Higher deductible plans will be available in the exchange.

It's such a small percentage, that I think the government could fairly heavily subsidize it and not really blink an eye. Maybe it would end up costing the person more on a premium basis than a family without those, but it would still be doable. The government does this on a regular basis with the disabled, underage parents and kids somehow not covered.

I think if you just say "we got this" on pre-existing conditions, you're going to see that 2-3% really increase. Like JIMGA is saying (I can't believe I said that, I may need to wash my mouth out with soap), it defeats the purpose of having insurance for a lot of people.

A high deductible plan is worthless, especially for those who work part time. It only makes sense for someone who has a pre-existing condition and knows they will go over that deductible amount. But of course that pre-existing condition wouldn't be covered under the current system and even if it was, the lifetime cap (which is eliminated under ACA) would be reached pretty quickly. And your 3% number is not accurate.

The issue is more than places have to cut someone's hours and potentially have them pay more for insurance coverage. I'm pretty sure even the high deductible exchange plan will be more than the $40 a check that this home depot plan cost (family, $2500 deduct). The most comparable ACA plan I found was around $400. So, now that person just lost 3-4 hours of work a week and is now forced to pay $300 more a month for insurance.

The other problem is many lower income people, small businesses and others without employer insurance sometimes opt to have extremely cheap private plans with deductibles in the $5K to even $10K range. With the ACA, there's a cap on that deductible amount which means their premiums could also drastically increase.

You don't see that with disabled or low income - it seems like that would be a lot easier to "fake" than a serious pre-existing condition that prevent normal coverage. Again, oversight would be needed, but it's already done in the above examples. There are conditions like Fibro where you can get on disability (with insurance) and there's no real way to prove you have it.

It makes perfect sense for those who can't afford normal coverage or who are young and have families. If they get in a massive auto accident, they are only out $5K worst case. That's the purpose of insurance. It's not to cut prescriptions down from $50 to $10. I think we have forgotten the entire concept of what level of base health insurance is "needed".

This is the kind of thinking that needs to change in order to reduce medical trend. The point of insurance is not for the buyer to only buy it if they think they'll get something out of it -- it's to protect the buyer from catastrophic losses.

And if medical costs had any basis in reality, I'd agree with you.

Healthcare providers & health insurance providers have one of the biggest scams running in American history - a step under our financial institutions.

That is the number referenced for people with pre-existing conditions that cannot get coverage either through an employer or an existing public program.

The problem is that you don't have to fake it -- just let it happen. I mean, it's called a pre-existing condition -- so you got the condition before you had insurance. The easy way to let it happen is to just not buy insurance. I don't think there could be any kind of oversight that will say, "yes, you have this pre-existing condition, but, see, we've determined that you really should have bought insurance, so tough break" -- the only thing that comes close is an individual mandate.

This is a key point. The goal of health insurance is not to allow everyone access to $10 doctor copays and $5 monthly prescriptions. It's to ensure they don't get wiped out by unforeseen/catastrophic events. I think the level of entitlement on what everyone should be given when it comes to health insurance options is not a good thing. It may not make everyone happy, but the idea that some guy who works full time at a factory should get access to cheaper doctor visits than someone out of work isn't a terrible thing.

That would be wife's sister's long-time boyfriend. He has had 4 major wrecks in the past 18 months or so. No way he should be on the road at this point.

At least he is a giant leach on the side of Connecticut's taxpayers as well.

And my point is that especially for someone who is working part time, the high deductible plans mean they could suffer a catastrophic loss before they receive one dollar of benefit.

But what's the advantage? If you don't have it - you get cheaper options through your employer or outside broker. If you happen to get the condition, then you are forced to go with a public option that is more expensive, a higher deductible and has worse coverage. This is because you are now grouped with higher risk people.

I don't see too many people going "well, I could go through my employer or a local co-op without my pre-existing condition. But, if I can somehow get cancer or heart disease, I can pay more for less coverage on this public plan. Let's do it!" :eek:

I think most high deductibles fall under the "sucks ass" category of losses, rather than the "catastrophic" -- even for part-time folks.

We've decided that some basic health care is a right in this country. The question is what is that level?

With pre-existing conditions, the word "insurance" is pointless. The event has happened and someone needs to pay for medical treatment.

One big problem is that insurance is tied to the workplace. The implication being that health care requires a productive worker. That and treating health care as a right are incompatible concepts.

One way to help solve this problem would be government expansion of free clinics, focusing on non-emergency immediate care and preventative care. Doctors could trade having their medical school costs paid by spending a few years in one of these clinics - like we do with the armed forces universities. But it wouldn't be as good as what's available privately. Nurse practitioners could also play a big role in these clinics.

Expecting employers and insurance companies to solve these fundamental problems is a very strange and inefficient way to attack the problem.

You're not factoring in the subsidies for lower incomes.

Then they should pay a higher premium every month to get a $1000 plan instead of a $3000 or $5000 one. Everyone has choices. Some people decide that they would rather save the $200-300 a month and spend it on other things and "risk" a $5000 plan. Other people prefer the peace of mind and stick with the $500 to $1000 deductible plan that costs more a month. Maybe they don't get to go out to dinner as much or drive a worse car, but they have that choice.

At our company, people can choose a $250 deductible plan for $350 a month or a $2500 plan for $30 a month. A lot of people choose the latter - for many it's a smart move as they just put another $100-$200 a month in a medical expense account they can roll over and save the $100-$150 a month in premiums.

True, if it's a lower income person they may get a small tax break for upgrading their plan. But, the minimum amount they can pay for "base coverage" is going to be more because the deductible max that the ACA institutes. Remember, there's a pretty heavy "employer paid piece" in their current $40-50 a check. The total cost for the plan is probably over $300 and the employee only pays $50. Even if the tax break is outstanding, it's not going to cover 80% of the premium.

Which is all I could get as a self-employed person. But Michigan is better than most. So what will happen with Obamacare is my premiums will rise about 10%, my deductible will remain about the same, and I will have insured access to fewer doctors. It's a blow, but not a huge one.

In some states, like New York, where many of the Obamacare mandates were already in place, which meant the price of individual insurance was so high that it didn't make sense for most insurance companies to offer it, this opens up the individual market. Costs go down because healthy people will now offset the cost for those with expensive conditions, who were setting the price of this insurance. Any examination of the cost of implementing Obamacare should reflect what it is people are actually getting, because saying New York benefits ignores the scale of who receives that benefit. It's apples and oranges there. In Michigan, it's a little more realistic. In some states, where the individual market was already competitive, Obamacare may well double premiums - or more - because a high percentage of the new clients are in that 1-3% with serious pre-existing conditions. Analysis is not rocket science here.

Honestly, most people who have insurance paid through work have absolutely no idea of what health care costs in this country. Low co-pays are a very expensive benefit.

This is exactly right. I have seen the "employer paid" part of most benefits and it is staggering. Here's a table that shows it globally:
http://www.bls.gov/news.release/ebs2.t04.htm

At our company, it's around the normal 70%. For the $250 deductible plan, the employee pays around $350 and company pays around $800 on top of that. If we all got dropped to the exchanges tomorrow, what do you think the impact would be on current employees with that plan?

Yeah - I was kinda wondering that myself. Somebody working 28 hours a week at a minimum wage job is totally going to qualify for some level of the subsidies.

:D

SI

To be fair, I still think it's a giant turd. But what we have now is a giant turd. My hope is that a public option comes out of this and that we have to take a step back to take two steps forward. If that doesn't happen, then we're all screwed anyway as this is a giant sloppy kiss for insurance and drug companies, as you stated above.

public option >>>> current system > ACA

SI


The problem is that the bolded fact means nothing. The 85-90% rate of return for Congress is all they care about. Who cares if the group you're a member of has a 10% approval rating if it means nothing. It might cause you to lose a little sleep at night for a bad working environment. But you only run a 10% chance of losing your job every 2 years and that job has a LOT of perks. Even worse, because of the gerrymandering, your districts get more red and more blue so even if you fire your Congressman, it's for someone more extreme, not less.


Nah, that's in 2 weeks for the debt ceiling debate. Ready for that one next?!?

SI

Can't you just look on the exchanges and find out?

I am not a fan of ACA. Of course I am in a bit of a unique situation. Family of 5, my wife's employer provides us all with health insurance. She works 24 hours a week but is paid for 40 hours (she works Sat and Sun 7pm to 7am so overnight and weekend shifts gives her 2 pay differenials and the hospital considers her full time despite it being 24 hours.)

We have a fairly average health plan that costs a few hundred a month. If she were to lose these benefits due to her 24 hours of work then in CT, the exchange board happily says that the "affordable" health care costs for my family would be in the $700-$900 range per month. I would pay double.

Not cool.

Luckily, it doesn't appear they will take away her benefits.

I approve the CA, but the affordable part is not true at all.

It's too bad Tom Clancy never wrote a book about a member of the president's cabinet stealing the trillion dollar coin and using it to fund a coup (somehow).

Actually, some of that should be the goal of comprehensive health care reform. Incentivize people financially to do preventative care so catastrophic care is less necessary.

I want everyone to get their scheduled colonoscopy because early tests and outpatient surgery are much cheaper than long term end of life care for even 10% .

I want anyone with TB to pay their $5 for a perscription and take their meds because drug resistant TB doesn't care about your insurance status when it infects you and it's damn expensive to treat and sometimes fatal.

Hell, I would have loved to have a sin tax on sugar and I LOVE SUGAR (tho do not have diabetes). Whether the government is doing it or whether Anthem is doing it, someone is passing along the cost of the premiums from a diabetes patient to me in terms of higher premiums to cover that person and higher hospital costs because insurance companies don't have any incentive to bend the cost curve.

It's all interconnected whether the government is doing it or whether some insurance company is doing it. And prevention is a lot cheaper than treatment so financial incentives towards prevention save us treatment money in the end.

SI

They did make a Simpsons about it, tho:
http://www.snpp.com/episodes/5F14

Then again, it was season 9 and by then, things were starting to get silly

SI

I'm not sure where they're getting the funding from, but we're open for business through Friday. Monday, 40% will be sent home while the rest of us get to work without pay until they pass a budget.

