I want to start a small business. I'll start out with a few employees, and try to grow. How is my business affected by the various plans proposed for health insurance in America?
Status Quo (most states): Since I'm small, I don't have to give my employees an insurance plan. They pay for their insurance out of pocket, if at all. Some will likely not get insurance so they can spend their money on other things, like bigger houses. Those with insurance will overpay for their coverage because they can't negotiate, and will probably be underinsured. I may have to pay slightly higher salaries to make up for the lack of benefits in order to attract good workers, but since people generally don't understand the values of employer insurance packages, I won't have to pay much more. My costs are kept low, and I am better able to function as a small business. Republicans and Libertarians like this arrangement because it helps small business development and entrepreneurship, even though it exploits workers a bit and sets up people for hardship and bankruptcy if they develop health problems. Half of US bankruptcies, largely the cause of our economic collapse, are due to inability to pay medical bills.
Individual Mandate: My employees will be required by law to buy their own insurance. They are likely to buy catastrophic coverage with the lowest premium and least coverage. They will probably be underinsured. The minimum wage is the same, and my competition could consider ending employer-provided insurance, so I won't have to worry about paying much more in salaries, if any more at all, to make up for my employees' health insurance costs. Insurance companies love this arrangement because the government is forcing people to give these companies money, and the government will probably pitch in for people who need help paying. Free money for insurance companies, cheaper labor for businesses. Real Republicans and Libertarians don't like the government interference (most Rs are bought off by insurance lobbyists and have no values), and liberals don't like the poor quality of insurance and the burden on the working poor who may not qualify for enough subsidies.
Employer Mandate: This is my nightmare. The government would force me to pay for my employees' insurance. Since I have a small business, I don't have leverage to negotiate a good price. There are some small business collectives, though, that can negotiate together, depending on my state. I sure wish there was a national insurance market so the collectives could negotiate more freely. I have to deal with the local insurance monopoly. Combined with minimum wage laws and competition with larger businesses that can negotiate better, paying for health insurance plans for my employees may inhibit my small business's growth, or even make it unsustainable. My business may not last long, or even get started. It's a shame because consumers would really benefit from my business's existence, but not enough to justify paying the prices I would have to charge to stay in business if I have to pay for health plans. This plan also leaves unemployed people in the lurch, and when my business fails my employees will have nothing. Maybe my business can survive if I fire some people and work the others harder. Big businesses like the employer mandate because they already give their employees well-negotiated health plans, and this would make it harder for new competition to sprout up.
Public Plan: Ah, I could relax. Everyone has basic health coverage. They can buy fancier private plans if they want, but the basics are covered, and are better than the old private catastrophic plans. I am more likely to be able to pay competitive salaries or reinvest profits. My employees are secure. Real Liberals (not the bought-off ones), unions, health economists, and the poor favor this idea because it provides security and needed health care to all Americans, and improves the stability of our nation's economy while setting a stage that fosters small business innovation. Republicans and Libertarians hate the plan because it is government control (they blindly hold on to a belief and a value despite all the harm their decisions cause), and insurance companies hate it because they love the profits they get from our current horrible system.
Showing posts with label public health insurance. Show all posts
Showing posts with label public health insurance. Show all posts
Saturday, December 12, 2009
Tuesday, September 29, 2009
No Public Option
The Senate Finance Committee excludes a public option. This really is no surprise. We know that Baucus is in the pockets of insurance companies instead of his constituents, as are many other politicians. It is also blatently apparent that the entire Republican party is united to prevent the Obama administration from accomplishing anything good for America. The Republicans want the Obama administration to fail at improving our country and serving its citizens, just so the Republicans can cite the failure while campaigning for the next elections.
What can we do?
Well, we obviously need some campaign finance reform, for starters. There is an organization working to accomplish this goal. Change-Congress.org, organized by the illustrious Lawrence Lessig, fights against the sway that special interest groups (insurance companies) have over our government. When there is more of an incentive for politicians to work for their constituents, and less of an incentive for them to pander to money-grubbing companies, we will see policy decisions that are better for this country.
Did we need a public option?
Well, the CBO says that various plans proposed would cut the US deficit by tens of billions of dollars over the next ten years, while providing health care to tens of millions of American citizens who currently have no insurance. I've seen other organizations estimate that the deficit would drop by even more, since the CBO did not look at every related variable. There are different plans, though, and different ideas of what the public option would look like. So, there are proposals that include public options that would help many Americans and save our country money, which are both outcomes we need. There are other ways to get these outcomes, such as a single-payer system (HR676, Medicare for All, has hardly been mentioned) or extremely tight regulation on insurance companies, but a public option was the most likely to make it through congress. It just isn't likely enough.
I am confident saying that any politician currently opposing/stalling efforts to increase the government's involvement in health care, either through a public option, marketplace, expanding Medicare, or more strictly controlling private insurance companies, is motivated only by the drive for personal power. These politicians enjoy their campaign contributions and visits from lobbyists, and the Republicans know that sticking with the party line ensures they will keep getting support in future elections. The politicians who are fighting for the health of our citizens are the ones who care about their constituents.
What can we do?
Well, we obviously need some campaign finance reform, for starters. There is an organization working to accomplish this goal. Change-Congress.org, organized by the illustrious Lawrence Lessig, fights against the sway that special interest groups (insurance companies) have over our government. When there is more of an incentive for politicians to work for their constituents, and less of an incentive for them to pander to money-grubbing companies, we will see policy decisions that are better for this country.
Did we need a public option?
Well, the CBO says that various plans proposed would cut the US deficit by tens of billions of dollars over the next ten years, while providing health care to tens of millions of American citizens who currently have no insurance. I've seen other organizations estimate that the deficit would drop by even more, since the CBO did not look at every related variable. There are different plans, though, and different ideas of what the public option would look like. So, there are proposals that include public options that would help many Americans and save our country money, which are both outcomes we need. There are other ways to get these outcomes, such as a single-payer system (HR676, Medicare for All, has hardly been mentioned) or extremely tight regulation on insurance companies, but a public option was the most likely to make it through congress. It just isn't likely enough.
I am confident saying that any politician currently opposing/stalling efforts to increase the government's involvement in health care, either through a public option, marketplace, expanding Medicare, or more strictly controlling private insurance companies, is motivated only by the drive for personal power. These politicians enjoy their campaign contributions and visits from lobbyists, and the Republicans know that sticking with the party line ensures they will keep getting support in future elections. The politicians who are fighting for the health of our citizens are the ones who care about their constituents.
Friday, September 11, 2009
Obama's Health Care Reform Speech
I'll just try to comment on his speech briefly.
It is a bit overreaching for Obama to be determined to be the last president to try to reform health care. We have no idea what the needs of America will be in fifty years. We will need constant monitoring, evaluation, and reform in order to adapt to future needs.
Over half of US personal bankruptcies are due to medical bills. Employer-provided health insurance (subsidized by the government) has been and is a bad idea. It is hard for US companies to compete internationally, and good American citizens get screwed if they are laid off or self-employed. Small businesses are over-burdened if forced to provide insurance, and the employees suffer either way. Trying to buy insurance individually strips away negotiating leverage and further hurts people.
America takes less care of its citizens than any other major nation. Not only has the government dropped the ball on taking care of everyone, but it lets insurance companies use techniques like rescission to exploit citizens. Obama is calling out our nation, an arrogant nation that likes to believe it is the best, on its cruelty and heartlessness towards its own members.
Obama correctly points out that we all pay more when the uninsured and underinsured end up in the emergency rooms for trivial problems, or major problems that could have been prevented by cheaper basic care. We pay more money as a country for pathetic health outcomes. What he doesn't go into are the details about that: our high payments for cancer treatments and whatnot to extend people's lives just a little instead of focusing on paying for basic and preventative care that would extend more people's lives by a lot. That would raise more "grandma-killing" nonsense, but it really is a great waste that hurts our whole nation. Is baby-killing better? Or worker-killing? Medicare and Medicaid costs are so bad because we provide expensive treatments to people who are going to die anyway, and we enable people with chronic illnesses like diabetes to not minimize their problems. When we can accept the fact of death for the elderly (the private insurance companies actually do have Death Panels, and they're effective at denying care to anyone), and get people to take the barest responsibility for themselves, costs will drastically drop. We also need to cut down on drugs as a whole culture. Pharmaceutical pill-pushing is costly, damaging, and out of control.
Single-payer systems are great, but not the only good solution. Making individuals buy private insurance is a terrible idea. The insurance companies would love that windfall.
The Republican party is united. That is their great strength. Unfortunately, they unite behind terrible ideas. The Democrats, instead of being blind sheep and puppets, like to think for themselves. This strength allows for creativity and progress. This unfortunately leads to many different ideas, such that even when these ideas are good, they split the votes and lead to conflicts that ultimately allow the Party of No to succeed.
