Question about Obamacare

[t_host1]

Interesting.

A fee just to see the doctor has never existed here. But some form of it was introduced for the first time by our conservative/nationalist ÖVP-FPÖ government in 2001, but was scrapped after just 2 years because of massive criticism. The "outpatient center" fee (around 10$ per visit) was considered a burden on low-paid members of the society such as single mothers who work part-time and discouraged them to see a doctor, which led to the opposition calling it asocial. In the end, the Constitutional Court voted to scrap them.

Since 2004 again, every medical visit here is free of charge again (doesn't matter if you visit your personal doctor, or the outpatient center).

Not only that, the state health care carriers are also running surpluses each year.

That doesn't mean problems like crowded outpatient centers do not exist here: There have been reports in Vienna for example that outpatient centers are often full on weekends, because people don't want to wait until Monday to check their problems (the overwhelming majority - like 90% - of Austrian GPs are not open on Friday afternoon/Saturdays/Sundays).

In the meantime, this has been mostly solved with a combination of an information campaign by the doctors chamber/union that people should only visit if they have a serious problem and not because of a simple cold etc. and by requiring more doctors to open on weekends.

In general, it can be discussed to introduce a small fee of let's say 1-5$ to see a doctor, but certain segments of the society should be exempt: low-income persons, minimum-pension-receivers, unemployed persons, people on welfare, students, etc.

I'm generally against a level- or "metal"-based "car insurance like" health care system like Obamacare offers, because a life is not comparable with a car that can be bought again when it's fully damaged.

The SAME health care services must be available to ALL people, no matter if they are low-income or if they earn 1 Mio. € a year. Otherwise you are creating a class-based system in which, using a famous quote, "all people are equal, but some people are more equal than others".

Because I would be interested in what happens in the Obamacare system, if you are a low-income receiver and apply for a Bronze plan and get cancer ? Do you get the same care as someone with a Platinum plan ? Or do you have to pay more OOP costs than the other, if you need a ton of radiation sessions, chemo sessions, surgeries, therapy etc. ?

Don't you think a system like this is strange and "asocial" ?

Are the doctors/union a abiding subservient of the rules as you?

[🐒Gods of Prosperity🔱🐲💸]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

[7,052,770]

For the record, a lot of exchange plans have different networks at different metal levels,  so a bronze member may not beable to cchoose between as many doctors as a platinum member.  They will be funneled to cheaper providers to keep premiums down.

[jaichind]

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

Correct.  This is why this Left wing dream idea of Medicare for all does not work.  Medicare "works" mostly because it keeps cost under control by underpaying doctors.  Medicare is the same thing but with a even bigger underpayment.  Obamacare is just making that underpayment even worse in Medicare.  The doctor makes up for it by charging corporate and individual health care plans more to make up for this loss who in turn will charge more for these plans.  If we put everyone who are uninsured on Medicare then this underpayment gap will grow bigger which in turn lead to either less doctors, or doctors charging the corporate heath plans more or both.  And of course in reality this is really the same thing as the people working in the private sector that gets wages from these companies subsidizing these people on Medicare since the company will merely pass that cost onto its employees.  On my W-2 form it says my health insurance plan costs my company around $30K.  That is $30K my company would have paid me if they did not have to pay for this.  And if this number becomes $40K or $50K because of the increased subsidies the insurance plan I am on has to take on for those Medicare  then my compensation will merely be reduced to make up the difference as my company will its profit margin come hell or high water as that is their job, to make a profit for their shareholders.  So Medicare for all is merely tax all working people to pay for subsidized healthcare for all that are not working.  Which in turn is just socialism.   

[7,052,770]

Doctors are way overpaid already.  Anyone who goes into medicine for the money shouldn't be a doctor in the first place.

[Tender Branson]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

I'm talking about our health carriers, not US ones:

http://www.statistik.at/web_en/statistics/Public_finance_taxes/maastricht_edp_indicators/government_deficit/052873.html

They are running surpluses for years now. They are funded by the social security contributions by each worker/retiree. Social security contributions are automatically deducted from the gross wage you earn and the more you earn, the higher the social security contributions. Social security contributions in Austria means A) health insurance B) pension insurance C) work-related accident and recovery insurance and D) unemployment insurance.

[Tender Branson]

Interesting.

A fee just to see the doctor has never existed here. But some form of it was introduced for the first time by our conservative/nationalist ÖVP-FPÖ government in 2001, but was scrapped after just 2 years because of massive criticism. The "outpatient center" fee (around 10$ per visit) was considered a burden on low-paid members of the society such as single mothers who work part-time and discouraged them to see a doctor, which led to the opposition calling it asocial. In the end, the Constitutional Court voted to scrap them.

Since 2004 again, every medical visit here is free of charge again (doesn't matter if you visit your personal doctor, or the outpatient center).

Not only that, the state health care carriers are also running surpluses each year.

That doesn't mean problems like crowded outpatient centers do not exist here: There have been reports in Vienna for example that outpatient centers are often full on weekends, because people don't want to wait until Monday to check their problems (the overwhelming majority - like 90% - of Austrian GPs are not open on Friday afternoon/Saturdays/Sundays).

In the meantime, this has been mostly solved with a combination of an information campaign by the doctors chamber/union that people should only visit if they have a serious problem and not because of a simple cold etc. and by requiring more doctors to open on weekends.

In general, it can be discussed to introduce a small fee of let's say 1-5$ to see a doctor, but certain segments of the society should be exempt: low-income persons, minimum-pension-receivers, unemployed persons, people on welfare, students, etc.

