NationStates Jolt Archive

ok i need someone to explain how this "plan" is not going to cost me a bundle.

i now get heath insurance through the husband's job. he tells me that in addition to the $4000/year that we pay the company pays an additional $12k for it. (not that he couldnt be lying to me)

under mccain's plan we would pay income tax on that $12k--an additional.... lets call it $3000...then there comes some tax credit that doesnt come to US to pay for our income tax but to some insurance company...$5000...

so does that lower our taxable insurance income to $7000--that we then pay...oh lets call it $2000 in taxes on... or...well WHAT?

somebody here must know how it would really work. it CANT be that it will increase my income tax--that just not john mccain, hes a teddy roosevelt republican, a true maverick, a reformer, a de-regulator, a tax cutter.....

It's all in the jargon. What you comfortingly believe to be 'plan' is in fact a mish-mash of soundbites and hastily grasped upon ideas thrown together in a sort of amorphous blob of political chicanery.

Sorry about that.

OK, here how it's going to work:

1) It is going to cost you a bundle.

2) You still won't be able to rely on your coverage.

See? It's simple.

Oh, and I forgot 1(a): The tax you pay on what your employer pays on your behalf -- which is actually treating that as if you are paying it out of your paycheck, not your employer paying it before paying you -- anyway, that tax will likely match a good portion of the break given to the insurance company, so essentially... it will destroy the concept of employer-provided health insurance by fobbing the costs onto the employees.

you forget the part where the free market is going to solve it all.

ok i need someone to explain how this "plan" is not going to cost me a bundle.

i now get heath insurance through the husband's job. he tells me that in addition to the $4000/year that we pay the company pays an additional $12k for it. (not that he couldnt be lying to me)

under mccain's plan we would pay income tax on that $12k--an additional.... lets call it $3000...then there comes some tax credit that doesnt come to US to pay for our income tax but to some insurance company...$5000...

so does that lower our taxable insurance income to $7000--that we then pay...oh lets call it $2000 in taxes on... or...well WHAT?

somebody here must know how it would really work. it CANT be that it will increase my income tax--that just not john mccain, hes a teddy roosevelt republican, a true maverick, a reformer, a de-regulator, a tax cutter.....

He's also bullet proof, and can turn invisible, And back in '06 he also developed the amazing super power of lying about everything he's ever said, accomplished, and stood for.

you forget the part where the free market is going to solve it all.
This IS how the free market solves it all. Ain't it great?

and they wonder why this is the greatest country on earth!

OK, here how it's going to work:

1) It is going to cost you a bundle.

2) You still won't be able to rely on your coverage.

See? It's simple.

Oh, and I forgot 1(a): The tax you pay on what your employer pays on your behalf -- which is actually treating that as if you are paying it out of your paycheck, not your employer paying it before paying you -- anyway, that tax will likely match a good portion of the break given to the insurance company, so essentially... it will destroy the concept of employer-provided health insurance by fobbing the costs onto the employees.

Oh, and another heartwarming part of this is that it's taxing you on income that you'll never see any part of (you know, by treating the employer's portion of the insurance as if it is income to you). So I guess, this also means there's no such thing as a before-tax deduction from payroll anymore. So special. *tears up just thinking about it.*

It will cost you a bundle to keep existing insurance and still be impossible for me to afford it, as I don't have an employer that offers it. Some plan.

and they wonder why this is the greatest country on earth!
Personally, I believe all of this is designed to eventually force everyone to buy their own fully self-paid private insurance direct from the insurers rather than have it provided as a work benefit at all.

Personally, I believe all of this is designed to eventually force everyone to buy their own fully self-paid private insurance direct from the insurers rather than have it provided as a work benefit at all.

Of course, because it's all about "personal responsibility,"

Personally, I believe all of this is designed to eventually force everyone to buy their own fully self-paid private insurance direct from the insurers rather than have it provided as a work benefit at all.
thats what the husband says (as he was pretending that he loved the idea)

and that would have some positive benefits in that companies wouldnt have the expense of health insurance and so would be more competitive with companies from countries with nationalized health care.

but without getting an extra $12k (or $7k, depending on how this plan really works) in yearly pay all it really does is save companies money while making sure that no one can afford health insurance. and if the companies have to raise everyones salaries it doesnt save them any money.

I think I've already posted this, so forgive me if you've heard this one before:

This episode of NPR's Fresh Air (http://www.npr.org/templates/story/story.php?storyId=93975730) gives you a pretty good analysis of the McCain and Obama health plans. Policy wonk Jonathan Oberlander wrote this article for the NEJM (http://content.nejm.org/cgi/content/full/359/8/781), and Terry Gross interviews him about it.

As I understand it, if you have employer-sponsored health insurance, you're currently getting a benefit (the employer-paid portion of the premium) that you're not taxed on. Lucky you, right? Someone buying their own heath insurance gets no tax benefit. The McCain plan would give both you (with your employer-sponsored insurance) and Mr. Joe PrivateInsurance the same tax credit: $2500 (or $5000 for families.) To pay for the tax credit, he'd tax that benefit that you're getting.

Since it will now be more expensive for companies to provide health insurance, the plan assumes that many companies will either drop coverage or raise your premium to the point where it makes more sense for you to go to the private market. The McCain plan assumes that the private market will become more competitive and less nutty because there will be more demand, which will foster competition.

Personally I think this is bollocks. There are plenty of supposedly competitive markets out there (the cellphone service market, for example,) that don't appear to function efficiently, and many of those service markets (again, cellphone service) that are providing much, much simpler products than health insurance. But there are arguments in favor of doing this as well.

The other potential problem with McCain's plan is that it doesn't address the escalating costs of providing healthcare. Why exactly costs have gone up so much faster than inflation is a knotty question, but there's no question that they have, and McCain doesn't lay out any reason why costs won't continue to rise under his plan. If, as expected, the tax credit is either fixed or tied to the CPI, the purchasing power of that tax credit will erode pretty quickly, as health costs are rising about twice as fast as CPI.

I think I've already posted this, so forgive me if you've heard this one before:

This episode of NPR's Fresh Air (http://www.npr.org/templates/story/story.php?storyId=93975730) gives you a pretty good analysis of the McCain and Obama health plans. Policy wonk Jonathan Oberlander wrote this article for the NEJM (http://content.nejm.org/cgi/content/full/359/8/781), and Terry Gross interviews him about it.

As I understand it, if you have employer-sponsored health insurance, you're currently getting a benefit (the employer-paid portion of the premium) that you're not taxed on. Lucky you, right? Someone buying their own heath insurance gets no tax benefit. The McCain plan would give both you (with your employer-sponsored insurance) and Mr. Joe PrivateInsurance the same tax credit: $2500 (or $5000 for families.) To pay for the tax credit, he'd tax that benefit that you're getting.

Since it will now be more expensive for companies to provide health insurance, the plan assumes that many companies will either drop coverage or raise your premium to the point where it makes more sense for you to go to the private market. The McCain plan assumes that the private market will become more competitive and less nutty because there will be more demand, which will foster competition.

Personally I think this is bollocks. There are plenty of supposedly competitive markets out there (the cellphone service market, for example,) that don't appear to function efficiently, and many of those service markets (again, cellphone service) that are providing much, much simpler products than health insurance. But there are arguments in favor of doing this as well.

The other potential problem with McCain's plan is that it doesn't address the escalating costs of providing healthcare. Why exactly costs have gone up so much faster than inflation is a knotty question, but there's no question that they have, and McCain doesn't lay out any reason why costs won't continue to rise under his plan. If, as expected, the tax credit is either fixed or tied to the CPI, the purchasing power of that tax credit will erode pretty quickly, as health costs are rising about twice as fast as CPI.

So basically he will in the end be fucking with a benefit that I need and use, all in the name of interfering in the free market with only some an amorphous un-proven guess that eventually costs will come down

Fuck him, there is no way that no matter what happens to the private market they will cover the 75 percent premium payment that my work currently provides

I think I've already posted this, so forgive me if you've heard this one before:

This episode of NPR's Fresh Air (http://www.npr.org/templates/story/story.php?storyId=93975730) gives you a pretty good analysis of the McCain and Obama health plans. Policy wonk Jonathan Oberlander wrote this article for the NEJM (http://content.nejm.org/cgi/content/full/359/8/781), and Terry Gross interviews him about it.

As I understand it, if you have employer-sponsored health insurance, you're currently getting a benefit (the employer-paid portion of the premium) that you're not taxed on. Lucky you, right? Someone buying their own heath insurance gets no tax benefit. The McCain plan would give both you (with your employer-sponsored insurance) and Mr. Joe PrivateInsurance the same tax credit: $2500 (or $5000 for families.) To pay for the tax credit, he'd tax that benefit that you're getting.

Since it will now be more expensive for companies to provide health insurance, the plan assumes that many companies will either drop coverage or raise your premium to the point where it makes more sense for you to go to the private market. The McCain plan assumes that the private market will become more competitive and less nutty because there will be more demand, which will foster competition.

Personally I think this is bollocks. There are plenty of supposedly competitive markets out there (the cellphone service market, for example,) that don't appear to function efficiently, and many of those service markets (again, cellphone service) that are providing much, much simpler products than health insurance. But there are arguments in favor of doing this as well.

The other potential problem with McCain's plan is that it doesn't address the escalating costs of providing healthcare. Why exactly costs have gone up so much faster than inflation is a knotty question, but there's no question that they have, and McCain doesn't lay out any reason why costs won't continue to rise under his plan. If, as expected, the tax credit is either fixed or tied to the CPI, the purchasing power of that tax credit will erode pretty quickly, as health costs are rising about twice as fast as CPI.
i heard that episode when it aired but at the time i didnt realize that the tax credit goes directly to the insurance company (unless you get insurance for less than $5k/year for your family, then the rest goes into a health care account)

unless that credit comes to ME, it cant help but cost me a bundle more money, can it?

i heard that episode when it aired but at the time i didnt realize that the tax credit goes directly to the insurance company (unless you get insurance for less than $5k/year for your family, then the rest goes into a health care account)

unless that credit comes to ME, it cant help but cost me a bundle more money, can it?

The tax credit "goes straight to your insurance company" the same way that your car loan goes straight to the car dealership. Before, your employer was paying $5k (at least) to the insurance company; now you are, via the tax credit.

I think the real problem is when that $5k doesn't cover the insurance that you need.

Actually, I misspoke (miswrote?) in that first post. I should have re-read the report I linked to! McCain's plan doesn't simply assume that the price of private-market insurance will come down, it proposes some changes which should, it theorizes, drive down costs:

1) Allowing health insurance to be bought across state lines. Many states have their own set of laws regulating the health-insurance industry, such as coverage mandates (e.g. insurance must cover the cost of birth control.) Removing the state-line barriers basically lets consumers choose between sets of mandates, and gives them the option (in theory) of going with a cheaper plan from another state.

Obviously this puts huge pressure on state legislatures to undo regulations that the industry sees as costly. This may or may not be a good thing.

2) Change Medicare reimbursement to payments based on outcomes (vs. the current fee-for-service system.)

3) Making the costs of healthcare more visible may slow spending. The argument goes something like this: sure, employer-sponsored healthcare is great if you can get it, but the net effect of it is that some people have too much health coverage and some people (without employer-sponsored care) don't have any. A more fair system would mean that more people could afford some coverage, even if that meant that the formerly-lucky few couldn't afford as much.

The tax credit "goes straight to your insurance company" the same way that your car loan goes straight to the car dealership. Before, your employer was paying $5k (at least) to the insurance company; now you are, via the tax credit.

I think the real problem is when that $5k doesn't cover the insurance that you need.
i just dont get how it works when its a tax credit.

so i have NOW a tax bill of .....10k .... with this plan i would have a tax bill of .....13K ..... but i get a tax CREDIT (which credits normally come off the bottom line of my tax bill) but instead of it going to ME to lessen my tax bill it goes to some insurance company--to help pay the premiums? ...which lowers my insurance income to 7k (supposing a company paid insurance bill of 12k with 5k taken off by the credit) which i STILL have to pay income tax on.. which brings my tax burden from 10k to... $12k ...and i still have to pay more income tax because it wasnt a true tax credit.

ALL NUMBERS ARE PULLED OUT OF MY ASS EXCEPT THE TAX CREDIT NUMBER

but if i DONT get insurance from my employer, i still pay 12K (maybe more) for my insurance but the feds send 5k to my insurance company for me. leaving me to pay 7k out of my pocket. which is nice if i buy private insurance now but not all that helpful if he thinks that i can suddenly afford an extra 7k out of my already meager income.

