Skip to main content

As Don McCanne of PNHP says, Sen. Wyden's proposal is an individual mandate to purchase private health plans. Much has been written about the flaws of such  models, and no attempt will be made to address most of those issues  here. Rather only one serious fundamental flaw in the application of economic theory will be discussed.

The theory is that in competitive labor markets, total compensation is determined by the market, but the distribution between payroll and other benefits such as health plans and pensions does not influence the total compensation. Thus termination of a health benefit program results in an increase in wages that has the same monetary value.

In Sen. Wyden's proposal, not only does it assume this theory to be true, it also provides back-up enforcement by requiring that employers increase wages by the same amount of the health benefit that will be terminated under this Act, but only for the first two years. After that, the competition of labor markets resumes, but without the complication of a health benefit program. Employees are on their own for accessing and funding their health plans.

The Lewin Group December 12, 2006 Cost and Coverage Estimates for the "Healthy Americans Act" Prepared By: John Sheils, Randall Haught, Evelyn Murphy

(The Healthy Americans Act is a bill being introduced by Sen. Ron Wyden of Oregon.)

Executive Summary (excerpts):

The "Healthy Americans Act" (HAA) establishes a centrally financed system of private health insurance for all Americans except those covered through Medicare or the military. Participants would chose from a selection of private plans offered through newly created regional purchasing organizations called "Health Help Agencies" (HHA's). All Americans would have coverage at least as comprehensive as the health coverage now provided to members of Congress and federal workers, although an actuarially equivalent substitution of HMO and Health Savings Account (HSA) plans is permitted.

Employers would be required to "cash-out" their health plans by terminating their existing health coverage and paying the amount saved to their workers in the form of increased wages. The current tax exemption for employer provided health benefits is eliminated to strengthen incentives for families to seek lower cost coverage. However, a new  "health premium" tax deduction is created so that these wage increases do not increase federal personal income tax payments. To maintain incentives to control costs, the deduction is fixed and can  
not be
increased by purchasing more costly coverage. However, a new "health premium" tax deduction is created so that these wage increases do not increase federal personal income tax payments. To maintain incentives to control costs, the deduction is fixed and can not be increased by purchasing more costly coverage.

All HAA participants would pay premiums through their annual income tax filings. The program would fully subsidize the premium for those below 100 percent of the federal poverty level (FPL), with the premium phasing-in for people living between 100 percent and 400 percent of the FPL. People who do not have enough income to pay taxes are assumed to be eligible for the program with full subsidies, thus eliminating the need to apply separately for assistance as under the current Medicaid program. Employers also would be required to pay an assessment ranging from 2 to 25 percent of the national average premium for the minimum benefits package, depending upon firm size and revenues per worker.

E. Private Employer Impacts (excerpts):

Private employer health spending under the HAA is reduced under the HAA by $309.8 billion, from $428.8 billion under current law to $119.0 billion under the program.

We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers "cash-out" their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.

This reflects that the employer’s true cost of employing workers includes all compensation costs including: wages less employer payroll taxes, health benefits, pensions, and other non-cash benefits. In competitive labor markets, eliminating the health benefits (or any other form of compensation) would bid-up other forms of compensation such as wages so that aggregate compensation levels are largely unchanged.

http://wyden.senate.gov/...

Sen. Wyden's plan (with links to the Act and other documents): http://wyden.senate.gov/...

Comment:  Sen. Wyden's proposal is an individual mandate to purchase private health plans. Much has been written about the flaws of such models, and no attempt will be made to address most of those issues here. Rather only one serious fundamental flaw in the application of economic theory will be discussed.

The theory is that in competitive labor markets, total compensation is determined by the market, but the distribution between payroll and other benefits such as health plans and pensions does not influence the total compensation. Thus termination of a health benefit program results in an increase in wages that has the same monetary value.

In Sen. Wyden's proposal, not only does it assume this theory to be true, it also provides back-up enforcement by requiring that employers increase wages by the same amount of the health benefit that will be terminated under this Act, but only for the first two years. After that, the competition of labor markets resumes, but without the complication of a health benefit program. Employees are on their own for accessing and funding their health plans.

