Americans for Tax Reform put together the tax increases in the latest version of Obama's health care takeover. Some of these are outright tax increases; some are reductions in deductions, which causes paying increased taxes; some lower the standard for the IRS to rule against the legality of a deduction, which increases the taxes. Especially insidious is the tax on medical devices on page 339. Obama wants a piece of my hip replacement.
H.R. 3962, the "Affordable Health Care for America Act" has been introduced--all 1990 pages of it. This gargantuan beast contains thirteen new tax hikes. Here they all are, with description and page number (PDF version):
Employer Mandate Excise Tax (Page 275): If an employer does not pay 72.5 percent of a single employee's health premium (65 percent of a family employee), the employer must pay an excise tax equal to 8 percent of average wages. Small employers (measured by payroll size) have smaller payroll tax rates of 0 percent (<$500,000), 2 percent ($500,000-$585,000), 4 percent ($585,000-$670,000), and 6 percent ($670,000-$750,000).
Individual Mandate Surtax (Page 296-97): If an individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of 2.5 percent of modified adjusted gross income (MAGI) or the average premium. MAGI adds back in the foreign earned income exclusion and municipal bond interest.
Medicine Cabinet Tax (Page 324): Non-prescription medications would no longer be able to be purchased from health savings accounts (HSAs), flexible spending accounts (FSAs), or health reimbursement arrangements (HRAs). Insulin excepted.
Cap on FSAs (Page 325): FSAs would face an annual cap of $2500 (currently uncapped).
Increased Additional Tax on Non-Qualified HSA Distributions (Page 326): Non-qualified distributions from HSAs would face an additional tax of 20 percent (current law is 10 percent). This disadvantages HSAs relative to other tax-free accounts (e.g. IRAs, 401(k)s, 529 plans, etc.)
Denial of Tax Deduction for Employer Health Plans Coordinating with Medicare Part D (Page 327): This would further erode private sector participation in delivery of Medicare services.
Surtax on Individuals and Small Businesses (Page 336-37): Imposes an income surtax of 5.4 percent on MAGI over $500,000 ($1 million married filing jointly). MAGI adds back in the itemized deduction for margin loan interest. This would raise the top marginal tax rate in 2011 from 39.6 percent under current law to 45 percent--a new effective top rate.
Excise Tax on Medical Devices (Page 339): Imposes a new excise tax on medical device manufacturers equal to 2.5 percent of the wholesale price. It excludes retail sales and unspecified medical devices sold to the general public.
Corporate 1099-MISC Information Reporting (Page 344): Requires that 1099-MISC forms be issued to corporations as well as persons for trade or business payments. Current law limits to just persons for small business compliance complexity reasons. Also expands reporting to exchanges of property.
Delay in Worldwide Allocation of Interest (Page 345): Delays for nine years the worldwide allocation of interest, a corporate tax relief provision from the American Jobs Creation Act
Limitation on Tax Treaty Benefits for Certain Payments (Page 346): Increases taxes on U.S. employers with overseas operations looking to avoid double taxation of earnings.
Codification of the "Economic Substance Doctrine" (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.
Application of "More Likely Than Not" Rule (Page 357): Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties. If there is a tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability
Cross posted at Economic Freedom.
Posted by Ron Hebron at November 04, 2009 05:51 PM | Email ThisThat is not a tax, it's keeping health care spending to actual health care and not Vitamins. You can get prescribed Aspirin if you need it to be covered through your HSA or FSA.
Cap on FSAs (Page 325): FSAs would face an annual cap of $2500 (currently uncapped).
That is not a tax.
Corporate 1099-MISC Information Reporting (Page 344): Requires that 1099-MISC forms be issued to corporations as well as persons for trade or business payments. Current law limits to just persons for small business compliance complexity reasons. Also expands reporting to exchanges of property.
That is not a tax, that is a form to help corporations file income taxes. It's reporting.
Codification of the "Economic Substance Doctrine" (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.
This is not a tax, and your description is not true. First of all the IRS already does this, that's why the word "codification appears." Second, it prevents a company from doing things specifically for a tax loophole and no other legitimate reason. Companies shouldn't try to game the system.
Application of "More Likely Than Not" Rule (Page 357): Publicly-traded partnerships and corporations with annual gross receipts in excess of $100 million have raised standards on penalties. If there is a tax underpayment by these taxpayers, they must be able to prove that the estimated tax paid would have more likely than not been sufficient to cover final tax liability
That is not a tax, again. That is an enforcement tool.
Five of your eight items are not taxes. You can't bullshit a bullshitter, Ron. Stop trying.
Posted by: John Jensen on November 4, 2009 07:44 PMMichele: If the US economy cannot handle $30bn in taxes annually then we are a pretty shaky economy indeed. I think you're being too dramatic, though.
However, I don't favor the rich person surtax, I much prefer the Senate bill's financing. And good point about it not indexing to inflation. That's a sharp comment from you.
Posted by: John Jensen on November 4, 2009 07:48 PMIt's easy to say other people should pay more and that mike should pay nothing or "just a little more". but mike, we keep finding out that big-name democrats aren't paying their taxes anyway--which is apparently why you guys keep wanting everyone else to pay more. Because your dem brethren apparently aren't paying their fair share to begin with. I'm guessing you aren't paying much to begin with. And if you feel you are undertaxed then by all means send in extra this year. How about an extra $20,000 or so? Put your money where your mouth is and pay big instead of expecting everyone else to.
And this isn't about paying "a little more". Read the list; this is about A LOT more. On people who are already paying a lot more. Apparently that doesn't include you.
Posted by: Michele on November 4, 2009 08:18 PMThe system is a a set of rules, a "game." You and everyone work(s) with and around the rules. Tightening the rules to cause more tax money being collected is an increase.
Posted by: Ron Hebron on November 4, 2009 08:27 PMAmericans for Tax Reform put together the tax increases in the latest version of Obama's health care takeover. Some of these are outright tax increases; some are reductions in deductions, which causes paying increased taxes; some lower the standard for the IRS to rule against the legality of a deduction, which increases the taxes. Especially insidious is the tax on medical devices on page 339. Obama wants a piece of my hip replacement.
The disingenous liberal ploy to play linguistic twister is nevertheless exposed. These ARE taxes as they will result as a matter of instituting a "health care" bill by democrats in congress. Thus, all 13 are legitimate concerns about additional taxes incurred by the U.S. taxpayers who can expect a lowering of their quality of healthcare as a result of attempting to include a relative few (12-15M- leaving out the illegals, those that are eligible for Medicaid yet don't sign up and households making 70K/yr but feel their health enough not to have healthcare insurance), but even after all is said and done, still leaves 10 million uncovered (of the ever fluctuating figure govt provides of 36M).
Throwing the baby out with the bathwater = Liberal reform. Where I come from that's called ignorant.
Posted by: Rick D. on November 4, 2009 08:40 PMIt's not tightening the rules, it's enforcement of the faith and intent of the rules. And it's already done, so it is absolutely not an increase.
Rick D: The headline says "new taxes." The headline is being dishonest.
Posted by: John Jensen on November 4, 2009 08:53 PM...more linguistic twister, John? Honestly. May I suggest you re-read the last sentence of your comment @ 5 and apply it to yourself.
Posted by: Rick D. on November 4, 2009 09:15 PM@ 5 should be @ 4.
