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Your Take: Health Care Reform Bill
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You knew this was coming. 
On Sunday, the House passed H.R. 3590, the Senate version of the health care bill, along with another bill (H.R. 4872 Reconciliation Act of 2010) to reconcile differences. HR 3590 was signed into law on Tuesday and the reconciliation bill, which the Senate passed yesterday.
Overall my feelings on the bill are mixed but mostly positive. I like the reform elements like preventing rescission and excluding children for coverage for pre-existing conditions. I love that we are moving a little towards preventative care versus prescriptive care, I’d like to see more of that. I’m a little mixed at some of the small business elements where employers are forced to buy insurance, but I think they are palatable because they don’t take into effect unless you have over 50 employees. I’m indifferent to the various Medicare and Medicaid elements that affect doctor payments because I am unfamiliar with how the system actually words (vs. on paper).
A big piece that concerns me are state health exchanges and how they’ll be implemented. It worries me because the bill requires some people to get insurance but doesn’t necessarily make things more affordable. It’s not clear whether insurance companies are required to participate and not everyone is eligible. It’s a bit too much gray area, you know?
Finally, how will insurance companies respond? If the Anthem Blue Cross rate hike in California is any indication, insurance companies know that the death spiral is a very real phenomenon. You don’t raise rates 39% because you think now is a good time to rip people off, you do it because you have no choice. I wonder how insurance companies will respond to the bill before some of its provisions take effect.
As for paying for these changes, we’ll be paying for the changes in the bill by increasing taxes on single filers earning more than $200,000 (about 1 million people) and couples earning more than $250,000 (4 million couples). While some would cry that this is “spreading the wealth around” (and it is) and un-American, remember that the Bush tax cuts slashed the tax bills of the taxpayers who are now seeing their tax bill increase. Pendulums swing two ways in its search for equilibrium.
What do you think about it? I’ve heard all the philosophical arguments from both sides, how this gives millions of Americans hope that their health won’t be denied or how this is the government telling you how to live your life… and I think philosophical arguments are overblown. Everyone talks about how government keeps spending and how it’s the party in power’s fault because of XYZ… which everyone knows is crap because every politician spends like there is no tomorrow (because if they don’t spend on their constituents, there won’t be a tomorrow for them!).
Let’s ignore these overarching arguments that matter only to politicians and let’s talk about the specifics of the bill that you like or dislike. Do you think putting the Medicaid tax on unearned investment income for those earning more than $200k/$250k is bad? What about penalizing employers who have more than 50 employees and don’t offer health care? What specifically do you like and dislike? The point isn’t to try to change someone’s mind about it but understand what people like and dislike about it and how it personally affects them.
Go!
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The bill does nothing for affordability. Since 85% or more of your premium dollars go towards paying claims how does the new bill help? I live in NJ and we have had reform for quite some time. No max on benefits, guaranteed issue and no pre-x in most cases. We also have some of highest premiums in the country. As a broker, the average renewals we see come in at a 20% increase or MORE every year. How does the new bill help? It doesn’t! What a waste.
They need to combat the real cause of premium increases. Claims incurred!!!That means preventive measures like eating healthy or not smoking or the other controllable measures you can take to keep yourself healthy.
Part of the bill does require restaurants with more than 20 locations to post the caloric content of their foods… Then again, you can’t lead a horse to water, but you can’t make Americans eat healthier.
This part of the bill along with the suntan tax are just small steps by the government to mandate behavior changes to help control medical costs. Expect more in the future as the costs of this bill skyrocket.
This bill does nothing to curb obesity, chronic diseases, administrative costs, medical malpractice insurance costs, defensive medicine.
It only scratches the surface of promoting prevetnative care.
So as mentioned, this bill only opens access to INSURANCE, it does nothing to drive down COST.
tome, here is some information on what the bill does in regard to preventive care. It could do a lot more, but it’s a start.
I’m in total agreement with Mike. This bill doesn’t fix the bigger problems with our system.
It does tax 5 million people (well, 5 million filers) and provide insurance for 32 million people who previously didn’t have it. I’m okay with that.
It does tax 5 million people (well, 5 million filers) and provide insurance for 32 million people who previously didn’t have it. I’m okay with that.
i can dig it.
I don’t care for the tax on tanning salons. While I haven’t ever attended one (so it doesn’t really affect me or my purchasing decisions), I dislike taxing a luxury item for the heck of it. One could argue the skin cancer angle for justification, but then why not go after obesity and tax fast food or candy where there is added incentive to change behaviors?
Personally, I also dislike what I’m hearing about flexible spending accounts. With a new lower maximum and removal of OTC meds it just means I’m paying more for my health care. Hopefully, this will correspond with lower premiums so it is a wash, but I expect a price hike for the next few years before things start to go lower.
Just my two cents.
The tanning tax is just stupid. Going outside without sunscreen is far worse.
I’m on the fence on a “fat” tax. On one hand, it could generate a huge amount of tax income. On the other, it’s punishing people who only enjoy fast and unhealthy foods on occasion.
FSAs and HSAs are two of the best types of health care payment methods. Whenever Americans have to pay for something with their own cash, they ususally always find the best deals and make informed decisions. It’s when you remove the direct payments that costs start to rise. Look at insurance, I pay my $10, and the rest is billed to insurance. I couldn’t begin to tell you how much my dental or health bills actually are. If I were to actually pay out of pocket, I would be searching for the best doctor within my price range and negotiating from there!
Tom, tanning beds aren’t better than sunburn, and in fact may be worse (especially since they allow year-round use and therefore increase overall exposure). See http://www.mayoclinic.com/health/tanning/HQ01487.
I live in Massachusetts, and it seems to me that one of the stated goals at the start of this whole reform process was controlling costs of medical care for the entire (aging) nation. It seems to me that the bill does not really do enough to do that. There are several gimmicks and projections at cost cutting, but not enough real reform besides a few pilot projects to investigate ways to keep future health care costs down.
I have no problem with extending coverage to the people in the country who don’t have it, but it seems irresponsible to do so without making the system you are adding them to any more solvent.
“I think they are palatable because they don’t take into effect unless you have over 50 employees.”
A little anecdote. My father started his own company (with 2 friends). They grew the business in 3 years to have 48 employees. They STOPPED hiring. They didn’t expand anymore and didn’t take on any new work. They could have easily grown the company bigger, and hired more people. Want to know why? Because when you hit 50 employees, a whole bunch of federal regulations hit you like a ton of bricks. It wasn’t worth it.
This health insurance bill will retard job growth.
Sorry to nitpick, but it sounds like, from your anecdote, that this bill won’t affect job growth very much, if at all. After all, sounds like there were already enough reasons not to cross the 50 employee threshhold BEFORE this bill was passed.
Or, did I read that wrong?
I have no other anecdote but that one. However, there are plenty of businesses that had grown bigger than 50 prior to that, meaning that it was worth it to them to grow bigger. Not everyone would have made the same decision as my dad (actually one of the owners wanted to grow more, but the 2 vetoed it). Is this added regulation going to alleviate that, spurring more job creation? No.
What my anecdote points out is that regulation adversely affects hiring decisions. Previous regulation cost probably 50 or so jobs right there. What business going forward will opt to say no thanks when they would have grown more – think of it as a continuum instead of a light switch (not everyone has the same decision point).
What’s the over/under on comments for this? 400?
I think that’s a fair mark. I will have the over please.
I’ll take the under… I’m gonna say in the low 300s
@MadHatter
I thought the same thing when I first read about the reform. My first reaction about the tanning bed tax was that I am just waiting to see how long it will be until they start putting a higher tax on fast food. Really though, why not…
If we are paying higher prices for alcohol and cigarettes, why not pay more for other “vices”? I doubt it will make too many people stop eating fast food, but if it at least gets a few people to pack a sandwich from home instead of opting for a Big Mac, then it would be a positive change.
A big part of why so many people eat fast food is becuase it is very cheap. And when you are living hand to mouth and have to feed your family you may choose from the $1 Menu at McDonald’s instead of paying $0.58/lb for some bananas. I piece I heard on NPR, and another that I read about the cost of being poor opened my eyes to this situation.
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/17/AR2009051702053.html
http://www.npr.org/templates/story/story.php?storyId=5317290
I agree. The value menu is what is keeping too many underprivilaged people alive. Unfortunately, it is also what is killing them.
Yet this bill does nothing to address those issues.
I think it might also be a “who is being taxed?” question. Tanning salons are going to hit wealthier people where fast food would include taxing poorer people as well. I’m not so sure I agree with the tax-the-rich philosophy to pay for things. I think taxing to provide incentive to change behaviors is much more useful.
Fun note: Petra, which was an ancient frankincense, myrrh, and spice hub composed mainly of traders, implemented a regressive tax scheme as a barrier to entry in the marketplace.
Wealthier people?
You must not live in the South. Tanning beds are on every other corner where I live. Hell, my sister OWNS her own tanning bed.
saladdin
I am from the South (Houston – on the coast, which might explain the lack of tanning places). Fair enough, though. My assumption was that only wealthier people would spend money on such a thing (you know with the sun and all being free). Regardless, let’s say “wealthier people*”.
*includes some irrational purchases.
Sound good?
