I say this as a Wisconsin emigrant that watched my home state shoot itself in the face time and time and time again.
It is honestly such an entrenched and complex problem I do not see any way it is going to be fixed (or get better) anytime soon.
Because of the donors to each side - small government boosters like the Koch’s for the Republicans, insurance and pharmaceutical companies to the Democrats - it’s going to be very hard to move to a single payer solution. Even if you don’t think that’s the right way to handle it, you must admit that there is not much money behind it
Benefits are a tool to turn workers into slaves, and stop job mobility. Sure there are other benefits, but healthcare is the biggest and most costly. The better health a company gives the more likely employees are to stick with it.
https://promarket.org/donald-trumps-economic-policy-pro-busi...
Could they have done better?
Normally a big bill like this would pass the House. Then the Senate would make several changes in order to get enough votes to pass there. Then it would go back to the House, where the House would make another round of changes...then back to the Senate, and so on.
But in this case, that stopped early. It came from the House. Changes were made in the Senate that were able to get it through, 60-39 (60 were needed because Republicans were filibustering). One of those 60 was from the person temporarily filling the seat of the recently deceased Senator Kennedy.
It went back to the House, and while it was there the special election to fill Kennedy's seat was held, and a Republican won, and the Democrats lost the ability to break a filibuster.
So the Democrats in the House went with the bill as it came from the Senate, because that was the only thing they could pass that would not have to get past a Senate filibuster. (They were able to make some changes separately, because some of the changes they wanted, such as some relating to subsidies, because those counted as budgetary changes, and there is a separate procedure for reconciling budget changes between the House and Senate that is not subject to filibuster).
Wikipedia has a good, detailed, account: https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...
I don't think, deep down, republicans think the current system is better. They just don't trust whatever replaces it won't be much worse. It's easy to say "if we were just like <X European country> we could offer universal healthcare and also save money!" But <X European country> probably has trains that are vastly better than ours despite costing less to operate. They have schools vastly better than ours that they spend less money on. Clearly there is more to the equation.
Fortunately since this is a global forum, people can point out that the situation in AMerica is farce.
The basic stats are just solid - every first world country does better.
You guys have the worst of all worlds, and because of America's prediliction for everything market oriented, and the absurd partisanship - you have no solutions, and are ok with people getting cured in the ER.
https://www.nytimes.com/2017/07/07/health/health-insurance-t...
(Edited to include the missing point about income/payroll)
Interestingly, McCain proposed fixing this during the 2008 election and was slammed for it by Obama.
Maybe it's your political class that's broken.
- The US is ~4x more populous than Germany (most populous in Western Europe)
- The US is ~15x larger than France (largest in Western Europe)
- The US is significantly more racially diverse than any country in Europe which is a huge advantage in many ways but also comes with more challenging governance particularly when you factor in the US's legacy of slavery & racism towards blacks (~12% of the population).
- The US also has greater financial inequality (much, but not all of which is due to government policy of course)
I could list a few more bullet points, but you get the gist. The US is just bigger and more complicated that other places. It makes us harder to govern efficiently.
Maybe there have to be some federal ground rules. But having wider experimentation would seem like a good thing, for discovering good ways to run a system.
There would be nothing to prevent a healthy person from living in a low tax/no gov't health care state until they get sick and then moving to a high tax state/state paid for care.
Those customers are perfectly capable of moving. Many of them are simply chronically ill, with things like kidney disease. But anyone who's been on a plane in the US lately can tell you that the elderly have no trouble getting around, either.
New York isn't much better. It's #39. New Jersey, home to a huge percentage of the NYC workforce, is #50!
Further the noise around pension obligations is mostly meaningless alarmism from people who don't know any better. If California is on the verge of bankruptcy why is California's bond rating at AA-? Why is New York's bond rating is AA+? Why are investors all over the world, particularly sovereign wealth funds, in fact standing in line to loan money to these high-tax, high-growth US states? Ex-real estate and ex-China, these economies are in fact the engines of growth for pretty much the Western hemisphere.
