Yesterday’s WashPost had an article about Hillary’s plans for health care when she’s elected. While I generally like the Clintons, I felt like her involvement in the reform efforts of ’93/’94 might have been a strategic mistake. In the article, she claims that she’s “learned a lot” in the past decade and that the numbers of uninsured create undeniable pressure to universalize coverage.
I’m thrilled that health care is becoming Democrats’ #1 issue, but I’m not gonna lie- I’m skeptical about follow-through. There were nearly 40 million uninsured in 1994, and the Dems had the House and Senate. Everyone was talking about HC reform during the ’92 election as they are this time around, so really, what’s different between then and now?
I guess my problem is that suspciciously missing from Clinton’s website (nevermind her media appearances) is the how. Apparently Obama is actually putting together a plan, which will be a good read. I’m just anxious to see what the Dem. candidates come up with and interested to see if the Republicans have any sort of comeback.
Because apparently he really phoned in a recent health care discussion with the other candidates. Roundtables, great. Consensus? Good freakin’ luck.
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I’m looking for a candidate who’s willing to piss certain people off doing health care reform, not necessarily to “bring everyone to the table.” I want populism, not a special interest gabfest.
At this point, I remain scorchingly skeptical until proven wrong. And PLEASE, someone, prove my skepticism wrong and outdated! But so far HC talk by the major Dems has been the equivalent of the crumbs Repubs have dropped for the Christian right – top dressing to get them (party players) where they want to go, not necessarily to do what we want them to do.
Wonkette paraphrases Obama’s health care performance:
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And so far, that’s still what we’re hearing from him.
and the Kaiser link to what’s known about Obama’s efforts to put together an actual detailed plan thus far. I just took a look at it and this caught my eye
Either 1) Obama’s full of cr-p 2) He’s trying to have it both ways which is very disingenuous (this may be the same as #1) or 3) someone needs to explain to him and his health policy staffers that a streamlined single payer system can incorporate employers’ contributions for hc coverage. In fact, in the U.S. it must use employer funding since that’s where so much of the money comes from at present. The difference would be that all employers would be required to contriubte, using an equitable formula, just as individuals will be required to conribute.
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While we’re on the topic of nat’l reform plans, despite Wyden’s “pretty on paper” hc proposal, there is no way in hell that employers will ever give back to workers what the employer now pays into hc costs (wht the Wyden plan is premised on). If you believe that, then I’ve got a bridge in Brooklyn you might want to buy…
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Back on the the state scene, the MA Health Care Trust legislation uses employer funds as well as sliding scale funds from individuals to finance a state-based universal coverage using single payer financing system, as it should.
I can understand the practical reasons for employers to offer health care (attract better employees), but I don’t see a moral reason for the government to force employers to offer health care.
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Can anyone help me out?
I recommend Norman Daniels’s “Just Health Care” as a starting point. I don’t really think there’s a moral reason for the government to force employers to offer care- I think there’s a moral reason for the government to offer care, and Employer Mandate fans just want to build on the current system in order to get there.
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BTW, an employer mandate by itself isn’t sufficient to universalize health coverage anyway- maybe making it anything but moral. It’s Pay or Play: Employers either Pay a tax towards a social insurance fund, or they Play by accepting a credit and provideing a basic level of health insurance for their employees… creating a system that neglects the unemployed and further stigmatizes disenfranchized groups. Many firms pay for employee insurance by cutting wages, but firms with many workers near the minimum wage will be forced to cut workers instead. As a result, uninsured low-wage workers, the intended beneficiaries of health care reform, will be disproportionately likely to lose their jobs under the Employer Mandate, working against health care reform’s aim to improve equity.
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An employer mandate imposes immediate costs on businesses, which are transferred to employees through lower wages or to consumers through higher prices. The government will not incur any additional costs for citizens whose employers “play”” because employers will purchase insurance from the private market. Those whose employers “pay” will receive insurance from the government (or just have the gov’t buy a private plan for them), but the government will lose money if the employer fee is inadequate or if employers with predominantly high-risk employees “pay” and the government suffers from adverse selection. Needless to say, this is a problem MA is facing now with Chapter 58!!
