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Post by Deleted on Aug 3, 2019 18:26:23 GMT
The biggest debate among Democrats is Medicare for all. The progressive wing of the party is all in for it. The moderate wing of the party and those outside the party not so much.
The question is where do you stand?
Bernie got all testy when during the debate this past week he was challenged about what would be covered and he claimed “I wrote the damn bill”.
My thinking, after reading Sanders white paper, his grand plan on how to pull this off is flawed because of the assumptions he made. Specifically the cost on treating sick people and the cost of implementing it.
The biggest flaw in the ACA is they underestimated the number of sick people and the cost associated with it. Sanders has done the same thing and just like that tiny little fact caused no end of problems for the ACA, it will for all the M4A plans. The other minor problem is the cost of implementing the program. Currently there are 44M folks enrolled in Medicare. I don’t care how efficient one thinks the administration of Medicare is today, there is no way it can go from 44M to 320M in a short period of time without encountering major problems and costs.
What I think should be done is to fix the ACA and require all states to expand. Medicaid for starters. Also make sure all states have a strong Insurance Commissioner to regulate health care rates increases based on losses a carrier pays.
Because of underestimating the number of sick people the individual markets were hit the hardest with higher premiums/deductibles that in some cases spilled over into the employer sponsored plans.
Prior to the 2016 election I read an article that the individual markets were starting to stabilize which would have resulted, in a lot of cases, premiums stabilizing. By increasing the income threshold a lot more folks would of had help in paying the premiums.
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Just T
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Post by Just T on Aug 3, 2019 18:55:14 GMT
I honestly do not know where I stand on this issue, or how to fix it. What I do know is that something MUST be done. There has to be a way to fix the problems with healthcare in this country. Other countries have figured it out, and I may sound naive, but why can't we??? A person should not have to lose everything they have and go bankrupt because their child got cancer. I do not think healthcare is a luxury that only rich people should be able to access. I hate that the majority of the lawmakers who decide what WE all can have for healthcare is something they and their families will never have to worry about.
I have very mixed feelings about the ACA. I do believe that every single human should have access to affordable health care. But the way the ACA impacted me and my very middle class family is that it took a healthcare plan we had, that we liked, that was affordable for our family and our needs and drastically changed it. And drastically increased the cost while lowering the coverage we now have. How is that "fair?"
Like I said, there has to be a way to fix it. I don't know the answers as to how, but we HAVE to. Maybe it's because I am coming to an age where health problems begin to set in (mid 50s), and it scares the shit out of me to think that we already have pretty crappy coverage that we way overpay for.
I probably should not have responded to this thread because I really do not know enough to debate it. LOL But, like I said, something must change.
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Post by revirdsuba99 on Aug 3, 2019 19:31:36 GMT
I have very mixed feelings about the ACA. I do believe that every single human should have access to affordable health care. But the way the ACA impacted me and my very middle class family is that it took a healthcare plan we had, that we liked, that was affordable for our family and our needs and drastically changed it. And drastically increased the cost while lowering the coverage we now have. How is that "fair?" That is not fair!! Although I really have no solution either! What ever they do it has to be phased in, not gone today, new next week!
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Post by freecharlie on Aug 3, 2019 20:43:14 GMT
I didn't vote because I don't know. I do think insurance companies need to be able to make money. I do not believe they should overcharge to get it. I know that at my district the premiums went up because for every dollar we paid, insurance paid out 2. I get that they needed to raise the rates. They also should lower them when our usage goes down.
Dh has fabulous health insurance that allows us all on it as well. I selfishly do not want our insurance to change. It is affordable and has great coverage.
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Post by Merge on Aug 3, 2019 22:11:19 GMT
I think there should be a non-profit, government-paid option for everyone who wants it, just as there is public K-12 education for everyone who wants it. Both should be robust and well funded to the point where most people don't feel the need to go elsewhere. Ethically, I don't think that education or healthcare serve people best when profit is the motive.