Posted by: Rick D. on November 4, 2009 09:21 PMdo you even pay Federal taxes ? I am OK about paying more taxes as I voted against I-1033. It depends what this is for - for this oppressive proposal - HELL NO ! I refuse to fund health care for illegal aliens or subsidize abortions for these two reasons alone and I want the Guvmint to not be involved. Universal Health Care was actually reversed in the Netherlands and is now more affordable - according to a fellow worker who is from there. mike's and JJ's arguments are not intellectually honest. BTW - you are selfish for supporting something the majority of
Americans don't want - 57% do not want this and the more we see what is in the House Bill - the fewer people want this.
Whining ? I don't give a damn what you liberal progs want to call it. How would you like it if a Republican administration were able to make it unlawful for anyone to did not pay Federal taxes to vote ? You and fellow leftwing nuts would be whining and crying and marching in demonstrations. That is how most moderates and conservatives and other normal people see this as - a power grab that is designed to hurt 85% that have Health Care to help the 15% (actually 11%/4% uncovered that don't).
There are other ways for Health Care reform which is needed. The GOP has a 230 page bill that I would consider supporting after I see it. I know that mike and JJ would not support this, even if it is helps the 85% that have Health Care, rather than the 15% that don't have as the Dems House Bill will only do.
This draconian bill would not pass in Canada or the UK. The Dems in Congress are SOB's and sneaky cowards who have tried to pass this in the dead of night, with as little review and as quickly as possible to create as little resistance as possible. These a**holes must be voted out in 2010, regardless if this piece of crap passes or not, just by their arrogant actions. We need to pass something, but it needs to be done correctly and be a win-win instead of a win for illegals and uninsured and a loss for the insured citizens. The devil is in the details of this 2,000 page bill and nothing you say will sway me away from the fact that is the worst bill written also according to the Wall Street Journal. I yield to the Liberal Progressives for their superfluous rebuttal.
1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
2. Grant program for wellness programs to small employers (Section 112, p. 62)
3. Grant program for State health access programs (Section 114, p. 72)
4. Program of administrative simplification (Section 115, p. 76)
5. Health Benefits Advisory Committee (Section 223, p. 111)
6. Health Choices Administration (Section 241, p. 131)
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
14. "Public Health Insurance Option" (Section 321, p. 211)
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213)
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
23. Independence at home demonstration program (Section 1312, p. 718)
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191)
41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
42. Public Health Investment Fund (Section 2002, p. 1214)
43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
45. Grant program for training in dentistry programs (Section 2215, p. 1240)
46. Public Health Workforce Corps (Section 2231, p. 1253)
47. Public health workforce scholarship program (Section 2231, p. 1254)
48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
51. Prevention and Wellness Trust (Section 2301, p. 1286)
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
57. Grant program for public health infrastructure (Section 2301, p. 1313)
58. Center for Quality Improvement (Section 2401, p. 1322)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
64. "No Child Left Unimmunized Against Influenza" demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)
83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)
86. Health and Human Services Coordinating Committee on Women's Health (Section 2588, p. 1610)
87. National Women's Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women's Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research (Section 2588, p. 1617)
90. Health Resources and Services Administration Office of Women's Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women's Health (Section 2588, p. 1621)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
97. Program of Indian community education on mental illness (Section 3101, p. 1722)
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
99. Office of Indian Men's Health (Section 3101, p. 1765)
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
106. Mental health technician training program (Section 3101, p. 1898)
107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)
I suppose. This would certainly explain why a tax cheat like Timothy Geithner ended up not only being put in the Obama cabinet, but in the position as head of the IRS. Take it up with your hero, mike.
Posted by: Rick D. on November 4, 2009 09:36 PMRick D, the real world is more complex than you want to pretend. Yes, we should not allow corporations to game the tax code for their benefit. I'm glad you're in the unique position of arguing for corporations to game the tax code, because that is a lame position to be in.
Posted by: John Jensen on November 4, 2009 10:27 PMObama and the Progressive Democrats like Pelosi are going to 'screw' the entire American way of life by stifling Free Speech and putting the government so far into debt that no one will purchase any treasury bonds. Hyperinflation with 'printed' money will ensue!
Posted by: Tim on November 4, 2009 11:10 PMI pay medicare(less) taxes. If 0bama takes any money saved from medicare(less) and applies it to his programs, then that is a new tax. If there are savings to be made in the medicare(less) program, then the savings should be returned to those who paid taxes.
Posted by: arby on November 5, 2009 04:27 AMNot to go all Ayn Rand on you guys here, but yeah... I'm selfish. So are you, for demanding that I give up my stuff so you have healthcare.
Posted by: Andrew Brown on November 5, 2009 05:18 AMHa. Coming from someone that tackles real world problems using emotion rather than logic, that is a rich comment. This is nothing but an Obama/Democrat shell game that will hurt everyone in the long run in terms of the cost of healthcare, quality of of care you receive and increased generational debt. All while expanding the bureacracy of a big, clumbsy, incompetent federal government that has proven time and again, it is incapable of efficiently providing anything.
This isn't that complex to break down, John. I prefer freedom from the tyranny of government while you prefer being swaddled close to the bosom of it.
Posted by: Rick D. on November 5, 2009 05:20 AMIt's funny how liberals call conservative greedy when conservatives don't like the liberal's mony and power grab.
Remember whee a book came out a few years ago that documented clearly that the conservatives were far more generous than liberals?
The truth is not that conservatives are not generous and the liberals are, it's that the liberals want to be generous with OTHER PEOPLE'S money. When your donations in time blood and money catch up to us conservatives THEN maybe you can have a seat at the table, but until then, quit pointing fingers and start digging into your own pockets first.
If you think something is worth supporting, support it, just like conservatives do. The real issue here is not greed it's about power. Liberals want to control the money and have the government (read: liberal advocacy groups) decide who the winners and losers are. And the more government does that, the more corruption occurs. Always.
Posted by: Eyago on November 5, 2009 05:25 AMNow, if you want to argue that we should forgo those benefits because we wouldn't want to "delay for nine years the worldwide allocation of interest", or because we don't want to tighten standards on $100M+ corporations who underpay their estimated taxes, be my guest. But it's not exactly a compelling argument.
Posted by: scottd on November 5, 2009 06:23 AMAnd the bill also reduces premiums. Unlike the Dem plan.
I know we are all just crazy, evil conservatives for wanting a plan that doesn't bankrupt our economy further. We'll see next year if moderates and independents agree with all of the Dem big spending.
Posted by: Jeff B. on November 5, 2009 07:14 AM1. Employer mandate won't affect me because my employer provides health insurance. Frankly, I don't care about employers who don't -- they're part of the problem.
2 Individual mandate won't affect me because I maintain health insurance. Again, I don't care about freeloaders who game the system expecting to either obtain insurance just before they incur big expenses or by making use of public services (like emergency rooms) and then stiffing them. They are also part of the problem.
3. I've had an FSA for years -- never used it to buy Tylenol or other non-prescription items. If I did, the impact of losing favorable tax treatment on those purchases would be negligible.
4. I have never put more than $2500/yr into an FSA and don't know anybody who does.
Like I said, I don't see much impact on me or anyone I know, but I see plenty of benefits to HCR. However, I'm willing to listen. Tell me how Ron's list impacts me, but be specific and quantitative. Otherwise, it's just more ideology and I have more important things to worry about.
Posted by: scottd on November 5, 2009 07:43 AMFord did not.
The CBO scored the 230-page House GOP alternative bill and the results look much better for the economy and also addresses some key issues. Check it out for yourselves.
#30 - we want change in the system, but not the draconian way that you and your ilk do. It is transparent that it's about the significant power grab by the left, so that the government will have control of over 40% our economy within 5 years when Health Care becomes Single payer. What do you want - to have a more centralized government than Red China, pushing toward that of North Korea ? Those are the so-called unintended (?) consequences that you all support.
