Why This Republican is Praying for Obamacare

March 15th, 2010 at 12:25 am | 81 Comments |

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I’m a healthy (haven’t missed a day of work in 4 years), well-off (if things go well, I could make $200,000 this year), thirty-something Republican policy wonk. I donated to John McCain’s Presidential campaign. Good friends of mine held prominent positions in the Bush White House. I worked at a senior level for a big-name Republican politician. The last few months, I’ve helped several clients (Republican pols and trade associations you’ve heard of) try and throw cold water on President Obama’s health care plan. Indeed, large parts of the plan — subsidies for the middle class, greatly increased regulation of the private economy, and the genuine threat of health care rationing — offend my political beliefs. But, personally, I’d like to see Obamacare become law.

I’ll cut to the chase: I couldn’t ever handle my wife’s current health problems without insurance and the current precarious state of my own health coverage causes me tremendous anxiety and leads me to personally support the Democratic agenda for health care reform. As a result of chronic severe life-long asthma, a heart condition, and a lifetime of terrible medical luck — a broken arm that developed a bone infection in her 20s — she’s a physical wreck, entirely unable to work. I’m quite sure that no individual insurer would (or should) ever write an individual policy that includes her unless obligated to by law.

Even with a pretty good income of my own and the resources of our families we’d have enormous difficulty paying anything close to the medical bills my wife has run up without very comprehensive insurance. One stay she had at a major hospital cost over $130,000 and afterwards my then-employer’s HR director all but accused her of raising health insurance premiums for everyone in the office. (She was right.) A recent visit to the emergency room that included an MRI cost over $10,000. And I haven’t even seen the tab for her most recent 3-day hospital stay.

For now, largely thanks to President Obama’s policies, none of this is a major problem even though my co-pays and deductibles can exceed $500 a month (and our health insurance is, by all accounts, a very solid PPO plan). The federal government picks up about half of the health premium from the job my wife held before she got too sick to work — I made too much to qualify for the full 65 percent subsidy now available — but even this won’t last forever. We have about 7 months left on the subsidy and another few after COBRA runs out altogether.

After that, the options aren’t that good. I’ve made an agreement with one of my larger clients to add me to its payroll and health insurance plan if I ask them. The problem is, I’ll feel like crap if the company does this for me: it’s a small business with about 15 employees and my wife’ s health problems will probably raise premiums for everyone enough to have a material effect on the company’s bottom line and cut take home pay for all employees. Likewise, my wife, who can’t work, has put in an application for Social Security disability and, if it’s approved, will eventually qualify for Medicare. But, despite having worked to help craft Medicare policy on the national level, I didn’t know that she’ll have to wait two years to enroll. (Frankly, she probably could have qualified a year ago but, largely out of a mutual “we don’t need welfare” attitude, we didn’t apply then.)  And, after COBRA runs out, even one hospital stay would cause serious problems unless I rely on my client’s willingness to put me on its plan. The state I live in offers a “last resort” health care plan and, I could also create a “small group” consisting of myself and my secretary, who already has insurance through her husband, but either of these options would give us a very high monthly premium and even higher co-insurance every time my wife goes to the hospital.

We’d be better off (and I think society would too) under something like Obamacare. In a “public option” or community-rated individual market plan offered through an exchange I’d have no problem paying a premium and the costs of any subsidy we paid would be distributed across the entire exchange rather than focused narrowly. This seems a lot fairer than putting us on a heavily subsidized community-rated national health care plan largely intended for the elderly or, worse yet, forcing every employee of a small business to pick up a portion of our health care costs.

And I can’t see any other way to get through. No developed country, not even ours, requires the very sick to pay their own hospital bills in full. Through group plans, community rating, and public coverage, someone else will always pay a portion of the bills for the truly sick.  After all, my wife exercises when she’s healthy enough to, keeps her weight within recommended guidelines, gets all preventative care doctors say she should, takes her medications, eats right, has never smoked, and drinks only once in a while.  Her conditions result entirely from genetics and bad luck. It is one thing to say she should be responsible (she is) and another to say that my family deserves enormous financial hardship because of things entirely beyond our control.

In fact, the total level of subsidy would probably go down under Obamacare. Right now, we get a COBRA subsidy I don’t deserve. Without some serious reform, it’s likely that my wife will ultimately end up on Medicare with taxpayers picking up a large portion of her bills in any case.  What makes sense is a policy that would give us sturdy health insurance covering all of her preexisting conditions with predictable, if high, premiums and enough benefits that we won’t owe thousands of dollars out-of-pocket after a single hospital stay. It seems pretty simple but, absent sweeping health care reform, no such option exists or will exist.

Such an option includes the (modified) community rating and guaranteed issue provisions of Obamacare. Making these things work, in turn, requires something similar to an individual mandate to purchase health insurance. Without that, people will buy insurance only when they get sick. (New Jersey has tried that.) A mandate, in turn, would require some subsidies for lower income individuals to purchase health insurance. And, with that, one basically has Obamacare.  In this context I’m not even sure that a pure “public option” is a bad idea largely because, managed properly, it would skim off people like my wife and might actually moderate premiums in a privately managed individual market.

My interest, I must admit, is selfish. I’m never going to end up on the streets as a result of my wife’s medical bills and my wife is never going to go without needed medical care. I’m grateful that she can see all kinds of specialists without waiting for them and get high-tech diagnostics anytime a doctor thinks it might help. I wouldn’t wish any other nation’s medical system on her and understand that some of these things could well get worse under an Obamacare-like agenda. But, for now, it seems like the best option.

Recent Posts by Arthur Greene



81 Comments so far ↓

  • balconesfault

    Who knew FrumForum had become such a popular hangout spot for socialist commenters and posters?

    I suspect that a lot of centrist Republicans understand that had Bush not successfully pushed through Medicare Part B, and been rewarded with a much bigger support from elderly voters, he would likely have been a one-term President. And if Republicans hadn’t worked really hard last summer to enlist the Medicare crowd it’s likely healthcare reform would have passed months ago. So discussing “socialism” just reflects electoral reality in America … Americans don’t like the term, but they sure like the programs.

  • SpartacusIsNotDead

    Vadum wrote: “A commenter suggested Greene was courageous for taking this stand. If courage consists of feeding at the public trough, then yes, Greene is courageous.”

    I think the commenter was referring to Greene’s willingness to advocate for a healthcare reform that would put him at odds with all of his clients. Of course, Greene used a pseudonym and not his real name.

    Your position, however, is actually courageous and honest as well. There are very few Republicans and conservatives who will come out and say the government should not use taxpayer money to help anyone pay for medical care or, presumably, education or social security. Instead, they’ll come up with all kinds of crazy ideas and half-truths about the effect of health care reform or some of these other programs when, in their hearts, their simply opposed to programs that they perceive as helping someone else, but don’t have the courage to say they don’t want the government to help others.

    Your honesty is rare and, fortunately, so is your viewpoint. The overwhelming majority of all people in this country want public education, government retirement security for senior citizens, government healthcare for senior citizens and government health care for people who can’t afford to pay for health care. In fact, a majority of people in this country even want a government-run for health insurance as well as workers compensation insurance.

  • ASG

    Alex Knepper: So what you’re saying, then, is that you want to use the force of the law to make other people pay for it instead so that you can live somewhat more comfortably?

    Kind of like the fire department, everyone shares the cost, those whose homes never catch fire loose out. Should we base your contribution to the police department on whether or not you have ever been robbed, and if you have been robbed more than four times in your life, the police no longer have to respond to your 911 calls?

    sinz: If ObamaCare passes, I’ll enjoy guaranteed issue nationally and the benefits of the health insurance exchange. But the vast majority of Americans, who don’t need those benefits, will come off worse off under the plan. And they are what I care about.

    This is the truth, and the only fault I see with the current Democratic plan and most other significant attemtps at health care/insurance reform is that they miss this point- if we have true health reform, it will cost more for healthy people, but people with catastrophic or chronic illnesses should pay no more than any one else. I do mean no more, no copays, no deductibles, there is no reason that someone who has the misfortune of cancer (except smokers who bring it on themselves and pay for the treament through taxes) or type I diabetes should pay one dime more than someone with the fortune of good luck. The healthy person already has the benefit of longer life and ability to do more with that life (idealized movies of the week not withstanding), there is no reason that in a civilized country everyone cannot pitch in those who are truly of less good fortune.

  • ASG

    sinz54: (apologies for leaving out the 54 earlier) The MA experience suggests that it’s still fiscally unsustainable to cover those with pre-existing conditions, even with such a mandate for universal coverage as RomneyCare had.

    If this is truly the case, then the only logical options are to either eliminate the insurance companies and go with a national single payer system, or just let those with pre-existing conditions suffer financial ruin and die young.

  • ASG

    vadum:No one is saying his family deserves financial hardship. That’s ridiculous and is a loathsome rhetorical trick. Greene is arguing that his family’s need for medical services entitles him to the property of others. That’s what it boils down to. This so-called Republican abandons the idea of personal responsibility.

    Since I am going to give you the benefit of not thinking you mean a type I diabetic or a childhood cancer patient is responsible for causing his own illness, all that it left is that you are an anarchist and think there should be no governemtn pooling of resources for anything that might benifit one individual more than another. I am sure you also feel that there isno need for a military to exist except to use the property of someone in Florida to stop an invasion in Maine.

