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8 Roads to Universal: [Democratic Health Care Plans]
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Well my position is by and large wages are already heavily stolen from workers by their employers, particularly in the C-Suite level, so that rock’s gotta get pushed up the hill at some point
it's going to cause a huge shift in the kinds of shit people will put up with because of a good compensation package
maybe they're less likely to kill themselves with 80 hours of overtime because their wife or kid is dying of cancer
maybe they're less likely to put up with a shitty boss because their insulin costs too much without insurance and they'll get put in a high risk insurance pool or have a HDHP at a new job
It'll change a lot of shit and eventually wages will compensate for how difficult it is to get people to put up with dumb bullshit instead of literally holding their or their loved one's lives over a flame to get them to do their bidding.
ok, lemme see if I can be more clear about what I mean
We say regularly that "my taxes pay for your x" is nonsense as an argument, right? Your income tax didn't pay for an M-16, that's just not how it works. Taxes are your contribution to the general welfare of the nation.
So, it's not possible for money, previously paid by my employer to my insurance as part of my employment compensation package, to shift from Aetna to UHC. A federal tax increase on a business is not, cannot be equivalent to a decrease in my personal compensation from that business even if I also get a new similar thing from the government at the same time.
Even if I am now getting a million times better healthcare, even if I have to spend thousands less than I once did on a bill, it doesn't change the fact that I also have just absorbed a decrease in my employment compensation. Now, if your argument is "well, get rekt, we're gonna let employers fuck you a little bit so we can make UHC a thing" then OK, that sucks for me. If there are enough like me, maybe you don't get to do the UHC thing unless you make it suck less, maybe not, that's what voting is for and it won't be the first time I've ended up on the short end of a healthcare benefit for everyone else.
But don't piss on my shoulder and tell me it's raining, yeah? "These taxes pay for your new healthcare so you break even!" is not how we do taxing, and if it was, "The government should only get money for wars if people check the war box on their 1040 form" would be an idea that made sense.
It's hard to put a price tag on how much better this will improve working people and their families lives
Come Overwatch with meeeee
I feel like we've kind of gone down this rabbit hole far enough
Perhaps let's return to debating the merits of the different ideas presented in the OP
So basically, you're pushing back against other people having healthcare in a way that doesn't effect you because of some kind of pride/principal?
Yeah, I highly doubt I'll be able to even begin to understand the mindset behind this.
On the one hand, longer transitions to new laws are smoother. If a public option slowly got more attractive, people could transition over time away from employer mandated insurance—and employees saying “I’m not taking the benefits, just give me a salary bump” one at a time might be easier for employers to say yes to.
On the other hand, people need help now, and I think the ACA, which had a pretty long, smooth transition path, shows that people have an easier time understanding and tracking one big change than lots of little changes over time. The Trump admin is successfully undermining this year’s ACA enrollment by slashing the ad budget, but part of the reason we need an ad budget at all is that people don’t really understand what the ACA is in total, because it’s all these little bits and pieces you might not have noticed becoming part of your life.
So a big rapid push for change might be scarier for people in the short term but if you can pass it it seems more politically protected over time.
I agree that people largely won't go for it, but that's a separate conversation. The philosophical foundation for universal healthcare is that it's a moral imperative to help our fellow human beings if able. If someone is traveling to the US for healthcare, we need to be asking what is happening such that they weren't able to get healthcare at home, and whether there are people there still in need who aren't able to afford travel.
It's imperative that we not confuse political feasibility with our ideals.
Well, it's an imperative for some. For others, foreigners don't rate as people, so why should we give them healthcare.
This is very much a perfect is the enemy of good situation.
This seems to me to be more a problem with your employer than the government health care.
If your employer doesn’t fix their compensation package to account for not having to pay out their end of health care costs then they are shitty as hell. Sadly a lot of employers will try to do this if it happens.
The good thing is if you have a union they should be using that as a bargaining position.
Yeah I imagine countries with UHC will just start covering american citizens for free assuming we cover theirs while on vacation or on temporary residency or whatever. That seems like an extra benefit to having a system like that. No longer needing to spend money on health insurance while traveling is another good thing. Not that it was expensive to begin with because usually their healthcare costs are actually reasonable there.
Another large benefit is the reigning in of healthcare costs because of single payer means that even undocumented illegals who don't get free coverage might actually be able to afford to pay their care if it doesn't cost $32000 to spend a night in the hospital.
No, it's completely the opposite of that in every possible way.
1) I'm not "pushing back against other people having healthcare". I'm for some kind of UHC in principle.
2) It absolutely does affect me, specifically in the way I described above - I will lose compensation post-M4A.
3) It's not pride or principle, it's the standard way of thinking about taxation as a concept. You can't have it mean one thing when you want me to like it, and another thing when you don't care if I like it.
Did this exist in the various European states pre-EU? Does it now? I'd be curious to see how that works.
I see the philosophical foundation as a moral imperative to help our fellow citizens. The United States cannot provide free healthcare for the world's population - this is obvious. We have to draw a line somewhere and declare that these people will be covered by the new plan, and those will not.
I don't see a lot of moral distance between "the people who are here" and "the people who are here legally" with regard to providing them universal care.
Very few, possibly no, employers will do this. They are already losing an enormous tax deduction, and paying a tax increase to cover the plan, and would owe additional payroll taxes if they hand over the compensation as cash. Because of the way we've built healthcare so far, it's expensive to shift that money from insurance premiums to payroll. I feel like none of the plans take this into account, nor do any of them address the loss of the employer deduction.
None of them address the massacre of the health insurance industry they represent either, including the job losses and impact to the economy from a company like BCBS or Aetna shrinking to compete in the new landscape. That's less of a concern, but still entirely unaddressed by all 8 plans afaik.
We already do it now because it's kind of shitty to let someone die on your doorstep because you don't want to pay for their bandages. Arguably it's one of the reasons we have an out of control healthcare cost problem since "uninsured" is factored into our premiums.
Health tourism is a thing, but I think people overstate just how much it costs in a single-payer UHC system. It's just a way of diverting a debate away and making it focus on a topic we don't need to talk about. People from the Philippines aren't going to travel here for treatment for some booboos.
Well.
No.
But I'm not suggesting I'd oppose M4A because it screws me out of a five-figure sum in my compensation package. I'm just saying that hey, you guys, this shit is gonna cost middle-class Americans billions of dollars in lost compensation, maybe we should do something about it.
Back in the 50s, Belasco's family owned land near Dallas. Then the State decided they needed a reservoir on that land, so they... didn't just say GFTO and fill the valley with water. They compensated people for the loss that occurred as a result of the new public benefit. Why not do something similar here? Legislate shifting insurance premiums to payroll increases and exempt the increase from payroll taxes for idk 5 years at a gradually diminishing rate?
Shitty medical coverage already costs them more. Middle-class America comes out ahead.
Canada seems to take it quite seriously, and does not want Americans to travel there for free healthcare then return home. This seems entirely reasonable to me!
I think this is actually a much more important issue. These companies employ millions of people to sit in call centers and push paper. These jobs are dull and not terribly well paid but physically easy and don’t require high qualifications. If they vanish in a puff of smoke there will be chaos. And the millions of people who do these jobs will most certainly vote against their jobs vanishing.
Right, it's pretty easy to drive across the border and get some free coverage. It's less likely someone from Russia or South Africa or the Philippines is going to hop on a plane. I know what you're saying, you don't want to pay for health coverage of illegal Mexicans and central americans crossing the boarder. I'm telling you treating them is pennies on the dollar and we'll still come out ahead because we already fucking do it.
I'm not convinced this is going to be the case, but I do believe we should try to make it true. It'll be a question of execution as we massively scale up a plan, and there's no guarantee that something we love at size x will still be amazing at size 300x.
I don't know if you'll need the glut of people currently working in the industry, but they can shift to paper pushing for the medicare system (and we should have some sort of onboarding process to get those people to work for medicare) because the increase in people will mean a lot more needs to be handled paperwork wise.
Others can transition to working for hospitals and medical clinics doing the other end of the insurance work like submitting claims and coding doctor's notes.
I don't see a world where all benefits are available on equal footing, though, regardless of legal residence status. Drugs can cost literally $300,000-$800,000 a year. Last chance cancer drugs can cost comparable amounts to extend life at a very low quality, for a few months. The health system does not want to invite everyone in the world who needs that kind of care to visit. And if we're feeling flush enough to feel like spending that money on improving the world's lot, there are a lot better ways to do it.
So why does Canada feel so strongly about not wanting Americans to do it?
“Yeah you are going to lose your job. But most likely most of you will get new jobs in a similar field, soonish. Hope you have plenty of savings for the transition!”
Other thread:
“It’s ridiculous that government workers won’t be paid until after Christmas if the government shuts down. Don’t you know how few people have enough savings to cover 2 weeks without pay?!”
I don't think they feel as strongly as you think they do.
I suspect they do. If Canada treated Americans for free, all those folks who go to Mexico for cut-price healthcare would go to Canada for free healthcare.
Some of that is a matter of relative scale and just how open our mutual US/Canada border is. I think we'd end up with a different (but not better) scenario down south.
Canadian hospitals bill tourists and illegal immigrants directly, pursue them through collections, attempt to collect in their home countries, and may even seek to bar re-entry into Canada (though this seems uncommon). They take it seriously enough.
It's a pretty big deal, especially as far as administering the system is concerned. And you can definitely get people riled up with stories of people who basically spend the bare minimum in the country to qualify for health coverage and then the rest of the year somewhere else. (usually the caribbean in the stories you do see on this)
The government takes it seriously, for sure. The Canadian people though? I'd say "properly billing healthcare tourists" is pretty far down the list of issues we care about with regards to our healthcare system.
Certainly not as big of a deal as a somewhat distressingly large chunk of Americans take offense to treating people they don't like even if they are legal citizens.
Do you really want to end one of NASA's signature achievements? Why can't you just be grateful that we've acheived low earth orbit?