The Blue Cross Blue Shield Foundation (now headed by outgoing Senator Jarrett Barrios) came out with the results of a big poll on the new health care law yesterday. Take a look at the results — nice charts on this pdf.
The critical finding of the survey is that people really want universal health care — to the point of being willing to pay higher taxes — just “because it’s the right thing to do.” The importance of that cannot be overstated. There’s a moral consensus to make universal coverage work. We seem to have agreed that health care is a social good.
That’s a remarkable political achievement. The actual policy, as you’ll see, leaves people pretty cold.
Most folks (57%) expressed support for the individual mandate. But when asked about the specifics of some of the plans recently made available, the results are mostly quite negative. Nutshell: People agree that the plans are too expensive for folks of moderate income.
PLAN DESCRIPTION:
The first plan is for an uninsured 37-year-old single adult whose income is $42,000 a year. This plan includes three doctor visits a year that cost the patient $25 a piece. The individual must pay $1,500 in other medical expenses before he or she starts receiving benefits. After this deductible is met, this person will pay for 20% of the cost of doctor visits, hospital stays and tests. The maximum amount this person will have to pay for medical services in a year is $5,000. Prescription drugs will cost $15 for generic brands and 50% of the cost of other brands. The plan would cost $259 a month.
Oops.
So either we make the plans much more affordable (premiums and out-of-pocket expenses), and that means controlling costs by dealing with perverse incentives and special interest parasitism; or we increase subsidies all the way up to folks who are decidedly middle-class, which starts to sound like … single-payer! Not that there’s anything wrong with that …
Again, again, again — the takeaway message of this is that people value health care for everyone, and they’re willing to sacrifice for it. There is great leeway for ambitious, transformational change that pursues those goals.
…and something I’ve long wondered about.
<
p>
The critical finding of the survey is that people really want universal health care — to the point of being willing to pay higher taxes…
<
p>
To what extent would those higher taxes be a substitute for medical insurance premiums that people are already paying? Including cost shifting due to people who don’t have insurance, are covered by Medicaid, or are otherwise judgement-proof (no assets). Has anyone done any calculation on that? It might very well turn out that, for many if not most people, taxpayer-supported health care financing (and that’s what it is, financing) might actually be lower cost than the current system.
Well, until we have the ability to buy into a public health insurance system, we can’t know how much it would cost, at least under our system in America, or MA.
<
p>
But we do know that most countries with single-payer spend far, far less on health care than we do, and a government payment system would almost certainly be more efficient: neither shareholders nor expensive executives to pay, economies of scale, lower administrative expenses, no marketing or underwriting expenses, etc.
I should say lower marketing expenses. Everything needs to be marketed — even the post office.
then you’d realize that this universal health care system is pie in the sky nonsense.
<
p>
Our federal government with all of its convoloted beaurocratic BS is the kiss of death.
<
p>
Keep in mind: Europe is not USA. The way they do business is entirely different.
<
p>
For me, I do not want to be directed to Dr. XYZ or a DO or a PA/RNP. I want to see the MD I want to see. There are too many hacks out there—-way too many. This would be a medical nightmare from hell and so bloated with idiot federal hacks that can’t find their own ass with both hands that the program should be called “The Titanic Plan.”
<
p>
Ever deal with BC/BS with a billing issue? God help us—they are the private sector, the alleged best and look what goes on. I just got through going round and round with GIC—like a dog chasing it’s tail over a chicken and egg issue.
For me, I do not want to be directed to Dr. XYZ or a DO or a PA/RNP. I want to see the MD I want to see.
<
p>
…most HMO-like plans have lists of care-givers that are “in network” (subject to reduced co-pays) and others are “out of network” (subject to substantially higher co-pays, or whose fees will not be covered at all). Fee-for-service plans are less restrictive, but they’re much more expensive.
<
p>
It’s nice that you want to see the doctor that you want to see, but your plan may not allow that.
<
p>
BTW, when I had BC/BS I was wondering what I was paying for, for my US$8K premium per year. They covered literally nothing. My mother in law, in Germany, paid an equivalent premium to a private insurer, irrespective of the fact that she was a breast cancer survivor and they covered everything. Including prescription eyeglasses.
<
p>
<
p>
<
p>
<
p>
We should be lucky to be as “screwed up” as the VA.