Posted by: KDS on November 5, 2009 08:02 AMPlease don't mischaracterize me. I haven't worked for a large employer in more than 20 years. I care very much about the individual and small employer markets. My comments asked for specific and quantitative reasons why I should care about the items Rob listed. So far, nothing but ideology.
Posted by: scottd on November 5, 2009 08:51 AMObama declares a National Emergency about H1N1 flu
Obama holds a Halloween party at the White House for 2000 children
Obama's government can't provide the H1NI flu shots for hardly anyone
There are over 1000 H1NI deaths so far in the United States with 100 being children
Posted by: Tim on November 5, 2009 09:02 AMThe nation is overwhelmingly against the Democrat plan, but Nancy Pelosi wants to ram it down our throats anyway. As usual, Dem efforts amount to fantastic overreach that leads to blowback.
Posted by: Jeff B. on November 5, 2009 09:10 AMThere are two sides to the pre-existing condition argument. On the one had there are legitimate cases where people got sick and were either dropped or not allowed to transfer coverages. That is a problem to be solved. On the other hand you have people who choose not to be covered and then want that coverage to occur after the fact, that too would be a problem.
The thing is, either way it is an abuse of the system. Insurers are right to be unwilling to cover people who come to them to insure against what has already occurred. And if you MAKE the insurers cover pre-existing conditions, it will only result in them having to spread the costs to all those people who are paying into the system. There is no "fee money" out there
If you are of the mindset that health INSURANCE is a fundamental right, then you are looking for everyone to get it whether they choose to buy it or not. That will encourage the unscrupulous to simply forgo buying it until after the fact so they can save their dimes to buy big screen TVs instead.
Ultimately, we are all responsible for our OWN long term security and we should all buy catastrophic health insurance on our own and not go crying to the government when we fail to take care of ourselves. But that is what you say should happen. You say people should be irresponsible and then be allowed to get everyone else to pay for their mistake.
Posted by: eyago on November 5, 2009 09:19 AMMost employers cap FSAs and folks who need more should probably shift to an HSA.
Posted by: John Jensen on November 5, 2009 10:11 AMRon thinks I should worry about $100M corporations losing some arcane tax breaks instead of worrying that my family could lose health care coverage when they need it most. I'm not sure why he thinks that. No one else seems to know why, either.
Posted by: scottd on November 5, 2009 10:22 AMOK Mike, tells how much is "a little more" that you'd be willing to pay. Give it a number.
$50 more a month, $1400.00 a year, $2000.00 a year? Give us a number and tell us how magnanimous you are with YOUR money.
What if, like the Romney plan, that this doesn't cover all the uninsured? What then? How much more are you willing to pay at that point? Give us a good clear number Mike.
Posted by: G Jiggy on November 5, 2009 10:27 AMHow many people are you willing to let die because we don't help them? 40,000? 10,000? 10?
How many years do you want our government to last before it goes into bankruptcy because of Medicare spending? 3? 4? 5?
How much money do you want taken from your annual raise to pay for health care? All of it? Most of it? Half of it?
Posted by: John Jensen on November 5, 2009 10:32 AMYour point is not germane to the discussion of how poor the Government will be to manage Health Care.
This article, from the Washington Post shows the count.
Senate Approves War Funding Bill After Obama Presses Democrats
"A war funding bill passed the Senate overwhelmingly yesterday, but the 91 to 5 vote came after a fractured process that included objections from Republicans and Democrats alike, and required President Obama to intervene repeatedly to lobby members of his own party for his foreign policy vision."
"At Obama's behest, the bill includes $7.7 billion to prepare for pandemic flu..."
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/18/AR2009061804094.html
Also, please provide an up-to-date link to your comment:
"if there have only been 1,000 H1N1 deaths, it's running far lower than average flu-related deaths for seasonal flu: 2,000 deaths per month. "
As I understand it - Most of the flu cases this year are H1NI but I need a link to support that.
I never said I was willing to let anybody die at/for any cost. I never said that I was willing to let government go bankrupt funding Medicare. I never said I wanted more money taken from my annual raise.
None of which you referenced will be cured or helped by the present health care "plan". All will only make those things worse. Government intervention has a very bright history for making things worse. In fact, Medicare is a perfect example along with your two other examples. In fact if it wasn't FOR government intervention, more people could afford health insurance.
Try again.
Posted by: G Jiggy on November 5, 2009 11:58 AMIf the House (excluding the leadership) has any brains and ethics of serving their constituents, they'll reject this unconstitutional piece of garbage masquerading as HR 3920 and build on the GOP bill - nah they are too many proud a-holes and neo-commies and guess they don't care about being reelected, according to their actions.
mike put a sock in it. you show your ignorance and bigotry - hypocrite (correct spelling).
Posted by: KDS on November 5, 2009 12:07 PMHalf of seniors were in poverty before Medicare. Now poverty is virtually eliminated among seniors. You want to tell seniors they shouldn't have Medicare? Be my guest.
Posted by: John Jensen on November 5, 2009 12:27 PMInsurance companies and employers pay that. People wouldn't have Cadillac plans if they have to pay for it themselves. That's why they even exist.
Some of the revenue for the plan is generated by tax on wheelchairs, hearing aids etc. My wheelchair was over 8 grand...not motorized either.
The plan will also lead to for millions more having access to wheelchairs, hearing aids, etc. So why would prices go up if the marginal cost goes down?
All at gunpoint threat.
A little dramatic?
Posted by: John Jensen on November 5, 2009 12:31 PMThe Republican bill does absolutely nothing to control insurance companies, and gets rid of the regulations states have already laid on them. (What happened to state's rights?) Changing the GOP bill to do these things would mean actually making hard choices, a concept the GOP is familiar with. Their plan does almost nothing to achieve universal health care. It is a stupid plan that will lead to people getting worse insurance coverage, not better access.
I'm glad they proposed a bill. It illustrates exactly how selfish the party leadership is. (30 million people we could insure with a very most cost of $30bn a year? ABSOLUTELY NOT.)
Posted by: John Jensen on November 5, 2009 12:33 PMI said nothing about being selfish. That is a problem with you liberals. Contrary to your preconceived notion, conservatives are not selfish but rather believe as the founders did, that people are better off when they take responsibility for themselves rather than rely on the government to do it.
Now, you raise up legitimate points which I already alluded to in my earlier post. There are cases when denial of coverage is a problem. I am just pointing out that there is a converse where people will wait until the fire before buying fire insurance. I find neither answer acceptable, so you have to do better than to attack my character when you don't bother to even read the words that I wrote the first time.
I think everyone needs to have catastrophic health insurance and that they should be responsible for buying it themselves, that they cannot be turned down if they were legitimately trying to maintain coverage, and that they should be allowed to get covered if they chose to avoid paying into the pool until after they get their illness. And in the case of the poor, an insurance voucher is a reasonable way to go as an assistance program.
Posted by: eyago on November 5, 2009 12:37 PMThat is not just a LIE but a DAMN BALD FACED LIE!
Posted by: The Truth on November 5, 2009 12:46 PMI checked -- my HC plan isn't a "cadillac" plan, so no extra cost there for me. BTW, Ron's list refers to the House bill -- I don't think it includes a surtax for cadillac plans.
I have a sister who uses a wheelchair. Eight grand sounds kind of high for a non-motorized one, but I'll take your word for it. How much do you pay out of your own pocket for yours? How much more do you think you'll pay (on an annual basis) under the House bill? I don't think consumer costs will go up much, if at all. After all, HCR will bring more customers to device manufacturers, so that might offset some of their taxes.
