There’s several articles that don’t seem to be gaining traction in the media in this health care debate that is all the rage of late. In the span of three approximate years of the Romney universal health care plan he deposited on the state prior to playing “conservative” in the GOP primaries, they’ve already begun to ration the health care due to exploding and unsustainable costs.
First to be cut? 30,000 *legal* immigrants. Well now, don’t that bode well for the liberal/progressive mantra.
The new state budget in Massachusetts eliminates health care coverage for some 30,000 legal immigrants to help close a growing deficit, reversing progress toward universal coverage just as Congress looks to the state as a model for overhauling the nation’s health care system.
The affected immigrants, permanent residents who have had green cards for less than five years, are now covered under Commonwealth Care, a subsidized insurance program for low-income residents that is central to the groundbreaking health care law enacted here in 2006.
Critics of the cut, which would save an estimated $130 million, say it unfairly targets taxpaying residents and threatens the state’s health care experiment at a critical time.
“It either sends the message that health care reform cannot be done, period,” said Eva Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, “or it opens the door to doing it halfway and excluding immigrants from the process.”
Gov. Deval Patrick has proposed restoring $70 million to the program, which would partly restore the immigrants’ coverage. But legislative leaders have balked, saying vital programs for other groups would have to be cut as a result. The cut, which would affect only nondisabled adults from 18 to 65 years old, would take effect in August unless the legislature approves Mr. Patrick’s proposal.
“The governor has made a very good and compelling case relative to providing for legal immigrants,” Robert A. DeLeo, the speaker of the State House of Representatives, said Monday. “On the other hand, there is only so much money that we have.”
The Romney health care law did “succeed” in one way. Since it’s implementation, MA has the lowest uninsured population, with only 2.6% uninsured, compared with a national average of 15%….
…. for a while, that is. And at rapidly increasing premiums to the insured. Instead, the true legacy of the Romney health plan is it’s proof that “reform” relying on government subsidized health care is simply impossible with today’s population trends, declining economy and guaranteed lower earning capacity with Obama’s Congressional spending.
And the legal immigrants cut? They have a double whammy because they do not qualify for other federal aid, including Medicaid.
Is this what Congress has in mind? It must be, because the Kennedy/Dodd health plan was modeled after the MA universal health plan, despite it’s proof that government costs for health care have increased 42% in it’s short life span thus far, and sits at 33% above the national average.
Advocates promised that the Massachusetts plan would make health insurance more affordable, but according to a Cato study, insurance premiums have been increasing at nearly double the national average: 7.4 percent in 2007, 8 percent to 12 percent in 2008, and an expected 9 percent increase this year. Health insurance in Massachusetts costs an average of $16,897 for a family of four, compared to a national average of $12,700.
In fact, Michael D. Tanner at Cato predicted the rationing of health care as inevitable in a blog post back in March of this year.
Massachusetts has significantly reduced the number of people in the state who lack health insurance. However, it has not achieved, nor does it expect to reach, universal coverage. (The best estimates suggest that more than 200,000 state residents remain uninsured). And, significantly, roughly 60 percent of newly insured state residents are receiving subsidized coverage, suggesting that the increase in insurance coverage has more to do with increased subsidies (the state now provides subsidies for those earning up to 300 percent of the poverty level or $66,150 for a family of four) than with the mandate.
The cost of those subsidies in the face of predictably rising health care costs has led to program costs far higher than originally predicted. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009.
Now the state is turning to a variety of gimmicks to try to hold down costs, including possibly cutting payments to physicians and hospitals by 3-5 percent. However, the Times quotes health reform experts who have studied the Massachusetts system as warning “the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care.”
Not only are those legal immigrants… precisely those the good intents of idiot legislators are trying to protect… being the first busted out of the program, the very hospitals that have served them are also now endangered. One such hospital, Boston Medical Center, filed a lawsuit against the State of Massachusetts.
BOSTON — A hospital that serves thousands of indigent Massachusetts residents sued the state on Wednesday, charging that its costly universal health care law is forcing the hospital to cover too much of the expense of caring for the poor.
The hospital, Boston Medical Center, faces a $38 million deficit for the fiscal year ending in September, its first loss in five years. The suit says the hospital will lose more than $100 million next year because the state has lowered Medicaid reimbursement rates and stopped paying Boston Medical “reasonable costs” for treating other poor patients.
“We filed this suit more in sorrow than in anger,” said Elaine Ullian, the hospital’s chief executive. “We believe in health care reform to the bottom of our toes, but it was never, ever supposed to be financed on the backs of the poor, and that’s what has happened in Massachusetts.”
The central charge in the suit is that the state has siphoned money away from Boston Medical to help pay the considerable cost of insuring all but a small percentage of residents. Three years after the law’s passage, Massachusetts has the country’s lowest percentage of uninsured residents: 2.6 percent, compared with a national average of 15 percent.
Low-income residents, who have benefited most from expanded access to health care, receive state-subsidized insurance, one of the most expensive aspects of the state plan. But rapidly rising costs and the battered economy have caused more problems than the state and supporters of the 2006 law — including Boston Medical — anticipated.
~~~The suit comes as Congress looks to Massachusetts as a potential model for overhauling the nation’s health care system. Even before the suit, the state’s fiscal crisis had cast doubts on the law’s sustainability.
To help close a growing deficit, the Democratic-controlled Legislature eliminated coverage for some 30,000 legal immigrants in the new state budget. Gov. Deval Patrick, a Democrat, is seeking to restore about half of the $130 million cut, but lawmakers have expressed reluctance, saying that doing so would require cuts to other important programs.
