies based on income already exist, so we’re helping the poor. If you don’t carry insurance, then add penalties, withhold benefits or garnish wages.

But everyone should know that the responsibility falls on them. And everyone should have some incentive or penalty associated with healthier living. That’s the only way we’re going to get the country to reverse the obesity epidemic plaguing our healthcare system and driving up costs for everyone.

I think the individual mandate would have to be much stronger than it was even when it was in effect and the low income subsidies would probably have to be extended but I guess I'm game. I'm not down with not covering all 10 benefits, though. I think every one of those should just be part of health insurance (but if you want to skew towards lower premiums/higher deductibles that's ok I guess).

 

[baltimorened]

My man, I'd really appreciate it if you'd stop telling me what policies I support and otherwise putting words in my mouth (I'll apologize for deliberately making one of your arguments seem worse earlier).

• I don't want Single Payer. I've repeatedly stated that I prefer a public option though a fully German style system could work well for us.
• I've never said that I want "free" healthcare and I've explicitly said that I specifically don't want healthcare free at the point of service sans preventative treatments (eg physicals, colonoscopies, birth control). I think there should be a modest co-pay (income adjusted, perhaps) for all non-preventative services because the data overwhelmingly supports the idea. In fact, the VA should do that too.
• I've also never said that I want the government to run hospitals (though they do that now with the VA and do a bang up job, and are better than the community on most metrics), in case you were worried about that.

If the government was insuring everyone, the year to year volatility is going to be pretty small. That's an enormous risk pool. If private insurers are able to stay solvent with profoundly smaller risk pools, the government should be able to as well.

sorry if I misinterpreted your positions..

 

[baltimorened]

Were you not aware that there are some people with jobs but without health insurance? There are 23 million uninsured Americans who are part of working families. 60% of uninsured working Americans have employers who don't offer healthcare.

I'm not saying things should be free for them but I think they should be able to get an annual physical and not have to go to the ER for everything. The only payroll taxes these people currently pay that might be going towards healthcare is the Medicaid portion and we should all know that not every state expanded Medicaid and it's very difficult to get on in South Carolina.

definitely beating a dead horse (me)....but what about the ACA? Wasn't that the purpose of the bill, and people can buy the cheapest plan and get the basic healthcare? But, we still have an estimated 28 million uninsured 16 years after passage of the bill.

 

[FLaw47]

definitely beating a dead horse (me)....but what about the ACA? Wasn't that the purpose of the bill, and people can buy the cheapest plan and get the basic healthcare? But, we still have an estimated 28 million uninsured 16 years after passage of the bill.

And the GOP killed the individual mandate (to be fair, it didn't seem to be achieving much), several states refused to expand Medicaid, the cadillac tax was repealed, and subsidies have been cut back.

Honestly, the best argument against the government having more involvement in healthcare is "The GOP is occasionally in power and will do their best to ruin everything." And no, that's not being unfair towards the GOP.

 

[baltimorened]

And the GOP killed the individual mandate (to be fair, it didn't seem to be achieving much), several states refused to expand Medicaid, the cadillac tax was repealed, and subsidies have been cut back.

Honestly, the best argument against the government having more involvement in healthcare is "The GOP is occasionally in power and will do their best to ruin everything." And no, that's not being unfair towards the GOP.

all of that might be true..but no matter all the circumstances, if you don't have health insurance, you can go on the ACA exchange and buy it...unless you're not a citizen are in jail or on Medicare...My point is and has been, that health insurance is available

 

[FLaw47]

all of that might be true..but no matter all the circumstances, if you don't have health insurance, you can go on the ACA exchange and buy it...unless you're not a citizen are in jail or on Medicare...My point is and has been, that health insurance is available

I don't think anyone has ever claimed that insurance was ever literally impossible to get. This doesn't seem like a good faith argument on your part.

In fact, I explicitly said earlier that everyone should be able to get reasonable care at an affordable cost which has not always been true and, while improved with the passing of the ACA, is not in a sufficient place.

 

[baltimorened]

I don't think anyone has ever claimed that insurance was ever literally impossible to get. This doesn't seem like a good faith argument on your part.

In fact, I explicitly said earlier that everyone should be able to get reasonable care at an affordable cost which has not always been true and, while improved with the passing of the ACA, is not in a sufficient place.

just a data point for your thinking...according to KFF, about half 52.2 % of the uninsured may be eligible for Medicaid or subsidized healthcare but simply are not aware of face some other barrier to enrolling

 

[FLaw47]

just a data point for your thinking...according to KFF, about half 52.2 % of the uninsured may be eligible for Medicaid or subsidized healthcare but simply are not aware of face some other barrier to enrolling

I'd love to see the study you're referring to; I can easily see a situation where "eligible for subsidy" covers any assistance at all, which might not be enough to make a dent.

I believe I've answered a lot of questions you've asked but haven't gotten a lot of response (namely on what the government's role in healthcare is) and have also really clarified on what I, personally, want for our country and what I'm willing to contribute towards that. Did you have any thoughts?