The rest of your post is a little hard to follow, so I'll just wait for some real numbers from you. Remember, I want to know how the items in Ron's list will affect me -- otherwise, I don't care.
Posted by: scottd on November 5, 2009 12:57 PMAccording to CBO, the GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrat's bill, the CBO says, will slice $104 billion off the deficit.
$104 billion is greater than $68 billion. So again: the Democratic bills reduce the deficit more than the GOP bill does.
Posted by: John Jensen on November 5, 2009 12:58 PMSounds like a great ROI on that Dem plan.
Posted by: Dengle on November 5, 2009 01:05 PMYou keep trying to put words in my mouth (or . . uh, keyboard). I said nothing about eliminating Medicare. What I will say is this. Medicare is now (for a month now) officially broke. They spend more than they take in and are now using up the previous surplus which will be completely gone in a few years. Just another example of a broke-dick government program and THAT was the point I was making.
You know John, I don't mind some épées émouvantes with you but when you dodge around trying blame me for things I don't say and then try and make points from what isn't said, you make it difficult to keep on point.
But I have to ask John, How does Medicare get somebody out of poverty? Is this another statistic like "jobs saved"?
Posted by: G Jiggy on November 5, 2009 01:06 PMGood catch. It doesn't.
Posted by: John Jensen on November 5, 2009 01:18 PMLook, Medicare does things better than the private sector. It gets better prices on procedures, it operates more efficiently, and has universal coverage. Then why it is having financial troubles? Our premiums have gone up 120% since 2000, but Medicare taxes have stayed the same. We all know people without health insurance, but every old person is covered by Medicare.
Medicare does have waste. The Democratic bills save about $600 billion of waste. They institute reforms to actually fix Medicare so it's solvent. It helps fix the problems you talk about. The GOP "plan" does nothing of the sort -- for partisan political reasons.
Let's start off by saying that Medicare has less troubles than private health insurance. Medicare doesn't have troubles simply because it's government-run, but because every reform has to go through a partisan Congress which is open to lobbyist influence and requires 60 votes in the Senate. Again, the Democratic plan helps address this by allowing independently-recommended reforms to have a simple up or down vote without lobbyist amendments. It has grants for experimenting with new methods of payments. It tries to fix the problems with Medicare.
make points from what isn't said, you make it difficult to keep on point.
In other words, you want me to focus on what's important to conservatives and not what's important to everyone else?
Look, you want to talk about individual cost. I think it's also worth talking about the death toll, the government cost, and the collective cost because those are the substantial reasons to reform health care. We cannot pretend that having millions without health insurance has no human or moral cost. Of course it does. $30bn a year in new taxes to save many, many lives and improve the lives of tens of millions? Sounds like a great value. Another $60 billion in Medicare savings and improving that problem? Sounds like a smart thing to do. The GOP is against both!
$30bn a year is a drop in the bucket. The military costs about $700bn a year
Without reform, health care costs are going to keep going up and up. These bills don't make all the tough choices to fix the cost problem, but certainly the GOP doesn't either. You know why? Because those choices are tough. And when we're all in it together -- and no longer comfortable cutting off tens of millions of people from health care -- we're going to have to make tougher choices instead of simply rolling along with the status quo like we have for decades.
Posted by: John Jensen on November 5, 2009 01:42 PMBTW, the constitution is not a living document like the Progressives try to make it.
Posted by: KDS on November 5, 2009 01:58 PMYou are making some assumption/claims that I think need to be re-evaluated...
Look, Medicare does things better than the private sector. It gets better prices on procedures, it operates more efficiently, and has universal coverage.
a. Medicare can command lower rates, but does not mean that it is doing things better. Since it is not the only player in town, the true costs are shifted to the other players which makes Medicare look better and the others look worse. This advantage will be lost when there are no other players to who the shift can be made.
b. Where is the data that shows it is more efficient? I think you may be referring to overhead costs, an issue in dispute.
Medicare does have waste. The Democratic bills save about $600 billion of waste.
If there is so much waste, how can it be so efficient? If there is so much waste, why was it not fixed before? Were the Dems just holding that in their hip pocket until they needed it as a trump card for health care reform.
Let's start off by saying that Medicare has less troubles than private health insurance.
Let's not. I don't buy that premise.
Medicare doesn't have troubles simply because it's government-run, but because every reform has to go through a partisan Congress which is open to lobbyist influence and requires 60 votes in the Senate.
You call that a good thing? The problem is that once something has that much money and influence, it breeds corruption and special interest groups vying for money. What you end up with is a system that is run by influence peddling and not what is best for the patient or the doctor.
I'd say more but my machine just went wonky on me and I have to reboot.
Posted by: Eyago on November 5, 2009 02:20 PM"Let's start off by saying that Medicare has less troubles than private health insurance."
-
No.
I must dig out my 1993-era "Hillary's Health Care Makes Me Sick" sticker, for old time's sake.
Posted by: yaddacubed on November 5, 2009 03:09 PMThis cost-shifting argument doesn't appear in economics. McDonald's can get ground beef a lot cheaper than the rest of us. Does that mean we pay more for ground beef because of cost-shifting? No. It's purchasing power. Medicare is a bigger market, it can get better prices.
Medicare still pays more than most other advanced health care systems. Those other systems do just as good with a lot less money. We're capable of doing the same. There is tremendous waste.
b. Where is the data that shows it is more efficient? I think you may be referring to overhead costs, an issue in dispute.
First, its overhead costs are much lower -- an issue that is not "in dispute." Second, it pays much better prices for medical treatments. Third, Medicare Advantage could be a cheaper private alternative to Medicare but in fact costs more to the government than Medicare.
If there is so much waste, how can it be so efficient? If there is so much waste, why was it not fixed before?
Politicians convince old people that saving Medicare money is just like cutting Medicare, and the calculation is that it's not worth risking scaring old people unless you have a good political balance like insuring 30 million old people.
Medicare is more efficient than the private insurance industry by almost every measure, even if it has significant waste. Guess what that means? There is a far more waste in the private insurance sector that. That's why premiums are skyrocketing.
Are you implying that we have an efficient private health care delivery system? We have the most costly system in the world with no great boost in quality compared to more regulated, cheaper systems.
Were the Dems just holding that in their hip pocket until they needed it as a trump card for health care reform.
Dems were just holding it in their hip pocket? In case you haven't noticed, they've just got a President who won't veto their work and this is the first major piece of legislation from the Democrats. Why didn't the GOP pass these cost savings when they had power for six years? Why didn't they do anything to Medicare besides make it more costly?
Democrats are making tough choices and fighting hard for a tough health reform bill. The GOP, on the other hand, gave a giant hand out to drug makers and added more deficit spending to Medicare. It was an irresponsible approach.
"Let's start off by saying that Medicare has less troubles than private health insurance." Let's not. I don't buy that premise.
You don't have to, but premiums have jumped by 120% in the last ten years -- they've more than doubled -- and millions of people have lost health insurance. Medicare has added millions to the program and has not incurred a tax increase over that time.
You're right: Medicare isn't perfect and will bankrupt the government if we do nothing to fix it. But why do you ignore that private health insurance will bankrupt all of us if we do nothing to fix it?
Medicare has a private alternative, it's called Medicare Advantage. It costs 14% more to the government than normal Medicare Parts A and B. The private sector cannot do Medicare more efficient, and clearly cannot do universal coverage.
"Medicare doesn't have troubles simply because it's government-run, but because every reform has to go through a partisan Congress which is open to lobbyist influence and requires 60 votes in the Senate." You call that a good thing? The problem is that once something has that much money and influence, it breeds corruption and special interest groups vying for money. What you end up with is a system that is run by influence peddling and not what is best for the patient or the doctor.
