What is "affordable" healthcare?

[Oregone]

Are there are firm definitions yet as to what is "affordable"?

For each income bracket and the amount of dependents, is there any definition yet for the maximum amount people should be expected to pay in this new reform?

What is everyone's opinion of what is "affordable"? For a single father who makes $50,000 a year and has 4 children? How about a bachelor making $40,000 a year?

What finite amount would be affordable for this people and others (and no, Im not talking about subsidies as a reform, but what everyone should reasonably be expected to pay out of their own pocket).

This is supposed to be "Universal Health Care", so Im trying to get a grip on what people here, and the legislators, may think affordable really means.

[Hutzpa]

1. There should be no such thing

as affordable health, there lies the confusion.

When you say affordable health the first thing that comes to mind is money/finance,
how much is it going to cost, these are all questions people would asked.

If they can get free health care in cuba with clinics every 5 miles why not United
States(?)

Enough of these twisted and confusing terms to describe health care.

People should not have to pay to use clinics, this should be seen as a payback
from the government to it's citizens.

[Oregone]

2. But clearly in this current "Reform" context, people are promoting it with the concept of affordable

Yes, while that would be nice, what you mention, its not what you are getting. There will still be a price-tag. What *should* it be?

[Hutzpa]

3. $100,000

should be the maximum to cover every states.

You have to remember, some states standard of living is higher
than others, for example, California and Texas have different
economic status, for instance, a family earning $30,000 in California
would meet hardship compared to a family earning the same amount in Texas.

The bottom line is, I don't think there should be an amount on health care,
it should be the right of every citizens for its government to take care
of especially after paying your taxes.

In England, health is paid for from your wages, just like social security.
$50-60 a paycheck would go toward health care and the more you earn the
higher the taxes.

My 2 cents

[eridani]

34. Bingo. The word "affordable" should NEVER be used in the same sentence with "health care"

It is a word that doesn't even make sense unless you are talking about a commodity. Health care should be a public good, and it is absolutely asinine to talk about "affordable" public goods.f When was the last time you ever heard anyone talk about an "affordable" fire department or municipal court system? What we ask of institutions that provide public goods is that their budgets be SUSTAINABLE.

[uponit7771]

4. Family of four = 150.00 full coverage, no deductibles, no co pays, no limits for dental, eyes, menta

...etc

[Oregone]

5. That seems beyond affordable.

150 a month and you have white straight teeth for all your children? On whose dime (because $150 a month doesn't cover the costs, so more must be collected on the backend from someone else)? Why is it those people's responsibility, such that all your children have perfect teeth?


BTW, I don't think that is on the realm of possible in the context of this reform (which will remain mostly private provider based). For example, I have single-payer insurance, and I pay $108 a month for my family, but have no dental/eye/mental, and I have a 5% GST, plus income taxes (so its way more than $150 a month in a super efficient system with less benefits). Im not sure who should put up the rest if $150 is affordable, or why they should be obligated to. You see what I mean. I am trying to determine net affordability costs, with taxes included. If its just merely 150 a month, someone else is covering the rest to make it affordable for that person.

[avaistheone1]

16. It costs less than that in Canada, and other European countries.

[Oregone]

17. I live in Canada. I just outlined my plan

When you figure in taxes (GST/income), it is way beyond $150 a month. Now, how you going to pull that off in this "public-option"/multipayer system with dental/vision and all the goodies? Thats not realistic.

[Cleita]

39. They are talking about sin tax, taxes on tobacco, booze, gambling etc.,

however, I think they are going to have to think about increasing P/R tax by lifting the caps on the rich like Obama wants. I think he has the better way of doing it.

[Oregone]

40. Sin tax for this is a bit ridiculous for this

It shift the burden to those that can afford it the least. It burdens a class of people and lowers their posterity's chance at social mobility (where such posterity will not be "sinning" so much). And meanwhile, the rich, who aren't picking up the tab, have the most to gain from the ever-growing, ever-entrenched sinning sub-population.

There are a lot of better ways to do it and people should be ashamed of considering this

[Cleita]

42. I agree, but that's what they are talking about. n/t

[Cleita]

6. When did the debate change from access to health care to affordable health

care, which is what we have today, if we can afford it? Every person in this nation needs access to necessary and quality health care whether they can afford it or not. Affordability shouldn't even be an issue. I hate it when the corporations change the words of the debate.