It's hard to tell because they don't list all the coverage. But, a $250 deductible plan for Blue Cross/Blue Shield (what I currently have) is listed for between $700 and $1200 a month in AZ. Given our household income is above the floor for subsidies, the approximate increase in cost for us if our company dropped coverage appears to be atleast double what we pay now - and maybe a lot more. Let's hope it doesn't happen...

That was answered 1986 when Reagan signed a law that said doctors are required to treat emergencies regardless of the patients ability to pay.

All this stuff is just an extension of that. It's really not a huge change in who receives health care, it's a change in how it's done. Currently hospitals have to bill us extra to cover the costs of those who can't afford it. That's why you're paying $10 for an Aspirin.

This is why the complaints over a mandate are stupid. We are paying for uninsured people as it is since that bill in 1986 was passed. Nothing is really changing. We aren't all of a sudden stuck footing the bill for other people's health care. We have been doing that since 1986. This just organizes it better and hopefully saves money by not having all the uninsured running into a hospital and costing 10x more than what it would be to just see their doctor.

I guess one way of looking at it is that the bill is stupid because our whole system is stupid. We could just join the rest of the industrialized world at some point.

Again, we have a great system for a vast majority of the working public. Why not come up with ways to cover those who are uninsured and leave the rest of us who have very affordable healthcare (with 70% of our premiums paid for by our employer) alone?

What is your guarantee that if there were no ACA, that there wouldn't be any changes to your healthcare coverage?

And by what basis do you arrive at the conclusion that we have a great system for the vast majority of the working public? By your own experience? Our system of healthcare ranks towards the bottom of the industrialized world, both for affordability and expected life span.

Well most people don't agree with your first sentence, so that's your answer to the "Why not" in your second sentence.

And let's not pretend that Republicans are trying to replace Obamacare with some alternate plan. They just want it overturned immediately and nothing else.

Of course, the Republicans don't want to come up with an alternate plan, because if they do, some Democrat is gonna propose it in 20 years and they'll once again look foolish opposing something they once supported.

Your employer isn't paying that. It's a pass-through cost, just like your 401k and other benefits you receive. It's built-in to your salary. If employers didn't have to pay for health insurance, you'd take home the difference.

There hasn't been for the last 12 years I've been with this company and it's doubtful it would change - that is unless the government came out with a new system that our company could use as a justification to offload us and save some cash.

By the plans offered by most companies. For most fulltime workers, they have access to company subsidized plans with reasonable deductibles ($250 to $750) ranging in the $250-$500 a month premium cost to employee. We do a benefits study every year and this is what we find. This is significantly cheaper for those deductible levels than anything you find in these new exchanges.

Again, as long as companies don't start dropping coverage, we will all be fine. But why setup a way for them to do that under the cover of Obamacare? It's almost like the administration is hoping a bunch of companies drop coverage, people are faced with double their premium cost per month and come crying to Obama/democrats to make it a public option for cheaper. The cynic in me thinks this could be the endgame. Of course, in the interim, we may be faced with numerous families looking at massive premium hikes to receive similar coverage they had with their employer.

They pay it because it's a massive writeoff for them. If they lost the incentive to pay it or were faced with a way to save money by not covering employees and save face by saying everyone can join exchanges - many companies would jump at it as it would increase their profit margin.

Basically, alot of what I'm hearing is that the fine for companies not covering employees should be much higher so the cost of offering coverage is less than the penalty they'd pay for dropping coverage. I'm totally down for that, but I certainly doubt any elected Republicans would agree.

I would be fine with that. The problem is a lot of lower wage workers would certainly be moved to part time to ensure companies aren't subject to fines if they don't want to cover 30-35 hour part time workers. But, given the alternative of a bunch of fulltime guys losing their current coverage, I would take that tradeoff in a second. There should be no feasible way that a company would stop providing benefits to fulltime employees and someone come out ahead financially.

The point of this is provide coverage to people who don't have it - not to reshape how people with existing employer paid care get coverage. At least, I *hope* that's the point here - at this point I'm not even sure what the point is of this plan.

This, this, a thousand times this. An enormous part of the problem with the entire health care system is how, somewhere along the way, insurance stopped being "insurance" and became interpreted to mean "paying for access to 'discounted' health care".

I'm not that freakin' old at the ripe age of 46. As a kid, health insurance didn't come into play unless there was a hospital stay (or at least vist) involved. Prior to going into business for myself I was fully employed by other companies for something like 14 years, of which I saw ANY employer funding health care even available only for a couple of those years (although I realize that was likely true in a minority of industries).

It got flipped on its head somewhere along the way, and it occurred relatively quickly.

Your salary is a write-off for them as well. Your benefits are all factored into your salary.

