"It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds." Samuel Adams

Sunday, November 23, 2014

Egregious subsidies


According to the Urban Institute as reported in USA Today, in 2016 more than 7 million people will be receiving health insurance subsidies under Obamacare. "On average, the subsidies pay more than 75% of premium costs, or about $4,700 per year." That adds up to $32,9000,000,000.00. Where will this money come from? Primarily from the taxes of people not receiving subsidies. Please help me understand this injustice, Mr. Gruber.

25 comments:

Tom said...

less than 1% of the federal budget. Big deal. Some comes from less costs in other healthcare expenses the government currently pays.

Dave said...

The percentage of the total is irrelevant; subsidies are just another name for welfare, designed to create dependency on the federal government.

tom said...

well, when you have an idea of how the common family can afford a health insurance policy of $10-12k a year, you let me know and also let your congressman know. also tell your congressman to end all the corporate welfare while you're at it.

Dave said...

Sounds as though you are admitting that the subsidies are in fact welfare payments. So I agree, let's get rid of all welfare: corporate, personal, unemployment compensation, farm subsidies, the whole bunch of it. And there are other ways to deliver and pay for health care other than all the traditional methods. Free your mind, Tom. Think creatively. Think, no government involvement, or at least minimal involvement.

tom said...

as I said...when you, Dave Huston, comes up with a solution, you tell me. I gave you my solution long long ago.

Dave said...

My solution is that everyone have a medical spending account which is opened when a child is born. Anyone can deposit money into it at any time. The money can only be used to pay for medical expenses. Perhaps a certain amount of income would be required to be deposited into it on a regular basis once a person starts working. The point is, everyone would be continually accumulating funds for medical bills throughout their lives. Most of it would get spent toward the end of life. Whatever is left over could be left to survivors. The biggest challenge would be finding a way to prevent the government from tapping into what would become an enorous amount of stored cash. In the beginning, there would need to be some kind of insurance for catastrophic circumstances, but even that may become unnecessary once the system really gets rolling.

What would be your objection to such a system?

tom said...

sounds like a mandatory tax to me. Also how can you expect someone who is making $25k a year with 1 or 2 kids to have money for rent, transportation, food, etc. and any left over for deposit into 4 accounts. Or, do we put kids to work as soon as they can walk. To me, your idea is totally unworkable. Meanwhile, what happens to the poor guy who is 30 years old and gets really really sick. He wouldn't have near enough money in any account to pay for his medical costs. Geez, when I went to the ER a few months ago, the bill was over $7k for 4 hours and some meds and tests. That alone is more than 25% of what the guy who makes $25k a year. end of life is where medicare expenses are, not necessarily total medical expenses as a whole. Go back to the drawing board.

Dave said...

Tom, you weren't listening. I said that in the beginning there would need to be insurance, especially to cover high costs. But most money is spent at the end of life, not the beginning. Plus, auto insurance can cover some medical costs when traffic acidents are involved.

For the life of me, I can't understand how on earth you figure this would be a tax. The money belongs to the individual. He either earns it or it is given to him. Charitable groups could also make contributions. Grandma and grandpa could help out if needed. It absolutely can work. It would also reduce medical costs because the consumer would once again be in control of how his money is spent. No more third-party payers once it all gets rolling.

So what's your real issue with such a plan?

Dave said...

One reason I know this plan could work is because if I had been saving all the money I have spent (or has been spent by my employers) for my health insurance over the past 40+ years, I would have somewhere between $250,000.00 and $500,000 right now. That's after deducting everything that's been spent on doctor bills for me, my wife, and my children. I can pay a lot of doctor bills with a quarter of a million. Plus, I could get a policy with a $50,000.00 deductable for peanuts.

tom said...

you said, "that everyone have a medical spending account which is opened when a child is born". You also said, "Perhaps a certain amount of income would be required to be deposited into it on a regular basis once a person starts working."The only way that happens is if it is legislated and if you are required to put money in an account, that to me is the same as a tax. What do you do to the people who don't open an account or who don't make their "required deposit"? Throw them in jail? Let them die in the street if they get sick"

You say, " Grandma and grandpa could help out if needed." Do you think everyone has a granma and grandpa, or even parents? Do you think everyone grows up with parents like ours who had money and would loan it to us as adults...knowing they would probably never be paid back? There are 330 million people in this country and not all of them are as fortunate as David Huston or Tom Huston. Where exactly would you be today if not for dad loaning you money, co-signing loans and all the other stuff he did for his children. How many Bill Huston's do you think are out there? And if you think non savings it's all because of a lack or personal responsibility or religion, then you really need to get out some. It's tough out there for a lot of people.

I am glad you have good health. I am glad I have good health. But that doesn't mean the guy next door to me has good health. He could sock money away for ten years and have it drained just like that for one appendectomy.

You still need to tell me how the guy who makes $25k is suppose to sock money away. You can say if you had been given the money you spent on insurance, you would have all this money today, but you don't know that for sure. One....who says employers would ever give you their share of insurance to you in your paycheck as cash? I don't believe that they would. Nor do you know if you would not have taken that "insurance" money of 30 years ago and done something different with it and not saved in a special account for that medical day to come. I never felt I needed insurance until 90 days ago, since I never get sick.

