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The Affordable Healthcare Act requires that employers with more than 50 employees provide health insurance to everyone working more than 30 hours a week. Companies which do not do this pay a penalty of $2,000 per employee.

It also requires individuals to carry health insurance, and if they don't have health insurance they must also pay a penalty of $95.

Due to intense lobbying, the Obama administration will allow businesses another year before they have to supply healthcare to all full time employees or pay a fine. They now have until January 2015.

Individuals, however, must have healthcare or pay a fine as of January 1st, 2014.

Which means all those employed in the hospitality, service, and other industries where healthcare is not typically provided will be required to pay a fine, or pay for their own health insurance, all while employers get a break.

Seems a little backwards, giving those in low wage jobs a "break" by delaying their receipt of affordable healthcare, smacking them with a fine if they don't pay for it out of pocket, and letting the businesses make another year's profit off cheap wage.

If they're lucky they will be making just barely enough to scrape by, but still living far enough in poverty that the individual mandate doesn't apply. Of course, they still won't have healthcare, but at least they won't be fined for being poor and without healthcare.

Comedy of errors.

http://www.bbc.co.uk/news/world-us-canada-23156568

Shoulda just gone with Canadian-style free healthcare. It just appears, here. Literally no one pays for it, it is summoned from the void and bestowed upon us. Yes, we had to sacrifice a few virgins to a few dark gods, and yes, the fowl sulphuric smell of our hospitals is hard to ignore, but at least no one gets fined for not having health insurance.

Plus, free birth control.

Just to be clear: if both individuals and corporations were starting these the same time, a lot of those people wouldn't have to pay a fine, because they'd have to be able to get health insurance through their employer. But since the corporations get a year's extension, the people have to cough it up themselves somehow, magically?
That's dumb, that.

The whole thing is dumb. Scrap it all. Though, at this rate, by 2015 everybody will have a waiver, it seems.

Bubble181 said:

Just to be clear: if both individuals and corporations were starting these the same time, a lot of those people wouldn't have to pay a fine, because they'd have to be able to get health insurance through their employer. But since the corporations get a year's extension, the people have to cough it up themselves somehow, magically?
That's dumb, that.

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Pretty much, which is why I don't understand what the hell they're doing. This isn't going to work if it's not an all or nothing thing. I wouldn't be surprised if they pushed back the individual portion of it soon. It's just too stupid to not.

Chad Sexington said:

Shoulda just gone with Canadian-style free healthcare.

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Well duh. Obamacare is fundamentally flawed. It either shouldn't have been implemented at all, or it should have gone full throttle to the single payer system.

This frankenstein of a monster, however, is bad all around.

Shakey said:

Pretty much, which is why I don't understand what the hell they're doing. This isn't going to work if it's not an all or nothing thing. I wouldn't be surprised if they pushed back the individual portion of it soon. It's just too stupid to not.

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From what I read, it's a political ploy. Midterm elections are coming up, and they're using this as a kiss up to businesses to make the Democrats look better. It also takes away a line of attack by Republicans against their opponents.

stienman said:

Well duh. Obamacare is fundamentally flawed. It either shouldn't have been implemented at all, or it should have gone full throttle to the single payer system.

This frankenstein of a monster, however, is bad all around.

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I'm certain it's a calculated failure to provide a stepping stone to single payer.

"Welp, we tried fixing it with the private sector (hee hee no we didn't) and look how bad everything is, so, welp, nothing to do now but nationalize the whole darn thing!"

GasBandit said:

I'm certain it's a calculated failure to provide a stepping stone to single payer.

"Welp, we tried fixing it with the private sector (hee hee no we didn't) and look how bad everything is, so, welp, nothing to do now but nationalize the whole darn thing!"

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As both an individual who is concerned with health care coverage (and getting the tax payers to stop paying for so much healthcare), and as an individual who voted for the schmuck in office (really got suckered on that one), I can't believe I'm saying this... but I hope that this is the last piece of ammunition needed by the GOP to repeal the whole damn thing.

GasBandit said:

I'm certain it's a calculated failure to provide a stepping stone to single payer.

"Welp, we tried fixing it with the private sector (hee hee no we didn't) and look how bad everything is, so, welp, nothing to do now but nationalize the whole darn thing!"

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For once, I hope you're right

Charlie Don't Surf said:

For once, I hope you're right

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And the sick thing is it'll probably work because your average American voter has become too lazy and scared to handle the responsibility that comes with liberty.

GasBandit said:

And the sick thing is it'll probably work because your average American voter has become too lazy and scared to handle the responsibility that comes with liberty.

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bla bla bla yeah whatever, just give me the free government healthcare since for-profit healthcare is the worst idea in human history

Charlie Don't Surf said:

bla bla bla yeah whatever, just give me the free government healthcare since for-profit healthcare is the worst idea in human history

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1) Really? The worst idea in human history? Even worse than "Hey, I bet the Jews are to blame for all this?"
2) God forbid anybody who goes to school for a decade give-or-take and runs up dozens of thousands of dollars in education expenses makes money from dedicating his life to healing.
3) Never mind... Charlie is being Charlie.[DOUBLEPOST=1372888029][/DOUBLEPOST]

Charlie Don't Surf said:

bla bla bla yeah whatever, just give me free stuff

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There... FTFY

it's not free, I'd probably have to (happily) pay higher taxes if it was implemented

Charlie Don't Surf said:

it's not free, I'd probably have to (happily) pay higher taxes if it was implemented

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Out of curiosity, it seems like you'd actually be happier in Canada or one of many European countries.

