I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: murf on January 20, 2010, 05:10:59 PM
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Would some kind American please explain your health care system especially regards dialysis patients. I know in Australia, everybody is covered for almost everything - whether PD or HD. What is the big fuss about changing your present system and why are so many people against President Obama changes to the system? Do you have to pay for dialysis and what is the score about not having health insurance?
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There's no way any American is going to be able to fully explain this, and you wouldn't want anyone to try. Trust me. This is a huge question. I'll give you my understanding of it as briefly as possible.
We have a system of Medicare (fed gov't) that covers certain people, but only at 80% (patient would pay 20% of the costs unless they qualify for further assistance) for most services, even dialysis and transplant, and the rules for getting Medicare are a bit arbitrary. Everyone over 65 is eligible. Dialysis patients and transplant patients get it automatically thanks to some relentless advocacy in the 1970s, and people who are disabled two years can often get it, but that depends on when you become disabled. If you are over a certain age when you become disabled, you need to have work credits (you need to have earned a certain amount of income in your lifetime) in order to be eligible for Medicare. If you are someone who never worked, say a stay-at-home mother, and you become disabled at 40 with cancer, sorry. Try to hang on until you're 65.
Insurance is generally group or private. What someone like me, with a history of ESRD and transplant, wants is group. Group insurance almost always comes through work, usually what we call W-2 work (a tax form, W-2 means you are an employee, not a contractor). Laws vary from state to state, the state where we live now has no mandate that employers must offer this insurance to employees. The reason that you want group is that the employer and the insurance company must offer the same deal (with minimal exceptions) to all employees (and their families) and pre-existing conditions clauses are limited. There are no health exams.
Private insurance is an excellent way to get.... uh, hosed, is the most polite word I can think of. Some of the best insurance horror stories involve paying into private insurance faithfully for years, suffering a health crisis, and then having the insurance company pore over your application documents looking for anything they can call a pre-existing condition. There is a famous story about a woman with cancer who had her insurance rescinded because she did not declare a case of acne on her application. This is what people refer to when they say "uninsurable". Private insurance companies can and do turn applicants down all the time for not being healthy enough (preexisting conditions like ESRD, or our friend who has asthma, or our other friend with persistent migraines, or....)
Almost everything must be pre-approved by the insurance company. Anyone who calls an insurance company, regardless of whether it is group or private, will hear a recorded message saying that basically they are not responsible for whatever their own reps say, and that you must wait for formal approval. This can take forever, with all sorts of delay tactics employed. Did you know that liver transplants are considered experimental? Either did I! Until CIGNA said so, and a 17-year-old in LA died. This is what we are up against.
There are other ways to pay for health insurance, and state programs, and of course, COBRA, which is what I am dealing with now (a federal law that if you are fired or quit your job involuntarily, the company must let you continue to buy into their group insurance for a certain period of time, but you will pay much, much more than the premiums that the employees pay). I don't know all of the different rules and possibilities with health insurance, and as far as I can tell, neither does anyone else. I am sure there are exceptions to everything I just wrote. It is an incredible, self-sustaining bureaucracy.
As for why Americans fear health reform, that is an equally enormous question, and I'm not exactly sure myself, since everyone I see on a regular basis, including my GP, cannot wait for the day. The people who have the most to lose from reform (insurance companies, for example) also happen to have an awful lot of money to put toward convincing everyone that it would be the end of civilization.
Aren't you sorry you asked? ;)
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Thanks for the great information but all I could really say is "what a mess". I know we complain about our health system in OZ but it just does not compare.
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If an American's employer does not offer health insurance for whatever reason (and the reason is not always that they don't want to!) then the American would need to independantly contact an insurance co and procure their own insurance. This would not then be 'group' insurance and it is very difficult to get. In the case of someone with kidney disease, not even ESRD yet they simply will not give it to you at all. So, your GFR is at 34 and dropping quick and you have no insurance. You can pay for all the testing, lab tests, medicines (even $1000/month chemo to see if it will push your membranous gn into remission) Dr visits, hospital visits, etc out of pocket if you can afford it, or (and this scenario following is for a person who works and therefor does not qualify for gov't assistance unless everyone in the entire family stops working and becomes so destitute that they cannot feed themselves, for then and only then may you be approved for gov't assistance) you can feel awful, not pay for anythng, not get any medicine or see any Drs and sit there wasting away until you think you are ESRD, go to Dr and pay for testing.......vicious circle until you finally start dialysis and THEN you are eligible for Medicare if you or your spouse have 40 work credits. This is what we have lived for 10 years. Luckily we had the money to pay everything.
Ahhhhh, the USA. But I am very thankful I live here and not in Afghanistan. :O)
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Until you are a small business owner you will never understand the hardship of insurance for employers. It's horrible and it's sad. There is absolutely no way we could afford insurance for our employees, even if we pay 50% of the employee's premium monthly. Plus, our employees can't, or won't, pay their 50% either, so they opt out every time. It's so unaffordable. We currently have Humana and it's just me and my husband. Our employees would only accept coverage if we paid 100% of their premium and that's not possible. We are a small business and small business makes small money overall. I have great coverage and I'm not complaining at all about that, but the cost is outrageous and it goes up every year. I dread Nov 2011 when I lose my Medicare. They pick up all the difference now. It's maddening. But I'm not going to say we are better or worse than any other country. They all have their problems.
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Private insurance is an excellent way to get.... uh, hosed, is the most polite word I can think of.
I could go into my dealings with private insurance, but I'm trying to keep my blood pressure down. :banghead; However, I will leave a link to the story of a fellow I met by the name of Nathan Wilkes:
http://www.calnurse.org/media-center/in-the-news/2007/january/page.jsp?itemID=29367834
It pretty much sums up how bad private insurance can get.
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I sure don't understand the US system either. Every country in the developed world has some type of universal health care except the US. What are they so afraid of?
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Some of us don't want the Government all up in our business.
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I'm so hesitant to post, as I live in Canada so don't really have a dog in this fight. From other boards I am a part of, this is an extremely emotional issue for Americans. I'm guessing that the majority here are in favour of some form of socialized health care, because you or a loved one needs it.
However, in another discussion that started out with a similar question, the discussion quickly degenerated to, "Why should I pay for health care for someone else? I have good insurance." Basically it came down to why should I have to look after my neighbour who is less fortunate than I am. One person actually equated providing universal health care to buying new cars for everyone, which I personally found very offensive.
And there's a huge fear of the unknown, I think. Lots of money has been put into campaigns to scare John Q. Public.
I'm so glad I live in Canada. For us, it's a no brainer - if you're sick and you need medical care, every person in this country is entitled to it.
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The fact is us Americans already pay through the wazoo for those who cannot or chose not to afford to pay for health care. And not all of them are even Americans. People come from Mexico and show up in our hospitals, are treated, never asked if they are a citizen, and then they go home to Mexico. Who paid for that? Also we pay for the people who, because they have no medical insurance and a private Dr's office will not let them in unless they pay, go to the ER for basic medical care. This not only costs the American tax payer but also cloggs up the ER so that when we go for something real that our regular DR cannot handle we have wait hours and hours while little Jose's ear infection is treated. (This really happened to me, I am not making it up).
One of the proposals for our health care overhaul was that if you did not carry health insurance you would be taxed extra. Two problems with this: 1. It implied that people who do not have insurance don't pay their medical bills. Nothing could be farther then the truth, not EVERYONE doesn't pay. My hubby and I have been paying medical bills for 10 years for a man with kidney disease!!! (And we don'e have insurance). 2. No insurance co would give hubby insurance because he had kidney disease!!! Since he was not on dialysis yet he did not qualify for Medicare. So what in the heck are you taxing him extra for when he can't get insurance?
I am just getting started :shy; but I will stop now.
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Our system is broke and it needs fixing...bad. Why can't they just make if affordable for EVERYONE???
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It seems to me that history is being repeated.
In 1948 when the British National Health Service was created the politician driving it (Aneurin Bevan) had every bit as much resistance to change as Obama has. The medical profession voted something like 90% against the NHS and proposed not to cooperate with the proposals. The political opposition was against reform because of the infrastructure costs. There were not enough doctors or hospitals to cater for the increased demand resulting from free health care. World War II ended only 3 years earlier and every hospital in London had bomb damage to a greater or lesser extent. The government would have to finance the rebuilding and extension of hospitals yet the Treasury was near bankrupt because of the war.
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Canada's health care system was implemented in 1972 and it too involved struggle, controversy and resistance to change.
http://www.dufourlaw.com/ndp/tommy.htm
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I'm now hoping for something similar to Canada, Monrein. Fingers crossed.
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It really all depends on your point of view whether health care is a right or a privilege. I believe it is a right and I am for socialized medicine. The problem here in the states is the HUGE amount of money that is made off of health care. Insurance companies love to take your premiums and then find every excuse they can come up with not to pay out benefits. That applies to all types of insurance, car, home, anything that is insured. It is disgraceful and nothing more than good ole American greed. A government health care option would force the insurance companies to get in line and cost them MILLIONS in revenue. The Republican party is and has always been in bed with big business and that includes insurance companies. They could give a rats ass about a poor family with a dying child. Their answer to every social problem is PERSONAL Responsibility. Just another way of telling the poor people of this country to piss off.
