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The 47% have no idea how much healthcare reform will cost them

8:30 am by | 99 Comments

It may be unpopular to say so, but it is true: the U.S. is very close to, if not past, the tipping point at which the majority of the people are net beneficiaries of big government — or so they think. People who receive a check from the government may see voting for a smaller government as contrary to their best interest. If they don’t pay taxes, why should they care about a tax increase?

Perceptions are, however, deceiving.”Healthcare reform,” as the (Un)Affordable Care Act (ObamaCare) is billed, probably shows more clearly than anything else how most Americans, including Romney’s notorious 47%, are harmed by government “benefits.”

Lower wage earners, who produce real goods or provide a service their fellow Americans value, pay for those benefits even if they’re not liable for federal income tax. Fifteen percent is taken right off the top of their earnings for the Social Security/Medicare tax. This is 100% a tax, and 0% an investment. It is 100% spent, immediately, on other people’s entitlements, with a politician’s promise that the workers may get an entitlement someday, paid for by future workers — if they and the program survive long enough.

All Americans, including the working poor, will, as early as 2013, be hit with the medical device tax and the rest of some 18 ObamaCare-related tax hikes amounting to perhaps $500 billion. Starting in 2014 is the ObamaTax proper, the individual and employer mandate. Most Americans will have a choice of one tax (a “penalty”) or else a much higher tax equivalent (a “premium”) for an ObamaCare compliant health plan. Even if the employer continues to offer insurance, the employee has to earn all the money that the employer uses to pay for it. The premium has to cover all the ObamaCare mandates that the worker may not need or want, or to which he objects.

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All Americans also have to pay the hidden regulatory taxes. ObamaCare will have tens of thousands of pages of rules. Compliance will be so costly that most independent physicians may close their doors.

Beyond tax increases, expensive employer mandates, or simple uncertainty about what the rules will be, will cost untold numbers of jobs. As more people are forced onto Medicaid, access to care will worsen. Obama’s “accountable care organizations” will incentivize “providers” to cut services to Medicare beneficiaries. So even the current beneficiaries of entitlement programs, a big chunk of the 47%, will be harmed by ObamaCare.

So who are the true beneficiaries of big government, who should most dread the budget hawks and vote to maintain the current regime? They are members of the affluent, privileged class, many of whom live inside the Beltway. They make more than $100,000 per year, and of course they pay income taxes. Or so it seems.

Actually, the money that goes back to the Treasury from their paychecks came from the Treasury in the first place — that is, from the earnings of those who toil in the private sector. If taxes go up, those whose money comes from government, whether directly or indirectly, might or might not have fewer dollars to take home, but while they may gain less from taxpayers, they still lose nothing of their own creation.

Republicans need to explain why they will repeal ObamaCare. Besides lower taxes for almost everyone, even those who don’t pay federal income taxes, more people would be able to keep their current insurance, their doctor — and their job.

Some people are government dependents because of misfortunes beyond their control. But to have 47% of the population in such a situation is a disaster for everyone except for the 0.0001% super-elite who aim for absolute control.

We need politicians who can help people gain the ability and desire to work, rather than cling to an overburdened government wagon pulled by declining numbers of the “rich.” Healthcare reform is an ideal opportunity to educate people about the dangers of that wagon.

Once they understand the situation, most Americans, not just 53%, should be on the side of limited government.

Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Jane Orient MD

By Jane Orient MD

Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine.
Visit website | More posts by Author

98 comments
PeterKafin
PeterKafin

"The premium has to cover all the ObamaCare mandates that the worker may not need or want, or to which he objects."


That's more or less the definition of insurance.  It's not specific to the ACA.   For example, I am highly unlikely to need treatment for breast cancer for I am a man.  Never the less, my insurance premium (pre ACA)  pays for other people to have that care.  I may "object" to all kinds of care that people receive, yet, my premium pays for it.

Incidentally, trying to rename it the "unaffordable act" denotes the emotional maturity of a fifth grader.  The American health care system (insurance and all) is already a mess about which everybody has been complaining.  The ACA was designed to address many of those complaints.

dumbledore04
dumbledore04

Another illiterate and innumerate physician for ignorance as the basis for public policy.

