Okay ... so the health "care" pan is starting to take some actual form......

[Stinky The Clown]

..... and many of the details under consideration are being rolled out.

(Note: I strongly favor a single payer universal system ..... but am willing to take a strong public option as a first step. I favor tax increases, if need be, to fund such a system. I favor the removal from the process all the insurance companies.)

I'm willing to wait a while longer as the "sausage making" process on Capitol Hill grinds forward.

But what is emerging is, at its most elemental levels, pretty encouraging. Under $88K income (family of four) you pay nothing and get a "public option" plan. Over $250K you start to do the heavy lifting, with heavier lifting further up the pay scale.

Most people will be able to buy into the basic public plan for $5,000 (individual) and $10,000 (family). Or you can keep the plan you have if you love it so much. :snort:

All of this has lots of names and various caveats and modifiers and double speak.

Here's the bottom line. The public option has every potential to grow into the the plan of choice for most Americans. With prices set by the government, and once serving most Americans, there is little practical difference between this plan and single payer.

Except for the name.

And I'm okay with that.












edit to fix a typo

[Coyote_Bandit]

1. Ummmm......

That's not a pay nothing plan if your income is under $88K. It's a subsidized plan.

It is an additional mandated cost with a penalty for noncompliance for those who are already poor, hungry and food insecure. Somehow I think most of those hungry and food insecure folks are going to be noncompliant and still without health care.

[Stinky The Clown]

2. See .... that's what I was referring to .....

..... funny, ambiguous labels.

"Subsidized"

Depending on the amount of the subsidy, that cold be tantamount to "Free". We just don't know for sure what the final bill will be. I can't imagine someone below the poverty line being mandated to pay 50% of their income for health care under this new plan.

[Coyote_Bandit]

3. The numbers I saw

(and I will search for a link) showed that those who qualified for the subsidy were expected to pay anywhere from just under 2% to just under 12% of their income (adjusted gross if I remember correctly).

That's a lot of money to folks who are already going without food. I'm guessing most of those folks will be noncompliant and worse off than they are now - without insurance and health care and facing penalties.

[lumberjack_jeff]

15. A family at 134% FPL (about $33k)

Who do no get health coverage at work, will get affordability credits which cap their premiums at 1.5% of their income (about $500)

The same family earning 399% of FPL (about $88,000) Will get affordability credits which cap their premiums at 11% of their income (about $9000)

People who lack coverage via work, and make more than $33k won't get healthcare for free. If they make more than $88k, they won't get a subsidy either. HOWEVER, their total annual expenditures are capped at $10k.

Nevertheless, it is a major improvement over the status quo.

[backscatter712]

14. True, but it would be a huge improvement (assuming the subsidies aren't watered down.)

I did some back-of-the-envelope calculations - if you're making $88,000/year (that's 4X the federal poverty line for families - it's about half that for an individual,) premiums are capped at 11% of income, about $806/mo. Still obnoxious at the high end of the subsidy line, but at that end of the subsidy line, you're getting something resembling a middle-class income, so food & shelter probably isn't such a struggle..

At the low end of the subsidy line, 133% of the poverty line, about $13,000/yr for an individual, $26,000 for families, you're capped at 1.5% of income for premiums. At that point, premiums would set a family back about $32/month. I'll take health insurance for $32/mo.

Below 133% of the poverty line, you're eligible for Medicaid under the new health care laws, and you get health care for free.

I'm not saying it's perfect, but it's definitely helpful.

[lumberjack_jeff]

17. 133% of FPL is $29,326 for a family of 4 or $14,400 for an individual. n/t

[backscatter712]

29. OK, let me revise the low-end numbers:

At 133% of FPL, the House bill states you pay 1.5% of income.

That's $36.66/mo for a family of 4, or $18.00/mo for an individual.

And IIRC, the percentage of income goes up on a sliding scale until you hit 4x FPL where it hits 11%.

[dflprincess]

37. $88K for a family of 4; $43K for a single

Just making the limits a little clearer, I agree with what you said.

I didn't vote for Romney Care last November.

[kath]

4. $10K per family is about 8-9X what the Canadians pay...

see other thread:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6074075

The insurance companies will still be sucking WAY, way, way too much money out of the system.

We don't need mandatory INSURANCE or universal INSURANCE - we need UNIVERSAL HEALTH CARE.

[Stinky The Clown]

5. I agree with you .... as stated in the OP

The praise here was for a good first step. The bil that comes out is not the end of the story. It will/has the potential to evolve toward single payer and the was forward is right there is the current plan.

[enlightenment]

7. Presumption of evolution, Stinky.

This plan will not be touted as a first step but presented as some sort of miracle fix - and by the time they even get it in place the political winds will have shifted again and something else will have caught their attention.

Potential is only as good as the the willingness to strive for real change. Aside from a few voices in the Congressional wilderness, no one in a position to actually effect real change is interested in upsetting the free-market status quo or the people who give them the big bucks to do what they do best - campaign for another term in office.

I fully expect to see this pronounced, once they get finished dicking around with it, as the 'BEST' plan. It will not be called the 'first step' and that will be, pretty much, the death knell for any real change happening - in my lifetime, anyway.

The show they put on for the announcement will undoubtedly be grand, though - political spectacle at its finest. I'm sure they're already working on their speeches and soundbites for posterity.

This is a good plan if the intent is to do what they have done - protect the insurance industry and reassure the rest of their private cash cows that they mean them no lasting harm.

Still, I applaud you for finding a way to be positive about it. Really.


*edited to change a sentence so it sounds as if I may have a grasp of the language

[Stinky The Clown]

8. **If** the public option is a good plan. and **if** it is cheaper than any comparable private plan .

The evolution will happen because people simply migrate to the public plan. Once the public plan serves the majority of people, it will become **the** plan ..... and the insurance companies will be left to sell little more than 'gap' plans and other such bullshit.

Whether or not this happens is anyone's guess. I'm betting the public plan will get serious play a year or three down the road.

[enlightenment]

13. Some big 'ifs' there, but

I apologize for misunderstanding where you were headed with the evolution of the plan.

I thought you were referring to a gradual (but inexorable) move toward what the rest of the civilized world has - a single payer health care system. I understand now that you were referring to a gradual move toward the government sponsored health insurance plan.

My bad. Sorry.

[Stinky The Clown]

19. Actually, both ......

... as people move to this pubic plan, it will, de facto, become single payer, will it not?

[enlightenment]

31. Not really.

Not as long as there is a defacto 'insurance company' in-between the patient and the health care.

I do understand that some folks think the public plan is the same, but it's not. It's still functioning on a sliding scale, based on income - which is a more volatile and unstable payment plan than simply saying 'we're going to take XX% out of your paycheck every month to pay your portion' (and of course, your portion combines with everyone's portion to help defray the cost of the unemployed).

Sliding scales are easy to change because they are not encoded in law (like a tax percentage would be). Instead, they are placed in the code and don't require votes to amend. So, like insurance premiums now, the individual will always have to wonder if those payments will change (go up) regardless of a change in their income, because some bright bulb decided they could squeeze a little more out of the public to get some extra money for another project or two.

Like the comment I just read from Nancy Pelosi, who thinks we could use the 'extra' money after funding their spiffy new insurance plan to pay down the deficit. (Not only was that handing the opposition a fresh clip of ammunition, it was proof that a lot of those folks see this as a way for the government to make more money off the backs of the populace).

Still, moving on.

Basing it on the Medicare plan isn't the same as single-payer, either, really - although people like to equate the two. Medicare uses a 'provider network' that can and does create problems for users now. How will that improve without forcing doctors to accept public option patients (and force isn't in the Congressional dictionary when it comes to this). By offering incentives? Scientific management principles have proven that offering incentives only works to a point.

Nor am I seeing any proof that anyone but the unemployed would be eligible for the 'public plan' - it looks like everyone with a job will be forced (and in this case, force is the word - mandate is a euphemism) to acquire some form of insurance from the available 'exchange' - and those exchanges (whatever that means) will operate at the state and regional level, not the national one. I could be misreading this part; it's difficult to decipher.

I have seen figures that state the 'public option' will only cost 5% in overhead, compared to the 15% that private insurers use - but how much overhead will these multiple 'exchanges' have? I haven't seen anything about that.

Bottom line, there really is a big difference between a nationalized healthcare system and the thing they are cobbling together in Congress.

I understand that I'm not going to get what I want (unless I move to another country that has it) - I just tired of watching the contortions as people try to equate the public option with a real single payer system. Every once in awhile I guess I just need to voice my opinion - so I can be roundly smacked down by the 'how dare you criticize' squad.

And I don't mean you. I'm not criticizing you for trying to be optimistic . . . I suppose I'm responding to you because you haven't been a member of that roving hit team.

I await my smackdown . . .

[Stinky The Clown]

41. If you think I'm going in engage in some debate on minutia, you're wrong

We really want the same end result, you and me.