<
p>
Seriously, MCRD — I don’t know who you are, or where you imagine you get your information, but you are just making stuff up. Again. As usual.
Veteran’s Administration is extremely efficient, according to the VA. But, others may disagree….
<
p>
Walter Reed had a reputation of as a great hospital too.
but fortunately we’re not just relying on VA’s own figures. We’re talking about satisfaction rates, among other measures.
Krugman has pointed out that the success of the VA has not gone unnoticed by the government-can-never-work idealogues who have tried to fix the success with some extra helpings of outside contractors.
The savings of switching everyone to single payer is about 30%, while also covering everyone. Nationally, it would save 300 billion dollars. I don’t know how that would translate in Massachusetts, but surely we’d cover everyone while saving tens of millions overall.
<
p>
Eldridge would pay for it with a 3% employer tax and 3% personal tax, which would save both the employers and people a lot of money over what they’re already paying.
A 3% personal tax would cost me a HELL of a lot more than I currently pay for my health insurance through my employer.
<
p>
My plan (Cigna) currently costs me $59 per month and my employer contributes $334.20.
<
p>
A 3% personal tax would cost me $3,600 per year, an increase of $2,892 per year, or $241 per month.
<
p>
No thank you.
your employer retooled your compensation package to reflect a new healthcare landscape, and then gave that $334.20 to you rather than to a private insurance company?
<
p>
Morte likely that the employer uses the $334 not spent on employee’s insurance costs to fund the new 3% tax imposed on the employer.
One of the reasons that I support Ed O?Reilly?s campaign for Kerry?s Senate seat is that Ed advocates a national single payer program. I believe that only the federal government has the funds to make single payer a reality for all Americans. With Michael Moore?s film SICKO hitting the theaters the end of the week, we have a window of opportunity to pressure all candidates to support Conyers? bill for single payer.
<
p>
Back in the nineties, national and state organizations supporting single payer made a mistake. They were convinced by corporate pundits to use ?universal? rather than ?single payer.? The argument was that no one knew what ?single payer? meant. Of course, ?universal? can apply to mandated private insurance plans like the one we have now here in Massachusetts.
<
p>
Now advocates for single payer have to make up for lost ground in explaining to the public at this point how single payer would work, why it would cost less, AND how it would provide MORE jobs.
<
p>
maniac
First of all this alleged poll (I assume) was taken in Massachusetts, ergo rendering it meaningless re guageing the national sentiment. Massachusetts is essentially a socialist state, as opposed to say the Dakotas, Wyoming, Montana, Texas, Kansas, Nebraska, etc.
<
p>
Let me ask you this. If in fact we have a national single payer system, what is to prevent, physicians, PA’s, RNP’s, and RN’s as well as lab tech, and X-ray techs from forming a union and engage in collective bargaining and drive wages up since there is only one game in town.
<
p>
Will you deny healthcare workers to form a national union, to engage in collective bargaining and withhold services or strike.
<
p>
If I saw my wages artificially being surpressed you can bet that I would become a union organizer in a heartbeat and I would have absolutely no problem in going out on strike as my brothers and sisters did at Brockton, UMASS Medical and other hospitals. And since there is a single payer I would want top dollar. If there is only one game in town, and wages are essentially controlled then I want as much money as I can bargain for. Plus benefits!
Do you think it came from the land of the Fairies or something?
<
p>
As for your points, nurses, ect. are often already in unions.
<
p>
No one’s going to deny them the ability to form a union or to pay them franks and beans. They’ll be paid well.
<
p>
The savings in a single-payer system don’t come from slashing wages, they come from cutting administration expenses. HMOs spend 30% of their money on administration expenses, while Medicare spends 3%. That’s a lot of money to save.
<
p>
That said, there isn’t “one game in town.” The Government won’t own the hospitals, etc. They’ll pay them. The nurses, doctors and hospital employees will be just that – hospital employees, not US employees. Seriously, you need to do your research before you make these kind of weird accusations.
This study was in fact conducted where?
<
p>
A sinlgle payer will be the defacto employer. If you have a business and only one customer/revenue stream then who calls the shots and makes the rules?
