3M stopping retiree medical

[GregLee]

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Originally Posted by jebmke There are many people, despite having the technical capability to do so refuse to file their taxes electronically and/or have their refund direct deposited to their bank account ...

I am among those. I've never found a reason to file electronically -- usually it would have cost me more, because I'd have to pay for some program or processing service. Why should I do that? And getting a refund faster would be no use to me, because I never get a refund. I'm waiting for some incentive to be offered.

[jebmke]

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Originally Posted by GregLee I am among those. I've never found a reason to file electronically -- usually it would have cost me more, because I'd have to pay for some program or processing service. Why should I do that? And getting a refund faster would be no use to me, because I never get a refund. I'm waiting for some incentive to be offered.

Well in that case we should eliminate e-filing altogether.

[ERD50]

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RE: If this change was clearly better, resistance would be minimal. I agree we need change. -ERD50

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Originally Posted by jebmke Sadly this is often not the case. .... Years ago when direct deposit was being introduced in payroll processing my employer struggled to get acceptance. Despite special incentives (free bank account at a designated, national bank) and the obvious advantage of getting cash in your bank account earlier, employees refused to sign up for direct deposit. We finally had to make it mandatory.

I agree with you in that I think direct deposit is better. But if a significant % of people were resistant, it wasn't "clearly better" to them (the old saying that perception is reality). It might be a matter of better education of the advantages, or dispelling any unfounded fears, or maybe "baby steps" to build confidence/trust?

The "DO NOT CALL" list received overwhelming public support. It was clearly better. Sure, Health Care is more complex, and bad information was thrown all around. But the bill even over-complicated a complex situation (not going to re-hash all those details again), and a significant number of people were put off by that. It just wasn't/isn't "clearly better" to many people.

-ERD50

[samclem]

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Originally Posted by jebmke Well in that case we should eliminate e-filing altogether.

No, E-filing should be free for anyone. The IRS issues tons of propaganda each year claiming that e-filing saves them abiut $15 per return. Okay--then why does it cost me anything to efile? Shouldn't the government be encouraging it? If anything, they should charge people who file onpaper. IIRC, The IRS cut an unholy deal with software providers and e-file servicers in which the IRS agreed to not provide free efiling for most customers.

Nope, they get paper copies from me. It's cheaper and really no more trouble (for me).

And if I have to file a bunch of 1099s due to the new health care "reform" law, those will be on paper, too. Written in crayon and crumpled up in the envelope. With similar copies (sans SSAN) to every legislator who voted for that abomination.
But, I'm not disgruntled or anything.

[huusom]

I have to say that peoples on this forum are very informed about health care problems we're facing.

However, most of my friends who are covered by employer provided health insurance have absolutely no ideas what they really cost. They are so surprised when I told them what it will cost them if they have to purchase insurance for themselves. They all agree that reform is needed once this is known to them.

[jebmke]

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Originally Posted by ERD50 I agree with you in that I think direct deposit is better. But if a significant % of people were resistant, it wasn't "clearly better" to them (the old saying that perception is reality). It might be a matter of better education of the advantages, or dispelling any unfounded fears, or maybe "baby steps" to build confidence/trust? The "DO NOT CALL" list received overwhelming public support. It was clearly better. Sure, Health Care is more complex, and bad information was thrown all around. But the bill even over-complicated a complex situation (not going to re-hash all those details again), and a significant number of people were put off by that. It just wasn't/isn't "clearly better" to many people. -ERD50

That was my point. Even in the face of fairly straightforward evidence people didn't want to change (the direct deposit -- I agree, the HC issue is more complex). I find this is fairly typical. When I was working I found it easy to quickly categorize people into three groups. (1) likely to change and would lead change (2) reluctant to change but would change when lead properly and (3) against change and often would resist. Often the last group would self-select and leave on their own. Occasionally they had to be assisted out the door.

Speaking of do not call. Have you seen the new one -- "do no kill"?

New 'Do Not Kill' Registry To Allow Americans To Opt Out Of Being Murdered | The Onion - America's Finest News Source

[youbet]

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Originally Posted by huusom I have to say that peoples on this forum are very informed about health care problems we're facing. However, most of my friends who are covered by employer provided health insurance have absolutely no ideas what they really cost. They are so surprised when I told them what it will cost them if they have to purchase insurance for themselves. They all agree that reform is needed once this is known to them.

Do your friends realize that the "reforms" identified so far do little or nothing to reduce the aggregate cost of healthcare to American society? In fact, some are saying that unsubsidized health insurance premiums may actually increase as a result of the current set of reforms.

We seem to have a little ways to go yet in terms of controlling costs.

[huusom]

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Originally Posted by youbet Do your friends realize that the "reforms" identified so far do little or nothing to reduce the aggregate cost of healthcare to American society? In fact, some are saying that unsubsidized health insurance premiums may actually increase as a result of the current set of reforms. We seem to have a little ways to go yet in terms of controlling costs.

