Transitioning from employer-paid healthcare to tax-paid healthcare

[chucky2]

Originally posted by: Gonad the Barbarian

Originally posted by: chucky2

Originally posted by: Gonad the Barbarian
Your two problems or worse still exist if no action is taken. 2 isn't happening either way, lawsuit reform has been shown time again not to make any substantial difference, and your lost wages in 1 will be worse with health care costs increasing as they are. Reform can be far from perfect and still be a massive improvement over the mess we have now.

BS 2 can't happen. If the Fed. is going to nationalize HC, then they can nationalize Dr. and RN programs or provide heavy subsidies...even have their own schools. If the current institutions are output limited, which I doubt, but still, even if they are, then more programs will need to open up.

And as far as 1, I have employer based HC, so no, it won't be worse. What will be worse is UHC passes based on increased taxing, my employer drops HC, I get no or meaningless raise, and my taxes skyrocket to pay for HC now, and increased cost as costs go up: See 2.

That's worse. What's not worse is keeping my employer based HC and having small increases.

Chuck

2 is certainly not happening on its own. We're no worse off if current reform doesn't address it, but it would of course be an improvement if it did.

I am not even sure how you can say this. We currently have a shortage of HC professionals in the country, one of the many reasons our current HC system costs $$$. A UHC type bill is going to either mandate or allow everyone access to the same amount - no greater - of HC professionals we have now. So, same supply, double the demand. What is going to happen to price and quality? Why would you ever expect price to go down in this situation and quality to - at minimum - stay the same?

1 will be worse without reform as your wages are curtailed to cover ever increasing insurance costs or your employer drops your coverage altogether. Insurance costs are outpacing wage increases by a large amount. Taking that trend to its extreme absurd end you'll end up paying your employer to work to keep your insurance. Getting insurance from your employer doesn't make you immune from the very problems that are in large part prompting reform. At the very least you're one layoff away from being without it.

Yes, but for a large amount of people in the US right now, we do have employer paid HC. So when that goes away, where does all that money go to that the employer way paying? The current employees get large raises? Somehow I don't think these companies are going to do that. Hire more people? Possibly to some degree...but only to the degree they feel needed. Or, pocket the $$$. That seems much more likely.

I understand what you're saying...I'm saying I really don't trust companies to be freed from paying for HC and magically just give their employees all that money they've been paying. So what's the advantage to me if the employers don't pay for HC again?

Chuck

 

[shira]

Originally posted by: chucky2

Originally posted by: Gonad the Barbarian
Your two problems or worse still exist if no action is taken. 2 isn't happening either way, lawsuit reform has been shown time again not to make any substantial difference, and your lost wages in 1 will be worse with health care costs increasing as they are. Reform can be far from perfect and still be a massive improvement over the mess we have now.

BS 2 can't happen. If the Fed. is going to nationalize HC, then they can nationalize Dr. and RN programs or provide heavy subsidies...even have their own schools. If the current institutions are output limited, which I doubt, but still, even if they are, then more programs will need to open up.

And as far as 1, I have employer based HC, so no, it won't be worse. What will be worse is UHC passes based on increased taxing, my employer drops HC, I get no or meaningless raise, and my taxes skyrocket to pay for HC now, and increased cost as costs go up: See 2.

That's worse. What's not worse is keeping my employer based HC and having small increases.

Chuck

Where is this "nationalize health care" coming from. None of the plans get rid of private insurance, and none have a public option yet. The most likely plan(s) will define a potential future (5 years out) public option that's contingent on private insurance companies not meeting cost-containment goals. So your statement about nationalizing MD and RN programs seems absurd. What is far more likely is that public funding will be offered to existing schools to expand their programs.

As to your second point: The ONLY source of funds identified in any of the bills are (1) penalties for employers opting out of proving HC to their emplyees, (2) tax penalties to individuals who refuse to get insurance, and (3) taxes on high-income (looks like a $500k threshold right now) individuals. None of these revenue sources is likely to affect you.

