News Should resources be reallocated from retirees to those in greater need?

[phyzguy]

I've never really understood the high cost of healthcare.

My solution is that I don't carry health insurance because I am healthy, take pains to keep myself that way, and refuse to pay premiums the vast majority of which would be used to cover those either not as fortunate as I am, or those who willingly trashed their physiology over the years. While I feel bad for the former, I have no mercy towards the latter.

I edited down your long post. You raise some good points, but let me ask you a question. What if you take this approach, as many do, and have some major medical problem, say a car accident. Will you then say, "I guess I rolled the dice and lost, please let me bleed to death on the side of the highway?" I'll wager you will not. You will accept the emergency care that the hospitals are required by law to give you, and those of us who do carry health insurance will pay for your treatment. This is why everyone should be required to carry health insurance, because everyone needs medical care at some point in their lives.

 

[WhoWee]

I edited down your long post. You raise some good points, but let me ask you a question. What if you take this approach, as many do, and have some major medical problem, say a car accident. Will you then say, "I guess I rolled the dice and lost, please let me bleed to death on the side of the highway?" I'll wager you will not. You will accept the emergency care that the hospitals are required by law to give you, and those of us who do carry health insurance will pay for your treatment. This is why everyone should be required to carry health insurance, because everyone needs medical care at some point in their lives.

Because the majority of large medical claims come from either accidents or major illness - plan designs have been flexible. A 20 something in perfect health may want a $10,000 deductible to keep premiums low and have preventative and emergency care in place. Then, for a few dollars per month, a $10,000 accident plan (or term life) can be added to offset the large deductible - just in case.

If choices are limited - premiums will increase (IMO).

 

[klimatos]

Those debt/GDP numbers don't reflect i) the outlandish pension guarantees made to California government employees which will cause future debt increases, shortly, ii) that California is already maxed out on its tax rates compared to most other states, so that it can not raise taxes to pay those pensions.

I live in California. I know of no law that says that we are "maxed out" on our taxes, nor any law that says we cannot raise them even further. If you know of such a law, please provide a citation.

Many states have higher state taxes than does California; and California taxes have been higher in the past than they are now.

While many Californians would agree with you that some pensions are "outlandish", nevertheless, the promises were made and accepted in good faith and we are both legally and morally bound to honor them.

"A promise made is a debt unpaid."

 

[mheslep]

I live in California. I know of no law that says that we are "maxed out" on our taxes, nor any law that says we cannot raise them even further. If you know of such a law, please provide a citation.

The reasons, not laws, that I had in mind preventing California from raising taxes include i) working people leaving the state and ii) California taxes being higher than the states to which Californians are traveling. http://data.bls.gov/timeseries/LASST48000003"

Ca labor force

Texas labor force

Many states have higher state taxes than does California...;

I do not think so, unless two make many. Only Oregon and Hawaii have higher top income tax rates than California's 10.3%. Of those two, Oregon has zero sales tax, Ha's is 4%, while Ca's sales tax (state and local) is 8.3%.
[PLAIN]http://www.taxfoundation.org/UserFiles/Image/maps/stateincome_c_small.png
California's business tax is 8.8%, with only a few states topping that - Il, DC, Pa, NJ.

So there is no law saying California can not raise taxes further, but I think it is a safe bet that Ca will gain no further revenue from doing so, i.e. Ca taxes are maxed out.

 

[mheslep]

Obviously a 3 or 5:1 ratio isn't sustainable, its why the long-term budget problem IS health care.

Agreed.

... (we spend a lot more as a nation,

Agreed. And too many people go uncovered.

but we don't see much by way of results),

Disagree. Meaningful results mean to me good and prompt medical outcomes: cancer, heart operation survival rates and the like, and not how many die from accidents or homicides, or whether a particular gene pool reflects low incidents of heart disease. The latter cases won't be changed by reforming the health care system. My research indicates nobody beats US medicine on these terms. It is medical excellence that I want to keep intact in the reform of the system, which I agree is needed.

 

[ParticleGrl]

Meaningful results mean to me good and prompt medical outcomes: cancer, heart operation survival rates and the like

But you can add to that infant mortality, preventable deaths, etc.

My research indicates nobody beats US medicine on these terms. It is medical excellence that I want to keep intact in the reform of the system, which I agree is needed.

It depends on the marker. By most quality of care studies I've seen, the US is a mixed bag. We are great at using a great deal of money to extend a cancer patient's life by a year or two. We are pretty poor in categories like preventable deaths and infant mortality.

 

[mheslep]

But you can add to that infant mortality,

I don't think so. The reported difference between the US and France/Germany is down to http://www.google.com/publicdata/ex...ountry:USA:FRA:DEU&ifdim=country&hl=en&dl=en":

It has also been common practice in several countries (e.g. Belgium, France, Spain) to register as live births only those infants who survived for a specified period beyond birth.

In other words what's recorded as fetal death (stillbirth) there might be an infant death here.

...preventable deaths, etc.

Such as those caused by hypertension, smoking tobacco, high cholesterol, malnutrition, STDs, etc? These are behavior related, having little or nothing to do with any health care reform proposals on the table.

...By most quality of care studies I've seen, the US is a mixed bag. We are great at using a great deal of money to extend a cancer patient's life by a year or two.