As I said, this plan is not perfect, nor is it single payer.

The OP said it was a good first step.

[enlightenment]

42. Nope. Wasn't trying to 'engage' you in anything more than

polite discussion.

I generally do not attempt to change people's minds. Neither do I spend a lot of time haranguing them or smacking them around because I don't care for their opinion.

Nor do I make a habit of being hyper-defensive of what I posit in a post. You're free to think what you want about it - or dismiss it as an attempt to make your OP look bad (I assume that's what you're saying).

[wolfgangmo]

6. SMALL correction

You are right but it does our side no good to be wrong on the facts.

Canadians spend about $3600 a year per person for universal care. That make 10k about 2 to 3 times as much.

[kath]

11. Well, several Canadians here have said that they pay only about $100 per month for a family,

and there is NO cost at point-of-service -- no co-pays, no deductibles, no 80-20 split of hospital charges and expensive things like MRIs, CAT scans, physical therapy, etc. So, approx $1200 is their TOTAL monetary outlay.

[cbdo2007]

9. "Under $88K income...pay nothing and get a "public option" plan." - clarification?

Then you go on to say, "Most people will be able to buy into the basic public plan for $5,000 (individual) and $10,000 (family)."

I skimmed through most of the House bill and have been trying to find more news about numbers and figures...but I agree with some other posters, that there are still going to be premiums that need to be paid that those with incomes under $88K who currently do not pay for insurance are still not going to pay.

Also, does anyone have any figures on what the lifetime max (cap) would be? It's nice for they to say stuff like, "no one will go bankrupt anymore due to health care costs..." but that don't mean sh*t until we see some numbers. $25,000 would put a huge percentage of Americans in bankruptcy but the "cap" has to be more than that.

[tekisui]

10. The public option is vital. It will only grow stronger.

Each election the repukes will have to accept it or run on a platform of taking healthcare away or reducing benefits. Once public option gets in, it is here to stay and grow.

[Stinky The Clown]

21. And as it stays and grows, it will, de facto, become the single payer we really want.

[Laelth]

12. Correction.

If you make less than 133% of poverty you pay nothing. If you make 88K/year or more as a family, you pay $10K/year. If you make $43K/year and are single, you pay $5K/year. I calculate that I will get hit with a new tax bill for $3K/year that I, most likely, can not afford.

While part of the cost of this plan will be paid for by a slight increase in taxes on the rich, the majority of the cost will be paid by the uninsured--people who already can not afford to buy insurance. Trust me, if I could afford it, I would have bought it already. While the rich will see a small increase in their marginal tax rates, the uninsured will get hit with a whopping new tax bill equal to 12% of their gross income.

This is insane. It is unconscionable. The struggling middle class will deeply resent this new tax bill, and they will leave the Democratic Party in droves.

:dem:

-Laelth

[cbdo2007]

16. Yeah...the more I read about it...

the more I'm wondering how it's really going to benefit anyone. Why do they think the "uninsured" are currently uninsured? Cause it's too expensive. Making them "buy in" to any plan isn't going to get them on board, especially when they'll still probably get stuck with 10-20% coinsurance on any doctor visits anyways.

While it's true this plan will help some of the extreme cases posted here on DU from people who stubbed their toe and had to get their whole leg amputated and now owe $100,000 in medical expenses...but the typical average family with houshold income of $50,000 a year that can't currently afford health insurance will be paying a lot for the "right" to have it.

[Laelth]

20. This bill helps people with pre-existing conditions, no doubt.

It also helps people who have chronic illnesses (because it eliminates the total, lifetime caps on insurance payouts). But it also seriously hurts the uninsured, and places the financial burden squarely on their backs to make this system work. I am not uninsured out of choice. I am healthy. I am uninsured because I can not afford it, and now I will be hit with a $3K/year tax bill (that I can not afford, but must buy--else I am a criminal) for pathetic insurance under the public option that no doctor and no hospital will be required to take.

Frankly, I would much rather have no change at all. This bill, for me, is worse than doing nothing.

:dem:

-Laelth

[cbdo2007]

22. It will affect small companies the same way...

Say a company has 10 employees with $500,000 total payroll. Currently they can't afford to offer health insurance to their employees, especially with the economy slow they are struggling to make payroll as it is. Under the public option plan, they would then be charged an 8% tax on their total payroll amount, or $40,000, which they couldn't afford in the first place. Boom - someone just got layed off cause the company either had to pay $40,000 to health care or $40,000 in new taxes.

