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Joshua Shulman

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How We Pay For Health Care Now

Posted: 06/19/2012 4:26 pm

While we all wait to see whether the Supreme Court will overturn decades of established precedent by gutting Congress's power under the Commerce Clause so that it can overturn the Affordable Health Care Act, it's worth taking a moment to remember how health care is paid for now.

The controversial part of the Affordable Care Act (call it "Obamacare" if you want, but just remember that before it was Obamacare it was "Romneycare") is the individual mandate. That's the part of the law that charges an additional tax to anyone who does not have insurance. You get a choice: buy insurance, or pay a tax. For people who can't afford insurance, enough subsidies will be given so that they can afford it. But middle class people who don't want to buy health insurance will be penalized by paying this tax. It's true; and it's certainly understandable why it's controversial.

But what happens right now to middle-class people who don't want to buy health insurance? Most of them get away with it, because they're healthy. But every year some percentage of them get a serious illness, or get hit by a car, or fall off a ladder. Remarkably, these people -- your friends and neighbors -- don't stay at home and die, wishing all the while they had bought health insurance. Instead, they go to their local emergency room. There, they get treated, and are sent home with a $100,000 or $300,000 or $1,000,000 invoice. They declare bankruptcy, bilk their creditors, and stiff the hospital.

Who pays for that? You do. You pay for it in higher taxes to pay for hospital bailouts, higher insurance premiums, and higher hospital charges.

Don't like it? Here are your options: (1) Stick with our current system in which $56 billion in medical care was provided to the uninsured in 2008, resulting in higher taxes, insurance bills, and hospital charges. (2) Obama(Romney)care. (3) Have emergency rooms stop treating the uninsured. This would mean repealing the Emergency Medical Treatment and Active Labor Act (EMTALA), which has required emergency rooms to treat all comers since 1986, when it was passed with great bipartisan support. Such a repeal would leave uninsured people to bleed to death, curable diseases to go undiagnosed, and babies to die in their mothers' wombs for want of medical care. The L.A. Times recently ran an interesting article detailing this colorful history of of EMTALA.

Obama(Romney)care is starting to look pretty good to me. We'll find out soon if the Roberts Court agrees.

 

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While we all wait to see whether the Supreme Court will overturn decades of established precedent by gutting Congress's power under the Commerce Clause so that it can overturn the Affordable Health Ca...
While we all wait to see whether the Supreme Court will overturn decades of established precedent by gutting Congress's power under the Commerce Clause so that it can overturn the Affordable Health Ca...
 
 
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HUFFPOST SUPER USER
William1950
everything I say could be wrong.
09:41 PM on 06/21/2012
romobama care is better than nothing... medicare for all would be better... still paid for with taxes..
09:45 PM on 06/20/2012
Really, would you like your neighbors and fellow Americans to die for lack of medical care? We pay enough into the system to cover everyone if we get the administrative and non-contributory middle men of the industry out of the equation. Universal care is a successful solution that many countries all over the world have established that can be a mix of private and public money, like our current medicare is. Or look at the Scandinavian countries, or most recently Taiwan. systems that take care of the people for less money per person than we are spending now in the US. And people don't have to suffer and bleed to death for no reason either.
Frankly I am stunned that you would watch your daughter die because she couldn't get insurance. Or your best friend, because that is what is going on. 45,0000 people die every year for lack of medical care here in the states. Do we not take care of our own?
HUFFPOST SUPER USER
DJleary
09:44 PM on 06/20/2012
Everyone wants health security and everyone would get insurance if it actually both - "insured and was affordable".
Right now it's extortion and will apparently continue to be so.

Bilk one's creditors- how absurd!
03:59 PM on 06/20/2012
Frankly, if the SCOTUS strict constructionists found that the Constitution supports a CORPORATIONS inalienable right to free speech, they will surely strike down the dreaded "Obamacare."
HUFFPOST COMMUNITY MODERATOR
Veneita
If trolls had minds, they wouldn't be trolls
02:53 PM on 06/20/2012
Well put
02:18 PM on 06/20/2012
Thank you. Nicely said.

If America wants to be honest, time to say no insurance card, no treatment. We don't have the stomach for those consequesnces yet so many rail against a law that begins to address the sinkhole that is our current system.
01:20 PM on 06/20/2012
The current attitudes in the GOP have revealed an affinity for Option #3, repealing the Emergency Medical Treatment and Active Labor Act. I found a show video explaining how it might work:

http://www.youtube.com/watch?v=grbSQ6O6kbs
Bufford P Tusser
Impeach this!
02:01 PM on 06/20/2012
good stuff
03:02 PM on 06/20/2012
Twisted humor, our mutual metier.
Keep smiling, my friend!
01:08 PM on 06/20/2012
The republican position is predicated on selling the idea that the private sector does things more efficiently; which happens to fly against all the metrics ever gathered about healthcare. Last I looked insurance bureaucrats put their pants on one leg at a time as do government functionaries.
Bufford P Tusser
Impeach this!
02:03 PM on 06/20/2012
Actually, they put our pants on one leg at a time.