I have no problem with continuing private insurance as well, for those who can and want to pay, just as we have private schools.
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Post by SockMonkey on Aug 3, 2019 22:20:48 GMT
I voted Medicare for All, because I think that should be the end goal.
In the meantime, we should use the ACA as a foundation to build forward toward that goal, integrating the public option. It will take time to unfuck what health insurance in this country has become (a massive business that operates for profit and not for the well being of literally anyone except CEOs).
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Post by annabella on Aug 3, 2019 22:43:31 GMT
Someone was telling me that he doesn’t want free medical care for all because then he’ll be taxed 50% like in Europe. But I said if people are spending half their paychecks on repaying college loans and self pay insurance it’s the same thing, just done a different way. Likewise to the mom who spends a ton on daycare and college saving plan for the kid. If we get taxed more, we no longer have to spend money on these other things. As is we don’t get our whole paycheck because we pay out of pocket for Daycare (especially for short maternity leave), college, medical care, which is free in Europe. We also have a problem in this country with seniors not having enough money for care. If we are all taxed more, all essential things in each stage of your life will be free regardless of your income level. Americans are high consumers with online shopping and credit card debt and would be against taking home less money.
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Post by chaosisapony on Aug 3, 2019 23:38:49 GMT
I think there should be a non-profit, government-paid option for everyone who wants it, just as there is public K-12 education for everyone who wants it. Both should be robust and well funded to the point where most people don't feel the need to go elsewhere. Ethically, I don't think that education or healthcare serve people best when profit is the motive. I have no problem with continuing private insurance as well, for those who can and want to pay, just as we have private schools. This, exactly. How it would best be accomplished I have no idea. But I think this should be the end goal.
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lindas
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Post by lindas on Aug 3, 2019 23:58:41 GMT
I think there should be a non-profit, government-paid option for everyone who wants it, just as there is public K-12 education for everyone who wants it. Both should be robust and well funded to the point where most people don't feel the need to go elsewhere. Ethically, I don't think that education or healthcare serve people best when profit is the motive. I have no problem with continuing private insurance as well, for those who can and want to pay, just as we have private schools. The problem is just about everyone will want it but how do you pay for it? Let's face it, it's the middle class that always gets hit the hardest on taxes and Medicare for all wouldn't be any different. You can't tax the 1% enough to cover the cost alone. Medicare's payment error rate was cited at 11%, roughly $41 billion dollars, in 2016 so just imagine how much worse it would be if everyone was on Medicare.
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Post by lisae on Aug 4, 2019 0:20:10 GMT
I voted to fix the ACA. I have no problem with a public option (as long as there are options) but we need to fix what we have to start with. As someone who has purchased her own insurance for over 20 years and started with a pre-existing condition (a disease I inherited), I have had plenty of experience purchasing insurance prior to and after the ACA. The ACA fixed many issues for me including removing the cap on prescription drugs. My prescription is now available generic but it wasn't for about 15 years so I know what a limit that $2,000 cap could be when you had a prescription over $300 per month. The main thing I like about the ACA is that I get a choice every year what plan I want to go into. Currently I'm in a high deductible plan since I don't have high drug costs at the moment. For years, I was too frightened to raise my deductible because you could go up but you could not go down. Lowering your deductible under the old system meant reapplying for insurance and having to provide all your medical history. There is plenty to be improved but it is a good start and let's not forget how hard it was to even pass that with a Democrat President and control of both houses.
I'm not in favor of Medicare for All because there is no way way our healthcare system will continue to function if hospitals and doctors have to rely on only what medicare will allow for expenses. What they charge is often far too high but what medicare allows is often just a fraction. I've seen the statements from my husbands and my parents supplemental insurer and medicare so I know that many times Medicare is only paying 10-25% of the requested amount. Often this means a surgeon is getting $60 or so for a followup office visit. I've seen hospitals only get $300 or $400 for an hour long MRI. The $4000 or so they requested may be excessive but they aren't going to be able to maintain equipment that costs millions of dollars and the staff needed without better returns.