The problem is no one sees this benefit. If tomorrow, a company stopped providing health care coverage and everything shifted to an exchange, most people wouldn't realize that they just lost a pretty hefty benefit. There are ways that companies could decide as a group to no longer provide health care coverage but "work with all their employees to find acceptable replacements in the form of this marketplace exchange system". Maybe their deductible increases a bit, premiums increase a bit more, they now pay more for office visits and maybe even can't see the same doctors. But, for the rank and file workers, most wouldn't even realize they just took a massive "benefit cut".

Do you really experience a world where people are not worried about their health benefits and aren't incredibly grateful for any coverage they have? I think most polls show that health care and medical coverage is one of the number one concerns of most Americans, not something they don't realize they have.

In addition, isn't what you describe companies doing above exactly what has happened to healthcare over the last few decades, increasing premiums, increasing deductibles, less control over who they see?

One of those rare times I can say I agree with Jon. One of the biggest problems with our health care system is that everyone wants any possible medical care, no matter the cost, and they want it for free. They view insurance as a subscription model. If you talk to people about generalities they may agree there needs to be a kind of rationing, but when you talk specifics, no one is willing to have themselves or a loved one not receive a procedure that might help them because it's too expensive. I think the heart of the problem is that our medical technology has far outstripped our economy. We can do more than we can afford to do for everyone.

Where I undoubtedly differ from Jon therefore is that I think this ties back to how income for the average American has stagnated over the last 50 years. People want that discounted health care partly because the reality is most people can't afford health care anymore. If we switched to catastrophic coverage and people paid for their medical care, people would realize the salaries they receive for their work are not sufficient to cover medical care, because the average American has not kept up with cost of living expenses over the last decades. This has been hidden in part by the insurance system but now the health care costs are crushing it.

Just to be clear. Isn't this the EXACT same thing I was telling you on Facebook yesterday and you thought I was nuts to advocate delinking healthcare from employment? And now you are in favor of it today? :cool:

And I place a great deal of the blame for those costs -- which stretch back through the health care providers to the cost of their training in the first place -- on the shift in the payment model over the years.

Ain't that the truth. Before I was an Investigator with the Department of Labor, I was a Benefit Adviser, while I was in law school, and would get calls from Participants. Lots of people weren't happy with the system - we'd get quite a bit of pre-existing condition calls for one.

Isn't all of our employer provided healthcare already government subsidized in terms of tax breaks to the companies providing it?

Also, ever increasing premiums (that are passed onto workers) for coverage that still can easily result in bankruptcy is a great system for the vast majority of the working public? It's only good for those who never get sick, which if that's the case, then why have insurance at all- sounds like you're buying something that's not even worth the paper it's printed on.

SI

And when you develop a chronic condition and happen to get laid off and can't get new coverage because of your preexisting condition?

What then? Just tough luck you're fucked and bankrupt?

From a foreigner's perspective...

This Obamacare stuff already passed congress and was signed as a law in 2010?

Basically, the Republicans are blocking the passage of a new budget in order to get this law modified? And the Democrats are refusing to compromise since they had already won the battle when this was still a series of Bills back before 2010?

I suppose I don't understand how the US govt works, but are there no safeguards to the Federal Budget in case of political Partisanship?

In the Philippines, if congress fails to enact a budget, the previoud year's budget is automatically grandfathered in, just to avoid the potential stoppage of Government services.

Nope - no safeguards, because we're silly.

Yuck, sounds like you have a stressful job. Imagine how many great employes your competitor can get if they are the only one to offer benefits. Those employees may be so great that their output would surpass that of the company filled with non-benefited employees.

It's a little late & I've had a long day buuuuut .... I think that would accomplish the same thing in the U.S. right now, since last year's budget would not have included funding Obamacare.

Same as the basically everything but Obamacare budget that the House approved but the Senate rejected.

The rhetoric among editorialists and press is so stupid. A professor of modern history is calling this the most extreme move in US history. I guess 1) since she only knows modern history, she wouldn't know about the Southern states seceding and 2) she probably doesn't know modern history that well if you act like this has never happened before.

Also, what's with the "mandate" about the election in saying it was all about the ACA? Everyone is implying that the election was about ACA vs. anti-ACA. That's stupid. I would bet that if Obama was anti-ACA, he still would have won. And even if Romney won, I would almost bet that ACA would still be in effect. There were several logical reasons why Obama won that went beyond ACA.

Not really, since Obamacare was the subject of a separate mandatory spending bill. That's why the House has to specifically defund Obambacare rather than fund it.

With the bonus of avoiding this silly mess. ;)

It is a silly mess because it is the wrong fight. Unfortunately, there are many in DC that want to maintain the fiscal status quo and will not fight to change.

I was reading about this recently. Until late in the Carter admin the government did continue at previous spending levels. Only after the Justice Dept wrote a series of opinions in 1980 did we get to the mess we have now.

We're fucked.

I'm thinking no clean debt limit raise is > 90% probability at this point too FWIW.

Actually thinking I might put a bit of a short down on some of the domestic indexes in expectation of that.*

*just my personal thinking, not an investment recommendation.

I wouldn't worry about that quote too much. He's just whistling past the graveyard there I believe.

This would be a more effective argument if "employer coverage" tended to be "good coverage".


Um, actually, it would be better than what's available privately. Because what's available privately for free is, basically, nothing. Which is kinda the whole point of ACA.

