No health care for you! Come back one year...

[W2R]

UncleMick, I think just about all of our past insurance commissioners have done time in jail! The insurance mess down here is just one more motivation to move north, as you have done.

 

[Zoocat]

They found it.

Rejected: A benign polyp was found and removed on my last colonoscopy.

That is typical. The insurance companies will deny coverage for anything these days.

Lots of people are afraid to go to the doctor for fear of something (anything!) being diagnosed and treated and ending up on their medical record. The fear is future denial of insurance. I struggle with this myself. I would really like to change insurance companies but to do so I can't afford to have any more diagnoses or treatments on my records.

 

[samclem]

Congress has decided to use the employer mandate to achieve health care reform.
(From the WSJ)

WASHINGTON -- House Democrats on Tuesday unveiled sweeping health-care legislation that would hit all but the smallest businesses with a penalty equal to 8% of payroll if they fail to provide health insurance to workers.
The House bill, which also would impose new taxes on the wealthy estimated to bring in more than $500 billion over a decade, came as lawmakers in the Senate raced against a self-imposed Thursday deadline to find ways to finance their health-care bill. Senators are weighing a combination of several more-modest tax increases, including some that would hit health-care industries.
Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt.
The relatively low thresholds for penalties triggered criticism from business groups and Republicans, who said the burden on small business is too high.
Rep. Dave Camp of Michigan, the top Republican on the Ways and Means Committee, said the House bill would "impose massive new taxes and mandates on employers, especially small businesses."

AAAARRRGGGGHHH!! Health care/health insurance is a contentious issue, but the only thing almost everyone agrees on is that having employers pay for the health care of their employees is crazy. It makes people afraid to quit their jobs and try something new, it leaves people without insurance when they lose their employment, and the two things ("I need a job" and "I need a gall bladder removed") have nothing whatsoever to do with each other. So, Congress has decided this one universally despised facet of our present system will be the centerpiece of the new approach we were promised.

It is a mess in Massachusetts, so I guess we should bring it to the other 49 states.

The folks who study and know health care issues and who have devoted their lives to working in this area must wonder how all the collective wisdom and experience gained in the US and abroad ends up producing this result.

Here are the experts.

A

 

[ziggy29]

Yep. Whatever changes we make to the health care/health insurance situation, one thing that needs to happen is the decoupling of employer and health insurance. This goes in the opposite direction and, for that reason, I think it's a mistake.

 

[FUEGO]

FYI, for those interested in reading up a little, the House Democrat's proposal that they entered today as referenced above in the WSJ and elsewhere on the AP. Some concise summaries of what the bill includes.

I'm still reviewing their summary pages to see what real effect it would have.

 

[FUEGO]

The house proposal could be really good news for ER types. The low to moderate income folks are supposed to have their premiums capped at between 1.5% of income for those around poverty level and 11% of income for those making 400% the poverty level. So without knowing the tiers in between, lets say they require 5% of $40,000 income for a family of 2. $2000 a year in premiums.

They also specify that the age based premiums can't vary more than a 2 to 1 ratio. So presumably a 21 year old may pay $2000 a year and the 64 year old may pay $4000 a year. Presumably these are also capped by the income maximums too.

This is all based on the assumption that there will be no asset test for premium discounts based on low to moderate income status.

If this works out the way it is looking like it might, then my $10,000 line item for retirement health insurance may have just shrunk a lot.

 

[DallasGuy]

One thing I really like about the House Health Care plan is that it would change the laws so that health insurance companies can not deny coverage based on a pre-existing condition. Also, the insurance companies would not be able to charge more if you do have a pre-existing condition. This would stop the cherry picking that the insurance companies currently do. The House plan also includes a government sponsered health insurance plan which I think is a very good idea because it would force the health insurance companies to bring their premium costs down and actually be competitive with their premiums. I find it quite laughable when the health insurance companies complain that a government health insurance plan would drive them out of business. The only thing it would do would bring their profits down to a more reasonable level. The executives at these companies are trembling because they're afraid they'll have to say good bye to their huge year end bonuses. Too bad...maybe a customer who is buying one of their insurance plans won't get denied coverage instead! I have absolutely no sympathy for health insurance companies at this point....my COBRA premium was raised 37% last year....in one year. I really wonder if that was the result of the insurance companies trying to have customers pay for the bad return they had on their investments due to a down stock market. Just a guess, but I wouldn't put it past them.