No, it is not a good thing at all. Democrats want to fix it. The bills establish an independent Medicare payment commission to suggest reforms in an up-or-down vote without lobbyist contributions leading to undue influence. This idea is in the model of the MedPAC group established my Republicans, except better at getting the politics out of payments.
Republicans are, of course, against the entire bill so somehow find a way to argue against this good idea too by arguing that the commission would be unchecked bureaucrats -- both a lame and a wrong accusation.
Guys, Medicare ain't perfect. But it's a lot more humane than private insurance and does things cheaper than (our) private sector does. It needs some serious reforms, and the Democratic bills do a lot of work on that front.
But the original point was comparing a health insurance exchange to Medicare. They're a hell of a lot different. So is the public option. Medicare is something that doesn't need to be vilified, but no one is proposing anything like Medicare for All or a government-takeover.
Posted by: John Jensen on November 5, 2009 03:15 PMIt has less cost growth than private plans.
It's more efficient and cheaper than Medicare Advantage plans.
It gets better prices on procedures and drugs than private plans.
It has universal coverage.
It has raised its revenues mechanisms recently, while the private sector has raised premiums by 120%.
People who have Medicare like it better than people on private like their private insurance. It's more popular.
You tell me, on what grounds is private insurance operating better? Is it the fact that they kick people off insurance plans? Is it the fact that they deny coverage to those with pre-existing conditions? Is it the fact that they have done absolutely nothing to control health care costs?
I'm not saying we should close private insurance companies -- I'm saying we could stand to learn from what Medicare does right, and fix what it does wrong.
Posted by: John Jensen on November 5, 2009 03:24 PMAs I wrote in 60, "According to CBO, the GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrat's bill, the CBO says, will slice $104 billion off the deficit. $104 billion is greater than $68 billion. So again: the Democratic bills reduce the deficit more than the GOP bill does."
You can use Google or the CBO website to prove me wrong. I am pretty tired of people screaming "LIAR" without doing their own research, frankly.
Posted by: John Jensen on November 5, 2009 03:27 PMThis cost-shifting argument doesn't appear in economics. McDonald's can get ground beef a lot cheaper than the rest of us. Does that mean we pay more for ground beef because of cost-shifting? No. It's purchasing power.
This is an incorrect argument I believe. If we were comparing McDonald's price per pound of hamburger to say a local mom-and pop burger joint, we would see the same effect as medicare verses a small insurance company. Ultimately the hamburger provider needs to make a profit. In selling to McDonalds, they might cut their margins lower because a) they want the business, and b) bulk deliveries provide economy of scale cost reductions. Ultimately, though, the provider of hamburger still needs to make a profit, so if her takes hit on the McDonalds sale, he has to still make up for it by selling a higher price to others. In this case, however, McDonalds' ability to negotiate price reductions is based on the fact that if a supplier has to raise his price too high to other buyers he will lose that business, so McDonalds can only negotiate the price so far.
In the case of Medicare, you have that effect going on already as some providers are unwilling to accept medicare patients because they lose too much money and cannot recoup it from private carriers. In addition, there are very little economies of scale at work here. There is no way for a health care provider to get more efficiency out of large numbers of medicare patients to make up for the lower payment. In some cases there might be providers who will take medicare patients because they have excess capacity and would rather take 95% recover of costs verses zero payments and idle hours.
Medicare still pays more than most other advanced health care systems. Those other systems do just as good with a lot less money. We're capable of doing the same. There is tremendous waste.
I'm not sure what this is about. Is it related to government medical programs in other countries? I have not read data on that to respond.
Is there waste? Probably. But there are also different methods of treatment in other countries. In our we tend to want to run CT scans for tension headaches and take all kinds of drugs for what ails us. Europe is much more holistic in their medical approach, which usually means fewer "dollars" spent to address many patient ills. But that is an area I'm not prepared to get into.
Politicians convince old people that saving Medicare money is just like cutting Medicare, and the calculation is that it's not worth risking scaring old people unless you have a good political balance like insuring 30 million old people.
I don't buy that. Everyone likes efficiency and it's easy to sell. The problem is, politicians use things for politics and that is art of my argument that you pretty much just made. When you make something that people become dependent on it gets used for political leverage and not for the benefit of people. And you want more of that.
Medicare is more efficient than the private insurance industry by almost every measure, even if it has significant waste. Guess what that means? There is a far more waste in the private insurance sector that. That's why premiums are skyrocketing.
No. Read the heritage report. It breaks down the apples to oranges comparison into more of an apples to apples.
http://www.heritage.org/Research/HealthCare/wm2505.cfm
Premiums skyrocket bacause of a ton of factors like coverage mandates (sex change operations, accupuncture, massage, chiropractic, etc.) As these are mandated additions, prices go up. Prices also go up as demand for expensive screening procedures go up. Lots of things cause prices to go up. On cannot simply look at the increase of premiums and cry foul without a clear analysis of what is driving them. If insurance companies are paying too much in executive compensation, that is a legitimate gripe, but one should first make sure that you compare it as a percentage of overall expenses before they comment, and that would be true for any cost, malpractice insurance, everything. The problem is, people demonize rather than discuss facts.
Are you implying that we have an efficient private health care delivery system? We have the most costly system in the world with no great boost in quality compared to more regulated, cheaper systems.
Not at all. You paint a false dichotomy. I am all for addressing the problem, but we do not have to choose between what we have now and the government take over option as our only two choices.
But the original point was comparing a health insurance exchange to Medicare. They're a hell of a lot different. So is the public option. Medicare is something that doesn't need to be vilified, but no one is proposing anything like Medicare for All or a government-takeover.
Than you have not been paying attention. The key players on the democrat side ALL want the takeover, but if they sell it that way they can't get it, so they try and spread the medicine out a ways and sugar coat the pill. Don't be obtuse, it ruins your credibility.
Posted by: eyago on November 5, 2009 04:30 PMIt's just called purchasing power. We can't seriously believe that mom and pop subsidize McDonald's.
Let me make something clear. Every insurance company should be paying what Medicare pays, or maybe slightly more. Providers get far too much money for the quality of medicine we receive. Check out this quote from the CEO of Kaiser Permenante: "If you take U.S. care delivery and price it to the Canadian model – same care, same drug, same office treatment, same duration of stay – but price it at the Canadian fee schedule, we go from spending 17.6 percent of GDP on health care to 11.5. If you just put us in a single-payer system, we go from 17.6 to 16.9." (I don't want to argue about Canada, no health care system is perfect but we are particularly bad on cost and access in this county.)
In some cases there might be providers who will take medicare patients because they have excess capacity and would rather take 95% recover of costs verses zero payments and idle hours.
So wouldn't Medicare prevent more cost-shifting toward "idle" time in this case?
In addition, there are very little economies of scale at work here. There is no way for a health care provider to get more efficiency out of large numbers of medicare patients to make up for the lower payment.
There are economics of scale. The overhead of a MRI machine is large, but that doesn't mean each use of it should cost $3,000.
There is another solution: Don't do useless procedures. We need to stop paying a fee for each service -- both in the public and private sector.
I'm not sure what this is about. Is it related to government medical programs in other countries? I have not read data on that to respond.
It's more than a simple answer, but in our system there is no incentive at any step of the way to keep costs down. If all we had was Medicare for all, we'd probably have better allocation of care (i.e. less unnecessary tests) and specialists would not get paid nearly as well. We would not have fee-for-service.
We have to figure out a way to achieve these results -- or other cost-cutting measures -- without a single-payer system.
