Forcing a vote for a bill that is ill designed and unpopular seems like a strange concept. Of course, you may believe that some who oppose it will be intimidated at the last minute and swing it to a victory, it seemed to happen in the November election.
Of course if it does pass, it still has to go to the Senate and the drama will continue. If it fails or they cancel the vote, they can move on to the rest of their rob the poor agenda.
To those of you not paying attention, the basic republican philosophy is to give more to the rich, because they make things happen and it encourages more people to become rich.
If it was only so easy.
Now, They don't have enough rich people to get elected so they have to fool the not so rich into thinking they will also benefit. Some might if they don't mind a society where the haves and the have-nots keep getting further apart.
It is much more likely that these people will become a have-not then that they will become wealthy and trying to stay in the middle is really pricey.
Which brings us back to health care, the one thing most likely to cause a financial catastrophe. Now a country where a bad diagnosis can mean not only a fight for your life but also a chance to impoverish your family is hardly a civilized place.
Losing your job is of course also a terrible blow but one you have some chance of recovering from. But a significant illness, can impoverish you while also possibly killing you. A certain number of people have decided it was better to end it rather than put up with the treatment and the financial danger. I don't know if we have enough data to figure that out, but I believe it is significant.
It doesn't seem like the vote today, if it happens will be successful because the changes aren't harsh enough. A bunch of well off old white men think anyone who happens to get pregnant should have to figure out how to pay for it, and they have to have the baby by the way.
The fact that so many Americans vote for these people is the really sick thing. Many just vote for the party thinking it represents them, but of course if they aren't wealthy it really doesn't.
We have almost two years of this before we get to vote again, lets pay attention.
Showing posts with label health reform. Show all posts
Showing posts with label health reform. Show all posts
Friday, March 24, 2017
Friday, March 3, 2017
Health Care
Ultimately sick and injured people will get treated. The question becomes at what cost and do we want to invest in keeping those people healthy in the first place.
Now, it the world of many republican congressmen, certain constituents felt they had been inconvenienced by the Affordable Care Act. They liked the fact that their kids could stay on until age 26 and that preventative care was not subject to deductibles or co-pays, but they thought it might have made some premiums go up, and if they owned a business with more than 50 people they had to offer heath coverage.
Also, they felt the individual mandate was Government telling people what to do, although I doubt many of those people would go a day without coverage anyways.
It also occurred to them that they were probably paying something for it in their taxes and they didn't like that, although as I said before its a pay now or pay later situation.
These things do not qualify as a disaster and in fact the initial outrage that existed in anticipation of the law actually sort of died done. Repeal Obamacare became a thing you said, sort of like saying Amen at the end of a church service.
In fact many of the people calling for the repeal of Obamacare like the Affordable Care Act, they just didn't know it was the same thing.
Of course the term Obamacare was designed to stir up racism from the start and our media and many others played along because it was a catchy name. It caught on so well that most Americans didn't know the real name of the law or even what was in it.
Now like the dog that catches the car, the republicans have to come up with something. Providing multi state coverage, although think that is a state thing and savings accounts that are tax free help the people that don't have a problem now. Even then, they may lose the pre-existing condition and age 26 benefit they love.
Just letting the insurance market do what it wants will of course bring us back to where we were in 2008 and that is probably not an acceptable solution.
Complicate this with our semi simpleton president who now understands the issue is complex, surprisingly, and has made promises that the congress doesn't want to keep.
Fun and games, except people who lose needed coverage die, so maybe not as much fun as just political games.
Now, it the world of many republican congressmen, certain constituents felt they had been inconvenienced by the Affordable Care Act. They liked the fact that their kids could stay on until age 26 and that preventative care was not subject to deductibles or co-pays, but they thought it might have made some premiums go up, and if they owned a business with more than 50 people they had to offer heath coverage.
Also, they felt the individual mandate was Government telling people what to do, although I doubt many of those people would go a day without coverage anyways.
It also occurred to them that they were probably paying something for it in their taxes and they didn't like that, although as I said before its a pay now or pay later situation.
These things do not qualify as a disaster and in fact the initial outrage that existed in anticipation of the law actually sort of died done. Repeal Obamacare became a thing you said, sort of like saying Amen at the end of a church service.
