What happens if we make your sample voter (who is, I point out, only 5 years from Medicare – and if you don’t think that affects her thinking, you don’t know many older people) aware that other people who don’t even belong to her husband’s union are paying in part for that Cadillac plan? Would she find that unfair?
Most people are resistant to understanding such things, and – let’s face it – most don’t understand how the tax brackets work. So perhaps the easiest way to drive this home is to make health insurance premiums for employer-sponsored programs taxable.
The typical employee-plus-one total premiums in Wisconsin run to a tad over $13,000 annually (I’ll give a link if you like, but I’m lazy today). So let’s say the Cadillac plan is running $15,000. If she and her husband are in the 22% tax bracket, their taxes on this benefit would be $3,300.
If she and her husband have to pay this amount, would she still be so proud of her situation?
I think I despise that idea, and the post you wrapped around it; and I think she’d despise that idea, as well as the post you wrapped around it, and won’t trust you when next you come around trying to win her over with a cross-your-heart promise you already figure isn’t the truth - shhh - but you don’t figure you can sell her with truth, you figure you have to tell her that, uh, if she likes her plan, she can keep it? You recommend that, knowing it ain’t true, as the approach?
There are structural problems with the economics of our healthcare system that need to be addressed and I’ve never seen any proposal that does anything but talk about who’s going to pay the bill.
The principles of supply and demand economy are deeply distorted in our current healthcare system, because in most cases the bills aren’t being paid by the people receiving the goods and services. Imagine a restaurant that charged you one “all you can eat” price, but that paid their chefs by the piece for everything you ate. And those chefs got to advertise and market their food. Those chefs would have a business model that revolved around getting you to eat as much as possible. Now I’m not saying the majority of medical care isn’t necessary. But when I had cataract surgery in both eyes, they insisted on doing it as two surgeries and I had a total of 17 assorted pre-op and post-op visits in addition to the surgery cost. I owed co-pays on all. And I had to pay some anesthesiologist twice, for something that was like, as they put it “a glass of wine to relax you”. I could have suggested a cheaper way to accomplish this.
But there is a thriving industry that wants you put you in a doctor’s office as much as possible and get you to take as many medications as possible. I used to have a Cadillac plan, and I got a lot of physical therapy and psychotherapy when I was on that plan. But when I dropped back to a cheaper plan and had to pay $60 a session for this, I decided I didn’t need it all that much.
The high deductible insurance everyone loves to hate provides what insurance should, protection against a devastating event. The insurance model isn’t designed for ordinary care, but ordinary care has become cost prohibitive. And the ordinary care part of the policy is the part the consumer perceives that they need. They don’t think too much about the catastrophic care part because most of them never use it.
Some employers had add-on policies that covered workers from “first dollar” to the amount of their deductible. Then some employers just started offering the just add-on policies as insurance. Cheap insurance that appeared to pay for everything. And the customers loved it. Unless something happened and they actually needed it. Frankly, in a lot of ways insurance is like buying a car you probably will never drive. People might really like a car that sits in their garage all day because they’ve never once had to drive it. It may seem presumptive to tell them that they are wrong and their car sucks.
But they can be wrong.
It seems to me that all the healthcare plans revolve around who’s going to pick up the tab for our fundamentally broken system. But I’m afraid unless the underlying system is reformed and reined in they are all doomed to fail.
Worked for Obama (Obamacare is now popular, but it would never have gotten passed at all without that fib).
So…you are proposing that Warren promise to raise her taxes first to make the Cadillac plan a kind of toxic asset she will be glad to get rid of? Frying pans and fires come to mind.
Fair point though that it might be better if she is like 54 instead of 60.
Ann Hedonia, I agree with your take. I have for years advocated that we give everyone a much cheaper HDHP/HSP combo as a kind of birthright. If their employer gives them supplemental insurance beyond that, OK. But as practical and efficient as my idea would be, it seems to have no purchase in the body politic, so I don’t mention it that often anymore.
Yeah, suggesting someone might not need a doctor immediately for every little thing is kind of the third rail, isn’t it, and it seems beyond the pale to suggest a little watchful waiting for minor issues and problems that are known to sometimes be self-resolving. But that is the result of a lifetime of conditioning by the medical industry.
My young nephew ( who was living with me at the time )went to the ER on News Year Day because he felt nauseous and his heart was racing. I tried to tell him he was experiencing his first hangover and he just needed to rest and wait it out, but he wouldn’t hear it.