My biggest problem with it is that I want a single-payer system. As far as I’m concerned, I’d rather deal with the government for my health care, since if I don’t like how it’s run I can vote them out, than private, for-profit industry where I really have no choice (I don’t see only being able to get reasonably priced health insurance through an employer, and then having to follow rules on what doctors to use, being told what procedures you can have no matter what my doctor thinks, etc. as being a good thing, and that’s how our system works.)
I have no problem with the tanning tax, and really I think they had a great opportunity – but failed – to tax other items, such as plastic and cosmetic surgery (of which the majority are not really necessary and the people are going to pay anyway, so I don’t see why not). And states are already looking to tax candy, soda, fast food, etc.
I agree that it won’t do enough to get providers to lower costs and therefore health care in general (which are a huge portion of health care costs). However, I think there are only a few options to get this it happen: make all health care non-profit and put all workers on salaries; paying a set amount per patient, rather than procedure (this would need some sort of regulation, and I’m not sure this is the best way); or revamp the entire system so that health care workers do not have to pay as much for schooling, placing them on a reasonable salary, decrease the need for malpractice insurance… but ultimately this could only really be done with a one-payer type system.
I also don’t see why insurers currently do not have the power to force providers to keep costs down. I’ve seen medical providers drop insurers for one reason or another, but why can’t the reverse happen? This is especially true in Massachusetts where its known that certain hospital groups get significantly more pay for similar services from insurers.
Overall, I think its a step in the right direction. Government is meant to provide basic services for the good of the people, and I think basic health care for everyone is a right, and this is a step in that direction.
I call shenanigans! Pick something that you pay for that is a luxury and imagine a tax on that to pay for something arguably unrelated. The whole “it can lead to skin cancer” argument is flawed when you consider two things 1) what they didn’t tax and 2) the cost of skin cancer on the system as a whole (not even comparable to other problems). Just because you don’t care to partake in a given activity doesn’t mean it can be taxed for the hell of it.
I do like you arguement about having the freedom to move wherever and not worry about health care with a new job; however this doesn’t necessitate government health care, just a severence of health care with employment.
Simple, boating. They tax moorings yet all that money generally doesn’t go to anything related to boating.
As for separating health care from employment, since health insurance for some reason only becomes affordable as groups team together to pay, you would need to tie yourself to something to get a decent affordable plan.
I still maintain that if the insurance companies had to go to the each individual, like we buy car insurance, than to have the “deep pockets” of companies to pay for most plans, things would change radically. I as a consumer would not be willing to pay the $800 per month that my employer pays to cover me, (and that with a $2000 deductible) if it came out of my pocket. Why is it acceptable because its coming out of my company’s pocket?
I agree, but this would require hospitals and doctors to provide a cost for their services so a true comparison can happen and I don’t see them doing that. Also, then you could argue that everyone would need to purchase this insurance, just like individuals in many states are required to carry car insurance.
Michele, that is a good question – because it is not acceptable if your company is paying highway robbery charges. One major reason we have come to this point in America is that insured Americans who have, for example, a $30,000 medical bill that the insurance company pays for, don’t care about the exploitation because they don’t see it as their own exploitation. We’ll say the bill should have been $3,000 , but the insured feels fine since they don’t believe they paid the bill. Great coverage! Except that it’s the reason other claims obviously have to be denied. We need to pay attention to our spending, including what is spent on our behalf. (And “on our behalf” is pretend in this case, because we are the exploited and *they* have a good game going) If we were frugal in that way, we could be a thriving country without this health care fiasco.
Wow!
The people making the majority of health care decisions would not be elected officials. The decision makers would be the permanent bureaucracy that works for those people. They’d be (at best) appointees, and at worst government workers-for-life. Why would you assume that the Government is easier to deal with than a private insurer? At least you can fire the insurer if you’re dissatisfied. Political turnover takes years – and its too one-size-fits-all.
Sure, there are many barriers that prevent insurance companies from competing. But those could be lifted. After all, we get car insurance, and homeowners insurance, and life insurance from the private market. I understand the need for Government regulation – especially consumer protection-type regulation that prevents an insurance company from arbitrarily deciding not to cover an illness even though the plan you signed up for says they have to. That’s common sense. But beyond that, without market forces at work, healthcare will become increasingly inefficient – every centrally-planned economy that’s ever existed testifies to the failure of this model.
And why not tax tanning? Because some people like to go tanning for recreation, just like other like to go jogging. Individual rights and choices are important, and taxes reduce the freedom to individuals because they put more things out of reach.
As far as a single-payer system with very limited, “reasonable” salaries for doctors… the reason this can’t be done is because it discourages the best and brightest from getting into the field in the first place. If there’s no financial incentive to work hard to become a doctor, people will choose alternative careers. People are not “born” doctors – they can become other things. And trust me, most of the really smart students, whether in engineering, medicine, or something else, are already thinking about potential earning power when they reach sophomore year of undergrad.
Your argument on the role of government is a philosophical one that many Americans disagree with. For example, I think Government is meant to provide appropriate protections against exploitation of people, not to actually provide the services. The Government should be a regulator, not a provider.
“The Government should be a regulator, not a provider.”
That just about sums up anything I could every say about any Government program.
Thanks, Fred.
No matter the government system, they are accountable to the public, therefore they’re easier to deal with than a private insurance, except if maybe you have enough stock in that insurer to guide their direction. And saying you can “fire” your insurer is overly simplistic. When you can only get reasonable health care through your employer and your employer offers one option (which is common, at least for small businesses), you can’t just fire them and find someone else. Health care doesn’t work that way.
You assume that there can actually be a true free market, which doesn’t really exist anywhere. And to protect the consumer, you need to have regulation, so talking about a free market in health care doesn’t make sense. Taking away regulations would not improve the situation at all unless you know that companies will not team up to keep prices artificially high, full disclosure for all plans and options is provided, and people are educated.
Taxing tanning doesn’t put it out of reach. If individuals want to tan, they can go outside.. if its too cold, they can fly south. No one is stopping them from doing that. We already pay taxes to upkeep parks, you pay to go into national parks and use state parks, taxes are paid to upkeep sidewalks and roadways. Its all paid for, so even for jogging and other recreation you could find a tax related to it.
“As far as a single-payer system with very limited, “reasonable” salaries for doctors… the reason this can’t be done is because it discourages the best and brightest from getting into the field in the first place. If there’s no financial incentive to work hard to become a doctor, people will choose alternative careers.” I disagree with this. I would bet that if you ask a group of doctors, the majority would not mention money as the main reason why they entered the field. After all, if money was the driver for people choosing careers, you wouldn’t have successful non-profits, social workers, restaurant servers, teachers and others that love their job but do not get paid all that well. Some of these people are also the best and brightest and choose not to follow money and I would think a good majority of people would fall into this group. I think a reasonable salary would be accepted by doctors.
As for government being a regulator and not a provider, the government provides significant services that have been necessary for our significant growth and progression over the past half a century. If the government was just a regulator, we would be no where as powerful as we are. For example, the government has created and upkeeps the necessary transportation infrastructure that has allowed for our economy to grow (the interstate highway system, other highways, ports, etc.). The military and homeland security are necessary services. Affordable housing, something that would essentially not be built without government help, is a service, unless you want a lot of homeless people. There are a number of other necessary services that the government needs to do because without them, our economy would not be robust, or even decent, and our country would not be able to sustain the level of quality of life that we have (and we never would have gotten here in the first place). Sure, as a regulator it has a role, but the government’s services are integral to our success.
“Some people like to go tanning for recreation.” Some people also like to drink alcohol and smoke cigarettes for “recreation” too. Yet they tax these vices…
I will say this again. People are stupid.
There is no reason to focus on anything education based. No amount of education will stop people from eating McDonalds or sitting on our ass and watching TV. The only thing we can do to curb actions is money based not education. Tanning beds are stupid. I know that and you know that but people get in them every day. Cancer education will not help you have to outlaw them or make it too expensive to be dumb.
Tax fast food enough and people may slow down on those $1 Double Cheeseburgers which should/will lower fatness which lowers health care costs.
But that will not happen. We are too dumb.
saladdin
We are stupid and breed damn near as fast as rabbits.
I was disappointed that the abortion part of the bill was taken out. Birth control reform is what we should address.
saladdin
Abortion is not birth control and should never be used as such. I would support actual pregnancy prevention methods in a bill, but abortion is not pregnancy prevention.
I don’t think that someone who is considering an abortion is thinking of it as their primary means of birth control. It’s not a pleasant procedure.
Saladdin I think the fair thing would be to let the fetus make the choice of killing him/herself after they are born. For example you would be able to make that choice for yourself instead of advocating for the killing of someone else.
Fetuses, imaginary beings or potential beings don’t make choices. Those who are born are subject to suffering and death, or watching the same of family members and loved ones who cannot get ordinary respect and compassion from their fellow human beings. To love what lives in your head at the expense of real human born life is less than realistic or compassionate.
saladdin, I’m confused as to what gives the Government / anyone else the authority to decide that lower health care costs are better than the enjoyment of a double cheeseburger (or hundreds of double cheeseburgers) over my lifetime.
Freedom is the fundamental right to decide what I want to do with my life, without someone outside of me telling me what I have to do.
What if I decide to sit on my butt all day long and watch TV. Should I get taxed for that? What if I decide to ride the elevator instead of take the stairs? What if I decide…. you get the idea.