THE PLAN
Finally, the meat and potatoes.
1) Enrollment in the public plan is optional if you have other insurance.
This is good. It will be healthy for private insurers to have to compete. Right now they have virtual monopolies in most of the country. People get to choose what they like (this is not always good because insurance plans can be hard to understand, and people are manipulated by advertisements). It is great to make health insurance mandatory. This will reduce waste due to ER visits, and reduce financial hardships for those who have sudden medical needs but didn't have insurance. Unfortunately, there is a hardship waiver for people who still can't afford the premiums. This is where the feds should just pay the premium, but later Obama says that he won't allow that. Hopefully Medicaid will take up anyone who can't afford the public plan premium.
2) Rescission is illegal for everyone.
This is good. People can have more security.
3) Federally mandated cap on out-of-pocket expenses.
This is interesting. I assume that the cap will depend on a person's income, and not be the same for everyone. This will raise premiums for everyone.
4) Federally mandated coverage for routine check-ups and preventative care.
This is probably very good. He mentions tests for cancer, and that worries me. Some cancer tests are very expensive and/or have high false-positive rates, leading to much dangerous, expensive, and unnecessary treatment. I'm especially thinking of prostate cancer. Overall, though, it will be good to regularly tell more people that they need to lose weight, eat better, stop smoking, etc... I hope this doesn't just give doctors more opportunities to prescribe unnecessary drugs.
5) Public plan for anyone.
This is great, if it is affordable. COBRA is absurdly expensive, especially since it's offered to people who just became unemployed! This will definitely help small businesses and self-employed persons, too. No one can be denied for existing conditions.
6) Here Obama talks about an insurance marketplace. It seems like items 2-4 above would only apply to insurance companies who want to participate in the marketplace. Earlier, it sounded like those rules would apply to everyone, but now it seems like they only apply to private insurers who compete for the customers in the public plan pool. That's good incentive for working people to quit their company plan and join the public plan, but maybe only if company plans lose their tax breaks so the true costs are apparent.
7) No coverage for illegal immigrants.
If you want American services, become an American.
8) No federal money for abortions.
Someone said to me that the public plan can still cover abortions because it will be fully funded by premiums, and not federal money. I am not sure about that. It still sounds like the government would pay 900 billion dollars over a decade for the plan, but expects to get that money back from premiums. Obama didn't say he wouldn't spend federal money on the plan. He only said it wouldn't increase the deficit. It is important for the plan to not spend federal money on abortions because the plan would get shot down.
9) Conscience laws still apply.
These are terrible laws that protect health professionals who refuse to do their jobs.
It is not clear to me what incentive insurance companies have to participate in the exchange. This plan says it will have low premiums, but also provide far more services to a group of people likely to have more health problems. Though there is a lot of waste and inefficiency and advertising in other insurance companies, I still do not see how this plan will work. What is offers is going to be expensive. New customers would only be profitable if they pay in more than they cost, and I am skeptical.
If it really would work, I'll sign up. I would love to have the health plan Obama describes. If I felt a need for additional coverage, I am sure a private insurer will have options available to supplement me.
Obama also proposes experimenting (hooray!) in several areas to see if malpractice reform would be helpful. This is something that I already think would be helpful, for the same reasons that Obama wants to try it, and the experimentation would help prove whether it is or not. I am very happy about that.
So, there are some good ideas there, and I am excited about some of them, but I am also skeptical that it will work out as described. We definitely do need reform. Our current system is terrible. Almost any implementation of this plan would be an improvement over what we have, but I think it is likely that it will not meet expectations, and that failure will be used in the future to oppose more needed reform, and against good politicians.
It is a bit overreaching for Obama to be determined to be the last president to try to reform health care. We have no idea what the needs of America will be in fifty years. We will need constant monitoring, evaluation, and reform in order to adapt to future needs.
Over half of US personal bankruptcies are due to medical bills. Employer-provided health insurance (subsidized by the government) has been and is a bad idea. It is hard for US companies to compete internationally, and good American citizens get screwed if they are laid off or self-employed. Small businesses are over-burdened if forced to provide insurance, and the employees suffer either way. Trying to buy insurance individually strips away negotiating leverage and further hurts people.
America takes less care of its citizens than any other major nation. Not only has the government dropped the ball on taking care of everyone, but it lets insurance companies use techniques like rescission to exploit citizens. Obama is calling out our nation, an arrogant nation that likes to believe it is the best, on its cruelty and heartlessness towards its own members.
