Shall employers be responsible for health care?

[question everything]

Dick Gephardt in 2004 and John Edwards now still want employers to be the major venues through which Americans get health insurance. The proposals that are offered by many candidates concentrate on supplementing this main venue.

A disclaimer. I am not an employer, never been one, nor is my spouse. Never even been a self employed one. However 8 years ago, during yet another change of jobs and facing a very expensive COBRA payment I decided to pay for my own. Yes, it is expensive and is getting more so every year. But at least I figured that I would get one while still healthy and relatively young (everything is relative) with the hope that if I do develop a major health problem that I will be in and will not be terminated.. though one can never know..

We have to remember that employers who pay for health insurance call the shots. They are the one who change carriers whenever they see fit; they are the one that carry - if they choose - a copy of the health history that every employee has to fill when joining the program. They are the ones who get a report of which employee sees which provider. No, not the details of the visit but if a female member of the family visited an OBGYN who is known to be the only one in the area to still perform abortions... if a family member sees an oncologist..

This may be me: I like to keep my privacy. I don't think that it is anyone's business if I develop a devastating disease. Perhaps I will tell my boss, but I would like to determine when and where. Perhaps it is an age differences with so many today expose all on Oprah, or on MySpace and other public places...

I also think that when employers pay for health care they use this as an excuse to cut on wages. I'd rather be paid for what my work is worth and let me seek the best health insurance for me at this time of my life.

Some 10 years ago Congress came with the portability law where if you are covered and change jobs you cannot be denied a new coverage. However, I think that pre-existing conditions still kick in so we still have the unhealthy situations where people stay in jobs that they hate, or that they have long lost any fit just because they need the medical coverage. And I think that I've seen comments about this even here on DU.

We have to remember that employer provided "benefits" came after WWII when there was a wage freeze.

And I have to wonder how much of health care costs have enjoyed a free ride upward all those years since most of us do not pay directly. Yes, our premiums are going up but do we know the real cost? Can we negotiate, seek the best deal for ourselves? And how many of us actually see a doctor's or a hospital's bill? Most of us pay the office visit, or the deductible and let the insurance take care of the rest.

We trust the market economy for all of our other purchases to lower prices based on changes in consumer demand. Why not for health care? No, when we are having a heart attack we are not going to search for the best ER or a cardiologist; we will do this when shopping for our health insurance. And if we were real consumers we may stay away from those insurance companies who give obscene compensations to their CEOS, or who are even traded on the stock market. And we will demand that our representatives look at the spiraling increase cost of health care - if we think that something is not right there. We may even move to a system where our payments go to the ones who actually provide health care, not the ones shuffling papers and making sure that they keep costs down (meaning denying coverage).

To go back to my first comment. All the proposals are aimed at helping the ones who are not covered by the "preferred" program - employers. And this is why many realize that universal health program will be soundly rejected, we even see this here, on DU. Most Americans who are covered by their employers and are the most active in politics like what they have. Or if they are currently unemployed, liked what they used to have.

But if we are responsible for our own coverage, perhaps we will eventually settle on some type of a hybrid program where we pay taxes for a universal care but that leave us to go "private" if we so desire. I have often compared such an approach to our school systems. All of us support public schools with our taxes - whether we use them or not. However individuals are free to send their kids to private schools, and to pay for them.

Oh, one last point. About 30 years ago Congress decided to encourage Americans to provide for their own retirement and established the IRA (traditional) where payments were deducted from their gross income.

I think that something similar needs to be done with payment for health insurance. Instead of letting health care cost that exceeds 7.5% of income to be an itemized deductions, payments for health insurance, at least, should be an income adjusting item. No doubt, Congress has the means to calculate the loss of revenue from these adjustments and compare them to the cost of treating uninsured people in the ERs.

I would appreciate DUers input. I supported Edwards in 2004 but now am not sure, precisely for the main pillar of his platform - forcing employers to pay for health coverage.

[Hieronymus]

1. No, health care should be single payer, as all other Western Nations have.

[Demeter]

13. D'accord! Si'! Ja Vohl!

[LeftCoast]

38. You are incorrect actually

Switzerland (at least) has universal, multi-payer healthcare. It is a system I prefer to single-payer actually, as it provides both choice to the consumer AND innovative ways of saving money on healthcare. For example, one Swiss insurer offers a 50% rebate on your premiums if, after two years you are still as healthy as you were starting.

