Health Care: Why Employer Responsibility is Needed
There a strain of liberal advocacy for national health care that hopes for the system to get worse, in the assumption that only then can serious reform happen. Ezra Klein makes this argument in a post attacking the Chicago Retail Workers bill as a danger since it might actually improve the lives of Wal-Mart workers. Instead, according to Ezra, progressives should "view a slightly better menu of options for Wal-Mart employees as delaying the ultimate, more important victory."
So the worse the lives of low-wage workers, the better for certain liberal social engineers trying to enact national health insurance. Then, we can eliminate employer responsibility for health care with a completely government-financed system?
Which makes no sense.
Ezra makes a broader argument about "progressives" like himself serving the public interest better than unions -- which I'll return to later in the post -- but let's start with why employer responsibility for health care is not going to happen, at least any time soon.
The Numbers: Look at this graph of who currently pays for health care in America
Currently, federal and state governments cover just 39% of funding for $1.75 trillion in US health care spending annually. So for the government to take over the rest of health care financing would requre roughly a $1 trillion annual increase in general revenue taxes. (This doesn't include the costs of extending health care to those presently foregoing health care because of lack of insurance, but it's reasonable to argue that savings from a national system could pay for the uninsured.) Look again at the graph above-- without that employer contribution to health care, does anyone seriously think there is any way to help out the families paying hundreds of billions out-of-pocket or going without health care presently?
Back in 1994, the rightwing filibustered even the moderate Clinton reforms; they will lay on railroad tracks to prevent these kinds of revenue increases. Yet folks like Ezra want retail workers in Chicago to go with less health care today so that liberals get a better opportunity to convince William Kristol that blocking single payer health care is a bad idea.
Employer Responsibility in Other Countries: Ezra also makes the argument, as he has before, that the current problems Ford and General Motors face is due to requriing employers to be responsible for health care costs. Yet he ignores the basic fact that Detroit's main Japanese competitors operate in a country, Japan, which is based on employers paying for health care. In fact, the Japanese health care system looks a lot like the "fair share" requirements that unions and their allies have been promoting across the country.
So if Japanese companies are increasingly dominating the global car market under a system of employer-responsibility for the health care of their employees, let's abandon the argument that employer responsibility for health care is the problem. The overall costly, dysfunctional US health care system may be a problem for all employers, but making the employers pay their fair share of costs in a reformed system is no obstacle to global competition.
But let's go back to the present cost numbers to refine what national health care needs to accomplish, with a different graph (also courtesy of the California Health Care Foundation)
The Burden on Working Families: Now to amend the number above, some of the present health care costs by individuals and businesses are taxes already paid for Medicaid and Medicare, so the really relevant spending on health care for those not covered by those programs are the $442.1 billion spent by individuals and $342.8 billion spent by businesses on insurance and out-of-pocket health care expenses.
So here's a question for progressives. Don't we want to keep that $342.8 billion employer health care commitment in place and concentrate new taxes on easing the $442.1 billion burden of health care expenses paid by individual families?
Of course we need reforms of the system to eliminate wasteful paperwork, avoid duplication and control costs, but as Japan and a number of European countries show, that can be done in a system where employers retain a financial responsibility for paying their fair share of health care costs.
Part of Ezra's argument is trying to blame unions for the lack of national health care in the country. It's actually amazing that he argues that unions are only interested in "tangible gains for their workers now," while ignoring the historic role of unions in fighting to enact Medicaid and Medicare and SCHIP for children and a range of other government programs. And guess what, no Wal-Mart workers in the US are in unions, so bills to increase health benefits for Wal-Mart workers DOESN'T create tangible gains for unionized retail workers right now. It does have long-term gains for union workers since a level playing field, where all employers, union and non-union, have similar health care costs, may help unions, but that just points out why unions actually inherently and institutionally push for a "just society for everyone."
Contrary to Ezra's supposed opposition between the "progressive movement" (a nebulous institution) and the union movement, a more just society is better for union workers, which explains why unions have been core part of social advancement, from the New Deal and Great Society to the civil rights movement.
