dimitrig said:

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As for Europe versus the US...

My aunt migrated from Northern Europe to the US. Here in the US (Bay Area) she was diagnosed with terminal cancer and they basically sent her home to die. She went abroad for healthcare and she is alive now almost 40 years since that diagnosis.

Even so, she will admit that if you are REALLY rich the healthcare is better in the US. For most people, though, US healthcare is a joke in comparison. In Europe her doctor still makes house calls and it is completely free for her - no co-pays, no deductibles, no nonsense.

How often does your doctor make house calls? How much do you pay for that insurance again?

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"curing" cancer in the US is literally illegal and folks have been prosecuted for using the term. Cancer here can only be treated, meaning medically. Usually that means chemo-therapy, which, by itself is a death sentence and/or surgery which unnecessarily expensive.

Lots of folks outside standard medicine have had great insights into cancer and have been able to cure it without any medicine at all, much to the amazement of their doctors. But you better keep it to yourself otherwise.

LudwigsFountain said:

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wifeisafurd said:

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LudwigsFountain said:

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wifeisafurd said:

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bearlyamazing said:

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Many of the countries that have nationalized healthcare have long waiting times, too. Many Canadians come to America for healthcare.

One of the big problems paying for nationalized healthcare is that we already have a big tax burden here with income taxes, payroll/social security tax (double the tax at 15.3% for self-employed), property taxes, state taxes in most states, gas tax and sales tax. Our economy and economic growth would be crushed with the tax increases required to pay for a plan like MFA.

2/3 of the country are on employer paid/cost shared healthcare or Medicare/Medicaid. It's a noble goal to try and get to 100% but they have to come up with some other feasible way to get the other 1/3 better healthcare options without blowing up the economy. The deficit's already horrendously bad. It would explode with a MFA plan or if we bear all the burden, it will crush growth and consumer spending. No way to spin around that fact.

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You do understand that under medicare today, most people (81%) have insurance supplements that pay for a substantial portion of their costs? This is a huge shift in dollars from the employer to the individual. And you do understand that the individual (unless below certain poverty lines) pays premumims for the base coverage? There seems to be some misconception that medicare if free or a give away. It isn't. And part D (meds) is high co-pays. So there is a huge cost shift from employer to a retired individual. I really think you don't know how medicare works.

What Medicare does do is provide everyone that qualifies insurance, and contain costs by being a huge provider (for example, essentially no doctor can afford to not accept Medicare's lower payments since it is such a large provider). They theory is that if is essentially the only provider, the costs will go down even further. It is not free, most everyone on Medicare pays something. It is not perfect. Drug costs can be high, certain things are not covered, there are coverage gaps - thus, you need to pay for a supplement. There are other complaints as well, but the point is there is no perfect system - at least not one than is cost-effective.

I'm on Medicare. You clearly are not. It isn't a give away or budget buster. The Supplementary Medical Insurance Trust Fund is expected to be adequately funded over the next 10 years and beyond because premium income and general revenue income for Parts B and D are reset each year to cover expected costs. Part A is still is positive, but expecting to need higher than planned premium increases starting in 2048 assuming Obamacare remains good law and some provisions in Trump's 2019 budget pass (so far there seems to be bipartisan support). If not, there will be higher than expected premiums sooner. There is more complexity, but in general, I'm not seeing where your claims come from.


Doctors and other health care providers will make less. Will that mean less doctors in the long run, maybe. What happens in most places is certain doctors, the top guys in specialities, become private doctors for the rich, who will pay above national health care prices. So for most things you see a national doctor and for the very serious stuff you may use a private doctor or health facility. That is how it works in Australia which has a system close to MFA. The Canadian system is different than Medicare, it's based on individual taxes and Canadians paying for a 30% co-pay. But provider costs are much lower due to the government monopoly, so that 30% is more manageable. Unlike Medicare, you must see you general doctor first (they are the gate keeper) and depending on the urgency of your condition you get seen by a specialist doctor or get a specialized test (this doesn't apply to emergencies obviously). So there can be less wait or more wait. That simply isn't the system under Medicare..

You need to remember that it is the individual, not the employer, who pays for medicare currently, so I don't get some of the discussion, unless Sanders is going to do a Warren and tax the wealthy, transactions, etc.. That is not my understanding. Sanders's version for financing Medicare-for-all includes raising employer-side payroll taxes by 7.5 percentage points in order to raise roughly $3.9 trillion over 10 years. On average, this is less than what employers are currently spending on premium contributions for their employees, so workers and employers should generally come out ahead under this system. Companies with younger employees will probably lose. those not covered by an employer plan will have to pay taxes instead of premiums (this probably is to fit within the SCOTUS legal decision on Obamacare). I think the supplemental insurance will stay be paid by individuals and I'm not sure what he is doing on co-pays, etc. There is a progressive tax rate which I will not try to explain.
The point is that while the structure of Sanders's plan is broadly progressive and broadly beneficial to most households and companies, the exact calculus of who ends up ahead and who does not hinges on a complicated set of factors. There will be some losers and winners. Sorta like Trump's tax cuts.