Whether through union efforts or in the open job market, compensation is negotiated, at least theoretically. That includes wages and often health benefits and pensions. It does not include food. It does not include housing. It does not include transportation. It does not include any other basic needs. Those needs fall under the category of personal responsibility - use your wages wisely to meet those needs. Now health care is shifted away from being considered as part of the compensation package, over into this realm of personal responsibility.

Have wages kept up with the costs of basic needs? There certainly has been a redistribution from wage earners to the wealthy. The minimum wage has not been increased for many years. Consumer debt continues to expand. Personal savings are now a negative. Personal insolvency continues to grow. Yet employers are not providing wage increases that are indexed to food, nor to housing, nor to transportation. Now that they are no longer in charge of health coverage, they will feel no obligation to index wages to health costs either.

The Lewin report contends that price competition between health plans, and greater administrative efficiencies will lower costs significantly. If the consolidated efforts of employers have been unable to control costs and waste, how can individual purchasers ever expect to exert market pressures to achieve these efficiencies?

The last section of the Act list many other potential sources of cost savings. Reading the list, the savings potential for many is simple rhetoric, not supported by fact. Some of them would actually increase costs. The Act excludes more effective cost measures such as those of the single payer model.

The point is that costs will continue to increase and wage earners will have to face those costs alone. Employers will have divorced themselves from the problem and will not make an exception for health care anymore than they already do for food, housing and transportation.

Wyden's plan falls apart since it depends on price competition of health plans, which in turn depends on shifting more unaffordable costs directly to those who need care.

For those who are interested, you sign up for Don's Quote of the Day at the Quote of the Day Listserv.

Again we ask, Why should the Wyden bill be getting support & publicity, when the much longer standing "Medicare for All" proposal, currently packaged in Conyers HR-676 languishes on the backbench? Conyers, Dingell (prior years' sponser) along with Senate co-sponser Kennedy, are all more senior than Wyden. The bill has been circulated gathering congressional, grassroots and labor support... and that of lots of our new congresscritters.  If it is shunted aside for Wyden's bill, then it means either Conyers and Kennedy and their co-sponsers have not been serious with us, or the Democratic congressional leaderhip is not serious about them.

Rep. John Conyers HR-676 "Medicare for All"
http://www.house.gov/...

Write to your Congressperson to support Conyers "Medicare for All"
http://www.healthcare-now.org/...

Add your name to the petition for "Medicare for All"
http://www.healthcare-now.org/...

Contact both your Senator and Sen. Wyden to tell them what you think:
http://www.senate.gov/...

Originally posted to DrSteveB on Fri Dec 15, 2006 at 04:46 AM PST.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Too true (4+ / 0-)
    Recommended by:
    coral, hestal, vome minnesota, Mary Mike

    My health insurance costs have increased three times faster than my wages over the past five years.  There is no justification other than my employer is looking to pad their bottom line and the insurance companies are doing the same.  

    A tyrant must put on the appearance of uncommon devotion to religion. - Aristotle

    by DWG on Fri Dec 15, 2006 at 05:19:55 AM PST

    •  I'm not sure you're right to blame your employer (0+ / 0-)

      I don't know what you mean, if it's the percentage or the absolute dollar amount of your share that's going up.. but for what it's worth, the raw cost of my health insurance increases 10-15% per year, with big jumps every time someone goes across a decade in age (ie, from 29 to 30 or 39 to 40, etc). I doubt your employer is getting rich off of passing off additional health care costs to you - presumably they have more lucrative ways to get rich. ;-)

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Fri Dec 15, 2006 at 08:38:56 AM PST

      [ Parent ]

  •  My congressman (4+ / 0-)
    Recommended by:
    coral, hestal, vome minnesota, Mary Mike

    Already sent him an email.  He ran on health insurance so hopefully he won't fall for the Wyden bill or one like it in the House when Conyers already has a good one.

    I've said it before and it bears repeating, until we get the middlemen out, we'll never have a system that puts the health and well being of the people ahead of their bottom line.

