no public option

[westvirginia]

It isnt stopping those things, just making the cost to engage in those things higher as a deterrent.

 

Just like a speeding ticket. if it was only 10 bucks and didnt affect my insrsnce, I would have a ticket a week. But considering the cost of the ticket and resulting insurance premium is high, I decide to not engage in risky behavior as a result.

 

OK, so if the cost to engage in those things is so high almost no one can pay it, it still isn't stopping those things? Careful, you're walking kite twine above the Sears Tower here. Just like you shouldn't get a deduction for purchasing a home over renting. fedgov is saying "this is good", so we'll give it favorable tax treatment, but this is bad, so we'll screw those people." And what happens when something like, oh, spending money on country clubs and golf is deemed bad? "You should waste that money, let's tax it at 25% and give that to the 'less fortunate'." How do you like it now?

[Perchoutofwater]

bpwallace,

 

My response to your response.

1) Illegal Immigration - Yes there would be some cost associated with this, but it would be offset, not only by the reduced cost in health care, but in the reduced cost in education, and illegal immigration is a major drag on education which is something else the government just keeps throwing money at.

2) Tort reform - I would not limit real damages in any way. Real damage would also include future income. Again I'm just talking about getting rid of punitive damages, nothing else.

3) Government paying it's fair share - I agree we need to get rid of the waste and hospitals do waste money on decorative things. Part of this is to try to make them more attractive to potential clients than their competitors. It is hairy as to how to remedy that. Probably the best way would be to find a "prevailing wage" for each type of doctor, the actual cost of tests including wear and tear on the equipment, and have a real estate allowance ie how much the room costs based on property values and make an average hospital the bench mark. Then if you want to go the spa hospital you know you are going to pay more for a luxury insurance program or more out of pocket.

4)Portability - It is one of the tenants of Obama's plan, if that were all that were in his plan I'd support it.

5)The only reason I question the constitutionality of the requiring coverage is that I have no choice. If I don't have a car I don't have to buy insurance. So there is a choice. Also, it is states that require insurance, not the federal government. What isn't enumerated is left to the states.

6) State are regulating what has to be covered, and who can provide the coverage. If you get rid of these regulations you would have more competition. As it is you can only get about 5-10 health insurance carriers per state. If you lifted some of these regulations you could easily have 4 to 5 times as many to choose from.

7&8) We agree on.

9) It is for health reasons. The easiest way is to say any business that has a drive through, whether you go in or not. It could be refined some based upon "CAFE" standards

 

Got to go pick up my baby girl and take her to soccer practice, this was fun.

[Perchoutofwater]

One of the biggest frauds being perpetrated on the American people (thanks to insurance companies and their politician shills) is that high insurance premiums are caused by "trial lawyers."

 

Its the market. Insurance companies make their $$$ from investments. When the market is good, premiums hold steady or drop, as insurance companies compete for $$$ to invest. The amount of the premium isn't all that important, its the potential from the investment. When the market is bad, insurers need those premiums to pay the light bill, so they go up.

 

Most states have enacted caps on medical malpractice damage awards. I bet you that medical malpractice case filings are down in just about every state. They have plummeted in Michigan due to "tort reform" and to an activist judiciary that has curtailed medical malpractice cases and has just about eliminated automobile negligence, premises liability and products liability lawsuits. I have see numbers that show that in Michigan, the 2008 medical malpractice case filings are less a 1/4 of the number that were filed in 1986 (from 3,629 to 847 in 2007 - Michigan has a population of 10 million). How much do you think medical malpractice insurance rates or automobile insurance rates have dropped in that time, as a result? They haven't.

 

Show me where insurance premiums have gone down in a hard market due to tort reform, and maybe I'll change my tune somewhat. The market is cyclical. Tort reform is not. If tort reform worked to reduce premiums, you should see a pattern somewhere, shouldn't you?

