Most of what we call "Cadillac" plans here is basic coverage in other countries.

[Hello_Kitty]

Not having high deductible and co-pays and not having limitations on what will be covered is not an extravagance. It's not even about the proposed excise tax, though that is an outrage. It's about the fact that a person has to pay an average of $8K a year to get coverage that people get in other countries at less than half that cost per person.

[Oregone]

1. Yeah, sad.

Hell, no copay and no deductible insurance should be ultimately where everyone wants to go to; you cannot have equality and access for all if you charge at the point of use, as this causes self-rationing among the poor.

Instead of promoting the idea, the US has decided to tax plans that may follow that a bit. Outrageous.

[dkf]

2. I saw sicko last night thanks to a post here.

We really do have it worse than the rest of the world. I had no idea how badly we compare in our way of life.

[jtrockville]

3. For me, the most eye-opening: all were people WITH insurance.

It highlights that insurance is the problem, not the solution.

[dkf]

5. I had heard of these types of cases before which made me beyond upset over

The mandate with no public option. Hcr does nothing to address unfair denials.

[Jamastiene]

46. I'm still in shock that in England and France

they can just go to the doctor and if something is wrong, get treated. AND...this part floored me...if they are poor, they can go to the Cashier and get money to cover their trip to the hospital and back home. :wow:

Why can't we have that?

[LibDemAlways]

79. We can't have that because the bureaucrats who run our "for profit"

"health care" (I use the term loosely) system have no interest in actually keeping anyone healthy or fixing people's ailments. They exist solely to make huge profits for their shareholders and to assure that the CEO lives in a mansion and flies around in a private jet.

Here in Los Angeles we have a proud tradition of dumping indigent people onto the streets once they've been released - which happens very quickly once it's determined they can't pay their bill. The system is broken and the Dem's plan to mandate that people pay for insurance they more than likely can't afford is a sick joke.

[JCMach1]

82. Even here in the UAE, there is nothing like going to the payment window and getting a paid in full

stamp with no currency changing hands...

The first time this happened after our daughter had an 8 day illness back in 2004, we nearly passed-out with relief.

[treestar]

4. Other countries have more sensible people in them

We are stuck with what we have.

[Armstead]

7. Other countries have politicians who have actually led ion this issue

[treestar]

30. Who?

this is a democracy. People are ultimately responsible and should take responsibility, not just sit back and say the politicians should have made it happen. Those politicians knew they were elected by the voters and rationally want to do what the voters want and avoid what the voters don't want. They also have to work together and compromise with each other and realize they may have a constituency that is not going to get what it wants.

Nelson, for example, has to and should represent the voters of Nebraska and therefore cannot and even should not do just whatever the President wants.

[FreakinDJ]

6. My Cadilac Health plan has $500 per day deductable

and Gee Whiz - now I get to pay a 40% exsize tax too......

[karynnj]

61. If your plan is an individual plan, and you are paying cadillac rates,

you are likely one of the people who will gain because you will buy a better plan for less from the exchange. (Same goes if you work for a small business.)

If it is employer plan for a large company, are you sure that it costs enough to be a "cadillac plan"?

[ProSense]

8. Yeah, and it took decades for them to get there. The US has to start somewhere.

Also, while the U.S. per capita cost will drop as premiums drop, the uninsured population in the U.S. is currently equal to almost the entire population of the largest European countries. So spreading the cost across more than 300 million Americans is bound to reflect a larger per capita rate. Think about it, a country with 50 million people and 15 percent uninsured has to cover the cost of about 7 million citizens. That's one-seventh of the uninsured in this country.

Japan's population is nearly one-third that of the U.S., with the uninsured in this country equal to nearly one half of Japan's.

Canada's per capita cost is now $5,452.

The comparisons are apt, but the U.S. has to start somewhere.

[Hello_Kitty]

9. The most generous estimates have the uninsured adding 8% to the average premium.

So mandates (and don't forget that 23 million will still not have coverage even when mandates go into effect) will not bring health insurance costs down so that they're on a par with other countries.

[ProSense]

10. You don't think 8%

across the entire population is a lot? Those people without coverage, including undocumented immigrants who recieve emergency Medicaid for medical treatment, still count.

The bottom line is that reform will lower premiums, and that's a huge step in the right direction.

[Armstead]

11. An honest question -- How will it lower premiums?

I'm not asking a sarcastic rhetorical question. I really want to know.

