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View Diary: Why is nobody talking about the OTHER Obamacare subsidy? (178 comments)

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  •  It isn't about sympathy (24+ / 0-)

    but when I read a comment like this,I am struck by how low American's expectations have fallen.
    Two earners with a couple of kids pulling in 90K  are not living  particularly large...except when contrasted with the vast majority of the US population. (and yes,global population) US median wealth has dropped to 27th in the world.

    "George RR Martin is not your bitch" ~~ Neil Gaiman

    by tardis10 on Fri Nov 22, 2013 at 09:20:23 AM PST

    [ Parent ]

    •  I think that at $90k you can pay for yourself... (11+ / 0-)

      and don't need a public subsidy to help you do that.

      There has to be a cut-off somewhere, doesn't there?

      After all, the Medicare sur-tax of 3.8% on investment income, which pays for a lot of Obamacare, kicks in at $200,000 income.

      So does the 0.9% surtax on regular income.

      It would hardly make sense - except in Washington, of course - for someone to both be paying a sur-tax and getting a subsidy.

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Fri Nov 22, 2013 at 09:32:03 AM PST

      [ Parent ]

      •  There should be a soft cap rather than a hard one (10+ / 0-)

        Right now after 400% of the poverty level there is no subsidy.

        At 400% you are subsidized so that a silver plan shouldn't cost you more than 9.5% of your income.

        I see no reason why that couldn't be extended outward to whatever income level you please.  At some point 9.5% of your income will be greater than the typical cost of a silver plan for your age group and you get no subsidy.  

        "It was believed afterward that the man was a lunatic, because there was no sense in what he said." "The War Prayer" by Mark Twain

        by Quanta on Fri Nov 22, 2013 at 09:54:47 AM PST

        [ Parent ]

      •  90k in one family breaks down as this: (20+ / 0-)

        Dad makes 50k and Mom makes 40k (because we all know about the income inequality) and has 2 kids, say 12 and 8.

        So Dad makes $24/hr while Mom makes 19. Do you really think this family isn't living paycheck to paycheck? They net about 5k a month.
        What if the kids are 8 and 4 and they have $1000+/mo in childcare to pay for? 2 cars so they can get to work 15-20 miles away? A $1000 mortgage too? What if one kid is in college instead? That's 1400 a month right there. Hope there aren't any college loans to pay off, either.

        Do you still have little sympathy?

        I agree that if you have an individual making 90k just for themselves, they are able to do this with no problem. But honestly, 90k isn't what you think it is, especially for a family. Just remember that.

        Full disclosure: The above situation is not me (except for the kid in college and college loan parts) so don't make it about me crying that we only make 90k, because we don't.

        We currently pay 5% of our net income to health insurance premiums, and that's because my wife has a zero premium policy, mine policy is meh, and I bought our 2 kids' insurance on the open market. Otherwise it'd be about 10% if we were all on one plan together.

        5% is acceptable (and I think a good taxable level for universal health care) - but why should the family making half what I do be forced to pay 10% of their net income for the same thing I get?

        •  Honest question... (7+ / 0-)

          Is the $90K adjusted gross or the gross?  If I live in a high cost, high tax area, $90K for a couple is nothing and after taxes and other tax deductable expenses not to mention the cost of housing in areas like New York, well, it isn't that far from poverty with two kids.

          If it is after taxes and tax deductable expendatures, Hell, Mitt Romney may qualify.

          How are these income levels calculated?  Is the poverty level based on national statistics or local?

          "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

          by Buckeye Nut Schell on Fri Nov 22, 2013 at 01:44:35 PM PST

          [ Parent ]

        •  A family with two cars who own their home? (12+ / 0-)

          NO, I don't have a lot of SYMPATHY. I have empathy that they are working hard to stay where they are and are scared about what they have being eroded away.

          But no, they don't need a subsidy.

          Take that family of four with both parents working at minimum wage. THAT I have sympathy for.

          Yes, our overall health expenses are too high. That is what we need to keep working on. One cure is to get more doctors and nurses. One cure is to provide more primary care.