And Medicare is not free for the recipient. DH is currently at nearly $400 per month for Medicare and his supplement. It pays everything so it is a better deal than private insurance but I can't see the costs being that low and covering everyone. I also think that it doesn't hurt people to pay a co-pay for doctors visits. People say that a single payer system works in other countries but the culture of those countries is often so different. In Europe, many people are clustered in urban areas where they do far more walking. Their relationship with food is far different than ours. Americans aren't always the best at caring for our bodies. High insurance cost isn't the only reason we pay more than any other developed country for our heathcare. We don't often care as much for ourselves as we could.
The biggest reason I'm against it in the campaign is it a losing idea. The only thing that matters is beating Trump. You will not convince enough moderates to vote for a candidate that wants to get rid of their private insurance to defeat Trump.
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Post by librarylady on Aug 4, 2019 1:10:35 GMT
I remember when Medicare came into existence. There were arguments on both sites (for it and against it). Pundits declared it would bankrupt the US. ...It would never work, etc. Now, many years later it is here and we are not bankrupt over Medicare.
The key to Medicare and Obama care is that EVERYONE must participate. Obamacare/ACA has fallen apart because the idea was changed to allow people to leave the program. When that happens, the healthy leave the plan and the unhealthy ones drain the system...and the premiums for the ones left in the system become very expensive.
I have been on Medicare for about 6 years. So far, we have been able to get the medical care we need. We were forced into a Medicare Advantage program and our premiums have jumped significantly.
It is complicated but all other western nations can solve the problem, it makes me angry that the US can't seem to do it.
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Deleted
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Post by Deleted on Aug 4, 2019 1:44:33 GMT
We need to fix our health care system before we even think about health care for all.
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likescarrots
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Post by likescarrots on Aug 4, 2019 2:06:03 GMT
We need to fix our health care system before we even think about health care for all. What does this even mean? And are you honestly trying to argue that there are human beings in this country not worthy of being treated for medical conditions?
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Deleted
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Post by Deleted on Aug 4, 2019 2:18:06 GMT
We need to fix our health care system before we even think about health care for all. What does this even mean? And are you honestly trying to argue that there are human beings in this country not worthy of being treated for medical conditions? As a mom to 2 medically complex, fragile, special needs kids I see the shit show fuckery known as health care. You want to know how many times I have had to file state level grievances to get what was MEDICALLY NECESSARY for my children? (9) That is on top of 15 entry level grievances. How many loop holes I have had to jump through to get a needed referral? How many hours spent in the ER to have my dying sickly child cared for (28 hours) Until our health care system is reformed there should be no added weight to an already horrible system because those of us in it will have many more problems getting the care we need. And if you think the ACA helped with ER wait times, think again. And we have private paid for through work insurance.
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Deleted
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Post by Deleted on Aug 4, 2019 2:19:45 GMT
Oh yeah and that is on top of a 6 month wait to see a needed specialist.
4 month wait to get insurance to cover a procedure.
And over $200,000 in out of pocket expenses WITH health coverage.
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Post by Merge on Aug 4, 2019 2:22:10 GMT
What does this even mean? And are you honestly trying to argue that there are human beings in this country not worthy of being treated for medical conditions? As a mom to 2 medically complex, fragile, special needs kids I see the shit show fuckery known as health care. You want to know how many times I have had to file state level grievances to get what was MEDICALLY NECESSARY for my children? (9) That is on top of 15 entry level grievances. How many loop holes I have had to jump through to get a needed referral? How many hours spent in the ER to have my dying sickly child cared for (28 hours) Until our health care system is reformed there should be no added weight to an already horrible system because those of us in it will have many more problems getting the care we need. And if you think the ACA helped with ER wait times, think again. And we have private paid for through work insurance. Wait, are you saying that no one else should have access to health care until you get yours? I'm sure that's not what you're saying. I'm so very sorry about your medically fragile children. We have that situation in my extended family as well. Might I suggest that the for-profit nature of your insurance and the medical facilities have exacerbated your problem? And that a non-profit solution might ensure that you get what you need without having to fight for it? Insurance companies exist to take your premiums and give you as little benefit as possible. It's the only way they make a profit. Regardless, you have my complete sympathy.
