r/Eugene • u/Denderian • 2d ago
Oregon's transition to Universal Healthcare: the first state?
/r/oregon/comments/1hstcnp/oregons_transition_to_universal_healthcare_the/21
u/TheRisingValkyrie 2d ago
Ill believe it when I see it to be honest.
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u/No-Split-866 2d ago
Pepole really don't understand it. I'm all for it but if you don't have insurance now. When you do, you will be forced to pay for it. Under Obama care as they call it. It was written into the tax code. I split mine with my employer it's 2k a month. I'm hoping it goes down, not up. In a universal system.
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u/TheRisingValkyrie 2d ago
Universal health care is a tax increase. We already pay the same if not more in taxes than countries that already have universal health care without factoring in our medical expenses and cost for plans. I currently don't have insurance because it's gotten so out of hand.
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u/throwawaypickle777 2d ago
Well my insurance is $376 every 2 weeks all year. That’s $9776 for my share of it which is 25% of the premium. So my employer pays just south of $40K. So would that be worse If it was a “tax”? Money is money? Because as it stands I have to pay 10% of my income to ask some dimwits in an office who have no medical degrees if I can please have my prescription every 3 months.
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u/TheRisingValkyrie 2d ago
I am uninsured because it'd cost me $1200/mo to be on insurance as someone with chronic illness and disability. The tax will not be nearly as high as deductibles, medical expenses, and your share...and I would hope less corrupt companies would consider putting that 40K back into their staff if they no longer need to pay that.
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u/OOkami89 2d ago
You think that the government is suddenly going to do right by it’s people?
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u/TheRisingValkyrie 2d ago
Oh hell no are you kidding?
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u/OOkami89 2d ago
Then we can know for certain that this would fail many people
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u/No-Split-866 2d ago
I just googled it, but the bottom 50% earners are paying 2.3 % of the federal budget. If it's accurate.
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u/No-Split-866 2d ago
We pay less in federal taxes than most all Western countries with universal health care. But We are talking on a state level, i guess, so I'm all in. I've always thought if we could take the cost out of it. Like malpractice lawsuits. Would you go to a learning clinic. Something similar to a beauty college.
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u/vaeleborne 2d ago
Pretty much every iteration the amount in tax is well under the amount you pay through employer and much more so when buying outright.
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u/No-Split-866 2d ago
I'm not sure what you're saying. But I do know my work group of about 300 hundred are lumped into a group. The more we use it, the more it goes up. Cancer pregnancy, anything long-term will affect our cost. We've had healthy good years, and it didn't go down. It's totally fucked.
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u/vaeleborne 2d ago
I’m just saying a universal healthcare system costs less money generally than that of health insurance offered by employers or bought elsewhere. In other words universal healthcare system = good on your wallet as well
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u/No-Split-866 2d ago
Gotcha the Middle man. Have you seen the Pacific Source office in springfield. If you could cut that fat out. We would lose several jobs. But perhaps we could obtain more pcps.
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u/Van-garde 1d ago
Glad you brought that up:
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u/No-Split-866 1d ago
O ya, they are very transparent about it. So we feel guilt as individuals when we are sick or injured. Some more so than others. Then you have a couple that point out others.
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u/Van-garde 1d ago
If you combine your risk pool with others, it stabilizes the system.
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u/No-Split-866 1d ago
I can't remember the numbers, but the size of the work group does dictate options. Some smaller companies in Lane are self insured seems to be the way for a smaller work group to go. My Dad's company had its own doctors office on campus. Pcp type stuff was handled at work.
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u/Van-garde 1d ago
Dad’s company meaning he was the owner, or he worked there?
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u/No-Split-866 1d ago
Union employe. 3 k employees give or take at the time. I like your wiki link. This is what people don't understand. With the federal health care act aka Obama Care, we needed the healthy population to buy in. I've actually never even needed my insurance fingers crossed 🤞. My wife would be dead without ins.
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u/No-Split-866 1d ago
Health insurance conversations never go well in this sub. It seems full of low iq ideas. Like free health care and doctors everywhere would fix it. Oregon just sucks in this category plain and simple. The best thing we have going is OHSU.
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u/505ismagic 2d ago
A quick read of the 2022 legislative study will illustrate how implausible this is. (Link on the OPS website)
It assumes many waivers, consents and adjustments from Medicare, medicaid, aca etc to keep federal funds flowing at the same rates for current enrollees, and additional funding for newly covered folks.
It assumes essentially all practicioners will accept a single payment schedule and billing criteria set by the state. While aggregate compensation is nearly the same, individual practices will be higher and lower. I'm sure the losers will be fine transferring some of their current income to others.
It assumes that eliminating co pays and deductibles only increases usage by 2%.
Proposed funding is a 7.5 to 10.25% payroll tax and an 8.2% income tax. Boom times for McMansion builders in Clark County. These are high enough rates, when added to the current 9.9% rate to get a significant number of high income folks to start working remotely in WA and NV.
The state has to balance its budget every year. How does it adjust for a recession, and a drop in income and payroll taxes, or a bad flu year, and higher spending.?
The total spend in 2026 was forecast at $55billion. Millions of individual payments to providers. How on earth would it scale that kind of system? Anyone try and get unemployment straightened out during the pandemic?
Finally every dollar of that 55 billion currently goes to somebody. They will each figure out if they are better, or worse off under the proposal. Those who expect make less will descend on Salem with pitchforks and cash. The polite lobbyist version of "Plata o plomo"
It's an interesting thought experiment, but color me skeptical. (Not a fan of the current system. Unfortunately, reforms can't start from scratch, they have to start from here.)
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u/Van-garde 1d ago
Your argument appears to ‘boil down’ to, ‘the wealthiest are opposed, so it won’t work.’ Am I reading that right?
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u/505ismagic 1d ago
Not exactly. More like you are rearranging the flow of $55 billion annually. While total is similar to what we are spending now, there will winners and losers, and you should expect the losers to fight hard. If you don't have a politics plan for how you overcome those objections, I don't see how it happens.
Separately, I'm skeptical of the state's capacity to administer a program of this size effectively. The annual general fund budget is $16B. This is 3 times as large. With that much money flowing, they will need good fraud and abuse control, and resist special pleading from worthy causes that just want a little piece of $55B.
I'd point to homelessness and addiction as areas that we all agree are important and urgent, and where it's tough to find much evidence of an effective response.
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u/Ketaskooter 1d ago
Most countries with universal healthcare and I’m pretty sure all European countries have higher out of pocket costs than the USA right now. There’s no reason to expect out of pocket costs to go down with a change to universal healthcare.
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u/stinkyfootjr 2d ago
When Obama care first came out with the a public option at the state level some group, (I can’t remember who), had the numbers that said between Medicaid money the state gets and the money that public employees get for health care and a moderate tax on the rest we could have universal basic care but the public employees went ape shit because their level of insurance would drop.
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u/505ismagic 20h ago
It's really really tough.
I think any significant reform is federal. The feds already provide a majority of the funds, and the supremacy clause gives them much more room to maneuver.
Incremental is more realistic than global. US Healthcare is trillions of dollars every year, millions of jobs. About 1 in 5.5 dollars that move anywhere in the economy is paying for Healthcare. The critical problem is how do we decide how much to pay to who, and for what? The folks who developed, produced and distributed the covid vaccines saved millions of lives, and improved the day to day lives of billions of people. There has never been a virus vaccine developed as quickly at that scale. They should get paid a bunch. But how much is a bunch, and how does it get split amoung the scientists, the folks who put up the manufacturing capital, the folks who stirred the vats, and the national guard tech that gave me my shot at the fairgrounds is a fiendish problem.
If it were me, I'd start with supply. If a drug is approved by another country with a credible approval process, you can sell it here. Likewise, if you are a licensed MD in a developed country, you're welcome to immigrate and practice here. Revoke the veto rights hospitals have on competitor expansion. Let folks expand meidal school slots. Make it easier to produce and import generic, long established meds. If some slimeball is trying to sell insulin for $600, we should be able to source it from any other developed country.
Lots of rent seaking regulation in Healthcare. A dental hygienist can't just do cleanings unless they work for a dentist, which means the dentist gets a cut.
We should study seriously which Healthcare is most effective. My wife's life was saved by some very good, and shockingly expensive cancer treatment. Thank God for insurance. Three years of out of pocket max.
But the Oregon medicaid lottery experiment was not able to find any meaningful improvement in health outcomes for folks who received medicaid, compared to those who remained uninsured. They got more care, they felt better initially, probably due to less financial stress. To me, this suggests that much of our excess spending is not actually improving health. But identiting the waste with confidence, and then getting the system to stop paying is tough. In a political fight between providers and accountants, my money's on the providers.
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u/OOkami89 2d ago edited 2d ago
God I hope not. The government already can’t be trusted to be competent or benevolent.
Anyone on disability or ssi knows that the government is both incompetent and oppressive.
Edit: downvoting won’t change facts.
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u/pandit_the_bandit 2d ago
geezus NO. all i need to see is how awful OHP is. and Medicare. Let me decide for myself what insurance I want.
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u/Moon_Noodle 2d ago
OHP has been pretty great for my disabled partner, but go off lol
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u/OOkami89 2d ago
If your partner is disabled then they will know that the government is both incompetent and oppressive
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u/Moon_Noodle 2d ago
She gets to see a doctor, gets mental health care, and a much needed surgery she wouldn't otherwise get. I have a lot of issues with the government, but OHP isn't one of them.
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u/OOkami89 2d ago
OHP has one dentist in the city. It’s better then nothing but not by much.
Heck the government can’t even provide free healthcare for its own veterans.
It makes zero sense that any thinks a universal healthcare is going to be any better.
One of the veterans my stepdad worked with died around Christmas because the treatment that would have saved his life kept getting pushed back.
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u/GarmBlack 2d ago
Definitely need more doctors, though. Challenging to find one these days.