You all missed me. Especially EagleFan & JiMGA. Admit it. :p

Yes. But we need more diagrams!

If you'd just stand still however ... ;)

Wait? How did I miss an NFL in Pictures?!?


Oh, and hi, flere

SI

This...if that was a stick-figure GWB, I'd have enjoyed it MUCH more.

He hid it in the thread rather than breaking it out into its own like he used to.

That is pretty much how the US budget process works as well. But this current situation isn't related to a new budget, it is to raise the debt ceiling. They are basically agreeing to pay for things that the previous budget authorized. By raising the debt ceiling, they aren't adding more spending to the deficit. But, what the Tea Party Republicans are trying to do is to exact concessions before authorizing the government to pay for obligations that have already been authorized by Congress.

Isn't the current situation about the budget? The mess in 2 weeks will be about the debt ceiling.

SI

Yeah i didn't want to say anything because his rant sounded so good even though the specifics were a little off.

D'oh you are correct. They were so close to each other in timing, I had forgotten they were separate. But back to the point about a budget, they aren't voting on a new budget. They are voting on a continuous resolution, which keeps spending at the previous levels, which like the debt ceiling vote, doesn't add any new spending.

Most employer-based coverage is very good - better than anywhere in the world and cheaper to the consumer. I've had two surgeries for less than $200 out of pocket each with no wait and with the doc of my choosing. My wife just had a child (with both of us staying an extra night) and the out of pocket was around $500. I have access to the same insurance that 500 factory workers do (none have college degrees or make more than $20 an hour). A basic summary of our plan is $350 a month for employees, $250 individual and $500 family deductible, 90% coinsurance after that. See any doc for $15 or specialist for $30 in network (which are every one I've ever been referred to or found has been). $50 copay for an ER visit. Prescriptions are cheap (most under $15) and you can even set aside money pre-tax for the year to pay your deductible and some of the copays you expect.

As someone who also handles a lot of hiring and works with our HR, I see comparable benefits across the industry and we are certainly not any better than most companies out there. Intel, Honeywell, Motorola, Insight, On Semi - all have the same plan as we do.

It's like congress, most Americans hate the "health care system" but are happy with their plan. Things do need to be improved, but our plans are very fairly priced for most of the working public. People happy with their Health Care don't go on the news and say "Yeah, I only had to pay $250 for a major surgery - seems fair to me". The issue is with people who don't have employer based coverage and that's where the effort should go initially.

I love the idea of delinking it - provided it gives the same level of care for the same out of pocket for working people. If you came to me tomorrow and said "Hey, you can get that same Blue Cross plan you are on now for $350 (or even $400) but it's subsidized by the government instead of an employer" _ I would be all for it. However, if I have to pay $700-$800 for the same coverage if it's delinked (what I would have to pay at minimum on an exchange) then I'm not in favor of it.

Arles, the costs your employer pickup are pass-through. You can't just say that an employer is picking up the tab out of the goodness of their own heart. It's part of your salary. You are paying not only what your portion of the premium is, but what your employer picks up too.

Your employer is not subsidizing anything.

It's great that this is your experience, but the data paints a different picture:

http://www.commonwealthfund.org/Publ...-and-2007.aspx


Another consequence:

http://www.commonwealthfund.org/News...n-4-Years.aspx


Note both studies are from 2008, but cursory google searches indicate the trend continued to 2013.

This is the key point that people have been pointing out to him for a couple pages, but he seems to fail to grasp.

With regards to 'value' - two of my three kids were born in England, we paid $0 out of pocket for their births and time in hospital, the 'plan' had a monthly cost of around $450 for a family of 5 (ie. my NI contributions which incidentally was the maximum possible to make, if you were on minimum wage they'd be far less).

Seeing a doctor in the UK costs $0 its a 'right', seeing a specialist costs $0 ... if you need medical drugs then you pay a fixed cost regardless of the cost of the drug involved (and if you're unemployed then the cost is waived) - please do note however that cosmetic surgery and suchlike isn't allowed under the NHS unless there is a damned good reason (i.e. serious burn victim etc.).

With regards to the quality of the care, the US is pretty similar to what I've received in other countries (not just the UK, but elsewhere also) - they appear more 'test happy' over here and rarely see you on schedule (instead making you wait for 30 minutes to an hour past your appointment time), but thats about the only difference I've seen myself.

I personally miss the reassurance I had in the UK that when a member of my family was ill all I hoped for was that they got better - in the US when someone is ill I also have to worry about what its going to cost us and whether its covered under the insurance plan we have ... even when it is the out of pocket expenses are ludicrous at times - I estimate I pay around $3-4k per year in out of pocket expenses for a family of 5 who are in the main very healthy ... thats on top of whatever SEGA are paying for the insurance itself.

I know this affects a lot of peoples approach to medical care, I've friends I play football with who should be seeing doctors (they have niggling injuries) who don't because they feel they can't afford to - that to me shows something is wrong as it leads to people putting 'off' getting checked out until its too late and could be a serious issue.