 

Im my experience, lawyers in Michigan do not file cases for a "quick settlement." It just does not happen. A good friend of mine called me after his grandmother, just a nice old lady as you'll ever meet, tripped on a curb at a casino and smashed her face into the pavement. I wrote a letter on her behalf, I got a call a couple of days later. "We're not going to pay her a dime. We'll give her some tickets to the buffet." No sh*t. I'm telling you, it ain't worth anyone's time to pursue a case without merit. You have to remember, most PI attorneys take fees on a contingent basis. In MI, the max is one-third. So say that you come to me with a case that is worth, objectively, about $30,000. That means that the most that I'm going to get, if we settle the case without any costs, is $10,000. Every hour I spend on that case diminshes my return. Every dollar spent on costs diminishes my return. So lets say case the settles for that 30,000 after I put 100 hours worth of time and 3,000 in costs. I get $9,000 - about $90.00 per hour. I get less with more time and more costs. And I may get nothing if the insurance company digs in its heels and tries the case. So who is going to waste their time on frivolous cases? Certainly not many people working on a contingency.

 

I have good friends and colleagues who practice medical malpractice and personal injury law. Or who did, as many are doing divorce work or whatever else comes in the door. A medmal lawyer in these parts is probably not going to take your case unless your damages are about $200k. That means if your doc botches your surgery, you need another, but recover quickly, you're SOL. You only needed another surgery, why should you be compensated for that? I know that I enjoy undergoing needless surgery.

 

Who does tort reform hurt? The injured person and his/her family. Who does it help? Insurance companies. It doesn't help a doctor one whit. it doesn't help the public one whit.

 

As I see it, a doctor is just a pawn. In many cases, a rich pawn, but a pawn nevertheless.

 

All I'm talking about capping is punitive damages.

[Azazello1313]

I've said many times that malpractice reform, while probably a good idea in general, is not going to have a major impact on overall health care expenditures. very few people claim it will (though perch always has a bug in his butt about it).

 

the big problem as it relates to costs is that the people who have insurance (and hell, many if not most of those who don't) are so sheltered from the cost of the care they receive, that there is very little incentive anywhere in the system to cut costs. the first and most important thing to be done is to stop sheltering healh benefits from taxation. you can offset the tax hike with a lump sum tax credit for the amount of basic health plan. people who don't have insurance can use the tax credit to purchase it. this important step would begin to sever the employer/health care link that is at the heart of so much of the inefficiency and inequality in our system. then consumers have some relation to the care they recieve, and it begins to be in peoples' interests to get cheaper, higher deductible plans.

[bpwallace49]

OK, so if the cost to engage in those things is so high almost no one can pay it, it still isn't stopping those things? Careful, you're walking kite twine above the Sears Tower here. Just like you shouldn't get a deduction for purchasing a home over renting. fedgov is saying "this is good", so we'll give it favorable tax treatment, but this is bad, so we'll screw those people." And what happens when something like, oh, spending money on country clubs and golf is deemed bad? "You should waste that money, let's tax it at 25% and give that to the 'less fortunate'." How do you like it now?

 

I disagree. Speeding, alcohol, and smoking are all things that affect others by their utilization.

 

Speeding can cause car accidents and jeopardize the public health . . raising health care costs.

 

Alcohol causes health problems , which raises health care costs

 

Smoking causes health problems, and in others.

 

ALL of which get paid for by others in the "group". Why not make people responsible for their dangerous behavior or pay more to the system to offset theor increased liability to the system?

 

Golf and country clubs are a silly comparision and you know it. That does not affect the HEALTH of others.

[Rebellab]

So, as healthcare reform is debated, I hear one repeating sound. Lower cost. How do we do that? I am sure there are a hundred ways. My concern is when healthcare(used a broad term encompassing everything) is no longer profitable what will happen? Suddenly it is not profitable to find a cure for AIDS or cancer. Research is stopped because healthcare is no longer profitable. New drugs to lower cholesterol or blood pressure etc are not developed because there is no profit in it. Where do we end up? Money is a powerful motivator.

[Yukon Cornelius]

One of the biggest frauds being perpetrated on the American people (thanks to insurance companies and their politician shills) is that high insurance premiums are caused by "trial lawyers."

 

Its the market. Insurance companies make their $$$ from investments. When the market is good, premiums hold steady or drop, as insurance companies compete for $$$ to invest. The amount of the premium isn't all that important, its the potential from the investment. When the market is bad, insurers need those premiums to pay the light bill, so they go up.