State officials expressed surprise at the lawsuit, saying that Boston Medical received $1.5 billion in state funds in the past year and should not be seeking more in the midst of a fiscal crisis.
“At a time when everyone funded and served by state government is being asked to do more with less, B.M.C. has been treated no differently,” said Dr. JudyAnn Bigby, the state secretary of health and human services, in a prepared statement. “We are confident that the administration’s actions in this area comply with all applicable law and will be upheld.”
If there is one thing that Congress and Obama have right, it is the rising costs of health care. They are not, however, entirely honest in why those costs are rising. And truth be told, the GOP alternative… depending more on reforming Medicare/Medicaid fraud, medical litigation, and allowing private insurers to form more pools of packages that could offer lower costs to the public… has it’s price tag that may (or may not) be less since it can’t get to the forefront to be compared in detail to the lone proposal the Dems offer.
What they don’t mention is how much is affected by fraud, frivolous litigation, extraneous administrative costs, medical care built around litigation prevention as opposed to needed procedures, etc. Before any plan by any party goes into effect, these arenas need reform, and middle man waste of HMOs needs to be kicked to the curb. Then let’s see how much shortfall is left.
But even with those savings, there is a guarantee of a shortfall. Both party plans address legitimate issues about the inevitable increase in health care on the horizon. As a Feb 2003 report by the CDC pointed out in their synopsis, Public Health and Aging: Trends in Aging — United States and Worldwide, the advance of the Baby Boomer and aging population overwhelms the declined fertility birth rates of the past decades, increasing the demands on public health systems, and medical and social services.
Also what both plans address is the move to preventative methods for the most costly “chronic” afflictions:
In 2002, the five most expensive health conditions were heart disease, cancer, trauma, mental disorders, and pulmonary conditions.
Heart disease and trauma ranked first and second as the two most expensive conditions in terms of total health care spending; however, with respect to per-person costs, cancer was the most expensive and heart disease the second most expensive.
Taken together, these five conditions accounted for a substantial proportion of total health expenditures in 2002. The 15 most costly medical conditions in the United States accounted for 44 percent of total U.S. health care spending in 1996.
Twenty-five percent of the U.S. community population were reported to have one or more of five major chronic conditions:
· Mood disorders.
· Diabetes.
· Heart disease.
· Asthma.
· HypertensionSpending to treat these five conditions alone amounted to $62.3 billion in 1996. Moreover, people with chronic conditions tend to have other conditions and illnesses.
When the other illnesses are added in, total expenses for people with these five major chronic conditions rise to $270 billion, or 49 percent of total health care costs, according to 1996 MEPS data. On an individual level, treatment for the average patient with asthma was $663 per year in 1996, but when the full cost of care for asthma and other coexistent illnesses is taken into account, the average cost was $2,779.
Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions. Persons with five or more conditions also have high hospital expenditures. In New York State during 2002, of the 1.3 million different persons admitted to the hospital, the 27 percent with five or more chronic conditions accounted for 47 percent of all inpatient costs.
Obviously, as the ageing population overtakes the younger population, these costs will be skyrocketing at a more intense rate of speed. All with the reality that there is less working population to support the top pyramid of retirees, combined with longer life expectancy in the US.
a prescription for failure
I ran across a very interesting Internet Q&A with Ron Lee, a progressive thinking professor at UC Berkeley, on the Population Reference Bureau site when discussing the quandary of ageing and it’s effect on not only the health programs targeting the elderly, but all government social welfare programs. The major flaw in the ointment for both Romney’s MA universal health care, and Obama/Congressional proposals, is they all depend upon funding from the taxpayers.
But there are two major flaws not addressed in these pie-in-the-sky reforms from both parties…
First, there will be less taxpayers to support the young unemployed, and the elderly retirees.
Second, the current scale of spending is severly cutting into the American taxpayers’ capacity to earn… fueled not only by an economic decline, but the increased taxes that will have to be mandated to support the government welfare programs and unprecedented spending. (i.e. cap and trade, stimulus, burgeoning Congressional federal programs associated with all… with employees *also* supported by the taxpayers).
The “big picture” view of combining the repercussions for all Obama and Congressional plans was the very reason that I composed the post, EXPOSE’… Obama’s “cartoon horror movie” to destroy US economy revealed in “single cell” trailers just two days ago. When the media and Congress present how their “remaking of Obama’s America” will have minimal affect on the taxpayers’ wallets, they tend to do so in “single cel” mode. ala this single program will cost you “x” amount…. but “look at the benefits and savings”, they say.
However when you take the enormous scope of the Congressional/Obama agenda en toto, then pile on the effect of inflation and the devaluation of the dollar with that amount of national debt…. not to mention the increased daily costs that will be incurred with all this “clean energy” we’ll be paying thru the nose for at both ends- creation and useage… the effects on our wallets translate to one reality. Our earning capacity is not only regressive, but may just bite the dust big time.
Even John Kerry’s gospel source on cap and trade, the PERI Report, suggests all these “good paying” jobs Obama promises to create don’t result in incomes more than $51K annually… *with* college/bachelor degrees. It will take a long time to pay off those student loans at that rate. (oh wait… Obama wants the taxpayer to pay for that too….)
Working from that study, we provide evidence on this type of job breakdown in Table 10, where we sort the total number of jobs generated by $1 million in spending according to three job credential categories:
High-credentialed jobs requiring at least a bachelor’s degree and paying on average • $24.50 an hour.
Mid-credentialed jobs requiring some college but not a B.A. and paying on average • $14.60 per hour.
Low-credentialed jobs requiring a high school degree or less and paying on average • $12.00 per hour.
