I do believe you're right. As I think about it, I realize there are many things that are not a right. There is no right to government subsidized hurricane insurance and I would be happy to live without it. There is no right to public roads or public schools. In fact, there is no right to publicly financed police or fire protection and neither was actually the norm when our country was created.
Originally Posted by badbullgator
There are many things that we choose to do that are not "rights". We choose to do them for a variety of reasons -- good or bad -- and charge the costs back to the overall population.
Personally, I think we took a wrong turn in having employer financed health insurance and believe we would be better off if we got rid of it. Failing that, we should at least eliminate all public subsidies for such insurance and treat the full cost as income to the recipients and employees should receive pay stubs that show their full income, including the employer subsidy for insurance, and the deduction to pay for that coverage. Why should employees receive a tax break not available to the uninsured or to the self insured?
Currently, we all pay for health insurance benefits for ourselves and for others. However, the full cost of these benefits is hidden behind the curtains.
If I try to buy employee coverage for my staff, I must agree to pay a minimum of 50% of the total cost and to provide coverage for all staff if I have 10 or fewer employees. Why is this true? Because insurance companies know that younger and healthier employees will not opt to buy insurance at all if they have to pay the full cost and are provided with a choice. Some of the costs being ascribed to national health insurance represents the cost of providing insurance for the uninsured and the underinsured. Other costs simply represent a shift from employer paid premiums to publicly paid premiums.
As an employer owning a small business (varying from under 10 to about 110 staff over time), I found myself thinking about health insurance a lot. One year I saw our premiums increase by over 40% because of two employees: one person that had a heart attack and open heart surgery three weeks after joining our staff, and one employee that purchased fertility services after only a few months of employment to become pregnant and have her premature twins while on our policy. Those two employees represented more than half of the total health claims incurred on behalf of my 100 staff. In both cases, their health bills exceeded their total salaries. In both cases the employees had worked for us less than six months and did not return to work after incurring their expenses. However, they continued to be charged against our plan under COBRA for more than a year. The impact on our experience rated plan lasted for three years. I will admit that my experience in those two cases had some effect on my hiring decisions thereafter even though the law prohibits employers from considering such issues. As a company, our health insurance costs were so high that we could not compete for some business where our allowable overhead rates were capped (AT&T was the client) and lost revenues and terminated 35 staff as a direct result. Ultimately, we eliminated all dependent coverage subsidies. When our insurance company insisted that we subsidize 50% of the cost for all staff and dependents, we eliminated coverage altogether.
I view employer financed health insurance as discriminatory against small employers and as a deterrent to employment of lower income staff and older staff. It contributes directly to outsourcing and off-shoring of jobs and damages our economy more than would be the case with more broadly based taxes (corporate or personal). Increases in the cost of health insurance have far outpaced increases in either revenues or salaries. Over a period of 10 years, I saw the costs of our family coverage increase from less than $3000/year to over $20,000/year. I'm sure that it was a coincidence that during the same period many of the insurers actually were becoming direct service providers at the same time and that their profits were increasing by double digit amounts each year. The system that we have now is completely broken. If we do not move towards national health insurance, I predict that the percentage of uninsured and underinsured will increase to be a majority of the population over the next ten years.
Jeff I'm completely with you up until the last couple sentences. What has the government done to allow you to put all your trust in them to run health care. I can cite a lot of things that make me feel the opposite way about the government being able to run health care.
I can see us moving in two directions.
Originally Posted by eildydar
1. Eliminate health insurance altogether. Let everyone pay their own bills or do without. This would dramatically reduce the cost of health care and help us get rid of those people, like myself;-), who may have outlived their utility. If there is health insurance, make all purchases individual -- no group coverage. Why should an employee of a large company be able to get rates lower than anyone else? Discriminatory pricing violates the spirit of anti-trust laws and creates inappropriate economic results.
2. Cover everyone and spread the cost. That may be done with individual premiums, taxes, deductibles, coinsurance, etc. However, no matter how it is financed, coverage should not be optional. The reasons are that individuals undervalue risk and those who incur the greatest health care costs are also the least likely to be able to be productively employed during the period that care is needed. That creates a market that will not result in economically sound pricing. That does not mean that the government should be either the provider of care or necessarily the primary financial intermediary. Let the marketplace offer products that provide some trade-offs between premiums, deductibles, coinsurance, cost control mechanisms, and services to attract customers. However, insurers should not be able to discriminate based on age, prior conditions, etc. to avoid cherry picking. I find it odd that those who are loudest in condemning government inefficiency are also loudest in opposing any option of a public financial intermediary saying that they will not be able to compete against it and will lose their business. If the government is inefficient, it should be easy enough for a private carrier to win customers despipte that competition.
