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Author Topic:   Bernie Sanders is a Centerist
LamarkNewAge
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Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


Message 61 of 76 (822815)
11-01-2017 5:16 PM
Reply to: Message 60 by Taq
11-01-2017 1:35 PM


Re: Combo reply (to RAZD and Coyote)
quote:

This was the problem with the ACA markets. They were burdened with a disproportionate number of sick people. The same could happen to California if they don't use rules for acquiring residency, or something of the sort.

The ACA wanted younger people to pay insurance companies premiums, and many choose not to.

I don't think it was an issue of very sick people buying insurance. (there was a preexisting condition coverage issue, but that does not seem like the same thing you are saying)

California could have a 9.1% payroll tax (or 4.5% by an employee and 4.5% ,matched by the employer) and the remaining 4% of GDP(not 3.5% as I said earlier) to pay for the (amount presently unfunded by existing federal and state money used for California health care) collective pooling would be funded.

I don't want the income tax to be the main funding driver however. Whatever is settled on should be flat and across the board (not just on the rich because the upper 1% or 2% won't be able to be taxed alone without hurtful economic consequences). Everybody should pay the same income tax rate that is settled on. I would try to keep the income tax increase no higher than 4%, and spread out the other $53 billion across all the other taxes (property, sales, snack, gas, tobacco alcohol, hotel, etc.).

quote:

The very sick are usually not employed or retired, and they make up a large percentage of overall healthcare costs in any system. Something like 85% of your lifetime healthcare costs occur in your last 5 years of life.

California won't need to have rules much different than current Medicaid programs have. Or any different at all.

Why would those types of people get any benefit moving to California?

Edited by LamarkNewAge, : No reason given.


This message is a reply to:
 Message 60 by Taq, posted 11-01-2017 1:35 PM Taq has responded

Replies to this message:
 Message 62 by Taq, posted 11-01-2017 5:58 PM LamarkNewAge has responded

    
Taq
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Posts: 7263
Joined: 03-06-2009
Member Rating: 3.2


Message 62 of 76 (822821)
11-01-2017 5:58 PM
Reply to: Message 61 by LamarkNewAge
11-01-2017 5:16 PM


Re: Combo reply (to RAZD and Coyote)
LamarckNewAge writes:

The ACA wanted younger people to pay insurance companies premiums, and many choose not to.

I don't think it was an issue of very sick people buying insurance. (there was a preexisting condition coverage issue, but that does not seem like the same thing you are saying)

Before the ACA, the uninsured were made up of a lot of people who were denied insurance and couldn't get it through their job. Once those markets were opened they were catering to a demographic that was disproportionately old and sick. It was very much about very sick people entering the insurance market, as well as people in rural markets where there was no competition between hospitals and therefore higher prices.

Regardless, if you have a single payer system then you are going to attract people who are too sick to work and kids with chronic conditions. People are going to be faced with tens of thousands in medical bills in Iowa or moving to California and paying a tiny, tiny percentage of what they are currently paying. It's a no brainer. You could even have situations where the mother moves with a sick child to California while the father stays in Iowa and keeps working.

Edited by Taq, : No reason given.


This message is a reply to:
 Message 61 by LamarkNewAge, posted 11-01-2017 5:16 PM LamarkNewAge has responded

Replies to this message:
 Message 63 by Modulous, posted 11-01-2017 6:45 PM Taq has responded
 Message 64 by LamarkNewAge, posted 11-01-2017 8:23 PM Taq has responded

  
Modulous
Member
Posts: 7501
From: Manchester, UK
Joined: 05-01-2005
Member Rating: 1.9


Message 63 of 76 (822823)
11-01-2017 6:45 PM
Reply to: Message 62 by Taq
11-01-2017 5:58 PM


Re: Combo reply (to RAZD and Coyote)
Regardless, if you have a single payer system then you are going to attract people who are too sick to work and kids with chronic conditions. People are going to be faced with tens of thousands in medical bills in Iowa or moving to California and paying a tiny, tiny percentage of what they are currently paying. It's a no brainer. You could even have situations where the mother moves with a sick child to California while the father stays in Iowa and keeps working.

