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eridani's Journal
eridani's Journal
December 27, 2012

Bruce Bartlett: A Conservative Case for the Welfare State


Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.

This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state.


In a new paper for the New America Foundation, Professor Lindert summarizes his findings. He points out that there are huge efficiencies in providing pensions and health care publicly rather than privately. A main reason is that in a properly run welfare state, benefits are nearly universal, which eliminates vast amounts of administrative overhead necessary to decide who is entitled to benefits and who isn't, as is the case in America, and eliminates the disincentives to work resulting from benefit phase-outs.


Thus, for no more than the United States already spends through government, we could have a national health-insurance system equal to that in Britain. The 7.6 percent of G.D.P. difference between American and British total health spending is about equal to the revenue raised by the Social Security tax. So, in effect, having a single-payer health system like Britain's could theoretically give Americans 7.6 percent of G.D.P. to spend on something else--equivalent to abolishing the payroll tax.

This is a powerful conservative argument for national health insurance.

Comment by Don McCanne of PNHP: Thank you, Bruce Bartlett, for perhaps the greatest Christmas gift of all - a rationale for why we all have to join together to provide health care for everyone.

(The 2003 NEJM article cited is that of PNHP co-founders Steffie Woolhandler and David Himmelstein, plus Terry Campbell of the Canadian Institute for Health Information.)
December 26, 2012

Next Challenge for the Health Law: Getting the Public to Buy In


There lies the challenge for Enroll America, a nonprofit group formed last year to get the word out to the uninsured and encourage them get coverage, providing help along the way. With the election over and the law almost certain to survive, the group is honing its fund-raising and testing strategies for persuading people to sign up for health insurance — a process that will begin in less than a year.

The group has raised only about $6 million so far — but financial backers include some major players in the medical industry: insurers like Aetna and Blue Cross Blue Shield, associations representing both brand name and generic drug manufacturers, hospitals and the Catholic Health Association.


They are also skeptical. Many who participated in the focus groups or survey reported bad experiences trying to get health insurance, and doubted that the law would provide coverage that was both affordable and comprehensive.

“It’s two major mountains that need to be climbed,” Mr. Pollack said. “People are unaware of the benefits that could be provided to them, and they have to overcome skepticism, based on their past experiences with trying to obtain insurance.”

But the survey found that even with federal subsidies, many uninsured people may balk at the cost of coverage. Only about a third of respondents leaned toward thinking monthly premiums of $210 for a single person earning $30,000 a year, for example, were affordable.

Those amounts became more acceptable when respondents were told it would “protect you from thousands of dollars of medical debt if you got sick” or “cover all of the basic care you need.”

In the end, Lake Research Partners recommended that Enroll America not cite specific dollar amounts at all when they talk to the uninsured about new coverage options. “Talking about ‘free or low cost’ plans may be more motivating,” the survey authors wrote in a report.

Comment by Don McCanne of PNHP: From the days of the Clinton effort to reform health care, Ron Pollack of Families USA has opposed single payer reform as not being politically feasible, supporting instead reform based on private insurance plans. Likewise, Celinda Lake of Lake Research Partners has actively rejected single payer while using her polling and focus group activities to push the rhetoric of "Choice" to promote private insurers, glossing over the fact that private insurers take away choice of health care professionals and institutions. Both Pollack and Lake have had considerable influence in Democratic administrations.

Now that they got their wish and we have reform based on private insurance plans, they have a new hurdle and that is to try to sell the program to the public. They have formed a new organization, "Enroll America," to do just that, and the private insurance industry is front and center in financing the organization.

Just as they concocted the "Choice" campaign to sell the legislation, they are now concocting the "Free or Low Cost" campaign to sell the uninsured on the new coverage options. When the survey found that many people may balk at the cost of coverage even with the subsidies, Lake recommended that Enroll America not cite specific dollar amounts at all when they talk to the uninsured about new coverage options.