Why "Fair Share" Advocates Have the Right Idea: Here's a thought. Maybe the unions and churches and community allies like ACORN, all representing millions of working families, aren't dumb. Maybe they recognize:
- That the multi-hundred billion dollar per year health care contribution by employers can't easily be replaced by tax revenues;
- That the better option is to require a level playing field where ALL employers are required to make a commitment to health care for their employees, so none has an unfair competitive advantage; and
- That new tax revenues would be better spent on easing the $442.1 billion burden of direct health care spending by families, rather than using that revenue to subsidize large employers like Wal-Mart.
I'm in favor of moving towards an integrated national health care system, since it's the best way to make sure no one falls through the cracks and to achieve a more rational, less costly health care system. But if employers bail on their present spending on health care, that just means that the government will have to raise MORE revenue to achieve such an integrated system and make it less likely.
Some believe that the worse the health care system gets, the better, since that will open up the possibility of national health care reform. But it's actually the opposite-- the more we shore up the employer side of health care responsbility, the more likely we can afford to bring the rest of the population into a reformed system.
Update: Ezra has a couple of replies over at Tapped, and he makes clear that he opposes most interim reforms, because they might not be perfect, so it's better that workers currently without health care stay that way until a comprehensive system can be adopted. But one point where he's just wrong is implying that some unions like SEIU oppose the Chicago law. In fact, the SEIU Illinois State Council has the Chicago bill on their front page:
http://www.seiu-illinois.org/:
"History was made on Wednesday, July 26 as 35 Chicago aldermen voted in support of higher wages and better benefits for retail workers. In the face of enormous corporate, political and media pressure against the measure, aldermen passed the Big Box Living Wage Ordinance, which requires that large retailers in city limits pay at least $10 an hour and $3 in benefits by 2010."
Of course everyone thinks a better, more comprehensive system is better than the present one. But the question is why folks like Ezra spend so much time attacking union and community activists who are trying to push the reforms that can be done at the moment. Most of those groups, including the unions, support more comprehensive reforms as well, but it doesn't help when supposed allies trash these local efforts that are up against tough attack by corporate opponents to begin with.
![different graph](http://www.nathannewman.org/laborblog/archive/HealthSpendingbyContributor.jpg"){kind=link}
I don't understand the distinction between :
and
Isn't the second just a tax under another name? Why couldn't a completely publicly funded system just add a per capita employee tax to replace corporate health care payments?
I think the real issue is that we keep talking about providing health care insurance coverage instead of talking about providing health care. A real universal health care system would not require an insurance industry, just a payment processing function. This is why Medicare has a 2% overhead rate while private insurance keeps 30% of all premiums for expenses and profit.
The liberals have already lost the battle by buying into the conservative set up of an insurance mechanism. Instead of abolishing it they are just trying to figure out ways to funnel more money into an unneeded collection of middlemen which will then cover those currently excluded.
We need health care, not insurance.
--- Policies not Politics
Daily Landscape
August 18, 2006 7:28 AM | Reply | Permalink
I don't think things have to get worse, and I don't wish to take away anyone's health benefits. In fact, I feel sure we're on the roll toward universal health care, and it's about time unions supported it, rather than just gains for themselves. What's all this talk about the union role in backing social security, if that's all decades ago, and now they can't even agree to oppose Lieberman?
John
http://www.haberarts.com/
August 18, 2006 8:22 AM | Reply | Permalink
In a sense all regulations -- minimum wage, environmental laws, consumer protections law, etc. -- are a form of "tax", but there is a key difference. Taxes transfer funds from business or individuals to government; regulations require businesses to channel resources into specific changes in behavior, such as eliminating toxic emissions or providing their employees with health care.
An economic distinction is that regulations are often used to stop companies from "externalizing" costs onto the public. Instead of being able to artificially cut their costs by dumping pollution cleanup costs or costs for health care of their employees on the public, regulations require companies to properly price the costs of their actions-- paying the necessary funds to prevent external costs to the public.
There is of course a political distinction as well, possibly based on the public recognizing employer responsibility not to dump these costs on the taxpayers. Many regulations are more popular than taxes. The minimum wage is far more popular than an equivalent multi-billion dollar tax would be -- and the minimum wage is more targetted at the low-wage employers that are the problem.
I agree that there is a lot of waste in the insurance system and a number of states are looking into reforms where employers could buy into state-provided health care systems, cutting out the middle-man altogether. But none of them are likely to suceed without a strong employer responsibility.
August 18, 2006 8:25 AM | Reply | Permalink
I think that employers being on the hook to provide health care makes as much sense as employers providing K-12 education or 911 service. But while we're in this system I would like to see small business get the same assistance from fed, state, and local governments that giant businesses do, and tie it directly to health insurance.
Cheers for Lamont's position on this.
August 18, 2006 8:54 AM | Reply | Permalink
Given the trend toward "virtual cooperations" and contractors rather than employees, how does a mandate on employers help the self-employed? I emphasize here that such people as computer scientists often are involuntarily forced into being independent contractors, ironically while traditional self-employed professionals, such as physicians, get sucked into corporations or quasi-corporate alliances?
I argue that a healthy population is an essential part of national security, especially where preventive or contagious disease medicine is involved. That funds healthcare through general revenues.
--
Howard
*equal opportunity offense to both extremes*
August 18, 2006 9:15 AM | Reply | Permalink
John - I worked on the 1994 Single Payer Health Care Initiative. Unions were some of the largest supporters of the effort. Look at this list of supports of SB 840, the current single payer bill. On the list of supporters are:
And many other union locals as well.
What annoys me is that unions have been supporting national health insurance for decades, yet various liberals bash them for supposedly not supporting it. It's just a libel against unions that ignores history and reality.
August 18, 2006 9:24 AM | Reply | Permalink
Nathan,
I think what you're saying is that it's politically easier to force employers to provide health care (i.e., a regulation) than it would be to tax them into paying for a government-based system. Even though both are a kind of "employer responsibility."
I see your point. But while the former might be politically more advantageous, it still has the problem of tying health care to employment. How do we solve the problem of losing your health care when you switch jobs or become temporarily unemployed?
It seems like this should be part of an ideal health care system. How do we make that happen?
-- Bruno and The Professor: Dynamic Talk Radio
August 18, 2006 10:02 AM | Reply | Permalink
The only reason health care "ties" anyone to a particular job is that they fear other jobs WON'T have health care. If all employers have responsibility to provide health care in some way, then people can be assured that when they switch jobs, they won't lose coverage.
As for the unemployed, many states are expanding Medicaid to cover higher income levels, thereby covering most of the unemployed whose lack of income should gets them qualified. We probably need more focus on waiving some of the asset tests or other limits on getting such health care during bouts of unemployment.
Reforms are moving us towards a system where employers cover people when they are employed and the government covers everyone else. Expanded coverage of kids means that the government is also moving to cover the children even of those who are employed, so the employer responsibility is increasingly going to be just for the employee him or herself.
As everyone gets some kind of coverage, it should be easier to encourage more rational coordination of the system, since it will be harder for any player to dump their costs on someone else. Ezra fears that incrementalism will make reforms harder, but the reality is that the most serious reforms are being discussed in state where most people have some kind of coverage-- not in the states with the worst systems.
August 18, 2006 10:29 AM | Reply | Permalink
Businesses do not generate a need for health care by their employees in the same way they generate pollution by their operations. Holding businesses "responsible" somehow for something they have nothing to do with makes no sense.
August 18, 2006 10:30 AM | Reply | Permalink
Again, how does employer responsibilities help people that are increasingly forced to be contractors?
--
Howard
*equal opportunity offense to both extremes*
August 18, 2006 10:56 AM | Reply | Permalink
I don't want to reduce people to machines, but companies do have to pay to maintain their equipment, so why isn't maintaining the health of employees a proper cost for an employer? Wage and benefits are supposed to cover the costs of maintaining the livelihood and health of their employees. Having the government subsidize some employers-- like Wal-Mart, gives those companies dumping those costs on the public and unfair competitive advantage.
August 18, 2006 10:58 AM | Reply | Permalink
A universal payroll tax on employers (as in France) is a tax. I think French emplyers would be quite glad to move to a Danish or British sysem where the tax is on general revenue (income tax or VAT).
Bite the bullet. A national health system means shifting a lot of money from an inefficient and rigged private market to a more efficient state-funded one. The beauty of the proposal is that the current US system is so wasteful that universal coverage can probably be had for no extra overall spending at all.
August 18, 2006 11:00 AM | Reply | Permalink
Is this sarcasm? I'm not so sure.... And for that matter I think I may be answering a rhetorical question.
Employers who presently don't offer health insurance benefits, or which offer only substandard benefits, don't worry about maintaining the health of their employees, because those "human resources" are cheap and easy to replace. Machinery is not.
August 18, 2006 1:04 PM | Reply | Permalink
You are equating things that have nothing to do with one another. Dumping toxic waste into the water supply is not the same thing as "dumping employee's health care costs onto the government."
Governments educate children from elementary school to high school because an educated populace is good for the whole. A populace which gets good preventive health care, and early treatment for illnesses and injuries is also good for the whole.
The only way a universal health care policy can work is for all to pay in (with the same exceptions that there are now in place), and for that huge pool of healthy and unhealthy, young and old, to share the risks. It works in every other developed country. Why is that so hard to understand?
Employers could underwrite, or give "Medical Flex-Bucks" for example, but the system should be a universal single-payer system.
Instead of being able to artificially cut their costs by dumping pollution cleanup costs or costs for health care of their employees on the public, regulations require companies to properly price the costs of their actions-- paying the necessary funds to prevent external costs to the public.
"Artificially cut their costs?" You mean so they could meaningfully compete with Japan, Canada, Germany, and France? A good universal health plan would be the biggest boon to manufacturing and development since the beginning of this century.
and... paying the necessary funds to prevent external costs to the public. Guess who this plan is for? THE FREAKING PUBLIC! EVERYBODY!!
Now one huge fly in the ointment is the fact that the very people who have to vote on this issue have a completely gold-plated health care plan already. My mother (who gets my father's federal plan) never pays a dime in co-pays or deductibles. Do you really think the Frists, the Lieberman's, and the whole rest of the "entitled many" in Congress would ever willingly give that up? I don't.
What does that have to do with toxic waste?
Jan Knaus
August 18, 2006 3:11 PM | Reply | Permalink
I've got the answer! All the newly unemployed health insurance industry people can get hired to form a human wall across our southern border. They are used to being heartless and saying "no" to people who are suffering. They would NEVER make exceptions, and they LOVE paperwork! They would be perfect for the job, and so two problems would be solved at once.
George Bush, You're welcome!
Jan Knaus
August 18, 2006 3:17 PM | Reply | Permalink
Wages and benefits are payment in exchange for services rendered, not a subsidy, investment, or support. If health insurance is part of the agreed contract, fine. If employers can retain employees by paying them in nothing but styrofoam packing peanuts, fine. Neither logic nor economic theory demand that employers provide health insurance.
In place of a socialist government, you would mandate thousands of socialist companies. It's difficult to see how this would be more economically efficient than universal access to health care.
August 18, 2006 3:32 PM | Reply | Permalink
Re: If all employers have responsibility to provide health care in some way, then people can be assured that when they switch jobs, they won't lose coverage.
People do not lose coverage now when they switch jobs. That was taken care of under 1996's HIPAA cat: you can't be denied coverage when you change jobs. The problem is that people may not find a new job easily (in bad times it can take months or even years), or they may be forced into early retirement, or they may want to become self-employed-- but health insurance premiums are beyond many people's means.
August 18, 2006 4:02 PM | Reply | Permalink
Also, the level of insurance offered in one workplace is light-years away from that of another. Many jobs offer, for example, a Blue Cross/Blue Shield plan. But the telephone company may have a policy with no deductible and a $10 co-pay, with full coverage for hospitalization. They may offer it to all employees, whether full, or part-time. Premiums may be paid totally by the employer, or a small percentage shared by the employee.
The department store in the same town may also offer BC/BS, but with a high deductible; a large co-pay, and a 30% in-hospital plan. The employee may have to pay hundreds of dollars for premiums as well. So saying, as you do:
People do not lose coverage now when they switch jobs. That was taken care of under 1996's HIPAA cat: you can't be denied coverage when you change jobs.
...is disengenuous at best. That is the whole point. Our health coverage is a complete crap-shoot. You can go from paying $200 a month to cover your family with a reasonable deductible and co-pay, to $500 + per month, with a $400 + per person annual deductible and $30 per visit co-pay, and still "not lose coverage."
