Exactly what are the features of the Cadillac plan that make it excessive in terms of benefits?

[dkf]

Does it encourage too many trips to the doctor? Too many surgeries? Overmedication?

Is the excessive behavior the fault of the doctor or the patient?

Lastly how does it compare to any other country's experience? Do Americans with unlimited use see the doctor that much more often than say a Canadian?

Personally I'm not thrilled to see the doctor. I do it when I have to.

[Betsy Ross]

1. Dental and Rx coverage.

Union household with union benefits.

[napi21]

4. I don't know what your dental and RX coverage is, but I have both and both

SUCK! My son has great HC coverage through his very large & popular employer and he said the same thing. Dental coverage is a joke. RX is OK in most cases, but with the more expensive plans, there is NO copay or very low ones.

[PVnRT]

26. Dental coverage is "Cadillac"? Huh?

[karynnj]

32. NO - The answer is if the family plan is over $23,000 or the single plan over $8,5000

AND it is employer paid - not purchased by the individual.

[karynnj]

31. Not true - I have yet to see anyone post that they are in a union and

have a plan costly enough at the moment to be taxed. In addition, the two employer plans I know of, one from a mid-size business and the other from AT&T both include dental and Rx coverage and neither are Cadillac plans.

The hint is that less than 4% of people have plans that are.

[napi21]

2. I think they don't have any or extremely low copays, n/t

[dkf]

5. Yeah but does this encourage abuse?

And by whom? Is the doctor making extra money on tests because he can?

[napi21]

10. I don't think so. Have you ever known anyone who just went

to the Dr. for no reason? I haven't. As far as Dr's abusing it, I think it's up to the patient to ask why they want a test done, or why that particular drug. There really should be responsibility on the patient too.

[villager]

3. you lose your fear of going bankrupt via medical procedure -- so the gnawing doubt must be restored

...so that the citizen is easier to control...

[napi21]

6. I guess I don't understand your post. Our HC has a max

out of pocket. $2,500. I' not saying everybody has $2,500, but most wont have to go bankrupt.

[villager]

9. I was responding to the notion of what might make it "excessive" in the eyes of the goverment

Some light parody of the notion it might be excessively helpful/comforting to a citizen, most of whom cannot afford to be sick.

Thus, the "U.S. government" division of the insurance cartel looks for ways to "equalize" things -- why should one group of people imagine they have good health care, when no else does? Or will?

[dkf]

12. Unless there is a denial of coverage.

Sicko talked about how they bonused and promoted doctor reviewers who denied coverage for any reason. There is still no protection for denials or for out of network doctors or hospitals. Also for lacking preapprovals. There was a woman who was denied coverage because she didn't get approval as she lay unconscious in the ambulance prior to getting to the hospital. You should see it.

[FrenchieCat]

7. It is defined as a premium value of over $23,000 per year.

That means, if you are a family of 4, and your premiums (whether you pay for them yourself or your employers pay them on your behalf) exceeds $23,000 per year.

That's nearly $2,000 per month!

The excise tax in on anything over the $23,000 per year......and does not tax the actual first $23,000.

[dkf]

13. I'm wondering though if they want there to be a cost consideration to

Use. Is the governments real goal to discourage use by making it more expensive for each procedure or visit?

[FrenchieCat]

19. No. The goal is so that the medical industry can stop taking advantage

of those on Cadillac Plans,
like they do Medicare billing.....

[dkf]

21. Are they?

I do wonder why medical costs are so expensive. I still feel like I don't have a handle on the problem. It gets blamed on uninsureds going to the hospitals but since most Americans are covered that doesn't make sense to me.

[jljamison]

8. the argument goes something like this

lets generalize and stipulate that those with cadillac health plans have plans with low or no deductibles, wide access and high or endless limits.

Therefore the cost vs effectiveness is not considered when multiple treatment options are presented. Go ahead with that rotator cuff surgery rather than try and seek relief through physical therapy and strengthening exercises. Go ahead with the MRI on the sore knee rather than avoiding it initially and trying to resolve the problem without expensive diagnostics. Go ahead and use lipitor ($160 per month for 20mg/day) instead of trying simvastin ($60 for 3 months) for hypercholesterolemia. It never hits their pocket so cost is not a factor.

how does this inflate costs? A couple ways:

a) it "feeds the beast" - momentum builds within the medical community to overtreat as a matter of course. i think that's pretty thin argument, but there it is.
b) the insurance companies that provide these policies have to recoup their profits elsewhere, by cutting coverage or rescission or denying claims, etc.

c) the more expensive treatment options might themselves lead to more problems that have expensive remedies, such as catching an infection while in a hospital.

d) it limits access to medical specialists for those who really need the treatments. Doctors in a way busy themselves up chasing expensive procedures from patients covered by cadillac plans.

none of them are that compelling to me. Maybe there are other ways that I haven't listed here (probably are).

[stevenleser]

11. Thanks Jl. Probably the most coherent description of the reasoning I have seen so far.

I still prefer a tax raise on the top bracket but at least I can see where some folks are going with this piece now.