 

Most states have enacted caps on medical malpractice damage awards. I bet you that medical malpractice case filings are down in just about every state. They have plummeted in Michigan due to "tort reform" and to an activist judiciary that has curtailed medical malpractice cases and has just about eliminated automobile negligence, premises liability and products liability lawsuits. I have see numbers that show that in Michigan, the 2008 medical malpractice case filings are less a 1/4 of the number that were filed in 1986 (from 3,629 to 847 in 2007 - Michigan has a population of 10 million). How much do you think medical malpractice insurance rates or automobile insurance rates have dropped in that time, as a result? They haven't.

 

Show me where insurance premiums have gone down in a hard market due to tort reform, and maybe I'll change my tune somewhat. The market is cyclical. Tort reform is not. If tort reform worked to reduce premiums, you should see a pattern somewhere, shouldn't you?

 

Im my experience, lawyers in Michigan do not file cases for a "quick settlement." It just does not happen. A good friend of mine called me after his grandmother, just a nice old lady as you'll ever meet, tripped on a curb at a casino and smashed her face into the pavement. I wrote a letter on her behalf, I got a call a couple of days later. "We're not going to pay her a dime. We'll give her some tickets to the buffet." No sh*t. I'm telling you, it ain't worth anyone's time to pursue a case without merit. You have to remember, most PI attorneys take fees on a contingent basis. In MI, the max is one-third. So say that you come to me with a case that is worth, objectively, about $30,000. That means that the most that I'm going to get, if we settle the case without any costs, is $10,000. Every hour I spend on that case diminshes my return. Every dollar spent on costs diminishes my return. So lets say case the settles for that 30,000 after I put 100 hours worth of time and 3,000 in costs. I get $9,000 - about $90.00 per hour. I get less with more time and more costs. And I may get nothing if the insurance company digs in its heels and tries the case. So who is going to waste their time on frivolous cases? Certainly not many people working on a contingency.

 

I have good friends and colleagues who practice medical malpractice and personal injury law. Or who did, as many are doing divorce work or whatever else comes in the door. A medmal lawyer in these parts is probably not going to take your case unless your damages are about $200k. That means if your doc botches your surgery, you need another, but recover quickly, you're SOL. You only needed another surgery, why should you be compensated for that? I know that I enjoy undergoing needless surgery.

 

Who does tort reform hurt? The injured person and his/her family. Who does it help? Insurance companies. It doesn't help a doctor one whit. it doesn't help the public one whit.

 

As I see it, a doctor is just a pawn. In many cases, a rich pawn, but a pawn nevertheless.

well said and i cant type that much.

[bpwallace49]

bpwallace,

 

My response to your response.

1) Illegal Immigration - Yes there would be some cost associated with this, but it would be offset, not only by the reduced cost in health care, but in the reduced cost in education, and illegal immigration is a major drag on education which is something else the government just keeps throwing money at. This will spin off into a hugh discussion on legality and how to deport people that we shouldnt get sidetracked on. I move we table this point . . .

2) Tort reform - I would not limit real damages in any way. Real damage would also include future income. Again I'm just talking about getting rid of punitive damages, nothing else. thanks for clarifying, and I agree.

3) Government paying it's fair share - I agree we need to get rid of the waste and hospitals do waste money on decorative things. Part of this is to try to make them more attractive to potential clients than their competitors. It is hairy as to how to remedy that. Probably the best way would be to find a "prevailing wage" for each type of doctor, the actual cost of tests including wear and tear on the equipment, and have a real estate allowance ie how much the room costs based on property values and make an average hospital the bench mark. Then if you want to go the spa hospital you know you are going to pay more for a luxury insurance program or more out of pocket. I agree with having real costs associated with care, and then having people "choose" to spend more for the spa hospitals if they so choose. Too much $$ is being spent on being attractive rather than functional, especially with admin costs (just my opinion on this one)

4)Portability - It is one of the tenants of Obama's plan, if that were all that were in his plan I'd support it. One of the best provisions of Obama's plan from the get go. Unfortunately, the current bill is nowhere near "Obama's" anymore once Congress get ahold of it . . .

5)The only reason I question the constitutionality of the requiring coverage is that I have no choice. If I don't have a car I don't have to buy insurance. So there is a choice. Also, it is states that require insurance, not the federal government. What isn't enumerated is left to the states. But you have a"choice" to exist and live right? If that is assumed that in fact, you ARE alive, then couldnt it be addressed as providing for the common good? Strike that, I REALLY dont want another segeway inot founders intent here . . . but can you agree that people that are alive SHOULD have insurance just like people that have cars SHOULD have insurance?