I don't buy that. Everyone likes efficiency and it's easy to sell. The problem is, politicians use things for politics and that is art of my argument that you pretty much just made.
Everyone likes efficiency and it's easy to sell? Maybe. But the GOP has scared the crap out of old people by calling the waste-savings proposed "Medicare cuts," and old people vote. Look at the GOP's frame of the issue -- that's why it's been tough to reign in Medicare. We have to move Medicare reforms out of Congress and the broader partisan process.
If Medicare efficiencies are easy to pass, why weren't they already passed? I don't understand what you're implying.
When you make something that people become dependent on it gets used for political leverage and not for the benefit of people. And you want more of that.
You know, I think we've had a pretty respectful conversation so let's not get into this stuff. I don't want people to depend on the government -- that's a wicked frame. I want everyone to have health insurance coverage -- whether it be private insurance or a public option. I think it is the morally right thing to do.
Premiums skyrocket bacause of a ton of factors like coverage mandates (sex change operations, accupuncture, massage, chiropractic, etc.) As these are mandated additions, prices go up. Prices also go up as demand for expensive screening procedures go up. Lots of things cause prices to go up. On cannot simply look at the increase of premiums and cry foul without a clear analysis of what is driving them. If insurance companies are paying too much in executive compensation, that is a legitimate gripe, but one should first make sure that you compare it as a percentage of overall expenses before they comment, and that would be true for any cost, malpractice insurance, everything. The problem is, people demonize rather than discuss facts.
The Heritage Foundation is partisan.
Health care costs did not explode during the mid-90's. Was it because coverage mandates stopped during that period? No, it's because HMO's were denying unnecessary treatments. Some folks got told no, and there was no difference in medical outcome. HMO's have since become unpopular, and people want their insurance company to approve everything so they often do and so there's more waste in the private insurance sector. That is probably the biggest driver of costs -- the rise of PPOs. I think it's cute to blame acupuncture -- and of course that shouldn't be mandated coverage, I agree -- but an MRI is about ten times more expensive and probably a lot more common.
A good first step would be disincentivizing the super-expensive insurance plans that let consumers get anything they want with no co-pays. An MRI shouldn't be something one gets willy-nilly, right? The Senate bill does this by taxing expensive plans. It's good policy.
You're right, there are of course a variety of reasons for the cost growth. But Medicare covers a lot too -- even many unnecessary treatments -- and hasn't seen the same massive growth in costs since its growth rate is smaller.
Not at all. You paint a false dichotomy. I am all for addressing the problem, but we do not have to choose between what we have now and the government take over option as our only two choices.
You paint a false dichotomy. No one is proposing a government-takeover. The vast majority of those below 65 will still have private insurance. There will be one publicly run plan that will capture less than 10 million people. No one will be forced onto it.
Than you have not been paying attention. The key players on the democrat side ALL want the takeover, but if they sell it that way they can't get it, so they try and spread the medicine out a ways and sugar coat the pill. Don't be obtuse, it ruins your credibility.
I have no idea what you are talking about. All of the bills in front of us rely on the private sector to deliver insurance to the vast, vast majority of Americans. You imply it's a step toward single-payer. In fact, it does more to entrench the current employer-based system than it does to dismantle it.
Posted by: John Jensen on November 5, 2009 05:07 PM
Sorry, JJ - those are faulty ass-umptions and your response does not add up. You are only presenting part of the story. That runs contrary to all of other reports I have seen. I have said it several times, that the true cost is closer to $2 Trillion. In post #62, these numbers are shown, which I can believe;
"GOP spend $61B to cut the deficit by $68B.
Dem spend $1.5T to cut deficit by $104B"
Sounds like a great ROI on that Dem plan." (figures lie and liars figure)
If you are going to stick to that story, then explain quantitatively why these deficit reductions don't add up. Until then, it doesn't pass the laugh test.
And while you're at it, show us the link that backs up your explanation so it can be evaluated for credibility. Finally, the Democrat Bill is unconstitutional on its face I stated in #66. The constitutionality test has not been applied, but it has been brought up and if you don't believe that, just google it. I can get more specific about that, if need be.
Posted by: KDS on November 5, 2009 06:31 PMFirst let me say that I don't usually bother to debate unless I think it will be a good exchange. (About the only other times I comment is to call someone out on their obvious partisan rant.) So, by implication, by taking the time to address your comments I am giving you the credit of being a worthy foil to spar against.
It's just called purchasing power. We can't seriously believe that mom and pop subsidize McDonald's.
It's not a perfect analogy. In a pure market situation there are simply too many options for the buyer and so it is with hamburger. But in a controlled or restricted environment, it is possible for mom and pops to subsidize McDonalds. In the case of insurance, baucasue I IS a restricted environment, it is possible for other insurance carriers to subsidize medicare otherwise why wouldn't they simply pay the same price that medicare does. I think the data is readily available to them.
Let me make something clear. Every insurance company should be paying what Medicare pays, or maybe slightly more.
Which begs the 1.3 trillion dollar question. Then why don't they? Can't insurance companies simply refuse to pay so much? Works for Medicare.
There are economics of scale. The overhead of a MRI machine is large, but that doesn't mean each use of it should cost $3,000.
True statement, but not what I was addressing.
There is another solution: Don't do useless procedures. We need to stop paying a fee for each service -- both in the public and private sector.
No arguments from me on that. In this case there is value in a single payer because it would have the authority to regulate procedures and disallow diagnostics and treatments. HOWEVER, I am very leery of that kind of authority from what would be a huge bureaucracy. The potential for problems would be much like what is seen in the UK. So, while I like the idea of minimizing useless procedures, I do not want it to be done by a government entity. I tend to lean toward having the patient decide what he is willing to pay for when going above and beyond the generally accepted procedures. But with that would require tort reform to protect doctors from having to practice defensive medicine.
It's more than a simple answer, but in our system there is no incentive at any step of the way to keep costs down.
Mostly true, and that is because the consumer is mostly divorced from the cost.
We have to figure out a way to achieve these results -- or other cost-cutting measures -- without a single-payer system.
I think there are a lot of ideas out there that address this issue and not one of them (as far as I know, but I could be wrong not having read the nearly 2000 pages of the bill) are part of any plan that is up for a vote.
If Medicare efficiencies are easy to pass, why weren't they already passed?
My point is that because it is the government, decisions about the program - who it covers, how it covers them winner, losers, also rans - are all subject to political jockying. That will only get worse as government gets more and more enmeshed in the system. I favor more individual control.
I want everyone to have health insurance coverage -- whether it be private insurance or a public option. I think it is the morally right thing to do.
I too want no one to be left out where they cannot gain access to a catastrophic health insurance option at a reasonable price. I just don’t want the government to do it directly. I am ok with vouchers that can be used in a free market system. I do think it is a shame for our country to have a few million people who want but cannot get insurance coverage, and I do think conservatives have failed to properly address this need and left themselves vulnerable first to the claim they are heartless and second to the machinations of the statists.
Oh, and I apologize if I misconstrued your position to be in favor of a statist solution. You seem much more willing to address problems from a fact based approach rather than an ideological one.
The Heritage Foundation is partisan.
They are conservative. I think that is different. It does not necessarily negate the validity of their analysis.
A good first step would be disincentivizing the super-expensive insurance plans that let consumers get anything they want with no co-pays. An MRI shouldn't be something one gets willy-nilly, right? The Senate bill does this by taxing expensive plans. It's good policy.