If we wanted to as a society, we could slowly erode every right to make ANY decision that wasn’t “in the best interest” of society. But sometimes enjoyment of things is GOOD, even if it isn’t “good for you”. We’re all going to die sometime… death has a 100% win rate.
Do you really have freedom? Of course not. You are told when to go to work when to go home, how fast to drive, to wear a seat belt, which side of the road to drive on. Blah, blah…
It’s idealism vs reality.
I remember the exact date I lost my idealism.
saladdin
saladdin,
I’m actually not told when to go to work or when to go home… that’s a fatalist view of employment. I reach an agreement with my employer on those items in a fair trade. We’re both free to walk away.
Speed limits are designed to prevent me from taking away another person’s freedom by being reckless. That makes sense to me. Same is true for which side of the road to drive on.
As for seatbelts, there should be an opt-out privilege for that, too.
Really? You are free to walk away from your job?
How will you buy food?
That is not freedom.
saladdin
Fred, you may have a job where you don’t actually have a boss outside of yourself, but in this household every move we make and when we make it is determined by work hours – which have changed often, at the employer’s whim. No way do we want to walk away, as it is the best job we are aware of for our lifestyle. But it isn’t what I call freedom. Interesting that you call this a fatalist view. It’s reality. And the freedom to walk away equals the freedom to be homeless – or “choose” homelessness, as some would say.
Yana, I realize that other pressures affect people’s decisions when it comes to employment, and that not everyone has the same degree of latitude, but to define freedom as saladdin wants to just doesn’t make sense.
For instance, I cannot jump off a roof and avoid falling to the ground. That doesn’t mean I’m not free… Freedom does not mean there are not consequences for my actions. Freedom means that someone else isn’t imposing those consequences.
The Government doesn’t (and shouldn’t) make anyone have a particular job. If I choose not to work for a year, potentially because I’ve lived a lifestyle far below my means and saved the money to do so, I should be allowed to. If I haven’t saved the money and I choose the same, the fact that I’m not eating is still a choice. Point is, the Government shouldn’t be deciding what people have to do with their money. They shouldn’t tell others they have to buy healthcare… If they are allowed to make that rule, why couldn’t the Government make a rule that you can never have a big mac, or drive a car, or leave your house?
Fred, I agree that the government should not be mandating the purchase of health insurance. The decision of whom to do business with lies with the individual.
This bill is disappointing and deceptive on so many levels.
1) It does nothing to lower costs. In fact it does just the opposite. It increases costs.
Perverse incentives permeate this bill to entice people to just pay the fine while healthy and only buy the insurance after they get sick, again contributing to the country’s general financial woes.
2) It is not paid for. CBO accounting gimmicks aside, outlays will far exceed revenue from new taxes.
3) It endangers the financial health of the country, which is shaky at best right now.
4) It will result in much higher taxes for the productive elements of society. Don’t be surprised to see the budget commission come back recommending a major overhaul of the tax code that dramatically penalizes success. But even that won’t be enough. This bill almost ensures the US will have a national sales tax or VAT.
5) States will have to dramatically increase taxes to cover the unfunded mandates within this bill.
6) Insurance companies effectively become regulated utilities, or arms of the government, and many of them will not survive.
7) Businesses and state governments will have to make the decision whether to take the more expensive route of maintain existing insurance plans or adopt the more cost effective approach (at least for them, but not the taxpayers as a whole) of dumping everyone into the exchanges.
9) States will bear the costs of job retaining programs for state insurance regulators, insurance company workers, other people in the medical industry as well as student loan providers since we nationalized that industry Venezuelan-style.
10) But most troubling is that we have now politicized healthcare, transferred an unprecedented amount of power and control to politicians and bureaucrats, given this unscrupulous gang of buffoons dominion over our very bodies.
Can we say we are all Europeans now? If I wanted to live in Europe, I’d be living in Europe. I prize my shrinking freedoms. I don’t want any sugar daddies taking care of my family, especially those in Washington. Congress blew a golden opportunity to decouple healthcare from employment (which was created in the first place by Washington meddling with wage and price controls in WWII). Instead they’ve taken the first step into turning us all into wards of the federal government, beholding to the politicians for our very existence. But wasn’t that the plan all along?
Some thoughts:
#1 Costs will increase no matter what, just under this bill they’ll increase less. So I’m not sure what your point is here.
#2 Without the CBO, who should we trust to decide what the costs will be for any legislation, or should we just never think about it?
#3 I financial health has been beat up by the health industry as it is, I’m not sure this worsens it.
#4 Taxes will need to go up anyway, or programs cut (which is unlikely). The health care piece is not the sole reason for this.
#7 I’m not sure that many companies will choose the penalties over providing health insurance. Health insurance continues to be an incentive provided by employers, and to keep the best, they will have to provide the best (after all, isn’t that the argument for allowing ridiculous bonuses and pay to Wall Street, you have to pay them ridiculously or they’ll leave?). Plus, even in countries with socialized medicine there is private insurance (the UK for example).
#8 I think people are too lazy to want to try and play the system like this. Although this may happen, I think it would be relatively few.
#10 I prefer to be able to vote out a politician who is screwing with my health care than be at the mercy of an insurance company where I have no say.
And of course we’re no where close to Europe’s system. After all, we still spend significantly more, cover fewer people and our successes (life expectancy and such) are below most of those countries. Personally, I’d rather have a government system, so I could choose any job, no matter the benefits, move anywhere for an opportunity without worrying about how to obtain health care and cover my family, and take risks in entrepreneurship that I hesitate to do because of the lack of affordable health care in the market.
Couple things:
#1 – Costs will not increase slower, this bill does not address actual heathcare costs, so most likely they will continue to rise at the same rate or rise faster. The US aging and will only continue to age until all the baby boomers are dying off, that alone drives up costs.
#2 – CBO only analyzes what is placed in front of them. The Democrats utilized all the accounting gimmicks. Read Paul Ryan’s analysis. Of all the indepth reviews of the costs of this bill, his was by far the best, and most detailed. It was do detailed, at the Health Care Summit, after he talked through his analysis, neither Obama nor any Democrat had a rebuttle. It wasn’t CBO’s analysis that was flawed it was the numbers provided by the Democrats. The CBO cannot provide a good analysis with garbage numbers. Garbage in Garbage out.
I think Tom gave sufficient responses to #s 1 & 2, so I will address some the other issues.
#3: I don’t understand how “financial health has been beaten up by the health industry.” It’s not as if insurers are are making huge profits. Last I read, the health insurance industry has a profit margin of 2-3%. I saw a ranking of industries by profit margin a few months back that had health insurers ranked 85th.
#4: Why is a foregone conclusion that taxes must always rise when there are ample government programs that are more than worthy of being cut?
#7,8: You might be right about companies choosing health insurance over the penalty. But an alternative would be for businesses to not provide insurance, pay the penalty, and split the financial benefit between employer and employee. These employees would effectively be paid more than their counterparts at businesses that chose to go the insurance route. Based on the estimates that I’ve seen, this would have employees getting a $2,000-4,000 bonus. If a person is too lazy to play the system for $2-4k, they don’t deserve it.
#10: I think history shows that this is an ineffective approach. By nature, politicians screw over the public. In the case of insurers, your pocket book could do the talking if we had a truly competitive market. Unfortunately, the government has set it up so that there are very few insurers to choose from. And the more we move toward a government run system, the less competition there is.
It really depends how you measure “success.” Studies have shown that the US actually ranks #1 for life expectancy when non-health care related deaths are accounted for. Unfortunately, the US has an extremely high rate of death in these areas (car accidents, homicides, etc.). Not to mention that the US is way ahead of Europe when it comes to medical advances. The US health care system has been subsidizing Europe’s system in this way for decades.
What “shinking freedoms” do you think Europeans don’t have?
As someone who lives in both the US and in The Netherlands I am very confussed by your comment.
Overall, I’m upset that the Democrats worked very hard to push through this bill without addressing huge projected deficits in social security and medicare first.
I know that the conservative pundits are always crying wolf when it comes to deficits – that this or that will be the last straw. Regardless of that, I am worried that the more we increase spending and taxes without addressing the deficit, the more likely we are to experience a seriously devalued dollar or a dollar crash.
I’ve been having trouble putting my finger on what the next big collapse will be… we went from tech stocks to real estate. Will currency be next?
Hard to know… but I wish our Government would start tackling the REALLY hard problems like the deficit / debt. It appears no one wants to do this. As Jim said in the article, politicians have to keep spending to keep their constituents happy.
I wish people would stop fighting over this. We need to realize that we all take care of eachother anyway. I hope the greedy jerks who oppose change never have to deal with the possibility of losing their jobs and their health insurance and their home and their entire lives because of illness.
We are reaching toward more of the 7 deadly sins every single day.
In the end who do you answer do?
In the end we answer to ourself and our families. We do what is best for ourself and family with a passing thought to the greater good.
saladdin
And if someone doesn’t? Do you *forcibly* require someone to pay for you, at the threat of jail?
I’m all for freely helping each other out. Of course, if this makes things worse, then you’ve helped no one and hurt a lot of other people. That’s a big gamble.
That is the problem. We do not freely help anyone out. We are not designed to be selfless so we have to be forced. Drop the charitable deduction from taxes and charities will go under. We want our piece of the pie first.