  • grackle

    As I understand it, the GOP approach is to create a state “high risk pool” for those with pre-existing conditions, each state running its own pool. That’s the same proposal that McCain made in his 2008 presidential campaign.

    The problems with this are obvious. Some states, like California, are already so insolvent that they can’t afford to implement such a pool on their own–at least not without making draconian cuts to what is covered. And any high-risk driver who is in an auto insurance high-risk pool due to having many accidents will tell you that his premiums are sky-high.

    So yes, Mr. Greene might get coverage for his family under the GOP plan. But it is likely to be minimalist coverage (catastrophic care only), at a premium so high he may not be able to afford it, unless he’s affluent.

    The states would get 25 billion from DC. Considering that the subject is a very small group(those with pre-existing conditions who cannot find affordable insurance), that amount should be ample incentive. The premiums could not be higher in cost than 150% of the average premium in that state. Many states already have some version of this.

    Any medical condition would be covered, not “catastrophic care only.” Of course, it is anticipated that those who cannot find affordable insurance would necessarily possess a pre-existing condition which might require “catastrophic care,” but their more mundane medical needs would also be taken care of. States would not be allowed to make “draconian cuts to what[medical condition] is covered.” Also, unlike the Democrat plan, there would be no waiting lines to enter the program.

    Of course, states like California might have to institute some sane fiscal policies, but surely it is unfair to blame the GOP(and sentence all Americans to a draconian healthcare system) because California and other profligate states might be unwilling to curb their spending.

    Moreover, Mr. Greene states that, “the state I live in offers a “last resort” health care plan.” By law such plans now have a premium cost capped at 200% of the average premium in that state – not free but also not prohibitive for someone who, by his own account, stands to earn $200,000 this year.

  • balconesfault

    The states would get 25 billion from DC. Considering that the subject is a very small group(those with pre-existing conditions who cannot find affordable insurance), that amount should be ample incentive. The premiums could not be higher in cost than 150% of the average premium in that state.

    A few problems:

    First, I do not understand how this works. If premiums can’t be higher in cost than 150% of the average premium in the state, the policies will clearly need subsidization. Insurance companies aren’t turning these people away because they pose slightly more actuarial risk than the general insurance pool – they’re turning them away because they pose significantly more risk.

    I could easily see the true cost of those policies being 3x or 4x the cost of the regular insurance pool – and it will actually get worse when you reduce the incentive for employers to carry group policies by ensuring that their employees with pre-existing condition could get reasonably priced insurance outside thei group pool, since shedding coverage for those employees would be a direct pathway to the employer to significantly reduce their cost of insurance.

    Second, the 25 billion works under the assumption that across society, more and more companies don’t keep cutting insurance benefits to employees as the costs of policies take a bigger and bigger bite out of their profits. Given our current economic conditions, that seems like an extremely risky bet.

    Meanwhile, we’re not doing anything to address the healthcare needs of the millions of Americans who can’t afford a decent comprehensive insurance plan, but aren’t eligible for Medicare. Not to mention the subset of them who have pre-existing conditions that would kick them up to that 150% premium making it even a bigger bite out of their rent money.

    As I said above, however – I agree that Mr. Greene is on thin ice here. His narrow call for healthcare reform is like calling for Government to pass programs which benefit people in his situation, but don’t expand the coverage to help anyone else if it’s avoidable.

  • JonF

    Re: The difference being that it takes a decade of work to train to be a doctor — and it takes billions of dollars to develop a single new life-saving drug.

    Irrelevant. You are aware that today’s agriculture involves lots of high tech stuff too, and our clothing is certainly not spun from wool and cotton on hand-operated looms?
    There’s still a surfeit of healthcare in this country. Pretty much all seriously ill people do get healthcare: they just have to travel through the bankruptcy courts or similar such nonsensical venues to obtain it. This is a howling absurdity, and not something dictated as a necessity by markets.
    Again, we are not some Third World hellhole of a country. We most certainly can provide healthcare (at non “cadillac” levels) to all our people without straining oursrseles. We have universal food and universal clothing, largely by market devices (with some public backstop as necessary). I see no reason we cannot also have universal healthcare in the same manner: leave the providers private of course, but backstop with public funds where necessary, much as we do with food (e.g., food stamps).

  • JonF

    Grackle,
    A better way to do this would simply be to have the Federal Govenment assume the position of reinsurer, covering all high dollar claims and claimants above a certain level (probably determined by individual income) . This is more or less analogous to how the Feds end up being the reinsurer (though we don’t call it that) in cases of natural disaster, with FEMA and the like filling in where private insurance falls short. Since reinsurance is by far the priciest aspect of most insurance, the premiums for private policies would fall to much a lower level, perhaps even becoming affordable for people with preexisting conditions.

  • grackle

    Myself, earlier: The states would get 25 billion from DC[for Universal Access Programs]. Considering that the subject is a very small group(those with pre-existing conditions who cannot find affordable insurance), that amount should be ample incentive. The premiums could not be higher in cost than 150% of the average premium in that state.

    The commentor: A few problems: First, I do not understand how this works. If premiums can’t be higher in cost than 150% of the average premium in the state, the policies will clearly need subsidization. Insurance companies aren’t turning these people away because they pose slightly more actuarial risk than the general insurance pool – they’re turning them away because they pose significantly more risk.

    The “subsidization” is the 25 billion from DC.

    I could easily see the true cost of those policies being 3x or 4x the cost of the regular insurance pool – and it will actually get worse when you reduce the incentive for employers to carry group policies by ensuring that their employees with pre-existing condition could get reasonably priced insurance outside the group pool, since shedding coverage for those employees would be a direct pathway to the employer to significantly reduce their cost of insurance.

    Now it’s me that can’t quite “understand how this works.” How would providing a Universal Access Program for those with pre-existing medical conditions who cannot find affordable insurance and therefore NOT employed and under ANY employer’s group insurance “reduce the incentive for employers to carry group policies” as an employee benefit? Programs very similar to the GOP’s Universal Access Program already exist in many states(even the article’s author’s state, apparently) and yet no such reduction in incentive seems to have occurred.

    And it’s understood that such a group(those with pre-existing conditions unable to find affordable insurance) would require an inherently more expensive premium, perhaps even “3x or 4x the cost of the regular insurance pool” – thus the 25 billion subsidization from DC.

    Second, the 25 billion works under the assumption that across society, more and more companies don’t keep cutting insurance benefits to employees as the costs of policies take a bigger and bigger bite out of their profits. Given our current economic conditions, that seems like an extremely risky bet.

    If companies were to significantly cut insurance benefits to employees due to higher insurance costs, a risky assumption, it would seem to me that the GOP healthcare plan which is designed to lower the cost of insurance would be one answer. Let’s allow the selling of medical insurance across state lines, institute tort reform for medical malpractice suits, allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do, and see what happens to the cost of insurance.

    Meanwhile, we’re not doing anything to address the healthcare needs of the millions of Americans who can’t afford a decent comprehensive insurance plan, but aren’t eligible for Medicare. Not to mention the subset of them who have pre-existing conditions that would kick them up to that 150% premium making it even a bigger bite out of their rent money.

    I can only quote again from an earlier comment:

    Of those who are uninsured (the President said 30 million in his address to Congress) a significant percentage (amounting to 10 million or more people) are uninsured by choice, i.e. they can afford insurance but are young and healthy and don’t care to buy it. The actual number of uninsured who need help and aren’t eligible for any other program is probably under 5%.

    As for that 5%, surely some way can be found to provide health care for them, even perhaps some way requiring a modest monetary payment from them, without sentencing the other 95% of Americans to a lifetime under a draconian and costly system. I don’t believe my purpose in life should be to prevent some folks comprising a small percentage of the population from a having “bigger bite out of their rent money” for various goods. Perhaps they should find a cheaper apartment.

  • balconesfault

    As for that 5%, surely some way can be found to provide health care for them, even perhaps some way requiring a modest monetary payment from them, without sentencing the other 95% of Americans to a lifetime under a draconian and costly system.

    You do realize that of those 95% of Americans who would be sentenced to this cruel fate – almost 35% are currently receiving Medicare or Medicaid?

    If companies were to significantly cut insurance benefits to employees due to higher insurance costs, a risky assumption, it would seem to me that the GOP healthcare plan which is designed to lower the cost of insurance would be one answer.

    Whether it would really result in lower healthcare costs is up in the air. What it most certainly would do would be to release a larger number of people with pre-existing conditions into the marketplace, where they would need to be recipients of your government subsidized insurance in order to receive coverage (currently they’re subsidized by all their fellow plan-mates with lower risk factors). This would then drive up the amount of money government will need to pump into the program in order to maintain its solvency.

    As for my earlier contention that companies would find some way to reduce their group insurance costs by incentivizing those with pre-existing conditions to opt out and purchase government insurance instead – I’m a big believer in the ability of large companies to find loopholes in any system and take advantage of them, if said loopholes exist on a broad enough scale. For a company with multiple outlets across state lines to deal with this loophole on a state-by-state basis (and thus be seen as treating employees in some places differently than others) the economy of managing such a program probably balances out the benefits.