I know that some people might receive subsidies.

But what will control overall rates for the majority of the population? And what will prevent rates from going so high that it remains unaffordable, even withy subsidies?

[Hello_Kitty]

13. And apparently, the excise tax isn't properly indexed for inflation

So when your premiums do go up they start getting taxed, which will cause more employers to reduce or drop coverage.

[ProSense]

17. "which will cause more employers to reduce or drop coverage" Pure speculation

with no basis in fact. Employers who drop coverage will be subjected to fines.

How would not providing health care keep a company competitive?

[Hello_Kitty]

18. And what is it you think you are doing? Speculating.

You have no assurance that premiums will go down after HCR. You hope they will.

[ProSense]

21. "You have no assurance that premiums will go down after HCR." What?

To repeat, the CBO found that premiums go down under health-care reform

[Hello_Kitty]

26. Yes, because of reduced benefits caused by the excise tax!

Premiums will be less but so will the coverage. Which means more co-pays and deductibles.

However, CBO and JCT estimate that most people would avoid the cost of the excise tax by enrolling in plans that had lower premiums; those reductions would result from choosing plans that either pay a smaller share of covered health care costs (which would reduce premiums directly as well as indirectly by leading to less use of covered medical services), manage benefits more tightly, or cover fewer services.

....Thus, people who remained in high-premium plans would pay higher premiums under the excise tax than under current law, and people who shifted to lower-premium plans would pay lower premiums under the excise tax than under current law—with other factors held constant.

http://www.talkleft.com/story/2009/11/30/134417/50

[ProSense]

27. What does that have to do with the point? Also, you left out the most important part

The CBO:

The reductions in premiums described above also exclude the effects of the excise tax on high-premium insurance policies offered through employers, which would have a significant impact on premiums for the affected workers but which would affect only a portion of the market in 2016. Specifically, an estimated 19 percent of workers with employment-based coverage would be affected by the excise tax in that year. Those individuals who kept their high-premium policies would pay a higher premium than under current law, with the difference in premiums roughly equal to the amount of the tax. However, CBO and JCT estimate that most people would avoid the cost of the excise tax by enrolling in plans that had lower premiums; those reductions would result from choosing plans that either pay a smaller share of covered health care costs (which would reduce premiums directly as well as indirectly by leading to less use of covered medical services), manage benefits more tightly, or cover fewer services. On balance, the average premium among the affected workers would be about 9 percent to 12 percent less than under current law. Those figures incorporate the other effects on premiums for employment-based plans that were summarized above.

link

Not only will premiums go down for those plans, the CBO doesn't take into account the other protections in the Senate bill.

The Truth on Health Care Reform and Taxes

Second, the excise tax levied on insurance companies for high-premium plans, the so-called "Cadillac tax," will affect only a small portion of the very highest cost health plans – a total of 3% of premiums in 2013. The vast majority of health plans fall below the thresholds set in the Senate plan and would be completely unaffected by the provision. And those that are above the threshold would only face an excise tax on the generally small portion of the plan that exceeds the threshold. As a result, based on analyses by the Joint Committee on Taxation, only about 3% of premiums will be affected by this provision in 2013. In addition, the Senate plan provides special protections to plans held by workers in high-risk professions – like police and firefighters – as well as by those over 55.

[Hello_Kitty]

29. 3% in 2013 and 19% in 2016.

I really don't understand how people can claim on one hand that the excise tax is no big deal because it won't affect many plans, but on the other claim it will raise a lot of money.

[ProSense]

37. You are ignoring the facts. n/t

[levander]

52. Yes, in 2013 it won't affect many union plans, but by 2016 and 2019...

From http://www.nytimes.com/2009/12/29/opinion/29herbert.html?_r=3&ref=opinion">Click:

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

[karynnj]

63. If costs rise and this appears to be about to happen, a change in the threshold

is the type of thing that could be changed via reconciliation. That means it needs just 50 Senators.

[levander]

67. The excise tax is a big way they pay for the bill...

You've heard Obama's slogan "reduces budget deficits in this decade, and the next!". Amongst the political tricks behind that claim, and especially in the 2nd decade, is the fact that the amount of money coming in from the excise tax grows. You raise the excise tax and you greatly reduce the amount of income the government receives to pay for this bill, especially in the 2nd decade.

Yeah, I know, in that case, you just want another income tax on the rich from reconciliation...