[dflprincess]

38. The people who benefit the most from this will be the people who benefit from the current system -

the insurance company executives.

[Phoebe Loosinhouse]

23. How will you get hit with a 3K "tax bill"? Please explain. nt

[Laelth]

26. I will get a 7K subsidy for insurance because my family makes less than $88K/year.

(but more than 133% of poverty-level). If you make 133% of poverty or less, the insurance is 100% subsidized. I will get a 70% subsidy (approximately), and I have to pick up the other $3K to pay the full $10K bill for public-option insurance. It's a new tax, on me, and I doubt I will be able to pay it. If I don't pay it, I will be a criminal. Basically, this bill dictates that I can and must pay 12% of my gross income for insurance every year. The truth is, I can't afford a tax bill for $3K/year. If I could, I would have insurance already.

I hope that makes sense.

:dem:

-Laelth

[Phoebe Loosinhouse]

28. You have a family without any insurance at this time

and you feel that $3000 a year or $250 a month or 62.50 a week is too much.

As one of the currently uninsured,if you had a family member go to the emergency room right now for pretty much anything you would probably rack that up in one visit. If you had anything close to a serious illness or accident you would rack up thousands and thousands of dollars and would probably join the ranks of those who declare bankruptcy due to medical bills. You are playing medical roulette, right now - and I understand it's not by choice.

(Could you share the source of what subsidies kick in at what level? I'd like to look at my own situation in real dollars)

I wish we could get it down to what other countries pay which is still about a 1/3 of what they are talking about, but what is under discussion is a LOT better than the current environment.

What amount do you feel you should pay for family coverage in a new public option?

[Laelth]

30. LOL. I am already legally bankrupt. My debts exceed my assets.

I just haven't filed yet. And, yes, my wife and I are both uninsured. You can believe me or not, as you choose, but we can not afford to pay $3K/year in additional taxes. We can't, but we will be forced to or become criminals.

Let's be very clear. The majority of the cost of this bill will be paid for by a massive, new tax on the uninsured equal to 12% of our gross income.

That makes no sense to me. I suspect the struggling, uninsured middle-class will deeply resent this new tax burden and will abandon the Democratic Party in droves. I sincerely hope the Progressive Caucus can prevent the passage of this disastrous bill.

:dem:

-Laelth

[cbdo2007]

33. Don't forget your deductible before the "public option" kicks in...

and you'll still owe 10-20%% coinsurance on any services after you pay deductible.

Let's see...what other realistic fees are there that most people here think are covered that the currently uninsured are going to be stuck with?

[Laelth]

34. Yeah. Even after I am forced to buy insurance, I still won't be able to see a doctor.

I won't be able to afford the co-pay.

:dem:

-Laelth

[Phoebe Loosinhouse]

44. I certainly believe you and I have been there

Please don't think I'm not sympathetic to your situation. I absolutely know what it is like to select which bill to pay and when 3000 might as well be 30,000 or 300,000. Your situation is actually probably the best time to "go naked" in terms of health coverage if you feel you are at the abyss anyway.

But, are they considering "net" or "gross" income as stated on tax returns? - that could make a big, big, difference in what people pay out. Is it possible that a subtle but major point has been missed? If it is income based, it almost sounds like a yearly premium would be based on the previous year's tax return and perhaps lag by a year - To one's advantage one year, to one's disadvantage another, but averaging out in the end. Perhaps tax refunds could be credited against the subsidy?

If you were going to get a 3K tax refund under the current system, would you consider allocating that towards health care as a fair return?

[Laelth]

45. It's gross, as far as I know.

I suppose I could give back my earned income tax credit, but that check really bailed me out two years ago. I think it's more fair for those who can to pay in. This bill puts the burden squarely on the uninsured, themselves, and that sounds like political suicide to me. Best to allow me (and all the people like me) not to have to worry about health care, let me work, and make money. In a few years, I'll be paying plenty into the system through ordinary income taxes. That, I think, would be the most fair. The current plan is paid for, essentially, by very regressive taxation. Not wise.

:dem:

-Laelth

[Laelth]

32. In further response to your other questions--

I saw a table in a thread here that lays out the subsidy levels, but it's basically, always, 12% of gross for those who make more than 133% of poverty and less than $88K/year as a family. Then it is capped. This bill is actually somewhat good for families who make more than $88K/year because their tax bill will be capped at 10K/year.

