Free or Universal Healthcare Versus Medicare & Medicaid

[Kirk W]

Because there is a thread in the forum RVing on a Budget that has wandered to become a discussion of healthcare, I thought that I would start a new thread on this forum to talk further about the subject. The idea of free or inexpensive access to healthcare probably is of importantce to most everyone here and certainly to those of us who live on any sort budget that is less than unlimited. Here is a little bit of information that I found. Free healthcare means everyone gets needed medical care and pays nothing with government paying the bill, from tax revenues. Universal healthcare means everyone has healthcare but it could be that each one must bjy health insurance with only the indigent healthcare actually free. I found the following article to be quite helpful.

Countries With Free or Universal Healthcare

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According to the STC report, all but 43 countries in the world offer free or universal healthcare. However, the standards among these countries can vary widely. 

Who is eligible for Medicare?

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Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

You are receiving retirement benefits from Social Security or the Railroad Retirement Board.

You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.

You or your spouse had Medicare-covered government employment.

Medicaid Eligibility

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To participate in Medicaid, federal law requires states to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups (PDF, 177.87 KB). States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible.  

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state (most states cover children to higher income levels), and states were given the option to extend eligibility to adults with income at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may choose to do so at any time. See if your state has expanded Medicaid coverage to low-income adults

 

[GlennWest]

In theory I see good in universal healthcare. But not government run healthcare. Our government ruined our social security. 

[pjstough]

3 hours ago, GlennWest said:

In theory I see good in universal healthcare. But not government run healthcare. Our government ruined our social security. 

Just curious, what do you believe our government has done to ruin social security?

[Kirk W]

4 hours ago, GlennWest said:

Our government ruined our social security. 

Let's not get political on this so please tread very lightly. We have now been drawing from SS for nearly 18 years and like most recipiants, I would love to get more but I also have done some math. I made a copy of my record from the SS website and came up with the following numbers. 

In 40 years of employement where I paid into SS I contributed of $50,595 and my employers contributed a like amount. Additionally I paid $11,431 into Medicare when working. I also pulled up the records from my digital financial records and the total amount of SS that will I have drawn out comes to $333,270 when I reach may anniversary date.  

The numbers are just facts, without editorial comment.

Edited August 22, 2022 by Kirk W

[GlennWest]

Don't know how you going to discuss this without being political. Only way this will happen is government mandate. 

[mptjelgin]

22 minutes ago, GlennWest said:

Don't know how you going to discuss this without being political. Only way this will happen is government mandate. 

I agree. This is 100% a political issue. 

[Kirk W]

2 hours ago, GlennWest said:

Only way this will happen is government mandate. 

No need to be political to discuss the different types of plan and how they would work. You are probably right, but we already have government involed and many of us are past the age of 65 and use Medicare. Is there a better way? I suspect that there is but I don't know what that might be. 

[GlennWest]

I don't trust our government. Now if the individual states could oversea it??? They would have to answer to the voting class. Easier to keep honest. 

[Kirk W]

9 minutes ago, GlennWest said:

Now if the individual states could oversea it???

The states do manage Medicaid and for that reason there are differences from state to state. I know that the feds do mandate some things about it, which is pretty typical of most anything that is funded by the federal government. The states also regulate the Part D plans that are privately run, the supplementals to Medicare and the Medicare Advantage plans but I am not sure just how much. Medicare by State   In addition, 17 states and the District of Columbia have their own healthcare exchanges to buy coverage prior to Medicare. Which States Run Their Own Health Insurance Exchanges?   I have always thought that state control was better, like you do but wonder if prices would be better, or higher due to smaller exchanges? As I understand it, you are permitted to buy health insurance outside of the exchanges but can't get a government subsidy if you do so, assuming that you would qualify for one. I was already on Medicare before the ACA was put in place in 2010 so am only familiar with the changes it made to Medicare, other than what I have read about the plans. The internet seems to be full of articles about the plan and the changes since it was first put into place. 

To me a lot of the problem is the complexity of the problem. Just figuring out what is best for us is a major chore. I think that I was spoiled in my working career as we always had healthcare coverage provided by my employers. 

[GlennWest]

We sure agree on the complexity of medicare. I don't have a supplement. Just a b c. Too confusing. And if universal healthcare does happen it will likely be Medicare for all. 

[2gypsies]

1 hour ago, GlennWest said:

We sure agree on the complexity of medicare. I don't have a supplement. Just a b c. Too confusing. And if universal healthcare does happen it will likely be Medicare for all. 

Whats a "b.c."?

We have a supplement.  We have never paid a co-pay or medical bill and we've have surgeries and cancer.  Would never do without a supplement.  Hospital bills run into many, many thousands.

Edited August 22, 2022 by 2gypsies

[GlennWest]

Sorry. That should be A B and D

 

Edited August 22, 2022 by GlennWest

[GlennWest]

I signed up for a supplement. Set it up for bank pay and they canceled me. I had make a payment initially too. I am not drawing SS yet so reckon they had a problem with that. Anyway that why. But I am very healthy and not real concerned.

Edited August 22, 2022 by GlennWest

[Twotoes]

I dated a woman who was born and raised in Russia and emigrated to America as an adult and became  US citizen.  I asked her about so called free health care. Her reply was that it was a joke. In her words, "You could not get an appointment for several months. By that time you were either dead or no longer sick. Even if you got in all the Dr did was percribe an Rx and nobody could afford to fill the perscription." She said salaries were half what they are in the US and the cost of goods was double.

[Kirk W]

4 hours ago, 2gypsies said:

We have a supplement.  We have never paid a co-pay or medical bill and we've have surgeries and cancer. 

We too have a supplement. You must have the plan N supplement. We have the plan G supplement that is the same except that we do pay the annual Medicare deductibl each year and then nothing more after that. The premiums for us dropped by about 130% of the amount of the deductible when we changed from N to G. Both are good plans but expensive. But my former employer supplies us with an HRA that wil cover all of the premiums for plan G suppliments makes it pretty easy. I realize that I am fortunate to have chosen a really good employer. 

[bigjim]

Are you guys having to pay income tax based on SS you are being paid now. I know I am on a portion of it based on tax schedule. I believe that some states that have income tax figure you SS payments in your state tax. It would be interesting to know how much I have paid in from money I have collected.

[Kirk W]

Jim, federal income tax is not applicable to SS until other income exceeds $25,000 and the amount taxable increases until income is $34,000 when 85% of SS is subject to income tax and the remaining 15% is never taxed. States vary on how they look at SS and since TX has no state income tax it doesn’t apply here. 

[bigjim]

Now that you quote it I recognize those numbers.  I do think it should not be taxable at all IMO  Of course it once wasn't federaly.

[Payroll Person]

SS when deducted is post tax. IOW, it is not excluded from tax calculations such as FWH. So some will say SS contributions were taxed when made, and in some cases, are taxed when benefits are received.

If it was done like a retirement plan, where contributions were pre tax, then benefits fully taxed (at likely a lower rate for many compared to their earning years), it may be more clean. As it is, SS ends up taxed twice for some.

Like anything, one must look at their own situation and try to get the best results for themselves. 

[RV_]

Social security started in 1939.

From the IRS "MYTHS AND MISINFORMATION ABOUT SOCIAL SECURITY - Part 2" :

"The taxation of Social Security began in 1984 following passage of a set of Amendments in 1983, which were signed into law by President Reagan in April 1983. These amendments passed the Congress in 1983 on an overwhelmingly bi-partisan vote.

The basic rule put in place was that up to 50% of Social Security benefits could be added to taxable income, if the taxpayer's total income exceeded certain thresholds.

The taxation of benefits was a proposal which came from the Greenspan Commission appointed by President Reagan and chaired by Alan Greenspan (who went on to later become the Chairman of the Federal Reserve).

The full text of the Greenspan Commission report is available on our website.

President's Reagan's signing statement for the 1983 Amendments can also be found on our website.

A detailed explanation of the provisions of the 1983 law is also available on the website."

