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ACA repeal wheels in motion vs The Twilight Zone and railroad switch yards.....
I have been home recovering from shoulder surgery, so I have not looked at this thread until today. I read fast and I am fairly knowledgeable, but this thread caused me to throw up my one good hand in frustration. Please, MFOers, don't try to argue using mainly links to other sources to make your points. Reading what I just did was akin to "Death by a Thousand Links." I do not mean to cast doubt on the usefulness of the sources provided, but I do mean to remind writers that the reader can't possibly click on multiple links in one post and expect his/her attention not to drift. Academic articles abandoned numerous footnotes for the reason that they distract from the delivery of the writer's message.The truly curious reader looks at the endnotes but first one wants to know the writer's original contribution. In the same way I want to know what each MFOer has to say, not what his/her sources have to say.
Between the NCAA basketball games I watched (all of them because I was in a lot of pain and could only usefully sit with my arm propped up) I surfed the cable news channels for views on the health-care crisis. Journalists spend a lot of time yakking! Best take-away for me of the whole mess was David Gergen's response to the CNN anchor's query about what Trump will have to do to turn things around. "He's going to have to start reading the stuff," Gergen gurgled. Given the reports that POTUS plays golf when not watching cable means that the learning curve will be very steep.
I understand the points, but I don't have anything to say on these issues as smart or informed as those I cite, and since I learn from others' posted links, usually more than from what they themselves say (except for msf, e.g.), I'm glad to have links, and was hoping (since I read a lot) to provide something along those lines too.
Can anyone point me to information on why the Rand Paul HC proposal doesn't get a look at? Or reasons why it doesn't seem to pass muster even within his own party? TIA
Can anyone point me to information on why the Rand Paul HC proposal doesn't get a look at? Or reasons why it doesn't seem to pass muster even within his own party? TIA
Well no, not me but I was wondering what you like about it and why it has more general appeal.
My own impression was that the Rand Paul $5000 HSA tax credit would be fine for those who had a spare $5000 handy to put into an HSA every year. I suspect that many of the lower-income people most in need of help with medical care wouldn't get much from that.
The following quote from a Motley Fool article pretty well comes to the same conclusion:
"The other big problem is there still isn't a definitive pathway to affordable health coverage for low- and middle-income individuals and families, at least based on this initial look at Paul's bill. Leveling the tax deductions between individuals and employers and creating a tax credit associated with HSAs are nice treats for those consumers who can afford their own health insurance, but they might not be a replacement for the millions of Americans who needed monthly premium subsidies to afford health coverage."
@Anna - actually I am woefully uneducated on this entire debate (read: disabled vet who is taken care of) but I am not ambivalent because my adult children are affected. I'm starting the learning process and Rand's proposal was tossed my way as a compromise between the hardcore's on both sides. Just trying to become informed.
I was about 52 when I first looked at HSAs. When I ran the numbers, it looked like they only work for young healthy people who can spend many years building up the balances to the point where a serious health problem could be covered. I decided someone 10 years from retirement shouldn't consider them if better fits to their age were available.
“What if 30 percent of the public had Health Savings Accounts?” said Paul. “What do you do when you use your own money? You call up doctors and ask the price"
"Hello, my foot is swollen and it really hurts- can you please tell me what you charge to take care of that??"
When I ran the numbers, it looked like they only work for young healthy people who can spend many years building up the balances to the point where a serious health problem could be covered. I decided someone 10 years from retirement shouldn't consider them if better fits to their age were available.
Anna, not sure what #s you are running, but a tax break on HSA money going in and no tax paid taking it out is the best "retirement" fund available to anyone. Better than an IRA, better than a Roth, better than a 401k. I'm building mine up to help defer health care costs in retirement and I'm 63 years old.
A huge improvement an HSA could have is being able to pay health care premiums with the money, at least for supplemental Medicare insurance. Not doable today. This seems like it should be a no-brainer in whatever HC system we end up with, but I never hear it mentioned.
@MikeM- If I'm reading Anna correctly, she seems to be extrapolating on my observation that an HSA is an advantage only under very limited conditions.
First, if you don't have a pretty decent income to start with, it seems unlikely that you are going to have the resources to even contribute to an HSA, or at least to contribute any meaningful amount. That's why the Rand Paul proposal is so totally cynical with respect to those in this country who, income-wise, don't have access to decent medical care in the first place.
