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According to this data chart, about 30% of physicians are female. According to this article, its about 23.1%. But then it goes on to note that nurses are 94.5% female. And this study indicates that physician assistants ("PA"s, in layman's terms kinda halfway between a nurse and a doctor) are now 60+% of the field.

So mid-20 to 30 percent for doctors,
60 percent for PAs,
and a whopping 94.5% for nurses,
and you're crying foul that "the man" is holding women down? Must be news to those 230,000 female M.D.s!

By your hideous gender equality standards, we should be kicking out female nurse applicants until we get a nice 50/50 gender balance going. In other words, cutting the field by 90%! Hope you don't get sick...

The number of male and female MD graduates is almost equal: http://kff.org/other/state-ind... and women outnumber men in obtaining a degree: https://collegepuzzle.stanford...

BCBS is a consortium of insurers coming together and offering plans. The BCBS group accounts for the majority of the enrollment . . .

Sorry, but citation very badly needed. Let me help: Here is a study of insurance carrier shares for ACA marketplace plans in seven states, hot off the presses from last month. It shows BCBS as having 97% market share in the whopping state of Rhode Island. After that it's 29% in California, 24% in Minnesota, 18% in New York, and not even enough share to make the charts in the rest. Is that what you meant by "a majority"?

Now, back to my question: What insurance company has validated the 7.1 million figure trumpeted by the administration, where, when, and how? It should be very simple to answer given your original matter-of-fact statement that "[a]ll of them seem to be putting out similar numbers in terms of those enrolled." Should I hold my breath?

How high is "insanely high"?

For a family with two 40 year-old non-smokers and two children under 21, making the median household income of $50,054/year, the average annual silver plan premium, nation-wide would be $9700/year. That's a lot, but not unreasonable given what a silver plan covers. But here's the kicker: Uncle Sam cuts your taxes to the tune 65% of your premium, so effectively you only pay $3373/year. If you were getting anything close to silver plan coverage for much less than $281/month, I'd be very surprised. You can do this calculation for yourself at http://kff.org/interactive/sub... if you like. If you have a reasonably profitable consultancy, the prospect of paying $9/day to insure four people shouldn't be that daunting.

But some small businesses don't generate much income at first, and the tax breaks in Obamacare don't help you because you aren't paying much federal income tax yet. That's what the Obamacare Medcaid expansion is for. It covers *all* your health care expenses if you make 138% of the poverty line or less. Unfortunately about half of the states have opted not to expand Medicaid, even though the expansion woulds be entirely funded by the federal government. If you live and work in one of these states and make less than 138% of the poverty line, you need to get coverage at work or you're screwed. Even a bronze plan, at $249/month, is more than people who are supposed to be covered by Medicaid expansion can pay. Blocking Medicaid expansion at the state level is a key tactic in ensuring that working people experience Obamacare as ruinously expensive.

Finally, it's important to remember that Obamacare doesn't set insurance premiums. What you pay *for* is regulated, but the *amount* you pay for it is determined by the market. Increases in premiums, or too-good-to-be-true plans that are dropped, result from outlawing practices like dropping you from your insurance when you get sick, or raising the premiums so much when you get sick that you're forced to drop your coverage. So the increased premiums under ACA are simply the market price for insurance that actually works the way people expect it to (i.e., when you get sick, it pays for care until you are no longer sick).

If you are one of those people who pre-ACA had awesome health insurance for your entire family below $100/month, your old insurance was almost certainly too good to be true. Insurance companies dropped those policies when the ACA outlawed the deceptive practices that made them profitable.

Here's a subsidy calculator and here's a market place see what's happening for yourself.

Depends on your age, I'm turning 60, and the wife is 62, health insurance for us is in the neighborhood of $1,200 - $1,900 per month; that's more than most mortgage payments! There no rhyme or reason for the prices that is appearent, there are plans with deceint coverage and high deductables that are cheaper than plans with for-crap coverage and deductables of $20,000! My subsidy is just over $900.00 which is good for me, not so good for the rest of the taxpayers.
I know this sounds outlandish, so here's Subsidy Calculator and Health insurance quote site so feel free to try different scenario yourself.

Yes I can see somebody making good money and still not being able to afford health insurance.

There are 2.4 Doctors per 100,000 people in the US.

The number of doctors per 100,000 people in the US is a bit higher than this. Per the Kaiser Family Foundation, there were 834,769 professionally active physicians in the US in November, 2012. The US population at the time was 314.8 million (per the US Census Bureau's Population Clock), making the number of doctors per 100,000 people a more reasonable 265. Here's a graph showing the number of physicians per 10,000 (note - not 100,000) people in the US.

Your claim is not 100% true.

The states of Oregon and New Hampshire in the United States do not collect sales tax.

NOW it's "nuff said", bitch.

And to further drive the point, New Hampshire manages to keep the streetlights on and the fire departments funded, while California (and a number of other governments) are going down in flames.

This despite California having one of the highest tax rates in the US ($3,266 per person per year, ranked 11th) compared to NH ($1,760 per person per year, ranked 42nd). (source)*

Before we debate whether the court's decision seems equitable or "reasonable" for the purpose, let's stop and consider whether the basic premise - that the state needs the money - is valid.

Consider a hypothetical situation where the state was completely funded by some other means. I don't know what that would be, but let's suppose the state has investments that return a profit or something. If the state didn't want to expand, didn't need to increase services, and didn't need more money... in that situation, does this tax seem equitable or reasonable? What function does it have, and is the benefit of that function worth the cost of compliance?