And if you are self-employed, you better hope you never actually GET SICK! Or that when you apply for it you never already had cancer, or back trouble, or depression, or high blood pressure, or diabetes! Your premiums will be out of this world, and you can probably only hope for catastrophic coverage at best.
Our system is broken and sick, and we have the entire developed world to look at and choose what has already worked for them; we can choose the elements that are consistent with our way of life. We don't have to re-invent the wheel. It is beyond my imagination to figure out why we have not even started on solving this huge human problem.
Jan Knaus
August 18, 2006 8:12 PM | Reply | Permalink
I have been self employed for 15 years. I pay $586 a month for Blue Cross with a $1,200 yearly family deductable, $35.00 copay and no perscription coverage.
I was extremely greatful that I had it when my daughter started having Grand Mal seizures last December. What I do not understand is how it has resulted in oweing hospitals, pediatricians, pediatric neurologists, labs, and even ambulance companies waaaaay more than $1,200.00. Like five times more.
You bet the system is broken. Medical Insurance is basically legalized graft.
UHC now.
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August 19, 2006 7:25 AM | Reply | Permalink
Sorry to hear about your daughter's medical problems, workerbee. I hope she'd doing better.
Part of the problem is the language that insurers use to get you to buy their policies. $1,200 out of pocket maximum sounds good except that it doesn't include "non-allowed charges" and it doesn't include "out of network charges" and it doesn't include "this" and it doesn't include "that."
When I had my own personal policy, the insurance company would not cover my mammograms. Why? Because I had breast cancer, so they were not considered to be screening tests. Now, is that a smart way to do health-care?
Most insurance companies have gleefully devised a new scheme to get out of paying for some screening tests, which they cover at a higher rate. Example: If you have a routine colonoscopy, as recommended for your age, many policies cover this @ 100% after a small co-pay. If it turns out that the colonoscopy is positive, ie you have a polyp, or cancer, then they change the code from "screening" to "diagnostic" and then it goes up against your deductible, which, if you haven't met, you pay more for the test. That same policy I mentioned above came with a $5,000 annual deductible, so I always ended up paying every penny of my medical expenses, plus more than $300 a month to the "Insurance Company." ---> I put that in quotes because they surely were not insuring me!
I got a job mainly to get a good insurance policy, which I did.
Jan Knaus
August 19, 2006 8:16 AM | Reply | Permalink
I am well aware of the issues you raise, however the big problem isn't with insurance when people change jobs: if the level of coverage is important to them, presumably they only accept job offers with good benefits. A far bigger problem is insurance coverage for people who, for whatever reason, are not in the workforce full time, or who are self-employed.
My point was that simply tinkering around the edges of the employer-provided health insurance system is NOT going to solve the healthcare problem we have. Sure, some of it is worthwhile stuff, especially when it comes to reforming large, profitable businesses like Walmart which provide low or no benefits. But we shouldn't fool ourselves in thinking that this route will ever get us to universal coverage.
August 19, 2006 8:20 AM | Reply | Permalink
Thanks Jan, she is better thanks to the medication that isn't covered. a mere $600.00+ a month. I have to get it from Canada, where it is a mere $270.00 a month.
I hear you about the job. I might take one if a position opens up at one of my clients, but I'd have to sit down and run the numbers.
As I am getting a divorce, it might be worth it to get my daughter on the Connecticut Husky plan and just forget about coverage for me.
I just can't afford this anymore.i'm not sure i ever could, but one tries to be responsible. When I think of the tens of thousands of dollars I've paid into the system, UHC sure sounds good to me. I'd certainly have one less LARGE stress in my life. Funny how people never talk about the 'quality of life' issues, isn't it?
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August 19, 2006 8:43 AM | Reply | Permalink
Your sad experience is at the base of a new industry, created as a result of managed care gaming, that healthcare providers, and sometimes individuals, counter-game to maximize reimbursement. Claims going to the benefits manager [Note 1] have two key elements of coding, one or more diagnoses [Note 2] and the service(s) performed [Note 3]
One of the keys is finding the optimal service (CPT) coding. There are numerous pieces of software for providers that analyze the charge codes entered by the clinician, and determine if they can be reorganized under a better-reimbursed code. Let me give you a hypothetical here, because I don't have the CPT book at hand. You may have been reimbursed for screening mammograms, but not for mammograms for medical (i.e., drug) management of the disease. There very well may be a separate CPT code for mammograms used to plan radiation therapy, which could be covered where monitoring is not -- it's a special case of "screening" as a prerequisite to a new treatment, rather than ordinary following the disease.