One stay or surgery in a hospital without insurance can mean financial ruin.
Luckily there is socialized medicine for ESRD or we would all just die. It is called medicare.
Before some Repub starts to rag on me. Did you or do you receive medicare benefits for your dialysis or transplant? Let's not be a hypocrite now.
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BASSMAN I am a Republican. But. I think this goes deeper than that and can be explained by the greedy or the non greedy. And I totally agree with you, all types of insurance are a total scam and about 1 thing: the almighty dollar. It is shameful.
Cash speaks: EPO at Sam's wholesale pharmacy is $490 if you pay cash. How much is it at the dialysis clinic? I have not received a bill yet (when we do get a bill you might get a post from my hubby saying I had a cardio event) but I have had others tell me that their bills come in and the EPO is $2,000. This is due to insurance and the convoluted way it works which results in nothing more than raising the price of absolutely everything.
We have no insurance so everything came out of our pockets until hubby started dialysis and then Medicare kicked in. When he had to go for the AV Graft surgery I called 4 different hospitals, just the hospital fee differed from $2350 (what we paid) to $10.150. Why is it like this? What if someone didn't know to call different hospitals. Man, it is bad.
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Oh, Kelly, I can imagine providing insurance as a small business is beyond difficult. My father owned his own business in SoCal (where employers are mandated to provide insurance) for over 25 years, and at home he had 6 kids, with 2 who were uninsurable on the individual market. I cannot even imagine the premiums that he paid, and I know he did not make a dime in income for the first four years in business.
I have always heard that if you are forced to pay cash, negotiate in advance with the hospitals and doctors (you can't usually do this with pharmacies) and try to pay what an insurance company would pay - about 40% of the asking price. Of course, in emergency situations, it is too late to negotiate. When I contracted viral meningitis, I went to the ER and ended up being admitted to the hospital for 10 days. The bill was $60,000, but by agreement the insurance company only paid $18,000, and I had to pay whatever was left on my deductible (several hundred). If I had not had insurance at all, wow. Call the bankruptcy lawyer, because there is no way I would have been able to pay them $60,000.
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I have always heard that if you are forced to pay cash, negotiate in advance with the hospitals and doctors (you can't usually do this with pharmacies) and try to pay what an insurance company would pay - about 40% of the asking price.
I have had US doctors tell me that insurance companies have threatened to drop them if they give "cash discounts" (IOW, allowing individuals to pay the insurance rate).
The insurance system in this country is unconscionable.
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Yes, I have Medicare following transplant and 1) I pay over $100 a month for it and 2) I've been paying into Medicare for over 25 years (just like many, many others). I don't feel I've been "given" anything. So, no, I don't feel like a hypocrite. I started working as soon as I became old enough and they've been taking it out ever since. I'm currently paying into Medicare and I STILL have to send them over $100 a month. They aren't even Primary, they are Secondary and they will only become Primary at 30 months, so they will only be Primary for six whole months.
In my opinion Medicaid is the problem, not Medicare, because so many people who are not eligible for it have it. I'd be willing to bet I've spent more of my money on the uninsured and the losers who just don't pay when they have the means than I have for myself.
At this point I will listen to any kind of reform, I just don't think we should accept the first thing that's thrown out. AFFORDABLE FOR ALL. I'm not asking for a hand out. Again, I pay for my Medicare.
And Cariad, you are so right. It's disheartening to be a small business owner and not be able to help out the employees more. If I could I'd pay them all $20 and hour and give them full coverage. It's just not possible and it's really sad.
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My whole point is medicare IS a GOVERNMENT insurance program. One hundred dollars a month and even the payroll deductions over the years are affordable. Now if a person could get on medicare before 65 years old, ESRD the problem would be solved!!
I have been paying it all my life too. I have also private insurance through my work.
I am referring to the 47 MILLION Americans with NO insurance. They pay into the system too.
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What we need in The United States is "cost" reform. The costs for health care doesn't even make sense! We found my brother's hospital bill from when he was born in 1956. Hospital bill was $25 and his circumcision was $8.
We would not even need insurance if costs were reasonable. Maybe catastrophic insurance like the good old days. Now we need catastrophic insurance for a zit.
These doctors, dialysis CEO's, Hopsital administrators etc... make too damn much money.
I'm all for making a profit, but not off sick people and tax payers.
Go start a coffee shop!
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I understood your post, Bassman. I really did. I honestly wasn't attacking you or your post. :beer1; But I really don't feel like a hypocrite. :) I'll be 42 in March and this might be my only chance to get back what I've paid into Medicare. Actually, I feel blessed, but it has nothing whatsoever to do with the Government.
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Would some kind American please explain your health care system especially regards dialysis patients. I know in Australia, everybody is covered for almost everything - whether PD or HD. What is the big fuss about changing your present system and why are so many people against President Obama changes to the system? Do you have to pay for dialysis and what is the score about not having health insurance?
In Amerika, healthcare is expensive. They have tried about twenty times since I was born to change it. The powers that be and the media system use scare tactics to make socialist medicine something to be afraid of. Something about not having enough choice. Freedom has its drawbacks. "Healthcare Providers" are the insurance companies, when in fact the basic job of insurance companies is to make money, secondary to actual healthcare. Besides employing millions of people who wouldn't have jobs otherwise, the healthcare providers spend a lot of money making sure that the people believe that healthcare is a privilege rather than a right. Obamah started out trying to change the health care system, but the powers that be used the scare tactics so strongly that the bill got watered down so much that it made him look like an idealistic idiot. The transition from the current system is so great and there are so many greedy "higher ups" that there won't be any actual change in the healthcare system. It's sad.
When the systems start breaking down, and just printing more Amerikan dollars won't fix the problems and the wretched excess rich people are really the only ones that can actually afford healthcare, can afford healthcare. . .
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I'm going to post here simply because I'd like response to show up in my "new posts" section. The only comment I will make (since I am totally torn about the issue) is:
There are places in American where people from countries with socialized or government health care or flocking for treatment. Ditto with health care professions flocking to come work and to gain great comments for their resumes.
I have Medicare and a Cadilac (supplement plan and drug plan -- it does cost out the (censored). But you can correct me if I am wrong but I get the impression that dialysis patients are covered by medicare and provided drug help. Is it good to have bad Kidneys?
Again, I am torn with the issue...
Obama promised change. We got change (the banks surely did, the auto companies surely did). But change isn't good unless it is change for the better... is it? and is it?
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I'm going to post here simply because I'd like response to show up in my "new posts" section. The only comment I will make (since I am totally torn about the issue) is:
There are places in American where people from countries with socialized or government health care or flocking for treatment. Ditto with health care professions flocking to come work and to gain great comments for their resumes.
Yes, the medical tourism issue has been flogged over and over again in the debate. I do not doubt that some rich people from other countries come to the US to get the most expensive healthcare in the world. However, the flow is also huge in the other direction. I recall hearing about cosmetic tourism years ago. There was an article that gushed about how you could travel to South Africa, get a facelift and a booblift and weeks of being pampered at a spa - for less than just the hospital bill for an American facelift.
I think everyone's heard stories of Americans going to Mexico for cancer treatment.
I have Medicare and a Cadilac (supplement plan and drug plan -- it does cost out the (censored). But you can correct me if I am wrong but I get the impression that dialysis patients are covered by medicare and provided drug help. Is it good to have bad Kidneys?
As I think others have pointed out, it's more complicated than that. If you have private insurance when you are diagnosed Stage 5, then Medicare is only secondary and your private insurance remains primary for 30 months, when it flips. And it gets more complicated from there, as Medicare pays, I believe, 80%....
What I do know is that we're paying out the ass for a private policy, on COBRA, that tries to deny payment at every turn. We get unexplained bills from medical providers after we have a) paid our co-pay, and b) also been told we have reached our "out of pocket maximum" for the year.
Our private insurance has no out-of-pocket maximum for prescriptions, so our liability is virtually unlimited there.
Again, I am torn with the issue...
Obama promised change. We got change (the banks surely did, the auto companies surely did). But change isn't good unless it is change for the better... is it? and is it?
Yes, I am quite disappointed in how the insurance cabal has once again managed to dominate the debate with ridiculous scare tactics and lies to protect their profits. You want "death panels"? Try to get your insurance to cover an "unapproved" treatment.
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Please note that more than once in my little statement I stated that "I am torn" on the issue. I had medicare and my insuurance long before I had my kidney problem so I'm really not up on details. I've worked really long and hard (well not so hard... not so long either as I think about it but I've worked) to protect myself with insurance. I try not to be so selfish or isolated in my thinking as I understand so many points of view, and I don't want to be a part of this debate. I simply want to read what the rest of you believe. I could decide whether I'm pro or con that way, not that it would have any influence.