          •  Don't see how more doc's and rn's reduces costs... (1+ / 0-)
            Recommended by:
            indres

            Saw a discussion this morning that costs appear to be under control + projected < 1.5%/year growth till 2020.

            One link alluded to patients/docs making better, cheaper, smarter, decisions on treatment/preventative care.

            •  More docs/RNs = more competition (3+ / 0-)
              Recommended by:
              marina, Notreadytobenice, KingTag

              A lot of the problems with health costs are because of a lack of competition.

              If doctors had to compete with each other for business, wouldn't costs be lower?

              Trivia: there are 2 industries that are exempt from the anti-trust laws: major league baseball and health insurance companies.

              Cheers.

              Against stupidity the gods themselves contend in vain. Friedrich Schiller

              by databob on Fri Nov 22, 2013 at 05:45:29 PM PST

              [ Parent ]

              •  I'm not sure law of supply and demand.... (1+ / 0-)
                Recommended by:
                Odysseus

                holds in medical professions. The legal profession has abundant # of J.D.'s and still paying $200-300+/hour at least here in Boston.

                For the Professions, consider Managed Competition as having the best benefits vs. costs for our country.

                I'd like to see managed competition considered for other trades as wells. Major League Baseball players and Major League CEO's come to mind.

              •  It doesn't work like that. In places with (2+ / 0-)
                Recommended by:
                Cardinal Fang, kurt

                an abundance of doctors and especially hospital beds expenditures are higher. Examples: Boston area and that town  in TX that Atul Gawande wrote about (the New Yorker, June 2009).

                What is needed is more primary care providers and fewer specialists. Except psychiatrists — more, many more of those are needed.

                Competition in personal services doesn't reduce prices. Do you really look for the cheapest doctor — or the cheapest barber/hairdresser?

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                by samddobermann on Sat Nov 23, 2013 at 06:04:23 AM PST

                [ Parent ]

                •  Actually, we don't need more psychiatrists (0+ / 0-)

                  a large part of today's apparent epidemic of mental illness is due to people living in constant economic and social insecurity...if people who wanted them could find living wage jobs that were reasonably secure, there'd be a whole lot less depression. A lot of what looks like mental illness (I'm not saying all, obviously there are plenty of genuine schizophrenics  and bipolars out there) is just a normal reaction to living in very screwed up society.

                  What we really need are gerontologists. Caring for elderly patients calls for special training, and when doctors without that training make mistakes, it not only injures elderly patients, it sends Medicare costs through the roof.

                  "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                  by Alice in Florida on Sat Nov 23, 2013 at 04:37:45 PM PST

                  [ Parent ]

                  •  We need both. But Psychiatrists are (0+ / 0-)

                    in very short supply. And when someone with a serious disabling mental illness has to wait 6 to 12 weeks between appointments or can't get a hospital bed when the need is very high — as for Gus Creeds — there is a serious lack.

                    You denigrate mental illness with your "it's a reaction to a crazy society" dogma. People with serious depression don't get better if you give them a job. Often they can't DO a job. We are not seeing an epidemic of mental illness. Low grade depression in people in ghastly situations is normal and not illness.

                    And adequate diagnosticians are of utmost importance as well as close supervision at the start of treatment. we don't have that.

                    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                    by samddobermann on Mon Nov 25, 2013 at 12:47:33 AM PST

                    [ Parent ]

                    •  I agree there is a shortage (0+ / 0-)

                      of hospitals and psychiatrists, I just thought you were suggesting that there was an epidemic of mental illness--based on the way antidepressants and antipsychotics are being doled out (including antipsychotics being used as an all-purpose remedy), that's what a lot of people seem to think. The overall nastiness of today's society,  the bullying, the insecurity, can push a lot of "normal" people over the edge.

