McCain and Obama on the Issues

[chinaco]

Originally Posted by samclem

And here is the corollary to your "fact:" A business cannot pay less than what is required to keep their workers, or those workers will leave. Employers do not have to offer health insurance right now, do they? Of course not. Why do they offer health insurance? Because other employers offer it, and they will not attract the best employees without this perk. It is part of the total compensation package. Well, why do employers offer this type of special compensation. They get to pay for the health insurance premiums with before-tax money, and for this reason alone they can buy group health coverage at a lower price than you can. Is this fair? Why can't you buy your own insurance with before-tax money?

A particular employee with a particular set of skills and attributes is worth a particular amount. Period. Employees look at total packages of compensation today and make decisions on where to work. Once employer-paid insurance s eliminated, that employee is still worth the same amount to all businesses, and when they can't "pay" the employee with this perk, they'll find another way to keep him/her--probably with more $/hr. That's the way markets work. As Growing Older points out, the market is not perfectly efficient, but it's getting more efficient all the time (exhibit 1: Monster.com. The job info marketplace is more efficient than ever before. Exhibit 2: worker mobility stats--people are acting on the information).

That's what McCain's plan does. It levels the playing field and allows individuals to purchase their own insurance at the same cost employers now pay by moving the tax incentives from business to individuals.

Think of the present system: Would anyone deliberately design such an abomination? Why on earth should a person depend on his/her employer for health care? Do we depend on our employers to provide us housing? It's a crazy system, and Obama's plan calls for maintaining it.

McCain's plan isn't perfect, but it's a more fundamental reform that addresses some of the root problems with our system. Obama's plan equates to putting a rose on a garbage can.

That is how he implies it will work out. There is nothing to make it actually workout that way. Insurance premiums will continue to increase for individual policies and insuracne companies will redline individuals. Since individuals have no collective bargaining power to negotiate lower rates.

IMO McCain's plan is not worth pursuing. I am ok with using tax cuts for people that have to purchase insurance... but if he intends to keep healthcare in the private sector... more reforms are needed. Shifting the tax burden to the middle class that have healthcare benefits at work or through retirement is not very palatable to me.

McCain's plan puts it square on the back of Middle-Class America. The taxes for those benefits means nothing to a family that makes $250k a year or more. But to a family with combined income of $75k to $100k it is substantial. Plus he does not address other root problems... The health Insurance industry and how healthcare is administrated.

Health care has become a bread and butter issue for the middle class. the rising costs and lack of it through job loss is threatening the middle class... almost as much as a bad economy.


It is either a blind spot he has or is just lip service.

[Texarkandy]

I'm very pessimistic about govt solutions to health care

IMO
McCain's plan has a worthy conservative goal, but I don't think you would be able to get there from here without a whole lot of pain & it would take a considerable amount of time for the industry to adjust - thus it would never get off the ground.

Obama's solutions are, I believe, actually do-able esp given a Dem congress (if they can beat back the lobbyists - there would have to be some sort of gov. pay-off to the healthcare industry). Problem is the end-result will be government run socialized rationed health care (despite his claims to the contrary)

I confess a personal bias in that Obama would like to dump uninsurables into the Federal Employee Health Benefit Plan resulting in further coverage cuts & increase cost to me. (FEHB is my plan and part of my compensation package - not a "freebie" as some like to characterized it.)

[Brat]

Oh yah. Large employers use Benefits Managers in HR who have the knowledge and experience to evaluate insurer offerings, and they know the needs of their workforce. OPM has done a very good job for the Fed workforce. I see great opportunity for Consumer Reports or Checkbook to publish an analysis but nothing up front to negotiate except, maybe, AARP.

The one thing I don't want is the prohibition of services that some find offensive. I have no problem if some don't use those services, or if there is a policy that is designed for them, but don't force their beliefs on me.

Tex, we are similarly situated. What if OPM separated the policies so that the risk premium is evident and the additional cost paid not just by Fed employees/retirees?

[samclem]

Originally Posted by whitestick

In this potential new era of no employer supplied plans, how are we to negotiate to get the same level of coverage and benefits that we previously had.