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I'm torn, as well, Dan. It's maddening the way it is now and it's maddening the way they are presenting it to possibly be. I want good change, either way, so that my heart and mind can finally be at ease. It's not like all this crap we're all going through as ESRD patients is every going to go away, right? :( We can only hope it gets better. :pray;
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There's no way any American is going to be able to fully explain this, and you wouldn't want anyone to try. Trust me. This is a huge question. I'll give you my understanding of it as briefly as possible.
We have a system of Medicare (fed gov't) that covers certain people, but only at 80% (patient would pay 20% of the costs unless they qualify for further assistance) for most services, even dialysis and transplant, and the rules for getting Medicare are a bit arbitrary. Everyone over 65 is eligible. Dialysis patients and transplant patients get it automatically thanks to some relentless advocacy in the 1970s, and people who are disabled two years can often get it, but that depends on when you become disabled. If you are over a certain age when you become disabled, you need to have work credits (you need to have earned a certain amount of income in your lifetime) in order to be eligible for Medicare. If you are someone who never worked, say a stay-at-home mother, and you become disabled at 40 with cancer, sorry. Try to hang on until you're 65.
Insurance is generally group or private. What someone like me, with a history of ESRD and transplant, wants is group. Group insurance almost always comes through work, usually what we call W-2 work (a tax form, W-2 means you are an employee, not a contractor). Laws vary from state to state, the state where we live now has no mandate that employers must offer this insurance to employees. The reason that you want group is that the employer and the insurance company must offer the same deal (with minimal exceptions) to all employees (and their families) and pre-existing conditions clauses are limited. There are no health exams.
Private insurance is an excellent way to get.... uh, hosed, is the most polite word I can think of. Some of the best insurance horror stories involve paying into private insurance faithfully for years, suffering a health crisis, and then having the insurance company pore over your application documents looking for anything they can call a pre-existing condition. There is a famous story about a woman with cancer who had her insurance rescinded because she did not declare a case of acne on her application. This is what people refer to when they say "uninsurable". Private insurance companies can and do turn applicants down all the time for not being healthy enough (preexisting conditions like ESRD, or our friend who has asthma, or our other friend with persistent migraines, or....)
Almost everything must be pre-approved by the insurance company. Anyone who calls an insurance company, regardless of whether it is group or private, will hear a recorded message saying that basically they are not responsible for whatever their own reps say, and that you must wait for formal approval. This can take forever, with all sorts of delay tactics employed. Did you know that liver transplants are considered experimental? Either did I! Until CIGNA said so, and a 17-year-old in LA died. This is what we are up against.
There are other ways to pay for health insurance, and state programs, and of course, COBRA, which is what I am dealing with now (a federal law that if you are fired or quit your job involuntarily, the company must let you continue to buy into their group insurance for a certain period of time, but you will pay much, much more than the premiums that the employees pay). I don't know all of the different rules and possibilities with health insurance, and as far as I can tell, neither does anyone else. I am sure there are exceptions to everything I just wrote. It is an incredible, self-sustaining bureaucracy.
As for why Americans fear health reform, that is an equally enormous question, and I'm not exactly sure myself, since everyone I see on a regular basis, including my GP, cannot wait for the day. The people who have the most to lose from reform (insurance companies, for example) also happen to have an awful lot of money to put toward convincing everyone that it would be the end of civilization.
Aren't you sorry you asked? ;)
Nice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.
Rerun's point on costs of healthcare vs. health insurance is a point too often glossed over. One solution that could be a game changer that I have not seen is allowing Medicare reimbursement to Mexican healthcare providers - at say 80% of the 80%. I think the surveying and the accounting could be handled.
It would relieve a lot of pressure on the system if 5% of Medicare beneficiaries moved to Mexico. Medicare would see immediate savings. The decrease in demand would increase price competition at home. It wouldn't cost anything if people didn't want to move but I think a lot of people would end up moving.
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We have not had medical insurance until MM got Medicare when he went on dialysis. Before that we paid out of pocket for everything for his kidney disease and YES, ALL THE DR'S AND HOSPITALS GAVE US UP TO 75% DISCOUNT. I asked everybody and they obliged. But the bill had to be paid up front, ahead of the procedure to get the discount. No discount on drugs.
The price of healthcare (procedures, Dr office visits, etc.) is outrageous. I think I've already posted this but I'll say it again, because we were paying cash for MM's AV Graft installation I called several hospital to get prices. The price ranged from $2350 to over $10,000 just for the hospital bill. And that was the discounted 'cash up front' price.
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I'm going to post here simply because I'd like response to show up in my "new posts" section. The only comment I will make (since I am totally torn about the issue) is:
There are places in American where people from countries with socialized or government health care or flocking for treatment. Ditto with health care professions flocking to come work and to gain great comments for their resumes.
I have Medicare and a Cadilac (supplement plan and drug plan -- it does cost out the (censored). But you can correct me if I am wrong but I get the impression that dialysis patients are covered by medicare and provided drug help. Is it good to have bad Kidneys?
Again, I am torn with the issue...
Obama promised change. We got change (the banks surely did, the auto companies surely did). But change isn't good unless it is change for the better... is it? and is it?
It is still only 80% covered ( a negoated payment) the rest is picked up by my suppliment. Some drugs are not covered by the patD drug plan or if they are,are so expensive that you get to donuthole in just a few months and then pay out of pockey. No it is not a good thing to have bad kidneys.
example: I had a little over $800 left until donuthole in Dec 2009. Decided to pruchase 93 Fosrenol 1000mg tabs (doc has been giving me samples for last 2 years) Got script ,went to Walgreens and they billed the insurance $700 for 93 tabs. That is almost $7 a tab.
Oh yes, the only time Disability Social Securit will drop the need for required work credits is if you have lost your eyesight. I know,that is what I origionally got disability for. You can work a little a one day,have accident that would leave you legally blind and get disability. I am legally blind.
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To understand why the U.S. health care system is the way it is, it helps to understand the history.
During World War II, all prices and wages were frozen. Employers were not allowed to offer higher wages or higher salaries to attract and retain workers. So the Franklin Roosevelt administration hit upon the idea of allowing employers to offer group health insurance to their workers as a tax-free fringe benefit in lieu of wage raises. This was a good deal for both the employer and the employee, since health benefits were tax free unlike wages.
After World War II, the Internal Revenue Service tried to rescind the tax benefits of group health insurance. But this benefit had become so popular that Congress overrode the IRS and kept the benefit. And it's remained that way ever since.
Unfortunately, this has had the side effect of decoupling health care costs from those who pay them, since the employer never sees the medical bills, and the employee's health insurance premiums are paid by his employer regardless of the claims he files. Hence there's no incentive to hold down costs--and costs have risen faster than inflation as a result.
It has also had the undesirable side effect of tying an employee's health insurance to his employer. Because if the employee loses his job, he loses his group health insurance with it. In the 1950s when large corporations offered virtual lifetime employment to their workers, this wasn't much of a problem. But today, companies downsize all the time and workers change jobs all the time.
Most of the proposed health care reforms have focused on trying to deal with these kinds of problems.
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Just one question. What happens in USA if you get chronically (possibly terminally) ill and have no insurance. Does the government step in? BTW, I didn't want to start a political debate, just be informed about a health system in another country.
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Just one question. What happens in USA if you get chronically (possibly terminally) ill and have no insurance. Does the government step in? BTW, I didn't want to start a political debate, just be informed about a health system in another country.
You Can receive emergency stabilizing treatment at any hospital emergency room regardless of insurance or ability to pay. People die in this country every day that could be helped but have no insurance.
Anytime this subject comes up it will turn political if you live in the USA.
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Out of curiosity I just googled "died because of no health insurance". Give it a shot. Some interesting reading.
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bassman, your pic is really spooky. And kind of scary. :O)~
I cannot tell you how many people I have told about the cash discount. The tech/helper at the chiropracter clinic I went to was suffering from kidney stones.....she was having them at home because she did not have insurance. I told her to phone ahead and ask for a cash discount! She had no clue. One of the Dr's I go to (for MM), when we check out the Secretary cannot give me a cash discount unless I verbally ask for it. ?WTF?
There are State Health agencies in most states that will help but lots of folks don't know about them and if they are told no they give up. You have to fight for it sometimes. And that is sad but that is the way it is.
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I didn't have insurance when I was originally diagnosed with kidney disease in 1994. My neph did the biopsy at a huge discount and he got the hospital to discount some, too. I paid small payments, but regularly on my account without fail and when I got the balance to like $600 I called them and said that I'd send in a payment of $300 today if they would consider writing off the balance. SHe had to check with some high ups but they agreed. Apparently it's done all the time. Try it if you haven't, but you have to have a good record of payment I think. I had to give her the check # over the phone and promise that it would go in the mail and be postmarked that day. But, it saved me $300.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
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bassman, your pic is really spooky. And kind of scary. :O)~
Just curious BASSMAN. Is your name Bassman like a fish? You know Large mouth bass or brown bass, or is like a baritone, electric bass or acoustic bass? Fish or musical? You look like an aliein. Maybe that is what a fish/man looks like on your planet. :waving;
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bassman, your pic is really spooky. And kind of scary. :O)~
I cannot tell you how many people I have told about the cash discount. The tech/helper at the chiropracter clinic I went to was suffering from kidney stones.....she was having them at home because she did not have insurance. I told her to phone ahead and ask for a cash discount! She had no clue. One of the Dr's I go to (for MM), when we check out the Secretary cannot give me a cash discount unless I verbally ask for it. ?WTF?