It doesn’t take an Einstein to figure that “some college” translates to about $600 a week, before taxes. Assuming a 33% tax structure (in our dreams with this spending…), that’s $1752 take home monthly. Under Obama’s HASP mortgage restructuring of 31% of disposable income, that “some college” person can afford a mortgage of $540 monthly which… at 5.8% rates… is a $92,000 home. And that’s NOT including property taxes and insurance.
Wow…
If this is Obama’s idea of good paying jobs and a future, we can be assured he will have few “wealthy” people making over $250K to rob for taxes.
Since any potential of success for health care, or any other programs, is vital to taxpayers’ earning capacity (which Congress can then abscond), how is it they believe their plans are in any way realistic, let alone sustainable?
According to the Berkeley professor’s response (mentioned above) to a question, they aren’t without further redistribution of wealth measures.
Barbara Haley: Even though the ratio of elderly to the working-age population in the United States will roughly double over the next few decades, the dependency ratio is going down. What alternative to the regressive payroll tax (that currently funds old age) should the US adopt, to take full advantage of this?
Ron Lee: Barbara — The Total Dependency Ratio is the ratio of the youth population plus the elderly population to the working age population. A more refined measure is the Support Ratio based on empirical age profiles of consumption and labor income, used to form the ratio of equivalent workers to equivalent consumers. This ratio declines at .2% per year from now through 2050 (analogous to a rise in the dependency ratio).
This rate of decline is, I think, very slow, particularly in comparison to the much bigger changes in the finances of the Social Security system or Medicare. But by construction, it is considering not only these govt programs targeted to the elderly, but rather all govt programs and also the age patterns of private consumption.
You raise a good point about the payroll tax being regressive. I agree. The original idea was that the progressivity of the benefit schedule would out-weigh the regressivity of the payroll tax, but because poor people die younger than rich people, it is not clear whether actual benefits are progressive.
One could, of course, fund old age benefits out of the income tax, but I think most people would rather see a tighter relation between what benefits you receive and what contributions (payroll taxes) you pay. One way to do this is the so-called National Defined Contribution systems that are common in Europe, but these do nothing to make the system more progressive. That then requires a separate redistributive component, which some plans like the Swedish one have.
First of all, I’d like to note to Mr. Lee that the US already has it’s own form of “national defined contribution” system… it’s called Social Security, and is also another massive failure about to happen. And all for the same reasons that these social welfare reforms proposed by Obama and buds are nothing but a prescription for failure. They all depend upon an adequate earning capacity to support both the top and lower tiers of the population. In short, Ponzi schemes don’t work when there are less people participating.
Another point about the NDC systems… as a 2003 Cato report by William Shipley pointed out, Europe is experiencing the same problems there with their PAYGO pension programs in tandem with their own population pyramid inversion and economic woes.
The last bit about Sweden’s “separate redistributive component”? This one genuinely makes me laugh out loud. From this analysis of Sweden’s “partially defined contribution plan” by the School of Business from Stockholm University.
Due to changes in the age structure in many industrialized countries, we are currently experiencing a trend where countries tend to shift pension systems from a defined benefit system to a [partially] defined contribution plan. These shifts may have far-reaching consequences for retirees. The key issue in moving from a defined benefit type of pension system to a defined contribution plan is to make individuals more responsible for their own pension investments, and to a larger extent than before, let them bear the actual investment risk.
Anyone remember the Dem’s outcry to “the George W. Bush proposal” to reform Social Security? I believe it was described as “privatization” along with the prerequisite sneer and spit.
The Stockholm professors, after a three part analysis, came to the conclusion that a pensioner invested in the world market has a higher “Pension at Risk” measure than via the old, traditional method similar to our social security structure. That would be, of course, take funds from every penny you earn to dole back to you as retirement checks monthly.
Then again, this report was done back in 2000… when the economy was suffering normal swings in ups and downs. It’s now 2009, and the Stockhom professors do not address this base reality…. what about if these these social security programs are bankrupt (as they are)?
These are the choices for the working stiff… let the government take your cash and pocket it for your retirement fund (and piss it away). Or have the option of pissing it away yourself in the world market. Considering today’s economic reality and population trends, “Pension at Risk” measure is less about risk than it is about who bears responsibility for that risk… the individual earner, or the government.
I’ll take that responsibility myself. Were I to be able to have back all that money they’ve withheld from me since I was 16 years old, I suspect I could have handled it better. And if I didn’t, at least that responsibility was mine alone to assume.
BTW, for some interesting reading on Obama’s regressive payroll taxes and Social Security, visit a June 2008 post by The Provocateur, a Chicago mortgage broker.
No one denies the old adage, “an ounce of prevention is worth a pound of cures”. But short of mandating “an apple a day to keep the doctor away”, the devil in the details is what anyone’s plan costs, and what they expect as results for taxpayer money spent.
According to TITLE III of Kennedy’s Senate version, we get ourselves yet another government council and federal employees… the National Prevention, Health Promotion, and Public Health Council. It’s a Presidential appointee for the big kahuna/chairperson, of course. This council will be consist of Secretaries from HHS, Agriculture, Education, FTC, FCC, Transportation, Defense Dept, VA, Interior, Labor, Homeland Security, HUD, the EPA, Director of the Domestic Policy Council, the US Patent & Tradmark Office, Office of Personnel Management, Chairman for Corporation of National and Community Service…. AND any other person the “chair” feels they want to add.
