Kevin thinks it will be easy, but I don’t see it. Do we get rid of the employer mandate, which will be super expensive? Do we raise the limit to 35 hours a week, which would probably result in somewhat less dumping, but would still cost a bunch of money? And which program would Democrats like to cut to pay for the extra expense? Because Republicans would definitely not be on board with raising taxes for it.
This isn’t just politically hard; it’s actually hard.
One of the many reasons the legislation is such a disaster.
It’s like squaring the circle. Of solving a Rubiks cube that’s been taken apart and put together the wrong way.
It isn’t that hard, just make three changes:
1) Make the mandate threshold 50 FTEs (e.g. 50 x 35 paid hrs/week) rather than 50 full time employees, so there’s no incentive to turn full time positions into part time ones.
2) Phase in the penalty (i.e. only apply it to FTEs over the threshold), so there’s no stepwise disincentive to growing past the threshold.
3) Instead of requiring that big employers pay for all of a full-time employee’s insurance, require that big employers pay a pro-rated share of every employee’s insurance, so (again) there’s no incentive to turn full time positions into part time ones.
Or drop the employer mandate altogether; getting rid of employer-based health insurance is worth paying for.
Because Republicans would definitely not be on board with raising taxes for it.
That, I think, is an understatement.
Great solution you have there Jim: Screw the small businesses even more!
“Or drop the employer mandate altogether; getting rid of employer-based health insurance is worth paying for”
Holy crap. I think this is the first smart thing that Jim has ever said.
Businesses should really only pay for current services rendered. Meaning, just pay me cash now for work I do now. I can figure out the rest. I’ll buy my own insurance and invest as I please for retirement.
There really is no other responsibility a company has to its employees than to pay cash for current services rendered. The fact that leftists think there is some other responsibility on the part of businesses speaks to how out of touch and greedy people like that are.
“I’ll buy my own insurance”
Bankers only lend to those who don’t need it, and
Insurance companies only write health insurance to those who
don’t need it. We’ve had 30 years of people buying individual insurance
and it doesn’t work particularly well. My GF has a minor medical condition,
her insurance costs her $400/month, the rates under the state based exchange
look to be $250/month. I can’t complain….
“the rates under the state based exchange
look to be $250/month. I can’t complain….”
And who are you stealing from to get the other $150? The answer is me. Your girlfriend has no right my money for herself. Same for me. I have no right to your money for myself. I have no “right” to health care as long as it is being funded by others. That is called a privilege, not a right.
A right is something that you have that requires no action from anybody else for you to have it. Free speech is a right and it requires no action from you for me to have freedom of speech.
We used to have true medical insurance. It was called “major medical”. It meant you took care of your regular maintenance health care, and the insurance took care of any major accidents or whatever.
Look at car insurance. Car insurance doesn’t pay for your gas, oil changes, or regular repair costs. Car insurance only pays for major accidents, for major damage due to that accident and injuries from that accident.
If we went back to that, insurance would be incredibly cheap, because it wouldn’t be trying to pay for everyone’s regular doctor visits.
so what stopped Major Medical? The answer is there is no money in it. Catastrophic coverage proved to be a loser as a product line.
A case of cancer, coronary artery bypass surgery, all that proves to be insanely expensive. if the market in health insurance worked, it’d be fine, and the market in car insurance works in large part because almost everyone is required to have car insurance and
the products are standardized and they can total a car.
You realize when the insurance company totals your car, it’s an
auto deathpanel.
So if you accept those predicate conditions, you get working insurance.
“if the market in health insurance worked, it’d be fine, ”
Although expensive, it did work just fine. How did Obamacare change the status quo? Mandating everyone buy insurance doesn’t bring costs down. Rates have been going up and so is the cost of care.
Obamacare did not do away with the insurance market. It just forced everyone to participate in it by taxing people who don’t buy insurance, companies that don’t provide insurance, and people who’s policies are determined to be too good. How does Obamacare “fix” the market? It doesn’t.
Forcing everyone to buy a policy with government mandated services doesn’t do anything to fix the underlying problem of cost which is the driving factor in limiting access.
Of course, since the uninsured numbers track closely with unemployment, getting our economy back on track would expand coverage easier and with less government intrusion than Obamacare. Well, I guess getting the economy back on track is pretty hard for Obama so it is easier to make some declarations.
Comparing humans and cars isn’t the best way to go. For one thing, people have to have car insurance because of the potential of damage caused by you towards others. Health insurance is for damage that happens to you, not damage you do to other people’s health.
“You realize when the insurance company totals your car, it’s an
auto deathpanel.”
To determine if a car is totaled, the cost of fixing it is weighed against the value of the car. So if it costs more to fix it instead of buying a new car of the same year/model, it gets totaled. What it doesn’t have anything to do with is the longevity of the car.
Many totaled cars can go on to have a long dependable life if they were fixed. But they are not fixed because you go buy a new car. So is this like a person buying a new body or the government buying a new person? Because the government shouldn’t be in the business of buying people like chattel.
With people, there is no market value. So how do you decide when someone’s life no longer has any value? Why is the government making this distinction instead of a person and their doctor?
What you are saying is that people’s lives have no value other than what some government agent says it has.
One other thing.
Bankers lend to those who can pay back the loan. It has nothing to do with “need”.
We haven’t had free market individual health insurance for maybe 50 years or more. At the very least since Medicare was passed. Medicare largely destroyed any free marketness that there was in health care. Medicare is a monopsony, which is the flip side of a monopoly. A monopoly is one seller to many buyers, and because there is only one supplier there is no controlling force on the pricing the monopoly can demand. A monopsony is one buyer and many sellers, and because there is only one buyer, the buyer can demand all sorts of crazy things without restraint. Both distort what the market would otherwise be with many buyers and many sellers.
This is the downfall of single-payer, or in our case next year with mandated buyers, which morally is not any different. Both cases use government guns to make someone be part of the “market”. Whether through taxes or a requirement to buy a policy, if you don’t do it and resist hard enough you will be shot by government troops.
The government can pretty much make you have running water and a working sewer system in your home too.
Cities will annex nearby areas, and attach every house to city water and sewer. You don’t get a say it. You get a bill. A big bill.
Canada makes everyone play in health canada, the world hasn’t ended there.
The government can pretty much make you have running water and a working sewer system in your home too.
Cities will annex nearby areas, and attach every house to city water and sewer. You don’t get a say it. You get a bill. A big bill.
I find it interesting how you justify this sort of thuggish and authoritarian legislation on the basis of forced annexation, a notorious power grab and source of corruption. Complete reversal of these laws of coercion look better every day.
Expanding on someguy:
Insurance takes the true costs, adds overhead (50%), adds 10% for profit, and hands the bill back.
Government-based insurance takes the true costs, adds -lots- of overhead (100%), does skip the profit, does hand the bill back, and can’t be sued.
The solution to the problems of Big Business isn’t making Bigger Business Monopolies with sovereign immunity and the right to use force.
except medicare has less overhead then private insurance.
Medicare doesn’t advertise, it doesn’t have expensive execs,most of the fees are collected by the IRS.
Same with Private toll roads. The Dulles Toll Road is $1.75 and the Dulles Greenway is $20.85. Somehow, I don’t think the private entity has managed to achieve any efficiency.
No, Medicare’s cost on a per/patient basis is about 12% higher than private insurance.
What you don’t know about Medicare is that it royally screws doctors. What happens is that Medicare is allotted a certain budget every year. If the demand for the services exceeds the budget that Medicare has, Medicare just tells all doctors they are going to get less.
What do you think that forces clinics to do? The answer is to raise costs on everybody else to make up the difference just so that they can stay in business.
And where is the major cost in health care? The answer is dealing with insurance companies and Medicare. Unless you actually see the inner workings of a small clinic, you really have no idea what the government/insurance system does to a small clinic business.
The reason you get to see the doctor for only 2 minutes out of your 15 minute appointment is because the other 13 minutes are spend dealing with the stupid medical chart that has to be just right for the insurance company/Medicare, or else it doesn’t get reimbursed by the insurance company/Medicare.
So, that is why there are now more clinics going to a cash-only basis. Here’s an interesting story http://www.aarp.org/health/health-insurance/info-08-2013/direct-primary-care.html.
A key excert:
“Under the traditional system, most medical practices need a large staff to ensure that they are reimbursed by health insurers. This results in higher overhead — which eats up to 60 percent of a typical practice’s revenue — and forces doctors to see more patients in order to cover costs.”
I hope you read that. 60% of the overhead is just dealing with the damn “system”. Not actual medical care. You want to drop medical costs by 60% overnight? Repeal Obamacare and all existing employer mandates.
Your girlfriend’s medical costs would drop 60% automatically without you threatening to kill me with a government gun if I refuse to pick up the rest of your girlfriend’s medical cost.
But, as a leftist you would never agree to such a thing because it doesn’t involve threatening to kill the populace to get society to be a certain way.
It is too complicated to determine why health care is so expensive and to devise plans to address those causes. It is much easier to just declare what a doctor can receive as payment for any given inspection or procedure.
We’ve had 30 years of people buying individual insurance
When? Last I checked subsidized employer-based insurance isn’t individual insurance.
My GF has a minor medical condition, her insurance costs her $400/month, the rates under the state based exchange look to be $250/month.
I like how such arguments devolve so often to selfish interests. You got your piece of squeeze so you aren’t complaining. We on the other hand, are paying for that squeeze. So we’re complaining.
Who determines “need”?
I do. Send me a masseuse. And someone to force-feed me the peeled grapes. I’m below my daily USDA minimum calories, calories are clearly health-related, and it’s a right.
So, start the auditions to fill the positions that are my right.
“1) Make the mandate threshold 50 FTEs (e.g. 50 x 35 paid hrs/week) rather than 50 full time employees, so there’s no incentive to turn full time positions into part time ones.”
That will create an incentive to fire people until you get under 50 FTE’s. Or prevent a company from hiring more so that they stay under 50 FTE’s. Great move. In short it fixes nothing.
Stupid suggestion which doesn’t deal with the main problem of basing things on workers.
Besides which, the more you have to shorten the per person work week, the more you have to divide the work and the less efficient you become. Put simply, you get more productivity out of 1 person working 8 hours a day than you do 8 people 1 hour a day simply because of start-up and stop-work ramping. Plus you need 8 desks, 8 sets of tools, 8 stacks of paperwork, 8 employee/management interactions, and on and on and on………
It makes for a highly inefficient business.
This sort of tinkering with how a business works shows unbelievable lack of knowledge about businesses from a guy who says he runs one. Furthermore tinkering with businesses at this level – severe micromanaging – just to make a gargantuan, grotesque, unworkable Federal program work is just plain silly.
BTW just what is the name of your company, Jim and what do you do? You haven’t answered.
“2) Phase in the penalty (i.e. only apply it to FTEs over the threshold), so there’s no stepwise disincentive to growing past the threshold.”
Another Sterling idea…let’s boil the frog slowly so that they won’t know their business is being micromanaged.
Silly idea – all it does is lengthen the time of lousy economy – something Obama has been really good at.
Most business owners are not dumb – they will see – HAVE SEEN – what’s coming down the pike and will – and HAVE acted rationally.
Yea, I do wonder myself. But it’s feasible, if he has someone he trusts doing the books for him. Besides he’s allegedly tapping into the Massachusetts Romneycare, so there probably wouldn’t be a big change for him under those conditions.
Make the penalty the property of the employee, and allow it to reside in a 401(k)-like tax-free medical-only account.
The particularly moronic part is that the penalty current just goes into the gaping maw – it doesn’t provide anyone involved with any coverage for anything.
Good idea.
Do note that this broke down under Social Security. The money “promised to you” isn’t -yours- (there was a court case over this, the people lost).
So it must be completely transferred to the employee.
It’s like squaring the circle. Of solving a Rubiks cube that’s been taken apart and put together the wrong way.
I bet this one would be easy to solve.