    But if I’m running some company with a large enough employee base, and my insurance agent comes to me in the fall and says “we’re going to have to bump your premiums another 25% next year – unless you find a way to encourage the 5% of your workforce who either have a certain condition or a family member with a certain condition to opt out and buy into the government program” … I’m listening. Because it may be a minor matter to pay an opt-out bonus to those employees sufficient for them to buy into the subsidized program that in net creates a large savings company wide.

    Why wouldn’t I?

  • grackle

    Me, earlier: As for that 5%, surely some way can be found to provide health care for them, even perhaps some way requiring a modest monetary payment from them, without sentencing the other 95% of Americans to a lifetime under a draconian and costly system.

    You do realize that of those 95% of Americans who would be sentenced to this cruel fate – almost 35% are currently receiving Medicare or Medicaid?

    Yes, primarily Medicare, which would necessarily have to be severely rationed under the Dem’s plan. Provided new entrants to Medicare could even find a doctor who would take them on as a patient. I guess the government would have to “force” American doctors to take new Medicare entrants. Now that I think about it, I suppose much the same would be true for Medicaid.

    Me, earlier: If companies were to significantly cut insurance benefits to employees due to higher insurance costs, a risky assumption, it would seem to me that the GOP healthcare plan which is designed to lower the cost of insurance would be one answer.

    Whether it would really result in lower healthcare costs is up in the air.

    As opposed to Obamacare? Which would be, as Obama emphatically claims, deficit-neutral? The commentor actually BELIEVES that? I say at least try the less extreme measures in the GOP plan instead of jumping off into a vast new entitlement.

    What it most certainly would do would be to release a larger number of people with pre-existing conditions into the marketplace …

    HUH? Again, I can’t quite understand how this works. Trying the less extreme GOP plan would “release a larger number of people with pre-existing conditions into the marketplace.” I think the readers need a fuller explanation of such a puzzling conclusion.

    … where they would need to be recipients of your government subsidized insurance in order to receive coverage (currently they’re subsidized by all their fellow plan-mates with lower risk factors). This would then drive up the amount of money government will need to pump into the program in order to maintain its solvency.

    If the commentor is worried about the extra cost he suspects will be incurred should the GOP plan ever be put to the test he must be out of his mind with apprehension about Obamacare, which creates a vast and entirely new entitlement of 1/6th of the total US economy encompassing EVERY single American. Here I will pause to offer my sympathies to this poor soul who must be literally wracked with anxiety.

    As for my earlier contention that companies would find some way to reduce their group insurance costs by incentivizing those with pre-existing conditions to opt out and purchase government insurance instead – I’m a big believer in the ability of large companies to find loopholes in any system and take advantage of them, if said loopholes exist on a broad enough scale. For a company with multiple outlets across state lines to deal with this loophole on a state-by-state basis (and thus be seen as treating employees in some places differently than others) the economy of managing such a program probably balances out the benefits.

    I may not be understanding the commentor’s meaning here but I am afraid that it boils down to, “If the GOP universal Access Program were to be adopted the companies might game the Program.” I wonder if the commentor believes the companies would “find loopholes” in the similar(but not quite as good) program which is contained in Obamacare? But, as I pointed out before, similar programs for those with pre-existing conditions have already existed for some time in many states without evidence that the loophole-finding has occurred.

    But if I’m running some company with a large enough employee base, and my insurance agent comes to me in the fall and says “we’re going to have to bump your premiums another 25% next year – unless you find a way to encourage the 5% of your workforce who either have a certain condition or a family member with a certain condition to opt out and buy into the government program” … I’m listening. Because it may be a minor matter to pay an opt-out bonus to those employees sufficient for them to buy into the subsidized program that in net creates a large savings company wide. Why wouldn’t I?

    Twenty-five percent seems kind of exorbitant, even for a rather far-fetched hypothetical. I can see such a thing as within the remote realm of possibility if the insurance company were to threaten a premium increase of, say, 2%. But a company with a large employee base is going to have ways of dealing with such a contingency. Like telling the agent, “Well, the guys from Acme Insurance have been bugging the Board to change our insurance provider over to them; I guess we’ll give them a call.” Companies with a “large enough employee base” have a LOT of clout in the world of insurance providers.

    Also, the company would “find a way to encourage the 5% …” how, exactly? Harass them? And how would the 5% “opt out”? Employee benefits are usually NOT an option for the employees. Employees cannot usually go to Human Resources and tell them, “Hey, you know what? I don’t think I’ll be under certain company benefits anymore.” If you work there, you get the benefits. Period. It’s not a menu that employees get to pick certain main items and not others.

  • ASG

    grackle: Twenty-five percent seems kind of exorbitant,

    Lets do the math, start with say a $1000/month plan and a company of 50 employees. That gives an annual pool of $600,000. Say 25% of that is overhead including profits for the insurance company, leaving $450,000. This manages to cover the routine expenses of the eployees and their famiies, a few with chronic illnesses, some older employees with higher basic needs. Now one employee has a child diagnosed with cancer, and treatment could last for a few years before the child is cured. Meanwhile the spouse of another employee has a stroke, and requires a few years of rehabilitation. The costs of those two catastrophic ilnessess, affecting a mere 4% of the employee base could easily exceed $150,000 per year and force a 25% increase in premiums to offset the costs. Spreading these increased costs amond other customers isn’t going to happen, why would the insurance company hold onto a cusomer who is guaranteed to cause losses. Other insurance companies might offer a lower premium for the first year, but would quickly increase their premiums once the costs were discovered.

    grackle: Also, the company would “find a way to encourage the 5% …” how, exactly? Harass them? grackle: And how would the 5% “opt out”? Employee benefits are usually NOT an option for the employees. Employees cannot usually go to Human Resources and tell them, “Hey, you know what? I don’t think I’ll be under certain company benefits anymore.” If you work there, you get the benefits. Period. It’s not a menu that employees get to pick certain main items and not others

    The original commenter suggested that the employer migh offer some (financial?) incentive for the employees to opt out of health insurance.

    grackle: And how would the 5% “opt out”? Employee benefits are usually NOT an option for the employees. Employees cannot usually go to Human Resources and tell them, “Hey, you know what? I don’t think I’ll be under certain company benefits anymore.” If you work there, you get the benefits. Period. It’s not a menu that employees get to pick certain main items and not others

    I’d like to know where grackle has worked all of his life, as not only is it normal to have to choose whether or not to take advantage of the company health insurance, but also choose among a variety of options with different tiers of coverage, and employee contributions to the premiums.

  • balconesfault

    What it most certainly would do would be to release a larger number of people with pre-existing conditions into the marketplace …

    HUH? Again, I can’t quite understand how this works. Trying the less extreme GOP plan would “release a larger number of people with pre-existing conditions into the marketplace.” I think the readers need a fuller explanation of such a puzzling conclusion.

    Yes – I apologize here, and when I re-read my post I realized this ambiguity – had there been an edit function I would have altered it.

    What I meant to say was not that the Republican plan would “release a larger number of people with pre-existing conditions into the marketplace”, but that “If companies were to significantly cut insurance benefits to employees due to higher insurance costs” this would “release a larger number of people with pre-existing conditions into the marketplace”. I apologize for the sloppy writing.

    If the commentor is worried about the extra cost he suspects will be incurred should the GOP plan ever be put to the test he must be out of his mind with apprehension about Obamacare, which creates a vast and entirely new entitlement of 1/6th of the total US economy encompassing EVERY single American.

    I’m not so much worried about the extra costs, as I’m convinced that they’re very likely understated, and that at the end of the day they create a mechanism for covering far fewer additional uninsured Americans at a much higher cost per person.

    I may not be understanding the commentor’s meaning here but I am afraid that it boils down to, “If the GOP universal Access Program were to be adopted the companies might game the Program.”

    Actually, I fully expect companies to game the system, if there are significant cost savings to be had. It’s what I would do if I were in that decision making role for a large corporation.

    I wonder if the commentor believes the companies would “find loopholes” in the similar(but not quite as good) program which is contained in Obamacare?

    I’m certainly open to the possibility. But I don’t see the mechanism whereby a company reduces the actuarial risk of their insured pool by sloughing off lower wage employees … ironically it is the higher wage employees who are more likely to have some pre-existing condition that increases the risk pool – and these higher wage employees would be ineligible for the current Democratic healthcare proposal.

    Meanwhile, ASG did an excellent job of defending my hypothetical. In fact, it suggests that my proposed numbers may have been conservative.

  • balconesfault

    grackle: Also, the company would “find a way to encourage the 5% …” how, exactly? Harass them? grackle: And how would the 5% “opt out”? Employee benefits are usually NOT an option for the employees. Employees cannot usually go to Human Resources and tell them, “Hey, you know what? I don’t think I’ll be under certain company benefits anymore.” If you work there, you get the benefits. Period. It’s not a menu that employees get to pick certain main items and not others</i?

    ASG: The original commenter suggested that the employer migh offer some (financial?) incentive for the employees to opt out of health insurance.

    In fact, I work for an employer who recognizes that much of their workforce are part of dual wage-earner couples. Thus, they offer a decent sized bonus if I opt out of coverage by my company and rely on my wife’s company for coverage. Meanwhile, anyone in a dual wage-earner couple with a family has probably been through the annual exercise of looking at benefits and employee contributions for both policies and making the decision as to which policy they’ll rely on for coverage of the employee plus family, rather than simply the employee.