:

1) Allowing health insurance to be bought across state lines. Many states have their own set of laws regulating the health-insurance industry, such as coverage mandates (e.g. insurance must cover the cost of birth control.) Removing the state-line barriers basically lets consumers choose between sets of mandates, and gives them the option (in theory) of going with a cheaper plan from another state.


as i remember from that fresh air episode THIS Provision is one of the most egregious. certain states have higher insurance costs because they mandate that ALL people must be covered, even those with pre-existing conditions. this raises the average cost of insurance but very much helps out those who would be denied all insurance otherwise. if a person can opt out of THAT plan and buy insurance from another state those mandated programs will become too expensive for anyone to buy and the pre-existing conditions people will be screwed.

although from his webpage i see that mccain is going to "encourage" states to develop "gap" plans to cover those pre-existing condition people.

as i remember from that fresh air episode THIS Provision is one of the most egregious. certain states have higher insurance costs because they mandate that ALL people must be covered, even those with pre-existing conditions. this raises the average cost of insurance but very much helps out those who would be denied all insurance otherwise. if a person can opt out of THAT plan and buy insurance from another state those mandated programs will become too expensive for anyone to buy and the pre-existing conditions people will be screwed.

although from his webpage i see that mccain is going to "encourage" states to develop "gap" plans to cover those pre-existing condition people.I have just one question.
Will I still be able to afford pie? :(

as i remember from that fresh air episode THIS Provision is one of the most egregious. certain states have higher insurance costs because they mandate that ALL people must be covered, even those with pre-existing conditions. this raises the average cost of insurance but very much helps out those who would be denied all insurance otherwise. if a person can opt out of THAT plan and buy insurance from another state those mandated programs will become too expensive for anyone to buy and the pre-existing conditions people will be screwed.

although from his webpage i see that mccain is going to "encourage" states to develop "gap" plans to cover those pre-existing condition people.

You're right; that almost seems to defeat the purpose of insurance, to share the risk. Not offering insurance to someone with a pre-existing condition may be better for the business, but then it doesn't become much better than a savings plan.

This months edition of Consumer Reports had analysis of both plans, and it was very thorough and useful. Some groups will actually do better under the McCain plan, not just insurers. (I may be remembering incorrectly, but I think those who already have insurance will do better, despite the tax.)
Of course, that doesn't mean the plan is better, or even good.

You're right; that almost seems to defeat the purpose of insurance, to share the risk. Not offering insurance to someone with a pre-existing condition may be better for the business, but then it doesn't become much better than a savings plan.

This months edition of Consumer Reports had analysis of both plans, and it was very thorough and useful. Some groups will actually do better under the McCain plan, not just insurers. (I may be remembering incorrectly, but I think those who already have insurance will do better, despite the tax.)
Of course, that doesn't mean the plan is better, or even good.
it made sense to me until i found out that the tax credit doesnt go to ME.

unless it does go to me if i have employer provided insurance....

I have just one question.
Will I still be able to afford pie? :(
yes but only pumpkin pie.

yes but only pumpkin pie....Will the Dark Side still have cookies? :(

...Will the Dark Side still have cookies? :(
the dark side always has cookies

but you dont want to know what kind.

the dark side always has cookies

but you dont want to know what kind.Light Side, for the win. :p
But, in all seriousness... will there be cake?

1) Allowing health insurance to be bought across state lines. Many states have their own set of laws regulating the health-insurance industry, such as coverage mandates (e.g. insurance must cover the cost of birth control.) Removing the state-line barriers basically lets consumers choose between sets of mandates, and gives them the option (in theory) of going with a cheaper plan from another state.


The stupid thing about it, of course, is that the other state, with the cheaper plan, will capitalise on the new market by raising their price.

Unless their state is then forced to drop the mandated coverage - in which case providers will simply opt out of offering it.

Light Side, for the win. :p
But, in all seriousness... will there be cake?
cake is eternal.

no force of darkness can defeat it.

cake is eternal.

no force of darkness can defeat it.Good, because life without cake would not be worth living. :D

The McCain health plan seems best summed up in three words . . . "Don't get sick."

The McCain health plan seems best summed up in three words . . . "Don't get sick."

That's the one for me then, since it's the one I have already... ;)
:(

Good, because life without cake would not be worth living. :D
you said it, brother!

i just made a nice yellow cake with chocolate frosting this afternoon.

life is sweet.

I recommend everyone watch Mike Moore's "Sicko".
He points out the massive inadequacies of the US Health System.

Americans, like Canadians, the British, Australians and most Europeans, should have universal health care funded by all taxpayers. This privately insured health system is a sick joke.
Why has America tolerated it for so long??

I recommend everyone watch Mike Moore's "Sicko".
He points out the massive inadequacies of the US Health System.

Americans, like Canadians, the British, Australians and most Europeans, should have universal health care funded by all taxpayers. This privately insured health system is a sick joke.
Why has America tolerated it for so long??

Because if you advocate universal health care paid for by the tax payers you're a dirty commie, and possibly a mutant traitor as well. If Friend Government meant for us to get adequate health care we'd all be rich.

Because if you advocate universal health care paid for by the tax payers you're a dirty commie, and possibly a mutant traitor as well. If Friend Government meant for us to get adequate health care we'd all be rich.

Paranoia references for the win.

Unless you're a commie-mutie-traitor yourself. Hmm...*dials it in*

ok i need someone to explain how this "plan" is not going to cost me a bundle.

i now get heath insurance through the husband's job. he tells me that in addition to the $4000/year that we pay the company pays an additional $12k for it. (not that he couldnt be lying to me)

under mccain's plan we would pay income tax on that $12k--an additional.... lets call it $3000...then there comes some tax credit that doesnt come to US to pay for our income tax but to some insurance company...$5000...

so does that lower our taxable insurance income to $7000--that we then pay...oh lets call it $2000 in taxes on... or...well WHAT?

somebody here must know how it would really work. it CANT be that it will increase my income tax--that just not john mccain, hes a teddy roosevelt republican, a true maverick, a reformer, a de-regulator, a tax cutter.....

Just as a minor point, in all likelihood your husband's employer pays more than $12,000 a year if you're paying $4,000. Either that or your husband's employer offers your husband a raw deal. Most group health insurance offered by major employers are more in the 80/20 or 85/15 employer/employee split range.

edit: Oh, I suppose you might have children, yes? If you do then ignore what I just said.

The tax credit "goes straight to your insurance company" the same way that your car loan goes straight to the car dealership. Before, your employer was paying $5k (at least) to the insurance company; now you are, via the tax credit.

I think the real problem is when that $5k doesn't cover the insurance that you need.

This is the most correct explanation I think I've seen.

I feel all special and stuff, this thread is my bread and butter.

Currently, most health insurance in the United States is group health insurance offered through major employers. Group health insurance, in essence, is when a company or some other organized entity negotiates an insurance plan with an insurance provider to cover all employees they deem eligible. There are two major types of employer-sponsored health insurance, self-funded and fully-insured. The differences are distinct but irrelevant for this discussion, so if anyone has any questions let me know.

When you get a job and you sign up for your new health plan with your new employer, the rate that you see that they charge you is only your personal portion of the total premium. In reality, your company pays a significant portion of the total premium. The average employee contribution for single and spousal health insurance is 16%, while family coverage (that being you plus spouse plus child/children) is 27%. These averages have remained relatively constant for the past 8 years. That means that your employer, on average, is paying 84% if you just have yourself or you and a spouse, and 73% if you have kids, of the total cost of the medical insurance. What really happens is the company pays the insurer a pre-negotiated premium every month for whatever total sum was decided upon, and the money coming out of your check is just you paying your company back (in most cases, some companies do things a little differently).

Now, the reason companies can afford to do something like this is because, currently, the government offers huge tax incentives for non-monetary compensation such as this. If your insurance costs $10,000 a year, and your company is paying $8400 of it, they get huge tax breaks on that $8400, sometimes 100%. This, obviously, is done to encourage employers to offer health insurance so a majority of people are covered. The government wants this so that they are not on the hook for health care costs if people were getting sick and injured while uninsured; programs like Medicaid.

Now, take Mr. Small Businessman. He owns his own bar/restaurant/antique shop/porno studio. He's not presently employed by a company that has group health insurance. By the very virtue of him being his only employee prevents him from obtaining group health insurance. So he's forced to go out and get his own individual policy. Say he's even lucky enough to find an insurer who's willing to offer him a reasonable plan at $10,000 a year (which in all likelihood he never would, but again, irrelevant to this particular discussion). Now, both your plans cost $10,000, but you have your company footing 84% of your bill, while he has none. So he's stuck with the full $10,000. On top of that, your company is getting a huge tax write-off on their $8400, while he's paying for all $10,000 of his after taxes. It doesn't seem very fair to Mr. Small Businessman, and in reality, it isn't.

McCain feels this is unfair for Mr. Small Businessman (and Mr. Large Businessman too, which I'll get to). So he proposes to level the playing field. And how do we level playing fields in this great country of ours? By lowering everyone to the bottom! Mr. Small Businessman will now get a tax credit to help offset the rather crippling costs of insuring himself, $2500 in my example. And McCain proposes to help pay for all these generous tax credits how? By removing the current tax benefits major employers get for offering employer-subsidised health care. So now, your major employers will no longer get any tax breaks on that $8400 we've been discussing, and will now have to pay for it after tax. What's more, YOUR weekly payroll contributions, which now by law come out of your check pre-tax, lowering your taxable income, will now come out after tax. Hooray!

Sarcasm aside, this will have two effects. For the privately insured, it will offer minor relief from the costs of self insuring. $2500 may even seem like a good sum of money, given my example. But my example is flawed in one major way. The biggest, baddest reason companies are able to offer insurance at sums like I've used ($10,000), is because of the negotiating power they possess when they approach insurers about group health insurance. When UHC or BCBS see a company like General Motors approaching with their 100,000+ potential customers, they lower the individual rate somewhat in order to secure the contract. So, larger companies are able to get their employers lower rates. Mr. Small Businessman has no such negotiating clout, and would likely be stuck paying a much higher individual rate, sometimes as much as 200% what group health care costs. So, that $2500 looks a lot less helpful when you're staring down a $20,000 yearly insurance bill. And I won't even get into family coverage.

Now, for those of us currently on employer-sponsored health care (just over 60% in the United States in 2007, compared to 9% privately insured), this will have a much more deleterious effect. With those tax breaks being stripped away, most companies would find the incentive to offering health care to their employers removed. Why foot 84% of the bill if you're not getting anything out of it, right? So, less solvent companies would immediately begin downgrading or even removing their group health plans. This would force hundreds of thousands of people onto the open market to look for health care. For the companies that continued to offer health care, their employees would find their personal responsibility multiplied. Many, many people would be forced onto vastly inferior plans due to cost.

Now, the idea is that flooding the market with hundreds of thousands of individual payers would force the market to compete, thus lowering prices. The question becomes, do we feel market forces would compel insurers to compete to such a degree that they lowered their costs by 84%? Because that, in essence, is what it would take to make individual rates competitive with what people are currently able to obtain from group health plans.

ok i need someone to explain how this "plan" is not going to cost me a bundle.

i now get heath insurance through the husband's job. he tells me that in addition to the $4000/year that we pay the company pays an additional $12k for it. (not that he couldnt be lying to me)

under mccain's plan we would pay income tax on that $12k--an additional.... lets call it $3000...then there comes some tax credit that doesnt come to US to pay for our income tax but to some insurance company...$5000...

so does that lower our taxable insurance income to $7000--that we then pay...oh lets call it $2000 in taxes on... or...well WHAT?

somebody here must know how it would really work. it CANT be that it will increase my income tax--that just not john mccain, hes a teddy roosevelt republican, a true maverick, a reformer, a de-regulator, a tax cutter.....

I found that confusing. I'm no good at figuring out this kind of stuff. But if I know John McCain it'll screw over anyone who isn't rich.

Just as a minor point, in all likelihood your husband's employer pays more than $12,000 a year if you're paying $4,000. Either that or your husband's employer offers your husband a raw deal. Most group health insurance offered by major employers are more in the 80/20 or 85/15 employer/employee split range.

edit: Oh, I suppose you might have children, yes? If you do then ignore what I just said.
ya but do you know how this mccain health insurance plan would work? ive READ that its pretty much neutral for most people who have insurance through work now but i just dont see how that can be the case if *I* dont get the tax credit.

im not happy with the idea of putting everyone into the individual insurance purchase category unless there is a huge change in regulations of what can be offered at what price.

Getting back to the Mr. Large Businessman bit.

This is pure speculation, but to me it seems painfully obvious that this proposal by McCain is nothing but pandering corporations. Currently, with the skyrocketting costs of medical care, companies are finding it harder and harder to foot the bill for their portion of subsidised health insurance. Already, in this industry, we are seeing an increasing number of employers guiding their employees to Consumer Driven Health Care, an insurance model that puts more of the onus on preventative care by the employee due to the higher personal costs to said employee (you can read up on CDHPs here (http://en.wikipedia.org/wiki/Consumer_driven_health_care)). Many companies are doing what is called "locked in" company contributions, which means that companies are setting a ceiling for what their responsibility will be to insurance premiums, and anything over that ceiling will shift to the employee's portion. This is having the effect of ballooning personal insurance premiums for even those under group health plans.

This is all taking place because companies are finding it more and more difficult to provide adequate, subsidised health care to their employees.

A big reason why the costs to the company are rising are what are considered high-risk employees. People with long-standing medical issues, older people, obese, etc. When a company requests a bid from an insurance company, they supply the insurer with demographic data of the employees: no medical history is reported, as that would violate HIPAA regulations, but statistical data about the breakdown of the employee population by age, race, gender, location, job description, etc. The insurer uses this information to make a bid on what they believe the average premium would need to be to ensure that they are funded for all forecasted claims. The more unhealthy the population, the higher the premium goes. So, if you're a 23 year old male working a desk job, you probably pay a higher premium than you might necessarily claim, and this is so the 63 year old father of four with a diabetic wife isn't forced to pay a crippling premium to cover his obviously higher-risk family. The insurer spreads the risk, so to speak, figuring out what the average they need to charge to end out on top.

Now, demographically, the workforce is aging. The Boomer generation is approaching Medicare age and there are not enough people enterring the workforce to offset this. Similarly, the workforce is getting more unhealthy. Obesity is rising among most populations, including the workforce. So as more and more people become more insurance risks, the premium that the insurers feel they need to charge goes up.

Take the two people I mentioned above. We'll call the 22 year old Joe and the 63 year old Dan. Currently, under an employer plan, Dan has access to an affordable premium because there are plenty of Joes to spread his risk around to. Dan may cost the insurance company a fortune, but there are six or seven Joes out there who pay more in premiums than they use in health care each year, so it balances out. But, like I said, the workforce is aging. The ideal ratio that I've heard in meetings and such is 4 to 1. For every Dan, you want four Joes, to adequately spread the risk. But that's not the case anymore. The burden is becoming intolerable for companies, and they want a way out.

That's exactly what McCain's plan gives them. If they're stripped of their tax incentives, then they can eliminate their health insurance plan and poof! No more risky Dans.

But what happens to Dan and Joe? Well, Joe is the kind of customer the insurance companies dream of. They would like nothing better than for every customer they have to be Joes, paying for more premium than they use in care each year. Joe will get a sweet deal from a private insurer. It may even rival what his company offered. As for Dan? I'm sure most people can figure that out, but the only reason he was given an affordable rate before was because of all those Joes to spread the risk to. Now that he has to negotiate a rate for just himself, he's going to find very few insurers who even want to cover him, and of the ones that do? They will only offer him the most painful rate they have. After all, why would they want to insure such a risk?

So, Dan gets an awful insurance plan that covers very little, or worse, finds he can't get insured at all. So, next time he needs to pick up insulin for his wife, or one of his kids gets pneumonia, they're out of luck.

It's a play to employers, and to insurance companies. Employers get to dump the insurance benefits that are killing their bottom line, and insurance companies get to cherry pick who they cover, leaving the people who need insurance the most in the worst shape.

And the people that can't find affordable coverage anywhere? Well, they go on Medicaid, and the taxpayer gets to subsidise their care instead.

ya but do you know how this mccain health insurance plan would work? ive READ that its pretty much neutral for most people who have insurance through work now but i just dont see how that can be the case if *I* dont get the tax credit.

im not happy with the idea of putting everyone into the individual insurance purchase category unless there is a huge change in regulations of what can be offered at what price.

Based solely from what I've been able to glean from the proposals I've read online, the plan has two major components. He will offer a $2500 individual/$5000 family tax credit to anyone not offered insurance through an employer. To fund these tax credits, he intends to eliminate the tax breaks that employers currently enjoy by offering group health care.

So, if you don't have employer coverage, you get some relief on your health care costs. If you have employer coverage, then technically everything remains neutral. But your employer is now paying a ton more in taxes each year on their portion of your insurance. He's removing the incentive to provide health care, as it's going to cost companies inordinate amounts of money to continue to provide that coverage if they're paying millions more in taxes.

Take General Motors. It's an extreme example. They have almost 100,000 employees. Most of them are covered under union plans. If we estimate that GM is paying $10,000 in medical premiums for each employee, that's $1 billion they pay in medical premiums. Now they likely don't pay a dime in taxes on that $1 billion, which is huge for them. But under McCain's plan, they would pay taxes on it just like anything else. I don't know what corporate taxes on $1 billion would be, but I'm confident that it's a large enough sum of money to make GM contemplate whether offering insurance is in their best interest. Now, GM is kind of stuck because of the whole union thing, but for non-organized companies, there's really nothing to make them not offer insurance other than as a means to attract talent.

Health care is already becoming something companies are finding it harder and harder to offer current and prospective employees, and McCain's plan only aims to make it even more difficult.

edit: In all likelihood, what companies will do is shift the new tax burden onto the employee; imputed income. I've always had a hell of a time explaining imputed income.

Based solely from what I've been able to glean from the proposals I've read online, the plan has two major components. He will offer a $2500 individual/$5000 family tax credit to anyone not offered insurance through an employer. To fund these tax credits, he intends to eliminate the tax breaks that employers currently enjoy by offering group health care.

So, if you don't have employer coverage, you get some relief on your health care costs. If you have employer coverage, then technically everything remains neutral. But your employer is now paying a ton more in taxes each year on their portion of your insurance. He's removing the incentive to provide health care, as it's going to cost companies inordinate amounts of money to continue to provide that coverage if they're paying millions more in taxes.

Take General Motors. It's an extreme example. They have almost 100,000 employees. Most of them are covered under union plans. If we estimate that GM is paying $10,000 in medical premiums for each employee, that's $1 billion they pay in medical premiums. Now they likely don't pay a dime in taxes on that $1 billion, which is huge for them. But under McCain's plan, they would pay taxes on it just like anything else. I don't know what corporate taxes on $1 billion would be, but I'm confident that it's a large enough sum of money to make GM contemplate whether offering insurance is in their best interest. Now, GM is kind of stuck because of the whole union thing, but for non-organized companies, there's really nothing to make them not offer insurance other than as a means to attract talent.

Health care is already becoming something companies are finding it harder and harder to offer current and prospective employees, and McCain's plan only aims to make it even more difficult.

edit: In all likelihood, what companies will do is shift the new tax burden onto the employee; imputed income. I've always had a hell of a time explaining imputed income.
part of the plan is supposed to be adding the money paid by the employer for insurance to the annual income reported on your W2 to be taxed as regular income. so my income tax bill would go way up.

THEN it is supposed to somehow be offset by the tax credit but if that tax credit is supposed to go to the insurance company its not going to defray the added income tax.

not that i trust the insurance companies not to say (for those who buy insurance themselves) "whoa we are getting an extra 5k/family policy, lets raise the rate by $2,500. they'll still get a bit of a break".

part of the plan is supposed to be adding the money paid by the employer for insurance to the annual income reported on your W2 to be taxed as regular income. so my income tax bill would go way up.

Yeah, imputed income. It is added to your income for tax purposes, but you don't actually see the money. The reason that doesn't happen now is because the companies don't pay taxes on their contribution. I fully expect that they'll go the way of imputed income, just like any benefit they don't get tax credit for, like DP insurance or life insurance.


THEN it is supposed to somehow be offset by the tax credit but if that tax credit is supposed to go to the insurance company its not going to defray the added income tax.

Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

I'm not sure how exactly it would work either, but it seems that the credit pays for the insurance premium? Either way, it's laughable that he believes there's a family out there that would be able to find health care coverage less than $5000 annually.


not that i trust the insurance companies not to say (for those who buy insurance themselves) "whoa we are getting an extra 5k/family policy, lets raise the rate by $2,500. they'll still get a bit of a break".

They won't even need to pull anything quite so sneaky. The cost for individual health care is ALREADY $2500/$5000 higher than group care because they don't have the negotiating power.

This plan will give the 9% of Americans who are privately insured minor relief, and will cost a majority of the 60% of Americans who are covered by their employer more money.

That's exactly what McCain's plan gives them. If they're stripped of their tax incentives, then they can eliminate their health insurance plan and poof! No more risky Dans.
Is there some reason a company can't just bow out of the health plan on their own, without finding someone to force its hand for it? It sounds like putting my hand on a hot stove, and then asking for someone to kick me in the face so I'll be forced to let go.
But what happens to Dan and Joe? Well, Joe is the kind of customer the insurance companies dream of. They would like nothing better than for every customer they have to be Joes, paying for more premium than they use in care each year. Joe will get a sweet deal from a private insurer. It may even rival what his company offered.
If Joe gets insurance at all, rather than spending the money on a car or drinking money. 20-something year old males are not known for our foresight.

Yeah, imputed income. It is added to your income for tax purposes, but you don't actually see the money. The reason that doesn't happen now is because the companies don't pay taxes on their contribution. I fully expect that they'll go the way of imputed income, just like any benefit they don't get tax credit for, like DP insurance or life insurance.





I'm not sure how exactly it would work either, but it seems that the credit pays for the insurance premium? Either way, it's laughable that he believes there's a family out there that would be able to find health care coverage less than $5000 annually.



They won't even need to pull anything quite so sneaky. The cost for individual health care is ALREADY $2500/$5000 higher than group care because they don't have the negotiating power.

This plan will give the 9% of Americans who are privately insured minor relief, and will cost a majority of the 60% of Americans who are covered by their employer more money.
thats how it seems to me. but its too stupid a plan to even be proposed if that is the case. it would be a massive income tax increase which would seem to be against john mccains most basic political stance.

not that i dont oppose it for the other obvious reasons but the increase in tax should be a deal killer for everyone.

i guess he just wants to be able to say he has a plan and that that plan is NOT socialism.

Is there some reason a company can't just bow out of the health plan on their own, without finding someone to force its hand for it? It sounds like putting my hand on a hot stove, and then asking for someone to kick me in the face so I'll be forced to let go.

It depends. Pretty much any company that's organized has it written into its union contract that the company has to provide health insurance. There's always haggling over the figures, but it's pretty standard fare. I believe any sort of governmental entity is mandated to provide insurance, though those entities are usually organized as well.

As for private, non-organized companies? No. There's no mandate requiring they offer benefits. It just comes down to talent attraction. Talented employees expect a company to offer a generous benefits package, and health care is a big part of that.

What this plan potentially allows is for the companies to withdraw health insurance from their benefits package and blame it on the government.


If Joe gets insurance at all, rather than spending the money on a car or drinking money. 20-something year old males are not known for our foresight.

That's potentially very true. I haven't been able to figure out what the McCain plan is for the uninsured. I doubt they get the credit if they don't get insurance, since that seems to be the whole point.

I recommend everyone watch Mike Moore's "Sicko".
He points out the massive inadequacies of the US Health System.

Americans, like Canadians, the British, Australians and most Europeans, should have universal health care funded by all taxpayers. This privately insured health system is a sick joke.
Why has America tolerated it for so long??

The main reason that universal health care issue has been debated for a very long time now is the fact that it has been seen in america as very contriversial. True, Americans spend alot more on medical bills than their counterparts and for some the bills are unbearable. And it is also true that doing nothing to the system wont solve anything. But there is a dark side to the silver lining of the system. Many countries abroad have decided that it was okay to establish such health care system, but, some are now feeling the "aftershocks" of government provided healthcare.

Canadians, for example, are finding that they are producing less and less medical technology and medicine because U.S. markets are making more profit off of medical drugs. This is because a universal heathcare system would eliminate such profit off of pharmaceutical drugs, on which the average medical drug costs over a few billion dollars to create, so most of these live saving medicines are actually not going to make a profit in the short run. So, heathcare makes it worse....

England, an other example, has patients waiting for months at a time to get treated by doctors and find facilities are intollerable at some times. Logic would dictate that now these doctors cannot make a profit, there level of service decreases and fewer doctors are in practice. Another strike on universal heathcare....

However, France has decided to give up the universal heathcare system, but not entirely, to accomidate the peoples choice in doctors, physicians, as well as the medical drugs and treatment options. It is paid 3/4 by government and the rest private insurance, as well as the sickest having the best coverage under the plan. Its not the universal heathcare system of the mindset, and its expensive to the taxpayer, but it seems the French have the best heath in the entire world. Link:http://www.npr.org/templates/story/story.php?storyId=92419273

So, it seems that no universal healthcare or total universal heathcare are two extremes that dont work the best, but a combo of the two...

thats how it seems to me. but its too stupid a plan to even be proposed if that is the case. it would be a massive income tax increase which would seem to be against john mccains most basic political stance.

not that i dont oppose it for the other obvious reasons but the increase in tax should be a deal killer for everyone.

