Monday, January 18, 2010

No Cost Containment and a Fat New Tax

by Lionel Emde
The San Francisco Chronicle is reporting that a provision of the proposed new federal health care bill may well result in a new tax on Kaiser Permanente, Blue Cross, and other HMO's.
Small business owners and individuals would be affected, while public employees and people covered in large corporations will probably not have to pay it.
I think it's time to acknowledge the cluelessness of a political class that would even think of such a destructive idea in a time of 20% unemployment, a housing crash, and declining business.
I've never been an anti-tax advocate before, but I'm undergoing a rapid transformation as we are being bled to death by a political class that has nothing financially to worry about and could care less about the little people who elected them.


Unknown said...

Thank you for posting this Lionel and for your comments!

Steve Sinai said...

I voted for Obama and was hoping he and the Democratic majority would do something to improve the screwed-up health care situation. Since I work for myself, I buy my own health-insurance, and experience first-hand the soaring premiums and reduced benefits.

Washington's botching it. This whole process looks like one big, pork-barrel-driven, design-by-committee cluster-f*ck.

It's hard to understand what will come out of the Washington, but over the last few months I've gotten the sense that I'll ultimately be paying more for premiums to provide coverage for others, while I get nothing. For me, at least, it looks like they're making the situation worse.

This doesn't mean I buy into the Republican bs that everything's fine and dandy. At least Democrats recognize there's a problem. Republicans, with their inane, "This is America and we have the best health care system in the world"-mantra have their heads up their butts on this one.

Unknown said...

We do have one of the best health care systems in the world. People can get care when they need it even if they do not have insurance. Here we have the Dems in charge and if they would stop with all the give away programs and buying votes and actually do something constructive, I would be all for it. This 2,000 page bill has things in it that no one can understand even if it was read.

I think they should all be fired...we would save a lot of money on salaries and their wonderful health care and retirement benefits.

Steve Sinai said...

"People can get care when they need it even if they do not have insurance."

Then why would people buy health insurance?

Lionel Emde said...

If you can't afford health insurance in America, you're dead.

Anonymous said...

Since both Sinai and Emde seem to have a learning disability, I will once again provide them a link:

Unknown said...

I see dead people...

Steve Sinai said...

I'd still like to hear from Lois as to why people buy health insurance if they can get free health care?

And the link from Anonymous is for clinics that provide minimal, primary care. If I need a tb test, then maybe I'll use a government-run clinic. I can understand why Anonymous is afraid to put their name behind their statement.

Unknown said...

As a responsible working person, I can take care of myself and do not need to depend on the kindness of strangers to take care of me. It's called responsibilty, pride perhaps. Of course, if something happened where I was not able, perhaps I would be forced to rely on the welfare system.

I have children who have had jobs, had medical insurance, lost jobs, have no medical insurance and thank God they are healthy. If something happened, there is Chope, SF General, clinics that they might be forced to go to. They cannot be denied medical help. Talk to any fireman. In an emergency, they are not asking for the person's medical insurance card.

Would I prefer that my children have medical insurance? Yes, I would prefer that they had medical insurance. Will they buy medical insurance if they are forced to? No. They will pay whatever penalty that the Government can bleed from them.

Anonymous said...

Sinai really needs to improve his reading comprehension skills. Clearly, the HRSA site refers to comprehensive health care for all. Sinai's interpretation is self-serving and myopic. Fortunately for all of us, his opinion means nothing. Here it is again for those of you who choose to use your brains rather than your arse:

Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide
•checkups when you're well
•treatment when you're sick
•complete care when you're pregnant
•immunizations and checkups for your children
•dental care and prescription drugs for your family
•mental health and substance abuse care if you need it
Health centers are in most cities and many rural areas.

I strongly recommend Sinai find a nearby center and get his brain and his eyes examined.

And, of course, good job again on your anonymous comment posting hypocrisy, Sinai.

Jeffrey W Simons said...

in light of what Sinai said, I recall one of Don Peebles' presentations where he showed the population growth of cities around Pacifica as being between 3% and 8%, while Pacifica's population decreased 3% over the last 20 years. Someone in front of us stood up and clapped. That was the last public event my wife was willing to attend in Pacifica.

Steve Sinai said...

Anonymous, if the government-run health clinics are so good and take care of all your health needs, why doesn't everyone use them? Why do people complain about the costs and difficulties of getting private health insurance if the government-run clinics are an option?

Still afraid to use your real name, huh?

Unknown said...

I will answer for Anonymous. The government wants total control.

Steve Sinai said...

The government wants total control? That's a wing-nut answer.

Steve Sinai said...

Whether someone is willing to put their name behind their statement speaks to how seriously the statement should be taken. It's very relevant.

Mostly though, I just think it's cowardly to attack others while hiding behind "Anonymous" or a pseudonym. I have my guess as to who Anonymous is, and I believe he's more motivated by a personal grudge than anything else.

Anonymous said...

There's lots of us anonymouses

Steve Sinai said...

I guess that means there's lots of cowards.

Unknown said...

Main Entry: wing nut
Function: noun
Date: circa 1900
1 : a nut with wings that provide a grip for the thumb and finger
2 slang : a mentally deranged person
3 slang : one who advocates extreme measures or changes : radical

You are really into the name-calling thing, aren't you, Steve? I cannot imagine which one you were trying to call me.

Kathy Meeh said...

Thanks Lionel, and for your follow-up comments Steve. Putting a separate tax on fully-insured group and individual medical plans (which most of them are in California) is a bad idea.

Even companies which have 500+ Employees do not always like to self-insure. The fully-insured PPO and HMO plans tend to be more balanced because they follow CA managed-care requirements; plans include high level catastrophic insurance coverage provisions, full legal employee disclosure through provided documents, and employee kits. There is also more reliance upon insurance carrier services (member, employer, critical illness, pharmacy review, claims, out-of-area connection, provider relations, legal). And, the employer having assured "hands-off" is a good policy too.

With self-insured plans there's more need for efficient HR, accounting and legal Departments, bank account with reserves, monthly claims reconciliation, expected annual swings in cost, separate catastrophic insurance; more opportunities for things to go wrong, greater liability and risk to the employer. Self-insured employers use insurance carrier networks, some member services and general insurance carrier oversight.

Of course, more clinics are needed to service the public, and many exist now. Anonymous may benefit from some of those services he listed, and "anger management" looks like its covered. Lois probably nailed his riddle, as did the ad hominem by Scotty.

Being anonymous is sometimes more transparent than you might think. Comments, playing games and selecting heroes and anti-heroes are all clues. Steve has made thoughtful comments regarding the health care reform, and even if you don't agree targeting him for the sake of causing personal damage reflects more on you than him. Please join the conversation, rather than sitting on the sidelines sniping.

Steve Sinai said...

Didn't you just equate Van Jones with crap, Lois?

Kathy Meeh said...

Lois, some people really do want a complete government take-over of health care. No doubt about it. Complete Medicare, and maybe the entire system which is currently all private corporations collapsed and folded into a government system. That would be total chaos.

My guess you got the "wing nut" comment on this one thanks to some prior "nasty comment" interference from "anonymous", see how that works anonymous? Just my opinion.

Anonymous said...

Anonymous said...
There's lots of us anonymouses

Steve Sinai said...
I guess that means there's lots of cowards.
There's lots of assholes here.

Neener neener neener.

What a juvenile jerk you are.

Unknown said...

Kathy,thank you for acknowledging that "some people do want a complete government take-over of health care".

Unknown said...

"Casualty of a right wing "get back" smear campaign"

Steve, I was equating that whole discussion with crap.

Suzanne Valente said...

How sad! Once again Steve Sinai has taken a legitimate discussion regarding an important topic and turned it into a childish, name-calling tirade.

As a healthcare provider, maybe I can clarify a bit of this discussion. Community health centers DO exist, and they fill a need for many people that DOES include comprehensive care in addition to preventive care, dental, vision and prescriptions. Just ask any healthcare provider trained here in California--we have all worked in these facilities as a part of our training. Why the leadership in the Congress and the President talk about people dying in the streets as a part of this healthcare reform discussion baffles me, as they allocated approximately 100 billion dollars to these health centers in the stimulus package in anticipation of rising unemployment and heightened need. This information is irrefutable, and all on government web sites. The first step to a rational discussion would require an acceptance of what would be considered as fact (unless you have an inability to trust your government on ANYTHING). I trust them on this information because I have seen and worked in these clinics firsthand.