[levander]

50. That reduction he's talking about is ~1%

From one of Ezra's articles you linked to: http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_re.html">Click:

Health-care reform is expected to reduce premiums in the large group market by about 1.5 percent, and in the small group market by about 0.5 percent.

-1% is about the same as it was before. And, there's no indication that minor decrease is anything more than a one-time event. There's the CMS report which says that health care costs will go up faster in the future under this bill. So, we can expect the same medical inflation rates and even higher we were experiencing before this bill.

Now, he does bring up some interesting points about the individual market, which is a small percentage of the country. But, I'm definitely looking at what he says about that further. So, I appreciate the link. I'm in the individual insurance market, so some of that stuff affects me.

[Hamlette]

24. my premium would go down

because I would no longer have to pay for the health care of ppl who don't have insurance.

[Jamastiene]

48. You really believe that?

I guess so, but I know different. They might tell you that is why your health care is so expensive, but it is not the truth.

http://www.counterpunch.org/scahill01072004.html

[Hamlette]

55. yes, I really believe that

I understand that those without coverage are billed the most but I also know that many bills go unpaid. And the cost is passed on to those of us with insurance through higher costs all around.

Here's my point: I don't care. I don't care that my insurance company pays more for my care so that those without insurance don't go without some level of care. But the reason I don't care is that I don't pay. My employer does. Which is one of the reasons health care costs are so out of control in this country. The "average Joe" doesn't care and hence doesn't pay attention and doesn't even know he/she is paying $200 for an aspirin.

I know exactly what I pay for car insurance. I do price checks to see if I can find a cheaper policy all the time. I never do that with my health care.

[levander]

45. It doesn't lower premiums...

You saw the letter the CBO wrote to Evan Bayh? It said most premiums will remain about the same. A small percentage of Americans, who are in the individual insurance market, will see rises of 10-15%.

[Hello_Kitty]

12. It's not insignificant, but it's not the magical panacea proponents claim it is.

You still have to deal with the 92% that is still much higher than what other countries. Furthermore, what makes you so sure the insurers are going to pass the savings on to us anyway? When has that ever happened? They figure you're used to paying whatever you're paying and will continue to do so.

[ProSense]

16. The point of reform

is to address this:

You still have to deal with the 92% that is still much higher than what other countries. Furthermore, what makes you so sure the insurers are going to pass the savings on to us anyway? When has that ever happened?

You're assuming that reform puts no accountability in place.

[Hamlette]

25. insurance companies must spend 80-85% on medical costs

15-20% limit on admin costs and profit. Government programs have a 15% limit so it is not far off.

[Hello_Kitty]

28. Which makes it even worse

It's essentially a "cost plus" contract with the insurance cos. being guaranteed a profit no matter what they spend. Think about it: 15% on a $200 aspirin is a helluva lot more than 15% on a 20 cent aspirin. And don't hand me bullshit about how the gov't won't let them get away with price gauging. They've been letting the defense industry get away with it for 50 years.

[Hamlette]

35. what you're talking about is the cost of medical services, not insurance

Why would an insurance company spend $200 for an aspirin to make $30 profit when they can spend 6 cents? Where does the $170 go? If the medical services start gouging that is an entirely different problem and might have to be faced at that time.

I worked for an insurance company (workers' comp) we were regulated by the Insurance Dept in our state (as are health insurance companies) we were also highly competitive. No way we'd spend $200 on an aspirin. We'd be out of business in a heart beat.

[Armstead]

54. They can rake in more in premiums to squeeze more profit

So lets say they want to maintain or increase their profits while still adhering to the 15 percent limit.

If you were an insurance executive what would you do. I'd jack up the premiums to bring more in.

[Hamlette]

57. and throw 85% of it away?

I don't buy it. As much as I hate insurance companies, I don't think in a competitive market they would jack up rates and throw 85% of the increase in the toilet

I worked for an insurance company and I don't see it happening. We would have been out of business in a nano second had we done that.

[Armstead]

58. Percentages

They may "throw more away" on coverage but they rake in more in the 15 percent.

15 percent of 10 dollars is $1.50

15 percent of 100 dollars is $15

[Hamlette]

73. and GM makes 10% of every car they sell so they'll charge a million dollars for a car!

competition. It's about competition. The insurance company who charges 6 cents for an aspirin will run the company that charges $200 for an aspirin out of business.