Obama correctly points out that we all pay more when the uninsured and underinsured end up in the emergency rooms for trivial problems, or major problems that could have been prevented by cheaper basic care. We pay more money as a country for pathetic health outcomes. What he doesn't go into are the details about that: our high payments for cancer treatments and whatnot to extend people's lives just a little instead of focusing on paying for basic and preventative care that would extend more people's lives by a lot. That would raise more "grandma-killing" nonsense, but it really is a great waste that hurts our whole nation. Is baby-killing better? Or worker-killing? Medicare and Medicaid costs are so bad because we provide expensive treatments to people who are going to die anyway, and we enable people with chronic illnesses like diabetes to not minimize their problems. When we can accept the fact of death for the elderly (the private insurance companies actually do have Death Panels, and they're effective at denying care to anyone), and get people to take the barest responsibility for themselves, costs will drastically drop. We also need to cut down on drugs as a whole culture. Pharmaceutical pill-pushing is costly, damaging, and out of control.
Single-payer systems are great, but not the only good solution. Making individuals buy private insurance is a terrible idea. The insurance companies would love that windfall.
The Republican party is united. That is their great strength. Unfortunately, they unite behind terrible ideas. The Democrats, instead of being blind sheep and puppets, like to think for themselves. This strength allows for creativity and progress. This unfortunately leads to many different ideas, such that even when these ideas are good, they split the votes and lead to conflicts that ultimately allow the Party of No to succeed.
THE PLAN
Finally, the meat and potatoes.
1) Enrollment in the public plan is optional if you have other insurance.
This is good. It will be healthy for private insurers to have to compete. Right now they have virtual monopolies in most of the country. People get to choose what they like (this is not always good because insurance plans can be hard to understand, and people are manipulated by advertisements). It is great to make health insurance mandatory. This will reduce waste due to ER visits, and reduce financial hardships for those who have sudden medical needs but didn't have insurance. Unfortunately, there is a hardship waiver for people who still can't afford the premiums. This is where the feds should just pay the premium, but later Obama says that he won't allow that. Hopefully Medicaid will take up anyone who can't afford the public plan premium.
2) Rescission is illegal for everyone.
This is good. People can have more security.
3) Federally mandated cap on out-of-pocket expenses.
This is interesting. I assume that the cap will depend on a person's income, and not be the same for everyone. This will raise premiums for everyone.
4) Federally mandated coverage for routine check-ups and preventative care.
This is probably very good. He mentions tests for cancer, and that worries me. Some cancer tests are very expensive and/or have high false-positive rates, leading to much dangerous, expensive, and unnecessary treatment. I'm especially thinking of prostate cancer. Overall, though, it will be good to regularly tell more people that they need to lose weight, eat better, stop smoking, etc... I hope this doesn't just give doctors more opportunities to prescribe unnecessary drugs.
5) Public plan for anyone.
This is great, if it is affordable. COBRA is absurdly expensive, especially since it's offered to people who just became unemployed! This will definitely help small businesses and self-employed persons, too. No one can be denied for existing conditions.
6) Here Obama talks about an insurance marketplace. It seems like items 2-4 above would only apply to insurance companies who want to participate in the marketplace. Earlier, it sounded like those rules would apply to everyone, but now it seems like they only apply to private insurers who compete for the customers in the public plan pool. That's good incentive for working people to quit their company plan and join the public plan, but maybe only if company plans lose their tax breaks so the true costs are apparent.
7) No coverage for illegal immigrants.
If you want American services, become an American.
8) No federal money for abortions.
Someone said to me that the public plan can still cover abortions because it will be fully funded by premiums, and not federal money. I am not sure about that. It still sounds like the government would pay 900 billion dollars over a decade for the plan, but expects to get that money back from premiums. Obama didn't say he wouldn't spend federal money on the plan. He only said it wouldn't increase the deficit. It is important for the plan to not spend federal money on abortions because the plan would get shot down.
9) Conscience laws still apply.
These are terrible laws that protect health professionals who refuse to do their jobs.
It is not clear to me what incentive insurance companies have to participate in the exchange. This plan says it will have low premiums, but also provide far more services to a group of people likely to have more health problems. Though there is a lot of waste and inefficiency and advertising in other insurance companies, I still do not see how this plan will work. What is offers is going to be expensive. New customers would only be profitable if they pay in more than they cost, and I am skeptical.
If it really would work, I'll sign up. I would love to have the health plan Obama describes. If I felt a need for additional coverage, I am sure a private insurer will have options available to supplement me.
