Vote once and never vote again

Oh Dickens do you currently have school age children? I could write all day about the things they come home saying...including the 50 odd genders they are taught at 8 years old and that only white people are racist..
As my 9 year old grandchild said " well, that's my childhood ruined....I can never unknow that now"

Thank you for this, everyone- most helpful.
Yes, I think that the employer contribution was the problem for my daughter when she and her husband were hoping to work in California. Her diabetes was the sticking point.

Wyllow3

Its a nightmare Siope !

It IS a nightmare to decipher and it would be rare to find a US citizen that understands it. They might have well written all of the rules in Sanskrit.

Chocolatelovinggran

Thank you Macadia for the update. That is good news for all America. How recent is this? I was in California just before lockdown.

I'm not sure how recent, Chocolatelovinggran. I would have to do some research. I think ACA began around 2010 but it had some bumps in roll out where they would fine people for not signing up for it. It is better now. (Some called it ObamaCare, but that is not the real name). Large corporations are also required to pay for insurance for their employees - at least part of the cost. In the end, it's the pharmaceutical companies and insurance companies who are the clear winners, as always.

Its a nightmare Siope !

I want to add something

Re Part A deductibles/excess costs. There are no limits to the number of benefit periods in a year. So if you were in hospital three times, for even two days each time, you’d pay close $5000 just for being there.

Part D is drug coverage. It’s not free either. And the premium is deducted directly from your state pension equivalent.

What Medicare Part D drug plans cover

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier

If there’s a generic drug, but your doctor says you should take a branded one, you have to pay for it yourself. If drug companies put up prices midway through an insurance period, your costs rise.

Costs for Medicare drug coverage

You'll make these payments throughout the year in a Medicare drug plan:

Premium
Yearly deductible
Copayments or coinsurance
Costs in the coverage gap

It’s impossible to say what these come to as they vary from person to person. The national base premium is around $35 a month, but premiums depend on income as well as other factors. The maximum in deductible is $545 a year. Co-pays are the killer, but once you and your insurance company combined have spent about $6000 on medication, your co-pay will only be 25%.

Anecdotally, my brother-n-law, a fit 80 year old, spends almost 50% of his income on Medicare and medication costs.

Well done if you got to the end of that lot!

I find it hard to believe anyone thinks it’s a good system, let alone better than any universal healthcare system, particularly for older people or those with chronic health conditions.

Medicare, continued

Part C

What is Medicare Part C?

Medicare Advantage Plans, sometimes called “Part C”, are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs.

Most include Medicare prescription drug coverage (Part D) (I will come back to part D)

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

The premiums, co-pays and deductibles vary by Plan. You must have Part B, and keep paying for it to be eligible for Part C.

Actually, when he became elderly (65) he was covered under their American old age health scheme. I believe he calls it Medicare - universal for old people and far less dear than his working (under 65) coverage

I’m eligible for Medicare. Let me tell anyone who cares how it works, and what it costs.

There are several ‘parts’.

Part A is ‘free’. It covers some inpatient care but only in hospitals that accept Medicare.

*Medicare-covered inpatient hospital services include*:

Semi-private rooms
Meals
General nursing
Drugs (including methadone to treat an opioid use disorder)
Other hospital services and supplies as part of your inpatient treatment

*Medicare doesn't cover*:

Private-duty nursing
A private room (unless medically necessary)
A television or phone in your room (if there's a separate charge for these items)
Personal care items (like razors or slipper socks)

*What you have to pay*:

You pay this in each benefit period:

Days 1–60: $1,632 deductible.(a deductible is the same as an excess on UK insurance)
Days 61–90: $408 each day.
Days 91 and beyond: $816 each day while using your 60 lifetime reserve days.
Each day after you use all of your lifetime reserve days: All costs.

It’s worth noting this:

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Part B - which is not free, it’s insurance and costs $174 per month, with a deductible (every time you use it) of $240.

Part B covers part of the cost of things like ambulances, equipment (from blood sugar tests to oxygen, from crutches to ambulances), and pays towards some medications. If you have an approved insulin pump, it means your insulin can’t cost more that $35 a month.

To be continued…

I think Trump wants to reverse the ACA. I don't think he knows what it's like to have a household budget and pay for medicines. Out of touch. Kamala gets it.

On ACA, I found this - not behind a wall, a long boring piece.