 

Virtually every physician practicing in the United States has disproportionately benefited from government subsidies to medical education, hospital construction and medical and pharmaceutical research.

 

They all benefit from a legal system that delays settlement of even the most egregious malpractice cases for so long that many of the victims die before their cases are settled and they, or their families, are justly compensated.

 

When physicians are willing to pay their own way we might be concerned.

bikerdogred1
bikerdogred1

And another 47% don't care because they are not paying for it.

kentucky thunder
kentucky thunder

The idea that thyere are millions of uninsured Americans may be accurate. But the statement that they are without healthcare is an out and out lie. Every single ER that I have been into has a sign posted somewhere (and frequently inside the front door of the hospital as well) that basically states that no one will be denied medical treatment due to an inability to pay. This is a FEDERAL LAW, and has been for decades. The costs are supposed to be forwarded and billed to the Feds. However, the feds got far behind the eight ball, and once Obama came in, ceased to reimburse the states altogether, thus leaving the hospitals on the hook for almost a TRILLION dollars of debt on their own. They had no money, but still couldn't turn any one away. That is why one of the first phrases in English an illegal learns is "I want to see a doctor." The moment that phrase is uttered in an ER, it's over. They MUST be treated. ERs in Southern California have closed at an alarming rate because they can no longer support the expense. At a hospital in LA where my wife worked for 16 years, her department in a sub-field of cardiology turned a large profit. It was what kept the hospital open because the ER bleed would have otherwise killed the whole facility!

Ooops. The real world calls. Later....

InsAgent
InsAgent

mwbright-just love how you keep promoting the cost of h/c in Singapore.  Such a good example to follow.  Americans have always valued their freedoms and interference from Gov't.   Singapore is such a free society to live in and admire.  For example, the Rattan Cane is a legally sanctioned form of punishment and is often employed for over 30 types of offence, such as robbery, breaking and entering, assault, rape, living off the earnings of prostitution, vandalism etc.

Like many countries in the region, penalties for drug use, possession or trafficking are very severe indeed. Singapore does have the death sentence and it is used for narcotics offences.

Driving while drunk could get you 10 years in prison!  Homosexual acts may lead to imprisonment. Kissing between men, for example, is illegal.  There are very strict laws in place that keep Singapore the squeaky clean place it is. The following are prohibited... Smoking in public, chewing gum, spitting in public, littering, jaywalking. Failure to observe these laws will result in stiff fines.  The fine for forgetting to flush the toilet in a public convenience is S$500.

If you have a balcony or garden, be aware that if you have flower pots, or anywhere that collects water and mosquito larvae subsequently breed, you risk being fined as a result.

I would guess that you have never worked in either the H/Care field or insurance for that matter.  I have worked in both industries and I can tell you from experience that ALL of your thoughts are flawed.  The ACA will do nothing to improve H/Care or lower the cost of coverage.  Why are the insurance companies raising the rates now you ask.....to prepare for all the freebies and mandates that start 1-1-14.  OH, you thought they would wait until the 2014 to prepare for the additional expense......Tells me you've never run a business either.  A single payor system like you endorse and so champion from other countries has to limit care.  Again a difficult business concept for you to understand since you have never run a business or met a payroll.  Like so many libs, you are clueless and have no idea what you are promoting.  I just wish I could be there the day the "Single" payor tells you that the cancer treatment you or a family member needs is not available.  Sorry, we've already maxed out on those services this year and no funds available.  Happy Trails Db/As.

Mason Cobb
Mason Cobb

1st time on this website.  Is most of what you publish mindless, p[artisan rants like this?  I'd rather spend my compressed time reading something intelligent, instead.  Well, g'bye...

