Health Versus Wealth

iVillage Member
Registered: 04-16-2003
Health Versus Wealth
48
Fri, 07-09-2004 - 11:54am
Health Versus Wealth

By PAUL KRUGMAN

Published: July 9, 2004

Will actual policy issues play any role in this election? Not if the White House can help it. But if some policy substance does manage to be heard over the clanging of conveniently timed terror alerts, voters will realize that they face some stark choices. Here's one of them: tax cuts for the very well-off versus health insurance.

John Kerry has proposed an ambitious health care plan that would extend coverage to tens of millions of uninsured Americans, while reducing premiums for the insured. To pay for that plan, Mr. Kerry wants to rescind recent tax cuts for the roughly 3 percent of the population with incomes above $200,000.

George Bush regards those tax cuts as sacrosanct. I'll talk about his health care policies, such as they are, in another column.

Considering its scope, Mr. Kerry's health plan has received remarkably little attention. So let me talk about two of its key elements.

First, the Kerry plan raises the maximum incomes under which both children and parents are eligible to receive benefits from Medicaid and the State Children's Health Insurance Program. This would extend coverage to many working-class families, who often fall into a painful gap: they earn too much money to qualify for government help, but not enough to pay for health insurance. As a result, the Kerry plan would probably end a national scandal, the large number of uninsured American children.

Second, the Kerry plan would provide "reinsurance" for private health plans, picking up 75 percent of the medical bills exceeding $50,000 a year. Although catastrophic medical expenses strike only a tiny fraction of Americans each year, they account for a sizeable fraction of health care costs.

By relieving insurance companies and H.M.O.'s of this risk, the government would drive down premiums by 10 percent or more.

This is a truly good idea. Our society tries to protect its members from the consequences of random misfortune; that's why we aid the victims of hurricanes, earthquakes and terrorist attacks. Catastrophic health expenses, which can easily drive a family into bankruptcy, fall into the same category. Yet private insurers try hard, and often successfully, to avoid covering such expenses. (That's not a moral condemnation; they are, after all, in business.)

All this does is pass the buck: in the end, the Americans who can't afford to pay huge medical bills usually get treatment anyway, through a mixture of private and public charity. But this happens only after treatments are delayed, families are driven into bankruptcy and insurers spend billions trying not to provide care.

By directly assuming much of the risk of catastrophic illness, the government can avoid all of this waste, and it can eliminate a lot of suffering while actually reducing the amount that the nation spends on health care.

Still, the Kerry plan will require increased federal spending. Kenneth Thorpe of Emory University, an independent health care expert who has analyzed both the Kerry and Bush plans, puts the net cost of the plan to the federal government at $653 billion over the next decade. Is that a lot of money?

Not compared with the Bush tax cuts: the Center on Budget and Policy Priorities estimates that if these cuts are made permanent, as the administration wants, they will cost $2.8 trillion over the next decade.

The Kerry campaign contends that it can pay for its health care plan by rolling back only the cuts for taxpayers with incomes above $200,000. The nonpartisan Tax Policy Center, which has become the best source for tax analysis now that the Treasury Department's Office of Tax Policy has become a propaganda agency, more or less agrees: it estimates the revenue gain from the Kerry tax plan at $631 billion over the next decade.

What are the objections to the Kerry plan? One is that it falls far short of the comprehensive overhaul our health care system really needs. Another is that by devoting the proceeds of a tax-cut rollback to health care, Mr. Kerry fails to offer a plan to reduce the budget deficit. But on both counts Mr. Bush is equally, if not more, vulnerable. And Mr. Kerry's plan would help far more people than it would hurt.

If we ever get a clear national debate about health care and taxes, I don't see how President Bush will win it.

http://www.nytimes.com/2004/07/09/opinion/09KRUG.html?hp

iVillage Member
Registered: 03-27-2003
Fri, 07-16-2004 - 6:59am

I feel really blessed.


Elaine

iVillage Member
Registered: 03-18-2000
Fri, 07-16-2004 - 9:18am

Elaine can't you continue your present health insurance by paying the premiums?


What an upheaval in your life! My sympathies. Chris

cl-Libraone~

 


Photobucket&nbs

iVillage Member
Registered: 04-16-2003
Fri, 07-16-2004 - 11:33am
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His proposal shows how out of touch GWB is with real life problems. I really don't think he understands the conditions surrounding ordinary working people. First you have to come up with the $2000 to contribute to the plan, really, when most people live paycheck to paycheck. Then you can tell him just how far the plan will go toward footing the bill for an uninsured family. This is like a small bandaid for a severed leg.

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Is this an example of GWB helping corporations? The Medicare prescription plan is a disaster for retirees. I understand once you choose a plan you must stay with the plan, while the drug companies can change the drugs covered and price for drugs anytime.

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He will sell it as a great gift to the uninsured; a con artist can make trash seem like treasure, something people don't realize until it's too late.

iVillage Member
Registered: 04-16-2003
Fri, 07-16-2004 - 11:46am
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Perhpas you will find another job before COBRA runs out. If not, there are often state services that help reduce the cost of drugs if you cannot get insurance; they are not advertise so you have to take the initiative. Take care.

iVillage Member
Registered: 03-26-2003
Tue, 07-20-2004 - 3:54pm
I've been lurking...mostly hit and miss! ;)

Time seems to have really gotten away from me this summer...(that and the fact that my 14 yr old daughter hogs the 'puter most of the time!) LOL! But I'll be here!

iVillage Member
Registered: 04-16-2003
Fri, 08-27-2004 - 5:32pm
While we get passionate about the conflicting interests of an incident almost 40 years ago, the problems of today fall by the wayside. Here I go again, trying to start a discussion about our failing health care system. Is GWB correct that the reason health care is so high is because of malpractice insurance for doctors? Are drugs over-priced because of research expenses?

America's Failing Health

By PAUL KRUGMAN

Published: August 27, 2004

orking Americans have two great concerns: the growing difficulty of getting health insurance, and the continuing difficulty they have in finding jobs. These concerns may have a common cause: soaring insurance premiums.

In most advanced countries, the government provides everyone with health insurance. In America, however, the government offers insurance only if you're elderly (Medicare) or poor (Medicaid). Otherwise, you're expected to get private health insurance, usually through your job. But insurance premiums are exploding, and the system of employment-linked insurance is falling apart.

Some employers have dropped their health plans. Others have maintained benefits for current workers, but are finding ways to avoid paying benefits to new hires - for example, by using temporary workers. And some businesses, while continuing to provide health benefits, are refusing to hire more workers.

In other words, rising health care costs aren't just causing a rapid rise in the ranks of the uninsured (confirmed by yesterday's Census Bureau report); they're also, because of their link to employment, a major reason why this economic recovery has generated fewer jobs than any previous economic expansion.

Clearly, health care reform is an urgent social and economic issue. But who has the right answer?

The 2004 Economic Report of the President told us what George Bush's economists think, though we're unlikely to hear anything as blunt at next week's convention. According to the report, health costs are too high because people have too much insurance and purchase too much medical care. What we need, then, are policies, like tax-advantaged health savings accounts tied to plans with high deductibles, that induce people to pay more of their medical expenses out of pocket. (Cynics would say that this is just a rationale for yet another tax shelter for the wealthy, but the economists who wrote the report are probably sincere.)

John Kerry's economic advisers have a very different analysis: they believe that health costs are too high because private insurance companies have excessive overhead, mainly because they are trying to avoid covering high-risk patients. What we need, according to this view, is for the government to assume more of the risk, for example by picking up catastrophic health costs, thereby reducing the incentive for socially wasteful spending, and making employment-based insurance easier to get.