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Post by Merge on Aug 4, 2019 2:25:22 GMT
I think there should be a non-profit, government-paid option for everyone who wants it, just as there is public K-12 education for everyone who wants it. Both should be robust and well funded to the point where most people don't feel the need to go elsewhere. Ethically, I don't think that education or healthcare serve people best when profit is the motive. I have no problem with continuing private insurance as well, for those who can and want to pay, just as we have private schools. The problem is just about everyone will want it but how do you pay for it? Let's face it, it's the middle class that always gets hit the hardest on taxes and Medicare for all wouldn't be any different. You can't tax the 1% enough to cover the cost alone. Medicare's payment error rate was cited at 11%, roughly $41 billion dollars, in 2016 so just imagine how much worse it would be if everyone was on Medicare. You might not mind paying a little more in taxes if you know you're not going to have to pay tens of thousands in premiums plus a high deductible. Maybe you could educate me about what a payment error rate is and how it relates to this conversation. As I see it, things are terrible now. We have to do something completely different. And if that doesn't work, we try something else. But paddling along with the current system should not be an option.
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lizacreates
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Post by lizacreates on Aug 4, 2019 2:59:25 GMT
I don’t even know how we can realistically convert all privately-insured and uninsured people to Medicare. As it is, seniors like myself who are on Medicare have to purchase supplementary insurance – Medigap (through private insurers) – to cover those expenses not paid by Medicare. The alternative, Medicare Advantage, is private insurance. Medicare also does not cover long-term care in nursing home or assisted living facilities, easily the most expensive of all. There is no cap on out-of-pocket costs so if you’re in poor health, those costs can be staggering. Prescription drugs are under Medicare Part D and they’re run by private insurers. We can’t even control prescription costs. So, if Medicare as is, is not sufficient to cover all costs, how will we do it for everybody? If the goal is to put everyone on Medicare, then we first have to figure out how to fix it before putting everybody on it.
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Post by mrst on Aug 4, 2019 9:27:58 GMT
As someone who has lived in the UK and Spain, the American system horrifies me. We get free excellent healthcare as we need it. My taxes have NEVER been close to 50% and I earned a good wage. I get free healthcare in Spain. Excellent again and totally free. My whole tax bill is less than 500 euros a month. My prescriptions tun to maybe 5 EUROS a month. If I need a doctor I can see one the same day or the next day, and if needed I can see a consultant within a couple of weeks. I have full blood tests every 6 months and ECG blood pressure tests. I just can't see why a supposed 1st world country like the USA can't organise something better than it has.
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Post by stormycat on Aug 4, 2019 12:19:45 GMT
What does this even mean? And are you honestly trying to argue that there are human beings in this country not worthy of being treated for medical conditions? As a mom to 2 medically complex, fragile, special needs kids I see the shit show fuckery known as health care. You want to know how many times I have had to file state level grievances to get what was MEDICALLY NECESSARY for my children? (9) That is on top of 15 entry level grievances. How many loop holes I have had to jump through to get a needed referral? How many hours spent in the ER to have my dying sickly child cared for (28 hours) Until our health care system is reformed there should be no added weight to an already horrible system because those of us in it will have many more problems getting the care we need. And if you think the ACA helped with ER wait times, think again. And we have private paid for through work insurance. I have a child that has a lot of medical needs. He is covered under my husbands insurance. Here in PA with a qualifying diagnosis they are eligible for Medicaid and parents income isn’t considered. My son has a TBI,CP and Epilepsy. Everything is covered , surprisingly I have not had to fight for anything or has any issues. I realize how fortunate we are, I really do. Does your state have a waiver program to help out with secondary insurance? It’s hard enough to take care of a sick child and then have to worry about expenses. Heather
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Post by lauradrumm on Aug 5, 2019 8:27:31 GMT
The damn insurance companies and drug companies have to be regulated!