There are State Health agencies in most states that will help but lots of folks don't know about them and if they are told no they give up. You have to fight for it sometimes. And that is sad but that is the way it is.
When I had my kidney stones, I just took them with me where ever I went, There was no discount for having them just at home. I didn't think to ask for a discount. This was years ago and I remember them hurting me very much. I didn't have a classy job like a tech/helper at a chiropractor, but I do remember that for several days, I couldn't have gone to work, if I wanted to.
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I didn't have insurance when I was originally diagnosed with kidney disease in 1994. My neph did the biopsy at a huge discount and he got the hospital to discount some, too. I paid small payments, but regularly on my account without fail and when I got the balance to like $600 I called them and said that I'd send in a payment of $300 today if they would consider writing off the balance. SHe had to check with some high ups but they agreed. Apparently it's done all the time. Try it if you haven't, but you have to have a good record of payment I think. I had to give her the check # over the phone and promise that it would go in the mail and be postmarked that day. But, it saved me $300.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
Having to negotiate and bargain for discounts in this way is not a cakewalk even when one is healthy. To be ill and have to do battle in this way leaves me beyond perplexed.
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I am so monrein, its like you are at a yard sale , I have many issues wit my healthcare, but I would not change it for the world. And at the end of the day and so thankful I have a government that puts my health ahead of insurance companies
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Just one question. What happens in USA if you get chronically (possibly terminally) ill and have no insurance. Does the government step in? BTW, I didn't want to start a political debate, just be informed about a health system in another country.
It looks to me this happens:
http://www.pnhp.org/news/2009/june/illness_medical_bil.php
A lot of times even when you have insurance.
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The problem is people wanted reform and this bill was not reform.
Instead it was 1000's of pages that was loaded with legal mumbo jumbo that was wide open to interruption down the road instead of being specific.
The idea of taxing people health care benefits was probably one of the most harmful things to come up in the whole thing.
They should have did a single payer system (something Baucus refused to even be truly heard) and also eliminated earned income credit. Use that money that is given out in earned income credit towards health care instead.
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I have to agree with you BigSky!
By the way, this discussion has reminded me of a question I have. I remember when my kid was in the clinic back in 2000. My recollection was my private insurance was getting gouged, while it appeared Medicare was the one holding back costs. I was wondering if it is still that way?
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Nice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.
Thanks, Bill, I'm enormously flattered. I am not back on dialysis, and have a 2nd transplant scheduled for March, but if you ever need a strongly worded opinion piece on transplant, I do believe I'm your gal. Work credits even at 65? Man, it's even worse than I thought.
Kimcanada, monrein, thank you for your insight. Yes, the emotional toll can be immense, having to work up the courage and the self-esteem to advocate for yourself while ill is beyond the abilities of many people. I also imagine that it is no picnic for the providers. I have seen my GP - a lovely man, and my favorite doctor - turn people away for lack of a co-pay or cash to pay upfront. My GP is certainly cheaper than an ER, and will be able to deliver much better service, but he also occupies the bottom income rung for physicians and has to look after his own practice.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
I couldn't disagree with this statement more. I guess it depends on what you place under the "health care" umbrella, but I have heard of plenty of people turned away, especially with severe mental health issues. I have said this before, but in my decades of post-transplant life, I have had all but zero success getting help with prescription drugs.
Having medical bills written off on your record affects all aspects of your financial life - ability to get loans, sometimes even ability to get jobs. I went to UW-Madison in 2002 for an appointment with a transplant nephrologist, after two separate calls to my insurance to make sure I was covered there. The reps said yes, absolutely. This was before those messages warning "even if the rep says you're covered, we might just surprise you." Well, United Healthcare took so long to process the claim, that I ended up going a second time 6 months later before getting a letter in the mail from the hospital saying "you were never covered here, and you now owe us $5000 for your two visits". We appealed it to the ends of the earth, finally were forced to settle for $3000, and it went on my husband's credit report as a settlement, since the insurance was group through his work. It is only now falling off his record.
Murf, Bassman is right, it is impossible to discuss this without a political argument springing up. There are people here who work just as hard as anyone else, cannot get or afford insurance, pay taxes which include taxes for Medicare, pay toward the salaries of government employees (who almost always have excellent coverage) and then are allowed to fall into bankruptcy or worse when they need medical care. It is very political and very personal.
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cariad, There is lots of help for folks in the US, you CAN get it. People tend to accept no as an answer instead of actually putting forth effort and getting help for themselves. I agree that if you are sick it is not easy to fight for yourself...but the help is there if you want it. I also have been successful in getting several prescrip drug co's to send us drugs free of charge, so that help is there as well. Not everyone fits into their qualifications but some of us do. One of the requirements is that you do not have medical insurance (and no Medicare either).
I believe you misunderstood the 'having medical bills written off', the Dr (or hospital) does not actually do a "write off", it does not go against your credit. You are making a deal, bargaining, getting the person to do the procedure at a lower price. This absolutely does not go against your credit. I have been doing it for 12 years now, I know. I never ever ever walk through a Dr's office or do any other medical thing without asking for a cash discount. Well, now I do because MM has Medicare.
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cariad, There is lots of help for folks in the US, you CAN get it. People tend to accept no as an answer instead of actually putting forth effort and getting help for themselves. I agree that if you are sick it is not easy to fight for yourself...but the help is there if you want it. I also have been successful in getting several prescrip drug co's to send us drugs free of charge, so that help is there as well. Not everyone fits into their qualifications but some of us do. One of the requirements is that you do not have medical insurance (and no Medicare either).
I believe you misunderstood the 'having medical bills written off', the Dr (or hospital) does not actually do a "write off", it does not go against your credit. You are making a deal, bargaining, getting the person to do the procedure at a lower price. This absolutely does not go against your credit. I have been doing it for 12 years now, I know. I never ever ever walk through a Dr's office or do any other medical thing without asking for a cash discount. Well, now I do because MM has Medicare.
I appreciate your thoughts, Malibu, but have to say I still disagree just as strenuously as before. There is help available for some things, but not all, and it is a maze of qualifications and proving income and assets, and potentially lethal delays. Did you hear about the little boy who died of a tooth abscess a few years ago?
Warning, very sad: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html
Trust me, when I speak of people having difficulty advocating for themselves, I am not really putting myself in that category. I would not be where I am today, nearly 34 years post-transplant, about to enter a clinical trial that I don't even qualify for, if I were unable to advocate for myself. My husband is also excellent at this. I have two kids, there is no way I am going to have a go at American life without medical insurance, so if letting insurance lapse is a requirement, count me out. As you said, not everyone fits their qualifications, so I don't agree with statements that it is just laziness or ignorance that keeps everyone from getting care.
I think you may have overlooked a few details in my story, which was actually about a settlement, where the hospital 'writes off' a portion of my bill, in other words, puts it down as a loss. What Kelly described - owing $600 and asking them to take less, you can do with just about anything, but it most certainly can end up on your credit report if the creditor (the hospital) makes that choice. I am not talking about the same kind of bargaining that it appears you do. I already had gone to the appointments because my insurance told me it was covered - it was really too late to bargain with them, though I tried, my husband tried, and my father the tax attorney tried. And we did get the bill reduced significantly. It wasn't really the hospital's issue or fault in my opinion, anyway - the battle was with insurance. I needed to keep good relations with the hospital since I was undergoing a transplant eval, and they absolutely will turn you away from a transplant for lack of insurance or suspected inability to pay for maintenance over time. We even called the hospital after the fact (during mortgage refinancing) to ask that they please take it off our record, and they simply stated that did not do things like that.
I agree that there are options out there for some, and that a major hurdle is getting this information to the people who need it. I just cannot agree with the idea that the US will never turn someone away from medical care - that is simply not true.
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Nice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.
Thanks, Bill, I'm enormously flattered. I am not back on dialysis, and have a 2nd transplant scheduled for March, but if you ever need a strongly worded opinion piece on transplant, I do believe I'm your gal. Work credits even at 65? Man, it's even worse than I thought.
Kimcanada, monrein, thank you for your insight. Yes, the emotional toll can be immense, having to work up the courage and the self-esteem to advocate for yourself while ill is beyond the abilities of many people. I also imagine that it is no picnic for the providers. I have seen my GP - a lovely man, and my favorite doctor - turn people away for lack of a co-pay or cash to pay upfront. My GP is certainly cheaper than an ER, and will be able to deliver much better service, but he also occupies the bottom income rung for physicians and has to look after his own practice.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
I couldn't disagree with this statement more. I guess it depends on what you place under the "health care" umbrella, but I have heard of plenty of people turned away, especially with severe mental health issues. I have said this before, but in my decades of post-transplant life, I have had all but zero success getting help with prescription drugs.