Mind you, providers can be sloppy as well. I have never looked through a detailed hospital bill for myself or friends and not found billing for things not done, often through error. For example, I once had a miserable case of food poisoning. I was properly charged for the IV needle and insertion. I was properly charged for the dozen or so units of IV fluids. I was, however, charged for 47 sets of the tubing between the fluid and the needle -- one was actually used. On a recent ER visit, for a leg infection, I was charged for a very good antibacterial cream -- except that it's only used on open wounds, which I didn't have.
--
Howard
*equal opportunity offense to both extremes*
[Note 1] I use the term "benefits manager" to cover not only true insurers, but self-insured companies operating under ERISA legislation. Self-insured companies usually hire a company that has the claims processing capability to manage the details, and such companies are almost always insurers. So, when I was working for self-insured Nortel, which had waived preexisting condition exceptions as a condition of my employment, I actually submitted claims to US Healthcare, which eventually merged with Aetna.
[Note 2] Generally coded by some version of the International Classification of Diseases, produced by the World Health Organization. Current versions might be ICD-9, ICD-10, or some transitional variant. There are some exceptions in diagnosis coding, the most common being in mental health, where the Diagnostic and Statistical Manual produced by the American Psychiatric Association is used. DSM-IV is current, although there are supplements. Medicare, for inpatient treatment, uses an entirely different system of Diagnosis Related Groups (DRG).
[Note 3]Usually coded according to Current Procedural Terminology (CPT), produced by the American Medical Association.
August 19, 2006 8:53 AM | Reply | Permalink
I agree completely with the second part of what you said, but the first part:
... the big problem isn't with insurance when people change jobs: if the level of coverage is important to them, presumably they only accept job offers with good benefits
...has me puzzled. The level of insurance coverage is important to everyone. Healthy people can get sick; they can get injured.
A person's job is what they do almost every day, and if you think it is reasonable for a person to decide how they will spend the majority of their waking hours based on health benefits then you and I aren't even speaking the same language.
Health care in this country should not be in the hands of employers, just as public health (like flu vaccines) should not be provided at drug stores, WalMarts, etc. Every citizen should have access to preventive and maintenance health care. Every citizen should pay a premium for that (unless they qualify for assistance, as they do now), and it should be independent of employers.
Employers who want to attract the best and the brightest can certainly subsidize payments, and can augment it as well. But whether you work for IBM, WalMart, GW University, for a mom & pop grocery, or for yourself, you should have access to affordable, excellent health care in this country.
Jan Knaus
August 19, 2006 8:20 PM | Reply | Permalink
Now you have struck another nerve:
I have to get it from Canada, where it is a mere $270.00 a month.
I presume you know that what you're doing is illegal? Now, what, may I ask, other than Cuban cigars, are American citizens prohibited from buying overseas and bringing back home?
Jamaican Rum -- no problemo. Arabian coffe -- ditto. Jewelry, guns, French wine, European cars, Iranian rugs (on the cheap, of course), Mexican silver (at huge discounts) --> All fine and dandy.
But buy a legitimate prescription drug and bring it back! That is against the (Big Pharma created) law. Why? Because our government is worried that the drugs may not be safe. Oddly, I haven't heard that Canadians are dropping dead every day because of their prescription drug problems. So maybe there is another motivation for this law.
Workerbee, I truly hope this mess gets solved in time for you to get a decent policy and stop worrying constantly, which I know you are doing. Until I (finally) landed this job, I woke up in fear every day that I was going to have a recurrence of my cancer, or that something else would happen. I remember hoping that it would wait to happen in January so that I could satisfy my $5,000 deductible early and maybe get the insurance company to pay out a few bucks before the end of the year. Is this how it supposed to be? NO
And it bothers the hell out of me that no one in Congress, the White House, or any other federal agency can even empathize with this because they are completely immune to it. They are covered, and with a gold-plated policy, so they really don't care personally, and they don't care politically because the insurance companies and pharmaceuticals are paying huge megabucks to keep the status quo.
Jan Knaus
August 19, 2006 8:40 PM | Reply | Permalink
The last thing I want to do is get on your nerves.
:-)
As far as legality goes, it's a grey area. There are two sets of laws one must deal with, the U.S. laws, as well as, the Canadian ones.
To get around the Canadian laws, one must have a Canadian doctor write the prescription. This can be done in Canada, or by a docotor reviewing the medical files of the U.S. patient. In our case it's fairly simple. My daughters disease is straightforward enough, and there aren't too many drugs that she can take. The one prescribed is the best, with the least amount of side effects. I get the same brand name drug made by the same drug manufacturer, although there is a genetic equivilent available. It has been available for years in Canada, but only just in the last month, here.
The other hurdle is the U.S. law. That is truly murky. According to U.S. law, I can get up to 3 months of this prescription from Canada, so I order 3 months at a time. It is true that customs could seize this shipment and destory it at any time, but I doubt very much they would seize this shipment. They are much more likely to seize a drug that is known for abuse.
In any case, until they clarify the law, it isn't being enforced with any regularity or gusto.
I wonder why?
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August 20, 2006 2:40 AM | Reply | Permalink
Re: The level of insurance coverage is important to everyone.
No, actually it isn't. It is important to people with health problems, to people with children, and to people who are middle aged and older (and fear the onset of health problems). It is not important to young and healthy people, who think they don't need good health insurance. In my 20s I had a relationship partner (my same age) who shrugged off the fact that he didn't have health insurance, and even when he could have gotten it through his (well-paying) job (for $80 a month) he didn't, saying something to the effect that he had better things to spend his money on.
Re: A person's job is what they do almost every day, and if you think it is reasonable for a person to decide how they will spend the majority of their waking hours based on health benefits then you and I aren't even speaking the same language.
What's unreasonable about using benefit levels as one of your filters for determining what job to take? Four years ago I had two job simultaneous offers. One paid very well but had no health insurance (it was a start-up); the other had fully employer-paid insurance but paid less. While the benefits weren't the only concern in the mix I took the latter-- as I being "unreasonable". But anyway, how many of us would be at the jobs we currently have if we didn't need something (like money!) from them?
Re: Health care in this country should not be in the hands of employers
Here we agree 100%, and also with the rest of your post.
August 20, 2006 5:33 AM | Reply | Permalink
It is not important to young and healthy people, who think they don't need good health insurance.
Young people may think that health insurance isn't a priority, but the fact is, as I said -- healthy people can get sick, and they can get injured. Good driver may think they don't need car insurance; they drive slowly, and only to church on Sundays. In my state, by law everyone who owns a car MUST have car insurance. In other words, regardless of the fact that someone may mistakenly believe that they don't need to be insured, the state REQUIRES them to be.
Thinking that something isn't important is moot when the 20 year-old breaks a femur in a skiing accident, or finds out that he/she has leukemia.
What's unreasonable about using benefit levels as one of your filters for determining what job to take?
Nothing unreasonable about the scenario you describe; you give an example of a person who is obviously desirable to two employers, and is making a choice between two good options; one with good benes and lower salary versus a higher-paying, but riskier job.
The overwhelming majority of employees are not in that situation. They need to find a job they can do; one that will pay enough, and provide for their needs, and they need to get hired. The way you presented it in your first post sounded like you were suggesting someone start with needed benefits in mind, and find the job that would provide it. Maybe I misunderstood. My main point is that most people seeking employment are not sitting in the cat-bird's seat, picking and choosing the best of three or four options.
I live in Charlottesville, Virginia. UVA is the biggest employer. They give benefits ONLY to full-time employees, and they have thousands of less-than-full-time employees. What do those people do? Private insurance is just too expensive for most, especially if they have EVER had a health problem.
Jan Knaus
August 20, 2006 6:49 AM | Reply | Permalink
Workerbee, YOU did not get on my nerves at all! I meant that the situation that you are in infuriates me, and I wanted to show how ridiculous it is that you can buy liquor in Canada perfectly legally, but legal, medically indicated medications are (as you said) "legally murky."
Sometimes my sarcasm comes off the wrong way. It was aimed at our system, of which I consider you and your daughter to be victims. Sorry if I didn't make it clear!
Jan Knaus
August 20, 2006 6:59 AM | Reply | Permalink