QUOTE, March 26, 2024: President Biden and Vice President Harris have a different vision, which they will lay out in North Carolina today. They believe that health care is a right, not a privilege, and that we must protect and strengthen the Affordable Care Act to continue lowering health care and prescription drug costs and expanding coverage to more Americans.

Under the President and Vice President’s leadership, more Americans have health insurance than ever before, with a record-breaking 21 million Americans signing up for ACA coverage this year—9 million more than when they took office. The President and Vice President have fought to protect and strengthen the ACA and Medicaid with critical health care protections, like free preventative care and guaranteed coverage regardless of health status or gender.

President Biden and Vice President Harris have also made health care under the ACA more affordable than ever, saving millions of Americans an average of $800 per year on health insurance premiums. And after decades of failed attempts, and without a single Republican vote in Congress, President Biden beat Big Pharma by passing the Inflation Reduction Act—which for the first time in history is giving Medicare the power to negotiate lower prescription drug costs, capping insulin at $35 per a month per prescription for seniors and people with disabilities, and capping out-of-pocket prescription drug costs for Medicare enrollees at $2,000 a year starting in 2025.

The President and Vice President are not done lowering health care costs and improving health care for the American people. They want to build on the progress they have made to further lower prescription drug costs and health insurance premiums; expand access to care, especially mental health care; and protect Americans from getting ripped off by corporations. While Republicans officials try to rip Americans’ health care away, President Biden and Vice President Harris are fighting to:

Lower Health Insurance Premiums Permanently. Make permanent the expanded premium tax credits that were last extended by the Inflation Reduction Act so millions of Americans do not see their net health insurance premiums spike by hundreds or thousands of dollars starting in 2026.
Close the Coverage Gap. Provide Medicaid-like coverage to people in the 10 states that have not adopted Medicaid expansion.
Keep Kids Covered. Provide States the option to avoid children losing coverage due to red tape from birth through age 6, and cut red tape for families on Medicaid.
Make Home Care More Available. Invest billions more in home care so the hundreds of thousands of older adults and individuals with disabilities on Medicaid home care waiting lists get the care they need in their homes.
Ensure Access to Mental Health Care. Increase access to mental health care by expanding coverage in Medicare and private insurance, applying the mental health parity requirements to Medicare beneficiaries, and extending Medicare incentive programs to address mental health provider shortages.
Prevent More Surprise Medical Bills. Protect consumers by applying surprise billing protections to ground ambulance providers so people do not have to worry about an unexpected bill for their ambulance ride.
Crack Down on Junk Facility Fees. Eliminate unwarranted “facility” fees on telemedicine and other outpatient health care services for consumers.
Let Medicare Negotiate Drug Prices for at least 50 Drugs Every Year. Expand the number of drugs Medicare can negotiate from 20 to at least 50 per year, cutting prices for major drugs that seniors rely on, like those used to treat heart disease, cancer, and diabetes. Alongside other reforms, this will reduce the deficit by an additional $200 billion over the next ten years.
Cap Out-of-Pocket Prescription Drug Costs for Everyone. Expand the $2,000 out-of-pocket prescription drug cap to people with private insurance so that all Americans have the peace of mind that comes with not being forced to choose between filling their prescription or putting food on the table.
Cap Medicare Cost-Sharing at $2 for Common Generic Drugs. Establish a new permanent Medicare benefit limiting monthly Medicare Part D cost-sharing for certain high-value generic drugs to $2, such as for those used to treat hypertension and high cholesterol.
Protect and Strengthen Medicare for Generations. The President will block Republican efforts to dismantle Medicare and instead will extend the life of the Medicare Trust Fund for generations by making the wealthy pay their fair share toward Medicare and dedicating savings from Medicare prescription drug reforms to the Hospital Insurance trust fund.

Macadia

^Re the US health care system : if your baby is born with a condition requiring ongoing support, s/he is uninsurable and the costs of any surgery, medication, or aids will be funded by you. I understand that many parents seek help from charities or churches in this situation.^

ChocolateLovingGran This is no longer true since the Affordable Care Act was put in place during the Obama era. The change was made so that any citizen with a pre-existing medical condition can be insured. Before that change, yes, people would die because they could not afford medical treatment. If they own no assets and their income is so low that they cannot afford to pay for insurance, the government pays for their insurance (or their baby's insurance) and all of the medical costs are free.