                      The real tragedy of psychiatry is how it is practised these days, which may be in part a function of shortage, which is that they spend little time with patients and mostly concentrate on writing prescriptions. It may be onn of the things that pushes doctors away from choosing that as a speciality...that and maybe it's not a great way to make money. Or maybe not many doc's want to be around the mentally ill, just as they don't want to be around old people. Or, given the shortage of general practitioners, they don't like treating people....

                      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                      by Alice in Florida on Mon Nov 25, 2013 at 08:37:30 PM PST

                      [ Parent ]

                •  I know a number of people (1+ / 0-)
                  Recommended by:
                  Notreadytobenice

                  who look for a cheap hairdresser, if not necessarily the cheapest. I am among them, living in a city where it's not at all unusual for a woman (we pay more, you know!) to spend upwards of $100 for a haircut. My hairdresser is a nice, competent lady working in a very dowdy, unfashionable salon, and she charges $35.

                  I don't think the comparison is really apt, though. A bad haircut can't kill you (though it might kill your social life for a few weeks). I don't choose my doctors that way, and they are all over the place on price.

                  "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

                  by sidnora on Sun Nov 24, 2013 at 04:19:25 AM PST

                  [ Parent ]

                  •  Do you call around for the cheapest? (0+ / 0-)

                    Or do you ask about quality measures? do you even know what to ask?

                    Do you ask how often they perform some type of surgery? do you ask about infection rates and other quality indicators before you go in the hospital?

                    Do you even research whether the propped treatment has any value at all?

                    Nice that you are happy with a mid cost hairdresser but that doesn't mean you shopped based on cost.

                    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

                    by samddobermann on Mon Nov 25, 2013 at 01:02:20 AM PST

                    [ Parent ]

            •  Are you referring to "Choosing Wisely"? (0+ / 0-)

              It's a terrific initiative that's helping docs and consumers make more value based healthcare decisions. It's an important initiative but we shouldn't stop there.

              I want to live in a world where George Zimmerman offered Trayvon Martin a ride home to get him out of the rain that night. -Bishop G. Brewer

              by the dogs sockpuppet on Sat Nov 23, 2013 at 09:34:39 AM PST

              [ Parent ]

          •  The BEST cure is to get the middlemen out (12+ / 0-)

            of the system.

            CEO's of companies such as McKesson - a large part of whose business is simply the distribution of prescription drugs to Medicare patients in nursing homes - make in the tens of millions per year. McKesson CEO John Hammergren took home $145.8 million in 2010.

            CEO's of "non-profit" regional hospital systems such as Carolina Healthcare's Michael Tarwater make in the multiple millions per year. Tarwater pulled in $4.76 million in 2012, while the combined haul for the top ten members of the executive suite was nearly $20 million.

            CEO's of "non-profit" health insurance companies such as BC/BS of NC's Brad Wilson are paid millions - $2.5 million for Wilson, and nearly $10 million combined for the top six members of the executive suite.

            This sociopathic pattern repeats itself throughout thousands of corporations that make up the Medical-Industrial Complex, one of the greatest perpetrators of massive-scale larceny in the history of mankind.

            Single-payer, single-provider government healthcare. NOW!!!

            "Bernie Madoff's mistake was stealing from the rich. If he'd stolen from the poor he'd have a cabinet position." -OPOL

            by blue in NC on Sat Nov 23, 2013 at 04:12:00 AM PST

            [ Parent ]

            •  How? (0+ / 0-)

              How are you going to make all doctors become employees?

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Sat Nov 23, 2013 at 06:06:42 AM PST

              [ Parent ]

            •  Doesn't have to be single-payer, single-provider (1+ / 0-)
              Recommended by:
              databob

              There are a variety of models for a national health system that work successfully in various countries around the world. I don't understand how they all work--the British system is the easiest to understand--but the French and Germans and others also have excellent healthcare at much lower cost than the US.

              "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

              by Alice in Florida on Sat Nov 23, 2013 at 04:44:13 PM PST

              [ Parent ]

          •  Which is why the ACA has provisions (1+ / 0-)
            Recommended by:
            radical simplicity

            doing exactly what your last paragraph calls for.