I know you hate HCR but please, come up with an argument that makes sense instead of turning yourself into a Palinesque idiot to make a point.

[Armstead]

92. You are being a "Palinesque idiot"

An insurance company doesn't charge for aspirin. It pays the providers for the aspirin.

yes the ryukles of competition apply to a company like GM. But insurance companies don;t have any real incentive to get into any significant price wars under this.

[Hamlette]

93. Armstead, fuck you. n/t

[dsc]

15. It took some of them decades but by no means not all of them

England pretty much did it overnight in the immediate aftermath of WW2 for instance.

[Jamastiene]

49. It took England a grand total of 5 years from the time they

came up with the idea to giving it to the people. That certainly is not decades.

[treestar]

32. One thing every one of the other countries has going for it is

a smaller population, making for a more manageable possible system. No wonder the U.S. was last.

In fact there is a risk - large countries with national systems have pretty bad systems - China, the Soviet Union's system wasn't known for being too good. It's no wonder people here are leery and we finally overcame that under President Obama.

[depakid]

70. That fact is actually a big plus for economies of scale

providing a broader risk pool and greater leverage on drug prices.

Too bad Obama squandered those- along with his populist political capital, to buddy up and make sweetheart deals with- and for the health insurance industry and PhARMA.

[treestar]

77. Selling that to the voters

is the problem. Like I said, they see that the communist systems did not work, see the size of the U.S. and that makes it hard to sell them. They perhaps don't have a generalized hatred of business, either.

[depakid]

78. Selling it to the voters would be easy!

Hell- well over 70% supported the public option in the midst of a huge propaganda campaign.

Show them what an Australian style two tiered system looks like- point to the superior scores on health outcome measures- and major health indicators and emphasize that no one goes bankrupt or loses their homes if they or a family member fall ill or is injured- and BANG.

Dems are the majority party for a generation.

I mean- who wouldn't want the option of private insurance that costs $60.00 a fortnight (every two weeks) with a $250.00 excess (deductible) with a generous drug subsidy that pays about 3/4's of an already lower, negotiated price!

Or in the alternative, straight up Medicare.

[JoeyT]

83. How does it keep coming down to the voters?

Not only did 70% support a public option, but I can't name a single person I know, Democrat or otherwise, that was against being able to import drugs. I don't even know a single person that knows a single person that thinks it was a bad idea. The only people at this point that argue against it are the ones that are going to insist anything done by a D is a good thing.

This "It's the will of the voters!" line is nonsense. The will of the voters means nothing. The will of those that can buy access is what's important. If the will of the voters was important the Free Trade agreements would've been gutted like fish, we'd be able to get our medications over the internet, and the War on Drugs would be over. None of which are going to happen any time soon.

[jtrockville]

38. We could have started by trying what is known to work.

Health care systems in other countries provide perfect examples of what works and what doesn't. We tried to fix a broken system by forcing more people to participate in the broken system.

Sure we had to start somewhere, but we could have chosen our starting point much more wisely.

[Jamastiene]

47. Uhm, it took England 5 years.

http://en.wikipedia.org/wiki/National_Health_Service_%28England%29#History

That, clearly, is not "decades."

[ProSense]

56. There is a difference between where they are now

and how long it took them to pass a plan.

[MercutioATC]

14. One inportant thing to remember: Unions sacrificed wages in return for good health insurance.

In a lot of cases the "Cadillac" health plans are not a perk for the wealthy, they're a benefit to ordinary workers paid for with wage concessions.

[Lugnut]

75. Yes they did.

Fifteen years ago those of us who had health insurance had "Cadillac plans".

I had major spine surgery in a teaching hospital in Philadelphia in 1994. The only thing I had to pay for out of pocket was my phone calls. My primary coverage was through my employer in a union-negotiated contract. My secondary coverage was through my husband's employer in a union-negotiated contract. I never had to use my secondary coverage.

[JoeyT]

84. Yep.

Of course we're not actually pro-union anymore, so that point won't hit very hard.
Unions are one more group that can get bent as they carve out historic histrionic historyness.

[rasputin1952]

85. Regardless of what you think of Unions today...

the history of Union activism got us, among other things:

An 8 hour workday
A 40 hour workweek
Overtime
Medical benefits
Vacation
Safer workplaces
The Right to Bargain for Wages
Protections from predatory management
Paid holidays
Holidays in general
Child Labor Laws
Protections from workplace harassment
Barring sexual, racial, age, orientation, etc discrimination
Living Wage
The Minimum Wage
Cost of Living Adjustments

And a whole lot more. Without Union activities, none of these would be a reality. Even Federal and State laws have been based in initial Union advocacy. There is nothing more that business would like than to see such things as collective bargaining, strikes and paid "benefits" be taken from the equation.