Edit: Oh, one other revenue source I forgot to include: A tax on "gold plated" plans. However, the premium thresholds being talked about for this tax would impact many plans for middle-class taxpayers, so this option probably won't be pursued.

 

[shira]

Originally posted by: blackangst1

Originally posted by: chucky2

Originally posted by: CADsortaGUY
I got to

the single payer system liberals and apparently most Americans want

and had to stop. If you start with that sort of premise/assumption, how can anything later be even close to reality?

I agree, but I still played along. Seriously though, if some plan can address my two main concerns, I'm all ears on it. Until those two are addressed though, it's a double deal breaker.

Chuck

Im in the same boat.

My part of my current benefits are approx. 11% of my gross, and thats for a gold plated plan. My employer's portion is about 16% of my gross, so altogether 27% of my gross is for healthcare. Now, unless the government's cost is 1/2 or more of current (which is HIGHLY unlikely), my increase from my employer (the $$$ I pay for my portion) wont offset the new increase in taxes to cover my new healthcare plan. This troubles me.

Well, perhaps you ought to consider NOT getting a gold-plated plan.

One of the contributors to increasing health care costs is plans that cover almost anything, with very small or no deductibles or co-pays. When consumers have such plans, they have absolutely no incentive to reduce their consumption of and demand for health care services.

If the changes in funding premiums induces people such as you to NOT get gold-plated plans, that's a GOOD thing, regardless of what you personally would prefer.

 

[Acanthus]

Originally posted by: ebaycj
And as far as "Tort reform" goes, since we know it doesn't work (as evidenced by IL and TX), why not provide a government option for malpractice insurance to doctors? It's just another cost in the system that we all end up paying into.

Increase the supply of doctors, and start firing the bad ones instead of suing them?

 

[Patranus]

Originally posted by: Acanthus

Originally posted by: ebaycj
And as far as "Tort reform" goes, since we know it doesn't work (as evidenced by IL and TX), why not provide a government option for malpractice insurance to doctors? It's just another cost in the system that we all end up paying into.

Increase the supply of doctors, and start firing the bad ones instead of suing them?

LOL - How are you going to increase the supply of doctors when the government wants to pay out medicare rates (70 cents on the dollar)?

 

[CADsortaGUY]

Originally posted by: shira

Where is this "nationalize health care" coming from.

Did you not read the thread title when you clicked on it? Did you then skip right over the OP? Sheesh - you must really want to beat harvey and mcowen...

 

[CADsortaGUY]

Originally posted by: shira

Originally posted by: blackangst1

Originally posted by: chucky2

Originally posted by: CADsortaGUY
I got to

the single payer system liberals and apparently most Americans want

and had to stop. If you start with that sort of premise/assumption, how can anything later be even close to reality?

I agree, but I still played along. Seriously though, if some plan can address my two main concerns, I'm all ears on it. Until those two are addressed though, it's a double deal breaker.

Chuck

Im in the same boat.

My part of my current benefits are approx. 11% of my gross, and thats for a gold plated plan. My employer's portion is about 16% of my gross, so altogether 27% of my gross is for healthcare. Now, unless the government's cost is 1/2 or more of current (which is HIGHLY unlikely), my increase from my employer (the $$$ I pay for my portion) wont offset the new increase in taxes to cover my new healthcare plan. This troubles me.

Well, perhaps you ought to consider NOT getting a gold-plated plan.

One of the contributors to increasing health care costs is plans that cover almost anything, with very small or no deductibles or co-pays. When consumers have such plans, they have absolutely no incentive to reduce their consumption of and demand for health care services.

If the changes in funding premiums induces people such as you to NOT get gold-plated plans, that's a GOOD thing, regardless of what you personally would prefer.

So how does the gov't subsidizing(public option/medicare/etc)/providing HC(UHC) address the issue you state?(bolded)

 

[PokerGuy]

Originally posted by: shiraWell, perhaps you ought to consider NOT getting a gold-plated plan.

One of the contributors to increasing health care costs is plans that cover almost anything, with very small or no deductibles or co-pays. When consumers have such plans, they have absolutely no incentive to reduce their consumption of and demand for health care services.