  •  I have been following your diaries. (11+ / 0-)

    It is a long list, but I spent 30 years developing and running systems for Medicare, Medicaid, Champus, BC/BS Plans, Association Groups, HMO's of several models, Self-insured municipalities and large employers, very large health insurance companies, and international carriers for US companies with employees abroad.  I have even supplied systems to oil companies in the Middle East and one for a part of the Saudi government.  I have been a benefits administrator for a self-insured group with 50,000 employees.  I have developed wellcare systems in the 1970's and worked with panels of well-known physicians and others who were studying the supplier end of health costs.  The net of all this is that I clearly saw that the employee has no leverage at all unless he is part of union group or some such.  The plans you have designed are good ones, but I don't think you go far enough in some cases.  I am somewhat sympathetic to the plight of the docs and their associates.  But the plan that Wyden proposes is a disaster.  At least 50% of the population will suffer and suffer greatly.  The guys who run HMO's, insurance companies, etc. will destroy the employee.  It will be hard to watch.  But these guys have been waiting for decades for an opportunity like this.  They are probably peeing in their pants.  I wish I knew the answer to your question as to why this plan is sucking up the oxygen, but it has to be money -- it always has been.  Keep up the good work.

    If you don't have an earth-shaking idea, get one, you'll love building a better world.

    by hestal on Fri Dec 15, 2006 at 05:22:18 AM PST

    •  Isn't Wyden's plan like the French plan? (1+ / 0-)
      Recommended by:
      Winnie

      I seem to recall that the highly successful French plan is a multi-payer plan.  Sounds like Wyden is trying to emulate that plan.

      I'd appreciate hearing the extent to which that is true or false, and why you believe it would be a disaster.

      Cheers.

      •  No! false comparisons to European "multipayer" (12+ / 0-)

        One of the common myths/distortions sometimes made is to compare some sort of plan for a future U.S. multi-payer universal care based on our existing for-profit stock-company corporatized insurance industry (e.g., Wyden, AHIP) to what European countries have.  As PNHP-Nick has said elsewhere:

        This often sounds good, but really belies a misunderstanding about health policy. Because countries like France, Germany, Switzerland, etc. have multi-payer systems with private health insurers as well as (near) universal health coverage, some people like to say that we can find a way to provide universal care in a multi-payer system. This, the argument goes, will be more "politically feasible" because you won’t have to take on the private insurance industry and all of their power.

        But the answer is, the "private" insurers in those systems are so fundamentally different from what we think of as a "private insurance company" in this country that they might as well be from another planet. I’ll give you just a few examples. The most highly-privatized system in Europe is probably Switzerland. Even there, private insurance companies are required by law to be nonprofit, their premiums, benefit structures and plans are set by the government, they are required to community-rate (i.e. they are not allowed to screen out the sick and deny them coverage, the fundamental way that U.S. insurance companies make money), and – get this – if one of them happens to enroll a healthier population and make more money, they have to give it away to the companies that made less.

        Can you imagine U.S. health insurance companies being any more likely to go for that than for single-payer? They might as well go out of business! The idea that a system like that is going to make a proposal more "politically feasible" is totally ridiculous. That’s why I say in the talk that just as fundamental to the idea of "one-payer" is the notion that for-profit insurers must be eliminated. Also, the added cost of the Swiss multi-payer system makes it the most expensive. The reason we advocate single-payer for the U.S. is that it saves more money, but it is also "ready to go out of the box" because we already have one single-payer system (Medicare!) and all the infrastructure and know-how ready to make it work.

    •  with your experience (5+ / 0-)
      Recommended by:
      coral, Winnie, joanneleon, Mary Mike, 07rescue

      ...you should do some diaries on your knowledge and experience.

      ...join and contribute (your knowledge and experience; not asking for $; lol) to PNHP (not just docs are members).

      ...I am curious as to your "not far enough" what would you suggest that is more than Conyers "Medicare for All"?

      •  I think that the health care provider (9+ / 0-)

        system should be revamped as part of a new health care system for all Americans.  The docs have some legitimate gripes and some not so much.  With a new overall system there is a chance to fix what is wrong with the providers' part.  Generally speaking, I think that the docs should design and run the health care system for America.  The general goals can be set by the citizenry and the docs can design a process for reaching those goals.  There are many parts of our national system, not just healthcare, that would be better off if docs were in charge.  For example, war - whether to go, how to conduct it, and when to get out.  Extending the role of physicians to include the health of all citizens in all aspects of life and to give them commensurate authority would kick our nation forward.  

        I am reluctant to say more here, not because I am I have any special knowledge or ideas, but because I don't want to be identified.  I have already said more than I should have.

        Also I am writing a book and part of it includes proposals for financing and managing health care programs.  Beyond the way that the patient and the provider are kicked around by the payer today, there is something that can be done to improve management.  But it all fits into a revamping of Congress, the Executive, the Supreme Court, and the other major public institutions.  Health care is the trigger to my plan, and changing it shows how all the others should be changed.  

        To put it another way.  Congress is the reason that we don't have health care for all and for many other insults to the common citizen.  It is time they were replaced.  My ideas do just that.  The Framers were not in love with Congress, it just was the best thing they could come up with given the era, the population, the government, the politics and the technology.  If the Framers had then the technology we have now the Constitution would look very different.  We have an 18th century system serving, poorly, a 21st century nation.  And in many respects health care is the best part of our system, tcehnologically, but not in terms of human suffering.  Sorry to ramble so much, but we need sweeping changes.

        If you don't have an earth-shaking idea, get one, you'll love building a better world.

        by hestal on Fri Dec 15, 2006 at 05:52:30 AM PST

        [ Parent ]

  •  ah yes reality (0+ / 0-)

    i just commented in deaniac83's diary:

    given a no-win single payer solution on grounds of political disagreement and pragmatism, one would expect an honest legislator NOT to endorse current beneficiaries of the MIC market.

    one would expect an honest legislator to remediate the flawed statutory infrastructure that indemnifies monopolistic business practices and profiteering through market arbitrage.

    there are indeed more ways than one to skin the cat (heh) of health care "coverage". conclusively capturing consumer/patient dependencies and $$ value for the MIC is not one of them.

    his proposal (andy stern's affinity notwithstanding) evinces continued abrogation of gubment intervention in "free market" anarchy.

    wyden's proposal attempts to institutionalize shrub llp HSA products that have failed to deliver putative financial "coverage".

    OTOH, in labor as well as the MIC markets, single payer not merely represents but aggregates the countervailing financial and economic force needed to "correct" uncompetitive terms of trade.

    Diversity is the key to economic and political evolution.

    by MarketTrustee on Fri Dec 15, 2006 at 05:33:28 AM PST

  •  Wyden's view (10+ / 0-)

    I happened to be invited to participate in a call yesterday with bloggers (McJoan, I believe, was also on the call). Acknowledging that I have not had time to read the entire bill and so this may all become quite clear and rosy, I would only make three points:

    1. He invoked the presence of SEIU president Andy Stern at the unveiling of his plan. It was quite subtle but there was an implication that Stern endorsed the plan. In fact, Stern's statement focused mostly on the crisis in health care. He devoted one sentence to Wyden's plan, saying that it made a "critical contribution" to the debate. That reminds me of the Mad magazine spoof years ago of movie advertisements that would excerpt a few words from a long review, leaving out the negative.
    1. I found Wyden's explanations about where the cost savings come from to be still quite fuzzy. He rests most of his assumptions on the community rating piece of his bill (he says this will draw vast opposition from the insurance industry) and consistently uses the Lewin Group analysis as his defense. Wyden says that his bill would save $1.48 trillion over ten years. That sounds like a big number but, when we spend $2.2 trillion per year, that savings is, in my humble opinion, relatively small.
    1. When I asked him why he had rejected single-payer and had left the private insurance industry in control of the system, his entire argument rested on the political--that only his kind of plan had a chance of passing on a "bi-partisan" basis.

    "Bi-partisanship" has brought us wonderful things like the resolution to invade Iraq and, on topic here, the Part D Medicare plan...well, the list goes on. In this case, with the massive amount of money flowing from the insurance, hospital and drug industries to members of Congress, it should not be a surprise that Wyden views a bill that keeps those powerful interests in place as the only politically doable legislation. Wyden did not make a single argument against the necessity of single-payer.

    The inclination on the part of some people is to tip the hat to Wyden because he has the courage to wade into this debate with a full-blown proposal. I'm not one of them--a bad bill is a bad bill. A bill that leaves our healthcare future in the hands of the industry is not a positive contribution. And  if the Wyden bill--or something similar--is the frame from which we start, I'd rather it not have come to light at all.

    So, it strikes me that the reality is that unless the people are organized to mount a serious grassroots campaign to achieve a real national health care plan--not just "universal"--we are going to get some incarnation of a Wyden-type plan. And I believe we will be right back where we started, in a health care crisis, in the years following the adoption of such a plan.

    Personal thanks To DrSteveB who has done a masterful job outlining single-payer.

    •  SEIU & Families USA - endorsed or not? (2+ / 0-)
      Recommended by:
      Floja Roja, 07rescue

      Wow... your point #1 could be a biggie.  The only concern I had was why SEIU & Families USA had seemingly lined up behind this...?

      From original press release:

      Speaking at a morning news conference, Wyden was joined by a diverse group of individuals concerned that health care in the United States is on life support. Joining the Senator were Andy Stern President of SEIU, a 1.8 million-member labor group; Steve Burd, Chairman, President and CEO of Safeway, a Fortune 50 employer; Ron Pollack from Families USA, a leader on health care for the low-income; Mike Roach, a 30-year member of the National Federation of Independent Businesses and small business owner from Oregon; CEO Bob Beal, a medium-size business owner from Oregon; Malene Davis, President and CEO of Capital Hospice; Don Schumacher, Executive Director of the National Hospice and Palliative Care Organization; and Pat Maryland, Chairperson, Citizens’ Health Care Working Group.

      Now we all know why the corporate execs. and insurance and for profit health industry lobbyists were there...

      Why was Ron Pollack from Families USA there and were they really endorsing the Wyden plan, with full knowledge of what it is and is not?

      Why was Andy Stern of SEIU there and were they really endorsing the Wyden plan, with full knowledge of what it is and is not?  There was some speculation that the particular nature of SEIU and its membership might make them a little less progressive than we would like on this particular issue. Or maybe they were NOT endorsing Wyden's particular plan.

      Again, even for the "let's get the best plan we can" compromisers, Wyden's is really bad for most working people (i.e. most people).

      And the cost saving, as analyzed by PNHP are phony.

      •  Oh... Steve Burd is a bad Burd (2+ / 0-)
        Recommended by:
        Brooke In Seattle, Floja Roja

        He's the reason I stopped shopping at Safeway. Not only did he try to break the unions (using Wal-Mart as a wedge) but he strong-armed vendors into providing donations he bundled up to get a seat at the big table with Bush in 2004 elections.

        Whatever his interests in this they are not good. That needs to be questioned.

        Mais, la souris est en dessous la table, le chat est sur la chaise et le singe est... est... le singe est disparu! -- Eddie Izzard

        by CSI Bentonville on Fri Dec 15, 2006 at 06:49:43 AM PST

        [ Parent ]

      •  SEIU (1+ / 0-)
        Recommended by:
        07rescue

        I just don't know. SEIU has been putting a lot of effort into health care. Andy is no wallflower so if he was going to embrace the Wyden plan, he would explicitly. My hunch is that his statement is out there to encourage the debate. I've dropped him an email to get clarification. Will report if I get an answer.

      •  Stern / SEIU (1+ / 0-)
        Recommended by:
        07rescue

        I'm making it clear that this is my own personal opinion and not the official one of PNHP, but many of us believe that Andy Stern is opposing single-payer not just because he buys into the whole "political feasibility" bit, but because it is in SEIU's interest to do so.

        Look at this this way: SEIU is organizing the only sector of of the economy that can conceivably get better health benefits than it does now. The Autoworkers, Steelworkers, etc, are all watching their benefits deteriorate.  As long as workers HAVE to join SEIU to get benefits, that's good for Andy. Its worth nothing that the California Nurses Association (responsible for Arnold's referendum defeat) and the National Nurses Organizing Committee often accuse Andy Stern of wanting SEIU to be "his personal temp agency." and thats why thousands of nurses broke with SEIU, partly over their terrible health policy.

    •  Community rating (0+ / 0-)

      He rests most of his assumptions on the community rating piece of his bill (he says this will draw vast opposition from the insurance industry) and consistently uses the Lewin Group analysis as his defense.

      Of course, the real meaning of community rating is that everyone pays an average premium. By definition, that means that half will pay less and half will pay more. It also means that most of us will pay in the same amount for our health insurance over our lifetime that we do now, just more when we are younger and less when we are older.

      There is nothing about community rating as a concept that should cause overall costs to go down. It is possible, I would say likely, that over the long term that having everyone covered will bring costs down.

      One of the ways that insurance companies compete between each other today is on how well they are able to estimate risk. That's the task a whole profession, actuaries, are devoted to.  For example, a factor in my fire insurance is the distance to a fire station. Unless they are still able to use zip code as a factor (ooh, zip code 90210 is wealthy and healthy, rate them less; zip code 90010 is poor and unhealthy, rate them more; zip code 90006 is elderly, rate them more), I don't see how competition between health plans will actually have any meaning. The sickest people will choose the most generous plans until they go out of business or change their policy conditions.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Fri Dec 15, 2006 at 08:50:17 AM PST

      [ Parent ]

  •  Are you suggesting (3+ / 0-)
    Recommended by:
    elfling, relentless, Mary Mike

    that adding another tax loophole, a federal bureaucracy, and a huge giveaway to an insurance industry that skims a third of our dollars just to deny care, is not the best solution to the US healthcare crisis?

    It is clearly the way to virtually universal healthcare, since the costs are covered for those below the poverty line, we just need wait until 99.5% of americans are below the poverty line.  Once the Bush gang finishes of that pesky US middle class, everything will be great. This bill, turning busy americans to the tender mercies of a 'marketplace' for complex insurance, will certainly help bankrupt thousands, but their garnished wages will be lower after 2 years...

    Maybe we can start calling the former middle class the indentured class, since those who could never get credit cannot be owned by a bank.

  •  Assuming that, after 2 years, employers... (2+ / 0-)
    Recommended by:
    coral, Mary Mike

    would continue to pay the wages necessary to cover the cost of purchasing insurance is naive in the extreme.  Maybe, in a country w/ a vibrant union movement and w/ relatively tight labor markets, the assumption would be valid.  The US, obviously, does not have a vibrant union movement, and labor markets are variable.

    I have no enthusiasm for the Wyden plan.

    Some men see things as they are and ask why. I see things that never were and ask why not?

    by RFK Lives on Fri Dec 15, 2006 at 06:02:47 AM PST

  •  I agree with you. (2+ / 0-)
    Recommended by:
    paige, Mary Mike

    The public has to demand change, and the power of the blogosphere can be proven once and for all if it can create that demand.

    Arguing over deductibles, employer taxes, physician payments, annual costs/savings is just what the big boys want us to do.  That kind of analysis is necessary ultimately, but not now.  Now the focus, in my opinion, should be on creating public outcry and Congress, bless their little hearts, are not helping.  They mistake discussion about details with movement.  It is merely a distraction.

    If you don't have an earth-shaking idea, get one, you'll love building a better world.

    by hestal on Fri Dec 15, 2006 at 06:05:43 AM PST

  •  Some questions (1+ / 0-)
    Recommended by:
    Floja Roja

    I haven't been able to follow all the details. It gets to be too much at least when my focus of interest is elsewhere.

    I do like the idea of a national healthcare along the lines of Canada.

    I also know that no matter how wonderful a plan is the despicables will find ways to take advantage and abuse it for personal gain.

    What I'm wondering most here though is while I agree the healthcare system needs a complete overhaul, what really are the chances of that happening?

    Who stands to lose if there's a complete overhaul and how likely is it that they won't fight it tooth and bloody nail?

    And how politically connected are the players who are invested in the current system?

    Frankly, at this point I'm all for something that breaks an employer's hold on its serfs who can't leave for a better opportunity because of the fear of healthcare loss and I'm in for places like Wal-Mart having to pony up in a more equal way instead of on the backs of state and local taxpayers in the locality they are in.

    I also have never seen Wyden as a bad guy so I'd hate for people to demonize him here. Regardless of the flaws there might be, at least he is coming up with something and getting the conversation going again. Just maybe this is what's needed to get the Conyer's bill some attention.

    Thanks for your consideration.