I disagree with this. If people what to buy plans that allow them to have all the wasted diagnostics they can dream of and an insurance company wants to sell it to them, there is no cause to tax it. What is missing here is that the consumer is not directly responsible for paying the premium and thus feels no pain while demanding the services. They should have a direct causal connection between price and value. The government plan option will not directly affect the demand of the patient for Cadillac service because it will still insulate the consumer from the price/value equation.
All of the bills in front of us rely on the private sector to deliver insurance to the vast, vast majority of Americans. You imply it's a step toward single-payer. In fact, it does more to entrench the current employer-based system than it does to dismantle it.
I disagree. The programs such as public option which have the businesses paying less in taxes than they would in premiums will shift people to the public option. The unfair competitiveness of the government program with things like not having to pay state taxes which runs an average of 2%, and having certain administrative costs such as marketing and collections off book will make it easier for people to choose the government program over the private one. There are other aspects of the nearly 2000 page bill that help direct the program to the ultimate goal. I’m sorry, but once a government has its hand in a program it rarely gets less involved. It seems to find ways to expand its reach. SChip is another example of a program meant to help poor kids that has grown to include adults and even families well above any real level of poverty. In fact, before we joined the ranks of the unemployed and I considered us to be making reasonable wages, we qualified for SChip.
Whether you want to believe it or not, I will say again, the big players on the Dem side all want government run healthcare, and this bill they are trying to push through is simply a step in that direction. They all know they can’t do it at once, they just need to make inroads one step at a time.
Here's the dirty secret; the reason that the deficit is reduced more by the Democrat plan than the GOP plan. It is because it increases the deficit by over $1.361 Trillion, but $1.465 Trillion is transferred to the States, which cuts the Federal deficit by $104B, while adding the $1.465 Trillion to the deficits distributed among the 50 states.
The GOP plan transfers $0 to the States. That is stated in the GOP plan. I'd still like to see that link that represents your assertion to see if it explains the dynamics of this giant shell game by the Dems, who have refused to show their bill on-line 72 hours before the vote. What a bunch of fraudulent a-holes!
Posted by: KDS on November 5, 2009 06:55 PMA Tale of Two Approaches:
Pelosi Plan
Unfunded Mandates on States? YES. Federal mandated
expansion of Medicaid to cost
states $34 billion over first ten
years according to CBO.
GOP Alternative
Unfunded Mandates on States? NONE.
Pelosi Plan
Medicaid Coverage Mandates? YES. Raises threshold for
mandatory Medicaid coverage to
150% of FPL ($33,000 per year
for a family of four); Requires
states now covering above 150%
of FPL to maintain eligibility.
GOP Alternative
Medicaid Coverage Mandates? NONE.
Pelosi Plan
Foster State Innovation? NO. In fact, Sec. 2531(a)(4)
prohibits states from receiving
new incentive payments to adopt
liability reforms if they put limits
on attorneys' fees or impose caps
on damages.
GOP Alternative
Foster State Innovation? YES. Gives states the tools to
create their own innovative
reforms that lower health care
costs.
Pelosi Plan
Real Medical Liability
Reform? NO. No real medical liability relief is included.
GOP Alternative
Real Medical Liability
Reform?
YES. Implements reforms that will reduce costly, unnecessary
defensive medicine practiced by
doctors trying to protect
themselves from overzealous trial
lawyers.
As shown in post #78
Pelosi Plan is Chock-Full of Bad News for States:
1. Where in the constitution does it give the federal government the power to force me to buy a particular product? Which is exactly what this plan does, I either buy insurance or I pay a fine for not having it.
2. Why does an employer have an obligation to provide medical coverage? Employers originally did that as a way of attracting employees, not because of some mystical obligation they supposedly have (same thing applies to retirement plans).
3. If the government does take over health care, what protections are there against things like dictating what kinds of food people are allowed to eat. Since the public is paying the bills, they could claim that it's in the public interest to ban certain foods. And before you go accusing me of paranoia this is already happening. A lot of places have banned cooking with trans-fats in the name of public health. This will only get worse when the government is paying all the bills.
Posted by: Ken on November 6, 2009 04:51 AMSome people just open their mouths wide and drink.
We have gangsters in the White House.
Anybody want to bet that federally subsidized health insurance will be substantively different?
Posted by: what part of ill-legal don't you understand? on November 6, 2009 09:18 AMOf course I am -- I'm making my argument and not yours.
I said the Democratic bill reduces the deficit more than the GOP bill does. That is a FACT and many people, including you, fail to actually understand the words that I am writing.
You're right that I left out plenty of details, sort of how you left out in post #79 that Republicans do nothing to expand coverage to all Americans and do nothing to end discrimination of pre-existing conditions and do nothing to end price discrimination based on gender.
But yep, I'm right. The Democratic plan reduces the deficit more than the GOP plan.
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Eyago, it is possible for other insurance carriers to subsidize medicare otherwise why wouldn't they simply pay the same price that medicare does.
If Blue Cross pays less for a procedure than Pacificare, does than mean Blue Cross is cost-shifting to Pacificare? No, this is a distinction we share for Medicare and it doesn't make too much sense to me.
Which begs the 1.3 trillion dollar question. Then why don't they? Can't insurance companies simply refuse to pay so much? Works for Medicare.
It works for Medicare because they have larger purchasing power and send a lot more money to hospitals.
Hospitals often have monopolies over certain areas or regions. Why can't insurance companies get near-monopolies to concede on prices? That's not a mystery.
I think real fix is to not pay fee-for-service, not adjust the individuals fees. Or just have the government mandate fees for every hospital to accept -- like many other systems around the world -- but that'd be politically problematic.
HOWEVER, I am very leery of that kind of authority from what would be a huge bureaucracy. The potential for problems would be much like what is seen in the UK. So, while I like the idea of minimizing useless procedures, I do not want it to be done by a government entity.
The UK is not a model I want to emulate.
I think the best system is having non-profits run basically government-mandated insurance programs with very specific schedules. I'd think something like France, which does not have a particular issue with rationing but still focuses on "generally accepted procedures."
We don't even attempt to generate that type of data in this country. It makes little sense to me. (Reform fixes that.)
I tend to lean toward having the patient decide what he is willing to pay for when going above and beyond the generally accepted procedures.
Makes sense. The French model has supplemental insurance for these cases, and it seems to work great for them.
But with that would require tort reform to protect doctors from having to practice defensive medicine.
Tort reform is a bigger issue than once I thought it was, but it still is no where near the importance that the GOP places on it. Many states have laws capping malpractice awards and have abysmal medical cost growth.
I think if the GOP wanted a grand compromise over the summer, they could have killed a public option and gotten tort reform. I commend Obama for basically pushing his party to include tort reform grants in the legislation -- it's a good first step.
My point is that because it is the government, decisions about the program - who it covers, how it covers them winner, losers, also rans - are all subject to political jockying. That will only get worse as government gets more and more enmeshed in the system.
"The government" is different from "the Congress." We need to give the "government" the ability to actually get payment reforms passed without Congressional amendments and political jockeying. IMAC in the health reform bill does exactly that. It's a great idea.
We're not going to get rid of Medicare. It's here to stay. We should make it as efficient as possible, and we need a way to do it without going through the normal Congressional process.
I too want no one to be left out where they cannot gain access to a catastrophic health insurance option at a reasonable price. I just don’t want the government to do it directly. I am ok with vouchers that can be used in a free market system. I do think it is a shame for our country to have a few million people who want but cannot get insurance coverage, and I do think conservatives have failed to properly address this need and left themselves vulnerable first to the claim they are heartless and second to the machinations of the statists.
Well said.
If people what to buy plans that allow them to have all the wasted diagnostics they can dream of and an insurance company wants to sell it to them, there is no cause to tax it.
