What happens to a small business with 10 or fewer employees one or two of whom have actual sick people in their families? Eventually the insurance cost is going to reach your so-called gold-plated limit. You make it sound like all of these plans are covering massages and spas.

If they instituted a cap that wasn't indexed to inflation in health costs, would that essentially be a path towards single-payer?

Chris: We'll have to wait for more details on the plan, but I wouldn't be surprised if small businesses got special assistance or exemptions. It might also serve as incentive to go into the federally-run group pool where the business wouldn't be on the hook for fluctuations.

Ezra schrunches nose and smells rationality wafting from the OMB. Fear not, the industry will have it's aerolizer spary out before that scent gets to Capitol Hill.

If they're serious about this, my prediction for any healthcare bill passing goes from a shade under 50/50 to below 30%

"And more generally, people who get health care coverage from their employers -- how many lawyers do you know without health benefits? -- are richer than those who don't. But those who don't -- self-employed truckers, say -- are subsidizing them."

I don't think lawyers are a particular good example. At higher level, big law firm partners, by definition, do not have employer paid health benefits. The partners in a partnership are employers themselves. All the law firm partners I know pay 100% for the cost of their health insurance. It's the "lower" paid associates, and staff that have employer paid benefits.

Also, a lot of lawyers are solo practitioner, and they don't have employers paid health insurance either. Some solo attorneys are more successful than others, so the health coverages do vary.

My point is, the dividing line is not really income level. I personally know solo attorneys with 7 digits annual income paying for their own health insurance. The difference is between regular/W-2 employment and the freelance/1099-MISC contractors.

Employers pay employees salaries and benefits because they are expecting to extract profits above those compensation cost. A lot of people at high end had decided to keep those profits for themselves and pay for their own health insurances.

In summation, the freelance employment clusters in both very high end(Lawyers, Doctors, Consultants, etc.) and low end. I don't think your assertion that self-employed people generally earn less is true.

It's hard to believe there are enough people with gold-plated health plans for this to be enough of a revenue generator to help pay for everyone else, and why won't the wealthy simply practice their usual tax avoidance like they do with other forms of income? They've successfully done that to the point the rich pay lower tax rates than the poor in many cases.

"But the employer tax exclusion isn't likely to dissolve completely. It's too much political pain. People like artificially cheap health care."

Health care in the US is not artificially cheap. Held hostage to for-profit institutions, especially health insurers, the costs are instead artificially inflated. And naturally, the inflation catches you coming and going. I've paid out tens of thousands of dollars over the years in insurance premiums, in exchange for what turned out to be only a few hundred dollars worth of actual health services. Yet the few times I've sought any medical care in the US while lacking insurance, the inflated costs have been almost prohibitive. There's nothing cheap whatever about the Rube-Goldberg health care "system" we've got.

Obviously, fiddling with tax incentives will achieve nothing more than very temporary and modest relief. The for-profit imperative is always to absorb as much money as people are able/willing to spend for health care - or, at least, for the appearance of health coverage. Obama is proposing to do what the last 40 years have shown is undo-able, to hold down costs within a system that exists to inflate costs - by means of the same kinds of marginal tweaks that have never accomplished anything significant in the past.

Thus the Obama plan is a dead horse. The McCain plan was a dead duck.

So does this count as an insurance program I could sign up through the government?

I am waiting for this option. I'm hoping a public option would crowd out private insurance, and lead to a generation of solidly Dem voters.

You wait a good long time in this post to point out the obvious - that elimination of the employer tax benefit on health plans has been the cornerstone of the Republican "alternative" proposal to healthcare... and even longer to admit that, as McCain (and others) demonstrated, that proposal is actually a serious loser. Expecting Congress to take away the employer benefit - or even "cap" it at some odd figure - is brave, but probably unrealistic. Republicans already know that Democrats run against that idea. Democrats know the idea is a loser, especially with young urban professionals who get coverage through their... employers. If that's the best we've got... we're in serous trouble.

All of this brings up the familiar problem with the McCain plan - you can't just end the employer benefit without a clear proposal about what's next. What will happen - what we already know will happen - is that if you limit the employer tax break, or eliminate it gradually, you are asking employers to exit health coverage. And they will, in droves. Absent some clear indication of where people willl get coverage, you are, as McCain did, expanding the individual insurance market, where we already know many people can't afford good coverage, and many people will forego coverage either because they are healthy or they can't afford it. That, it seems to me, is the worst of all worlds... which is exactly what I said - and as I recall, what you said - about the McCain plan.

And on top of all of that, there are also consequences to cutting Medicare Advantage, something that may matter to seniors (though from what I've heard, many managed care organizations seem resigned to the idea that the money will drop, without dropping their plans). And all of this, I think, matters less than knowing what the alternative is supposed to be... or how we get there. Asalways, I think the biggest problem in all of this is that too many people - who could be drastically affected by a change like eliminating the employer tax break on health insurance - have not been brought up to speed on what's wrong... or why we need to make a change, and why that change involves them. Until we do, massive change like this really can't fly. And in some ways... I'm not sure it shouls=d. I'd be happier if, first, we talked about what we plan to do to make Medicare better, smarter, and more efficient. A commitment to really address Medicare, i think, would be a sign that not nly are we willing to do step 1... we're also not racing to do step 10 out of order.

"The employer tax exclusion cost about $134 billion in 2007."

I believe that understates the extent of the cost of the tax exclusion because if I am correct the $134 billion is only the amount of foregone revenues for income taxes but not for the Payroll tax which amounts to roughly another $100 billion.

"The employer tax exclusion cost about $134 billion in 2007."

The irony here is the definition of cost. When you don't tax particular activities this is viewed as cost?

Is there any limit or restriction on the things you think ought to be taxed?

Did I further understand that you think $134 billion will pay for nationalized healthcare? Not on a bet.

I don't know, I find myself awfully skeptical of a standard deduction that phases out for certain income levels. If, for example, you eliminated the deduction at $125K, my family would be screwed because of the way business taxes work. As a self-employed business partner, my wife earns more than that annually -- it's considered her income, even though the business expenses come out of that amount. Plus, you have to factor in cost-of-living; in San Jose, our low six-figures makes it hard to make ends meet with one kid, two dogs, and a mortgage. But you simply can't do the kind of cutting-edge work we do (both of us work with children with autism) in very many places, and the Bay Area is one of them.

Eh, we're all screwed anywho.

Per the recent analysis by Lewin Group & Commonwealth:

Universal health does not have to mean an increase in global costs. Stark (or Conyers) versions of Expanded and Improved Medicare for All do reduce and control total costs in a way that the Obama/Baucus plans and all the other proposals, do not.

Only by falsely taking Single Payer off the table do we limit the discussion this way.

I'd counsel great caution on employer health care benefits being trimmed or eliminated. The choice to move to a non-employer plan should ONLY rest with the employee - when and if they conclude there's a better plan for their family. Otherwise FEAR will slice off a huge part of the support for a major restructuring of healthcare.

Voluntary migration, not government mandate.

BTW: there are some implications on retiree healthcare insurance involved in any changes to employer healthcare tax deductions, if only indirectly. For instance, my former employer self-insures (as do most really large companies) and they include retirees in their pool thereby making their retiree Medicare supplemental insurance (Parts B and D of Medicare) substantially less expensive because the pool includes those still working. My portion of the supplemental coverage actually went down for 2009 over 2008 as a result of this practice.

So don't play with my Medicare supplemental insurance, hear me?

People like artificially cheap health care.

well, golly gee whiz, who wouldn't? who wouldn't like artificially cheap everything? people really are rational economic actors, y'know.

but as has already been pointed out above, what we really have is an artificially expensive system.

you've been asking for blogging assignments lately, so here's one: give us some good and detailed wonkery on how hr 676 will save lives and money. do this without throwing in any gratuitous but it's politically unfeasible! whining.

http://www.gamegoldme.com

well, golly gee whiz, who wouldn't? who wouldn't like artificially cheap everything? people really are rational economic actors, y'know.

but as has already been pointed out above, what we really have is an artificially expensive system.

sdfsdfsdfsdfsddsds

Laptop Batteries
Laptop Batteries discount laptop battery

http://www.igchest.com