If the changes in funding premiums induces people such as you to NOT get gold-plated plans, that's a GOOD thing, regardless of what you personally would prefer.

That is the libtard mentality in a nutshell. You should lose your earned benefits so it can be handed over to others who have not done a thing to earn them. Force you to lose your "gold plated" coverage, which is part of your compensation package, so countless illegal immigrants and welfare recipients can be added under the socialist healthcare umbrella. Thanks, that sounds great!

 

[PokerGuy]

Originally posted by: Acanthus

Originally posted by: ebaycj
And as far as "Tort reform" goes, since we know it doesn't work (as evidenced by IL and TX), why not provide a government option for malpractice insurance to doctors? It's just another cost in the system that we all end up paying into.

Increase the supply of doctors, and start firing the bad ones instead of suing them?

How exactly does one magically increase the supply of doctors when at the same time trying to reduce how much they make? Logically, the higher the salary for a profession, the higher the supply of qualified individuals. You will never be able to significantly increase the number of qualified doctors if you reduce their pay.

 

[PokerGuy]

Originally posted by: Craig234
This isn't exactly new, but I haven't seen it broken out.

It seems there's a challenge in the healthcare reform politically: if the system of employers paying for most healthcare is changed to one in which taxes pay for most healthcare (the single payer system), there will likely be a big taxpayer backlas at this 'new' tax that reduces the expenses for business.

It's not clear what to do about that. One option is to just not make the change, somehow leave employers paying the cost, but can that be defended other than for politics?

One issue would seem to be the idea that the thousands per employee that business saves doesn't have any direct link to that money going to the employees' pockets for their new healthcare tax. What's to stop business from just pocketing the healthcare savings, and employees getting the burden?

That's a pretty huge political barrier - people don't want a new tax, and even if it's addressed, t's hard to get people to not fear the change.

It might be tempting to want to legislate a solution, to force employers to somehow either continue to pay for the cost or to give the savings to employees, but if one employer offers healthcare and another doesn't, why should the one who does have a government-forced cost while his competitor gets an advantage, instead of the coluntary basis on which it's done now? That seems unfair.

There might be some solution - for employees who already pay their own cost, this isn't a new cost, just a different name on the check, so the issue is those who have it paid.

Perhaps the best solution is to leave it to employers and employees to sort out - as long as that doesn't create too much political backlah against reform.

Hopefully, most employers would shift the funds to compensation. A law COULD at least require employers to clearly diclose to employers what they do with the money.

Edit: I deleted a referent to how many people want single-payer, because the issue is less clear than the comment suggested. It's not cnentral to the topic.

For what it's worth, polls vary over time, recently dipping for it; in an earlier poll between no change and single-payer, 65% chose single-payer, but in a more recent poll with various options, single-payer support was at 32%. If I recall correctly, the 'public option' seems to have majority support.

Of course we all know employers would pocket the amount they would save by kicking their employees onto a government run disaster health plan. Why would they do anything else? It would make no sense for them to do anything else.

There's also an implicit assumption in there that overall costs will remain the same, that the cost burden is being shifted from one place to another. The reality is that the costs will skyrocket, so not only is the burden going to be shifted, it's going to be a bigger burden as well. There is no way the government does anything cheaper or more efficiently than the private sector. It's never happened and it will never happen. Adding millions of newly insured patients also puts a huge burden on the health care provider system, something we are clearly not prepared for. There's already a shortage of primary care providers. Add millions of new patients without a way to (short term) increase the number of providers, and you create a wonderful disaster.

 

[Ausm]

From what I read, most employers are fighting against this. It really baffles me why they are reluctant to go to a tax based HC system for their employees. I think it boils down to power. The power that employers have over their employees.

 

[rudder]

Originally posted by: Patranus

Originally posted by: Acanthus

Originally posted by: ebaycj
And as far as "Tort reform" goes, since we know it doesn't work (as evidenced by IL and TX), why not provide a government option for malpractice insurance to doctors? It's just another cost in the system that we all end up paying into.