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Obviously there would still need to be some Medicaid-equivalent to cover the unemployed, keeping the system fragmented and, inevitably, some gaps in coverage. Yackety yack… My point is, I don’t love employer mandates. I’d rather eliminate the employer-based system altogether.
Let’s be clear on that. Under a state or national single payer system one administrative entity collects funds for the system, guarantees coverage and pays all the bills – hence the phrase “single payer”. It can collect funds from employer, say using a payroll tax model, and from individuals using a portion of income tax. Single payer financing for universal coverage streamlines all kinds of bureacracy and reduces huges amounts of admin. waste that characterize our current fragmented system.
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What’s so bad about having employers continue to contribute to the health and welfare of the communities where they do business?
If it was, then I was totally off base. In which case, sorry for the confusion!
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But I’m unclear then how the SP plan could be employer-based… So individuals and employers are both taxed? Or only individuals whose employers aren’t taxed are taxed? I guess I just haven’t seen a model for employer-based SP before…
which is addressed in the MA HC Trust (Sinlge Payer) bill
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Section 21, Funding the Trust, item
(6) All monies collected through payment by all employers in the commonwealth of a Health Trust premium, based on their payroll, starting with the enactment of the benefit plan of the Trust, as determined by the Trust in consultation with the Department of Revenue. The amount of this premium shall be in line with, or less than, the average contributions that employers make toward employee health benefits as of the effective date of this act, adjusted to a rate less than national health care inflation or deflation. The premium shall be collected through the Department of Revenue for deposit in the Trust Fund.
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Any employer which has a contract with an insurer, health services corporation or health maintenance organization to provide health care services or benefits for its employees, which is in effect on the effective date of this section, shall be entitled to an income tax credit against premiums otherwise due in an amount equal to the Trust fund premium due pursuant to this section.
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Any insurer, health services corporation, or health maintenance organization which provides health care services or benefits under a contract with an employer which is in effect on the effective date of this act shall pay to the Trust Fund an amount equal to the Health Trust premium which would have been paid by the employer if the contract with the insurer, health services corporation or health maintenance organizations were not in effect. For purposes of this section, the term “insurer” includes union health and welfare funds and self-insured employers.
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An employer may agree to pay all or part of the employee’s Health Trust premium imposed by the provisions of this section. Such payment shall not be considered income for Massachusetts income tax purposes.
is one subject of debate.
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the anachronistic system of relying on businesses to support individuals healthcare is probably the biggest flaw of our system. (along with the inordinate influence of the insurance and pharma cartels). so to turn to businesses to fund a single payer system at an exaggerated rate may only perpetuate this problem.
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we need to get business out of the chain of healthcare delivery. that is why single payer should be the most PRO-BUSINESS model there is.
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one concern for many people is that they consider their current employer provided coverage as part of their benefits package, thus part of their income. and tax-free no less. so that if their employer is no longer footing the bill, in effect they are getting their compensation package cut. (which is but one of the perversions that our flawed system has wrought).
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so any payment that a business makes toward a statewide pool that runs equivalent to their previous employer compensation rates might out to be considered a means rather than an end. a transitional phase in full implementation of a single payer system.
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and after it is worked out that people can then shift into a publicly administered system without suffering a net compensation loss, then begin to look and act toward the end of eliminating the unnecessary role of business (and the insurance cartel!) in our healthcare decisions.
Thanks, Jen! From your comments and those of others, it seems like I’m not the only one who doesn’t see much of a reason for businesses to be thrown in the middle of their employee’s health costs.
first fairdeal, re your comment “and after it is worked out that people can then shift into a publicly administered system without suffering a net compensation loss…”
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that’s a huge challenge. How can it be guaranteed that employers will shift the dollars they curretnly pay into worker hc costs into increased wages? I really don’t see that ever happening. Do you? How would it be accomplished?