<
p>
Re medicare viz a vis HMO. Do you have any idea the amount of documentation that is required now by medicare providers and how much it costs. Do you know how much time a physician/RN spends on doing the paperwork to justify the reimbursement? The problem is that many people are coming out with these alleged great ideas that have no idea what they are talking about. Probably thirty per cent of my time is spent doing foolish paperwork rather than direct patient care.
<
p>
No, that is catagorically false.
<
p>
I don’t know how I can spell it out any more simply:
<
p>
h o s p i t a l s
<
p>
a n d
<
p>
d o c t o r s
<
p>
w i l l
<
p>
s t i l l
<
p>
b e
<
p>
i n d e p e n d e n t
<
p>
get it?
<
p>
That means each and every hospital hires their own employees, pays them their wages, etc. etc. etc.
<
p>
There will still be collective bargaining, which would of course help determine costs of procedures. Do you seriously think progressives, the people pushing universal health care the hardest, are going to suddenly go on the attack on unions, organizations we strongly support? Are you… I don’t know, insane?
<
p>
This is stupid. Single-payer exists in countless countries. I don’t see poor doctors in England, France, Canada or elsewhere. Nurses do fine as well. My mother is a freaking nurse, for heaven’s sake. Would I really argue for a policy that would make my middle class family poorer?
Take
<
p>
<
p>
or
<
p>
<
p>
Either quote is a prediction of the future. For you to call his quote “wrong” or he yours, sounds like some of the reasoned arguments on either side of the road near abortion clinics.
<
p>
To extrapolate the health system of Canada or France or … to the US takes a real leap of faith.
<
p>
Administrative expenses are a source of waste in the system, but no Massachusetts HMO spends 30% on administration. The range is usually 12-15%.
and then all of the other players in the system that must deal with the insurance industry’s bureaucracy must create their own layers of bureaucracy / paper-pushers…
<
p>
Get it?
<
p>
That’s how we get to the 30-40% total system-wide admin, marketing spending.
Just to shine some reality on the thread, does anyone have some authority for the 30% admin and marketing spending figure?
Anybody wonder why we NEVER HEARD about these report findings from the lege>?…
<
p>
<
blockquote> from LECG Final Report commissioned by the MA Lege on HC Financing and Universal Coverage. Excerpts from pages 12, 56, 57(total 172 pages)
<
p>
…Total administrative costs
<
p>
Administrative components Administrative
Premium $1.00
<
p>
$.27-.62 of every premium dollar goes toward administrative expenses
<
p>
from page 12:
<
p>
B. SOURCES OF HEALTH CARE COVERAGE AND COSTS IN MASSACHUSETTS
<
p>
IN 2002 LECG estimates there are more than 399,000 individuals with no health insurance in Massachusetts. Of these 72,000 are children and 327,000 are adults. There are an estimated 860,000 citizens with Medicaid as their primary coverage and another 120,000 senior citizens with a combination of Medicaid and Medicare coverage. There are 858,000 Medicare beneficiaries, of which 535,000 have some prescription drug coverage. There are over four million Massachusetts residents with employer-based coverage, both public and private.
<
p>
Costs of the health care system are estimated to total more than $41 billion in 2002, 56 percent of which is paid by public sources. Total care that is federally matched under various Medicaid assistance regulations total more than $8 billion, indicating that the federal share of Medicaid approached $4 billion in 2002. Public and private employer based insurance pays nearly $14 billion in costs. Out-of-pocket expenses are estimated at $1.64 billion for the insured and $356 million for the uninsured.
<
p>
and from pages 56, 57
<
p>
Figure 2 Typical Shares of Insurance Based Health Care Costs Medical services account for 68 -90% of total expenditures Profit: 2-5% Administration 5-20% Reserves/capital accumulation: 3% Hospital ?inpatient: 20-40% Hospital ?ambulatory: 5-10% Physician: 16-24% Behavioral health: 10-20% Pharmacy: 10-17% Ancillary services: 5-12% Other: 2-6% Medical services account for 68 -90% of total expenditures Profit: 2-5% Administration 5-20% Reserves/capital accumulation: 3% Hospital ?inpatient: 20-40% Hospital ?ambulatory: 5-10% Physician: 16-24% Behavioral health: 10-20% Pharmacy: 10-17% Ancillary services: 5-12% Other: 2-6% Profit: 2-5% Administration 5-20% Reserves/capital accumulation: 3% Hospital ?inpatient: 20-40% Hospital ?ambulatory: 5-10% Physician: 16-24% Behavioral health: 10-20% Pharmacy: 10-17% Ancillary services: 5-12% Other: 2-6% 3. ADMINISTRATIVE COSTS Government costs of regulating the health care industry and administering the Medicaid and other State-based direct care programs are generally recognized as comparatively low or efficient. We adjust government administrative costs for increased economies of scale in the reform models in the next chapter. Federal government costs associated with administering the Medicare, military, and federal employees insurance program are not included in the base case.
<
p>
Figure 3 shows the range of administrative costs that insurers and providers generally report as a share of an insurance premium dollar. Please note that these shares are not the percentage of each provider?s income. For example, since physicians receive $.16 to $.24 of a premium dollar, the percentage of their income dedicated to administrative costs is 25-30 percent of their income, on average. A specific physician, or type of physician, may spend more or less. Like the shares of cost by category of provider, the population being served, the delivery system design, and local market conditions cause administrative costs to vary. Figure 3 Administrative Shares of Health Care Insurance Other administrative includes ancillary services, behavioral health, and pharmacy. Total administrative costs Administrative componentsPremium $1.00 premium $.27-.62 of every premium dollar goes toward administrative expenses Insurer administrative costs: $.05-.20 Hospital administrative costs: $.08-.16 Physician administrative costs: $.05-.08 Other administrative costs: $.09-.18 *Other administrative includes ancillary services, behavioral health, and pharmacy.
<
p>
Total administrative costs
<
p>
Administrative components Administrative
Premium $1.00
<
p>
$.27-.62 of every premium dollar goes toward administrative expenses
<
p>
Insurer administrative costs: $.05-.20 Hospital administrative costs: $.08-.16 Physician administrative costs: $.05-.08 Other* administrative costs: $.09-.18 Insurer administrative costs: $.05-.20 Hospital administrative costs: $.08-.16 Physician administrative costs: $.05-.08 Other* administrative costs: $.09-.18
<
p>
Read entire report here LECG Final Report
The statement was this:
<
p>
<
p>
The quote you’ve pasted, says nothing about HMOs. Nothing.
<
p>
However, your quote does disprove the 3% Medicare figure:
<
p>
<
p>
Note that the overhead from a private premium dollar goes toward (i) hospital admin (ii) physician admin, then too must a medicare dollar go towards those costs. The same admin that process Medicare also processes private insurance claims.
<
p>
The sum of the hospital plus physician is 13%-24% and that’s not counting the direct overhead inherrent in Medicare (i.e. the government employees and medicare system).
<
p>
I can see someone arguing that admin is 30% of each premium dollar, but you can’t compare that to 3% for Medicare. By your own figures it’s at least 16%: 3 + 8 + 5. At the high point of the range it’s 3 + 16 + 8 or 27%.
<
p>
Could either you or Ryan address that? Still sticking by the 30% versus 3% overhead rates?
One goal of administration is discourage those who need assistance from enrolling and encourage those won’t. A single payer system does not need to devote any energy to what is essentially an anti-social effort.
Let me ask you this. If in fact we have a national single payer system, what is to prevent, physicians, PA’s, RNP’s, and RN’s as well as lab tech, and X-ray techs from forming a union and engage in collective bargaining and drive wages up since there is only one game in town.
<
p>
I don’t know what goes in the UK or France, but I have a pretty good idea what goes on in Germany. As I mentioned, the German system is not government provided, but it is government organized. In Germany, there are a number of “sickness funds” (Krankenkassen) to which employees are assigned (primarily based on profession). In point of fact, the Krankenaertze (doctors who take patients who are in the government-organized system, which include most doctors) actually have a negotiating entity that negotiates with the Krankenkassen over rates. Call the entity a union if you wish, but there is negotiation. And, despite that, Germany’s health care costs on the order of half the US system, both in terms of GDP and per-capita spending.
<
p>
I suspect–but cannot prove–that similar negotiations go on in the UK and France, where, I gather, the medical personnel are actually employed by government.
<
p>
Your “Chicken Little” scenario (“drive wages up”) seems to be a bit misplaced.
What is USA famous for? What did Daimler Benz just dump like a hot potato for ten cents on the dollar?