Can you be more specific about the bolded statement. The vast majority of Medicare beneficiaries don't pay any premiums for Part A. If you pay any amount of Medicare tax for more than 40 quarters, you are not charged a premium. Also it was my understanding that the Part A fund is expected to become exhausted far sooner than 2048, so I looked up the 2019 Medicare Trustee report and sure enough, that fund is projected for exhaustion in 2026. Personally, I think that's optimistic because the projections assume that the cost-savings provisions of the laws in place will be observed even though they typically get eliminated or watered down in the annual budget process. In fact, the trustees started recognizing this phenomenon a while back by inserting this caveat in the report:

"In view of these issues [primarily the one I noted above], it is important to note that the actual future costs for Medicare may exceed the projections shown in this report, possibly by substantial amounts."

If you're saying that Medicare are taxes are going to go up I couldn't agree more except I think that will happen far sooner that 2048.

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Really good question on Part A. OMB number which I can't figure out how to link. Please note the assumptions in my post.

Those "going broke" headlines are all about Part A, and only Part A. Sorry this gets complicated but here it goes.


Part A is hospital and hospice or long term facilities (note that coverage is limited if it gets to that), not doctors, meds, or everything else. I probably should have said a few more times I was speaking generally, since Medicare is complicated. But Medicare Part A is funded primarily by payroll taxes (FICA), general allocations by Congress funded by certain income taxes, insurance premiums, and earnings on the funds held by the Trust Fund.


Most people age 65 or older are eligible for free Part A if they have worked and paid Medicare taxes long enough (usually 10 years). The issue then on Part A to cover these people is whether you have to raise the payroll tax more. For Medicare for all, you then have to add people who have not paid in under 65 who should have less hospital time in general, but let's not go there to answer your question and only look at the present. To the numbers:

Around 15% (depending on the year, etc) pay premiums and the premise is that premiums rise generally with the CPI, and what the provider is paid rises at that rate as well. In other words, the provider bear the brunt of there costs rising faster than the CPI and they then try to put these costs on privately insured patients and the uninsured, by doing things like trying to charge $50 dollars for giving you aspirin. Every once in a while hospitals succeed in getting more money and that usually means an increase in taxes and occasionally premiums.

On the income tax side, Part A is also maintained through taxes on social security benefits, a special tax on high income people of .9%. The payroll tax side is 1.45% paid by employees, and 2.5% for high income workers. The self-employed pay higher taxes, and there are some other complications. The assumption was that population would alway increase, so that the funds could be used for retirees, which of course doesn't work when the baby boomers retire and the number of beneficiaries is outpacing the number of people who pay into the program and it also doesn't work if everyone, not just retirees, are on Medicare.

As of mid-2019, the trust funds were earning an average interest rate of 2.845% on their securities. Part A has over a Trillion Dollars in reserves.

The question is really about when does a gap develop on the payroll side (as subsidized by income taxes and investment earrings), as the beneficiary growth overtakes population, and it would become a pay as you go system. The projections are all over the place, and vary by assumption. But there was a magic date in the media of 2026. Because it anticipated the aging Boomers, the Part A built up a trust fund while its costs were relatively low. But the commentary is that reserve is rapidly being drained, and, in 2026, will be out the money.

Obamacare added a tax to shore up Plan A (but also added people to Medicare) and in his last two years, Obama cut Medicare spending on the backs of providers, and the Trump budget adds $500 billon annually to Plan A, again on the backs of providers, which changes the doomsday projections. The other thing under the Trump budget is complicated.

Currently, if you start taking Social Security before age 65, you automatically get signed up for Part A when you hit that Medicare-eligible age. Waiting until after age 65 to tap Social Security results in automatic sign-up, for Part A as well. And while you could choose to opt out of Part B (outpatient care) if you have coverage elsewhere, you must remain enrolled in Part A or pay a steep price. The only way they can opt out of Part A is either not to apply for Social Security in the first place or, if you already have, repay the Social Security Administration all the money you received and anything Medicare has spent on their health care. Meanwhile, although Part A is free as long as you have at least a 10-year work history of contributing to the program through payroll taxes, it can also cause snags if your other insurance is a high-deductible health plan with a health savings account, or HSA. That's because under current rules, you cannot contribute to an HSA if you are on Medicare, even if only Part A. Offered in conjunction with high-deductible health savings plans, HSA's come with a triple tax benefit: Contributions, earnings and qualified withdrawals are tax-free. However, as mentioned, you can't contribute to an HSA if you're on Medicare, even if just Part A. Trump's budget would change that by allowing beneficiaries with high-deductible health plans to make tax-deductible contributions to HSAs or to medical savings accounts. The concept is that employees now wait longer to retire, and will delay Part A choosing instead to build-up HSAs and other plans for tax deductions. While this plan helps Plan A solvency, it costs the general plan an estimate $16 billon a year which is added to the deficit. (Basically future taxpayers will subsidize Plan A more).

This means Obama and Trump have cut money for provider, not participant benefits. PolitiFact - It's wrong to claim Trump budget cuts $845 billion from Medicare (https://www.politifact.com/factchecks/2019/mar/26/joe-biden/trump-medicare-budget-cuts-billion/) and Trump is substituting in tax benefits to stay off Plan A. Again, note my assumptions is the post that (1) Obamacare stays in place, and (2) Trump's budget, at least with respect to Medicare, sticks.

The alternative fix for to all this, in a non Medicare for all scenario, is simply to raise premiums and payroll taxes more than projected. However, Obama and Trump generally have gone the cost cutting route since it is less painful politically.

Excellent summary of how Part A works. One quibble -- what's your source for the for Part A having over a trillion in reserves. According to the Trustee report, the balance in the A trust fund at the end of calendar 2018 was just over $200 billion. Here's the link:2019 Medicare Trustee Report. See page 10.

As far as the "cost cutting route" goes, as I said before those provisions more often than not are at least ameliorated in future sessions of congress, if not eliminated or suspended. (Speaking from 40+ years in healthcare finance.)

Another worrisome aspect is that the projections included in the Trustee report are typically optimistic. For example, if you go back to the report from five years ago the A trust fund was projected to run a surplus and end 2018 with $224 billion, more than 10% greater than the actual results.

Everyone loves Medicare and no one has an explanation with how we're going to deal with the enormous financial hole it's in. As I said before it has an unfunded liability of some $40 trillion.

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I don't have recent details. But for years now, there have been massive spending wastes in the military sector. Even conservatives and ex-career military brass have acknowledged this. At one point our defense secretary Donald Rumsfield acknowledged that up to 3 trillion was not even accounted for. It is things like this and other types of corruption in our public sector that has made it so hard to balance the budget. The reason why nothing has been done about it is that the 2 main political parties have no will to do so.

Now, finally a few candidates are speaking about the corruption in Washington and they seem sincere about doing something about it. But most of those that typically identify as fiscal conservatives are silent. Instead, others are busy accusing them of socialism.

Anyway, there are solutions. They require a change in political culture. And that requires some political will. I would suggest voting for those that have that will if you want to deal with the debt.

wifeisafurd said:

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Cal88 said:

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wifeisafurd said:

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Blue Moon said:

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Quote:

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Ludwigs Fountain wrote:

Everyone loves Medicare and no one has an explanation with how we're going to deal with the enormous financial hole it's in. As I said before it has an unfunded liability of some $40 trillion.

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I figure we can start with taking the money we normally spend on invading other countries in unproductive wars and weaponry to kill people we don't like. After that, we can reevaluate what is necessary to make a necessary public good economically viable.

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Point taken, but when did you ever see a Peace Dividend? There is a snarky answer to my question, but not invading does not equate to a drop in military spending. It seem like the only time military spending drops in during sequestration.

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The notion that invading and occupying countries like Iraq, Afghanistan and Syria doesn't add to the military budget is re1arded. Where do you think the Pentagon's missing trillions went...

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When is the last tine military speeding went down dufus?

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When was the last time we elected someone with the political will to do that? Everybody loves to hate the "left" but left wing policies would have saved the budget had they been practiced in full and we still would have had plenty of national security. BTW, our arms agreements with Israel have probably significantly decreased our security. An argument can be made that 911 was a result of our constant military support of Israel. I am not against Israel as a nation, but I do agree with Trump when he says other nations have to stop relying on American military aid. I wonder if he includes Israel and Saudi Arabia, two countries that use our weapons to violate international law in Palestine and Yemen?

helltopay1 said:

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DearBearly: liz Warren is not a socialist. She is a grifter who will do ( and has done) and will say( and has said) anything to advance her career. Her character was exposed for all time when she falsely claimed to be a Cherokee Indian not only on her University application form but also on subsequent law school & law firm application firms. When she was caught, her laughable excuse was that her "great grandfather had high cheekbones." A person asked for the time of day last week, and, when she accurately told the time, everyone present actually fainted. If Liz had a dime for every falsehood she has told, she would have more money than Bloomberg. I used to think Hillary lied 400 times a day, but, I think Liz was her tutor. Every Demo who has stayed in the race is a faux socialist. i.e. they all say socialist things 24 hours a day in order to stay viable with the radical left which now controls the party. Don't think thew far left has taken over thge party???Just ask Nancy---A year ago Nancy proclaimed that "impeachment had to be bi-partisan in order for it to be effective & warranted. What changed her mind???Easy--she was threatened with losing the speakership unless she changed her mind----everyone in Wash knows that--the only authentic 'socialist" in the race is Bernie---and, he really is much closer to communism than socialism---please google his entire life--he has despised thge Democratic party all his life-In addition, Hillary said three days ago that " nobody likes him." So--let me get this straight--the Demo party is probably going to nominate a 79 year old communist who had a heart attack recently who "nobody likes." The Demo party prior to 1975 or so used to be normal & sane. I know--I was around in 1975 and was a proud, informed Demo. Then, the seeds of insanity were planted during the Vietnam war, and, the result is plain for all to see. Time for a nightcap...

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I hate Elizabeth Warren and I have firmly established that. I also have firmly established that I don't like what she did in holding herself out as a Native American. However, everything you say she did here she did not do. It is complete right wing BS that has been debunked. She never called herself Cherokee on any application.

I like how Warren invariably cites her teaching background to connect with large swaths of Americans. Didn't she teach for like 2 years (and hated it, presumably due to pay and type of work) like 30 years ago?

heartofthebear said:

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wifeisafurd said:

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Cal88 said:

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wifeisafurd said:

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Blue Moon said:

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Quote:

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Ludwigs Fountain wrote:

Everyone loves Medicare and no one has an explanation with how we're going to deal with the enormous financial hole it's in. As I said before it has an unfunded liability of some $40 trillion.

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I figure we can start with taking the money we normally spend on invading other countries in unproductive wars and weaponry to kill people we don't like. After that, we can reevaluate what is necessary to make a necessary public good economically viable.

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Point taken, but when did you ever see a Peace Dividend? There is a snarky answer to my question, but not invading does not equate to a drop in military spending. It seem like the only time military spending drops in during sequestration.

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The notion that invading and occupying countries like Iraq, Afghanistan and Syria doesn't add to the military budget is re1arded. Where do you think the Pentagon's missing trillions went...

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When is the last tine military speeding went down dufus?

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When was the last time we elected someone with the political will to do that? Everybody loves to hate the "left" but left wing policies would have saved the budget had they been practiced in full and we still would have had plenty of national security. BTW, our arms agreements with Israel have probably significantly decreased our security. An argument can be made that 911 was a result of our constant military support of Israel. I am not against Israel as a nation, but I do agree with Trump when he says other nations have to stop relying on American military aid. I wonder if he includes Israel and Saudi Arabia, two countries that use our weapons to violate international law in Palestine and Yemen?

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Just wanted to make the point that during recent times the only time military spending went down was during sequester. Presidents conservative and liberal always seem to increase military spending.

As for wars, you have already paid for the bullets, the bombs, the planes, the tanks, the fuel, and on and on. And the guys in the military get paid no matter where they spend their time (they do get some extra pay for war zones). It is mostly sunk cost, that is now being amortized when used, and mostly stuff that will NOT be replenished anyway, because the government has ordered new, improved stuff already. Talk to someone you know in military procurement (my father was in aerospace so I can). The big ticket items, like airplanes, missiles, ships, etc. are all on long term contracts that will continue regardless of war or peace. BTW, the stuff that we ship to our allies is a generation behind typically - only are troops get to play with newest toys.

Getting back on topic, national insurance doesn't have to break the bank or stop wars to be viable.

wifeisafurd said:

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Just wanted to make the point that during recent times the only time military spending went down was during sequester. Presidents conservative and liberal always seem to increase military spending.

As for wars, you have already paid for the bullets, the bombs, the planes, the tanks, the fuel, and on and on. And the guys in the military get paid no matter where they spend their time (they do get some extra pay for war zones). It is mostly sunk cost, that is now being amortized when used, and mostly stuff that will NOT be replenished anyway, because the government has ordered new, improved stuff already. Talk to someone you know in military procurement (my father was in aerospace so I can). The big ticket items, like airplanes, missiles, ships, etc. are all on long term contracts that will continue regardless of war or peace. BTW, the stuff that we ship to our allies is a generation behind typically - only are troops get to play with newest toys.

