Universal Healthcare

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I'm assuming with your background in economics, this is a rhetorical question, but obviously taxpayers will ultimately pay for the subsidy. The government pays the subsidy, and the governments gets the money from taxes.

This reform won't do that, because you're not buying your health insurance privately. Since you're on the company health plan, it doesn't really affect you at all. (See below for a little more detail.)

Setting aside for the moment that if health care reform fails, we're not getting another bite at this apple for quite awhile, how exactly would you propose that I fight this legislation? Both of my senators and my congressman supported the public option and early buy-in for Medicare (although to be fair, none of them favored single payer). I don't have a problem with them. The Senators and Representatives that opposed these measures don't live in my state or district. Are you suggesting I move?

I break down the uninsured into three broad classes: 1) Those that want and can afford insurance, but cannot get insurance due to a pre-existing condition. This bill helps them, as insurance companies won't be able to exclude people on the basis of a pre-existing condition. (Although insurance companies can charge people with a pre-existing condition 50% more than those without one.) 2) Those who don't want insurance, because they feel they won't need it. These are typically younger people who have low health care costs. Arguably, this bill hurts them, as there is a personal mandate, meaning if you can afford health care insurance, you have to buy it or pay a fine. and 3) Those who want insurance, but cannot afford it. This bill may or may not help those people, depending on the exact income. As I said, I'm not convinced a family of four making around $50,000 will be able to afford $6,000 annually, and if you have a very low income - in the $20,000-$30,000 range, you're exempted from the personal mandate entirely.

If you currently have employer-provided health care insurance, this bill does virtually nothing to hurt or help you. You're already covered, so you don't have the issue of the personal mandate. Since your company does the price negotiations with the insurance company, there won't be a cost change for you with this legislation (the subsidy only covers people who are purchasing insurance privately). I also don't see how this legislation would greatly increase the cost of insurance - in fact, one could assume the opposite may be true. With a personal mandate, you are expanding the risk pool over more people. Sure, some of those people will be paying a reduced rate for their insurance, but that's subsidized by the government to the insurance industry. So the insurance industry will still get "full price" for those people.

 

Ok, perhaps "settling for second best" isn't the right terminology. Settling for the crapper would be more like it. Health-care reform didn't sell under Clinton because the economy was doing well. The "average person" wasn't hurting. Now, they are. On top of that, the issue has been pumped up enough by this whole debate that I firmly believe a new bill would quickly follow the death of this bill.

As for how to achieve that end if your representatives in Congress are already on your side, the best you can do is be vocal about it and how bad the current bill is (and I think it's pretty bad).

 

One more thing - we're not quite done with this yet. Since the House and Senate versions of this bill are worlds apart, there's going to be a conference committee between the two chambers to work out a compromise for the bill. WHile I don't hold out much hope for a public option getting back in, there is the possibility for some changes. I don't think there are many big changes that will make this bill into a great bill, but "less bad" may be a possibility.

 

Killing the mandate would be a good start. I don't think there's really any need for it. It doesn't seem to help anyone, while it may potentially hurt some.

 

A private mandate with a public option isn't so bad, because you can be reasonably sure that you would be able to purchase insurance at a reasonable cost. The issue I have with no public option with a private mandate is that if you are considered a high risk group (say over 55, with a pre-existing condition) the insurance company can charge you several times as much as their standard cost, which may make it unaffordable. Under the scenario I presented, that person could legally be charged four times the amount of whatever the regular rate is by the insurance company, and if his income is above a certain level, he HAS to buy it. Usually, when the government makes you buy something, they also have some means of regulating the price of it either directly through legislation or indirectly through industry regulation - although that would still technically be legislated as well (like auto and homeowners).

I agree with you insofar as I think the mandate is a poor idea if you don't have a public option to go with it.

 

The insurance companies will get 30 million new customers who will be forced to buy insurance (don't you wish you had a customer base that was required by law to purchase your products and services? ) and, even worse, it will be paid at taxpayer expense for those who can't afford it. The idea is exactly that, Aldeth, that younger people will be paying into a system they will not use very much, and help pay the expensive care that older people require, which is suppose to "bend the cost curve" downwards). In theory, it does create a much needed safety net for people who don't have employer based insurance, for whatever reasons (and that's a good thing for all of us).


The bill includes regulations to make sure that insurance companies don't just suck in the extra profits, but that most of the windfall profits go towards providing health care for their clients. I'm sure there will be massive loopholes that insurance companies will use to get around the regulations. Or they could just ignore the regulations like most companies do, since no one bothers to enforce any of the regulations on these guys anyway.

The way I understand empoyer based insurance to work, is that the employer pays the actual cost of the care, and the insurance companies just administer the plans for the employers. That means they really don't care much about preconditions, like when they actually have to pay the cost of care themselves, such as in non-employer based policies. When the clients start actually having to use the policies, the insurance companies just start finding reasons to drop the clients. But if you are employed, and in an employer based plan, you are pretty safe - for as long as your employer is willing to pay for you. That can change. And as costs go up, it will start changing for even more people.

That's one thing I can say for Americans: They never bother to act until the crisis is upon them. Then they become hysterical, and undoubtedly, as more and more of them start bumping up against the failing system, they will demand that something be done. And of course, it will fall onto the government to do something (the public option). But for now, most feel a false sense of security in their employer based plans. It is in the interest of most employers to provide the benefits that employees need. But there will be a tipping point once the cost becomes too much for them to bear. That's the real question, because the cost of health care is built into the price of goods and services that we buy from those companies that provide the care. In the end, you are still going to pay, one way or another.

 

I agree Chandos. Typically, if you are getting health care from your employer, you A) won't be dropped but have B) little to no choice in the company you go through or the type of plan you get. That's why I was interested in a public option. If there were multiple plans offered, I could have chosen to keep what I had at work, or switch to something else. My insurance at work provides a pretty good level of care, but it is also quite expensive. I would love if I could get my plan at something along the lines that Blades described above.

But that's the thing. We only have two tiers of insurance offered to us. The low end one costs little and provides little, which may be not so bad if you're single, but you definitely don't want that one if you have a family. The other plan provides much better coverage, but at a significantly higher price. The mian reason I buy the plan I do is that there is a cap on how much I can pay in a year - in my case, my out of pocket expenses (beyond the premiums of course) cannot exceed $5,000. The lower plan has no such cap.

 

Aldeht, that cap is only for in-network expenses, correct? I would like a public option myself, as we were railroaded on the birth of my 1st daughter, who spent 20+ days in the NICU. The out of pocket expenses for out-of-network charges cost of over 10K. We were pissed, pursued explanations and basically were stuck with the bill. It's paid, in installments, but we were not looking for that kind of bill. That type of non-sense billing needs to go. I would hope any new Health-Bill/Reform would fix those type of issues. They way the billing bounces around is nuts! It needs to be streamlined and made understandable to those who aren't lawyers.

 

Yes, but that's not an issue for me. I live in Baltimore County, and one of the best hospitals in the nation - Johns Hopkins - is in-network. It's only about 15 miles away - I can be there in about half an hour.

 

Aldeth - I agree about the PO, it could have provided more choice and made the insurance companies compete for your business. The Medicare buy-in was an even better option, because it would have used the existing public option framework, and it would give people with higher risk factors greater security than they have now. The insurance companies used Leiberman to kill it because they knew that the more people use the PO, the less they are interested in the hassles of private insurance.

 

Ah, but what would happen to employer insurance if there's a competative public option?

 

The PO was only going to made available for those who did not have employer based insurance. In the case of the medicare buy-in, ask your employer who he would rather be paying on and which one is far more expensive to carry - an employee who is 25, or one that is 55?

 

From the beginning HC reform was focused primarily on those who were uninsured or difficult to insure. The working assumption (and IMO the correct one) was that most people who were receiving insurance from their employer would keep their employer insurance plan for two reasons: 1) They would want to see how the PO works in practice before switching from a plan they are pretty comfortable with and 2) Because employers typically pay a portion of the health care costs, it is unlikely that a PO would represent a significantly lower cost.

The fact is that most people who get their HC insurance from the employer are fairly satisfied with their plans. They may not love them, but they won't jump from them unless they feel there is an option that will be cheaper or provide better service, and right now, even if there was a plan for a public option in place, the cost and level of service you would receive with that would both be unknowns.

 

One thing that scares me about a public option is that employers will start paying less of the healthcare benefits, putting more on the employees, using the PO as an excuse, knowing there is another option for their employees out there. The bargaining chip of Healthcare won't be as valuable to the workforce anymore. Being a part of a family that is insured through our employers, I definitely don't want that to happen.

Another thing that bothers me is this question. What impact will this have on the Medical field itself. My wife works in it. Will this drop Salaries? Benefits? The unknowns right now scare me.

 

Blades,

How will more people having access to HC harm the medical industry? Such a suggestion seems absurd to me. If more people have HC, more people will go to see doctors, more people will receive treatments, more people will get perscriptions, more people will get surguries. If anything, it seems to me that there would be increased demand in the field of medicine. When has an increase in demand ever resulted in lower salaries or benefits?

I'm also not sure about the employers offering decreased insurance benefits either. First of all, there is the point that there likely isn't going to BE a public option, which kind of makes this question moot. Secondly, as I said earlier, I think this will only become a realistic scenario if the public option, if it ever comes into place, is popular and affordable. And if that happens, then you may be able to purchase insurance at a similar cost to what you're currently deducting from your paycheck (well maybe not you - from what you posted you have a very reasonable employee contribution).

 

The point is that with a decent PO, employers may well drop their insurance rather than pay it. If the PO is poor, employer health insurance is still a job incentive, but if the PO is good and affordable, a job-changing health plan becomes much more expensive.

Aldeth:
I'm less concerned with employees leaving employer-based health plans, and more with employers doing so. Mind you, this isn't necessarily a bad thing, but it's a consequence to be considered in writing such a bill.

It depends on how those people negotiate prices. If more people join a single plan, then that single plan will be able to lower prices, which means the doctors get payed less. Medicare and Medicaid are already facing this as a serious problem. Imagine adding millions of currently uninsured to them.

 

If more people join a plan, prices will go down, but it has nothing to do with shafting doctors out of money. It has to do with risk pools. Medicare has this problem because most of the people in their risk pool are high-risk people. So yes, let's imagine adding millions of people currently uninsured to the system... And what you discover is this is the very reason for the personal mandate. If you don't make healthy people buy health insurance, and only provide it to the people with pre-existing conditions, what happens? Everyone's premiums go up.

The purpsoe of the personal mandate is to get healthy, low-risk people into the risk pool as well. Since the odds of them needing any type of catastrophic care are relatively low, their premiums pay for people who are more likely to need that type of care.

Really, risk pools are the basis for which all insurance is based. If you don't understand the concept of risk pools, assumptions you make about how pricing for large plans work will be fundamentally flawed.

 

That is why I posted that comment in question form. I was looking for input, because to be honest, alot of my wife's co-workers have said those exact things, expressing the same sentiments. They are worried, which in turns worries me. We can post all we want, trying to post sources from all over the net, spewing alot of stats (not that you do Aldeth, I generally like and respect your opinions) but they see the trends and know how the changes effect them in their field. All of them are educated, so if the majority starts to ask those questions, it makes me worry for my wife. We aren't paying for grad school just to have her salaries get dumped to a level that a non-grad job would pay. That would squeeze us big time.

I think our lower contribution has to do with my wife's company being a leader in their field. They take care of their employees. I was expressing this about concerns IF there is a PO. If not, your right, moot point.

 

Consider that companies that can afford it, and are doing well, will more than likely keep it. On the other hand, companies who are faced with lay-offs or paying for increases in health care may have an option to keep jobs that may otherwise be lost. I'm sure a lot of workers and their families would appreciate that.

 

This is wrong. Major health insurance providers negotiate with doctors to lower costs of procedures. That means the doctors get payed less for their work than on other patients. Medicaid, for example, pays my father (PhD and decades of experience) less for a client than someone working on their Master's would bill for an uninsured client. Many doctors refuse to take clients for Medicaid because they pay so low.

I understand this, and it's not a bad idea, but it's not the way many people understand the system. If you told most 25-year-olds that they were going to have to pay more in order to defray the costs of older people, or even to defray their own projected future costs, they wouldn't like it. It's indirectly dishonest. It's business as usual, I know, but I think it's a bad idea.