Posted: Sun Mar 28, 2010 8:37 pm
Mainly @Cheyd
I'm both sad and happy that I haven't had the time to contribute more to this.
Happy in the sense that a number of people have contributed their feelings about their health care systems in other countries.
In your last post, you've exposed a sort of "plot" of this plan to lead us to single payer, which you frame as a bad thing. I can only speak in terms of policy and expectations, but there's people, completely unsolicited by me, who say "I live with a single payer health care system, and it's fine". The world has not collapsed for them. I don't understand your blanket objection to it.
In the 60's, with the passage of Medicare (senior citizen med benefits), many of the same claims of ruin of health care and freedom in the US were made. Can you see senior citizens being able to obtain adequate private insurance in this day of "pre-existing conditions" can you see any group of private non profits reliably, seamlessly covering their care ?
The bill with immediate changes have passed, no public health plan was added to it. So what if it had. The way it was written earlier, was that it was simply another health insurance plan, that was required to support itself with the premiums it collected. So it would have simply been another competitor, what would have been wrong with that?
Is there a different solution?
If the other party had different solutions to this problem, they could have proposed, during the time that they controlled the Presidency and Congress under Reagan or Bush II. They chose not to.
More specifically
I can't find backup for some of the claims you make in your most recent post.
Here's the page with the text and summaries of the law (no longer a bill)
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
There's no truth to the massive hiring of IRS agents for audits (or otherwise). If you don't believe me, here's a video of the IRS Commissioner telling Congress the same thing 3 days ago.
http://www.youtube.com/watch?v=sluAS6Z5MEU
Relevant part:
REP KIND: And IRS agents are not going to go out and auditing taxpayers to verify if they have obtained acceptable health insurance, will they?
IRS Commissioner SHULMAN: No.
The bill is paid for by a combination of taxes on Pharmaceutical, Health equipment and insurers, a tax on those making over $200,000/yr and those with health plans costing over $10,000/yr. While an argument could be made that industry taxes could be passed down, that's hardly the same things as claiming the middle and poor will support it. If you have a link saying that it supported by the lower and lower middle class, than I would be very interested to see it, because it would be new to me and not much is new to me in this specific policy area. You are entitled to your own opinions, but not your own facts.
The Exchange (health ins for individuals). On the one hand, you are against that people are forced to buy insurance, on the other, you are upset that the penalty for not buying isn't harsh enough to insure compliance. I don't think you can have it both ways. (BTW it's not $1500, it's 2% of your income). Either the mandate is awful, or it should be properly enforced. 17% of people are uninsured. That is the part of the population the Exchange is aimed at. Of this, some will get insurance through their employers (more below). Both Netherlands and Switzerland have similar system of mandatory purchase of individual insurance, I don't know the penalties in those countries, but neither has 'collapsed' into single payer. Both spend less per capita than we do. While I would like to see stronger penalties for those above the 8% threshold I doubt many of the the people involved will jump back and forth. Most people pay their taxes despite, not owing enough to trigger action by the government. Most people tend not to be that financially ruthless. Insurance companies, on the other hand, will work hard to get each healthy person into a federally regulated plan with subsidies. But as mentioned before, in the small chance that there is a 'collapse', if the result is single payer, I don't see the problem.
Given the choice between two exact same jobs, one with health insurance and one with out, people would choose the one with it. employers aren't going to be suddenly withdrawing health insurance in a concerted manner without offering something to replace it in monetary terms.
More specifically, I think you are misinformed on some of your claims.
There is a wide area between the minimum acceptable coverage and when the tax for a $10,000 kicks in. I have an HMO covers most of everything. $10 visits including specialists, discount drugs,low cost outpatient and no cost inpatient. It costs $8,000 a year. Well under the Excise tax limit (which doesn't even start until 2018!). Employers deduct insurance premiums from their taxes
Small businesses (50 employees and under) will get a 35% credit on their premium costs, going up to 50% in 2014. Large businesses (50 or more) pay a fine, as you mentioned, if they don't provide good coverage.
But I don't see where you get the idea that not offering coverage at all allows them to escape that fine. It doesn't. NO coverage is not offering good coverage. again if you can provide a link. I want to see it.
Costs:As it is, our health care spending costs are 16% GDP, far more than any country in Europe or Japan. Saying that we are shifting a sector to govt control is hyperbole and you admitted as such above. This is a solution and abetter than the status quo. The CBO states that it will reduce the deficit, by 100 billion over 10 years. I haven't checked the costs of Medicare, yet even the most deficit conscious Presidents didn't kill it.
