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News Mcain's plan will decimate employer based health coverage

  1. Sep 16, 2008 #1

    adrenaline

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    http://www.nytimes.com/2008/09/16/opinion/16herbert.html?hp

    Does anyone else think this is a bad idea?


     
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  3. Sep 16, 2008 #2

    Evo

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    Re: Mcain's plan will dessimate employer based health coverage

    That's insane!
     
  4. Sep 16, 2008 #3
    Re: Mcain's plan will dessimate employer based health coverage

    I'm too lazy to do the math myself, but given that an increasing share of worker compensation in the US comes in the form of benefits, and specifically medical benefits, wouldn't a new tax on this end up being on of the biggest tax hikes (particularly on workers) ever? Apart from the negative impacts it would have on the health of the entire country, obviously.
     
  5. Sep 27, 2008 #4

    Astronuc

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    Re: McCain's plan will dessimate employer based health coverage

    OK - McCain's plan won't work.


    But that leaves two main questions.

    How do individuals obtain affordable health care?

    What is the role of government in the health care system? - Strictly regulatory, i.e. ensure a certain level of quality? Intercession (consumer protection), as in when a health insurance company denies health care?


    http://health.usnews.com/articles/health/2008/08/25/how-crafty-health-insurers-are-denying-care.html
     
    Last edited by a moderator: Apr 23, 2017
  6. Sep 27, 2008 #5

    russ_watters

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    Re: Mcain's plan will dessimate employer based health coverage

    What's the fraction of income that is health insurance in a benefits package? 5%? And the highest marginal tax rate right now for middle class people is 25%, so .5*.25= 1.25%.
     
    Last edited: Sep 27, 2008
  7. Sep 27, 2008 #6

    Ivan Seeking

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    Re: Mcain's plan will dessimate employer based health coverage

    In some cases it is probably more like 20%. It depends entirely on the employer and the package.

    For me to cobra insurance for one, it cost something like $400 per month. Take a family of four with a nominal income...

    Btw, that was twelve years ago.
     
  8. Sep 27, 2008 #7

    Astronuc

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    The cost of health insurance depends on coverage (individual, individual+spouse, family; low-high deductible; medical, dental) and size of group. I've seen $8000-12000/yr for family coverage if an individual depending on where and what.

    A friend recently purchased COBRA for a few months at about $1000/mo. My daughter (in college) alone would pay $275 - $400/mo on her own.

    http://www.kff.org/insurance/chcm090904nr.cfm [Broken]

    Compare that to the median annual income of about $47K.
     
    Last edited by a moderator: May 3, 2017
  9. Sep 27, 2008 #8

    mheslep

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    Obama's plan is going to flatline employer based coverage too as the paper from HA suggests, but his plan will eventually dump everybody into 'National Health' instead of building up an individual system.

    The referenced journal articles from Health Affairs free online for a few more days:
    McCain
    http://content.healthaffairs.org/cgi...ff.27.6.w472v1 [Broken]
    Obama
    http://content.healthaffairs.org/cgi...ff.27.6.w462v2 [Broken]
     
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  10. Sep 27, 2008 #9

    mheslep

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    Re: Mcain's plan will dessimate employer based health coverage

    Employers would have to start giving that benefit to as straight salary, as they should be now IMO. Taxwise, you'd still get the break individually on that income that you turned around and spent on health care.

    http://money.cnn.com/2008/03/10/news/economy/tully_healthcare.fortune/ [Broken]
     
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  11. Sep 27, 2008 #10

    mheslep

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    Adenaline:

    Given that awhile back you said:
    what part of McCain's plan do you not like?
     
  12. Sep 28, 2008 #11

    mheslep

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  13. Sep 28, 2008 #12

    adrenaline

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    1. Administrative expenses are twice as high in nongroup markets as in group markets. The costs are higher because insurers in this market spend resources on medical underwriting. One reason that nongroup plans appear less costly is that they offer less coverage. The typical deductible in nongroup plans is about $2,750, compared to about $1,000 for group policies. Coinsurance rates average 26 percent in nongroup plans, compared to 20 percent in a typical employer-based plan.. Many services are not covered at all. Most of my patients with individual private insurance do not have basic screenings covered like 3000 dollar screening colonoscopies, mammograms and paps. I can only do a pap on them if they have a vaginitis! I already know that these individual policies do not offer the coverage my group plan does, which covers dental, vision, all screenings etc.


    And this is examining healthy applicants. The ill are simply denied coverage outright in the individidual market.


    In other words, even if you pay exactly as much as your employer did, your plan will still be worse due to the higher cost of individual underwriting etc. Also, people assume under his plan employers can now give that amount previously delegated to group insurance premiums as extra salary to the employee. As an employer, I don't see any tax advantage of giving my employees a 10,000 dollar a year raise. It's not going to happen.




