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SueSTx

The pros and cons of UHC

30 posts in this topic

In a post in the MILA forum, the subject of Universal Health Care has come up several times.  This is a good place to discuss the benefits and disadvantages of UHC.

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Sue you mentioned there was no free ride.  I always knew that countries with universal health care had to pay for it somehow, but I never bothered to google how.  So I just did and found this

In 2016, the average unattached (single) individual, earning an average income of $42,914, will pay approximately $4,257 for pub- lic health care insurance. An average Canadian family consisting of two adults and two chil- dren (earning approximately $122,101) will pay about $11,494 for public health care insurance.

This doesn't seem that different to me than the current system in place under Obamacare.

Except in the USA you can refuse to enroll and pay a penalty  This is my main objection to it- you are enabling people to be irresponsible, and cry whose me, help me out anyway, when they refuse to pay WHAT THEY CAN, to the system  And yes I know this is a republican idea. 

Am I missing something?

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I personally feel the whole health care system is messed up.  I am on Medicare and have a supplement that I pay for.  Recently when I was in the hospital when the insurance paid and I got a bill, it showed that nearly 2/3 of the original submitted bill had been negotiated away.

Do private pay patients have the same forgiveness or do they go bankrupt trying to pay the outrageous total?

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14 minutes ago, skipped said:

Sue you mentioned there was no free ride.  I always knew that countries with universal health care had to pay for it somehow, but I never bothered to google how.  So I just did and found this

In 2016, the average unattached (single) individual, earning an average income of $42,914, will pay approximately $4,257 for pub- lic health care insurance. An average Canadian family consisting of two adults and two chil- dren (earning approximately $122,101) will pay about $11,494 for public health care insurance.

This doesn't seem that different to me than the current system in place under Obamacare.

Except in the USA you can refuse to enroll and pay a penalty  This is my main objection to it- you are enabling people to be irresponsible, and cry whose me, help me out anyway, when they refuse to pay WHAT THEY CAN, to the system  And yes I know this is a republican idea. 

Am I missing something?

We don't have copays. There isn't an 'in network' or 'out of network' division.

Yes, we do triage, and there is a wait time for non emergent things. But that's b/c there's no 'filtering' done, b/c someone's ins won't cover it, or someone doesn't have ins. Everyone that needs, say, a hip replacement gets one, but those who are in more serious need jump the line.

Two of Wolf's aunts had hip replacement. One had it within 24 hrs, I think the other had to wait a cpl of weeks.

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You don't have to have copays here if you are willing to pay higher premiums.

As a nurse.  I strongly believe in triage. I see a lot of waste in providing aggressive care that would be better utilized as palliative. There are a lot of unrealistic outcomes of family members. and patients.  That's another thing I don't see eye to eye with republicans.  They like to call them "death squads".  I prefer to call them realistic and quality of life.  Procedures often make people worse not better.

There is a wait here as well (but guessing probably not as long).  My = husband hurt his back and was going to have to wait 6 weeks to see an ortho MD.  Actually it worked out because he ended up seeing a chiropractor and hasn't needed to see a MD for 20 years.  

Are "alternative medicines" like chiropracters and acupuncture covered under universal health care?

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8 minutes ago, skipped said:

You don't have to have copays here if you are willing to pay higher premiums.

As a nurse.  I strongly believe in triage. I see a lot of waste in providing aggressive care that would be better utilized as palliative. There are a lot of unrealistic outcomes of family members. and patients.  That's another thing I don't see eye to eye with republicans.  They like to call them "death squads".  I prefer to call them realistic and quality of life.  Procedures often make people worse not better.

There is a wait here as well (but guessing probably not as long).  My = husband hurt his back and was going to have to wait 6 weeks to see an ortho MD.  Actually it worked out because he ended up seeing a chiropractor and hasn't needed to see a MD for 20 years.  

Are "alternative medicines" like chiropracters and acupuncture covered under universal health care?

I honestly don't know, b/c we haven't used them in over a decade. I don't think so, though, at least in the provinces I've lived in. Different provinces cover different 'options'.