Okay…
This conglomeration of federal appointees from virtually every government department hunker down to “recommend” to the President and Congress how to achieve “national wellness”. Considering where the recommendations are headed, this means only one thing…. legislative mandates on “wellness”. Not only that, *specifically named” are the usual sin habits we nasty common folk engage in… smoking, poor nutrition, and “sedentary” behavior… or lack of exercise. Nutrition, in itself, covers a vast and vague territory. Presumably fast foods to alcohol will be the first and primary targets, but unlikely to be the last or only targets.
The Senate plan gives these brain trusts no more than one year to come up with a “strategy” to present “federally supported prevention, health promotion and public health programs”…. all of which will require hidden and unforecast spending that is not included in the current CBO analysis.
The chairperson of this new “council” must report back annually and may, of course, use all the personal data collected by enrollees on their race, gender, education, communities, income etal…. as mandated in Sec. 204, 205 and 332. This data, per “da plan” can be shared with any and all federal agencies… and perhaps Craigslist if they deem it beneficial.
Answer… there is none…. yet. What we have is the “promise” of prevention programs: decided by a panel of appointees, then mandated by legislation. All costs are as of yet, unknown, and to be determined down line . And of course, conveniently *not* included in today’s cost projections. That’s next year’s spending surprise… and the year after and year after.
Maybe I’m just old fashioned, but I prefer the method that insurance premiums are reduced when you voluntarily participate in programs, or earn because of behavior: aka a discount.
For example in the auto insurance world, there are safe driver discounts, safe car discounts, bundling of insurance discounts, good student and senior discounts… all bent on rewarding good behavior.
Would it not make more sense for continuing with health insurance providers who give you discounts for voluntary health prevention? And, in fact, this is one arena where… on the surface… the GOP plan has it right.
• Promotes prevention and wellness by giving employers and insurers greater flexibility to financially reward employees who seek to achieve or maintain a healthy weight, quit smoking, and manage chronic illnesses like diabetes.
• Rewards high-quality care, instead of encouraging health care providers to order more and unnecessary services.
I say “on the surface” since we can see nothing but an abstract that the majority Congress and media does not allow to be pursued. But without spending a bit of the taxpayers’ dimes, without enacting nanny laws on what we can eat, drink or how much body fat is legal, the private plan can open new jobs for programs and facilities that would satisfy insurers discounts for reduced risk. It’s a free market job creator, and not a cash cow drain as we are looking at now.
There is so much more in the details… but what we have before us is an Obama/Congress Frankenstein monster, created in the image of Romney’s Frankenstein in Massachussetts… a creation already coming apart at the seams stitching the potpourri of govenment bodies used, and unsustainable because of declining incomes/taxes and government structure needlessly increasing the costs.
And Obama? This is already turning into such a mess that the new talking point is being spread around to distance himself from the damage…. “this is Congresses’ plan, not Obama’s”. He solemnly vows spins, “…I won’t sign any health-care bill that adds to the deficit..” knowing full well that any government option adds to the deficit.
I would like to remind the Community Organizer/Delegator in Chief that “… only dead fish go with the flow”. I might also add they land on the same beach as the rest of the debris.
Vietnam era Navy wife, indy/conservative, and an official California escapee now residing as a red speck in the sea of Oregon blue.
This government healthcare is a big kettle of worms. Doctors spent a lot of time and money to become doctors. College graduates’s student loans are a drop in the bucket next to doctors. Many doctors are no longer taking new medicare patients because medicare drastically cuts payment to doctors. What’s going to happen when the government pays all the bills? I’ll tell you what will happen. Older doctors will quit practicing medicine. There will be a shortage of doctors. Foreign doctors will fill the vacumn. Of course, they will have to take tests to see if they are qualified. When they fail the tests they will be given easier tests in order to be qualifed because the problem will be acute. The UK has such a doctor problem that they have muslim doctors trained in their fly be night schools and it seems they are also militants who try to bomb airports. It will be wonderful to have muslim militants taking care of our illnesses. What better way to get rid of some of us legally with the government’s help?
Also, Obama says he will rtake $300 billion from medicare to heop fund his program. Who is he trying to kid? That money is long gone. Congress spends all that money as soon as it comes in.
Funny you should mention kennedy and ‘going off a cliff’ on the 40th anniversary of Chappaquiddick.
I would like to think that our Congercritters are smart enough to look at MA and draw the obvious lesson, but then I always have been a bit of a dreamer.
It is like we have this lab experiment already set up and running (and failing) for them to observe, but will they see it? Will they draw the right conclusions?
No, if they realize that it is a failure, they will say, “But we will do it better, and our plan will be too big to fail.”
Exactly, Dr. D. I think they can see MA failures very well. But I believe is that they don’t want the US voter smart enough to figure the parallel. And in the relatives silence of the media in drawing comparisons over the past month, they may very well succeed in keeping the dumbed down populus, dumbed down.
Quite simply, with economics, population trends, and the projected costs, there is no “reform” that can be done using government health care. They should turn their “reform” efforts to free market solutions and almost zip costs to the US taxpayer.
Kennedy, off a cliff off a bridge— semantics. I wonder how much it is costing to keep Kennedy around? If Obama care passes would they pull the plug. Oh never mind he has the politicians brand of free health care.
hats off to mata for another well put together post. my neighber thinks the government should provide health care to all, i asked her how it should be paid for. she said that the government has plenty of money to cover us all. i have tried to give her an education, but it is difficult to educate someone who is set on freebis. she is uninsured, as is her last child left at home, her husband has insurance through his job but won’t put them on it because of the cost, he wouldn’t be able to buy his toys or whiskey anymore. so she lets her daughter suffer until her fever will get to 104 and she has been throwing up for 3 days, then she will take her to the walk in clinic staffed by nurse practicioners. she could get a job to help cover healthcare for herself and her child, but then she wouldn’t be able to sleep in and play on any one of their 4 new laptops. she is the reason the rest of us don’t want to pay other peoples way. pisses me off. there has to be an end someone, a line as to when people actually ant to provide for their own and stop wanting the government to do it for them.