Obama ACA has been very successful in taking care of poor people's health. However, it seems the Republicans would like to repeal/lower the ACA and parts to Medicare (old people), Medicaid (poor and disabled).

Or so I read, I'll look in the Economist.

Macadia

^Re the US health care system : if your baby is born with a condition requiring ongoing support, s/he is uninsurable and the costs of any surgery, medication, or aids will be funded by you. I understand that many parents seek help from charities or churches in this situation.^

ChocolateLovingGran This is no longer true since the Affordable Care Act was put in place during the Obama era. The change was made so that any citizen with a pre-existing medical condition can be insured. Before that change, yes, people would die because they could not afford medical treatment. If they own no assets and their income is so low that they cannot afford to pay for insurance, the government pays for their insurance (or their baby's insurance) and all of the medical costs are free.

This is no longer true since the Affordable Care Act was put in place during the Obama era.

Isn't the ACA something that Trump wants to "improve" because he considers it too expensive?

He's said that he will make it better - but I can't find any proposals on how he would do this?

Thank you Macadia for the update. That is good news for all America. How recent is this? I was in California just before lockdown.

Re the US health care system : if your baby is born with a condition requiring ongoing support, s/he is uninsurable and the costs of any surgery, medication, or aids will be funded by you. I understand that many parents seek help from charities or churches in this situation.

ChocolateLovingGran This is no longer true since the Affordable Care Act was put in place during the Obama era. The change was made so that any citizen with a pre-existing medical condition can be insured. Before that change, yes, people would die because they could not afford medical treatment. If they own no assets and their income is so low that they cannot afford to pay for insurance, the government pays for their insurance (or their baby's insurance) and all of the medical costs are free.

HattieTopper by all accounts, he is grooming his family to continue in his place.

Dickens
There was a debate on GN between two posters some time ago now where one argued that her opinion, irrespective of any factual evidence, was as equally valid as any opinion based on identifiable data and facts.
The poster felt strongly about an issue, and would vote accordingly. And there are various bodies, think-tanks, groups, organisations, and populist 'priests' ready and waiting to engage or enrol such acolytes.
This worries me just as much as any idealistic or naive 16-year-old.

Totally agree Dickens. I spent many years in the company of 16 year olds and wouldn’t want to give them the vote, on the whole. But some are very astute, more perhaps than 60+ year olds.

Re the US health care system : if your baby is born with a condition requiring ongoing support, s/he is uninsurable and the costs of any surgery, medication, or aids will be funded by you. I understand that many parents seek help from charities or churches in this situation.
My fit and well thirty five year old would be unable to access health insurance ( and is potentially unemployable) in America, as she is an insulin dependent diabetic.
Deaths from diabetes are not uncommon there, I have been told, because the diabetic has insufficient funds to purchase insulin.
No, the NHS isn't perfect, but it keeps my hardworking daughter alive every day, and if my next grandchild was born with disabilities, then the one worry the parents wouldn't have is " who will pay for the operation/ drugs/ therapy needed?"

Norah

M0nica

Norah whatever your brother's experience, the American health system only delivers for those who stay employed for a large company that can afford the cost of health insurance. Had he been unfortunate to enough to lose his job, his experience would have been very different.

Health bills are the biggest reason for personal bankruptcy in the USA. Nearly 10% of the population cannot afford health insurance and many cannot afford adequate insurance. The biggest problem is in old age when people have retired and are no longer covered by employer based schemes.

Older couples have found themselves homeless and on the streets because of health based personal bankruptcy. There is a reason why American average life expectancy is 76, well below the UK at 81.

From your numbers, I assume 90% of the American people can afford health insurance. Though it matters not in the UK, as we have perfect health care.

Actually, when he became elderly (65) he was covered under their American old age health scheme. I believe he calls it Medicare - universal for old people and far less dear than his working (under 65) coverage.

He could be wrong, of course. Perhaps he misunderstood his pay packet.

M0nica, I've no need to defend my brothers pay packet or health insurance. I made a post noting he was quite glad of his monetary opportunities and glad to come home in the end.

I've never had timely tkr, nor has my husband, we both had private tkr (x2 each). I'm not sure the NHS is doing terribly well, but not a debate anyone who will pay instead of wait should enter.

Interesting links. I wonder how the NHS compares to Medicare?

