Who Else Is Watching The Debate?

lizmonster

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Insurance companies offer health care plans. Companies negotiate group rates, and offer choices (often not more than one or two) to employees. The cost of the plan is deducted from the employee's paycheck.

Pre-ACA, if you didn't have a plan offered through your employer, you could buy one from the insurance company yourself. But what was available was unaffordable to nearly everyone. (I looked at one point because I wanted better coverage than what was on offer through my employer. It was a non-starter.)

When you change jobs, you can keep your insurance, but not for the same negotiated cost. In general, when you change jobs, you change insurance. If your new employer doesn't offer the same insurers as your old employer, that often means changing doctors.

The overhead on the system is massive. It also employs a lot of people.
 

frimble3

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I am Canadian. I used to work in private health insurance. A system can have both government and private insurance.

[FONT=interface_regular]Canada has a [/FONT][FONT=interface_regular]decentralized, universal, publicly funded[/FONT][FONT=interface_regular] health system called Canadian Medicare. [/FONT][FONT=interface_regular]Health care is funded and administered primarily by the country’s 13 provinces and territories. [/FONT][FONT=interface_regular]Each has its own insurance plan, and each receives cash assistance from the federal government on a per-capita basis. Benefits and delivery approaches vary. All citizens and permanent residents, however, receive [/FONT][FONT=interface_regular]medically necessary hospital and physician services free at the point of use.[/FONT][FONT=interface_regular] To pay for [/FONT][FONT=interface_regular]excluded[/FONT][FONT=interface_regular] services, including [/FONT][FONT=interface_regular][/FONT][FONT=interface_regular]outpatient prescription drugs and dental care, provinces and territories provide some coverage for targeted groups. In addition, about two-thirds of Canadians have private insurance.[/FONT][FONT=interface_regular][/FONT]
Red is Medicare (government services) and blue is private insurance (choice of companies, as usual).
Private insurance can be bought by individuals, and is frequently provided by large employers (on their own or negotiated by unions) who can take advantage of group rates.

It's a clever way to encourage employee loyalty.
 

frimble3

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DO the employers provide the health care, or is it just arranged through them and paid for by the government? Or does the employee take it as part of their salary/wage, and so they pay for it (in which case - can't they choose their own?)
Here, healthcare is mainly paid by the government, through your taxes. The Federal plan takes your tax money and gives it back to your provincial government, each of whom administers their own plan, depending on the perceived needs and wants of their people. In B.C., it's the Medical Services Plan
(MSP). There used to be a monthly charge for it, but as of last year, the cost was fully covered by the government.
Yes, the individual plans are either paid directly by the individual, or, by the employer (who pays less per person, because they are buying in bulk). So, unless your employer's plan is really minimal, it's cheaper to get it through them than to buy it yourself.

The employer does not make up their own plan, BTW, they sign up for a plan from a real health insurance company, although they can pick what they want to cover. (This is where you get stuff like employers refusing to cover birth control, etc.)
There is a lot of paperwork and rejection in insurance, it's bad enough from the employer's POV that they have to sign people up, and provide forms, etc. They don't want the trouble that comes from telling people that whatever they want isn't covered.
 
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cbenoi1

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They don't want the trouble that comes from telling people that whatever they want isn't covered.

It's also easier to punt claims to the insurers. Good luck su***ers!

-cb
 
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Tazlima

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Insurance companies offer health care plans. Companies negotiate group rates, and offer choices (often not more than one or two) to employees. The cost of the plan is deducted from the employee's paycheck.

Pre-ACA, if you didn't have a plan offered through your employer, you could buy one from the insurance company yourself. But what was available was unaffordable to nearly everyone. (I looked at one point because I wanted better coverage than what was on offer through my employer. It was a non-starter.)

When you change jobs, you can keep your insurance, but not for the same negotiated cost. In general, when you change jobs, you change insurance. If your new employer doesn't offer the same insurers as your old employer, that often means changing doctors.

The overhead on the system is massive. It also employs a lot of people.

At my old job, I had the fun task of "choosing" the policy for my company every year. I'd get quotes from multiple companies, create a spreadsheet that allowed apples to apples comparisons of approx. 30 plans, eliminate the obviously terrible options, go over the rest with a fine-toothed comb, narrow it down to the two or three best choices, summarize these for my boss, who had the final say...

...and she'd put off looking at the data until all the deadlines were passed and we had no choice but to go with the updated version of the crappy plan we were already on.

The next year, about a month out, she'd ask me to round up quotes again and the process would repeat.

Just one of the many, many reasons I'm no longer at that job.

A few numbers for the curious:
(keep in mind that this is only health insurance... vision and dental weren't covered, or even offered)

My data's a couple years out-of-date, so premiums will have gone up since them (they went up every year like clockwork), but here's a rundown of
approx. what was charged and who paid what.

Part of the idea behind employer-provided healthcare is that the employer can pay all or part of the premium, so it becomes part of your pay package. In theory, it can be a very nice perk. My current employer actually pays the bulk of the premium for all employees, and it's incredible. It's also, in my experience, vanishingly rare.

In reality, the employer chooses what portion they pay, and in shitty hands, it's a good way to say "yes, we offer health insurance to our employees," while the reality is so prohibitively expensive that many employees decline coverage, so the company doesn't have to pay a dime.

My previous, crappy employer paid 1/2 of the employee's premium, and $0 of any additional premiums if you wanted your spouse or children covered.

The plan we had actually wasn't too bad... not great, but then, ALL the options, even the most expensive, were crappy (High deductibles and insane prices for out-of-network coverage... whatever you do, don't get sick when you're out of town).

For our particular plan, the monthly pricing was roughly this.

Employee Only: $450
Employee + Spouse: $900
Employee + Children*: $850
Employee + Spouse + Children*: $1,200

*Doesn't matter how many children, it's a flat rate.

So for an employee with no family, the company would pay $225/month, and take $103 out of every bi-weekly paycheck to cover the rest.

For our lowest-paid employees, making $8/hour, this was about 20% of their take-home pay, already more than they could afford, so most went without and used the same health plan that saw me through my 20s, crossed fingers, home remedies, and, very occasionally, leftover medicine from when your dog was sick. (Hey, antibiotic eye ointment is antibiotic eye ointment, amiright?)

If you had a spouse and kids, well, the company would still only pay $225/month. The employee would then have approx. $450 deducted from every... single... paycheck. For the folks making $8/hour, this would have left them with approximately $75/paycheck to actually take home.

Every single one of them was told upon hiring, "oh yes, we offer health insurance to all our employees after three months of employment."

(Oh yeah... can't forget the grace period, which is standard procedure even at the good companies. Don't have existing coverage when you're first hired? Better hope you can make it to the deadline in one piece).

 
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Roxxsmom

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I work for a community college, and so am a public employee. Since I am part time, I have the option of paying a monthly fee to get health insurance that covers less than the full timers' insurance but is still a good deal better than nothing. Fortunately, my spouse is full time at the same college, so I get the spousal coverage. 20 years ago, the district paid the entire premium, but now full-time employees (in this case my spouse) have to pay some of the premium out of pocket each month. I think it's around 300 a month now.

So far spouses and kids are included in the package, so there is no extra for family members. This becomes a bone of contention sometimes when contract renewal time is up with the union, and there are always a few libertarian types (even at a college) who are adamant that they shouldn't have to pay a bit more out of pocket so the faculty with spouses and/or kids pay a lot less each month. Thus far they have been voted down.

The default insurance for our district is Kaiser Permanente, which is an HMO and the pioneer of capitated coverage (which removes the incentive for doctors to refer patients for tests and treatments that aren't needed but also disincventivizes them from referring patients for tests and treatments that could be beneficial outside of a standard flow chart--good luck getting diagnosed with an autoimmune condition unless you have absolutely classic symptoms).

There are good things about KP and some not so good things. It's great for vaccines, preventative care, certain routine screenings (like drop-in mammograms) and affordable prescriptions (for generic drugs in their formulary, anyway). It's not always great if you have a rare or unusual disease (a zebra instead of a horse) that isn't on their diagnostic flow chart and which may require a more individualized approach to treatment. If you tell your doc that you worry about autoimmune disease, because you are achy and tired a lot and have this weird asthma that only developed a few years back, and your mom has an autoimmune disease and they often run in families, the doctor gets glassy eyed and tells you you need to lose weight and exercise more (never mind that exercising is harder than it once was, thanks to the asthma and achiness). As for cancer or a serious condition, the quality of treatment you get depends on how well yours responds to a "standard" protocol. Instead of routine colonoscopies after 50, they do a yearly fitt test and only refer you for a full colonoscopy if there is blood detected in your stool (which shocked my brother the oncologist). People do get elective procedures there, like joint replacements and so on, with some waiting.

Our plan has a 15 buck co-pay for most initial office visits, but certain routine tests and screenings are "free" (that is due to the ACA, I think), and ER visits are 100.00 if you don't get admitted. But if you have surgery or an involved diagnostic procedure (like endoscopy), you pay nothing out of pocket, which is amazing. Their mental health coverage used to be appalling (they would refer you to a class on depression and maybe one or two short visits with a counselor), but since the ACA, they have a referral system to outside mental health care providers with a small co-pay. Your MD will basically prescribe an antidepressant on demand, however, and they are very flexible for the ones in their formulary.

So in some ways, KP is like a socialized medicine system--very by the books when it comes to determining care, and doctors constrained by what is covered and having to jump through certain pre-determined hoops in order to keep costs down. Many Americans have HMOs that operate on this model nowadays, and many have to pay a lot more out of pocket or still get huge bills after a surgery or intricate procedure. So I'm not sure why a nationalized system is so terrifying.
 

Roxxsmom

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One moment I thought was interesting was when Trump was going on about how windmills kill "all the birds" (as if he gives a shit about nature) and accusing Biden of wanting to destroy the oil industry, and then saying, "You hearing this, Texas?"

Clearly he IS nervous about how close he and Biden are polling in Texas this time around.

An interesting bit of Texas trivia, of which Trump is clearly unaware, is that Texas is the US leader in wind energy (maybe it's because of all the hot air blowing around down there?). So being in favor of wind energy is actually good for Texas.
 

Chris P

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The "You hearing this, Texas" comment just highlights it's more about image than facts. Texas (and Pennsylvania) means "oil," particularly in the 1950s and 60s world Trump seems to live in. I remember living in Mississippi in 2008 when Obama won. Local Democrats were pointing out that Mississippi received more federal dollars than it paid in taxes, and a McCain presidency would likely have have meant less money coming into the state.

Trump hopes to make big of Biden's "we're transitioning from fossil fuels" comment, but as the article points out the writing's been on the wall for years. When I came back to the US in 2014 after two years in Uganda (I didn't make it home at all during that time) I was amazed and encouraged by how much more wind power I saw than when I left. Maryland (more so than Virginia, must be state program of some sort) has tons of rooftop solar. The economics of renewables are getting progressively more favorable, and at some point these market-minded conservatives are going to catch on. I do agree a rapid hard stop on all fossil fuels would be hugely disruptive, but we can't hold on to how things used to be.
 

MaeZe

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So I'm watching Democracy Now and the issue of the commutations was covered. How many sentences is Trump bragging he commuted?

Well it turns out during the Obama/Biden administration they commuted thousands! Thousands! So I looked it up. Turns out it was true.

COMMUTATIONS GRANTED BY PRESIDENT BARACK OBAMA (2009-2017)

Holy cow! I didn't know this. Obama never bragged about this.


I sent this link to the Lincoln Project. I hope someone there sees it.

I think I'll send it some some editors and other groups.
 
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JJ Litke

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Apparently I'm not going to get any response to this, so I'd just like to request that we not insult each others' home states or countries. If I wanted verbal abuse, I'd go instigate Scottish Twitter and at least get some clever ones lobbed at me.
 

Roxxsmom

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Is this meant to be funny?

God, I am just beyond exhausted now.

I suppose it is, as it's true in both a literal and metaphorical sense. Texas does have many windswept plains.

Note I was thinking of your governor as a particular source of the metaphorical hot air.

Sorry if it came off as a jab at all Texans. I did not want to be hurtful. I guess I'm sort of numb to aspirations against states from a political standpoint, being from CA and receiving an endless parade of disparagement for us being so "blue," even from some fellow Californians who are lately talking about how they want to move to Texas for the "lower taxes," which is a bit ironic. Oh, and because our governor is a "fascist" for his mask mandate (which they ignore without consequence anyway). Note, I do not wish these folks on your state.
 
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