Having medical bills written off on your record affects all aspects of your financial life - ability to get loans, sometimes even ability to get jobs. I went to UW-Madison in 2002 for an appointment with a transplant nephrologist, after two separate calls to my insurance to make sure I was covered there. The reps said yes, absolutely. This was before those messages warning "even if the rep says you're covered, we might just surprise you." Well, United Healthcare took so long to process the claim, that I ended up going a second time 6 months later before getting a letter in the mail from the hospital saying "you were never covered here, and you now owe us $5000 for your two visits". We appealed it to the ends of the earth, finally were forced to settle for $3000, and it went on my husband's credit report as a settlement, since the insurance was group through his work. It is only now falling off his record.
Murf, Bassman is right, it is impossible to discuss this without a political argument springing up. There are people here who work just as hard as anyone else, cannot get or afford insurance, pay taxes which include taxes for Medicare, pay toward the salaries of government employees (who almost always have excellent coverage) and then are allowed to fall into bankruptcy or worse when they need medical care. It is very political and very personal.
I was talking about the ER mainly. I didn't even think as deedp as mental health. You're right. You may sit in the ER for hours, but you will eventually be seen. Good or bad. That's why most people with no insurance go to the ER for a cold and those with insurance pay for it. :(
But you are right, Cariad.
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bassman, your pic is really spooky. And kind of scary. :O)~
Just curious BASSMAN. Is your name Bassman like a fish? You know Large mouth bass or brown bass, or is like a baritone, electric bass or acoustic bass? Fish or musical? You look like an aliein. Maybe that is what a fish/man looks like on your planet. :waving;
I play electric bass as well as guitar and also bass fish so call me either, BASSMAN or BASSMAN. I will answer to both.
I will have my wife take a picture and I will post it. If she take 100 I might get one good shot. I am not very photogenic.
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Know what... I read an entire novel that was just about 800 pages, is 1000 pages like ultra amazing ??? People should read more
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The problem is people wanted reform and this bill was not reform.
Instead it was 1000's of pages that was loaded with legal mumbo jumbo that was wide open to interruption down the road instead of being specific.
The idea of taxing people health care benefits was probably one of the most harmful things to come up in the whole thing.
They should have did a single payer system (something Baucus refused to even be truly heard) and also eliminated earned income credit. Use that money that is given out in earned income credit towards health care instead.
Why not tax health benefits? I know my union insurance would be good enough that it would result in some tax but why not? They tax everything else provided through work - why not insurance? It's all pay to me.
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dang ... double post
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Nice cariad. One quibble you need work credits when you reach 65 too. If you ever want to blog dialysis reimbursement you'd be welcome on DSEN.
Thanks, Bill, I'm enormously flattered. I am not back on dialysis, and have a 2nd transplant scheduled for March, but if you ever need a strongly worded opinion piece on transplant, I do believe I'm your gal. Work credits even at 65? Man, it's even worse than I thought.
Kimcanada, monrein, thank you for your insight. Yes, the emotional toll can be immense, having to work up the courage and the self-esteem to advocate for yourself while ill is beyond the abilities of many people. I also imagine that it is no picnic for the providers. I have seen my GP - a lovely man, and my favorite doctor - turn people away for lack of a co-pay or cash to pay upfront. My GP is certainly cheaper than an ER, and will be able to deliver much better service, but he also occupies the bottom income rung for physicians and has to look after his own practice.
USA will not turn you away, and there are ways to get amounts lowered or even written off in full. Drug companies will help you with medications, as well.
I couldn't disagree with this statement more. I guess it depends on what you place under the "health care" umbrella, but I have heard of plenty of people turned away, especially with severe mental health issues. I have said this before, but in my decades of post-transplant life, I have had all but zero success getting help with prescription drugs.
Having medical bills written off on your record affects all aspects of your financial life - ability to get loans, sometimes even ability to get jobs. I went to UW-Madison in 2002 for an appointment with a transplant nephrologist, after two separate calls to my insurance to make sure I was covered there. The reps said yes, absolutely. This was before those messages warning "even if the rep says you're covered, we might just surprise you." Well, United Healthcare took so long to process the claim, that I ended up going a second time 6 months later before getting a letter in the mail from the hospital saying "you were never covered here, and you now owe us $5000 for your two visits". We appealed it to the ends of the earth, finally were forced to settle for $3000, and it went on my husband's credit report as a settlement, since the insurance was group through his work. It is only now falling off his record.
Murf, Bassman is right, it is impossible to discuss this without a political argument springing up. There are people here who work just as hard as anyone else, cannot get or afford insurance, pay taxes which include taxes for Medicare, pay toward the salaries of government employees (who almost always have excellent coverage) and then are allowed to fall into bankruptcy or worse when they need medical care. It is very political and very personal.
I was talking about the ER mainly. I didn't even think as deedp as mental health. You're right. You may sit in the ER for hours, but you will eventually be seen. Good or bad. That's why most people with no insurance go to the ER for a cold and those with insurance pay for it. :(
But you are right, Cariad.
Not all ERs are equal but this emergency room entitlement get's you stabilized not treated. If you have cancer, your cancer isn't going to be treated in the ER. If you're bleeding they'll stop the bleeding but there is a huge difference between being stabilized and being treated.
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The problem is people wanted reform and this bill was not reform.
Instead it was 1000's of pages that was loaded with legal mumbo jumbo that was wide open to interruption down the road instead of being specific.
The idea of taxing people health care benefits was probably one of the most harmful things to come up in the whole thing.
They should have did a single payer system (something Baucus refused to even be truly heard) and also eliminated earned income credit. Use that money that is given out in earned income credit towards health care instead.
Why not tax health benefits? I know my union insurance would be good enough that it would result in some tax but why not? They tax everything else provided through work - why not insurance? It's all pay to me.
That is kinda like saying they should tax medicare and medicaid benefits.
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I wish we could have single payer health care in the U.S.. That way we all get insurance and we can all sleep soundly at night.
The Insurance companies always get their way because they have huge amounts of money to pay for Lobbyists whose sole job is to go to Washington and buy off politicians. Our politicians aren't even listening to us anymore as is evident in the fact Obama's Health plan ideas will be defeated after being watered down so much nobody is happy about it anymore. An American politician's only thought is toward $ for their next election so they can stay in office. They know where that $ comes from. (Don't even get me started on the Supreme Court decision this week which basically allows unlimited donations to politicians from corporations and groups). American health care is run by Big Corporations. If the people truly had the choice, I think most Americans would agree every American is entitled to medical coverage. The question is regarding how to implement a program.
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If insurance weren't a player in healthcare it would be affordable. Insurance (Companies) are the main culprit of our obscenely high priced medical care.
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I wonder what the percentage of people is that want health reform and the percentage against. A true number tho, and I think when you have people one one side of the other you never get a true #
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The problem is people wanted reform and this bill was not reform.
Instead it was 1000's of pages that was loaded with legal mumbo jumbo that was wide open to interruption down the road instead of being specific.
The idea of taxing people health care benefits was probably one of the most harmful things to come up in the whole thing.
They should have did a single payer system (something Baucus refused to even be truly heard) and also eliminated earned income credit. Use that money that is given out in earned income credit towards health care instead.
Why not tax health benefits? I know my union insurance would be good enough that it would result in some tax but why not? They tax everything else provided through work - why not insurance? It's all pay to me.
That is kinda like saying they should tax medicare and medicaid benefits.
Medicare is funded by employment taxes (and premiums) - Medicaid isn't tied to employment. Why is receiving $2,000 a month in insurance benefits - company paid premiums - different from receiving a car and driver for personal use?(see Tom Daschle) Or a $24,000 year end bonus?
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I really believe the biggest cause for our medical costs is waste and the fact that our Government doesn't do anything
to remedy this problem.
Here is a prime example - I have been getting certain appliances (ostomy) through a gov't. approved provider for thirty some
years. A few months ago I ran out and had to purchase these appliances on my own. I went to a local surgical supply house who
charged me $23 per box. I noticed that my gov't provider was charging the Government $129 for the same box. I called every
government agency as well as my Congressman and Representative to alert them about the outrages prices they were paying.
I got nowhere - no one wanted to be bothered, nor did they care.
For fun I called the Gov't provider and asked them how they could charge the Gov't $129 for something I could buy for $23.
Their answer was that they had the additional cost of shipping the product to me. The shipping I found out was a flat UPS cost of
$6 - so much for that.
Multiply this example by many thousands to see the effect waste has on our health system. Why isn't this problem addressed ?
I assume the answer to that is someone is making a lot of extra bucks.
Bruce
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Medicare is funded by employment taxes (and premiums) - Medicaid isn't tied to employment. Why is receiving $2,000 a month in insurance benefits - company paid premiums - different from receiving a car and driver for personal use?(see Tom Daschle) Or a $24,000 year end bonus?
Receiving $2,000 in government insurance benefits is no different than receiving it via the private sector. Fact is it doesnt matter if its tied to employment or not as people can work and receive medicare and medicaid.
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Medicare is funded by employment taxes (and premiums) - Medicaid isn't tied to employment. Why is receiving $2,000 a month in insurance benefits - company paid premiums - different from receiving a car and driver for personal use?(see Tom Daschle) Or a $24,000 year end bonus?
