What you are observing is what must happen before the USA backs through the door of universal, single-payer health care: employers realizing they must shift the burden of health care off their backs in order to compete in the new global economy. While this isn't the ideal way to get to the desired result, it just might work.

It has never made much sense for health care and employment to be tied together. In fact, that linkage has been the source of a great deal of unnecessary suffering. And it has been a major contributor to the enormous cost and inequality of American medicine.

When we finally do arrive at the logical end of this process (hopefully sooner rather than later), we'll kick ourselves for having to be dragged into it kicking and screaming.

Thank goodness Andy Stern thought of this. I don't know where we'd be without him.

And yes I'm being snarky. The real issue here is that in the 1990s businesses with health care costs unermining their competitive edge decided not to back the Clinton proposals, despite Clinton's big NAFTA olive branch and the fact that the proposal was very much in those businesses interests. It's not like there's anything new to the idea. What's new is that Stern has decided to have a get together with the business community and, in particular, Wal-Mart. Wal-Mart has agreed to something, but we're not sure what and we're not sure what they'll commit to get it. And Stern has undermined a major Change To Win corporate campaign that had active support from the AFL-CIO unions as well.

The issue is whether Stern's desire to accomplish something has led him to buy a pig in a poke. I suspect it has, but the jury is still out.

Is this true? I thought that everyone (or almost everyone) retired and over 65 was on Medicare and those who had any kind of private insurance, whether provided by their employer or not, just had Medigap insurance to pay for Medicare doesn't. At least that's how my father's health insurance was set up after retirement.

My own father is in a group of retired local government civil servants, they formed the group to buy the Medigap, it's fairly large. The rates keep going up as their group ages, pretty nastily, because, of course, people in this elderly group get chronic sickness and have expensive care that runs Medicare out pretty fast. There's no one young in the group, see. They've changed plans twice in like 3 years. I know other elderly who have the plans changed all the time for the same reason: because the group they are in makes another deal to try to keep the rates down.

I've recently had to do research for family where I ended up reading a bit into how very complicated this is. I didn't figure it out to my satisfaction, but I saw enough to know it's a mess, what goes on with all of this and it varies state to state.

The way it often works is that to get the protection of gap coverage, you get put in a managed care plan of some kind, and you follow their rules like any other member of the managed care plan, their doctors, their drugs, approved facilities etc. You give up the freedom of the fee-for-service nature of Medicare in order to get the gap coverage. (That really sucks, mho!) You give your insurance co. card when you go for care, not your Medicare card, but in actuality the insurance company doesn't pay a cent while Medicare is paying until Medicare is exhausted.

But with most hospitals, it seems the hospitals go directly to Medicare for their charges until exhausted, then the insurance co. after that (while the doctors at the hospitals bill the insurance co.!) There is huge huge money involved between Medicare/Medicaid and big hospitals, and what is going on is not really the per patient reimbursement you think, that you see on paper. Since the 1980's they do not get paid fee for service, but instead there is PPS, Prospective Payment System. The patient still gets treated on the books as if it's fee for service, but hospitals are paid based on the patient's diagnosis related group (DRG). The money is played with in several ways, such as that hospitals that do public service (i.e. in a bad neighborhood, end up with a lot of no pays from uninsured emergency,) they get more than the others!

The problem also is that once you are in a group or plan, and you or your spouse becomes acutely ill, you are stuck in that group, no one else is going to take you for Medigap, and all you will have is Medicare. Heck, you don't even have to have any illness, try shopping to find someone to give you a decent medigap plan that you can afford when you are 80. Bascially most people get stuck in the group they are in when they retire, and then that group slowly gets undesirable.

Keep in mind also that Medicare when you are on it is not free, there are premiums that you have to pay as well as some co-pays, limits, etc. It varies how much you pay and how you pay. If you are in a plan like my father's, you don't pay those premiums, directly, you pay the insurance co. So the insurance co. must pay them through some deal and I would not be surprised to find some surprises there. Is the auto industry including that in their figures/complaints? I don't know.

For those who have no Medigap, this is why a Medicare drug plan was so urgent, and people were willing to take whatever shit was offered by Congress. Fewer and fewer on Social Security with a small pension could afford to pay for their drugs out of pocket! But it also throws a whole new system into play with those that do have Medigap, that of the insurance companies getting more.

BTW, a whole industry has grown up to get some of that Medicare hospital money, private LTAC (Long term acute care) hospitals. They apparently are willing to take less than ICU charges but more than a regular hospital room to give equivalent to ICU service. It's for people who have better than a 50/50 chance of getting better (Medicare rules) not candidate for hospice, not strong enough for a regular rehab, needing ICU type technological services. They are often just floors leased from regular hospitals! Before, someone like that would have been sent to a nursing home to slowly die because of lack of fancier technological services (Like weaning off respirator, etc. It's not just for the eldery by the way.) But Medicare does not pay for nursing homes very long! So ta-dah--invention of LTAC to stretch out the time Medicare will pay. Approved for Medicare payment by Congress.

What I concluded in the end is that it's all such an incredible money shifting mess! Not really worth researching beyond that point, just should be scrapped! I could see that one bandage in one place would cause bleeding in another place, someone is always winning and another is losing the roll of the dice as to where the money is going.