Obamacare - practical discussion

Obamacare - practical discussion


Awesome calculator TravelorerMSY. I’m truly blessed to have a low cost health insurance family plan with my company and not have to rely on ACA care (though I did for 2 years for my wife/dependents as a contractor because my small business employer family plan was garbage).

This calculator also emphases in my mind the need for a solid retirement plan and pre-planning because you really never know how presidential administration changes and healthcare costs might play out. Case in point, you might expect on paper to plan a Roth conversion but may end up disadvantaged in doing so due to administration changes. I fully fund a Roth for me and wife annually, mostly because we are currently in a lower tax bracket with her as a SAHM but largely because I want flexibility for retirement income. As a planner myself, it is humbling to think of how many people are clueless to their retirement savings and future planning.


One thing no calculators do (because they can’t) is the impact of losing CSR subsidies when you exceed 250% FPL. That can take a great Silver plan out of play. All depends on how much you use medical care and whether the lower OOP matters to you with CSRs.

We’re still staying below 200% so I’ve not been converting any Roths or harvesting CGs. I would like to in some future world where HC insurance has been fixed, but Bronze plans are not something I want to have right now.


You don’t ? Then obviously you must not comprehend what a ‘peer reviewed study’ entails.

Calling those “studies” is a misnomer and of course misleading, as they are merely paid for propaganda, or based upon paid for propaganda.

Why ? You have a belief. A belief that cannot be substantiated, because it’s baseless.

You’re the one making false claims you cannot substantiate, because they are not possible to substantiate.


Not sure I would be making any changes right now, as I posted upthread, just six short months from now it may all be over but the cryin’, if the administration convinces a federal judge to shut down the pre-existing conditions provisions and strike the limit on premiums for older Americans. The whole thing could collapse.


According to you, my critique (which laid out why their 57% conclusion is flawed) is baseless. Understood. If you don’t have a direct response to what I specifically wrote and all you are going to say is that the study is peer reviewed, and therefore flawless, I supposed we’ve reached an impasse on that.

No. My question to you about your claim was a separate point from my argument above. You claimed (around post 228) that the ACA ended medical bankruptcies which made up the largest portion of bankruptcies. Setting aside the argument about how large a portion they were, I asked for a cite to substantiate the claim that medical bankruptcies ended after the ACA. You never provided one. Then, I pointed out in the Warren study that they didn’t even come to the conclusion that lack of health insurance was the driver behind medical bankruptcies. Do you care to address any of what I just re-summarized?


IMO the pre-existing conditions rule is here to stay, there is widespread support for that on both sides regardless of any court action. It will be reimplemented if struck down.

Did anyone find it curious that HHS reversed itself on not paying the risk-sharing obligations last week? I did, wonder if they’re finally worried that actively sabotaging the ACA will hurt them in November.


Thats not really the measure of what does or doesn’t happen nowadays unfortunately.


Bernie plan cost estimate is out, actually, there are several and all of them are within the ball park of each other.

The latest one is 32.6 Trillion over 10 years. There’s another one that comes in at 24.


Yeah, what’s $2-3T/year of other people’s money?

After taking into account current government health care financing, the study estimated that doubling all federal individual and corporate income taxes would not fully cover the additional costs.

“Even though people don’t pay premiums, the tax increases are going to be enormous. There are going to be a lot of people who’ll pay more in taxes than they save on premiums.” Thorpe was a senior health policy adviser in the Clinton administration.


And yet the Mercatus study shows that Sanders’ M4A plan is cheaper than continuing with our current system, despite covering everyone and eliminating cost-sharing.

As long as there are savings and improved coverage, who cares if the line item on your paycheck says “Medicare tax” rather than “private health insurance” (and the line item not on your paycheck for the ever-so-popular high deductibles and copays)?


Well, it’s all of “our” money anyway unless we also make a law that no $, no treatment and have people die outside of hospital. The big question to me is exactly how much additional tax per person is needed. Assuming that we no longer have to pay for private health insurance.


Why aren’t businesses jumping to support this plan. Seems very pro-business. (no sarcasm I could see huge business savings here).


The current system doesn’t give you any expensive care you want if you don’t pay for insurance or pay out of pocket. You can get stabilizing emergency care for free (at least if you’re poor, they can’t collect), but they’re not going to provide very expensive treatments like organ transplants or joint replacements or whatnot just because you might be better off with those.