[aquart]

2. Healthcare should NOT be tied to employment.

This is a huge mistake in this country. Getting healthcare off the backs of businesses will be one major step in restoring economic health to this country. A healthy population is a national security issue and should be treated as exactly that: a vital federal concern.

[MADem]

3. I go for the national health care model. The "employer pay" model discriminates against small

business owners, and really HAS to exempt TINY business owners, and the large companies benefit from economies of scale.

Level the playing field, nationalize it. And shove more doctors into the damned mix, too, by giving scholarships to docs who will work in underserved areas.

[glowing]

4. I agree... mainstreet America can take itself back if it can compete.

by leveling the healthcare worry, people would have choices in their jobs.

[LiberalFighter]

15. You are partly right

Big businesses pay more of the health care when it involves 2 income families. IF the insurance plan for the big business is better than the small business then the family will more likely use the big business plan instead of the small business. It might cost more for the other families that derive their income and health plan from the small business.

We don't know how much companies themselves pay for the health care. Maybe they don't pay anything or maybe the portion they pay vs the employee is higher or lower than other companies.

But if we have national health care it would equalize the playing field for businesses.

Health care insurance companies would lose out in the profits they currently receive. CEO's and other top executives will be crying with the loss of big salaries and benefits.

[Joe Bacon]

5. America will never have national health care

That's a sad truth. Americans are too selfish to support it, even if Kucinich got single payer to the point that the Congress is debating it, you can bet that Harry and Louise will pop up again to brainwash the masses into keeping the status quo. Yep, Harry & Louise will tell you that it's not in YOUR interest to have a government bureaucrat ration your health care, but they won't utter a syllable about how it's in your interest to have an unelected corporate bureaucrat beancounter deny you anything.

My parents lost their home paying medical bills. What do my sisters have to say about that? Well, they sure were glad that Mom and Dad weren't in Canada where everyone waits and waits and waits. My sisters swallow the Kool aid. Both of them have chronic conditions and have problems paying for their medicines, but they are not interested in any national health care program. I just shake my head and I gave up trying to comprehend why they are so stupid.

The sad truth is that no country in the world is as selfish as the USA. No other country comes close.

[question everything]

7. I agree. Which is why I think that the first step

is to get employers out of the equation.

And then, if the load is too harsh, we will have a universal system only if it comes from the voters, the majority of them. It has to be an upward move, not a downward one.

[Demeter]

14. Harsh Methods. We Are Already At This Point for 40 + Million People

How many will it take?

[question everything]

22. Most of the 40+ million are poor, homeless, mentally ill

who, in most cases, are not actively involved in politics. Which is why they need us to worry about them, which is why even some Republicans realize this is a problem because when they do go to the ER their cost of treatment is added to the cost of the insured ones.

But if regular middle class people all of a sudden realize that when they are paying for everything, health care all of a sudden is too expensive for them, when the rate of increase in health care far exceeds that of their inflation pay increase (if at all) they will be the ones pushing for universal coverage.

After all, if these days you tell someone that health care should be handled by a government agency, you cannot really hold it against s/he if the reply would be: oh yeah, like FEMA? Like the Defense Dept.?

[Manifestor_of_Light]

30. I am NOT poor, homeless, or mentally ill.

I am a third generation Democrat, my dad was a union organizer, and I have been active in politics for many years.

I fell out of the middle class. Me and millions of others since Clinton backed NAFTA and the good paying jobs left. I can't find a job. I have not had health insurance since my SO was laid off from his crappy low paying job a little over a year ago. We are both suffering from age discrimination.

I have several chronic health conditions i take medication for.

My SO has a BS and MS in physics, and an associates' degree in video production.

I have an AAS, a BA in Biology and a Doctor of Jurisprudence (law degree).

It's not like we don't have skills and talents and experience. We're expensive and overqualified and over forty.

Neither of us can find a job, and we are going to sell my house and move to the country to survive.

We're part of that 40 million that fell out of the middle class. Insurance should not be tied to employment. It should be single payer and universal. Preventive health care is much cheaper than the expensive health care we have now. People don't get checkups and preventive care, and they don't get treated at all until it's quite expensive to treat.

