Gotta Cover Those Pre-Existing Conditions

[M Paquette]

The poll is more a measure of the knowledge level and ideological orientation of the folks being polled than anything else. I need only look at the statements posted on various online forums to see the variation between what people believe they know and reality.

 

[athena53]

That would surprise me seeing as how the "Cadillac tax" never went into effect, is not scheduled to start until 2020, and may not even happen then.

OK, I stand corrected. I never liked the idea of the Cadillac penalty, anyway; allowing employees to compete for good people with enhanced benefits should be encouraged.

 

[ziggy29]

So, watching the debate tonight, all the candidates mentioned they'd not exclude based on pre-existing conditions no matter what form a future health care system would have. IMO, the pre-existing coverage is a good given as a starting point .

This is one of the aspects of health care reform that probably 95% of the people agree with. IMO, no way anyone messes with that directly. That said, this is only financially workable with a "mandate" that everyone be covered, one way or another. Will they all go that far? It sounds good to say we won't go back to the days of people being uninsurable because of preexisting conditions, but will they advocate a system that doesn't produce adverse selection?

 

[NW-Bound]

OK, I stand corrected. I never liked the idea of the Cadillac penalty, anyway; allowing employees to compete for good people with enhanced benefits should be encouraged.

+1

However, benefits such as healthcare should be treated as taxable income. Else, allow me and other people who pay our own healthcare premium to deduct it.

 

[Gone4Good]

OK, I stand corrected. I never liked the idea of the Cadillac penalty, anyway; allowing employees to compete for good people with enhanced benefits should be encouraged.

Many wonks blame the employer-centric method of delivering heath insurance for a variety of ills. Chief among them is that rising heath insurance costs have largely been masked as lower wages.

And because the ultimate user of the insurance doesn't have the first clue what they're paying for it, there's almost no demand response to price increases. Which means that prices can just go up without fear of losing customers.

Also tying your health insurance to your employment at Megacorp distorts the job market by raising the costs of job switching. As a result, fewer people leave big companies to work at smaller ones because they'll lose their insurance if they do. And up until recently that insurance might have been irreplaceable. Fewer still will leave to start their own business.

Wonks like the Cadillac Tax because it encourages us to move away from employer sponsored health insurance. Pretty much every one else hates the idea.

 

[ziggy29]

However, benefits such as healthcare should be treated as taxable income. Else, allow me and other people who pay our own healthcare premium to deduct it.

Agreed that it needs to be consistent, one way or the other. I tend to think the "health insurance tied to employer" model is a mostly bad one, and this tax treatment contributes to it. It works great for people who have very good employer group insurance (myself included). For everyone else, it pretty much sucks.

For one thing, the employer model mostly hides the cost of care. For another, it puts small businesses at a disadvantage in hiring good people because they can't offer the gold- or at least silver-plated health insurance many large employers can.

The Cadillac tax is a band-aid. It doesn't change the fact that employer-paid and individual-paid insurance are treated a lot differently when it comes to income taxes.

 

[Taxman59]

I tend to think the "health insurance tied to employer" model is a mostly bad one, and this tax treatment contributes to it. It works great for people who have very good employer group insurance (myself included).

The original purpose of this tax benefit was to give employees an effective wage increase without violating the prohibition on wage increases during WWII. Employers were unable to keep employees during the war because they were prohibited from giving wage increases without government permission. They increased the health benefits and, to prevent it from being wages, it wasn't taxed to the employee. It was a stupid rule that became intrenched in the employee benefit package. It should have been abolished 70 years ago (or never put in place in the first place).


Have the day you deserve, and let Karma sort it out.

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[scrabbler1]

+1

However, benefits such as healthcare should be treated as taxable income. Else, allow me and other people who pay our own healthcare premium to deduct it.

+100. Those in group plans get three benefits over those in individual plans: One is the lower rate from simply being in a group plan; two is this lower rate being partly subsidized by the employer; and three is the favorable tax treatment by the employer subsidy and the fully pretax employee share. I saw that third part, the part you posted about, up close and personal when I first switched from my employer's subsidized plan in 2007 to COBRA in 2007-08 to an individual plan at in 2009. I went from partly subsidized plan to COBRA (still cheaper than a plan on my own but only partly tax-deductible) to my own individual plan (more expensive and mostly non tax-deductible).

Let the employer subsidy be full taxable AND have any premiums paid by individuals be tax-deductible from the first dollar, not after 10% of AGI. We can enter it on our 1040 forms the way we enter IRA deductions, for example.

 

[hnzw_rui]

Let the employer subsidy be full taxable AND have any premiums paid by individuals be tax-deductible from the first dollar, not after 10% of AGI. We can enter it on our 1040 forms the way we enter IRA deductions, for example.

+1. People shouldn't have to do itemized deductions for health insurance premiums and it should be tax deductible from the first dollar.