People make selfish decisions every day even though we know it screws our neighbor.
We have to force people to drive the speed limit. The DAMN SPEED LIMIT. That tells you right there that we have to be forced to do the most basic, common sense thing.
Yes, we have to force by taxes or threats.
saladdin
Is it the chicken or the egg? The government has been crowding out private charity for decades now. While we still give tax breaks for charitable giving, a lot of people now use the excuse of paying taxes so now they don’t have to give.
One thing I have noticed is more nonprofits opening businesses to generate revenue which they use for their projects.
saladdin
I agree 100% with your assessment of human nature. That is precisely the reason we have to do as musch as we can to avoid having coercive power too concentrated in one single place. If the govevernment has too much power you will become a slave because bureucrats are flawed (selfish) humans too looking for themselves first.
The same can be said for corporations, insurance companies, doctors or anyone. So I don’t think placing government as being the most susceptible to this is rational.
I’m 28 and healthy, and have a very strict diet that I follow. Still, my insurance premiums sky-rocket every 6 months to a 30% increase. It’s ridiculous. If this change caps increases, then it’s a good change no matter how you look at it. If it doesn’t, then it was useless. I hate how HMO’s and private insurance companies are making the big bucks.
If by “big bucks” you mean 3% profit margins?
3% is not that bad in an economy where cash earns less than 1%. Most banks are earning around 3-4%.
profit margin, not earned interest
Premiums increase because cost of care increases. You are paying more because health care costs are rising and people are requiring more care.
There are no caps in this bill.
There is a Medicare payment freeze, but that is not a cap.
Sec. 10909 – I like. My wife and I just adopted our son and the adoption tax credit is a big help! It was set to expire at the end of 2010. When Obama spoke at Notre Dame, he said the country needs to make adoption easier. I couldn’t agree more. The average cost of a domestic US adoption is $30K – and that’s if you’re successful. Counting the money we spent on the multiple failures we had before we got our son, we easily doubled that figure.
Absolutely. It’s a shame that a system that helps both parties – parents and children – has to be so costly.
I consider myself to be a fiscally responsible, social liberal but not a Democrat or Republican. I think the bill has good intentions but it will not fix the health care system. It will only make the system more bureaucratic, cost more than they say and add to the deficit.
The bill should have focused more on regulating the insurance industry and pass a real TORT reform before anything can be fixed. They can’t expect to bring down health care cost when doctors are spending upto 20% of their income to pay for malpractice insurance. It also won’t lead to better care, because doctors are not practicing preventative medicine but rather defensive medicine.
According to a recent study, 20% of medical tests are unnecessary and the public always thinks it’s because doctors want to make money by billing for these tests but the truth is they don’t want to take a chance and get sued later. Imagine, if they pass a real tort reform you can possibly cut the cost by that much.
Although, I like a lot of the things in the bill like covering everyone and insurance companies not being able to deny coverage for preexisting conditions, etc …. it will not fix the crisis and sooner or later everyone will have to pay so it won’t just be the rich but everyone’s taxes will be raised. That is the only way to fund it without digging deeper on the deficit.
I guess after all it’s between an ass and an elephant. One is no better than the other …. you get my point?
My father in law was an ER doctor for 25 years in NC, his malpractice premiums were around 50% (only sued once!). Can you imagine paying almost HALF of your income to an insurance company just to do your job?
Is that pre or post tax? I imagine it is a business write off correct? Either way that sucks.
I don’t know for certain if it’s pre or post tax, but I’m assuming it’s pre because I know it is a business write off. Don’t get me wrong, he’s made a lot of money, mostly because he gets to pass that through to his ‘customers’ and we all get to pay it instead. He’s now making more working for the local government and picking up some small business clients.
Yes, yes, yes! Amen, brother.
I’m still scratching my head on the health reform bill. It’s a good start but what really will be accomplished?
Why does health care cost so much in the U.S. and the benefits that we reap are far less then in other countries?
Simple.
Very little incentives for the average person to be healthy. No consideration for the costs of the latest test, gadget, procedure, medicine, etc… regardless of the benefits associated with it (and the research that supports it).
Too easy to access Emergency Departments. ED’s have transformed themselves to a teritary care center because of the convenience. Make it simple to refer people back to primary care clinic/care provider versus having them gum up the system in the ED.
Obviously, in order for that to happen a huge change in the litigious state of the nation would need to occur.
What makes you say, then, that it is a “good start”. A good start towards what exactly?
Does the government run anything well? Look at the USPS and how much money that loses a year. They should have focused more on deregulation…not more regulation!
Ah, but the USPS runs it self… http://www.csmonitor.com/Commentary/the-monitors-view/2010/0302/US-Postal-Service-no-more-Saturday-delivery. And they need some reform in order to keep up with our growing country and replace the money that we no longer spend due to email and electronic bill paying. I don’t think the USPS is a good comparison. Maybe Medicare/Medicaid would be a better comparison. Just my two cents.
Martha, the USPS does run itself, but they also have a federal non-compete mandate that gives them exclusive rights to deliver first class mail.
If you look at the USPS accounting data, it receives $3.5 BILLION annually from the federal government. All this and they still can’t turn a profit.
Saying USPS “runs itself” is much akin to saying the Fed and Freddie/Fannie are not government run agencies (albeit Freddie/Fannie are officially now).
Imagine what postage would really cost if they ran the biz correctly!
It probably be less. I hope they finally drop Saturday delivery, it’s a waste. Honestly for residential, they should only deliver once or twice a week. If you need more than that, then you pay extra. I think our water bill is the only one left that I actually get through the mail, and being given 25 days to pay it, I’m not worried about what day it comes on. Oh and end the non-compete delivery to mailboxes
Mail is becoming less important as time goes on, but time-sensitive things still get delivered. I think once all billing and other important correspondence goes paperless, we could cut down on mail delivery, but for now it’s not practical – since we’re currently used to 6 deliveries a week.
Does the private sector run anything well? Look at Enron? They used deregulation to perfection.
saladdin
I thought they used partial deregulation to perfection?
Sure, I think technology does a pretty good job. Keeping up with Moore’s law like that must be hard work.
The private sector has a much bigger incentive to run their businesses well. What incentive do Government have? It can’t be fired or punished. We can only elect new officials, and what are the odds that they will fix the problem? Slim to none – look at Social Security and Medicare, those programs are poster children for mismanagement.
So if the private sector is bad at running business, the Government is far worse.
Private sector has only one goal- make money.
Government has multiple goals.
Comparing the two are impossible and silly way to try and make a point. Apples and oranges.
saladdin
Both are still fruit.
And how does a private sector make money? By wooing customers to their company. If we had inter-state health insurance, it would be a much better system due to the competition.
I agree, you can’t really compare. And private industry, as a profit making enterprise will make every effort to keep profits up, and this means going against its own ethics and mission statements if necessary. And they can, since they’re just statements, not laws.
This is called a straw man argument. Millions of businesses around the would run very efficient, effective businesses that make all of our lives better. A more appropriate example would be the Madoff ponzi scheme where, despite new regulation in response to the Enron debacle, the SEC still gave Madoff an A rating. Oh wait, that doesn’t really support your stance does it.
Yes, but most of those businesses do not decide between the well being of an individual and profits.
Ahhh…the wonders of the invisible hand.
Since when making a profit and the well being of the people are mutually exclusive? A business that is looking to create sustainable profit will by that very goal tend to fill the needs of the individuals.
Despite the ocassional Enron, I bet you are better off here and today than you would’ve been in Europe or before the creation of the corporation.
They aren’t, but most companies now don’t care about long-term sustainability, they only care about quarterly results. This is an overarching problem across our economy, even though there are exceptions.
Like Jim, I have my concerns, but overall a it’s step in the right direction.
This bill will force changes to be made in an industry that has gotten too comfortable with the status quo. These companies answer to their shareholders, and couldn’t give a rats ass whether you live or die as long as they profit off of you.
Go on, search online for all the people denied the very health care they paid for when they actually needed it. People say that it’s only a minority and most people are satisfied with their plans. Well, yeah, when you aren’t deathly ill on your death bed, you’re the golden goose for the insurance company.
If you’re one of the people who actually have good insurance, then good for you. Most people don’t, and can’t get decent insurance. I lived for 22 years without insurance, until I graduated from college and got insurance through my employer. My parents still don’t have insurance because they have to choose between putting food on the table or paying for insurance. Damned if you do, damned if you don’t.
This bill isn’t the end of the world like the Republicans would have you believe, and it isn’t salvation like the Democrats would like you to believe. This bill is a step towards real reform, to break out of this status quo, and make changes.
You’re delusional if you think the US has the best health care SYSTEM in the world (I won’t argue that the level it can provide is tops). All the advances and technology doesn’t mean squat if you don’t have access to it.
I agree with you on one front. I think everyone should have access to health insurance no matter their current health. If they do have pre-exisiting conditions, I don’t think they should be denied coverage. So, it is a step in the right direction.
However, you did not address the biggest concern of the Republican party… cost of the bill. How will this thing be paid for? If you believe that it will reduce the deficit, just read Paul Ryans analysis of both the bills true cost and the CBO report. Ryan’s analysis uncovers a startling number of accounting errors and “tricks”. These numbers were given to the CBO, which only uses numbers it’s been given to come up with a final analysis. If you don’t believe Ryan, just think about the total unfunded liablities within Medicare, and now add subsidies for 35+ million Americans. There is no way this thing will reduce the deficit, especially when it does not address rising health CARE costs.
