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Incremental Universalism ?? It's Coming . . .



Hey... Hey... Hey...

After the inauguration and the hoopla dies down you'll be hearing this quite often:

Incremental Universalism

It's the way the Health Care package will be sold and it's coming as sure as the sun rises . . .

Single Payer? Apparently, not at the start of Obama's watch.


Stay warm ... Stay safe ...

~OGD~


19 Comments

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For general information . . .

Mass. health plan has national appeal

~OGD~

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There is a downside, a flaw if you will, to the Mass. health insurance. Yes, 97.4 % of residents have it, but the cost per individual is sometimes very uneven.

There is an example I am personally aware of. A couple, engaged to be married, both pay for their health coverage as required by Mass. law. The fella, who works for a large business concern and makes a good income, pays around $60 a month for his coverage through his firm. The young lady, an independently employed beautician who makes a much smaller income, pays around $150 a month for coverage. Of the two, she is harder pressed to come up with the money, but must do so otherwise she will be fined by the state.

That's a little lopsided, isn't it?

Patching health coverage with duct tape and mother spit is just not gonna hold it together.

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Don't forget that the Massachusetts plan was largely designed and promoted by the Romney Administration. As in Willard Mitt Romney, the guy who ran for the Republican nomination this year.
What some may see as a bug may have been intended as a feature.
Whether it's a feature intended to keep the burden on those least able to pay, or intended to diminish enthusiasm for universal coverage laws - I couldn't tell you for certain.
I have my suspicions.

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You don't say how much the employer pays in addition to the $60 paid by the employee.

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Well, that's because I don't know what the employer's contribution actually is. I would assume it's the $90 or so balance.

I probably should have said 'out of pocket' cost to make myself more clear.

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But what is lopsided is presenting only part of the situation. It's a given that being self-employed means you have to cover your own "benefits", so if the employer contributes $90, it's not lopsided at all, it's exactly equal cost for both parties, just not shared by both equally.

As a self-employed freelancer I'm quite aware of apparent inequities, but they aren't all real inequities, and this one doesn't seem lopsided (if the $90 is in fact paid by employer).

That said, group coverage often is cheaper, so it's possible the employer doesn't pay anything like $90.

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It's still an inequity... If the government forces you to buy something the government should guaranty that it's affordable.

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(In)Equity and affordability are different issues.

It the coverage costs 150, and your employer pays 90 while my employer pays 50, that's between me and my employer, not me and the government which mandates coverage.

Look at automobile insurance for a comparison. It's mandated (at least in many if not all States), but if you have a terrible record and DUIs, why should insurance coverage be "affordable" just because you're broke?

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Howdy Destor . . .

Here's a PDF link from the Robert Wood Johnson Foundation titled "Do Individual Mandates Matter" that may help explain the importance of the mandate issue and expand on the very good point that you have raised. Following is the introductory summary.

Summary: How necessary are individual mandates for ensuring that all Americans have health coverage?

Many reform proposals being discussed at the state level and in the presidential campaigns include mandates that individuals must obtain health insurance.The Massachusetts reforms, for example, include an individual mandate for adults, conditional on there being an available policy that meets the affordability standards set by the state. Others would make participation in insurance programs voluntary, but create new ways to encourage people to obtain insurance.

In this brief, we delineate the reasons why an individual mandate is essential to achieving universal coverage. In so doing,we discuss why it is critical that individual mandate proposals specifically address the affordability of adequate health insurance coverage and develop fair and effective ways to enforce the mandate.

http://www.rwjf.org/files/research/uimandates012008.pdf

In addition: If you notice in my previous comment below, my primary preference is that we as a nation institute the USNHI Expanded and Improved Medicare for All system.

Although, if it does come down to a system that requires a mandate for coverage, my position on this mandate issue is as follows: 1.) The system must provide muscular mechanisms to mandate affordable pricing of plans. 2.) If you can afford a percentage of the mandated coverage, or the total cost of coverage, then one should carry their equitable responsibility for their own health and the health of their family. If one is unable whatsoever to afford the coverage the system should have allowances to provide the coverage.

About the Robert Wood Johnson Foundation

~OGD~

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Thanks for fixing the cite. I ended up crashing for half an hour.

Creeping socialism.

Pretty soon, all the sick people will be able to seek medical treatment.

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Well, from a really broad perspective, they CAN do that now.
It's just that most of them haven't been able to get it - that may change soon, which will be just cause for celebration.

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I'll be doing a happy dance when that day comes.

One of the golden financial rules is to not live beyond your means...and I don't. Except when it comes to health care. If I get sick and need a $300 anti-biotic, I have to pay $300. I don't have a choice...because while I am living within my means, the prescription coverage I can afford won't cover non-generic meds.

It's just insane.

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Was that a rant? I think it was a rant. I'm sorry. Please ignore the crazy lady.

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Rants have never been off limits at TPM - not to my knowledge. (even though that hardly qualified in my view)

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I can hardly wait for it to get here.

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Thanks for the report, OGD. Hope you're right.

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There you go, OGD! You're already at the top of the Google list - when you click your link!

Good work!

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Evening check-in

Nice to see you all . . . Thanks to everyone for chiming in.

Undoubtedly, there remains many a hurdle to get over and hoops to jump through before anything such as the Massachusetts type plan becomes a national reality that is affordable and equitably covers all the citizens of the United States.

As so many here already know, many detractors say that we as a nation cannot afford this type of universal system. I am of the camp that say we cannot afford not to institute a system nation wide.

In the macro-economic sense, in 1989 we spent $1.2 trillion in this country on health care. In 2001 the costs were $1.4 trillion dollars. That number rose to $2.1 trillion on health care in 2006 and reached $2.3 trillion in 2007. And according to National Coalition on Health Care while citing a report from the National Health Expenditure Accounts Projections Team at HealthAffairs.org:

In 2008, total national health expenditures were expected to rise 6.9 percent -- two times the rate of inflation.

Total spending was $2.3 TRILLION in 2007, or $7900 per person. Total health care spending represented 17 percent of the gross domestic product (GDP).

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP.

Plus: The Henry J. Kaiser Foundation 2008 annual report states:

Premiums rose a modest 5 percent this year, but they have more than doubled since 1999 when total family premiums stood at $5,791 (of which workers paid $1,543). During the same nine-year period, workers’ wages increased 34 percent and general inflation rose 29 percent.

This year many workers are also facing higher deductibles in their plans, including a growing number with general plan deductibles of at least $1,000 – 18 percent of all covered workers in 2008, up from 12 percent last year. This is partly, but not entirely, driven by growth in consumer-directed plans such as those that qualify for a tax-preferred Health Savings Account.

The shift has been most dramatic for workers in small businesses with three to 199 workers, where more than one in three (35 percent) covered workers must pay at least $1,000 out of pocket before their plan generally will start to pay a share of their health-care bills – rising from 21 percent last year.

By any measurement, while looking at all those numbers and speculating on the probable "...inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud..." I personally see there needs to be a major overhaul of this nation's health care system.

My favorite is the USNHI Expanded and Improved Medicare for All system ... Although, I'm willing to compromise in the short term and over the long term watch the "incremental universalism" eventually overtake the present way of doing inefficient business.

I'll close with what I pointed out initially. We cannot afford not to institute a system nation wide. The future of our economic security depends on it.

~OGD~

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Yes, health care costs may be "bubbling" too. The questions are:

How much could be prevented by how much early cost?
How much waste?
How much non-medical profits?
What are the actual distributions of outlays?
(for starters, look at mean AND median, but also look at other slices of the pie)

And

How to get to a better "place" from here? Sometimes "you jist caint git thar from here" applies.

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