Single payer... some solution

[dogtowner]

It's OK. The US health care system is difficult for Americans to understand. It must be mind boggling for Europeans.

The ACA requires employers with more than 30 employees to provide health insurance to its employees. It requires the insurance company to cover people with "pre existing" conditions, i.e., people with diabetes and heart conditions can still get health care. It allows parents to keep their children on family health care to age 26, instead of 18. Not a lot of 18, or even 26 year olds have jobs that provide health insurance. It requires everyone to have health insurance or pay a tax to defray emergency room care that has to be provided regardless of ability to pay. It also sets up state "exchanges" where people can buy into group insurance even if they're self employed or un employed. It makes it possible for people on welfare and Medicaid to get a job without losing their health care.

It's not single payer government insurance as so many seem to believe. It's what was politically possible to pass despite the insurance lobby. It also does nothing to control costs, which were out of control before the bill was passed.

To clarify pre existing, if you are diagnosed with a chronic disease and change insurance either by your employer changing providers or a job change this does not apply. The point is to encourage you to maintain insurance (and treatment) to manage it. Without it you can forego insurance until something worse ensues then sign up.

 

[dogtowner]

So how/where does ACA come into play?

Oh and by the way, if I'm being a pinhead just nod and I'll shut up but I'm just trying to get my head round all this so thanks for your kind replies!

ACA mainly gives indigents an insurance card as their premiums get paid by tax payers. However these policies all have large deductibles that indigent cannot pay so they are worse off overall.
Re the child coverage, as long as the kid is a dependant (student typically) they were covered so it was 18-23ish.

 

[Old_Trapper70]

It's not a huge problem apart from spiraling costs which are a direct result of gov't healthcare. The spiral can be traced to the advent of Medicare and medicaid.
Government is the problem not the answer.

Still with the right wing *********, and lies. When physicians salaries have quadrupled, the cost of medications have increased 5000 fold, etc., it is kind of hard for intelligent people to place the blame on Medicare, Medicaid, or the ACA.

 

[The Scotsman]

Docs are limited by their choice as well as gov't max. From the gov't perspective you don't want too many for fear they can't accommodate the volume.
So yes, if you move you are not guaranteed to see the closest as the crow flies. Same applis to any insurance. Docs are free to self cap and most do.

Cool got that - roughly the same here - population/demographics and all that - makes sense I guess.

Medicare is required of all working people except federal workers, they have a seperate thing. Medicaid is available nationwide but you have to qualify for it on income, disability or age.
Yes there is and was a minimum level of care available to anyone regardless of citizenship and has been so long before obamacare. It was viewed as indigent care.

So Medicare and Medicaid are completely different seperate schemes?
Medicare in a nut shell then is .... provided or avaliable if you are unemployed, retired or cannot work for some disability or other means preventing you from gainful employment? I guess for the retired it would be means tested? If your pension is more than a specified amount then you would have to go elsewhere?

Medicaid - provided or available only if you are working but earning less than a minimum amount? and working in a company with less than 30 employees? I assume you have to go through some form of vetting process in order to prove that you qualify for medicaid?

 

[The Scotsman]

The ACA requires employers with more than 30 employees to provide health insurance to its employees.

Okay got that. I would assume that this is probably some basic scheme but nevertheless better than the alternatives of medicare/aid?

It requires the insurance company to cover people with "pre existing" conditions, i.e., people with diabetes and heart conditions can still get health care. It allows parents to keep their children on family health care to age 26, instead of 18.

Okay got that too.. the acceptance of the pre-existing part seems to be a good benefit.
Regarding the Insurance Company - are they limited by Government to a certain set of providers or are you free to choose whichever one you like - are all insurers willing accept ACA applicants?

It requires everyone to have health insurance or pay a tax to defray emergency room care that has to be provided regardless of ability to pay.

Emergency room = A&E (UK equiv Accident and Emergency).... where the ambulance schlepps you if you've fallen under a bus?

So if I'm reading this right if you are carted to A&E you obviously have to pay - coverage either being provided by an existing Medicare/aid or ACA "policy" or you pay cash but the cash payment is then subsidised as if you had ACA coverage?
The regardless of the ability to pay seems odd - if you are earning a "median" good wage for example but don't want to buy medical coverage is the tax payer still subsidizing your A&E bill - did I get that right?

It also sets up state "exchanges" where people can buy into group insurance even if they're self employed or un employed. It makes it possible for people on welfare and Medicaid to get a job without losing their health care.

I guess these are sort of health care "Mutual" schemes?

When I lived in Germany they had a similar the same sort of thing, in days of old the guilds formed mutuals so that guild members could afford healthcare. The member paid a monthly due and at the end of each year if the mutual was in profit the dues were reduced and the excess carried over into the next year or if the mutual was in deficeit then a cash call was raised to each member to fill the gap. This developed over the years until they developed a "trading scheme" where once a year the mutuals would meet and those with deficeits would trade with those in profit to smooth the edges so to speak. I was with HanseatischenErsatzkasse and boy did we use them... never had an issue with them.