I've seen amusing figures for Health Tourism in the UK that suggest the NHS spends more money on Stationery than it does on Health Tourists. Perhaps California might take a look at how other places deal with this phenomena?

https://www.surreyandsussex.nhs.uk/...sident-UK-Citizens.pdf


This message is a reply to:
 Message 62 by Taq, posted 11-01-2017 5:58 PM Taq has responded

Replies to this message:
 Message 65 by Taq, posted 11-02-2017 11:42 AM Modulous has responded

    
LamarkNewAge
Member
Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


Message 64 of 76 (822825)
11-01-2017 8:23 PM
Reply to: Message 62 by Taq
11-01-2017 5:58 PM


Re: Combo reply (to RAZD and Coyote)
quote:

Before the ACA, the uninsured were made up of a lot of people who were denied insurance and couldn't get it through their job. Once those markets were opened they were catering to a demographic that was disproportionately old and sick. It was very much about very sick people entering the insurance market, as well as people in rural markets where there was no competition between hospitals and therefore higher prices.

Regardless, if you have a single payer system then you are going to attract people who are too sick to work and kids with chronic conditions. People are going to be faced with tens of thousands in medical bills in Iowa or moving to California and paying a tiny, tiny percentage of what they are currently paying. It's a no brainer. You could even have situations where the mother moves with a sick child to California while the father stays in Iowa and keeps working.


California has a bit more than 12.0% of the nations population.

Outside of California, fully 20% are on Medicaid already.

My numbers and logic are about to get very rough, but bear with me.

That leaves 68% who might possibly have something to gain by moving to California. (I suppose it depends on what kind of benefits the Medicaid program has in the home state the beneficiaries live in)

But, can't they get the most generous Medicaid benefits in New York? (Is California not matched in benefits in other places too?)

Do they really have to go to California?

But away from single payer programs, and lets get to the ACA.

A lot of people already had insurance before the ACA. The majority of the (net) 10-12 million or so of people covered nationwide by the ACA changes are Medicaid enrollees. Not too much has changed in the insurance marketplace (net) enrollee numbers.

On a net level, insurance companies are making profits. The fact that profits are spread over many different companies nationwide means that no individual company is reaping the entire reward of all the net profits. Too many hands in the cookie jar, but it is the insurance profiteers that are the ones that we need to catch red handed (not the consumers).

Speaking of the net situation, I doubt that the overall "cost" to California will be very negative when you consider all the forces that draw outsiders into the state. Heck Medicaid keeps adding enrollees, but the federal cost isn't projected to reach 3.0% of GDP by even so distant a date as 2050 (it will go from 1.8% today to 2.7% by 2047). 75 million today. Over 85 million around 2025.

I just don't consider the macro-economics harmful. Medicaid only is "harmful" because it strongly encourages a "spend down" of assets (the ACA might have changed that, but I'm not sure) and a move away from working most full time jobs(or from working at all). Families get punished for marriage too.

Universal Single Payer (especially "free stuff" for ALL - rich or poor) solves that problem.

Health consumers benefit and just have a lot to offer an economy hungry for growth.


This message is a reply to:
 Message 62 by Taq, posted 11-01-2017 5:58 PM Taq has responded

Replies to this message:
 Message 66 by Taq, posted 11-02-2017 11:53 AM LamarkNewAge has responded

    
Taq
Member
Posts: 7263
Joined: 03-06-2009
Member Rating: 3.2


Message 65 of 76 (822837)
11-02-2017 11:42 AM
Reply to: Message 63 by Modulous
11-01-2017 6:45 PM


Re: Combo reply (to RAZD and Coyote)
Modulus writes:

I've seen amusing figures for Health Tourism in the UK that suggest the NHS spends more money on Stationery than it does on Health Tourists. Perhaps California might take a look at how other places deal with this phenomena?

The situation in the UK is a bit different since they are surrounded by countries who have single payer systems like they do. It is also much more difficult for non-citizens to gain residency in the UK than it would be for someone to move from one US state to another. However, I would be quite pleased if someone proved me wrong because I would love to see a state based single payer system work and thrive in the US.


