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Jesus trying to take political action without unduly upsetting the moneychangers and their interns. Source: http://easyyolk.blogspot.com/2010/03/monday-in-temple.html
Apparently, I and people like me were the ones who killed Single Payer. Everything was well in hand and then … whoops! We were mean to people and so it died.
The sordid tale — or at least some vague accusations of terrible things being said by aggrieved voters to office interns — may be found in this letter from Elizabeth Sholes, Director of Public Policy for California Church Impact, the lobbying arm of the California Council of Churches. California Church Impact sports the following motto on its website:
We advocate for those who can’t afford high-priced lobbyists: low-income mothers, hungry children, elderly.
I hope that we can all agree that that is a lovely sentiment.
First, Ms. Sholes explains how the people who dropped the ball were the sponsors of the Single Payer Study Group. Here’s the relevant excerpt:
Over a year ago the single payer grassroots steering committee, the State Strategy Group, agreed to create a panel of experts who would do a new fiscal analysis to update the information from the Lewin Report. IMPACT helped find experts on health care financing for the panel, and the SSG knew that it would cost about $250,000 to get this done well.
For both the incoming governor, Jerry Brown and all the new legislators, this evidence of cost savings for individuals, families, small business, and the state was crucial. Single payer had to show it would be at least as if not more effective than federal health care reform in cost savings for all parties. It would be impossible to convince legislators unfamiliar with single payer that it was a very responsible measure without those data.
Consequently, in its first foray under Senator Leno’s authorship, the bill did not pass on the Assembly floor. There were simply too many grave doubts, and the newer members had no interaction with single payer supporters who might have eased their concerns.
In response to that loss, the SSG decided suddenly to abandon SB 810 and the fiscal report and go the initiative route thinking it would be simple and that the governor could put it on the ballot. That is not possible since it would have to be done legislatively and requires a supermajority vote. To do an independent initiative with signature gathering is extremely expensive. SSG fund raising therefore turned to obtaining the $2-3 million needed just to do a signature drive, but the money never materialized for the ballot measure, much less the financial analysis.
No initiative. No fiscal study.
Ms. Sholes may or may not fully appreciate that, in presenting the matter as she does, she is in effect calling her “allies” like Sen. Leno and 18 other Democratic Senators irresponsible. They, after all, supported single payer without the requisite study — given that “this evidence of cost savings … was crucial … [and it] would be impossible to convince legislators unfamiliar with single payer that it was a very responsible measure without those data.” (Yet 19 of them irresponsibly voted “yes” anyway, based on existing evidence! Thanks for the support, “ally”!) And is it the case that new members had “too many grave doubts … [having] had no interaction with single payer supporters who might have eased their concerns”? Did they, um, seek out such interactions? I know plenty of people who would have talked to them! We’ve interacted with Sen. Correa, but he just keeps repeating that “the state’s piggy bank isn’t big enough.”
But the failure wasn’t ultimately the legislators’ fault, you see: it was the supporters who killed the bill … FOREVER!!!
Senator Leno continued to shepherd SB 810 until, as is customary, it went into “suspense” the last week of January in Senate Appropriations. Suspense occurs when there are large questions about costs and means to cover them. Despite the pressure to hold the bill for lack of financial analysis, President pro Tem of the Senate Darrell Steinberg used his leadership strength to send it to the floor. At the first floor vote, five Senators abstained, all of whom had the same fiscal reservations expressed by Senators in Appropriations. