Healthcare Part II

[Kalbear]

Okay, I'll speak for myself.

You're an idiot if you think that it's impossible for the US to have universal health care. This is not because it is simple to do. It is because it has already been done in other countries that share similar governmental styles, similar problems both domestic and foreign, and similar cultural mores. And quite frankly, once anyone has done something it becomes much easier to copy the things that worked over there. The hardest thing is to do something new.

Note that 'much easier' does not mean 'easy'. It just means 'easier than it would have been'.

There are plenty of things that could derail UHC - and most of them are represented by Chataya and Swordfish - namely, that they simply don't want it. I can't argue against that point; UHC won't happen if people don't want it. Again, I thought that so pedantic as to not bring it up, but Swordfish, you're absolutely correct. If the people don't want something, there's a good chance it won't happen. Similarly, if a bill for UHC isn't presented, chances are it won't happen either. If you really believe that this is also equivalent to what I said or has any bearing on why I said what I did, I'm not sure that English is a good language for you.

Chataya inferred that UHC simply cannot work in the US for a variety of reasons. Those reasons have been completely shot down. Her sole bastion is that the current system is working well for her in the short term, and she does not want to change it because of that. And that's respectable, but that has nothing to do with a UHC program in the US actually working out well and meeting its goals.

[Swordfish]

Okay, I'll speak for myself.

You're an idiot if you think that it's impossible for the US to have universal health care. This is not because it is simple to do. It is because it has already been done in other countries that share similar governmental styles, similar problems both domestic and foreign, and similar cultural mores. And quite frankly, once anyone has done something it becomes much easier to copy the things that worked over there. The hardest thing is to do something new.

Note that 'much easier' does not mean 'easy'. It just means 'easier than it would have been'.

There are plenty of things that could derail UHC - and most of them are represented by Chataya and Swordfish - namely, that they simply don't want it. I can't argue against that point; UHC won't happen if people don't want it. Again, I thought that so pedantic as to not bring it up, but Swordfish, you're absolutely correct. If the people don't want something, there's a good chance it won't happen. Similarly, if a bill for UHC isn't presented, chances are it won't happen either. If you really believe that this is also equivalent to what I said or has any bearing on why I said what I did, I'm not sure that English is a good language for you.

Chataya inferred that UHC simply cannot work in the US for a variety of reasons. Those reasons have been completely shot down.

:lol:

All righty.

[TrackerNeil]

I prefer the Baucus plan over any that have been proposed thus far. It seems to expand access to coverage, keep the market private rather than introducing a public option, and seems to be reasonable in its cost projections.

I've been reading about the Baucus plan, and although I support a public option, this plan is a definite improvement over the current system. Unlike some liberals, I am not prepared to let the perfect become the enemy of the good, so if this plan is what can pass the Senate, I'm all for it.

BTW, go Kalbear!

[Annelise]

I've been reading about the Baucus plan, and although I support a public option, this plan is a definite improvement over the current system. Unlike some liberals, I am not prepared to let the perfect become the enemy of the good, so if this plan is what can pass the Senate, I'm all for it.

Appeaser! :P

I wonder what it will end up looking like. I saw Baucus made adjustments to tax and subsidies, but said it would still reduce the deficit. I wonder what else is in store.

[TrackerNeil]

Annelise - I get more grief on my reform position from liberals than from conservatives. I think some liberals have this idea that now that Barack Obama is in office he'll give them the moon and free ponies as well. They fail to understand the four syllables "fil-i-bust-er."

I would support a co-op system which would run without government support (self-funding), which would only be available to the self-employed and those currently without insurance; i.e., the Baucus plan. This is not seen by most people as "UHC", which generally involves strong government intervention into the US health care market - usually envisioned in some form of a public insurance plan.

These co-ops...if they're such a good thing, I have to wonder why there aren't more of them now. Also, I heard an expert on NPR saying that health insurance cooperatives are really difficult to start these days because of the massive amounts of money that must be held in reserve.

[TerraPrime]

TN:

I think you should always negotiate up and make the other side come to you. I think we're giving up on public option too soon.

Also, my own view is that health care is not going to be improved here without some cost control measures. Relegating health care to non-profit co-ops is not, imo, a solution. It does nothing to address the underlying causes of why we're here in the first place. It also does not address the issue of decoupling employment from access to health care. For these two reasons, I cannot but look at the Baucus plan as an appeasement compromise that does nothing but window-dressing. The middle-class families that are one medical catastrophy away from bankruptcy are still praying for good health and no accidents, and the people who're stuck in under-paying jobs for the sake of minimal medical coverage are still stagnating. If I sincerely think that the Baucus plan is a step in the right direction, even a small step, I'd be more enthusiastic about it.

Plus, I just don't trust anything from Baucus, who's the top recipient of insurance company dollars in campaign contributions (what was it at last count, 3 million?). It's like trying to buy a used car in Chicago from a guy who's last name is DiMaggio.

[Shryke]

But I'm worried that the author is missing something, because I can't imagine that no one else could notice such a paradigm-changing element.

You can't?

I don't even think the rest of the finance committee supports the Baucus Bill. Unless something drastically changed in the last 48 hours or so, I think you are talking the bill more seriously then your government is.

[Kalbear]

Some parts of this sound OK actually, but is this guy right that this is going to happen? And if he is, why is no one else talking about it?

That's one of the larger risks, and its one that I'm surprised Chats isn't up in arms about.

I do not feel that the reasons why UHC cannot work in the US have been "completely shot down". That is your opinion. I feel that you are basing your opinion on some biased studies.

I'm basing my opinion on the rest of the free world (and some third world countries too). There are plenty of very different systems out there; pick one that works for the US. I think Switzerland's system would be easiest: computerize and streamline all administration, force all companies to provide a very specific minimum amount of care with precisely the same values for those procedures, allow companies to make their money off any extra services, and provide for those who cannot get care. But there are many others. Taiwan's is a model of bureaucratic nirvana. Japan's has some of the best cost-cutting measures out there in their fixed pricing model. Germany has a number of advantages of Switzerland but provides a bit more (at a higher cost).

The biased studies are case studies of these various countries - all of whom have less per capita spending on healthcare than the US by at least 1/2. All of whom have better health metrics. All of whom cover 100% of their country's populace.

[The Progressive]

This (bold) is entirely untrue. Please see my previous post on the matter.

I do not feel that the reasons why UHC cannot work in the US have been "completely shot down". That is your opinion. I feel that you are basing your opinion on some biased studies.

I would support a co-op system which would run without government support (self-funding), which would only be available to the self-employed and those currently without insurance; i.e., the Baucus plan. This is not seen by most people as "UHC", which generally involves strong government intervention into the US health care market - usually envisioned in some form of a public insurance plan.

Why would you prevent working people from enrolling in this national co-op if they're unsatisfied with their current employer-provided plan?

In addition, the startup cost for any co-op is too staggering without initially government loan.

[Swordfish]

Because of Baucus' spot on the Senate Finance Committee, his bill is likely to be the best barometer of what the final result will be. That said, it looks like we're going to go through another month or so of negotiations, amendments, etc...before we have the final product that the President could sign.

Fortune has an article that is saying something I haven't heard anyone else say. Basically they are suggesting that the Baucus bill creates very strong incentive for large employers to drop health coverage, period. If this is true, the implications of this are enormous. But I'm worried that the author is missing something, because I can't imagine that no one else could notice such a paradigm-changing element. Everyone knows that most American with insurance get it through their employer. He suggests that the bill would, for example, take a large company which pays $500 million for health costs and take that down to $40 million. He suggests that this would drive those who lost their employer-based coverage into high-deductable catastrophic coverage plans (although hopefully with increased wages from their employer).

These are the kind of unintended (assuming they are) consequences a lot of us idiots are petrified about.

This in particular is something I've idiotically brought up before several times, although not exactly in these terms:

The big danger is that the middle class will suffer sticker shock and rebel. Congress will have no choice but to enact a highly subsidized public option resembling Medicare. That's the only way to restore generous plans to middle-class families at something approximating what they used to pay. Then America will be stuck with two subsidy systems, one for low earners, and the other for the middle class. At that point, all previous cost estimates get revised upwards, by factors of two, three or even more.

Once you create an environment where employers are incented into dropping group insurance, you're at the doorstep of single payer. there's simply no way around it.

And the burden for paying the tab will fall squarely on the shoulders of the middle class, as it always does.

[The Progressive]

These are the kind of unintended (assuming they are) consequences a lot of us idiots are petrified about.

This in particular is something I've idiotically brought up before several times, although not exactly in these terms:

Once you create an environment where employers are incented into dropping group insurance, you're at the doorstep of single payer. there's simply no way around it.

And the burden for paying the tab will fall squarely on the shoulders of the middle class, as it always does.

Oh noes, the sky is falling.

If the tax burden for public health insurance increased while corporate contribution decreased, then corporate tax could always be raised.

[Shryke]

Isn't the idea to create an insurance market for these people to be dumped on to if they get dropped from their employers plans?

Once you create an environment where employers are incented into dropping group insurance, you're at the doorstep of single payer. there's simply no way around it.