Other solutions (tort reform, plans crossing state lines, health savings accounts, catastrophic plans):
Plans across state lines. Without regulation similar to that in the new law,
Insurers would simply pick up stakes, and base themselves in the state with the most lax insurance regulations. Consumers would be the big losers. That's exactly what happen with credit card issuers and would happen with health insurers.
Health Care saving plan/Medical savings plans: These accounts only work in as far as a person makes enough money to put some into the plan to begin with. Someone making $10/hr (or unemployed) can't take advantage of the tax benefit, they are too busy paying for rent and food. And even if they could , the tax advantage isn't great for them, since they aren't at a high bracket to begin with.
If you give people a fixed amount of money into that account to pay for health insurance, you run into all the cost/deficit arguments that you made before. Without regulation, the insurers will simply boost the price by the amount of the subsidy,which will do nothing for health care costs.
Catastrophic plans.
Personally, I think Catastrophic plans go the wrong way, by only insuring against big things, but requiring high deductibles and ordinary costs to be born by the person. This put incentives to avoid regular care, and in some cases it is possible to have this kind of plan and yet still not afford to get care.
Nonetheless, the health care reform law allows exchanges to offer catastrophic plans to people under 30. (Sec 1302, but take my advice and read a summary, the actual text is longer than this post!). So that solution is part of the overall law.
Now there's nothing in current law to prevent these ideas from being tried concurrently, so if some have merit, they should be tried, but they aren't an answer.
While not a perfect bill (now a law), there is much to be admired in it and it represents a clear move to the better in my point of view.
I'm both sad and happy that I haven't had the time to contribute more to this.
Happy in the sense that a number of people have contributed their feelings about their health care systems in other countries.
In your last post, you've exposed a sort of "plot" of this plan to lead us to single payer, which you frame as a bad thing. I can only speak in terms of policy and expectations, but there's people, completely unsolicited by me, who say "I live with a single payer health care system, and it's fine". The world has not collapsed for them. I don't understand your blanket objection to it.
In the 60's, with the passage of Medicare (senior citizen med benefits), many of the same claims of ruin of health care and freedom in the US were made. Can you see senior citizens being able to obtain adequate private insurance in this day of "pre-existing conditions" can you see any group of private non profits reliably, seamlessly covering their care ?
The bill with immediate changes have passed, no public health plan was added to it. So what if it had. The way it was written earlier, was that it was simply another health insurance plan, that was required to support itself with the premiums it collected. So it would have simply been another competitor, what would have been wrong with that?
Is there a different solution?
If the other party had different solutions to this problem, they could have proposed, during the time that they controlled the Presidency and Congress under Reagan or Bush II. They chose not to.
More specifically
I can't find backup for some of the claims you make in your most recent post.
Here's the page with the text and summaries of the law (no longer a bill)
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
1) Everyone is not required to BUY insurance, people are required to HAVE insurance. If you get insurance the govt through Medicare (retiree pension), Medicaid (very poor), or through your employer. You have it and don't have to buy it. If you can't find good insurance for below 8% of income, you don't have to buy it and you avoid the penalty.The current law mandates that everyone is forced to buy insurance, and goes so far as to hire 16,000 additional tax agents solely to review people's insurance coverage and determine if it meets some arbitary minimum level. The goverment will provide subsidies for low and mid income families, but it also places the majority of the tax burden on that same group (figure I read was over 60% will be placed on families making within 300% of the poverty level - ie. $66K for a family of 4
There's no truth to the massive hiring of IRS agents for audits (or otherwise). If you don't believe me, here's a video of the IRS Commissioner telling Congress the same thing 3 days ago.
http://www.youtube.com/watch?v=sluAS6Z5MEU
Relevant part:
REP KIND: And IRS agents are not going to go out and auditing taxpayers to verify if they have obtained acceptable health insurance, will they?
IRS Commissioner SHULMAN: No.
The bill is paid for by a combination of taxes on Pharmaceutical, Health equipment and insurers, a tax on those making over $200,000/yr and those with health plans costing over $10,000/yr. While an argument could be made that industry taxes could be passed down, that's hardly the same things as claiming the middle and poor will support it. If you have a link saying that it supported by the lower and lower middle class, than I would be very interested to see it, because it would be new to me and not much is new to me in this specific policy area. You are entitled to your own opinions, but not your own facts.