 

[dogtowner]

Cool got that - roughly the same here - population/demographics and all that - makes sense I guess.




So Medicare and Medicaid are completely different seperate schemes?
Medicare in a nut shell then is .... provided or avaliable if you are unemployed, retired or cannot work for some disability or other means preventing you from gainful employment? I guess for the retired it would be means tested? If your pension is more than a specified amount then you would have to go elsewhere?

Medicaid - provided or available only if you are working but earning less than a minimum amount? and working in a company with less than 30 employees? I assume you have to go through some form of vetting process in order to prove that you qualify for medicaid?

Medicare becomes available upon retirement or, I believe, disability. It is not means tested as you will have been paying into it your working life. Kind of a retirement plan for medically related matters subsidized by tax dollars.
Medicaid does not require you to be employed.

 

[dogtowner]

Okay got that. I would assume that this is probably some basic scheme but nevertheless better than the alternatives of medicare/aid?

No, not basic, rather comprehensive but carries a hefty deductible (first several thousand come out of pocket outside well care).

Okay got that too.. the acceptance of the pre-existing part seems to be a good benefit.
Regarding the Insurance Company - are they limited by Government to a certain set of providers or are you free to choose whichever one you like - are all insurers willing accept ACA applicants?

Insurance companies can choose to offer ACA policies or not. They can pick and chose which states as well. Providers are limited to which sign contracts with ins co same as any other policy. ACA simply establishes coverages and provides subsidies for indigents.

Emergency room = A&E (UK equiv Accident and Emergency).... where the ambulance schlepps you if you've fallen under a bus?

So if I'm reading this right if you are carted to A&E you obviously have to pay - coverage either being provided by an existing Medicare/aid or ACA "policy" or you pay cash but the cash payment is then subsidised as if you had ACA coverage?
The regardless of the ability to pay seems odd - if you are earning a "median" good wage for example but don't want to buy medical coverage is the tax payer still subsidizing your A&E bill - did I get that right?


I guess these are sort of health care "Mutual" schemes?

When I lived in Germany they had a similar the same sort of thing, in days of old the guilds formed mutuals so that guild members could afford healthcare. The member paid a monthly due and at the end of each year if the mutual was in profit the dues were reduced and the excess carried over into the next year or if the mutual was in deficeit then a cash call was raised to each member to fill the gap. This developed over the years until they developed a "trading scheme" where once a year the mutuals would meet and those with deficeits would trade with those in profit to smooth the edges so to speak. I was with HanseatischenErsatzkasse and boy did we use them... never had an issue with them.

If you have insurance it will be billed. Else you will be billed. If you are billed and do not pay the provider eats the cost but they just apply a factor on paying customers to support what becomes pro Bono work. The law simply states that you cannot be refused necessary care because you cannot pay.

 

[Openmind]

http://www.sacbee.com/news/politics-government/capitol-alert/article151960182.html

Just for california it would cost more than the current state budget.
Affordable healthcare ? Nope.

Totally disagree! A "single payer" type of coverage, as a "Medicare for all" would save a LOT Of money, because it would increase the pool of people eligible to be covered, and include younger, healthier people when , today, medicare only covers the most expensive "end of life," elderly and disabled people.

This may be too difficult for you to understand, but all you need to look at, really, is why private insurance has not made a big deal about taking people over 65 away from government insurance. . .they don't WANT to cover that population, because there is no profit in it!

And yet, it is the ONLY WAY to lower the per capita cost of healthcare.

 

[dogtowner]

Totally disagree! A "single payer" type of coverage, as a "Medicare for all" would save a LOT Of money, because it would increase the pool of people eligible to be covered, and include younger, healthier people when , today, medicare only covers the most expensive "end of life," elderly and disabled people.

This may be too difficult for you to understand, but all you need to look at, really, is why private insurance has not made a big deal about taking people over 65 away from government insurance. . .they don't WANT to cover that population, because there is no profit in it!

And yet, it is the ONLY WAY to lower the per capita cost of healthcare.

Read the article. Cali for EVERYBODY double the entire state budget.

Single payer is a bad joke.

 

[Old_Trapper70]

Read the article. Cali for EVERYBODY double the entire state budget.

Single payer is a bad joke.

Yes Dog, we know. It is so much better for poor people to just get out of the way, and die. Did you read the article?


"“Health care spending is growing faster than the overall economy ... yet we do not have better health outcomes and we cover fewer people,” Lara said at Monday’s appropriations hearing. “Given this picture of increasing costs, health care inefficiencies and the uncertainty created by Congress, it is critical that California chart our own path.”