OSHA, the EPA and a host of other Federal Agencies would not exist if it were not for early Union activities. People died on the streets, on railroads, in mines and in industry to gain what we consider "givens" at this day in age. Many were jailed and prosecuted...for sure, it has not always been pretty, but think of where we would be if it were not for active Unions and people willing to put themselves on the line for basic fairness and safety if it were not for those who were willing to act, not just for Unions, but for the workforce in general.

We are far better off because of those who were willing to take a stand.

You benefited greatly by their sacrifice, do not take that lightly.

[JoeyT]

88. Never fear: I don't take it lightly.

I should have stuck a sarcasm tag in there somewhere.
I was mostly commenting on the fact that unions seem to be one of the groups we're told not to care about anymore.

[rasputin1952]

89. Not to worry...

as a former Shop Steward, I am a strong Union advocate.

I've stood up against my former Union as well...Ethics, to me is an extremely serious matter; when Unions have been in opposite w/ethics, I've stood against them...but the true problem is those that don't realize just where they would be w/o Union activism in the past. So many people have never understood what Unions have done to protect them over the decades, they hear about corruption and "evil unions", usually because there is some "socialist" tag applied to them. I'm proud to have been Union, I guess that makes me a proud Socialist, Liberal, Progressive as well...something I'll never back down from until people are finally treated equally...:pals:

[Dinger]

19. K & R

Because you are 100% right!:)

[Dinger]

20. Rec # 25 From Me

:)

[Hamlette]

22. I don't know which countries you are talking about

or which policies you consider Cadillac. I have excellent coverage with very small deductibles and co pays. I bet I haven't spent (knock on wood) $1,000 total in the last 12 years I've been on the policy to cover my family. It costs my employer about half of what a Cadillac plan would pay.

Also, France, which is considered to be the best health care system in the world pays only 70% of all health care costs and a very high percentage (like 80-90%) of the French have private insurance to pay what isn't covered.

My parents lived in Scotland for 5 years and my sister lived in different European countries for nearly 10 years. Their systems might be different than you assume. For instance, the British system would not refill my mom's high blood pressure meds telling her to lose 20 lbs, walk or run 5 miles a day, and quit smoking. She did it but I don't think Americans would be happy to be told the same thing. IT's where we have to get in this country, or do like the French. You can have your private insurance pay for it.

I am a long time advocate of HCR and I wish this were a better bill but I don't think we should be making shit up ala Sarah Palin to make some political point.

Additionally, I think all employer provided health care insurance costs should be taxed. Most people have no idea how much their insurance costs the employer. Its one of the reasons we've dug ourselves so deep in a hole on this issue. People don't care because the employer picks up the tab. If you had $12,000 added to your income each year for tax purposes, you'd be working with your employer to find a better way. And when Congress proposed universal single payer coverage, you'd start to see the advantages to you of such a plan.

[Hello_Kitty]

31. Oh yeah, it's working people's fault that health care costs are so high

Yet another stellar talking point!

Do you guys ever listen to yourselves? Would you be willing to make phone calls or knock on doors in your community and explain to people how they need to be taxed on their health care plans?

[Hamlette]

36. Oh, dear Kitty

its clear you don't understand the issue. If you do, and I've misjudged, explain to me how I "blamed" working people for high health care costs.

One of the reason health care costs are so high is that we don't see them. Our employer picks up the tab so we don't care if the hospital charges $200 for an aspirin or our employer pays $20,000 for our insurance policy.

I get taxed on my auto insurance, my house insurance etc. Why not my health insurance? Yes, I'd rather have universal coverage but we'll never get there as long as ppl are able to say "keep the government off my Medicare" Ppl have to understand why the cost is killing us.

[Hello_Kitty]

41. Like I said, go out and sell that to your neighbors.

Good luck.

[Hamlette]

53. why would I do that? And why does that matter? My neighbors don't believe in evolution

If it is the right public policy decision, that I don't want to spend the rest of my life knocking on doors to sell it is meaningless blather.

I'd rather pay taxes on the $12,000 my employer pays for my health insurance than pay $12,000 in taxes for health care. Why is that difficult to sell? Or understand? Or whatever the hell your point is?

Not only that, if there is an additional 16% "income" to tax (via taxing health insurance) we would adjust the marginal rates for income tax and the poor and middle class (the workers I think you called them) would probably not pay any more in taxes than they do now. The higher brackets would take the hit. It's not being considered as a way to raise revenue, its being considered to wake Americans the fuck up and make them realize what a friggin hole we have dug ourselves into because our health care costs will bankrupt us.

But regardless, do you have a Cadillac plan? (Please, use the definition in the Senate bill, not your own). Then why do you care? If you do, don't you believe in a progressive tax policy? Not willing to pay your share?

That's what gets me about this debate. I really don't see the other side as anything but selfish (ie not wanting to buy insurance, not wanting to pay taxes on Cadillac insurance plans).

I guess its just where the right meets the left. I thought it was based on ideas, now I understand it is based on selfishness.

[Hello_Kitty]

64. Who the hell are you calling selfish?

You don't want to waste your precious time organizing support for this bill though you want it and think it's a good thing. Well, who do you think is going to do it then? What do you think is going to happen if the GOP re-takes Congress in 2010? Think we're going to see any of those "improvements" you and other supporters tell us we're going to get?

[inna]

72. "Selfishness", how ridiculous! This tax is regressive, not progressive.

An excise tax on high-end health insurance benefits is an extremely regressive tax on the middle class:
http://fdlaction.firedoglake.com/2009/10/19/an-excise-tax-on-health-insurance-benefits-is-middle-class-regressive/

Teachers, policemen, firemen, coal miners, union members all tend to have very generous health insurance. For the top 0.1% of income earners (people making over $2,000,000 a year) in this country, health insurance benefits are a tiny percentage of overall compensation. For many middle class families, health insurance benefits are a significant portion of total compensation. Placing an excise tax on health insurance worth over $21,000 will hit the middle class much harder.

For example in 2019, let’s assume a CEO makes $3 million a year and has a family health insurance plan worth $43,000. Whether or not he pays the excise tax or has the money converted to income, he is paying taxes on an extra $22,000. That is only a 0.7% increase in the amount of taxable earnings for the CEO.

On the other hand, picture a coal miner, policeman, or fireman making $65,000 a year with a family health insurance plan worth $27,000. He will be paying taxes on an additional $6,000 of his earnings. For the middle class family, that is a whopping 9% increase in the amount of their earnings which is now taxable.

In 2019 the tax on benefits should generate–at most– two to three percent of its revenue from the richest 0.1% of households. By contrast in 2007, 12.3% of the nation’s income went to the 0.1% richest people in the country. Relative to their income, the tax on benefits would generate very little from the richest Americans. A flat, across-the-board, 1% tax on all earnings would generate a dramatically greater proportion of its revenue from the richest Americans than this new excise tax on health insurance benefits.




Btw, note that by 2019 the tax on benefits would affect around 40% of insurance plans that would otherwise have been offered.

[Hamlette]

74. sadly, no

It is not taxed separately. There would be an adjustment to the marginal rates.

[freddie mertz]

23. Right. And most are products of collective bargaining agreements the Dems used to support.

Strange days indeed, indeed.

[Hello_Kitty]

34. There have been threads where I don't recognize this place.

$50k a year is now "rich". And unions are bad.

[ProSense]

39. Strawman

Who said unions are bad? Critics of the bill had no problem denouncing unions for opposing the Wyden amendment.

The unions' argument on that issue was protecting collective bargaining.

[Hello_Kitty]

40. In a thread about the excise tax

People were claiming the dastardly unions were getting unfair tax breaks. Like it doesn't ever occur to people that if they want what unions have they ought to stop listening to corporate propaganda and start organizing.

[ProSense]

43. Again,

there were those (who are now against the excize tax) who criticized the unions for opposing the Wyden amendment. The fact is, that the Senate bill contains protections for some of these plans the unions are concerned about.

It didn't appear to them at that time to listen to the unions.

Like I said, claiming that people think unions are bad is a strawman.

[Dinger]

51. Same Here (nt)

[frazzled]

33. And you got your information where?

I think out of your head.

Many studies have shown that these 'cadillac' plans are higher cost, but not necessarily higher benefits. Indeed, no one has been quite able to figure out why they cost more.