    As for Mcain's worthless tax credit, it is not indexed to health costs -- which rise much faster than inflation -- or really to anything at all. That means, year-by-year, it buys you less.



    For the record I dont think obamas plan is any better but why is Mcain destroying what is obviously working welll for most employees? As an employer , his plan will save me money but as a physician I also know what lousy coverage these individual insurance plans cover.God forbid one your kids gets leukemia... guess what, there is nothing to protect the individual family purchaser from getting a statement that doubled or tripled in premiums as soon as the diagnosis is made. ( This happens a lot to my patients with individual coverage.) They pay the triple premiums because they know they can't simply move to another plan now that they have a horrible preexissting condition.

    Last , underwriting coverage for millions of individuals will involve more adminstrative expense and not just on the insurance end, m illions of individual plans will also mean millions of different rules and precerts, authorizations etc. Most doctors are not going to blanket accept all these individual insurances even if they pay better, that experiment is already failing with the privatized medicare insurance plans. When Medicare started offering privatized individual plans (Medicare Advantage plans) I saw myself having to hire extra staff just to deal with the paperwork crap. Instead, I only take basic medicare part B ( even though Medicara part B pays me less that cost is offset by not hiring more administrative personel to deal with the privatised plans.) I personally know 15 other docs in the community who refuse to participate with these Medicare advantage plans for the same reasoning.
     
    Last edited: Sep 28, 2008
  14. Sep 28, 2008 #13

    Art

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    I can never understand why America as the richest country in the world doesn't have a national health service. Britain has had theirs since 1946 and even when the most right-wing gov'ts were in power none attempted to disband it as it's advantages overwhelmingly outweigh it's flaws by any metric.
     
  15. Sep 28, 2008 #14
    McCain's plan calls for sending the $2,500 per person or $5,000 per family directly from the treasury to the insurance companies. Other than the fact that individuals, as has been mentioned by adrenaline, can not purchase adequate individual insurance for that sum, it is still a government run plan.

    Government involvement is what his plan is supposed to eliminate.:rolleyes:

    McCain believes that competition will lower costs to the consumer. Where has he been? Competition in the medical insurance field has played itself out.

    They have already reduced costs to the point where they are reducing services, and cutting payments to medical professionals.
     
  16. Sep 28, 2008 #15

    mheslep

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    I'm curious as to why you didn't address your original concurrence that the employer tax exemption was a problem?

    Certainly there are low end individual plans with poor coverage. I also know for a fact that I can get my exact same good coverage BCBS group plan as an HSA from BCBS on the individual market for substantially less money. Same plan, less money. The employer contributions to the group plan are the only thing making it worthwhile. Furthermore, there are non employer based groups - professional societies, churches, and I'd expect these to flourish under McCain's plan, happily so, as then health care is not tied to a job.

    In general the pre-existing condition issue needs to be addressed - with a GAP or the like. However, I don't know that these problems are limited to the individual market. Getting into and out group plans - changing jobs, etc, causes the same problems, to what extent I can not tell.

    As as sometime employer, I can say it will happen or some employees will eventually seek life elsewhere. Because with the individual tax break to cover the health plan from elsewhere they'll see more take home. I don't see any serious dispute about the math on this: with the average health plan (maybe not the Cadillacs) and the planned individual breaks most people come out ahead - at least in the near term. In the future, w/out indexing the break, that might change.

    There's also some smug paternalism built into the current employer - employee relationship because of health care that I would like to see dismantled. Instead of 'keep working here because the workplace is rewarding', its 'keep working here because I provide your health care and otherwise you are on your own.'

    There's assumption above in cost accounting that health costs will keep rising as they are - 9% / year under the current employer based system. A major reason for dumping employer based is that it will finally create a real market, which we don't have now, and that will bring costs down once people actually start paying for health care themselves. Already, we have people moving much routing medical care under the high deductible HSAs, which by definition has zero claim work, i.e., when a patient just pays cash.

    At 9% per year its not going to be working well for long for anyone. It is either something like this or the whole thing will be nationalized in 10 years.
     
  17. Sep 28, 2008 #16

    cristo

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    That is just what I was thinking on reading through this thread!
     
  18. Sep 28, 2008 #17

    mheslep

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    We have a tax deduction now, under the employer plan. The money doesn't come 'directly from the treasury', its your money. The govt would not run anything more under McCain, except perhaps the Guaranteed Access Plan, if that. You do not 'buy' your healthcare, group or individual with just the the tax break.

    There has not been a real free market for health care in the US since before WWII when the employer based system was created by accident, and before which health care was almost completely individualized and largely affordable.

    That's because you and I dont pay anything besides our $20 bucks. The 'insurers' do it all. That's got to stop.
     
    Last edited: Sep 28, 2008
  19. Sep 28, 2008 #18

    mheslep

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    How national do you want it? Its already 50% government run by dollars through medicare/medicaid/veterans. Britain is not 100% nationalized either, 10% of Britains are on private plans and growing.

