Diceman, as regards the $275 charge, the businesses affected have to be of a certain size; there’s a small-business exemption. Mainly the charge is targeted at Wal-Mart and McDonalds, which are said to be the major abusers – i.e., large employers who typically don’t offer affordable healthcare, but whose employees are often users of so-called “free care.” It’s an open question whether other businesses will opt out of providing insurance, and choose to pay the state fee instead. I suspect that for most businesses wanting employees of a certain caliber, axing the health plan is not a winning strategy. Also, there may be union contracts that effectively prohibit companies from doing that.
Sleestak, to answer your questions, in my scheme, copays and deductibles would go away. These are, after all, just a tax under another name, and for the sake of efficiency, I’m proposing one source of taxation, rather than myriad sources. The minimum benefit level would be mandated (and could be modeled on what HMOs offer now as a minimum benefit level), and prescriptions would be covered, same as today.
I know people like to complain about government inefficiency and bloat, but in my proposal, the government will do little more than collect tax money and use it to pay the HMOs for their enrollees. The HMOs (which are amost all nonprofit in Massachusetts, incidentally) will continue to do what they’re trying to doing now – manage healthcare utilization, provide customer service, efficiently process claims, etc.
All right, this is a hobbyhorse of mine. My talking up my proposal is my way of saying that no, Massachusetts didn’t quite get it right this time. But even at that, Massachusetts at least made an effort, which is more than most states can say.
It’s even worse than that. Employers who don’t provide insurance would only pay $295 (not $275) per employee PER YEAR - not per month.
Now why would any company who doesn’t already provide insurance jump to do it, since they can avoid doing it by paying a fine of $295 per person? Meanwhile the employee will have to find his own coverage (for far more than $295 per year) or lose his state income tax exemption.
Sal, I say this not to be mean, but this simply won’t work. People will vastly overuse coverage if you take away the decuctibles and co-pays. They will visit the doc for the common cold “just to check to see if it’s something bad.”
I used to work in the healthcare IT industry, and we used to see this sort of usage problem come up when employers dropped deductibles below a certain amount. You’d get lonely older folks going to the doctor just for human contact (while I admit this is sad and awful, I don’t think having them use the doctor’s office for a social call is a good idea). They simply must be set at a certain rate to discourage people from, for instance, going to the emergency room instead of to their local doctor. I have stepped-up copays on my health plan where I pay 20 for an office visit, 50 for urgent care, and 100 for ER visits (unless admitted). You have to have those sorts of disincentives.
Crazyjoe, this effect has been studied, and been found to be a negligible factor in overall healthcare utilization. Don’t have any good cites handy, but maybe somebody else does. Also, you could hypothesize that the effect goes the other way, namely that people defer getting necessary health care because of copays or deductibles, and so end up as more expensive cases.
That said, I don’t have a hugely strong feeling one way or the other about copays or deductibles, and I don’t think my proposal stands or falls on that relatively minor question.
Maybe that’s correct, but we’re operating here entirely on your suppositions. I wanna see the actual costs of the plan laid out. You simply saying “they’ll save money” doesn’t necesarrily make it so.
Nope, I don’t. I live in a state where the guy administrating some investments for the state’s unemployment insurance has absconded with many millions of dollars. So, I real likely to trust any state health insurance administrator to behave honorably either. Power and money is to dishonest politicians like shit and honey to flies.
crazyjoe, your proposition is full of crap. It’s a typical American attitude, but it just ain’t so, as anyone who has experience health care in countries with universal health care can tell you.
Emergency rooms and doctor’s offices are not clogged with healthy bored people. They’re filled with sick and injured people. And when you hike co-payments, all you do is discourage people from getting annual physicals or seeing the doctor when they have a minor affliction-- and instead end up having seizures at work and spending 3 days in the ICU.
The ovewhelming majority of people who use health care (that is, everybody) are pretty damn responsible with it. There are probably, as a percentage, more doctors with fraudulent billing practices than patients showing up to say hi.