The Exchange (health ins for individuals). On the one hand, you are against that people are forced to buy insurance, on the other, you are upset that the penalty for not buying isn't harsh enough to insure compliance. I don't think you can have it both ways. (BTW it's not $1500, it's 2% of your income). Either the mandate is awful, or it should be properly enforced. 17% of people are uninsured. That is the part of the population the Exchange is aimed at. Of this, some will get insurance through their employers (more below). Both Netherlands and Switzerland have similar system of mandatory purchase of individual insurance, I don't know the penalties in those countries, but neither has 'collapsed' into single payer. Both spend less per capita than we do. While I would like to see stronger penalties for those above the 8% threshold I doubt many of the the people involved will jump back and forth. Most people pay their taxes despite, not owing enough to trigger action by the government. Most people tend not to be that financially ruthless. Insurance companies, on the other hand, will work hard to get each healthy person into a federally regulated plan with subsidies. But as mentioned before, in the small chance that there is a 'collapse', if the result is single payer, I don't see the problem.
Employer insurance. Even under voluntary insurance, the offer of employer based insurance was a very valuable benefit. It will continue to be so.On the business side, if a company doesn't offer a "good enough" insurance plan, they are subject to fines. If they offer too good of one, their employees must pay a "cadillac tax". But, if they just say "screw it" and don't offer any, they don't have to deal with being auditted, pay the same (and possibly more) in fines, and don't have their own out-of-pocket expenses for the insurance. Effectively, there is zero upside to the company offering their employees health care.
Given the choice between two exact same jobs, one with health insurance and one with out, people would choose the one with it. employers aren't going to be suddenly withdrawing health insurance in a concerted manner without offering something to replace it in monetary terms.
More specifically, I think you are misinformed on some of your claims.
There is a wide area between the minimum acceptable coverage and when the tax for a $10,000 kicks in. I have an HMO covers most of everything. $10 visits including specialists, discount drugs,low cost outpatient and no cost inpatient. It costs $8,000 a year. Well under the Excise tax limit (which doesn't even start until 2018!). Employers deduct insurance premiums from their taxes
Small businesses (50 employees and under) will get a 35% credit on their premium costs, going up to 50% in 2014. Large businesses (50 or more) pay a fine, as you mentioned, if they don't provide good coverage.
But I don't see where you get the idea that not offering coverage at all allows them to escape that fine. It doesn't. NO coverage is not offering good coverage. again if you can provide a link. I want to see it.
Costs:As it is, our health care spending costs are 16% GDP, far more than any country in Europe or Japan. Saying that we are shifting a sector to govt control is hyperbole and you admitted as such above. This is a solution and abetter than the status quo. The CBO states that it will reduce the deficit, by 100 billion over 10 years. I haven't checked the costs of Medicare, yet even the most deficit conscious Presidents didn't kill it.
Other solutions (tort reform, plans crossing state lines, health savings accounts, catastrophic plans):
I don't know where you got that. Texas passed strict tort reform in 2003 and in 2006, they still had one of the highest per capita health care costs in the US. McAllen, Texas has become a poster boy for high medical costs. California has had pain and suffering portion of malpractice awards capped since the 1970's. It's had no effect of health care costs or premiums either. Malpractice costs are about 1% of total health care costs. If you were to eliminate them completely, you wouldn't make a dent.Tort reform (limiting the liability a doctor has in a lawsuit) would have been an EXCEPTIONAL move, it's doing wonders in Texas
Plans across state lines. Without regulation similar to that in the new law,
Insurers would simply pick up stakes, and base themselves in the state with the most lax insurance regulations. Consumers would be the big losers. That's exactly what happen with credit card issuers and would happen with health insurers.
Health Care saving plan/Medical savings plans: These accounts only work in as far as a person makes enough money to put some into the plan to begin with. Someone making $10/hr (or unemployed) can't take advantage of the tax benefit, they are too busy paying for rent and food. And even if they could , the tax advantage isn't great for them, since they aren't at a high bracket to begin with.
If you give people a fixed amount of money into that account to pay for health insurance, you run into all the cost/deficit arguments that you made before. Without regulation, the insurers will simply boost the price by the amount of the subsidy,which will do nothing for health care costs.
Catastrophic plans.
Personally, I think Catastrophic plans go the wrong way, by only insuring against big things, but requiring high deductibles and ordinary costs to be born by the person. This put incentives to avoid regular care, and in some cases it is possible to have this kind of plan and yet still not afford to get care.
Nonetheless, the health care reform law allows exchanges to offer catastrophic plans to people under 30. (Sec 1302, but take my advice and read a summary, the actual text is longer than this post!). So that solution is part of the overall law.
Now there's nothing in current law to prevent these ideas from being tried concurrently, so if some have merit, they should be tried, but they aren't an answer.
While not a perfect bill (now a law), there is much to be admired in it and it represents a clear move to the better in my point of view.