Clinton Health Plan May Tap Pay

jjjoy, LPN · Feb 12, 2008

If a company doesn't offer health insurance then many people never get their own, mainly because it's so expensive & comparing policy coverage can also be confusing. There are also the issues of pre-existing conditions making it next to impossible to qualify for health insurance or having to pay astronomical premiums.

I've met many a person who balks at paying several hundreds of dollars per month for a basic health insurance policy, especially if they are young and healthy. How many per diem nurses who get a higher rate of pay in lieu of benefits actually go out and obtain their own health insurance? Most of the ones I've met are either on a spouse's policy or simply go without.

In regards to paying for those "on the dole" - we're already paying for them anyway. By enforcing all employed people to pay (and hopefully it wouldn't be out of proportion for those who make minimum wage or those who make more than average), at least everyone would be contributing to the insurance pool and everyone would be (theoretically) covered in some way. In that case, concerns would revolve around making sure health insurance policies were actually offering insurance and not a functionally useless policy.

Still, I think the biggest issue one way or another is having affordable health care for those with "pre-existing conditions" as well as a safety net for catastrophic events that could financially ruin a person.

HM2VikingRN, RN · Feb 12, 2008

The best way to pay for UHC is to make it a fair sustainable contribution through a combination of payroll tax and VAT. The most specific proposal includes:

A universal public system would be financed this way: The public financing already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any and all other out of pocket payments. For the vast majority of people a 2% income tax is less than what they now pay for insurance premiums and in out-of-pocket payments such as co-pays and deductibles, particularly for anyone who has had a serious illness or has a family member with a serious illness. It is also a fair and sustainable contribution.

http://www.pnhp.org/facts/singlepayer_faq.php#raise_taxes

pickledpepperRN · Feb 12, 2008

We had a young attorney who was planning to start buying health insurance after he paid his student loans. I guess he though his youth and good health would keep him OK for a while.

He was in an accident. Admitted to our ICU for a couple days.

I wonder who paid the bill.

Jolie, BSN · Feb 12, 2008

In order for the government to be a least a little effective, we all can't specifically earmark exactly where we want each of our tax dollars to go.

You are right, there are functions that must be handled by the federal government, such as national defense, regulation of interstate commerce, etc. I have no problem with my tax money supporting those functions. My beef is when tax dollars are taken and used for "services" that I (and most capable Americans) do a much better job of ourselves, including investing for retirement and providing healthcare. Even if you argue that there are some Americans who are incapable of providing those needs for themselves, that does not justify mandating participation by those who neither want or need these "services". They should then be "means tested" just as other social welfare programs are. As much as I detest SS, at least I am still free to invest on my own (which I do, because I believe I will never collect a dime of SS.) It is a frightening prospect indeed that healthcare may be completely taken-over by the government, leaving Americans with no alternative.

jjjoy, LPN · Feb 13, 2008

Do those who oppose SS do so mainly because they think they'll get nothing in the future (which isn't how it was originally set up)? Or because they'd rather keep that money to spend/invest how they choose?

As I understand it, SS was specifically set up to pay out to ALL seniors, not just those without any resources, because it was thought that that would make it more palatable for everyone to contribute, even those who had very little chance of ever actually needing to supplement their retirement income.

There are many who think that if SS is tweaked (increase age of retirement, change the benefit schedule), that it CAN continue to supplement retirement, especially for those who don't have a good retirement plan or much retirement savings (whether due to poor planning or due to bad luck - such as having to deal with a debilitating illness). And not everyone can expect to get as much out of it as they put into it. It's kind of like an insurance policy that way.

SS does need revamping, but I do want to live in society where if I happen to fall upon bad luck, especially in my old age, that I won't be afraid of becoming homeless or not being able to pay for medications that I rely on. I do save for retirement but that doesn't mean something won't happen wherein I'm too old & worn out to be fully gainfully employed but don't have enough to live on. Social programs might also fall through, so I'm not counting on it. So having both seems like a balanced bet for both society and individuals.

Jolie, BSN · Feb 13, 2008

Isn't the idea behind tapping pay to make sure that those who do have financial resources DO pay into health insurance instead of opting out which can increase costs for all by removing healthy people from the insurance pools and by ending up needing more gov't assistance because they didn't have health insurance when they needed it?