Not everyone. I'm Joe. I pay $15 a week for health care. That's roughly $800 a year. That means that my company pays about $5000 a year for me. $5800 total. I don't know exactly what my tax would be on $5800, but I doubt it would be $2500. So I could, theoretically, make more money under McCain's plan than I do now.

But I'm an outlier. For the bulk of Americans, those with families, I just don't see how this plan won't cost them a whole lot more.

Not everyone. I'm Joe. I pay $15 a week for health care. That's roughly $800 a year. That means that my company pays about $5000 a year for me. $5800 total. I don't know exactly what my tax would be on $5800, but I doubt it would be $2500. So I could, theoretically, make more money under McCain's plan than I do now.

But I'm an outlier. For the bulk of Americans, those with families, I just don't see how this plan won't cost them a whole lot more.
isnt that only if the tax credit goes to YOU, joe? if it goes to the insurance company you still have to pay taxes on that 3300 that your employer pays for you.

and any money you "make" on the deal...say your insurance costs $2000...goes to a health care savings account.

*snip*

France pays for its universal healthcare largely out of payroll taxes which discourage job creation. I prefer switzerland's mandatory self-insurance, without payroll taxes, healthcare system.

isnt that only if the tax credit goes to YOU, joe? if it goes to the insurance company you still have to pay taxes on that 3300 that your employer pays for you.

and any money you "make" on the deal...say your insurance costs $2000...goes to a health care savings account.

Okay. I get a tax credit for $2500. I also have to pay the taxes on $5000 worth of company provided health care. I'll estimate 30%, which is totally being pulled out of my ass. So I owe $1500 in taxes that the company used to be able to write off. I'm still contributing my $800 a year and my company still contributes their $5000 a year, but now I have to pay the $1500 in taxes. But my tax credit is $2500, so there's $1000 extra there. What happens to it. It goes into an HSA, Health Savings Account. HSAs work like money market accounts (my current HSA is down 21%, :(), so I can theoretically earn money as long as I don't have to dip into it to go to the doctor too often. It works exactly like my current health plan. I, personally, would benefit from McCain's plan.

Most people, however, are not limited to the medical care burdens of a healthy 25 year old white collar male. I go to the doctor once a year for a checkup, and maybe once a year for a penicillin prescription if I get a cold. I am not most people, though.

The McCain health plan seems best summed up in three words . . . "Don't get sick."
Or, if you do, make sure you've married an extremely wealthy heiress beforehand who can afford to pay for your treatment.

Okay. I get a tax credit for $2500. I also have to pay the taxes on $5000 worth of company provided health care. I'll estimate 30%, which is totally being pulled out of my ass. So I owe $1500 in taxes that the company used to be able to write off. I'm still contributing my $800 a year and my company still contributes their $5000 a year, but now I have to pay the $1500 in taxes. But my tax credit is $2500, so there's $1000 extra there. What happens to it. It goes into an HSA, Health Savings Account. HSAs work like money market accounts (my current HSA is down 21%, :(), so I can theoretically earn money as long as I don't have to dip into it to go to the doctor too often. It works exactly like my current health plan. I, personally, would benefit from McCain's plan.

Most people, however, are not limited to the medical care burdens of a healthy 25 year old white collar male. I go to the doctor once a year for a checkup, and maybe once a year for a penicillin prescription if I get a cold. I am not most people, though.
yes but you have missed the part where YOU dont get that tax credit. it goes directly to the insurance company.

IF that is the way it works for empoyer provided insurance.

oh and btw, i have been reading and appreciating the long explanatory posts you have been making in this thread.

Or, if you do, make sure you've married an extremely wealthy heiress beforehand who can afford to pay for your treatment.

Redwulf is right, but that's the direction that health care in the United States has been heading for the past 10 years. Right now, we have a health care culture in this country of "get sick, go to doctor, get prescription". It's all reactive. We don't do much of anything to avoid getting sick, we just get sick and then expect to be given a pill to make it all better. That's expensive. The trend is towards preventative care. Getting people educated. Getting people into gyms or to see nutritionists. Doing everything you can to avoid having to go to the doctor at all, because that's less expensive, and ultimately, better for you.

McCain's plan just seems to take what should be a voluntary process that people need to be eased into, and makes it into a mandatory punch in the face.

yes but you have missed the part where YOU dont get that tax credit. it goes directly to the insurance company.

I don't directly get the money, no. McCain's website says it is "essentially cash," which couldn't be further from the truth. The credit goes to the insurance company. They use it to pay off the $1500 in taxes that the company used to not have to pay, but now does. Anything that is left over after it pays those taxes goes into my HSA. I get to control the HSA investments, and I can either use it to pay for out-of-pocket medical expenses, or, I can hold onto it until I turn 65, and then it becomes another retirement vehicle. So, I may not get a nice check in the mail, but I do "get" the money, so to speak. It doesn't just disappear into the insurance company's coffers.

I don't directly get the money, no. McCain's website says it is "essentially cash," which couldn't be further from the truth. The credit goes to the insurance company. They use it to pay off the $1500 in taxes that the company used to not have to pay, but now does. Anything that is left over after it pays those taxes goes into my HSA. I get to control the HSA investments, and I can either use it to pay for out-of-pocket medical expenses, or, I can hold onto it until I turn 65, and then it becomes another retirement vehicle. So, I may not get a nice check in the mail, but I do "get" the money, so to speak. It doesn't just disappear into the insurance company's coffers.
oh sdae, that makes NO sense.

i get insurance, i file taxes, my tax credit goes to the insurance company, the insurance company pays money to my employer?

if i get 5000 in insurance money paid by my employer and stuck onto my W2 so i have to pay income tax on it but the $2500 in tax credit doesnt come to ME to offset my extra income tax, it just doesnt work.

so maybe i have it wrong and the tax credit DOES come to me if my employer pays my insurance?

edit: In all likelihood, what companies will do is shift the new tax burden onto the employee; imputed income. I've always had a hell of a time explaining imputed income.
Go on, I'm interested.

Excellent posts btw. Easy to read and explained the situation succinctly.

This story is rather appropriate for this thread:
http://www.theonion.com/content/news/man_succumbs_to_7_year_battle_with

I recommend everyone watch Mike Moore's "Sicko".
He points out the massive inadequacies of the US Health System.

Americans, like Canadians, the British, Australians and most Europeans, should have universal health care funded by all taxpayers. This privately insured health system is a sick joke.
Why has America tolerated it for so long??

lolz, our system may be broken, but at least it isn't Canadian...

http://www.cato.org/pubs/pas/pa-613.pdf <--read, it's quite interesting, even though I still wouldn't vote McCain...

The trend is towards preventative care. Getting people educated. Getting people into gyms or to see nutritionists. Doing everything you can to avoid having to go to the doctor at all, because that's less expensive, and ultimately, better for you.
quite right. A better, long-term, approach would be to offer tax-credits for gym memberships. Paying an unisured fatass to lose 30 pounds now would save the country potentially $hundreds of thousands later from them being holed in a hospital bed with half their leg amputated from Diabetes.


While I was in China last year, I tried Traditional Chinese Medicine (TCM). Not only did I find it worked but the concepts behind it were - well, logical. TCM looks at preventing or ridding yourself of illness, not just alleviating symptoms. When you're coming down with the 'flu, all a Western doctor will do is give you some pills for your headache, aches and pains, blocked nose etc. Stuff that's going to make you feel better, but not actually cure you. Keeps the pharmaceutical companies happy though.

quite right. A better, long-term, approach would be to offer tax-credits for gym memberships. Paying an unisured fatass to lose 30 pounds now would save the country potentially $hundreds of thousands later from them being holed in a hospital bed with half their leg amputated from Diabetes.

I wonder if there's ever been a cost benefits analysis of periodic lipo suction plans for the obese financed by the government.

lolz, our system may be broken, but at least it isn't Canadian...

http://www.cato.org/pubs/pas/pa-613.pdf <--read, it's quite interesting, even though I still wouldn't vote McCain...
Bearing in mind that the Cato Institute is a rather extreme libertarian think tank whose aims are to promote "limited government, individual liberty and free markets".

So them saying Universal Health coverage is a Bad Thing is not that surprising.

It's all in the jargon. What you comfortingly believe to be 'plan' is in fact a mish-mash of soundbites and hastily grasped upon ideas thrown together in a sort of amorphous blob of political chicanery.

Sorry about that.

Exactly. McCain doesnt have a health care plan.

oh sdae, that makes NO sense.

i get insurance, i file taxes, my tax credit goes to the insurance company, the insurance company pays money to my employer?

if i get 5000 in insurance money paid by my employer and stuck onto my W2 so i have to pay income tax on it but the $2500 in tax credit doesnt come to ME to offset my extra income tax, it just doesnt work.

so maybe i have it wrong and the tax credit DOES come to me if my employer pays my insurance?

I'm sorry. I'm trying my best here.

The way I understand it, the credit goes straight to the insurance company. It goes there to offset the cost of your health insurance; specifically, it offsets the company's cost.

So, your insurance costs $16,000. $4000 to you and $12,000 to your employer.

Now there's this extra $2500 from the government that's there to help pay for your insurance. Since I doubt highly that the company will lower YOUR rates any, we'll say that this $2500 helps offset the company's contribution.

That means now you pay $4000, your employer pays $9500, and the government pays $2500.

This is nice and all, but the government says, "by the way, you have to pay taxes on all that money you contribute for Ashmoria's insurance. No more tax breaks for you!" and taxes your company on the money it contributes.

Your company says, "well fuck, we're not going to pay for this," and shifts the payment onto you, in the form of imputed income.

So now, the REAL cost of your insurance has gone up. It was $16,000, but that was untaxed. Now that it's taxed, we'll generously say it's now $23,000.

So your plan costs $23,000. Presuming your company is nice enough to go back to that $12,000 figure, this means that the company pays $12,000, the government pays $2500, and you pay the rest. $8500. You were paying $4000, so this means your contribution goes up $4500. These numbers are all based on me making up tax numbers and stuff, but that's the general gist of it.

Most families are going to be in your position. I'm on the other end of the spectrum.

My insurance costs $5500. I pay $750, and my employer pays $4750. The government comes in and offers to pay for $2500 of that, but makes my employer pay $1500 in taxes on that $4750.

The real cost of my insurance goes from $5500 to $7000, but there's an extra payer now. Presuming both my and my company's contributions remain the same, I pay $750 of the $7000, the company pays $4750, and the government offers to pay $2500. But because the cost only went up $1500, there's $1000 left over from the government after the insurance company is all paid up. The government doesn't trust me enough to just hand me that money, but they say I can invest it in my HSA. I figure I'm up $1000, so why the hell not?

I think I did a better job this time, but I know I confused myself once or twice along the way and had to go back, so let me know. :(

I wonder if there's ever been a cost benefits analysis of periodic lipo suction plans for the obese financed by the government.
And you could reduce costs by selling all that excess fat as soap or cooking oil!

Sdaeriji, I'm sorta getting it now. thanks for your patience and explanations.
One thing:
Say your employer decides it can no longer afford to pay for your health insurance, as it now gets no tax breaks.
Would this then mean - using your figures above - you, as the employee, would now have to stump up the whole $23,000 yourself, minus the $2500 'tax credit'?

So your health insurance goes from $4000 personal contribution to $20500.
Am I reading this right?

Does anyone else feel like they need a flow chart when they hear McCain Health care plan?

Go on, I'm interested.

Excellent posts btw. Easy to read and explained the situation succinctly.

This story is rather appropriate for this thread:
http://www.theonion.com/content/news/man_succumbs_to_7_year_battle_with

Imputed income, really?

Alright.

When a company offers a benefits package, the benefits are traditionally broken up into two groups for payment purposes: pre-tax or post-tax. The groups are defined by whether a benefit is considered tax-exempt or not. Things like 401(k)s and health, dental, and vision insurance are tax-exempt, so are paid pre-tax, while things like long term disability and most life insurance are not tax-exempt, so are paid post-tax. Most benefits are also subsidised by your company; that means they pay a portion of the total premium to the insurer. When a benefit is tax-exempt for you, it is almost always also tax exempt for the employer.

There are a few exceptions, however. The most common one I see is domestic partners (this is also a huge argument by gay rights groups for the right to marriage). My health insurance is pre-tax for myself. If I had a spouse, it would be pre-tax for her too. Same for any potential children. But it is not for a domestic partner. Coverage for a domestic partner under group health insurance is not considered tax exempt. This means two things. One, it comes out of my paycheck after taxes. Two, the portion of the premium that my company covers for my DP is also taxed. Naturally, the company doesn't really want to have to pay those taxes. So, what they do, is they add to my paycheck the value of the benefit they're paying for my DP. It goes in as income, gets taxed, and then is removed from my pay. So, I pay the taxes for their portion of my DPs insurance.

