Trumpcare vs. Obamacare, what would you choose?

[Rodney Mills]

I'm not sure if you understand the gravity of what Donald Trump*proposed to cut out of the U.S. medical services, so here is a synopsis.

Obama introduced a healthcare program called The Affordable Healthcare Act. It is loathed by the far right wing of the Republican party and persons who had a healthcare insurance group health plan as part of an employment or union agreement, as a socialistic program funded by the tax payer. A sort of "Lower away chaps, I'm in the lifeboat," or a familiar expression that disparages someone named Jack.

Prior to Obamacare those not covered by the above or lived on limited funds relied on the hospital emergency room treatment, in turn overloading the emergency room system. Obamacare offers coverage that financially assists people with the premium costs on a sliding scale from roughly $20,000.00 income to $45,000,00. Below 20k no charge; above $45k you paid the full insurance premium
.
The part of one's premium that was paid, be it all or part, was paid by the federal government to the state government who in turn paid the insurance company.

There are three choices of coverage, the cheapest has a high deductible which had to be met before benefits kicked in and primarily is coverage for catastrophic major health events. The highest premium package has a minimal deduction and covered fully.

Prior to Obamacare persons with preexisting conditions e.g. cancer, heart condition, congenital illness, a history of backache, found that many insurance companies would not offer insurance to these applicants with preexisting conditions, and if they do, the applicant will pay a much higher premium than those without preexisting serious illnesses. Obamacare said the preexisting conditions MUST and WILL BE covered at no additional cost.

The framers of Obamacare foresaw that the sick and the elderly in the 50-64 year old range would rush to buy-in, young healthy people would not. So over a period of four years there was a graduated scale of a fine for not signing-up. The final year fine and for ongoing years roughly equal the annual insurance premium, so it was a "no-brainer" get insurance or pay out for nothing. Consequently, 20 million signed up, and for the first time and had medical coverage.

Trumpcare:

First off there would be a sliding scale of payment towards the premium similar to the above example except it wouldn't be a cash payment it would be paid in the form of a tax credit. In simple terms, you have a tax credit of $2,000.00 you knock it off your federal income tax liability....except do you? There are no details out all we are told is it is a tax credit. Is it $2,000.00 deducted from your tax or is it a $2,000.00 deductible (credit towards tax liability) if so and you are in a 20% tax rate your $2,000.00 tax credit is worth $800,00 to you. If you don't owe tax then the $2,000.00 tax credit is of no use to you, you have no rebate and would pay full price for your insurance premium. This would hit the low income family the hardest.

Trump care will do the following:

Lower the premium to the 20-29 year olds "as they don't get as sick as old folks so shouldn't pay the same." Elderly citizens will pay higher, limited to five times higher than the young, as the elderly use the medical service the most, particularly 50-64 year old ( at age 65 you qualify for Medicare the seniors health program (these rates will be increased too)). The projected increase for the 50-64 group is anticipated to on average increase $3,600.00 per annum per person. The average younger retiree increased by $2,500.00 per year per person.

It became obvious to Pres. Trump that he didn't have the votes even though the Republicans had a twenty-three vote advantage. Trumpcare only had a seventeen percent of voters nation-wide for it. Fifty-seven percent against it and wanted to retain Obama care, and the balance not sure or no opinion.

Republican congressmen representing working and middle class areas were reading polling results showing they were going to loose their position as congressmen at the next election if they voted for Trumpcare; thus, they wanted to keep Obamacare and would vote no. Affluent districts with a majority of hard right voters warned their congressmen that they would be out of office if they voted FOR Trumpcare as they wanted a total closure on ANY form of medical coverage government sponsored, just insurance on the "free market." Viewing anything less as "socialistic healthcare So they proposed to vote no. Consequently, Trump warned the no voters in the first group HE would work to see they were not reelected and to the right wing he promised to cutout the following Obamacare 10 Essential Services to sweeten the deal:


The following is a last ditch offer by Pres. Trump to the right wing "House Freedom Caucus" of the Republican party to support his plan to dump Obamacare.


"Nevertheless, according to reports out of Washington late Wednesday, the Trump White House and Republican Congressional leaders were offering to repeal the essential health benefits as a lure to get the most conservative Republicans, the House Freedom Caucus, to support the leadership’s repeal bill. The measure is scheduled for a floor vote Thursday, but the Freedom Caucus thus far has been united in opposition, saying the repeal leaves too much of Obamacare in in place.

These essential health benefits include at least the following items and services:

1. Outpatient care—the kind you get without being admitted to a hospital
2. Trips to the emergency room
3. Treatment in the hospital for inpatient care
4. Care before and after your baby is born
5. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
6. Your prescription drugs
7. Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and
occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
8. Your lab tests
9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
10. Pediatric services: This includes dental care and vision care for kids.

Removing these services from hospital patients is not enough? How would you like it if these items disappeared from your NHS, that is before your NHS was removed in its entirety?

Is there anybody reading this that would vote to have their HHS gutted or cancelled as Pres. Trump and Co. wished to do to ours?. Thank goodness he lost.

I and my wife have 100 percent medical coverage. We can afford the premiums. Up to seven years ago my priciple worry was my youngest son. He was in his early forties, he's overweight, and smokes and claimed he couldn't afford medical insurance. My family has a history of sudden death heart failure and he's a candidate. In addition to losing him, what do I do if he survives a stroke but needs continued medical treatment? Do I put my wife as well as myself at financial risk by paying his medical bills because he as an adult refuses to buy medical insurance. but can find the money to smoke?

Obamacare was a great relief to us. It assisted my son with the premiums, gave him coverage (forced him to with the penalty payment), If he chose to forego the insurance and pay the fine then it relieved me of the responsibility to pay any of his medical bills, because he now has the opportunity to get affordable medical coverage. For seven years that "monkey was off our backs," and he underwent regular medical check-ups too, for the first time since he has been an adult. And guess what? He voted for Trump, "As it's not the governments position to tell us what to do."

A neighbor and friend who is a right-winger of the Republican party is in the same boat, his son is a mirror image of mine, plus his divorced daughter too. Guess what?...he and his wife voted for Trump as well.

[Keith Tindell]

I still cannot see him carrying out his full term, but we wait and see. I am at odds with a lot on site as I believe he will prove to be a disaster ,kt

[Keith at Tregenna]

I still cannot see him carrying out his full term, but we wait and see. I am at odds with a lot on site as I believe he will prove to be a disaster ,kt

In time ?

K.

[happy daze john in oz]

Rodders, here in Oz the push to get all employees into private health cover gathers pace year on year. If you do not have it you pay an additional Medicare levy.

But the problem is each April 1st the premiums rise, by more than inflation, which sees many dropping out or reducing cover.
That in turn puts more presser on the funds to have a bigger increase next year and on the public health service.
Biggest cause of this is the Medicare Levy stuck at 1.5% of income.

Both myself and my wife and brother have all had public hospital treatment since 2013, Cancer for brother and I, knee op for my wife. We all had far better experiences than friends who had similar in private hospitals.

The problem is this, should the gov run a suitable medical system for all, or should it be all public?

The fact is that medical can be seen as a business and no gov should be involved in any form of such.

In my humble opinion the following should be the norm.

A public health system run at arms length from the gov with Medicare levies being raised over a number of years to 6%.
Private cover for those who wish to pay for such.

The only option to this is for the employer to pay private cover as part of a salary package as was the case when we were employed in the university system.

There is no easy answer as most companies when it comes to medical cover will often refuse an existing condition.

In the case of USA I think some cover by the gov, be it Obamacare or Trump care for those who are of insufficient means and a form of private for those who can afford it.
Your system is a little different to ours.

[Des Taff Jenkins]

Hi Rod.
Thanks for that run down I now have a clearer picture, though it is close to what I thought it was.
My view, as a country we have to live together be it in harmony or not, we vote for a group of people to to look after the countries resources, wealth, safety, and the health of all its citizens, I think it is incumbent on the people we vote in to look after the health of everyone to the same high standard regardless of their income, unfortunately there are many who as long as they are up there jack don't care about the person {It could have been them] who through no fault of their own {except maybe smokers and drug takers] are in need of medical help they cannot afford. The perfect world is not yet upon us
Cheers Des

[Rodney Mills]

A big thanks to both of you for great educational responses.

I too am not in favor of governments running anything other than what they are elected to do, govern, and not to interfere with the free flow of commerce. That being said, it cannot be left to business to set the direction of a country, or where an industry can set a policy that effects the pocket book, health, and wellbeing of the citizens.

Most countries, if not all other than the U.S., have a government run medical program (some like Oz supplement it with private insurance).
Obamacare is medical policy set by the government with market directed insurance companies issuing policies for a fee with government paid subsidies. In theory it should work, in practice it isn't. First. it is not national (one price fits all) it is by state. Large populated states get reduced prices from insurance companies, low populated states pay higher. It is fifty states bargaining individually for prices instead of the government with the clout of all fifty states bargaining for one price for all. The insurance companies set the policy price and can pick and choose which state they want to sell. And as conditions change and are not to their corporate interest they can leave a state. In addition states have the option of accepting the government subsidies and the conditions that go along with it, or going alone. Many of the Republican states elected the later, in theory they didn't want Federal government involvement, in fact they wanted to defeat Obamacare.

Our annual insurance and pharmaceutical rates are also increasing above inflation. What really disturbs me is a large percentage of new medicines and drugs are created and manufactured in the states. I am NOT saying our scientists are better than yours. What the U.S. is able to do is offer top money and conditions for research to the worlds best and induce many of them to move to the U.S..

The top medical schools get millions in research funds and with the reputation of say Harvard University with tons of money can recruit the top scientists and students for huge salaries or scholarships in the best equipped labs. Both McGill in Canada and Cambridge in the U.K. have complained about this.

Suppose a wonder drug is found. It eventually ends up in the hands of a pharmaceutical company, either U.S. or another country, usually with factories in the U.S. and Europe. They set the price for the drug in the U.S., pushing the drug price to the limit. If one has insurance, up goes the premium, if one doesn't have insurance then a limited income tax payer is covered by Medicaid (the tax payer funds it). The answer from the drug companies is the "outrageous price of research!" Excuse Me!

In other countries with government run programs, they go to the drug companies and negotiate the price at considerably cheaper prices than we in the states pay. Canadian shipmates are well aware of the U.S. citizens crossing the border to buy their drugs in Canadian pharmacies.

So as far as I'm concerned medicines and drugs do not work when left to the "free Market". Imagine what our drug prices could be with a population of 360 million and negotiated as your countries government do. Trumpcare is a license to steal.

[happy daze john in oz]

Rodders, the system here with prescription medication is quite simple.
If you are working you pay the retail price for the drugs.
If a senior or on a health card the you only pay $5.30 per script and when you have reached about 40 scripts for the year the rest are free.

Gov puts many drugs on the Prescription Budget Scheme, a scheme run by the gov to provide drugs at a low cost. The list may change at times depending on needs.

Currently the cost annually of Welfare is around $155 billion and health care about $75 billion.

The current form of Medicare came into being in 1985, there had been a previous one but not so encompassing, by a Labor gov.
The concept was great but sadly badly administered.
In 1996 just before being kicked from office the PM. P. Keating commissioned the Australian National University to conduct an audit on Medicare.
I was at that time in touch with another Food Services manager in that uni and he sent me a copy of the draft report.
It stated that, Medicare initiated at 1% of salary should have been increased by some 0.25% every six months until it reached 6%. At that level there would be enough to fund a national disability scheme as well. We are now in the early stages of such a scheme but currently unfunded.

That PM was in need of an op, but he never took out health insurance saying, 'I have great faith in Medicare and know I will be seen to very quickly'!!

[Ivan Cloherty]

Is there a doctor in the house? I'm getting confused!

[Des Taff Jenkins]

Hi Rod.
I have had prostate cancer for the last 15 years, I had radiation treatment for three months as i was on a pension it cost me nothing, for the last 14 years I have had an implant of Zoladex every three months, at first it cost $1700 a shot now reduced to $1,200, without it I would probably carked it by now as there was no way I could have payed for it from my pension. The pharmaceutical companies know they have to come to the party with the federal Govt for that reason, prices are reviewed every twelve months.
We are lucky, for one, we don't have your large population and two the number of states, so the feds handle most of the health, dealing out the money to the states
Cheers Des