Even then, employer provided insurance has a leg up since health and dental insurance premiums are exempt from Social Security and Medicare taxes.

 

[NW-Bound]

Our tax codes are so messy and inconsistent because they keep adding things piecemeal. Then, nobody dares change anything, because it takes a lot of work and public support to unravel it. Once you give people something, they raise hell if you take it away.

When a special clause is given to a particular group, the rest of the population may not object, because it is not perceived as hurting them. They think that the other guys win, but nobody is losing. Only with time that the unfairness becomes apparent. Or in my case, when I no longer had employer insurance and paid big bucks out of my own pocket that I realized the absurdity of our laws. Prior to that, I never gave this matter any thought. Doesn't everybody work for a megacorp or the government, and don't they all have employer insurance?

+1. People shouldn't have to do itemized deductions for health insurance premiums and it should be tax deductible from the first dollar.

Even then, employer provided insurance has a leg up since health and dental insurance premiums are exempt from Social Security and Medicare taxes.

When I had self-employed income, I was able to deduct my health insurance premium from the 1st dollar, but still had to pay SS and Medicare on it, I believe (when you do taxes with software, you may not pay attention to how all these moving parts fit together). Thanks for bringing this up.

 

[GTFan]

Great discussion, y'all have summed up all the problems and the political difficulties I see in getting true reform done.

- the Republicans all want to repeal/replace the ACA but no one wants to get rid of pre-existing conditions, which requires some sort of mandate to be economically feasible. The result is no consensus on a replacement plan.
- tying employer insurance to massive tax benefits (for both employer and employee) means the market is skewed heavily in favor of those plans, and the Cadillac tax is going nowhere politically. Not to mention that it also ties people to corporations just for the much better and cheaper insurance they usually get. The result is a way less than optimal insurance pool for all, with healthy workers in corporate pools and everyone else in the ACA or government plans.
- expanding Medicare to cover all appears to be DOA no matter who is in charge of either branch. The only way I could see it happening is with Dem supermajorities in both houses and that's not going to happen (barring a collapse of the personal insurance market in some states).
- costs continue to rise higher than inflation and pricing bears little resemblence to reality for the average consumer. Couple that with a lack of open and transparent pricing to enable a competitive market and the result is that it will eventually collapse under it's own weight. We've already seen pullback on markets and networks by ACA insurers for a variety of reasons.

If you're looking for answers, I have none with the current political environment as it is. Something bad is going to have to happen before any real change takes place IMO.

 

[ShokWaveRider]

The fact we are even discussing this is so sad, all citizens should have affordable healthcare coverage period. Anyone who does not agree with that, well......

Single Payer, mandatory coverage for all is "really" the only solution.

 

[pb4uski]

While I am skeptical in general and note that pre-existing conditions is not mentioned at all ...this part caught my eye.

Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

 

[MichaelB]

<mod hat on>

This is an interesting and useful thread, one of the reasons it has lasted this long is because it is focusing on specific policy measures and how they affect us. No reason it can't continue another 120 posts, but we need to keep it partisan and candidate free, please.

<mod hat off>

 

[explanade]

One thing about price transparency though, when I shopped dental insurance, I couldn't compare plan to plan because they listed all these different dental procedures and specialities and I couldn't tell how to compare apples to apples.

I would think it would be a lot more complicated for medical procedures and specialities.

Or think of an analogy, a lot of restaurant websites post menus with prices for dishes. There are a lot of simple dishes you can directly compare but that really doesn't tell you which dish from which restaurant is similar or better.

But restaurant expenditures are minor. If you compare getting a CAT scan at different clinics, will the procedure be comparable? Maybe facility A has a newer machine with better scanning resolution. Maybe facility C has more experienced CAT scan operators or radiologists. Maybe facility C has an all-inclusive price while the other facilities have separate line items for say the license fees they pay to turn the machine on. Maybe facility D has a radiologist to read the scans who's not in network for your insurance so it'll cost more.

All this assumes you have some time to compare these services at leisure. Some procedures, you may not have the luxury of time to compare and you end up at a facility which isn't the lowest price or gets the best Yelp reviews.

I think it will be useful to have this information. If nothing else, maybe providers will feel pressure to reduce prices or offer price-matching policies if a competitor has the same procedure for less. Or maybe if they get the best Yelp reviews, they'll be emboldened to charge a premium vs. the other local competitors.

But ultimately, I'm not sure having this price info. will lead to individual decisions which in the aggregate lowers medical price inflation.

 

[EastWest Gal]

Individuals can't shop for emergency rooms if they are having a stroke or a heart attack. That is a problem waiting for a solution. And Yelp reviews don't work very well for medical care because those who are the most ill are too busy trying to survive to post a Yelp review. And the doctors giving out the most addictive narcotics might get the best reviews on social media.