IMHO, this is a great read on government healthcare.
http://www.city-journal.org/html/17_3_canadian_healthcare.html
An alternate health care bill was proposed by several republicans senators and representatives. It is interesting and worth a look if one has not reviewed this thought process.
Patients’ Free Choice Act — includes a long and short summary ofthe proposal.
The bill addresses fixing Medicare/Medicaid first and the disparity of tax breaks
for corporations vs small businesses among many other proposed points.
http://www.house.gov/ryan/PCA/index.htm
Thanks, American Voter. I have the archived PDF and DocsTOC to a more formal version than the ‘GOP Alternative” link I provided above. As I said, I don’t see this to be the quintessential answer, nor definitive answer to the health care problem. Is it better than the 615-1000+ page House/Senate version? At first glance. But it also suffers from being government mandate/funded heavy as well at the “glance”.
Then again, you can’t compare a 1000 page bill to a four page synopsis with any credibility, eh?
Here’s the GOP embed of their shorter proposal. Nothing, of course, has details nor CBO scrutiny for costs.
PCASummary –
Thanks, American Voter. I have the archived PDF and DocsTOC to a more formal version than the ‘GOP Alternative” link I provided above. As I said, I don’t see this to be the quintessential answer, nor definitive answer to the health care problem. Is it better than the 615-1000+ page House/Senate version? At first glance. But it also suffers from being government mandate/funded heavy as well at the “glance”.
Then again, you can’t compare a 1000 page bill to a four page synopsis with any credibility, eh?
Here’s the GOP embed of their shorter proposal. Nothing, of course, has details nor CBO scrutiny for costs.
PCASummary –
BTW I love your blog!
Food for thought, on health care: Each state should run a health care lotto, 1 dollar Lotto ticket for say 500 bucks dental care: or eye care, or 1000 toward tests or hospital care.
Health care reform, if enacted, will be the biggest travesty this country will have ever undertaken. Trouble is, once you enact it, you can never go back!
Mike Volpe, here, I am the blogger referenced. First, thanks for the link. I just have a few thoughts here. First, the state closely modeled to Obama’s vision is California, from cap and trade, bloated government, central planning, union involvement, their increasing dependence on Medicare, most of the things that Obama is trying to implement have already been implemented and that’s why they are near bankruptcy.
Second, there’s no doubt that health care reform is necessary but most politicians are trying to fix the wrong problem. There are three significant problems with the system. First, doctors get sued way too often. My biggest loan was for a doctor at over a mil and I did the loan to insure their former patient wouldn’t take their home in a suit. The doctor told me his malpractice insurance was $50,000 yearly for a million worth of coverage. The normal home owner’s insurance on a million dollars is about $1000. That means you are fifty times as likely to be sued than have your house burn down. Either doctors are really incompetent or its too easy to sue.
Second, employer provided health insurance is killing the system. It takes decisions out of the patients hands and puts them into the hands of insurance companies and employers. Why would we want a system where insurance companies have this much power?
Third, insurance companies have regional monopolies. For instance, in Texas about 40% of insured are insured under Blue Cross Blue Shield. I(f you’re a doctor and BCBS doesn’t include you in their network, you’re done. Again, why is the inusrance company in so much power?
So, you fix those three problems and you fix health care. Here’s my proposal.
http://theeprovocateur.blogspot.com/2009/07/coming-health-care-bubbleand-its.html
Mark Volpe, you are I are on the same tack with reforming laws that drive up medical costs with unnecessary treatment as litigation prevention, and the costs of E&O insurance. A doctor, like any other businessman, needs to cover the expense of doing his business, and these costs are reflected in the consumer charges.
I’m not sure I can agree on the employer benefits. Please note that word… benefits. It’s important. An employer is not mandated to provide individual/family health insurance. Nor are they required to give that benefit back to you in cash if you prefer a different plan than they offer. It would be like working in a place that provides lunches as part of their benefits. You don’t like the lunch they serve, and bring your own. You don’t have the right to demand a raise because they don’t supply a lunch you like.
If you prefer another health plan than offered, go buy one at your own expense. Employers offer these benefits as incentives, and to be competitive in attracting a higher caliber of employee. They are not a “right” as an employee.
When employers purchase premiums “in bulk”, so to speak, they get a break on the costs. But let’s take your idea that the employee should be able to choose a different plan. If the employer or group association diverts the premium outlays into a fund for the employees, they can choose one several alternative plans instead. In fact, I know of several unions that operate exactly that way… allowing a choice between a couple of different plans. As you know, this is much the way a mortgage broker functions vs a mortgage banker.
But again, unless the union or group association is large enough, you lose that “buy in bulk” price advantage and the costs are higher. The local mom and pop store can’t compete with the prices of Walmart chain stores. It’s for this reason that the GOP versions advocate allowing more business groups to form an alliance, allowing lots of mom and pops to get the prices the Walmart chains enjoy. But again, you’re “limited” to the selections. If you want the full spectrum, go out in the market and purchase what you want. It’s not like they don’t exist.
I do understand the choice of professionals limitation. It is a real drag to have a local professional that you cannot use, and have to drive 50 miles to a participating facility instead. What also annoys me is this “primary doctor” crap that is always inserted in the middle of any and all specialists for justification of coverage. This middle man stuff drives up unnecessary costs and wastes a doctor’s time.