What do you like about American so much that's keeping you here?

Charlie Don't Surf said:

it's not free, I'd probably have to (happily) pay higher taxes if it was implemented

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Have fun dying of prostate cancer when the quality of care drops and a panel decides whether you get treatment or just painkillers.[DOUBLEPOST=1372890058][/DOUBLEPOST]

stienman said:

What do you like about American so much that's keeping you here?

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Canada doesn't want him either, I'd assume.

Seriously, it's pretty damn hard to move to Canada. Much harder than to the US, and our immigration system is "broken" I'm often told.

Last I looked it wasn't terrible if you had good professional technical/engineering/computer skills, but I suppose that's because, unlike the US, they value highly skilled workers.

The pay isn't as good as in the US, though...

stienman said:

Last I looked it wasn't terrible if you had good professional technical/engineering/computer skills, but I suppose that's because, unlike the US, they value highly skilled workers.

The pay isn't as good as in the US, though...

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Exactly. The few people I have talked to about it in canada say their problem is their doctors decide they like being paid and move to the US. The people who want to move to Canada are the deadbeats who want to sponge. "I'd gladly pay higher taxe-" SHUT UP YOU MAKE NOTHING

GasBandit said:

their doctors decide they like being paid and move to the US.

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While doctors do make more in the US, Canadian doctors are not exactly poor with their multiple houses and killer vacations and nice cars and killer investment portfolios. That's not like "Boo, the rich doctors," thing either. They work hard, and are rewarded with the ability to live a high quality of life.

Only compared to some. And, of course, let's not forget the ever-present elephant in the room that the only reason Canada can afford to spend so much on social programs is because of its proximity to the US. And even with all that spending, their MRIs are still much fewer and have a queue months long. And do we even need to bring examples from the British NHS in?

And I'm not saying the American medical system was perfect, either. But socializing it would simply lower the standard of care. And Obamacare is even worse - tantamount to, at its core, trying to solve hunger by making it illegal to not buy food. It's so bad, all its biggest supporters are lining up to get waivers so they won't be subject to it.

First things first: no, Canada does NOT want Charlie. We have enough wackos as it is thank you very much. Some even home-grown.

Chad Sexington said:

While doctors do make more in the US, Canadian doctors are not exactly poor with their multiple houses and killer vacations and nice cars and killer investment portfolios. That's not like "Boo, the rich doctors," thing either. They work hard, and are rewarded with the ability to live a high quality of life.

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Ya I'll ask one of my relatives thats a doctor about those multiple houses they have, and ask him if I can borrow one or something.

Oh wait, that's not what happens. Maybe some severe specialists that are doing elective surgeries (which people still pay for out-of-pocket) for huge money (plastic surgeons) have that, but the typical doctor? Uh, no. They make good money, but not what you're describing.

I don't know a lot about how things work in US but, I think Gasbandit is right. Helping everybody is not possible and is more rational to give care to those who work for it and they of course will receive better treatment. The same way that dead penalty in general is better for the society even if a few innocents are killed. I'm not being sarcastic but I can actually respect someone who thinks like this (even if I don't agree) and is capable to still do that if some day they find themselves in the other side of the equation.

Eh, Belgium's got a practically completely socialized medicine, and we have amongst the top rated medical care in the world - higher than the US (as far as average care goes), some of the most advanced Western medical research centers, and people from all over the world come here for medical care. I'm not a fan of a lot of things Belgian, but our Health Care works, for a certai vaule of "works". It is, of course, dreadfully expensive and inefficient, but what isn't?

GasBandit said:

And do we even need to bring examples from the British NHS in?

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What, you mean like this guy?

mroosc1979 said:

What, you mean like this guy?

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More like these hundreds of thousands of guys.

When you give a government bureaucrat veto power over your healthcare, you just snap the chain around your own neck.

The wealthy are still able to purchase additional/faster care under the NHS system, but then that's not much different than the US. If you're poor here, you will receive minimum emergency care to help you survive, but not elective, routine, or preventative care.

I think, though, that like the US, the NHS system works for about 90% of the people under it, and its only the 10% outliers that don't fit well into that system and don't have the financial means to get additional care.

There will always be outliers, though. The question is, do we let people blame themselves for their own lack of insurance, or do we let them blame the government for providing reasonable across the board care that doesn't fully address their specific need?

One of the articles I read from the AARP about the Canadian system, busting the major myths people have with socialized healthcare, showed that while people on average wait longer for routine operations and care that aren't emergencies, the total cost of healthcare is significantly lower. If they wanted faster care, or to cover more situations, they would necessarily pay higher taxes. I don't think that's an unreasonable trade off.