Can you imagine? Just as they sold the nation on legislation using "Choice" for a program that takes away choice, they now are selling the nation on "Free or Low Cost" plans that the uninsured cannot afford to pay for. What chutzpah!

Where is the Occupy movement? Maybe we should occupy Enroll America and use it instead to enroll everyone in a single payer national health program - an Improved Medicare for All.

December 17, 2012

Chained CPI Imposes Painful Social Security Benefit Cuts and a Benefit Bump-Up Provides Only Limited

he National Women’s Law Center has released a new report, “Chained CPI Imposes Painful Social Security Benefit Cuts and a Benefit Bump-Up Provides Only Limited Relief,” available here: http://www.nwlc.org/resource/chained-cpi-imposes-painful-social-security-benefit-cuts-and-benefit-bump-provides-only-lim. It analyzes how effective the “20-year benefit bump-up” proposed in the Bowles-Simpson report would be in protecting vulnerable beneficiaries from the impact of switching to the chained CPI. (NWLC’s other materials and infographics about the chained CPI are available here: http://www.nwlc.org/chained-cpi-what-it-and-what-it-means-women.)

NWLC’s new analysis finds that for the typical single elderly woman – a woman whose initial benefit is $1,100 per month, the median benefit for single women 65 and older:

• The cut from the chained CPI would reduce her monthly benefits by an amount equal to the cost of one week’s worth of food each month at age 80. She would still have two years to wait before receiving any help from the bump-up.

• The Bowles-Simpson bump-up would restore her monthly benefits to current-law levels for only two years – and then her benefits would fall behind again.

• By age 95, the cut in her benefits would equal the cost of three days’ worth of food each month.

The report also explains that the bump-up would provide no relief to most of the poorest elders who rely on Supplemental Security Income (SSI). SSI beneficiaries would get a double hit from the chained CPI, because it is used to adjust both the initial benefit level and subsequent benefits. But every additional $1 in Social Security benefits reduces SSI benefits by $1 – so a small increase from the bump-up would provide no additional income to most SSI beneficiaries. And some SSI beneficiaries could be even worse off, if the bump-up in their Social Security benefits pushed them slightly above the SSI eligibility threshold – and they lost automatic Medicaid eligibility.

People disabled at an early age also would be severely impacted by the chained CPI. The Bowles-Simpson 20-year bump-up would apply to recipients of disability benefits, starting 20 years after the disability determination. But some proposals for a “birthday bump-up,” such as the proposal in the Rivlin-Domenici deficit reduction plan, would provide no help to recipients of disability benefits.

Joan Entmacher
Vice President for Family Economic Security

December 14, 2012

Trends in Premiums and Deductibles, Eroding Protection and Rising Costs Underscore Need for Action

For full report, click "Issue Brief" at this link:

Across states, the total average premium reached $15,022 per year in 2011 for family coverage, an increase of 62 percent since 2003.

Although premiums are rising more slowly than they were before enactment of the recent reforms, private insurance spending per person is projected to continue to grow more rapidly than incomes over the next decade.

By 2011, there were 35 states in which the annual premium equaled 20 percent or more of income, compared with just one state in 2003. And there are now no states where premiums amount to less than 14 percent of median incomes, compared with 13 such states in 2003.

Although workers are paying more for insurance, their premiums are buying them less financial protection because of the rapid increase in deductibles from 2003 to 2011. The resulting shift of medical care costs onto workers and their families has led to higher out- of-pocket costs for medical bills--on top of higher premium costs. By 2011, 78 percent of workers faced a deductible, compared with about half (52 percent) in 2003.


To date, with highly concentrated insurance markets, the path of least resistance for insurers has been to simply pass on the rising costs of medical care and higher prices, while adding insurance administrative costs and profit margins. In fact, the major national private insurance companies have done well throughout the recession years, with strong pretax profit margins and administrative costs that have largely kept pace with increases in medical care costs.


The Affordable Care Act's effectiveness in tackling costs, however, will require collaboration among public and private stakeholders to ensure that markets operate in the broad national interest of better health, more positive health care experiences, and lower future costs.

Comment by Don McCanne of PNHP: It just gets worse. Family insurance premiums are now over $15,000 - more than 20 percent of income in a majority of states. Family deductibles now average over $2000. Family incomes have not kept up with inflation, much less with the cost of health care. Yet private insurers are thriving.

Many are hoping that the Affordable Care Act will provide some relief. The PNHP website (http://www.pnhp.org) has a plethora of reports and studies indicating that there is no hope that that we will have truly substantial reform under this Act - only administratively-complex tweaks.

The authors of this report state that the Affordable Care Act's effectiveness "will require collaboration among public and private stakeholders." This is the fundamental reason that there is no hope. Under our current dysfunctional financing system, which was left in place by this legislation, that collaboration must be voluntary - an impossibility since each vested interest is jockeying for the most advantageous position.

Under a properly designed single payer system, the publicly-administered policies are designed to ensure collaboration of all parties. What works in the interests of the patients also works in the interests of the
collaborators. Until the nation is ready to demand structural reform that benefits us all, we are going to continue to see the numbers in this report grow even worse.
December 14, 2012

Raising Medicare eligibility age off the table--other methods of cutting it are unfortunately not

Medigap cost sharing: Some members of Congress propose limiting or prohibiting “first dollar coverage” in Medigap plans—a widely used form of supplemental insurance to Medicare. This increased cost sharing for Medigap plans would bring the most harm to those beneficiaries who have the greatest need for supplemental coverage—the sickest individuals with moderate incomes. As a result, many beneficiaries forced to pay more would forgo needed health care, resulting in poor health outcomes.

Benefit redesign: The most discussed redesign proposals would combine the Medicare Part A and Part B deductibles, implement a single coinsurance rate for health services, and create an out-of-pocket spending cap for beneficiaries. The benefit redesign proposals currently under discussion would increase costs for Medicare beneficiaries, providers, and other insurers. Instead of reducing the costs of services, the most discussed among these proposals merely shift costs to people with Medicare.

Income-related premiums: Some policymakers propose higher cost sharing for the wealthiest 25 percent of Medicare beneficiaries (individuals with annual incomes of $47,000 or couples with incomes of $94,000). According to the Kaiser Family Foundation, such proposals could lead higher-income beneficiaries to drop out of Medicare Part B, resulting in higher premiums for poorer and sicker beneficiaries who remain on Medicare. Already the Medicare Part B and Part D premiums are higher for beneficiaries with annual incomes above $85,000, or couples with incomes over $170,000.

Medicare Rights Center supports proposals that address the real spending problem—rising health care costs in the system overall—not cost-shifting proposals that place the burden of reducing the deficit on Medicare beneficiaries, half of whom live on annual incomes of $22,000 or less and are in no position to pay even more for their health care.

Visit the Medicare Rights deficit reduction webpage.
December 14, 2012

Dear “Chained-CPI”: When You’ve Lost the VFW, You’ve Lost America

Raising Medicare age is now off the table. The chained CPI needs to be off the table too. Not surprised at awareness among veterans, as this would hurt disabled veterans even more than SocSec beneficiaries, for the simple reason that they are on disability far longer than most people are on SocSec.


The “chained CPI” is an attempt to camouflage deep cuts to Social Security and other benefits, along with tax hikes on middle class wages (but not for high incomes), in a forest of numbers and terminology.

Know who’s expert at camouflage? Veterans. And a whole lot of their organizations hate the “chained CPI.”

A wide range of organizations representing the nation’s veterans signed a joint letter to leaders in Congress which said “we are writing to express our opposition to changing the formula used to calculate the annual cost of living adjustment (COLA) because of the harmful effects it will have on veterans and Social Security benefits.”

The organizations signing on to the letter (17 in all) spanned generations, with the Vietnam Veterans of America and Iraq and Afghanistan Veterans of America. It includes former enlisted personnel as well as the Military Officers Association of America. Gold Star Wives, an organization of widows and widowers whose spouses died while on active duty, was represented. And so was the VFW, or Veterans of Foreign Wars, an organization that had traditionally been staunchly conservative.

Here’s a thought for politicians who might be considering the “chained CPI”: When you’ve lost the VFW, you’ve lost America.

December 11, 2012

STUDY: Raising Medicare Eligibility Age Would Devastate America’s Most Vulnerable Seniors


The Center for American Progress (CAP) today released a new study highlighting the devastating effect that raising the Medicare eligibility age would have on America’s seniors.

CAP’s study finds that if lawmakers were to raise the eligibility age to 67, as many as 5.4 million 65- and 66-year-olds would have to search for alternative coverage sources — either by postponing retirement, enrolling in an individual plan on one of Obamacare’s statewide insurance exchanges, or qualifying for Medicaid. This dynamic alone will drive up all Americans’ costs by making existing insurance pools older, sicker, and costlier to treat.

The report further estimates that while the federal government would save a net $5.7 billion, raising the eligibility age would end up costing states, employers, and Americans an added $11.4 billion in health care spending. Worse still, seniors living in GOP-run states that have very high concentrations of poor, elderly Americans yet have refused to take part in Obamacare’s Medicaid expansion would be hit hardest by the eligibility hike, and as many as 435,000 seniors could end up uninsured by 2021 if lawmakers end up following through on the proposal:

Raising the Medicare eligibility age from 65 to 67 is fundamentally un-serious entitlement “reform.” It’s the kind of proposal that sounds logical — after all, it’s true that Americans are living longer on average — and makes for a quick and easy political pitch. But a brief dive into its mechanics and consequences shows it for what it really is: a shoddy political deal that ends up costing double what it saves by shifting the cost of health care from the federal government onto states, employers, and Americans’ premiums — all while doing absolutely nothing to address the actual roots of America’s skyrocketing health spending.
December 11, 2012

Revealed: Big businesses taking on jobless young people to work unpaid over Christmas in Britain

These fuckers need to be stopped in every country. If those useless parasitic shitstains would PAY for peoples' labor, then they wouldn't be jobless!


FIRMS including Tesco, Argos and Superdrug have taken on staff who will work for free and claim their benefits - but they will lose them if they drop out of the scheme.

SOME of Britain’s biggest firms have drafted in thousands of jobless youngsters to work for free during their Christmas rush.

The Sunday Mail can reveal a massive recruitment drive for unpaid labour under a Government-based scheme over the festive season.

High street names such as Tesco, Argos and Superdrug have taken on young people who work for free for six weeks while claiming their benefits.

And critics fear staff at Jobcentres are under pressure to put more people into the programmes – when they could have been given jobs – to meet strict Government targets.

December 11, 2012

Raising the Medicare Eligibility Age—Stories to Break Your Heart

And hopefully convince you that if you multiplied them by the inevitable tens of thousands, you would have a mass murder of American citizens that would make Al Qaida insanely jealous. I collected these online during the Simpson-Bowles committee debate in 2010, some from DU.

The Congressional Budget Office estimated that this change would save the government $124.8 billion between 2014 and 2021, and that’s not even accounting for the incremental increase. So it would actually save less than that. And, there are several things not factored into that calculation. For one, this would mainly just shift costs to businesses and individuals, and because 65 and 66 year-olds are relatively sick populations, it would mean higher overall health care spending, because providers would demand rates based on the private market rather than Medicare. Plus, younger people now in a risk pool with 65 and 66 year-olds would pay higher premiums. Second, lots of these people would go onto the exchanges, where the federal government would pay exchange subsidies. So you have to subtract that from overall savings. Third, Austin Frakt and Aaron Carroll showed that this would be bad for overall health, because people wait until their Medicare kicks in to get things taken care of. As a result, in the long run you get people coming on Medicare who are sicker on net, COSTING the government money overall.

So those are the facts about moving Medicare eligibility to 67. It’s a terrible idea all around. The other part is that it’s just a cruel thing to do. In the space of a year and a half, we went from allowing 55 year-olds to buy into Medicare to considering raising the eligibility age to 67. Only one of those two is a better deal for the American public.

My mom died at 61 while getting ready to go to work in the morning, stressed by the prospect of hoarding enough money for retirement and gobbling pain killers for her arthritis to make it through the long days in order to keep her output high enough so she wouldn't be laid off before she could collect Social Security. Age is only a state of mind when your body isn't a wreck because of your age. The idea of trying to encourage seniors to put off collecting social security in order to work longer, and the implication that collecting on the benefits of social programs that one has paid into for decades is a cop-out of some sort... offends me.

An old friend of mine died on Christmas Eve last year. The family didn't want anyone to make any calls until the day after Christmas. They said she wouldn't want to "spoil" anyone's holiday. That's her. That's they way she lived. Thinking of others. Maybe she thought it was a part of getting older. Maybe she thought the odds of this being serious weren't likely. Maybe it was the expense . Maybe it was fear. Maybe it was the million things that made her delay seeking health care in favor of taking care of everyone else in her life.

A lot of people knew she wasn't feeling well. No one insisted she get an answer for her malaise and discomfort. The bottom line is that my friend hasn't been feeling well for a long time and she didn't get adequate health care. That's the new normal in the U.S. Be sick and don't know why we're sick. She finally got to where she had to have an answer for her health problems. She got the diagnosis. The Big C. Stage IV breast cancer. That was the beginning of December. She died Christmas Eve. The cancer may have killed her, but it was really socialized neglect.

Laid off two years ago, and currently underemployed at a slightly-above-minimum wage job and filling in the gaps with freelance work. Lowest quote I could get for health insurance is more expensive than my rent (which I'm barely making as it is). Frankly, I'm afraid to go to a free clinic for a checkup. If I have some lurking illness that's terrible and expensive, what could I even do about it? At this point, all I could afford is a bullet (and I'd still have to ask someone to loan me a gun).

Yep, diabetic here and can't afford to be tested as often as I should be. I can't afford the test strips to do it at home and I can only get the meds that a local grocery pharmacy gives for free. Oh and yes, I DO have insurance, but it covers none or very little of this. I have all sorts of things I'd like to have taken care. A mole check, dental exam, female exam. I haven't been to the dentist in a few years, and I only go see my doctor (at $75/office visit) when I have an issue that needs meds. Haven't been to the OB in three years either. My husband finally found a job after two years, but no benefits are offered.

I'm really worried now because I need to go, but don't want to worry about being labeled with a pre-existing condition. I'm right around the age where things start to go wrong too. Then you worry what they will find after you haven't been to the doc’s for along time that could've been fixed had you gone earlier. What a nightmare.

I dropped my high-deductible individual policy after the premiums kept rising a minimum of 10% per year, even though I NEVER used up my $5000 deductible. When I suffered the double whammy of an injury and a slow period in my business, I ended up with medical bills that were more than I could afford but STILL didn't meet the deductible.

I realized that I couldn't keep paying premiums and also pay off the bills from my injury. I dropped the insurance after I received a notice that the premiums would go up 30% on my next birthday, because it was one of those ones that ends in a "5" or a "0."

Say they raise Medicare to 67. What difference can two years make? Two years ago, Sally noticed a breast lump. She told herself that it was “just hormones”—even though she went through menopause over a decade ago. She told herself it was “probably nothing”. Many times, she thought about seeing a doctor and getting a mammogram. But she knew what her physician would say. She needed a biopsy. And Sally had no insurance. The bank which had employed her for the last eighteen years had laid her off, just a couple of years before she would have qualified for retirement. They sent her job overseas—and sent her life in a downward spiral. Sally worked seventy hours a week in minimum wage jobs trying to keep up her house payments and cover her bills. Her jobs did not provide health insurance. She had no disability insurance, either. She was just barely getting by. And then she found the breast lump.