This is not a step toward real reform, however. It just creates another massive unfunded liability.
My experience, from being well insured with a large company, to being subjected to private insurance (and their underwriting process) is that we currently have the worst healthcare system in the civilized world.
I’m glad something got passed, and hope it’s the first step in raising the US health insurance and heath care process beyond an experience similar to buying a used-car. If you’ve researched and purchased private insurance, you might know what I mean.
In the short term, I hope the Federal “high risk pool” is properly implemented.
I currently pay for private health insurance, but don’t really get it as it has exclusions due to a pre-existing condition (that got resolved in 2003).
Jon, you are confusing heathcare with the insurance industry.
Santos, I understand the difference and interrelationship between healthcare and health insurance.
My experience has been that US healthcare suffers from too much emphasis on money. When I was well insured, doctors still made decisions based on money. My GP (before I fired him) mostly cared about saving money by denying me diagnostic procedures. When I went directly to the specialists, they funneled me to their choice procedures (at up to 80 thousand an operation). I had to be my own GP and eventually found Doctors that focused on what was right for me, not just the monetary considerations.
Today, US healthcare is dictated by the insurance companies that have the natural private business goal of maximizing profit. I think this new bill is a good first step towards maximizing the benefits of healthcare, not maximizing the profits of private insurance companies.
One of the things I dislike about this health care bill is the fact that it removes our right to choose whether or not we want insurance. Through this bill you are required to get insurance whether you want to have it or not. If you don’t want it, you have to pay fines.
The other thing that stinks about it is that costs WILL go up for everyone because of it. Sure, your taxes may not go up if you’re making less than 200k or so, but your premiums surely will go up – even more than they would have otherwise.
When they kill the ability for insurance companies to put caps on coverage, or to exclude people due to prior illness, or charge more to people who use more health care (whether it’s right or not) – of course rates are going to go up for everyone – except the ones who are unhealthy! Some of the people who will be hurt most by this are the people who are healthy, and currently have lower premiums. Say goodbye to those low rates!
So even though your taxes don’t go up, your rates will. And since the government can subsidize their own public health care plan up the wahoo, of course people are going to switch to the cheaper government plan, which will mean the insurance companies can’t compete and many of them will die in the long run.
Also, because there will be more people insured, and the costs of preventative visits removed – there will be some level of health care rationing, longer waits for specialists and procedures. I for one am not happy with this trade-off.
If you don’t get insurance and you happen to need emergency health care, you walk into an ER and get it. If you can’t pay, you go bankrupt and the hospital eats it. If people are willing to die rather than get care they cannot afford, then the current system can work. People are not willing to do that.
Everyone’s costs will go up without caps but that’s not to say the current system is the right way to do things. If you need routine services to stay alive and you hit the limit, what happens? It’s easy to point out scenarios where people are cheating the system in any system, but there are plenty of people who benefit through no fault of their own.
There is no public health care plan, so I don’t know what you’re talking about there.
I never said the current system is the ideal one either. I think there are a lot of things that need to take place to bring the costs of health care down so it becomes more affordable to the average person.
Some of those things include tort reform (outrageously high costs of insurance for doctors, which in turn means higher costs, and premiums for consumers), more competition in the insurance industry including the ability to buy insurance nationwide, and even a possibility of some sort of group coverage for high risk individuals.
In regards the public health care plan, i mis-spoke about that. Obviously there isn’t a public option… yet. I think this HCR is the first step towards that, however.
I do think tort reform is fine, but I don’t think its as big of an issue as everyone makes it out to be. As for buying insurance nationwide, this is leading in that direction, just saying there’s a minimum standard of care that needs to be provided, so an individual doesn’t see a great deal and then find out later that it covers nothing. And a high-risk pool can be helpful, but it can only do so much when unless the high risk is spread out.
What about those that are admitted and treated during emergencies that were never given a choice. Should they go bankrupt for actions they had ot control over.
What about an uninsured parent who has a child with cancer? If the paent chooses not to treat the child (not sure they can unless for religeous reasons) they are ridiculed and outcast. If they do, they are bankrupt.
“If people are willing to die rather than get care they cannot afford, then the current system can work. People are not willing to do that.”
Jim, this is an extremely insightful comment. As a society, we can’t bear the idea that someone who chooses not to have healthcare will die if they cannot afford service. I, for one, believe that mandating insurance is OK, as long as there is a waiver process put in place that gives you the choice of explicitly taking the risk. E.g., you sign a paper that says, “I am choosing not to have insurance. I will be responsible for all of my own payments, up front, or for finding payments. If I am unable to pay, I understand that I will be denied services, which could result in my death.”
Why can’t we have something like this? It seems like the typical disclaimer you’d sign when you go sky diving. I, for one, wouldn’t sign it. But someone might, and I want to preserve that right.
Fred,
I like that idea. It would provide many people the option that would placate their fears of the government taking over. However I fear that when they do get sick the sentiment would be a backlash against the government. In some situations it is a lose-lose situation. I read an insightful article, in a magazine for individuals with clotting disorders, how we are all one diagnosis away from a change in opinion on the value of health insurance. Its a sobering thought, if you end up in the emergency room, or diagnosed with a life-threatening illness we do not think of the costs. However when you throw a waiver, then we may just figure out how much people are willing to pay for their health care.
Martha, I definitely understand what you are saying… and I certainly think only a fool would choose not to have health insurance if they were able to afford it (or it was provided by the Government if they didn’t have the money).
But, I guess I’m for preserving the right to foolishness. Some people think eating big macs is foolish; others think smoking is foolish; and still others thing base jumping is foolish (who would risk their life for a thrill?) The problem is that we all define foolishness differently, and that’s why individual rights are important.
So, if someone signs the waiver, and then they feel angry with the Government or society when they need a liver transplant and don’t have coverage, so be it. Maybe a charity would raise money for those people’s coverage… I dunno. But I think preserving the freedom is important.
Fred, I don’t see the value in health insurance just as I don’t see the value in extended warranties on computers. When you buy one of those, you have no control over what you get for the money. You are told where to get service and what service is covered. You have no power, and the money is gone. At least those are a smaller waste of money, and I don’t think there are further “co-pays”.
I want health care when desirable and necessary. I am wondering whether you know whether this new legislation requires the insurance companies to pay claims. Currently, when one goes to a medical group/doctor/hospital, one must sign a form stating that the patient and not the insurance company is responsible for the charges. In other words, the bottom line is that the patient pays when the insurance company fails to pay. If insurance companies are required to pay claims under this legislation, that alone is a real and significant difference adding some value to the product. Still can’t work though, without cost reforms.
I would be okay with this, but add that if one chooses not to get health care, and then wants it, there is a waiting period.
The knowledge of this bill is quite abstract.
It is likely that the knowledge, and opinions formed from it, of more than 90% of the population consists of 30-second sound bites or 100-word articles on the Health Care Bill.
The fear of the bill is largely based upon uncertainty and the success of ideological campaigns against it. Support for the bill is also ideological and/or from those who believe they will “benefit” from it.
Unless someone has read the entire bill and done extensive research on each item, any opinion is not more than speculation, which is likely colored by a bias to a certain ideological perspective.
In general, I do not like government involvement in my life. At the same time, I can not state an opinion of the bill with any confidence because I have not read it or experienced it.
We will only know in time how “good” or “bad” it is.
Too bad 90%+ of the politicians that voted for the bill never read it…
Why is this even coming up? They rarely read entire bills any way. This is not new.
saladdin
Just because it isn’t new, doesn’t make it right.
I think Kent nailed the truth of the matter.
I agree with most of the bill, but i haven’t read most of it. Hey, sounds like the author of this article
I guess I have a different take on this. Something is better than nothing for sure, but without regulation Insurance companies can do whatever they want. I have been in HR for more than 15 years at a few companies and not a year goes by that HI increases are in the double digits, sometimes as much as 20%. Without some kind of fix, many companies are going to reach a tipping point and choose not to provide that insurance 80% of us say we are so happy with. What then?
If you are in an area where there are only 3 companies and they all fix their prices, how is that fair to a consumer? It’s not an open market, There is no real competition. You can’t really shop around because Apple A costs the same as Apple B and C.
The one thing I continue to ask, especially people who have insurance through their employers, is: If you personally had to cut a check for $700 to $1600 every month for your HI, would you still be happy with it?
I am with you but I don’t know enough about the specifics of this bill. I am glad that something, anything was done about health care, because the health care system in the US is the most expensive in the world, yet our health numbers are worse than in other OECD countries. But I wonder whether costs will be controlled enough. I think a public option would have helped in that.
There is bigger issue that bothers me about the bill: the way it came about. It seems like the political environment is very polarized these days. The US has done best when both parties have worked together on issues. I also think that this is the will of the people. Most people – either on the right or the left – are in the center. And most people want the government to solve problems that cannot be solved by individuals or the markets. Alas, this bill was written and passed by one side only without getting the benefit of contributions from the other side. I am convinced that a constructive cooperation between both parties would have yielded a better bill. So, let’s keep our fingers crossed that this bill will indeed be an improvement over the existing system.