Does that follow?

Does anyone else feel like they need a flow chart when they hear McCain Health care plan?

I need a flow chart whenever McCain speaks.

quite right. A better, long-term, approach would be to offer tax-credits for gym memberships. Paying an unisured fatass to lose 30 pounds now would save the country potentially $hundreds of thousands later from them being holed in a hospital bed with half their leg amputated from Diabetes.

Possibly the best example. Paying to have overweight people to see nutritionists and go to a health club may cost a company $1000 now, but it's a damn sight better than having to pay $1000 a month for insulin for the rest of their lives when they get diabetes, nevermind having anything amputated.

Would this then mean - using your figures above - you, as the employee, would now have to stump up the whole $23,000 yourself, minus the $2500 'tax credit'?

So your health insurance goes from $4000 personal contribution to $20500.
Am I reading this right?

Yes. It's probably even worse than that. If your company up and decided to stop offering health insurance, you would eventually* have to find an insurance plan and pay the total cost yourself. And since you'd no longer have the negotiating leverage your company had when they got that $23,000 rate, you'd probably find it to be even more expensive.

* - I say eventually because there are laws that mandate that if an employer suddenly ceases its health insurance plan, all the employees covered by any of the plans that were terminated are entitled to continue their coverage for a set period of time. I believe the period is 36 months from the date of the termination, where the employees could elect to continue the coverage. They would be responsible for the entire premium, but they would be able to remain in the group plan. Also, if an employee is medically disabled when it happens, they are allowed to continue under the plan until they qualify for Medicare.

Imputed income, really?

snip

Does that follow?
yup it does, thank you.

Redwulf is right, but that's the direction that health care in the United States has been heading for the past 10 years. Right now, we have a health care culture in this country of "get sick, go to doctor, get prescription". It's all reactive. We don't do much of anything to avoid getting sick, we just get sick and then expect to be given a pill to make it all better. That's expensive. The trend is towards preventative care. Getting people educated. Getting people into gyms or to see nutritionists. Doing everything you can to avoid having to go to the doctor at all, because that's less expensive, and ultimately, better for you.

And how is the average American with no insurance supposed to do that? A lot of us are living pay check to pay check and have a hard enough time paying our rent and bills and buying food.

And how is the average American with no insurance supposed to do that? A lot of us are living pay check to pay check and have a hard enough time paying our rent and bills and buying food.

If you have NO insurance then you don't really fall into either category. I'm talking about people who have grown up on HMOs, where everything is just a $15 co-pay, no matter how expensive it really is. People are insulated from the true cost of medical care, and that causes people to be irresponsible with it.

But the idea is that company-sponsored plans should, and increasingly are, focusing on keeping people from getting sick in the first place rather than treating them once they do get sick.

But the idea is that company-sponsored plans should, and increasingly are, focusing on keeping people from getting sick in the first place rather than treating them once they do get sick.

Great idea, the problem is company sponsored insurance programs are increasingly ceasing to exist.

I'm sorry. I'm trying my best here.

The way I understand it, the credit goes straight to the insurance company. It goes there to offset the cost of your health insurance; specifically, it offsets the company's cost.

So, your insurance costs $16,000. $4000 to you and $12,000 to your employer.

Now there's this extra $2500 from the government that's there to help pay for your insurance. Since I doubt highly that the company will lower YOUR rates any, we'll say that this $2500 helps offset the company's contribution.

That means now you pay $4000, your employer pays $9500, and the government pays $2500.

This is nice and all, but the government says, "by the way, you have to pay taxes on all that money you contribute for Ashmoria's insurance. No more tax breaks for you!" and taxes your company on the money it contributes.

Your company says, "well fuck, we're not going to pay for this," and shifts the payment onto you, in the form of imputed income.

So now, the REAL cost of your insurance has gone up. It was $16,000, but that was untaxed. Now that it's taxed, we'll generously say it's now $23,000.

So your plan costs $23,000. Presuming your company is nice enough to go back to that $12,000 figure, this means that the company pays $12,000, the government pays $2500, and you pay the rest. $8500. You were paying $4000, so this means your contribution goes up $4500. These numbers are all based on me making up tax numbers and stuff, but that's the general gist of it.

Most families are going to be in your position. I'm on the other end of the spectrum.

My insurance costs $5500. I pay $750, and my employer pays $4750. The government comes in and offers to pay for $2500 of that, but makes my employer pay $1500 in taxes on that $4750.

The real cost of my insurance goes from $5500 to $7000, but there's an extra payer now. Presuming both my and my company's contributions remain the same, I pay $750 of the $7000, the company pays $4750, and the government offers to pay $2500. But because the cost only went up $1500, there's $1000 left over from the government after the insurance company is all paid up. The government doesn't trust me enough to just hand me that money, but they say I can invest it in my HSA. I figure I'm up $1000, so why the hell not?

I think I did a better job this time, but I know I confused myself once or twice along the way and had to go back, so let me know. :(
thats even worse!

not the explanation but the possibility that its right.

but as i was thinking while in bed listening to david letterman ripping john mccain yet another asshole....

i dont pay income tax on the insurance premiums i pay NOW. its routed by the company through a health care savings account thingy that works the same way the 401K does. its pre-tax income that is spent only on medical stuff that includes insurance (and would include other things if we had constant yearly expenses that arent covered by insurance if you know what im talking about) (when i say *I* i mean "my husband")

so that means that mccain is also going to get rid of THAT benefit that is already sheltering some of my income from tax.

The good think about McCain's plan is insurance wouldn't be sold state by state anymore. That will allow individual plans to be portable and more competition would be very good.

The bad thing is 20 million insured people will lose coverage under his plan.

That's the short version.

It will cost you a bundle. It will also cost your employer a bundle 'n a half if they offer health insurance.

Okay, McCain wants to kick you a $5000 tax credit. I can say from personal experience that $5000 doesn't go bugger in terms of American health care. It won't cover an MRI. It won't cover a year's worth of diabetic supplies (no personal experience), it won't even cover a knee replacement. It doesn't come close to cancer surgery or chemotherapy regimen.

If you take the tax break, you'll have to navigate the (very predatory) world of health insurance, on your own and unguided. Can you swing $1200 a month for your family?

Savings account for medical care? Sorry, you could save $100 a week for five years and a case of arthritis would wipe it out before you can say "acetominophen prescription."

On top of that....... McCain would tax the benefits your employment coverage gave you, as if they were wages. So if you're lucky enough to have medical coverage at the place of your employment, the insurance would take care of your dental fillings/carpal tunnel/celiac disease treatment/your choice here.

But...Those benefits would be taxed. Not to you, but your employer. Can you see where I'm going with this? Can we say "Health coverage dropped?" Or heck, they might even fire your illness-riddled ass in a downsizing swoop.
There's your choices with McCain.

And if I may, I'd like to close with Obama's health plan. Very simple. He'd open up the Federal Employees' Medical Plan to anyone who doesn't hold single coverage or coverage through employer or state high-risk pool. And it only costs $175 a month, per person, because of the buying power of huge masses of people. And nobody turned away for any reason.

It will cost you a bundle. It will also cost your employer a bundle 'n a half if they offer health insurance.

Okay, McCain wants to kick you a $5000 tax credit. I can say from personal experience that $5000 doesn't go bugger in terms of American health care. It won't cover an MRI. It won't cover a year's worth of diabetic supplies (no personal experience), it won't even cover a knee replacement. It doesn't come close to cancer surgery or chemotherapy regimen.

If you take the tax break, you'll have to navigate the (very predatory) world of health insurance, on your own and unguided. Can you swing $1200 a month for your family?

Savings account for medical care? Sorry, you could save $100 a week for five years and a case of arthritis would wipe it out before you can say "acetominophen prescription."

On top of that....... McCain would tax the benefits your employment coverage gave you, as if they were wages. So if you're lucky enough to have medical coverage at the place of your employment, the insurance would take care of your dental fillings/carpal tunnel/celiac disease treatment/your choice here.

But...Those benefits would be taxed. Not to you, but your employer. Can you see where I'm going with this? Can we say "Health coverage dropped?" Or heck, they might even fire your illness-riddled ass in a downsizing swoop.
There's your choices with McCain.

And if I may, I'd like to close with Obama's health plan. Very simple. He'd open up the Federal Employees' Medical Plan to anyone who doesn't hold single coverage or coverage through employer or state high-risk pool. And it only costs $175 a month, per person, because of the buying power of huge masses of people. And nobody turned away for any reason.
The $5000 tax credit is for insurance. It's not going to replace the medical expense credit.

The problem with Obama's plan is he is grossly underestimating the cost. And it's a single payer system. It's going to be bankrupt and swimming in beurocracy.

The $5000 tax credit is for insurance. It's not going to replace the medical expense credit.

The problem with Obama's plan is he is grossly underestimating the cost. And it's a single payer system. It's going to be bankrupt and swimming in beurocracy.
Can you demonstrate this with some supporting evidence and clarification, please?

Can you demonstrate this with some supporting evidence and clarification, please?

You just need to think about it. Right now, the US spends about 16-17% of GDP and covers maybe 80% of people. Now, the budget deficit next year, even if healthcare stays at the same level is going to be a little over a trillion dollars, maybe more. These are facts.

The people without healthcare, tend not to have it because they are poor. So you can't get the money from them. And, well, taxes are going to have to go up anyway - which is very bad considering the state of the economy - but not to pay for healthcare, the moneys already been spent.

So there just isn't the money. Anywhere.

That's not to say that a single payer system couldn't work. In fact I think it would be a great way of solving a lot of problems. It just wouldn't be the type of healthcare that Americans are used to. And though I haven't bothered to check, I am pretty sure that Obama is not selling a plan where we all get covered, but people - especially the old - receive substantially less care.

And all this talk of collective bargaining to get lower costs is just talk. It doesn't work that way. The discounts gained, if any, will be so slight as to not even make a dent in the shortfall.

I actually expect that nothing will be done. Whoever is the next president pretty much has his hands completely tied in just about every respect given the situation right now. I suppose we could cancel the military.

Not enough worker bees anymore.

Can you demonstrate this with some supporting evidence and clarification, please?

I thought you and I always agreed that a single payer system was wrong for the US?

If you're talking about the cost, part is conjecture from state Medicaid programs and part is from things like this:
Obama said he could “pay for every dime” of his spending and tax cut proposals “by closing corporate loopholes and tax havens.” That’s wrong – his proposed tax increases on upper-income individuals are key components of paying for his program, as well. And his plan, like McCain’s, would leave the U.S. facing big budget deficits, according to independent experts.
http://www.factcheck.org/elections-2008/factchecking_obama.html

Obama says his health care plan will garner large savings – $120 billion a year, or $2,500 per family – with more than half coming from the use of electronic health records. And he says he’ll make that happen in his first term. We find his statements to be overly optimistic, misleading and, to some extent, contradicted by one of his own advisers. And it masks the true cost of his plan to cover millions of Americans who now have no health insurance.
http://www.factcheck.org/elections-2008/obamas_inflated_health_savings.html

It'll take me some time to dig up examples from states.

I still think healthcare reform has to happen before UHC can be implemented in any effective way. Make healthcare more efficent to deliver, put insurance companies on a tighter leash, then work at insuring everyone. Then the government can purchase healthcare through private companies for the uninsured. The way Oregon does, for example.

In the mean time, I think we need to streamline an integrate the existing free systems already in existence. Yes, that's a bandaid, but it will help short term while the larger issues are sorted through.

Let's be honest. The US will be lucky if unemployment is under 15% this time next year, and gdp has only shrunk 5%. Financials account for about 40% of the profits of the S&P - well they claimed they did.

Nobody is going to have time for healthcare reform. I wonder why they even bother talking about it.

Let's be honest. The US will be lucky if unemployment is under 15% this time next year, and gdp has only shrunk 5%. Financials account for about 40% of the profits of the S&P - well they claimed they did.

Nobody is going to have time for healthcare reform. I wonder why they even bother talking about it.

Well, there's many things that can be sorted while the economy is sorted. For example, if legislation can be drafted that reduces the number of insane law suits, that will reduce the cost of healthcare. I need to dig up the cost breakdown of a perscription drug and examples of the absolutely insane lawsuits leveled at pharma companies every year.

Restructuring the existing systems would help too.

I agree though. The economy has to be fixed before we can start beefing up social programs. I hate that reality, but it's neccesary.