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this leads to dan’s comment about “throwing employers into the middle og their workers hc costs” – the reality is that the responsible ones are already there!! and it will be next to impossible to undo that IMHO (someone please convince me otherwise).
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So, if this is the reality of things, one thing I said above bears repeating: What’s so bad about having employers continue to contribute to the health and welfare of the communities where they do business? As long as gov’t makes the rules that are fair and applied across the board.
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For an example of a presidential candidate who’s boldly put out a detailed plan trying to get us on a solid track to universal affordable coverage (that lays the groundwork for attrition and demise of the private insurance industry’s domination), check out the Edwards Plan here
Government never makes rules that are fair and applied across the board. Even if it tries, a few elections later, it will get skewed for pork-based reasons.
“and after it is worked out . . “
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got a little lazy. thought i might be able to sneak that one through.
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the transition into single payer deserves a more detailed (many more) post than i have the keyboard stamina for at the moment. so please allow me to defer on that for the moment. (just call me obama!)
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but on the employer thing; it is simply not logical. most people know that employer based healthcare in america is a historical fluke. and a fluke based on a 19th century model. we are not living in staffordshire 1877 with the factory town, factory store, factory housing, and factory infirmary . in our modern, mobile society it is no more logical to expect employers to provide healthcare to their employees than it would be to expect landlords to provide it for their tenants.
How about de-linking the employer contribution away from specific employees but continue to collect monies from employers (in an equitable manner) into a Health Care Trust Fund to promote the health and welfare of the entire community where that employer does its business (or where they’re based)?
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Due to the unfortunate historical fluke our reality is that a huge portion of hc spending ($62Bil in MA in ’06) comes from employers. It would be awful hard to imagine how to replace that source of funds in anything close to a fiar equitable way.
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The U.S. employer-based insurance model developed from wage freezes during WWII that led to employers competing for scarce workers by creating “job benefits” including health insurance. (A way to attract workers that got around the wage freeze.)
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Streamlining the financing of our bloated hc system is but one important way we must bring some sanity and affordability to the system. Single payer is my preferred method for this but I will concede that there are other things that help in this area as well.
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Financing is but one area of the system that needs an overhaul, along with re-tooling the delivery system to promote prevention and health promotion and bring care to where people live, work and go to school. Improving and protecting quality of care is another (saves money and pain and suffering). Reducing the various barriers to timely access to care, with universal quality health insurance coverage being the paramount way to make progress on this
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Cost controls thru bulk purchasing and price negotiotions to address Pharma price gouging and pushing unneeded drugs on us through DTC advertising. In one sense it’s encouraging that there are so many clear ways to tackle these problems and make measurable progress.
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Too bad that broad-based political leadership is a missing ingredient. Maybe that will change.
from this conversation is that there isn’t just one way to do single payer. I kinda figured that SP in the United States would take a similar form to plans seen elsewhere.. apparently not? Or else I just don’t know enough specifics about other countries’ strategies.
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It’s a good question, Ann, about how to redirect the money currently spent by employers on health care to health care w/o going through employers. I don’t really know. There was an op-ed in the WSJ today about changes in the health care debate- I didn’t get a chance to read the whole thing, but I saw a blip about how “the employer-based health insurance system is ‘slowly dying'” in today’s Kaiser Report.
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I still think that eliminating employers from the picture altogether is the way to go, eventually- but if we need to keep them in there in order to get universal coverage first, without forcing an eternal dependence on them (or even reviving our reliance on them), then maybe that’s okay.
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Thoughts??
is a pretty overworked phrase.
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but in this case, it really is a change in the – yes, fundamental – structure of how healthcare is delivered in this country.
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and a really good starting point is for people to become comfortable with the notion that if we want different results from our system, that we are going to need to create a model that is . . . different.
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and any discussion that exposes the pros and cons (and i believe that it is overwhelmingly con) of any employer based funding and delivery system is a good thing.