I know from comparing paystubs, friends in the US were paying way more for insurance than I was losing in taxes per pay, and of course, not all my tax deductions were for health care.

Wait time is really dependant on the triaging, honestly. If you're deemed able to wait, then you do. If it's emergent, then you don't. Unfortunately, as you pointed out, patient/family expectations are often unreasonable/unrealistic.

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28 minutes ago, skipped said:

You don't have to have copays here if you are willing to pay higher premiums.

I don't understand that, not at all. We'd much rather save money, pay Catastrophic and pick up the co-pays/drugs etc.

To each their own, insurance is a huge waste - our budget only works our way.

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9 minutes ago, JanelleK said:

I don't understand that, not at all. We'd much rather save money, pay Catastrophic and pick up the co-pays/drugs etc.

To each their own, insurance is a huge waste - our budget only works our way.

Unfortunately, the understanding I have (please correct me if I'm wrong) is that those who struggle w/co-pays certainly could NOT afford the higher premiums.

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1 hour ago, skipped said:

Sue you mentioned there was no free ride.  I always knew that countries with universal health care had to pay for it somehow, but I never bothered to google how.  So I just did and found this

In 2016, the average unattached (single) individual, earning an average income of $42,914, will pay approximately $4,257 for pub- lic health care insurance. An average Canadian family consisting of two adults and two chil- dren (earning approximately $122,101) will pay about $11,494 for public health care insurance.

This doesn't seem that different to me than the current system in place under Obamacare.

Except in the USA you can refuse to enroll and pay a penalty  This is my main objection to it- you are enabling people to be irresponsible, and cry whose me, help me out anyway, when they refuse to pay WHAT THEY CAN, to the system  And yes I know this is a republican idea. 

Am I missing something?

Can I just clarify that 'average' refers to family size, NOT income, in Canada?

I also found an article in the National Post...
That per capita rate would put Canada near the high end of what other advanced economies pay. According to the CIHI, in 2014, the last year for which comparable data was available, Canada spent $5,543 per resident, more than the United Kingdom ($4,986) and Australia ($5,187) but less than Sweden ($6,245) and far less than the United States ($11,126).

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For those interested, a breakdown of average incomes across Canada. (It's by the Canadian government, so no ads or anything)

Don't get too excited about Yukon/NWT. The price of everything up there more than makes up for the difference in earnings, LOL

Note: no difference was made in having children, how many, etc. It's solely looking at what every census response averages out to. Personally, I don't know ANYONE in my area that makes 70k+ a year, and weirdly, another table I found shows the average income for my province about 44k

http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/famil108a-eng.htm

Edited by ImpishMom

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2 hours ago, skipped said:

Sue you mentioned there was no free ride.  I always knew that countries with universal health care had to pay for it somehow, but I never bothered to google how.  So I just did and found this

In 2016, the average unattached (single) individual, earning an average income of $42,914, will pay approximately $4,257 for pub- lic health care insurance. An average Canadian family consisting of two adults and two children (earning approximately $122,101) will pay about $11,494 for public health care insurance.

I believe, skipped, this is a result of poor article wording. NOT your fault.

The median Canadian family income is in in the $70-75K range.

www.macleans.ca/economy/median-income-in-canada-is-over-70000-says-census/

1 hour ago, ImpishMom said:

Unfortunately, the understanding I have (please correct me if I'm wrong) is that those who struggle w/co-pays certainly could NOT afford the higher premiums.

OK, I need clarification.

Are you referencing low cost Catastrophic Insurance instead of Supplemental Insurance at high premiums to avoid co-pays? OR?

ETA:  to your answer below, I agree. This stuff gets backwards easily - lower premiums are always best in my mind.

Edited by JanelleK

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7 minutes ago, ImpishMom said:

Unfortunately, the understanding I have (please correct me if I'm wrong) is that those who struggle w/co-pays certainly could NOT afford the higher premiums.

The way I look at it is, a lot of the people who struggle with copays, probably don't need the higher premiums.

if you are young and relatively healthy, chances are, you aren't going to need the insurance anyway.  So you would be smart to opt for the lower premium high deductible catastrophic health insurance and take your chances. Cause even  if you do need the insurance, with catastrophic at least your worst case scenario is capped. 

I picked the catastrophic health insurance my hospital offers because, mathematically, the extra premiums didn't match the copays.  The only person who would suffer would be the person who didn't have the $3000 individual $6000 family available in the bank  if something happened in January.  And even if they did, hospitals offer payment plans, you could pay the bill monthly out of the money the hospital puts into your HSA monthly.  The company was putting  $100 money into my HSA, and if you added the premiums that I've saved between the different cost in the plans, I would break even in 2 years.  Personally I have use my HSA, to which I have donated zero dollars, used the money the hospital has added and have paid for everything out of pocket for the last 5 years and am still $6000 ahead.   And that's not counting the $10,000 dollars I've saved in premiums over the past 5 years. 

The few times I've tried to make a claim so that I could at least meet my deductible have been a nightmare.  Insurance companies don't want to pay for anything.  What the heck good is the insurance anyway.

Yes I'm lucky because I'm healthy.  But even if I wasn't, I still say the difference between the insurances offered by my hospital make it idiotic to not pick the high deductible plan.  Not to mention the fact that the insurance picks and chooses what it's going to pay for anyway and I don't trust it.

,The premiums are lower with high deductible.  It's just a risk that IMO  That's why young people would rather just pay the penalty.  The problem is, when they have a preexisting condition, then they want on the insurance. 

 

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3 minutes ago, JanelleK said:

I believe, skipped, this is a result of poor article wording. The median Canadian family income is in in the $75K range.

OK, I need clarification.

Are you referencing  low cost Catastrophic Insurance instead of Supplemental Insurance at high premiums to avoid co-pays? OR?

I'm saying that the folks who struggle to pay copays most are to be the least likely candidates to afford higher ins premiums to avoid the copays.

That's my current understanding, anyways. If I'm wrong about how it all works out, please let me know.

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2 hours ago, skipped said:

Except in the USA you can refuse to enroll and pay a penalty  This is my main objection to it- you are enabling people to be irresponsible, and cry whose me, help me out anyway, when they refuse to pay WHAT THEY CAN, to the system  And yes I know this is a republican idea. 

Am I missing something?

As I understand it, health insurance is mandated under Obamacare b/c it's the only way to insure larger numbers of people. The penalty, to my knowledge, was established in an effort to enforce the requirement, not to give anybody an "out" (my word). The govt isn't saying, "If you don't want to have healthcare, you can pay to opt out." Rather, they're saying, in effect, "If you don't have health care, there's a financial consequence." At least, that's my understanding of it. Perhaps I'm wrong.

Personally, IRL, I don't know anyone, young or old,  who would prefer to pay the penalty. But I suppose there could be some (Maxine and Mike and some of their relatives might sometimes be ok w/ it).

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I think insurance should be mandated.  I don't think people should be allowed to opt out.  I don't think the penalty equals the cost of the health insurance.  The penalty is cheaper.  That's why most young healthy people are picking it.  (I'm sure there are some people out there that are doing it on principle- they don't think the government should tell them what to do but I doubt it's a large percentage )   Most people are saying they "can't afford it".  My hairdresser says she can't afford it.  But she just bought a tanning bed for her basement.

You want to opt out- fine.  Just don't expect anyone to bail you out or want you and your preexisting condition on my health insurance. I don't want to here you whine about how unfair it is.  (I had to hear hairdressers mother whine about the ER bill hairdresser had to pay for strep throat).  Be responsible for your own decision.

What happens when you get sick and have your preexisting condition and now you want on the insurance plan everyone has been paying into all these years as like me mostly healthy?  I think you should be SOL  I've paid way more into my insurance than I've gotten out of it.    Eventually it might even out but really I hope not. I'd rather not need it.

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37 minutes ago, RoseRed135 said:

As I understand it, health insurance is mandated under Obamacare b/c it's the only way to insure larger numbers of people. The penalty, to my knowledge, was established in an effort to enforce the requirement, not to give anybody an "out" (my word). The govt isn't saying, "If you don't want to have healthcare, you can pay to opt out." Rather, they're saying, in effect, "If you don't have health care, there's a financial consequence." At least, that's my understanding of it. Perhaps I'm wrong.

Personally, IRL, I don't know anyone, young or old,  who would prefer to pay the penalty. But I suppose there could be some (Maxine and Mike and some of their relatives might sometimes be ok w/ it).

OK, maybe not prefer, but millions of people pay the penalty vs paying the premiums. The gov't may be thinking/saying what you wrote, but it's not working that way because the premiums are higher than the penalty. It's not working, the young healthy - older than 26 (off mom's policy) are NOT helping prop up the fund to pay for old unhealthy.

I'm old and I prefer to self insure and pay catastrophic. Of course younger people prefer that as well.

ETA: IF I added all the premiums we've saved over the years, with a catastrophic cap, it would be a LOT, just as skipped explained in her example. I'd guess $40-50K, maybe, insurance is a rip-off.

ETA: As skipped said above, while I was typing not reading, my hair, wax and toe gals opt out. Why? Because they're healthy/young and it's far cheaper to opt out - they know their care will be paid for in the ER anyway.

Edited by JanelleK

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3 minutes ago, JanelleK said:

OK, maybe not prefer, but millions of people pay the penalty vs paying the premiums. The gov't may be thinking/saying what you wrote, but it's not working that way because the premiums are higher than the penalty. It's not working, the young healthy - older than 26 (off mom's policy) are NOT helping prop up the fund to pay for old unhealthy.

I'm old and I prefer to self insure and pay catastrophic. Of course younger people prefer that as well.

Ok, thanks, Janelle!

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When I pay an insurance premium whether it be auto, health or home, I am insuring myself against the possibility of needing it in the future and not having it. 

If I wreak the car, I can't afford to pay someone's hospital expenses out of my pocket.  If our home burns down, there is no way I could replace clothing, furniture and a house.  If hubby or I have a major health issue such as cancer, there is no way I can pay for treatment.

I can pay the premiums now, or file bankruptcy later.

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I think that young and/or healthy people think that they can opt out because they won't need it.  But do they think about what happens if they suddenly do?  I'm not one to go to the doctor unless I'm really sick.  Two of the past three years, I came no where near meeting my deductible.  The third year, I had to have a hysterectomy.  Certainly not something I had planned on, or expected and I more than met my deductible.  Thank goodness I did have insurance!

Two scenerios:   Many years ago, my DH was laid off and we lost insurance for him and our two sons. I was covered at my work.  It was hard, but we managed to get and pay for insurance to cover until he got another job.  BIL worked at same place and was also laid off, he opted to not buy insurance for family.  Unfortunately, their 4 yr old had a benign tumor in her leg and had to have surgery.  Took them a very long time to get over that financially.

Second:   One of my former co-workers worked part time, but not enough to be able to get health insurance thru the job.  Her husband was self employed as a Real Estate Agent.  They chose not to pay for family health insurance because "it cost too much".  They both had GOOD jobs.     On a family skiing vacation, one daughter broke her femur and had to have multiple surgeries and time in the hospital.   Somehow, they were able to declare her a "ward of the state", after the fact, and the one daughter basically was covered by welfare, or public assistance.  So, guess who ended up paying because they chose not to.   
IF they had been in need, I wouldn't have minded it a bit to help them out.  But it did touch a sore spot when you'd drive by their house and see 4 vehicles, 2 Harley Davidson's, a nice boat for skiing and 2 jet skis in the yard and garage...... And these weren't old, junk ones, either.

With the current system, I am paying for my health insurance until turn 65.  Thankfully, that isn't far off.  If I wasn't able to qualify for the insurance subsidy under the ACA, I would be paying all of my social security to my insurance premium.  It's not a good system, but for now, at least I'm getting some benefit from it.

It was also mentioned above about waiting times.  I believe that if it is an emergency, you won't have to wait as long.  But it is true, that sometimes it can take up to 4 or 5 months to see a specialist.  I don't think this has as much to do with our insurance system as it does a shortage of physicians.