Sal Ammoniac points out that many major businesses currently pay for health care for their employees, but the trend in the U.S. is to remove health care coverage. Some of those are ailing companies (like GM), but some are healthy vibrant companies. Heck, my union is in the process of negotiating a new contract, and my company no longer wants to cover health care. In fact, the company violated the terms of our contract (which is still in effect until we negotiate a new one) and stopped making health care payments on behalf of employees months ago (the union is picking up the slack, and has filed a grievance with the national labor relations board)
It’s a fair point. Let’s make the following assumptions for the state of Massachusetts: a non-Medicare population of around 5.4 million; a working population of 3 million persons; a $400 a month individual cost for a basic HMO plan (see some figures here); and existing governmental health insurance expenditures of nearly $8 billion. With these assumptions, by my back-of-the-envelope reckoning, the standard business levy would be around $6,000 annually.
By contrast, a Brandeis University site indicates that “the average annual healthcare cost per employee is $7,999.”
Now, bear in mind that many current hospital costs – for free care, bad debt, etc. – are shifted onto the insurance companies, such that the posited $400 monthly cost for insurance is probably higher than it would be in a system with universal coverage. Plus, with universal coverage, you could create huge administrative efficiencies through the imposition of a single medical coding system and standardized electronic claim forms.
Bear in mind that these are quick-and-dirty numbers. The actual analysis would take a hell of a lot of work. But it does suggest that most businesses would pay no more than they currently do, and some would pay less. And if you could achieve significant administrative efficiencies, they could pay a lot less.
The Canadian health care model is essentially what Uncle Beer is proposing: the government runs a health insurance plan (called funnily enough, in Ontario for instance, the Ontario Health Insurance Plan) to which all citizens are insureds. For those that are employed, their employer pays the premium (by law). For those that are unemployed, the government contributes on their behalf. When I go to the doctor, I present my insurance card. The only time I ever see a bill is on the rare occasion that the insurance people send me a “verification” letter that basically asks me to confirm that I received the services they are being billed for (just auditing, I presume).
It ain’t perfect, and it’s not run as well as it could be. But it works for the most part.
The earned income credit (in addition to any other tax rebates) would have provided you with between $692 and $1114 depending on your marital status. It doesn’t cover the whole $1764 cost but it puts a healthy dent in it by itself. Additional tax credits should cover the rest. Doesn’t matter how you slice the pie, if you come up short at the end of the day it’s still a negative on the balance sheet.
I think it’s great that MA has decided to try this. They can be the guinea pigs for the rest of the states. Since it took 2 years to legislate I’ll assume it has the voters approval.
Yay for artificially stimulating demand via government fiat, which will lead to increased health care prices for all! Yay!
This is all so silly. The reason that health insurance is sooo expensive is because of government regulations in the first place. Governments force insurance companies to cover alcoholism, marriage counseling, etc., which forces the price of health insurance up needlessly. When people then make the rational decision to forgo the overpriced health insurance, the government then steps in and mandates they buy it! Great!
Get the government out of health care. Completely. For everyone’s sake. Well, everyone except the HMO’s, as they benefit the most from government interventions.
I’ll believe you when you can give me a cite about how much it costs the health system when the government forces insurance companies “to cover alcoholism, marriage counseling, etc.”
Oh, and you can also give me a cite that shows where countries that have no government involvement in healthcare have better health systems that countries that do.
Hmmm. Perhaps I wasn’t clear enough then; that isn’t what I was proposing at all. Here, in a two-paragraph nutshell is what I believe to be a fair universal healthcare plan:
The general populace is given an opportunity to vote on the desirability of universal healthcare, rather than something legislated by your elected representatives. This issue is too important, and potentially too expensive, to be left entirely up to lawmakers who’re subject to all sorts of undue influence. If the majority of the voters disagree that universal healthcare is desirable, the issue is dropped. If they agree, then a plan is developed thru which every resident of the state is supplied with an identical level of coverage. This plan is put together, in several distinct pieces probably (like general care, catastrophic care, prescription plans, vision & dental care, hospice, in-home assistance, maybe even life insurance), by an independent, bi-partisan commission directly elected by the state’s residents. Residents would again have an opportunity to vote on each individual piece of the healthcare plan as the commission crafts it; simple majority vote would signify approval or disapproval of each piece. The regulations authorizing the formation of the commission would also describe the limits by which the plan could be changed in the future through commission-only actions; modifications to the plan outside that scope would again require a vote of the state’s residents. All residents are then required to enroll in each portion of the plan approved by the voters unless they specifically opt out by filing whatever form is provided for such. Those persons opting out must pay out of pocket for any services for which they have declined coverage. Enrollments are automatic from year-to-year and would be identical to your coverage(s) from the previous year.