[Oregone]

7. I thought it was supposed to be about both.

For example, they are promoting "access" to health care in this bill by perhaps mandating (perhaps). So (almost) everyone will be covered AND supposedly at a lower cost. But at what cost? What is a reasonable cost to ask people to pay yearly? 10% of their income for middle class?

Its not enough to expand healthcare access to everyone if it will destroy intergenerational mobility to afford it. In fact, part of "access" is affordability.

This bill is not about universally making sure everyone will have access. It seems to be more about making sure people are insured, and their ability to make such payments, co-pays, and deductibles will really determine if they have access (as well as if the insurer approves the care).

I continually hear talk about lowering costs to make things "affordable". What are families expected to pay under this bill. Nothing is free, not in any system. If it will be less, and "affordable", Id like them to define what they mean by that.

[Cleita]

12. Well, if that's the case, they have it ass backwards.

The people who really need health care, the sick and ailing, won't get what they need because once they are sick and ailing they won't be able to afford it. There is no other definition. The affordability argument is another distraction in this debate.

[Oregone]

13. I don't think it is a distraction at all, and it is very important to the debate

Who is supposed to pay and how much are they supposed to pay? If there will be a sliding scale subsidy, how much left over will be left?

Access to health insurance is irrelevant, because people have to 1) afford the insurance and 2) afford to use the insurance (co-pay/deductible). Only when they meet those conditions, can they use it and have access to actual health care. This is the reality in a mostly private provider based system they are going with.

Unless the politicians draw some lines in the sand on what people are expected to pay for this care (that may be mandated), it will be entirely market driven and arbitrary (and therefore, not sensitive to the needs of the patients). I thought there was talk of multi-tiered plans (gold/silver/platinum) with set services and set prices. I hope those prices will be "affordable" universally for all.

[Cleita]

14. Access to insurance. That is the problem.

We need access to health care not insurance. Since this are powerful corporate entities that Congress seems to think they can't fight, we will get sold down the river of affordability, unless you fight about it. Multi-tiered plans are BS and only divide society by classes unless there is a basic plan that everyone is covered under. Everyone, whether street person or billionaire gets the same basic plan that covers all health care needs. Now if you want to sell insurance for gold, silver or platinum above that.. not instead of...but above that, then we will have joined the rest of the civilized world.

[avaistheone1]

20. Affordabiliy is one of the key issues. US health insurance costs rise nearly twice as fast as pay.

The cost of health insurance in the United States climbed nearly twice as fast as wages in the first half of 2007, with family coverage costing employers around 1,000 dollars (714 euros) a month, a poll showed Wednesday.

Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, while wages went up by 3.7 percent, the Employer Health Benefits Survey released by the Kaiser Family Foundation and the Health Research and Educational Trust showed.

The 6.1 percent rise in health insurance premiums marked a slowdown from the rate of increase last year, but also strongly outpaced inflation, running at 2.6 percent.

"In 2007, the increase in health insurance premiums was about twice the rate of inflation and not quite twice the increase in workers' pay," Kaiser vice-president Gary Claxton said in a webcast.

Premiums for family coverage have surged by 78 percent since 2001, while wages have gone up 19 percent.

http://rawstory.com/news/afp/US_health_insurance_costs_rise_near_09122007.html



Affordability has always been an issue. If you can't afford health care you can not access it.

Health care is no longer affordable for the working and the middle class in this country.

[Cleita]

24. Apparently you got your stats from the industry. Now try to go

get some from the Harvard doctors who have figured out that all the money that gets collected in premiums by the insurance and HMO parasite businesses can be diverted to actually delivering quality health care if put into the hands of a single payer and probably for half of what it costs today. Affordability means you are either filthy rich and independently wealthy or you have a job that can pay for all of that health care. Of course those too sick to work or out of work or not on the social register today need not worry. Nothing will be affordable to them as long as this sick corporate system is allowed to continue.

[Oregone]

25. "Nothing will be affordable to them as long as this sick corporate system is allowed to continue."

Considering I can't get one straight answer on, in this proposed system, what would be affordable for a $50K earning single parent with 4 children, your statement may very well be correct.

I'm asking a really difficult and abstract question in many ways. There is supposed to be a better, new reformed system coming with a "public option" and 350 private payers, which is supposed to be more "affordable". So ok, for specific income and dependents, WHAT THE HELL DOES THAT EVEN MEAN?!? Seriously. I would love to know.

And aside from initial costs of the actual insurance...when you consider, due to insurances' tendency to not pay for costs, 75% of insured people go bankrupt in medical catastrophes...I wonder if ANY reasonable price in this system can really pass a bona-fide "affordability" test.

[Cleita]

26. It can't. It shouldn't. Health care access shouldn't be measured by affordability.

It's that simple.

[Oregone]

27. Health care should most definitely be affordable, and it should be a priority to make it so

If you look at most civilized nations, people pay more and more the wealthier that they are. People at the bottom pay little to nothing for health care, and those on top, who benefit the most from a stable and healthy society, bear the largest burden. But this large burden is just a minimal expense and "affordable" for the super-rich, just as nothing is "affordable" for the impoverished family.

Most, if not all, civilized and truly universal health care systems subsidize the costs based on tax revenues, and as such, it creates an affordable burden to all members of that society with a variable cost based on income.

If affordability becomes a secondary criteria, you can give all the access and coverage you want to people, but if they cannot afford to pay for it or to use it, they have no access at all. If paying for it gets in the way of affording healthy food, saving for college, and generally improving one's life condition (by further entrenching people into a caste system), one must wonder if the virtual "benefit" is worth the cost of indentured servitude for health care.

Unfortunately, we are not dealing here with a system that will be funded at a variable rate based on income. People will be buying still into primarily private plans. If the reform does not leave their annual out-of-pocket expense within some realistically affordable range, this entire concept of "reform" is for naught.

[Cleita]

38. You make a point that needs to be clarified. In a true single payer universal

health care every one pays what amounts to a premium in taxes according to their ability to pay, so the tax is progressive. The risk is spread throughout the population and everyone has access to health care with a health care card issued by the government, who pays for the health care once the provider bills them with your card number for what ever office visit, procedure, treatment or medication that you received. No one is excepted even those, too young, too sick or too old to work anymore. Because government isn't siphoning off profits and administrative costs for advertising and buying off politicians, the premium taxes will probably be a lot less than what businesses are paying in health care benefits today. Since we have the example of other countries that are doing the same, that probability is most likely a certainty.

[Oregone]

41. But...unfortunately...

This isn't going to resemble at all what is going to happen in the US.

The ONLY way they could attempt to do anything like this, is have a sliding scale subsidy that climbs to infinity among the income range, and funds 100% of health costs at the bottom and 0% at the top, all funded from progressive taxation and leaving the out-of-pocket costs "affordable" for those in the middle. Again, its not going to happen like this.

:(

So in the meantime, you are probably going to still see out-of-pocket health care costs ranging from $5000 to $15000 a year for middle class families to buy into and use plans. In a lot of scenarios, that is back-breaking and not affordable at all.

[Cleita]

43. They seem to have to complicate something that could be simpler and

smarter in execution. I blame the for profit health care industry for this.

[avaistheone1]

33. I have been a staunch supporter for single payer health system for a long time.

I am very familiar with the cost benefits.

You are preaching to the choir on this one.

[Milo_Bloom]

8. Free and not a penny more!

[Oregone]

9. But that is incoherent with the "public-option" reform

Everyone will still pay their premiums and there will maybe be a sliding scale subsidy to promote "affordability" (whatever that is).

Remember, even in "free" systems, it is funded by taxes, in such a way the funding can be defined as a percentile of someone's income, per taxable bracket for the most part. They, in fact, break this question down in a much more sensible manner than we can with the multi-payer system that exists.

[handmade34]

10. free is a misnomer in this case

I believe we should be free to go to a health care facility and receive care without any out of pocket costs. At the same time I think taxes should be raised to cover the costs.

[quidam56]

11. Affordable health care won't do any good until we have quality health care.

As a former health care giver, I am shocked to see what is called quality health care now in Tennessee and Virginia. http://www.wisecountyissues.com/?p=62 Clearly profit care is more important than patient care.

[avaistheone1]

22. That is easy to say if you already have coverage by a health plan.

Of course their is always room for improvement. My understanding is that most people are pretty pleased with their Medicare and Veterans medical care.

I don't think we can postpone a public option any longer. There is never going to be a better time than now.

[wildflower]

15. I agree with those saying it should be about equal access to health care for all,

rather than just affordability. But you're right, that's what a lot of the discussion in the media is focusing on.

So to answer your question, what about a percentage, like 1%? If someone makes $200 per month, health care costs $2 per month. If someone else makes $1000 per month, health care costs $10 per month. And if someone makes $10,000 per month, it costs $100 per month.

Does that sound too low? Too high?

But then again, this idea is starting to sound almost like tax-funded single-payer, and apparently we simply can't have that.

[Oregone]

21. Well, Im not asking about it in what should be, but what will be (multipayer/public-option reform)

People will still be purchasing health insurance plans on their own after this reform (or through their employer). What specific price should we expect these people in this context to pay?

Yes, Im a single-payer advocate that thinks everyone should be universally covered, but thats not whats going to happen. People will still buy into plans.

1% would simply be too low. It wouldn't raise enough money collectively to cover the gross national health care costs. It wouldn't put a dent in it.

But this is more what Im asking. What percent of someone's income, at what bracket, is acceptable. I would envision a graduated system with marginal rates (like a tax code) and deductions for dependents to truly define what is "affordable". I could only hope the reform would be able to meet that definition, but no one is really attempting, in the public sphere, to honestly define it.

[valerief]

18. It means insurance companies will still rob us blind. nt

[Oregone]

19. It seems like no one can answer this question in the context of the reform (including politicians)

So who knows, eh? Maybe

[leftofthedial]

23. whatever diminishes insurance company (that is, bank) profits the least

[Joe the Liberal]

28. Affordable?

You shouldn't have to pay anything for health care outside of taxes, case closed.

[Oregone]

29. Im trying to ask this in the context of this new reform

You will still be purchasing insurance plans, paying premiums, and co-pays, and deductibles. What, in this multi-payer context, is affordable for people at certain income levels with certain number of dependents?

Get it? They are saying this reform will make care more "affordable". What is affordable? What can a single parent making $50K with 4 kids afford reasonably? What can a single person making $40K afford? How do you determine that? And once you do, will this reform meet that criteria?

Yes, Id rather see it all funded with taxes. BUT, not going to happen. Thats the reality. At some point, the politicians may need to draw lines in the sand to let people know what their idea of "affordable" means in this multi-payer system.

[Joe the Liberal]

30. In that case I honestly don't know.....

but it's all the more reason why a universal free health care system like the ones in most other countries would be ideal. You wouldn't even have to ask that question because affordability wouldn't even be an issue.

[Oregone]

32. In those systems, affordability is inherently built straight into the system

Since people are taxed a variable amount based on income and deductions (no one is taxed an unaffordable amount in theory). So yes, it isn't a question you need to ask, but, those system could more easily actually answer it.

In this system, its actually shaking out to be a very peculiar and confusing question.

[Oregone]

31. Look, I guess what I was sort of asking for....

Was a finite breakdown.

Look, the reform isn't going to be tax-funded and socialized. It still going to be people buying private plans, paying co-pays, and having deductibles. While I appreciate and largely agree with what most people mentioned about free health care and such, things are not headed that route whatsoever.

Therefore, there is still an individual costs factor to determine. So I was trying to figure out what could be reasonable to expect someone to pay yearly when you consider all those costs. Because in reality, reform or not, those costs will still exist.

For example:

< $10K - 0% of income a year
$10K to $20K - under 2.5% of income a year
$20K to $45K - under 5% of income a year
$45K to $90K - under 10% of income a year
beyond - under 15% of income a year

People earning those amounts could probably afford that chunk of their income maybe to personally spend on care/insurance, depending on their circumstance

Then, for each dependent, subtract like $5 K off their income to see if they fall into a different bracket or something.

People will be personally paying, whether it be in deductibles, premiums, or co-pays EVEN with the "public-option". They say the want to make it affordable. For people at certain income levels, what is the ceiling threshold people should be expect, in this system, to pay if it is supposed to target affordable levels?

While I understand this ceiling isn't going to be legislated (and I would talk more about that later), it should at least be questioned and examined.

[uponit7771]

36. OK, then just say 1% above the worlds average but now the avg per yr cost is 7900

...after tax dollars which is more than 20% of a US persons take home pay.

That does account for wage range which might be smaller but that 8k number is STUPID.

http://www.nchc.org/facts/cost.shtml

[Oregone]

37. Though, not everyone would have to pay that with a subsidy

You could lower that to 10% of someone's income up to $90K, by proving a 50% subsidy. Such a subsidy could be raised by taxing the rich (increasing their health care related costs).

There are smart ways where you could still fund an $8K to $10K per capita health care expenditure, such that everyone was contributing to the pool in a way thats "affordable" for their specific circumstance. Im under the impression that this will be part of the "reform". I wonder what is in mind for the unsubsidized portion and if people will reasonably be able to pay that much.

[harun]

35. It is code for "less outrageously unrealistically expensive".

[busymom]

44. I think you raise an interesting and important question....

Should income bracket be a factor? Probably...but It is hard to break that down into percentages. It also might be a little unfair to ask the single man earning 80K to pony up more because the single mom with 3 kids earning 30K doesn't earn enough to contribute more for her children. In essence we are forcing someone else to pay for the lifestyle choice of someone else. I, for example, have 5 children. I wouldn't dream of forcing someone here to pay a higher premium to quasi insure my children just because my income is less than theirs is. I think that makes this a very tough issue and is one of the many reasons to tread slowly with healthcare reform.

Income should count, but quite frankly, if you are a hunter, bungee jumper, mountain climber, smoker, are overweight, etc....then perhaps you also should have to pay a higher premium? BTW, I am overweight, so I would have to pay a higher premium by my own standards.

But lets even move beyond the issue of who should pay what. There is so much crying and wringing of the hands at DU that healthcare should be free...we should have a doctor on every block like in Cuba (hey, be my guest to go and get quality care from one of them.....cough cough...). One of the questions also has to be whether or not we get what we pay for. Healthcare is not free in any country and in many of the countries that people mention here, it is paid in the form of higher taxes paid in by every single member of society...not just the top brackets.

Also, there are the issues of litigation. In the UK and Germany, you can't sue your doctor over every fart. As a result, there is less defensive medicine practiced. That means no MRI for every headache, abdominal CT for every stomach problem, etc....because in most cases it is overkill. That can, however mean, less frequent discovery of a serious issue. Also, in the UK and Germany single rooms are reserved for private pay patients. That will happen here too. There will be less scanners because upkeep is too expensive, there will be longer waits because if you are paying less, people generally will work less...and...you might see people who otherwise would have been very smart doctors going into business or another field where they can earn more for less time invested. This might mean lower quality care over the long run from physicians as well as more care by mid-level providers.

Let's face it....if your employer told you that if you got your job this week done a little sooner and finished a little extra that he would give you a monetary bonus, you would kick it into high gear. Who wouldn't. If your boss said that you had to do more work for the same or less pay, you would probably look for a different job or find a different employer.

[Oregone]

45. "If your boss said that you had to do more work for the same or less pay"

The benefit of single-payer (health insurance socialization vs health care socialization) is that is keeps a pay-for-service model. Where I live, there are private clinics everywhere that do quite well with walk-in temporary patients, who just perform whatever service is actually needed. They do not over-practice for revenue, because they have more available patients in the population. And fortunately, they don't have to have a professional biller on premises or outsource to a biller at 10% of the gross receipts. I think that single-payer is a pragmatic, centrist middle ground that solves a lot of problem that full takeover may introduce, as well as eliminates all the problems of private/employer based health-care. And as a bonus, its funding is always theoretically affordable via taxation.



I think, all in all, this is almost an impossible question to ask in the environment where people are purchasing private plans. Its almost foolish to promote the aspect of "affordability" with this reform, being that it is almost undefinable. And when it comes to private people buying private insurance plans, how then do you justify other people carrying a burden? Its almost contradictory.