Strengthening Constitutional Self-Government

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Yuval on the Real, Fundamental Difference on Health Care

...between our two candidates. McCain’s plan levels the playing field between employer-based and other sources of health care. Say, as Biden often does, that your employer really does spend $12K on your health care. Without the tax break, he might not want to do that any longer. Then, it follows, he would give that compensation directly to you in salary. Instead of paying you in insurance, he’d pay you in salary. So you could expect, say, a 9K raise. Plus you’d receive a 5K tax credit or subsidy from the government for insurance (which it could afford because of the increased tax revenue that would come from taxing money spent on health care). You’d end up with maybe 14K to spend on health care for your family, with a wide variety of private options from which to choose. You could afford to choose to have private, affordable, portable health insurance. Health insurance that is much more really YOURS.

NOT ONLY THAT, Yuval explains how Obama’s plan would be a magnet pulling people away from employer-based health care into a system run by the government.

Let’s hope that McCain goes on the offensive by laying out these specifics and aggressively accusing Obama and Bidening of being extremely misleading the public when it comes to comparing the two plans.

Discussions - 8 Comments

Levin says,

"the portion of your wages spent on coverage becomes regular take-home pay, which you can use to buy insurance."

As a small business owner and employer of several, I have to laugh at the naivety of that statement. Give some a raise and not others for the same work? If only life worked that way. Levin is overselling this big time.

Part of the problem, it seems to me, is that we underestimate the extent to which a most people (who have insurance) have gotten used to not having to think very much about their health insurance. They like having their job or the government tell them what to do--even if what they are told to do stinks. It is one less thing that they have to think about and/or spend time comprehending and/or be responsible for directing. And we have succeeded in making health insurance and health care billing so complicated that it's not really fair to consider such people as simply lazy or irresponsible. Even though I know that we are very fortunate to have excellent employer based insurance (excellent, that is, as these things go), I dread the re-enrollment period and wading through all the yearly changes to the plans and having to pick between them. But this is nothing compared to when there is problem with the billing or doctor that was used in an ER is not considered "preferred," or the testing facility is out of network, etc. If these minor considerations within a more or less pre-determined plan seem to be daunting, imagine how daunting it must seem to a large number of people when they imagine taking tax credits and going out to shop for insurance from scratch. It sounds good in principle, but McCain should be talking not only about how much better and fair it would be--but also he should explain why it would be (if it would be) easier.

Julie, you are right that most people do not relish the thought of spending hours shopping for health insurance plans. But they would do so if it could tangibly improve their living standards. Most people would probably be ok with the current health insurance system except that 1)rising health insurance premiums are killing their wage growth and 2)changing jobs (common in our modern economy)means a gut wrenching break in coverage. Any successful selling of market oriented reform has to focus much more on how it solves problems 1 and 2 and much less time talking about increasing "choice". Choice is at best an instrumental good. Conservatives have to sell healthcare reform in terms of lower costs, rising living standards and more security.

Pete: add "convenience" to your list and I'm on board with you. It has to be straightforward and clear. I think people don't mind taking responsibility for their lives when what it is easy to understand what is expected.

Keep in mind..
From an employer's standpoint, taking $12,000 in payments for health insurance and converting it into $12,000 in wages/salary results in an additional 7.65% cost to the employer for the employer's share of FICA/Medicare taxes.

I run a small medical practice. The reason pricing of medical services, and coverage/claim process is not clear is two fold:

1) It's mostly the governments fault ;) When Medicare/aid started the game of not paying what a service was worth years ago, the pricing became irrational. If they only pay $50 for something that costs you $80 to break even, you have to make it up elsewhere. McCain's plan would make this worse, in that he will push for reductions (reduction in payments to doctors/providers) to make up for his credits.

2) The private carriers/providers now continue in this tradition. I work in with this everyday and not even I can decipher a bill I get from a hospital. Finding out what something really costs, and what the insurance company really paid, is not possible (they will not tell you). The providers have a big stake in keeping it this way because they play a game with local/state/feds on the cost of indigent care and tax breaks. The insurance companies benefit because they can control costs by covering what and when they choose.

SOOOooo, with all parties involved benefiting from the current system, "transparent pricing" would be the largest, best, but hardest to reach reform. In fact, it's all but impossible. We will have a fully socialized system before that because that is an easier sell (people really think this is what they want) from a political point of view. Then, transparency will be irrelevant, because their will be only one provider (the government) with the power of the sword (no real accountability except the horribly inefficient "political" one). In other words, you will die waiting for an MRI...but hey, you will be "covered" :)

P.S. McCain’s plan is incoherent at best, and defiantly makes some things (like pricing) worse. His idea that I am going to give a $cash$ raise to some of my employees and not others is so naive it makes Obama look like a wise statesmen…

Julie, you are exactly right about convenience but in the short run, a system built around individuals purchasing their own health insurance can't help but be more time consuming than one in which they are obligated to pick from whatever few plans are offered by their employer. I imagine that mechanisms for making choices more quickly and easily will come into existence (think Travelocity but for purchasing health insurance) but there will probably be a lag. Thats why it is so important to stress cost and security at the begining. Maybe creating a program for easy comparison shopping would also be good.

Lets create a department of homeland comparison shopping for the purpose of purchasing healthcare with money thats not worth its weight in toilet paper. healthcare is screwed ect ect, where is the growth going to come from to get revenue for any sort of change which will mean more spending somewhere. rather the government rapes the tax payers through taxes on incomes or products or just prints the money and debases the currency. How about a radical solution. End healthcare. Lets try social darwinism now that we are so receptive to other socialisms.

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