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We are in the process of trying to figure out insurance for the next year. It is a gigantic mess. And you get what you pay for. Unfortunately we can't justify spending 1800 a month for insurance similar to what we had while full time employed by major companies. That's more than our mortgage and we still have a 6000/12000 deductible and copays and no drug coverage. So we will go for lesser coverage, less flexibility, and hope we don't need it too often. At least we will be covered against catastrophic that would wipe out all we have spent our entire lives working and saving for. I have come to the conclusion that everyone would be better off if we had a single payer system like Medicare for everyone. All people would have to pay taxes for it and if you wanted more than good basic care you could buy more. There is so much profit at so many levels of medical care coming out of the system,  that we end up paying two or three times what anyone else in world pays and get less care. 

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2 hours ago, SueSTx said:

When I pay an insurance premium whether it be auto, health or home, I am insuring myself against the possibility of needing it in the future and not having it. 

If I wreak the car, I can't afford to pay someone's hospital expenses out of my pocket.  If our home burns down, there is no way I could replace clothing, furniture and a house.  If hubby or I have a major health issue such as cancer, there is no way I can pay for treatment.

I can pay the premiums now, or file bankruptcy later.

Yep. And that's why so many people select very low cost catastrophic cap policies and very high deductibles. I wouldn't dream of insuring any other way. The houses, cars, tuck, health all have high deductibles save the premium differences and use the savings IF there is ever a claim, we've not had one. Precisely what skipped explained above about her plan.

ETA: To what Deb asks below. Our health Deductible, in the medicare gap years was $10K  for each of us. The cars, truck, vehicles have $1m liability for other people's property and health/life if we cause a wreck - and no coverage for our collisions ie: if we wreck our vehicles ourselves it's a throw away. The house deductible is as high as our insurer will allow, I believe $10K. And the kicker? Our life policies are more than my social security check. No LTC policy.

Edited by JanelleK

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Just curious as to what people consider high deductibles?  I know what one considers high can be totally different from someone else, depending on personal situation.

I'm not asking people to share what theirs is, just curious on opinion.  Mine is $6,650.

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11 hours ago, JanelleK said:

Yep. And that's why so many people select very low cost catastrophic cap policies and very high deductibles. *I wouldn't dream of insuring any other way.* The houses, cars, tuck, health all have high deductibles save the premium differences and use the savings IF there is ever a claim, we've not had one.

ETA: Precisely what skipped explained above about her plan.

Re the *bolded*: I know a number of people with pre-existing conditions (evidently unlike you, you are very lucky) who can't afford high deductibles for their ongoing health care needs. They are young and make very modest incomes, and happily have found ACA plans that work for them with low premiums through tax credits  and with cost-sharing subsidies for deductibles and doctor visits. Unfortunately these are now in doubt for 2019. And in many places, as has been widely covered in the media and described in earlier posts here, 2018 plans already have much higher costs than they did a year or two ago, especially for people whose incomes are higher than the mandated means-tested levels. 

The history of the ACA, with the unintentional typo that led to unanticipated major changes when the composition of the congress changed in 2010, political maneuvering in the courts, current regulatory changes by the executive, gaming of the system by insurance companies (looking at you Aetna), all point to the need for simple universal coverage. I know at the moment there is a debate whether that should look like Medicare for All or Medicaid for All and haven't read enough to have an opinion, but I think eventually some kind of single payer system will be in place in the U.S. The question is how long it will take and how many people will need to see their health suffer before it happens.

Edited by Julia33
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Here is an article that surprised me that was published a couple of months ago in which several health economists chose winners in a system of brackets among 8 health care systems. Among the unexpected outcomes for me: Switzerland, which has a highly regulated private insurance system that is carefully monitored by the government, not dissimilar to what the ACA was supposed to be but is not because of politics, did very well. 

Also, an early bracket pitting Canada and Great Britain strongly favored the latter. That surprised me because in Britain the National Health actually runs health care systems and employs the doctors, while in Canada the taxpayer-funded provincial governments pay providers who are in business for themselves. Somehow I had assumed the Canadian system would lead to more competition and thus be more efficient. But according to 4 of the 5 economists, not so.

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html

Edited by Julia33

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