We have a clear-cut case of a state that is fiscally prudent and well-managed without excessive taxation.

Before we allow the states to apply the brakes to internet commerce, shouldn't we first consider what the state will do with the money?

(*) NH taxes are about 50% of California, but spends proportionally much more than 50% per person. California is simply inefficient at making use of taxes.

http://www.huffingtonpost.com/2013/10/03/health-care-costs-_n_3998425.html

http://kff.org/health-costs/

http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html

I'm glad you base your outlook on your anecdotal evidence. You're part of the problem.

Actually, there is something useful here.

The Kaiser Family Foundation calculator has been working fine for months now. I looked into whether the Health Sherpas might improve on that. They do. The KFF calculator comes up with a single annual figure for a Silver plan; the Sherpa calculator brings up a comprehensive list of available plans along with monthly premiums.

I had already looked to my state's web site to find which providers were available, and sure enough, they were on the Sherpa list. Also, there was indeed a silver plan listed that exactly matched the estimate that KFF gave me.

If you are not eligible for the subsidy (I'm not either), why go through the exchange? The Sherpa does a very useful thing in listing your options. The fact that they don't connect with the byzantine government backend is actually a win for people who don't need the subsidy.

I don't know the specifics of where you live or what your insurance policy is.

If your insurance company is telling you that you have to pay more for worse insurance after the ACA, then you should talk to somebody who knows a lot about health insurance, who isn't making money out of you, and who can give you objective advice about how to get insurance cheaper.

If you can't find anybody else, ask Eric Stern. https://twitter.com/_ericstern He was able to show people in your situation how to save thousands of dollars a year.

Here's the Kaiser subsidy calculator. http://kff.org/interactive/subsidy-calculator/

If I'm shopping for something, I want to know how much it costs. I don't care what the list price was before the discount, I want to know how much I have to write on the check.

You would have. After your comparison shopping. When you were handed off to the insurance company offering the plan selected. As you describe, insurance companies like Kaiser seem to be able to manage this quite well.

It's perfectly reasonable for Healthcare.gov to give both the unadjusted price together with the premium after the subsidy. That's the way I, as a user, would want it. And it shouldn't be a major programming task, since the Kaiser Foundation did it on their web site. http://kff.org/interactive/subsidy-calculator/

That is probably what the administration officials were thinking too. History proves otherwise.

There are a lot of reasons why Healthcare.gov fell apart, but I don't think there's any evidence that this was one of the problems, and if there is evidence I'd like to see it.

Read the transcripts of the contractors who just testified before congress. They clearly state that the gov't was ordering changes as late as two weeks before launch. For example requiring registration rather than anonymous plan browsing.

If I'm shopping for something, I want to know how much it costs. I don't care what the list price was before the discount, I want to know how much I have to write on the check.

It's perfectly reasonable for Healthcare.gov to give both the unadjusted price together with the premium after the subsidy. That's the way I, as a user, would want it. And it shouldn't be a major programming task, since the Kaiser Foundation did it on their web site. http://kff.org/interactive/subsidy-calculator/

There are a lot of reasons why Healthcare.gov fell apart, but I don't think there's any evidence that this was one of the problems, and if there is evidence I'd like to see it.

I think the reason this became an issue is that the Republicans want users to have sticker shock, and want it to be as difficult and discouraging as possible. They see any effort to make it simpler and more useable as somehow underhanded.

I'm retired and receive OASDI. Because that amount is so low, I also get a small SSI check. Lastly, because my income is so low, my state pays my Medicaid premium. Given how my life has worked out thus far, I know it was a close-run thing and I'm fortunate for what I do have. So thankfully I don't have to go through what I see other people having to deal with.

Point is that for grins I used the calculator at Kaiser - http://kff.org/interactive/subsidy-calculator/ - and got a shock. Using my income, it turned out that my total premium was essentially equal to said income. I was too poor for subsidy. (Results are posted in my journal.)

WTF?

That's some crazy shit, man, number ten thousand. Whether the Prez intended to sell out to the oligarchs or has no balls I dunno; at this late stage it really doesn't matter, I suppose. I think he should have pushed for single-payer right from the start. Alternatives would have been to expand Medicare for all and fold in Medicaid via a method like the exchanges (w/o the craziness, of course) or to have said that what the House gets, all get, or vice versa.

And if this hidden no-privacy shit is so, then the ACA sucks beyond belief. Thing is, there are some likeable provisions - no turn-down for pre-existing conditions, emphasis on results - outcome based, with an eye towards prevention rather than crisis, publicly posted rates for procedures and tests from all providers, and the attempt at rational fee structure. One key fuckup was folding to Pharma.

And yes, for all that's right, ER for E stuff, clinics for the rest. Kicker is ensuring that clinics are available - I do note that some companies, Walgreen's for example, are getting into that and that should help. I've lived in too many places where you either could afford to go to a doctor or you went without. That situation leads to what are effectively a lot of walking wounded. Healthy (and happy) workers work better. Too many in power can't seem to get that simple thought into their heads - that, or they get their jollies from the pain of others.

Case in point: all those crying about "socialized" this and that the past forty years should take note of the study done by the GAO (or maybe it was OMB, my memory sucks) back during Nixon. It showed that the economic loss due to simple illness alone was more than three times the cost of the most expansive national plan ever proposed. If memory serves it's one of the arguments Nixon used in his effort to get a national health plan.