Enables them to go through the pockets whilst they dress.
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Victoria-nola
There is no way to peace; peace is the way.--Muste
07:56 PM on 06/21/2012
Brilliant!
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RUKidding0
Freedom is Fundamental
01:03 PM on 06/20/2012
ObamaCare FAILS to cover more than 1.5 BILLION poverty stricken around the world to whom Republicans STUBBORNLY REFUSE to provide insurance coverage - when it would ONLY cost $10 - $15 TRILLION annually to provide this much needed coverage.

This unconscionable greed must be addressed and the rich required to contribute their fair share to this basic human right. The intransigence of the rich makes it ever more clear that the only solution to forcing them to pay their fair global share is World Socialism under the auspices of the U.N.

Remember in November that only Obama and his Social Democrat Party will always support the commonsense solution of one world government, united under the benevolent rule of World Socialism ... with Obama as world president.
HUFFPOST SUPER USER
Earl Gray
Lighting up straw men everywhere
12:47 PM on 06/20/2012
The $56 Billion in unrecovered healthcare works out to about $500 per family for every family in the US.

More to the point, based on about 25% of housholds being uninsured, that represents about $2,000 per uninsured household. Except, since the 25% don't contribute, it ends up adding $650 to every insurance policy.

The GOP's effective position, then is that the 75% responsible (or lucky, more like) enough to carry insurance should subsidize the 25% to the tune of that $650 per person, per year.

What happened to the GOP's "personal responsibility" mantra here?
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HUFFPOST SUPER USER
dch58
To think is to differ.
12:23 PM on 06/20/2012
That, pretty much sums it all up.

It's really a question of how much will we pay.
11:59 AM on 06/20/2012
Or option 4: Put aside fears of "evil socialism" and copy the UK's National Health Service. Despite shameful attempts by the UK's current Conservative government to dismantle it in order to make money for private medical companies, it remains an effective, efficient and cheap system for delivering healthcare to the entire UK population. It would never occur to a British person to worry about how to pay for even the most complex and expensive healthcare - we can relax and know it'll be there, paid for by everybody's taxes when we need it. (At half the price, per head of population, of US healthcare).
Bufford P Tusser
Impeach this!
02:08 PM on 06/20/2012
We need to eliminate the unnecessary middle man.

Only two required entities in health care.

The provider and the recipient of said care.

Kinda like going to the grocery store and handing some guy $100 who in turn gives it to the cashier and you leave with $70 worth og food stuffs.

The joker who got the 30 bucks brought no value to the transaction.
02:44 PM on 06/20/2012
Outlaw health insurance and the cost of health care would be reduced by 1/3 immediately.
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Rascals Veda
Go. Do. Be.
02:29 PM on 06/20/2012
Not to mention greater longevity, happiness and productivity in those countries with national health, but also a great (listen up, republicans) burden lifted from corporate liability.
11:24 AM on 06/20/2012
Then there is the much more expensive care that occurs when those without health insurance do not go to a doctor with symptoms of something that may be much more easily and inexpensiely treated early on as opposed to later. Heart, diabetes, cancer... We pay for that as well.
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HUFFPOST SUPER USER
srsbap
Forward not backwards
11:17 AM on 06/20/2012
The middle class continues to get crushed by low wages and healthcare costs! Thank the GOP as they sit and do nothing tax the one per cent now! That is how we pay for let the rich pay their fair share!!'
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DeskJockey13
Happy Hedonist Humanist
11:53 AM on 06/20/2012
Don't you mean "job creators", LOL!
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Gestas
Mountain Man
10:46 AM on 06/20/2012
You may be surprised how quickly you get sent home from the Emer. Room if you don't have insurance.
itolduso
lateral thinker
12:38 PM on 06/20/2012
But the hospital still 'bills' the city/county/state/feds exhorbitant charges for their 'stabilization' of the uninsured before they kick them to the curb...and THAT'S what never gets talked about...WHY it costs so danged much...a patient's insurer will be charged $125. for an x-ray ...yet the hospital will claim a $1500. loss for the exact same xray of an 'uninsured' patient...and be 're-imbursed' by city/county/state/feds
01:17 PM on 06/20/2012
As noted in a recent LA Times article, many doctors and hospitals have a three-tier pricing structure for many, if not all, procedures: (1) the "list price", (2) the negotiated insurance rate (which may vary depending on the insurer), and (3) the cash price. http://articles.latimes.com/2012/may/27/business/la-fi-medical-prices-20120527

Any doctor or hospital that charges a governmental entity a higher price than the lowest price that the doctor/hospital is willing to accept from a patient who pays in cash or via insurance should be prosecuted for medicare/medicaid fraud.