We'll see how long it lasts though. The thesis here is that when you combine the nonsense alarmism around debt and the cherished American belief that governments can do no right you get a recipe for enormous underinvestment and malinvestment. And Americans are so disconnected from reality that they probably will vote for any idiot who starts crying about "fiscal responsibility" and cuts public investment in these economies.
I don't understand what California's bond rating has to do with the impact of its unfunded pension obligations.
Yeah that's now how any of this works. First, average muni bonds duration is 10+ years. Short-term debt is inherently safer than long-term debt but all investors will look far beyond a particular bond. Especially when dealing with sovereign entities who can't go bankrupt they are much more concerned about the risk of default (on anything, not just bonds). That's actually what the credit ratings measures -- a comprehensive evaluation of ability to service all debts. They are not at all bond-specific.
Logically, if investors really did believe these states were doomed then they would also be forced to conclude that the states themselves know they are doomed (all information is public) and at any moment the states will take measures before they are destroyed to prevent their own destruction. These measures will inevitably be some form of default. So if you're lending money to an entity who everybody knows will default at some point in the future it would be naive to think any one particular debt instrument is safe. Defaults, by their very nature, are very unpredictable. That's why investors will demand a real risk premium even for extremely short-term debt (30 days) from borrowers with low credit ratings. This isn't economic theory btw, this is economic fact, supported by two centuries of market data.
Suffice to say, Cali and NY bonds are actually set to out perform so the market does not believe that either state is going to default in the next 10 years or even the next 30 years.
Whether or not California is "on the verge of bankruptcy" is questionable. There's a lot of pension to pay out, sure, but the United States is over a trillion dollars in active debt about to add hundreds of billions more, and nobody describes the USA as "on the verge of bankruptcy."
Furthermore, you automatically assign this "on the verge of bankruptcy" aspect to a political party in power, ignoring the very important fact that you just named three states with the biggest, oldest metropolitan areas in the nation. And just because I'm expecting "but HOUSTON!", as a former houstonian, I say let's just hold tight and see what happens when the oil runs out, because the last time it did I was juggling hundreds of unemployed engineers living in houses they couldn't afford driving an hour to get to one interview.
You'll note in my post I never tried to argue the Democratic party was better - although if we want to I can argue about the value of leftist policy until I'm blue in the face. I will say this - if I walk into my house and the stove is on fire, but my dog has crapped ok the carpet, I put the stove fire out first.
What if we capped politician benefits across America at what the average American's is?
One big thing is-- if we ended Healthcare's ability to 'lobby' washington... made it illegal to spend healthcare money in lobbying endeavors, they could divert that to r/d and other worthwhile endeavors...
All insurance companies are --are companies that take our money and pay medical companies...couldn't the medical companies become the insurer?
What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof.
Hospitals would then have a guaranteed monthly residual income they can track/chart and use to figure out their budget. We'd no longer be wasting ANY money on insurance CEO's, etc...
When traveling your host hospital pays the guest hospital, or other providers. The hospitals could work with each other to bring prices/costs down.
There are solutions and there's ways to pay for things, like maybe dropping progressive income taxes for consumption/vat instead... a vat would be paid by anyone in the country regardless of legal status, citizen or immigrant. So everyone would contribute.
Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax on everyone?
> We'd no longer be wasting ANY money on insurance CEO's, etc...
> What if we capped politician benefits across America at what the average American's is?
Feel-good moves that would save little real money, because at the end of the day what costs money are the salaries for all the middle class people involved in the health care system (doctors, nurses, administrators).
> progressive income taxes for consumption/vat instead... a vat would be paid by anyone in the country regardless of legal status, citizen or immigrant.
Except the people who want universal healthcare want the tax system to be even more progressive.
If at the same time pre-tax salaries increase by 15-30 percent when the employer no longer has to pay $16k for insurance, most employees would probably prefer it. (Apart from people earning 6 digits -- and in Germany those people can opt for private gold-plated insurance instead, too.
End income tax, move to consumption tax/vat. (A modified version that would be sort of a negative tax). Basically, you'd have basic income making everyone who has a physical address (must spend some of the $$ on residence) would receive a check for whatever the poverty level is divided by 12.
Then everyone is a tax payer and pays consumption tax, we'd also have a land value tax, which would be more even on what land is 'worth' regardless of if you're using it for it's total 'worth'.. E.G. -- 2 people own same amount of land, same location, one builds a skyscraper, one doesn't, they both pay what the land/property would be worth if the area was 'fully developed', encouraging people to not just 'hold' land but 'use' it, or pay as if they did, so they might as well develop or sell it to someone who will.
We'd have to figure out ways of getting more off the top of the pile, as consumption does take a bit from the lower classes and funnels it up, but they're getting it back in terms of GBI + Healthcare.
Consumption tax could be tied to a citizen ID, ID = 10%, no ID = 15% tax rate. Could work in a +5% for college grads who used free education grants, until they're > 30 to pay for free college (State/Community schools). This way they pay back when they shop, but it's not permanent and it hurts a lot less than normal loans/etc...and doesn't affect credit. Or could just have a 'twenty's' tax of +5%, whether you go to college or not you pay an extra 5% from 20-30 to on goods, to pay for those who 'took' the advantage to go to school.
I like to believe that there's 'out of the box' ways to do things... I'm a social democrat with some techno-libertarian ideas, I feel the government needs to work and support all people, but it needs to do so in a way that can eliminate the most 'bureacracy' as possible, and drive down costs. I'd be happy if govt could be ran completely by AI and have maybe 10 people over-seeing / auditing the machines.
I'd like to see bills submitted like github issues - small, easily enacted/reversed 'pull requests' that only change small bits of law/codes. Instead of 10-100+ page omnibuses, everything would need to be < 5 pages (or something rudimentarily agreed upon - I'm not a lawyer/politician), and it must only effect a specific item or items that relate to each other. No combining other things for political 'fancy' or posturing.
Carriers are like bases that can easily be deployed as needed. Maybe keep 2 or 3 carriers off the coast not necessarily 'docked', to run maneuvers to keep 'training' up, reserves could come and run ops maybe every few months to stay 'fresh'... Ideally, we'd not need to call any up until WE are under direct imminent threat.
Furthermore, I think a lot of our future wars will be fought with technology, drones, robots, and not need as much military personnel anyways.
Our military budget should be on par with Russia, instead we're equivalent to the next 7 largest militaries combined. There's no need for that much expense (except to pad lobbyist coffers).
I am all for fighting fewer wars. But until that actually happens our carrier forces are over stretched.
The thing about lots of "downtrodden" people is they want opportunity - not support from the government. They want to be able to stand on their two feet to support their wives and kids - not to have Warren Buffet pay for their meals.
It's pretty hard to stand on your own feet in a hospital bed.
Poor people want a fucking break. When I was poor we'd watch all the rich people on TV get arrested and let off with a slap on the wrist and ask ourselves, "what the fuck?" We'd see pics of OJ partying with cocaine and porn stars in expensive clubs, then get away with murder. I don't know where you get this sense of "righteous wholesome poor people just trying to skip coffee for a day so they can put two more pennies in the savings account and one day be able to support their kids," poor people want to support their kids today, right now.
Republicans have no interest in the possibility of any kind of functioning public option, nor any kind of pro-consumer market reform that would actually deliver healthcare. It's simply not in the list of things they talk about.
The rest of the developed world shows that anything short of national healthcare system is an expensive mistake.
But their choice of doing so was guided by right-wing ideology. The Democratic Party is a center-right party. You might not be able to single out any one party for this problem, but you can certainly indict those who further this kind of thinking in the face of its demonstrable moral and economic failure.
Yes, removing this reduces costs - by creating a category of people who can't get insurance at anything resembling a price they can afford, and therefore either have to suffer, go bankrupt, die, or all three.
And then, when coverage was revoked, why would any other person insure this new cancer patient?
[1]: http://www.washingtonpost.com/wp-dyn/content/article/2010/03...