A smart economist can come up with theoretical justifications for either argument. The evidence suggests, however, that the Kerry position is much closer to the truth.

The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)

And the U.S. system does have very high overhead: private insurers and H.M.O.'s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.

Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."

My health-economist friends say that it's unrealistic to call for a single-payer system here: the interest groups are too powerful, and the antigovernment propaganda of the right has become too well established in public opinion. All that we can hope for right now is a modest step in the right direction, like the one Mr. Kerry is proposing. I bow to their political wisdom. But let's not ignore the growing evidence that our dysfunctional medical system is bad not just for our health, but for our economy.

http://www.nytimes.com/2004/08/27/opinion/27krugman.html

iVillage Member
Registered: 03-23-2003
Sat, 08-28-2004 - 11:20am

John Kerry's economic advisers have a very different analysis: they believe that health costs are too high because private insurance companies have excessive overhead, mainly because they are trying to avoid covering high-risk patients. What we need, according to this view, is for the government to assume more of the risk, for example by picking up catastrophic health costs, thereby reducing the incentive for socially wasteful spending, and making employment-based insurance easier to get.


This is SOOO true.


iVillage Member
Registered: 04-16-2003
Sat, 08-28-2004 - 12:44pm
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I agree in many respects:

1) Too much paperwork required by insurance. Why so much paper work? So they can eliminate as many claims or pay reduced payments. I bet each drs office has to have at least one employee that deals with insurance claims.

2) The insurance companies want to make sure no one cheets, but somehow people will always find a way. I had a dentist who gave me a porcelain crown instead of a gold one but forgot to tell me the insurance wouldn't cover the extra cost. Both the insurance company and I refused to pay, so the doctor submitted a claim for work not done. The insurance company didn't tell me of the additional claim, I didn't find out for a year after the dentist died.

My big beef is really with medicare: I am my mother's guardian, but medicare refuses to send me the information about the medicare she receives. So I have no idea what her medical care costs are. This complaint is not so much paper work as ineffective procedures. I assume it is very small because because she is very healthy but who knows?

3) I agree, the insurance companies are busy doing promotional work at the expense of the insured. They also have high profit margins. I am a capitalists, so I realize that companies advertising are legitimate expenses, but when there is no attention paid to "reasonableness" whose to say what is excessive.

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Many insurance companies don't pay for preventative care. And here again you have excess, then when people turn up in pain or ill, it is more difficult to diagnose illness so many unnecessary test are conducted. A long list of possibilities and limited time. I have no idea what GWB was referring to do. I image there are some people who go to the doctor for every ache and pain, but it couldn't be too many. MO is that he is just making fun of "some people" his minions have some place to direct their anger. This tactic of deriding some group through implication is very disgusting to me. It reminds me of grade-school behavior--make fun of someone who is different.

BTW, how's your knee?



iVillage Member
Registered: 04-16-2003
Sat, 08-28-2004 - 3:38pm
Why am I not surprised!

Edited to include:

Terry Brauer, the CEO of HealthCare Initiatives, Inc. and HealthCare Management Consultants, Inc. An in-depth analysis of Bush, Kerry, and single payer universal carrier solutions is available @ www.healthcare-consulting.com/2004ElectionVotersGuide.html www.healthcare-consulting.com/2004ElectionVotersGuide.html.

Bush Plan Is a Windfall for Health Care Industry

Commentary, Terry Brauer,

Pacific News Service, Aug 27, 2004

President Bush has been touting the virtues of his health care plan during the campaign. It took him more than 3 years to formulate one. As presidential health care plans go, his is terrible for consumers, but terrific for health care providers and insurance companies.

Bush`s plan to use association health plans (ASPs) as a means of controlling health care costs for small businesses is absurd. Even America's largest employers are unable to control health care costs. Both General Motors and Ford Motor Co. have called on the federal government for help in reining costs in.

Other nations' health care systems, which cover their entire populations, cost at least 50 percent less per person per year than Americans pay for their health care, and 45 million Americans aren't covered at all. Clearly, hundreds perhaps thousands of small businesses banding together to buy health insurance will have no greater success in controlling costs.

Health savings accounts (HSAs) are the president's second innovation. But relatively few families can afford them, what with higher deductibles, higher co-pays, and more money deducted from workers' paychecks for premiums and HSAs.

Tax credits, another feature of Bush's plan, work well for businesses and individuals that can afford to front monthly health care premiums. Most individuals and small businesses, however, can't afford very expensive monthly premiums.

Medical malpractice liability tort reform is another of the president's health care plan cornerstones. If successful, all people, regardless of the nature or extent of their injury or death from medical negligence or bad judgement would, if vindicated, be awarded a maximum fixed amount. Their pain, suffering and inconvenience -- temporary or permanent -- regardless of age, would be evaluated on the basis of a single maximum award amount.

Bush keeps saying that tort reform will reduce health care costs. It won't. Insurance cost escalation for malpractice liability, property and auto insurance stem from the same source -- poor returns on insurers' market investments, mismanagement and greed.

Health care providers instead should purge their ranks of incompetent and impaired offenders, use technology to reduce medical errors and train staff to be more diligent in the care of patients. Provider organizations -- physicians and hospitals -- have been trying to "educate" their members for decades in an effort to reduce medical errors. It hasn't worked. The vast majority of medical errors is caused by a tiny minority of repeat offenders, systemic defects and impaired health care professionals.

The people who oppose a rational and equitable health care system for America are stakeholders in the status quo. They invariably surface and support superficial or cosmetic and impotent changes. Bush has placed on display this election year each of the elements that serves to directly or indirectly enrich special interests -- ASPs, HSAs, tax credits and medical malpractice tort reform. Under the guise of "consumer-directed health care" and "consumer choice" these elements together will add further complexity and devastation to a chaotic health care non-system that is in the process of implosion.

Bush and his supporters believe that the private sector will do a better job than government in administering and financing health care for America. But six decades of a private sector employer-based insurance system have failed to control costs, ensure quality and patient safety and guarantee universal access.

We know that the health care non-system is rife with fraud (at least $100 billion annually), waste and abuse. We know that 45 million Americans are permanently uninsured and 82 million were uninsured for various periods of time in 2002-3 for various reasons.

We know that our hospital emergency rooms are jammed with people seeking both urgent and primary care services. We know that more people are bankrupt, impoverished, physically impaired or dead (18,000/year) because of health care costs. Yet, stitching together additional mirage panaceas -- ASPs, HSAs, tax credits, tort reform, etc. -- constitutes the main feature of the president's health care plan.

A single payer universal health care system for all Americans will be best for the nation and our future -- for health care consumers, their families, doctors, nurses, pharmacists and thousands of employers.

Employers and individuals would pay into a general fund. The risk would be spread among the entire population. The federal government would be the payer. Consumers would select any health care providers they wanted that were approved by the federal government. Quality information would be available through the Internet and accessible by all.

The government would establish fair and equitable payment rates for products and services. Layers of unnecessary waste, fraud and abuse would be reduced or eliminated. Hundreds of billions of dollars would be reallocated to patient care. Physicians and other providers would cease spending valuable time on billing and other administrative issues unrelated to patient care.

More Americans have been temporarily or permanently uninsured and more health care special interests have been more profitable in the last few years than at any time in our history. A single payer universal health care system would be transparent and won't enrich and reward the current roster of industry special interests and Bush supporters, which is primarily why President Bush isn't proposing one.

http://news.pacificnews.org/news/view_article.html?article_id=75d8ab8442603156df9bb58770ef3eed


Edited 8/28/2004 3:40 pm ET ET by hayashig

iVillage Member
Registered: 03-23-2003
Sat, 08-28-2004 - 9:39pm

BTW, how's your knee?


Doing much better, thank you!