Receiving $2,000 in government insurance benefits is no different than receiving it via the private sector. Fact is it doesnt matter if its tied to employment or not as people can work and receive medicare and medicaid.
I think you're confusing premiums and benefits. Under the Senate bill premiums were going to be subject to tax, not benifits. If my employer, as part of my employment, paid my Medicare premiums - or my FICA obligation for that matter - why not treat it as income like everything else I'm paid (although Medicare premiums would be below any threshold being discussed in Congress).
My employer is writing a check to an insurance company on my behalf. They don't write the check unless I work. That sounds like pay to me. Why shouldn't it be taxed? How is that different than if they write the check to me and I pay the insurance? If they paid my mortgage would that be nontaxable income? - I don't think so. Why should health insurance be some special category of benefit?
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Because it cost so dang much!
...kidding...
Speaking from an until-now self employed person, we pay too much dang taxes anyway! IF they made that taxable too employers would have to pay EVEN more. The 6.2 and 1.45, not to mention the state and the federal unemployment ATE MY LUNCH buddy.
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Also, if medical benefits get taxed, those who are young and healthy willl say "screw this!" and opt out of their employer's benefit plan. This leaves only those who need it on it, and as such, the premiums for those existing members will continue to rise, since there are no longer the healthy ones in the pool who "pay" premiums but never or rarely use it. Over time (and in some cases, it may not take much tme) the employer will either have to charge the employees higher premiums for their insurance, or drop it altogether. This would then leave many people with pre-existing conditions and histories scrambling for health coverage that will either deny them, or charge them so much they may have to sell everything and live in their car. Until we get some real health care reform happening in this country, without special deals to special states, this is, unfortunately, the state of healthcare and how it is paid in this country. :(
KarenInWA
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Because it cost so dang much!
...kidding...
Speaking from an until-now self employed person, we pay too much dang taxes anyway! IF they made that taxable too employers would have to pay EVEN more. The 6.2 and 1.45, not to mention the state and the federal unemployment ATE MY LUNCH buddy.
Sure but income is income. When you exclude some part of the pie from taxation that part grows. One reason driving the escalating cost of insurance is that it is paid outside of regular salary taxation.
People don't see the money spent on insurance premiums on their behalf as potential income, in part because it isn't treated as income by the IRS. If it was all taxed maybe people would prefer cheaper high deductible plans - that would be good.
If iPods were untaxed income everyone would have really nice iPods but that isn't a good role for the tax system.
Karen the Senate bill had the mandate which was intended to address the situation you describe. If young people opted into cheaper high deductible plans - healthcare savings accounts that would be appropriate and save the system money.
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I just have to say: the more I read, the less I understand. ???
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So Bill, are you saying that in your opinion one of the reasons health insurance costs so much is that it is tax free?
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So Bill, are you saying that in your opinion one of the reasons health insurance costs so much is that it is tax free?
Yes. BTW people who are self employed don't have the same tax break. They can't deduct limitless insurance costs from their taxable income. There are tax credits and complicated tax rules but the net is not the same - large businesses and people who work for large businesses get more of a tax incentive.
I'm someone who thinks tax policy is a bad way to implement public policy. We'd be better off if we had an efficient and uncomplicated tax system and used public policy to achieve public policy goals. The mortgage intrerest deduction is another one that is extremely politically popular but is bad public policy. Distortions caused by taxes always carry a price.
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I think you're confusing premiums and benefits. Under the Senate bill premiums were going to be subject to tax, not benifits. If my employer, as part of my employment, paid my Medicare premiums - or my FICA obligation for that matter - why not treat it as income like everything else I'm paid (although Medicare premiums would be below any threshold being discussed in Congress).
My employer is writing a check to an insurance company on my behalf. They don't write the check unless I work. That sounds like pay to me. Why shouldn't it be taxed? How is that different than if they write the check to me and I pay the insurance? If they paid my mortgage would that be nontaxable income? - I don't think so. Why should health insurance be some special category of benefit?
There is no confusion.
What you say is no different for medicare.
Employers pay half of social security you owe and half of medicare you owe. They are writing a check to the government on your behalf. They dont write the check unless you work. You benefit from it, they do not.
Why not tax medicaid. Anything of value given can be taxed. Why not something worth several thousand dollars a year.
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I think you're confusing premiums and benefits. Under the Senate bill premiums were going to be subject to tax, not benifits. If my employer, as part of my employment, paid my Medicare premiums - or my FICA obligation for that matter - why not treat it as income like everything else I'm paid (although Medicare premiums would be below any threshold being discussed in Congress).
My employer is writing a check to an insurance company on my behalf. They don't write the check unless I work. That sounds like pay to me. Why shouldn't it be taxed? How is that different than if they write the check to me and I pay the insurance? If they paid my mortgage would that be nontaxable income? - I don't think so. Why should health insurance be some special category of benefit?
There is no confusion.
What you say is no different for medicare.
Employers pay half of social security you owe and half of medicare you owe. They are writing a check to the government on your behalf. They dont write the check unless you work. You benefit from it, they do not.
Why not tax medicaid. Anything of value given can be taxed. Why not something worth several thousand dollars a year.
FICA isn't quite the same as Medicare premiums - FICA and Medicare premiums are independent of each other - but it is an interesting example. FICA is a withhold, you see your gross pay and then you see that FICA was taken out of your pay. Employers match what you pay but everone knows about FICA and how much it is costing them each month. Compare that to insurance through work.
There isn't a line below your gross pay that shows what your insurance premium was the previous month. The sort of high end plans the Senate Bill would tax are the ones that cost $500 or more a week. That would get people's attention if the $500 showed up on their pay stub, was taxed as pay and then deducted. I don't think as many people would have sky's the limit insurance plans if they knew what they cost and could pocket money not spent on these high end policies.
What you'd expect is that employers would provide insurance up to whatever threshold was taxed and beyond that people could top off the plan with their after tax income but the good thing about this is that people would begin to pay attention to what their insurance is costing and would act to keep the cost down if they received the benefit of their actions.
I'm not sure what you're trying to say about FICA and Medicaid. If you have Part B you owe premiums, that's not the FICA tax that employers withhold. The FICA tax is prepaying insurance or qualifying you to buy Medicare. Paying FICA isn't a benefit in the same sense paying your insurance premium is a benefit. There are people paying FICA while they also pay Medicare Part B but I and people like me are the exception. If you're below the age threshold and you get cancer you can't decide to use Medicare, even if you've been paying FICA for 20 years. But you should be able to immediately use your employer paid insurance.
Medicaid is need based, as is all public assistance. Taxing public assistance doesn't make sense. You can't get blood from a rock but it is true SSDI, food stamps, et al are income of a sort. Sure ... If it amounted to more than $30,000 a year for an individual it should be taxed. It doesn't, so it isn't.
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Murf mate I think this means that we should never bash our medicare again because we get a bloody good deal!!!!
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bigsky -- employers do not pay half of the ss and mc you owe.......they MATCH what you pay. Whatever you pay they have to pay the exact same thing.
Bill, there are a goodly number of people who are self employed, especially here in the South. That cuts out a huge chunk of your reasoning on insurance costs being high because it is tax free. And what about the numbers of people who do not have health insurance? That is another huge chunk. I just don't by that. And I do think that people know exactly what their insurance costs. Unless you are referring to the folks who have their premiums totally paid by their company. There are not that many of those left around here.
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FICA isn't quite the same as Medicare premiums - FICA and Medicare premiums are independent of each other - but it is an interesting example. FICA is a withhold, you see your gross pay and then you see that FICA was taken out of your pay. Employers match what you pay but everone knows about FICA and how much it is costing them each month. Compare that to insurance through work.
There isn't a line below your gross pay that shows what your insurance premium was the previous month. The sort of high end plans the Senate Bill would tax are the ones that cost $500 or more a week. That would get people's attention if the $500 showed up on their pay stub, was taxed as pay and then deducted. I don't think as many people would have sky's the limit insurance plans if they knew what they cost and could pocket money not spent on these high end policies.
What you'd expect is that employers would provide insurance up to whatever threshold was taxed and beyond that people could top off the plan with their after tax income but the good thing about this is that people would begin to pay attention to what their insurance is costing and would act to keep the cost down if they received the benefit of their actions.
I'm not sure what you're trying to say about FICA and Medicaid. If you have Part B you owe premiums, that's not the FICA tax that employers withhold. The FICA tax is prepaying insurance or qualifying you to buy Medicare. Paying FICA isn't a benefit in the same sense paying your insurance premium is a benefit. There are people paying FICA while they also pay Medicare Part B but I and people like me are the exception. If you're below the age threshold and you get cancer you can't decide to use Medicare, even if you've been paying FICA for 20 years. But you should be able to immediately use your employer paid insurance.
Medicaid is need based, as is all public assistance. Taxing public assistance doesn't make sense. You can't get blood from a rock but it is true SSDI, food stamps, et al are income of a sort. Sure ... If it amounted to more than $30,000 a year for an individual it should be taxed. It doesn't, so it isn't.