The main problem I have with social healthcare is that I am not part of many risk factor groups, but I'm still paying as much as the person who's destroying their lungs and liver voluntarily even though I'll pay far more into the system than I'll ever get out. Yes, I might still get cancer or Alzheimer's, but the statistical risk is lower, and currently my insurance premiums take into account my lifestyle.

Under social healthcare they can't discriminate based on voluntary behavior. In the same way they can't prevent people from spending food stamps on twinkies and ice cream, they won't be able to give people who live healthier lives a discount on insurance. Private insurance can.

Of course that's one of the reasons they are trying to reach a compromise with the mandates and health insurance exchanges, but, for instance, forcing faith based organizations to supply insurance for procedures and care they do not agree with shows that we are already heading in a direction where the government will ultimately decide what we can and can't get at these exchanges, regardless of our lifestyle and needs.

stienman said:

One of the articles I read from the AARP about the Canadian system, busting the major myths people have with socialized healthcare, showed that while people on average wait longer for routine operations and care that aren't emergencies, the total cost of healthcare is significantly lower. If they wanted faster care, or to cover more situations, they would necessarily pay higher taxes. I don't think that's an unreasonable trade off.

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Unfortunately that doesn't seem to do a lot either. If you compare health care spending per province per person, Alberta and Saskatchewan are among the highest spenders, but Alberta is near-top in most result categories, but Saskatchewan is near the bottom. (summary 1, primary source 1, primary source 2 (can't get much better than cihi)) So there's other factors that are swamping even amount of money into the system. As the cliche goes up here, "Throwing money at the problem does not mean it's a solution" no matter how much certain groups say that it is.

Also, it's illegal to try and pay for your own care. There are 3 single-payer systems in the world, Canada, Cuba, and North Korea. We're part of a great group there, eh? Look to Europe, not Canada for better models.

Eriol said:

Also, it's illegal to try and pay for your own care.

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Oof! That's a doozy. So if the government doesn't agree with my desired treatment plan, I have no real recourse, regardless of my means. Sounds like there's good business in opening a cash practice on this side of the border...

stienman said:

Oof! That's a doozy. So if the government doesn't agree with my desired treatment plan, I have no real recourse, regardless of my means. Sounds like there's good business in opening a cash practice on this side of the border...

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If you have the means, and it's serious, you go to the USA! Seriously. I'm not engaging in hyperbole. That's what happens.

Many in Canada are dead-set against having any health care you can pay for yourself up here (beyond elective I mean) as they say it causes "Two-tier health care" and that the public system will become a wasteland with all the "good" people being in the for-profit centres. Well wake up: it's ALREADY happening, it's just that the dollars (and staff) are going to the USA instead of staying in Canada and getting taxed.

stienman said:

forcing faith based organizations to supply insurance for procedures and care they do not agree with shows that we are already heading in a direction where the government will ultimately decide what we can and can't get at these exchanges, regardless of our lifestyle and needs.

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It's already bad enough that under the current system I get herded into which doctors I can see, which pharmacy I can use, what hospitals I can go to, and when they overlap, it's even worse. Kati went in for a procedure with a doctor who was in network, but because the hospital itself was not in network, we had to pay the non-network rate even though the work was performed by that same doctor who is in network.

--Patrick

Yea, the promise of cheaper insurance through HMOs never really panned out.

For most youth simply socking the premiums away and insuring yourself is often more competitive, unless you end up with cancer or a few other expensive diseases or conditions.

stienman said:

Yea, the promise of cheaper insurance through HMOs never really panned out.

For most youth simply socking the premiums away and insuring yourself is often more competitive, unless you end up with cancer or a few other expensive diseases or conditions.

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That's I chose a high deductible plan with an HSA at work. Hopefully the best of both worlds.

Covar said:

That's I chose a high deductible plan with an HSA at work. Hopefully the best of both worlds.

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My brotha by anotha motha. Same here.

Interesting tactics for avoiding the mandate are on display in this article:

http://money.cnn.com/2013/07/08/smallbusiness/obamacare-fatburger/index.html?hpt=hp_t3

The article is about how it's already costing businesses who were trying to prepare for it, but it does demonstrate a few tactics I hadn't thought about for avoiding the mandate without reducing your number of employees.

I love how the fact that CEOs are unconscionable dickbags who will do anything to screw over their employees for their own profit are trying to play the victim.

"our employees are suffering because we fired them to avoid giving them health insurance."

Perhaps that's true, but in many businesses, such as fast food, margins are so thin due to competition that adding insurance would leave them with only one choice - shutting down.

I worked in fast food when I was younger, and they treat their employees like dogs.[DOUBLEPOST=1373395007][/DOUBLEPOST]And it's kind of sad that we've come to accept that as the norm.

Bowielee said:

I worked in fast food when I was younger, and they treat their employees like dogs.

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Chick-fil-a doesn't, and their service shows.

There's a place down here called Raisin' Cane's. I can't tell if the employees are happy because they're treated well or because they're lobotomized.

Bowielee said:

I worked in fast food when I was younger, and they treat their employees like dogs.[DOUBLEPOST=1373395007][/DOUBLEPOST]And it's kind of sad that we've come to accept that as the norm.