Well, there's many things that can be sorted while the economy is sorted. For example, if legislation can be drafted that reduces the number of insane law suits, that will reduce the cost of healthcare. I need to dig up the cost breakdown of a perscription drug and examples of the absolutely insane lawsuits leveled at pharma companies every year.

Restructuring the existing systems would help too.

I agree though. The economy has to be fixed before we can start beefing up social programs. I hate that reality, but it's neccesary.

Oh, the insane lawsuits are going away anyway. The insurance companies are bankrupt. So that shit is going to be cut right out. The US is going to become considerably less litigious in general.

But the reality is that most likely every penny is going to be needed for social relief programs. At the same time, the bond market is going to constrain the size of deficits AND the tax base is going to shrink. I see large cuts in defense, education...well just about everything really.

For my money, I would just copy the NHS in the UK, and recapture the revenue (About 6% of GDP) which could be used for other stuff, like not having such a huge debt. And I would tell everyone they'd just have to suck it up. (The more spartan level of care that is and rationing).

Oh, I agreed with you. I just wanted you to do that so that the lurkers and other readers who aren't posting would understand why it would happen that way. :)

Oh, the insane lawsuits are going away anyway. The insurance companies are bankrupt. So that shit is going to be cut right out. The US is going to become considerably less litigious in general.

But the reality is that most likely every penny is going to be needed for social relief programs. At the same time, the bond market is going to constrain the size of deficits AND the tax base is going to shrink. I see large cuts in defense, education...well just about everything really.

For my money, I would just copy the NHS in the UK, and recapture the revenue (About 6% of GDP) which could be used for other stuff, like not having such a huge debt. And I would tell everyone they'd just have to suck it up. (The more spartan level of care that is and rationing).
Honestly, I don't think Americans will be happy with a UK NHS model. And I'm not saying that's a good mentality at all. But I think many people labor under the delusion that NHS is like private insurance without the cost or the hassle.

Spending a great deal of my early 20's uninsured in America, I became very savy to the US's free healthcare system. And it's a good system, but it's cumbersome and not user friendly. For example, I severely sprained my ankle without insurance. First I took a trip to the county health office (no county hospital nearby). I see someone who can give a cursory exam, but this facility doesn't have xray. So I have to go to another free clinic down the road. That clinic has seperate paperwork, and a wait list.

If I'd have know about that clinic ahead of time I'd have totally signed up early. But now I'm on a wait list. I call around to private clinics and find one that will xray me without an exam. So I get two exposures ($40) and wander back to county. I wait in the queue all over again to have the county doc look at them.

And you can often get free meds from pharma companies too. Some clinics integrate this system, others don't.

I just think we need a system that provides a minimum level of care first. One that isn't cumbersome to navigate. If someone is lucky enough to live near a county hospital, they're golden. Otherwise, you run into problems like I did. Wait times are inevitable, but we could form a more cohesive system.

Honestly, I don't think Americans will be happy with a UK NHS model. And I'm not saying that's a good mentality at all. But I think many people labor under the delusion that NHS is like private insurance without the cost or the hassle.


I know they wouldn't be happy with it. But I say tough, because it's really the only practical solution given the amount of nonsense that has gone on since 1987. Things have been entirely too lax for the vast majority of the population for far too long.

But the idea is that company-sponsored plans should, and increasingly are, focusing on keeping people from getting sick in the first place rather than treating them once they do get sick.
Only they're not really focusing on keeping people from getting sick in the first place. All they are doing is reducing or denying or charging more for coverage. All they are doing is trying to get people not to use the system by forcing those who have the least money and clout to pay the most and do their own negotiation.

Essentially, the message is that you can be as sick as you want, as long as you suffer and die on your own dime.

Plenty of insurers offer preventative health maintenance programs, but they are rudimentary at best and are not marketed the way prescription plans are. I'm talking about things like discounts or coverage for such things as gym memberships, vitamin regimens, nutrition programs, etc. -- the kinds of things that actually prevent illness by supporting basic good health and promoting accurate health education. There is no real effort -- only lip service -- given to actually promoting healthy lifestyles that can reduce the chances of disease, degenerative aging conditions, and chronic illness conditions.

But let's not kid ourselves here. There's billions of dollars in health care, but little money to be made from health itself. Healthy people don't take pills. That means healthy people don't buy pills. The government doesn't want to pay for public health, employers increasingly cannot pay for health care, but the medical industry sure as shit does not want us to stop buying their products. Of that you can be sure.

My take on the entire health insurance/care industry is that it is corrupt to its roots. No plan that is not a whole new system is going to fix it, in my opinion.

But of the two plans currently on offer, McCain's is nothing but an insult to the public.

Honestly, I don't think Americans will be happy with a UK NHS model. And I'm not saying that's a good mentality at all. But I think many people labor under the delusion that NHS is like private insurance without the cost or the hassle.

Spending a great deal of my early 20's uninsured in America, I became very savy to the US's free healthcare system. And it's a good system, but it's cumbersome and not user friendly. For example, I severely sprained my ankle without insurance. First I took a trip to the county health office (no county hospital nearby). I see someone who can give a cursory exam, but this facility doesn't have xray. So I have to go to another free clinic down the road. That clinic has seperate paperwork, and a wait list.

If I'd have know about that clinic ahead of time I'd have totally signed up early. But now I'm on a wait list. I call around to private clinics and find one that will xray me without an exam. So I get two exposures ($40) and wander back to county. I wait in the queue all over again to have the county doc look at them.

And you can often get free meds from pharma companies too. Some clinics integrate this system, others don't.

I just think we need a system that provides a minimum level of care first. One that isn't cumbersome to navigate. If someone is lucky enough to live near a county hospital, they're golden. Otherwise, you run into problems like I did. Wait times are inevitable, but we could form a more cohesive system.

The problem is - this just isn't true.

It's not the first time these sorts of stories have floated around here, so there must be a couple of places in American where you can get free healthcare, but it's clearly not true of the whole nation. I live within fifteen miles of a county hospital, and there's no free healthcare. Some of the facilities will see you at reduced rates, but there is nowhere this side of Atlanta (120 miles) that will see you for free... with or without waiting for doctors or queueing for xrays.

We got turned away from the doctor who was supposed to be giving our baby his shots, because we only had $25 of the $30 they said it would cost.

That's how much America cares about it's poor.

The problem is - this just isn't true.

It's not the first time these sorts of stories have floated around here, so there must be a couple of places in American where you can get free healthcare, but it's clearly not true of the whole nation. I live within fifteen miles of a county hospital, and there's no free healthcare. Some of the facilities will see you at reduced rates, but there is nowhere this side of Atlanta (120 miles) that will see you for free... with or without waiting for doctors or queueing for xrays.

We got turned away from the doctor who was supposed to be giving our baby his shots, because we only had $25 of the $30 they said it would cost.

That's how much America cares about it's poor.

You can get it around here I think. (NYC), but I've never used it, so I don't know what it is like. All kids in NYS are covered.

But my general impression is that your experience is more typical.

The sick thing is that elderly wealth americans tend to retire to places with little or nothing in the way of social services because 'they don't want the tax burden' yet the fuckers are quite happy to suck the medicare tit till the country is bankrupt.

I really do believe that the country has to get over its upper middle class hypochondria and start spreading the care around. Not doing so is costing hundreds of billions a year. It's a national disgrace that is driving the US over a cliff rapidly. (Not to mention its going to end up in virtual intra-generational warfare once people figure it out).

The good think about McCain's plan is insurance wouldn't be sold state by state anymore. That will allow individual plans to be portable and more competition would be very good.

The bad thing is 20 million insured people will lose coverage under his plan.

That's the short version.

You know, the whole portability point is something that I've heard before as a benefit for McCain's plan. But the reality is that some 75% of health insurance plans offered in this country are in some way or another tied to one of the big payers; United HealthCare, BlueCross BlueShield, Kaiser, etc. Portability is hardly a concern for a majority of the insured. And the worst part is that for the people who most desire portability, those who are in the few remaining local HMOs, McCain's plan doesn't help them one bit. So McCain's plan offers increased portability for the people who already had it adequately, and doesn't even help the minority that might have wanted it.

Or heck, they might even fire your illness-riddled ass in a downsizing swoop.

Well, no. That's very much illegal. You're right that they might just get rid of the whole insurance plan if they're finding that their workforce uses too much care, but to eliminate people based on their medical care violates a lot of laws, notably laws that prevent a company from obtaining or even trying to obtain an individual's medical record. Even the perception of layoffs based on medical care would be enough to get the company sued to kingdom come.

It could be worse. You could living the the UK. Have the health service, which is okay until you need life saving cancer treatment and live in the wrong road. Ah, the good old postcode lottery. Gotta love polititions.

You can get it around here I think. (NYC), but I've never used it, so I don't know what it is like. All kids in NYS are covered.

But my general impression is that your experience is more typical.

The sick thing is that elderly wealth americans tend to retire to places with little or nothing in the way of social services because 'they don't want the tax burden' yet the fuckers are quite happy to suck the medicare tit till the country is bankrupt.

I really do believe that the country has to get over its upper middle class hypochondria and start spreading the care around. Not doing so is costing hundreds of billions a year. It's a national disgrace that is driving the US over a cliff rapidly. (Not to mention its going to end up in virtual intra-generational warfare once people figure it out).

What it basically comes down to is that the US has some of the best healthcare in the world... AND a Third World healthcare system (i.e. little or none). And, there's really no excuse for it. The US could have 'free' healthcare for all by cutting the major inefficiency out of healthcare, insurance and pharmacy industries, and be actually making those things work together for the good of the CONSUMER, rather than the shareholder.

(Obviously, it wouldn't be 'free', it would come out of taxation - but as a far lower premium).

It could be worse. You could living the the UK. Have the health service, which is okay until you need life saving cancer treatment and live in the wrong road. Ah, the good old postcode lottery. Gotta love polititions.

I've lived there. The system isn't perfect. You might have to wait hours to see a doctor, and your optional surgery might take weeks or months to rolla round... but you WILL get care, you will be able to afford it... and essential surgery is pushed to the top of the list.

In the US, you won't get care unless you can pay, and if you CAN pay, you may end up bankrupt (even with insurance).

Only they're not really focusing on keeping people from getting sick in the first place. All they are doing is reducing or denying or charging more for coverage. All they are doing is trying to get people not to use the system by forcing those who have the least money and clout to pay the most and do their own negotiation.

Essentially, the message is that you can be as sick as you want, as long as you suffer and die on your own dime.

Plenty of insurers offer preventative health maintenance programs, but they are rudimentary at best and are not marketed the way prescription plans are. I'm talking about things like discounts or coverage for such things as gym memberships, vitamin regimens, nutrition programs, etc. -- the kinds of things that actually prevent illness by supporting basic good health and promoting accurate health education. There is no real effort -- only lip service -- given to actually promoting healthy lifestyles that can reduce the chances of disease, degenerative aging conditions, and chronic illness conditions.

But let's not kid ourselves here. There's billions of dollars in health care, but little money to be made from health itself. Healthy people don't take pills. That means healthy people don't buy pills. The government doesn't want to pay for public health, employers increasingly cannot pay for health care, but the medical industry sure as shit does not want us to stop buying their products. Of that you can be sure.

My take on the entire health insurance/care industry is that it is corrupt to its roots. No plan that is not a whole new system is going to fix it, in my opinion.

But of the two plans currently on offer, McCain's is nothing but an insult to the public.

The health care industry be damned, I'm talking about companies in other industries that are being absolutely bankrupted by increasing medical costs. There is a real move in the industry towards pushing more preventative care because that is increasingly what clients are demanding from their insurers.

I have no doubt that private insurance policies offer squat in terms of preventative care coverage. But private insurance is not my field, so I don't know if I can speak very intelligently on it. But group health care is being forced, with the health care industry kicking and screaming along the way, towards more consumer responsibility and more preventative care.

Companies want the insurers to stop the current practice of simply medicating every problem and actually focus on keeping their employees healthy. The trend started internally at major employers; companies began offering healthy lifestyle incentives. Something as small as joining a tobacco-cessation program would get you $15 a month off your medical premium. Joining health clubs, taking health risk assessments; things aimed at keeping your employees healthy and aware of their own health. The insurance companies weren't involved with these programs at the start in any way. Employers started funding these programs because they realized $100,000 spent now could save $1,000,000 in medical claims later.

As someone who works in this field, I completely agree that the insurance industry as it currently exists is as corrupt as can be. These companies invest as much money into fighting claims as they do paying them (pure conjecture, not an actual factual statement). I've heard more stories that would just wrench your heart than you can possibly imagine. Every time I think I've heard the most despicable thing an insurance company has ever done, I hear from a new employee with an even more awful tale.

