"Getting rid of the employer link in health care would be tremendously healthy for the system."
Uh, respectfully, NO, Ezra. As long as employers pay a percentage of healthcare costs, they will use their influence and power to keep costs low. And, lets be realistic, large corporations still have much more leverage to strongarm insurers than any organisation of healthcare customers. So, a system that commits employers to contribute to insurance costs, and at the same time allows people to keep the insurance in times of unemployment, would be the best of both worlds. Btw, in Germany, the obligation to pay half of the insurance fees led many corporations to start their own healthcare insurance subsidies (Betriebskrankenkassen) and thus strengthened the competition.

Love the video... hate the plan for the usual PNHP reasons:

Senator Wyden’s Healthy Americans Act aka: “Employer coverage is dying, so let’s kill it faster”

Basically it relies on competition between private insurers to contain costs (but unclear how this would happen since no evidence that health insurers work that way… they only compete for who can get the healthy and wealthy). And individuals have to negotiate their way through the morass of private offerings.

From Dr. Tsou who was there for an earlier presentation by Wyden (forum was sponsored by AmeriHealth, a large Medicaid HMO):

http://www.pnhp.org/news/2008/february/wydens_healthy_ame.php

Wyden and Bennett said there were five major goals in their plan which was a piece in progress. Those goals were choice of plans to fit each family’s needs, portability which is tied to individual insurance supposedly with a lifetime guarantee of coverage as good as members of Congress (a term he used repeatedly), tax reform to support the same tax benefits that large employers get, healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite - market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care. Bennett says that many Republicans have a hard time even agreeing on universal health coverage.

Wyden mentioned that we spend $2.3 trillion on health care, but were not getting enough value for our money. In order to pay for the premiums to go to private insurers, they would require all employers to give all American workers the actual value of their health care benefits in higher wages but that they then turn around and require you to take those wages and purchase individual insurance. (This idea is something of value to single payer advocates but instead of paying premiums, you would pay taxes to fund a single payer plan. ) There would be three large private insurance risk pools. The first would be all employees who would basically buy into a program like the federal employee health benefit plans. The second would be all individual self employed and uninsured who would be in another big risk pool. In order to avoid adverse risk selection, they would require community rating by insurers and no preexisting condition exclusions. The third risk pool would be all Medicaid patients who could buy their insurance from Medicaid HMOs like AmeriHealth, but if the benefits were not as good as what members of Congress get, the federal government would subsidize these plans to ensure complete benefits. (actually, Medicaid benefits are generally much more comprehensive than private insurance, but because they pay so poorly, few providers accept Medicaid payments).

Several questions were asked, but my question basically challenged why they did not choose single payer since private insurers have much higher administrative costs, that single payer would be a much better negotiator of health prices and quality than Mrs. Jones down the street, and what kind of fines would they envision to enforce their mandate. Wyden stated that whenever he has a public forum, some single payer advocate explains the advantages of single payer and there is cheering in the audience. Then there is someone in the back of the room who denounces government. And finally, someone says “we want what you have”. Wyden pulls out his health card and says that he has private health insurance and explains that his plan would give Americans “what members of Congress have”. This seems to quiet the audience from his perspective. (I have no doubt that members of Congress do not face the denials so nicely outlined in Sicko.) In terms of transparency in prices and quality, Bennett said repeatedly that Utah’s Intermountain Healthcare delivers much better health care for less money and that presumably his state would benefit if there was more transparency in cost since they presumably would choose Intermountain Health. Bennett also seemed to believe that the risk pools were so huge that they could drop the private insurance overhead to “3-4 percent”, (which is sheer fantasy). They dodged the question about “fines” for enforcing the mandate, basically saying that terms like “garnish your wages” were words that opponents use and that basically the plan would deduct premiums from our paychecks in order to fund the plan. (Why deducting premiums from our paychecks to fund private insurance companies is acceptable but deducting a smaller amount using taxes to fund single payer was not acceptable seems an important question, but I wasn’t given a chance to debate them because so many others had questions.)

Others asked about malpractice, about whether states would be allowed to experiment with health care reform (they would), assurance of quality of care, etc.

They believe that since they have a bipartisan bill with six Republicans (Judd, Gregg, Grassley, Coleman, Crapo, Alexander) and six Democrats (Stabenow, Nelson, Lieberman (no surprise here), Carper, and Landrieu) plus the National Federation of Independent Businesses, the CEO of Safeway, and SEIU, they have a good shot at setting the framework for the next president. Add to that that Obama and Clinton are basically using the framework of private insurance in their plans and you have the basis to worry about another 4-8 years of a costly failed experiment in health care reform.

Despite these rumblings, I think it is pretty clear that the American people want single payer. It is the politicians who are out of tune with this. We will need to do a lot more educating about this. The impending recession may cause millions more Americans to lose their health insurance. Simply requiring them to buy insurance is not a solution in the face of a recession and we should demand that Congress create a real safety net, not one based on the fantasy that everyone buy overpriced for profit private insurance with huge deductibles.

Apropos, what about the Frontline special about healthcare systems all around the world?
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld
Not worth a blog post???
:-(

I feel like this video is also risky because it will instill fear in Starbucks patrons that they can no longer be guaranteed good customer service if Wyden's plan is enacted.

Hehehe, Lauren! Yup, no foam with my coffee, pls.
:D

What's to stop employers from complying initially with the plan's mandate to provide the health insurance $$$ directly to the employee, and then cut back on those $$$ provided to the employee year after year? Saves the employer money, doesn't it?

I don't like the ad. It valorizes petty vengeance, which diminishes the overall nobility of the cause.

"What's to stop employers from complying initially with the plan's mandate to provide the health insurance $$$ directly to the employee, and then cut back on those $$$ provided to the employee year after year?"
Last century, it used to be the unions. In this new millenium, I don't know...

If Jenny's mom has health care that covers orthodontics, she's got one hell of a plan. Seriously, I don't think anyone stays in a job because a kid has crooked teeth. But if Jenny needs daily insulin injections, then her mom has a problem.

Anon,

"but my question basically challenged why they did not choose single payer since private insurers have much higher administrative costs"

This is an Urban myth, private insurers have lower administrative cost then any single payer plan in the US. Self Funded plans have administrative cost half those of single payer or lower.

Generally speaking if you took a room full of people that don't know anything about our current delivery system and never owned a business they would come up with something this stupid. Couple obvious blunders that would kill this plan immediately;

"Under Wyden's plan, employers would no longer provide health coverage"

I don't see anywhere that they account for the HUGE increase in distribution, right now 260 million people are covered by 1 million or so plans. To scrap the entire employer based system and market direct to all those individuals is going to cost a fortune! Your talking billion dollars annually minimum. Imagine all the people that can't figure out insurance when their employer hands it to them, now your forcing them to shop and choose their own plan. Major mistake.

"but would have to offer benefits at least equivalent to the Blue Cross "standard" option."

Who decides this? Talk about killing innovation. Would HSAs or CDHC exist under such regulation? How do we innovate if everything needs congressional approval first?

"In most cases, insurance premiums would be withheld from paychecks, as they are now."

So employers are now going to track and collect different deductions for every single employee? Talk about administrative nightmare! If you have 100 employees that all have different carriers does the employer need to pay those 100 carriers? Damn those details, ruin more great sounding ideas.

"Eliminating employers as an additional payer would encourage consumers to use health care more efficiently. "

On what basis does this make sense? If your employer isn't paying the bill but tax payors are your civic obligation will lead you to consume wiser? This is laughable logic.

"with individuals, employers and government each investing something into the system"

Didn't it claim one web page earlier the absence of employers would lead to greater consumerism, but here they are contributing again???

"Health Help Agencies will lower administrative costs by coordinating payments from employers"

This sounds an awful lot like Cal Choice, CA's small group reform, CA has one of the most expensive insurance markets in the world. Far from decreasing cost it skyrocketed. Oops that's right facts don't effect Progressive legislation, they just bounce right off.

"With the ability to compare plans based on quality, cost and service, individuals—rather than their employers—will be able to choose the health plan that works best for them and their families.
"

OK this is Cal Choice nd Cal Choice has been a failure, why will this magically succeed?

"they can be required to verify their enrollment in a private health insurance plan."

Requiring someone show valid ID and that they are a citizen is racist and bad, forcing them to show proof of participation in government health care scheme good?

"For the first two years of the new system, employers who currently provide employee health benefits will be required to convert their health care premiums into higher wages for employees.

Employers who don't provide health benefits will be required to begin making phased-in “Employer Shared Responsibility Payments.”

Sounds like a great excuse to cancel your insurance plan if your an employer.

"These payments will reflect the relative ability to pay of small and large employers and low- and high-wage industries and will have no impact on the insurance coverage of their individual employees."

Politicians will determine how much I can afford to pay on my employees behalf. And this won't stifle people starting new businesses, you know the engine of America.

"taxpayers will no longer be asked to foot the bill for expensive visits to the emergency room."

I thought one of the main features was free coverage up to 400% FPL? We are not only paying for expensive ER but needless trips to the Dr and their pain medicine addiction.

Side note, national healthcare will be a godsend for anyone abusing pills, no more buying them on the black market, now you get free insurance and free drugs..and it will still save the tax payors money! Why don't we throw in some coke and weed and really save some bucks.

Basically this is a plan built by idiots for idiots. You really must have negative knowledge of our current system and complete lack of common sense to think any of these proposals would work.

I would challenge the premise of the video that all the workers are trapped in jobs that they don't want but are chained there because of healthcare. Does anyone *really* believe that this is the usual and not the exception??

I also liked the racsim where the snotty white woman complains at starbucks to a young black worker. Yeah, we shouldn't have to take that from Ol' Whitey.

Here's a link to how Wyden's plan is described on his website.

I share many of the objections to the plan that have already been raised. The one made by Gray about essentially taking away the bargaining of larger organizations such as corporations and putting the "shopping" in the hands of the individual consumer is particularly telling IMHO.

I can see how The Healthy Americans Act might appeal to the "ownership society" and "personal responsibility" crowd. Hey, just arm the consumer with his "own money" and, in principle, "perfect" information (that's not so hard, is it?), and that is a recipe for … exactly what?

A disaster.

We would get the same sort of implosion over time of the system that we would get if we gave in to the blandishments of some of this same crowd (not, of course, the Democrats listed as co-sponsors currently, though Lieberman-D/I has in the past rhetorically flirted with "restructuring" Social Security in this direction) and privatized Social Security by giving people their contributions and telling them they should go shopping on Wall Street to get their secure retirement. Though there would be some restraints on investments at the front end, does anyone doubt that the lobbying by the financial services industry would generate loosening over time and we would end up with … something like the now failing Chilean Social Security system and the UK system, which is reportedly gouging the pensioners on service fees – or worse?

In the same way, if it's me + some extra jingly + my brother-in-law Fred who knows everything + the Internet as my guide, when Fred is not available standing tall against skyscrapers full of very clever people in Hartford figuring out ways to sell me less insurance for more, I have no doubt who wins that contest over time. It's like playing against the House in Vegas. I may actually win occasionally, but in the end, if I keep playing, I'll more likely be walking out with a barrel around me to hide my nakedness.

And now project the outcome to the population level.

On top of all this to talk about disproportionately shifting the responsibility for choice – which is what these sorts of plans do -- to the layman in an area which is complex financially to begin with, and, on top of that, really and truly complex when it comes to the science of the matter, is very misguided.

Yes, there should be a cooperative relationship between the patient and the health care provider, and in the end we are formally responsible for making our healthcare choices. But the fantasy that we all know as much -–or even nearly as much – as the professional does in this area such that we can intelligently choose the entire framework, as distinguished from making an informed decision about a specific matter at a particular point in time is … a fantasy, and a pernicious one.

If you doubt me, check up on how Aflac has insinuated itself through compliant personnel departments in many corporations throughout the U.S., and managed to sell so-called "supplementary" health insurance policies – typically pitched with all the fear they can summon up to "additional" cancer coverage – which make flight insurance seem like a bargain. Or recall how the private health insurance industry could manage to sell so many active duty service personnel shipped off to fight George's war in Iraq truly execrable life insurance policies which provided even less in benefits than the one they were getting at no additional charge from the Federal Government.

Like sheep to the slaughter, just as is happening in Medicare Part D.

By the way, aside from Wyden, take a look at the progressive luminaries who have tentatively signed on to The Healthy Americans Act.

Would you buy a used car from Judd Gregg, (there is no Senator Judd currently seated in the U.S. Senate, though there is, of course, Senator Judd Gregg from New Hampshire; presumably Anonymous meant instead to list) Bob Bennett, Charles Grassley, Norm Coleman, Mike Crapo, or Lamar Alexander; or even Debbie Stabenow, Bill Nelson (who should know better since he was formerly the Commissioner for Insurance in Florida), Joe Lieberman, Tom Carper, or Mary Landrieu?

"This is an Urban myth, private insurers have lower administrative cost then any single payer plan in the US. Self Funded plans have administrative cost half those of single payer or lower."

Nate, pls show some evidence supporting your view that this is an urban myth. Every single study I read showed that private insurance has higher administrative costs up to 25% of the total.

As for your other points - if you were right, none of the healthcare systems in other nations would work. But the do, at lower costs than in the US.

Lauren, there are a hell of a lot more people in this country that work behind those counters, and they are fucking sit of snobby elitists like you who think it's there god given right to shit all over them because your mommy and daddy made more money than theres did.

Let me guess, you're a Hillary supporter who thinks those folks are happy about taking your shit?

Paige:
What's to stop employers from complying initially with the plan's mandate to provide the health insurance $$$ directly to the employee, and then cut back on those $$$ provided to the employee year after year? Saves the employer money, doesn't it?

Not much, but then, what's stopping them from getting rid of health care now?

soullite,
i think you missed the sarcasm in Lauren's comment, but that could just be wishful thinking on my part.

Maybe, but my personal experience indicates that a lot of people really do think 'customer service' means 'putting up with my abuse', and not 'being polite and helpful'.

It's like everyone in this country who has an education think it proves them superior to everyone else who doesn't.

El Viajero:
Huh? Do you have kids? It it not a fun thing to change insurance and have to find a new doctor...or doctors for all family members, various specialists or special needs, etc. It it more the fear of losing a favorite doctor , the unknown insurance of a possible new job that can cause people to just stick it out.

Hell, look at Charlie Gisbon saying that it's the fucking apocalypse if he has to pay taxes at the same rate as everyone else.

Lmao, 6% of the population is a 'heck of a lot of people' only because Charlie Gibson is one of those people.

I would challenge the premise of the video that all the workers are trapped in jobs that they don't want but are chained there because of healthcare.

First, the video didn't say that all workers are trapped in jobs they don't want because of health care. That's a straw man you're using to, once again use as an excuse to spit on the workers that you hate. If you would get the hell out of your mother's basement and talk to regular people for a change, you'd realize that this is a serious issue for a lot of people.

What's to stop employers from complying initially with the plan's mandate to provide the health insurance $$$ directly to the employee, and then cut back on those $$$...

What's to stop them from shifting more of the costs of premiums onto workers under the status quo? Same thing, right? And guess what, they're doing so every day.

I think single payer advocates ought to consider backing the Wyden plan. If you get rid of the workplace/healthcare connection entirely, and mandate universal coverage, pretty soon nearly everybody is going to be getting some kind of subsidy from the government, provided the legislation is sufficiently generous. And I predict it will have to be, because congresscritters aren't stupid enough to pass a bill that's going to be truly, genuinely, massively painful (in the financial sense) to literally millions of households. So, in short order the vast bulk of the American people will be depending on Uncle Sam for at least some of their healthcare provision. And that's but a step or two from single payer.

Well, I don't know if my remark was "sarcastic" but it was meant to be a joke. On the other hand, there might be some people who'd watch the ad and think "Well, I wouldn't be as obnoxious as that woman ordering the latte but if Wyden's plan passes Starbucks employees won't have to be as nice to me anymore." And employers could watch it and worry that their employees will start pulling down their pants and sitting on the photocopier (although I imagine it's more likely that they'd prefer not to have employees who hate their jobs and are only there for the insurance, and prefer not to be responsible for health insurance in the first place). But mostly my comment was meant to be a joke; I don't think either of these is a serious concern.

Useful infomation. I learned something today.... Keep the good work. Very impressive.

If that's what you thought of the ad though, it says a lot more about your own class bias than you'd probably like to admit. An Ad like that will have a lot more emotional resonance than some here seem to think. Probably because most of the people here are upper-class and don't have a clue how hard it is out there for most Americans and how truly god-awful it is to have been lower class for the past 10 years. 'service workers' have clearly warped into 'servants' and even 'slaves' in the eyes of most people in the upper classes.

all because Jenny needs braces.

Could you have come up with a worse example? If braces are your only problem you are set indeed. How about if you had breast cancer or are a diabetic or have some other chronic disease?

Anyway Wydens bill does not sound too bad a separation of employment and health insurance would be a positive move. Seeing how much some healthy people value health insurance I wonder if a state could offer heath insurance to anyone at a fixed price and make it revenue neutral.

BTW IMO what any insurer, state or private, needs is help form the consumer to control spending. I have 2 possible ideas to get this help:

1. You could have Gov provide insurance with an annual deductible equal to the ones adjusted net income – the poverty rate for ones family size. A family of 4 with income of say 200,000/year would have a deductable of about $175,000 and so it would pay for them to seek affordable cancer or heart disease treatment.
2. You could insurance that one starts with a fairly high payments when on is young where a small part of the payment goes to health insurance and the rest goes into a heath annuity for the owner to spend on healthcare. One’s deductible would rise over time as the annuity grows some annuities would get into the hundreds of thousands. At some point some owners of the annuity could start to draw cash from the annuity. Thus the consumer would be spending his own money and thus would help the insurer contain spending.

Apollo healthcare anyone?

Also reducing excessive licensing of medical professionals might help on the cost side.

It might also make sense to ban insurance from covering things like back surgery that show no benefit.

Glad I read through the comments. Bloix beat me to what I was planning to write. Coverage for braces is the Holy Grail. We keep working because Jenny needs check ups, may break her arm or may need an appendectomy. If she needs to see an out-of-network specialist, needs her eyes checked, ends up needing glasses or most of the time even standard dental work, then we're paying out of that paycheck.

Braces? Better have healthy savings, a generous relative or a great job or all three if you want to think about that.

Thanks for your health policy analysis. It's the best online.

I find the ad deeply offensive and condescending. It seems to imply that working at Starbucks or for middle management is only for those who have no other choice. Why do so many knowledge workers denigrate any job that isn't similar to their own (or well-paying)?

This reminds me of when I looked up the video of the banjo scene from Deliverance on YouTube and one of the comments remarked that someone had recently went to find what the actor who played the inbred, banjo-playing kid was doing now. Turns out he is a dishwasher in a diner or something like that, and the person saying that remarked that that was sad. The next comment was, "Why is that sad?" Is it really the case that all the people working at those kinds of jobs are to be pitied? Those jobs are not going away any time, and I don't see what's wrong with them. I've long thought that there is a fundamental lack of respect for work qua work regardless of how difficult that work may appear to be or how little schooling or training it requires.

The work meritocracy was coined by Michael Young in his book "The Rise of the Meritocracy" to _satirize_ a future where merit is taken to its extreme. There is so much condescension towards the working-class people by the very people who purport to be fighting on their behalf. You can't insult and advocate for the working class at the same time.

Also, even before I watched the ad, I noticed that the picture used in its advertisement is of the very 80s-looking blond who (condescendingly) remarks, "You call this foam?" Now why, in a clickable ad linking to a video about providing portable healthcare, is the picture chosen that of the dolled-up, attractive blond. That pic could just as easily be used for an escort service targeting older executives. Maybe I'm just easily offended today, but for the life of me I can't figure out how that picture in any way telegraphs the message or substance of the video. But I know why it was chosen, and that too disappoints me.

Mitch, lots of people don't like their jobs and would do something else if they could get away with it. It's not condescending at all, it reflects the truth for a lot of people. There's a reason why "Office Space" is a cult classic.

What's condescending is for some well-off person to say, "you know, employees are just so happy, just like cotton pickers on the plantation!" To dent that a lot of people are tied to a job because they don't want to give up their health insurance bespeaks a profound ignorance of what many people experience.

That's a straw man you're using to, once again use as an excuse to spit on the workers that you hate.

Speaking of strawmen....It seems that I have no standing to discuss the issues because I don't agree with Tyro and must be branded a worker hater.

El Viajero:
Huh? Do you have kids? It it not a fun thing to change insurance and have to find a new doctor...or doctors for all family members, various specialists or special needs, etc.

ropty,

Let's all remember that the employer is under no obligation to provide any health insurance to you or your family, so let's be fair here.
What you are complaining about is the inconvenience of finding a new doctor, and that's about it.

You really must have negative knowledge of our current system and blah blah right wing bile etc.Posted by: Nate | April 16, 2008 6:31 PM

Oh, Nate, Nate, Nate. I'll tell you what, buddy - go to any country in western Europe and run for national office. Run on the platform that you are going to bring their citizens good ol' USA style free market healthcare, and abolish the healthcare systems that they have. Make it your only platform in your campaign. Never shut up about it, talk it up. See how well that works out, then get back to us.

Let's all remember that the employer is under no obligation to provide any health insurance to you or your family

This is precisely the reason why the commercial resonates with people-- they're tired of acting like they should be THANKFUL that an employer provides a mechanism that prevents them from being bankrupted my medical bills. Being treated by your employer as if they're doing you a favor for the privilege of having health insurance isn't cool. In fact, such an attitude is the precise definition of spitting on workers.

Any legislation which results in getting people health coverage WITHOUT the attendent condesension from employers is a good thing, pecisely because people don't like to live like that.

Mitch Schindler I agree with you I was washing dishes in a reastarant at 28 years old. All work has dignity.

Gray,

"Nate, pls show some evidence supporting your view that this is an urban myth. Every single study I read showed that private insurance has higher administrative costs up to 25% of the total."

I could send you 50-100 service agreements showing what we charge our clients. I could redact the name of the insurer and send you the agreements we have with carriers to administer claims. I could send you pages from 1000 prospects we quoted on and didn't get.

I don't have a study, but most Health Care "studies" aren't worth the paper they are typed on. I do have 17 years experience actually doing the work in quesitons and selling the service. I know what we charge, what our competitors charge and what insurers charge.

I know every "study" that has made that claim I have read I can discredit in 2 paragraphs. If you care to link to one I'll gladly give you a handful of reasons why it ismisleading or out right lying. As a starting point any study done in % comparing private systems to Medicare does so becuase the claims cost of Medicare is twice that of private insurance. 5% of Medicare is $300, 10% of private is $350. Throw in taxes, CMS, and regulation and that 5% is well over 10%. Include any amount of fraud and your over 20%. When you do an actual dollat to doallar comparison your talking $1200 a year in admin and fraud for Medicare versus $700 for private assuming 20%.

Oh, chowchowchow, chowchowchow, chowchowchow go to any American blog discussing healthcare, and make an intelligent comment, something that actually contributes to the discussion. Make it your passion, don't stop, keep making produuctive comments and displaying even the smallest amount of inteligence, don't shut up just contributing instead of detracting from the discussion then get back to me.

Your comment was that of an idiot. Why would I ever want to hold office in the cease pool that is Europe? If I were to go solve the European health care crisis, they have one to your just not enlightened enough to know about it, I would be doing them a disservice. Their system is also headed for collopse, check out the funding problems of the regional NHS, but high unemployement, large disfranshised muslim population, skyrocketing Euro, and Eastern Eurpoean countries eating their lunch are morepressing issues. Any of the above will kill them long before HC cost if not addressed.

I think we as a country would be further off sending your ignorant pipe dream of a system to Europe then my reality based solutions.

Nate, chowchowchow has a good point: most people with access to other options would consider your solutions ridiculous and run away screaming from them.

Also, quite honestly, anyone who's compared Europe to many parts of the US would hesitate to describe is as a "cease pool."

It's always hilarious, but unsurprising, how those advocaiting the most ignorant ideas in the USA are the ones most ignorant about what goes on outside the USA. The horrible, horrible spelling of your rant just drives the ignorance home, however.

I know every "study" that has made that claim I have read I can discredit in 2 paragraphs.

Hell, you've just discredited every study ever undertaken by man and redefined the structure of the English language in one sentence. In fact, I think you've undermined the entire meaning of the word "study".

Mission accomplished! Well played sir!

...those advocaiting the most ignorant ideas in the USA are the ones most ignorant about what goes on outside the USA.

It doesn't matter if you're discussing healthcare or any other subject, the left's desire to worship Europe always raises it's ugly head.
You need to understand that we are not Europeans. We are Americans.
I thought of Tyro and his comments when watching Southpark where uberliberals were sniffing their own farts.

If we're going to get health care reform passed, we need to get legislators in place who are committed to that goal. It's great to see that Wyden's plan already has 14 Senators signed on, and even more encouraging that it's a mix of Democrats and Republicans. It helps to get evne more support, and in Oregon Jeff Merkley is running in the Democratic Senate primary for the chance to unseat Gordon Smith. He's supporting Wyden's plan (it'll be nice to have both Oregon Senators on the same page here), and as Speaker of Oregon's House he helped usher through state health care reform bills.

If Wyden's plan can successfully control costs, then I think that it's a big step in the right direction. The problem isn't only one of having insurance. It includes having access to the necessary care and keeping costs from getting too high.

Nate -

I've been working in HR for 25 years and am laughing about your claim that the Admin costs of single payer systems are more than that of private insurers. Here's a bit of data for you - dated, but still.... A friend of mine was Benefits Mgr for United Brands in the early 90's. They were self-insured, using Aetna as their vendor. That is, Aetna cut checks to docs for them. That was cheaper that actually buying health insurance from Aetna. And Aetna charged them 28% of every dollar spent at that point. A $100 bill for health care resulted in a $128 check to Aetna. That 28% was ALL administrative cost.

At the time, as I recall, the adminstrative cost of Medicare was about 4% - and the Candadian national health care system was about the same. So, Aetna was charging, for it's administration, 700% of what the government plans were charging.

Michael,

Thanks for the laugh I got from your post. You either have a bad memory or hang around some really stupid people. Aetna was their TPA, vendor would also include other services such as PPO, UR, and PBM.

There are a number of errors in your reasoning;
1. You compared administrative cost for various systems as a percent of claims, this only works if their average claims cost is equal, Medicare is roughly twice that of private plans.
2. I highly doubt they charged 28%, that would imply they where on a cost plus administrative agreement. If your friend really contracted with Aetna on a cost plus basis like that he was an idiot, everyone at that time except goverment plans paid for administration on a PEPM basis.
3. Early 90s a case that size we where charging $10 PEPM for claims administration. Not knowing what their PEPM claims where we have no idea of knowing how much your friends company was paying compared to other self funded plans or Medicare. If they where paying more then $10 they where suckers.
4. How many memebrs where covered by this plan? Did they have any stop loss coverage? If so you can't include all of the premium as an administrative expense as it reduces claims. You need to offset the majority of it.
5. Medicare never had 4% administrative cost. Payments to Medicare intermediaries is in that ball park but that is only a fraction of the cost of running Medicare.

So Michael two questions;
1. How much do you suck at your job?
2. Are you still laughing?

Some educaiton for you, since you obviously need it.

Ignoring fraud, CMS, Congressional staff and all other Medicare Expenses except those to the Intermediares you are looking at 5% of 6K or $300 a year PEPM for administration.

For a large client we would charge $18 for Claims, $4 for PPO, and $2.25 for UR. That is a total of $24.25 PEPM to administer the plan. Times that by 12 months and your annual cost is $291. Average annual claims for private insurance is 3.5K so as a percent our admin is 8.31. That's real live accuarate as of today data. Not dated, not second hand from your friend. So if you ignore the $600 a year in fraud and all the expense from CMS and Congress Medicare is still more expensive. How stupid are you feeling right about now?

Do you read the paper Michael? In today's paper under the Intelligence Report some Harvord professor claims 70 billion out of the estiamted 400 billion Medicare budget will be lost to fake claims and mischarges. Please explain how this meshes with your claim of 4% and superior efficency. Simple math would seem to show Medicare loses more to fraud then it cost to administer a private plan. Any of sheepful progressives clamoring for single payor are free to chime in on how this is the prefered system despite it's significant cost increase.

دردشة

thanks