<
p>
Ever deal with the state and federal beaurocracy? This country is famous for one thing, taking a good idea and screwing it up and making it cost three times what it should ie IRAQ!
<
p>
What does a German doctor make (with standard of living equanamity) in contrast with US doctors? A Boston RN makes between 60K and 120K. Do German healthcare workers make this?
<
p>
I’ll tell you right now that there are damn few medical practioners who will increase their workload for the same or less money—-not in this country. As a matter of fact
there are more than just a few medical practitioners (many RN’s) who have had it and have found niche emplyment that uses their education and absolutely no BS, malpractice, late nights and weekends.
<
p>
Chicken Little? We’ll see.
Germany is famous for organization and innovation
<
p>
Even Germans laugh at notions like that. Germany is famous for over-organization and over-engineering (backups for the backups for the backups). I learned that in discussions with Germans themselves. In Germany.
<
p>
I don’t have the slightest idea what the net revenue is to a German doctor. What I do know is that, when I got my first check-up by a private German physician the service was better than anything I have seen by a US facility and price was lower (I was private pay). Since then, I’ve noticed the inefficiencies in the US system, in comparison to our experiences in Germany (example: doctors in Germany not only perform x-rays and ultrasounds, but also read them, whereas in the US, they have three people involved: one to perform the x-ray or ultra-sound, one to interpret the x-ray or ultra-sound, and yet another (the doctor) to diagnose the interpretation. That leads to added cost.
<
p>
<
p>
In a nutshell, the best solution is The Mass. Health Care Trust bill on the state level and HR 676 on the national level.
<
p>
Ann Eldridge Malone, RN, MSN
Alliance to Defend Health Care
“working for health justice for all”
Interesting questions, from which you can draw an opposite conclusion to yours:
<
p>
<
p>
Ya, healthcare’s a Right. Told you so. Hmmm…Wonder though, what the poll would return to the question, “do you believe everyone has a right to hot coffee in the morning?”
<
p>
<
p>
Does that mean that old, homeless guys can’t get free Viagra or that mean that old, homeless guys can’t get free knee replacements? Which one, or both, or neither. This is hard stuff! Who’s to decide what the limits are? Yeaa! The Government!
<
p>
<
p>
Whoa. Deal breaker. 68% like the current healthcare with the current system. That’s 68% who’ll be loath to change.
<
p>
The ‘people who don’t receive healthcare’ don’t appear to be excluded from the polling data.
Does that plan suck! And it costs friggin $295 a month?
<
p>
Are they crazy? How are people supposed to have $5k, earning about 42 grand, when they’re already paying 300 dollars a month? And how are they supposed to afford medication at those rates?
<
p>
Wow, these plans are worse than I thought – and that’s saying a lot, since I’ve been paying close attention.
<
p>
My insurance: $5 co-pays for doctor visits, (though i think free check ups), $25 emergency… and I don’t know about drugs, since it’s been so long since I’ve needed a perscription, but I know it’s not 50% for a non-generic. What happens if a generic isn’t available?
Charley, good you tell us where to find the internals on this poll? The chart is on the BMG server.
<
p>
All I see in that chart is people saying that a sucky plan, well, sucks. I don’t see people eager to hand over money to make it less so.
It seems the plan balances monthly costs with a maximum yearly payment of $5,000. I would have opted for a higher yearly maximum in exchange for lower monthly payments, but I suppose I may be less risk adverse than others.
<
p>
$42,000K a year translates into $2,700/mo after taxes. Figure in roughly $1,000 for rent, $600 for utils & food, and another $400 for transportation, it seems that making the monthly payment of $260 is doable. If you can healthcare spending account, you might even be able to do a little better.
<
p>
It also seems reasonable that this person could afford the $5,000 deductible. No doubt, it would be tough as it would consume the bulk of his discretionary spending. Does the $3,000 in premiums count towards the deductible?
<
p>
I’m curious to know how those who rank this as “unfair” came to their decision. Would it be “fair” for the person making $20,000/yr to get this same plan for free and the person making $80,000 have to pay $520/mo? Does it at all matter that the person making $20,000 is also receiving state funded housing, food and college tuition? These are things I think about as the government takes away a bit of our liberty.
Does a more affluent person have to pay more for groceries than a less affluent person?
<
p>
Do I have to subsidize another because I chose to work three jobs and another person works 40 or less a week. How do we penalize drunks, drug addicts and women who have one illegit kid after another?