We are talking apples and oranges. I am talking about people with employer-based coverage and you bring up the underinsured which (by and large) aren't given employer-based options or choose to pay less for higher deductible plans. Hey, we have a plan that's $30 a month with a $2000 deductible. Someone could switch to that tomorrow and then complain to ABC news the next week when something happened that their coverage stinks - and be right! But, they chose it. If people feel that $200 to $400 a month is too much for family health insurance on employer-provided coverage and go with the cheapie plan, there are consequences for that.

Of course it's a benefit, but it's one that many people don't see. That's my point and companies would have a much easier time cutting benefits and having people join exchanges than cutting another benefit (ie, giving everyone a 5% paycut - which would be seen as terrible even though the actual impact was less). I'm not even sure what we are arguing right now? Companies provided a benefit of health insurance (just like a 401K match or salary) but could remove it for certain employees if they could hide behind the ACA as a shield. I just wish to penalty for doing that would be higher - that's all I'm saying.

And I'd be paying a 45% individual tax rate, plus a payroll tax and a VAT tax on top of it to get that. I'm very happy paying $200-$500 for serious events/surgeries, choosing my doctor and surgery time, while paying a small premium that ends up about 3-4% of my salary with a tax rate in the 35% range. Again, when you add in taxes paid, premiums paid and money out of pocket (esp with a medical expense account that's pretax), US employees get by far the best deal.

The point was that you were arguing that you only pay $300 for a premium because your employer covers the other $400 while if you had to buy it on your own it would be $700. But you're paying $700 now, it's just not showing up on your pay stub. You aren't saving money by getting it through your employer.

And people absolutely see the benefit otherwise companies wouldn't do it. Why would a company provide a benefit if the employee didn't factor it into their decision?

Thats fine and obviously everyone has different choices and priorities, I liked the fact that the priority in Europe is to ensure everyone has access to quality medical care regardless of income level myself.

I'm glad you're in a good place and are able to look after yourself and your family - thats awesome, however I personally believe EVERYONE should have access to quality medical care not just those who have good financial standing.

You indicate a sweeping 'US employees get by far the best deal' - the well paid might do*, the lesser paid definitely don't in my opinion .... they get what they can often making do without health coverage at all.

*I'd debate this as most American's I know are far more 'stressed' than English people I know - partially I believe because of the lack of a safety net, long hours working and the potential unpredictability of their outgoings (due to variable health costs etc.) ... there is more to life than raw cash imho and I think quality of life is the most important thing.

I've been at places purported to have good insurance by both people inside and outside the company but I'm not certain that if I didn't suddenly have tk's health issues that I wouldn't be bankrupt right now.

SI

I agree with everything you say here. My point is that if the result of switching from employer-provided health care to Gov't-provided healthcare is that I now have to pay double out of pocket for premiums, I'm not in favor of it. Now, if my employer would agree to shift that $400 to me as a "health care bonus" or I would get some kind of tax rebate for that $400 and my out of pocket stays the same - I'm fine with that. But saying "Well, you were paying $350 out of pocket and now you need to pay $700 without any additional raise/benefit/subsidy/tax cut to cover the difference" is what I object to.

I hope you are right. I just feel that unless their are steep penalties down the road, it will be very appealing for some companies to drop coverage under the guise of "Well, the ACA is here and you can get similar coverage there. To make it up, we will give everyone a 2% raise". I really hope I am wrong and this doesn't happen in the next 3-4 years.

To put a bow on this - I am certainly for some sort of healthcare reform for people without good employer based options. It's awful what people who have pre-existing conditions or work part time and don't qualify for a good healthcare co op have to pay for quality coverage. My point is let's focus just on that (part time workers, pre-existing conditions, other poor famlies not currently covered by existing programs) as step one. Get those people covered then we can start the debate on broadening it to some form of government system.

The ACA is setup to encourage companies to eventually drop covered employees as that will reduce the risk and reduce overall costs. There are some fines, but they don't have a ton of teeth when you look at the cost for providing benefits. Plus, the ACA would love more 25-45 year old middle class families with no serious health issues and stable jobs joining up. It's like having a car insurance company that covers only DUI offenders and then adding a bunch of perfect drivers. Over time, paying that $800 to $2000 fine is going to look very appealing compared to dolling out $400-$500 a month to cover certain levels of employees. I'm sure Execs and high paid will be fine, but the rank and file positions (unskilled, hourly, "replaceable" level) may lose their healthcare coverage and be forced to pay much more out of pocket for these exchanges.

Again, time will tell, but I would have much preferred a system that completely excluded people with existing coverage for this phase (ir, make the fines more what it would cost to cover). Don't even give companies the carrot of considering cutting benefits or some will do so to save money.

Oct 17 is the real D-day I think. I'll start the countdown

T-14

GOP legislator: Boehner won't let government default on its debt - CNN.com

FYI, I brought it up as a reminder that the main purpose of ACA was to provide affordable health care for those who are currently uninsured or underinsured (and don't qualify for another government program).

But I just noticed in your response to RainMaker about employer-based plans that you already recognized this, so I'll drop it.