6) State are regulating what has to be covered, and who can provide the coverage. If you get rid of these regulations you would have more competition. As it is you can only get about 5-10 health insurance carriers per state. If you lifted some of these regulations you could easily have 4 to 5 times as many to choose from. i dont agree with the state issue, as that would make moving across state lines with portability very difficult. Most (if not all?) insurance companies are available in all states. By making it a state issue you threaten the portability and severing insurance from employers. Portable HAS to be across ALL state lines for this to work, IMO

7&8) We agree on.

9) It is for health reasons. The easiest way is to say any business that has a drive through, whether you go in or not. It could be refined some based upon "CAFE" standards Now you are just for a differnt arguement . . .stay on target!

 

Got to go pick up my baby girl and take her to soccer practice, this was fun.

 

See how much we can discuss when it isnt degenerated into partisanship?

[bpwallace49]

So, as healthcare reform is debated, I hear one repeating sound. Lower cost. How do we do that? I am sure there are a hundred ways. My concern is when healthcare(used a broad term encompassing everything) is no longer profitable what will happen? Suddenly it is not profitable to find a cure for AIDS or cancer. Research is stopped because healthcare is no longer profitable. New drugs to lower cholesterol or blood pressure etc are not developed because there is no profit in it. Where do we end up? Money is a powerful motivator.

 

How is there no profit in keeing people healthy? They STILL pay premiums, but just get less for their investment if they are healthy.

 

if your arguemnt is that we should keep people sick beacuse it is more profitable? Interesting stand to take . . . . .

[Rebellab]

How is there no profit in keeing people healthy? They STILL pay premiums, but just get less for their investment if they are healthy.

 

if your arguemnt is that we should keep people sick beacuse it is more profitable? Interesting stand to take . . . . .

 

 

Just a concern that I have been thinking about. I am not saying to keep people sick to make money, but what is the incentive to make people healthier if there are less profits in healthcare, not insurance.

 

I think you and Perch are dead on with charging a tax for a Big Mac. I am also a proponent of a sin tax. It is my choice to have a drink, (I don't smoke or I would use that analogy) if it costs more than I guess I will pay it if I feel I want one. I am dealing with a guy right now that smokes two and a half packs a day. He is tickled to be in North Dakota where they don't have as much tax on cigarettes. Someday he could be a strain on our healthcare system, why not charge him more.

[Furd]

Furd . . . . . that was an AWESOME post! Well done and well reasoned.

 

 

Thanks. But I have posted something similar to that 6 or 7 times over the years.

 

I used to represent doctors and hospitals. I did it for just about 7 years. I saw the writing on the wall due to tort reform and even though I liked medical malpractice law and I was building my practice, I bailed to the commercial sector. My hourly rate doubled in one day. I look at my comtemporaries at the time I left medmal and there is no question that I made the right move. Personal injury firms, plaintiff and defense, are breaking up left and right. Even though I really don't have a dog in the fight (personal injury represents less than 5% of my practice) I still follow personal injury law.

 

The insurance companies have been absolutely masterful in their portrayal of lawyers as villains. Plaintiff's lawyers try to counter, but they are dismissed out of hand due to their self-interest. The defense attorneys that I know pretty much agree with everything I posted. But, they're not going to say anything because they would be committing professional suicide if they did - insurance companies would pull their files or, at the very least, stop sending work to them.

 

In any event, it just gets to me when persons who haven't the slightest clue about the American civil jurisprudence system [this ain't a reference to you perch] bemoan the sytem and rail on "frivolous lawsuits" and "trial" lawyers and cry for tort reform.

 

I acknowledge that the system isn't perfect. The biggest problem, IMO, is that there aren't enough good judges - smart, decisive judges that aren't afraid to pull the trigger when necessary. Juries get it right, most of the time, particularly when the judge ensures that the case is presented to the jury the right way.

Edited September 29, 2009 by Furd

[bpwallace49]

Furd, I am a new kid on the block . . . y'all are new to me . . . except that tollbag Taz . .

[Jimmy Neutron]

Ya'll read the article Az linked in another thread - there's good fodder there to last for weeks...

[Perchoutofwater]

See how much we can discuss when it isnt degenerated into partisanship?