There's a lot of good people out there, living on a pretty decent planet despite all its dangers; it never ceases to amaze me that we spend our lives with so many getting fucked over by so few. From my own life and what I know of others' I know that life can be hard enough all by itself. We don't need assholes making it worse. (I apologize for all the profanity. It's no excuse, I'm just really browned off by all this... stuff. Selah.)

>you're better off just paying the fine
Only if the entire family are smokers, or they are making a 6 figure salary. You can check it out at http://kff.org/interactive/subsidy-calculator/
A (non smoking) family making 50k will pay a maximum of $4500 per year. Single people will be half that. those making half that amount will be capped at 3% of salary.

I plugged my family's info into the calculator at the Kaiser Foundation's web site: http://kff.org/interactive/subsidy-calculator/

US Average for the state, 2014 dollars (vs % of poverty,) annual income of $75000, 2 adults @ 40 and 2 kids - no smokers and no employer coverage available

Household income in 2014:318% of poverty level. Unsubsidized annual health insurance premium in 2014:$9,700 Maximum % of income you have to pay for the non-tobacco premium, if eligible for a subsidy:9.5% Amount you pay for the premium:$7,125 per year
(which equals 9.5% of your household income and covers 73% of the overall premium) You could receive a government tax credit subsidy of up to:$2,575
(which covers 27% of the overall premium) - Based on the Silver plan.

"For example, you could enroll in a Bronze plan for about $5,465 per year (which is 7.29% of your household income, after taking into account $2,575 in subsidies). "
Now, when I plugged in my ACTUAL income I didn't qualify for a subsidy. Lucky me, I suppose. The subsidy didn't hit $0 until $94,201 for this family of 4.

Things get pretty bad taking it the other way. If I have $0 income I may qualify for medicaid, but the ACA subsidy is $0 for the noted plans. This is true up to precisely $23,549, after which a subsidy of $9,229 becomes available for the same Silver plan noted above.

Sounds pretty good to me. The glaring hole below $23,500 income is addressed by other programs - still a weakness in the existing law (yes, it is actually a Law - passed by both houses of Congress, signed by the President and validated by the Supreme Court of the United States) that was originally addressed, but whose language was stripped out over the bargaining table over the course of the ACA's inception. Were you actually looking at data or just talking points when you made your post?

While my 'insults' are based on easily disprovable 'facts', yours seem more to be delusions based on your warped perceptions.

Here is a whole bunch of stuff for you to disprove.

My investigations show present pre-existing exclusionary periods all over the map. Indiana is 10 years. Some have unlimited exclusion riders. More on that below. Alabama places no restrictions on the amount an insurance company can charge you - effectly an exclusion. Oklahoma insurance companies are allowed permanent exclusion on any condition, defined as any illness or any injury that occured any time before the insurance policy was taken out. The only protection there is that as long as the insured keeps up their policy payments, the company cannot refuse to renew.

Montana allows for elimination riders. These permit companies to avoid the 12-month look back limit by permanently excluding a pre-existing condition from coverage.

http://www.healthinsurancequotes.com/2012/02/an-overview-of-montana-state-health-insurance-laws/ Link provided as info on th epermanent exclusionary rider.

So do 37 other states. Georgia, Alaska, Arizona, Arkansas, Colorado, Connecticut, Deleware Note, Indiana can not make permanent exclusion riders, but they can refuse coverage for a Pre-existing condition for ten years.

Info:

http://kff.org/other/state-indicator/individual-market-portability-rules/

From the web page, in case people don't want to read the link (though I highly suggest it)

Elimination Rider: In many states, health problems disclosed at the time of application may be permanently excluded from coverage by an amendment to the individual health insurance contract called an elimination rider. Once coverage begins, a consumer who makes claims under the policy may be investigated to see whether the health problem was pre-existing. In many states, it is not necessary for a health condition to have been diagnosed prior to the purchase of coverage for it to be considered pre-existing. Depending on state law, insurers can look back months or years prior to the policy's purchase for evidence of a pre-existing condition. This process is sometimes called post-claims underwriting.

There might be some confusion between HIPPA - non group coverage, and non HIPPA coverage.

But there is no question whatsoever that in many cases, a Helath insurance company can include a rider that says they will not pay for a pre-existing condition

Now signing on to the ObamaCare website, my minimum premium for coverage that I will have to pay each month for not using any of it at all, will put me out of work. The least expensive I've been able to find is in the $300 range.

Have you looked at a subsidy calculator? That may make your healthcare choice significantly more affordable. I make 400% of the poverty line (in the same boat as a software developer in GA making a fraction of what I used to), and that would provide me with over $2500 in subsidies (if my employer didn't cover me).

That doesn't make it free, but it takes it down to under $100/mo for me.

P.S. Not to rub salt in your wounds, but have you ever considered that part of the reason you make a fraction of what you used to and are saddled with such debt is because you keep electing people who are utterly uninterested in helping people like yourself, while you delude yourself into thinking that you're one of the "haves" because of your present help?

Yup, because that raise in premiums was really the effect of the ACA. Newsflash: health insurance premiums rose an average of 13% every year from 1999-2009. Source: http://ehbs.kff.org/pdf/2009/7937.pdf

Also out of pocket costs were increasing 5% a year on top of that. Source: http://www.reuters.com/article/idUSTRE62O1DJ20100325

So yeah, I HIGHLY doubt that the ACA caused even a penny of that increase. If it did, it was because some exec there said "Hey, we can claim the ACA is causing us to raise rates and raise them even more than usual."