Sure there is. Look at the Swiss. Or a bunch of other European nations.

You don't need the government to directly insure these people, you just need to have the government set up a way for these people to buy their own insurance at an affordable rate.

[Guy Kilmore]

That's exactly it. I read the other 4 articles by this guy, and he seems to be a bit of an alarmist.

I DO NOT think that mass dumping of employees would occur, despite the small penalty, simply because employers want to attract and retain top talent. It's also the reason why employers offer 401(k) plans - they certainly aren't required to.

The penalty is there to dissuade the employers that otherwise have dumped employees in the past (Wal-Mart) onto state plans, when states have attempted to implement statewide-UHC, such as with Tenncare.

I don't think it's a risk for most employers.

I will also had that states like Minnesota, the Dakotas, Iowa, Wisconsin, Illinois and Massachusettes (I am sure I am missing some) also have close to statewide healthcare and have been able to avoid the whole dumping issue.

[Kalbear]

I DO NOT think that mass dumping of employees would occur, despite the small penalty, simply because employers want to attract and retain top talent. It's also the reason why employers offer 401(k) plans - they certainly aren't required to.

I thought there were substantial tax benefits to companies for 401k plans. Is that not correct?

[Swordfish]

That's exactly it. I read the other 4 articles by this guy, and he seems to be a bit of an alarmist.

I DO NOT think that mass dumping of employees would occur, despite the small penalty, simply because employers want to attract and retain top talent. It's also the reason why employers offer 401(k) plans - they certainly aren't required to.

The penalty is there to dissuade the employers that otherwise have dumped employees in the past (Wal-Mart) onto state plans, when states have attempted to implement statewide-UHC, such as with Tenncare.

I don't think it's a risk for most employers.

Probably true when talking strictly about 'dumping'.

I don't doubt that it probably wouldn't happen all at once.

however, a good example of how this creep would occur is already playing out with defined benefit plans. My company has phased them out for new employees.

When the labor pool is large, as it is today, then the employers need not go above and beyond for new employees. Factor in also that new employees are many times in the exact demographic that doesn't really care that much about insurance, and i could easily see things going that direction.

[Shryke]

You could probably also funnel the money from the penalty directly into some sort of Health Insurance program for those dumped. Essentially forcing the company to pay the employees premiums anyway.

[Swordfish]

There are also substantial tax benefits to companies providing health insurance. It is a deductible cost, much as the employer contribution to the 401(k) is deductible by the company.

Guy - please; there is a North Dakota and a South Dakota. There is no "the Dakotas". :)

Swordfish - Defined Benefit retirement plans were phased out in the 1980's - employers didn't realize in the beginning how horribly expensive they were...especially with employees living longer. I don't think it is analagous to compare health insurance with DBPP. It's more analagous to compare health insurance with a 401(k).

True, i don't think it's particularly analagous now. but if you remove the tax benefit, and throw a couple hundred million at the bottom line, AND you provide a public option, however inefficient.......

I could easily see companies saying F it......

[Guy Kilmore]

Guy - please; there is a North Dakota and a South Dakota. There is no "the Dakotas". :)

My apologies, I have no excuse, for I do know better. :leaving:

[Swordfish]

I believe you are correct in that if a public option is presented, then only the very top talent will be offered additional health insurance, much like they have Rabbi Trusts, stock option grants, and all sorts of other goodies that Joe and Jane Employee don't get.

I think you are misunderstanding me about the tax benefit. I am not talking about the fact that employer contributions to employees are not part of the employees' taxable income - that's a separate issue (it's a bonus to the employee on their personal return). I'm talking about the fact that as a company gets to deduct that as an expense from revenue. Very simplistically -

Revenue

Less: expenses (G&A, CGS, payroll, 401(k) match, health insurance, etc)

= Net Income

*tax rate

=tax

That won't go away, and employers DO have incentive to attract talent. If there is no public option, they need to keep offering health insurance as a benefit to obtain the talent, at every level. If there is a public option, they will be able to say F-it, with a straight face. Except to the c-suite.

Gotcha.

yes, i was misunderstanding what you meant by tax benefit.

thanks for the clarification.

[The Progressive]

The US government forgo roughly $200 billion each year in lost revenues because of tax subsidies for health insurance paid by employers. These subsidies includes: (1) employer health benefit contributions for workers and retirees, (2) health benefit deductions for the self-employed, (3) health spending under flexible spending plans, and (4) the tax deduction for health expenses.

http://www.kff.org/insurance/7779.cfm

Cut these subsidies by half and over ten years we will have sufficient revenue to paid for meaningful health care reform.