 

Yep, and I think we agree on more than you realize. Item #6 - I'm saying get rid of state regulations which are limiting the number of options available in each state.

[bpwallace49]

Yep, and I think we agree on more than you realize. Item #6 - I'm saying get rid of state regulations which are limiting the number of options available in each state.

 

Ok . thanks for clarifying.

 

Did you read Az's link in the other thread? Extremely well written. (not Az, the article . . .)

[Randall]

Why did democrats allow 2 senators representing 2 of the 5 smallest states who got the highest contributions from insurance companies write this.

 

Baucus said these contributions of over $750,000 a year didn't influence him? Really. Businesses like this don't make bad investments this large.

 

His bill funnels tens of billions to these companies and taxpayers are paying the bill.

 

This is far from over. Once again lobbyists are controlling the senate.

[westvirginia]

I disagree. Speeding, alcohol, and smoking are all things that affect others by their utilization.

 

Speeding can cause car accidents and jeopardize the public health . . raising health care costs.

 

Alcohol causes health problems , which raises health care costs

 

Smoking causes health problems, and in others.

 

ALL of which get paid for by others in the "group". Why not make people responsible for their dangerous behavior or pay more to the system to offset theor increased liability to the system?

 

Golf and country clubs are a silly comparision and you know it. That does not affect the HEALTH of others.

 

And once again, you make my point for me. You don't want freedom, you just want to argue over a different set of chains.

 

My paradigm is completely different from yours - I don't think HC is a right. You own you, thus you are responsible for you. You shouldn't be taken care of by anyone else nor should you have to take care of anyone else.

 

Az is right - the only real problem with HC is that people are insulated from its cost, so they have no incentive to cut those costs. Give everyone the same tax deductions (or a credit that gives poor people enough welfare money to pay for it is even better) businesses get for buying insurance and allow companies to sell it across state lines. This will do more to lower costs than all the government bureacracies combined. And probably some law should be passed that you can't turn someone down - to spread the risk of sick people over the population of those that are healthy.

 

But that wouldn't give these statist politicians more control now, would it? Why can no one see that this is about control more than ANYTHING else???

[Azazello1313]

I disagree. Speeding, alcohol, and smoking are all things that affect others by their utilization.

 

Speeding can cause car accidents and jeopardize the public health . . raising health care costs.

 

Alcohol causes health problems , which raises health care costs

 

Smoking causes health problems, and in others.

 

ALL of which get paid for by others in the "group".

 

and that right there is my biggest philosophical problem with nanny state paternalism, particularly in the form of government control/spending on health care. because when health care is treated as a public right backed by massive government expenditures, and you and I are paying for each other's health care, then suddenly it's my business what you eat, smoke and drink. it's my business where you put your peener, and what sort of reproductive choices you make. and see, I don't WANT those choices of yours to be any of my business, nor do I want my choices being any of yours.

[Ursa Majoris]

FWIW, I'm leaning towards the simple state-funded-through-taxation catastrophic insurance coupled with mandatory HSA / pay for the rest of it yourself idea. What the Frankenstein lurching out of Congress does is further patch up and expand a system that absolutely has to fail through lack of accountability.

 

The LASIK argument made in the article Az linked to is very convincing.

[Perchoutofwater]

FWIW, I'm leaning towards the simple state-funded-through-taxation catastrophic insurance coupled with mandatory HSA / pay for the rest of it yourself idea. What the Frankenstein lurching out of Congress does is further patch up and expand a system that absolutely has to fail through lack of accountability.

 

The LASIK argument made in the article Az linked to is very convincing.

 

+1

[bpwallace49]

and that right there is my biggest philosophical problem with nanny state paternalism, particularly in the form of government control/spending on health care. because when health care is treated as a public right backed by massive government expenditures, and you and I are paying for each other's health care, then suddenly it's my business what you eat, smoke and drink. it's my business where you put your peener, and what sort of reproductive choices you make. and see, I don't WANT those choices of yours to be any of my business, nor do I want my choices being any of yours.

 

Who is arguing that point at all?

 

I am saying if you ARE involved in dangerous behavior that could raise the costs on others, you should have to PAY for that ability. I am already pissed that I have to subsidize smokers, drinkers, etc through my health insurance. What is wrong with having the people that engage in risky/dangerous behavior pay MORE for that right if those extra funds are used to even out everyone's payments?