I can attest to this myself. When we moved to our current city, we decided to opt for the PHP plan, since we hadn't been that keen on the HMO plan (different insurer) from my husband's previous employer in a different state. The new was fine, until the deductible started to go up, and that is at most about the amount we spend on health care each year. It didn't seem like a good deal, though we liked our doctors. Lo and behold, we decided to switch to the same plan's HMO version, where we (a) pay less premium; (b) have zero deductible as long as we stay in the network; and (c) get to keep our exact same doctors. Even when I need to see a specialist (say, the opthamologist, all I have to do is call our internist's office and they send a letter over.

In the end, then: we were paying MORE and getting LESS for a "fancier" plan. If we are ever going to drive prices down in this country, we have to start by trying out something like this excise tax on insurers (it's not on you).

[Hello_Kitty]

42. Your anecdotal experience notwithstanding:

Generally speaking, the higher the premium on a plan, the lower the co-pays and deductibles will be. And the excise tax will cause employers to scale back coverage. http://www.kaiserhealthnews.org/Stories/2009/December/02/cadillac-tax-cost.aspx

[frazzled]

62. No, only 4% of the costs of higher priced plans can be explained by better benefits.

This is admitted by even fierce opponents of the excise tax, as for example at http://www.thehealthcareblog.com/the_health_care_blog/2009/12/the-coming-clash-over-cadillac-plans.html

The latest research shows less than 4% of the higher cost of some plans is due to extra benefits.

Opponents (aside from some unions, who have bargained away increased wages for non-taxable benefits) argue that these plans are more expensive because they're insuring older workers or workers in high-risk jobs or in very expensive areas. That would indeed be unfair, and the bill has already made exclusions for these groups (miners, say; and companies with a high proportion of workers over 55).

The tax itself is estimated to affect only 10% of plans in the country, the top 10% most expensive plans. Plans that are double what the average employer-sponsored health insurance plans cost. The cost of benefits is not fixed. That is to say, you don't get x percent better benefits for every x percent the plan costs. That is proven in study after study. What is being tried here is to bend the curve of costs over time--while at the same time raising the revenue to achieve universal coverage for the uninsured in this country.

From the taxation perspective, here's the deal:

The assessment proposed in the Senate is not a new tax; it is the elimination of an existing tax break that is provided to exactly these firms. Under current law, if workers are paid in wages, they are taxed on those wages. But if they receive the same amount of compensation in the form of health insurance, they are not taxed. As a result, the tax code has for years provided a large subsidy to the most expensive health plans -- at a cost to the U.S. taxpayer of more than $250 billion a year. To put this in proportion, the cost of this tax subsidy to employer-sponsored insurance is more than twice what it will cost to provide universal health coverage to our citizens.

The excise tax on generous insurance plans would simply offset this bias for the most expensive health insurance plans -- and only on a partial basis. To understand how, consider two firms. One has an average insurance cost per family of $13,000, the national average. The other spends twice that much, $26,000 -- perhaps because its workers are older or perhaps because it provides much more generous coverage. Under today's system, a typical middle-income worker at the first firm gets a tax break of $4,550 while a worker at the second gets a $9,100 break. Taxpayers are literally sending twice as much money to the second firm simply because its insurance is more expensive -- regardless of the reason.

All that the excise tax would do is mitigate this tax preference. The second firm in this example would pay a 40 percent tax on its health spending above $23,000, for a total tax of $1,200. Even after this tax, the second firm would get a net tax break of $7,900 -- almost three-quarters larger than the break for the first employer. So we have not taxed that second firm. We have simply (partially) offset the enormous tax break it was already getting from the government.

http://www.washingtonpost.com/wp-dyn/content/article/2009/12/27/AR2009122701714.html

I think we need to look at this through the other end of our lens: we always are saying we want health care reform, not health insurance reform. Workers with expensive plans (for whatever reason) need to be bargaining for better health CARE from their employers, not more expensive health insurance.

For 90% of the nation, this excise tax will affect nothing--except help to insure 30 million people who have no insurance.

[Hello_Kitty]

76. But the excise tax isn't properly indexed

Based on projections of premium increases, by the CBO no less, 20% of plans will be subject to it by 2016 and that percentage will go up. Since the Senate bill is claiming that a lot of money will come from this excise tax I don't expect it will be stripped out of the bill.

[depakid]

69. It's all part of the move toward junk insurance

that many can't afford to use for primary and preventative care- and that won't put a dent in the rate of medical bankruptcies.

[Faryn Balyncd]

44. 2 people I know have a "Cadillac" plan costing $17 K/year with $20,000 DEDUCTABLE

(over $37,000 before the insurance company pays a dime.

And their premiums are rising at 40% per year.)

[Hello_Kitty]

59. Wow! Is this an individual plan or through their employer? eom

[Faryn Balyncd]

60. It is a professional group plan for self-employed. They are in their early 60's and have been....

.....rejected by other plans.

[Hello_Kitty]

65. They'd actually save money in the exchange.

Of course, by the time it kicks in they'll be Medicare eligible anyway.

[Lydia Leftcoast]

81. They'd actually save money by going uninsured

Unless they're very wealthy, premiums plus deductibles would bankrupt them anyway.

[Faryn Balyncd]

87. Their "Cadillac" plan is essentially only protection of their modest HOME and PENSION (IRA)...:

They have never met the deductible in over 20 years, yet, in their early 60's, were still denied insurance under other plans.

And because the catastrophic insurance company has not negotiated competitive rates with providers, the bills they receive are not the discounted rates HMO's, PPO's, and most insurance companies pay, but the inflated "regular" rates charged the uninsured. When one of them had a outpatient thallium stress test for which Medicare pays a generous $1100 (for the hospital's outpatient "technical" portion alone, which includes neither the thallium contrast material nor the radiologist's nor the cardiologist's bill, all of which, including the thallium, were billed separately) and for which insurance companies in the geographic area have contracted prices of between $1700 and $3300) they received the $6300 bill the hospital charges the uninsured, even though they had paid in advance a deposit exceeding the amount charged insurance companies.

The only reason for keeping the insurance is to protect their home and self-funded pension in the event of major illness.

A registered nurse in this same city who had a coronary bypass (which was covered by insurance at the usual discounted prices) had so-called "regular" bills(which is the amount that would be charged to those without contracted discounts, including the uninsured) of over $700,000.

These facts strain credibility, and the information regarding the amount of contracted discounts is closely guarded by insurance companies and providers, and is not available to the public at the time insurance policies are purchased.

Such data can only be uncovered by means of a significant amount of detective work, but has been documented by NUMEROUS SOURCES other than the above link.

The average patient is totally outmatched when dealing with this opaque & predatory cartel pricing, which has resulted in the formation of a cottage industry of fee-based medical bill "advocates" and "consultants" who will negotiate on behalf of a patient.

[Odin2005]

66. K&R

[tnlefty]

68. Heh, those "Cadillac" plans can still almost bankrupt a family...

I know from experience. And our plan doesn't cover physicals for me or our 3 offspring, so it doesn't apply to the deductible, so we don't have them. And now I'm going to get taxed for this shit? Makes my head explode, as I was hoping that through this fight something better would emerge for everyone, but I suppose it's too much to ask.

[BrklynLiberal]

71. That is the truth......

[Hawkowl]

80. Cadilliac is BANKRUPT!

Oh the irony! It burns!

[Mass]

86. Add to that discrimination toward companies that hire an older workforce.

and companies that are in higher priced market.

Even if I was going to believe the rational (something I do not), the bill is discriminatory because they do not tax companies which offer extravagant benefits, but companies that have high premium.

The other problem with this is that it will mostly hit companies that actually offer low copays insurance. It therefore makes having a decent insurance a luxury.

[Vinca]

90. The so-called "Cadillac" plans really shouldn't be judged

by how much they cost, but by what benefits they provide. Many high cost plans are high cost because insurance companies are gouging already cash strapped people who are either older, have pre-existing conditions or both. Just because a policy costs a small fortune doesn't mean it's a good policy . . . let alone a "Cadillac" policy. That said, taxing health insurance coverage over obscene Wall Street profits makes zero sense. The capital gains tax rate charged to Wall Street high rollers should be axed and replaced with the same income tax schedule we peons have to live with.

[Faryn Balyncd]

91. "Cadillac" is a PR term who purpose is to disguise the reality that ALL plans will inflate to taxabl

....levels within a few years. It will hit the middle class worse, & sooner, than the Alternative Minimum Tax.


Every one of the politicians knows it.


They intentionally did not index it for inflation, and PRETEND that the plans that it will cover AT THE OUTSET are extravagant plans, when some are simply overpriced, substandard plans.