Increase the supply of doctors, and start firing the bad ones instead of suing them?

LOL - How are you going to increase the supply of doctors when the government wants to pay out medicare rates (70 cents on the dollar)?

There are plenty of doctors in India who would be very willing to work in the U.S. at a reduced rate. If A U.S. company can save a lot of money on IT by using H1B visa holders think how much money the U.S. Government could save by expanding this. States could also save money as they would not have to subsidize public medical schools anymore. It is a win-win.

 

[Athena]

Originally posted by: chucky2
I am not even sure how you can say this. We currently have a shortage of HC professionals in the country, one of the many reasons our current HC system costs $$$

We do have a physician shortage in the US and we do pay more than residents of any other country for their services. There is no indication though that the first is the cause of the second. In fact, the more doctors there in an area, the higher costs are likely to be. Massachusetts has the largest concentration of physicians in the country and some of the highest costs -- with not enough primary physicans to care for all the residence who are required to buy health insurance.

The data indicate though, that the nation as a whole would be better off if a significant amount of the care the existing practioners are providing were directed to different locales and specialties. That would go a long way toward improving access to care.

Well, until we see a bill that address #2 to start getting some competition into HC, and easy the current supply shortage, adding sh1tloads of additional people is going to only do one thing: radically drive up costs and/or lower overall quality.

Healthcare is not a commodity that responds to free market "laws". It is largely supply, driven. It turns out that the more insurers you have in an area, the weaker they are when it comes to negotiating with suppliers and the higher local costs.

 

[PokerGuy]

Originally posted by: rudder
There are plenty of doctors in India who would be very willing to work in the U.S. at a reduced rate. If A U.S. company can save a lot of money on IT by using H1B visa holders think how much money the U.S. Government could save by expanding this. States could also save money as they would not have to subsidize public medical schools anymore. It is a win-win.

No. Doctors are highly trained professionals that hold people's medical care in their hands. They should be paid accordingly, the pay should not be brought down to the level of what some third world doctor would be willing to work for.

 

[Athena]

Originally posted by: Ausm
From what I read, most employers are fighting against this. It really baffles me why they are reluctant to go to a tax based HC system for their employees. I think it boils down to power. The power that employers have over their employees.

I don't know which employers are against having a national health financing model that includes employer contributions. HR executives at multinational companies know that their health care costs are not just lower, but more manageable in countries with different models of health care financing.

Let's dive into a healthcare insurance pool

 

[Gonad the Barbarian]

Originally posted by: Ausm
From what I read, most employers are fighting against this. It really baffles me why they are reluctant to go to a tax based HC system for their employees. I think it boils down to power. The power that employers have over their employees.

Yep. It's easier to keep workers in their job when it's not just their livelihood on the line but potentially their very lives. This is probably the very worst thing I see about our current system, the way it stifles job mobility. As an extension, it might even be that the added cost of health benefits is less than the higher wages it would require without them to retain the same workers. How many people in the workforce are mainly working their current jobs for the health coverage? How much more would businesses need to pay to keep those positions filled if health coverage was out of the equation? How many employees would be happier to take a pay cut to work another job if they weren't potentially putting their lives on the line to do so?

 

[boomerang]

Originally posted by: Ausm
From what I read, most employers are fighting against this. It really baffles me why they are reluctant to go to a tax based HC system for their employees. I think it boils down to power. The power that employers have over their employees.

They're reluctant because they don't know how to plan to run their businesses. There are so many potential taxes, fines, tariffs, fees and the like that could negatively affect businesses in this country that they're sitting on their hands waiting and fighting back if they have the resources.

Who's going to hire employees, expand their business or make long term commitments of capital when the business climate is completely unknown? This administration is openly hostile to business. Many of Obama's closest advisor's are either admitted Marxists or at the least embrace Marxist ideals. If I was a business owner and saw what was happening in DC I'd be paralyzed. I would intentionally be so until I knew how things were going to shake out. As of right now, at the very soonest, that won't be until after the 2010 elections.

Try to see both sides of the issue. Remember who employs the majority of people in this country - small businesses.

 

[shira]

Originally posted by: CADsortaGUY

Originally posted by: shira

Where is this "nationalize health care" coming from.

Did you not read the thread title when you clicked on it? Did you then skip right over the OP? Sheesh - you must really want to beat harvey and mcowen...

The thread title was "tax paid" healthcare," not "nationalized health care." And even "tax paid" is a gross misnomer: The plan under consideration would subsidize HC premiums for low- and middle-income households with vouchers. Nothing in the OP refers to "nationalized HC," which would be a single-payer system run entirely by the government, not a voucher-subsidized, multi-payer system run mostly by private insurance company's.

Sheesh - you must really be trying to beat PJABBER and Patranus.

 

[Fingolfin269]

Businesses will always be smarter, or at the very least more agile, than the federal government. This transition would surely end up screwing over those who work for a company that provides them with health benefits simply because they will be able to stay several steps ahead of the government. The feds just move too slowly to keep every business in check. By the time they are able to react to businesses finding a loophole it will be too late. Damage done. Game over. Etc.

 

[shira]

Originally posted by: CADsortaGUY

Originally posted by: shira

Originally posted by: blackangst1

Originally posted by: chucky2

Originally posted by: CADsortaGUY
I got to

the single payer system liberals and apparently most Americans want

and had to stop. If you start with that sort of premise/assumption, how can anything later be even close to reality?

I agree, but I still played along. Seriously though, if some plan can address my two main concerns, I'm all ears on it. Until those two are addressed though, it's a double deal breaker.

Chuck

Im in the same boat.

My part of my current benefits are approx. 11% of my gross, and thats for a gold plated plan. My employer's portion is about 16% of my gross, so altogether 27% of my gross is for healthcare. Now, unless the government's cost is 1/2 or more of current (which is HIGHLY unlikely), my increase from my employer (the $$$ I pay for my portion) wont offset the new increase in taxes to cover my new healthcare plan. This troubles me.

Well, perhaps you ought to consider NOT getting a gold-plated plan.

One of the contributors to increasing health care costs is plans that cover almost anything, with very small or no deductibles or co-pays. When consumers have such plans, they have absolutely no incentive to reduce their consumption of and demand for health care services.

If the changes in funding premiums induces people such as you to NOT get gold-plated plans, that's a GOOD thing, regardless of what you personally would prefer.

So how does the gov't subsidizing(public option/medicare/etc)/providing HC(UHC) address the issue you state?(bolded)

One option under consideration is a 40% tax on the portion of HC premiums that exceed a threshold figure - currently, I think that figure is $25,000 a year for a family. That would represent a big dis-incentive for buying these plans.


You know, the hypocrisy of the right-wing posters on the topic of HC reform is astounding. They all say, "we need to reduce costs." But when presented with practical ways to reduce costs - the public option (to foster competition) or taxing gold-plated plans (to reduce the incidence of these plans, and thus the demand for services) - right wingers are all up in arms.

I guess the right just wants to mouth good-sounding phrases, but doesn't have the gumption to actually do anything about what they say is important.

 

[Athena]

Originally posted by: boomerang
Try to see both sides of the issue. Remember who employs the majority of people in this country - small businesses.

Remember which employers are most hurt by our current dysfunctional health care financing model: small businesses. 60% of small businesses do not offer any coverage to their employes. In most cases, that's not because they don't want to but because they can't afford it. Health insurance policies fo small businesses are rated in the same way that individual policies are -- by age, sex, and medical history. A family business with a significant number of long time employees pays significantly more than a similar sized start-up with few older people. The billing clerk's high-risk delivery of twins can increase the business owner's by thousands.

There's nothing in the current bills that would actually help small business owners who want to do better. The only advantage of the exchanges is that they would eliminate sex-based rating. It seems to me that instead of fining small businesses for not offering health care and hoping that the fine would somehow end up paying for the employees subsidized private insurance, it would be much more effective to have a mandatory payroll deduction for all employees that would go into coverage for those employees. That's how most countries deal with the problem. ALL employers pay into the fund and everyone has the same level of care. If some employers want to additional coverage, let them buy private, supplementary insurance for their employees.