This year, Sally qualified for Medicare. She went to see a doctor immediately. She got that mammogram and the biopsy. Six out of ten lymph nodes were positive and she has metastases in her bones. The good news is breast cancer kills slowly. Chances are, with radiation and chemotherapy, she will still be around when her youngest child graduates from college. The bad news is she will die in pain. Excruciating pain that morphine will not even begin to control. And she will never see her grandkids. Ask Sally what difference two years can make.

Two years ago, Ted’s wife, Jane died. Jane was a public school teacher, and she had good benefits including health insurance. The couple retired early—and then, Jane had a sudden massive heart attack and died, leaving Ted alone and uninsured. His Medicare would not kick in for two more years. Ted had high blood pressure and diabetes, both of which had been well controlled up until then. However, his family doctor insisted that he get regular lab work to follow his diabetes, and Ted could not afford the tests. Before retiring, he and his wife had carefully calculated what it would cost for the two of them to live---and now he was trying to get by on half that amount. Going back to work in order to get insurance was out of the question. No one would hire a 63 year old with hypertension and diabetes.

For two years, he made his medication “last” by taking a quarter of the dose he was prescribed. When he ran out and started getting headaches, he would go to the nearby Doc-in-a-Box for refills. Each time, he saw a different doctor. Each doctor advised him to see his regular doctor for check ups. Each time he agreed. He was not lying. He really did intend to get that check up—just as soon as he had insurance again.

Two days before his 65th birthday, Ted suffered a stroke. Now, he is paralyzed over the right side of his body and unable to speak. Doctors say his high blood pressure and uncontrolled diabetes did it. Ted will spend the rest of his life in a nursing home. The bills will be paid by Medicare and Medicaid. The church where Ted taught Sunday school classes will miss him. The neighbors will miss him, too. His grown kids wonder why he never came to them for money for his medical expenses. But Ted was brought up to believe that parents should look after their children, not the other way around. He was told that a man must be independent. Now, he has to ask a nurse for help each time he wants to use the bathroom. Ask Ted was difference two years can make. But don't expect an answer. He still can't talk.

I am 68. I retired at 65. Right after I retired I required 2 stents. Bill? Close to 100 grand. Without Medicare I would not have lived passed 65. Ask me what the difference is.

At 57 my dad could no longer get insurance on the open market. He was healthy, but the insurance companies were all skittish and came up with reason after reason to deny him, regardless of what his primary care physician said about his current and previous health status.

Being a small business owner (and I mean small) meant that my mom had to work until he could get on Medicare, even though she was older and could have retired. She made a deal with her boss to cut to part time and then pay for the health insurance benefit. If her boss hadn't been so understanding and my mom hadn't been so good at what she does, my dad would have spent several years without insurance at a time in a man's life when he probably should have it most. It also meant he had to stay in business longer—until the crashing economy destroyed it and ate up my mother's retirement. Raising the age to get Medicare is unconscionable. I can't believe it's even on the table.

One of my friends here got breast cancer at 63. She had just lost her job, because the business closed. She faced her diagnosis with no insurance. Her husband has Medicare. She told him to let her die. He would not do it. She is 65 now, and on Medicare. They are $63,000.00 in debt. This is the real figure.

She is doing well physically and emotionally. She works at a local grocery store to help pay off the debt. It will never be paid off. Who knows, maybe she is one of the lucky ones. She did not die.

I am 57. In a perfect world, I will stay healthy, my firm will want to keep me forever instead of replacing me with a lower paid younger worker, and birds will always sing and the sun will always shine. But the world is not perfect. If I lose my job in my early 60's, will I be able to afford to buy health insurance on the open market? I shudder when I try to guess what that would cost...someone at that age, who will no doubt have SOME physical ailment(s), as most seniors do. I would be hoping to hang on until I get Medicare at 65, and even then, unless I get supplemental coverage, that wouldn't cover that much. But it's something.