In fact many of the people calling for the repeal of Obamacare like the Affordable Care Act, they just didn't know it was the same thing.
Of course the term Obamacare was designed to stir up racism from the start and our media and many others played along because it was a catchy name. It caught on so well that most Americans didn't know the real name of the law or even what was in it.
Now like the dog that catches the car, the republicans have to come up with something. Providing multi state coverage, although think that is a state thing and savings accounts that are tax free help the people that don't have a problem now. Even then, they may lose the pre-existing condition and age 26 benefit they love.
Just letting the insurance market do what it wants will of course bring us back to where we were in 2008 and that is probably not an acceptable solution.
Complicate this with our semi simpleton president who now understands the issue is complex, surprisingly, and has made promises that the congress doesn't want to keep.
Fun and games, except people who lose needed coverage die, so maybe not as much fun as just political games.
Saturday, January 9, 2010
Health Insurance and Hiring
If you run a business, one of the big impediments to hiring is the cost of benefits and in particular the cost of health insurance and until recently, pensions. This country had evolved a system where the primary responsibility for the providing of health insurance for most has become the responsibility of the employer. Over the years we have seen skyrocketing increases in this cost and while many employees have attempted to reduce cost via HMOs and other changes such as higher deductibles, the incremental cost of hiring an employee now includes an ever growing tab for health insurance. Add to that the uncertainty related to what the Government is going to require and even further what the economy is going to look like and you would have to be very confident in your future business to hire anything other than temporary or contract workers.
Until recently and in some cases still, the growth in pension liabilities was becoming a great strain on employment. However, very few small businesses attempt to offer pensions any more outside of a 401 plan. This type of benefit is a defined contribution plan and defines the costs you as an employer are responsible for in a pre-determined way. When I first reviewed compensation plans, most companies offered defined benefit plans that required them to pay a certain level of benefit for the employees retired life. This puts all the risk on the employer. A defined contribution plan switches the risk to the employee largely since the 401 plan will only provide income until it is gone. Of course most employees also have social security to fall back on and employers face some risk in that area if the rates go up, but nothing like the risk of a defined benefit plan.
It would seem we could learn a lot from this pension change. If the costs of health insurance could be defined to the same extent that the pension cost have been, employers would be more likely to risk hiring. One way to do this would be for everyone to effectively fall under a Government plan funded by taxes and where the variable cost of hiring an employee no longer included a health insurance risk. This solution is politically difficult with many arguing that the Government is unable to run anything well. I personally don't agree with that but it is not a viable option at this time. The other option would be to have a defined contribution health benefit for employees where the cost to the employee was defined, similar to a defined contribution pension plan. There has been some movement in this area via the use of savings funds, but I am not aware that there is any widespread movement in this direction. To some extent this is the way the federal employee plans work although the contribution amount is determined by a formula related to the average cost of all the health plans included. Employees pick up a variable cost depending on the plan they choose and the more expensive plans actually cost the employees more. The net result of this has been some cost containment as a certain number of employees switch to more affordable plans every year, reducing the average cost below what it would have been and therefore reducing the Government contribution below what it would have been otherwise. The Government pays the lower amount of the following
a) 72 percent of the overall weighted average; or
b) 75 percent of the total premium for the plan you select.
What you will note from this is that if you pick a plan that has higher than average costs, the Government contribution for you is less. The formula has a built in incentive to control costs.
Now, the size of the Government workforce gives them significant influence and most companies only have one health insurance provider. However, even in the absence of a public option, we could and should have a benefit pool that employers could join where the benefits from many insurers were available to that companies employees and where the employers could define the amount they would contribute, either as a percentage of the average or a set amount. The difference would become the employee's responsibility but the employee would get the benefit of being part of a large pool with many choices.
This blog for today has gotten a bit longer than I like so I'll return to this subject and explore more options tomorrow.