This coverage is then paid for thru a progressive tax (similar to the income tax) levied specfically and only for this purpose and collected thru payroll, unemployment, social security, etc. dedcutions. These payments are tax-decuctible - both federal and state. In the case of minors, or other dependents, the persons your tax payments insure, are identical to the persons claimed on your state (or federal if the enacting state doesn’t happen to have an income tax) income tax return. The accounting of all this could be incorporated in your usual tax filings without too much difficulty. Employers would pay no portion of the costs of this plan directly; the responsibility for funding will be entirely upon the individual citizens of that state.
It is only in this manner that the citizens can be certain they’re getting the coverage they need and how much it is costing them. It also make the state accountable for their expenditures.
I don’t have much problem with your proposal, except perhaps that it’s a little cumbersome. I think it’s actually a moot point whether employers and individuals pay. If individuals are to pay, they’re going to have to be paid a little more, presumably out of the money employers save by not offering a health benefit. It’s the same money in the end, and how you feel about whether employers or employees pay is, I suspect, ideological.
Really? And you base this on what set of statistics? I might not be able to cite mine (proprietary company info that I no longer have access to) but I did work in the industry and I did see this sort of thing happening. I know that in countries with universal healthcare, lines and waiting a long time are not uncommon things. Here, depending on your doc, you can usually get in the same day if you need to see one for a cold.
I find it odd that you might think that American health care consumers have no need to change their ways of thinking, that they will magically change if they switch to universal health care.
This is only partly true. I have stupid moron friends who were taking their newborn to the ER every couple of weeks for things like “she’s constipated” or “she bumped her head.” Her copays for ER visits obviously were not high enough.
My copays for drugs are to the point where I always ask the doc for the older, more established drugs that are likley to have generic substitutions. Because I know how much drugs can cost me at the counter, I don’t take the most newfangled drugs out there when plain old amoxicillin will work just fine. But if your co-pay is, like my dad’s, 5 bucks per script, you don’t have any incentive to educate yourself about cost.
Maybe in your country. Here in America we need a major culture shift in order for this to happen. You’re not going to get this culture shift just by switching to national health care.
I think the chance of UHC passing would be very small, once your average Joe understands his effective price tag. Your average Joe wants the other guy to pay just as much, if not more, than the undue influences on the lawmakers you refer to.
It’s $295 per year ?! Holy shit, that’s only 24 bucks per month! Someone is going to have to fork over a ton of money to fund this program, and if it ain’t the businesses, then it’s going to be either the state of Massachusetts (by raising taxes) or the people themselves.
Say you are a 25-year-old healthy, single male, looking for cheap health insurance. You don’t drink…period. Now, when looking at various plans, it would make sense to purchase a plan that didn’t cover alcoholism, right? Alcoholism coverage costs some nonzero amount of money. So, in a free market, you could look for a plan specifically tailored to your needs, and that plan would save you money.
But when the government steps in and mandates that all insurance policies cover alcoholism…the costs of alcoholism coverage don’t just disappear. They are passed on to the consumer. And for our sober 25-year-old, those costs are a complete waste of money. He is forced to either subsidize other people’s alcoholism treatment or forgo health insurance entirely…an entirely inefficient result.
Obviously there is no cite on this, because every first-world government is heavily involved in health care provision, so there is no possibility for a study. And comparing American healthcare to Somalian health care is obviously comparing apples and oranges, as the lack of regulations in the Somalian health care industry is obviously overwhelmed by the lack of wealth in that country.
That’s the opinion of a couple of Massachusetts doctors who wrote this article criticizing the MA plan and recommending a single-payer program instead: