How will making health insurance mandatory help?

[ponderingturtle]

Mortimer how does being shown that the uninsured will be denied organ transplants, for good reasons(if it is likely that they will not be able to take anti rejection drugs it is better to give the liver to someone whos access to the drugs they will need is not questionable).

Does that change your position any or are you ignoring your that your claim that being insured was unimportant to organ transplants has been disproven?

 

[WildCat]

As I understand it, the present US system for health insurance is significantly compulsory anyway. I think that an employee can opt out of the cover linked to their employer, but they always lose a tax break, and in many (most?) cases they also fail to get any compensation for the net premiums either.

Almost all employer coverage requires the employee to pay a percentage of the premium. So if you opt out you get a bigger paycheck because your share of the premium isn't deducted.

 

[mortimer]

Mortimer how does being shown that the uninsured will be denied organ transplants, for good reasons(if it is likely that they will not be able to take anti rejection drugs it is better to give the liver to someone whos access to the drugs they will need is not questionable).

Does that change your position any or are you ignoring your that your claim that being insured was unimportant to organ transplants has been disproven?

I will modify my claim. Without insurance, one can (not will) be denied an organ transplant. Of course, even with insurance, one can be denied an organ transplant.

 

[WildCat]

Brief siderail: the Blue Cross plan I have for my family from my school district is much better coverage and costs $10,800 a year. There are multiple school districts in the coverage pool, so perhaps that keeps costs down a bit?

Of course, because you get into buy into that pool. Anyone else has to buy an individual policy. Employer-based health insurance favors larger companies at the expense of smaller businesses and individuals.

And the bill before Congress, by requiring employers to offer coverage, actually further entrenches the flawed US model of employer-based coverage.

eta: you also don't get taxed on your benefit. Anyone else buying insurance outside of an employer plan has to pay for it out of pre-tax gross income. You do not get to deduct health insurance premiums for tax purposes.

 

[WildCat]

I will modify my claim. Without insurance, one can (not will) be denied an organ transplant. Of course, even with insurance, one can be denied an organ transplant.

Show one hospital's transplant policy in which a non-insured, non-wealthy person is eligible for a transplant.

 

[mortimer]

Show one hospital's transplant policy in which a non-insured, non-wealthy person is eligible for a transplant.

Even if I could, this was never my claim.

 

[mortimer]

Show one hospital's transplant policy in which a non-insured, non-wealthy person is eligible for a transplant.

As it turns out...

Trying to Help the Poor

Thankfully, not all transplant centers turn away uninsured patients, pointed out Mary Simmerling, a bioethics fellow at the MacLean Center for Clinical Medical Ethics at the University of Chicago. She also runs a regional ethics consortium on organ transplants.
"Some [centers] have the luxury of really helping their transplant candidates to pay for the medications," she said, referring to the anti-rejection drugs that must be taken post-transplant and can sometimes cost more than the surgery itself.
The staff at the University of Michigan Transplant Center tries to help uninsured patients find a way to pay, said Dr. Jeffrey Punch, director of the transplant center. For some patients, financial assistance through Medicare or Medicaid can be arranged, although there are income limits.
"At our transplant center we have evaluated thousands of patients for liver transplantation, and we virtually never do a transplant without a plan for how it will be paid for," he said. "But we have only very rarely turned down a patient because of lack of insurance. In virtually all circumstances, the patient can arrange coverage of some sort."
However, because there is little governance over the transplant centers, it is not known how many people receive care like that at UMich or are turned away because of a lack of money, said Dr. Mark Drazner, a cardiologist at the University of Texas Southwestern Medical Center.

http://abcnews.go.com/Health/story?id=1514702

 

[WildCat]

As it turns out...

http://abcnews.go.com/Health/story?id=1514702

And how many such patients do they treat in a year? You've found the exception that proves the rule.

And note the "Medicare and Medicaid" thing. You may get your transplant, but at the expense of puting you and your family into abject poverty permanently.

 

[Francesca R]

Almost all employer coverage requires the employee to pay a percentage of the premium. So if you opt out you get a bigger paycheck because your share of the premium isn't deducted.

OK. So they can't get back the remaining percentage (any idea of the range this % takes?), or the tax deduction. Those are the bits they are forced to pay.

 

[mhaze]

Show one hospital's transplant policy in which a non-insured, non-wealthy person is eligible for a transplant.

There certainly have been such cases.

And by the way, public hospitals in my state are funded by property taxes, thus your complaint if it has any merit would be with state decisions - or their administratiave arm, the county. And the county has elections, and people can on their own decide such things.

Without any of your style "help" from a corrupt bureocracy 2000 miles away.

 

[mortimer]

And how many such patients do they treat in a year? You've found the exception that proves the rule.

And note the "Medicare and Medicaid" thing. You may get your transplant, but at the expense of puting you and your family into abject poverty permanently.

WildCat,
If you're interested in how many patients they treat in a year, feel free to call or write them to find out. I'm not particularly interested.

I did note the Medicare thing. Looks like that is one resource the hospital uses to pay for transplants for the uninsured, but as they noted, it has income limits.

Abject poverty? Evidence that the uninsured who receive transplants end up in abject poverty, please?

 

[ponderingturtle]

There certainly have been such cases.

And by the way, public hospitals in my state are funded by property taxes, thus your complaint if it has any merit would be with state decisions - or their administratiave arm, the county. And the county has elections, and people can on their own decide such things.

Without any of your style "help" from a corrupt bureocracy 2000 miles away.

So you prefer corrupt local bureocracies then.

 

[carlitos]

The average cost of health insurance premiums for a family of 4 is over $13,000. Do you really think this is affordable to a household earning $40,000 or $50,000? Not many people will stop paying the rent to buy health insurance.

Consider the dynamics of the $40 or $50 K though. Some employer or employers are providing benefits and payments in addition to that income. If the employer stopped paying their portion of employees' health care, they could pay that money to the employees, and they could spend as they see fit. Given the figures here about avg. policies, and typical benefits packages, we could be talking about $6,000 - $10,000.

I really don't understand the desire to have employers or the Federal government in the health care decision and payment process. It's one of the most personal things there is, your health care.

 

[Dunstan]

I really don't understand the desire to have employers or the Federal government in the health care decision and payment process. It's one of the most personal things there is, your health care.

I don't know that anyone, conservative, liberal, or otherwise, specifically desires to have the system work that way.

It's a classic case of path dependence. There were tax incentives for employers to provide, and employees to take, compensation in the form of health insurance. Maybe having it be employment-based had some risk-pooling advantages for insurers, too, I'm not sure of that. The obvious disadvantage to such a system, that you're in a rough spot if you change jobs, was perhaps not seen as such a big deal in an era when people didn't change jobs as often and health care wasn't as expensive.

Once such a (mostly employer-based) system arose, it became tough to get rid of, because the people who have insurance tend not to want it changed, and it's hard to come up with good reform packages that leave the employer-based relic intact.

 

[carlitos]

I agree with you on the history, I just wish we could move forward to end the employer-based system. Off the top of my head:

- 5 year 'transition plan' where nothing changes other than mandated portability of policy from job to job.
- During this time, require all kinds of disclosures so that employees see exactly what portion of their compensation is health insurance. Highlight it on pay stubs, end-of-year totals come in the mail with your 1099 or W-2, etc.
- Open up multi-state market to health insurers by harmonizing state regs as best as we can (not sure of Constitutionality, but heck, they invoke the 'commerce clause' for everything else including growing pot in your back yard)
- At the end of the transition period, shift the money to the employee, keep it untaxed, and automatically transition the policy into their hands.
- Companies could offer to pay policies via payroll withholding for convenience, but you could opt out and buy your own policy.
- Keep and promote flexible savings plans to cover out-of-pocket expenses.

I strongly believe that insurance costs would come down over time with the increased competition. Pools of people spread across geography make more sense than employees of one company in one state.

 

[WildCat]

Consider the dynamics of the $40 or $50 K though. Some employer or employers are providing benefits and payments in addition to that income. If the employer stopped paying their portion of employees' health care, they could pay that money to the employees, and they could spend as they see fit. Given the figures here about avg. policies, and typical benefits packages, we could be talking about $6,000 - $10,000.

Why are you assuming there's benefits? In my industry (home repair/remodeling/rehab) the norm is no benefits at all. No 401(k), no health insurance, no paid vacation, no nothing.

Brought to you in large part by millions of illegal immigrants arriving to do the jobs "no Americans will do", and enabled by US, state, and local governments who refuse to enforce immigration laws. And, of course, property owners who hire them.

I really don't understand the desire to have employers or the Federal government in the health care decision and payment process. It's one of the most personal things there is, your health care.

Agreed 100% about the employer part, and half of the Federal part. Subsidies for premiums are absolutely essential, because for various reasons health care (and thus insurance) in this country are unaffordable for a huge chunk of the population, even those earning $40-$50,000.

 

[carlitos]

Why are you assuming there's benefits? In my industry (home repair/remodeling/rehab) the norm is no benefits at all. No 401(k), no health insurance, no paid vacation, no nothing.

According to progressive sites like this one, 60% of Americans have insurance through their employer. I won't pretend to know what percent of Americans are making $50,000 at a job with no benefits, but it's obviously not a majority.

According to the census, the median household income is $52,163. If 60% of Americans have employer-based health insurance, and 50% make more than $52,163, it stands to reason that most of those with employer-based insurance are in that top 50%.

Also according to the census, 2 of 3 Americans have private health insurance, with the vast majority (87%) having employer based, and the other 13% purchasing insurance themselves. With 87 million Americans already on government health insurance - medicare / medicaid / military, that leaves the infamous "45 million" Americans with no health insurance. Obviously, vast swaths of this population still receive health care, either by walking into the emergency room, purchasing health care directly, or some other means.

Brought to you in large part by millions of illegal immigrants arriving to do the jobs "no Americans will do", and enabled by US, state, and local governments who refuse to enforce immigration laws. And, of course, property owners who hire them.

I totally agree. If you look at the makeup of those in the skilled trades, and the income levels associated with this demographic change, it's a scandal. INS should raid job sites and perp walk every one of those responsible, from the CEO of Tyson Chicken to the union honchos who enable this fiasco.

Agreed 100% about the employer part, and half of the Federal part. Subsidies for premiums are absolutely essential, because for various reasons health care (and thus insurance) in this country are unaffordable for a huge chunk of the population, even those earning $40-$50,000.

If health care is unaffordable, why do the vast majority of those in the US have it? Why can't we go back to the days when people paid their doctor for a visit?

 

[mhaze]

So you prefer corrupt local bureocracies then.

Given the choice of one or the other, I'd go with local corruption.

Not that they are exclusive. Did you have a point?

 

[WildCat]

According to progressive sites like this one, 60% of Americans have insurance through their employer. I won't pretend to know what percent of Americans are making $50,000 at a job with no benefits, but it's obviously not a majority.

I'd bet it's the majority of those who don't have health insurance.

According to the census, the median household income is $52,163. If 60% of Americans have employer-based health insurance, and 50% make more than $52,163, it stands to reason that most of those with employer-based insurance are in that top 50%.

Don't confuse household income with individual income. They are not the same thing.

Also according to the census, 2 of 3 Americans have private health insurance, with the vast majority (87%) having employer based, and the other 13% purchasing insurance themselves. With 87 million Americans already on government health insurance - medicare / medicaid / military, that leaves the infamous "45 million" Americans with no health insurance. Obviously, vast swaths of this population still receive health care, either by walking into the emergency room, purchasing health care directly, or some other means.

Emergency rooms are only required to stabilize your condition, they are not the place to get cured. They'll stitch you up, they won't remove those stitches later. They'll revive you from the heart attack you just had, they will not provide you with follow-up care or prescription drugs. It's a bit of a stretch to call that "health care".

I totally agree. If you look at the makeup of those in the skilled trades, and the income levels associated with this demographic change, it's a scandal. INS should raid job sites and perp walk every one of those responsible, from the CEO of Tyson Chicken to the union honchos who enable this fiasco.

It got really bad in the real estate boom, nobody planned on staying in their homes more than a few years so they hired the cheapest workers they could dredge up hoping to flip it for a quick buck. No concern at all for quality, that's the buyers problem and he won't know for a few years because all the problems are hidden behind the walls...

If health care is unaffordable, why do the vast majority of those in the US have it? Why can't we go back to the days when people paid their doctor for a visit?

I've been without health insurance for many stretches in my life, and can attest first hand how difficult it is to even get to see a doctor when you don't have insurance, even when you can pay them. Try it sometime, call random doctors in the yellow pages to make an appointment. The first question they ask is "are you insured?" If not, they won't see you even though you can pay with cash, credit card, whatever. You end up getting shunted off to some clinic in a crappy neighborhood if you can go anywhere at all. I once had an ear infection that made me nearly deaf for a month, I couldn't see a doctor anywhere and didn't want to go to an emergency room (which they all said I could do) because despite popular belief they do bill you and send collection agencies after you, and they are extremely expensive. Eventually it cleared up on its own, but it was very scary for a time.

And you know what else? Even with health insurance I never see a doctor. I haven't had a physical exam since 1986. The goal is to not have a medical record at all, no record = no pre-existing condition the next time you have to buy insurance. It's totally screwed up.

 

[mhaze]

.... The goal is to not have a medical record at all, no record = no pre-existing condition the next time you have to buy insurance. It's totally screwed up.

Sometimes, a little relaxing trip to mexico is just the thing....