Healthcare for self employed engineer in the U.S

[yada]

Good luck. The ACA was your only option but they are getting rid of that. Just don't get sick or hurt. But supposedly Canada has a terrible health care system. How could you possibly NOT want insurance?

[tpowell1830]

 
Ok, so I have read all of the posts up to now and I see a theme that is typical. Healthcare is the ability of medical professionals to provide high quality care for humans who have accidents, illness, disease, etc. The US is a world leader in this, without a doubt, we have the very best hospitals, doctors and all the other medical professionals who provide this service. What everyone has been talking about is the ability to pay for it, which is not healthcare, but the price of healthcare. Let's not call the price and cost of healthcare, healthcare.

Insurance and Obamacare are the price of healthcare for individuals and, yes, it is expensive either way you go. But, here is my take on singlepayer, Obamacare or any other US government ran system. The US government is by and large a system that is basically ran by lobbyists of large corporations. What are insurance companies? Large corporations, simply put. Another thought on the US government creating a bureau (full of bureaucrats) that will effectively and efficiently run a healthcare program that pays for healthcare is a non-starter. Every bureau that is run by the US government is a joke. This is true of all of them that I know of, like for instance FEMA, that has done more good than harm. The US government is simply incapable of running a bureau effectively and efficiently.

With that said, where do we go from here? The US government is NOT going to give us a healthcare program that works, at least not in the near future. Obamacare costs individuals the same as if we went to the insurance companies ourselves and bought health insurance.

I am glad that there are countries out there that provide the cost of healthcare to their citizens without a lot of hassle. Of course, those countries are charging the cost through higher taxes, but if the governments are doing this efficiently and effectively, then that is a great accomplishment. Do the math and if it all adds up to savings per individual, then it is efficient and effective. Also, if it does not cause the good healthcare professionals to go somewhere else to get paid what they are worth then more kudos are in order.

 

[ehughes]

In the USA you roll the the dice and hope you don't get seriously sick.   


A reasonable plan through the ACA is about 30k a year  for a family of 4.  By reasonable I mean one that doesn't require a mortgage to pay deductable if you get really sick.

The other option is to bank that money in an HSA and pay cash.   You can do some negotiating but you should have at least 100k in reserves for serious health issues.

Make sure to mark up your services.      Think about your salary now and double it at a minimum.

This may seem like a lot but private insurance will do everything in their power to not cover you for anything.      Your only option is to have a large savings or be part of some larger group with negotiating power.

I work for a University research lab.    We pay for 10% of the premiums and it is about $425 a month for a family of 4.  The employer pays for the rest.     At this level we have to pay the 1st 3k every year of health care costs (per family member) before The deductable is met.

This is in line with most others I know who have an employer plan.

So, in this country,  you pretty much roll the dice or pay for insurance that you will have to fight with if anything serious happens.

[james_s]

My mom is self employed and for a while the insurance plan she was on found a way to weasel out of covering *anything* for an entire year. They were more than happy to keep taking her premiums though, and acted surprised when she left them.

People complain about the tax cost of single payer health insurance but we already pay much more than that, it's just not as visible since for a lot of us our employer pays for it as part of our compensation we never actually see.

[mtdoc]

People complain about the tax cost of single payer health insurance but we already pay much more than that, it's just not as visible since for a lot of us our employer pays for it as part of our compensation we never actually see.

Yes, and taxpayers are already subsidizing large amounts of uncompensated care and avoidable high cost care due to peoples reluctance to seek routine and preventative care due to high deductibles and co-pays.

We spend far more on healthcare per capita than any other country and have poorer outcomes than most of them.

[xrunner]

I have a marketplace plan, but look out - our Dear Leader Trump said last week that he wants to stop the cost sharing subsidies that help insurance companies pay for some lower income people's costs. If he sticks to that asinine plan next week the whole shebang will blow up and many of us will be in the shithole.

A quote from somewhere I can't remember -

“Let us eat and drink, for tomorrow we die!”

[cdev]

They could likely keep subsidies as long as they weren't discriminating against foreign service providers. So under the "patient mobility" scenario (code word for patient export/import) lots of tax money might end up getting sent overseas. Same issue likely applies to infrastructure. Do you build public infrastructure knowing that foreign firms are likely to be the winners of most of the contracts?


India in their trade facilitation agreement for services proposal, (among many other things to correct what they see as persistently trade restrictive practices by the developing world) seems to be proposing that the WTO force countries healthcare plans (also Social Security, so their IT consultant teams, etc. could keep their social security contributions..) to be portable across borders.  That might destroy the GATS protection currently enjoyed by SS.. which would be a disaster for Americans . I don't know.. Here is the relevant document.


----
Stuff thats related but not healthcare specific, it definitely DOES apply to healthcare IT including accountancy and bookkeeping, this is the larger issue also which is a war thats being waged on the wage gradients that result in people in some countries being paid many times more than the global average wage for that kind of work. .

India circulates concept paper on TFS initiative
http://www.twn.my/title2/wto.info/2016/ti161006.htm

Several South nations coalesce around Indian TFS proposal
http://www.twn.my/title2/wto.info/2016/ti160706.htm

The field that is really being targeted the most is IT. Including healthcare IT which is waiting on a number of things that big corporations want, basically they want to bget rid of regulations of all kinds, especially ones that information be kept in a source country, or that some percentage of employees be from that country, also they want the freedom to pay whatever wages they want, assuming its agreed upon by both worker and employer, (could be very low) Also they are working on data-specific agreements which some would say shred privacy.

This is a CRS report (Congressional Research Service on a related challenge by India of visa quotas)

Certain U.S. Laws for Foreign Workers Draw Fire from India in the WTO
 (The natural numbers offshored could become very high without the quotas, considering the current cost differential. Once we started rating everything by GNP, we lost the battle right there. Because a good "business case" can always be made for cutting wages and costs under that definition of growth.. (yes it sees cutting workers as growth if it leads to more profits) Considering that each L-1 visa lasts six yeas, imagining each back office offshoring firm IT worker could offshore maybe one job title a year, multiple people in the same company might share that title, though, taking an average of twenty people per offshoring consultant, thats 120 jobs lost per worker.. )

......

Its all very complicated and interrelated. We in the US, I feel have been making a big mistake by not seeing working conditions and wages in other countries as being tied to our own. And now our failure to care about the rights, dreams, and futures of others for so long is going to come back and bite us, I suspect. I don't know.

I just have a bad feeling. Poor sick people are not in any position to defend their rights or interests while they are sick, in an international arena.

https://www.thedollarbusiness.com/news/sitharaman-and-michael-froman-deliberate-visa-issues-and-totalisation-agreement/48322

https://docs.wto.org/dol2fe/Pages/FE_Search/FE_S_S009-DP.aspx

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2324078

http://www.rosalux.eu/fileadmin/user_upload/Publications/2017/8_Beyond_the_Doha_round-web.pdf

Don't know where that could go.

Given the opportunity, I think its inevitable that yes, insurers would jump at the chance to send patients to hospitals in india or other low cost nations. I think that given the opportunity to do so they definitely will. And make it a requirement of coverage as much as they can.

[rstofer]

Don't know whwere that could go. Insurers might send patients to hospitals in india

Seems to me I read somewhere that US insurers were already sending patients to India.  This was several years ago so I don't think this is a new idea.

[cdev]

Many employers self-insure. I think what you must be thinking of is likely on a very limited scale. Its my understanding from India's TFS submissions to the WTO that countries like the US do not have portability of health insurance benefits to other countries. Thats likely done for a bunch of reasons. the healthcare systems in other countries have a very wide range of quality. We should not make any assumptions as to quality, it varies quite a lot depending on where care is being rendered and at what price level. Elsewhere and here. Only the best countries have uniformly high standards.

Sending poor patients overseas might not be the panacea that some people think. For one thing, people might lose any subsidies in that situation if they were deemed to be able to afford the lower overseas rates. Also, if it became the norm, millions of jobs would be lost and healthcare here would likely become more expensive, not less, due to the need to cover costs. Competition in for profit health care would not lower prices, it would raise them. Thats the way it works and there has been a lot of misrepresentation about that. The cost increase is due to lower utilization of expensive equipment on a per patient basis.

Another issue comes up and that is the trade restrictiveness issue. WTO rules require that measures be "not more burdensome than is necessary to ensure the quality of the service".

Burdensome meaning for corporations.. not people. That would likely lead to more and more patients being sent overseas as fewer and fewer people could afford it. I am sure that some people would love that, but it would not be a good thing, it sounds to me like a potential precursor to genocide, to tell the truth.

History would back me up on that. I think that there is a clash with international law which may prohibit some kinds of exporting of patients, when framed as political especially. I don't know.

I do know that there is a lot of concern about the job losses due to various pressures perceived by companies, and it looks like a potential vicious circle of job shedding and subsequent collapse in buying could spiral out of control driven by individual business actions to reduce their bottom lines - added together it seems like a policy road which would be easy to take but which would potentially undermine the stability of society in a way which would be virtually impossible to reverse. Sure, business could offshore their entire back office operations pretty easily soon. Should they? No, they shouldn't.

Because there would be a large scale loss of trust. And people would expect the government to step in but deals like the GATS would prohibit that.

Quote from: rstofer on Today at 00:06:41

Seems to me I read somewhere that US insurers were already sending patients to India.  This was several years ago so I don't think this is a new idea.

[yada]

Ok, so I have read all of the posts up to now and I see a theme that is typical. Healthcare is the ability of medical professionals to provide high quality care for humans who have accidents, illness, disease, etc. The US is a world leader in this, without a doubt, we have the very best hospitals, doctors and all the other medical professionals who provide this service. What everyone has been talking about is the ability to pay for it, which is not healthcare, but the price of healthcare. Let's not call the price and cost of healthcare, healthcare.

Insurance and Obamacare are the price of healthcare for individuals and, yes, it is expensive either way you go. But, here is my take on singlepayer, Obamacare or any other US government ran system. The US government is by and large a system that is basically ran by lobbyists of large corporations. What are insurance companies? Large corporations, simply put. Another thought on the

(sic... or should I say 'sick'  ).

 

Heres a US government program no one it would ever give up: Medicare. My wife is American and on it. The only hassle about it is the "part D" which is the RX drug part, no surprise that part of medicare (A, B and D) is run by for profit insurance.

How can the richest country in the world not afford medicare for all? Worst part about repealing the ACA is pre-existing condition clauses are/will be back. I saw a story on he news where a girl was raped got HIV and that considered a preexisting condition. If she loses her insurance through the repeal of the ACA, she won't be able to get her very expensive anti viral drugs that keep her alive. That fucked up, a 25 year old girl is going die because of a greedy insurance company deems her unprofitable. That literally could happen to anyone.

[cdev]

And it is happening to all of us as you can read here.

[HackedFridgeMagnet]

Contrast the Australian system where my son had an important but not urgent operation, a difficult and very involved operation done by an awesome Orthopedic surgical team, but with both a Vascular team and a plastics team on standby for 6 hours in case of a mistake.
9 years later and it is almost time for the second and last operation. It will probably done with the same skill and care and all he will be left with is an impressive scar.


The only cost to us in the 2.5% medicare levy on our wages. (edit: it's certainly more than that, indirectly but I don't have a figure)
Anecdotal I know but I've never met anyone here who wants to get rid of our Medicare system.

[T3sl4co1l]

The only cost to us in the 2.5% medicare levy on our wages. (edit: it's certainly more than that, indirectly but I don't have a figure)

Why they bother tacking on 2.5%, I don't get.  Tax is tax...

https://en.wikipedia.org/wiki/Healthcare_in_Australia#National_health_policy
This says 150 billion.  Which averages to about 7000 AUD per person.

Tim

[vodka]

Ok, so I have read all of the posts up to now and I see a theme that is typical. Healthcare is the ability of medical professionals to provide high quality care for humans who have accidents, illness, disease, etc. The US is a world leader in this, without a doubt, we have the very best hospitals, doctors and all the other medical professionals who provide this service. What everyone has been talking about is the ability to pay for it, which is not healthcare, but the price of healthcare. Let's not call the price and cost of healthcare, healthcare.

Insurance and Obamacare are the price of healthcare for individuals and, yes, it is expensive either way you go. But, here is my take on singlepayer, Obamacare or any other US government ran system. The US government is by and large a system that is basically ran by lobbyists of large corporations. What are insurance companies? Large corporations, simply put. Another thought on the

(sic... or should I say 'sick'  ).

 

Heres a US government program no one it would ever give up: Medicare. My wife is American and on it. The only hassle about it is the "part D" which is the RX drug part, no surprise that part of medicare (A, B and D) is run by for profit insurance.

How can the richest country in the world not afford medicare for all? Worst part about repealing the ACA is pre-existing condition clauses are/will be back. I saw a story on he news where a girl was raped got HIV and that considered a preexisting condition. If she loses her insurance through the repeal of the ACA, she won't be able to get her very expensive anti viral drugs that keep her alive. That fucked up, a 25 year old girl is going die because of a greedy insurance company deems her unprofitable. That literally could happen to anyone.

All the insurance corporations do this,while they are winning on the game , they have to pay to you huge prices for the insurances when the game changes and the insurance corporation are seeing that they can lose, they begin to do unfair game : Re-interpret the contract condition, delay the Indemnities, induce or directly violating the laws, etc

Contrast the Australian system where my son had an important but not urgent operation, a difficult and very involved operation done by an awesome Orthopedic surgical team, but with both a Vascular team and a plastics team on standby for 6 hours in case of a mistake.
9 years later and it is almost time for the second and last operation. It will probably done with the same skill and care and all he will be left with is an impressive scar.


The only cost to us in the 2.5% medicare levy on our wages. (edit: it's certainly more than that, indirectly but I don't have a figure)
Anecdotal I know but I've never met anyone here who wants to get rid of our Medicare system.

So , here we are paying to SS ten times more(25,41%) ,adding the general budges ,add the VAT, IRPF, and the rest taxes. Still there, we are on deficit   

[HackedFridgeMagnet]

Why they bother tacking on 2.5%, I don't get.  Tax is tax...

https://en.wikipedia.org/wiki/Healthcare_in_Australia#National_health_policy
This says 150 billion.  Which averages to about 7000 AUD per person.

It must be politically more palatable to tell people this percentage is going straight to health.
It seems to work though as no-one is asking for this to be cut.

There is a difference in the collection of standard income tax and the medicare levy.  There are basically different thresholds and the medicare levy has less of them.
It obviously would be better to simplify this but it would probably come at a large political cost to anyone who attempted it.

[EEVblog]

The only cost to us in the 2.5% medicare levy on our wages. (edit: it's certainly more than that, indirectly but I don't have a figure)

Why they bother tacking on 2.5%, I don't get.  Tax is tax...

It's all about visibility, and I think that's a good thing.
You know exactly how much of your tax goes toward universal health care.
Same thing with other levies, it's better to spell them out and list separately than just increase everyone's general tax rate and it gets lost in the noise. Same happens with one-off tax levies like the gun buy back scheme we had for example, they simply added an extra tax for a year and it got listed on your tax return as such (I think mine was $300 at the time)

[W2NAP]

Here in Indiana, self employed, absolute cheapest plan via any provider, $1300/month, $13k max out of pocket per family, max $6k out of pocket per person.   

Under Obamacare my premiums went up 297% (so far, next year will again be another hike), granted I get more coverage due to the mandates, but it's coverage I don't want or utilize.

sweet another Indiana resident here.

im lucky the last few years I just kept my income low low low. thus paying very little on the mandated cov. granted the low low low income hurt real bad but better then being forced having to chose between paying more then half of my income to something i don't want or paying the gov a penalty cause i do not have it.

[T3sl4co1l]

It's all about visibility, and I think that's a good thing.
You know exactly how much of your tax goes toward universal health care.

Except that it's not, it says 10% of GDP of the general fund goes to it also.  That one tax would need to be ten times larger, if they wanted to keep it out of the general fund.

It's all about invisibility, and that's a good thing for politicians?!?

Tim

[mtdoc]

It's all about visibility, and I think that's a good thing.
You know exactly how much of your tax goes toward universal health care.

Except that it's not, it says 10% of GDP of the general fund goes to it also.

No, it says approximately 10% of Australia's GDP goes to healthcare spending which may very well equal 2.5% of income.

BTW - the US spends about twice that percentage of our GDP  and more than twice the amount per capita on healthcare yet ranks lower on almost all measures of care quality.

In fact, overall the US healthcare system consistently ranks last overall among the wealthiest countries. See HERE

[T3sl4co1l]

No, it says approximately 10% of Australia's GDP goes to healthcare spending which may very well equal 2.5% of income.

That doesn't make sense. GDP represents a lot more money than labor income.  How could 10% of a larger quantity ever equal 2.5% of a smaller quantity?

IIRC, typical stats for other countries (.au being a typical example, I just don't know the numbers for them all, .au included) are health care spending ~20% of gov't budget, give or take.

In the case of the US, federal budget is ~21% of GDP, so 2.5% of that would be 0.5% of GDP.

BTW - the US spends about twice that percentage of our GDP  and more than twice the amount per capita on healthcare yet ranks lower on almost all measures of care quality.

Yes, and?  I mean, that's what this whole thread is about.  Why are you restating this?  It sounds like you're deflecting from the above facts.  They're just numbers, I don't see why that would be uncomfortable...

Anyway, it would be foolish to think any country is exempt from political maneuvering.  Calling it a "2.5% tax" is a convenient way to raise tax revenue while the true cost of the program it supports is actually 20% (or whatever it is) of the total budget.

Tim

[mtdoc]

No, it says approximately 10% of Australia's GDP goes to healthcare spending which may very well equal 2.5% of income.

That doesn't make sense. GDP represents a lot more money than labor income.  How could 10% of a larger quantity ever equal 2.5% of a smaller quantity?

Income is not a subset of GDP!. It is also completely different than government revenues. You said "10% of GDP of the general fund goes to it also" (italics mine) which is incorrect.  I don't have time to look up the numbers right now but it is possible for tax revenues for 2.5% of income to be equal to 10% of a country's GDP ..  I have no idea whether or not that is true in Australia - it may not be - but it could be. That was my point.

You need to realize that the calculation of GDP is based on government spending, consumer spending and business investment - all of which are often funded by debt.  The calculations also include net exports (which may be negative).   Income is not part of the GDP calculation!

Also, countries have many citizens and corporations who receive large amounts of taxable income from abroad. 

BTW - the US spends about twice that percentage of our GDP  and more than twice the amount per capita on healthcare yet ranks lower on almost all measures of care quality.

Yes, and?  I mean, that's what this whole thread is about.  Why are you restating this?  It sounds like you're deflecting from the above facts.  They're just numbers, I don't see why that would be uncomfortable...

    ?? WTF


I'm not sure what you're in a tizzy about. Your "facts" are incorrect.  I agree with your general point about politicians - just trying to clarify the facts and provide more information that was not previously provided in the thread.

[HackedFridgeMagnet]

No, it says approximately 10% of Australia's GDP goes to healthcare spending which may very well equal 2.5% of income.

Not in this case.
GDP: $1 654 579 (millions AU) 2015-16

Total tax revenue $464 724 (millions AU)  2015-16  (+ any government revenue outside tax ? )

http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/5506.0Main%20Features82015-16?opendocument&tabname=Summary&prodno=5506.0&issue=2015-16&num=&view=

Anyway its a fair point but I would say very unlikely in a reasonably stable economy.

So multiplying it out 10% GDP = $165 457 (millions AU) which is 35% of the level of our tax.     it's more than I expected. But that also includes a lot of private health care going on as well.

[mtdoc]

So multiplying it out 10% GDP = $165 457 (millions AU) which is 35% of the level of our tax.     it's more than I expected. But that also includes a lot of private health care going on as well.

That's interesting. Thanks for the info. Personally, I'd be happy to pay 35% of my taxes towards a single payer health care system of the same quality as Australia's.  And Australia has a large advantage over the US since it does not spend anywhere the near the same percentage of tax revenues on the military.

[cdev]

They have different priorities there in Australia. Obviously since WE'RE NUMBER ONE, we don't need to invest in having healthy or smart people. /SARCASM.

Actually, I really envy you Australians. There is still common sense in this world. *sigh*

So, this is sort of relevant. Look what I found some time ago but had forgotten about. This is a capture from a Public Citizen PDF. This kind of explains a likely reason for the ACA repeal.

 Its easy to verify as true. Why won't the US media talk about it? Likely they don't want to admit that both parties in the US couldnt give a f*** about the people now, and the result is the US is using a WTO agreement and looking to foreign countries and workforces to solve our healthcare problem because we won't.