So to ask me, and others in that age range, to wait until 67 to get partial health coverage, when they've paid in all their working lives....WHEN THE RICH ARE RAKING IN TONS OF MONEY DUE TO LOWER TAXES...that just isn't right. AND WHEN THAT PROVISION IN MEDICARE ACT STILL EXISTS, THE ONE WHERE WE CAN'T NEGOTIATE PRICES FOR DRUGS....that is unconscionable. It's wrong. It's cruel. It's asking the most vulnerable to sacrifice, when the least vulnerable refuse to. Even if the wealthy lose a couple of tax loopholes...like that is the same thing as going without health care for two more years? It makes me sick just thinking about it.

I have a relative on disability. It's almost impossible to survive on no income for the waiting period...which is the point. Less people to have to approve. As Stalin was reputed to have said: “Death solves all problems—no man, no problem.” Funny to see us adopting the same stance...

If my mom had to wait until she turned 67 for Medicare, she would be dead now. Both of my grandfathers died in their late sixties, after a lifetime of hard manual labor. Both were staunch Democrats, by the way, and gave FDR the credit for their having a little something to live on when they retired. I'm glad they didn't live to see this.

My brother would have been 65 tomorrow, but he died from pancreatic cancer in early April of this year. Like my father who died at 64 from heart failure and my sister who is very ill and will be 63 in August probably will not reach the magic number for retirement either. I hadn't seen my brother since my father's funeral in 1985. He was one of the lost souls of Vietnam. Severely wounded by a 'popper', even winning two bronze stars for bravery in combat. Lyndon Johnson even pinned his Purple Heart on him when he arrived home to recover. He lost part of his foot and hand and had shrapnel in him they never removed. He came home and was briefly married, and fathered a daughter. Spent most of his years after that lost like so many of his brothers in arms. We had thought he had died years ago since there had been no contact with him from anyone in our families. But in April something told me to try and find him again. What I found was his obituary.

Neither my dad or my brother got to enjoy 'retirement'. And now the wealthy pricks in Washington are trying to make it worse for the rest of us. I am sure the system failed my brother, because if it was a caring system, he would have found the help he needed long ago. All they provided was hospice in the end.

I am 55 years old, skilled teacher, enthusiastic worker, and can't even get FACE TIME to interview for a teaching contract. Haven't had full employment in over three years. Haven't earned a living wage in over three years. Unemployment runs out in a few weeks. Probably just in time for me to have sold most of my belongings to prepare for homelessness. Don't suggest that I go 'live with family,' because I have no children and I grew up in an alcoholic family rife with physical, mental, and sexual abuse (..oh, for which I am blamed, ironically). I am hopeful that I can prepare myself for the loneliness, the isolation, the abject fear that is part and parcel of being homeless and POOR in this 'great country.' I am pretty sure I have the anger part down pat...

At least my elderly cat has died, so she won't be an additional worry in determining just where I can 'lay low like Brer Rabbit' during the remainder of my time on this planet. Have to figure out how to keep and feed my 13 YO dog...Have to find a way to cling desperately to the last shreds of my now elusive joie de vivre... So many decisions, so little time...


December 8, 2012

More employers to drop employee health insurance


In February, 2011 McKinsey & Company did a large (1,329) survey of employers asking about their intentions with the Affordable Care Act and found that 30% said their company would 'probably' or 'definitely' drop coverage as a result. McKinsey is an extremely credible firm, but that didn't stop supporters of ObamaCare from lambasting the survey because it was not consistent with other economic analyses. McKinsey had to issue a statement explaining it was not intended to be an economic analysis, it was an opinion survey. I would argue that such a survey is probably far more accurate than an economic analysis that must rely too much on assumptions. Indeed, it likely understated the situation. As employers learn more about the requirements of the new law they are more likely to run away from it.

