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At the End of the Day We Get Socialized Medicine
The voices of those discussing health care on the Sunday shows are lambasting Obamacare costs and problems yet are also discussing the poor in their states being covered. Susan Collins let out a tremor-laden lecture for bipartisanship as a solution while calling for a haircut on Big Pharma. She is unwittingly calling for socialized medicine because of her refusal to reel in any of Obamacare in the name of Medicaid in Maine.
This bill, about 10 percent of Obamacare repealed but covered by the word “repeal” isn’t going to happen. The usual players are jumping on the grenades for their fellow GOP and entrenching our stagnation regarding the coming crisis. The crisis will be massive before being addressed out of necessity. The decision will be made that all our citizens (perhaps non-citizens?) get coverage. Exactly how doesn’t this scenario come true?
Rand Paul has his principles and he also has millions of poor in his state and the hospitals/doctors who treat them breathing down his neck. I guess Rand doesn’t mind crap being the enemy of perfect.
John McCain has his overriding principle in place still, namely glorifying himself. He will go down in history as a narcissist jerk, disliked by conservatives plus laughed at by the Dems who used his ego and feeble mind for their own ends. He will vote against the President at nearly every turn until he’s passed away and even then I see the invisible thumbs-down from the grave, a final digit from narcissist to narcissist.
Lisa Murkowski hula-hooped her way amidst flowers and hugs from the Dems in her state as Alaskans boldly stood up in declaring health care a right. Somehow I see this “right” concept not working out so well.
This O’Care skinny repeal won’t happen, nor would it work in the long run anyway. The repeal would however help the GOP pass some other legislation based on momentum. Far be it for McCain, et al., to give some mo’ to The Donald.
These GOP heroes of Democrats are doing their fellow senators a favor, as the GOP really never expected to have the federal goodies get removed from their constituents. That would require leadership. Better to hide under their desks, duck-and-cover style. If they really wanted repeal they’d do something. Obviously our President hasn’t been an ideal leader (insert favorite insult or painful truth here) but he’s willing to sign almost anything.
Maybe giving money to the states and letting them figure it out will help some of this fiasco but I doubt that happens. Our leaders don’t have the stomach for this. Guess where their cowardice and incompetence ends? The rough socialized beast slouches toward DC to be born.
Published in General
At all levels of income? Everyone pays 15%? Do employers contribute?
They could set it up so that 7.5% comes from the employee and 7.5% comes from the employer, but that would only to be to mask the fact that the 7.5% from the employer is part of the cost of employing the employee. Thus it is the employee that pays the whole amount.
That was something of an oversimplification for discussion purposes – since this is Germany, no public policy is ever simple.
However, the underlying law states that everyone pays about 15% of their gross income in health insurance premiums. In most cases, employers pay half of that, but since there is no additional tax exclusion for the employer contribution (like in the US), there is general consensus that the employer contribution would simply be passed through to the employee without the requirement, so it can be considered as being deducted from the employee’s paycheck.
There are, however, a number of exceptions. The unemployed, disabled, low-income, students, etc., all have reduced rates. There is also an upper-level cap on premiums at something like the 75th percentile of income. Furthermore, there is also a parallel system of “private” insurance available to certain groups of higher earners (which covers about 15% of the population) that is allowed to calculate premiums based on actuarial risk. In this case, the premiums can vary from well below to well above 15% of income.
And even this explanation is an oversimplification.
@Mendel
I have been assured by people way smarter than me that the Cadillac Tax drives employer based insurance out of existence. In the long run that is the way it is supposed to work. Of course the whole ACA is a Rube Goldberg cluster**** that is run on capricious unconstitutional discretion.
Morning Mendel, Chris, Percival,
Mendel sorry to pester you, tell me about costs and payments. In my experience at the IU med center the docs don’t know where to get the cheapest MRI, or even think much about cost unless they are directed to by the institutions they work for. I think patients would like to know price, and if some patients are like my wife, even if a third party is paying she wants the best price. There is an exception, the few private practice docs know about price and where to get the best price. In general when someone else is paying it seems all parties become indifferent to price comparison. How does the German system keep track of price. Also I am interested in patients paying for services, even if the pay is more symbolic than substantive. Do German patients pay for office visits?
My understanding is that the Cadillac tax was designed to move people from low-deductible/co-pay plans into higher deductible/co-pay plans as a means of reducing excess consumption.
Since all of the experts seem to agree that employer-based insurance is a silly system, I’m sure the people who actually designed Obamacare would have loved to have seen it get replaced, either directly or through subterfuge. But the fact is that the law, as written, should have dramatically expanded employer-based coverage, since it required lots of companies who weren’t already providing their employees health insurance to do so.
I imagine that in light of creating such a complex system, expanding the one part of the private market which was already working decently was a very tempting proposition, especially since it would allow the bill to increase the number of people insured without having to increase taxes or government spending.
Those were the companies that cut hours rather than follow the new law. And the actual drop percentage-wise, most likely represents companies that used to provide coverage, but who realized they could do the same thing, hence the dramatic increase in part time employment.
Jim,
For the 85% of Germans who are covered by public insurance, nearly all prices are fixed centrally. There are huge databases containing every theoretical code and a national price that the doctor can charge for it (with some regional variations, I believe). For the remaining 15% covered by private insurance, I believe the insurance companies negotiate prices which are often higher than the state-mandated ones. As a result, doctors and hospitals love to treat patients with private insurance.
Patients pay co-pays on certain prescriptions, and the policy on co-pays for doctors’ visits changes every few years (currently there’s no co-pay). I’m pretty sure that there are no co-pays for any other medical services, either. There are no deductibles.
So there’s no price shopping at all. What does happen is that waiting lines emerge, so people go doctor hunting for a practice with a good reputation but without a backlog. It also means that patients with public insurance often get bumped in favor of patients with private insurance.
Finally, since everything is free and doctors get paid by volume, there’s also rationing. Every doctor has quotas for nearly every procedure they perform. For example, my pregnant sister-in-law was told by her PCP a while back that she couldn’t get a routine $20 blood test because the PCP had used his allotment up for the quarter and her condition wasn’t serious enough to merit a special dispensation. He told her to come back a few weeks later when the new quarter started. Similarly, most larger procedures need pre-approval by the insurance company, which can sometimes take a few weeks and often comes back negative if it’s deemed not absolutely necessary.
I agree. Just to clarify, my point was that the intention of the law, as written, was to force employer-based coverage to expand. Whether it was ignorance, malice, or otherwise that blinded the law’s drafters to the obvious unintended consequences of this intention is up for debate.
The ACA is such a scam. 1000% indefensible.
There’s a basic principle of pricing:
1: Spending your own money on yourself: Price Conscious.
2: Spending your own money on someone else: Extremely Price Conscious.
3: Spending someone else’s money on someone else: Price Indifferent.
4: Spending someone else’s money on yourself: The sky’s the limit, baby!
Let’s replace all the losers in Congress who break their campaign promises with politicians who keep them.
Are there such exotic creatures? None that I know of…I’m focused locally and state-wide anyway…DC is an irrelevance.