This is how it might work (thiis is not necessarily McCain's plan, but this is what I would do if it were the Samclem/Palin ticket(
- There are a finite number of plan types--maybe five. Some are high deductible, some are low deductible, all have catastrophic coverage (this is what "insurance" is supposed to be for, after all). Have set, required l;abels ("A" though "E"). The small number of insurance types makes the packages standardized and significantly enhances the efficiency of competition in the marketplace. This is how the medicare suplement policies are sold. In addition, one of the main government roles will be to collect, tabulate and disseminate information to consumers about the actual performance of the insurers, so they can make informed choices. For example, in each region a consumer could see stats on average customer satisfaction, average out-of-pocket costs, wait times for various typical services, etc. That way, you have a pool of informed consumers who are looking at a number of similar products and the price is easily seen. This model works in almost every other part of American commerce, it provides great products and services at the lowest prices possible. t can work in health care, too. The market doesn't work now because of all the factors that reduce competition, and especially because there's no firm link between the consumer and the insurance company. In today's whacky set-up, who is the true customer of the insurance company? The employer you work for. As a patient, you are nothing but a PITA to the insurance company. And the employer has very little incentive to choose the insurance company that provides the best service to patients--the company wants to keep costs down, so they get the cheapest company they can. The fact that Obama wants to maintain this system tells me he doesn't understand what is wrong. When we establish the link between those providing the service and those receiving the service, we'll have won 90% of the battle in fixing health care insurance in this country (including the problem of rising health care costs).

Yes, there are lots of questions remaining (retirees with existing coverage under retirement plans, people who have trouble qualifying for insurance, etc.) Some are spelled out now in Obama's and McCain's plans, some aren't. The details scarcely matter anyway, as they'll be changed during the legislative process. But right now, the basic question is: Does it make more sense for employers to be making decisions about insurance for their workers, or should those receiving the insurance services make these decisions?

[Independent]

Originally Posted by growing_older

This may be a general ideal, but I don't think our employment markets are efficient enough to really make this happen. Unless I am lucky enough to have several open job offers at once, I am forced to accept a single given job or continue looking. I usually have only a vague idea of working conditions there until I work the job. I may have to take a lesser job and work up to one I really want. For many worker finding ANY job with an acceptable compensation and benefits package is difficult. I can refuse jobs which fall below my minimally acceptable threshold of compensation, but I can never know if I have made an optimal choice. If I am already employed and looking at moving to a new job, the situation is similar though maybe the urgency is less. I also have to consider that if I make too many job changes I may become less desirable to future employers and reduce my ability to obtain higher compensation. Yes, it is a free market in that job seekers can accept or reject jobs, but job changes are so infrequent (a few per lifetime) and job availability is generally so illiquid that the market is not as optimized as the quote seems to imply.

Certainly the labor market isn't perfectly efficient. I think it works both ways - employees don't always find the best job, employers don't always find the best employees. I'd expect the market to get more efficient if this tax change resulted in a move away from employer-paid medical insurance - mostly cash offers are easier for employees to evaluate than offers that include complex medical insurance.

Even if the market doesn't get more efficient, I think that employees would easily identify the loss of insurance as something that has to be offset with thousands of dollars of extra cash.

[Gumby]

Samclem:

I can see that you have given this careful thought. My question is this -- even if you establish the link directly between the insurance company and the "consumer" individual, is there any evidence that this will result in more responsive insurance companies with lower premiums? I tend to think not. The insurance company is in business to make a profit for its shareholders, not to tend to the health care needs of the people who buy insurance. They accomplish this by charging the highest premiums they possibly can and denying coverage whenever they can. I don't see that individuals stand much of a chance against your average insurance company.

For these reasons, I think we ought to get insurance companies out of the mix entirely. Because their duty is to make a profit for shareholders, even if they are beyond reproach, it is an unavoidable fact that not all the dollars people pay go to actual health care. I would support a national health care system.

[samclem]

Originally Posted by Gumby

Samclem:

My question is this -- even if you establish the link directly between the insurance company and the "consumer" individual, is there any evidence that this will result in more responsive insurance companies with lower premiums? I tend to think not. The insurance company is in business to make a profit for its shareholders, not to tend to the health care needs of the people who buy insurance. They accomplish this by charging the highest premiums they possibly can and denying coverage whenever they can. I don't see that individuals stand much of a chance against your average insurance company.

Granted, it is not a perfect analogy, but the auto insurance, home insurance, life insurance, etc markets seems to work fine. There's a healthy marketplace, and people are generally satisfied with their insurance (price and service) -much more satisfied than with their health insurance. In all these cases, the insured is the customer, and pays fees directly to the insurer. I don't think it's a coincidence that in the one case where the "who pays--who gets" association is different, the system doesn't work.

There do need to be adjustments to take care of some unique aspects of health care. For example, high risk individuals. McCain's plan calls for one answer (separate from the individual insurance market we've been discussing) and Obama's plan calls for a slightly different approach (again, totally separate insurance program distinct from the employer-sponsored plan he favors). I'd prefer a slightly different answer, but, again, this can be worked out later.

Regarding stockholders and profits-there's no reason these insurance companies can't be set up as "mutuals" whereby the people paying the premiums are also the stockholders.

The advantages of getting employers out of the health business are huge.

[chinaco]

Originally Posted by samclem

...
The advantages of getting employers out of the health business are huge.

Not sure if you work or not... but employers seem to be getting themselves out of the business anyway. They are shifting more cost to employees every year.

[samclem]

Originally Posted by chinaco

Not sure if you work or not... but employers seem to be getting themselves out of the business anyway. They are shifting more cost to employees every year.

That's another reason Obama's plan is not going to work. Employers are already throwing in the towel, and Obama's plan cals for keeping them in the game. He's either gong to have to induce them to stay in the business (that is, use tax money to subsidize the system that isn't working now) or just accept more people into >another< system where the person getting the service is not the customer. And the problem will continue. . .

[Texarkandy]

Originally Posted by Brat

Oh yah. Large employers use Benefits Managers in HR who have the knowledge and experience to evaluate insurer offerings, and they know the needs of their workforce. OPM has done a very good job for the Fed workforce. I see great opportunity for Consumer Reports or Checkbook to publish an analysis but nothing up front to negotiate except, maybe, AARP.

The one thing I don't want is the prohibition of services that some find offensive. I have no problem if some don't use those services, or if there is a policy that is designed for them, but don't force their beliefs on me.

Tex, we are similarly situated. What if OPM separated the policies so that the risk premium is evident and the additional cost paid not just by Fed employees/retirees?

"What if OPM separated the policies"?

You mean the United States Office of Personnel Management would be running an insurance program for a high risk pool of uninsurable citizens & illegal aliens who are not federal employees?

Well, long as they are going to be wards of the state and get part of the same compensation package I do, send em on down to my office - whatever their disabilities I bet I could find a few useful things for em to do!

Hey, how about this - let's find a large company (perhaps GM?) with a good health insurance program as part of the employee compensation package & dump em all into their risk pool! Then we could have those employees pick up some of the tab.

Or how about we mandate that all businesses who provide a health insurance program for their employees also allow any non-employee off the street to sign on into their risk pool with the govt paying the premium? Now there's "choice" in health care plans!

As to your other point about "services that some find offensive" - I really don't know what you are talking about - abortion?

[Texarkandy]

Originally Posted by samclem

That's another reason Obama's plan is not going to work. Employers are already throwing in the towel, and Obama's plan cals for keeping them in the game. He's either gong to have to induce them to stay in the business (that is, use tax money to subsidize the system that isn't working now) or just accept more people into >another< system where the person getting the service is not the customer. And the problem will continue. . .

I see it differently. I think Obama's plan will work. It's very simple in concept -

Employers will be mandated to either"
A. provide health insurance for their employees, or
B. pay a tax to the federal governments health care insurance system.

In the long run employers will find it cheaper to just pay the tax, therefore everyone will end up on the government run health care system - and that's the objective!

[Brat]

Originally Posted by Texarkandy

As to your other point about "services that some find offensive" - I really don't know what you are talking about - abortion?

Actually I wrote that.

Abortion, the "morning after pill", contraceptives, treatment derived from stem cells, and the like.

Texarkandy was reflecting on statements by some that the health plans offered to Federal employees/retirees and Congress should be available to all. What we were talking about is how that might change the risk profile that actuaries use to predict utilization... and ultimately the cost. Right Tex?

[chinaco]

Originally Posted by samclem

That's another reason Obama's plan is not going to work. Employers are already throwing in the towel, and Obama's plan cals for keeping them in the game. He's either gong to have to induce them to stay in the business (that is, use tax money to subsidize the system that isn't working now) or just accept more people into >another< system where the person getting the service is not the customer. And the problem will continue. . .

Which is why the basic system requires reform... not just who pays.

[Texarkandy]

Originally Posted by Brat

Actually I wrote that.

Abortion, the "morning after pill", contraceptives, treatment derived from stem cells, and the like.

Texarkandy was reflecting on statements by some that the health plans offered to Federal employees/retirees and Congress should be available to all. What we were talking about is how that might change the risk profile that actuaries use to predict utilization... and ultimately the cost. Right Tex?

Despite my familiarity with FEHB & a number of the plans offered, I'll have to admit I have no idea whether any/all of the above are currently proscribed or whether there is a plan afoot to do so.

[Brat]

FEHB does not limit reproductive services or treatment based on the issues mentioned. There are some providers who may not perform those services but the patient can change providers. The key is that the patient and the providers choose.

There are a number of plans offered, some national others local. HMOs and fee for service, different deductables. The employer pays a fixed amount, the employee the balance. There are no free options.

[JB]

Originally Posted by chinaco

A decent summary of the key issues. Mostly lists the economic well-being related items. But a pretty good overview.

When I read this... Obama edges McCain out on a number of issues.

Your Money: McCain vs. Obama - Issue #1: Election 2008 (1) - CNNMoney.com

Thanks for posting this Chinaco. Obama's tax plan is presented clearly here and is often misrepresented. McCain voted against the Bush's tax cuts two times claiming that the benefits disproportionately benefit the weathly (among other things.) Obama's plan restructures the tax cuts to provide more benefit to middle income people (couples earning less than $250,000, and singles earning less than $200,000).