> The House voted 219 to 212 to approve the measure, with every Republican voting no.
[2]: http://www.washingtonpost.com/wp-dyn/content/article/2009/12...
> Vice President Biden presided over the 60 to 39 party-line vote, ...
This is in line with my original point - since when did facts become so malleable?
Of "the rest of the developed world", only one country (the UK) has a "national healthcare system", and even that's a bit of a stretch, because England, Scotland, Wales, and Northern Ireland all have different systems.
Canada runs healthcare at the provincial level. France, Germany, Spain, the Netherlands, etc. - all of those countries use private systems that cannot reasonably be called a "national healthcare system", unless you're going to stretch the definition so far as to say that countries like India (and the US) also have national healthcare systems.
England, Wales, Scotland and Northern Ireland makes 4 countries, just FYI.
This handy graphic explains in case of confusion: https://upload.wikimedia.org/wikipedia/commons/thumb/2/28/Br...
...yes, that's the point. When people talk about "the NHS", as they usually do on HN, they're conflating four different systems (or, more commonly, thinking only of NHS England).
The point, in case you missed it is that nobody outside the UK has what can reasonably be called a "national healthcare system" in this context.
You are making the big (and very american) mistake to attribute all problems to the party or president you don't like while overlooking the systemic problems that are there long term no matter who is in power.
You opened the can of worms, now eat it.
Healthcare costs were always increasing. That trend slowed under Obama.
https://www.factcheck.org/2015/02/slower-premium-growth-unde...
Democrats wanted a much better of the ACA, but let's not forget that Republicans were walking around talking about how they'd "oppose anything Obama did," without even reading the texts of the bills
http://swampland.time.com/2012/08/23/the-party-of-no-new-det...
So back to my original point - Republicans, why they be like they do?
"premium increases averaged about 60 percent from 2013, the last year before ACA reforms took effect, to 2017"
https://www.forbes.com/sites/theapothecary/2017/03/22/yes-it...
https://www.factcheck.org/2015/02/slower-premium-growth-unde...
Source: I've been in the Medical Field for 20+years.
We used to get 3-4 bankruptcy notices a month for our small single practice office, the bankruptcies were not usually from us, but because if you're in my office you're usually deep in the medical system. Now we get one or two a year because those people still choose not to have medical insurance.
The problem is we have higher than average healthcare costs, but it's not the doctors fault, it's the 15 million employees in the US that are nothing but middlemen, look into the Buffet, Bezos, Dimond project and their stance on Healthcare, it's the future.
2. "Obamacare" seems to an outsider to have been a hellish compromise - the only thing that could get passed considering the political balance of power at the time. It was far from the legislation that was originally intended - and that even legislation (what was deemed politically possible in advance) is probably far from what would be needed to fix the US healthcare system.
So it's entirely possible you ended up with a terrible outcome instead of the merely inadequate outcome that might have transpired in a different climate.
If I'd kept the same program that I had under the Obama administration, my costs would have doubled under the current administration (800->$1600mo).
[1] https://www.factcheck.org/2015/02/slower-premium-growth-unde...
"..the average premium for single coverage through employers has gone up 28 percent “under Obama” That’s right again, but much lower than the growth of individual premiums during Bush’s first six years. That increase was 72 percent."
Yes, that's a huge part of the problem right there. If I'm healthy and work hard to be healthy, I have zero interest in paying for someone else's health problems. I have my own family to feed and we're talking about massive amounts of money that I get no direct benefit from.
If your value system is "let the lepers die in the street," our value systems are so far removed from each other that the best thing we can do is respectfully not engage.
But because we're both already here, and you seem to care a lot about money, maybe we should talk about money?
Do you like living in a city, country, state with high GDP? This can improve the price of goods locally as your country has a stronger bargaining position in international trade agreements. This means higher paying jobs are available because bigger companies are willing to play ball to set up shop locally.
The health of the general population is tied directly to GDP. Healthier population, better GDP. If you like $$$, support universal healthcare. It's a good long term investment.