These employees are also likely to find at the Exchange:
* A clunky web site run by the state or federal government laying out the coverage options.
* Overpriced insurance options. (Because insurers can no longer ask medical questions, they will have no idea what kind of risks they are enrolling, or the premiums needed to cover those risks. They will err onthe side of caution and charge higher premiums.)
* Confusion about how much they will be charged for their share of the premium. (They will be subsidized, but the amount of the subsidy will vary according to their age, income, geographic location, family size, and choice of plan.)
* Insurance plans that cover a bunch of stuff they don't want or need.

Finally, they will realize that they don't need to go through all this. They can delay making a decision until they really need to get health care services:
* Exchange coverage is guaranteed to accept them at any time with no questions asked.
* They can save a whole lot of money by not paying premiums and using that money for more pressing needs.
* There is no meaningful penalty for failing to enroll. What penalty there is applies only to people who make enough money to pay income taxes, and it can be collected only by seizing whatever tax return is due the taxpayer. This can be easily avoided by upping deductions at the start of the year.

Most people have very few medical expenses in the course of a year. 50% of the people in the United States consume only 3.9% of all health care expenses each year, while the top 20% consume 78.3%. People in the top 20% will certainly want to be covered but the bottom 50% get no advantage from insurance coverage. They spend far less on services than they would on insurance premiums.

Comment by Don McCanne of PNHP: Greg Scandlen is a very well informed and respected member of the policy community who has been associated with conservative/libertarian organizations such as the National Center for Policy Analysis, Cato Institute, Galen Institute and Heartland Institute. This article for NCPA is presented in its entirety to demonstrate how much agreement there is with those of us at Physicians for a National Health Program in defining some of the problems with the highly flawed Affordable Care Act (Obamacare). This article could have been written by one of us at PNHP.

He does not offer any solutions in this particular article, though had he, it would undoubtedly be from his area of expertise and advocacy - consumer-driven health care, including health savings accounts and health reimbursement arrangements. That, of course, is quite a contrast from the single payer solution advanced by PNHP.

When there is so much agreement on what is wrong, why can't we agree on the solution? Perhaps it's our respective goals. We at PNHP want everyone to have affordable access to all essential health care services, as a matter of social justice. The advocates of consumer-driven health care seem to place the will of the individual consumer above that of society's collective will for health care justice. But the divide is not quite that simple.

Supporters of an improved Medicare for all still agree that the patient (health care consumer) should make the ultimate decisions on his or her individual health care, after being informed on the options. The role of the government is to remove the financial barriers to that care.

The consumer-driven advocates would add to the health care consumer (patient) the responsibility of making spending decisions so that they would shop for higher quality and greater value. The role of the government would be to ensure access to basic health care services for those who lack the financial resources to pay for that care.

The problem with the consumer-driven approach is that is what we have now, and it isn't working. Except for a marginal tax benefit, it doesn't matter whether the patient's share of cost comes from a health savings account orfrom other personal funds. The system perpetuates uninsurance and under-insurance which exposes far too many to financial hardship in the face of medical need.

An improved Medicare for all would eliminate financial hardship for individual patients while using public policies to reduce the excessive escalation of our collective health care spending. The latter is a task that our private insurers cannot master, but is ideally suited to a single, national, publicly-administered insurance risk pool.

Greg Scandlen understands this. He understands the inadequacies of his consumer-directed approach. I wish he could explain to us better, in terms devoid of ideology, just what is wrong with our approach - an approach that would provide everyone the care that they need in a progressively-financed system that we can all afford.

My comment: The following quote is from a slide show I saw a few years ago. “Chicago has 17,000 different plan designs” Allan M. Korn, MD, medical director of BlueCross/BlueShieldinterviewed on amednews.com by Robert Kazel Sept. 20, 2004. How in fucking HELL can people like Scandien say that we just don't have enough competition and still keep a straight face?

The whole POINT of insurance is sharing risk. We all pay for the fire department despite the fact that few will ever see their property burn. Effective health insurance amounts to forcing the healthy majority to pay for the sick minority--which is perfectly fair, as no one ever knows which group they will wind up in over a lifetime. The only purpose of private insurance in this country is to avoid doing that.

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About eridani

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity
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