You're right. The insurance companies have no intention of offering any respectable preventative care measures of their own volition. But the programs, and the initiatives, that I'm referring to have nothing to do with the insurance companies. Employers are creating and funding these programs completely independent of their insurers, because they realize the cost benefit of doing so.

What it basically comes down to is that the US has some of the best healthcare in the world... AND a Third World healthcare system (i.e. little or none). And, there's really no excuse for it. The US could have 'free' healthcare for all by cutting the major inefficiency out of healthcare, insurance and pharmacy industries, and be actually making those things work together for the good of the CONSUMER, rather than the shareholder.

(Obviously, it wouldn't be 'free', it would come out of taxation - but as a far lower premium).

Agreed on the first part. 100%. But I don't think that cutting efficiency out will be enough on its own. You have to remember I grew up in the UK, so I see the difference. Medical services are overconsumed, especially by the elderly. Most likely this is because there are so many perverse incentives right now.

And personally, I don't think healthcare is actually insurable. It's a terrible model.

thats what the husband says (as he was pretending that he loved the idea)

and that would have some positive benefits in that companies wouldnt have the expense of health insurance and so would be more competitive with companies from countries with nationalized health care.

but without getting an extra $12k (or $7k, depending on how this plan really works) in yearly pay all it really does is save companies money while making sure that no one can afford health insurance. and if the companies have to raise everyones salaries it doesnt save them any money.

That's the trick. The companies won't be raising salaries because they need to be more "competitive" (ie: their CEO needs a larger bonus) which leaves you with the additional taxes (on the portion of health care your employer pays) no pay raise and the same medical costs.

The "personal responsibility" is better understood as "you're on your own" mentality which flies in the face of everything the so called "christian conservatives" lift up in Jesus' teachings from the bible about "doing unto the least of these".(Matthew 25) There are maybe 9 places in the bible that specially deal with homosexuality and 900 passages talking about the effects of greed on the poor....

Frankly I think we need a nationalized health care plan or some very strong regulation on the existing health insurance system because I am tired of seeing people who need transplants denied until after the insurance company thinks they will already be dead (like in California last year) and I really don't get why prescription drug costs in Canada are so much less than in the US despite the fact that Canada has a nationalized system (and of course that's supposed to be way to expensive for us) If nationalized plans are supposed to be so costly, why are prescription meds in Canada so much cheaper?

Or you can just stop spinning on all this and vote obama in November as having a nation program side by side with employer provided health care is the best option imho

http://www.barackobama.com/issues/healthcare/

It could be worse. You could living the the UK. Have the health service, which is okay until you need life saving cancer treatment and live in the wrong road. Ah, the good old postcode lottery. Gotta love polititions.

Eh? I lived in the UK. It's very good for emergencies - better than the US because the ER isn't clogged with people who don't have family doctors. And it's very good for run of the mill family care type stuff.

Not very good for the expensive hi-techy stuff because you have to wait. And from an american perspective they are a bit stingy with prescriptions. Not so good if you are old either. But meh. The ancient have had their chance at life. Let it go.

And compare the infant mortality rates.

Now, the idea is that flooding the market with hundreds of thousands of individual payers would force the market to compete, thus lowering prices. The question becomes, do we feel market forces would compel insurers to compete to such a degree that they lowered their costs by 84%? Because that, in essence, is what it would take to make individual rates competitive with what people are currently able to obtain from group health plans.

Increased demand=higher costs is the other problem with that "logic" that McCain and Co want us to believe

and I really don't get why prescription drug costs in Canada are so much less than in the US despite the fact that Canada has a nationalized system (and of course that's supposed to be way to expensive for us) If nationalized plans are supposed to be so costly, why are prescription meds in Canada so much cheaper?

Prescription drug costs in Canada have little to do with whether their health care is nationalized or not and have almost entirely to do with the relevant patent laws. The United States has strict drug patent laws that prevent generic equivalents from coming onto the market for something like seven years. Canada, and many other nations, have no such protections, so generics are allowed to be marketted almost as soon as a brand name hits the market. This allows Canada to offer better prices because there's no patent protection for the brand names, where in the United States, they enjoy what is essentially a monopoly on the production of that drug for the duration of their patent.

Increased demand=higher costs is the other problem with that "logic" that McCain and Co want us to believe

Perhaps, but the thinking is that right now, private insurance companies have no incentive to compete, and therefore are operating way, way beyond cost. I think the premise behind flooding the market with new consumers is that it would encourage the private insurance companies to lower their prices to compete for the new customers.

I just don't see the prices going down enough to compensate for the lack of employer subsidisation.

Perhaps, but the thinking is that right now, private insurance companies have no incentive to compete, and therefore are operating way, way beyond cost. I think the premise behind flooding the market with new consumers is that it would encourage the private insurance companies to lower their prices to compete for the new customers.

I just don't see the prices going down enough to compensate for the lack of employer subsidisation.

Insurance companies don't have incentives to keep costs down in general. It's just not part of their world view. More competition wouldn't really change that.

Insurance companies don't have incentives to keep costs down in general. It's just not part of their world view. More competition wouldn't really change that.

I think it would lower costs somewhat. Isn't that what the free market is supposed to do? If two insurance companies are offering the same coverage, the one that has a slightly cheaper price will get more business.

The insurance industry is just too bloated and used to their own inefficiency that I don't see them being able to cut much out of there prices. Certainly not enough to offset the loss of employer subsidies.

I think it would lower costs somewhat. Isn't that what the free market is supposed to do? If two insurance companies are offering the same coverage, the one that has a slightly cheaper price will get more business.

The insurance industry is just too bloated and used to their own inefficiency that I don't see them being able to cut much out of there prices. Certainly not enough to offset the loss of employer subsidies.

I think you might initially see a slight drop if there were more market participants. But it won't change the re-insurance side, and a lot of the treatment levels are mandated, so where do the cuts come from? I mean yeah, there are inefficiencies, but the barriers to entry to the insurance business are huge, so it'll probably just mean that there are more insurance companies, not that anything radically new will happen. It's a bit like getting Ford to solve GMs problems.

And I guess my point is, that insurance companies have no interest in containing the increases in cost over time. Even if you manage to bring costs down a lot initially through competition, once you have a new market, there is no interest amongst them in containing cost increases going forward. Insurance companies tend not to give a shit about things like that because they just put premiums up, or stop writing policies.

Truth be told, most companies don't even negotiate anyway. They just solicit bids. It all comes down to the actuarial side really. (Edit: By that I mean smaller cos, which are the bulk of private sector employers, sub 5,000 types, I'm sure mega corps have some pull. But I'm not sure how much wiggle even that gives, GM has its tits in a wringer over costs, and if they can't do anything...)

I think it would lower costs somewhat. Isn't that what the free market is supposed to do? If two insurance companies are offering the same coverage, the one that has a slightly cheaper price will get more business.

This prompts another concern of mine about increasing the number of people going after private insurance. Is anybody going to help folks work out what plan optimizes their costs & benefits? I remember when Medicare Part D was first instituted (all of 2 years ago) and every pharmacy I went into was full of people wading through piles of brochures trying to decide which drug plan was best for them. At least some big chain pharmacies were holding Q&A sessions, though I don't know how much that helped.

You don't have to be stupid or uninterested to have trouble evaluating complex products like health insurance. It's pretty common knowledge in the financial industry that individuals, even smart individuals, are lousy at evaluating risks to themselves or even being honest about their own tolerance for risk. I don't see why that should be less true for health than for money.

You know, the whole portability point is something that I've heard before as a benefit for McCain's plan. But the reality is that some 75% of health insurance plans offered in this country are in some way or another tied to one of the big payers; United HealthCare, BlueCross BlueShield, Kaiser, etc. Portability is hardly a concern for a majority of the insured. And the worst part is that for the people who most desire portability, those who are in the few remaining local HMOs, McCain's plan doesn't help them one bit. So McCain's plan offers increased portability for the people who already had it adequately, and doesn't even help the minority that might have wanted it.
Eh, it's not that easy. Take Blue Cross. I had private insurance through them, if I ever moved out of state I wouldn't be able to take my policy with me. I'd have to apply for a new one under the new Blue Cross sector. Or Cigna, they're national, but don't sell individual policies in my state. Doesn't matter that Cigna provides coverage in my state, and their individual policies are fairly cheap in other states.

The problem is - this just isn't true.

It's not the first time these sorts of stories have floated around here, so there must be a couple of places in American where you can get free healthcare, but it's clearly not true of the whole nation. I live within fifteen miles of a county hospital, and there's no free healthcare. Some of the facilities will see you at reduced rates, but there is nowhere this side of Atlanta (120 miles) that will see you for free... with or without waiting for doctors or queueing for xrays.

We got turned away from the doctor who was supposed to be giving our baby his shots, because we only had $25 of the $30 they said it would cost.

That's how much America cares about it's poor.
That's where the whole disorganized and cumbersome part of my post comes in. And if there's free resources in your area, good luck finding them. Some areas they are very well hidden.

I know for adults, Planned Parenthood is a good place to start and their clinics will generally see minor ailments (mine do limited pediatrics and all essential vaccines as well) and know where to send folks whom they can't help. They're the ones that taught me the pharma trick.

The good think about McCain's plan is insurance wouldn't be sold state by state anymore. That will allow individual plans to be portable and more competition would be very good.
Couldn't hospitals simply accept patients from certain insurance companies?
The problem with Obama's plan is he is grossly underestimating the cost. And it's a single payer system. It's going to be bankrupt and swimming in beurocracy.
I think you'd find the U.S.A health system contains more beuracracy than a single payer system...

I think it would lower costs somewhat. Isn't that what the free market is supposed to do? If two insurance companies are offering the same coverage, the one that has a slightly cheaper price will get more business.

The insurance industry is just too bloated and used to their own inefficiency that I don't see them being able to cut much out of there prices. Certainly not enough to offset the loss of employer subsidies.
the problem with that being that there is no standard insurance package that you can price shop with. so you might find an excellent price on insurance that doesnt cover what you need covered. or costs you more in the long run because it doesnt pay for things that the more expensive plan covers.

like unit pricing on food used to be where went by weight and the other by volume so you had a hard time figuring out what was the better buy.

if they are going to throw us to the insurance wolves they need to mandate packages so even stupid people can make informed decisions about what company to go with.

Couldn't hospitals simply accept patients from certain insurance companies?
That's not how it works, unfortunately. That's the one and only good thing McCain is solving. Each insurance company is different, so I can only speak to my experience with Regence Blue Cross.

Basically, if I travel to another state, I'm covered. But if I move out of state, they'll drop me as soon as I change addresses. Now I could have my mail forwarded to a friend who could send me the bills, but then I get into insurance fraud. And they will start to notice that I use 100% of my healthcare in another state.

I think you'd find the U.S.A health system contains more beuracracy than a single payer system...

How do you figure? The only way the gov't is in the healthcare business is with Medicare and Tricare.

How do you figure? The only way the gov't is in the healthcare business is with Medicare and Tricare.

Private organizations can be just as bureaucratic and slow as public ones.

Private organizations can be just as bureaucratic and slow as public ones.

There's a huge difference. Insurance companies just insure, they don't own clinics or hospitals. You won't wait for four hours at a hospital because you have brand X insurance. You won't have to wait months for a surgery because of your insurance either.

The average consumer has very little beurocracy to deal with if any. Doctors are the ones who submit the claims, doctors are the ones that argue with insurance companies (if needed), not the patient. Consumers have a policy, they know what their policy covers and doesnt, if they need clarification they call.

There's a huge difference. Insurance companies just insure, they don't own clinics or hospitals. You won't wait for four hours at a hospital because you have brand X insurance. You won't have to wait months for a surgery because of your insurance either.

The average consumer has very little beurocracy to deal with if any. Doctors are the ones who submit the claims, doctors are the ones that argue with insurance companies (if needed), not the patient. Consumers have a policy, they know what their policy covers and doesnt, if they need clarification they call.

I was merely taking issue with your assumption that bureaucracy = government.

Anyway, I've used the French and German healthcare systems (as a foreigner, of course) and things went smoothly and quickly. I've never actually used the private system in the US (I've only ever used the military health system) so I really can't comment on the bureaucracy there.

I was merely taking issue with your assumption that bureaucracy = government.

Anyway, I've used the French and German healthcare systems (as a foreigner, of course) and things went smoothly and quickly. I've never actually used the private system in the US (I've only ever used the military health system) so I really can't comment on the bureaucracy there.

That's why I limited my comments to a single payer healthcare system in the US.

That's not how it works, unfortunately. That's the one and only good thing McCain is solving. Each insurance company is different, so I can only speak to my experience with Regence Blue Cross.