    Mais, la souris est en dessous la table, le chat est sur la chaise et le singe est... est... le singe est disparu! -- Eddie Izzard

    by CSI Bentonville on Fri Dec 15, 2006 at 06:43:32 AM PST

    •  fair enough... (1+ / 0-)
      Recommended by:
      coral

      I understand the realpolitik question.
      It is just that the details of the Wyden plan, as initially presented, really are worse than expected.

      Sure, one could give up on single payer Medicare for All, and go with some form of mandated care (require individuals buy insurance); combined  with some sort of tax payer support for those who cannot afford to buy insurance & with some sort of regulation of private insurers to assure that resulting sytem is really providing universal coverage... but Wyden plan particulars are a not very good example of even this approach.

      •  Um... (0+ / 0-)

        I don't understand. I thought my questions were valid. Where is this "realpolitik" assigning coming from? And why?

        And why are the questions not deemed valid enough for answers? If we don't understand who the adversaries are how can they be countered?

        Nevermind then I guess.

        Mais, la souris est en dessous la table, le chat est sur la chaise et le singe est... est... le singe est disparu! -- Eddie Izzard

        by CSI Bentonville on Fri Dec 15, 2006 at 07:01:25 AM PST

        [ Parent ]

        •  you're right (2+ / 0-)
          Recommended by:
          CSI Bentonville, 07rescue

          That it will be difficult. So was every great achievement in the history of human progress.

          The way I look at it is this: although "politically feasible" band-aid plans are easier to pass, they don't fix what's fundamentally wrong with the health system (i.e. our private insurance finance structure). So any gains in coverage that you get under them are going to be short-lived, and fail. Economic progress is going to be crippled to an unbearable point. At some point we will have to adopt the universal coverage and cost-control methods that the whole rest of the world has. Its worth noting that even much of the right wing is now saying this.

      •  Single Payer (4+ / 0-)

        The more I read and learn, the clearer it becomes that single payer is the only way to go.

        Any proposal other than the status quo--or something even worse for ordinary people than the status quo--is going to have a huge, well-financed opposition.

        So why not try for the best plan?

        The battle will be engaged no matter what.

        And in terms of educating the public and forcing the political establishment to pay attention, single payer also seems to be the way to go. Now, what we need is someone to do for health care, what Al Gore and An Inconvenient Truth have started to do for the climate crisis.

        Wyden plan just ain't enough.

        "Control of the initiative is control of the battle. In the alley, at the poker table or in politics. One must raise." David Mamet

        by coral on Fri Dec 15, 2006 at 07:31:15 AM PST

        [ Parent ]

    •  You asked (1+ / 0-)
      Recommended by:
      CSI Bentonville

      who would have the most to lose. Insurance companies and the politicians they donate to. The government, some say, get a lot of tax money from the insurance companies.

      So, we need to have campaign finance reform.

      We need to make them see that other more interesting jobs can be created if the insurance companies lay off workers.  

      Personally, I think it is a scam. Once they break the insurance contracts that have been promised to some of the unions/workers and get torte reform, they will go up even more.  Besides that it is too expensive for many many people.

      Life is what you focus on. I am focused on Christmas without Christ. It just ain't right.

      by relentless on Fri Dec 15, 2006 at 09:19:54 AM PST

      [ Parent ]

  •  My head is exploding. (0+ / 0-)

    I am a fairly intelligent woman, and some would say I'm fairly well-educated: I have a master's degree -- but it is in English, not macroeconomics.

    And this stuff makes my head explode. I am not a numbers person anyway, but when all these people start talking about percentages and deductions and salary increases then reductions blah-blah-blah, I want to scream. It makes no sense to me.

    And if it makes no sense to me, how do you think it sounds to the 80% of the population who don't have the education I have, or don't have the common sense or rational mind to understand it either? They keep it complicated on purpose to baffle people with their bullshit.

    The solution Wyden is promoting also doesn't take into account that people are human, and don't always act in their own best interests. Being given a big chunk of money at one time is not the best of ideas for a certain segment of the population -- and I would include myself in that group.

    I'd like to think maybe it's just too early, but I've read your other diaries at all hours of the day and night, and it isn't any clearer what the people in Washington, DC, are trying to do -- except continue to take advantage of we the people. In other words, it's not YOUR fault it's so incredibly complicated. Thanks for trying to explain it.