I'm generally against a level- or "metal"-based "car insurance like" health care system like Obamacare offers, because a life is not comparable with a car that can be bought again when it's fully damaged.

The SAME health care services must be available to ALL people, no matter if they are low-income or if they earn 1 Mio. € a year. Otherwise you are creating a class-based system in which, using a famous quote, "all people are equal, but some people are more equal than others".

Because I would be interested in what happens in the Obamacare system, if you are a low-income receiver and apply for a Bronze plan and get cancer ? Do you get the same care as someone with a Platinum plan ? Or do you have to pay more OOP costs than the other, if you need a ton of radiation sessions, chemo sessions, surgeries, therapy etc. ?

Don't you think a system like this is strange and "asocial" ?

Are the doctors/union a abiding subservient of the rules as you?

Generally not, but in a smaller country like Austria it's much easier to find compromises and not drag out issues so that there is no action. The unions and the government usually always find a way that is acceptable for the doctors and the patients.

[muon2]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

I'm talking about our health carriers, not US ones:

http://www.statistik.at/web_en/statistics/Public_finance_taxes/maastricht_edp_indicators/government_deficit/052873.html

They are running surpluses for years now. They are funded by the social security contributions by each worker/retiree. Social security contributions are automatically deducted from the gross wage you earn and the more you earn, the higher the social security contributions. Social security contributions in Austria means A) health insurance B) pension insurance C) work-related accident and recovery insurance and D) unemployment insurance.

Part of the differences are due to whether the deductions are state or federal, and who is assessed the tax.

A) Medicare is a federal deduction paid by both employer and employee. It's also federal for the ACA, but only for individuals and businesses that don't provide employee health insurance. Proposals to go to a straight deduction for insurance were rejected by Obama in early 2009 primarily due to union objections.

B) Social Security is a federal deduction paid by both employer and employee.

C) Workers compensation is generally a state mandate for employers to buy private insurance with the type of coverage (and associated cost) set by state law.

D) Unemployment insurance is a combination of state and federal taxes paid by the employer.

As you can see the tradition in the US is to shield the worker from most of these taxes and place them on the employer. For A and B the employer pays half the tax and for C and D the employer generally pays all of the tax.

[jaichind]

Generally not, but in a smaller country like Austria it's much easier to find compromises and not drag out issues so that there is no action. The unions and the government usually always find a way that is acceptable for the doctors and the patients.

I think the difference is more profound that smaller country vs big country.  I spent a good deal of time in Europe starting in the 1980s and repeated trips until fairly recently.  What I noticed is that the economic crisis of the 1970s and early 1980s had a profound impact on Europe (excluding UK and Ireland.)  For me Europe has mostly given up on growth as a solution to problems.  Not to say there is no growth in Europe.  But in the USA there is a very strong belief that the growth of the economy will create an environment where people with ability can over economic circumstances as the economic pie gets bigger.  In Europe they mostly given up on that as a solution.  Ergo in Europe, given everything is seen as zero sum, it is mostly about how to divide up the economic pie to create a harmonious society (to borrow from the CCP of the PRC.) In the USA they focus on how to grow that pie.  This cultural difference can be even seen in what sort of sports people like.  In USA, it is mostly about American football or basketball where there are high scoring games focused on offensive skills and a battle to see who can score more.  In Europe it is mostly about soccer where the games are low scoring and it is mostly about a zero sum world and how to stop they other guy from getting points. 

This means that Europe and USA will view things like healthcare and a whole host of issues differently at the grass roots as well as the likelyhood of cooporation at the grassroots on these goals.

[opebo]

jaichind, the only thing growing in America is its obese waistline and the tumor in its head.

[🐒Gods of Prosperity🔱🐲💸]

Doctors are way overpaid already.  Anyone who goes into medicine for the money shouldn't be a doctor in the first place.

Anyone who goes into medicine should be able to practice medicine and not have to spend a large amount of their time and resources on bureaucracy to get the payment they need for malpractice insurance and student debt, among other things.

[7,052,770]

Doctors are way overpaid already.  Anyone who goes into medicine for the money shouldn't be a doctor in the first place.

Anyone who goes into medicine should be able to practice medicine and not have to spend a large amount of their time and resources on bureaucracy to get the payment they need for malpractice insurance and student debt, among other things.

I obviously support the government drastically lowering the price of malpractice insurance and tuition too.

[🐒Gods of Prosperity🔱🐲💸]

Doctors are way overpaid already.  Anyone who goes into medicine for the money shouldn't be a doctor in the first place.

Anyone who goes into medicine should be able to practice medicine and not have to spend a large amount of their time and resources on bureaucracy to get the payment they need for malpractice insurance and student debt, among other things.

I obviously support the government drastically lowering the price of malpractice insurance and tuition too.

Then I can't see why you think doctors who want to get paid are being greedy.

[memphis]

Physician salaries aren't at the crux of health care costs. They should be paid well and they are. The problem is there are too many other hands in the cookie jar. Salesmen, insurance agents, tv ad men, debt collectors, and so forth ad infinitum. It's capitalism at its worst.

[Fmr President & Senator Polnut]

Physician salaries aren't at the crux of health care costs. They should be paid well and they are. The problem is there are too many other hands in the cookie jar. Salesmen, insurance agents, tv ad men, debt collectors, and so forth ad infinitum. It's capitalism at its worst.

Hence why a medical procedure will cost 4-5 times the amount there than it will here.