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Can you explain the ways they treated you badly? I did a newspaper route, then bagged groceries and pushed carts at the local supermarket, then worked on an assembly line, but none of those experiences were negative for me. Only one of them was enjoyable and positive, but never felt what you might be describing. I chose not to work at any fast food places because I like fast food, and at the time believed that if I worked any one of them and saw "how the sausage was made" so to speak, I'd have a hard time enjoying the food afterwards.

What was it about working for them that was so negative?

Bowielee said:

I love how the fact that CEOs are unconscionable dickbags who will do anything to screw over their employees for their own profit are trying to play the victim.

"our employees are suffering because we fired them to avoid giving them health insurance."

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... which they wouldn't have to do if not for Obamacare in the first place.

Actually, the fact they have been doing that shows that business had no idea they'd be getting an extension, which means the only possible explanation for Obama moving back the deadline is to shield Democrats up for re-election in 2014 from this horrible travesty of a job-killing, economy murdering bill.

I was not allowed to take any days off, or I would be fired. I was forced to work over 8 hour days, or I would be fired. I was called in to work on my days off, or I would be fired. I was told I would need to give at least 2 weeks notice of scheduling needs and even when I did, I was scheduled to work on days when I needed time off. I was forced to work with an injured hand (slipped into a deep fat fryer when it was on), or I would be fired (which is actually the day I quit).[DOUBLEPOST=1373397167][/DOUBLEPOST]

GasBandit said:

... which they wouldn't have to do if not for Obamacare in the first place.

Actually, the fact they have been doing that shows that business had no idea they'd be getting an extension, which means the only possible explanation for Obama moving back the deadline is to shield Democrats up for re-election in 2014 from this horrible travesty of a job-killing, economy murdering bill.

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And if they provided their employees with heath care in the first place, Obamacare wouldn't even exist. This is a circular argument.

Bowielee said:

And if they provided their employees with heath care in the first place, Obamacare wouldn't even exist. This is a circular argument.

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And if semen were flammable jerkoffs would power our nation.

Health insurance costs money. Not every job that exists merits that level of compensation. Health insurance is not a right, and the purpose of employing someone is not to find an excuse to give them health insurance. As illustrated, the fiscal reality was that if the provision of health insurance was a requirement, those jobs would not have existed in the first place. So, going from employed with no health insurance to unemployed with no health insurance AND in violation of the law requiring you to have health insurance... this is the solution provided by the health care act.

Bowielee said:

I was not allowed to take any days off, or I would be fired. I was forced to work over 8 hour days, or I would be fired. I was called in to work on my days off, or I would be fired. I was told I would need to give at least 2 weeks notice of scheduling needs and even when I did, I was scheduled to work on days when I needed time off. I was forced to work with an injured hand (slipped into a deep fat fryer when it was on), or I would be fired (which is actually the day I quit).

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That is pretty terrible, sounds like they were, if not outright breaking the law, at least skirting along it. I know if I ran into that I'd be talking with the state's attorney general, particularly for the injury incident. If you were a teen at the time then they definitely broke a number of child labor laws as well.

Are the conditions the same today? It sounds like it's possible that it could have been one terrible manager's or owner's bad management, rather than industry standard conditions, but having never been on the other side of the counter I don't know.

Those are terrible working conditions.

Bowielee said:

I was not allowed to take any days off, or I would be fired. I was forced to work over 8 hour days, or I would be fired. I was called in to work on my days off, or I would be fired. I was told I would need to give at least 2 weeks notice of scheduling needs and even when I did, I was scheduled to work on days when I needed time off. I was forced to work with an injured hand (slipped into a deep fat fryer when it was on), or I would be fired (which is actually the day I quit).[DOUBLEPOST=1373397167][/DOUBLEPOST]

And if they provided their employees with heath care in the first place, Obamacare wouldn't even exist. This is a circular argument.

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This is pretty much my experience when I worked my first fast food job as well. I didn't realize how terrible they treated folks, I just figured it was the norm.

Cajungal said:

There's a place down here called Raisin' Cane's. I can't tell if the employees are happy because they're treated well or because they're lobotomized.

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We're getting one of these near here soon. I'll have o check it out, if only so I have an option between chicken that makes me want to kill myself (KFC) and funding anti-gay activity (chick-fil-a).

GasBandit said:

Health insurance costs money. Not every job that exists merits that level of compensation. Health insurance is not a right, and the purpose of employing someone is not to find an excuse to give them health insurance. As illustrated, the fiscal reality was that if the provision of health insurance was a requirement, those jobs would not have existed in the first place. So, going from employed with no health insurance to unemployed with no health insurance AND in violation of the law requiring you to have health insurance... this is the solution provided by the health care act.

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It actually seems to me that the problem is that the fast food chains have priced themselves out of functionality due to over competition, not that the people who work there don't deserve benefits. When a company has to resort to abusive/disfunctional employeement practices just to stay in business, the problem isn't the employees. It's the market. We're going to see a massive market correction in the service industry very soon, but it's arguable that this is a good thing because it will lead to better service overall.