    I see little reason why a company wouldn’t quickly identify those employees with pre-existing conditions and offer them an “opt out bonus” slightly larger than the cost of buying into the 150% government run program, making it a win-win for both sides, if a lose for the taxpayers.

  • ottovbvs

    …….I got fed up with arguing with all these obviously middle or working class posters arguing against their own interest, or who have relatives on Medicare, but this was a very honest piece of analysis by Greene……in fact I’ve come across a few Republican diehards who have Damascene coversions when it strikes close to home…..and I don’t want to worry you further Mr Greene but I wouldn’t count on the reliability of this statement

    ” I’m never going to end up on the streets as a result of my wife’s medical bills and my wife is never going to go without needed medical care. ”

    ……Loose your job and you could easily und up on the streets or in the bankruptcy court.

  • SFTor1

    The conservative position on health care is pretty simple: “get rich, and you won’t have to worry about it.”

    The corollary: “if you’re poor, why should you get it?”

    It’s an honest attitude.

  • ottovbvs

    “It’s an honest attitude.”

    …….It may be an honest attitude but they’re seldom honest about it instead seeking cover in phony plans and phony grandstanding.

  • grackle

    grackle: Twenty-five percent seems kind of exorbitant,

    Lets do the math, start with say a $1000/month plan and a company of 50 employees …

    Fifty employees is NOT an employer with a large employee base, but rather what is commonly referred to as a “small” employer. Most small employers do not offer coverage so the above hypothetical is moot. My response assumed an employee base of thousands, a large employer replete with a Human Resources department, a Board of Directors, etc.

    The original commentor suggested that the employer might offer some (financial?) incentive for the employees to opt out of health insurance.

    Yes, but how would the “(financial) incentive” actually work? A straightforward “We’ll pay you X amount of money to opt out of our insurance benefit.”? It would seem to me to be simple matter of wording the legislation to prevent such deals: Since the Universal Access Plan is meant only for those who with pre-existing medical conditions who do not have and cannot find affordable private insurance it shall be illegal for any employer to pay employees to switch from the employer insurance to the Universal Access Plan …or some other similar wording.

    … not only is it normal to have to choose whether or not to take advantage of the company health insurance, but also choose among a variety of options with different tiers of coverage, and employee contributions to the premiums.

    The original hypothetical was of large employers, where it would not be “normal” to opt out of the company health insurance once electing it upon being hired. Granted that from the outset there would be a choice “among a variety of options with different tiers of coverage, and employee contributions to the premiums,” for example whether to include dependents in the individual employee’s coverage, and the type of coverage(if such an option is offered) but among large employers it would not be “normal” for employees to opt out of the coverage completely.

    But let’s say that the employee A’s spouse had a job in which one of the spouses’ company benefits was group insurance under which employee A could also be covered. The spouse and employee A might then very well choose to opt out of my employer’s health benefit(or take only the minimum medical insurance benefit) at an annual enrollment period.

    But the hypothetical was of folks with an expensive medical condition somehow being thrown out into the cruel world without ANY recourse to affordable private insurance. I still maintain the GOP Universal Access Plan is a better answer to such a problem than Obamacare.

  • grackle

    A commentor: What it[the GOP Universal Access Program] most certainly would do would be to release a larger number of people with pre-existing conditions into the marketplace …

    My reply: HUH? Again, I can’t quite understand how this works. Trying the less extreme GOP plan would “release a larger number of people with pre-existing conditions into the marketplace.” I think the readers need a fuller explanation of such a puzzling conclusion.

    The commentor: What I meant to say was not that the Republican plan would “release a larger number of people with pre-existing conditions into the marketplace”, but that “If companies were to significantly cut insurance benefits to employees due to higher insurance costs” this would “release a larger number of people with pre-existing conditions into the marketplace”.

    Again, I don’t see how this would work. Is the commentor asserting that if insurance costs go up that(large) companies would fire those employees with pre-existing medical conditions? Since insurance costs have most certainly have BEEN going up for some time can the commentor cite instances where this has happened? If so, isn’t this more of an argument FOR adoption of the GOP plan, with it’s mechanisms to address the rise in insurance costs?

    Me, earlier: If the commentor is worried about the extra cost he suspects will be incurred should the GOP plan ever be put to the test he must be out of his mind with apprehension about Obamacare, which creates a vast and entirely new entitlement of 1/6th of the total US economy encompassing EVERY single American.

    I’m not so much worried about the extra costs, as I’m convinced that they’re very likely understated, and that at the end of the day they create a mechanism for covering far fewer additional uninsured Americans at a much higher cost per person.

    So the commentor believes the GOP plan will be more costly than Obamacare – to the tune of … a much higher cost per person … – than Obamacare?? Or am I mistaken in his meaning? If so he could clarify by answering a simple question: Which does the commentor believe would be more costly – the GOP plan or Obamacare?

    Me, earlier: I may not be understanding the commentor’s meaning here but I am afraid that it boils down to, “If the GOP universal Access Program were to be adopted the companies might game the Program.”

    Actually, I fully expect companies to game the system, if there are significant cost savings to be had. It’s what I would do if I were in that decision making role for a large corporation.

    One man’s “game the system” is another’s “doing what’s best for the shareholders, while complying with the law,” I guess.

    Me, earlier: I wonder if the commentor believes the companies would “find loopholes” in the similar(but not quite as good) program which is contained in Obamacare?

    I’m certainly open to the possibility. But I don’t see the mechanism whereby a company reduces the actuarial risk of their insured pool by sloughing off lower wage employees … ironically it is the higher wage employees who are more likely to have some pre-existing condition that increases the risk pool – and these higher wage employees would be ineligible for the current Democratic healthcare proposal.

    So the commentor is saying, I guess, that employers would “game” the GOP plan but NOT “game” Obamacare. I can’t understand the why the commentor would make this assumption.

  • grackle

    Some further thoughts on what a previous commentor wrote in the paragraph below:

    I’m certainly open to the possibility[that companies would “game” Obamacare just as they would the GOP plan]. But I don’t see the mechanism[in Obamacare] whereby a company reduces the actuarial risk of their insured pool by sloughing off lower wage employees … ironically it is the higher wage employees who are more likely to have some pre-existing condition that increases the risk pool – and these higher wage employees would be ineligible for the current Democratic healthcare proposal.

    There’s an income requirement to be in Obamacare? If a high enough wage is earned then you are exempt from Obamacare? True, we don’t really know yet the exact final wording of Obamacare, but nothing I’ve read before the above comment claims that if a citizen earns a certain high wage that they would be “ineligible”(or ‘not subject to,’ depending on your opinion of Obamacare) for Obamacare. Am I incorrect in thinking that Obamacare would require that all citizens be subject to Obamacare? Or is there some clause in some version of the bill that has seen the light of day that I’m not aware of that renders some citizens that earn a high wage as “ineligible” for Obamacare?

  • balconesfault

    There’s an income requirement to be in Obamacare?

    There’s an income requirement to have your insurance costs subsidized, yes.

    You seem to regard Obamacare as some strange slogan, rather than really understanding what is in the healthcare bill.

  • balconesfault

    It would seem to me to be simple matter of wording the legislation to prevent such deals: Since the Universal Access Plan is meant only for those who with pre-existing medical conditions who do not have and cannot find affordable private insurance it shall be illegal for any employer to pay employees to switch from the employer insurance to the Universal Access Plan …or some other similar wording.

    The employer would not be paying employees to switch to the Universal Access Plan.

    He would be paying employees to opt out of the company plan.

    To work, you would have to mandate that if an employer carries a group plan, that he does not offer any kind of opt-out clause that benefits the employee in any other way.

    I suspect that this would end up hitting a lot of military retirees in the wallet, since there is no small number of them in the workforce who have full military healthcare benefits, and I would bet there is no small number of those who have negotiated larger salaries in exchange for opting out of the company healthcare plan.

    How much are you willing to tie employers hands when they’re trying to be creative about compensation packages?

    Again, I don’t see how this would work. Is the commentor asserting that if insurance costs go up that(large) companies would fire those employees with pre-existing medical conditions?

    No, Im asserting that as insurance costs go up, more employers will completely drop group insurance policies as being too big a burden.

    insurance costs have most certainly have BEEN going up for some time can the commentor cite instances where this has happened?

    Sure. To start:

    http://www.chicagotribune.com/business/chi-thu-t6-small-biz-uninsured-0feb26,0,1984771.story

    More recently:

    http://www.mcclatchydc.com/2010/03/02/89687/some-companies-drop-health-insurance.html

    If so, isn’t this more of an argument FOR adoption of the GOP plan, with it’s mechanisms to address the rise in insurance costs?

    Well, we all have opinions there. I don’t see the Republican plan as having the seeds to significantly change the trajectory of healthcare costs. That is a policy disagreement between us that I don’t think we’ll be able to argue our way out of.

    So even if they did blunt the rate of increase somewhat, I think that costs will still continue to rise, and will eventually still become unaffordable for many businesses – particularly those competing in a market where their overseas competitors have government subsidized healthcare.

    So the commentor believes the GOP plan will be more costly than Obamacare – to the tune of … a much higher cost per person … – than Obamacare?? Or am I mistaken in his meaning?

    The Senate Plan will take direct governmental action to expand coverage by about 30 million Americans, via subsidies for those who cannot afford to purchase comprehensive plans (this is where the means testing I noted in #72 comes in).

    The Republican plan will take direct governmental action to expand coverage by about 3 million, and will limit them to the most expensive risk pool to cover, which will certainly lead to a much higher cost per person. You are right that in total, the Democratic plan would cost more in direct government subsidies but at a lower cost per person.

    Actually, I fully expect companies to game the system, if there are significant cost savings to be had. It’s what I would do if I were in that decision making role for a large corporation.

    One man’s “game the system” is another’s “doing what’s best for the shareholders, while complying with the law,” I guess.

    Exactly right. I expect companies to game the system, precisely because their fiduciary responsibility to their shareholders demands that.

    So the commentor is saying, I guess, that employers would “game” the GOP plan but NOT “game” Obamacare. I can’t understand the why the commentor would make this assumption.

    I didn’t say that. I said that the “game” I was talking about – employers sloughing off their highest risk employees in order to reduce their group policy costs – was incentivized under the Republican Plan (which would subsidize the cost of uninsured high risk individuals if they opted out of the company plan) … while it was not incentivized under the Senate Plan (which would subsidize the cost of uninsured based on their economic status – which is more likely to mean younger employees who are actually good to keep in a companies insurance pool).

  • grackle

    Me earlier: It would seem to me to be simple matter of wording the legislation to prevent such deals …

    The employer would not be paying employees to switch to the Universal Access Plan. He would be paying employees to opt out of the company plan.

    Readers, this seems to me to be a rather exquisite distinction. Let’s just say the employer is paying the employee to opt out of the company plan and if the employee had a pre-existing condition that employee would inevitably end up on the Universal Access Program if the employee could find no other coverage.

    To work, you would have to mandate that if an employer carries a group plan, that he does not offer any kind of opt-out clause that benefits the employee in any other way. How much are you willing to tie employers hands when they’re trying to be creative about compensation packages?

    Naw, you could simply make it illegal for employers to pay employees to drop their coverage. Anything can be made against the law. There are many ways that employers paying employees to opt out of job-related insurance benefits could be made illegal. But what the commentor is talking about is not employers being “creative,” it’s really about employers conning an insurance benefit from certain of their employees who might need their insurance for the possible treatment of future hypothetical expensive medical conditions – what the commentor refers to as “high risk” workers.

    I suspect that this would end up hitting a lot of military retirees in the wallet, since there is no small number of them in the workforce who have full military healthcare benefits, and I would bet there is no small number of those who have negotiated larger salaries in exchange for opting out of the company healthcare plan.

    I doubt that large numbers of military retirees have negotiated larger salaries in exchange for not taking company healthcare plans. Such a thing would be a rarity. Salaries are usually negotiated based on skills, experience and educational level – not usually for opting out of a company benefit when an employee is hired.

    And after hiring, salaries and raises are usually negotiated according to job performance. “I know I’m a lousy branch manager but give me that raise anyway. I don’t take the company insurance, you know.”

    I would even bet, if there were a way to prove it one way or another, that many military retirees choose to take the employer insurance even though they have the retiree healthcare benefit. It’s not always easy to get treatment at VA hospitals and military bases, even if you are lucky to have one of those in proximity to where you end up living and working after retirement.

    … I’m asserting that as insurance costs go up, more employers will completely drop group insurance policies as being too big a burden.

    Well, then the individual will have to shop for coverage, but not across state lines at present. It’s a pity that shopping for medical coverage is not as versatile and as cost-saving as shopping for auto insurance. The GOP plan would change that lack of competition – to the benefit of the consumer. Obamacare won’t let it happen. But isn’t the root cause for an employer to “drop” things also a function of the overall economic situation? We ARE in a bad recession.

    Or a competing employer, that does offer the benefit, could hire the worker out from under the employer that couldn’t offer the benefit. Free market forces.

    Me, earlier: … insurance costs have most certainly have BEEN going up for some time can the commentor cite instances where this has happened?

    Sure. To start: http://tinyurl.com/c75jop

    More recently: http://tinyurl.com/ykhed6m

    About the McClatchy piece: It’s a bit vague. The main subject of the article(there’s a link to the complete article in the summary that the commentor links to) is of “companies that drop their health insurance coverage and don’t bother to tell employees,” which is illegal in North Carolina.

    It’s a practice that’s on the rise, says Kristin Milam with the state Department of Insurance.

    One thing that bothers me is that no figures are cited. A “rise” cannot be judged as significant or minor to readers unless there is some data to analyze.

    Also the statement is not about companies that drop their insurance per se but only about the ones that break the law by not warning their employees before they do. Companies that drop insurance might not necessarily be “on the rise” just because companies that do so without telling their employees might be “on the rise.” Statistically, dropping insurance could actually be on the decline even while those who do so without telling their employees could be “on the rise.” See the problem? Such are the subtleties of real-life statistics.

    Interestingly, the article makes it clear that if an employee has his insurance dropped there are options for those individuals:

    Milam says that in many cases, the insurance company that offered the group insurance will set up employees with an individual plan. Employees also can shop for an individual plan. Those with a pre-existing or chronic condition can turn to the state’s high-risk insurance pool.

    Another thing: The article is about small businesses. “A lot of small business owners are hurting right now …” asserts the article. And the Tribune article is also about small businesses. So all this is irrelevant to my original point, and the commentor’s original point, which was about large businesses with an employee base of thousands and a Board of Directors – who have a lot of clout in the insurance market. Since most small businesses don’t offer insurance to their employees it’s sort of futile to keep discussing the problems of small businesses vis a vis insurance for their employees. I thought I made all this clear in previous comments.

    One more thing: I think I might be swayed a bit more in my opinion by sources other than a McClatchy or a Tribune article. I don’t have much faith in the MSM these days. For me, they lost their credibility years ago. Even when they don’t have a political ax to grind or an ideological template to promote, they are frequently just flatly or perhaps sloppily wrong in their facts.

    I’ve worked for 2 employers that were frequently in the news. At one we used to post the articles on the bulletin board in the break room with the errors, distortions and misquotes underlined in red, which sometimes consisted of practically the entire piece. At each employer, every single article about the employer, perhaps 20 to 30 articles in all, had at least one error – at least one thing that was not true. We used to laugh about it. It was a standing item of(wry) humor.

    I don’t see the Republican plan as having the seeds to significantly change the trajectory of healthcare costs … So even if they did blunt the rate of increase somewhat, I think that costs will still continue to rise, and will eventually still become unaffordable for many businesses – particularly those competing in a market where their overseas competitors have government subsidized healthcare.

    These things evolve, don’t they? A lot of folks get their insurance through their employer these days. If Obamacare becomes law, as I think it will, 10 years down the road we may see most folks getting health care from the government – maybe sooner than that. The commentor is evidently certain that such a situation is to be desired. My instinct would be to try incremental measures to reform healthcare and keep government out of it as much as possible. It’s been my experience that market forces work better, that is if they are allowed to pertain in the first place.

    But I think US companies will be able to compete on more than an equal footing with overseas competitors, provided the US doesn’t sink into becoming a European-style socialistic economy, the first major step of which would be the government taking over 1/6th of the American economy through Obamacare. Even now, the US economy is the envy of the world. A few years down the road under a more socialistic system and who knows?

    Me, earlier: So the commentor believes the GOP plan will be more costly than Obamacare – to the tune of … a much higher cost per person … – than Obamacare?? Or am I mistaken in his meaning?

    The Senate Plan will take direct governmental action to expand coverage by about 30 million Americans, via subsidies for those who cannot afford to purchase comprehensive plans (this is where the means testing I noted in #72 comes in). The Republican plan will take direct governmental action to expand coverage by about 3 million, and will limit them to the most expensive risk pool to cover, which will certainly lead to a much higher cost per person. You are right that in total, the Democratic plan would cost more in direct government subsidies but at a lower cost per person.

    Well, I guess I WAS wrong. I thought that the commentor meant to imply that the GOP plan was more costly than Obamacare but he won’t go quite that far. Of course, he has to blow some smoke with the “higher cost per person” phrase and the “30 million Americans”(I believe only about 5 million have no healthcare through no fault of their own). But, heck, we won’t hold that against him. I kind of like ol’ Balcones and have friends who believe just as he does that Obamacare is the answer. They mean well.

    And I don’t really know why the commentor is debating the subject of cost, since in an earlier comment he emphatically declared that cost was not something he was “much worried about.”

    Me, earlier: So the commentor is saying, I guess, that employers would “game” the GOP plan but NOT “game” Obamacare. I can’t understand the why the commentor would make this assumption.

    I didn’t say that. I said that the “game” I was talking about – employers sloughing off their highest risk employees in order to reduce their group policy costs – was incentivized under the Republican Plan (which would subsidize the cost of uninsured high risk individuals if they opted out of the company plan) …

    But why would an employee with a pre-existing condition “opt out of the company plan” in order to pay a premium 150% higher than the average premium in that state when the employee contribution to a standard, normal employee insurance benefit is usually much lower than that? What would be the motivation?

    … while it was not incentivized under the Senate Plan (which would subsidize the cost of uninsured based on their economic status – which is more likely to mean younger employees who are actually good to keep in a companies insurance pool).

    Yes, but the proposed GOP Universal Access Program doesn’t “subsidize” “high risk” older workers, just any worker with a pre-existing condition that may find themselves without coverage, and not in the sense that money is given to those individuals.