            Remember the $10 Billion for about 1200 new Community Health Centers? They are being built now. Many new ones are operating now — providing primary care all over the country. Some even have special buses (?) that will be visiting schools in the area on a weekly basis.

            The insurance provisions are all in the Title I of the ACA. There are nine more titles.

            I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

            by samddobermann on Sat Nov 23, 2013 at 05:58:10 AM PST

            [ Parent ]

          •  Owning their own home (0+ / 0-)

            may be a wise economic choice and less costly than rent.  It doesn't necessarily mean no house payment, though.

            If you think you're too small to be effective, you've never been in the dark with a mosquito.

            by marykk on Sun Nov 24, 2013 at 05:53:53 AM PST

            [ Parent ]

    •  depends on where you live (7+ / 0-)

      $90K is a lot of money down here.

      my house cost $150K.

      -You want to change the system, run for office.

      by Deep Texan on Fri Nov 22, 2013 at 09:50:27 AM PST

      [ Parent ]

      •  A small, 1950s house w/4 bedrooms (4+ / 0-)
        Recommended by:
        Tommye, MRA NY, tardis10, kurt

        Is 400k+ around in the Boston area.  At home in VT, it's closer to $250k.

        So, using the absolute dollar value of someone's income as an indicator of need isn't entirely fair. A lot of conservatives have the knee-jerk reaction of "well move," but even that's not so simple: to move you need to be able to pay whatever it costs to get your stuff from where it is to where it's going - at the very least, that's gas, if you earn more and own a home, it's a moving truck and/or professional movers. You have to pay 3 months rent in advance (first, last, security), or you have to be able to sell your house in a stagnant market for at least what you owe on it, then you have to get a new mortgage on the new house. You have to leave your support network. If a parent is watching your kids while you work, now, you're going to have to find childcare in the new place. Chances are childcare will eat most if not all of the financial difference between the two locations' housing costs. Now, if you're hungry, you can probably swing by the home of someone you know and get to eat. If you move, who will you know? What will you eat on those days when you just don't have the money to make up for the empty cupboards? Will the new place have jobs that pay any better than where you are now?

        "Just move" assumes there are magical places where what you earn right now follows you, and all the support that currently offsets things you'd have to pay for elsewhere follows you, too. It's a fallacy.

    •  the belief (14+ / 0-)

      that people making almost twice as much money really have it almost as bad as the same size family at half the money when its the difference between $50 thousand and $94 thousand a year when the subsidy ends is incredible.

      Both families may spend all their income, 'need' more money, but I can assure you,  the family with the  $90k income has met a lot more 'needs' the the family at $50k.   Even with progressive tax rates, earned income tax credit,  I'd rather have $90k gross.   Most of where the money goes comes down to choices about how much excess is needed,  bigger houses, bigger bills, more cars, electronics, clothing, food, eating out, entertainment, etc.

       

      •  No one is disputing that 90k is more (23+ / 0-)

        than 50k, or that it buys more. My point is that the double earner 90K folks are living "tighter" than what my Union Dad did in the 1970's. We've defined (& accepted) expectations down. So that now,on a democratic blog,people have no problem stating that 40hrs of labor does not mean you shouldn't be poor....because  that is all your "value".  That is what 30+ years of wage stagnation,deregulation,privatization & financialization of the economy, concentrated ownership ,advertising and media lite have wrought.

        "George RR Martin is not your bitch" ~~ Neil Gaiman

        by tardis10 on Fri Nov 22, 2013 at 10:53:46 AM PST

        [ Parent ]

        •  nobody was saying that people (7+ / 0-)

          don't deserve the fair value of their work, nobody is arguing that in the last few decades real wages have been declining,  or that the value of money hasn't changed over time.

          What we are saying, is that those factors have happened as much to people still earning $50k a year as those earning $90k a year.    And when it comes to meeting basic needs and still buying insurance, subsidy or no subsidy,  a family at $90k a year can find more ways to squeeze a nickel that doesn't cut into basic needs than a family at $90k.

          Its like being in a  row boat with waves washing over the gunnells and some folks are sitting on the bottom of the boat and others on the seats, they are all in grave danger of drowning, but some foks already have water up to their chin and their position is immediately precarious.  

          No one is stating that single payer wouldn't be better and more cost effective than private insurance, but we are talking about 'unfairness' of no subsidy at a pretty high income level.  Those people probably don't have to choose food over their health insurance premium.

          •  It's not a contest (3+ / 0-)
            Recommended by:
            MRA NY, tardis10, kurt

            And nobody is arguing that people making 90k have it as bad as people making 50k, what they're arguing is whether or not people making 90k are rich and shouldn't receive healthcare subsidies.

            I'm with Tardis.  90k for a 2 worker household is not rich.   We should support the poor, and all the middle classes here, and not take such a tiny worldview that 2 individuals each making 45k per year are the enemy.

            If you want to get mad about something, get mad about the way the poor are being treated with the ACA.  In many states, they get NOTHING, because there's no medicaid expansion.  Even in some of those states where they do get medicaid, the medicaid rules state that the government gets paid back from the estate of the person after they die.  This is a penalty levied only on the poorest of us.

          •  Well, a family with $50K is stylin' (0+ / 0-)

            compared to one with $25K...

            "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

            by Alice in Florida on Sat Nov 23, 2013 at 04:48:31 PM PST

            [ Parent ]

            •  exactly (0+ / 0-)

              and except for the states with asshat republicans for governors or in the legislature, a family at $25,000 doesn't get asked to pay anything for the insurance.    They are also generally eligible for some other aid programs, food aid to some degree, sometimes housing subsidies, heat subsidies, etc.  

              A national single payer plan would be preferable so we wouldn't be drawing any lines.    But if you prefer the game of well someone is always worse off instead of dealing with the reality of who can meet needs versus unlimited funds for wants,  yes,   people with only $25k are worse off.  But both the $25k and $50k family is more stretched to meet actual needs.  But if new cars, big houses are more important for people earning $94k a year to you than people at $50k getting health insurance, you're right it is absolutely hellacious about those poor folks not gettting a subsidy.

      •  Problem is healthcare too expensive, not who pays (2+ / 0-)

        This is misdirected stress over who pays full freight vs. discounted, for a service that is much too expensive.

        My went to graduate school and got a phd in biology, with some skills relevant to biotech or genetics. Right now, jobs in biomedical research or even drug development chemistry are somewhat scarce due to layoffs, and many people work for years until they are nearly 40 at the standard NIH payscale of $39,000/year (and there are famous cases of people having to leave the field entirely because permanent jobs aren't there).
            However, people who went through medical school but then specialize in very similar research work - running clinical trials, or pathology research where they are mainly in a lab rather than treating patients - often get much much higher wages and command more resources and larger budgets. This is because there is restricted entry into medical school, so there is a shortage of medical doctors, but biology majors have become a dime a dozen.
           In any case, there are some high salaries and high profits in medicine, and there is no way for prices to go down without eliminating these factors which are maintaining artificial high prices now

        •  and that really wasn't the issue posed (0+ / 0-)

          I agree, no one except the super rich can afford unlimited care for all problems.

          Nevertheless,  I didn't say I wanted a health insurance system over single payer, or that payscales in general made sense.  Just that I know what the difference between living on $94k or $50k is, and it is large.  And if we are talking about meeting needs in a law intended to make health insurance more affordable,  wage scales can't really be addressed by the law.  Or even by our dysfunctional Congress.

          Save the family with a $100k, it's a major problem.   That was the original comment I addressed.  

    •  This isn't about living large (5+ / 0-)

      This is about survival.

      I agree that we have an increasingly bad wage/wealth gap. The disparity has been growing and that is bad.

      But none of my family ever lived large and they all worked very hard. We are out of our minds if we think we can guarantee everyone will live large on a US scale. What we have to do is guarantee that no one has to go without healthcare or live in the streets.

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