I'm reluctant to get into another country comparison discussion, but the difference for cancer survivors is not a "year or two." Five year survival rates are up to 5-20% better US vs Europe, or were back in 2007. For at least some cancers, the large majority of relapses occur inside 5 years, meaning if you survive 5 years it is likely something else will end up doing you in.
http://www.ncpa.org/images/1703.gif
http://www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/abstract

 

[MarcoD]

In other words what's recorded as fetal death (stillbirth) there might be an infant death here.

Infant mortality is very clearly defined as the number of children dying in their first year. Numbers are http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate" .

 

[WhoWee]

Did the retirees pay into the system, or was their retirement and health care part of their work/retirement compensation? If so, then companies and government must honor those promises, period. Yanking it away because it doesn't seem fair would be the height of unfairness to those to whom it was promised.

This issue seems to have been placed on the back burner. The reality is millions of retirees face the loss of company paid health coverage due to the elimination of a tax credit. These people will be forced onto original Medicare, a Medicare Advantage plan or a Medigap plan (if they can afford the premium). This will also increase the burden on the Medicare system.

http://www.nytimes.com/2010/03/30/business/30subsidy.html
"An association representing 300 large corporations urged President Obama and Congress on Monday to repeal a provision of the health care overhaul that prompted AT&T, Caterpillar and other companies to announce substantial charges for the current quarter.

Times Topic: Health Care Reform
The association, the American Benefits Council, said the provision — which reduces the tax deductions for companies with drug coverage for their retired employees — would deal a significant blow to corporate profits and would discourage companies from hiring more workers.

AT&T announced last week that it was taking a $1 billion charge because of the provision. Deere & Company announced a $150 million charge, Caterpillar a $100 million charge, and 3M a $90 million charge.

Many companies said they were taking these charges now, before the current quarter ended, to comply with accounting rules. But some corporate critics asserted that the companies’ rapid response to the health legislation was aimed at pressing the administration to repeal the provision.

James A. Klein, the president of the American Benefits Council, called the provision “a serious mistake that is having negative and unintended consequences.”

White House officials defended the provision, saying it was a deliberate effort to eliminate what they said was an unusually generous tax loophole."

my bold
Given the current discussion of "jobs" and eliminating "tax loopholes" (consider consequences) - this is an important topic.

 

[mheslep]

Infant mortality is very clearly defined as the number of children dying in their first year. Numbers are http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate" .

You missed the point. The question is about what constitutes a live birth, and that definition varies by country.

 

[MarcoD]

You missed the point. The question is what is about what constitutes a live birth, and that definition varies by country.

Ah. I doubt it, the definition, really varies between the developed countries, but point taken.

 

[WhoWee]

http://www.dol.gov/ebsa/Publications/retiree_health_benefits.html

"Providing for health care is an important part of retirement. Some employees are fortunate: they belong to employer-provided health care plans that carry over to retirement.
However, an important question arises for employees and retirees: How secure are my health care benefits after retirement? Under what circumstances can the company reduce or terminate my health benefits?
Employees and retirees should know that private-sector employers are not required to promise retiree health benefits. Furthermore, when employers do offer retiree health benefits, nothing in federal law prevents them from cutting or eliminating those benefits--unless they have made a specific promise to maintain the benefits.
The key to understanding your retiree health benefits lies in the documents governing your plan.
Review Your Plan Documents
To understand the terms of employer-provided retiree health benefits, you should first review your plan documents.
The Summary Plan Description (SPD) is a summary of the terms of the plan. Employers are required to provide a copy to you within 90 days after you become a participant in the plan.
For retirees, the SPD that was in effect when you retired may be the controlling document. You should save a copy of it. You also should save any SPD changes affecting your benefits after you retire.
In addition, there may be formal written documents that outline how your health plan is operated. These may include a collective bargaining agreement or an insurance contract.
You Should Know-Coverage Can Change
If your employer has reserved the right in the SPD or controlling plan document to change the terms of the plan, you may lose coverage at any time during your retirement. If your employer made a clear promise that you will have specific health care benefits for a definite period of time or for life, and did not reserve the right to change the plan in any formal written plan document, you should be covered."

 

[DoggerDan]

White House officials defended the provision, saying it was a deliberate effort to eliminate what they said was an unusually generous tax loophole."[/I]

Hmm... So it's ok for the government to raise public debt by trillions, but it's not ok for corporations to use an intentionally-created tax break valued in the millions.

Apparently, it's also ok for the Obama administration to falsely slight those who created it by wrongly referring to it as a "loophole."

I agree with the points you make, WhoWee.

 

[WhoWee]

Hmm... So it's ok for the government to raise public debt by trillions, but it's not ok for corporations to use an intentionally-created tax break valued in the millions.

Apparently, it's also ok for the Obama administration to falsely slight those who created it by wrongly referring to it as a "loophole."

I agree with the points you make, WhoWee.

I think calling this a "loophole" is very deceptive. Likewise, calling it a "tax break" implies the companies are receiving some type of benefit. This tax deduction is designed to account for payments made by the employer for the retiree benefits. If the companies have to pay taxes on the funds they've spent - they will stop paying. This (IMO) should be a legitimate business expense.