Until recently and in some cases still, the growth in pension liabilities was becoming a great strain on employment. However, very few small businesses attempt to offer pensions any more outside of a 401 plan. This type of benefit is a defined contribution plan and defines the costs you as an employer are responsible for in a pre-determined way. When I first reviewed compensation plans, most companies offered defined benefit plans that required them to pay a certain level of benefit for the employees retired life. This puts all the risk on the employer. A defined contribution plan switches the risk to the employee largely since the 401 plan will only provide income until it is gone. Of course most employees also have social security to fall back on and employers face some risk in that area if the rates go up, but nothing like the risk of a defined benefit plan.
It would seem we could learn a lot from this pension change. If the costs of health insurance could be defined to the same extent that the pension cost have been, employers would be more likely to risk hiring. One way to do this would be for everyone to effectively fall under a Government plan funded by taxes and where the variable cost of hiring an employee no longer included a health insurance risk. This solution is politically difficult with many arguing that the Government is unable to run anything well. I personally don't agree with that but it is not a viable option at this time. The other option would be to have a defined contribution health benefit for employees where the cost to the employee was defined, similar to a defined contribution pension plan. There has been some movement in this area via the use of savings funds, but I am not aware that there is any widespread movement in this direction. To some extent this is the way the federal employee plans work although the contribution amount is determined by a formula related to the average cost of all the health plans included. Employees pick up a variable cost depending on the plan they choose and the more expensive plans actually cost the employees more. The net result of this has been some cost containment as a certain number of employees switch to more affordable plans every year, reducing the average cost below what it would have been and therefore reducing the Government contribution below what it would have been otherwise. The Government pays the lower amount of the following
a) 72 percent of the overall weighted average; or
b) 75 percent of the total premium for the plan you select.
What you will note from this is that if you pick a plan that has higher than average costs, the Government contribution for you is less. The formula has a built in incentive to control costs.
Now, the size of the Government workforce gives them significant influence and most companies only have one health insurance provider. However, even in the absence of a public option, we could and should have a benefit pool that employers could join where the benefits from many insurers were available to that companies employees and where the employers could define the amount they would contribute, either as a percentage of the average or a set amount. The difference would become the employee's responsibility but the employee would get the benefit of being part of a large pool with many choices.
This blog for today has gotten a bit longer than I like so I'll return to this subject and explore more options tomorrow.
Monday, November 9, 2009
Health Care
While the country continues to move to some form of universal health care, you continue to hear fear mongers and well to do conservatives decry the reform as a form of socialism or even sometimes communism.
One of the things that a society needs to decide is what exactly does each participant get in return for abiding by the societal rules. If you consider modern society, each member of the society does their part by following rules, paying taxes, and participating in our representative government. Our basic national documents state that each individual has certain inalienable rights. One of these is the right to life.
Now, as health care has progressed, we have seen life expectancy expand. However, clearly access to care and especially preventive care is of utmost importance to such life expectancy. A significant number of our fellow citizens do not have access to this care. The dividing line is not simply between rich and poor. Oddly, the poor tend to have access via Government programs already. Those who don't have this care tend to be our lower middle class citizens or in some instances our blue collar workforce who are not employed by major corporations.
We have evolved into a system where health care and employment or wealth are linked. Now, if there is some justification for why an employee at an auto manufacturer, or other large corporation should get better health care than a construction worker or day laborer I would be curious as to what it is.
Often I hear analysts claim that Americans with health care are happy with it and don't want to see changes. Of course, that is similar to saying people who have anything of value are happy with it. The question that Americans have to answer is do they want to deny their fellows the same care? Another question to ask is do they want to leave their future access to care up to chance that they will remain employed?
The current state of health care is simply unfair and expensive. If you are wealthy or secure in your employment, you are one of the haves. Whether you are there because you are deserving or lucky is really irrelevant. We need, as a society, to extend health care to all.
One of the things that a society needs to decide is what exactly does each participant get in return for abiding by the societal rules. If you consider modern society, each member of the society does their part by following rules, paying taxes, and participating in our representative government. Our basic national documents state that each individual has certain inalienable rights. One of these is the right to life.
Now, as health care has progressed, we have seen life expectancy expand. However, clearly access to care and especially preventive care is of utmost importance to such life expectancy. A significant number of our fellow citizens do not have access to this care. The dividing line is not simply between rich and poor. Oddly, the poor tend to have access via Government programs already. Those who don't have this care tend to be our lower middle class citizens or in some instances our blue collar workforce who are not employed by major corporations.
