Arnold Has Spoken (Health Insurance)

[F M All]

Mykids, for the exact answers I suggest you look on the UK government website, but briefly the NHS is supposed to be paid for out of National Insurance contributions which are quite similar to FICA in the US i.e. not regular income tax but a percentage of earnings taken by the employer with an employer match, and I think there is still an upper earnings limit. I don't know all the current details because I haven't lived there for 15 years. I am not sure there is any traceable relationship between National Insurance and the NHS budget, I suspect not, although at some level the Government balances its books (or runs a surplus/deficit)
The tax system in the UK has exemptions and credits for the lower paid, and tax bands, so the lowest paid pay little or no tax and may get social security payments. Higher earners have higher tax bands and, of course, many schemes to avoid tax. Remember the Enron tax schemes were invented in the UK!!!

I think one aspect that everyone should be very careful about is that until one understands how a particular state's economy works as a whole it is difficult to compare. As a small example - in the UK most people are registered with a General Practioner (Doctor) which, these days is likely to be a Group practice i.e. several doctors working from one location. For "everyday" complaints, vaccinations, troubling but non life threatening symptoms, one makes an appointment and goes to the GP within a couple of days. You can usually see one of the doctors on the same day if you say you have the need. If you are incapacitated, maybe a sick child or you have something contagious, then the doctor will come to you (home visits - what is the copay on that in the US). If you become sick outside of normal surgery hours you will call your GP's emergency number and a doctor will come to see you, if necessary, or advise you on what action to take e.g. call an ambulance. If you have an accident then you either go to the nearest Accident and Emergency department or call an ambulance and the paramedics will stabilise you and get you to hospital. Dialling 999 in the UK connects you to the emergency services - Police, Fire and Ambulance, and they will despatch the required services - no insurance required.
The use of A&E and ER is therefore somewhat different from here. A small example but to compare the services you need to go into a lot of detail.

 

[F M All]

Also, could you give me an idea of what types of procedures might require someone to be placed in a queue?

Generally, non life-threatening or elective procedures. Sometimes hospitals do not have enough beds or staff for some operations. This is an area where there are loads of stories. People having operations endlessly postponed, people lying on hospital trolleys for hours because there are no beds. It happens, but the stories are often exaggerated by the wonderful tabloid press (c.f.National Enquirer). Sometimes Regional health authorities run out of budget and must delay operations into a new budget period. Some refer to a "postcode" lottery (postcode=zipcode). If you live in one area the queue for hip replacements may be long and the queue for cataracts short, if you live down the street those queues may be the opposite way round. This is where people do get stuck unless they have additional insurance to be able to go to a private hospital and avoid the queue.


One fundamental point though is that apart from white coat syndrome nobody is scared to go to the doctor. A bad diagnosis will not bankrupt you or prevent you from good healthcare - for life.

 

[maddythebeagle]

Wisconsin has had a proposal kicking around also that would include a payroll tax...I dont know if I agree with a payroll tax....I dont how this is going to affect the retire early crowd....no job=no payroll tax? I would like to see a broad tax that hits everyone and make everyone pay instead of this b.s of making someone else always pay for programs....

 

[bright eyed]

Humm didn't my state of Mass just deal with this? Isn't the lead already taken? Isn't the ground already broken? Oh wait, I'll bet he thinks we didn't do it right so he can be the first one to do it the way it should be done. Ugh.
[/quote]

Mass is the size of one of CA's counties btw , so it may be a different achievement by scale - and politically since many are trying to block the proposal because they don't want undocs to get covered.

 

[ESRBob]

I read somewhere this week that California would be the 4th state to implement something along these lines, but I don't think you have to be first to be a hero if you're able to make something like this work, especially in a state that size.

I've been sitting here grappling with a herniated disk for the past 2 weeks having a lot of time to think about how important good health coverage is for people, and how quality of life (for ERs and everyone else) could be really compromised if someone weren't able to get good coverage, or had chronic poor health.