Source: https://www.ssa.gov/history/InternetMyths2.html#:~:text=The taxation of Social Security began in 1984,Congress in 1983 on an overwhelmingly bi-partisan vote.

There is also a MYTHS AND MISINFORMATION ABOUT SOCIAL SECURITY (first part) here: https://www.ssa.gov/history/InternetMyths.html

[Dp26]

Thank you for the history.  It is always wise to look back.  However the benefits alter a recipient's taxation when received, just remember, at least at present, and since my first paycheck in the 70's, the contributions are taxed for all wage based taxes. Since the benefits may also be taxed on receipt, some amount is double taxed, one on contribution, and again the taxable portion of the benefit on receipt.  For those who calculate things such as if they can beat SS via private means, this must be factored.

Personally, I believe SS will never be allowed to fail.  If our basic way we elect and appoint leaders changes, it could change, but the odds of such a change are slim, and getting smaller each election cycle.

Many things changed during that administration. IIRC, it was the first administration (and repeated by all subsequent through Trump) to have altered FWH closer to the "edge" to make net pay appear higher. Candidly, the current basic calculations are causing some (those who trust the W4 defaults, which is no longer wise) to be under withheld, which was not the case ever before.

While I certainly have an opinion politically, I am comfortable limiting conversation to the results/ramifications since I have to deal with them no matter how they make me feel... Again, candidly, how current politics uses taxation issues ensures those in any field handling any form of taxation will have permanent lifetime employment/income. What I mean is there is no reason to anticipate any tax system getting simpler, and like repair of anything, fewer and fewer learn how to DIY.

[Jaydrvr]

While I am truly also annoyed by the concept of paying taxes on Social Security benefits after working and paying taxes for decades, the far worse offense to me, is that I still have to pay 17% taxes (self employment taxes plus Medicare) on any earned income,  even though I'm drawing Social Security. I paid into it, involuntarily, my entire life and now it's as though I'm required to pay my own paycheck. It never ends. Jay 

[Dp26]

For those who outlive the actuarial tables, it is a win.  For those who are at or a little below the tables, likely also a win.  For those who pass early, not so good.

My grandmother collected for just shy of 50 years.  A win.  My sibs and I collected for an average of 10 years when my father passed.  A win.

My non working spouse and disabled child will likely collect for many years (hopefully 50 or more for our child), another win.  We will max out our family amount for sure, and likely more, no matter the actuaries.

I plan on working until I can't, and not collecting until FRA, but my family past, present, and future, still a win.  While I am sure many beat the system via private, I have friends who will never recover from the last few market crashes, and wish they had taken more "wages" and maxed out their SS.

There are means to avoid SE tax on earnings beyond "reasonable" wages. Contact an above middling business attorney who is also an EA.  EA and JD after their name is worth paying for up front.  For instance, S Corp.  Owner/shareholders need to receive "reasonable" W2 wages, but any amount taken as a distribution is subject only to income tax.  The rub is making sure to meet reasonable wage rules, not short changing your SS contributions (hopefully max if able), and once you have a good history, lower wages (still at least "reasonable") and increase distributions. Once you no longer need wages, if able, you can work to meet the "inactive" participant, and take only distributions.

Again, seek expert advice, backed by good E&O insurance, as each situation is different.

[Ray,IN]

"Free healthcare" is a misnomer unless one has not, nor ever will pay taxes Universal healthcare has existed for the military, both active and retired for many decades.

[Kirk W]

It can be debated whether one could do better if the money contributed to SS were instead invested somewhere in a private fund but the main value of the SS system is that causes all of us to contribute to a retirement fund throughout our entire careers. Most of us do not get serious about such savings until much later and some folks never do. Also, it is a guaranteed return which we can't put into the wrong investment and loose it all or most of it, like private investments. For many people the SS checks are their only retirement income and for even more it is the majority of their retirement income. Defined pensions have pretty much ended for private industry to be replaced with "portable" funds via the 401k program. Like others, I doubt that we will seen the end of social security in my lifetime.