We have evolved into a system where health care and employment or wealth are linked. Now, if there is some justification for why an employee at an auto manufacturer, or other large corporation should get better health care than a construction worker or day laborer I would be curious as to what it is.
Often I hear analysts claim that Americans with health care are happy with it and don't want to see changes. Of course, that is similar to saying people who have anything of value are happy with it. The question that Americans have to answer is do they want to deny their fellows the same care? Another question to ask is do they want to leave their future access to care up to chance that they will remain employed?
The current state of health care is simply unfair and expensive. If you are wealthy or secure in your employment, you are one of the haves. Whether you are there because you are deserving or lucky is really irrelevant. We need, as a society, to extend health care to all.
Thursday, September 10, 2009
Health Reform
If you consider the issues that face the United States, we have some that have the potential to weaken the very fabric of our nation. Now, one of the things that makes America great is that we don't all have to agree on anything, but we all normally want to treat each other fairly. There is an ongoing debate between those who oppose Government involvement in just about anything and those who favor Government involvement.
Last night the President gave a speech to a joint session of congress and the nation of his proposal to fix health care in this country. For most Americans, health care is represented by the relationship they have with Doctors, Nurses, Dentists and other providers. They don't much think about the business of health care, until something happens that causes them to bear unexpected costs, either because they lose health coverage or have some other catastrophic event.
For some Americans health care simply is something they either do without or provide to themselves. Now, I'm not talking about those who believe in alternative medicine or holistic approaches. I'm talking about people who are not poor enough or old enough to get Government health care and don't have affordable health care options via their employee or on their own.
These folks are working Americans or small business owners who simply are unable to afford health insurance and gamble that they won't need it until they can afford it. Now, sometimes they win and sometimes they lose. After all, insurance is a gamble by its very nature. You can pay premiums for many years and never use the benefits, or use them much less than average. The real purpose is to provide protection from unusual costs that can not be covered from normal income.
The President proposal basically provides that these people will form a group and because of the size of the group, they will be offered affordable insurance. It will become mandatory for people to have health insurance, similar to auto insurance and there will be a concerted push to eliminate waste from the current system while pushing preventive medicine to further reduce cost.
There are of course other ways to solve the problem we face and there is still time to discuss them. The providing of cheap catastrophic protection is a good idea and should not only be used temporarily, but makes sense as one of the options is an ongoing insurance exchange.
What we do need it honest debate and honest commitment by all Americans to help solve the problem and move forward. We need to assure all Americans have access to health care in an affordable way and we also need to change the cost growth curve. Lets do it.
Last night the President gave a speech to a joint session of congress and the nation of his proposal to fix health care in this country. For most Americans, health care is represented by the relationship they have with Doctors, Nurses, Dentists and other providers. They don't much think about the business of health care, until something happens that causes them to bear unexpected costs, either because they lose health coverage or have some other catastrophic event.
For some Americans health care simply is something they either do without or provide to themselves. Now, I'm not talking about those who believe in alternative medicine or holistic approaches. I'm talking about people who are not poor enough or old enough to get Government health care and don't have affordable health care options via their employee or on their own.
These folks are working Americans or small business owners who simply are unable to afford health insurance and gamble that they won't need it until they can afford it. Now, sometimes they win and sometimes they lose. After all, insurance is a gamble by its very nature. You can pay premiums for many years and never use the benefits, or use them much less than average. The real purpose is to provide protection from unusual costs that can not be covered from normal income.
The President proposal basically provides that these people will form a group and because of the size of the group, they will be offered affordable insurance. It will become mandatory for people to have health insurance, similar to auto insurance and there will be a concerted push to eliminate waste from the current system while pushing preventive medicine to further reduce cost.
There are of course other ways to solve the problem we face and there is still time to discuss them. The providing of cheap catastrophic protection is a good idea and should not only be used temporarily, but makes sense as one of the options is an ongoing insurance exchange.
What we do need it honest debate and honest commitment by all Americans to help solve the problem and move forward. We need to assure all Americans have access to health care in an affordable way and we also need to change the cost growth curve. Lets do it.
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