    It merely helps states provide a policy that costs those individuals 150% higher than the average policy in that state, should those individuals find themselves unable to find coverage elsewhere. Mere “high risk” workers without a pre-existing condition, by which the commentor means older workers, would not be eligible and thus not be subsidized by the GOP plan and thus no incentive would exist.

    And I think an employer could find themselves in legal trouble in a hurry if the employer tried to start “sloughing off” older workers considering that the Age Discrimination in Employment Act of 1967 protects anyone 40 or older from this sort of thing. All this comment about younger and older workers is beside the point.

    Also, if any worker, young or old, develops a disability, which is frequently the case when a pre-existing condition manifests itself, they are protected under the Americans with Disabilities Act of 1990. I repeat: Anything can be made against the law.

    Me, earlier: There’s an income requirement to be in Obamacare?

    You seem to regard Obamacare as some strange slogan, rather than really understanding what is in the healthcare bill.

    Well, I admit that I’ve not read all, what is it, 2,300 pages of the bill? So I do probably need to learn more. The commentor makes a number of assertions about what is in the Obamacare bill. For example, the commentor has written that, “There’s an income requirement to have your insurance costs subsidized[in the Obamacare bill], yes.”

    Perhaps if the commentor would do me and the readers the favor of providing us with a link to the source of his information about Obamacare then I could understand more about what is in the Obamacare bill.

  • balconesfault

    The employer would not be paying employees to switch to the Universal Access Plan. He would be paying employees to opt out of the company plan.

    Readers, this seems to me to be a rather exquisite distinction. Let’s just say the employer is paying the employee to opt out of the company plan and if the employee had a pre-existing condition that employee would inevitably end up on the Universal Access Program if the employee could find no other coverage.

    Trust me – billions of dollars worth of business decisions are made all the time on such “exquisite distinctions”. That’s the reason why corporate lawyers make such excellent salaries.

    Naw, you could simply make it illegal for employers to pay employees to drop their coverage.

    You’re not paying an employee to drop coverage. Employees have to re-enroll in coverage on an annual basis. While most employers make it convenient by rolling over the previous years coverage, “opting out” is not dropping coverage.

    But I do find it remarkable that someone who believes so strongly in the free market is so ready to intervene in the ability of an employer and his employee to work out a compensation package which is optimal to both. Because that’s what employee health insurance is – part of a compensation package.

    It’s not always easy to get treatment at VA hospitals and military bases, even if you are lucky to have one of those in proximity to where you end up living and working after retirement.

    That’s not been my family’s experience. My military retiree father received excellent coverage at his local base hospital, with far less difficulty than he would have had going through the private medical system. My mom still receives great treatment there.

    Or a competing employer, that does offer the benefit, could hire the worker out from under the employer that couldn’t offer the benefit. Free market forces.

    Free market forces indeed. We’ll see how well that works in the current job market.

    Milam says that in many cases, the insurance company that offered the group insurance will set up employees with an individual plan. Employees also can shop for an individual plan. Those with a pre-existing or chronic condition can turn to the state’s high-risk insurance pool.

    Nobody argues this point. But if the state is subsidizing the high-risk insurance pool, then more people losing group insurance will increase the amount of money that the state is having to pay to pick up the extra people who can’t get goverage due to pre-existing conditions.

    That’s been my basic point all along.

    I don’t have much faith in the MSM these days.

    I’ll admit that I’ve found their coverage of the healthcare issues woefully lacking myself. Which is why people are running around arguing for forcing insurance companies to accept pre-existing conditions but are also against a mandate. They’ve not been educated.

    My instinct would be to try incremental measures to reform healthcare and keep government out of it as much as possible.

    My contention is that this is exactly what we’ve been doing for 20 years.

    But why would an employee with a pre-existing condition “opt out of the company plan” in order to pay a premium 150% higher than the average premium in that state when the employee contribution to a standard, normal employee insurance benefit is usually much lower than that? What would be the motivation?

    We’ve been through that – and your proposal is a rather draconian intervention by the government into the bargaining between an employee and employer, imo.

    Mere “high risk” workers without a pre-existing condition, by which the commentor means older workers, would not be eligible and thus not be subsidized by the GOP plan and thus no incentive would exist.

    I would argue that older workers are substantially more likely to have a pre-existing condition which labels them “high risk”. Do you dispute this?

    And I think an employer could find themselves in legal trouble in a hurry if the employer tried to start “sloughing off” older workers considering that the Age Discrimination in Employment Act of 1967 protects anyone 40 or older from this sort of thing. All this comment about younger and older workers is beside the point.

    Also, if any worker, young or old, develops a disability, which is frequently the case when a pre-existing condition manifests itself, they are protected under the Americans with Disabilities Act of 1990. I repeat: Anything can be made against the law.

    You’re talking about worker discrimination. I guess there is a question whether employees who aren’t in the high risk pool could sue their employer for not offering them the same “opt out” bonus that would be attractive enough to get the employee with a pre-existing condition to do so. A creative employer could remedy this simply by allowing their insurer to expand the menu of coverage levels, vary the menu by employee background, and make a certain amount of employer-provided money to purchase into the plan (many companies do parts of this already) … with, once again, an “opt out bonus” if the employee decided to purchase insurance outside the system. It could thus easily incentivize higher risk employees to take the bonus and avail themselves of the state plan.

    Perhaps if the commentor would do me and the readers the favor of providing us with a link to the source of his information about Obamacare then I could understand more about what is in the Obamacare bill.

    http://www.reuters.com/article/idUSTRE5BK0KA20091221

    Federal subsidies will be available to help them afford coverage. The subsidies will be available for people with incomes up to 400 percent of the poverty level, about $88,200 for a family of four. The poverty levels for 2009 is $22,050 a year for a family of four and $10,830 for an individual.

  • grackle

    The commentor, earlier: The employer would not be paying employees to switch to the Universal Access Plan. He would be paying employees to opt out of the company plan.

    My response: Readers, this seems to me to be a rather exquisite distinction. Let’s just say the employer is paying the employee to opt out of the company plan and if the employee had a pre-existing condition that employee would inevitably end up on the Universal Access Program if the employee could find no other coverage.

    The commentor replies: Trust me – billions of dollars worth of business decisions are made all the time on such “exquisite distinctions”. That’s the reason why corporate lawyers make such excellent salaries.

    Me, earlier: Naw,[in order to stop employers from gaming the system] you could simply make it illegal for employers to pay employees to drop their coverage.

    You’re not paying an employee to drop coverage. Employees have to re-enroll in coverage on an annual basis. While most employers make it convenient by rolling over the previous years coverage, “opting out” is not dropping coverage.

    Pardon me, readers, but this is just another exquisite distinction. By “opting out” of coverage an employee is not “dropping coverage”?? Whew!

    First the commentor says, “He[the employer] would be paying employees to opt out of the company plan.” When I point out that should this type of gaming of the system ever become a problem that it could simply be made illegal, he declares, [the employer is] “… not paying an employee to drop coverage.” Drawing a distinction between ‘opting out’ of coverage and ‘dropping coverage’ is patently a false distinction.

    I think the commentor’s problem here is that he wants to claim that since the employee usually has the option of voluntarily dropping(opting out/whatever-you-want-to-call-it) of coverage during annual enrollment periods that this makes it impossible to make it illegal for an employer to PAY the employee to do so. But this is nonsensical.

    But I do find it remarkable that someone who believes so strongly in the free market is so ready to intervene in the ability of an employer and his employee to work out a compensation package which is optimal to both. Because that’s what employee health insurance is – part of a compensation package.

    But readers it was not I that was worried about employers gaming the system. It was the COMMENTOR that bought all this up and I simply pointed out how the commentor’s anxiety could easily be alleviated by a simple law making the gaming of the system illegal. Then the commentor went down the bumpy road of exquisite distinctions in attempts to prove that making such transactions illegal would be impossible – a nonsensical stance. In fact, easy legal remedies aside, I would not be worried very much about employers gaming the system vis a vis the GOP Universal Access Program.

    Besides, Obamacare screws up the healthcare market so much that free market forces really have no chance of working as they would if the government did not interfere so much. The lack of the ability to buy insurance across state lines is only one example.

    Me earlier: It’s not always easy to get treatment at VA hospitals and military bases, even if you are lucky to have one of those in proximity to where you end up living and working after retirement.

    That’s not been my family’s experience. My military retiree father received excellent coverage at his local base hospital, with far less difficulty than he would have had going through the private medical system. My mom still receives great treatment there.

    Well, as long as we are offering personal anecdotes as proof … I have worked with many military retirees over the years and it’s been my observation that most chose to use the employer insurance for mundane medical reasons because the nearest VA Hospital was almost a hundred miles away and the nearest military base where treatment could be received even further. On the other hand, using the employer insurance involved a 10 minute drive. I do remember one fellow that developed an expensive illness that switched to the VA because the co-payments to the civilian doctor and clinic were going to be rather high compared to the free treatment at the VA hospital. Expense trumped convenience, you might say.

    Me, earlier: Or a competing employer, that does offer the benefit, could hire the worker out from under the employer that couldn’t offer the benefit. Free market forces.

    Free market forces indeed. We’ll see how well that works in the current job market.