That is a good point, but as Larry King said to Mitt Romney, how could you have bipartisanship if one sign refuses to negotiate? Both groups must work together, not one saying they want to work together and then refusing to agree to anything the other says.
It bothers me that it is so polarized but I’m not sure what to do in order to fix it.
I have no problems with the political parties. I would be more concerned if they did agree with each other. We need the fighting/bitching. It brings issues out that would have been overlooked and forces compromises. A one party system would be more hell then a two party system. I do think this is the best system but I question the outcomes at times.
We have always had political parties from the very beginning of our birth and always will.
saladdin
You asked for it!
I am for health care reform and this legislation, but not because I think this legislation is good or effective. It is in fact useless in and of itself, and cannot work.
There is something wrong with a middleman between the patient and his medical care. It creates costs. Medical costs are already exceedingly wrong, and it is because of them that insurance companies cannot pay claims. They are for-profit businesses. What can we do about this? The possibilities include eliminating health insurance companies, regulating costs – many charges should be reduced by 90% in my opinion. An example of this is the colonoscopy. In these parts, a gastroenterologist charges $1,500 for the procedure. I went to a family practice doctor who offered me the bargain price of $750. This tells me that the price range for a colonoscopy should be $75-$150. ER and hospital costs that I have seen should also be 10% of what they are.
I am for a single-payer system. I believe we could not get real reform legislation because of the opposition, and that if the proposal was bad enough, they felt it would be defeated. So we are going to do it the hard way, and many people will die waiting for sane and real reform.
I agree with your first few statements. Costs are way to high, and would be driven way down if there was no insurance middleman.
What we should have are individual and family FSAs and HSAs that everyone can buy into. We pay into them, if you are under a certain income level, so does the Government. If you have a major health issue that requires a lot of money to pay for, there should be a low interest rate loan you can take out. So not only can you shop around for medical care, but you can also shop around for medical loans.
These may not be the best ideas, but I’m just throwing stuff out there. Bottom line is costs need to be managed and without individuals or companies neogitating for care, costs will not decrease.
Jury, for me, is still out on single payer. If it eliminated Medicare, Medicaid, and other Government programs and had to release its accounting sheets every quarter then I’d be willing to be on board.
I don’t think medical loans would solve any problem, although it’s an interesting idea. When you have to get a loan for $100,000 for a procedure, that’s a bit daunting, especially if is something that happens out of your control.
I think it’s too early to really know what out of the bill will be successful. However, I think its a good first step to fixing the health care issues in this country.
Very simple but perfect statement.
saladdin
As an independent business person I think it’s hardly enough, but better than nothing. Health insurance is my biggest risk. If I get sick, I will have to shutter my business and go work for someone else for the benefits. What we have right now is the most anti-entreprenurial system in the world. I have many friends who would like to start their own gigs, but are uninsurable, so cannot do so.
And for the commenter who asked, “are we all europeans now”? Well, no. My family in France has far, far, FAR better health care than I have.
I have many exclusions, an enormous monthly payment, and long waits to get into see my doctors (my last GYN appointment was a 4 month wait for the doctor, or 4 weeks for an NP). My family in France has everything covered (vision, dental, etc), day-of or next day visits as a matter of course, health care is not tied to their jobs so it is always available, and excellent high-quality care for both urgent and chronic conditions. I’d trade in a minute. My profession and my business is tied to US companies and wouldn’t work in France, or I would move.
This healthcare “reform” comes down to two changes:
#1 Health insurance is mandatory.
#2 Health insurance companies can not deny people coverage.
Presumably, this will mean people who are young/healthy will buy into the insurance pools and when they get sick they will be covered.
I don’t understand what democrats are cheering and patting themselves on the backs for. There was nothing stopping people from doing this previously. It would be like a bunch of smokers cheering legislation that made cigarettes illegal because now they could finally be free of their addiction. Did they not realize they could have done it themselves all along?
The only people this bill helps are those who were irresponsible and did not have insurance prior to needing expensive health care treatment and those who were naive and assumed healthcare insurance that was tied to their employment would never be taken away.
This bill changes absolutely nothing at a cost of who knows how many trillions of tax dollars and an increase in the entitlement mentality that is so rampant in this country. For now, the “rich” are the only ones being forced to pay for all this, but eventually everyone will “pay” via reduced health care access.
Oh yah, because the tax increase is listed as a medicare tax increase, the government bureaucrats can point to their charts and say they delayed medicare’s insolvency by a few years. Of course it would take the government to double count tax revenues to show any benefit whatsoever…
I have to applaud Jim for starting a conversation that was spirited, but not at all vicious, on such a heated topic. Maybe he should run for public office?
This is a real tough one. I’m usually pretty opinionated, and usually an advocate of free-market type solutions, but I agree that our system is way too flawed to feel good about. I can remember when I started working and they didn’t even ask if you wanted the medical insurance. You just got it, and because it only cost $1.59 every two weeks, nobody cared much one way or another. Now that I’m paying $200 per month at the same employer for myself and my spouse, it’s a topic of much more interest. And I’m one of the lucky ones, with a good benefits package and my employer paying 75% of the cost. Where did we go wrong?? I read an article recently about how some hospitals tried a new model that increased efficency, profits, outcomes and patient satisfaction while saving money. Why aren’t we exploring more of that? And I do think Shakepeare might have been right about killing all of the lawyers. I feel like we need to address the fundamental root causes of out-of-control costs, and I have NO confidence in the government’s appetite or ability to tackle that.
Ha, I’m not sure that’s a good idea.
The tenor of the debate here is a testament to the community and not anything I did. I find that commenters and readers are a level headed bunch and I’m glad we’re able to discuss and debate without name calling or other insults (most of the time). I find that we have more in common, regardless of political leanings, than we would expect.
It sometimes seems that change will only happen when a reformer comes in or someone believes something is broken. But often, this never happens and things don’t get fixed and efficiencies aren’t found.
I think the health care bill is a step in the right direction, but not the end of the journey by any means. I just wish it would not be treated as a political football and that ALL our congress men and women would treat as the future of American and not a good vs evil fight between the major parties.
It is early days still, but it has got the ball rolling. It may cost Obama the presidency, but 20 years from now he will be remembered for starting the health care solution that American needed.
Here’s one item I’d like to know the purpose:
*Employers are required to disclose the value of health benefits on employees’ W-2 tax forms.
So does this mean I am going to get taxed on how much my employer pays towards my medical benefits? (what about dental and vision benefits also?)
That’s the Cadillac tax. In 2018, you’ll be taxed on benefits that exceed $10,200 for single individuals and $27,500 for families. So if you get $10,300 in benefits, you’d be taxed on $100 (the amount that exceeds $10,200) assuming no changes between now and 2018.
I think that’s ridiculous.
So what if a company wants to provide it’s employees with exceptional health insurance?
I wish I worked for that company!!
If they want to do that, because companies are so benevolent, they could increase your pay to cover the tax.
I recall a discussion of certain collective bargaining health insurance agreements being exempted from the “cadillac tax” – does anyone know if this is still true?
They weren’t exempt forever, they were exempt until 2018. The fixit bill adjusted the cadillac tax to start in 2018 for everyone, not just unions.
Eight years is a lot of time for this to change so we’ll see how this plays out.
Yes Obama will be remembered as the man who tried to ruin America. It is time for the welfare state to be done and quit trying to enslave a class of people who only wants something for nothing. Let the government take care of them forever. This health care bill has been said it is a great start by Cuba people figure that one out. This country is going broke and we cannot keep taxing the so called rich forever. We are a service country and with out the money to spend things are going to spiral down into a pit. The health care bill is a mess and will take years for anyone to figure out what is really in it and i think you will find more wrong and bad then good if we do not go broke first for we know it will cost this country more then they say it will. Sorry people but things are going up and the cause is not the insurance companies
The health care reform doesn’t address the root of the problem – cost. Sure… everyone now can have health insurance, but at what cost? So many fundamental reforms could be made, but weren’t even touched on, such as:
1) One of the key reason of bankruptcy due to health care is losing one’s insurance coverage when losing a job. Health insurance should be decoupled from the employer, and should belong to the *individual* so that it is 100% portable as long as one pays the premium. Employer-funded health insurance should be modified such that the employer provide some kind of “health insurance credits” that the employee uses to buy his own *individual* health insurance that is portable even when he leaves the company.
I agree that this is a huge problem. I know plenty of people who won’t leave their job to start a new business or find a job that they actually like because they’ll lose insurance. I like the health insurance credit idea, it’s the next best thing to a single payer system where everyone is covered regardless.
2) Another key reason of why health costs are so high is because of the no-to-low deductible health care plans. First-dollar coverage should encourage people to spend indiscriminately on health care and this is what drives cost up. First-dollar coverage insurance should be banned. A minimum deductible of say $1000 should be introduced. HSAs and HDHP works in lowering health care cost precisely for that reason… but Obamacare is going to kill it! Health insurance was never meant to pay for costs from doctors visit, it was meant to protect one from *major* bills in the five to six digits range!
This would require doctors and hospitals to provide the cost of services, and they don’t seem to want to do that.
That is something the bill should have addressed. More visibility into true costs of services and care.