    Personally, I find that a) if you get sick and have access the US is the best bet in the world, b)the US system is too expensive and drops many through the cracks.
     
  20. Sep 28, 2008 #19

    cristo

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    The point is that regardless of how much money you have, you can walk into a hospital and get treatment if it is necessary, or you can go to a GP and get seen whether you have any money or not.


    A grammatical point: the word meaning a person from Britain is 'Briton.'
     
  21. Sep 28, 2008 #20

    mheslep

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    Does that include illegal aliens?

    In the US if you don't have any means, one can sign up for government medicaid. Also, the US EMTALA law guarantees anyone, anytime can go into an emergency room and get help. The problem here is that the overall system costs/head are enormous, so that if you have middling means you can get squeezed hard. The care itself is excellent, if you have access. (Get on a plane and hop the pond if you get cancer in the UK).

    Regards walking into UK hospitals:
    http://www.cato.org/pubs/pas/pa-613.pdf, page 24

    Arg, apologies all 'round.
     
  22. Sep 29, 2008 #21

    Art

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    Yes it does include both legal and the estimated 400,000 illegal immigrants. There was a half hearted effort by the UK gov't to deny failed asylum seekers free care but there were so many exceptions and so much administrative chaos it proved impossible to implement. There are also a lot of so called health tourists who travel from poorer countries in the EU to receive treatment they cannot get at home. All of which is a drain on the NHS leading to long treatment times for some conditions such as cancer although this has improved recently with 99.9% of all suspected cancer sufferers now being seen by a specialist within 2 weeks of a GP's referral. http://www.performance.doh.gov.uk/cancerwaits/2008/q1/can_14.html

    Britain's NHS is by no means perfect and situations like the above need fixing as does the shortage of physicians in some specific areas such as dental services plus it is still recovering from years of Tory underfunding but overall the core principles of 'free at point of use' and 'treatment based on need' are solid principles to work to.

    With the money the US already spends on health they could easily have the best NHS system in the world without any of it's citizens ever needing to worry about the costs of medical bills again.
     
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  23. Sep 29, 2008 #22

    adrenaline

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    It's not a problem for me.



    We both agree there needs to be some inusrance reform regarding preexisting clauses. Two of my nurses came down with breast cancer,Humana increased their premiums, I threatened to purchase another health care plan for my coorporation. They bought down the premiums. An individual does not have that type of bargaining power.

    That is the key, Mcain's plan does not take that into account. Initially, the tax breaks will be fine, but in the near future, not worth a flip.

    Not how I run my business, but that is not really on topic here.



    If there was a nationalized health insurance my overhead would go down by a huge percentage. I have one medicare/medicaid biller and coder and 8 just to deal with the private insurers ( they check all 300 individual plans for the necessary precerts, prior authorizations, find out what labs I am able to send their blood ( lab corp, quest, hosptial etc.) and that's just the tip of the iceberg. So guess what, if all 15,000 of my patients go on individual insurance plans, I am going to limit it to 300 major ones. The rest are on their own. Theire is a growing and burgeoning movement (physicians for national health insurance) that is gaining quick momentum. The only docs who don't want this are the proceduralist who get excorbitant payments for relatively minor procedures. ( I don't mean general surgeons and vascular surgeons who are grossly underpaid for their time but opthalmologists, dermatologists, interventional radiologists etc.)


    I think this link gives a very non partisan critique of mcain's and obama's plan from economists who are a lot smarter than me. The upshot, Mcain's plan will do nothing to lower the number of uninsured and Obama's plan will not necessarily reign in costs. They confirm my impression of both plans. http://ap.google.com/article/ALeqM5j3QFmojE8Ft12Stb5Eru_cHBwqxgD937J6600 [Broken]

     
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  24. Sep 29, 2008 #23

    Astronuc

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    I see two problems with respect to health care:

    1. Too many people with preventable medical problems. The emphasis in health care needs to be on prevention, and that ultimately is up to the consumer. Diet and exercise (and avoiding alcohol/drug abuse and smoking) are key to preventing much illness.

    2. Too much administrative overhead on the part of insurance providers. Competition is supposed to put a downward pressure on prices, but I don't see a lot of competition. I do see redundant services - and that leads to excessive overhead.
     
  25. Sep 29, 2008 #24

    adrenaline

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    could not agree more. The Physicians for National Health Insurance estimate that " private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans"
     
  26. Sep 29, 2008 #25

    Astronuc

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    On the other hand, would anyone trust the government based what has happened the Fannie Mae or Freddie Mac? Well they were GSEs. :rolleyes:

    And whatever happened to the program from the President's Council on Physical Fitness which emphasized good diet and excercise - back 35+ years ago when I was in elementary, junior and high school? It doesn't seem to be emphasized as much.

    http://www.fitness.gov/
    http://www.presidentschallenge.org/educators/program_details/physical_fitness_test.aspx [Broken]
     
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