  •  I read the Healthy Americans Act (1+ / 0-)
    Recommended by:
    elfling

    this morning and took a few notes. Some things I didn't take notes on but remember bits of them. Like FoxNews and all insurances, it was FUZZY and without many concrete figures. Prepare to be confused.

    Some lines I read several times and still it didn't make sense and I am pretty good at comprehension.  They locked the pdf so you can't copy off sections to comment on, so my notes are typed by me.

    It did have something about saving 300 plus billion for businesses.  And the insurance companies  would save money because of less administration......(Nothing said about the insured saving money.)

    It says that the employer has to pay for two years before the plan starts....and that they have to cancel the insurances they have.  ????

    Page 127 discusses bonus payments to states for implementing State medical malpractice reform law.....which doesn’t make sense since earlier I read that the right to sue is lost since the new insurance is a government program.  But they threw Medicare into the mix so that added to the confusion.
    --------------------------------------------
    This is how they plan to charge businesses after the first 2 years:

    According to the percentile of the revenue of the employee for the preceding year.

    Revenue per employee national
    percentile of the taxpayer:
    Large     Small
         Employer    Employer
    0-20th percentile.............17%...2%
    21st-40th percentile........19%.....4%
    41st-60th percentile........21%.....6%
    61st-80th percentile........23%.....8%
    81st-99th percentile........25%....10%  page 96-97

    The Maximum additional rate shall not exceed 15%.  Page 105 has moree details of business charges.

    Large employer employees are more than 200 full time employees a year.

    My note: (The largest employers with the highest average wages will pay 25% of the insurance for workers, but if I read it right, most won't pay that much. So the worker could pay 90% of the costs, but I don't know.)
     
    I got the impression they are lumping it in with Medicare and they will be alike, but who knows.

    TITLE IV-HEALTHIER MEDICARE
    Subtitle  A-Authority to Adjust Amount of Part B Premium to Reward Positive Health Behavior
    SEC. 401 AUTHORITY TO ADJUST AMOUNT OF MEDICARE
    PART B PREMIUM TO REWARD POSITIVE HEALTH BEHAVIOR
    Section 1839 of the Social Security Act (42 U.S.C. 11 1395r is amended-
    (1) in subsection (a) (2), by striking "and (I)"
    And inserting "(I), and (j)": and
    (2) by adding at the end of the following new subsection:

    "(j)(1)  With respect to the monthly premium amount for months after December 2007, the Secretary may adjust (under procedures established by the Secretary) the amount of such premium for an individual based on whether or not the individual participates in certain healthy behaviors, such as weight management, exercise, nutrition counseling, refraining from tobacco use, designating a health home, and other behaviors determined appropriate by the Secretary. Page 60

    It looks like we should be prepared to give the insurance companies torte reform, plus quit smoking, get thin and probably limit our beer to get lower insurance prices.  That will eliminate low prices for 90% of the people:-)

    "(2)  In making the adjustments under paragraph (1) for a month, the Secretary shall ensure that the total amount of premiums to be paid under this part for the month is equal to the total amount of premiums that would have been paid under this part for the month if no such adjustments had been made, as estimated by the Secretary." page 70

    Long term care insurance is paid to this insurance from Social Security????  page 58

    page 137.  The excess of taxpayer's modified adjusted gross income of 62,500 for one, $125,000 for a couple.

    Social Security is counted in the amount of qualifying for lower payments.

    page 135. has a couple with a child is $15,210 in one place plus $2000, but then has $12050 for a couple.

    There are three tiers of insurance.  If you buy the more expensive tier you will not be subsidized.

    The insurance doesn’t start for two years, but the payments start now?

    Confused?  So am I.

    Life is what you focus on. I am focused on Christmas without Christ. It just ain't right.

    by relentless on Fri Dec 15, 2006 at 09:10:57 AM PST

  •  In the figures (0+ / 0-)

    on percentages the first column is large businesses and the last column is small businesses.  I didn't noticed they shifted.

    Life is what you focus on. I am focused on Christmas without Christ. It just ain't right.

    by relentless on Fri Dec 15, 2006 at 09:23:52 AM PST

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site