Norah There are many articles availabe that describe the deficiencies of the US health system. Here is one of many www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/ It encapsulates everything all the ones I looked at said. The fact that life expectancy is so much lower than ours speaks for itself.

I also remember seeing a documentary about a British doctor who went to the US twice a year and worked for a charity that helped people who could not afford healthcaare. The queue snaked round this big sports hall and included people with canceer and other serious illnesses.

I am no defender of the NHS, my family have suffered some quite appalling treatment over the last few years, but no one I know has been ever refused treatment or had difficulties because they could not afford to pay for NHS treatment.

I suppose he means that if he is elected people won't be allowed to vote for anyone else ever again.

He is an old man and cannot live forever. What happens then.

Silly statement.

Dickens

Casdon

My brother lived and worked in America for a number of years flappergirl, and he said the biggest mistake we make in the UK is in expecting that because we share a language and some elements of culture, that average Americans think like we do. He said that in fact they are as different from us as people from any other country. Your post illustrates that well, and you're right.

My OH also worked in the States (Houston TX) for a while and spoke similarly.

He was quite 'aware' that he was, shall we say, surrounded by people with guns. Despite the fact that his native country, Sweden, ranks high in gun ownership rates (per capita). Crime rates associated with gun ownership are relatively low, and since I think around 2017, the gun-associated crime rates have not increased. But Sweden's gun laws are acutely strict. Most gun licenses are issued for hunting.

Interestingly, he learned that most Texans can now open-carry without a permit, and without any training. Conservative activists have, apparently, been lobbying for years for 'permitless carry'. What could possibly go wrong?

That's certainly one part of the US culture that we don't share - though IIRC, Nigel Farage some years ago now was calling for a lifting of the ban on civilians owning handguns.

We'd a holiday homes in the Southern USA for years. Guns are a part to their rights. It seemed we knew no one without guns. Makes no sense to me or my husband, nor does the amendment to their constitution.

M0nica

Norah whatever your brother's experience, the American health system only delivers for those who stay employed for a large company that can afford the cost of health insurance. Had he been unfortunate to enough to lose his job, his experience would have been very different.

Health bills are the biggest reason for personal bankruptcy in the USA. Nearly 10% of the population cannot afford health insurance and many cannot afford adequate insurance. The biggest problem is in old age when people have retired and are no longer covered by employer based schemes.

Older couples have found themselves homeless and on the streets because of health based personal bankruptcy. There is a reason why American average life expectancy is 76, well below the UK at 81.

From your numbers, I assume 90% of the American people can afford health insurance. Though it matters not in the UK, as we have perfect health care.

Actually, when he became elderly (65) he was covered under their American old age health scheme. I believe he calls it Medicare - universal for old people and far less dear than his working (under 65) coverage.

He could be wrong, of course. Perhaps he misunderstood his pay packet.

Casdon

My brother lived and worked in America for a number of years flappergirl, and he said the biggest mistake we make in the UK is in expecting that because we share a language and some elements of culture, that average Americans think like we do. He said that in fact they are as different from us as people from any other country. Your post illustrates that well, and you're right.

My OH also worked in the States (Houston TX) for a while and spoke similarly.

He was quite 'aware' that he was, shall we say, surrounded by people with guns. Despite the fact that his native country, Sweden, ranks high in gun ownership rates (per capita). Crime rates associated with gun ownership are relatively low, and since I think around 2017, the gun-associated crime rates have not increased. But Sweden's gun laws are acutely strict. Most gun licenses are issued for hunting.

Interestingly, he learned that most Texans can now open-carry without a permit, and without any training. Conservative activists have, apparently, been lobbying for years for 'permitless carry'. What could possibly go wrong?

That's certainly one part of the US culture that we don't share - though IIRC, Nigel Farage some years ago now was calling for a lifting of the ban on civilians owning handguns.

Norah whatever your brother's experience, the American health system only delivers for those who stay employed for a large company that can afford the cost of health insurance. Had he been unfortunate to enough to lose his job, his experience would have been very different.

Health bills are the biggest reason for personal bankruptcy in the USA. Nearly 10% of the population cannot afford health insurance and many cannot afford adequate insurance. The biggest problem is in old age when people have retired and are no longer covered by employer based schemes.

Older couples have found themselves homeless and on the streets because of health based personal bankruptcy. There is a reason why American average life expectancy is 76, well below the UK at 81.