This country is entirely too short sighted.

[question everything]

33. I apologize. This did not come out right

The reality is that many of the uninsured are young healthy individuals who cannot afford and do not think they need insurance. Which is why any universal plan will have to be mandatory for everyone.

And, yes, many who caused the huge increase in the number of the uninsured during the past 15 years - or so - are middle class who lost their jobs.

I should have said unemployed, instead of poor. Either way, when you do not have a job your first priorities are food and shelter with health insurance come later.

I was coming from another thread of mine, about illegal immigration, when I questioned the assumption that illegals burden our hospitals. Several weeks ago "60 minutes" had a program about hospital "dumping" and it was clear that most are homeless and, in many cases, mentally ill.

[raccoon]

37. Please see my post # 31. Lots of working people don't have insurance

because their employers don't offer it.

ANd then there are those who can't pay the premiums on employer-provided insurance.

[raccoon]

31. Strongly disagree-with that statement,

"Most of the 40+ million are poor, homeless, mentally ill"

Most of the uninsured I know are just working for some employer who doesn't offer health insurance.

[LiberalFighter]

16. I would love to see a commercial with Harry and Louise

sitting at the table debating the issue. And then God comes down and shoots them.

[Joe Bacon]

18. The pimps who run the insurance racket have their bases covered

The pimps running the insurance racket won't give it up. They'll spend whatever it takes to torpedo any national health insurance proposal. I've seen their dirty work twice, in 1974, when the got Kennedy to abandon Kennedy-Griffith Single Payer and go with Wilbur Mills that let the pimps keep running the show. They manipulated the media just right to torpedo single payer in 1974.

then 1994 came around and the pimps first got that has been actor Monte Markham to push their managed competition scheme that they hatched at their secret meetings in Jackson Hole. They succeeded in steering Hillary away from single payer. Then they released harry and Louise from their pods to finish their own plan off.

We had prop 106 here in California in 1994 that would have established single payer. The pimps spent 100 million to tank it, they ran a masterful disinformation campaign, peaking when the Catholic Bishops went after 106 in the pulpit, saying that every girl would have abortions covered under it.

Its just so sad to see Mike try to change the perception, but he will fail at this too. It's just sad to see that every picture Mike has made backfired. Roger and Me led to GM shutting down even more plants. Bowling For Columbines backlash killed the Brady Bill extension. Fahrenheit 911 fired up Bush's base and played into Rove's hands. Sadly, I expect the same backlash to tank SiCKO. I know that Billy Tauzin is just sitting back and laughing at Moore. Tauzin is waiting for the right moment to unleash the latest version of Harry and Louise on a gullible public.

Billy is going to do everything he can to keep the cash going to his fellow pimps at the expense of everyone else. Given the track record of the past, he will succeed and single payer will go dead for another generation.

[Hieronymus]

19. Sadly, many Americans are as misguided as your sisters, but

it's just a matter of time until we follow the rest of the world.

[Warpy]

6. Health care cost escalation is a true measure of inflation

in this country because it is one of the things that can't be outsourced or manufactured offshore. Inflation numbers have been fudged for years by changing the contents of the CPI market basket to exclude all the necessities that were inflating in cost and include all the frills that were manufactured offshore.

We can't afford for profit insurance plans any more, we have simply gotten too poor as a nation. Some auto plants have hopped across the border into Canada to get out from under medical insurance obligations, not to save money on labor.

The cost of for profit insurance has been killing business for a long time, and cost shifting onto employees is killing them, too. Plus, the aim of an insurance company--to maximise profit--is at odds with its mandate to provide timely, appropriate and thorough care to sick people.

Some things don't belong in the for profit sphere, things where a degradation in service is dangerous: education, police, fire protection, the military, and health care.

Expand Medicare NOW. Accept nothing less!

[question everything]

9. Some of it

A friend got a pay raise of 4% "like inflation" while my health insurance premium is up 10%.