This message is a reply to:
 Message 63 by Modulous, posted 11-01-2017 6:45 PM Modulous has responded

Replies to this message:
 Message 68 by Modulous, posted 11-02-2017 6:32 PM Taq has not yet responded

  
Taq
Member
Posts: 7263
Joined: 03-06-2009
Member Rating: 3.2


Message 66 of 76 (822839)
11-02-2017 11:53 AM
Reply to: Message 64 by LamarkNewAge
11-01-2017 8:23 PM


Re: Combo reply (to RAZD and Coyote)
LamarkNewAge writes:

A lot of people already had insurance before the ACA. The majority of the (net) 10-12 million or so of people covered nationwide by the ACA changes are Medicaid enrollees. Not too much has changed in the insurance marketplace (net) enrollee numbers.

"Indeed, only 28% of exchange members in 2014 were in the coveted 18-34 age range, and that percentage stayed level for 2016. It's below the 40% level many actuaries say is needed to create a more stable rate environment. The insurance industry has a name for that condition, which Obamacare was designed to fight. It's called adverse selection. And so far, the ACA's medicine isn't working."
http://www.modernhealthcare.com/...160514/MAGAZINE/305149980

So it appears that young healthy people are not entering the markets while the older and sick are. That is a problem, one not faced by employer based insurance where all employees are enrolled.

Speaking of the net situation, I doubt that the overall "cost" to California will be very negative when you consider all the forces that draw outsiders into the state. Heck Medicaid keeps adding enrollees, but the federal cost isn't projected to reach 3.0% of GDP by even so distant a date as 2050 (it will go from 1.8% today to 2.7% by 2047). 75 million today. Over 85 million around 2025.

That expansion in Medicaid was based on income and not health, so you are going to get a lot of young and healthy people enrolled when you expand Medicaid. That helps. The ACA marketplaces are catering to people who don't qualify for Medicaid, and without much of an incentive for young healthy people to enroll you get a lot of people with chronic conditions enrolling in those marketplaces.

However, I'm not an expert by any stretch of the imagination. These are just some of the concerns I have with such a program, but I really hope it works.


This message is a reply to:
 Message 64 by LamarkNewAge, posted 11-01-2017 8:23 PM LamarkNewAge has responded

Replies to this message:
 Message 67 by LamarkNewAge, posted 11-02-2017 3:53 PM Taq has not yet responded

  
LamarkNewAge
Member
Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


Message 67 of 76 (822854)
11-02-2017 3:53 PM
Reply to: Message 66 by Taq
11-02-2017 11:53 AM


Re: Combo reply (to RAZD and Coyote)
NoNukes said:

quote:

"Indeed, only 28% of exchange members in 2014 were in the coveted 18-34 age range, and that percentage stayed level for 2016. It's below the 40% level many actuaries say is needed to create a more stable rate environment. The insurance industry has a name for that condition, which Obamacare was designed to fight. It's called adverse selection. And so far, the ACA's medicine isn't working."
http://www.modernhealthcare.com/...160514/MAGAZINE/305149980

So it appears that young healthy people are not entering the markets while the older and sick are. That is a problem, one not faced by employer based insurance where all employees are enrolled.


Here is text from your article.

quote:

Before 2014, health insurers could charge enrollees more based on their medical history. They could even deny coverage if someone had a pre-existing health condition. Preventing discrimination based on health status has been one of the law's most popular provisions and is favored by most Americans.

However, taking all enrollees requires younger, healthier and wealthier people to pay the healthcare costs of older and sicker patients. It's a core requirement if the country's fragmented health insurance marketplace—where every employer forms a group no matter what the demographics of its workers, and every individual or family without coverage is thrown into the same pool—is going to work.

Adverse selection reared its ugly head from the start. The colossal technological failures of the federal HealthCare.gov site and some state ACA exchanges during the initial open enrollment resulted in only 106,000 people selecting a plan in the first month.