Again, when the private sector fails to adequately provide for the people, then it is governments job to step in and try to fix the problem. Obamacare is a crappy kind of fix, but until enough people realize that universal healthcare is the fix along with each of us paying a little more in taxes to pay for it, then we have what we have. :)

and by the way.....MSAs are just another way to reduce one's tax liability today.

When we adopt something like this, then we are making some progress in this country.

http://hcfatcalculator.azurewebsites.net/CompareCoverages.aspx?strContrib=33

Dave said...

You're pulling a John Roberts on me by changing the meaning of the word "tax." Taxes go to the government; this money would go into a privately held medical spending account. Whatever I put in would continue to be my money under my control. It's just that I could only use it for medical expenses. You know, Tom, for a smart guy you sure are closed-minded at times.

The whole system rests on the reality that over half of the money spent on medical care is spent in the final three months of a person's life. We pay into the system all our lives in the form of insurance premiums and then collect at the end. That's how it goes for the vast majority (which is why Obamacare is an effort to force people to start paying in when they're young and healthy). I'm simply saying, instead of paying the money to insurance companies, let's just save it up and make our own choices as to care, who will provide it, and where it will be obtained. Now I realize there are a lot of practical details that would have to be worked out to make this work, but stop being so closed to the idea in principle.

When I was in Jordan in 1996, my guide told me they did not have health insurance. If someone needed medical care, they simply paid or their family paid. If the family couldn't handle the bill, then the whole neighborhood pitched in and helped pay it. Why would it be so unreasonable for local organizations to raise funds that would be placed in the individual health accounts of the less fortunate. I can see that happening. Even if we let the government deposit money into someone's account, it would still be under the control of the individual, not the government, which is a big part of the objective, regardless where the money comes from.

Futhermore, there would be a lot fewer people living in poverty if we would get rid of this moral welfare state and stop encouraging people to become dependent on the government. It is NOT the government's job to step in when the private sector isn't performing. The government needs to get out of the private sector's way so it can thrive and everyone can become more prosperous.

Your closed-minded attitude and negativity is why we are not getting much innovation in this area. So many people seem to only be able to think in terms of insurance (someone else paying the bills). The worst thing that could happen to American is a single-payer government controlled system. Youi think healthcare is expensive now, just wait till be get that.

tom said...

The worst thing that could happen to American is a single-payer government controlled system. Youi think healthcare is expensive now, just wait till be get that.

and I am sure you have stats to back that up. If the government dictates that you are required to deposit X amount of money into an account, that is just like a tax. Doesn't matter whether you keep the money for yourself or not. It is money you might be able to use for something more pressing than possible healthcare down the road. That's one of the complaints many have with Obamacare....dictating you must have insurance. There is no difference other than an MSA being tax exempt.

I suggest you go study some history on how things were when we were a laissez faire government. Like I wanna live like Lebanese live. No thanks.

I suggest you go out in the real U.S. world and talk to real people.

I don't think I am nearly as closed minded as you are big brother. I truly try to look at all sides and ascertain what is fact vs. fiction and what ideas might have merit and may work versus wishful thinking.

Dave said...

Tom, you are completely closed to new ways of thinking about how health care is delivered to Americans. I'm just proposing one possibiliy, and you have rejected it off-hand without engaging in any meaningful discussion. You make it very difficult to discuss my ideas when you change the ordinary meaning of words such as "tax." In your effort to reject my idea you have totally missed the essence of it. It's a plan based on the reality of how we pay for heath care (just like our current system), but it removes a large amount of government control, it empowers the people to make their own health care decisions, it brings competition into the health care marketplace, and it eliminates the immoral practice of forcing one segment of society to pay for the health care of another. What's so bad about all that?

Tom said...

This from your original post. "Where will this money come from? Primarily from the taxes of people not receiving subsudies. Please help me understand this injustice, Mr. Gruber."

So I received my property tax bill the other day and on it around 50% of my tax bill pays for the local schools. I have no children using those schools. Matter of fact, I have only seen about 4 kids in this neighborhood. I don't go to school. Is that fair to tax me for local schools?

Please help me understand this injustice, Mr. Huston.

Dave said...

It has long been a premise in this country that having an educated populace is in everyone's best interests. Therefore, everyone kicks in to provide free public education. I do not entirely agree with this view. I believe there ought to be tax credits for parents who send their kids to private school or who home school. I also believe that citizens over 65 or so should be exempt from any further school tax. This is why you should elect me as emperor of the United States.

Having said all that, your analogy does not work. People who don't drive have to pay for roads they will never drive on. There are many things we pay for with our taxes that do not directly benefit us personally. There may or may not be some kind of distant indirect benefit; nevertheless, we all chip into a common pool to accomplish projects we could not accomplish as individuals. That's how societies work. But that is not the same as taking money from one citizen and using it to pay the personal expenses of another. That practice is little more than legalized theft.

Dave said...
This comment has been removed by the author.
Tom said...

actually, I believe seniors should have their tax money go towards the schools. The schools are for the good of our society. Tax credits for private and home schooling? No way. That's an individual choice parents make. They should not benefit from that choice as long as their is public option available to them. IT is their responsibilty just as much as mine to support public schools.

Dave said...

Spoken like a true statist.

tom said...

Emperor Dave,


Just to show I am not entirely closed mind to your MSA idea I gave it some thought. To expand upon your idea and for it to possibly work here are some thoughts of mine.

1. you can have multiple MSA’s. Your parents can open one at birth if they are so inclined and able. They can make after tax deposits to it.
2. Employers must open accounts when they hire you. The employee can choose how much after tax dollars to put in each pay period. Not sure if a fixed minimum % should be part of the law or not. Whatever it is, it’s after tax.
3. Most people change employers throughout their career. New employer, new account, but you are allowed to rollover from previous accounts if you so choose. Much like you do for 401k’s.
4. IN these employer initiated accounts, they choose who administers the account, again, just like the 401k’s.
5. You can tap the account for any Dr. visit,prescription, etc. for any family memember, but not for over the counter stuff like aspirin and such.
6. A big part of the ACA is wellness visits. Part of this new law, you get one wellness visit a year courtesy of the government. Someone else can figure out what that wellness visit entails. Drs. would bill the government directly (much like medicare) for that one a year wellness visit.
7. Earnings within your MSA are tax free. Much like a Roth IRA.

Undecided, but I lean towards employers making a one time, at time of hire, contribution to this account of X amount of dollars. They in turn are under no obligation to provide insurance. IF they provide insurance, no contribution required. Obviously there needs to be some kinda phase in/out period.

I am concerned that this would give wall street of whole new pool of money to gamble with, so I would like to see even more regulation of what these shysters do and much more transparency on what their fees are…..NO HIDDEN FEES!!!!!!!

This might work, but I still don’t think one can save enough money over time, especially if one gets sick one or two or more times. A rise in min. wage would be required. Enough for it to some kind of “liveable” wage. I just don’t think anyone making $8 an hour can afford to save in a medical account.

Off to the golf course now.

Dave said...

Tom, I'm impressed that you have actually given my idea some serious thought. I admit I don't have all the details nailed down. The transition period from what we have now would be tricky. But the basic system is built around the reality that for most people, most of the spending is at the end of life. We simply need to figure out how everyone can save for end of life care and how the exceptions to the rule can be handled. This is where insurance will come in. But it will be more like auto insurance, covering the exceptional events, not the routine maintenance.

tom said...

The last time congress tried to address end of life issues, conservatives accused them of wanting to kill granma, so don't expect anything from them.

Your last reply kinda shows how unworkable in the real world this would be. Using words like the exceptions to the rule, routine maintenance. Who would decide that? Congress, HHS, insurance companies? What's an exception for one would it be for another? Routine for you may not be routine for someone else. During transition, which I think even you know would be a whole lot of years, how can you exepct one to save in a MSA and pay for insurance. The cheapest policy in SC right now is over $10k a year. That's a lot of golf.

I do wish you would tell me how someone making 10 bucks an hour has the money for a MSA?

Dave said...

OK, now you've stopped thinking again. By exceptions I only mean when someone has an expense earlier in life that surpasses what they have in their MSA. That's where insurance kicks in. We don't expect our car insurance to cover oil changes and front end alignments, and neither should we expect health insurance to cover routine check-ups and colds and broken fingers. But if a 22-year-old needs by-pass surgery, that's where insurance kicks in. Again, I don't have all the variables works out, but it is a plan that has lots of positives and ought to be considered. I'm sure others have other good ideas. The problem is when we think the answer is to be found in government. The VA debacle ought to be enough to show us that we can't rely on the government to provide us with health care. The purpose of govenment is to protect us, not provide for us.

tom said...

work out the variables and then get back to me.

The VA debacle has nothing to do with what I would like to see. I have no interest, nor am I aware that any politician has an interest in making all hospitals and doctors government institutions and employees. Universal healthcare means the government is the insurance company. Make an appendectomy in New York cost the same as one in Omaha. You hit medicare in January. Congrats. You might even like it. all the old guys I know absolutely love how easy it makes their lives.

tom said...

one more thing. Please point me to your source that an individuals out of pocket comes at the end of life care. I know it's a big chunk of the overall medicare budget. since oldsters are all on medicare.

Dave said...

Now you're putting words in my mouth. I never said that a person's out of pocket expenditures come at the end. I said that half of all spending on medical treatments come during the last 3 months of life. Obviously most of this is paid for by insurance and/or Medicare. The point is, we have a system where the largest percentage of spending comes at the end. This is not true for everyone, but it is true for a lot. It was certainly true for both of Barbara's parents. What this means is, the average guy pays into the system during his lifetime and collects the largest benefit at the end. Obviously some collect earlier and some pay hundreds of thousands into the system and never get much benefit for it. But we have to construct a national system that is built around the averages and at the same time provides for the exceptions. My proposal does that. Plus, it puts health care back into the free market and empowers citizens to make their own choices. It also converts insurance back into insurance and keeps the government's involvement to a minimum. What's not to like about such a plan?