And yes, everything Bowielee has described has happened at every minimum wage job I've ever had. All are also illegal... but that doesn't matter because your working a minimum wage job and therefore don't have the money to hire a lawyer to fight it in court. Even if you did, the amount you'd be awarded would be a pittance, especially if you had to offer up a sizable portion of your settlement to your lawyer. Honestly, the best way to get back at them when they try this is to just walk-off the job in middle of a busy time. You may lose your job but you've also shown them that abuse only leads to more frustration for them.

AshburnerX It's not bad chicken fingers. The sauce is more famous, but it's easy to imitate.

Anyway, health care.

stienman said:

The main problem I have with social healthcare is that I am not part of many risk factor groups, but I'm still paying as much as the person who's destroying their lungs and liver voluntarily even though I'll pay far more into the system than I'll ever get out. Yes, I might still get cancer or Alzheimer's, but the statistical risk is lower, and currently my insurance premiums take into account my lifestyle.

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I can't find any English language source to back me up on this for the moment, but a Belgian government study on this issue found that healthy people, on average, cost health care more than heavy smokers/drinkers/eaters do - the risk groups die off a lot younger. Average life expectancy of 8 or 10 years more, many of those in retirement homes, with several operations and usually near the end needing very high amounts of care (diapers, someone to wash you, feed you, clothe you) more than even out earlier cancer or liver failure problems. These comparisons were a few years old, so it would seem plausible that with more and more actually curing treatments available (organ donors, better radiation techniques, stem cell transplants,...) we'll see the unhealthy living longer again, but needing more care to do so - this isn't the case yet, though.

@GasBandit: As Ash said, the problem isn't the jobs but the market. We still have bars and restaurants here in Belgium - more per capita than the US, in fact - and all of our waiters have health insurance and make at least minimum wage. More exactly, they tend to make a lot more, since work in horeca is considered among the most heavy physically exhausting jobs we have - that is, of course, because I know plenty people who work in bars and routinely do 14 hour shifts, even longer in the weekends. Not many people can or want to work those kinds of hours, standing up, walking around, getting treated like crap. It's why we import people

from Africa. Anyway, you may see restaurant prices increase a bit to cover the health insurance. So what? You're already paying their taxes and so on for them as well - it's the nature of the beast.

AshburnerX said:

It actually seems to me that the problem is that the fast food chains have priced themselves out of functionality due to over competition, not that the people who work there don't deserve benefits. When a company has to resort to abusive/disfunctional employeement practices just to stay in business, the problem isn't the employees. It's the market. We're going to see a massive market correction in the service industry very soon, but it's arguable that this is a good thing because it will lead to better service overall.

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My only note is that nothing in the real world is based upon what you "deserve." What you earn/negotiate is what you get, not what you "deserve." Many people get less than they deserve, and many people get more. That's a specious measurement, and entirely subjective.

Bubble181 said:

I can't find any English language source to back me up on this for the moment, but a Belgian government study on this issue found that healthy people, on average, cost health care more than heavy smokers/drinkers/eaters do - the risk groups die off a lot younger.

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Yeah, most of the money spent in health care is in end-of-life care in the last few years... the 80 year olds trying to stave off the reaper for a few more years. It's a sensitive discussion because we all realize it's just pouring money down a hole, but nobody wants to sentence Meemaw to die. Thus the cost of insurance keeps going up as the baby boomers start to enter their twilight years as the insurance companies start to brace themselves for all the hip replacements, chemo sessions, and other heroic surgery to give them a few more years of bankrupting their grandchildren.

BTW all your text was forced into black, and using a dark theme, I had to quote it to read it.

@GasBandit: As Ash said, the problem isn't the jobs but the market. We still have bars and restaurants here in Belgium - more per capita than the US, in fact - and all of our waiters have health insurance and make at least minimum wage. More exactly, they tend to make a lot more, since work in horeca is considered among the most heavy physically exhausting jobs we have - that is, of course, because I know plenty people who work in bars and routinely do 14 hour shifts, even longer in the weekends. Not many people can or want to work those kinds of hours, standing up, walking around, getting treated like crap. It's why we import people

from Africa. Anyway, you may see restaurant prices increase a bit to cover the health insurance. So what? You're already paying their taxes and so on for them as well - it's the nature of the beast.

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You're talking about restaurants with waiters, which is different from fast food. Here, waiters can actually make really good money too, especially the hard working ones you reference who pull double shifts and are good at what they do. What is at discussion here are fast food jobs - counter cashiers and back room food prep with no waiters. McDonalds type stuff (you don't have waiters at McDonald's in Belgium, do you...?). These jobs were really never intended to be a career - rather, part time/first employment for young people in school or just entering the workforce, working largely for minimum wage. The foodservice equivalent of a paper route on your bike.

GasBandit said:

BTW all your text was forced into black, and using a dark theme, I had to quote it to read it.

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Sorry, I have absolutely no idea why or how. I know that's annoying as heck.