Health Care Abroad: Germany

Health Care Abroad: France

Health Care for All - Germany and France

 

[miniMUNCH]

Well I'm probably in the minority but when i finally start working for real (doing a post-doc), i will make plenty of money such that the added tax won't really be a problem whether it is indirectly compensated for or not.

Also... in may high tech science fields, salaries are competition based... it is generally not worth saving a couple million dollars to lose a significant of your PhD (and really good non PhD) scientists/engineers. So companies won't screw over 'the talent' because the talent will just leave for a company that won't screw them over.

Ultimately, companies that 'save' money due to healthcare savings will do something with that money... they will invest it new equipment, or into new jobs / 'workforce' retention (i.e. as new jobs are created in a given field, creating more demand for workers in the field, this necessarily will increase the average value of workers in the field).

For the individual person, i think it is best not worry about how the government or some company [that you work for] may or may not screw you over. It is better to focus our time on enjoying life and, wrt our profession(s), focus our effort on professional development and improvement.

 

[Ausm]

Originally posted by: Athena

Originally posted by: boomerang
Try to see both sides of the issue. Remember who employs the majority of people in this country - small businesses.

Remember which employers are most hurt by our current dysfunctional health care financing model: small businesses. 60% of small businesses do not offer any coverage to their employes. In most cases, that's not because they don't want to but because they can't afford it.

I work in manufacturing industry in the Midwest and we work with several small businesses that fall into this criteria. Most of those people have to rely on a spouse for healthcare and the ones that are single have to pony up and get boned buying individual insurance plans. But I know for a fact most of the single people go without any insurance because it is simply not affordable especially when you advance in age. Luckily the state I live in provides insurance for people with a pre-existing condition.

 

[Athena]

Originally posted by: Craig234
The question I have there is how the people without employer insurance will be paid for. Will it all be lumped onto business?

Everyone -- children, seniors, employed, unemployed -- would have the same coverage. That coverage would be financed through a combination of contributions from employees, employers, pension and government. 46¢ of every dollar spent on health care in the US today comes from public funds. If all the money now going into the patchwork of government paid care ( i.e. medicare, medicaid, working poor) plus employer premiums and employee contributions were directed toward a single financing system, we would have more than enough to provide quality care to everyone at less cost. That wouldn't necessarily mean either a government run insurance company (which is probably a bad idea) or government run health delivery. In France and Germany, the collected revenues are handled by large non-profit funds that pay for private providers.

 

[blackangst1]

Originally posted by: shira

Originally posted by: blackangst1

Originally posted by: chucky2

Originally posted by: CADsortaGUY
I got to

the single payer system liberals and apparently most Americans want

and had to stop. If you start with that sort of premise/assumption, how can anything later be even close to reality?

I agree, but I still played along. Seriously though, if some plan can address my two main concerns, I'm all ears on it. Until those two are addressed though, it's a double deal breaker.

Chuck

Im in the same boat.

My part of my current benefits are approx. 11% of my gross, and thats for a gold plated plan. My employer's portion is about 16% of my gross, so altogether 27% of my gross is for healthcare. Now, unless the government's cost is 1/2 or more of current (which is HIGHLY unlikely), my increase from my employer (the $$$ I pay for my portion) wont offset the new increase in taxes to cover my new healthcare plan. This troubles me.

Well, perhaps you ought to consider NOT getting a gold-plated plan.

One of the contributors to increasing health care costs is plans that cover almost anything, with very small or no deductibles or co-pays. When consumers have such plans, they have absolutely no incentive to reduce their consumption of and demand for health care services.

If the changes in funding premiums induces people such as you to NOT get gold-plated plans, that's a GOOD thing, regardless of what you personally would prefer.

Of course thats an option; however, I can afford it, and although I have enjoyed a complication-free life, if things go sideways, diabetes care can get VERY expensive VERY quickly, and I want the coverage there. I look at it preventative financial planning.