“Who do you think was willing to wait three to five hours or try three or four days to get on? They were probably the people who needed medical care the most,” Roy Goldman, a former chief actuary at Humana, said of the botched rollout. Approximately 6.3 million Americans had signed up and fully paid their ACA premiums by the end of 2014.

http://www.modernhealthcare.com/...160514/MAGAZINE/305149980


Here is something to consider.

(article is titled, Democrats Have Given Up on Private Health Care Markets — and for Good Reason by Jon Walker, October 8 2017, 9:50 a.m.)

quote:

This is critical because the only way to create a universal health care system without automatically enrolling people in public insurance is to aggressively force individuals to buy or maintain private insurance. This requires a society that sees maintaining coverage as a true social duty and a country willing to heavily enforce an individual mandate with big fines. The Swiss system earned its broad public legitimacy when voters approved it in a national referendum. In Switzerland, lying about having coverage can result in prison time.

The Republicans’ years of attacking the individual mandate makes turning it into a broadly accepted social duty difficult. And, with 66 percent of the public opposed to our weak individual mandate, it would likely take a bruising political fight for Democrats to push for a dramatically stronger individual mandate that could result in prison time. Even if Democrats did, it would be easy for a Republican president to undermine it administratively like Trump is doing now to the current mandate.

On the other hand, the expansions of public programs like Medicaid have gone very well, at least in states where Republicans haven’t prevented it. These programs are significantly cheaper, easier to implement, and more popular. The public strongly supports the ACA’s Medicaid expansion: 84 percent believe it is important to continue to fund it. Surveys show that on average people who received Medicaid through the expansion are more satisfied with their coverage and more likely to rank their coverage as excellent than those who bought private coverage on the new exchanges. People who have exchange coverage actually envy those with Medicaid.

https://theintercept.com/...democrats-public-private-markets


The fact of the matter is that Bernie Sanders was right to push for single payer.

Who wants to pay 6% of their income for a high deductible ($6000 high) Bronze plan which will eventually (after individuals pay the entire $6000) only pay 60% of covered benefits?

Or 12% for a Silver plan which also has a lot of out of pocket co-pays?

California single payer bottom line.

I still wish we could see definitively if existing California government programs and the Federal government programs spent on California are going to be $225 billion in 2017 (like the University Study I linked to) as opposed to the $200 billion number shown by the California state legislature.

The 15% payroll tax brought in $200 billion, so that means that the $106 billion additional cost (for a total of $331 billion) would be require just a bit less than an 8% flat income tax. But it only holds if the state will already have a $225 billion pot read (as opposed to $200 billion).

It could very well be just a 7.95% payroll tax (or call it a flat income tax), which is not only less than all those ACA plans, but cheaper than the 15.3% payroll tax most pay for Medicare and Social Security (and Medicare has premiums deductibles if one actually gets the benefits, not to mention big copays).

The plan could cost just $106 billion out of a state with a nearly $2.7 trillion GDP in 2017.

A 4% income tax would bring in a bit more than $53 billion, then another $53 billion would need to come elsewhere.

I hate sales taxes but perhaps a very small VAT (if only 1%) could bring in a good bit of revenue if there are no exemptions. 100% free healthcare is a big enough deal that perhaps a radical VAT can be considered(with the 1% tax being applied to food, car, and even house purchases) which perhaps can bring in over $20 billion a year (perhaps even more)?

The California state budget is presently $182 billion a year, but local taxes in the various towns and cities would bring the total up much higher. Perhaps as high as $400 billion, so a $106 billion additional cost (with additional property taxes collected at the state level) could only be 25% more in total taxes.

Edited by LamarkNewAge, : No reason given.


This message is a reply to:
 Message 66 by Taq, posted 11-02-2017 11:53 AM Taq has not yet responded

Replies to this message:
 Message 74 by NoNukes, posted 11-11-2017 9:08 PM LamarkNewAge has responded

    
Modulous
Member
Posts: 7501
From: Manchester, UK
Joined: 05-01-2005
Member Rating: 1.9


Message 68 of 76 (822870)
11-02-2017 6:32 PM
Reply to: Message 65 by Taq
11-02-2017 11:42 AM


Re: Combo reply (to RAZD and Coyote)
The situation in the UK is a bit different since they are surrounded by countries who have single payer systems like they do.