GasBandit said:

You're talking about restaurants with waiters, which is different from fast food. Here, waiters can actually make really good money too, especially the hard working ones you reference who pull double shifts and are good at what they do. What is at discussion here are fast food jobs - counter cashiers and back room food prep with no waiters. McDonalds type stuff (you don't have waiters at McDonald's in Belgium, do you...?). These jobs were really never intended to be a career - rather, part time/first employment for young people in school or just entering the workforce, working largely for minimum wage. The foodservice equivalent of a paper route on your bike.

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Eh. McD and similar still have waiters here, yes. Most don't come from behind the counter, but the pay's the same. You may be forgetting that in Belgium, "rounding up" is by most people considered decent tipping, and people like me who tend to give about 5% are regarded as "generous" to downright "excessive" - I've literally gotten into fights over it. A lot of people, even good and decent people who are otherwise free with their money, just don't tip here, even for very good service. Service is supposed to be included.

Bubble181 said:

Eh. McD and similar still have waiters here, yes.

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"Still" have waiters?! They've NEVER had waiters here.

Most don't come from behind the counter, but the pay's the same. You may be forgetting that in Belgium, "rounding up" is by most people considered decent tipping, and people like me who tend to give about 5% are regarded as "generous" to downright "excessive" - I've literally gotten into fights over it. A lot of people, even good and decent people who are otherwise free with their money, just don't tip here, even for very good service. Service is supposed to be included.

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Wait, you TIP at McDonald's?!




No wonder your country doesn't have any money left over to... you know... matter on the world stage.

GasBandit said:

"Still" have waiters?! They've NEVER had waiters here.
Wait, you TIP at McDonald's?!
No wonder your country doesn't have any money left over to... you know... matter on the world stage.

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No, we don't tip - that was my point. But, excepting very high-end places where waiting is done by *real* professionals, a waiter/cashier/boy will make roughly the same working a 10 hour shift at McD or at a regular restaurant. This isn't quite true in the US, since crappy cashier at McD makes minimum wage while a decent waiter at a restaurant will make possibly-less-but-can-get-decent-tips.

In Belgium, both make about the same: crappy per-hour, pretty good per-month (for someone without a degree or some good skills) if you're willing to put up with it.

The latest delay to be announced is the maximum out of pocket limit.

If you plan on getting cancer or another expensive disease or illness, consider putting it off until 2015, barring any future delays.

I wonder if we could get away with locking prices for procedures, supplies, drugs et cetera to what they cost in, say, Canada, without actually implementing single payer. Just spitballing.

GasBandit said:

I wonder if we could get away with locking prices for procedures, supplies, drugs et cetera to what they cost in, say, Canada, without actually implementing single payer. Just spitballing.

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Everything would just start getting more expensive in Canada then.

And taking out $100,000+ in loans for med school is gonna sound a lot less appealing.

Eriol said:

Everything would just start getting more expensive in Canada then.

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Yeah, I almost immediately started to think of a number of reasons why this could never be implemented in a way that could work. Heck, even if the US went single payer and did like the guy in the video says and had a massive bidding war for all the artificial hip replacement parts in the US, it'd really just drive all but one of the artificial hip companies out of business, and then next time there was bidding there wouldn't be more than 1 bidder.[DOUBLEPOST=1377112141,1377112102][/DOUBLEPOST]

blotsfan said:

And taking out $100,000+ in loans for med school is gonna sound a lot less appealing.

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Higher education is definitely one of the bubbles that needs to pop soon. It's gotten ridiculous.

We already expect that out of teachers, hasn't stopped communities from cutting their pay.

GasBandit said:

I wonder if we could get away with locking prices for procedures, supplies, drugs et cetera to what they cost in, say, Canada, without actually implementing single payer. Just spitballing.

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But that is actual Socialism.

sixpackshaker said:

But that is actual Socialism.

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Well, it's centralized government regulation, yes, but not exactly socialism. Certainly not to the extent adopting single payer would be. It'd be more akin to price-fixing laws - which aren't exactly lasses-faire either of course. But one would think that what a true socialist system spends per capita should be able to be the upper limit of what a capitalist system costs per capita.

But like I said, I've already thought of several reasons why it wouldn't work, and I was just spitballin' to begin with.

I'm just saying, providing health care is welfare. Where controlling the means of production is socialism.

sixpackshaker said:

I'm just saying, providing health care is welfare. Where controlling the means of production is socialism.

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But capping prices isn't "controlling the means of production." Providing healthcare itself would be controlling the means.

If an important reason of healthcare being overpriced is education being overpriced, shouldn't the government do something there too? I mean, not being able to get healthcare is more dramatic, but education is as much of a right to me. Actually, in a society that prides itself in equal opportunity, I'd say a problem in the access to education should be considered worse...

Also, making sure that there is free/cheap decent education for anyone who wants it is way cheaper for the government than making sure there is free/cheap decent healthcare for everyone.