[Cleita]

8. Part of the single payer plan would be to divert the money

paid to insurers to the health plan directly instead. hefore employers and probably employees would have to pay some percentage like they do for Social Security and Medicare. Most likely it would be included in the FICA deduction and co-pay. However, after that all employees and their families would be covered. Since Worker's Comp wouldn't have to pay medical benefits anymore this should in theory lower their Worker's Comp. insurance as well. I believe employers and unions, once they understand how a quality plan would work, would be right on board with it other than the insurance and PHARM industries who stand to lose big profits.

A fallacy that the insurance industry likes to play up is that free government health care is inferior. The fact is that it isn't free because everyone shares in the revenue pool like they do for social security. It just can be delivered more fairly and universally because SPUHC (single payer universal health care) can deliver the same quality health care for 40% to 40% less than it costs now and it covers everyone, not just those who are enrolled and basically cherrypicked for coverage to be least likely to need health care. Big profits are made on this at the expense of the sick and disabled. The hugenistrative costs and profits would be eliminated with SPUHC.

[welshTerrier2]

10. employers should not be the source of health insurance

the OP raised all sorts of issues about health care and health insurance.

i start with the basic premise, i.e. the basic fundamental value, that health care is a right. it is unacceptable to me to have ANY priority higher than the priority of protecting and preserving the health of each and every citizen. so, if i have a choice of buying a weapon from the military-industrial complex or paying for someone's health care, i do NOT buy the weapon. if i have to make a choice between fighting a war in Iraq or providing health care, i do NOT fight the war. it's all about priorities. JOB ONE for government should be to ensure that all citizens have access to quality health care. Nothing is more important than that. Period.

Now, are employers a good way to provide health care to all citizens? of course not. many people are not employed. also, under the current system, far too much power accrues to employers. if you lose you job, and this is always an implied threat, you lose your health insurance. and worse, now that you have no income, you can only get lousier insurance at much higher rates. that's a great system, eh? some "incrementalists" have proposed bandaid solutions that would make your current coverage "transferable" so that you wouldn't lose your coverage if you lost your job. that's not good enough. insurance is NOT health care.

and employers have NO RIGHT to know about your personal medical situation. is it just a little possible they might use your medical information to discriminate against you?

we need to put the power to make decisions about your health care where it properly belongs. we need to take BIG INSURANCE out of the equation. health care decisions should be made between doctors and their patients and NOT by insurance industry accountants. when the primary motive of those with the power to decide is profits rather than quality health care, exactly what kind of health care is likely to be the result???

[area51]

27. "JOB ONE for government should be to ensure that all citizens have access to quality health care."

:thumbsup:

There is no other position more pro-life than single-payer universal healthcare . It's a national security concern that citizens are kept healthy.

[question everything]

28. You know it and I know it and most DUers know it

however, the reality is that most are happy with their employer-provided insurance. They dread of anything offered by the "government" and the recent conduct by FEMA and by the Dept. of Defense just confirm their mistrust.

Even here - how many DUers actually trust the government?

[gizmo1979]

11. This is going to sound nuts

but if we really want to bring the cost of health care down.I think all major employers should drop insurance at the sametime.They wouldn't even have to drop it,just threaten to drop it and the panic in the insurance and healthcare industries would be massive.They would have to offer up some kind of concessions.
Even if we go to single payer,the costs will still be out of line.We need to blow up the whole system and start anew.

[avrdream]

25. When I worked in Texas,

many of the physicians I worked with were talking about dropping their malpractice coverage all at once. They, too, felt that the only way to make the insurance companies change tactics was with a MASS revolt.

Unfortunately, doctors can't even give a discount to cash-paying patients because the insurance companies then lower their reimbursements to that same level.

Additionally, if a physician (in Texas at least) drops their malpractice insurance, the other insurance companies will no longer reimburse the doctor. So, if you drop your malpractice, you have to go to a cash-basis only practice, which isn't very viable when it comes to surgical practices.

Any way about it, the insurance companies are the biggest contributors to this crisis. Requiring employers to then purchase insurance just keeps it going and going and going and going. Someone please make the madness stop!

[LiberalFighter]

12. Neighbor told me it would cost him $500 a month under COBRA law

to continue insurance if he retired.

[question everything]

23. COBRAS are expensive because they cover everything

that not all of us need at every stage of our lives. Some examples are maternity and pediatrics and orthodontics (if one has dental insurance).