<
p>
Should people with chronic illness pay more? How about folks with COPD who smoke?
<
p>
How dare you. Who the hell do you think you are?
Take as a starting point that government encourages some behavior and discourages others through, among other means, taxes.
<
p>
Having multiple children out of wedlock leads to societal problems. Government does nothing to discourage the practice; rather it provides protections (some see this as incentives) to procreate and collect.
<
p>
I’m not claiming the problem is rampant, but it does exist.
<
p>
Margery Eagan suggest we need a MADD-like organization to jumpstart a change in thinking about unfit parenthood.
<
p>
Based on your indignation, I’d say Ms. Eagan is right on the mark.
…that I should not pay taxes to support services that I will not make use of, or do not support. I’ll give you a laundry list. Public education (we have no children). Most police services go to protect commercial property. Roads (we really don’t travel on them very often; maybe there should be a toll based on usage). Courts (usually used by commercial interests). And that’s merely at the state level.
<
p>
At the federal level, virtually all of the federal government, including, but not limited to, the Department of Offense. It hasn’t served the US since 1945, and that was before it was the Department of Offense.
<
p>
If we were to get rid of those expenses, my taxes would be a small fraction of what they are today. On the other hand, if you really are retired military, you probably wouldn’t be receiving your rather generous pension from the Department of Offense.
Tough??? Tough?!? Aw, how “tough” to have little to no discretionary spending. You know what having little to no discretionary spending leads to? Mental and physical stress, bad health, and people leaving Massachusetts.
<
p>
Who are you to decide what a fair amount of discretionary spending should be? If the $5,000 consumes that much of this guy’s salary, he’s not going to be saving money. He’s going to be working just to pay rent/mortgage and his health insurance. What kind of life is that??
<
p>
I do believe it would be fair-er for someone making $20,000/yr to get the same plan for free and someone making $80,000 to have to pay $520 month. Why should someone who, by dint of either unfortunate circumstances, lack of opportunities, or just a calling to a skill that is chronically underpaid, not be able to have any money to spend for fun, to remind them that they are not just corporate slaves?? Basic costs of living should not be so expensive that a person can’t save, can’t go on a vacation, can’t occasionally go to a movie or have dinner out. Y’know, “the pursuit of happiness” that is supposedly part of our “unalienable rights.”
<
p>
I don’t care if the person making $20,000 is also receiving state-funded assistance in other areas. We have selfish idiots running around buying $700,000 pens and $40,000 purses or $32,000 gas-powered
hummers“off-road vehicles” and $47,000 Fantasy Coaches–for their kids.<
p>
And then we have the average Joe, whose yearly salary is probably half the amount of upper-crust “discretionary spending,” and we should begrudge the poor anything?
<
p>
For unto whomsoever much is given, of him shall be much required: and to whom men have committed much, of him they will ask the more. Luke 12:48
You argue that this wouldn’t be fair because — in the particular circumstance of someone who has to pay the deductible — he wouldn’t have money left over for fun.
<
p>
In other words, the person at $80K isn’t subsidizing the other’s insurance, they are subsidizing the other’s recreation. Just what standard of living should we all have? Should we all live in the same size house, drive the same car, have the same number of children? How much of someone’s lifestyle should be subsidized by another?
<
p>
Ultimately, you are arguing for wealth redistribution or some sort of narrowing of standards of living. Please describe what someone’s lifestyle should receive out of life and put into it in order to meet your standard.
<
p>
Also, I think you have taken the exception — someone who would have to pay the full deductible in a given year — and used that as the basis to judge the rule.
<
p>
<
p>
4. Do you believe everyone has a right to a vacation?
Yes ? 92%
No ? 7%
<
p>
5. Should there be any limits on that vacation? (Asked only of the 92% who answered yes to the previous question)
Yes ? 54%
No ? 39%
<
p>
6. How pleased are you with the vacation your receive?
Very ? 68%
Somewhat ? 24%
Not Very ? 5%
Not at all ? 3%
<
p>
I’m thinking, Vacations must be a Right!
Employers would have to:
<
p>
-Make sure that jobs pay not just a minimum wage but a living wage, one that might vary from region to region but never go below a certain point.