I've not exactly done research into the causes, but I think tacit collusion might have something to do with it. A quick google shows that the cost of higher education has gone up 12x over the last 30 years (compared to the cost of health care having gone up a paltry 6x and the cost of food having merely doubled). There's apparently a big argument going on about whether the increased cost of education is the fault of the universities or not, with one side saying it's because colleges are spending more money on administrators and resources, and the other saying that they have to do that because now students expect more out of their colleges such as "planned student life activities, career counselors, fancy dorms, nice gyms and up-to-date technology." They also say they need more administrators to handle compliance with the increasing levels of regulation on education, and they're getting less money in state budgets. And of course some will always blame the expense of collegiate athletic programs, while others will come back with college sports being an alternative revenue generator in various forms.

I thought it was increased federal loans gives schools the ability to hike up tuition.

The correct answer is:

E) All of the above

blotsfan said:

I thought it was increased federal loans gives schools the ability to hike up tuition.

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Could be part of it too. I've often said one of the things driving the increasing cost of health care is the fact that for so long we've been completely divorced from the actual cost of our health care. We want the best available and "whatever, it doesn't cost me anything, I pay my premiums. So charge the insurance company whatever the hell you want just give me my sessions in the SuperMechaDiagnosoTreatmentMachinePilldispenser." Something similar could really be said for the increased availability of more and more ridiculous levels of credit for educational loans letting universities charge whatever they think they can get away with because it's the same upfront cost to the student - nada but deferred responsibility! So where's the keg and my complimentary sorority chick? Wooo!

Fun fact: employer provided health insurance originally came about as a way to maintain competitive hiring in the face of insane wage control laws. "The government won't let us pay you more, but if you work for us we'll pay for most of your health insurance too instead! Whaddaya say?"

The reliance on College Sports as a revenue stream is almost at an end anyhow. It's entirely likely colleges will have to start paying their athletes like the professionals they are (instead of profiting off of their images and accomplishments) within the next few years, thanks mainly to numerous lawsuits being brought up. The EA/NCAA lawsuit that is heading toward the Supreme Court is just the tip of the ice burg. Once this happens, I fully expect athletic scholarships to get gutted like all the other ones.

GasBandit said:

Higher education is definitely one of the bubbles that needs to pop soon. It's gotten ridiculous.

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OH MY GOD YES

--Patrick

The nice thing about living elsewhere: you can compare and contrast.
Belgium has one of the best, and cheapest, education systems in the world ("cheap" of course being "mostly paid for by the government"). A year's studying at our best university costs about €600 (say $800 or so). Some post-university degrees are more expensive, but anyway - getting a Masters will cost you about €3000 over 5 years. And even so, for those who have trouble paying, there's scholarships all over the place and tax returns and whatever. Basically, anyone who can and wants to can get at least a Bachelor's, probably a Masters. It's one of our country's most socialist endeavors and one of our greatest accomplishments, really.
The downside, however, is that pretty much everyone wants to get a degree. And of course, most people don't actually have something specific they want to do. Sure, interested in animals, become a vet. Interested in French? Become a Romanist and teach. Turns out, most people who can't quite decide go do something like communication sciences, or psychology, or educational sciences, or cultural management. We're swamped in humane sciences degrees, and we have a continuous lack of, say, nurses, car mechanics, welders, carpenters, good hard-working laborers, etc.

In fact, nurses in some hospitals and retirement homes are getting cars in their benefits package, and a higher pay than the doctors working in the same institutions, simply because we can't find any. We have too many unemployed high degree people who "don't want to work below their level" (aka "get their hands dirty"), along with the opposite, the ones who dropped out and never got anything, and far too little technically savvy people and people who are willing to work. There's a lot of complaints about immigration, but the fact of the matter is - they're doing jobs our local youth doesn't want to do anymore.

Anyway, I'm a fan of the Belgian system, it's certainly better than a system designed to indebt all bright young minds while closing off college/university for anyone who can't afford it - but some sort of regulations/checks are somewhat in order. It's far too easy to stay a student and live off of society for far too long (a friend of mine just graduated in film studies at 32. Yeah, that's going to be a useful and contributing member of society!)

PatrThom said:

OH MY GOD YES

--Patrick

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Fear not. It is presently popping.

MindDetective said:

Fear not. It is presently popping.

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The banks went crazy there for a while, trying to find ways they could lend money to people. After the mortgage situation blew up, they promoted education loans. The schools thought people were taking out loans because education was so important, so they raised prices to meet the perceived "demand." I can't wait until textbook prices, tuition, and all that finally return to some sort of normalcy.

--Patrick

Man needs hernia surgery, schedules it and tries to use his medical insurance. Hospital wants $20,000 up front for his portion of the cost.

Man cancels surgery, goes to different hospital, claims "self paying/no insurance," Hospital charges him $3000.

Methinks I see a glimmer of a solution.

GasBandit said:

Man needs hernia surgery, schedules it and tries to use his medical insurance. Hospital wants $20,000 up front for his portion of the cost.

Man cancels surgery, goes to different hospital, claims "self paying/no insurance," Hospital charges him $3000.

Methinks I see a glimmer of a solution.

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Yeah, this kind of bullshit is coming more and more to light. NPR has really been hammering this kind of stuff home in the last few months and it's HORRIFYING the kind of stuff Hospitals/Health Care Systems are doing regarding costs. The question is, will anyone do anything about it and CAN anyone really do anything about it?