[dkf]

15. So the problem is the doctor right?

This is trying to control doctor behavior not patient behavior as patients don't know every option to try.

[FrenchieCat]

20. It is trying to bring down the cost of care

by getting rid of a system that prefers the high premium insurance holder.

[jljamison]

23. lets be fair

sure the doctor is part of the problem, but there are a lot of factors, and for sure the patient is major part of the problem

for example, take the lipitor vs simvastin question

the doc may have built up years of experience knowing that in all or most patients for whom they prescribe lipitor, it works, problem goes away, patient is happy, no need for more followup visits (other than monitoring liver function).

however, to switch to simvastin it almost guarantees needing another visit and another round of tests. thats incovenience and cost and time, etc. By the way, if the doctor visit is $150 and the blood panel is $300, that's $450. so your breakeven with going to the cheaper simvastin is pushed out a few months.

people don't usually like the answer - well, we could operate and that would probably fix it, but lets try a bunch of cheaper things that may or may not work.

they want the test and the definitive fix. if they have the cadillac plan, then why not?

[dkf]

25. More complicated than I thought.

You are making a Cadillac plan look awfully attractive though. I can see why an executive would want one.

[SpartanDem]

14. It's not about excessive benefits

but the real issue is the employer tax exclusion if you make 20k and you get in 6k benefit from your job you don't pay taxes on that 6k in compensation. If you buy that 6k of benefits on your own you don't get that tax break. In general, if make more you get better benefits and a bigger subsidy so it can be very regressive. In addition, your employer gets a tax break for those benefits with little incentive for control cost also giving insurers little incentive to control for cost. The system encourages tying employment to health insurance and for more expensive insurance.

[dkf]

16. It's kind of weird though because the government wants employers to provide

Health benefits but only to a certain point. Is the problem that a Cadillac plan lands up creating expectations on a high payout per procedure and then the other poor plans have to keep up with that?

[Clio the Leo]

17. Exactly. It's a kind of a tax break....

.... to those who (for whatever reason) have the most expensive plans.

Not only does it SOUND like some kind of GOP invention, it's just a poor management of American tax $$.


But this argument misses an important point: The assessment proposed in the Senate is not a new tax; it is the elimination of an existing tax break that is provided to exactly these firms. Under current law, if workers are paid in wages, they are taxed on those wages. But if they receive the same amount of compensation in the form of health insurance, they are not taxed. As a result, the tax code has for years provided a large subsidy to the most expensive health plans -- at a cost to the U.S. taxpayer of more than $250 billion a year. To put this in proportion, the cost of this tax subsidy to employer-sponsored insurance is more than twice what it will cost to provide universal health coverage to our citizens.
http://www.washingtonpost.com/wp-dyn/content/article/2009/12/27/AR2009122701714.html

[dkf]

18. The government shouldn't tax benefits that the taxpayer has no choice about.

Maybe if we were given an option to take it as benefits or salary then I can see doing that. The problem is a two tiered system where one class of worker gets a better plan with a tax subsidy and the others don't. That is definitely a problem but I don't see how taxing just high premium plans solves that in any way. The senate plan has no employer mandate as I understand it so access to group coverage is still unfair.

[SpartanDem]

22. It would be better

to subject benefits to the more progressive income tax. Taxing premiums isn't the optimal solution I'll admit, but it at least takes some of that subsidy away. As for the Senate not having an employer mandate I kinda think that is good the US needs to get away, like every other industrialize country, of tying employment to health care.

[jljamison]

24. yes but...

that's a matter of tax equity and not medical cost control.

[SpartanDem]

30. The two are tied very closely

the current taxs laws around health benefits ecourage more spending in addition to grossly unfair


If it does work, your insurer will design more affordable plans that don't run afoul of the tax because your employer will refuse to purchase plans that do run afoul of the tax. That's the point of the policy: to give employers an incentive to become more value-conscious purchasers of health-care insurance. "Employers are not shopping very well," says MIT economist Jonathan Gruber. "They're signing up with Blue Cross or whichever insurer they know, because what do they care? They just pass it onto wages."

http://voices.washingtonpost.com/ezra-klein/2009/10/explaining_the_excise_tax.html

[tsuki]

27. Cost of the plan. Everything that I have read defines "cadillac" on a

cost basis.

[Bluenorthwest]

28. For those who are young or paid no attention to politics

until very late in life, let me tell you that what they call 'Cadillac' is what people with decent jobs used to expect. It is what I had from age 21 or so. It is just good insurance, that is all.
And Union members who have strong health plans have usually given up higher pay rates to get those plans. Because that is what the employers suggested. And it was a fair compromise for all.
Just because you are used to a hoopti, this does not make a Kia into a Cadillac.

[jumptheshadow]

29. Correct

It's just good, affordable insurance that ensures you don't have to break the family budget with high deductibles and co-pays, and gives you a wider range of treatment options. It is what unions have fought and sacrificed for -- the right of the members to maintain a decent, middle-class standard of living.