Having said that, price transparency is hugely important anyway. And I think there needs to be price negotiations on medications, procedures, medical equipment and other things. The drug companies charge whatever they want. And it isn't as if you have a real choice in purchasing or not purchasing life saving and life prolonging medication. And insurance companies negotiate their rates with doctors, which drives doctors into bigger organizations, to improve their negotiating power but the rates vary from company to company and aren't published. Why should such information be any more private than anything else?

Heck, utility companies are private but they have to get government permission to raise their prices. Why can't drug companies and hospitals and large physician groups which are by nature a bit monopolistic have some real price regulation?

And if you get overcharged by (illegal) up coding and the like, you need to have a place to turn for real support. An individual patient has little power against these behemoth organizations.

So many doctors are whining that they are getting paid less under the ACA. But many aren't whining at all, and many who are whining are getting paid more. I think the doctor's political beliefs and party affiliation dictates the noise they make about the system, rather than what is actually occurring in their practices.

Few people do the hard work of actually thinking about real solutions to real problems. Instead it has been an us vs. them mentality, a giant tug of war between people stuck in a political viewpoint, while most people are hanging on for dear life on the middle of the rope over the alligator pond. There is room for better regulation of the industry; there are really silly regulations that need to be dropped and others that are sorely needed as this thread points out. This is a great thread.


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[EastWest Gal]

One other thing-insurance should cover vision care and glasses in full. And hearing aids. I've been wearing glasses since I was seven. Without them I would be disabled-unable to drive or even find things around the house. Yes, 14K gold frames would not be covered. In my world, glasses aren't a fashion statement.


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[ERD50]

Individuals can't shop for emergency rooms if they are having a stroke or a heart attack. That is a problem waiting for a solution. ....

Other industries have addressed that, no reason an ER can't as well.

If I go into Home Depot to buy a pipe wrench, they don't charge me one price if I have an emergency leak to fix at home, and another price if I'm buying for an upcoming project. And the same price at every HD, and comparable prices at other stores. Same with a tow truck, etc.

ERs and hospitals can have fixed prices for routine things, and set charges for the variable add-ons. Transparency is a good thing.

I think a rating system can be created for doctors and hospitals. It won't be perfect, but it should be better than nothing.

-ERD50

 

[explanade]

They're making gobs of money with the way things are.

What would be their motivation to set transparent pricing without being forced to do so?

 

[Nemo2]

ERs and hospitals can have fixed prices for routine things, and set charges for the variable add-ons. Transparency is a good thing.

I'd think there'd be an infinite number of variables after you factor in the enormous differences that can exist when comparing person A to person B.

Also, "a surgeon" is dissimilar to Gertrude Stein's rose.

 

[ivinsfan]

Other industries have addressed that, no reason an ER can't as well.

If I go into Home Depot to buy a pipe wrench, they don't charge me one price if I have an emergency leak to fix at home, and another price if I'm buying for an upcoming project. And the same price at every HD, and comparable prices at other stores. Same with a tow truck, etc.

ERs and hospitals can have fixed prices for routine things, and set charges for the variable add-ons. Transparency is a good thing.

I think a rating system can be created for doctors and hospitals. It won't be perfect, but it should be better than nothing.

-ERD50

Have you seen the movie "The Big Short"..transparency is good for consumers, for big business it's to be avoided at all costs. And Health Care is big business now.

 

[kcowan]

Is there a WebMD for hospitals? My doctor has said to specify a particular hospital in an emergency. But this only works if the emergency is local.

 

[photoguy]

One other thing-insurance should cover vision care and glasses in full. And hearing aids. I've been wearing glasses since I was seven. Without them I would be disabled-unable to drive or even find things around the house. Yes, 14K gold frames would not be covered. In my world, glasses aren't a fashion statement.

As a lifelong eyeglass wearer (and basically blind without them), this doesn't bother me. Glasses are known and basically fixed expenses which don't really need insurance. It's not an uncertain risk that needs to be mitigated due to extreme costs. Also there's is significant competition in the eyeglass market, so you don't need a pre-negotiated price.

Sure for low income folks, I'd be fine with health insurance covering eyeglasses. In fact, I think CoveredCA offers a vision plan but I never looked into it.

Before vision, I'd much rather see real dental insurance. Not some 50% coverage with tiny yearly caps. (But I don't see how it can work due to adverse selection).

 

[razztazz]

What would be their motivation to set transparent pricing without being forced to do so?

Ummmm..... Uhhh..... The Free Market...? BAH HAH HAH HAH HAH HAH....

 

[explanade]

The cost of glasses are out of hand now.

I was getting quoted $800 and above for Rx sunglasses, single vision. And of course, certain brands aren't covered by insurance or so the opticians say. I came across an optician forum and you can tell it's a scam, they'll charge the prices they think they can get.

Might be better for me to get Lasik again than to deal with ridiculous prices.

You can get good glasses at good prices at Costco but if you want something really nice they try to bend you over.