I'll believe it when I see it. If he does so, I wonder how long it'll take Cantor to stab him in the back.

That's an interesting opinion, but I'm not sure what you're basing it on, other than your personal satisfaction with your company's policy and your sense that other companies have similar policies. That sort of anecdote doesn't really demonstrate anything other than the fact that some people have a policy they like. I've never seen a statistic that backs this idea up.


But who exactly is going to agree to cover a population of uninsured and pre-existing condition patients? The reason the two populations are being combined is that's how it makes economic sense. Nobody is going to take premiums only from sick patients and net a loss--by pairing them with patients who are generally healthy, they can charge a decent premium to everyone.

Your suggestion seems to be that the government simply pay the health care costs for people who don't have good employer plans. I don't see how that's an improvement. Yes, you'd get to keep your cushy employer plan but certainly your taxes would increase. And now we'd have the government literally making health care decisions for anyone without a good plan, which is I think what a lot of people are trying to avoid.

National Business Group on Health (NBGH): National Business Group on Health: Pressroom


Who makes money from Food stamps? Or insuring the disabled? Or providing *free* premium options to lower income familes (like AHCCCS in AZ?)

They are setup as government program because they need to be heavily subsidized. I expect that the risk of covering pre-existing and some sick/low income people without access to employer-based coverage is also fairly risky. I would be fine setting up subsidized "exchanges" for these groups to ensure they have coverage options. Now, they may not be as cheap as what employer-insured people get, but they can be better than what's out there today.

No, everyone who doesn't have insurance open to get their own insurance through multiple venues:

1. Find a 40-hour job with employer-based coverage.
2. Find an insurance broker to get you a Co-OP or group coverage privately.
3. If neither 1 or 2 work for you (low income, pre-existing conditions, ...), we will have a government subsidized private health plan that is either state run or privately run (I'm fine either way) that you can join. Now, it probably will have a higher deductible than 1 or 2, an income ceiling to qualify (or pre-existing condition clause) and won't be as good a plan as employer-based because of the cost, but it will be an option.

The key to option 3 is that there are limits to who can join (income level, pre-existing condition that prevents other coverage, ...). This is very similar to what Arizona has with ACCESS - you are just raising the income level a bit (to ensure part-time workers qualify) and adding in the pre-existing conditions piece. I also wouldn't have this completely paid for by the government, they would be subsidized on a scale based on the level of coverage people want and their income level. The difference between this and the ACA is that it stops at a certain income level (say $40K) to ensure it's not used as an out for companies that may be pondering taking a fine and using the ACA as a shield to save cash on benefits.

So, your idea is to take healthy people with low premiums and group them together with sick/more at risk people and have their premiums shoot up. Sounds fantastic for the majority of fulltime working Americans who currently have good coverage. There's no need to do that - it's the throwing the baby out with the bath water strategy.

We have programs already setup in most states to cover the lower income families who need coverage. We just need to expand it slightly to cover those with pre-existing conditions and maybe raise the income level for who is eligible a hair to cover part-timers. I also think it shouldn't be fully covered once you get out of poverty. Maybe a sliding scale of % of premium paid by the person as their income level increases. This alone should cover a portion of the cost. This plan would be cheaper than the ACA as a significantly smaller % would need coverage. We can see how it does for a few years and as the uninsured decreases to a more minimal number, we could then decide if we want to try something completely different.

They've been doing it since 1986. Who do you think is footing the bill for the people who show up to a hospital without insurance? The people who show up with insurance.

Again, and my plan above drastically decreases the number of people without insurance without sticking it to middle class workers who have good health care plans. The initial goal should be to find a way to cover more of the uninsured and then take stock of the costs. That can be done without screwing people who have good jobs, make 40K-70K and who's employer decides over the next 4-5 years that there's really no need to subsidize employee coverage as they could go out and get their own plan for an exchange.

As stated in the PBS article, 2016+ is when the middle class could really get hosed by the "unintended" consequences of the ACA on their coverage:
http://www.pbs.org/newshour/rundown/...obamacare.html

But maybe I'm wrong and in 2016-2018 no impact will occur to the millions and millions with affordable premiums offered through their employers now. It's just a risk that I don't feel is necessary if the goal is to initially reduce the number of uninsured.

Those people with good jobs would be paying the taxes that subsidize your plan. I don't have a problem with your plan, it's in fact what Obamacare started out as in a way. I'm just saying that the people who are healthy and who get cheap, affordable insurance are going to be footing the bill no matter what. You're either paying it through higher premiums or through your taxes.

To a point. But seeing a 1-2% state tax increase to cover a percentage of the uninsured is better than having our monthly premiums double (which is likely if employer provided coverage stops for many people as a result of the ACA a few years down the road).

I don't mind having small tax increases to cover safety net programs (which is where many conservatives and I differ). I just want transparency into why the increase occurs and steps to be taken to ensure spending doesn't go out of control because the government gets an extra 2% of our cash. I also think that limiting the program and providing some form of premium from the people in this public plan (ie, it's not just free) will help limit the cost over time.