It's a misleading number. It comes from this study by the Fraser Institute. Basically, they said "the government spends X% of it's income on health care, therefore we can take X% of each citizen's tax bill as the amount that they paid for health care". This is perfectly reasonable on its own, but the GP cherry-picked the number for a married couple with no kids because they have the highest tax bill. This makes Canadian health care costs seem higher than they truly are.

If you do an apples to apples comparison, the Canadians have a clear advantage.

Single adult: $3780 in Canada, $5884 in US
Family of four: $11320 in Canada, $16351 in US

Canadian numbers are from the Fraser Institute study, US numbers are from this study by KFF.

In the United States, in 2009, Health Care Expenditures per Capita was $6,815, Medicaid Payments per Enrollee, FY2010 in the United States Aged $12,995, Disabled $16,292, Adult $3,039, Children $2,378, Total $5,592. so I don't see how the math will work out, 48% of Americans pay little or no federal taxes. Who is supposed to come up with this $1.75 trillion dollars to cover universal Medicaid, or even the 384,022,000,000 to bring Medicaid up to our expected level of care?

In the United States, in 2009, Health Care Expenditures per Capita was $6,815, Medicaid Payments per Enrollee, FY2010 in the United States Aged $12,995, Disabled $16,292, Adult $3,039, Children $2,378, Total $5,592. so I don't see how the math will work out, 48% of Americans pay little or no federal taxes. Who is supposed to come up with this $1.75 trillion dollars to cover universal Medicaid, or even the 384,022,000,000 to bring Medicaid up to our expected level of care?

Your switch won't matter at all. The plans are grandfathered in, not people. As long as the plan you are on was in existence on March 2013 and had people enrolled it's possible for it to be grandfathered. If a company chooses to keep a plan available you could even change to a grandfathered plan 10 years from now if you really want to.

Here's something I found with some more details on what would make a plan ineligible: https://www.aetna.com/health-reform-connection/questions-answers/grandfathering.html#4

  It's still not perfect as much of it just says "signficant increase" or similar, where "significant" is not precisely defined, but you'll note that it has more to do with costs and coverage changes, more than specifying what must be covered.

One thing that might help you is to figure out in advance if you'll be eligible for the subsidy, but note that it can only be used on insurance purchased on the exchange. Here's the best calculator I can find at the moment: http://kff.org/interactive/subsidy-calculator/

Since your genetic markup doesn't change (except for stray mutations but AFAIK not that spread to every cell in your body - single sperm cells are different) the question is can you pay off $1000 over your whole life and medical history? With every advance likely to come 10-50 years down the road? A quick search came up with this from Employer Health Benefits 2012 Annual Survey: The average premium for single coverage in 2012 is $468 per month or $5,615 per year. So over 70 years (probably some of them on a family plan, offset by paying for a family plan) you're likely to spend $400k on health plans.

That means you have to improve efficiency by 0.25%, either by simple prevention, earlier detection, finding the right diagnosis earlier, better treatment before we get to all the possibilities of genetic medicine and it will pay off. Not in the US of course, where they'll drop you like a hot potato and/or pocket the savings themselves, but in other countries with universal healthcare lifetime costs are on the same order. I just did the math here in Norway and to DNA sequence everyone would be 25-30% of one year's healthcare budget. If I divide by an average lifespan of about 80 then about 0.33% of the healthcare of a lifespan. That doesn't sound like an unreachable goal to me.

These programs, while laudable are not fiscally sustainable. There's been many studies and frankly it was based on a pyramid scheme whereby people who weren't eligible were paying into the system for those collecting the benefits. With more people retiring and living longer, both great things the tab gets larger and larger. This isn't necessarily bad but what doesn't get addressed is the fact that we have huge bureaucracies in place to manage and administer the programs that come along with that. There's also very little incentive to reduce costs where medical costs are concerned and that's the biggest variable the taxpayers are faced with. The ACA did nothing to reduce costs and imposed a system whereby everybody needs insurance or pay a penalty without really addressing the underlying problems of that variable cost in terms of double digit increases in healthcare expenses. According to this: http://www.healthleadersmedia.com/content/FIN-286687/Healthcare-Cost-Growth-Slows-but-Easily-Outpaces-Inflation insurance companies and medicare payments were up 5% vs. 2% inflation based on the most recent data. That's 3% over inflation for everybody. Does anybody stop to ask why our per-capita spending on healthcare has skyrocketed and we spend more than other countries with better longevity? http://facts.kff.org/chart.aspx?ch=359 If you look at this: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy we are #40... So we spend the most and we crappy results from it. Our government in terms of legislation, bureaucracy and policy has created a system whereby we all feel we "have the best healthcare in the world" but it's overpriced and overrated. It's a giant placebo. Unfortunately I don't see any of the members of congress, the administration or any of the health insurance companies or the medical profession fixing this because they've been given a license to rape us all in terms of our costs and now with ACA they have a federally mandated right to steal from you.

You apparently know very little about the ACA. For starters your comments about the fines is quite misinformed. Might want to check out this:
http://healthreform.kff.org/the-basics/employer-penalty-flowchart.aspx

In summary, the fines are there to cover cases where
1) the employer doesn't want to offer coverage to everyone, but does for a few key individuals.
2) the employer offers a plan that is more of a token plan and really doesn't cover a majority of a typical person's expenses.
3) the employer charges the employees a large amount (relative to their income) for the plan.

There's no provisions in there about "a huge fine if you offer a plan that even one employee doesn't like".

Yes I did. It is solvent. You're welcome to take a second to look that up.

What we argue about is when it might not be solvent, where the estimated dates vary by decades, and must necessarily assume any number of future conditions. It is worth being concerned about.

That $600 Billion / Year figure for military spending, on the other hand, is discretionary spending. That's outright spending of "right now" tax dollars and new debt, to supply the whole world with military resources and maintain our various ongoing operations overseas. Imagine Medicare were insolvent right now, because that's what we have today, and have had for ten years.

If you're feeling lazy, just scroll down to the first graph you see:
http://www.ssa.gov/oact/trsum/index.html

And you'll notice here, in '97 it looked like we were 4 years from (here, Part A) insolvency:
http://facts.kff.org/chart.aspx?cb=58&sctn=170&ch=1812

Well, most still accept new medicare patients. As in 74%. Compared to the 87% that accept new patients with private insurance. So ~15% of doctors out there will take new patients, but will refuse medicare as a payment. Depending how that's spread about it could be a problem for some locations. And it could grow into a widespread problem eventually. But I'm not shitting bricks at the moment. And if the usage of medicare is expanded, and EVERYONE is covered, I imagine that it would take less paperwork to try and get approved for medicare. I'm not sure how HR686 is worded, so it might only cover citizens and exclude our second class citizens, but that would be odd. And I imagine there's still paperwork to prove that what they did was really needed. Maybe it's worse than whatever deals they have with the insurance companies, but I can't imagine it's less corrupt. But that's entirely because I have zero faith in insurance companies.

But hey, if too many doctors/hospitals/whatnot decide that the gravy train of private insurance is too good to let go of, then the idea of publicly funded/privately distributed might indeed need to change to publicly funded and distributed. I see that as a viable option on the table. If it's just that the paperwork is too much, well, that's something we would need to improve and streamline. As long as corruption and fraud doesn't become a problem. No one said this was a simple problem to fix, and anyone telling you their solution is perfect is full of shit.

I posted this elsewhere, but its entirely relevant to most discussions on here -

In 2010 (year picked because figures are unlikely to be revised), the UK spent £118.2Billion on the NHS, for a population of about 63Million persons.

Thats a per population head equivalent of £1906 or $2954.

In that same year, the US spent about $381Billion on Medicaid and about $509Billion on Medicare - both of which highly intersect with what the NHS provides, for a population of about 311.5Million persons.

Thats a per population head equivalent of $2858.

Except the US Medicare and Medicaid programmes don't cover 311.5Million persons - Medicaid covers roughly 50Million persons, and Medicare covers roughly the same number - theres about a 6Million person intersection between the two (persons that are enrolled in both), so, again roughly, the total number of beneficiaries for these federal and state programmes is around 94Million.

That makes it a per eligible head equivilent of $9469.

And you know which system I would rather have? The one I currently use - the NHS at $2954.

The US system is just very very badly run.

Sources:

http://www.gao.gov/highrisk/risks/insurance/medicaid_program.php
http://www.gao.gov/highrisk/agency/hhs/reforming-medicare-payments.php
http://www.kff.org/medicare/upload/7305-05.pdf
http://en.wikipedia.org/wiki/Medicaid
http://en.wikipedia.org/wiki/Medicare_(United_States)

You're completely delusional. My relatives in Ireland, England, and Australia have much better healthcare than we have here in the US. They don't have to waste ages filling out forms; they just get care because they are citizens. And you know what? They pay less for their healthcare than we do.

Yes, you heard that right: we pay as much in taxes for Medicare & Medicaid as they do for universal healthcare. Plus, on top of medicare/medicaid, we also pay private insurance. Here's a breakdown of how we pay through the nose for our stupid healthcare system.
http://www.kff.org/insurance/snapshot/oecd042111.cfm

We should stop paying private companies and make Medicare universal. There's no reason healthcare in the US should be so miserable. If you still want a private plan, great, but stop making me pay twice what my cousins pay.

Oh, and by the way, Australia is not a depressed economy. And no, doctors don't consider quitting over "Obamacare". Creating a phony survey isn't the same as actually doing real work:
http://mediamatters.org/blog/2012/07/10/comically-awful-survey-says-83-percent-of-docto/187029

From http://www.kff.org/healthreform/upload/8168.pdf. (Note that FPL is "federal poverty level").

138% FPL - Medicaid
* No premiums
* Cost sharing limited to nominal amounts for most services

139%250% FPL - Exchange
* Sliding scale tax credits limit premium costs to 38.05% of income.
* Sliding scale costsharing credits

251%400% FPL - Exchange
* Sliding scale tax credits limit premium costs to 8.059.5% of income.
* No cost sharing credits

I am surprised and disappointed by this ruling. But not for the reasons you might expect.

I want the US to have universal health care, but I think the mandate was a back-asswards way of getting it and I dont think it will be successful.
It would have been far better to just make it a tax. This mandate only helps the health insurance industry slow its inevitable downward spiral.

Accoding to a 2007 study by Kaiser Permanente, http://www.kff.org/insurance/7692.cfm
Healthcare spending has risen steadily and has outpaced wages. This means that less and less people can afford healthcare, and in turn less people will be purchasing insurance. Of course this is cyclical, since with less people buying insurance, the insurance sompanies will ahve to increase their premiums.
And so the health insurance industry is already in a downward spiral that will eventually collapse.

I fear that the health insurance mandate will not stop this downward spiral, since it will be less expensive for healthy people to just pay the fine than to buy insurance. Eventually, the US government will have to intervene.

Taxpayers already pay for a large percentage of the populations medical services. If you count Medicare, Medicaid, Federal, State, and Local governments, that makes up over 100 million users, or 30% of the population. As less people can afford healthcare, the government will be shouldering a higher percentage.

Dont fool yourself. You are paying for this one way or another. Either by taxes, or by rising insurance costs. If your company is paying the premiums, you may want to ask them why you did not get a raise this year and they will tell you it was eaten up by premiums. insurance is after all a 'tax' that you pay in order for 'services' to be available when you need them. The healthy people end up paying for the sick people with chronic problems caused by obesity, diabetes, heart disease, lung and liver diseases, all could be prevented by good diet, exercise, and staying away from drugs, alcohol, tobacco, fat, and sugar. How does that make you feel when your hard earned dollars are going to pay for someones lung cancer treatment who has chain-smoked for 20 years?

Not that I am bitter or anything. i paid more for health care in the last 5 years than I did in taxes. The last 2 years I paid more in health care than I did for my mortgage. And that is with an employer sponsored plan and a healthy family. But the good news is that this will HAVE to change. We know it and there is a clear path to where we need to go. In the next 5-10 years we will have universal healthcare whether we vote for it or not.

Increase the premium contributions for those receiving subsidies annually to reflect the excess of the premium growth over the rate of income growth for 2014-2018. Beginning in 2019, further adjust the premium contributions to reflect the excess of premium growth over CPI if aggregate premiums and cost sharing subsidies exceed .54% of GDP.

Provisions related to the premium and cost-sharing subsidies are effective January 1, 2014. Cost-sharing subsidies Provide cost-sharing subsidies to eligible individuals and families. The cost-sharing credits reduce the costsharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of the basic benefit plan to the following percentages of the full value of the plan for the specified income level:

100-150% FPL: 94%
150-200% FPL: 87%
200-250% FPL: 73%
250-400% FPL: 70%

This is why Congress passed the Patient Protection and Affordable Care Act in 2010. This law "[p]rohibits individual and group health plans from placing lifetime limits on the dollar value of coverage, rescinding coverage except in cases of fraud, and from denying children coverage based on pre-existing medical conditions or from including pre-existing condition exclusions for children. Restricts annual limits on the dollar value of coverage (and eliminates annual limits in 2014)[.]" It also "[c]reates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months." The guaranteed availability of insurance provision will be implemented in 2014.

You should check to make sure that your insurer is not imposing an annual limit lower than what is allowed. As of 2014 they won't be allowed to have one at all.

Check it out.

Reality seems to contradict you. The US healthcare system is neither cheap (most expensive on the planet) nor efficient/good (usually towards the bottom of the list when ranking 1st world countries). In contrast, many of the cheapest and best systems for healthcare are either national healthcare systems (e.g., Canada and UK) or hybridized systems (e.g., the Netherlands).

Medicaid doesn't actually pay for anything not related to medical care. There are multiple agencies one has to deal with, HUD, Social Security etc...

Here is a link that shows what is covered by medicaid state by state. Medicaid Benefits: Online Database

Capitalism makes things cheaper. Blame something else.
Per capita, the United States spends more money on healthcare than any other country in the world. The country paying the second most is Norway. The US spends 50% more money per capita than Norway. The US ranks 36th in longevity. The majority of countries which have longer longevity than the US have per-capita healthcare costs that are less than half of what the US pays.
Per-capita healthcare costs by country: http://www.kff.org/insurance/snapshot/OECD042111.cfm
Longevity by country: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

The idea that capitalism makes things cheaper is *generally* true, but it's certainly not true in all cases. There are plenty of reasons that things can be cheaper or more expensive. In general, people don't want to go cheap with their healthcare, for fear of the repercussions. This makes it a sellers market, even when spending half as much produces the same or almost the same results. And there are plenty of other reasons why US healthcare is so expensive.

That's an awful lot of talk just to say that you think people should have access to a very high level of health insurance and care and that somebody else should pay for it. I grant that society has determined that everyone should have a basic level of health care paid for by someone else. But even in the countries which are claimed to have good health care systems, the cost of these systems per GDP has gone up significantly over the past few decades.

Personally, I think you should be embarrassed for providing such pathetic arguments for both addressing conflicts of interest and characterizing what people want. You can't "avoid" or "cancel" fundamental conflicts of interest (such as virtually every health care expert has an interest in the outcome of public health care policy). I don't advocate dropping an issue because everyone has a stake in it, far from it. But misunderstanding critical basic concepts doesn't help your case.

And the bottom line on a standard of health care is that the standard is fundamentally arbitrary. While scientific considerations may be able to rank treatments or patients by some ordering of viability or cost, how much public funds we should spend on health care, is fundamentally a political not scientific issue, So your blathering on backgrounds in health care, some flavor of crackpot economics, and the vague "guidelines," doesn't go one step towards justifying any level of public spending on private health care.

http://www.kff.org/uninsured/upload/7651.pdf

Small percentage of the uninsured.

http://www.jpands.org/vol10no1/cosman.pdf

Takes a guess, gets lucky, comes up with the same small percentage.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

You do realize that says that the federal government is paying for anything not covered by insurance for illegal aliens, right? Which means that any ER that has those costs can file a form to the feds and get their money back, right? Which means that I was wrong. Illegals are not a tolerably small portion of the costs of an ER. They are zero cost to the ER, and the way hospitals are run by grifters they are possibly a huge profit center for ERs. Clinic vists cost very little, and the ER can bill the government their usual profit-bloated price.

So I was right. No ER has ever closed down because of illegal aliens using them as clinics, because no ER should be losing money on them.

http://www.jpands.org/vol10no1/cosman.pdf
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
http://www.kff.org/uninsured/upload/7651.pdf

As I noted several times, I never said they were the sole reason, but one of the factors. And I also never said that denying them care was the right reaction. The contrary I diagnosed the issue as being their lack of access to other forms of health care.

Sounds to me like you're grasping at straws there. Regardless of the reasons for a shortfall a hospital will have to raise the rates on those who do pay to remain solvent. Here's a couple more links on the cost of the uninsured.

From a 2009 article Do Your Premiums Help Cover the Uninsured?.

What the new study suggests, though, is that providers often pass along the cost of treating the uninsured to their insured patients. Its analysis found that families pay, on average, as much as $1,100 extra and individuals $410 extra in health-care premiums each year in order to cover the cost of treatment to uninsured patients who cannot afford to pay their bills.

This page has links to a 2003 Kaiser Family Foundation study on the issue. I particularly direct your attention to "Link to full report, Who Pays and How Much? The Cost of Caring for the Uninsured". It's 7 years old but I imagine it still pretty much accurate if you account for the cost inflation in medical care and the increase in the numbers and percentage of the population that is uninsured.

Sounds to me like you're grasping at straws there. Regardless of the reasons for a shortfall a hospital will have to raise the rates on those who do pay to remain solvent. Here's a couple more links on the cost of the uninsured.

From a 2009 article Do Your Premiums Help Cover the Uninsured?.

What the new study suggests, though, is that providers often pass along the cost of treating the uninsured to their insured patients. Its analysis found that families pay, on average, as much as $1,100 extra and individuals $410 extra in health-care premiums each year in order to cover the cost of treatment to uninsured patients who cannot afford to pay their bills.

This page has links to a 2003 Kaiser Family Foundation study on the issue. I particularly direct your attention to "Link to full report, Who Pays and How Much? The Cost of Caring for the Uninsured". It's 7 years old but I imagine it still pretty much accurate if you account for the cost inflation in medical care and the increase in the numbers and percentage of the population that is uninsured.

Just thought I'd throw in another data point (sorry, PDF), for what it's worth. I'd also like to point out that among those who dislike the bill, there are some who dislike it because they don't think it goes far enough - however, some political commentators try to paint all dissatisfied people as being against any health care reform at all. It's just not that simple, even though we might wish it to be.

I'd like to point out that health care costs are growing exponentially in almost all developed nations, and in fact faster than GDP which is already exponential. The US simply started higher than most and has grown more strongly than the others that started out near the same level. http://www.kff.org/insurance/snapshot/chcm010307oth.cfm http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

In the long run, socialized medicine in other countries will begin to encounter the same expense problems as the US if they cannot curb the growth of their own health care expenses.

By the way, from that second article: I wonder why US health care spending surged during the 70's oil crisis, the late 80's-early 90's recession, and just after the tech bubble burst. There's probably an important relation there.

I need a bit more explanation than this.

Take for example this Medicare thing. It seems about 35-40 million Americans depend on it.
http://www.kff.org/medicare/upload/7305-04-2.pdf

I suppose for most of them, they would not survive without this support.

Given that apparently a large part of the USA populace is in favour of cutting Medicare spending, does this mean that they would like to see these 35 million or so people die?

That would be about 1 in 7 Americans, probably a lot of them children and elderly, who are not able to provide for themselves trough a paying job?

Or am I not understanding this Medicare program, and is it mainly spent on cosmetic surgery or something?

They might still be smiling since they'll get their face fixed for less than it will cost you after they smash your face in retaliation.

Compare how much the US is spending per person with the other countries:

http://www.forbes.com/2009/07/02/health-care-costs-opinions-columnists-reform.html
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita

And the average US citizen isn't getting better health care for all that spending.

That said, healthcare costs are increasing in many countries.

It's too easy for politicians to try to spend the money of future generations to win the votes of today's voters.

I think there should be a limit on how much public money each person gets for healthcare. A quota that depends on how rich the country is. Because as technology improves, there's going to be more and more things that can be done, but the costs for each "level" will increase way more than linearly[1].

Once you've used up your quota, you have to find the cash some other way (savings, donations, loans), maybe people should also be allowed to donate some of their quota to you if they want (subject to regulatory approval - to avoid abuse and swindling).

If you can't find enough money, too bad so sad, yes it's unfair that you have to die or stay crippled/sick, but it's also unfair to keep making everyone else pay for you past your allocated quota. And it means other people may get less as a result (which is also unfair).

Past a certain point, it becomes unfair to make others continue paying for you. Like it or not, the rest have done their fair share for you.

Some may ask, why should it be even fair for others to pay in the first place? I think it's fair to make people pay for the civilization they enjoy. To me it's uncivilized (and inefficient and crap) to have people sit in ER in order to get treatment, or even die needlessly from problems that are easily and cheaply avoided.