Expanding on someguy again:
One more consequence of health insurance actually being insurance as it is thought of in every other field I can think of is that bills for the routine stuff would be lower. Much lower.
I live in England, but I’ve heard something like “if an American doctor isn’t a millionaire, he’s doing something wrong”. Now, although doctors are highly skilled individuals, it’s not immediately clear that they are so much more so than (for example) civil engineers as to be worth ten times as much pay. The problem is that if the insurance company is paying, you never see the doctor’s bill – or if you do, you tend not to take much notice. And the same applies to bills for diagnostic tests and for materials used in medicine, too – both of which are ridiculously expensive.
If health insurance became actual insurance, there would be severe downward pressure from the market on all medical costs. And we all believe in a free market, right?
Your statement about American doctors all being millionaires shows a lack of understanding about American healthcare. Our doctors range from family providers (pediatricians, GPs, internal medicine, etc.) who are small business owners to surgeons and other specialists who work for major hospitals. The private practice doctors very often make well under $200,000 a year, work long hours, have high expenses and spend a great deal of time trying to get paid by the insurance companies and the government. They usually employ one or more people just to fight for those payments, adding a significant amount to their business overhead. Those doctors are being squeezed out of business by raising costs and reduced payments. Many are choosing to retire or join a hospital practice. For example, ObamaCare is forcing all medical practices to use electronic medical records. That’s an expensive process.
It’s true that top surgeons and other specialists at major hospitals earn high salaries but they represent only a small percentage of all doctors.
Yup.
Just to add:
In the Greater Seattle area, over the past three years we’ve gone from 30+ small independent cancer care clinics to those same clinics being wholly owned subsidiaries of a very small number of players. I’m not positive about the -large- cancer care clinics (Fred Hutchinson comes to mind – I know they have some strong agreements with a mega-hospital, but I don’t know if they’re -wholly- owned…)
But all of the 3-to-10 doctor clinics just flat gone.
The administrators are paid more than the doctors at the “non-profit” hospitals.
Providence has been snapping up all kinds of clinics on the East side. It is really confusing trying to set up appointments or find the right physical location when the only thing integrated is the name Providence or Rockwood.
A downside to such large market shares is that it is hard to get a good opinion on medical malpractice because there is the obligation to look out for the company and your coworkers and cover up misdeeds.
Now we have Reid saying it is a good first step toward single payer. It’s almost as if the Democrats have not been honest about their intentions when speaking to the public.
And Obama says he can suspend or enact anyhing he wants if he feels he has “support.”
What an awesome administration.
Obama says he can suspend or enact anyhing he wants if he feels he has “support.”
As long as Democrats control the Senate, any attempt to impeach Obama will only make it as far as the House. Since he has no fear of punishment or removal from office; he thinks that is all is the support he needs. I’m sure many of the LIV will actually believe that makes his actions Constitutional.
It’s strange how they believe they can make a royal mess of things and then offer more of the same as the solution to the problems they caused. I call this “failing upwards.”
All government is force.
And a mandate like the individual mandate or the employer mandate is simply the government using force to make people do what they would not ordinarily do. Liberals love government because it can be used to force people to act in ways liberals think they ought to act.
We call it tyranny and we dislike it intensely.
And liberals don’t seem to think about what could happen if an Ultra-Right Wing Executive and Congress collude.
Morons.
We also call it stupid as the government is not nearly smart enough to understand the effects of their actions.
There are only very very few instances where we should allow the government this sort of tyranny (war-making/draft and treaties for two examples), and even then if the government does something we don’t like they should be voted out.
I’m going to have to re-read the Federalist Papers to see what the Founders had to say about Congress colluding with the executive to create a composite power base. It’s very true that these days the Congress is not nearly jealous enough of their prerogatives.
Gregg, I think leftists know exactly what would happen if ultra-right-wingers did what they are doing. That’s why we’re going to have 40 million new leftist citizens in 10 years: to make sure right wingers (even just conservatives) will never, ever be able to win the Executive and Legislative branches. We’re done, folks, put a fork in us.