Patients are now so accustomed to being run thru a battery of professionals that I’m not sure their “choice” of doctor (as opposed to a facility) is as big on the list as perhaps the convenient location of the participating medical network. But none of this improves with Obama/Kennedy/Romney care… and in fact worsens.
Unlike you, I don’t consider the “choice” in need of reform but the costs (ala the insertion of primary care doctors and HMOs). All in all, this seems a moot argument.
Via your post, your dislike of employer health benefits means you want to discourage these. And you suggest a way to do this is to tax health benefits and set up mandated health savings accounts.
Frankly, I fail to see the benefit to the individual. As I said, just because an employer doesn’t provide you a health benefit doesn’t mean they’ll give you a raise for the difference…. nor should they. This leaves employees with the same income, and looking around to provide their own insurance individually. Today we call these people “the uninsured” because most plans – without that “bulk” packaging – are too expensive monthly. Which brings us full circle to the access to groups with plans for better pricing.
I’m not sure what bothers you about local “monopoly”. There are national companies, such as NHIC, and Blue Cross that operate in multiple states. However state laws differ, and each plan must cater to the state’s regulations.
Blue Cross is big in many states, but that doesn’t mean they are the only choice. Because they’ve got the lionshare of the biz regionally doesn’t classify them as a monopoly. It may just be that they have a good product that is in demand, since they are beating out the competition. Are you suggesting they should be capped on just how many may utilize their individual state plans?
What you are advocating (i.e. policies not crossing state lines) is a one size fits all national template. I’m sure most national insurers start with a template of the basics anyway, and alter each base package for the states demands.
But the one size fits all bit is absurd anyway. Health issues in one state may not be as expedient or regulated as in another due to geographic location, density of population, types of industry, climate etal. So what’s your “regional monopoly” point really about?
First, I don’t care if employers who remove their health insurance benefits would replace that with a raise, and I don’t really care.
By having employers being the ones most responsible for health insurance, the patient, or the consumer, is left out of the process of insurance. As such, they don’t really choose the health insurance. It’s why consumers hope their doctor will be part of a new package when they switch jobs. It’s because they have no decision making. By doing so, the insurance companies and the employers are in charge. As such, corrupt insurance companies abuse doctors and doctors have no recourse. The patients have little input into the decisions.
As for insurance companies having monopolies, I said REGIONAL monopolies and they do. In Texas it is BCBS, as it is here in Illinois. In almost every state one insurance company dominates. That happens for two reasons. First, health insurance has an exemption to the Sherman Anti Trust act. As such, they can get around acting like monopolies. Second, insurance doesn’t cross state lines when it is health insurance. That makes competition non existent. I’ve talked to several doctors who speak of uspeakable heavy handed tactics in Texas by BCBS and they have little recourse because without BCBS they have no practices. Such behavior would end if there was competition and it was the consumer, not the employer, making the decision. That’s because with competition, the insurance companies would have more to lose. With consumers making insurance choices, insurance companies would have more to lose when they abuse doctors. Consumers would simply leave those insurance companies that engage in that sort of behavior.
There are other ways to create the economies of scale and given how expensive health insurance is, it doesn’t really work anyway.
Mike, you aren’t make an iota of sense. Employers are not *responsible* for health care. They offer it as an employee benefit. Don’t want it? Work for someone else, or buy your own plan. Refuse the dang “free lunch”.
Second you keep saying individuals are left out of the “choice”. Like the provided lunch they may not like to eat, it’s a benefit at little to no cost to them. Again, if they don’t like the plan, they can check into other plans offered that may include their specific doctors. They have all the “choice” in the world with shopping elsewhere. It’s just not necessarily coming to them free from their employer as a benefit.
Whether they can get it for a good price is the question. But they most certainly have a “choice”. There is no law against you purchasing whatever plan you at your own expense… for now, that is.
And you still make no sense on your concept of “monopoly” in a region. National chain grocery stores have a “regional” monopoly as a dominate business compared to single mom and pop operations, or even local chains. The big chains generally enjoy that dominate market because of competitive pricing, but people can still wander in the mom and pops. Free market… gotta love it since it’s going out of vogue
INRE crossing state lines… guess what, neither does your auto insurance if you commute regularly to work across a border town. So let me repeat this. States heavily regulate health insurance. This affects premiums, as well as plan specifics.
There is much to be said about checking into the different states regulations and how they affect the costs. But then you begin to trample on the 10th Amendment wheni you start imposing federal demands as the states’s standards. Remember that pesky Constitution? Granted, those trapped in the heavily regulated states suffer the consequences. But this holds true for many products in states. Look at the different fuel standards between summer/winter and from state to state? Can the auto owner in California demand the cheaper gas be available, and usurp California’s fuel regulations?
But let’s leave the Constitution out of this for a minute and take that dead fish ride with the tide. My guess is you believe this would open up the competition. John Shadegg, an Arizona Republican, agrees with you. But not everyone does, and perhaps for reasons you are not thinking of.
Emma Lloyd at IHP’s health insurance blog doesn’t consider national policies an automatic win win. As she points out, the repercussions of companies having the pick of the litter in a national market may mean that the insurance companies do indeed, only pick the pedigree of the litter. This leaves the high risk individuals out in the cold… still.
Risk is risk to an insurance company… doesn’t matter whether it’s in your back yard, or nationwide. Having a bigger pond to catch the trout means the insurance companies can be more more discerning in what they keep for the mantle or frying pan.
Britanncus sez… “…demonized the British, Canadian and other worthy plans…. these radical entities are determined to keep the special interest organizations in absolute power….”