3) Inclusion of all pre-existing conditions. Great… now we include the sick people and this will drive premiums up! A better way to implement it should be to include all pre-existing conditions up to age of 30. So in this way, you have a choice of getting in when you are young and healthy (as it should be), or stay out and risk being uninsurable (it’s still your choice if you “don’t believe” in insurance).
When a pre-existing condition is something treatable, like diabetes, then it isn’t that big of a deal or really increase costs that much. And eventually, if people are not insured, others will have to pay for it anyway.
Great point. While I have no problem paying for all the old and sick, because I will eventually end up old and could end up sick (you never know), I do have a major issue with not this bill not strucutring any type of discount system: non smoker, non obese, gym credits, whatever.
There is 0 incentive for Americans to be healthy and this bill does nothing to change that. Preventative medicine is good, at detecting issues early, but it still puts the burden on the individual to change their behavior, which, again, there is no incentive to do so.
There is a multiplier for smokers which you can look at as a discount for not smoking.
But you are right, I don’t know why there is no sort of gym membership credit/deduction etc…
saladdin
I wonder if they were trying to avoid any “discrimination” lawsuits, or if they thought that was too much detail.
Because of our age, this reform will affect us the least of any of the comments I have seen so far.
We are retired and on Medicare, so problems with insurance through an employer is moot. Our HMO (Medicare does not cover preventative measures) premium is actually only one dollar short of being double what it was three years ago, but it is still within our budget… abrasive but not unattainable. Medicare patients are treated respectfully and within reasonable time limits.
Our tax rate is low because our income is Social Security and a monthly IRA distribution. Our savings account(s) would see us easily through a year or more.
Other than the age-related physical complaints, I am fairly healthy and take no meds other than vitamins and supplements. My mind is still sharp and I am determined to keep it that way as long as possible.
Should a catastophic illness be my fate, my ducks are all in a row and I am ready to go quietly because I truly believe that the human body has its limitations and should be allowed to quit with dignity when it’s ready.
~~~~ BUT ~~~~
I applaud the effort to make health insurance available to everyone but find the debt that will be passed on to future generations abhorant and unacceptable.
I do not agree with the Robin Hood idea of taking from the rich (through additional taxes) to give to the poor, even though I might be a benefiary of that process. In my opinion, that is simply communism at its beginning.
I believe that each person should have the privilege of PERSONAL choice without retribution in matters that do not physically affect another person.
I feel that if ADULT illegal immigrants were not afforded the same full benefits as legal residents, we could afford to make healthcare attainable. If they want the same benefits obtainable to legal residents they should become legal, productive, supportive residents. (Yes, I am a Californian.)
I think that this reform on the whole is only the first foot-in-the-door to a very long trial-and-error road to travel.
Shirley, I don’t believe in punishing the rich (however defined) or the poor. But it should be noted that any such punishment of higher income people via taxation is not transferred to the poor. It goes directly to the medical monstrosity that is the biggest scam ever inflicted on the people. I also don’t discriminate against immigrants of any kind or age, and don’t see a reason to place blame on them that belongs squarely on a system that makes incredibly excessive prices untouchable. If you really think about it, anyone who is not gaining financially from the medical/insurance/pharma system is “the poor”. Poor suckers.
I do agree with you that this is a “foot-in-the-door”, but the road will only seem long to those who don’t have the time healthwise to survive long enough for true reform. This is being done deceptively instead of in straightforward fashion, and full socialism may replace capitalism as a result. This is extreme.
Unfortunately, we’ve been increasing debt for years and this isn’t the only large increase. This issue should have been continued to be dealt with after the Clinton era, but was forgotten. However, I can see an argument being plausible that says health care for all improves the economy since all have access to preventative care and so productivity can go up raising revenues and decreasing debt.
The “Robin Hood” idea isn’t necessarily all bad. There are a lot of benefits for everyone when we try keep the lowest individuals out of poverty. And it’s easy to forget how much of our lives are actually impacted by these people and help keep the wealthy wealthy.
I’m not sure how this bill deals with illegal immigrants, but my guess is that it doesn’t matter since they are unaccounted for, and assuming they don’t pay income taxes, they can’t be a part of the system that makes sure everyone buys insurance.
Preventative care still rests with the individual and the obesity epidemic proves that prevention is not the answer.
Wow this thread got long fast! I am happy to pay my share for the bill. However, I wish that insurance companies were regulated nationally instead of on a state level. We should have moved beyond this provincialism years ago.
I am responding to you hopefully to get in the last word on this subject.
Last Word.
Bill Snider
I think some got sold a bill of sale. To call this bill Health Care Reform is a misnomer. It reformed nothing. Costs will still increase.
You are already seeing employers react. CAT, AT&T, and John Deere have already taken huge hits to their balance sheets. From what I am reading, the stock market should drop about 10% due to forward earnings being hit.
All these comments about how we now get to see it work….yep, we do.
The only government program that I am willing to accept as legal is single-payer/total government control via the “general welfare” clause. This clause is meant to extend to everyone and not a particular group. Now, that said, I am against the single payer because our nation is BANKRUPT! We cannot afford it.
Who is John Galt?
Cat, AT&T and JD are just 3 of a huge number:
http://www.dailyfinance.com/story/atandts-1-billion-charge-connected-to-health-reform-is-just-the/19416371/
Why can’t we have a single-payer system run by private companies? Eliminate employer sponsored programs, eliminate government run programs (Medicare and such), and have a program simliar to automobile insurance. You can go to any company and you can customize your coverage. The government can regulate this system details and provide subsidies to poor(must offer insurance to everyone regardless of pre-exisiting conditions). Competition will keep cost down. I do not see the downside.
These companies are reacting due to one piece of the bill that closes a tax loophole (the government was providing subsidies to these companies and letting them write-off the value of those subsidies even though it wasn’t there money, which is a bit ridiculous).
I do not know much about this bill. I am skeptical of it just because of the people that endorse it tend to be very big government people. These are the same people that developed and implemented policies that lead to the banking crisis in late 2008.
I am sure there are some good things in it but I would bet there are more bad than good. I just don’t like the idea of the government getting this deep into peoples lives. I do believe that our current health care system is one that has brought the most technologically advance health care to the most people ever in the history of mankind and that this bill will probably destroy that. Yes, there are problems with our current health care system but they need tweaking not a revamping of the whole system.
Oscar,
I find it hard to believe that it was the implementation of “big government” that led to the banking crisis of late 2008 since most studies show that it was the lack of regulation that led to that crisis.
Here is a good overview that explains how the subprime mortgage crisis occurred and was not prevented: http://en.wikipedia.org/wiki/Subprime_mortgage_crisis
And here is an article from The Economist (well respected) about how we need better regulation, not just more regulation to help prevent such crises in the future:
http://www.economist.com/blogs/freeexchange/2008/09/crisis_roundtable_work_smarter
But I agree with you that our current health care system has provided excellent care and innovation for those who can afford it.
@Martha
While the banking industry should receive its share of the blame for the housing bubble and subsequent banking crisis, the government definitely played a huge part. Consider the implicit (now explicit) guarantee of Freddie and Fannie. Then consider the various programs through which the government pushed banks to give mortgages to high risk borrowers. Then consider the fact that the government didn’t used to tax ANY interest paid on debt, but chose to levy taxes on all debt except mortgages (creating a huge subsidy to the industry). Then top it off with extremely low interest rates set by the Fed. Keep in mind that these examples are only a small sample of how the government has pushed home ownership for the past century. As a result, the various government programs provided ample incentive for banks to take more risks. So while banks were negligent for their lack of lending standards, the government was the catalyst for the much of the debacle.
Uclalien is spot on. I can’t explain it better than Peter schiff, so if you don’t believe uclalien, I suggest checking out the schiff report.
Agreed. The government, through a mass of deregulation, fostered the situation where business, motivated by the upside, took unnecessary risks, undermining the economy.
I’m glad that we can all agree that more regulation is needed in the financial sector.
I’m not sure that “more” regulation necessarily solve the issue. I think we are in need of more effective regulation. In some ways, this would require additional regulation. But in many other ways, it would require less. The system we have now is just a mess no matter how you look at it.
That said, given what I’ve heard/read that is coming out of Washington, I don’t see any truly effective change on the horizon. Much in the same what I feel about this health care reform, more often than not, politicians pass bills/laws simply to make it appear as if they are doing something, whether or not anyone believes it will be effective.
I should also add that we are talking about the housing and financial/banking sectors, two industries that experience more regulation and more government intervention than almost any industry that hasn’t been completely taken over by the government.
Honestly, I don’t see the “mass of deregulation” that so many people blame for the crisis. While deregulation occurred in some ways (Glass-Steagall), the reality is that the government was too big and slow to adapt to the new innovations that became widely used by the financial industry (e.g., CDOs). But it is my belief that government manipulation of the housing market, was the primary driver for the crisis. This manipulation created the incentives for the financial industry, home buyers, and real estate developers to take the risks they took. Absent the government’s manipulation of the housing sector, I’m skeptical that these other issues would have come to fruition.
Sure, we have advanced care, but if most people can’t afford that care and it isn’t used, what’s the point? Especially since most of these technological breakthroughs have come at the cost of taxpayers already through federal grants to hospitals and universities.
And making opinions on a bill just from the individuals that endorse it (and its a large, diverse group that do), is a bit silly.