There is cause. First of all, the government makes benefits tax-free. We don't have unlimited tax deductions for most things, and we shouldn't have it for health care.
The reason to tax insurance plans like this is two-fold:
1) to pay for universal coverage -- those tax credit you mention above.
2) to bring down the cost curve, which this policy does.
Taxation is an acceptable use of policy power that the government has. We cannot view it as some individual purchase when the use of these plans causes us all to pay more according to the CBO.
What is missing here is that the consumer is not directly responsible for paying the premium and thus feels no pain while demanding the services. They should have a direct causal connection between price and value.
They should, but won't under any scenario. Might as well encourage business to do what people would do: move toward cheaper plans.
The health insurance exchange is the biggest step toward the goal of getting customers to buy insurance on their own in US history. Establishing a marketplace where people can price-shop makes sense.
The programs such as public option which have the businesses paying less in taxes than they would in premiums will shift people to the public option.
I don't really know what you're saying here...?
You seem pretty informed, but you don't seem to know what the "public option" is. There's a "health insurance exchange" -- a marketplace that has a bunch of private options and one public option. Only individuals and very small businesses have access to this exchange (most of us will still get "group"/employer-provided insurance). In other words, no one is "put" or forced into the public option. The only people who get the public option or those who choose to.
The unfair competitiveness of the government program with things like not having to pay state taxes which runs an average of 2%, and having certain administrative costs such as marketing and collections off book will make it easier for people to choose the government program over the private one.
I believe the bills allow for national plans as long as they meet the coverage requirements for each state, so the state tax argument is still a level-playing field.
Collections will not be "off book." They'll have to collect premiums just like every other insurance company. The IRS will not do it for them. I want to pay for health insurance, not for marketing.
You're saying that if the public sector does things cheaper and better then consumers will use their brains and pick them. But then you elsewhere argue that the government can't do anything efficiently and can't control costs. I don't see how these arguments are in exact conflict.
The big power of the public option is that it can do payment reforms in concert with Medicare, and get rid of things like fee-for-service and hopefully motivate the private sector to do so too.
I don't think the public option is the big deal that either the GOP or the Democrats have made it out to be. But it's nothing like single-payer. Because there are still multiple-payers, and the public option would have to negotiate with providers, and the vast, vast majority of Americans will not even be able to access the public plan.
It seems to me that there can be nearly no proposal from Democrats that leads to universal health care without screams of "socialism" or "single-payer!" I'm just going to ignore it. We can barely pass this bill -- what makes you think we can pass single-payer in the future (post health care reform) when the moral case for universal coverage has largely disappeared? I don't think it's worth exploring the motives of some of the most progressive members of Congress when it's clear that the proposed policies lead to a system completely unlike single-payer.
Posted by: John Jensen on November 6, 2009 11:50 AMJJ - In the process, you inadvertantly helped make my argument.
"I said the Democratic bill reduces the deficit more than the GOP bill does. That is a FACT and many people, including you, fail to actually understand the words that I am writing."
False. I understood perfectly what you wrote and I pointed out the the dirty secret of how the Dems would accomplish that so-called fact that YOU curiously omitted. We have a shadow government that finds totalitarianism attractive and kool aid drinkers like yourself will overlook this all day long. In addition, you have yet to address the points I made about the draconian measures and the unconstitutionality of Pelosicare, but hey; that hasn't stopped you from defending the indefensible before.
Posted by: KDS on November 6, 2009 12:34 PMI said the Democratic bill reduced the deficit more than the GOP bill. You replied: That is flat out not true - show me credible documentation of that assertion to prove it. If I am wrong, I'll say it.
I showed you credible citations of the CBO, and you've yet to say you were wrong. You were wrong. You still are wrong. The Democratic bill raises a lot more money than the Republican bill because it actually fixes serious problems and gets near-universal coverage. The Democratic bill also cuts the deficit more.
Posted by: John Jensen on November 6, 2009 12:45 PMMakes sense. The French model has supplemental insurance for these cases, and it seems to work great for them.
I have not looked at the French system, but at first blush it seems like it has some beneficial aspects. I'll have to look into it.
I believe the bills allow for national plans as long as they meet the coverage requirements for each state, so the state tax argument is still a level-playing field.
Collections will not be "off book." They'll have to collect premiums just like every other insurance company. The IRS will not do it for them. I want to pay for health insurance, not for marketing.
I think you are not getting my point. The issue is that the government plan has inherent competitive advantages that give it lower admin costs on the surface and thus can offer lower premiums in a way that is not available to other organizations. This will tend to shift people out of private plans and distort the market.
See the wikipedia entry below which has a small amount of useful info in it including the following:
Krugman also said in 2007 that whilst a single payer system would be the most efficient and cheapest solution, a public insurance option could get the country towards single payer as through competition it would drive the private insurers out of business.
http://en.wikipedia.org/wiki/Public_health_insurance_option
There is cause. First of all, the government makes benefits tax-free. We don't have unlimited tax deductions for most things, and we shouldn't have it for health care.
Actually government makes employer provided health premium payments tax-free. A free market, consumer-paid program would not be tax free so there would be no reason to tax Cadillac plans, but now I see your point from before. I think the government can give tax deductions for health benefits up to a certain amount and then cut it off rather than impose surcharge taxes.
The programs such as public option which have the businesses paying less in taxes than they would in premiums will shift people to the public option.
I don't really know what you're saying here...?
Covered in the wiki above
You're saying that if the public sector does things cheaper and better then consumers will use their brains and pick them. But then you elsewhere argue that the government can't do anything efficiently and can't control costs. I don't see how these arguments are in exact conflict.
No. I said government has unfair advantages, or at least that was my intended point.
It seems to me that there can be nearly no proposal from Democrats that leads to universal health care without screams of "socialism" or "single-payer!" I'm just going to ignore it.
Conversely there is no republican plan that will not end in screams of "racist" and "hater of _____".
It's all the same stuff. I do think that the more government gets its hands on something the larger its influence grows. That does not mean I reflexively support the Republican alternatives by the way.
Anyway, on another topic, I do not believe that the Dem bill with all its grandiose and massive spending, cuts and changes being pushed fast and furiously is any way to solve a health issue. If they are completely excluding Republicans, then you know there is too much ideology in the results or they would be willing to truly negotiate real compromises. If there are any real good things in this bill, it is lost in all the rest of the garbage they are trying to stuff in it. I would rather they address the problem more systematically and one step at a time.
Jensen, Bla, bla bla. Make me laugh. What are you talking about ? Where is your reading comprehension ? Stop being defensive and go back and read my posts #79 and #80. It's really a simple point that you try to ignore. Try making your posts more concise and stop spewing half truths. Why don't man you up and acknowledge HOW COME the Federal deficit will be less under the Dem bill ? As I said, it may cut the Federal deficit - OK, but at the cost of increasing the deficit of every state which nore than offsets the Federal deficit it cuts. There's your answer.
For the 3rd time; You have yet to address the points I made about the draconian measures and the unconstitutionality of Pelosicare.
I understand that the CBO has not scored the final version of the House bill yet simply because its not final yet. They need to do some more wheeling and dealing for Dem Votes. So, until then your hand waving remains smoke and mirrors. The GOP now has a bill and if given the opportunity it will give us (not you and your ilk) a better Health Care plan with more choices with Tort reform with a plan that doesn't include illegal aliens and doesn't fund abortion at a lower costs to both Federal and State Governments. You know and I know that is the last thing the Democratic leadership would do - but it would be downright embarrassing to them if they had to compromise, but a relief for a majority of Americans.