Second, even if you do have a decent income, medical costs, especially for serious conditions, are so high that you would have to start while young and healthy (so as to not draw on the accumulation), and to contribute for many years in order to save enough to be useful in a catastrophic medical situation. Anna suggests that ten years is insufficient time to make this a useful retirement reserve, although, if coupled with Medicare after retirement it seems to me that it could make quite a difference, depending upon your ability to maximize the contribution.
Yeah, HSA in one's 60s or even 50s, with Medicare coming soon, seems an unpromising calculation.
All this libertarian blather centers on whether one thinks the richest country in the history of the world should offer healthcare to all without qualification (or without much). The sea change is happening: ... Senator Bill Cassidy, a Louisiana Republican: “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” Cassidy told the New York Times.
RP of course does not believe in this sort of thing. Freeeedom. He is hardly alone. Resentment of the perceived 'undeserving' has become this major, powerful driver of so much today. (Though not the undeserving rich.)
Joe, the math for putting money in an HSA works at any time, any age. There is no other savings vehicle that you can put pre-tax money in and take it out tax free (for health care costs only of course). Even if you spent each year what you put in, no yearly accumulation, it's still a great investment. That's like health care costs reduced 10, 15, 20% depending in your tax bracket. You have to pay the doctor bill anyway. Why not pay with tax free dollars?
I do understand lower income people may not have the resources to save in an HSA and that of course is the same reason they may not save in a 401k either. I have no answer for that one other than expanding medicare for all. I'm actually all for that idea.
Comments
In case you missed these high-level analyses today:
https://www.nytimes.com/2017/03/27/opinion/how-to-build-on-obamacare.html
(None of these tweaks will happen, almost certainly.)
also
http://www.vox.com/polyarchy/2017/3/24/15055636/aca-repeal-angry
Reach Across the Aisle, Mr. President For health-care reform to succeed, it requires buy-in and compromise from both parties.
MFOer has to say, not what his/her sources have to say.
Between the NCAA basketball games I watched (all of them because I was in a lot of pain and could only usefully sit with my arm propped up) I surfed the cable news channels for views on the health-care crisis. Journalists spend a lot of time yakking! Best take-away for me of the whole mess was David Gergen's response to the CNN anchor's query about what Trump will have to do to turn things around. "He's going to have to start reading the stuff," Gergen gurgled. Given the reports that POTUS plays golf when not watching cable means that the learning curve will be very steep.
The following quote from a Motley Fool article pretty well comes to the same conclusion:
"The other big problem is there still isn't a definitive pathway to affordable health coverage for low- and middle-income individuals and families, at least based on this initial look at Paul's bill. Leveling the tax deductions between individuals and employers and creating a tax credit associated with HSAs are nice treats for those consumers who can afford their own health insurance, but they might not be a replacement for the millions of Americans who needed monthly premium subsidies to afford health coverage."
Because it's draconian and unserious. Check it out:
https://www.washingtonpost.com/news/powerpost/wp/2017/02/15/freedom-caucus-ready-for-obamacare-replacement-that-expands-hcas-bans-abortion-funding/
Right. Sure thing.
A huge improvement an HSA could have is being able to pay health care premiums with the money, at least for supplemental Medicare insurance. Not doable today. This seems like it should be a no-brainer in whatever HC system we end up with, but I never hear it mentioned.
First, if you don't have a pretty decent income to start with, it seems unlikely that you are going to have the resources to even contribute to an HSA, or at least to contribute any meaningful amount. That's why the Rand Paul proposal is so totally cynical with respect to those in this country who, income-wise, don't have access to decent medical care in the first place.
Second, even if you do have a decent income, medical costs, especially for serious conditions, are so high that you would have to start while young and healthy (so as to not draw on the accumulation), and to contribute for many years in order to save enough to be useful in a catastrophic medical situation. Anna suggests that ten years is insufficient time to make this a useful retirement reserve, although, if coupled with Medicare after retirement it seems to me that it could make quite a difference, depending upon your ability to maximize the contribution.
All this libertarian blather centers on whether one thinks the richest country in the history of the world should offer healthcare to all without qualification (or without much). The sea change is happening:
... Senator Bill Cassidy, a Louisiana Republican: “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care,” Cassidy told the New York Times.
RP of course does not believe in this sort of thing. Freeeedom. He is hardly alone. Resentment of the perceived 'undeserving' has become this major, powerful driver of so much today. (Though not the undeserving rich.)
I do understand lower income people may not have the resources to save in an HSA and that of course is the same reason they may not save in a 401k either. I have no answer for that one other than expanding medicare for all. I'm actually all for that idea.