How much do I think I should have to pay? I have paid plenty in taxes over the years (sales taxes, gas taxes, property taxes, substantial capital gains taxes about 10 years ago, and for a few years, income taxes). I believe this plan should be paid for out of general tax revenues (like it's done in the U.K.) Those of us who can not afford new taxes right now, shouldn't have to pay any new taxes. When my income increases, I will be happy to pay higher taxes to make the system work.

A regressive, yearly tax on the uninsured equal to 12% of gross is a bad idea.

:dem:

-Laelth

[juno jones]

40. As someone who teeters on the edge of that 133% of poverty

The prospect of being constantly means tested for eligibility is daunting and the thought of being shunted into the medicare system which is currently overburdened and accepted by very few docs, etc. is uppealing. It is a wonderful system, don't get me wrong, but it has it's limits as to what it will cover and access to med care can be very limited depending on where you live. There are already people driving an hour to get to our public clinics in town. There are already wait times of weeks of months to get appointments for them. I fail to see how in many cases, the mere granting of medicare to a few more people is going to help without providing incentives and guarantees that med care will be availible. Where is the mandate for docs and hospitals to accept any of the public plans? This just sets poor people up to continue to recieve second-tier healthcare.


I am for a socially levelling UHC program that provides much of the same basic care to everyone, ala Canada.

On edit: I also notice (from what I understand) that the public option only is availible if your employer doesn't already have insurance. Like one of my former employer's insurance option? Basically a catastrophic care plan that didn't kick in for much of anything until you'd run up five grand or so, and then had ridiculously limited payouts that capped somewhere around thirty grand or so for an illness. Would a crappy plan like that prevent someone from even getting on medicaid despite income eligibility, etc?

[berni_mccoy]

18. Be prepared for the incoming attacks from the "progressives" here

But what they really are are short-sited single-payer only purists.

[cbdo2007]

24. Agree - it would be nice to have a real discussion about health care on DU...

and some real problem solving, but those conversations tend to get hijacked by the single-payer group who thinks a realistic option is for the govt. to cover everyone for everything all of the time with no exceptions and anyone making more than them should pay for the whole thing.

[Cleita]

36. Well, you have your minds made up so there is no room for a real

discussion. Nancy Pelosi took single payer off the table before it could even be debated in depth in Congress and so apparently has the insurance caucus at DU. Enjoy the plan you get because you aren't going to be much better off than you are now.

[Stinky The Clown]

25. I admire their tenacity

I was a purist for a while. Now that I see what's emerging, I am willing to accept compromise.

I think this is a big step in the right direction. Far from perfect, but a good first step.

[Cleita]

39. I'm agreeable to a public option if it's offering an improved and viable version

Medicare like Canadian Medicare to those who wish to buy into it including small businesses or even big businesses. It also needs to be given to the uninsured who aren't employed like the elderly (who already get it) children, the disabled and the unemployed and under employed who aren't covered at work. However, this is not what is emerging, but another gift wrapped package to the insurance industry with taxpayer's money and the usual siphoning of profits to Wall Street. It will be very costly as the Massachusetts plan has already proved to be that operates similarly. It will still leave 3% uninsured or approximately 17 million Americans and that's a conservative estimate put out by the CBO.

[BlooInBloo]

27. Why do you hate America?

:P

[Cleita]

35. Can you fry bacon in that pan?

:rofl:

It's been announced that Dennis Kucinich is introducing an amendment to make it possible for states to create their own single payer plans, if they don't like the federal plan. The reasoning is that this was the way the Canadians did it, one province at a time. So if a progressive state like California does it and it's successful other states will follow. California has twice passed a single payer plan through its legislature and twice Arnold had vetoed it. In this way, I think Arnold can be bypassed because it's a federal program administered by the state.

[haele]

43. It sounds similar to COBRA -

The only problem with it is that the levels of coverage are not set to area cost of living, but to a set income level, and that it's not really progressive for funding.

A person making $45K a year in Des Moines has far more income available once the basic cost of living is met to be able to spend on health care premiums than a person making $45K in San Fransisco, same with a family of 4 making over $88K a year.
The insurance seeker at that rate living in Des Moines may choke a bit when faced with the cost at these levels of coverage - but might still be able to afford it with some belt tightening, but the insurance seeker at the same rate living in San Fransisco is probably going to go without because they've already cut their spending to the bone paying for the roof over their head, basic utilities, critical transportation (private or public to work, school, food sustaining, and medical), food, and clothing.

If they set the levels to local cost of living or added a percentage to the regularly taxed Medicare where there is a sliding scale of cost increase, it would not be such a burden on the working middle class, who are the ones currently being priced out of health insurance as it is now.

Haele