Win tickets to see the smash hit musical Mamma Mia at the Roanoke Civic Center. Two winners will each receive four tickets!
Photo by Terps. Tag number obscured by Dan.
“I am good, but not an angel. I do sin, but I am not the devil. I am just a small girl in a big world trying to find someone to love.”
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Here is a question for people smarter than me.
If the Feds had decided to put every man, woman and
child on Medicare how much would it cost?
As you know Medicare is funded by a payroll tax
ie; a percentage of the monthly payroll in the
U.S. is deducted as Medicare Tax.
If everyone was covered, what would the percentage of
payroll would be necessary to fund the program?
If this program were initiated employers could offer to
pay employees Medicare Tax as a fringe benefit so as
to attract better employees .
Is this a plan that could work or is it just too simple?
This is not a sarcastic post, I have truly wondered
about the workability as an alternative to the
Affordable Health Care Act, (which no one can understand).
It’s an interesting question. And here’s the corollary:
Let’s say an employee with family plan health insurance benefits is paying $400/mo out of his/her paycheck now, and that represents 40 percent of the cost, and the employer is picking up the other 60 percent ($600 mo). That’s a total cost of $1,000/mo.
If everyone was on Medicare, would that cost both the employer and the employee LESS?
I don’t know the answer, but I’d like to hear it. Given that Medicare is the most efficient (in terms of overhead) insurance out there, and that NONE of it gets siphoned off as profit for the insurer, there’s a chance that it would be cheaper for both the employer and the employee. When you combine that with the fact that Medicare beneficiaries are the most satisfied with their insurance of anyone out there, it seems like an attractive option.
Here’s a potential drawback, though: The way it’s set up now, employer-provided health insurance is a flat fee. The minimum-wage worker pays the same monthly amount as the high-level manager, regardless of income. And the way Medicare is structured now, it’s a “flat tax” — everyone pays the same PERCENTAGE of their income.
I would wager that Republicans (even those who advocate for a flat income tax) would freak out about extending Medicare to all IF the cost to employees was set up as a flat tax.
They love the flat tax now, so long as it’s applied only to income taxes. Then, it’s “everybody paying their fair share.” But just try to impose one vis-a-vis single-payer healthcare and they will scream to the high heavens “Unfair! Unfair! Unfair!”
This, I believe, is one of the beneath-the-radar reasons that so many conservatives oppose single payer. They know they’re getting over now, relative to lower-wage workers. And they know they won’t be getting over under a scheme like that.
Here is another point to ponder.
The current health care system involves profit, part of the monthly
premiums include dividends for the shareholders of the
respective insurance corporations.
Take the profit out of the equation and what is left as actual
paid-out costs for services?
It is certainly something that needs to be explored. People on Social Security pay for their Medicare out of their benefit check so conceivably, everyone could pay something. We certainly need a better and less darned confusing system than we have. If nothing else, “Obamacare” has educated more people about the complexity and inequality in both the insurance and medical care systems.
The reason we have ACA rather than the single payer system Rob is asking about is 1. the GOP would not hear of it and 2. the insurance industry would not hear of it. Instead we have a more complicated system that assures the health insurance industry survives and makes a reasonable profit.
A single payer medicare system would be cheaper than ACA because 1. the government keeps a close eye on costs of procedures. Actually closer than private insurance. Why, because the insurance companies pass higher costs on to the insured. When the cost of medicine and health care goes up, your premium goes up. The insurers are concerned with what they pay out to the health care industry, not what they charge you. Accordingly, they negotiate fees with hospitals and doctors as to what they will pay and adjust your rates accordingly. In essence they make a profit. (One other little known fact is the insurers and medicare pay a lower rate for care than a non-insured person. A non-insured or non-negotiated heal care price is often much higher that what the health care provider accepts from an insurance company or from medicare.)
While the RWers on here will claim the government is inefficient, there is fraud, etc that is no more true for the government than for private insurance.
An all medicare plan would require general fund assistance to cover those not working and those not able to afford the coverage. That is also true for ACA and is true with medicaid and your higher insurance costs that cover these same individuals.
So the short answer is a single payer medicare plan is cheaper. However, that does not cover the cost of a loss of the health insurance industry that we all hold near and dear or to the GOP objections to such a system.
Take the profit out of the equation and what is left as actual
paid-out costs for services?”
No, not exactly.
Take the profit out of the equation and what is left is 1) actual paid-out costs for services + 2) operational overhead.
Single payer would save docs and hospitals money, too. Right now healthcare providers incur administrative expenses just to deal with God only knows how many different insurance companies.
Nice 2 minute video that explains how our corporations take advantage of developing nations. It’s called Confessions of an Economic Hitman.
The answer is becoming clear to me regards Medical Coverage. Two examples: I had a precancerous lesion frozen off. I made a $30 co-pay and my Blue Cross adjusted my $279 bill down to $100. I’d paid $30 up front and now will pay the $70 balance. Blue cross paid nothing. 2nd Example: With a physical I had $959 lab work (diagnostic pathology). Blue Cross allowed $150 and paid $30. I will pay $120. (this is Fed. Blue Cross…not some cut rate plan with huge deductibles). They, BLUE CROSS and other Healthcare providers are just an adjustment bureau these days, NOT really an insurance coverage. If we could receive healthcare @ these rates and NOT pay for health insurance, well hell, we be money ahead.
Dave I have been a follower of John Perkins for some time, he has been honest about his role in the absolute exploitation and deliberate robbing of other nations.
Perhaps those of you in Virginia have already heard about this. We’ll see what happens.
#9 Bubba, are you sure you’re not paying this because you haven’t covered the deductible for the year yet? For instance, my plan has an annual $500 deductible and I’ve got to pay that much out of pocket before the plan starts covering things.
gdad..My point is really about the the discounted rates that medical providers agree to. If we as individuals could receive services @ those rates we would not need to spend on health insurance. We would in most cases be better off to save that premium money and pay as we go. Hospital rates are also deeply discounted. I understand deductibles and don’t mind that part. I was an agent & manager in the health insurance business for years.
Old Bubba – I agree with you.
Now explain to me few things:
What are your going to do when Medicare is insolvent in 2024 (Medicare Trustees Report – May 2013) or 2016 by other estimates. (yea right: “the government keeps a close eye on costs of procedures. Actually closer than private insurance”. Guess they need to watch a lot closer !
How do you manage costs in a single payer system. Can you guess? It’s called rationing – know the term? After living in England and Canada for 5 of the last 12 years – this is what they do. Have gall stones in Ontario – right now it’s moriphine and 8 months wait for surgery – now lets not forget the drug rehab afterwards (this is just great for keeping costs down). For preventive measures, I have to say their systems are very good – just don’t have anything major required.
As per your comments of a flat tax on health care and Republicans “freaking out”, where are your facts for this. How about this – just why is it the liberals (Democrats) are “freaking out” and need all the exemptions from the ACA if it is soooooo good? and why did Congress opt out when democrats controlled both the house and senate?
An Independent who is tired of both Democrat and Republican bickering and would like meaning full dialog to solve the problem.
Medicare will go insolvent in 2024 because right now it serves a population that needs WAY more healthcare than the average younger American. You bring a lot of younger people into that mix, and you transfer all, or a portion, of the healthcare premiums that they’re paying or that are being paid on their behalf and all of a sudden the trust fund would be flush. How do we know this? Because the private healthcare insurance companies are not losing money, they are MAKING it.
Fyi, Britain doesn’t have a single-payer system. They have national healthcare. There’s a big difference. I’m not advocating that system.
The ‘cooch; winning friends and influencing people in 2013.
6 days ago there was a discussion on police questioning women who report rape. Here’s an article for consideration:
Perhaps if she had been given a way out of the snowballing lie an innocent man wouldn’t have lost 4 years of his life.
RIP Elmore Leonard.
#13 Old Bubba, I missed what you menat as your main point in the first post. I agree that insurance companies are raking in a huge amount of cash that could go to actual medical care.
Oh no, Laura. I love his stuff.
“Perhaps if she had been given a way out of the snowballing lie an innocent man wouldn’t have lost 4 years of his life.”
What do you have in mind, in terms of a “a way out of the snowballing lie?”
I’m not sure what you mean, Dave, but it sure sounds like the woman had one scary mother. A scary mother driven by fundamentalism.
One would think an actual Independent who indeed was “tired of both Democrat and Republican bickering” would not have accused inaccurately.
Congress originally “opted out” because the “exchanges” were going to be for those who could not get coverage from an employer due to cost or those who had no coverage available. Congress was already covering their employees. When the hue and cry went up that it was special treatment (as if that is new), they were told to join the exchanges too.
In reality at no point for any length of time was Congress “controlled” by Democrats in “both the house and senate” That is a right wing meme. Control means you have the votes to pass what you wan and in this obstruction age that is 2/3 not a simple and tiny majority.
I find this article very interesting. I wonder how much more of this we will see prior to 2014 and beyond??
Medicare deductions have not been in place long enough or high enough to pay for the expensive end of life care for the HUGE group of boomers about to hit the system. No one saw that coming apparently…
Republicans in Maine are getting increasingly weird. Maybe it’s because Obama kicked Romney’s butt there (by 15 points) in the 2012 election.
Now their governor says Obama hates white people. He must be drinking the Dinesh D-Souza Kool Aid.
(By the way, looks like Dinesh has a squeeze on the side.)
The quote below is from an Oklahoma oil billionaire. Birth control is his answer to climate change. The full link is at the bottom.
“Asked also about what role he sees renewables playing in confronting climate change, the top Republican donor and adviser downplayed their utility, pivoting instead to a much more controversial topic: Maybe, “we” should “provide rules” in the Middle East and Africa similar to China’s one-child policy.
“Overpopulation—that probably hurts the environment more than anything,” Hamm said. “Are we going to provide rules to stop overpopulating areas in Africa? Middle Eastern countries? Probably should. China did. Stop overpopulating areas with people. Should we in the U.S.? Maybe we should think about that, if we’re truly concerned about that.”
Dan – (By the way, looks like Dinesh has a squeeze on the side.)
Perhaps he took lessons from Newt.
Back to universal Medicare.
For the year 2013 the Medicare tax rate is a combined
02.9% of all income, ( employee-employer 50/50).
Depending on individual plans, most all employees with coverage
pay a portion of their coverage with the employee paying the lion’s
share for the coverage.
When I was working, my coverage cost me $209 per month for
me and my dependents. My employer paid in the $800 range for
each covered employee
12 X $1000. per month =$12,000.00 that is 10% of an annual
salary of $120,000.00. I did not make that much per year.
One would think with an adjustment of the tax rate
some sort of health care plan could work for all.
Maybe 12-14 percent? It could be done.
The results of a major research study by the Kaiser Foundation shows that health insurance costs continue to moderate since the passage of the Affordable Care Act. Sorta different that what the GOPTea Party would have us believe.
“with the employee paying the lion’s
share for the coverage.”
Sorry should have been employer paying lion’s share.
Sandi and Dan
They did opt into it either since they have opted out of both medicare and social security already. Yes, you and me pay for their privaleges and already subsidize their benifits. Are they going to be taxed for the health care benfits like I am with a “gold” plan? I don’t know the answer to this, but I would doubt they would.
If you read the Medicare Trustees Report (May 2013), their projections on insolvency included the projected number of new paying clients and the ones getting the new benifits under ACA. Your answer therefore still does not work – how are we going to pay for this and keep Medicare solvent.
In the senate, 60 votes are needed to break a filibuster or debate only and only 51 votes are required to pass a bill once it reaches the floor. In the house, only a majority vote is required for any vote. The only exceptions to this in the house and senate are in the cases of impeachment and amendments to the constitution which require a super majority of 3/5 and not 2/3. With these FACTS, and the final comprisal of the 113th congress: 58% senate democratic (including independents voting democratic) and 59% democratic (including indeopendents voting democratic) house, I would tend to say democrats controlled both house and senate.. Your answer implies a “left wing mime”.
Thank you Dan, I incorrectly stated single payer in England – I should have said National Health Care system – the systems are the different, but the outcomes are the same – rationing to manage costs.
An Independent who is tired of both Democrat and Republican bickering and would like to deal with facts!!
For the foodies on here, If you’re in the market bldg and Firefly Fare has Kurdish Tapsi as their special on their menu board, buy it. I’m not a vegetarian but this is a vegan dish that is so delicious. Eggplant, peppers, onions and potatoes in a spiced tomato sauce served over rice. Oh man is it good.
Wow… It happened. 34 comments all by liberals! Dan, I guess your plan is working! Hope all of you are healthy!
Rob, that is an interesting question.
I imagine that it might work for a short time, however problems are bound to arise, a few come to mind:
First, many doctors are currently not taking new medicare patients and there is, currently, a growing move to “concierge” services. In fact I pay a monthly payment to my doctor for guaranteed access within 24 hours. Granted not everyone can do this so eventually we are looking at a minimum of two tiers of medical care (those who can afford private care and those who must use whatever medical personnel that will take gov’t mandated salaries).
Also, it only takes a few minutes of watching TV to see commercials for things like “hoverround chairs”, “the newest diabetes tester”, or one of my recent favorites 200 catheters/month; all paid by medicare. When things are “free” many people seem to need them and this will continually drive costs up. And as stated in an earlier post, the “end of life care” is most expensive, and therefore the “death panel” argument comes into play (for cost saving measures).
And speaking of cost, your suggestion that an employer pay the cost as a “fringe benefit” is pretty much how our modern system got jump started, gov’t imposed wage freezes left employers few options to attract workers so employer paid insurance was a way to attract workers. However, just as this “fringe benefit” has now become a gov’t regulated “right” , I suspect (in the not too distant future) it would become a “mandate” (rather like the “family leave” program where some want to make the employer give “paid” leave.)
All of these costs must eventually be passed on to the consumer.
Our system before the ACA was not “broken”. A few “tweaks” would have been fine. The current monstrosity has proven unworkable even for those who are charged with making it work.
I think an important quote from your link is;
“This year, 78 percent of all covered workers face a general annual deductible, up from 72 percent in 2012”
It also states that those facing higher “deductibles” is up 31% vs 12%, which tells me that that when the “insured” has some “skin in the game” he/she makes wiser decisions.
I believe the commotion about the ACA has lead many to look closer at their health insurance instead of taking it for granted, and many employers are now educating their people better (as their people are taking on more of the costs).
Dan in #22 at 1:29pm: “What do you have in mind, in terms of a “a way out of the snowballing lie?””
Heat? Salt? A salty heat?
I don’t have a good answer. I would think it depends on the person, the person’s demeanor, physical evidence and other facts, etc. and that usually there isn’t a need to doubt the person making the accusations/report. Seems like the police officers would have a good BS detector.
For the small percentage of cases that are false accusations, maybe some of the accusers would recant if they thought they could do so with impunity before the trial.
Whatever it is, it should not be a method that would turn away any person who was a victim.
Not about Medicare, but, interesting link below:
Just another national headline about Virginia’s governor. It’s getting to be an everyday occurrence.
Another Chuck | August 20, 2013 at 5:26 pm Wow… It happened. 34 comments all by liberals! Dan, I guess your plan is working! Hope all of you are healthy!
There must be something wrong with my reading comprehension. No. 15 “j” didn’t sound too liberal to me. Did you read his comments, or just assume what you want to be true?
BTW, you’re welcome to join in the conversation. Liberals do listen to the other side, you know.
Perry D – if there were only a single payer plan the doctor would be out of business if they did not accept patients.
Do you really pay your Doc monthly just to see you when you are sick? He sounds like a greedy jerk interested in fleecing you rather than treating you.
Who knew jail food was so good.
We went to see Chris Hillman and Herb Pedersen last weekend at Kirk Avenue Music Hall. What a great opportunity to see a couple of legends up close. For those who don’t know the names, think Byrds for Hillman and Dillards for Pedersen, although both have other bands and much music to their credit.
We love Kirk Avenue Music Hall.
Yes J, the Republican’s unprecedented use of the filibuster “— extended debate to block a decisive vote” is precisely the obstruction that the Dems, lacking 60 votes, could not overcome. From the beginning that was their plan. At no point did the Dems in the Senate have 60 votes.
Ever heard of Robert Samuelson? “Now filibusters are routine. From 1919 to 1960, cloture (the decision to end debate, now requiring 60 votes) was filed 27 times. From 2003 to 2006, when Republicans controlled the Senate, they filed cloture 130 times to break Democratic filibusters. Since 2007, when Democrats took charge, they’ve filed 257 cloture motions“.
In January 2009 when Obama was sworn in, there were 58 Democratic Senators. Remember Republicans “contested Al Franken’s election in Minnesota and he didn’t get seated for seven months”.
Arlen Spector switched parties and that made 59…still one short. Then Robert Byrd was hospitalized…then Franken was seated but he was still at only 59…then Ted Kennedy died…and then there was Scott Brown. So no, the Senate never had a 60 seat “controlling” vote to get bills to the floor.
Those J, are indeed, facts, not “mime”.
34 comments all by liberals!
Yes, my remark on Elmore Leonard’s death (#19) simply dripped with leftist propaganda. What a relief it is not to have to conceal my true beliefs any longer.
Gov Bob’s looking a lot older these days.
Health Insurance Companies are just the “tip of the iceberg” on healthcare costs in the US. There is so much over-treatment to make additional profit and so many layers. Each layer is gaming the system to maximize profits.
Call it “ratoning” if you will but somebody needs to bring some sanity to the way healthcare is delivered and paid for in the USA.
Oh, the biggest driver of healthcare costs are related to lifestyle issues (diet, exercise, etc). Actually 40% of healthcare costs.
Dan, did Terps send you a picture of his truck? LOL
Wrong again, another chuck.
Color me stunned. The Cooch tried to block releasing emails that showed his office helped energy companies trying to steal royalties from Virginia landowners.
In the last 5 years the college I lead has become much more proactive in dealing with the employees covered by our health insurance plan. We have agree to pay half the cost of their membership in a local health club. Through that club we have offered our employees workshops on nutrition, weight control and a whole host of other issues. We have also increased the deductibles and the co-payments our employees are responsible for as part of the plan. What we have found is a significant reduction in the claims filed by our employees for certain kinds of treatments, medications, etc. There is no doubt in my mind that the proactive steps we have taken had lead to a lowering of the typical premium increases we had experienced prior to implementing the steps. Our employees, most of them anyway, are responding to the steps, incentives we’ve offered. Up until two years ago our typical premium increase year over year was in the 14% + range. Next year our premiums are flat and we get a premium free month. That saves us a little over 8% in 2014.
“Yes, my remark on Elmore Leonard’s death (#19) simply dripped with leftist propaganda. What a relief it is not to have to conceal my true beliefs any longer.”
Another Chuck has hardly wowed us with his analytical “skills,” Laura. So those kind of comments are kinda what you should expect.
sandi, ever heard of business ethics? no? didn’t think so.
and if anyone thinks obamacare is good, then tell me why obama is saying muslims, congress and himself don’t have to have the same plan…why is it good for just the hand picked that he hates, ie all Americans
I was out of town for a couple of days and see that the same old liberal crap continues, you people will NEVER learn..ho-hum, same old roanoke rag
we definitely need a better or different news organization because rt sucks
Are you a masochist, pammala? Why do you keep participating on this blog? There are plenty of online sites that print the news that suits your views, find them.
Thanks, Cuccinelli. I hope your face doesn’t hurt too much from this public slapping,
@pammala: I totally agree with you!
Some updated news on welfare queens.
trying to educate the small minded liberals debbie !!
I see your point, but unfortunately this is how OUR democracy works.
While you speak of the “rights” obstruction, why don’t you check the “lefts” obstruction – how many house bills were passed in this congress by the house and yet Mr Reid will not bring them to the floor for even a reading.
Both parties look like little childern.
Enjoyed the conservation and I hope you will look at both sides of the coin in the future.
Another example of why GOPTea Party folks are in trouble.
#54-56 Darn it, I thought maybe pammala had been relieved of the awful burden of having to read this blog and comment. I know it’s a heavy weight she carries, and I had hoped that maybe that load had been lifted from her.
#60 Some nice hypocrisy in that story, Ron:
“But as of August 12, the longtime anti-tax activist is earning a government salary of $68,245 annually for Pennsylvania’s tax collection agency. Puig, declined to discuss the irony, telling the Inquirer “after four years, I’m tired of media attention.”
pammala | August 21, 2013 at 12:03 am -”I was out of town for a couple of days and see that the same old liberal crap continues, you people will NEVER learn..ho-hum, same old roanoke rag ”
awww – did your mothership leave without you?
BTW, If you want one-sided echo chamber, you can probably look somewhere else…
Good link. Headline should read, “Bollings Revenge” – he was certainly the better candidate than Cuccinelli…
hilary = get bent sweetie
What pammala fails to grasp is that we HAVE learned and that is why her right wing BS is so widely rejected. Yes, you have enough people to make noise, but not enough to win.
#68 pammala, hon, maybe you should just return to the rehab. Your serenity needs more than a little work.
Re: j | August 21, 2013 at 7:43 am
Hope that past tense “Enjoyed doesn’t mean you are signing off.
This blog could use more folk willing to call for a curse on both wings and who can see when both parties look like little children.
The very fact that Dan has a thread Category “More right-wing nonsense” with 365 threads linked to it — yet no Category of “More left-wing nonsense” is proof that folk who can see the beam in both wings eyes are sorely needed here.
FWIIW, those on the right who can see no wrong on the right fighting those on the left who can see no wrong on the left offer little hope for moving forward being progressive in any real sense of the word.
We need more who can see both the right and left wing’s nonsense.
RE: j | August 21, 2013 at 7:43 am
but unfortunately this is how OUR democracy works.
I’m not so sure how unfortunate it is, overall.
Not sure the filibuster is the best way. However, I do believe that we need something in place to avoid Plato’s, Aristotle’s, Madison’s, Tocqueville’s , etc’s “tyranny of the majority” / “tyranny of the masses” — regardless of which wing has the majority at any given time.
IMHO, some sort of supermajority rules, constitutional limits on the powers of a legislative body, etc are needed.
OTOH, we do need to have someway to get some work done, some way to encourage seeking seeking consensus or at less compromise.
J, there can be no doubt that both sides have more than enough infamy but the issue of obstruction is a studied and authored and admitted finding. The Democrats have always been more willing to compromise and work with Republicans than the right wing “TEA Party” Republicans have been to reciprocate. Documented since Gingrich.
As to those partisan, political posturing bills in the House, that is merely ‘spinning wheels’ they knew would get nowhere and most are totally wrong-headed as well. Like the efforts to repeal “Obamacare” FORTY TIMES!
The Betrayal of the American Dream
It’s Even Worse Than It Looks: How the American Constitutional System Collided With the New Politics of Extremism
The Broken Branch: How Congress Is Failing America and How to Get It Back on Track (Institutions of American Democracy)
The Party Is Over: How Republicans Went Crazy, Democrats Became Useless, and the Middle Class Got Shafted
“Mike Lofgren retired on June 17 after 28 years as a Congressional staffer. He served 16 years as a professional staff member on the Republican side of both the House and Senate Budget Committees.“
Goodbye to All That
I have always looked at both sides and I am well aware of the ugly on my own side of the aisle. Reality is that the right wing voters in safely right wing districts are sending idiots to Congress and nothing is getting done right because of it.
Sorry, apparently the link to “Goodbye to all that” does not work.
Try this one:
Richard, re: 7:07,
Yes, I pay a monthly fee to insure immediate access along with other considerations. Many practices are now limiting their patient list to insure proper availability when need arises. I look at it a bit like keeping a lawyer on retainer (just in case). I believe this is going to be the “new normal” in healthcare, as many practices find the costs (malpractice insurance etc…) rising and payment from the likes of medicare falling. We are on the move to a two tier system, the ACA is accelerating it, as doctors are trying to find a way to survive.
I don’t think we will ever see a single payer system, but you are correct that those who refused the gov’t determined salary would be out of business.
I am not sure that would be a good thing as many of these talented individuals would surely find other work; and future talent will not want to fill the void as they could not make a satisfactory living, not to mention the need to pay all the bills they would have accumulated from medical schools etc…
Ron, re 9:14
Yes, these proactive steps you are taking and the fact that your employees are becoming more educated and have more “skin in the game” parallels with what we are experiencing. This is probably the best thing to come from the ACA “people are becoming more aware”.
The worst is that so many businesses are now trying to find a way to survive the increased costs a couple of examples today:
sadly, our company made the same decision regarding spousal coverage. I understand the reason, but what once was a “fringe benefit” to employee families has now disappeared.
Unintended consequences of a law that needed to be passed to be understood.
“I don’t think we will ever see a single payer system, but you are correct that those [doctors] who refused the gov’t determined salary would be out of business.”
Perry, do you actually believe docs would be on a “gov’t determined salary” under single payer? Or was that an unfortunate error on your part?
Because that’s not the way single-payer works, and no one’s talking about “gov’t determined salaries” unless perhaps they are trying to deceive others about how single-payer works.
FYI, I know specialists with practices in which 90 percent of their patients are on Medicare. And none of those docs is on public assistance. They work hard, and they’re doing quite well.
Perry D, define “many”? I never heard of an arrangement like you are speaking of.
My comment on “salary” is meant to define that they will be limited to what “gov’t” medicare etc.. will pay (not that gov’t would directly determine their salary).
Also, to a man/woman, all of my doctors; (unfortunately I have many) oncologists, heart specialists and GP’s, deplore the ACA and always speak of the difficulties of medicade.
I am not suggesting that these folk would live “hand to mouth” in a single payer system; and as you suggest your friends are “specialists” which brings a whole new dynamic to the conversation.
If your doctor friends are “all good” with the medicare system, that just cuts against what my doctors have said (I am not in that business, I can only repeat what I hear). However, I can only believe that when money (medicare) runs short, there will consequences.
Btw.. I am sure your specialist friends give kindly of their talents as do mine (for free) as they do understand and appreciate their “gifts” are for a greater good; I have friends who travel on “their own dime” to help those in less fortunate countries with their ailments.
Research concierge medicine,
I imagine it is much more common in high population areas, but “coming to a theatre near you”. It is the growing thing in populated areas with tens of thousands of potential patients. Doctors can cut their patient load and give better care to their patients, while still being able to make a living.
I have heard of concierge medicine, Sandi. I didn’t know any Dr’s around here participated, but it is real. Perry’s descriptions are correct in how it works. You pay a set fee for guaranteed access.
What is “medicade?” Did you mean Medicaid? Do you believe that is the same thing as Medicare? It’s not. We aren’t even talking about Medicaid. That’s a different issue. We’re talking about Medicare.
If one investigates the differences between them, one quickly gains a realization about how they are different, and the radically different opinions doctors have about them. And by that I mean, yes, the same doc may have one opinion of Medicare and a different opinion of Medicaid.
(I’m not accusing you of this, but there are a lot of people who will deliberately conflate the two, for the purpose of confusing the many people who don’t read carefully — our own “Frank” is but one example of the category of people who fail to read carefully).
And fyi, payments from Medicare, or private insurers, are not a doctor’s “salary.” It’s incompetent usage for someone to refer to them as such — unless that someone is slyly and deliberately doing for the purpose of deceiving a dimwit. (I don’t mean to suggest, necessarily, that you’re doing that).
Think of it this way: When you go to a ball game, and you buy a hot dog from a vendor, does it strike you that the $3 you fork over is his “salary?”
Probably not. Because “salary” implies someone is an employee of the person paying it.
Does anyone know of a single-payer system that didn’t develop some form of alternative medical treatment / medicine delivery for the rich or those able to step to the front of the line?
That is not to condom the idea of a single-payer system, which I support. IMHO, the single-payer system is not to provide medical treatment / medicine delivery for the rich or those able to step to the front of the line. They will nearly always find a way to step to the front of the line — what ever line it is.
The idea of a single-payer system is to provide medical treatment / medicine delivery for those who can even afford to get in the line, have a struggle in the line, might get knocked out of line by some unexpected event or hardship.
So, I don’t much care about rich, etc being able to step to the front of the line or in the case of concierge medicine having a different line.
#83, Dave Hicks:
“That is not to condom the idea of a single-payer system, which I support”(sic)
Dr. Freud, Dr. Freud…Paging Dr. Freud.
Re: Warren | August 21, 2013 at 8:37 pm
Good one, Warren.
I was not questioning that those willing to pay for the privilege could not get exclusive offers from doctors, I was questioning Perry’s assertion that “Many practices are now limiting their patient list” to do so. Again, I asked you to define “many” since I am not aware of it in the Roanoke Valley. Your assertion of “many” would likely have a least one “theater” near me already IMO.
If insurance for employees is such a burden, why not just do away with employer controlled/based coverage, pay employees the difference and let everyone get insurance in the “marketplace”? Is that NOT the “free market” way? There was no law that said employers had to offer coverage and now that there is, the burden is apparently insurmountable. Seems to me confirmation that there was a serious problem.
#76 Gee, Perry, I wonder why Breitbart didn’t mention this part of the letter to U.Va. employees?
“One major factor in rising medical bills to U.Va. is the “high” claims category. These claims, which typically reflect very serious medical conditions and treatments, exceed $100,000 for a single enrollee. The number of high-cost claims at the University has increased from 44 in 2008 to 104 in 2012 – and the cost of those claims has jumped from $7 million to $24 million.”
At my institution, in 2013, the college’s share of health insurance premiums per employee is approximately $10K. A major reason we don’t just add $10K to an employees salary is that it would be immediately taxable income at the local, state and federal levels. The current pretax nature of the benefit makes it a non taxable event for employees. For profits, I believe, get to deduct it as an expense. Richard likely knows more about that side of it than I do.
If I was to do that at my college, because it would be taxable income, most employees would net $7 to 7.5K of the benefit. Additionally, social security and Medicare taxes would apply up to the current maximums for both the employee and the employer. At my college, we pay 7% of salary into a retirement plan for the employees so that would also be an additional expense for the college. It’s more complicated than it seems on the surface.
Ron May | August 21, 2013 at 10:04 pm
That is why employers who want quality skilled employees have employe benefit programs — to be able to recrute and keep quality staff.
It is good business.
But how is it “good business” to refuse to cover a spouse? Having to keep up with two different plans and their rules is rather onerous IMO. “Quality staff” will not be happy with this change.
Ron, I did not necessarily mean pay people dollar for dollar what you are paying for their insurance, I meant add that money to the compensation pool. Thank you for admitting the tax advantage (subsidy if you will) that companies get for offering coverage. The bottom line is that employers nor employees REALLY consider insurance part of their compensation. If they did, it could easily go either way…
Too many people have chosen not to buy insurance and too many people could not afford to buy insurance and now, covering those people will be an added burden on both sides of the ledger, but hopefully one that is more widely shared.
I look for companies to have a higher burden just because people who have been taught to dread and fear the exchanges will opt for whatever plan their employer offers and that will be an additional expense many companies have not had to pay.
Re: Sandi Saunders | August 22, 2013 at 10:01 am
I was thinking the same thing.
The first thing that popped into my mind is the coverage of minor children. How managed?
It’s been a while since retired, but I also thought of the whole open season issue issue. I assumed that has been addressed. However, does anyone know?
Spouse ends employment. Does that automatically open the other spouse’s policy to add her/him? Any gaps? How about the children’s coverage?
The Preexisting conditions solution would be a help. But all kinds of potential issues come to mind.
One of the working spouse ends employment because of a medical condition that is currently being billed to that working spouse’s policy. How does that cost transfer?
Think surgery with follow-up appointments in basic initial charge.
Think in-net v. non-net.
Think participating practitioners/ providers on the first that are not participating practitioners/ providers on the second policy.
Ditto preferred providers . . . .
Think calendar year deductible and catastrophic protection Out-Of-Pocket maximum both starting all over again mid-treatment/ mid-year for both medical services and drug programs.
I remember, well, the mess when my wife had a stroke and lost her coverage from her employer. Luckily, she was already secondary on my insurance. So we dodged a lot of problems. But working out some of the above was a real hassle.
I have used the terms medicare/medicaid interchangeably. It was not my intention to confuse or deceive (it is not my nature). My only point was that the limited payments to doc’s are causing them to stop taking new patients.
Also, I used the word “salary” for lack of a better term for whatever limits the gov’t puts on services rendered.
Hope you cut me a break as I am, admittedly, not a wordsmith.
I hope the basis of my point came thru even though I might have garbled a bit and had some spelling errors.
Check this site, it is not the one I use but basically explains.
also, I agree that “free market” would be an interesting approach. That, however, opens another bag of worms.
Yes, that fits in with the conversation earlier about having “skin in the game” and wellness programs.
Being a “wordsmith” is not a requirement. Not conflating two very different things and misrepresenting others is much more egregious. That is not a conversation it is red herrings and straw men.
Dave Hicks | August 22, 2013 at 2:36 pm Re: Sandi Saunders | August 22, 2013 at 10:01 am I was thinking the same thing. – See more at: http://blogs.roanoke.com/dancasey/2013/08/too-small-on-the-tuesday-open-thread/#comments
This post perfectly articulated the need for a single payer system like medicare for everybody.
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Thu, 12 Dec 2013 05:12:38 +0000
Metro Columnist Dan Casey knows a little bit about a lot of things but not a heck of a lot about most things. That doesn't keep him from writing about them, however. So keep him honest!
He welcomes your rants, raves and considered opinions, so long as the language is civil (i.e. no four-letter words). He'll read all your posts and may or may not respond.