    Good workers are always in demand. Jobs are to be had even in a high unemployment situation.

    A quote from an article the commentor linked to:

    “Milam says that in many cases, the insurance company that offered the group insurance will set up employees with an individual plan. Employees also can shop for an individual plan. Those with a pre-existing or chronic condition can turn to the state’s high-risk insurance pool.”

    Nobody argues this point. But if the state is subsidizing the high-risk insurance pool, then more people losing group insurance will increase the amount of money that the state is having to pay to pick up the extra people who can’t get coverage due to pre-existing conditions. That’s been my basic point all along.

    And my point all along has been that the GOP plan would be less costly than Obamacare and allow more folks to keep their group insurance.

    Me earlier: I don’t have much faith in the MSM these days.

    I’ll admit that I’ve found their coverage of the healthcare issues woefully lacking myself. Which is why people are running around arguing for forcing insurance companies to accept pre-existing conditions but are also against a mandate. They’ve not been educated.

    Me, earlier: My instinct would be to try incremental measures to reform healthcare and keep government out of it as much as possible.

    My contention is that this is exactly what we’ve been doing for 20 years.

    Well we haven’t allowed medical insurance to be sold over state lines – which has stifled competition and resulted in higher insurance prices.

    We haven’t tried federal legislation to enact tort reform. Medical malpractice insurance in itself is very expensive and has no doubt contributed to the rise in the cost of healthcare but the hidden real cost is all the tests and procedures doctors have to resort to in order to protect themselves from malpractice suits. I’ve seen estimates that unneeded tests and procedures may contribute up to 25% of doctors’ and laboratory fees.

    There are other things that could have been done but just these 2 measures could have helped out with rising healthcare costs.

    Me, earlier: But why would an employee with a pre-existing condition “opt out of the company plan” in order to pay a premium 150% higher than the average premium in that state when the employee contribution to a standard, normal employee insurance benefit is usually much lower than that? What would be the motivation?

    We’ve been through that – and your proposal is a rather draconian intervention by the government into the bargaining between an employee and employer, imo.

    Making it illegal for employers to pay employees to drop their coverage would be … “draconian”??? But Obamacare, in which the government takes over 1/6th of the economy and which affects everyone in America is … NOT “draconian”??? WHOA!!

    Me, earlier: Mere “high risk” workers without a pre-existing condition, by which the commentor means older workers, would not be eligible and thus not be subsidized by the GOP plan and thus no incentive would exist.

    I would argue that older workers are substantially more likely to have a pre-existing condition which labels them “high risk”. Do you dispute this?

    No, but just because someone may be “high risk” doesn’t mean they actually HAVE a pre-existing condition – it just means they might in the future.

    Me, earlier: And I think an employer could find themselves in legal trouble in a hurry if the employer tried to start “sloughing off” older workers considering that the Age Discrimination in Employment Act of 1967 protects anyone 40 or older from this sort of thing. All this comment about younger and older workers is beside the point.

    Also, if any worker, young or old, develops a disability, which is frequently the case when a pre-existing condition manifests itself, they are protected under the Americans with Disabilities Act of 1990. I repeat: Anything can be made against the law.

    You’re talking about worker discrimination. I guess there is a question whether employees who aren’t in the high risk pool could sue their employer for not offering them the same “opt out” bonus that would be attractive enough to get the employee with a pre-existing condition to do so. A creative employer could remedy this simply by allowing their insurer to expand the menu of coverage levels, vary the menu by employee background, and make a certain amount of employer-provided money to purchase into the plan (many companies do parts of this already) … with, once again, an “opt out bonus” if the employee decided to purchase insurance outside the system. It could thus easily incentivize higher risk employees to take the bonus and avail themselves of the state plan.

    I guess I have to point out the obvious, which is that age discrimination laws do not apply to the young(“employees who aren’t in the high risk pool”) and thus the premise of the rather convoluted paragraph above is false.

    Me, earlier: Perhaps if the commentor would do me and the readers the favor of providing us with a link to the source of his information about Obamacare then I could understand more about what is in the Obamacare bill.

    In response the commentor offers a link to a Reuters article: http://tinyurl.com/yao2fhd

    The problem is that the Reuters article is dated months ago. The Obamacare bill has undergone many changes since then. How can the commentor be sure that the legislation about to be passed is the same? Especially since the source is another organ of the Mainstream Media, a source with which even the commentor finds much fault(no pun intended) with:

    I’ll admit that I’ve found their[the MSM] coverage of the healthcare issues woefully lacking myself.

  • balconesfault

    I think the commentor’s problem here is that he wants to claim that since the employee usually has the option of voluntarily dropping(opting out/whatever-you-want-to-call-it) of coverage during annual enrollment periods that this makes it impossible to make it illegal for an employer to PAY the employee to do so

    Every year, one’s healthcare benefits are subject to unilateral modification by the employer. He can drop it, he can increase the worker contribution, he can increase deductibles and out-of-pocket caps. Unless there is a long term contract governing benefits (usually this is limited to union situations) the only recourse the employee has is to accept the change or quit.

    But readers it was not I that was worried about employers gaming the system. It was the COMMENTOR that bought all this up and I simply pointed out how the commentor’s anxiety could easily be alleviated by a simple law making the gaming of the system illegal.

    Yes, you are passing a simple law which restricts the terms an employer and employee can negotiate as a basis for compensation.

    Besides, Obamacare screws up the healthcare market so much that free market forces really have no chance of working as they would if the government did not interfere so much. The lack of the ability to buy insurance across state lines is only one example.

    You do realize that the current system is as it is not because of Federal fiat – but because of States Rights? Each state has claimed for itself the right to regulate insurance within their state, and to do so they require insurers to be chartered in their state. You are calling for the Federal Government to effectively override each state’s ability to regulate how insurance is sold within their borders.

    Another policy which flies in the face of the Federalism policies usually espoused by conservatives.

    We haven’t tried federal legislation to enact tort reform.

    Again, an abrogation of state rights.

    Making it illegal for employers to pay employees to drop their coverage would be … “draconian”???

    Yes. As I noted before, my company will pay a decent annual bonus if we decide to rely on my wife’s insurance that year. You would ban this.

    But Obamacare, in which the government takes over 1/6th of the economy and which affects everyone in America is … NOT “draconian”???

    I’m not adverse to Government taking over healthcare … but this bill doesn’t do that.

    I guess I have to point out the obvious, which is that age discrimination laws do not apply to the young(“employees who aren’t in the high risk pool”) and thus the premise of the rather convoluted paragraph above is false.

    I think you misunderstood. My statement was that if a company went to some subset of their employee base and said “we will pay you 17K to opt out of our insurance plan this year (say the state plan for those with pre-existing conditions cost 15K, while the company plan cost the company 10K)”, someone not in that subset (particularly someone without pre-existing conditions who could go out and buy equivalent coverage on the open market for 12K) might rightfully claim that he’s being discriminated against for not having a pre-existing condition.

    The problem is that the Reuters article is dated months ago. The Obamacare bill has undergone many changes since then.

    Actually, no. That’s the whole point of the current debate over the Stupak Amendment. The language of the Senate Bill can’t be changed right now.

    Yes, there is process for reconciliation. But I have not seen any discussion of expanding access to subsidies greater than in the reference I provided. I guess I can’t also promise that the final bill won’t promise a new pony to everyone, but I think the person claiming it will has the burden of proof here.

  • grackle

    Me, earlier: I think the commentor’s problem here is that he wants to claim that since the employee usually has the option of voluntarily dropping(opting out/whatever-you-want-to-call-it) of coverage during annual enrollment periods that this makes it impossible to make it illegal for an employer to PAY the employee to do so

    Every year, one’s healthcare benefits are subject to unilateral modification by the employer. He can drop it, he can increase the worker contribution, he can increase deductibles and out-of-pocket caps. Unless there is a long term contract governing benefits (usually this is limited to union situations) the only recourse the employee has is to accept the change or quit.

    Of course most employers, with some limitations, can drop healthcare benefits for ALL their workers, BUT they can’t drop them for some employees they deem “high risk” and not the other employees, which is what the commentor was saying could happen. Older(“high risk”) workers are well protected by law from such illegal discriminatory shenanigans.

    And if the employer stops providing a healthcare benefit to(all) employees the employees are free to change employers and seek employment with competitors who provide the benefit.

    Me, earlier: But readers it was not I that was worried about employers gaming the system. It was the COMMENTOR that bought all this up and I simply pointed out how the commentor’s anxiety could easily be alleviated by a simple law making the gaming of the system illegal.

    Yes, you are passing a simple law which restricts the terms an employer and employee can negotiate as a basis for compensation.

    Gee, on one hand the commentor calls it “gaming the system,” but when he thinks it might enhance his argument, which it really doesn’t, he calls it negotiating “as a basis for compensation.”

    Me, earlier: Besides, ObamaCare screws up the healthcare market so much that free market forces really have no chance of working as they would if the government did not interfere so much. The lack of the ability to buy insurance across state lines is only one example.

    You do realize that the current system is as it is not because of Federal fiat – but because of States Rights? Each state has claimed for itself the right to regulate insurance within their state, and to do so they require insurers to be chartered in their state. You are calling for the Federal Government to effectively override each state’s ability to regulate how insurance is sold within their borders. Another policy which flies in the face of the Federalism policies usually espoused by conservatives.