Spoken like a true Marxist/socialist. Any more power to the people catch phrases you want to throw in, comrade?
One more for you, Mike Volpe. Comments by Sandy Praeger. Kansas insurance commissioner and president of the National Association of Insurance Commissioners, on selling policies cross state.
It is a shame that some Americans are so gullible, to the outlandish propaganda and lies spat in the newspapers, television and radio about Obama’s health care agenda. They have demonized the British, Canadian and other worthy plans. Hidden under a disguise cover, these radical entities are determined to keep the special interest organizations in absolute power. Comprising of the money-draining profitable insurance companies and their rich stockholders. They don’t want any changes to the broken system of medical care, because it will hurt the status quo. I was born in England, in the county of Sussex and until the inception of the European Union and the European Parliament dictating to Britain. That they must accept millions of foreign workers, the nations medical system was exemplary. I never had to wonder if I would have to file bankruptcy, to pay my medical bills, or listen to the incessant ring of debt collectors on the phone.
On several occasions I ended up in the cottage hospital and their was never a cost applied to it, never a ream of paperwork. Incidentally, I choose my own doctor where I Lived. The longest I waited for surgery was three months, as it was not an emergency. No doctor, no hospital or specialist asking me for my Social Security number, drivers license or if I was covered by a predatory for-profit insurer. No premiums, no-cops and pre-existing condition clauses. Yes! Didn’t have a private room, but who cares? Today the British Isles is being submerged under a barrage of legal and illegal immigrants, who have never paid into the system, have caused some rationing. Prior to the importation of foreign labor my trips to doctor, to hospital, the eye or a dentist was paid from my taxation. Unless we pass a national health care agenda, Americans will never know what it’s like to breeze through their lives, without worrying about paying for health care? Tell your Senators and Congressman you want an alternative to the–GET RICH– insurance companies, before a Universal health care is killed. 202-224-312 REMEMBER THE INVESTORS AND STOCKHOLDERS DON’T WANT THEIR PIECE OF THE $$$TRILLION$$$ DOLLAR PIE DISTURBED. EVEN SOME POLITICIANS HAVE THEIR DIRTY FINGERS IN THE PIE?
AS AN ALTERNATIVE TO THE PRIVATE HEALTH CARE, A GOVERNMENT SINGLE PAYER SYSTEM WILL ASSIST IN REVITALIZING THE WILTING US ECONOMY.
Spaeking of propaganda and hoping we are gullible…
Yeah, I am going to get health insurance I don’t pay for and don’t get taxed on but I am going to refuse it and on top of it not work for that company. I live in the real world.
The problem is that when insurance is provided and untaxed then people go for the most gold plated. As such, everything is covered. So, the never question any costs. Any and all tests are fine since they aren’t paying for it. Of course, that’s not what health insurance was meant for. Health insurance was meant to cover those costs you can’t afford. If you paid for health insurance yourself, that’s the type you’d get because it’s the cheapest. Instead, we have a system where your company gets it for you and you pay no taxes on it, and so you get the most expensive one. that just makes no sense. That’s one of the main reasons that health care costs are so expensive. Patients are no longer consumers.
So, you tax health insurance benefits like any other income. That discourages people from getting the gold plated health insurance. Second, you provide massive tax credits for health savings accounts and you encourage people to get health insurance on their own. That way the patient is in charge. If insurance companies treat their doctors poorly, and this happens routinely, the patient walks and finds another insurance company. That doesn’t happen now since you can’t walk since someone else is paying for it.
Second, you need competition. BCBS can’t have 40% of the Texas market. This means any doctor working in Texas has to be a part of their network. So, routinely, BCBS will cut fees that doctors attempt to collect. What’s a doctor to do. If they complain, BCBS just cuts them out. It’s not like their patients can go to a different insurer. There are none and besides their all under their employer’s plan.
So, you remove the exemption from Sherman and you allow helath insurance companies to cross state lines, like all other forms of insurance. Why can car insurance cross state lines but not health insurance?
What are you talking about, Mike? Depending the state, the DMV requires you get insurance from a carrier licensed in your state of residence. I can’t call a Nevada insurer to issue coverage on my Oregon auto. Some exceptions to that… college, military deployment, having a car at a vacation home, etc.
Additionally, some states have different minimums. Some are no fault, some at fault. Hang, even AAA’s California coverage and membership is different than Oregon’s AAA, and doesn’t cross state lines.
I repeat, I can’t demand a gas station in California supply me with cheaper fuel meeting Iowa standards when state laws impose their own regs on fuel sold in California. You simply cannot toss the 10th Amendment aside anytime you want.
Now if you’re just talking about traveling… whether your health insurance or your auto insurance… both may fully cover your hospital stay or accident, based on the policy issuer and their networks. Many have a nationwide network anyway and can provide you with a list of facilities that recognize all or most of your coverage. But no states have any law that states they must recognize an out of state insurer.
You keep harping on Texas. So I had a look to see what all your tadooooo was about (since you don’t provide any hotlink references)…
And one of the first things I found from the Dallas News this past May – talking about the efforts to make insurers loss figures public – was an interesting sidebar of data.
Obviously, if half of all the employed Texas are getting coverage thru self-insured corporate plans, that “40%” you are annoyed about with Blue Cross constitutes is not emcompassing all Texans with insurance… and probably doesn’t include those in the high risk pool. So I have no idea where you are deriving your figures or summations INRE a supposed “monopoly”.