 

Kinda like motorcycle insurance tends to be higher, because it is more dangerous than riding in a car . . . . they pay MORE for that ability.

 

WV, thanks for the anti-gobment rant, but we were actually trying to find some solutions to the problem, not rail against the anti-freedoms perpetrated by "the man" and overthrow the gubment. Seriously, couldya come up with possible solutions than rant about other stuff? This thread was actually pretty clean of that stuff for awhile . . . .

[Azazello1313]

Who is arguing that point at all?

 

I am saying if you ARE involved in dangerous behavior that could raise the costs on others, you should have to PAY for that ability. I am already pissed that I have to subsidize smokers, drinkers, etc through my health insurance. What is wrong with having the people that engage in risky/dangerous behavior pay MORE for that right if those extra funds are used to even out everyone's payments?

 

Kinda like motorcycle insurance tends to be higher, because it is more dangerous than riding in a car . . . . they pay MORE for that ability.

 

well, if that were the only way this sort of sentiment seeped into public policy, I might be with you. but look at the creeping smoking bans across the country. discriminating against people with higher prices may make economic sense, but it is politically unpopular. look at the flak the airlines catch for making hugh fat people either pay for an extra seat or get off. when the government is in control, they'd usually rather regulate "good"/"bad" behavior than come up with ways to efficiently allocate the costs.

[bpwallace49]

well, if that were the only way this sort of sentiment seeped into public policy, I might be with you. but look at the creeping smoking bans across the country. discriminating against people with higher prices may make economic sense, but it is politically unpopular. look at the flak the airlines catch for making hugh fat people either pay for an extra seat or get off. when the government is in control, they'd usually rather regulate "good"/"bad" behavior than come up with ways to efficiently allocate the costs.

 

What is wrong with the smoking bans? When you smoke, of affect those around you with the same smoke. Drinking /overeating can be somewhat individualized.

 

The airlines charging extra is a great idea and very apt, as long as they are reasonable expectations of the size of the passenger. Individual responsibility!

 

Even though they are politically unpopular, smoking bans are growing in size arcoss the US. Common sense is trumping politics in this case.

[Azazello1313]

the big problem as it relates to costs is that the people who have insurance (and hell, many if not most of those who don't) are so sheltered from the cost of the care they receive, that there is very little incentive anywhere in the system to cut costs. the first and most important thing to be done is to stop sheltering healh benefits from taxation. you can offset the tax hike with a lump sum tax credit for the amount of basic health plan. people who don't have insurance can use the tax credit to purchase it. this important step would begin to sever the employer/health care link that is at the heart of so much of the inefficiency and inequality in our system. then consumers have some relation to the care they recieve, and it begins to be in peoples' interests to get cheaper, higher deductible plans.

 

sounds like the thing that comes out of the finance committee might at least take a fairly weak, but still significant shot at this problem, with the Cadillac Tax:

 

Union leaders don’t even like the name Cadillac tax. They say, correctly, that the tax wouldn’t fall only on chief executives, investment bankers and the like. It would fall on some members of the middle class, especially unionized workers with generous health coverage.

 

The leading proposal in the Finance Committee would apply to family insurance plans that cost roughly $21,000 and up starting in 2013. For the sake of fairness, the threshold would vary based on geography and the average age of a company’s work force. In all, something like 10 percent of plans would be subject to the tax in 2013, according to the Center on Budget and Policy Priorities, a research group.

 

But the number of affected plans would grow over time. The Senate has been talking about having the threshold rise each year by the inflation rate plus one percentage point. Since medical spending has been rising much faster than inflation, more and more plans would probably cross the threshold in the years after 2013. Over the next decade, the Congressional Budget Office has estimated that the tax would pay as much as 25 percent of the cost of extending coverage to the uninsured.

 

“People are going to see this as a huge middle-class tax hit,” argues Gerald Shea, an A.F.L.-C.I.O. official overseeing its health lobbying.

 

Insurance companies — technically the targets of the tax — would pass on the cost to employers, and employers would presumably pass it on to workers. The cost of insurance could rise. Or perhaps more likely, companies would stop offering such generous plans.

 

Here’s the big question, though: Would that be so bad?