It's time for a change in the way that our country handles health care coverage. It's a big mess right now. It's not a good situation where people that actually have the money to buy health insurance get denied that chance because of a pre-existing condition. It's even worse when we have people in a country like the U.S. who can't get care because they can't afford it unless they go to an emergency room. Also, as others have said in this thread, it's pretty sad when people won't tell their doctor of possible minor health problems for fear it will be a new pre-existing condition.

For those of you that have guaranteed health coverage, I'm happy for you. But for those of us that have to buy our own coverage, this system is not good. Please don't let the conservatives in congress scare you into thinking that the status-quo is just fine. If you agree with that, you'll just be pushing the problem down the road to a later time just as we're doing with social security.

 

[samclem]

The house proposal could be really good news for ER types. The low to moderate income folks are supposed to have their premiums capped at between 1.5% of income for those around poverty level and 11% of income for those making 400% the poverty level. So without knowing the tiers in between, lets say they require 5% of $40,000 income for a family of 2. $2000 a year in premiums.

They also specify that the age based premiums can't vary more than a 2 to 1 ratio. So presumably a 21 year old may pay $2000 a year and the 64 year old may pay $4000 a year. Presumably these are also capped by the income maximums too.

This is all based on the assumption that there will be no asset test for premium discounts based on low to moderate income status.

If this works out the way it is looking like it might, then my $10,000 line item for retirement health insurance may have just shrunk a lot.

I wish the government would do something important, like make a law saying I could fly, or see through objects. That would be great. I guess no one wonders how the setting of premium caps that are below the cost of providing the service for 95% of people can co-exist with the statement that this thing somehow won't result in a big increase in taxes and also won't result in reduced quality of care. Right, it's al possible due to "increased efficiency"--the very thing for which the government is most famous. I can already see the efficiency and simplicity of these conflicting premium formulae.

I think folks are diggging through this pile of sh*t and imagining they've found their own personal ponies. "I'm okay, I found the part that says I'll get great care that is cheap--everyone else . . . good luck!"

 

[lets-retire]

I think folks are diggging through this pile of sh*t and imagining they've found their own personal ponies. "I'm okay, I found the part that says I'll get great care that is cheap--everyone else . . . good luck!"

I think this happens more often than not when it comes to government provided benefits. People think that government can pass laws that directly conflict with common sense and economics and they will turn out great.

From what I've seen, granted I didn't read the legislation being revealed right now, government is saying we will lower the cost of health insurance, but aren't really dealing with the other end of the equation what are they going to do to improve efficiencies and control costs? The biggest thing I've heard is, we aren't going to pay providers as much. That doesn't seem to make much sense, to me. Doctors already receive a much lower payout from the insurance companies so with the government option that pay would be even lower.

 

[ERD50]

One thing I really like about the House Health Care plan is that it would...

...stop the cherry picking that the insurance companies currently do.

.... it would force the health insurance companies to bring their premium costs down...

DallasGuy, please be very, very careful what you wish for. Especially when Congress is listening to the public, and remember - your wishes, if enacted affect *everyone*.

As others have pointed out, Congress cannot just magically dictate that costs be reduced - there will be some consequences, unless actual efficiency is somehow improved. Let's learn from history, and this somewhat parallel situation:

California electricity crisis - Wikipedia, the free encyclopedia

Bold mine -

The California electricity crisis (also known as the Western U.S. Energy Crisis) of 2000 and 2001 was a situation where California had a shortage of electricity. Although California's population increased by 13% during the 1990s, the state did not build any new major power plants during that time. [1]

....

Due to price controls, public utility companies were paying more for electricity than they were allowed to charge customers, forcing the bankruptcy of Pacific Gas and Electric and the public bailout of Southern California Edison. This led to a shortage in energy and, therefore, blackouts.

Did price controls lead to better efficiency of the system? Nope, just the opposite:

By keeping the consumer price of electricity artificially low, the California government discouraged citizens from practicing conservation. In February 2001, California governor Gray Davis stated, "Believe me, if I wanted to raise rates I could have solved this problem in 20 minutes." [2]

It's time for a change in the way that our country handles health care coverage. It's a big mess right now.

I agree. But the real question is - will this proposal improve the situation, or make it worse? I fear the latter.

-ERD50

 

[ERD50]

Please don't let the conservatives in congress scare you into thinking that the status-quo is just fine. If you agree with that, you'll just be pushing the problem down the road to a later time just as we're doing with social security.

Sorry, forgot to comment on this. Let me paraphrase you:

Please don't let the liberals in congress scare you into thinking that this is a real solution. If you agree with them, you may just be making the problem worse, and push that bigger problem down the road to a later time just as we're doing with social security and Medicare.

We all need more time to review the pros/cons of this bill. Based on recent legislation I've seen, I'll start out skeptical. If it does not address some root cause problems, it will just be expensive, ineffective window dressing. But to add on to a previous statement, if Congress gets the impression that 51% of the people can be convinced there is a pony in there for them - it will pass.....

-ERD50

 

[FUEGO]

I wish the government would do something important, like make a law saying I could fly, or see through objects. That would be great. I guess no one wonders how the setting of premium caps that are below the cost of providing the service for 95% of people can co-exist with the statement that this thing somehow won't result in a big increase in taxes and also won't result in reduced quality of care. Right, it's al possible due to "increased efficiency"--the very thing for which the government is most famous. I can already see the efficiency and simplicity of these conflicting premium formulae.

Heh, I kind of got that feeling too as I was reading the summaries. Grandiose promises for sure. My feeling is that these grand promises will be horse traded away if necessary and pork will be added to get the necessary number of votes to pass.

Some particular language that seems unbelievable is that the public insurance is going to be self supporting financially, yet affordable somehow. The plan makes it look like premiums will be whatever they are, and will vary based on geographic area (much like private ins today). Then if you fall within the income limits, you will get a credit somehow (voucher? tax credit? reduced premium directly from the public plan option?) that will be handled through existing public welfare offices at the local/state level.

So my premium may be $10000 a year for a family, but the income limits might make it only $4000 a year.

I think they are saying it will be funded from 1/2 trillion in cost reduction/efficiency and better delivery of service and 1/2 trillion from jacking the taxes up on folks making many hundreds of thousands and really jacking them up on folks making $1 million or more with an extra 5.4% tax (bringing the total fed tax rate to the highest bracket folks to 45% after the Bush tax cuts expire).

My hope is that they don't screw this up too bad.

 

[DallasGuy]

Sorry, forgot to comment on this. Let me paraphrase you:

Please don't let the liberals in congress scare you into thinking that this is a real solution. If you agree with them, you may just be making the problem worse, and push that bigger problem down the road to a later time just as we're doing with social security and Medicare.

We all need more time to review the pros/cons of this bill. Based on recent legislation I've seen, I'll start out skeptical. If it does not address some root cause problems, it will just be expensive, ineffective window dressing. But to add on to a previous statement, if Congress gets the impression that 51% of the people can be convinced there is a pony in there for them - it will pass.....

-ERD50

If the liberals really wanted to freak out the conservatives they'd be pushing for a single payer system similar to Canada's system. They know that would never pass, so they're trying to come up with something in between that and what we currently have. I actually believe that the best fix for the system is a single payer system. Under a single payer system some people would get better care while others would get worse care...nothing is perfect. But everyone would be covered.

The main point that I was trying to make when I mentioned the conservative scare tactics is that I believe something must be done to fix this. I didn't see the Bush administration trying to do anything about health care. At least the Obama administration is trying. Nobody knows if the liberal's plan will actually make things better or worse but at least they're trying. I just don't think the status quo can go on for much longer. If the conservatives have some better ideas other than just leaving the system alone, I'd like to hear them...maybe their solution would be better.

 

[ERD50]

... I actually believe that the best fix for the system is a single payer system. Under a single payer system some people would get better care while others would get worse care...nothing is perfect. But everyone would be covered.

I don't agree that single payer would be "the best fix". But regardless, single payer is *not* the only way to have everyone covered.

In IL, everyone who drives is required to have car ins. Yet, we don't go to our state for car ins, we have a choice of many privately run car ins companies. And they have to compete for my business. That is a much better system than "single payer", IMO.

... believe something must be done to fix this. ... At least ... is trying. Nobody knows if the ... plan will actually make things better or worse but at least they're trying.

Sorry, I' just don't accept the "I don't know if it will be better or worse, but we are trying" line at all. That's is what the Doctors told George Washington as they applied more leeches (yes, I know, leeches may actually be beneficial in some cases, but not in most cases they were used for at the time), "hey, we got to do *something*". That thinking got us ethanol from corn, and a host of other things we would be better off without.

I agree with you on one point - I'd like to see a decent plan offered up to compare to this one. I don't know, is it out there but has not got the attention, since... geez, I'm trying hard to avoid the partisan politics and labels here, but if a bill can't carry the majority in Congress, it just isn't going to get much attention.

Are there any good proposals?

-ERD50

 

[M Paquette]

The house proposal could be really good news for ER types. The low to moderate income folks are supposed to have their premiums capped at between 1.5% of income for those around poverty level and 11% of income for those making 400% the poverty level. So without knowing the tiers in between, lets say they require 5% of $40,000 income for a family of 2. $2000 a year in premiums.

They also specify that the age based premiums can't vary more than a 2 to 1 ratio. So presumably a 21 year old may pay $2000 a year and the 64 year old may pay $4000 a year. Presumably these are also capped by the income maximums too.

This is all based on the assumption that there will be no asset test for premium discounts based on low to moderate income status.

If this works out the way it is looking like it might, then my $10,000 line item for retirement health insurance may have just shrunk a lot.

That's interesting. I'm wondering what the difference in the details will be between a 10,000/year high deductible with HSA and and one of these 4,000/year plans, though. I'm pretty sure the 6,000/year difference didn't entirely go to executive compensation (unless you're with United Healthcare, of course).

Something has to give somewhere. There's going to be a subsidy hidden in there, and/or some severe limits on what care is permitted.

 

[Texas Proud]

Yep. Whatever changes we make to the health care/health insurance situation, one thing that needs to happen is the decoupling of employer and health insurance. This goes in the opposite direction and, for that reason, I think it's a mistake.

This is something I have to agree with.... I do not have 'choice'... well, I do, but not really... I can choose to accept the insurance plan my company has... or decline... there are not options as we are a small small company....

If I did decline... and went to get my own, the cost for an individual policy is high and I do not think 'pre tax'... so I get screwed there...

So if we are stuck with a bad plan, how does this new 'fix' to the system help me out any It does not, only cost me more....

 

[Texas Proud]

I find it quite laughable when the health insurance companies complain that a government health insurance plan would drive them out of business. The only thing it would do would bring their profits down to a more reasonable level. .

I find it laughable that people will say this is a 'level playing field'....

IF the gvmt had a true option that was level, then there should be NO cost to the taxpayers as the premiums would cover all the costs.... but that is not what I see... I see money going to this idea... why? Because they want to be the single payer of services... then they control it all..

Now, I am not saying that insurance companies are 'good'.... just that some of the rhetoric is just wrong...

 

[Martha]

I have insurance through the Minnesota risk pool, which is there for otherwise uninsurable people. The premiums are set between 110% and 125% of market price of similar plans. Premiums cover roughly 50% of the cost of the program. The rest of the cost is financed by a tax on insurance companies.