You know, I just don't buy the argument that we must force everyone into government-sponsored healthcare in order to dilute the risk pool and make premiums "affordable" for all.

If you believe the widely-quoted figure that there are 45 million Americans lacking health insurance, and you believe the breakdown that those lacking health insurance are young mothers and their children, low-wage earning families, employees in entry-level jobs, etc. then you see that those are not, generally speaking, unhealthy members of our society. They are mostly young working people, who should be relatively inexpensive to insure, especially since statistics also show that the health problems they experience largely stem from lack of access to primary, preventive care, which is the cheapest kind of care to provide. The most expensive pool of people to insure are the elderly and permanently disabled, both of whom already have access to coverage thru Medicare and Medicaid, and would not need to be factored into the argument of whether or not we should mandate participation in government-sponsored healthcare.

So there is no financial reason to force citizens who are satisfied with their current coverage into a government plan.

Jolie, BSN · Feb 13, 2008

There are many who think that if SS is tweaked (increase age of retirement, change the benefit schedule), that it CAN continue to supplement retirement, especially for those who don't have a good retirement plan or much retirement savings (whether due to poor planning or due to bad luck - such as having to deal with a debilitating illness).

That SS needs "tweaking" to remain afloat clearly demonstrates that the plan is not delivering what it originally promised.

Why would you believe that healthcare would fare any better?

jjjoy, LPN · Feb 13, 2008

That SS needs "tweaking" to remain afloat clearly demonstrates that the plan is not delivering what it originally promised.

By that logic, it would seem that the fact that current system of health insurance actually increases costs (through high administrative costs and inflated procedure costs) demonstrates that it's not a very cost-effective system.

SS has been around for decades. It doesn't seem like a failure that it would need tweaking after all that time.

PS I'm glad to have a civil discussion on these issues! :up:

azhiker96, BSN, RN · Feb 13, 2008

I think any government sponsored program (paid by you and me) needs to have incentives for people to make responsible healthcare choices. I see that with my car insurance. If I'm in accidents, or get speeding tickets, DUI, etc; my rates go up. Likewise, if I use tobacco, maintain an unhealthy BMI, fail to schedule screening tests (pap, mamo, colonoscopy, labwork, etc); I should have to pay more for my health insurance. I've communicated that by email to my favorite candidate (who is not Hillary) and hope it's included in his program.

HM2VikingRN, RN · Feb 13, 2008

I think the actuarial model is more expensive administratively. I personally think that a flat rate plan is better from both a financial and a social justice standpoint.

HM2VikingRN, RN · Feb 13, 2008

SS (and other defined benefit pensions) deliver a higher average rate of return than private accounts.

8. Author’s calculations based on a 7.9% return for defined-benefit plans versus a 7.1% return for defined-contribution plans (Source: Alicia H. Munnell and Annika Sundén, Coming Up Short: The Challenge of 401(k) Plans, Washington, D.C.: Brookings Institution Press, 2004).

http://www.sharedprosperity.org/bp204.html

Jolie, BSN · Feb 13, 2008

SS (and other defined benefit pensions) deliver a higher average rate of return than private accounts.

Our sources differ greatly on that assessment:

James Glassman has noted, "Returns to the investment portion of Social Security are extremely low. For persons born in 1960, returns are estimated at between 1 percent and 2 percent in real (inflation-adjusted) terms...

http://www.cbpp.org/3-11-99socsec.htm

What can Americans expect in future Social Security retirement benefits? A Heritage Foundation study reveals that the Social Security system's rate of return for most Americans will be vastly inferior to what they could expect from placing their payroll taxes in even the most conservative private investments. For the low-income African-American male age 38 or younger, the news is particularly grim: He is likely to pay more into the Social Security system than he can ever expect to receive in benefits after inflation and taxes.

If Americans were allowed to direct their payroll taxes into safe investment accounts similar to 401(k) plans, or even super-safe U.S. Treasury bills, they would accumulate far more money in savings for their retirement years than they are ever likely to receive from Social Security. For example: See link for full example:

http://www.heritage.org/Research/SocialSecurity/CDA98-01.cfm