The idea behind Senate Bill 562 is to overhaul California’s insurance marketplace, reduce overall health care costs and expand coverage to everyone in the state regardless of immigration status or ability to pay. Instead of private insurers, state government would be the “single payer” for everyone’s health care through a new payroll taxing structure, similar to the way Medicare operates."

 

[Openmind]

Read the article. Cali for EVERYBODY double the entire state budget.

Single payer is a bad joke.

You have no idea! California depends a LOT on federal match up for their medicaid program. The main reason is that California is one of the 3 or 4 states that has an ENTITLEMENT for people with developmental disabilities, and they MUST cover their needs. . .through medical, which, under President Obama, was matched by federal medicaid. I KNOW. . .It was my job to organise the life of 85 to 105 people with developmental disability within the California regional centres system. And, just as one example: ONE 17 year old youth with autism was costing the system $17,000 A MONTH in 2003.

Since Trump's stupidity and Ryan's evil mind are also trying to cut medicaid funding, California will be MUCH BETTER off by gathering ALL healthcare needs into single payer care. . . .Because the "per capita" expense will be lower. . . NO MATTER WHAT! Unless you preconize to just shoot those people in need?

But, don't bother your little mind. . .follow your puppet master and ignore the needs of millions of people. At least California will not fall for your selfish stupidity!

 

[Openmind]

To clarify pre existing, if you are diagnosed with a chronic disease and change insurance either by your employer changing providers or a job change this does not apply. The point is to encourage you to maintain insurance (and treatment) to manage it. Without it you can forego insurance until something worse ensues then sign up.

Sure. . .because, if you get fired, or if you want to become independent, you can still rely on COBRA, right?

Do you know how much COBRA costs for ONE person under the age of 50? In Colorado, it is now $1,200 a month. . .peanuts, right? Especially if you just lost your job, or if you ar trying to become an independent business person. . .or if you have a family to cover also!

SICK!

 

[dogtowner]

You have no idea! California depends a LOT on federal match up for their medicaid program. The main reason is that California is one of the 3 or 4 states that has an ENTITLEMENT for people with developmental disabilities, and they MUST cover their needs. . .through medical, which, under President Obama, was matched by federal medicaid. I KNOW. . .It was my job to organise the life of 85 to 105 people with developmental disability within the California regional centres system. And, just as one example: ONE 17 year old youth with autism was costing the system $17,000 A MONTH in 2003.

Since Trump's stupidity and Ryan's evil mind are also trying to cut medicaid funding, California will be MUCH BETTER off by gathering ALL healthcare needs into single payer care. . . .Because the "per capita" expense will be lower. . . NO MATTER WHAT! Unless you preconize to just shoot those people in need?

But, don't bother your little mind. . .follow your puppet master and ignore the needs of millions of people. At least California will not fall for your selfish stupidity!

The topic is the study on the cost of implementing single payer in california. It was astronomical. Medicaid pays all states the same. States may choose to offer more benefits at their expense.
Virginia has services for developmental disabilities.
Wrong on all counts.

 

[Openmind]

The topic is the study on the cost of implementing single payer in california. It was astronomical. Medicaid pays all states the same. States may choose to offer more benefits at their expense.
Virginia has services for developmental disabilities.
Wrong on all counts.

Did I say that Virginia didn't have services for developmental disabilities? In fact, EVERY STATE has services for developmental disabilities, but in a FEW STATES, including California, the services are AN ENTITLEMENT, and therefore are more extensive and there is no "waiting list" to obtain those services.

All states DO NOT get the same amount of medicaid! In fact, in California, the money spent on MEDICAL (which is the "California medicaid program" is a match between the State and Federal. . .and since there are a lot more people in California than in many (most?) other states. . .obviously they get more Medicaid funding! DUH!

You do not know what you are talking about. . .as usual!

Now, instead of blabbering, if you really want to learn something, why don't you research the CALIFORNIA REGIONAL CENTER system. You might, finally, understand!

 

[dogtowner]

Did I say that Virginia didn't have services for developmental disabilities? In fact, EVERY STATE has services for developmental disabilities, but in a FEW STATES, including California, the services are AN ENTITLEMENT, and therefore are more extensive and there is no "waiting list" to obtain those services.

All states DO NOT get the same amount of medicaid! In fact, in California, the money spent on MEDICAL (which is the "California medicaid program" is a match between the State and Federal. . .and since there are a lot more people in California than in many (most?) other states. . .obviously they get more Medicaid funding! DUH!

You do not know what you are talking about. . .as usual!

Now, instead of blabbering, if you really want to learn something, why don't you research the CALIFORNIA REGIONAL CENTER system. You might, finally, understand!

Medicaid is an entitlement. Its bebefits are offered equally to all states. Some states do not participate is every benefit offered because they choose not to. The dollar totals will vary by state simply due to population.
In any event none of this refutes the fact that single payer for california would be impossible to start much less sustain. And this is for the entire population and with medicare and medicaid.