Basically, if I travel to another state, I'm covered. But if I move out of state, they'll drop me as soon as I change addresses. Now I could have my mail forwarded to a friend who could send me the bills, but then I get into insurance fraud. And they will start to notice that I use 100% of my healthcare in another state.
It could be just as much a reduction of competition if hospitals accept only certain insurance companies (and insurance companies accept only certain hospitals). This could be used to informally keep the per-state system, or make.

How do you figure? The only way the gov't is in the healthcare business is with Medicare and Tricare.
I was thinking more of countries which use the single payer as the primary system.

The health care industry be damned, I'm talking about companies in other industries that are being absolutely bankrupted by increasing medical costs. There is a real move in the industry towards pushing more preventative care because that is increasingly what clients are demanding from their insurers.

I have no doubt that private insurance policies offer squat in terms of preventative care coverage. But private insurance is not my field, so I don't know if I can speak very intelligently on it. But group health care is being forced, with the health care industry kicking and screaming along the way, towards more consumer responsibility and more preventative care.
My experience as a recipient of plan coverage (I buy it because in Massachusetts, I have to, but I have been to doctors a rough total of five times since age 8) is with both employer-provided group plans and private insurance, which I must purchase now. My personal experience was that both kinds of plans include what many insurers call "wellness" plans or programs, which are what I was talking about as "preventative" health maintenance. However, the discounts and coverage for such things are so miniscule and the co-pays so relatively high in most such programs, that there is very little incentive for the insureds to use them, or to have anything to do with their health insurance plans until they get sick or injured. That is what I mean when I said that the insurance providers make no effort to promote preventative care, compared to encouragement to use, for example, prescription plans.

Companies want the insurers to stop the current practice of simply medicating every problem and actually focus on keeping their employees healthy. The trend started internally at major employers; companies began offering healthy lifestyle incentives. Something as small as joining a tobacco-cessation program would get you $15 a month off your medical premium. Joining health clubs, taking health risk assessments; things aimed at keeping your employees healthy and aware of their own health. The insurance companies weren't involved with these programs at the start in any way. Employers started funding these programs because they realized $100,000 spent now could save $1,000,000 in medical claims later.
And this is a very good thing, in my opinion. I wonder sometimes, when my usual miasma of pessimism and misanthropy thins a little occasionally, if insurance companies will someday react to such pressure. I wonder if I will ever live to see a day when insurance companies and users (employers and individual buyers alike) will lobby various levels of government together to do other health promoting things like reducing pollution, encourage walk-friendly municipal development, and improving our food production systems and food labeling requirements.

But then I see more ads ecouraging people to hassle their doctors to give them this or that prescription medication so that their diseases can be "managed" rather than cured, and I stop wondering about such things.

As someone who works in this field, I completely agree that the insurance industry as it currently exists is as corrupt as can be. These companies invest as much money into fighting claims as they do paying them (pure conjecture, not an actual factual statement). I've heard more stories that would just wrench your heart than you can possibly imagine. Every time I think I've heard the most despicable thing an insurance company has ever done, I hear from a new employee with an even more awful tale.

You're right. The insurance companies have no intention of offering any respectable preventative care measures of their own volition. But the programs, and the initiatives, that I'm referring to have nothing to do with the insurance companies. Employers are creating and funding these programs completely independent of their insurers, because they realize the cost benefit of doing so.
As I said, a good thing. When I get over the disappointment of seeing my happy dreams pop like soap bubbles (see above), I indulge in other fantasies -- equally happy-making -- of seeing the current system collapse into bankruptcy as the public (employers and individuals) abandon it altogether for an alternative of their own devising.

McCain's plan could work, ON ONE CONDITION.

The money that an employer pays to obtain coverage for an employee should be given directly to the employee and included in his paycheck as additional compensation and then the employee must be able to obtain either the same coverage he currently has from the employer's choice of companies for the same price he currently gets it for, OR he gets to shop coverages with other companies and if he gets what he needs for less, he gets to pocket the difference or at least put it into a tax deferred, medical savings account that he can draw on later for medical care costs or pass on to his heirs if he never uses.

Example (based on made up numbers): I take home $5,000.00/month. From that, I lose $500.00 as my share of the medical insurance cost and my employer pays $1,000.00 as his share. I am taxed on the $500, but not the $1,000.00. Under the new plan, I take home $6,000.00/month and can either spend $1,500.00 on medical coverage each month, while paying the taxes I pay on the extra $1,000.00 in income or I can find coverage that costs less than $1,500.00/month to offset the new taxes.

When I do my tax return each year, the $5,000.00 in tax credits is something I fill in on my return and that DIRECTLY offsets my "tax due" bill on the return. If I owe money after the reduction in my tax liability because of the credit, then I pay. If, however, I managed to get cheaper insurance and the reduction in taxes due as a result of the credit puts me in the black, then I get the money, or at least, it is put in a medical savings account I control and that I can pass on to my heirs.

Ok, its late, I'm tired and need you to tell me where this plan is full of holes. I don't like McCain's idea, but Obama's position is even less palatable to me since I see his plan as giving more control over MY health care to the Gov. than it already has. As someone who has dealt with Medicare/Medicaid and the VA, the idea of letting the Gov have ANY control over my health care decisions and coverage makes me ill (pun intended, but truly reflective of my position).

Agreed on the first part. 100%. But I don't think that cutting efficiency out will be enough on its own. You have to remember I grew up in the UK, so I see the difference. Medical services are overconsumed, especially by the elderly. Most likely this is because there are so many perverse incentives right now.

And personally, I don't think healthcare is actually insurable. It's a terrible model.

Even worse is the idea that it can be governed by market forces... the simple fact that you have only two choices: buy the product... or die - means that healthcare is totally unlike other products. Every healthcare provider is an automatic effective monopoly.

It could be just as much a reduction of competition if hospitals accept only certain insurance companies (and insurance companies accept only certain hospitals). This could be used to informally keep the per-state system, or make.
That's possible, but unlikely. Each is a business. For-profit or not-for-profit. It's not good business sense to turn away customers.


I was thinking more of countries which use the single payer as the primary system.
The experience I've had so far under a single payer system has been less than satisfactory. I haven't been in the system long enough to see possible solutions.

I'm looking at the way individual states run their Medicaid programs. The states that use their money to buy policies from private companies (at a discounted rate) have more people insured and better healthcare for the insured.

Or look at California's recent attemps at UHC. Single payer system would have cost exponentially more.

http://voicefortheuninsured.org/amaproposal.html

This is the health care policy proposal the AMA is lobbying for. I've been seeing ads about it for a lone while and finally went and looked it up, but from the overview on their website, I have a hard time figuring out just exactly what it is. I would appreciate hearing from NSGers who understand this stuff better than I, if you all have any opinion of it.

Though all of it is fairly vague, the only part that gives me immediate pause is the detail that says that those who choose not buy insurance even if they can afford it, should bear a tax burden for that. That sort of thing can be handled fairly, or it can be handled unfairly -- as is currently being done in Massachusetts.

There are also links to in depth info about the proposal and the pdf document of it, if anyone is interested. I confess I am just confused about how to judge whether this is a good proposal or not and how it stacks up against the candidates' plans.

Or look at California's recent attemps at UHC. Single payer system would have cost exponentially more.
Then why does it cost countries with UHC less per capita to pay for healthcare than the US, which only covers old people/the unable to work and federal employees?

That's possible, but unlikely. Each is a business. For-profit or not-for-profit. It's not good business sense to turn away customers.


It happens more then you think. Health is not a business.

You can do without a TV. You can't do without your meds or an operation.

Then why does it cost countries with UHC less per capita to pay for healthcare than the US, which only covers old people/the unable to work and federal employees?
So California and other state's single payer systems cost more why?

It happens more then you think. Health is not a business.

You can do without a TV. You can't do without your meds or an operation.

What on earth are you talking about and how does that relate to the post of mine? And how on earth are publicly traded companies not a business???

http://voicefortheuninsured.org/amaproposal.html

This is the health care policy proposal the AMA is lobbying for. I've been seeing ads about it for a lone while and finally went and looked it up, but from the overview on their website, I have a hard time figuring out just exactly what it is. I would appreciate hearing from NSGers who understand this stuff better than I, if you all have any opinion of it.

Though all of it is fairly vague, the only part that gives me immediate pause is the detail that says that those who choose not buy insurance even if they can afford it, should bear a tax burden for that. That sort of thing can be handled fairly, or it can be handled unfairly -- as is currently being done in Massachusetts.

There are also links to in depth info about the proposal and the pdf document of it, if anyone is interested. I confess I am just confused about how to judge whether this is a good proposal or not and how it stacks up against the candidates' plans.
looking...

have they come to the part in massachusetts where they penalize people who dont have insurance? what kind of penalties are they?

it seems like a wish list rather than a plan.

they want to tax your health insurance benefits from your employer and rebate that with tax credits based on your income level. so that, maybe, the average person would end up the same, the high income people would pay full taxes and low income people would pay little for their health insurance.

they also HOPE to do things like "reward" insurers for taking all comers regarless of health status and to find ways to wring some of the waste out of the health care system in general.

it doesnt seem to be so much a plan as a philosophy of what direction we should take in reforming the health care/medical insurance system.

looking...

have they come to the part in massachusetts where they penalize people who dont have insurance? what kind of penalties are they?
Yes, they have. Penalties are tax penalties, but exactly what they are and how they work is very unclear.

You have to include with your state tax return evidence of what the state is pleased to call "credible coverage" during the tax year. What constitutes "credible coverage" is subject to change. The state has already changed it once -- expanded it by mandating that we buy prescription coverage but not forcing insurers to offer it within any price ranges, which of course meant that people had to pay more and/or scale back the quality of their coverage.

Failure to prove to the state that you have such coverage will trigger tax penalties. If you ask the state just what those penalties are and how they work, you will not be told anything except that they could end up costing you "as much as $915.00".

However, when you read your state tax return, it specifically states that failure to prove "credible coverage" may result in disallowance of your personal exemption -- an amount over $4000 for an individual. Furthermore, for some levels of income, loss of the personal exemption can bump the person into the next higher tax bracket, costing the person even more out of their net income.

The state forms say absolutely nothing about a cap on penalties.

After having spoken with some state officials about this, I am of the opinion that Mass uses this confusion to intimidate people into complying with the program. However, the cost of living is so high in this state that an increasing number of people are choosing to risk the penalties at the end of the year, because they just can't afford to meet the "credible coverage" requirements every month.

Yes, they have. Penalties are tax penalties, but exactly what they are and how they work is very unclear.

You have to include with your state tax return evidence of what the state is pleased to call "credible coverage" during the tax year. What constitutes "credible coverage" is subject to change. The state has already changed it once -- expanded it by mandating that we buy prescription coverage but not forcing insurers to offer it within any price ranges, which of course meant that people had to pay more and/or scale back the quality of their coverage.

Failure to prove to the state that you have such coverage will trigger tax penalties. If you ask the state just what those penalties are and how they work, you will not be told anything except that they could end up costing you "as much as $915.00".

However, when you read your state tax return, it specifically states that failure to prove "credible coverage" may result in disallowance of your personal exemption -- an amount over $4000 for an individual. Furthermore, for some levels of income, loss of the personal exemption can bump the person into the next higher tax bracket, costing the person even more out of their net income.

The state forms say absolutely nothing about a cap on penalties.

After having spoken with some state officials about this, I am of the opinion that Mass uses this confusion to intimidate people into complying with the program. However, the cost of living is so high in this state that an increasing number of people are choosing to risk the penalties at the end of the year, because they just can't afford to meet the "credible coverage" requirements every month.
that seems to also be the problem with this plan and mccain's plan. they are not in the business of FORCING insurance companies to offer affordable plans. if you cant find one, you are screwed by the state.

do they even have some kind of standard package that all insurers must offer that is guaranteed to meet the state minimum requirements?

that seems to also be the problem with this plan and mccain's plan. they are not in the business of FORCING insurance companies to offer affordable plans. if you cant find one, you are screwed by the state.

do they even have some kind of standard package that all insurers must offer that is guaranteed to meet the state minimum requirements?
Nope. They don't even help the consumers that much. They issue their requirements, but there are no penalties for insurers not having plans that meet those requirements. Of course, to get more customers, they do offer plans that are compliant with state requirements, but there are no restrictions on the insurers' ability to change their plans at any time, even to make them non-compliant so that the consumer will have to go shopping again, just as there is no restriction on insurers' ability to refuse coverage on a claim, even though we are forced to pay premiums to them, nor any restriction on how much they can raise premiums at renewal. Yeah, it's a terrific plan. Just fucking peachy.

And yeah, having a second brain applied to the AMA proposal does help. It is as I suspected -- it is not a real plan, and even if it was, it would not be a good one because there is very little sign of protections for consumers in it.