    Me, earlier: We haven’t tried federal legislation to enact tort reform.

    Again, an abrogation of state rights.

    “States Rights”? When have I EVER written anything about “States Rights”? I believe that the consumer should be able to shop for medical insurance in the same manner that he shops for auto insurance – across state lines if need be. It would not harm “States Rights” one whit for this to come to pass. The commentor is setting up a ‘straw man.’

    Me, earlier: Making it illegal for employers to pay employees to drop their coverage would be … “draconian”??? But Obamacare, in which the government takes over 1/6th of the economy and which affects everyone in America is … NOT “draconian”???

    I’m not adverse to Government taking over healthcare … but this bill doesn’t do that.

    Well, all I can say is that a LOT of folks disagree.

    Yes. As I noted before, my company will pay a decent annual bonus if we decide to rely on my wife’s insurance that year. You would ban this.

    No, I wouldn’t ban it. The commentor said he was worried that such practices as described in the above sentences would constitute “gaming the system” by employers. I wasn’t worried about it, HE was. As I’ve stated before, I don’t believe such “gaming” would be a problem. I simply asserted that if he was truly worried about it that a law could be passed to make it illegal for employers to pay their employees to drop their coverage.

    He has since descended into a dark and convoluted cavern of exquisite distinctions in order to attempt to prove such practices could not be made illegal. And it turns out that although he is worried that employers would “game” the system by paying employees to drop their health coverage that he is only too happy to do it himself.

    Me, earlier: I guess I have to point out the obvious, which is that age discrimination laws do not apply to the young(“employees who aren’t in the high risk pool”) and thus the premise of the rather convoluted paragraph above is false.

    I think you misunderstood. My statement was that if a company went to some subset of their employee base …. [etc, etc.]

    The commentor is now claiming that his statement was something other than what it was. I just can’t let him get away with that even though I kind of like ol’ Balcones. If he wants to now change his statement he is free to do so but I will not let him pretend that the changed statement was his original statement. For the record here is the statement in question reproduced exactly as he wrote it:

    You’re talking about worker discrimination. I guess there is a question whether employees who aren’t in the high risk pool could sue their employer for not offering them the same “opt out” bonus that would be attractive enough to get the employee with a pre-existing condition to do so. A creative employer could remedy this simply by allowing their insurer to expand the menu of coverage levels, vary the menu by employee background, and make a certain amount of employer-provided money to purchase into the plan (many companies do parts of this already) … with, once again, an “opt out bonus” if the employee decided to purchase insurance outside the system. It could thus easily incentivize higher risk employees to take the bonus and avail themselves of the state plan.

    And again I will point out the obvious, which is that age discrimination laws do not apply to the young(“employees who aren’t in the high risk pool”) and thus the premise of the rather convoluted paragraph above is false.

    Me, earlier: The problem is that the Reuters article is dated months ago. The Obamacare bill has undergone many changes since then.

    Actually, no. That’s the whole point of the current debate over the Stupak Amendment. The language of the Senate Bill can’t be changed right now.

    Actually, YES. I’m kind of embarrassed for the commentor to have to point this out, but for instance, the Obamacare bill now possesses an element that was added just a few days ago having to do with part-time workers.

    http://tinyurl.com/y8r25db

    Speaking of Stupak, if the ObamaCare bill can’t be changed why has Stupak been holding firm against the bill until and unless certain language is added? Would Stupak insist on language to be added before he voted yes if language could NOT be added? Stupak has recently been arguing with Waxman and Hoyer on this issue.

    http://tinyurl.com/yfrmlyc

    http://tinyurl.com/yclt3re

    Here again, the commentor is simply incorrect in a major assumption. The ObamaCare bill could have been changed in any number ways up until the latest CBO report on it. In fact Pelosi and company have spent weeks secretly changing elements of the ObamaCare bill in order to get a better CBO score on the thing.

    http://tinyurl.com/yce5uuf

    Yes, there is process for reconciliation. But I have not seen any discussion of expanding access to subsidies greater than in the reference I provided. I guess I can’t also promise that the final bill won’t promise a new pony to everyone, but I think the person claiming it will has the burden of proof here.

    The commentor makes a statement based on a false assumption(the ObamaCare bill can’t be changed) but in his view I have the “burden of proof.” The bill HAS been changed. It has never been in any sort of unchangeable state until just recently. The Democrats could change it this very moment if they wanted to but they probably will not now that they have the CBO score they were looking for. Anyone who has followed the controversy should have known that.

    And we are suppose to believe what the commentor says is in the bill because he has “not seen any discussion of expanding access to subsidies greater than in the reference I provided.” A reference, by the way, from a quarter that he doesn’t trust himself: “I’ll admit that I’ve found their[the MSM] coverage of the healthcare issues woefully lacking.”

    Forgive me, readers, but I would not be making any bets in Vegas based on what “discussion” the commentor may or may not have stumbled across.

  • grackle

    The commentor linked to a Reuters article dated December 21, 2009 as a source of his assertions in regards to the ObamaCare bill and posted a quote from the article:

    Federal subsidies will be available to help them afford coverage. The subsidies will be available for people with incomes up to 400 percent of the poverty level, about $88,200 for a family of four. The poverty levels for 2009 is $22,050 a year for a family of four and $10,830 for an individual.

    http://tinyurl.com/yao2fhd

    But we have no idea whether these figures are accurate because the ObamaCare bill has been changed many times since the date of the Reuters article, so I was a bit dubious and said so:

    The problem is that the Reuters article is dated months ago. The Obamacare bill has undergone many changes since then. How can the commentor be sure that the legislation about to be passed is the same?

    The commentor’s response: Actually, no. That’s the whole point of the current debate over the Stupak Amendment. The language of the Senate Bill can’t be changed right now.

    But I knew just from watching FoxNews that Stupak has been trying for weeks to get the Senate to change the language in the bill so to claim it couldn’t be changed didn’t pass the smell test.

    Now I have came across an article with some interesting information. It’s an article dated March 19 about the deals being made to flip ‘no’ votes in the House.

    Tennessee’s congressional delegation successfully negotiated for $100 million in payments to state hospitals in the latest version of health care reform legislation, but officials said the arrangement isn’t a “special deal.”

    Within 153 pages of revisions unveiled in Washington yesterday is language that gives Tennessee a combined $100 million in Medicaid “Disproportionate Share Hospital” payments in 2012 and 2013.

    So, readers … as of March 18, TWO DAYS AGO, 153 pages of changes took place in the ObamaCare bill.

    http://tinyurl.com/yktr95g

    The commentor is a likeable guy and I am certain he is sincere in his belief in nationalized healthcare, although to believe as he evidently does that ObamaCare doesn’t represent the government taking over healthcare indicates that he doesn’t have a firm grasp on what is occurring. I have friends that hold the same viewpoint – good people, kindly people.

    But they and the commentor need to watch FoxNews every once in awhile because FoxNews reports what CNN, MSNBC, NBC, CBS, ABC, NYT, LAT, etc. won’t report. If they did they would know that Stupak has been wanting in recent weeks for the Senate to change the language on abortion in the bill and they would not be caught in a false assumption.

    They need to peruse reputable and authentically conservative blogs, not just the anti-Tea Party, anti-Palin, not very conservative blogs such as Frum Forum, to get the stuff the MSM won’t tell them.

    They need to read history written by historians educated before the 1960s in order to know the true significance of America – which is the most benign and benevolent great power the world has ever seen.

    I was at a friend’s home back during the campaign and she had MSNBC on during the Rev. Wright controversy. During that news segment MSNBC NEVER ran clips of Wright’s inflammatory statements, just video of Wright doing some ordinary preaching. I was astounded. The MSNBC talking heads had an attitude of sad and incredulous puzzlement in their facial expressions, language and tones of voice that the Right would attack a nice fellow like Rev. Wright.

    My friend and I discussed the Wright segment afterward. Her reaction was that the conservatives were prejudiced against Wright because he was preaching in that excitable style that some popular black preachers use – the dramatic delivery, gestures, emphatic voice and turn of phrase – and that Rightwingers held that against him.

    When I told her that Wright had preached in that same pulpit that AIDS was the result of a conspiracy by the US government to commit genocide against blacks and that the US was behind the 9/11 attacks she flatly refused to believe Wright had said those things. MSNBC would have surely reported on such controversial beliefs if Wright had REALLY said such things, she said. I dropped the subject because she was becoming agitated. To this day I don’t think she has any idea why Wright would seem so controversial and probably chalks the controversy up to Rightwing bigotry.

    Some of the MSM did feature some of Wright’s less crazy viewpoints, mostly in regards to the Israeli/Palestinian conflict, the bombing of Japan in WW2, Black Theology, etc., a lot of stuff that is essentially Progressive in it’s attitude toward history and current events, but what I saw was quick, incomplete and immediately glossed over by sympathetic talking heads.

    My point is that most folks like the commentor live in an insular information world. They watch TV and read blogs that make them feel good about their ideology. Any news that challenges these beliefs either doesn’t get reported to them or it is fragmented, incomplete, sugarcoated and delivered so quickly as to be barely noticed. Thus they are surprised to learn certain things – such as the fact that behind closed doors that Obamacare has undergone many changes recently, a reality the MSM is not anxious to dwell on.

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