[papau]

17. An inelastic good like medical care gets nothing out of a "free market" plus risk premiums

should not exist for health insurance for a nation - but in our system they do exist, indeed they must exist as each employer tries to insure only the folks who will not get sick - and those "risk premiums" add 15% to our national health insurance costs - for no reason.

I have no problem with the idea we should Maintain a free market as under Medicare where Doctors can opt out and try to price there services to a select clientèle willing to pay more. But Private insurance company control of health insurance is a financial, moral disaster for our nation that is also inefficient as to public health (we rank near last of the developed nations despite our spending the most).

As an aside, Dick Gephardt is owned by the insurance industry - that was told me by the CEO of the largest insurance company in his state - and Edwards is trying to get something as an addon to our current employer based system.

Paying for your own health costs is the con job of the GOP that is trying so as to move health dollars into the hands of non-health insurance companies - so that everyone in insurance can get some "asset under management" and the fees that go with that - as well as claim payment charges (that are rapidly being offshored as to jobs with the now jobless or less employed being told to pay those off-shore employees - this is not good for the economy).

The whole point of "insurance" or "coverage" is peace of mind - and you have kicked peace of mind to the curb when you avoid insurance premiums because you think you are healthy. Hell of a way to get a nations population healthy so they are not a burden on the rest of us.

"a copy of the health history that every employee has to fill when joining the program" is severely limited by law - why should not pretend otherwise. Medical Privacy has many laws saying what can and can not be asked - and who can see your response is severely limited and almost always requires your permission on a case by case basis. The employer does not get "a report of which employee sees which provider" - indeed if you know of an insurance company providing that information could you state it so I can get them shut down?

There is no efficient database of anyones problems and medical history that is such that a medical professional can use it easily - indeed getting such a database (similar to the one maintained by the VA) is one of the reforms proposed. As to insurance companies information about your health that is a record that uses a very limited descriptive code in what is called the MIB database - and that database has it's own set of laws that prevent anyone seeing it without your permission, and then those laws provide rules on who sees it and how the information is used should you give your permission for an insurance company to access that database.

Your privacy violation example is not real

Of course your total cost of employment is considered when wage decisions are made - but how is that changed if there where no employer provided benefits ? ? - the studies show the result is greed - folks try to "save" by not getting insurance of their own - just as you have done - hoping the state will provide through the ER rules that require life threatening problems to be attended to (stabilized only unfortunately). The result for the nation is less work output as public health drops and more people get sick.

The main Democratic candidates' proposals end pre-existing conditions - period. If your point is that pre-existing conditions exclusions - a requirement for non-group and small group health insurance from insurance companies so that insurance companies can make money - sucks, I'd say all agree with you. It is not an argument for a "free market" health care solution. The idea that you can negotiate, seek the best deal for yourself as to insurance policy and premium is a joke - I can design in an hour a policy that sounds great and provides near zero real benefits. To determine the value of what you are buying takes a list of questions that you'd have to ask that is long and you would not know what to do with the answers.

We do not trust the market for inelastic goods in near monopoly situations - that is the con job that brought you auto insurance special risk pools and electric rates in California that nearly bankrupted the state.

Your point as to the paper shufflers denying coverage is a reflection of the fact that exists in any system - care will be rationed - either by your running out of money if you take the risk on yourself, or by the coverage being limited to that which gives the best bang for the buck in terms of public health (with you having the option if you having the money to get coverage from an insurance company supplemental policy for that boob job).

American's covered by their employers is about 50% of the health dollar - the rest is government programs like Medicare and Medicaid for the poor, and local governments picking up uninsured ER, doctor, and hospital costs.

There is little reason to preserve the employer based system - other than the fact GOP is on its knees to the corporations.

But after all the above, we agree on what should be the ultimate health program - a hybrid program where we pay taxes for a universal care but that leave us to go "private" if we so desire.

You end with an idea of a cap on health costs - I assume that means costs for some limited set of procedures rather than nose and boob jobs - and indeed that is the result of single payer national health where the cost is a percentage of income (not wages only - but a percentage of income that includes investment income) that is a tax that pays for the basic coverage health system.

[question everything]

24. Thank you for an economic output

first, you misunderstood my post. I am insured. I just pay for my own insurance - to a Blue - rather then rely on an employer for this.