Just a point of information.

 

[FUEGO]

That's interesting. I'm wondering what the difference in the details will be between a 10,000/year high deductible with HSA and and one of these 4,000/year plans, though. I'm pretty sure the 6,000/year difference didn't entirely go to executive compensation (unless you're with United Healthcare, of course).

Something has to give somewhere. There's going to be a subsidy hidden in there, and/or some severe limits on what care is permitted.

If your high deductible plan can continue to exist in the future, the $4000 public plan may cover more stuff with less out of pocket maximums. So far they are saying there will be minimum requirements that must be met for coverage by the public plan and ultimately the employers too. No word on required coverage for completely private plans. I'm assuming the out of pocket max they are talking about will be less than $10,000.

The $6000/yr differential you are referring to will be made up for by direct taxpayer subsidies. So some new or modified existing govt agency will issue credits on behalf of low and moderate income people to pay into the public plan. The public plan itself will be self supporting they say, but it will undoubtedly receive lots of taxpayer subsidies via the credits to keep the premiums below a certain level for low to moderate income taxpayers.

 

[ERD50]

I have insurance through the Minnesota risk pool, which is there for otherwise uninsurable people. The premiums are set between 110% and 125% of market price of similar plans. Premiums cover roughly 50% of the cost of the program. The rest of the cost is financed by a tax on insurance companies.

Just a point of information.

If I understand you correctly, what Minnesota has effectively done (through a bit of clever sleight of hand) is to have increased the size of the pool (a good thing in many ways), and spread the risk and payments across that larger pool.

This higher risk pool is getting a discount, and that discount is paid by the lower risk group (the tax on the ins co will be passed on to those customers).

I still like the idea of mandating coverage for everybody, then everybody pays a fairer share. That high risk pool is sort of self-generating high risk participants - even at the relative bargain of 125% a normal policy, healthy people will try to avoid it if they can. So you end up with higher risk people in the pool.

Given the current mess, this might be a net positive, but I don't think it is enough, and it might give the false sense that there is some overall bargain here ("The rest of the cost is financed by a tax on insurance companies"), that makes it sound like "that guy behind the tree" is paying for it, which could just extend the problems.

-ERD50

 

[FUEGO]

This is something I have to agree with.... I do not have 'choice'... well, I do, but not really... I can choose to accept the insurance plan my company has... or decline... there are not options as we are a small small company....

If I did decline... and went to get my own, the cost for an individual policy is high and I do not think 'pre tax'... so I get screwed there...

So if we are stuck with a bad plan, how does this new 'fix' to the system help me out any It does not, only cost me more....

It will be "interesting" to see what impacts this legislation has on all of our employer provided health insurance plans. The legislation suggests that eventually employers will have to provide coverage that conforms to some minimum standards in regards to covered services, out of pocket maxes, no lifetime maxes, etc.

Right now I have a $2400 high deductible plan through DW's employer that costs us around $300 per year (yes year) and it is paid pre-tax, so it costs us closer to $200 after tax. It would be bad news if that policy is deemed substandard and we are required to either pay a lot more, or go w/ the public plan. As you have noted, taxation of health ins. is a crazy thing that will skew decisions in an inefficient manner. It may be cheaper after tax considerations to pay for a crappier more expensive employer provided plan pre-tax than a possibly better cheaper public plan using after tax dollars.

I think leveling the playing field with respect to taxation of health insurance premiums would go a long way towards "fairness" in the healthcare field. Ie - either tax employer provided health ins benefits (even if only the amounts above a certain threshold) or allow an above the line tax deduction for health ins. premiums up to a certain threshold. Maybe the threshold of the public plan premiums.

I haven't seen any details behind the cost calculations for this bill, but it is clear they are funding a huge part of this by massive tax increases on the wealthy. And I don't know how accurately they have modeled the second order effects of the legislation, such as all the people that decide to quit working to get better/cheaper healthcare or drop their employer provided plan for the cheaper public plan (for which they get subsidies).

 

[Martha]

If I understand you correctly, what Minnesota has effectively done (through a bit of clever sleight of hand) is to have increased the size of the pool (a good thing in many ways), and spread the risk and payments across that larger pool.

This higher risk pool is getting a discount, and that discount is paid by the lower risk group (the tax on the ins co will be passed on to those customers).

I still like the idea of mandating coverage for everybody, then everybody pays a fairer share. That high risk pool is sort of self-generating high risk participants - even at the relative bargain of 125% a normal policy, healthy people will try to avoid it if they can. So you end up with higher risk people in the pool.

Given the current mess, this might be a net positive, but I don't think it is enough, and it might give the false sense that there is some overall bargain here ("The rest of the cost is financed by a tax on insurance companies"), that makes it sound like "that guy behind the tree" is paying for it, which could just extend the problems.

-ERD50

Well, of course the other insureds are paying for it. I don't have a problem with that. They could very well end up in the pool someday themselves.

I gave the data point not so much as to suggest a solution but to give an idea of cost for a group that is going to be higher than average in cost. Yet spreading that cost around doesn't make insurance unaffordable in Minnesota. Minnesota has long had the highest number of insureds of any state. It has the risk pool. It has Minnesota Care for people who can't afford the pool and pay a sliding scale fee. It has (soon to be had) broader medicaid coverage than most other states. If you wanted insurance, you could get insurance. Yet Minnesota did not break the bank in doing this and we wouldn't have to on a federal level either. Our only problem is a governor who wants to cut, cut and cut anything to do with the poor.

Minnesota is also known for its general lower cost of health care, with even the Mayo clinic having a good reputation for lower cost yet its good outcomes.

 

[Texas Proud]

Right now I have a $2400 high deductible plan through DW's employer that costs us around $300 per year (yes year) and it is paid pre-tax, so it costs us closer to $200 after tax.

WOW.... now I could live with that plan....

My company pays 100% for the employees, but nothing for family... so I pay about $600 per month for the wife and kids... and we have a $4,000 deductible plan... but our company will pay for most of the deductible as long as only two people have high costs in a year (the plan family deduct is $12K, the company will only pay $7K)...

 

[Texas Proud]

Well, of course the other insureds are paying for it. I don't have a problem with that. They could very well end up in the pool someday themselves.

I gave the data point not so much as to suggest a solution but to give an idea of cost for a group that is going to be higher than average in cost. Yet spreading that cost around doesn't make insurance unaffordable in Minnesota. Minnesota has long had the highest number of insureds of any state. It has the risk pool. It has Minnesota Care for people who can't afford the pool and pay a sliding scale fee. It has (soon to be had) broader medicaid coverage than most other states. If you wanted insurance, you could get insurance. Yet Minnesota did not break the bank in doing this and we wouldn't have to on a federal level either. Our only problem is a governor who wants to cut, cut and cut anything to do with the poor.

Minnesota is also known for its general lower cost of health care, with even the Mayo clinic having a good reputation for lower cost yet its good outcomes.

Your last statements are what I think is the problem... all I see is the payment side... who has to have insurance, who gets to pay more... what the plan has to have, the deductibles.... but none of that addresses the COSTS of providing healthcare... from an accounting prospective, this is the 'income' side... yes, we will get more income in the system which might mean the amount of 'income' coming from my specific plan will go down.... but I still will go to the same doctor, get the same tests, get the same results... which means the 'cost' side is the same.... I do not call this 'health care reform'.... but welfare for the poor (which seems to include a good part of the middle class)....

 

[FUEGO]

I do not call this 'health care reform'.... but welfare for the poor (which seems to include a good part of the middle class)....

That's the key. This is welfare for primarily low income and to a limited extent middle income folks. This proposal will guarantee insurance to all at SOME price, and to the low and middle income folks at a limited price. Welfare = full price premium - limited price premium