L. M. Cobb, MD, FACS

ChadPen
ChadPen

The nation is about to look like Detroit.. Just watch

Infoman
Infoman

Great article! So true. We just received our health care insurance renewal rate info and the rate is going up 33%!!! Unbelievable!! Mr. President and those knuckelhead Dems promised O'bamacare would reduce the copt of heal;th care. What a bunch of bull!! But whats really frustrating is the way the media just went along with it and cheerleads for this administration. Wake up America! You have been fleeced!!

guest111222
guest111222

I stopped reading at the point this idiot said the 47% "don't pay taxes".

 

Just another mouthbreather brainwashed by KKKarl and his buddies.

 

Here's a hint:  Payroll taxes, sales tax, gasoline tax, and all the rest are TAXES.

oldfishergeek
oldfishergeek

Ultimately, Dr. Jane, the government take over of health care is not in your best interest, because after the "low hanging" fruit of single payer, big  pharma, and best practices are picked, the direction will turn to the fact that many Dr.'s are make way too much.  

Heywoodwest
Heywoodwest

Where I live we have the choice of one healthcare provider. Needless to say the policies on offer are not competitive either on price or coverage. Virtually any change to the system will help me to get healthcare that I can afford and that will cover me and my family.

The US has the highest health spending in the world - equivalent to 17.9% of its gross domestic product (GDP), or $7,960 per person (source OECD 2009), yet millions of people are not covered due to cost or pre-existing conditions. Just about every other developed country provides universal healthcare. As a result the World Health Organisation rates the USA as 38th in terms of effectiveness of it's healthcare behind Costa Rica and Chile and just ahead of Slovenia, Cuba and Brunei for goodness sakes!

Don't expect Obamacare to be perfect - it won't be. It's the first step to create an effective healthcare system, something other developed countries take for granted.

RichCharles
RichCharles

The costs on corporations for "obamacare"will be simple "Economics 101",pass the extra costs on to the price of that which you manufacture or sell in your place of business,as Denny's did in Florida.5% tax added to the dining bill.People are so stupid,they won't see it!!

nurse1986
nurse1986

Unfactual on so many levels that I can't begin to address them all....this is the type of misinformation that is fueling all of the lies.

MaryAnnKish
MaryAnnKish

You will be paying for a service and getting in line with those who pay nothing.............illegals included.

 

Hope you are not bleeding!

SarahAQ
SarahAQ

I hope the government runs health care as well as they do the post office. No lines. Financially solvent. No need for bailouts. No competition doing it any better.

Baldeman
Baldeman

There are 45 million American citizens that do not have health insurance.  Obamacare provides insurance to them but someone has to pay for it.  This article reminds us that the private sector WILL fund this cost.   It will come from our paychecks and reductions in our own heath CARE services.  The health insurance system and the health care system needs a serious re-structure - Obamacare does not do that.  

Sadlly Wiser
Sadlly Wiser

 @bikerdogred1 Actually, one of the points of the article is that the 47% who don't pay income taxes do help pay for it, both directly--through medicare taxes on low income wage earners (who do still qualify for certain entitlements), and indirectly--through lost jobs due to layoffs, and the increased cost of virtually everything due to regulatory taxes. To quote the above article, "So even the current beneficiaries of entitlement programs, a big chunk of the 47%, will be harmed by ObamaCare."

PeterKafin
PeterKafin

@kentucky thunder So what you are saying is that the ACA is greatly needed and welcomed.  Because, if I'm reading you correctly, providing catch all care from the emergency room to those lowest on the income ladder is the most expensive (and probably the stupidest) way to manage care.

JeanOcelot
JeanOcelot

@kentucky thunder

So if someone is mostly asymptomatic and is only showing the possibility of one of the 7 warning signs of cancer, he can get that "treated" at an emergency room?

dumbledore04
dumbledore04

"A single payor system like you endorse and so champion from other countries has to limit care."

 

You aren't seriously asserting that a private insurer can offer its policyholders unlimited care are you?

 

When your private insurer exhausts the loss cost component of its premiums and its surplus, it declares bankruptcy, and long before that happens it is limiting claims payments as best it can.

 

Resource scarcity affects both public and private insurers - not just public insurers.

GRE1
GRE1

@InsAgent Sounds like your idea of freedom is to be able to do illegial things...hm....

ChrisMarks1
ChrisMarks1

Case and point?  Yours was probably the most mindless comment of all...

dumbledore04
dumbledore04

 @ChadPen About to look like Detroit? Where were you when Bush left office in January, 2009 and the entire country was just like Detroit?

dumbledore04
dumbledore04

 @Infoman and you thought that your health care costs were going down after the devaluation of the dollar due to 8 years of W borrowing tens of trillions ?

 

Be real! Republicans led us into this morass and it will be decades before we recover from GWB and innumerate tea party republicans

BTeboe
BTeboe

 @Infoman Yes and we were supposed to be able to keep our doctor, and it was not a tax.  Whoever picked the name 'Affordable Care Act" deserves an award for satire.  I predict this utterly stupid plan is going to self implode.

Bulldog
Bulldog

We are talking federal income tax which a big part of the 47% get 100% back plus some due to earned income credit etc  Payroll or income tax has tunred into another forma of welfare   its sukcs...when you fiel your income tax every year when you get to 0 owed your done not federal governemnt pays you moer than what you put in   Learn about taxes and how it wokrs before you write anything

Ozzie14
Ozzie14

 @guest111222

 Read it again, she saId 47% don't pay Federal Income Tax!  OF course they pay other taxes.  Name calling, the first line of defense for libs.

Jack
Jack

 @guest111222 Why do you assume that people on government programs, should possess a auto anyhow + we are paying for their gas, when it is painful for me to fill my own tank with money & spent time "working" for & if they are paying payroll taxes, why do they get a government check.   Also where do I sign up for this one, anyone of them

ChrisMarks1
ChrisMarks1

 @guest111222 Oh fine, pretend the "idiot" said 'don't pay income taxes."  Then you can keep reading the article.

BTeboe
BTeboe

 @Heywoodwest No I completely disagree with your comment that at least we're getting closer to real healthcare.  Obamacare has nothing to with health or affordability.  The guy who named it the "Affordable Care Act" deserves an award for satire.  The only way we're going to get real healthcare in this country is to let the free market do it's job.  Hospitals need to post the prices as well as doctors.  People should be able to shop around. 

I'll give you a good personal and up close glimpse into our new health care system.  My mother who is 82 yrs old, and who lives in small town America is now on the hunt for a new doctor who will take Medicare.  Her old doctor decided that he didn't make enough money off of Medicare so he pretty much quit.  On her quest for a new doctor she was sent for blood work and other routine tests.  Medicare refused to pay the bills (which by the way were over $200 a piece).  Because my mom is also eligible for Tricare and because Medicare disapproved the test as being "not medically necessary" they refused to pay as did Tricare.  So guess how the deficit is going to be made up?  Out of my mother's pocket.  Still no doctor and $400 poorer.

That thing with Sara Palin and the 'death panels' well they are real.  Here's what I heard about a doctor, a neurosurgeon, had to say after returning from a conference in DC.  Patients are not referred to as patients, they are referred to as "units".  That little word right there makes me crazy.  Anyway, if you're older than 70 and you have an aneurysm or other type of brain bleed you will be given 'comfort care'.  Nothing more, nothing less.  No surgery for you because you're too old and you're life expectancy is not enough to warrant an expensive surgery.  So basically unless you want to pay out of pocket for the life saving procedure, you're going to die.

I don't know about you but I am not an automaton where I can be repaired by taking parts of the shelf, nor do I believe that after 70 you should be fed to the wolves.  I predict by the time they try to get this "TAX" worked out Obamacare will have self imploded.  Just wait until the full force of the law kicks in and then write and tell me how wonderful the care is.  We ain't seen nothing yet.

SarahAQ
SarahAQ

 @Heywoodwest

 There are a multitude of ways that the healthcare system can be reformed without a government take over, and at least half of them would cut healthcare costs signficantly.  NObama chose the one that would advance him most politically, not the one that was in the best interests of the entire US population.

Jemmy
Jemmy

@Heywoodwest ...sorry, you are wrong about Ocare....my physician told me I would no longer be able to receive the current tx I am getting and would have to get the old tx, more dangerous of the two because of this heinous interference into our private care!!

Really123
Really123

@nurse1986 This is a cop out. What are the facts that you know?

Jemmy
Jemmy

@SarahAQ ..the Post Office has been in deep water for many, many years! Why do you think they are contemplating no Saturday delivery and possibly fewer week days? Additionally, the inpact of the internet has diminished the amount of paper being used for letters, etc. How many e-mail cards have you gotten this year? We got about 1/5 of the Christmas cards we normally get......logistics!!

BTeboe
BTeboe

@This is called 'spreading the wealth' around. What we're actually doing is spreading the 'poor' around.

ChrisMarks1
ChrisMarks1

 @bikerdogred1 Oh absolutely, everyone is harmed by it.  Except those businesses that will grow to exploit the new regulatory requirements.  

dumbledore04
dumbledore04

 @JeanOcelot Of course the irrational and innumerate commentators here  want to fantasize about high quality care being available to aliens - but you are right on target.

 

The only care that ERs have to provide is stabilization and transfer. Most ERs do this inefficiently at best and usually the care in ERs is sub-standard.

 

But the bigger point, which they also ignore, is that the health care system has been morphing for decades and while Obamacare is not a panacea for our failing health care (finance) systems, no Obamacare wasn't a panacea either. Obamacare was a response to an already severely dysfunctional system - not the cause of the dysfunction.

.

What we need is an efficient health insurance system and managed care, capitation, the Medicare/Medicaid Prospective Payment Systems and the Diagnosis Related Groups systems are the antithesis of an efficient health insurance system.

 

The hands down most efficient health insurance program would be a single payer national health insurer. It would provide more care than any other health care finance mechanism though admittedly it would lead to none of the outrageous profits or huge executive compensation plans provided by our current system of hundreds of insurers, managed care organizations, HMOs and insurance risk assuming health care providers.

BTeboe
BTeboe

 @JeanOcelot  @kentucky thunder Come on man, that's really low to wish someone would lose their medical care and then be diagnosed with Cancer.  Let's try some civil debating.  Have you ever heard of thing called Karma.  We all have different views - and we should be able to say our views without hateful rhetoric.

ChrisMarks1
ChrisMarks1

@JeanOcelot @kentucky thunder Oh and hoping someone else gets cancer? Definitely makes you sound like a liberal.

ChrisMarks1
ChrisMarks1

@JeanOcelot @kentucky thunder Holy freaking crap!!! You want good health care? Go study hard, go get a job, and go work hard! You want free crap? Do nothing, the rest of us will pay for it, and you can say thank you! You don't get to be whiny about how your free health care isn't good enough!

ChrisMarks1
ChrisMarks1

 @dumbledore04  Bush borrowed tens of trillions?  You are quite confused.  The government added $3.5 trillion to the national debt in 8 years under GWB.  After 4 years of BHO, the debt has risen $7 trillion.  In other words, GWB added to the debt at about $438 billion per year.  BHO has been adding debt at $1.75 trillion per year or 4 times as fast.  

 

But, it's not actually the president that matters so much.  If you really want to see what's happening, things go bad when there is a democrat controlled congress, get better when there is a republican controlled congress and stay about the same when it is mixed. ObamaCare was the product of a democrat controlled congress (with such gems as "We have to pass the bill so that you can find out what is in it") and we are beginning to reap the fruit of this ill wind.

BTeboe
BTeboe

 @Ozzie14  @guest111222 I'm beginning to believe that.  Having to start off a conversation with a rude or vulger name is so not called for.  

dumbledore04
dumbledore04

 @BTeboe  @Heywoodwest 

 

Physician net revenues are declining in Medicare/Medicaid and EVERY third party insurer and managed care program across the board.

 

Obamacare doesn't impact physician revenues anywhere near as much as managed care, capitation, bundled payment systems and episode based care payment mechanisms.

 

Physicians are leaving medical practice because after 8 years of George W Bush their revenues sank while their costs rose dramatically.