Getting back on topic, national insurance doesn't have to break the bank or stop wars to be viable.

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The cost of war is NOT a sunk cost. I get what you are saying - we are buying those planes anyway - but there are a lot of other costs to fighting a war. The health care for our wounded veterans is but one example of such a cost. We built and operated bases in Afghanistan and Iraq for DECADES that we would have never needed otherwise. Maybe it's just a few tens of millions here and tens of millions there, but it adds up.

dimitrig said:

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wifeisafurd said:

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Just wanted to make the point that during recent times the only time military spending went down was during sequester. Presidents conservative and liberal always seem to increase military spending.

As for wars, you have already paid for the bullets, the bombs, the planes, the tanks, the fuel, and on and on. And the guys in the military get paid no matter where they spend their time (they do get some extra pay for war zones). It is mostly sunk cost, that is now being amortized when used, and mostly stuff that will NOT be replenished anyway, because the government has ordered new, improved stuff already. Talk to someone you know in military procurement (my father was in aerospace so I can). The big ticket items, like airplanes, missiles, ships, etc. are all on long term contracts that will continue regardless of war or peace. BTW, the stuff that we ship to our allies is a generation behind typically - only are troops get to play with newest toys.

Getting back on topic, national insurance doesn't have to break the bank or stop wars to be viable.

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The cost of war is NOT a sunk cost. I get what you are saying - we are buying those planes anyway - but there are a lot of other costs to fighting a war. The health care for our wounded veterans is but one example of such a cost. We built and operated bases in Afghanistan and Iraq for DECADES that we would have never needed otherwise. Maybe it's just a few tens of millions here and tens of millions there, but it adds up.

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KBE and Haliburton as well as other private contractors make a ton off of setting up villages, bases, rebuilding areas that are war torn etc. Tax payer pays the cost. Some tin foil guys like me think that Cheney, who had interest in Halliburton, helped contribute to 911 and the subsequent decision to go into Iraq because Halliburton would profit from it. Maybe that's where the 3 trillion went.

dimitrig said:

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wifeisafurd said:

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Just wanted to make the point that during recent times the only time military spending went down was during sequester. Presidents conservative and liberal always seem to increase military spending.

As for wars, you have already paid for the bullets, the bombs, the planes, the tanks, the fuel, and on and on. And the guys in the military get paid no matter where they spend their time (they do get some extra pay for war zones). It is mostly sunk cost, that is now being amortized when used, and mostly stuff that will NOT be replenished anyway, because the government has ordered new, improved stuff already. Talk to someone you know in military procurement (my father was in aerospace so I can). The big ticket items, like airplanes, missiles, ships, etc. are all on long term contracts that will continue regardless of war or peace. BTW, the stuff that we ship to our allies is a generation behind typically - only are troops get to play with newest toys.

Getting back on topic, national insurance doesn't have to break the bank or stop wars to be viable.

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The cost of war is NOT a sunk cost. I get what you are saying - we are buying those planes anyway - but there are a lot of other costs to fighting a war. The health care for our wounded veterans is but one example of such a cost. We built and operated bases in Afghanistan and Iraq for DECADES that we would have never needed otherwise. Maybe it's just a few tens of millions here and tens of millions there, but it adds up.

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I suggested a good portion is a suck cost. Not all. And we maintain bases all over the world for strategic reasons. If not in Afghanistan, somewhere nearby.

The real cost of war is measured more in the impact it has on those who fight them and the people where the fighting occurs. My problem is that even in times of relative peace, we don't seem to reduce defense spending to any material degree, and in fact defense spending almost always seems to be increasing, regardless of who is President.

And I still believe, as proved by other countries, the a national health system can be viable with or without war .

bearister said:

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That pales in comparison to the honor of being classified as a "bad" BI poster as confirmed by kelly09 to helltopay1. They recently draped their version of the Medal of Freedom around my neck at a ceremony at Pappy's.

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If it is any consolation, Bearister, you are in my top 5%..

How about a system where I can go straight to a specialist since I know my MD can't really do sh*t (don't most "problems" require a specialist anyways? Otherwise you can self-treat with a trip to Walgreens) instead of my MD ripping me/my insurance off for a $165 fee just so they can tell me what I already know?

GBear4Life said:

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How about a system where I can go straight to a specialist since I know my MD can't really do sh*t (don't most "problems" require a specialist anyways? Otherwise you can self-treat with a trip to Walgreens) instead of my MD ripping me/my insurance off for a $165 fee just so they can tell me what I already know?

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This is what a PPO allows for.