Wednesday, July 8, 2009

Health Care Reform

Senator: Lawmakers Having Second Thoughts on Taxing Health Care Benefits

WASHINGTON -- A key lawmaker says senators at work on health care legislation are having second thoughts about imposing a tax on high-end insurance coverage that workers receive on the job.

Sen. Kent Conrad says polling shows widespread public opposition to the idea, and lawmakers are now considering other options to help pay for an expansion of care to millions of people who now lack insurance.

The North Dakota Democrat did not go into details Tuesday.

In a compilation of four public opinion polls shown to lawmakers, opposition to taxing health care benefits ranged from 59 percent to 70 percent. In private talks, lawmakers have been discussing a tax on workers who receive coverage that has particularly high premiums.


This is all well and good, and not too shocking. The question though is, how are they going to pay for it?

Estimates of the cost of the program mostly hover around $1 trillion with the Congressional Budget Office going as high as $1.6 trillion. 1 trillion dollars is $3,300 for every man, woman and child in the country, or for my family of 5, our share would be $16,500. Considering none of my kids have a job, I'll likely be picking up their tab. If we go as high as $1.6 trillion, which if history with the federal government is a guide we will go with the higher estimate and add 20%, the cost to our family goes to $26,200.

Obviously the above numbers are a silly play with numbers, we will not directly be paying this amount. They do help put things in perspective though and shows just how much of a hurdle health care reform is.

We need to take a closer look at how we fund health care for people in this country.

I am in favor of health insurance for all. I do not view health insurance as a constitutional right, I do not view at as a God-given right, I view it as a way to save money. I am a firm believer that we would save money providing insurance for most people and working towards preventive medicine than to pay for a chronic disease that we could have headed off or lessened in severity with regular care. What happens now is people do not seek medical help until they have a heart attack when we could have been working with them all along to treat their high blood pressure, cholesterol, educate them on healthy living, etc. It is a living example of the saying "an ounce of prevention is worth a pound of cure".

One stipulation to this, I do not think it should be a lifetime of coverage. We need to stop the practice of entitlement being a career choice.

We already have universal health care in the US, we just distribute it poorly.

Because of a law called EMTALA (Emergency Medical Treatment and Active Labor Act) anyone presenting to an emergency room, irregardless of ability to pay, must be examined by a medical provider and treated for any emergent condition. Further, any woman presenting in labor must be treated, again, irrespective of ability to pay.

This is kind of a simplified explanation of the law but the point is that ERs have to treat patients with no regard to their ability to pay. Hospitals face a $50,000 fine for a violation of this act.

For the record, I am in favor of this law. A humane society would not let a man die of a heart attack because he cannot afford his hospital bill nor would we allow a woman to have her baby out on the street because they cannot pay up front.

The problem is how we implement the law. What the law does not say is that we have to treat everybody who presents to the ER. We only have to assess them for an emergent condition. ERs have defensively taken the law to it's extreme and treat everyone who presents to us.

I can tell you stories that would make you grit your teeth to the point of chipping.

I have asked people why they did not go to their personal physician for their presenting complaint and they will tell me "the doctor makes me pay". So they duck out on a $60- $70 office visit and let the public pay their approximately $1000 ER visit.

I had one woman ask for us to pay for her Ibuprofen prescription because she had no money. I had seen this same woman tuck a wad of bills under her pillow for safe keeping while in her hospital gown.

Don't even get me started on smokers. If you want to piss off an ER nurse or doc, tell them a smoker wants the hospital to pay for their prescriptions because they cannot afford them.

My point is that we need to reform the entire process.

Here are some statistics on the uninsured:

-28% are above 300% of the federal poverty level. The authors estimated that someone above 300% should be able to afford their own health care. (source)

-Illegal immigrants represent about 15% of the nation's 47 million uninsured people — and about 30% of the increase since 1980.

-Overburdened by the uninsured and overwhelmed by illegal immigration (search), public health care in Los Angeles is on life support.

Sixty percent of the county's uninsured patients are not U.S. citizens. More than half are here illegally. About 2 million undocumented aliens in Los Angeles County alone are crowding emergency rooms because they can't afford to see a doctor.

So using these numbers, approximately 7 million of the 47 million are illegals and 13 million are people that can afford the insurance but choose not to. Right off the bat let's drop them, that cuts our cost by 43%.

Next we apply a sliding scale to the rest of the people that we do insure. In other words, if someone makes 250% of the poverty level, subsidize their insurance, not pay for it all.

Some are not comfortable cutting out illegals, I am. As I said above, a just society would not let someone die because they cannot pay and we should not do so because they are not a citizen. For routine care, colds, tooth pain, etc, turn them away. Let them go home and have the taxpayers of their own country foot the bill.

As far people who can afford to pay and choose not to, same thing. Life is about choices and sometimes these choices come with risks. If one chooses not to get health insurance and they incur a large hospital bill, then they can pay for it. Finally we need to get more aggressive collecting these debts. Hospitals often write these bills off, which means you pay for it ultimately. This may be cruel and it may ruin someone's life. This would be sad but avoidable. We need to make people take personal responsibility.

I'm for health care reform and I am for assisting people who cannot pay, we just need to use some common sense.


LomaAlta said...