 

They are also leaving because most of them aren't doing their jobs - Their patients get sick and remain sick because they fail to take proper care of them. For a couple of decades physicians ran printing presses - making money the old fashioned way - charging for unnecessary services and charging for services they never provided.

 

Now, faced with having to stop the printing presses and actually work and perform a lot of physicians are assuming they can make more money somewhere else - the problem is that most of them are unfit for productive work of any sort. and will eventually realize this.

 

There are just so many slots available for limiting access to care - eventually someone actually has to provide care.

ChrisMarks1
ChrisMarks1

 @Heywoodwest Yep.  What we really need is competition in the medical marketplace and that just doesn't exist.  In fact, your doctor can't even tell you how much a treatment will cost before you consent.  I understand costs will vary for surgery once you get in there, but the same is true for the auto body shop and they are somehow able to give you a quote.  Anyway, the whole competition thing started getting blown up when due to WWII wage controls, employers started offering health insurance as an employment benefit.  That began the cost disconnect between patient and provider.  Nothing will really get better until the disconnect is fixed.

JeanOcelot
JeanOcelot

 @Jemmy  @Heywoodwest During my last visit to the clinic, my physician told me the same kind of lie.  And that's what it is - a lie from certain physicians (like the author.)

JasonSlanec
JasonSlanec

LOL...seriously, Jemmy?  You didn't catch on to Sarah's sarcasm???

ChrisMarks1
ChrisMarks1

 @dumbledore04  @JeanOcelot Part of your analysis is correct.  We do need an efficient health care system.  However, the problem is that we are going in exactly the wrong direction.  Open market competition, free of excessive regulatory burden, is how you improve the efficiency of the health care system.  We already had too much government involvement and Obamacare adds many, many, many MORE regulations.  Not less.  And we are already seeing the decline of care.  In the last two months I have observed several smalls things that used to be covered by BS/BC and Tricare are no longer covered and the expense must now be born by the patient.  And that's WITH rising premiums and co-pays.

PeterKafin
PeterKafin

@ChrisMarks1 You've largely missed the point of what it means to embrace capitalism as the operating economic system for our nation.  Perhaps I can make it more clear for you.  If everybody studied hard, went and got the best job they could, and worked hard, we would still have millions of working poor in this country.

The lack of good well paying jobs is not due to a lack of qualified workers.  Capitalism ensures that many people will be working at minimum wage.  When working at minimum wage for 40+ hours a week (as millions do) doesn't lift a family above the poverty line, and the govt. provides help, it doesn't mean that people wand free stuff.  It means that the inequality of our nation is starting to cost all of us some extra cash.  In my mind, it is just more evidence that we are all in this together and we can help each other in sane measured ways (like the ACA) or we can continue to do it in dumb and expensive ways (like providing emergency room care at the public's expense).  But, there is no way to avoid paying for the care of others.  Welcome to civilization.

dumbledore04
dumbledore04

 @ChrisMarks1  @dumbledore04 Chris - Do not confuse current payments for incurred costs. Bush's "off-budget" costs for two wars run to the tens of trillions - just because they weren't paid during his presidency doesn't mean he did not incur the costs.

 

Blaming Obama for paying Bush's credit card bills is the height of economic illiteracy.

dumbledore04
dumbledore04

 @ChrisMarks1  

 

Your doctor can't tell you how much your treatment will cost before you consent?

 

What weird universe do you live in? Your doctor can tell you how much it will cost - what they may not be able to tell you is how much your insurer will pay or what your co-payment will be.

 

You need to stop confusing what doctors do to evade responsibility for their actions with law. There are no laws that say doctors cannot tell patients how much something will cost or what the doctor's costs are.

 

You are doing the typical republican thing of excusing poor behavior as though regulations forbid honesty - the same sort of rationalization BP tried to use when they tried to blame the federal government for the oil spill because the federal inspectors didn't shut down their drilling. BP took the cheap path - not the federal government.

 

Doctors refuse to tell patients how much their treatments costs because they don't want their patients to know the profits they are making.