I did not say that the current reform is the way to go but reform is needed. I agree that meaningful cost control is not really addressed in the current reform. This is where we should focus our efforts. Instead of repealing the reform we should make it better so more americans are covered for less.

[ziggy29]

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Originally Posted by huusom I did not say that the current reform is the way to go but reform is needed. I agree that meaningful cost control is not really addressed in the current reform. This is where we should focus our efforts. Instead of repealing the reform we should make it better so more americans are covered for less.

I've said it before and I'll say it again: Get control of costs and health care inflation FIRST, and then any reforms concerning underwriting and universal access become MUCH easier to tackle. Instead, we focused on a couple of small chimpanzees in the room while ignoring the 800-pound gorilla that's responsible for most of the damage.

[youbet]

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Originally Posted by huusom I did not say that the current reform is the way to go but reform is needed. I agree that meaningful cost control is not really addressed in the current reform. This is where we should focus our efforts. Instead of repealing the reform we should make it better so more americans are covered for less.

Well, whether we repeal what's already been done and replace it with something better or we heavily modify the current proposal to get it in line with what is actually needed, costs will need to be controlled. It gives me a headache trying to think of things we should give up to keep costs down....... It's going to take a lot more, a LOT MORE, than just cutting out the fat to make things affordable in the future. Our politicians seem to be struggling to have the will to tell us that.......

[youbet]

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Originally Posted by ziggy29 I've said it before and I'll say it again: Get control of costs and health care inflation FIRST, and then any reforms concerning underwriting and universal access become MUCH easier to tackle. Instead, we focused on a couple of small chimpanzees in the room while ignoring the 800-pound gorilla that's responsible for most of the damage.

IMHO, you've got the picture in focus Mr. Zig......

[dex]

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Originally Posted by ziggy29 I've said it before and I'll say it again: Get control of costs and health care inflation FIRST, and then any reforms concerning underwriting and universal access become MUCH easier to tackle. Instead, we focused on a couple of small chimpanzees in the room while ignoring the 800-pound gorilla that's responsible for most of the damage.

I'm going to disagree with you on this one. The cost reduction proposal is the "one variable" (non) solution. It ignores the other variables. Most are looking at the expense aspect and not the revenue aspect.


Participation in health ins plans is going down faster than costs can be cut.

Participation in health ins. is going down due to companies eliminating it, jobs going overseas, healthy people not buying it, and in the future people moving to the gov't plan. So fewer people paying in means higher premiums (also, if you are sick you make sure you pay your premiums & you also increase costs).

So the question will be what comes first - cut medical costs to make it affordable and people participate or somehow lower premium cost (without regard to medical costs) so people participate (how would health ins cos. stay in business when losing $)?

Of course, the answer will eventually be neither - health costs will be 'nationalized'.

[samclem]

Both "getting costs under control" and "eating the elephant one bite at a time" sound very attractive right now, since we are now experiencing the problems of a "do everything at once" reform that also didn't control costs.

But, the problem with "controlling costs" is that there are two fundamentally different ways to do it, and how we to control costs affects the whole future of the effort:
-- Centrally-managed top-down price controls (e.g. the government will allow a charge of $168 for the MRI of one knee). We know that this approach produces scarcity, waiting periods .
-- Market forces: (co-pays that make patients aware of costs, competition between insurers and between providers to reduce prices). We know that this approach will hit poor people hardest.

There is a little "low-hanging fruit" than can be harvested one-bite at a time (tort reform, Medicare fraud and waste, govt-provided info on outcomes, etc), but much of the rest of the incremental reforms will only make sense if we know which general direction we are headed: Market based or "the borg."

[GregLee]

Quote:

Originally Posted by ziggy29 Get control of costs and health care inflation FIRST, and then any reforms concerning underwriting and universal access become MUCH easier to tackle.

I'm sure that is so. But since we never will get control of costs, waiting for universal access until we do would just mean we never would get universal access. So the statement of a truism becomes a code meaning `Forget about universal access'.

[traineeinvestor]

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Originally Posted by samclem Both "getting costs under control" and "eating the elephant one bite at a time" sound very attractive right now, since we are now experiencing the problems of a "do everything at once" reform that also didn't control costs. But, the problem with "controlling costs" is that there are two fundamentally different ways to do it, and how we to control costs affects the whole future of the effort: -- Centrally-managed top-down price controls (e.g. the government will allow a charge of $168 for the MRI of one knee). We know that this approach produces scarcity, waiting periods . -- Market forces: (co-pays that make patients aware of costs, competition between insurers and between providers to reduce prices). We know that this approach will hit poor people hardest. There is a little "low-hanging fruit" than can be harvested one-bite at a time (tort reform, Medicare fraud and waste, govt-provided info on outcomes, etc), but much of the rest of the incremental reforms will only make sense if we know which general direction we are headed: Market based or "the borg."

+1

Most of the debate is either about controlling the costs (and then wondering why there is a scarcity issue) or figuring out who pays what (preferrably someone else). However, I see a lot less debate about the supply side which has (potentially) at least two pieces of low hanging fruit:

1. recognise a wider range of over seas medical and nursing qualifications and encourage people with those qualifications to immigrate;

2. better tax breaks and other incentives for providing medical facilities and equipment.

I do not know enough about the industry to comment on how realistic these are?

Then, or course, there is the possibility of compelling incentivising people to lead healthier lives.

[Emeritus]

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Originally Posted by ERD50 It depends. Change is easy to accept if it is clearly better than the status quo. I could give numerous examples, one being the fact that you are posting this rather than handwriting a snail-mail letter-to-the-editor. If this change was clearly better, resistance would be minimal. I agree we need change. -ERD50

Clearly better to WHOM? If you have control of a key node in any network so that you can extract monopoly profits, You hate change and its worth a lot of money to You to stop it. voila you buy some polticians and it's stopped.

There is more "heat " in a swimming pool than in a match, but only a match can start a fire. It is the structure of power and the existence of a vulnerable node that allows change, good or bad. "Clearly better" means nothing if the people who want change are diffuse and it requires concentrated action.

Take radiology and the use of state licensing laws to eliminte the cost saving of Teleradiology. A few wealthy radiologists can buy enough legislators to defeat the shift.

[Richard8655]

This is why I applied for (and got) residence in Canada. Guaranteed health coverage at minimal or no charge, regardless of age or employment status.

[samclem]

Quote:

Originally Posted by traineeinvestor . . . However, I see a lot less debate about the supply side which has (potentially) at least two pieces of low hanging fruit: 1. recognise a wider range of over seas medical and nursing qualifications and encourage people with those qualifications to immigrate; 2. better tax breaks and other incentives for providing medical facilities and equipment. I do not know enough about the industry to comment on how realistic these are?

I'm not sure how much would need to be done to increase supply. There are indications that there is excess supply right now (many communities have excess hospital bed capacity, the wait times for sophisticated diagnostics is short and frequently high-capital-cost equipment is only used during "normal" business hours, etc). We deliberately limit the number of med school slots to help keep the wages of physicians higher (thanks AMA).

Still, just because we have enough health care providers now doesn't mean we'll have enough if insurance is expanded and demand increases. But, at least by some indicators, there's no shortage right now.

Regarding tax breaks for medical equipment--it's interesting that the present "reform" does exactly opposite, applying a tax to various bits of medical equipment.

[ERD50]

RE: easy to accept "clearly better" change:

Quote:

Originally Posted by Emeritus Clearly better to WHOM? If you have control of a key node in any network so that you can extract monopoly profits, You hate change and its worth a lot of money to You to stop it. voila you buy some polticians and it's stopped. There is more "heat " in a swimming pool than in a match, but only a match can start a fire. It is the structure of power and the existence of a vulnerable node that allows change, good or bad. "Clearly better" means nothing if the people who want change are diffuse and it requires concentrated action.

Agreed. But this Gallup poll asks -

Taking everything into account, do you think in the long run the new healthcare bill will make the U.S. healthcare system [ROTATED: better, would it not make much difference, (or make it) worse] -- than it is now?


Healthcare System

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2010 Mar 26-28 Better - 42% Not much difference - 11% Worse - 45% No opinion - 2%

edit/add: So, regardless of any powerful monopolies, the American public does not see Health Care Reform as "clearly better". That was my point regarding "acceptance".

further edit/add: I just scrolled down to the detail of that Gallup poll - when they ask specifics, the "Worse" tally is far greater than the "Better" in almost every case - cost, quality, "coverage".


-ERD50

[Emeritus]

Quote:

Originally Posted by ERD50 RE: easy to accept "clearly better" change: Agreed. But this Gallup poll asks - Taking everything into account, do you think in the long run the new healthcare bill will make the U.S. healthcare system [ROTATED: better, would it not make much difference, (or make it) worse] -- than it is now? Healthcare System edit/add: So, regardless of any powerful monopolies, the American public does not see Health Care Reform as "clearly better". That was my point regarding "acceptance". further edit/add: I just scrolled down to the detail of that Gallup poll - when they ask specifics, the "Worse" tally is far greater than the "Better" in almost every case - cost, quality, "coverage". -ERD50

Oh for goodness sake
How the hell would they know?


Supposed they were asked

Do you approve of the Death panels enacted into the new health care law?

Etc
CBS) Most Americans do not accept the theory of evolution. Instead, 51 percent of Americans say God created humans in their present form, and another three in 10 say that while humans evolved, God guided the process. Just 15 percent say humans evolved, and that God was not involved.
Poll: Majority Reject Evolution - CBS News
The world is full of people who will believe ANYTHING