Chuck, important post.
But don't forget who really pays income taxes in this country. The top 20% of the taxpayers pay virtually all of the tax. So, honest, working taxpayers will pay about 5 times the amount you listed. Their burden for a family of five would be approximately 5x$16,500 = $82,500 per year.

Taxation at this rate will kill the goose that supports 100% of people in America. The health care bill will unravel the economic and social fabric of America and make us look worse that Califronia is today, much worse.

LomaAlta said...

Chuck, if you use the $26,200 figure and 20% of income taxpayers paying for it all you get a tax of 5x$26,200 = $131,000.

If you try to tax the "rich" at this rate it will bring down the house of cards. Especialy when Obama is already going to tax them for the stimulus, cap and trade, and whatever other socialist legislation they dream up.

DEMs will not try to understand that you cannot confiscate all of the taxpayers money and still demand more.

Z said...

Chuck, I've had to spend about 3 days in an ER in the last five years...all 3 times, it cost me $3K to wait around and see nurses and have a test here and there until a doc finally acquiesced to come in. But, I've had excellent care, if a bit overboard for the symptoms..but, I kind of understand that.
During 2 of those stays (because I didn't have a curtain pulled around my bed on those 2 visits) I saw an illegal who couldn't speak English at all, Hispanic, in a private ER room with a docent inside calling all over his home neighborhood (he must have become 'sick' near the hospital far from home, which was near downtown LA) for the best prescription price! I assure you, nobody came in to do that for ME with my Blue Shield insurance! WHen she left, he sauntered out looking as healthy as one can, and just PICKED UP THE WALL PHONE and made some calls.
Imagine me picking up a phone I don't own without asking first?
After that, a Persian woman approached him and asked with a very broken English "I can use phone?" He just shrugged and handed it to her as he'd finished his conversations.
Talk about gritting teeth.
I'm with free health care beyond LIFE SAVING or LIFE GIVING to illegals.

How do THEY respect us if WE don't respect our own sovereignty? When they get much better than we who PAY DO? I hate to sound hard hearted, but...we have to start this...

Did you like McCain's idea of giving us all $5K to help pay our premiums?

cube said...

Common sense is what is needed to solve the health care problem in this country without resorting to socialized medicine. Unfortunately, common sense is decidedly uncommon, especially among democrats.

Chuck said...

LomaAlta, agreed. That is why I said that the numbers I used were a silly exercise. The botom line is that very few are going to pay all of the taxes, especially if Obama is held to his no taxes on people making less than $250,000 a year. In fact, this whole discussion makes that notion seem less and less likely. At some point the small percentage of people making this kind of money are going to collapse under the burden of the things they are expected to pay for.

Z, we spend a lot of money on illegals. I do not think it is cold hearted to cut them off.

As an RN, if someone needs life-saving treatment, I am morally bound to help them. Questions about ability to pay, etc are for later. I have treated child molesters (that is tough), drunk drivers that have killed people, drunks that are spitting at me and urinating on the floor.

We have an obligation to provide care without letting our biases interfere. I am okay with this. When I am sitting here typing, I am one person. When I put on my scrubs, everything changes. I know it sounds hokey but it is true.

With this said, I am okay with cutting off illegals and I am okay with making people that can pay, pay their bills. I do not find this incongrous.

As far as McCain's proposal, no I'm not in favor of his version. If we can pay, than let us. I do not complain about my insurance costs, I can afford it and should pay my way. I may complain about the high cost of it because of the waste I see in health care, but I pay my way.

What I am in favor of though is to give subsidies to people so they can afford their own insurance. I am absolutely against socialized medicine and would even redo all of the programs we have now. If we are going to pay for health care though, I would rather we do it with vouchers for private insurance.

As far as the ER doing too many tests, this is a whole other discussion and a very big part of health care reform we need to undertake.

Sorry, long winded. It is, for obvious resaons, a passion of mine.

Cube, summed up well, without my long-windedness. ;-)

Brooke said...

Our health care is so costly because we are so litigious.

Kill the lawyers, fix health care, I say! :)

MK said...

"Kill the lawyers, fix health care, I say! :)"

I like the sound of that Brooke.

In my view, Healthcare has to be approached like all big ticket items. It's like buying a house or a car, we don't expect others to pay for our house or car do we, so why should they be forced to pay for your healthcare.

We expect to be treated like adults so we need to start acting like adults and that has certain responsibilities, like looking after yourself.

shoprat said...

You're making too much sense for some people. It's a tough thing to turn a person away, but bureaucrats, almost by definition, are afraid to take responsibility for making a tough choice, and equally afraid of the almighty lawsuit.

Chuck said...

Brooke, "Kill the lawyers, fix health care, I say! :)" clearly you have worked in health care.

MK, same as buying a house, if one cannot afford top of the line insurance, they don't get it. We are not buying houses for people that can't afford them, yet anyways.

Shoprat, tyough choices are what needs to be made.

Brooke said...

Chuck, I have indeed worked in a hospital, two years in OB, four in ER.


Chuck said...

Brooke, I remembered you saying you worked in an ER, that is what I meant.

Larry Durham said...

Health care will never be as expensive...until it's free. And quality, I fear, will trend in the opposite direction.

How long before government sponsored euthanasia...some folks will simply be too expensive to keep alive.