As for the privacy issues - new laws may have ended these problems. But in 1990 while employed at a small - five employees - firm in Florida, the owner would routinely give me a copy of a report sent by the insurance company to him listing the medical provider and the charges. I even wrote to someone at the State government because I could not believe it and thought it was against the law. The reply was that this was an agreement between the employer and the insurance company and to "talk to him." I did not, of course.

Then, in 1994 I was in the personnel office of another small company in California filling for the regular personnel manager and I saw how all the personnel files contained the original medical applications. I talked to the insurance representative and requested to stop this practice. When the owner heard about it he was furious, did not want this practice stopped. I even asked an outside opinion and the reply was that while not against the law, it was better not to have this practice since by then, at least, the privacy of HIV infected employees was protected and eliminating the presence of medical history would protect the firm from any future breach of this privacy.

I did not suggest capping medical costs; I would not know how to. I do support paying for medical providers, not for CEOs of for-profit insurance and hospitals - like Frist's family business.

Right now most Americans who are covered by their employers are happy with what they have. And after one government agency botched helping hurricane survivors and another agency botched two wars in far away places, not to mention the shameful images of Walter Reed Hospital, you really cannot blame your average American for saying: government agency managing my health care? No, Thanks.

[Alexia Wheaton]

34. Sounds good to me.

If healthcare is inelastic, then the market should not take care of this part of the economy.

[Rosa Luxemburg]

20. people should pay a health tax and the rich pay a lot more

health tax should be income related and the unemployed, disabled, seniors, veterans etc go free. The very rich pay a lot more. Companies should pay the government a health premium each year dependent on their profits. Oil companies would pay millions. Small businesses would be exempt from this. State govt controls the health budget and each healthcare entity (hospitals and health centers, doctors offices etc. can join a healthgroup. Health insurance companies have to disband or join a healthgroup. Every US citizen, greencard or visa/work permit holder has access to treatment (free at the point of use).

[AZBlue]

21. What's the plan for the uninsured unemployed?

[question everything]

26. Here is Edwards' plan

http://www.johnedwards.com/about/issues/health-care/

Seems that they all talk about families, and children but not about adults.

[raccoon]

32. Oh, don't you know the working uninsured adults don't matter. :sarcasm: nt

[LWolf]

29. Universal, single payer, not-for-profit health CARE.

Instead of debating who is going to pay the insurance companies that then decide whether or not my condition is worthy of care, or whether I should go outside my insurance to get care, or how much extra I need to pay after the insurance premium has been paid,

I want universal health care, no questions asked, as a right for every single citizen. Paid for with tax money.

[SteelPenguin]

35. I am a business owner and I 100% agree with you

100%

"I also think that when employers pay for health care they use this as an excuse to cut on wages. I'd rather be paid for what my work is worth and let me seek the best health insurance for me at this time of my life."

This is totally the case. If we hire someone, the cost on our end is their salary plus benefits. It factors in, and can be significant. I'd rather not have to do algebra to figure out what an employee costs us and just pay them cash. I don't know about saying it's an excuse, but it's a major factor. I'd rather say "your salary is X, and if you'd like health care it's Y a month. Up to you."

Actually I'd rather not be involved in health care at all. It's ludicrous that I as an employeer am involved. Why is it my responsibilty to pay for your health care? For your children? Why should you be afraid to leave your job because you'd lose your health care?

I'm for anything that helps, but I just don't think Private Health Insurance companies or your Employeer should be involved at all ultimately. Single Payer graded scale out of your taxes. Something I don't have to think about, and my employees don't have to worry about.

oh also, I was self employeed for a while, and during that time moved states and had my own health care. I challenge anyone to do that and not be immediately for universal single payer national health care ala UK or Canada. Not only was it insanely brutally hard, but almost impossible to do, and inconceivably expensive.

I'm sick of living in a third world country.

[question everything]

36. Thank you. Yes, we expect employers, and schools

to take on too many social responsibilities that do not belong there.

Still, most people who are covered by the insurance offered by their employers like it, they do not want the government in their business so moving to a universal care will be a hard road.

As for individual coverage - they are hard to come by precisely because these are the exceptions.