Frankly, this is so far off topic of how the House/Senate/Obama/Romney plan are a prescription for disaster that I’m reticient to further debate you on “regional monopolies”, real or imagined. I don’t know the stats on Texas insureds who are opting for PPO vs HMO, and most nation wide companies (i.e. Blue Cross) offer both. But according to the Texas Dept of Insurance, there’s 40 health maintenance organizations that provide coverage to 99.9% of Texan HMO market, and the top 40 accident and health companies
provide coverage to 83 percent of the state’s insurance market.. (See Texas Association of Health Plans 2008 report)
Somehow, I’m not getting the impression that Blue Cross is the lone ranger there, sans competition.
Also notable in that report was some 2006 national stats that stated almost 60% of the 84% of the nation’s insured were getting that coverage thru their employer-paid plans. Plans that insure you regardless of health status. Individually purchased plans require applications and approval prior to receiving coverage. This brings me to your first remark:
So you’re the kind of guy who, when someone brings you a chocolate cake for your birthday, eats it and all the while whines that it’s not a NY cheesecake instead?
@ Brittancus
Well hell, why didn’t you say so. We don’t have a problem in the States with illegals not paying into our tax system. I’ll be calling that number today and resting like a baby knowing my government is going to pay for my healthcare.
Oh, and if it’s so good in jolly ole England, don’t let Lady Liberty hit you in the ass on the way back.
Brittancus posted the exact same comment (?) on American Thinker today. You don’t suppose he’s a …gasp! _spammer_ … do you!!!!
Though to what end, I have no idea.
But of course, suek. But I hought it was worthy of digging out of spam. I do so love exposing the left – using their own words – for what they are… socialist/Marxists.
I’ve read the post, very nice as usual. One thing that has come up in the comments is employer health insurance. I know, off topic. I have to say, I hate employer health insurance programs. If I had my way, you’d walk into State Farm and get your health insurance just like any other insurance. I have my cars, homeowners and life insurance through State Farm and get a great deal. Toss in the health care and let people control their own insurance. I didn’t retire from the Air Force, which I regret sometimes, so I’m in the same boat as everyone else. If you get a better job offer, you have to take into account the health care plan. Preexisting conditions, you better hope you don’t piss off the boss. Then of course, take care of the lawyers. Without tort reform, costs will never be under control.
As for the post itself, there is no such thing as a free lunch. How can you move to limit personal earnings while using the rich to pay for all your programs. Socialism just doesn’t work, no matter who tries to institute it, even the messiah.
At this point, Aqua, I’d say employer health plans is very on topic via the comments. LOL
INRE those thru the employer, they do cover everyone without a health exam. As for the preexisting conditions, I’m not sure. They have to take them regardless of health, but I’d say some accept the preexisting conditions (it’s not unheard of), and some don’t. Now private insurance? You need to “apply”, be examined, and may still have the preexisting conditions limitations upon acceptance.
But since you would like to purchase with your auto, homeowners and life with State Farm, why don’t you call them and get a quote? Here’s their site for their Health Insurance plans So what you ask isn’t impossible. And I’d love it if you posted back here their quote for you, family, etal.
I see no reason why more insurance companies cannot provide competitive plans as an alternative. No problems with that. I have problems with the government dictating standards, demanding data reporting based on race, gender, income, community and education… plus sharing that with every federal agency and whomever else they want. And I sure don’t want them offering plans subsidized with taxpayers money. I can flush the greenback down my own toilet, thank you.
I have yet to have heard a single “Obama Plan” supporter explain in any detail how this plan will “reform” health care or as they claim, make it less expensive. Shifting the costs does nothing to lower costs it just stick some other poor sucker with the bill.
The “we gotta do it NOW” attitude reinforces my opinion that this is a “snake Oil” scam.
@ Mata
I’ll check into it, but I’m sure it will be more than I’m paying through my employer. But probably not by much. I work for a small company. We have 75 employees. My health insurance is free, but for my wife and my son, I pay $16,800 a year. I have a high co-pay and a $1500 per person per year hospital deductible. Congress shot down the association bill that the republicans tried to put through a few years ago. It would have allowed small companies like mine, to band together with larger companies that do the same work. This would have done two things. It would have dramatically lowered our healthcare costs and it would have provided some portability. That would have made sense.
As for the rest of your comment, I agree…whole heartedly.
Totally agree with the forming of new alliances to get group plans prices down for people, Aqua. It’s one of cures I advocate the most… the ability for more to “buy in bulk”.
Looks like you’re still cheaper than MA, Aqua. But I would be very curious to see if the prices are similar, and if there is a huge difference between the coverage specifics.
I read yesterday that TennCare, another plan that’s been around and metastasizing out of control annually, is cutting 150,000 from their enrollees. Plus their time in the government healthcare biz has been fraught with fraud (insured dead people and out of staters), and made them one of the highest prescription drug using states to boot.
@ Mata
So where is the government coming up with this magic $12,000 number? I keep hearing that if your health care plan is more than $12,000, it is a “cadillac” plan and anything over that will be taxed. I certainly don’t see my plan as a cadillac. More like a Prius.
And looking at the new California budget, looks like a lot of old folks and kiddies are losing their plans. These guys just don’t learn. I think the honestly believe the only reason socialism doesn’t work is because no one has tried it their way.
I guess they mean the “gold plated” insurance when they say “cadillac”. Don’t know for sure, but that’s my guess.
They’re talking “national averages” there. Definitely skewed because, as Mike Volpe and I were sorta side discussing, there are some states that are over regulating their health insurers, and driving up that state’s costs… i.e. NJ, NY. When you average their overpriced plans with other states more reasonable regulation and lower state costs, you get a nice round number that has nothing to do with any of us sitting in a particular state.