Obama also proposes experimenting (hooray!) in several areas to see if malpractice reform would be helpful. This is something that I already think would be helpful, for the same reasons that Obama wants to try it, and the experimentation would help prove whether it is or not. I am very happy about that.
So, there are some good ideas there, and I am excited about some of them, but I am also skeptical that it will work out as described. We definitely do need reform. Our current system is terrible. Almost any implementation of this plan would be an improvement over what we have, but I think it is likely that it will not meet expectations, and that failure will be used in the future to oppose more needed reform, and against good politicians.
Thursday, July 16, 2009
Conservatives for Patients' Rights - Fearmongering Liars
I'm really busy this month with a big project, but I will take a minute to remark on the commercials being run by CPR. They've been on CNN during pieces about health care reform. These commercials use scare tactics to raise a fervor against a public health insurance plan. These commercials are misleading.
The one that comes to mind warns people that a public plan would put government bureaucrats between them and their doctors.
A) So what? That's better than having insurance company bureaucrats between people and their doctors. Insurance company bureaucrats do what they can to deny treatments. The government is proposing a public plan to increase the availability of care.
B) Good! As I've discussed before, doctors don't always follow best practices, and too often make uninformed, biased, ignorant decisions that could be prevented by informed oversight.
C) 47,000,000 Americans don't even get to see doctors right now, and the public plan would fix that. What stands between these people and their doctor is the absence of government involvement.
D) NO ONE IS FORCING ANYONE TO SIGN UP FOR THE PROPOSED PUBLIC PLAN. IT IS VOLUNTARY. IF YOU DON'T WANT IT, DON'T JOIN IT. There is no reason to oppose its creation.
The commercials also claim that the government would be financially wasteful, and cites other examples of government waste. This completely ignores the fact that the government-run health payers we already have (Medicare and Medicaid) are the least wasteful health payers, and are extremely efficient. In fact, many other corporate stoog... I mean Republicans are opposing a public insurance plan on the grounds that it would be so financially efficient that people would flock to it and private insurance companies would lose too much business. You can't have it both ways, conservatives. Stop with the obvious lies and misleading claims. Stop trying to convince the public to oppose what's good for the whole country just so you can keep collecting contributions from the insurance companies. Stop blindly believing that capitalism will make everything good, and start looking at the real world.
The one that comes to mind warns people that a public plan would put government bureaucrats between them and their doctors.
A) So what? That's better than having insurance company bureaucrats between people and their doctors. Insurance company bureaucrats do what they can to deny treatments. The government is proposing a public plan to increase the availability of care.
B) Good! As I've discussed before, doctors don't always follow best practices, and too often make uninformed, biased, ignorant decisions that could be prevented by informed oversight.
C) 47,000,000 Americans don't even get to see doctors right now, and the public plan would fix that. What stands between these people and their doctor is the absence of government involvement.
D) NO ONE IS FORCING ANYONE TO SIGN UP FOR THE PROPOSED PUBLIC PLAN. IT IS VOLUNTARY. IF YOU DON'T WANT IT, DON'T JOIN IT. There is no reason to oppose its creation.
The commercials also claim that the government would be financially wasteful, and cites other examples of government waste. This completely ignores the fact that the government-run health payers we already have (Medicare and Medicaid) are the least wasteful health payers, and are extremely efficient. In fact, many other corporate stoog... I mean Republicans are opposing a public insurance plan on the grounds that it would be so financially efficient that people would flock to it and private insurance companies would lose too much business. You can't have it both ways, conservatives. Stop with the obvious lies and misleading claims. Stop trying to convince the public to oppose what's good for the whole country just so you can keep collecting contributions from the insurance companies. Stop blindly believing that capitalism will make everything good, and start looking at the real world.
Tuesday, June 23, 2009
Insurance Industry Buys Politicians - Probably
FiveThirtyEight.com has a great post with a pretty graph about the likely effects of the amounts of money the insurance industry spends on politicians. The largest receiver of bri... contributions is Baucus, the guy leading the health care reform decisions, and who is opposed to a public insurance option.
FiveThirtyEight continues to be clear and responsible, pointing out that it did not take into account counter-lobbying from unions and other pro-public-option factions, and also that it is hard to tell if "perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around. Although I believe that accounting for ideology should correct for most of this".
FiveThirtyEight continues to be clear and responsible, pointing out that it did not take into account counter-lobbying from unions and other pro-public-option factions, and also that it is hard to tell if "perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around. Although I believe that accounting for ideology should correct for most of this".
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