Well sure - but the numbers I've seen suggest more UK citizens go to the US to pay for private operations (both cosmetic and healthcare since they avoid waiting) than US citizens come to the UK.

It is also much more difficult for non-citizens to gain residency in the UK than it would be for someone to move from one US state to another.

If there is a potential flood that might have an impact on the economics out there - higher demand of course, will drive house prices and rent up - there remains finite places to take up residency.


This message is a reply to:
 Message 65 by Taq, posted 11-02-2017 11:42 AM Taq has not yet responded

Replies to this message:
 Message 69 by LamarkNewAge, posted 11-03-2017 11:56 AM Modulous has acknowledged this reply

    
LamarkNewAge
Member
Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


Message 69 of 76 (822909)
11-03-2017 11:56 AM
Reply to: Message 68 by Modulous
11-02-2017 6:32 PM


Re: Combo reply (to RAZD and Coyote)
quote:

If there is a potential flood that might have an impact on the economics out there - higher demand of course, will drive house prices and rent up - there remains finite places to take up residency.

We are also overlooking the forest for the trees.

California will actually have cheaper healthcare than the other 49 states, so it should be seen as a NATIONAL benefit for people to migrate to California for healthcare.

The race-to-the-bottom situation of 50 separate states competing with lower and lower income (not to mention capital gains and such) taxes could hurt California in certain ways. I said "could".

But this whole idea that some people are unworthy and harmful (like our entire immigration debate) is more economically destructive and ignorant than accurate.

Texas has politicians who like to brag about all the jobs (supposedly) created, but they are "poached" jobs. Texas spends literally 50% of its entire state budget on tax giveaways to lure existing businesses to the state (Oklahoma is number 2 at that tactic and only spends about 20% of its entire state budget). Amazon is looking for a free lunch and this nationwide trend (think Foxconn in Wisconsin) is causing tax bases to be seriously eroded for state budgets (which require lots of infrastructure spending for businesses).

California is a productive state (like New York) and the freeloader states (like Tennessee and Texas) are not the economic contributors they are often made out to be.

Texas still has 16% of its population uninsured (though it was 25% before the ACA), so let poor Texans find a way to productive states (like California) so they can add to the nations GDP (and lower the total healthcare costs of the nation).

California leads and produces.

Texas sucks (not saying it can't eventually change).

Edited by LamarkNewAge, : No reason given.


This message is a reply to:
 Message 68 by Modulous, posted 11-02-2017 6:32 PM Modulous has acknowledged this reply

    
LamarkNewAge
Member
Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


(1)
Message 70 of 76 (823243)
11-07-2017 11:58 PM


Progressive takes governorship in New Jersey with 56% of the vote.
quote:

He has promised to push New Jersey in a progressive direction, vowing to legalize and tax marijuana, institute a $15 minimum wage, tighten the state's already strict gun-control laws, and ramp up funding for education, public-worker pensions, and transportation, while protecting undocumented immigrants and fighting the agenda of President Donald Trump, a Republican.

http://www.nj.com/...ersey_governor_election_race_polls.html

This is evidence that New Jersey isn't simply a moderate Democratic state that only votes for certain (non liberal) Democrats because of the abortion issue.

A 13% win for a very liberal Democrat is actually groundbreaking in this state.

The Corey Booker win didn't seem to settle the issue, but this has.


Replies to this message:
 Message 71 by RAZD, posted 11-08-2017 7:03 AM LamarkNewAge has not yet responded

    
RAZD
Member
Posts: 19215
From: the other end of the sidewalk
Joined: 03-14-2004
Member Rating: 2.4


Message 71 of 76 (823249)
11-08-2017 7:03 AM
Reply to: Message 70 by LamarkNewAge
11-07-2017 11:58 PM


Re: Progressive takes governorship in New Jersey with 56% of the vote.
A 13% win for a very liberal Democrat is actually groundbreaking in this state.