 

Currently, the health insurance you get from your employer isn’t taxed, unlike almost all the rest of your compensation. So employers and workers have both fallen in love with generous plans. If an employer pays a worker an extra $100 in income, the worker may keep only $75 of it, while the government will get $25 in taxes. But if the employer puts that $100 toward health insurance, the worker will get all of it.

 

This tax break causes us to buy more health insurance than we would if the playing field for taxes were level, much as the tax breaks for housing helped inflate the real estate bubble. In effect, the tax-free treatment is a subsidy for health insurers, doctors and hospitals. It encourages wasteful spending — the extra M.R.I., the brand-name drug that’s no better than a generic, the cardiac-stent procedure that has no evidence of extending life (but does have some risk).

 

If the Cadillac tax started to eat away at the this tax break, you could expect three things to happen.

 

First, employees would shy away from the most expensive plans. The evidence is pretty clear on this: when workers bear some portion of the cost of insurance, their choices change.

 

In the 1990s, the University of California began charging its janitors, secretaries, professors and other employees a monthly fee for their health insurance plan — unless they chose the least expensive one. Many switched out of the most expensive plans, often to save as little as $10 a month, notes the economist Thomas Buchmueller. The change also led insurers to compete harder for people’s business, improving the quality of the cheapest plans at the expense of the insurers’ profit margins.

 

Second, the most generous insurance plans really would become less generous, but the change would probably do nothing to harm people’s health. The distinguishing feature of these gold-plated plans tends to be their lack of co-payments. The $20,400 family plan that a typical New Hampshire state employee has, for instance, includes free M.R.I.’s, as The Boston Globe has reported. And when M.R.I.’s are free, people tend to get more of them than their well-being requires.

 

The most comprehensive study of health insurance, by the RAND Corporation, bears this out. People with Cadillac plans are no healthier than people with Chevy Malibu plans. (Similarly, Americans are no healthier than citizens of rich countries that spend far less on medical care.) “Taking someone who’s uninsured and giving them insurance unambiguously improves their health,” says Jonathan Gruber, a health economist at M.I.T., “but taking someone who’s well-insured and making them really well-insured doesn’t make them any healthier.”

 

Finally, we can expect that a Cadillac tax will, in the long run, increase workers’ incomes. The money companies spend on health insurance, after all, doesn’t come from nowhere. The more they spend on insurance, the less that’s available for wage increases. This is why wage increases are often meager when insurance premiums are growing quickly, as has been the case over the last seven years or so.

 

When asked about the potential benefits of a Cadillac tax — better wage growth and less wasteful medical spending, with no damage to health — labor officials tend to dismiss them as the stuff of airy economic theory. But they’re not.

 

The slow wage growth and spiraling health costs of recent years are not theoretical. The fact that people with Cadillac plans aren’t healthier than people with merely good insurance isn’t theoretical. The difference between what this country spends on medicine and what other countries spend isn’t theoretical.

 

There is no question that a Cadillac tax would be somewhat unpleasant for people with Cadillac plans. It could increase their insurance costs or force them into less generous plans.

 

By opposing the tax, the A.F.L.-C.I.O. is simply doing its job. It is defending the interests of its members who have such plans — just as business groups are defending the interests of their members. That is what special interests do: look out for their own constituents, even at the expense of the national interest.

Edited September 30, 2009 by Azazello1313

[westvirginia]

Who is arguing that point at all?

 

I am saying if you ARE involved in dangerous behavior that could raise the costs on others, you should have to PAY for that ability. I am already pissed that I have to subsidize smokers, drinkers, etc through my health insurance. What is wrong with having the people that engage in risky/dangerous behavior pay MORE for that right if those extra funds are used to even out everyone's payments?

 

Kinda like motorcycle insurance tends to be higher, because it is more dangerous than riding in a car . . . . they pay MORE for that ability.

 

WV, thanks for the anti-gobment rant, but we were actually trying to find some solutions to the problem, not rail against the anti-freedoms perpetrated by "the man" and overthrow the gubment. Seriously, couldya come up with possible solutions than rant about other stuff? This thread was actually pretty clean of that stuff for awhile . . . .

 

I gave you my answers, but you decide to write them off as "anti-blah blah blah"... Various levels of government have CAUSED this very problem (starting with FDR's wage fixing during WWII) and then you expect them to fix it? Really??? :loco: