Congressional Business Office
Sometimes I wonder if people research the government office websites, which are available to the public and aren't simply documenting a story. I don't care what news publication or media it is, there's usually a specific agenda. However, if you research these government office websites, you'll often find that no one is sharing all of the information. I prefer websites that I don't have to question the integrity or truthfulness of the author or media personality. I prefer scholarly articles for similar reasons. I came from a position in a quality department and without substantiated physical evidence, it means nothing to me and that's from anyone. To be completely unbias, you cannot focus on biased sources in any direction. The only way to form an unbiased opinion is to focus on facts; not beliefs, not hearsay, not feelings... I'm leaving this here to allow you to read it and form your opinion for yourself. This is the congressional budget office's policy proposal regarding universal health care. So, while so many people here are arguing about ridiculous stories that don't have substantiated evidence, I decided to do some research.
Summary
In this report, the Congressional Budget Office examines policy approaches that could achieve near-universal
health insurance coverage. Such approaches would provide nearly all people in the United States with financial
protection against high-cost medical events, increase
overall access to health care, and decrease the costs that
providers incur when they provide medical services to
uninsured people. The approaches also would increase
federal subsidies for health care.
As defined by CBO, a proposal would achieve near universal coverage if close to 99 percent of citizens and
noncitizens who are lawfully present in this country
were insured either by enrolling in comprehensive major
medical coverage or by receiving automatic coverage
through a default plan. Attaining such coverage would be
challenging, however. CBO is not aware of any existing
proposals—legislative or otherwise—that would achieve
complete (that is, 100 percent) universal coverage
because they all would require some demonstration of
eligibility (such as meeting criteria related to citizenship
or residency) that some eligible people would not comply
with for various reasons.
At a Glance
In this report, the Congressional Budget Office examines policy approaches that could achieve near-universal
health insurance coverage using some form of automatic coverage through a default plan. As defined by CBO,
a proposal would achieve near-universal coverage if close to 99 percent of citizens and noncitizens who are
lawfully present in this country were insured either by enrolling in a comprehensive major medical plan or
government program or by receiving automatic coverage through a default plan.
Components of Proposals That Would Achieve Near-Universal Coverage
Policy approaches that achieved near-universal coverage would have two primary features:
• At a minimum, if they required premiums, those premiums would be subsidized for low- and moderate income people, and
• They would include a mandatory component that would not allow people to forgo coverage or that would
provide such coverage automatically.
The mandatory component could take the form of a large and strongly enforced individual mandate penalty—which would induce people to enroll in a plan on their own by penalizing them if they did not—or a
default plan that would provide automatic coverage for people who did not purchase a health insurance plan
on their own during periods in which they did not have an alternative source of insurance. Because lawmakers recently eliminated the individual mandate penalty that was established by the Affordable Care Act, this
report focuses on approaches that could achieve near-universal coverage by using premium subsidies and
different forms of automatic coverage through a default plan.
Policy Approaches
CBO organized existing proposals into four general approaches, ranging from one that would retain existing
sources of coverage to one that would almost entirely replace the current system with a government-run program.
All four approaches would provide automatic coverage to people who did not enroll in a plan on their own.
• Two approaches would fully subsidize coverage for lower-income people and partially subsidize coverage
for middle-income and some higher-income people while retaining employment-based coverage.
Financing would come, in part, from broad-based tax revenues that were not linked to health insurance
coverage. Financing also would come from higher taxes on those uninsured people who were covered by
the default plan and whose premiums were not fully subsidized; those taxes would be equivalent to their
share of the premium. Collecting such taxes from uninsured people would pose challenges.
• Two approaches would fully subsidize coverage for people at all income levels. Financing would come
entirely from broad-based tax revenues, and people who did not enroll in a health insurance plan would
not owe additional taxes.
Under some approaches, the default plan would be privately managed. Under others, it would be a public
plan, operated by the federal government.
The approaches that CBO examined would require varying amounts of government spending to cover the
same number of people. They would all require additional federal receipts to achieve deficit neutrality.
If you care to read the entire policy proposal: https://www.cbo.gov/system/files/2020-10/56620-near-universal-coverage.pdf
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I've read it.
But this administration is doing nothing........./s
They aren't. They have no plan other than to tear down the ACA and leave millions uninsured and millions more uninsurable due to pre-existing conditions. The CBO is not run by the administration.
"CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence without regard to political affiliation. CBO does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis. Learn more about CBO's commitment to objectivity and transparency."
We've been waiting for that fantastic health care plan from the 'president' for almost four years now.
THEY'VE GOT NOTHING.
Please contribute to the topic in the seed.
Please contribute to the topic in the seed.
Thank you for that information. I don't know what else to call it other than a proposal; I understand that the CBO doesn't provide recommendations either way. That's the reason I used this information in the first place.
You obviously didn't even bother to scan the report.
The CBO cited the 7 proposed bills that have been filed during this session of Congress that they analyzed for the report. ALL of them were sponsored by Democrats, one passed the House last month. The 2 bills filed in the Senate were read, referred to committee and are STILL sitting there since February of 2019.
The report also cites the lawmakers that requested the analysis, ALL are Democrats.
So tell me why you think the report illustrates that the 'administration' is doing something in relation to this issue?
This is quite true. That's actually why I requested that he contribute to the topic in the seed.
From what I've read, there's positives and negatives to all of those proposals and some lack enough information for me to make a fully-informed decision. I would like to know how they would determine who pays what, because I don't know what they consider mid / moderate income; it's quite different from state to state, county to county, and even city to city within the same county. (you can see my example further down) It seems there's some holes in some of the proposals.
Only a couple of the bills have even had hearings so it is difficult to assess them. The one that passed in the House cites a sliding scale based on percentage of income above the poverty line [which is a bogus # IMHO]. HR 1425 AMENDS the ACA, it does not repeal and replace so much of the bill is a 'tweak'.
I did
The president was not the topic in the seed.
Absolutely agree. There's much that the so-called poverty line does not account for in regard to affordability.
Whichever approach anyone would like, my first concern is the idea of giving "residents" the same status as citizens. We should never be doing that.
Agreed..................but as said above.............
So if they don't recommend, I hope to hell we aren't paying for their exercises in futility.
I'm concerned about a lot of items shown and if this factual data will be ran with by any administration.
I'd like to know the definition of resident. Because quite frankly, that makes a big difference here. I know a lot of people that are in the process of obtaining citizenship along with their families. They are hardworking people that pay taxes and do everything legally. Do you think that people like that should be equal in this instance?
Not until they are sworn in as citizens. Citizens have rights that mere residents do not, nor should have!
So what would you propose? I ask, because if any administration decides to go through with a plan like this, I may lose my employer-based health, dental, and vision, which means all those people I work with that are currently going through the MANY YEARS of attaining citizenship would lose their insurance as well.
Moreover, if those people are paying taxes that help pay for things like this, why shouldn't they receive the same opportunity?
Why Vic..... We lived in Germany for six years. Worked there, paid taxes into the system, and I was covered for medical treatment as anyone else there while only being a resident.
Are you saying I shouldn't have been? Are you saying that residents in the US that pay taxes shouldn't get any benefits even though they have to participate by law? That's pretty evil.
Were you active duty during that six years? If you were not, were you covered by Tricare if you are retired Navy?
Could you vote in German elections?
Don't call anyone else evil
You're not the boss of FLYNAVY1!
Who died and made you moderator?
How many times have you referred to Democrats/Liberals/Progressives as evil?
Don't pretend he did.
Nah..... been a civilian since 1989.... This was normal employment by a German corporation. I was listed as a "special skills" employee by the government that allowed me to work with just a residency card.
Nope..... just a resident, not a citizen working with the permission of the German government for a private corporation.
Ah, gotcha...thanks. Just wondering
Again: Were you allowed to vote in a German election?
The Constitution gives 'residents' much of the same rights as citizens Vic.
Yes, it does and the people I'm thinking of completely deserve those rights.
It appears that we're in agreement on this... miracles can happen.
You see, Dulay, Citizenship is a very unique concept dating back to 7th Century Greece. A Citizen has important rights as a freeman. A citizen is not subject to a king, he has the right to vote, own property and live where he wants. Mere residents do not. Progressives are trying to blur the line between mere residents and citizens. Currently we have approx. 60 million non-citizens living in the US, more than any time in our history. Approx. 40 million of those have green cards and thus 20 million are illegal aliens. The privileges - only belonging to citizens, such as voting and leaving and entering the country legally or staying in the country indefinitely are being eroded by the left.
San Francisco allows illegal aliens to vote in school board elections as do other districts controlled by leftists. The state of CA allows illegals to come and go as they wish. The DACA program allows non-citizens to live here indefinitely.
Where is it leading? First, more power for democrats - evidenced by CA and second, the illegal aliens will have no investment in America and no allegiance to it.
They sure as hell CAN own property and live where they want. I have no clue where the hell you get BS information like that. Get educated.
You're trying to pretend that the Constitutional rights enjoyed by 'mere residents' don't exist. They DO.
The report in the seed cites "noncitizens who are lawfully present in the country".
So YOU are trying to blur the lines between residents and 'illegal aliens'. Just stop.
HOW? Please be specific. HOW would including lawfully present residents in health care coverage erode either of those privilege's Vic?
It always makes me chuckle when a conservative makes the admission that their policies are so unfavorable that even after the YEARS it takes for an immigrant to become a citizen, they KNOW they cannot win their hearts or minds or votes.
That is an extremely obtuse statement.
Read your own comments.
The fact that you've got nothing is noted...
It isn't so easy when you can't just sling BS and lock the seed is it Vic?
Again: HOW would including lawfully present residents in health care coverage erode either of those privilege's Vic?
The important question that isn't being addressed: what does insurance coverage provide?
Universal insurance coverage may only exacerbate the problem. We know that insurance is easier to provide. But is insurance what we need?
You bring up very valid points. What, in your opinion, do you believe is insurance that people need?
Do you know anyone in Canada or the UK that has Universal Healthcare? If so, have you had discussions with them about that healthcare? Do you believe that forcing all to have healthcare is infringing on freedoms to choose for oneself? Why (either way)?
I have lived in the UK where they have the NHS. The NHS will give everyone (including visitors) emergency care immediately. It will also give scheduled non-emergency surgeries on a schedule that varies from region to region and some might consider a bit of a wait. People who can afford it do buy additional insurance, but it is much cheaper than it is here and provides a doctor on demand, and by "on-demand" I mean, you can set up an appt there after work. Try doing that here, even if you are paying a fortune for your insurance.
Btw, my cousin is an orthopedic doc there, and he sees both NHS and private patients.
From what I understand, some like the NHS and some don't. My mother in law is from England and while she hasn't had to deal with the NHS since 1960 or 61, her siblings live there still. My daughter has a friend in England that she talks to a lot too. I've heard good and bad from the young and old. I don't have an opinion since I currently do not have to deal with it.
I can see my doctor same day. The doctor's office I go to has an "after hours" clinic set up too, which means no appointment necessary from 5-8 pm; that way I don't have to pay extra copay for "urgent care" and still get to see one of the doctors that practice in that office.
Seems to me what people need is medical care.
Is insurance providing healthcare? The question being addressed by universal health insurance proposals is "how do we pay for healthcare?"
At present the United States is annually spending over $11,000 per person for healthcare. We are spending over $3.6 trillion (with a T) on healthcare. Healthcare spending is 1.5 times larger than the Federal discretionary budget. Healthcare spending comprises over 15 pct of our national GDP. Too little money doesn't seem to be the problem.
The more money the United States has spent on healthcare, the less affordable healthcare has become.
IMO it would be wise to find out where the money is going before we talk about spending more on healthcare. Since we are currently spending $11,000 for every citizen and resident in the United States then we need to understand what we are getting for that money.
The NHS like any other system will have those who like it and others who will not. It is not perfect either. But it does provide a level of care for everyone, which here in the US we do not.
I can not see my doc the same day and I have private insurance. We do have an after hours walk in, but my insurance is so messed up (BCBS) that they have lost the code to my walk in and charged us for the visit recently, which is some nerve given I pay $2,700 a month for my family coverage and I don't get to see my doc, but some part-timer. In this way, England is better, since private insurance is a fraction of what I pay and I would get to see my doc.
From my perspective, I agree with that statement.
I have BCBS too. I struggle with getting meds I've been on for more than 11 years now. I wonder if a universal health care would even allow me to get the meds I need.
The one thing that the NHS and Canada have is cheap drugs. The reason is that the country negotiates the prices for the drugs. You know who pays the difference? We do. We need to do the same thing as most other countries with national health systems do, which is to negotiate drug prices.
Here is another little fun fact I found out when my daughter was working the labs at Johns Hopkins. The actual R&D is done by students at universities around the US. The drug companies make "donations" to said universities for this research. Then they take a tax write off for these donations. Then they farm out the manufacturing of these drugs to foreign countries to get the cost down. None of this benefits the American consumer, so drug companies make huge profits from our pockets.
That I am very well aware of; there is one in particular that doesn't have meds that seem to work no matter the type of medication. The company I'm referring to makes all kinds of generics and the armodafinil, modafinil, and amoxicillin that I've received from that company did NOT work.
The issue is though that armodafinil and modafinil usually aren't covered unless it's private insurance. I certainly can't afford the cost and it really sucks falling asleep while driving or working. I had to research US-based generic companies that produce my medication and I found two; those generics actually work for my sleep disorder and have to call the pharmacy in advance just to order them, because the one they've been told they can have in stock is the one that doesn't work. I recently found a pharmacy that was helpful and kind enough to explain how their system works in regard to warehouses and agreements with those warehouses and medicine companies. I miss when I could simply pay a higher copay for name brand at my request.
It's not too difficult to show that spending more increases inflation. And inflation makes things less affordable.
The medical inflation rate has been consistently higher than the overall inflation rate. Notice that healthcare has not experienced any deflation?
IMO we need to understand what is driving medical inflation before spending more. Simply spending more on healthcare will likely increase medical inflation and make healthcare less affordable.
The Week In Review: Medical Care Inflation
Interesting......... I decided to do further digging from your link (thanks for that by the way) and it appears that this particular issue started to occur in the mid 1980s, which then I decided to look at the reasoning and progression of "Reaganomics" [again]. That's when the inflation rates became noticeably different between overall and healthcare.
Yes. That raises the question: is health insurance a medical service or a financial service?
Wasn't Reaganomics intended to foster an economic transition from an industrial based economy to a services based economy? IMO what has been overlooked is that meant a transition to a financial services based economy.
Focusing on just healthcare as being inflationary excludes all the other items that are not keeping up with the overall rate of inflation. An example would be apparel. The pct. of expenditures by household is roughly 1/2 of 30 years ago and the overall inflation is about 1/2 of the headline number. Why is that. That repeats itself in some form or the other across multiple categories.
We scratch our heads at why healthcare inflation is so much higher, but maybe we should ask ourselves why other categories are not keeping pace, imo. (No, I am not happy or content with healthcare costs.)
It seems to me that health care costs are hugely inflated. The actual cost of production of most prescription drugs is a tiny fraction of what pharma is allowed to charge. Much of the groundbreaking drugs are developed via federal funding yet the American consumer gets charged MORE for the product than most of the rest of the world.
Pharma claims that they need to recoup the cost of development, even though it's obvious they do so based on their huge profits even in the first year of availability. Is there any other product that the cost of development is added to the cost to the consumer into perpetuity?
Then there are the charges for testing, especially technology like MRIs, CT scans, ect. Though the cost of setting up that technology is known more or less across the board, the charge for those tests differ widely and seem to be based on what the market will bare. It's also well known that 'reading' those scans has been outsourced to overseas, which leads to the question of quality standards and charging patients NYC prices for a 'doctor' in Delhi reading your CT scan.
I know for a fact that certain Hospital groups require their doctors via contract, to run patient mills, 15 min 'appointments' each, patient needs be damned. Hospital administrators control patient care, NOT doctors. I've had a 15 min. appointment with a $100+ above what BCBS pays the provider. It's outrageous.
I can only speak to automotive R&D; no one would be able to afford the cost of vehicles if R&D was rolled into the cost of the car for the consumer. When a one-off prototype part costs $10,000 and it's smaller than a piece of paper, trust me when I say, automotive R&D is extremely expensive. And yes, their profits pay for that R&D.
When I was in the ER for bulging a disk between L1 & L2, not only was the ER nurse rude as Hell, but all they did was give me shots for pain and swelling, made me take one step and kicked me out. I never saw a doctor. I received a bill for the ambulance for $600 to go 12 blocks. I received a bill for the doctor I never saw for $240. Then I received a bill for $1200 from the hospital for "space usage." I was only there for 45 minutes. I have BCBS. Three days later, I went to my regular doctor's office, saw a physician's assistant that gave me a shot of prednisone along with a 10 day cycle taken orally, which helped so much more than the stupid narcos the hospital gave me ($15 copay). The same day I saw the physician's assistant, I went to our chiropractor ($35 copay, "specialist") and he was appalled that they didn't even do x-rays or any sort of exam whatsoever. He helped me a lot over the following couple weeks. It is asinine how much hospitals and doctors charge.
Another thing regarding the "hurry up and get that patient out" mentality... my stepdad just lost half of his left leg YESTERDAY because they were in a hurry to get him out of the hospital and home. No, he's not diabetic. An osteopathic surgeon did surgery to repair a vein. He got a staph infection. He did weeks worth of outpatient IV antibiotics. A week after those IV antibiotics were done, he spiked a fever and his toes began turning black. The same osteopathic surgeon did another surgery to put a stint in a vein near his ankle. Color returned to all but his big toe. They shipped him to a rehab facility despite my mother's protests. They kept insisting that the color would return to his blackened big toe. I'm not a doctor, but know that once tissue is black, it's dead and there's no bringing it back. In the rehab facility, a first year resident was performing rounds, two days AFTER the rehab facility wanted to send my stepdad home. He checked my stepdad's foot, told my mother that he'd be right back, and had a vascular surgeon in tow. They immediately performed all the tests that should've been done two weeks prior. The vascular surgeon determined through those tests that should've been performed two weeks ago that he had gangrene and that it appeared that it was up to about mid-calf; thus, had to remove the leg from the knee down. Now... the test that determined this was an ULTRASOUND. I ask why an ultrasound wasn't performed to begin with and moreover, why no one seemed concerned that his toe was turning black and he was complaining that the bottom of his foot felt like it was on fire. Then, other questions arise like, why were they about to send him home? Why was an osteopathic surgeon performing vein and artery surgery without, in the very least, a consultation with a vascular surgeon? Legally, yes I know that an osteopathic surgeon can perform all kinds of surgery, but they are general knowledge of the body, but a vascular surgeon specializes in veins and arteries and knows what to look for if issues arise... not that the osteopathic surgeon wouldn't or shouldn't know, because they should, but I digress.
Why is it that I was able to pull scholarly articles and documents regarding the links between vein / artery surgery, Toxic Shock Syndrome (TSS) (which is a form of sepsis specifically starting as a staph or strep infection following surgery OR using a certain feminine hygiene product for too long), sepsis, and gangrene and learn enough to know that my stepdad's big toe was gangrenous for two weeks, but until that FIRST YEAR RESIDENT insisted that a vascular surgeon look at my stepdad's foot, the other doctor's, nurses, and physical therapists were about to send him home??? Why did they move him from the hospital [where there's an OR] to a rehab facility to begin with, considering his toe was still black and he was still in a lot of pain? Yes, I know that some of this is on my stepdad. He should have questioned everything and he didn't. He should've been more adamant about them paying attention and listening. He trusted them. He trusted that they knew what they were doing. People wonder why I question everything. People wonder why I research everything in depth. This is why.
Reaganomics was intended to reduce the rate of inflation. However, healthcare was not intended to be a capitalistic money machine; therefore, would not be affected by Reaganomics. Moreover, deregulation and the ASEAN [AFTA] agreement gave big pharma and doctors the opportunity to capitalize on inexpensive generic drugs made in India, China, etc. (that often don't have the potency that US generic drugs do for several reasons) or farm out tests or the judgement of those tests [providing results] to low-cost countries just like big pharma. My health insurance provider won't allow me to get name-brand meds. I am forced to receive generics. While I have found two US companies that make generics in the medication I take, it's difficult to get, because pharmacies are only allowed to maintain a stock of that generic medication that's made in India. That brand does NOT work for me at all. The pharmacist that I spoke with at the new pharmacy I go to, told me that he receives a lot of complaints about the medications made by that same company. He said he's reported them. Doesn't matter, because they're making meds at extremely low cost; therefore, no one will do anything about it... but the question still remains, are they even putting the active ingredient into those meds really? I'd love to see lab work done on meds that came from that company.
Ms. A, I love you! You are a teacher's dream!
This is true and without the funding, there is no coverage. And that is the issue. Of course, if they do away with the individual mandate, then the whole thing kind of comes tumbling down.
Ummmm haven't they already done away with the individual mandate? Or just the fine for failing to have insurance? I think the latter. In which case it should be tumbling down as we type.
It repealed the penalty for the mandate.
A federal appeals court Wednesday struck down part of the Affordable Care Act, ruling that its requirement that most Americans carry insurance is unconstitutional while sending back to a lower court the question of whether the rest of the law can remain without it.
And I was glad to see that go. When my husband and I were laid off at the same time, we both ended up working for a company that didn't provide employer insurance until the first 90s was done. Therefore, we were both working full time and didn't qualify for a low cost, short term insurance... we ended up going without for 3 months... we paid for it the following tax season. Funny thing is... I was the only one that ended up sick in that 90 days and I paid $110 out of pocket to be seen and the Amoxicillin cost me a whole $2.40, which was far less expensive than that penalty!!!
Well, as I said, right now I am paying $2,700 a month for a family plan, which is insane. So I would like to see something better than that. No one should have to worry if they can bring their child to the doc or end up in a hospital emergency room for strep throat. Do you know who pays for that? We do.
Exactly. And what you're paying is insane.
I have employer-based health, dental, and vision. While they don't pay 100%, they pay for most of it. I only pay $120 / month or something close to that (within a few dollars). Myself, my husband, my daughter, and son are all on that plan.
Who do you think is lying?
My twin daughters turned 26 in Aug, and will be coming off of our plan in Dec. They will be applying for domestic partnerships to get on their intendeds' plans as they are both still students. (they were supposed to get married but covid hit so they postponed till next year). I will get a break of some sort after that since it will be just me and Matt.
We used to have an employer-based plan, till my hubby lost his job and we both then were self-employed. The insurance has been a huge hit on us and we are lucky enough to be able to afford it. What if you are not?
Most people wouldn't be able to afford what you're paying. I know I couldn't. It's not like we live frivolously either. We don't have car payments. Our mortgage is $1100 / month (that's paying an extra month per year on the principle). And we don't really do anything for "entertainment" that costs money. We play board games. What I make per year isn't anything special nor does it lack for what I do. My income is median for my role in this state. However, according to the "comfortable" income is more than I make per year.
Love you too. I used to have to remind my boss when I was in the quality dept. that we were there for completely unbiased determination of a particular situation with a project. It was very clear to me after a short while that she had formed specific opinions regarding certain project teams or leads and it was reflected in her auditing. That's a huge no no.
The only thing that I would like is a list of definitions for "residency" or "mid" / "moderate" income. To me, mid or moderate income is very different in different parts of the country. Would they determine that by a ratio of taxable income to average cost of living? Because what mid-income is here is peanuts compared to mid-income in California.
Therein lies the rub. It's like a living wage debate. What we should have learned early on is that what may be good for a state (see Romney care) has a much different affect on a national level. I have held that conviction since the onset.
I think that would have to be determined regionally. There is another way to go. The Federal gov or the States could negotiate with hospitals, drug companies, and insurance companies on how much is a reasonable payout. That is what Canada does.
That's why if anything like this could even work or should be considered, a ratio formulation would have to apply; thus, making it equal across the board. Each city or county would have to have the formulation applied. I said city, because let's face it, Wayne County, MI includes a great deal of difference in cost of living too. For example: Detroit and Grosse Ile are both in Wayne County.
DETROIT
GROSSE ILE
This goes to show that not everyone can afford the same things; my family is somewhere in between those two above.
Yes I did.
I totally agree and I do think that there needs to be some sort of formula. That is the tricky part.
I'm pretty sure that there are smarter people than me that could figure out that formula though.
It's a trap! LOL. Unless you can find someone who isn't personally involved in the formulation. Catch 22
The government already has a COL formula which is used for federal employee wages. That formula pays more for the same job, depending on locality. In fact, Medicare/Medicaid have payment rates based on locality too. I don't see why they couldn't apply just as easily to all health care coverage.
That very well could be a viable solution.