<
p>
-Make sure that people get quality health insurance and adequate vacation/sick/personal days
<
p>
-Make sure that the work environment is conducive to work: ergonomically safe, environmentally safe, and flexible enough to accommodate people who work best under different circumstances (telecommuting, etc.).
<
p>
-Treat employees well. Reward good behavior instead of just punishing bad behavior. Make sure those in management positions are trained to be managers. Don’t just promote strong workers vertically–they may not want to be managers and they may not make good managers; institute horizontal promotions.
<
p>
-Truly listen to employees’ concerns (instead of spending thousands of dollars on “consultants” and then never changing anything). Make sure employee representatives are present in management discussions about short- and long-term strategic planning.
<
p>
-Pay people who work to help others what they’re worth: firefighters, police, teachers, nurses, daycare employees, social workers, public attorneys, those who work with the elderly and dying. It seems pretty obvious that we’d want top-notch quality in those (and similar) areas, yet we’re not going to get it if we can’t pay a living wage.
<
p>
As far as you think I’m proposing “wealth distribution or some sort of narrowing of standards of living,” I’m curious as to what would threaten a billionaire’s comfort level–not being able to buy a $46.5 million-dollar vacation home in Kaui? Not being able to trade up to a $470,470,000 gigayacht?
<
p>
Puh-leez. I’m just saying the the obscene income gap in the United States needs to be fixed. It’s in everyone’s best interest–remember, a chain is only as strong as its weakest link (p. 19).
<
p>
Not everybody is as greedy as the wealthiest twenty percent, who now account for at least 50 percent of total U.S. income. Most people would be happy knowing they don’t have to worry. Their families don’t have to worry.
<
p>
I don’t see that goal as being incompatible with our capitalist system. The problem with our system is it works only if everyone is on an equal playing field. We’re not even close.
But I believe someone making 42k a year should, after paying all of their expenses, be able to save up their money. Under your calculations, that person would have about $400 a month for whatever, but also have to worry about potentially $5k in other health care costs. What happens if that person takes perscription drugs for diabetes, depression or some other common disease? What happens if that person has kids or extended family?
<
p>
No, the premiums don’t count toward the deductible.
<
p>
Finally, I challenge your numbers: there are lots of other bills I don’t think you factor in. Travel expenses – be it public trans or car, gas alone would tack on at least a hundred a month. Insurance. Potentially, a mortgage, which would be far more than $1k. Or, if the person lives in the city, there’s not all that many single bedroom apartments for 1k. I have two friends, a couple, living together in a simple Brookline 1 bedroom apartment – rent, including parking, costs more than $1,500 and both earn far less than 42k.
<
p>
I don’t know what the 80k person should be paying, either. Personally, single-payer is really the only fair solution. Under the Conyers plan, it would only cost people 3% of their salary – which is a lot less than what most people pay for their insurance today. Our country would save 300 billion a year, while everyone would get top quality insurance.
Thanks for the thoughtful response, Ryan. In this scenario, I think we need to stick to the assumptions about this being about a single white male, which implies no dependents.
<
p>
At one point, weren’t the plans offered to have regional pricing? The question as it stands might indeed be deemed ‘unfair’ in high rent areas, but just fine in places where you can still rent a 1bd for $650.
<
p>
Prescription drugs for common diseases are likely available in generic. But, true, prescription costs alone may push this to the $5,000 limit. Brings me back to the question of choice among plans (a prescription-heavy benefit for example).
<
p>
To this point, I caught a little bit of the guest on the Paul Sullivan show last night, and her idea of tax refunds sounds intriguing. Combined with allowing anyone to open an HSA and providing a public agency to help people managing these decisions (something along the lines of a credit bureau) could provide flexibility and assistance.
<
p>
Saint Kermit will be interviewing Jarrett Barrios tomorrow (Thursday) night at 8 PM about this very topic, as well as his departure from the State Senate. You can join the discussion by listening to the program on Talkshoe and calling in.
<
p>
The best way to join us is to set up a Talkshoe account (click here to do so), then phone in using your own PIN. If you don’t have an account, we have two open lines for anyone – to use them, do the following at anytime after 7:45 tomorrow night:
(1) Call 724-444-7444
(2) Enter this talkcast ID: 23744
(3) Enter one of our special PINs: 6477744494 or 6477744495.
<
p>
We hope to hear you then.