The reality is a lot of people that don't have insurance can go out and get a policy tomorrow with a $2K-5K deductible and not have it cost a ton out of pocket from a broker. It's not perfect, but it is insurance and protects them in the event of a massive 15-30+K hospital bill. Most just don't know how, don't think they need it or can afford it (ie, they check on a $250 or $500 deductible plan and are shocked at the cost). The only people who really "can't get" insurance are illegals and people with pre-existing conditions. For the latter, that's where some form of program should be instituted to help them. For the former, there's really nothing anyone can do to resolve this outside of some form of amnesty (which comes with its own problems).

Interestingly, if you expand the polling sample beyond what is in Arles' link (only those who work for corporations with 2000+ employees were sampled, and only across 350 corporations), you find that while satisfaction with employer-provided plans remains high, the clear winner is Medicare: Reason-Rupe: 58 Percent of Americans Satisfied with Their Health Care; 23 Percent Dissatisfied - Reason-Rupe Surveys : Reason.com

That's great, but as my previous link showed (and this next link does too; and Arles' link does also), employer-based plans were already on the decline (both in terms of employers offering coverage, and the level of benefits offered) prior to the debate on ACA. It actually worse amongst small employers (which aren't surveyed by Arles' link, but are by mine).

Rate of employer-based health insurance keeps dropping

So, we're back to:


Is "most" employer-based coverage very good? Without a specific definition of "very good", it's hard to argue, but I'd be more comfortable with "good, but declining" based on the various links on offer, especially once one takes into account (as Arles' link does not), small employers, and knock-on effects from being underinsured on an employer-provided plan.

Is it better than anywhere else in the world? We've done this to death previously, and it's easy to find research (starting here: World Health Organization ranking of health systems) - Wikipedia, the free encyclopedia, but in general, especially when compared to other first world countries, it's on par at best, but more generally worse overall. And when you add in the % of GDP spent on health care, it's clearly not a value proposition.

Lastly, is it cheaper to the consumer? Well, no. It's not cheaper to the consumer when compared to any other single-payer system, unless you want to start arguing tax burdens, and even then you'd need to take into account the fact that US employers figure their contribution to your benefits as part of your salary, which is, in effect, a tax from a bottom-line perspective. In addition, as the studies I've shown have linked, one of the key problems with being underinsured (which is increasingly prevalent amongst those with employer-provided plans) is financial stress. Financial stress, in this instance, is due to lack of predictability of medical costs, which happens amongst the underinsured when high deductibles and out-of-pockets happen, which are increasingly the case (see also: High Deductible Health Plans).

If you then combine satisfaction with a plan (see also: http://www.deloitte.com/assets/dcom-...bal_062111.pdf for a global perspective) with cost of a plan to a consumer, making a case that the end-state of health care coverage for middle-to-upper class white collar workers with employer-provided coverage (because that's what we're talking about here, mainly) is clearly, plainly and significantly superior to other coverage provided worldwide is, in my opinion, not a case well-supported by data.

Borrowed from Facebook, but I thought this was funny....

GOVERNMENT SHUTDOWN AS COULD BE EXPLAINED TO A CHILD:

GOP: Can I burn down your house?
POTUS: No
GOP: Just the 2nd floor?
POTUS: No
GOP: Garage?
POTUS: No
GOP: Let's talk about what I can burn down.
POTUS: No
GOP: YOU AREN'T COMPROMISING

Cost is really easy. We spend way more per capita on healthcare than any other country. Hell, we spend close to most of the industrialized world just in government spending.

The problem becomes as to whether people think their tax burden going from 25-35% and increasing to 45-50% (Canada/UK/Europe rates) is worth the supposed "improvements" to their individual health care plans. I doubt many people with fulltime jobs ranging from 45K-100K upward would be excited to pay an extra 6K to 20K in taxes every year just to have some form of universal coverage that is likely not going to be as high a quality as the coverage they currently have.

Now, if you have a solution that does not either involve massive monthly premium increases or tax increases for working people, I'm all ears. Otherwise, I don't see the need to massively increase someone's tax burden or premium to solve a problem that doesn't exist for them. My advice is try to fix the actual problem of uninsured (mostly pre-existing, lower income and part-time workers not understanding their options), not add a massive tax/premium burden to the middle class with employer-based coverage.

:D

Whats wrong is that in FL the servers are crashed from all those people who dont want Obamacare.

That's because healthcare is a business here. It's not like that in London or Canada. We are going to spend more privately because there is more money to be made for companies

What's interesting about that graph is despite the fact that the US has lower wait times for surgery, higher overall quality of care and lower cost to the consumer (when taxes are figured in), the public cost is roughly on par with that in Europe or Canada. I'd also be interested in factoring the additional tax burden on citizens to have the decreased public cost. If the US increased their tax rate to 45% for everyone like the UK to have a public health system - I'm sure the overall costs would go down. Of course, then a normal fulltime worker making 60K who paid $3.5K pre-tax in yearly premiums and another $1K in pretax expenses would now save that money but be facing a tax increase of between $8 and $10K a year. Not exactly saving them money...especially when you factor in it's doubtful they would have the same quality of care options they do now.