Espy said:

Yeah, this kind of bullshit is coming more and more to light. NPR has really been hammering this kind of stuff home in the last few months and it's HORRIFYING the kind of stuff Hospitals/Health Care Systems are doing regarding costs. The question is, will anyone do anything about it and CAN anyone really do anything about it?

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Make health insurance health INSURANCE again, instead of pre-paid health plans. As in, only for major things, like cancer and horrific car wrecks. Pay day-to-day or less serious medical expenses out of pocket. Reintroduce market forces. Guarantee you there will be websites popping up like the cheap ticket/hotel websites that comparison shop/find deals at doctors and hospitals for you PDQ.

As the article mentions, the areas of medical expenditure where costs stay low and progress is made are the ones not covered by anybody's insurance. $2000 lasik vs $25,000 hernia outpatient surgery (that doesn't involve lasers or cutting open eyeballs).

Also, before we get too far away from the "education cost" thing....

I am most bothered by them having a legend and labelling each state. Do they know the point of a legend?

Silly New Hampshire. They just don't get it.

blotsfan said:

Silly New Hampshire. They just don't get it.

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Every 4 years when they get their primary first, I'm reminded by all the on-scene reporting how New Hampshire can count to potato.

As I read it, the problem isn't health insurance or even health insurance companies, it's hospitals inflating their prices to ridiculous amounts because of insurance. It's the hospitals jerking these people around and asking ludicrous fees, not the insurance companies.

That said, providing the same service for 7x the price because of non-essential differences like that would be illegal in Belgium - it's extortion.

Bubble181 said:

As I read it, the problem isn't health insurance or even health insurance companies, it's hospitals inflating their prices to ridiculous amounts because of insurance. It's the hospitals jerking these people around and asking ludicrous fees, not the insurance companies.

That said, providing the same service for 7x the price because of non-essential differences like that would be illegal in Belgium - it's extortion.

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The hospitals inflate the prices because they are required to treat everyone for emergency care, so they take huge losses when uninsured people rack up big bills and can't pay. Which means insurance gets more expensive, so less people can afford it. Which mean more people come in uninsured and the hospitals take more losses, so the prices go up again, etc.

It's a fucked up system, and no one really wants to fix it. Mainly because the people in charge of fixing it don't have to worry about not being able to afford insurance and can get the best care available.

It's largely a shell game. The hospital knows that each year the insurance company is going to try to negotiate a deeper discount, so they raise their prices slightly more than the actual increase in expenses so the insurance companies think they're getting a better discount. Meanwhile the insurance companies know this, and push for deeper discounts.

In both cases they have to not only make a profit, but also both have to cover expenses that are somewhat variable. Insurance companies have to pay out to patients with horribly expensive diseases, and hospitals have to cover patients that require immediate life saving treatment but can't pay for it.

However hospitals have to give everyone the same price structure to avoid lawsuits about giving preference to one customer over another in pricing. So they have to give out these hugely inflated prices to people who ask for them. About the only place where they can cut the actual charge down outside of insurance is at the time of billing. If a family explains hardship, and attempts to make some payments, they can often ask that the bill be reduced, and the hospital will do so if it means that the family will pay for the lower cost, but probably won't pay much if they have that high cost hanging over them.

A quick way to fix this system is to force insurance companies to stop paying hospitals directly. Standardize medical invoicing, bill the patients directly, have the patients agree to and pay the cost, and then get reimbursed from the insurance company. Give everyone the power to shop around, and eliminate the huge insurance billing department each hospital has to have simply to deal with 40 providers with 800 different fee schedules. I have two hospitals close enough for emergency treatment, and several more close enough for non emergency care. If I could call them and compare prices, I would.

Insurance companies can then provide standard payment amounts for services, hospitals could charge and compete on price to the consumer, and the consumer can keep the difference if they get a better deal and are satisfied with the service. Alternately they can pay more out of pocket if they want to choose a different provider.

Put consumers back in the loop, and let them be the drivers for lower cost.

This would also have the effect of treating insurance as insurance, rather than health care. Yes, you can buy into the play that includes birth control, it's just going to cost you more per month since it's a fixed cost. Or you can shop around and pay it directly to the provider, rather than asking for reimbursement periodically.

But that's never going to happen.

Shakey said:

It's a fucked up system, and no one really wants to fix it. Mainly because the people in charge of fixing it don't have to worry about not being able to afford insurance and can get the best care available.

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Yes. A co-worker of mine has a wife who works for a local hospital group. He gets a bigger paycheck because he does not subscribe to any of the health insurance plans at our job. Why? Because the health plan provided by his wife's employer is this: "You are covered 100%. For anything we (or anyone in our hospital group) can do. So is your family. Done." It makes me sooooo jealous.

--Patrick

I'm pretty sure that headline would hold true of the dumbasses in Washington who voted on it.

Covar said:

I'm pretty sure that headline would hold true of the dumbasses in Washington who voted on it.

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True, though something tells me you could "insert legislation name here" for that headline, and it would still be just as true. In any country.