So this plan could be simply characterized as privatization of Medicare?
The main reason they provide insurance is because they can pUnder the present law, employers don't need to provide any health insurance at all. They could get the same tax benefits (deductability of costs) simply by providing higher employee pay.ut all their employees together and get a group rate that is unobtainable to the employee as an individual. It's a "special deal" that the employee cannot get on his own, with or without a voucher from his employer. Depending on how the new exchanges (for those under 65 or over 65) are set up, that same advantage (no underwriting, same rates for all) would then be available to individuals. That's an entirely different set of conditions than what exists today, so I don't think we can say that the lack of employer vouchers now is evidence of anything.
It may have to do with separation of state/federal powers.Ryan-Rivlin pairs the spending cap in Medicaid with passing on the cost escalation and administrative risks to the states. One has to ask why the same approach isn't proposed for Medicare.
Have you heard of "health insurance exchanges"? That's how we can address this problem.this is why vouchers for individual policies will basically screw everyone
Agreed. Unfortunately, enactment of the legislation would leave insurers, health care providers, and seniors all on the same political side, pushing for continual increases in the size of government vouchers, so the size of the "defined contribution" might not be as firm as the "GDP+1" might lead one to believe. But that's not a problem with this legislation, per se, we already have the same problem with Medicare. It's a problem whenever the government is in charge of collecting and spending money. Various interests will use the political process to get the government to seize the personal property of private citizens and give it to them. This is perhaps the biggest challenge we face as a nation today.Another would be that it switches Medicare from being a defined benefit program to a defined contribution plan.
Under the present law, employers don't need to provide any health insurance at all. They could get the same tax benefits (deductability of costs) simply by providing higher employee pay. The main reason they provide insurance is because they can put all their employees together and get a group rate that is unobtainable to the employee as an individual. It's a "special deal" that the employee cannot get on his own, with or without a voucher from his employer. Depending on how the new exchanges (for those under 65 or over 65) are set up, that same advantage (no underwriting, same rates for all) would then be available to individuals. That's an entirely different set of conditions than what exists today, so I don't think we can say that the lack of employer vouchers now is evidence of anything.
Well, its worked fine for the people with the Medicare advantage plans, they like them a lot. It hasn't done a good job of controlling costs for the reasons we discussed previously--the government's inept establishment of target rates and feedback mechanisms.
Why do you believe that a very large (regional or even national) group size would be less efficient than smaller company-sponsored groups? Yes, the per-recipient costs might be higher, but that would be expected since people who are employed are healthier than those who aren't (really sick people can't hold a job). Since we've got a goal to cover everyone, we'll be paying for those less-well people anyway in some manner. I don't think such a large pool would be less efficient. After all, employers have admin costs to run these health care programs through many small pools, these costs should be included in any overall look at efficiency.I think it's very unlikely we'll get something that's as efficient as current group insurance for either of these if we go to vouchers - and that's why most employers don't use vouchers. But I've got an open mind, I'd be willing to look at actual experience with vouchers in an employer setting.
Okay, but let's make it a fair test and dump the inane government-mandated structure that now virtually guarantees Medicare Advantage will have higher costs than traditional Medicare.Yes, Medicare Advantage is fine for people who take advantage of the fact that the gov't puts more dollars into MA per enrollee than it puts into traditional Medicare. But the R/R claim is that they can reduce costs with vouchers. I'd like to get MA premiums down to traditional Medicare levels, then see if MA plans provide better benefits. R&R claim that should happen, let's try it and see if that's true before we force everyone to use vouchers because we believe an untested theory.
Anyone know where to find an analysis that relates the 1.45% Medicare payroll tax to the present expenses and projected future expenditures?
A tax increase is neither my first choice nor the complete solution, but I'd like to know what the options are. (By way of comparison, most analyses of Social Security fix-it proposals readily provide comparisons between a tax increase and the various flavors of benefit adjustments that could achieve balanced spending.)
Why do you believe that a very large (regional or even national) group size would be less efficient than smaller company-sponsored groups? Yes, the per-recipient costs might be higher, but that would be expected since people who are employed are healthier than those who aren't (really sick people can't hold a job). Since we've got a goal to cover everyone, we'll be paying for those less-well people anyway in some manner. I don't think such a large pool would be less efficient. After all, employers have admin costs to run these health care programs through many small pools, these costs should be included in any overall look at efficiency.
Okay, but let's make it a fair test and dump the inane government-mandated structure that now virtually guarantees Medicare Advantage will have higher costs than traditional Medicare.
Okay. But, it would be great if we could also limit their out-of-pocket spending on health care. These folks are (in general) very wealthy, and populist calls to limit their government pay and benefits miss the mark.Idle thought... The average age of representatives is 57.2 and senators 63.1 (as of 2009). That nicely grandfathers them into the old Medicare plan, although as Congresscritters they continue their coverage after leaving office, still at the princely rate of $503/year.
Perhaps the bill should also move all members of Congress onto the Medicare voucher system, purely as a check on viability, of course.
If they're in Congress for just one term, are they eligible for health care and pension for the rest of their lives?
What about their staff and other political appointees?
Not quite, they have to retire to get continuing health care. A young, congressman with 5 years of service would not qualify for an immediate pension so no health care. Also someone mentioned $500 but I think they pay the same rate for health care as all Federal employees. It is a decent plan but it isn't cheap.That's messed, up, one lousy Senate term to get lifetime healthcare.
I remember that one of the motivations Steve Jobs had for returning to Apple payroll was for the health care coverage for his family. He only wanted a $1 salary but cared more about the coverage.
Seems I am barely on the wrong side of most of the fixes no matter when and where they are occuring...
So would raising taxes.
But people don't want that.
Remains to be seen if people are willing to say no more Medicare for those under 55, after decades of paying Medicare taxes.
This is what taking responsibility looks like: Addressing the problem (cost growth) and not just throwing more money at the problem and bankrupting the country.I find it outrageous that the GOP will not address the overall problem... just trying to avoid their lack of fiduciary responsibility with SS and Medicare!
Do you reject the present Medicare system because it doesn't cover everyone? Anyway, the new health care law plus this revision in Medicare covers just about everyone. If it were to pass, I think it likely that the health care exchange systems would merge, though the funding streams would likely stay distinct (just due to governmental inertia).If they are not willing to create a national plan that includes everyone... Forget it!
I find it outrageous that the GOP will not address the overall problem... just trying to avoid their lack of fiduciary responsibility with SS and Medicare!
Why do you think they would merge? I would expect them to stay separate so the insurers can keep rates low for the younger group. I expect it would take a legislative mandate to merge them. But the GOP would be hard pressed to mandate merger since they don't acknowledge the legitimacy of the Obama program in the first place. I would be less skeptical if this was proposed as an extension of the current plan to the senior population rather than a separate privatization of Medicare with its high cost pool.Anyway, the new health care law plus this revision in Medicare covers just about everyone. If it were to pass, I think it likely that the health care exchange systems would merge, though the funding streams would likely stay distinct (just due to governmental inertia).
Have you heard of "health insurance exchanges"? That's how we can address this problem.