@Garrett: I am not sure what world you are referring to, but it is not the world of those of us who buy insurance on the private market in America. Your suggestion of a “high” deductible of $1000 is a dream for many of us. For most of us who are self-meployed, that is a low deductible that most of us cannot even aspire to. My rate for that deductible (per this year’s rate change) will be $700 a month. Obviously that’s more than I can swing. For a deductible of $5000, I will now be paying $300 a month. I have friends who have a deductible of $10,000 for over $400. It’s really bad unless you happen to be covered by an employer.
I have been involved in the healthcare field for over 30 years. The “poor” have always had coverage available through medicaid. They have to apply and follow through the steps of the process and then they are covered.
The group that are at issue are the working “poor”. They dont have ins through their employer and cant afford the premiums.
Currently we will all be taxed and forced to buy insurance – even if we can not afford it. The current rates will not be going down. So now you are forcing all of us to purchase something that we could not afford. If you make less than $88,000 you will be put into the medicaid “pool”. Apparently you have NO idea that there are not enough doctors taking Medicaid/welfare currently. They receive approximately $33.00 for a visit that they charge $100.00.The balance has to be written off by the doctors office. In the past this has been considered charity and most doctors will take some patients who have this coverage. Now we will all be on the medicaid/welfare program – that we have to “BUY” and will have our access to doctors restricted (currently is takes an average of 42 days to get an appointment if you have welfare). This time delay will have to increase, as you are adding millions of patients and no more doctors.
Secondly – with the decrease in reimbursement to the doctor – the quality of care will diminish as they will have to see a larger volume of patients in the same amount of time. The ability of the medical community to continue research and development will be halted. Therefore no more “innovations” in healthcare that we Americans take for granted and the rest of the world wants to copy.
The insurance companies will become “utilities” of the government. So now this is killing private sector jobs (way to go)
Medicare has been cut by $500,000 billion dollars. This will impact ALL seniors ability to see their doctors.
Who wants the IRS to be in charge of deeming insurance coverage amounts and then enforcing the collection of the premium?? They will be checking on all Americans – monthly- to make sure that you are buying ins, paying the amount they say – or you will be SUBJECT TO FINES – which the IRS has the power to collect. Who wants the IRS looking at them monthly???
Instead of “fixing” the problem for the Americans who need an “affordable” answer to the health insurance problem, we will now have the majority of Americans on a welfare(they are calling it a “state health exchange” -lets call it what it really is WELFARE, which will end up costing the same or higher than your premiums now (look to massachusets to see proof- their costs went up).You will be FORCED to buy ins and stalked by the IRS who will ENFORCE fines if you do not cooperate. You will not be able to see a doctor when you want- care will be rationed(currently is now for welfare)All reasearch and development and private insurance sales force – will no longer have jobs. Medicare has been decreased for the people who need it most.
AND they have taken over the student loan program – through the healthcare bill “sneaky”
Please pay attention to this fact – CONGRESS AND THEIR STAFF ARE EXEMPT FROM THIS BILL. They wrote the laws so that it does not apply to them. Think there might be something wrong that we have not even been told yet??
We need to be aware of this underhanded law that has over promised and will underdeliver and we and our children and their children will suffer for it. We all need to work to get American back to the land of the “FREE” – and get rid of the people in power who are trying to enslave us by making laws that they do not follow and are unconstitutional.
Rebecca, your post is very different from all the others I’ve seen here. I wonder what kind of involvement you’ve had with the health care system, because I don’t see anything in there that is believable. You actually make me love the health care reform bill, even though in itself it is not very lovable.
Are you saying Rebecca is not believeable? Because the same can be said for anyone commenting on this post, including you.
I also don’t follow why her statement makes you love the bill more?
tom, Rebecca’s post sounds angry and alarmist, as though we should be terrified by the legislation. She puts WELFARE in all caps, and makes sure we know she is an authority by her first sentence. My reaction is contrary to her intention. I support honesty, and will do the opposite of what someone using scare tactics tells me to do.
On the other hand, every other post I’ve read here shows thinking and honest opinion on the part of the writer. I appreciate diverse opinions because I like understanding how others think about this, and it helps me understand the issue better as well.
Fair enough, just wanted to clarify.
Dear Yana,
the reason that I wrote the information that I did was so that the majority of Americans who do not know the medical side of the healthcare bill can become more informed. If you have worked at an occupation for as long as I – in management as well as patient care – you have seen the “workings” of the helthcare system as we know it. Are you aware that physicians have been taking cuts on the medicare/medicaid system since the early 90′s? Their in-office costs have gone up and their reimbursement has gone down. Now they are waiting to see if there is an additional 20% cut for 2010. Who will continue working in a field that will be so regulated that they can not treat the patients based on their own judgement – nor get reimbursed at a rate that will sustain their overhead?
My post is not to scare anyone. Just to give additional information so that you can make a decision based on facts.
I am currently against this bill as it does not address the concerns of the people,and raises costs that will be passed on to future generations. However, there is a real need for healthcare reform so that we can continue to enjoy the best healthcare system available and I think that congress should listen to the American people and propose a bill that will truly help us in the way that is needed.
**********QUESTIONS TO ALL************
There has been a lot of great discussion so far, but I’m curious…
Do you support or oppose the current bill?
In general, what would have to change in the bill for you to support?
I oppose the bill.
In order to get my support the bill would:
1. Remove required coverage clause and penalties (but if you do not have insurance and get sick, you should pay at least 20% more for ala-carte care)
2. Address actual cost of care (malpractice, administrative costs, defensive medicine, preventative care, etc.)
3. Eliminate Medicare/Medicaid, employer sponsored healthcare (if employers used to offer health care, they must now add that to salary), and federal government program
4. Setup a the framework for a national heath insurance program (not run by Government), run by private insurers similar to our automotive insurance competition network, where people can chose their coverage, deductibles, and shop around for insurance. Everyone can get insurance through this program.
I think that’s it.
Support.
Macro view: Single payer
Micro view: Some type of gym credit. Required annual physical exam of some type to qualify initially.
saladdin.
I support the bill, but looking at it as a first step rather than a complete, final package.
The reason I don’t like the idea of allowing people to choose to be covered or not s because those that can’t afford it, won’t pay for it, and if they get sick, we’ll end up with the tab. If we can get those people to agree that they won’t seek any medical coverage, then fine, but I don’t see that as being realistic.
I would like to see a better attempt at cutting costs. I think the insurers, hospitals and providers should be non-profits only (similar to France’s system), and workers should be on a salary – some systems already use a salary system, such as the <a href="http://www.npr.org/templates/story/story.php?storyId=113052504&ft=1&f=1027"Mayo Clinic, one of the most respected health care providers in the country and world. Administrative costs should be cut (through the use of technology and a better medical record system). Med schools need to be more affordable so doctors can work for a reasonable salary and not worry about paying their loans.
I’d prefer a single-payer system, as I mentioned before, with med school costs kept reasonable with decent scholarships and other aid available, salaries for doctors, combined with tort reform.
Tom,
I agree with you on all the issues. We all need to research the items mentioned to have a clear idea of the direction healthcare should take.
I LOVE THE HEALTHCARE BILL. I think the tea party is cutting off their nose to spite their face. These poor people do not understand that older people will get $250 this year for help with their prescription drugs. Children cannot be turned away for pre-existing conditions. Lots more. READ!! The TEA PARTY only listens to uneducated people like Sarah Palin, Limbaugh, Beck and the senators. They’d rather listen to lies and ignorant FOX NEWS, than really seek out the truth. No matter, they’ll still benefit from HC Bill.
Guess what, Right now there isn’t anybody turned away because they can’t pay !!!!!!! Pal you have no clue on what is really going on in America !! Just keep on watching ABC,NBC, CBS etc… because they tell you just what you want to hear !!! Oh I for got they are the real news… NOT liberal jerks is what they are !! Lets screw up the whole health care for 32 million people…. Humm lets see 268 million people have health care now with out government being involved! Government has no business running that much of the of the economy !! It looks like I lost part of my comment. I sure hope all shows up.
Look,…..exhale……..keep it simple. What has govt. done so well that would make you give them a vote of confidence for this healthcare. Social Security, Medicare, Public Schools, Poverty- still here, Anything not broken or Bankrupt? Govt to me is sloppy unaccoutable work with a big pension based on a padded last three years salary. Why do you want it bigger?
Do not rely on Nancy Pelosi or Barak Obama to help you in your life- Look at Nancy’s California (Get your refund yet!). Look at history not only here, but around the world, make your own logical decisions and you will be OK.
A LOGICAL DECISION DOES NOT INVOLVE HANDING THE BILL TO MY 1 OR 4 YEAR DAUGHTER AND SON! THAT IS NOT RIGHT! NO WAY!
Needless to say, my head is still spinning! So much to dig out and through.
The government that governs least governs BEST!!There is no way with the government involved in health care that it will be cheaper to run period!!! This is just one more way obama is moving the country to socialism. Our founding fathers will be rolling over in there graves!! obama just upsets me so much the way he is ruining our country !!
I can’t believe even a democrat would think this is good. With the company I work for I have an HMO and have to pay about $65 a week, but I don’t see a bill. This could be taken away and if we have to pay it could put us in the whole. Our we as a country that stupid or am I missing something. To many egos in Washington with both parties and they need to get a clue before it’s to late. This country needs some serious help