Quite frankly, I would rather see option 1 than what we have today. However, I suspect that if we actually implemented option 1 it would not take long to move to option 2.
I for one am faced with the decision of health care every waking minute of my life. I have had two transplants, one kidney, one pancreas. I have lived under some form of government controlled health plan since the day I hit the ground. I am glad there is a government plan for people. Most independent companies laugh when they see me coming and when I did have independent health care it cost me three times the amount of my mortgage every month! I can't afford it. The thing is I am still young, 30 years old, and still will probably need a transplant or two before I kick the can; I have a degenerative kidney disease. I also pay on prescriptions that come out to around three grand a month.
To everyone that says government healthcare is the worst, I say it kept me alive for atleast 7 extra years. If I still had independent health plans I would be dead years ago because I would have stopped paying the premium. My choice, yup, but do ya let your family starve, NOPE.
My theory is to do away with all insurance. Reimbursement from all of them is THE biggest problem with health care. If you have insurance you company pays 15-40% of the billed amount. If you do not have insurance you pay the full amount. My specialty, until very recently, was virtually all self pay patients. Our rates were reasonable, the patients happy, and we made money. Now in the last 5 years or so we are seeing about 35% of our patients being insured for our specialty. What a non insured couple pays 10K for an insurance company pays 4K. Sounds very good for the insured couple, but at 4K we do not make money. We really do not at that amount of reimbursement. The lab business is the same thing. There are many, in fact I would say most, insurance companies that pay $3 for a urinalysis. This is a big looser for most labs. The premise the insurance companies use is that they will send volumes of these and you will make up for it in volume. The reality is that there is no way to provide that volume to make it profitable at the prices they pay. This leads to waste. Doctors will order more testing to make a little extra money. Why do I need my knee x-rayed when an MRI is ordered at the same time? Medical practices are beat to death by insurance companies. It is not only getting a small amount of money form them, but the amount of work required to get them to actually pay you in a timely fashion is ridiculous. In our small practice we have to have two full time insurance specialist to keep up with the work from insurance alone. The only people making money on insurance is the insurance companies. Doing away with insurance would make the market more competitive among doctors. They are already getting less than they bill so cutting prices by 40% would not be out of the question. We are very close to doing this ourselves, but because our competition takes insurance we are afraid we will loose too much business. We would cut our prices 35% and still make money while offering a good value for the money spent. I say pay for yourself on the open market with all medical expenses being deductible right off the top of your income and having medical savings accounts. An employer who now offers insurance could offer to match or pay a certain amount to the account each pay period as the benefit that insurance is now.
Think about it. If a doctor visit for a the flu now cost you $100 and your insurance pays them $40, without insurance they could charge you $50 for the same thing ad I am sorry but if you can't keep some money aside for medical treatment I don't know what to tell you. I would not be against some insurance for big items like major surgery ad things, but the cost of that compaired to coverage for everything should be small like disability insurance is
Originally Posted by YardleyLabs
The company that i own are a big enough that we can at least pay a portion of our employees health ins. I dont know for sure that the payor of group coverage is any better off than John Q on his own. My office manager is opting out and I hope that will be the tipping point that the ins. co. will not renew. With rates climbing at 20 - 40 % every year and salary increase of 5-10 % in a few years some of the older folks and women will no longer be able to have ins. Only young uns will be working. One of my best and oldest employees just went over another 5 year mark and between that and the 30 something % increase this year HIS 1/2 of the insurance went up 400 bucks per week. WTF ?:-x If someone can explain to me how to keep the level of quality of care and have the gooberment oversee it please show me. I have built parts for the military and been to the DMV neither has shown any resemblance of economy or service. I have also seen 1st hand public housing. I hope I have enough money after the new plan and tax increases to go to the private doctors who will not participate just as they dont now with medi-care/cade
I do not know what most people do for a living but on top of what I pay in regular bills there is no way I could afford to pay for my regular checkups plus my cost of prescription pills. It would come out to around an extra 3500 per month in just healthcare cost and that is if nothing went wrong. Another thing is the cost of just say the "shot" to compared to the cost of the doctor visit is what drives the money up. It has gotten way out of hand in the last ten to fifteen years.
First Question for you Jeff is, Why shouldn't insurance providers be allowed to discriminate based on age health and other factors. They take on more risk with a smoker so why not be able to charge more for that person who is going to be more than likely using the insurance a lot more than a non smoker.
Secondly, the government is inefficient but if one service is free and another service is going to cost money. Even a small amount of money a lot of people will be choosing the free option. The government also doesn't play by the rules of having to stay within a budget or actually have money to spend it. (Yes i realize businesses use credit also but not near the extent that government does)