It's enough to make you think about moving to places like California just to get the health insurance matter covered, if you were in a difficult situation in another state. That could end up helping California by bringing in more residents, growth etc. though not sure if that is a part of their thinking.

 

[MasterBlaster]

Medical treatment for out-of-state residents has to be addressed. Otherwise, as you posted, people without care will flock in.

I suspect that there will be some sort of waiting period or residency requirements before an out-of-stater could get care.

 

[samclem]

Humm didn't my state of Mass just deal with this? Isn't the lead already taken? Isn't the ground already broken? Oh wait, I'll bet he thinks we didn't do it right so he can be the first one to do it the way it should be done. Ugh.


Mass is the size of one of CA's counties btw , so it may be a different achievement by scale - and politically since many are trying to block the proposal because they don't want undocs to get covered.

20% of the people in CA don't have insurance, it is approx 10% in Mass. That is another big difference. Also, both Maine and Vermont attempted this (I think before Mass). It doesn't really matter which state did it first.

There was a good interview today on the Diane Rhem show (link to page, download the audio file there. http://www.wamu.org/programs/dr/. Beware: Leftwing bilge among the good info). One caller (not in CA) owned a small manufacturing biz, said the medical insurance he pays for his workers is 40% of his payroll costs. Under the CA plan, if companies don't provide health ins, they have to pay the state 4% of payroll. So, I think it is likely many employers will simply stop paying for insurance, and let workers get whatever (minimum) coverage the state offers. Ironically, then, the CA plan may result in >>less<< coverage for many workers. If employers need to attract more qualified workers, they'll just pay more in salary.
I don't think this is necessarily a bad thing. We need to weaken/break the link between provision of medical care and employment. That will help our industries be more competitive, and also reduce the irrational patchwork nature of healthcare funding in the US.

 

[ESRBob]

One caller (not in CA) owned a small manufacturing biz, said the medical insurance he pays for his workers is 40% of his payroll costs. Under the CA plan, if companies don't provide health ins, they have to pay the state 4% of payroll. So, I think it is likely many employers will simply stop paying for insurance, and let workers get whatever (minimum) coverage the state offers. Ironically, then, the CA plan may result in >>less<< coverage for many workers.

In the grisly world of sausage making, I suspect this is the one factor that is going to make all this 'reform' possible -- business collectively would love to get out from under the obligations it has to current and former employees for healthcare. What better way than to beat the drum for universal fairness? 4% of payroll sounds like a bargain, (15% or more would be typical in NY, though other states might be less). so I suspect it won't pay for anything like the levels of care people are getting today, but as you say, that could end up being a good thing overall.

 

[lets-retire]

I can see where people without insurance who live in surrounding states would try to obtain a job in the states that offer the insurance. Or even move to those states. If you initially live only a couple of miles outside the state that requires, universal insurance what would keep you from moving in, especially if you have some kind of illness that would make insurance very expensive. Wouldn't this sucking of the very ill into the states increase their costs and decrease the cost for insurers outside of the state?

 

[Martha]

Lets-retire, I think this is somewhat of a problem. You see that some with states that are more generous with other benefits than a neighboring state (for example, Wisconsin and Illinois and Wisconsin and Michigan). Still, most people want to stay home and don't move for benefits.

One more reason to have a national solution.

 

[perinova]

Making insurance mandatory is only part of the solution. The practive of not insuring already ill people or making them pay a high insurance need to be controlled as well, as it has been done in some states (NJ, MA...). The problem in those states is that since insurance was not mandatory the healthy individuals fell out of the system when insurance became more expensive. Since only ill individuals remained in the system the cost became very very expensive.
MA should now have both a mandatory insurance and cost same for everyone. That should solve the insurance problem. We will see. The new MAss. law comes into effect fully in July-2007. I would like to know what is happening to cost there.