Yeah, when I floated it here, the umbrage was flying fast and furious. You would have thought I was suggesting the poor eat their children instead of wasting taxpayer money on food stamps. :rolleyes:
*Canadian universal care doesn’t cover everything, however. Though the CHA dictates that medically-necessary services are covered at no cost, there is no distinct definition as to what “medically necessary” means specifically, leaving each province and territory to decide.
In Canada, regular visits to primary care doctors, hospitals, and diagnostic services are covered by Provincial Health Insurance. However, there is some cost sharing when it comes to other services, like ambulances, prescription/over-the-counter medications, dental care, vision care, and long-term care facilities. This does pose a bit of an issue for people who have large out-of-pocket expenses, but the government does provide a tax credit to ease this burden.
Private Health Insurance to Fill In the Gaps
Another somewhat contentious issue is private health insurance. Just like in the United States, private health insurance may be offered by employers. Canadians are also free to purchase private coverage to help defray from the cost of care which is not covered by the universal services (For instance, prescription drug plans help people pay for medications they need to take on a regular basis). Just like in the US, most of these private insurance companies are for-profit.*
Canada also does not cover prescription drugs.
Health care in Canada is managed by the provinces according to federal standards. It is only fair to say federal regulations don’t mandate prescription drug coverage, except during hospitalization where it is indeed required. There’s a variety in provincial drug plans and your quote does not seem to recognize that.
This is true and the reason why the arguments that taxing the rich will send them to the right side of the Laffer Curve are so fricking stupid. The hedge-funder in Greenwich would be happier making 20 million and his next door neighbor making 15 then he would with both of them making 30.
All the provinces have drug plans, they just aren’t all universal coverage. Afaik, they all cover low income and seniors. And as mentioned, drugs in hospitals are covered universally, which I think is an important point.
But I think I generally agree with your point that Canada’s system isn’t utterly free for all medical necessities.
You know what I don’t hear so much of, lately? News stories about some poor dumb schmuck getting lawyered out of their health care by an insurance company. Got tired of that in a big damn hurry! People who thought they were covered going broke because they won’t let a loved one just die.
And some did, didn’t they? Bound do happen, the cold equations don’t allow anything else, some died.
Its the efficiency, stupid! Around the world, well off countries do well, even poor as shit countries do better than they would have! The best balance between risk and protection is the widest possible grouping, Très duh, mais non? Even Obamacare, that mutant mechanism, half steam engine, half computer, does better than what we had! Who knows what we could achieve just by improving it. We’re the Americans, we figure out how to do stuff. If not us, who? If not now, when?
Canada permits the purchase of private insurance for goods and services not covered by the provincial plan(s), but not supplemental coverage for more or better service for items that are covered by the public plan.
I think one can get supplemental coverage for, say, a private room in a hospital. One can also purchase vision care or dental insurance. Or drug coverage.
But the basic Canadian plan is a cradle-to-grave plan, covering everyone, and providing the same level of coverage for everyone.
And for the record, in Ontario at least, it includes medications that you’re on that have nothing to do with your hospitalization. When you’re in there, it’s covered.
. . . so she’s a conservative then? Won’t vote for any change that requires her life to change, unless it means more free stuff for her personally?
Doesn’t sound like there’s a chance in hell she’ll be voting for any Dem ever. Certainly not when we face real economic, social, or environmental crisis.
Candidates who honestly and sincerely appeal to the voter who insists on keeping every scintilla of what they have are not candidates that can do anything positive for the nation.
My mother and sister report that dental, vision, hearing aids, and prescriptions are not covered. Plus there is private supplemental insurance, as noted upthread. So Bernie is in fact planning to offer something that does not exist there, and probably not anywhere. It’s important to remember that he is really more interested in sticking it to insurance companies than in just giving people health coverage. And as long as Elizabeth Warren does not deviate with her own plan, that is what she is stuck with as well.
Good point. Yet another reason why the Laffer curve is completely stupid.
I said right up front that the American voters who are decisive in national elections are not great people. But we have to curry favor with them to win even if it is nauseating. Would you prefer to just be pure and lose? How many people get healthcare that way?
And if you think swing voters are not as shitty and selfish as that, look again at the poll numbers I linked. Only 26% would support MFA if it would “lead to delays in some people getting certain medical tests and treatments”. 26% is actually a large number of people. Many tens of millions, and I’m sure you are one of them. But it’s not enough to keep from giving completely shellacked by the Republicans in the election—in which case you end up without half a loaf, or even a crumb of a loaf.
Fortunately, candidates don’t have to honestly and sincerely appeal to such voters. Doing so dishonestly and insincerely is fine as long as it gets the job done.
Frying pans and fires come to mind.