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Post by gar on Aug 5, 2019 8:46:11 GMT
You might not mind paying a little more in taxes if you know you're not going to have to pay tens of thousands in premiums plus a high deductible. This is what I aways think when these discussions come up. People say they don't want to pay higher taxes but they're apparently happy to get into massive debt or go bankrupt if they break their leg or suffer kidney failure or some such. I don't get it. P.S. The UK standard tax rate is 20%, 40% for higher earners.
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Deleted
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Post by Deleted on Aug 5, 2019 11:07:37 GMT
You might not mind paying a little more in taxes if you know you're not going to have to pay tens of thousands in premiums plus a high deductible. This is what I aways think when these discussions come up. People say they don't want to pay higher taxes but they're apparently happy to get into massive debt or go bankrupt if they break their leg or suffer kidney failure or some such. I don't get it. P.S. The UK standard tax rate is 20%, 40% for higher earners.and we don't pay any tax until we reach earnings of £12,500 ( $15,200 )
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johnnysmom
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Post by johnnysmom on Aug 5, 2019 11:51:36 GMT
I don’t know the answer (other than I agree something has to change, what we have now is it working) but I am curious about something....Not all doctors accept all Medicare patients. They usually have a number or percentage of Medicare (and medicaid) clients, when you call a doctor and ask if they’re accepting new patients before they answer they’ll ask what your insurance is. This is, at least in part there may be other factors, due to the low Medicare reimbursement rate. If all patients are Medicare then that would significantly impact the doctor/office income. They still have expenses, not the least of which is malpractice insurance.
My question is, in these other countries with universal health are medical malpractice lawsuits as frequent and high paying as in the US? A quick google search came back without much data, if I have a chance later I may look into it more but I’m curious from our global peas what their thoughts are.
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lizacreates
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Post by lizacreates on Aug 5, 2019 12:12:51 GMT
Since taxes were brought up, I might as well ask my questions here because I don’t know the answers and someone may.
Hypothetically, premiums for Medicare for All will be on a sliding scale. Those whose incomes are greater pay more. Let’s say we also institute a wealth tax, value-added tax, and taxes on all sorts of other things, and increase payroll taxes to raise the revenues needed to support this.
Let’s take a true single-payer plan like Bernie Sanders’ M4A. It’s estimated it will cost $28T for the next nine years WITH the assumption that healthcare providers will accept steep cuts in payments (and that’s a huge assumption). If providers refuse to accept steep cuts, the estimate goes up to $32T. So, that’s approx $3T to $3.5T we will have to raise in revenue each year in order for this not to be added to debt.
In 2018, we raised $3.3T in revenue and that’s to fund the entire federal spending, 15% of which is Medicare. In Bernie’s plan and other M4A plans, all payroll taxes will increase, and some are making the assumption that the 2017 tax cuts will be repealed. The middle class will pay more in taxes and the top 1% and 5%, theoretically, will pay much more, upwards to a 70% tax rate.
Even if we combine all of the revenue from all the tax increases, does anyone know if we can raise another $2.5T (85%) each year? Has anyone seen a plan that covers 100% of the costs of M4A? I’ve been reading about M4A for close to a year now and I’ve never found the answer. Because the financing of this plan, I believe, is the most important facet because this country is already drowning in federal debt. In delving into Bernie’s plan for financing, all his proposed tax increases will only finance 50% of his plan. Where will we get the other 50%?
So those are my two questions: (1) Can we realistically raise an additional $2.5 trillion revenue per year; and (2) If we enact Bernie’s plan, where do we get the 50% shortfall in revenue? If anyone has the answers, I would appreciate it.
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Post by Darcy Collins on Aug 5, 2019 12:53:41 GMT
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Post by iamkristinl16 on Aug 5, 2019 13:27:21 GMT
I'm not sure what the best way to achieve it is, but I would love for everyone to have the same coverage as those on Medicaid at a reasonable price. I think that the poor health of the country, cost of treatment and diagnosis, as well as the huge profits of the insurance and drug companies come into play with the costs of health insurance, and we need to address all of those aspects. We have amazing technology these days and can help people in ways that we couldn't in the past. Unfortunately, that is expensive and affects the costs to all.
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Post by iamkristinl16 on Aug 5, 2019 13:29:01 GMT
Since taxes were brought up, I might as well ask my questions here because I don’t know the answers and someone may. Hypothetically, premiums for Medicare for All will be on a sliding scale. Those whose incomes are greater pay more. Let’s say we also institute a wealth tax, value-added tax, and taxes on all sorts of other things, and increase payroll taxes to raise the revenues needed to support this. Let’s take a true single-payer plan like Bernie Sanders’ M4A. It’s estimated it will cost $28T for the next nine years WITH the assumption that healthcare providers will accept steep cuts in payments (and that’s a huge assumption). If providers refuse to accept steep cuts, the estimate goes up to $32T. So, that’s approx $3T to $3.5T we will have to raise in revenue each year in order for this not to be added to debt. In 2018, we raised $3.3T in revenue and that’s to fund the entire federal spending, 15% of which is Medicare. In Bernie’s plan and other M4A plans, all payroll taxes will increase, and some are making the assumption that the 2017 tax cuts will be repealed. The middle class will pay more in taxes and the top 1% and 5%, theoretically, will pay much more, upwards to a 70% tax rate. Even if we combine all of the revenue from all the tax increases, does anyone know if we can raise another $2.5T (85%) each year? Has anyone seen a plan that covers 100% of the costs of M4A? I’ve been reading about M4A for close to a year now and I’ve never found the answer. Because the financing of this plan, I believe, is the most important facet because this country is already drowning in federal debt. In delving into Bernie’s plan for financing, all his proposed tax increases will only finance 50% of his plan. Where will we get the other 50%? So those are my two questions: (1) Can we realistically raise an additional $2.5 trillion revenue per year; and (2) If we enact Bernie’s plan, where do we get the 50% shortfall in revenue? If anyone has the answers, I would appreciate it. How much is spent on healthcare premiums currently?
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lindas
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Post by lindas on Aug 5, 2019 13:29:25 GMT
So those are my two questions: (1) Can we realistically raise an additional $2.5 trillion revenue per year; and (2) If we enact Bernie’s plan, where do we get the 50% shortfall in revenue? If anyone has the answers, I would appreciate it.
(1) No, we can't realistically raise that much each year just by increasing taxes and (2) the debt ceiling would have to be raised every year. This doesn't even take into account the $1.6 billion in outstanding student debt that he wants to eliminate and the cost of free college he wants to institute.
Before we we start talking about giving out more free stuff maybe Cummings and his oversight committee should start looking into the waste, fraud and abuse that's already occurring in the federal government.
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lizacreates
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Post by lizacreates on Aug 5, 2019 14:18:57 GMT
Darcy Collins That’s what I was afraid of. It’s not that I’m against the philosophy behind M4A. It’s that in order to make this happen, an enormous amount of tax will have to be collected. Just speaking as an individual who was a business owner and now retired, if the gov’t had told me then that I’d have to triple payroll tax contributions, I would have had to downsize greatly to absorb that additional cost. iamkristinl16 For premiums alone? I don’t know. What I do know is TOTAL healthcare spending. What percentage of that was spent on premiums, I can’t tell you. lindas I’m doubtful as well because every analysis I’ve read cannot account for the shortfall (granted I have obviously not read every single one, but I’ve read plenty). Unless we, as a whole, are prepared to finance half of M4A with debt, I’m having a difficult time supporting it.
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