They are the same. The employer is paying a fixed premium of 1.45% of la lifetime of wages earned with them to medicare that will directly benefit the employee. Its all benefits that are not taxed. This is no different than insurance where employers contributed to it. The fact that private insurance benefits may be used sooner in most cases makes no difference.
If your employer doesnt list what was contributed to insurance that would be their accounting methods.
The perk of working is that you have the right to have a higher standard of living than those who do not work.
bigsky -- employers do not pay half of the ss and mc you owe.......they MATCH what you pay. Whatever you pay they have to pay the exact same thing.
Its called a match but in reality its not. All employers reduce wages for the position to make up for the amount that has to be matched. So in the end its actually coming out of the employees pockets.
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That is not true bigsky. I've just closed my company in December, we were an employer who had up to 35 emplyees and we did not lower their pay to cover our portion of taxes. We did not punish people for what was our obligation. And frankly that attitude is what is injuring America today. Cheat everyone out of every thing you can just to make a buck for yourself. My goodness bigsky, there are SO many taxes that company's pay, one would have their pay cut in half just to pay all of them. Not only did I pay school and municipal tax at home but I had to pay it for my company as well and I couldn't even vote on the issues in that area! STate unemployment, Federal unemployment, Franchise tax, I could go on and on and on and on....and on. The person who has not been self employed (with employees) does not realize how much in taxes a company pays. This is the problem of new administrations coming in and raising taxes for companies -- which is why some people get layed off. OK, I'm finished with the hijacking...back to the subject at hand.
Hmmmmmm, sounds a lot like insurance co's! :urcrazy;
I agree with Bill on the efficient and uncomplicated tax system. This would make everyones lives much easier. The mortgage interest deduction has eluded me as well; I am undecided though on if I like it or not.
One thing for certain, if we don't get this healthcare thing worked out we are going to be in a world of trouble real soon.
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Actually it is true. That is because it represents money which otherwise most likely would have been paid to the employee. Like anything for a business it affects the bottom line which in turn affects what amount of wages will be paid at that business.
While its true business pays taxes, they also push an awful lot of their expenses onto society to pay. What enables a business to do business is the passing of those expenses to the taxpaying public in general.
I.E. The airline industry would not exist without the costs of running airports, FAA, etc etc were not picked up by the taxpayers.
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A business is supposed to be able to do business by selling a quality product not by pushing anything on anybody.
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Here's a simplified look at the difference between what happens today vs. what would happen if health insurance was taxed.
Imagine a company with $1,000 in sales just to illustrate the math not to represent an actual company. This company pays you $100 - that's your salary. In addition it pays a $25 employer group insurance premium so you have employer group health insurance. You pay $5 in FICA and the company matches that paying $5 too. The cost of employing you is $130 from the employer's perspective, their taxable income is $870. Your taxable income is $95.
Now we change the law and we tax health insurance - the cost to the company is the same and their taxable income remains the same but your taxable income is $120 - your $100 base salary and the $25 employer group insurance premium less FICA which is still $5.
Assume the tax rate is 20%. In the first instance you are getting $25 worth of employer group health insurance, paying $5 in FICA and $19 taxes. In the second instance you are getting $25 worth of employer group health insurance, paing $5 in FICA and $24 in taxes.
Obviously you are paying more taxes - that sucks for you - but back to the original question: why should the money being paid to you in the form of health insurance not get taxed?
The difference isn't just that the $25 is on your pay stub it is that the $25 is taxed as normal wages. What's the argument for excluding it? We all have predictable expenses - if the company pays your country club membership that's income and is taxed as normal wages. If you're provided a car and driver that's income - you owe taxes based on its fair market value. There are all sorts of tax loopholes but the general point is that if you are given something of value that you use outside of work - that's your income and you owe taxes. That's true for everything except health insurance.
Making this change isn't the singular fix needed for the health system but it raises money which we need. The fixes have to generate savings to the public cofers. You can't fix the healthcare system without fixing the inefficiencies and distortions - one of several is this idea that insurance benefits should be uniquely sheltered from tax.
You can see that under the current system employer group insurance premiums are treated differently than FICA by the IRS. Medicare premiums never even enter into the discussion. FICA is a tax that coveys some benefit but that is true of every tax and taxes are a category different from paying a fee for a service. Medicare Part B and Part D premiums are fees for service - you earn the benefit of being able to buy this inexpensive insurance because you paid taxes when you were working to support people who were retired. You paid FICA, so you are allowed to enroll in Medicare and pay Medicare premiums - being allowed to paying Medicare premiums is an earned benefit.
Malibu there is no one fix that is going to address all elements of this problem. According to the US census (http://www.census.gov/prod/2008pubs/p60-235.pdf (http://www.census.gov/prod/2008pubs/p60-235.pdf)) the percentage of people covered "by private health insurance was 67.5 percent, down from 67.9 percent in 2006 (Figure 7). The percentage of people covered by employment-based health insurance decreased to 59.3 in 2007 from 59.7 percent in 2006. The number of people covered by employment-based health insurance, 177.4 million, was not statistically different from 2006." So 7.8% were self pay, that's a lot of people but the nearly 60% is the bigger problem. There's 20 some percent covered by government insurance plans - Medicare, Veterans, Medicaid.
I don't know what percent of that 60% with employer group plans would have been subject to tax under the Senate bill - I think it was less than a quarter but I can't seem to Google up a number right now. Right now there isn't any sort of ceiling on health insurance costs, and without something checking unlimited growth these high end policies are dragging the premiums for the rest of the 60% higher and higher.
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It doesnt meet the definition of income by any stretch of the imagination.
What you are suggesting is that they should also tax what workers comp pays for medical claims or even unemployment even though the benefits may not be used.
Not to mention you conventionally skipped taxing stuff like SCHIP. After all by your definition of income that too would count as income.
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They tax my disability income.
:Kit n Stik;
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It doesnt meet the definition of income by any stretch of the imagination.
What you are suggesting is that they should also tax what workers comp pays for medical claims or even unemployment even though the benefits may not be used.
Not to mention you conventionally skipped taxing stuff like SCHIP. After all by your definition of income that too would count as income.
SCHIP? what workers comp pays for medical claims? What are you talking about? The Senate Bill would treat payment of health premiums as income - the only people impacted are people with jobs and high end employer group insurance. Your confusing what the insurance pays doctors - not income, with what the employer pays the insurer - income. The premium is income NOT the claims.
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SCHIP? what workers comp pays for medical claims? What are you talking about? The Senate Bill would treat payment of health premiums as income - the only people impacted are people with jobs and high end employer group insurance. Your confusing what the insurance pays doctors - not income, with what the employer pays the insurer - income. The premium is income NOT the claims.
The alleged claim of "high" end insurance. LOL Except the definition of high end is actually normal everyday people.
Also if you are going to claim tax on insurance is needed, then ALL such things should be taxed and counted as income, being discriminatory in how applying it is a bit repugnant to the very foundation of this country.
I am not confusing anything.
Fact is employers pay workers comp insurance and its not counted as income, Also they pay unemployment insurance and its not counted as income.
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SCHIP? what workers comp pays for medical claims? What are you talking about? The Senate Bill would treat payment of health premiums as income - the only people impacted are people with jobs and high end employer group insurance. Your confusing what the insurance pays doctors - not income, with what the employer pays the insurer - income. The premium is income NOT the claims.
The alleged claim of "high" end insurance. LOL Except the definition of high end is actually normal everyday people.
Also if you are going to claim tax on insurance is needed, then ALL such things should be taxed and counted as income, being discriminatory in how applying it is a bit repugnant to the very foundation of this country.
I am not confusing anything.
Fact is employers pay workers comp insurance and its not counted as income, Also they pay unemployment insurance and its not counted as income.
Actually you are confused about the nature of both workman's comp and unemployment insurance. In the case of unemployment insurance the benefits are taxed when they are used, when the worker uses unemployment insurance that income is subject to tax. In the case of workman's comp you are confused about who is getting insured. Worker's comp pays (compensates) for medical care for injuries that happen while on the job. If there wasn't worker's comp you could (or would have to) sue your employer for negligence to be compensated for an on the job injury. Worker's comp is in the employer's interest, it insurers them against getting sued for injuries that happen on the job. And if the employee receives disability payments - those are subject to tax.
My point is that all income should be taxed - money that goes to pay insurance premiums should rightly be considered income. People like me who are in a union - everyday people - have high end insurance policies. Those should be taxed if their value is above a given threshold. If it resulted in the insurance having higher copays and deductibles to avoid the tax then I would be paid more - instead of always negotiating to keep these high end plans every time the contract is renewed they could negotiate pay raises - which I would prefer. With the added straight pay each individual could decide to spend their after tax money topping off their health insurance or on whatever they want - I don't think that is repugnant to the very foundation of this country.
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Actually you are confused about the nature of both workman's comp and unemployment insurance. In the case of unemployment insurance the benefits are taxed when they are used, when the worker uses unemployment insurance that income is subject to tax. In the case of workman's comp you are confused about who is getting insured. Worker's comp pays (compensates) for medical care for injuries that happen while on the job. If there wasn't worker's comp you could (or would have to) sue your employer for negligence to be compensated for an on the job injury. Worker's comp is in the employer's interest, it insurers them against getting sued for injuries that happen on the job. And if the employee receives disability payments - those are subject to tax.
My point is that all income should be taxed - money that goes to pay insurance premiums should rightly be considered income. People like me who are in a union - everyday people - have high end insurance policies. Those should be taxed if their value is above a given threshold. If it resulted in the insurance having higher copays and deductibles to avoid the tax then I would be paid more - instead of always negotiating to keep these high end plans every time the contract is renewed they could negotiate pay raises - which I would prefer. With the added straight pay each individual could decide to spend their after tax money topping off their health insurance or on whatever they want - I don't think that is repugnant to the very foundation of this country.
It would seem the only one confused would be you bill.
Both are benefits that are paid for by the employer that benefit the employee and both are insurance benefits. Also if there was no workers comp it would have to be demonstrated that the business was negligent in the matter of the injury of which very few are the case. Also it doesnt matter if they have workers compensation, if the business is negligent in some manner over an injury they still can be sued and workers comp does and has nothing to do with it. Workers comp solely pays the worker for injury and wages lost, it doesn't absolve nor defend the business from negligence over a injury.
A founding principle of this country is equality. What you are suggesting is not.
The very fact is you are suggesting people on government plans should benefit more than those who work and are barred from such programs just because they are working.
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Actually you are confused about the nature of both workman's comp and unemployment insurance. In the case of unemployment insurance the benefits are taxed when they are used, when the worker uses unemployment insurance that income is subject to tax. In the case of workman's comp you are confused about who is getting insured. Worker's comp pays (compensates) for medical care for injuries that happen while on the job. If there wasn't worker's comp you could (or would have to) sue your employer for negligence to be compensated for an on the job injury. Worker's comp is in the employer's interest, it insurers them against getting sued for injuries that happen on the job. And if the employee receives disability payments - those are subject to tax.
My point is that all income should be taxed - money that goes to pay insurance premiums should rightly be considered income. People like me who are in a union - everyday people - have high end insurance policies. Those should be taxed if their value is above a given threshold. If it resulted in the insurance having higher copays and deductibles to avoid the tax then I would be paid more - instead of always negotiating to keep these high end plans every time the contract is renewed they could negotiate pay raises - which I would prefer. With the added straight pay each individual could decide to spend their after tax money topping off their health insurance or on whatever they want - I don't think that is repugnant to the very foundation of this country.
It would seem the only one confused would be you bill.
Both are benefits that are paid for by the employer that benefit the employee and both are insurance benefits. Also if there was no workers comp it would have to be demonstrated that the business was negligent in the matter of the injury of which very few are the case. Also it doesnt matter if they have workers compensation, if the business is negligent in some manner over an injury they still can be sued and workers comp does and has nothing to do with it. Workers comp solely pays the worker for injury and wages lost, it doesn't absolve nor defend the business from negligence over a injury.
A founding principle of this country is equality. What you are suggesting is not.
It's called the "the compensation bargain." Look it up (http://money.howstuffworks.com/workers-compensation.htm/printable).
It should be clear after even superficially considering workman's comp that is is not the same as health insurance. Injuries that happen on the job are not the problem of the larger health insurance system.
How is it equitable for people who receive insurance through work to get a tax break that isn't available to people who self pay? Same insurance - if you get it through a large employer group plan, tax break; if you get it through self pay you don't get an equivalent tax break. The current rules don't sound equitable to me. If equity is your concern then you should favor taxing employer paid premiums.
The very fact is you are suggesting people on government plans shouldbenefit more than those who work and are barred from such programs justbecause they are working.
How do you come to that conclusion? Are you confusing Medicare benefits with insurance premiums again?
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It looks like you are the only one who is confused bill.
As to medicare, those taxes are indeed a premium paid by the employer that solely benefits the employee. That premium is 1.45% of wages earned while with the employer.
Its foolhardy to think its different because one benefit may be used before another.
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It looks like you are the only one who is confused bill.
As to medicare, those taxes are indeed a premium paid by the employer that solely benefits the employee. That premium is 1.45% of wages earned while with the employer.
Its foolhardy to think its different because one benefit may be used before another.
When or if they're used isn't the question - the nature of insurance is that is unknown. The difference between FICA and health insurance premiums are fundamental.
FICA is a tax - a shared tax. You have to pay FICA. You pay it to the Federal Government. It funds Social Security and Medicare.
You don't see any difference between taxes and insurance premiums? Are you just pulling my leg now?
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When or if they're used isn't the question - the nature of insurance is that is unknown. The difference between FICA and health insurance premiums are fundamental.
FICA is a tax - a shared tax. You have to pay FICA. You pay it to the Federal Government. It funds Social Security and Medicare.
You don't see any difference between taxes and insurance premiums? Are you just pulling my leg now?
It funds insurance benefits which is no different. It matters not when its used or how its funded or to whom it funded. The very fact is you want to tax people on something they may or may not even use.
Funny how you think anyone on the government teat should be exempt from the standards that you want to apply to everyone else.
Not to mention in numbers you think people should have to pay an extra 100 or more a month in taxes order to have insurance.
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When or if they're used isn't the question - the nature of insurance is that is unknown. The difference between FICA and health insurance premiums are fundamental.
FICA is a tax - a shared tax. You have to pay FICA. You pay it to the Federal Government. It funds Social Security and Medicare.
You don't see any difference between taxes and insurance premiums? Are you just pulling my leg now?
It funds insurance benefits which is no different. It matters not when its used or how its funded or to whom it funded. The very fact is you want to tax people on something they may or may not even use.
Funny how you think anyone on the government teat should be exempt from the standards that you want to apply to everyone else.
Not to mention in numbers you think people should have to pay an extra 100 or more a month in taxes order to have insurance.
So your saying if insurance premiums were considered taxable income you'd have to consider the employer paid FICA taxes taxable income? :( And then to be fair, employees would have to pay taxes on the employer's taxes! :'( :'(
I think a mnemonic device will help you keep this straight ... :secret;
A tax has three letters; you pay taxes to three levels of government: Local, State, Federal. :embarassed:
Goods and Services has many letters; there are many companies. :)
Goods and services are good! :) :) These are things you want and agree to buy. It's your choice! :bandance; :bandance;
Taxes are bad. >:( >:( You have to pay taxes and the government then spends your money! :stressed; :stressed;
If your $2,000 monthly insurance premium was taxable, and your effective tax rate was 25% ... you'd owe $500 every month! :embarassed: :embarassed: Watch out for those $4,000/month policies! Ouch!!! :banghead; :banghead;
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So your saying if insurance premiums were considered taxable income you'd have to consider the employer paid FICA taxes taxable income? :( And then to be fair, employees would have to pay taxes on the employer's taxes! :'( :'(
I think a mnemonic device will help you keep this straight ... :secret;
A tax has three letters; you pay taxes to three levels of government: Local, State, Federal. :embarassed:
Goods and Services has many letters; there are many companies. :)
I think you mean a moronic device. You are trying to use local to cover more than one entity of government. There are five areas of government. City, County, Tribal State, Federal, and no, not everyone pays taxes to "three levels" as you put it.
Also tax means nothing in the matter as it is still a paid for benefit by another party.
If your $2,000 monthly insurance premium was taxable, and your effective tax rate was 25% ... you'd owe $500 every month! :embarassed: :embarassed: Watch out for those $4,000/month policies! Ouch!!! :banghead; :banghead;
Yep that would be $500 ON TOP of the taxes people ALREADY pay.
So by your thinking people should pay $6000 extra a year out of income despite not having an net increase in their income.
Evidently you never considered or thought out such consequences of such a thing and the negative effect it would have on the nation.
But back to your taxes.
Lets see:
25% for your tax on insurance-your figure
15+% for income tax
6.2 % for Social Security
1.45% for Medicare
7% for State Income tax
That does not include: tire tax, oil tax, gas tax, landlline phone tax, cell phone tax, road tax, vehicle registration tax, land tax, home tax etc. etc. etc.
:oops;
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Local taxes (http://lmgtfy.com/?q=local+taxes)
Effective tax rate (http://lmgtfy.com/?q=effective+tax+rate)
And then you apply the tax credit that ALL the proposals include. McCain's was $5,000.
It could be more or it could be less but people would be making the purchasing decision. They would be able to decide to use every pay raises for the rest of their lives to pay an ever increasing insurance bill but I doubt that is what they would choose. Still it would be totally up to them.
You have never really said why this $48,000 in pay should be free of tax?
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Its not income. IRS makes that pretty clear.
Its up to people to spend THEIR MONEY, not up to the throttlebottoms to decide they should get all the PEOPLE'S MONEY and spend it as the throttlebottoms wish.
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It's not income but it's their money ... interesting. We're talking about people who are working right? Not heiresses?
BTW the musical comedy reference? classic.
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It's not income but it's their money ... interesting. We're talking about people who are working right? Not heiresses?
BTW the musical comedy reference? classic.
Tsk tsk again trying to take something out of context.