If you’re trying to “give” everyone a high quality of care, given many people can’t or don’t pay for that now, you’ll need to pay a whole lot more in health care costs to do it. That, combined with the fact many people can’t afford this, is why it’s prohibitively expensive and would require huge tax increases.

If the Democrats want to run on a “double your taxes for free healthcare” platform, they’re going to hand their opposition the next election because more than half the people are pretty happy with their current employer provided insurance, at least happy enough they’d rather keep that than pay a lot more for something that’s only a marginal improvement. Just look at how Obamacare has played out - screwing the tiny individual market and a rich minority of taxpayers (NIIT) plays fine, but when it comes time for a Cadillac tax on the average union worker’s plan, there are enough votes to delay that time and again.


I wish that anyone who wants govt run healthcare would have to live in country that has it … when they need it. I prefer the U.S. system, as fubar as it is.

As my wife puts it, you will die in a country with socialized medicine because you can’t get to see a doctor, and you will die in the U.S. because you can’t afford one. :fearful:


The $32T figure is likely the worst case estimate we’d see for M4A since its from Mercatus which is a libertarian think tank that would throw everything they can at inflating the figure to make it look like a bad idea.

Still 32T is less than we’re spending now and it would provide more coverage.

Also the 32T is not additional /new spending, its just moving who pays the bills from employers to government. WE already spend 3T a year in todays dollars between the govt, employers and individuals.

Whether or not you think the government would do a good job of running the system is another topic.

But it ain’t gonna kill everyone if the govt. writes the check to my Dr versus Cigna paying the bill.


100’s of millions of people do. And they are healthier end better taken care of than Americans.
Do you have any other than anecdotal evidence that people can’t get care there when they need it ?

I prefer the U.S. system, as fubar as it is.

And I had a good breakfast this morning, which proves that there’s no hunger in the world.

As my wife puts it, you will die in a country with socialized medicine
because you can’t get to see a doctor…

Again, where in a 1st world country with healthcare for all are those incidents systemic ?


I suspect the usual business lobbyists aren’t in favor of it because they are dominated by larger businesses that have less of a reason to want improvements. The way we handle benefits in this country (health, retirement, and others) favors larger businesses because they can amortize the overhead costs, many of which are roughly fixed, over a larger number of employees, and their leverage allows them to negotiate better deals for administrative services. This is why larger businesses often (but not always) have better benefits than smaller businesses. So while the larger entities would still save money under M4A and other socialized safety net proposals that enable them to stop running a side business of insurance, they may prefer the competitive advantage they have under the current system, not to mention the incredible leverage healthcare gives them over employees.

Conversely, smaller and medium-sized businesses should absolutely be in favor of social safety net proposals like this. I wish the M4A side of the Democratic Party (which generally supports other safety net proposals like family leave, another thing large businesses can easily do but small businesses can’t easily do) would do a better job highlighting how pro-business these plans are.


I’d expect that generally businesses would really prefer not to have to pay for health insurance.

OTOH I’d assume that generally businesses don’t really know how a M4A plan would work out and fear that their current health insurance premiums would just get replaced with a more expensive tax. Undoubtedly some businesses would pay more and some would pay less. Knowing which side you’d end up on is anyones guess.


Perhaps. There are other considerations in that as well. One is that employers often subsidize employee + spouse, employee + children, and family coverage at the same percentage level, which means employees who cover a spouse and/or dependents are effectively getting more pay than uninsured or single employees. If the M4A plan was financed with an employer-side payroll tax, perhaps an employer with a large share of uninsured employees (perhaps because the company’s coverage is so poor that enough of the employees have access to better coverage from a spouse or parent, if under 26) or single, childless employees could pay more. But even with this effect, it’s hard to envision a scenario where the vast, vast majority of smaller businesses wouldn’t be better off, given their inherent disadvantage in scale for benefit administration.


IF they are healthier end better taken care of than Americans, I would not presume it is due to better medical care. My opinions are based solely on my experiences using both types of systems and having worked with docs in countries with socialized medicine. I have not worked with any docs in the U.S. Most of them are tied to %*@# hospitals.

And a healthy one. :grin:

In Britain in Canada for two. Both countries limit resources in order to control costs. For example, you cannot buy an MRI machine, have trained technicians run it and only bill out the rate demanded by the government. Easier access may mean shorter wait times, but it means the govt has to pay out more money.