In my opinion, people still buy insurance because the waits are shorter in private practice, and you can choose your doctors and hospitals. If I needed a serious surgical procedure, I would prefer to pay and choose my surgeon. I have had personal experience with patients who desired to try cutting edge treatments to save their lives when, for example, traditional cancer care has failed. In that situation, community health centers would NOT pay for the cutting edge treatments, and frankly, neither would most insurance. This is generally the root cause of the stories you hear when people go bankrupt after medical care. Public health care (especially a single payor government system will NEVER be able to cover those types of treatments). Fact is, those who can pay will always get preferred care--it is just the way it is. In countries with government health care like the UK and Canada, those who want cutting edge care and can pay for it come here to the USA to get it. If we destroy that opportunity here, clinics for advanced care will be set up in ohter countries like Costa Rica--I was told about this by an insurance insider recently.

There ARE problems with healthcare, but more in its administration than the actual care provided. Insurance companies should be able to sell insurance across state lines, and we should be able to choose policies that cover what we want covered, instead of states demanding every policy sold in the state have mandated conditions covered. That reform would be a good idea.

Additionally, State Insurance Commissioners have the ability to regulate insurance companies more closely, and impose penalties for insurance companies who do not pay claims or unduly deny valid claims. I have had personal experience in this area, and I have found State Insurance Commissioners sometimes impose penalties, but only after hundreds or thousands of people have been victimized, and even then the penalties are so small as to fail to discourage the bad behavior by the insurance company. I think the money donated to political campaigns has a lot to do with this problem.

Pre-existing conditions are addressed by the current infrastructure. There is a State-sponsored pool of insureds who have pre-existing conditions. We, the taxpayers, underwrite their insurance. However, the pool is too small and often there are waiting lists for admission into this pool. This pool should be fully funded--it would be a cheap solution to the problem vs. overhauling our whole system to resolve this issue.

And this legislation is utterly silent on much needed tort reform. Defensive medicine costs us all. Why have the lawyers been left out of the picture? There's another follow the money issue. So much more...

Unknown said...

What a smart woman Suzanne is! Thank you for your insight. I knew most of that...just didn't know how to say it.

Kathleen Rogan said...

Did anyone read this article?
Health-plan tax would hit Californians hard

Kathy Meeh said...

Suzanne, I think comprehensive text and from a professional perspective, but Steve has also offered a solid perspective from that of a small business owner. And, as the prospect of health care reform stands right now I think most small business people would agree with Steve's view.

Federal oversight is needed, because state-to-state approach offers many benefit variations. Example, maternity: included, complications only, not included. And to the extent included big cost.

Reforms are needed within and outside the system. Suzanne has mentioned tort and possibly clinic reform. Multiple government agency overlap is another issue (county, state, etc.).

Individual and family health insurance plan access needs reform. Some people don't qualify, and the CA State plan is expensive and limited at the level of catastrophic coverage. To the extent such a plan exists in other states is unknown to me.

As Steve mentioned, cost is an issue. Example,
about 15 years ago, when New York included access to their medical plans for those who had not been insured prior, the cost increased $100 per person. It follows, that by adding such benefits as maternity and access to coverage will not reduce cost.

Pharmacy is another piece of needed reform. While waiting for a patient I observed three pharmaceutical representatives waiting to see the physician with boxes of "free" samples. No doubt these representative educate physicians, and delivery of samples adds value for patients, but is this kind of custom approach necessary?

To reduce cost there must be an actual effort to reform the entire system. Will it happen?
Wait and see.

Steve Sinai said...

Suzanne, I see you're still nursing your grudge from the time I said your Pacifica Watchdogs recall effort was an example of how Council's opponents keep shooting themselves in the feet.

That said, I appreciate that you actually put some thought into your comment, rather than resorting to meaningless, Glenn Beck-ian hyperbole like "The government wants total control" to the question of why do people buy medical insurance.

Kathleen Rogan said...

This current government wants total control. What are you blind?

Lionel Emde said...

I would ask Anonymus how he/she uses and likes the health care provided by the Web site he/she provided for the benefit of the "learning disability('d)" Steve and yours truly.
And it would be easier to address you if you selected a particular moniker, say, "smugcomments4" or "ivegotminescrewyou".

And please, use small words for our benefit.

To Ms. Valente: Why is it that there are 50 million health-uninsured people in America, and why are health-related bills the number one cause of bankruptcy?

Kathleen Rogan said...

I don't know about anybody else, but a family my size is going to get soooo screwed. We pay for our own benefits. Always have. After all the taxes by local, county, state, federal start, I'll be lucky if I have enough money left over to buy milk. No shopping for me. Not for a long long time.