So he ran on a Bernie Sanders / Working Families Party platform.

Wonder if the DNC is paying attention.

Enjoy


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This message is a reply to:
 Message 70 by LamarkNewAge, posted 11-07-2017 11:58 PM LamarkNewAge has not yet responded

Replies to this message:
 Message 72 by DC85, posted 11-08-2017 7:44 AM RAZD has responded

  
DC85
Member
Posts: 875
From: Richmond, Virginia USA
Joined: 05-06-2003


Message 72 of 76 (823250)
11-08-2017 7:44 AM
Reply to: Message 71 by RAZD
11-08-2017 7:03 AM


Re: Progressive takes governorship in New Jersey with 56% of the vote.
Wonder if the DNC is paying attention.

They are more likely to pay more attention to the Northam victory in Virginia as proof that the established faux "centrism" works

Edited by DC85, : No reason given.


This message is a reply to:
 Message 71 by RAZD, posted 11-08-2017 7:03 AM RAZD has responded

Replies to this message:
 Message 73 by RAZD, posted 11-08-2017 7:57 AM DC85 has not yet responded

    
RAZD
Member
Posts: 19215
From: the other end of the sidewalk
Joined: 03-14-2004
Member Rating: 2.4


Message 73 of 76 (823252)
11-08-2017 7:57 AM
Reply to: Message 72 by DC85
11-08-2017 7:44 AM


Re: Progressive takes governorship in New Jersey with 56% of the vote.
They are more likely to pay more attention to the Northam victory in Virginia as proof that the established faux "centrism" works

Indeed, the DNC doesn't pay attention to progressives, and are trying hard to get them out of the party.

Enjoy


we are limited in our ability to understand
by our ability to understand
RebelAmerican☆Zen☯Deist
... to learn ... to think ... to live ... to laugh ...
to share.


• • • Join the effort to solve medical problems, AIDS/HIV, Cancer and more with Team EvC! (click) • • •

This message is a reply to:
 Message 72 by DC85, posted 11-08-2017 7:44 AM DC85 has not yet responded

  
NoNukes
Member
Posts: 10059
From: Central NC USA
Joined: 08-13-2010
Member Rating: 1.9


Message 74 of 76 (823528)
11-11-2017 9:08 PM
Reply to: Message 67 by LamarkNewAge
11-02-2017 3:53 PM


Re: Combo reply (to RAZD and Coyote)
NoNukes said:

quote:
"Indeed, only 28% of exchange members in 2014 were in the coveted 18-34 age range

When did I say that?


Under a government which imprisons any unjustly, the true place for a just man is also in prison. Thoreau: Civil Disobedience (1846)

I was thinking as long as I have my hands up … they’re not going to shoot me. This is what I’m thinking — they’re not going to shoot me. Wow, was I wrong. -- Charles Kinsey

We got a thousand points of light for the homeless man. We've got a kinder, gentler, machine gun hand. Neil Young, Rockin' in the Free World.

Worrying about the "browning of America" is not racism. -- Faith

I hate you all, you hate me -- Faith


This message is a reply to:
 Message 67 by LamarkNewAge, posted 11-02-2017 3:53 PM LamarkNewAge has responded

Replies to this message:
 Message 75 by LamarkNewAge, posted 11-11-2017 11:56 PM NoNukes has responded

    
LamarkNewAge
Member
Posts: 978
Joined: 12-22-2015
Member Rating: 1.2


Message 75 of 76 (823533)
11-11-2017 11:56 PM
Reply to: Message 74 by NoNukes
11-11-2017 9:08 PM


Re: Combo reply (to RAZD and Coyote)
quote:

When did I say that?


You are so busy mumbling about how the Hillary Clinton couldn't possibly be (GASP - secretly!)manipulating the primary schedule with a corrupt DNC that you forgot all about this one.

You said it.


This message is a reply to:
 Message 74 by NoNukes, posted 11-11-2017 9:08 PM NoNukes has responded

Replies to this message:
 Message 76 by NoNukes, posted 11-12-2017 1:16 AM LamarkNewAge has not yet responded

    
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