[1] Billionaires might be able to afford the best. Maybe in the near future there would be tech to grow replacement limbs from scratch - e.g. a batch of 1000 replacements grown, with the best one selected. A billionaire could pay for that. But a country is unlikely to be able to afford to do that for every person who wants that and still be able to provide other healthcare to others, at least not for a long time. So on the "public money" plan in a rich country, you'd just get a high tech prosthetic.

"Creating a government-administered public health insurance option to compete with private health insurance plans" has the exact same level of support. (pdf, p. 11) So needless to say, neither of these things will ever happen.

Then describe it for me. What do they gain?

Lets look at socialism in the United States.

The U.S. spends about 20% of the nations GDP.
85% of the revenue collected by the U.S. government comes from 15% of the population.
Note that that 15% also acquires 85% of the adjusted gross income after basic living expenses.
The U.S. spends that revenue on:
9% Welfare
12% Defense
14% Education
14% Pensions
16% Health
All of which are socialist in nature. The bulk of the expense is covered by 15% of the population but 100% of the population benefits.

In some areas of the economy there are worker unions where the workers acting as one attempt to guarantee better wages and benefits for all. Usually the end result is not only better wages and benefits for union members but also for other areas of employment. And before anyone starts spewing the usual anti union rhetoric I suggest doing some research on the working conditions and wages of industrial workers in the United States prior to unions. And before bringing up GM versus Toyota note that Japan is even more socialist than the United States, their government is spending 30%+ of the GDP, so breaking the unions in the United States to pay for socialism in Japan is ludicrous.

I think any socialist system in which people are free to choose their own work to self-actualize, will suffer from a labour shortage in some sector, and so either people will be forced to work in a job they don't want to in order to compensate

That is communism and I believe you are correct, it doesn't work and it creates more problems than it solves.

Communism != Socialism

They are not the same thing. Socialism is practised at varying levels in virtually every industrialized western nation. People need to get over the propaganda they've been fed for decades. You can have socialism and still have private ownership of production, free market competition, compensation based on effort, skill and knowledge, etc. I know this to be true because its being done today.

Ah, the old "capitalism is exploitation" chestnut. Contrary to popular opinion, many people actually enjoy their jobs and are not being "exploited".

Ah the old "I don't agree with this guy so I'll try some simple labels to suggest they fit in some culturally negative stereotype, communist should work."

In 1980 the average CEO compensation was 42 times the average worker compensation, today its 319 times.
That is over 600% increase in compensation.

Median household income from 1980 to 2008 in 2008 dollars increased 14%, converted to current dollars for an accurate comparison thats a 173% increase.

From 1980 to 2008 the United States GDP grew over 400%

And yet here we are in the United States arguing over basic health care for the public because 1) as a nation we can afford it and anyone who says we can't is either a liar, in denial or hasn't bothered to actually look at the numbers and 2) because we have many cases where even individuals who have health insurance end up denied coverage which sometimes results in death.

Health insurance coverage sponsored by employers has continually dropped.
From over 68% of employees covered in 200 to under 60% in 2008.

By its nature capitalism is exploitation, I know that word has negative connotations but only because in some cases exploitation can turn into victimization.

When wages of 95% of the work force are suppressed to

Affording health care services *is* the problem.

Absolutely. How health care is paid for is irrelevant compared to that it is paid for.

Government intrusion into health care is what has and is causing the price of health care to go up.

That's odd. I thought it was monopolies, and the bizarre situation where everyone along the chain passes the buck.

Doctors get paid for service, meaning the more tests and operations they perform, the more money they make. These charges get passed on the health insurer that either drops the patient, or passes the costs onto the person paying the patient's insurance premiums, typically the patient's employer. Alternately, the doctor and/or the patient's insurer pass the charges on to medicare, which picks up the tab, because its the government. The patient never gets a bill, and so demands more and more services since according his/her perspective they are free.
Bonus Round: Medicare is BY LAW forbidden to negotiate lower prices for the services it pays for because it would be "a government price control." (Funny. When I took economics, this was called "a volume discount.")

You really need to actually learn how healthcare is paid for in this country, and how it's paid for in other countries with their "damn socialist medicine" before deciding on a cause. The fact that the US spends multiples what other OCED countries spend (16% GDP versus 10% GDP) with increases greatly outstripping inflation, while the US is 15th in life expectancy the only metric for effectiveness of healthcare that we should care about. After all, it's about living longer, healthier lives.

Clearly government involvement isn't the problem. In fact, evidence indicates that the lack of government involvement is the problem. Since everyone else has lower costs, and better health, than the US, and that's the common factor between the rest of the OCED that's lacking in the US.

And, while we are at it, fix unfunded mandated benefits of Social Security and Medicaid, which are currently 58 TRILLION in the hole.

[...]

The government *must* not ever be put into a situation where promised benefits are mandated to the point of bankrupting the country.

Wait. I thought you wanted to stop the government from paying anything. Make up your mind!

You can change the medical situation in america without government intervention.

Those with pre-existing conditions can't, and besides as a country the US can't afford to keep spending more for worse care.

Which will result in everyone getting another shitty government ran mess.

Yeah the government can't do anything right, that's why i only drive on private roads, i hire personal body guards because the police are useless and when my house burns down I'd rather use buckets of water than call the incompetent fire department!

I know people from other countries that have come to get american health care.

There are worse places than the US, it doesn't make the system any good, just its easier to move to America and get private care (especially from south American countries) than it is to get care in countries with better systems.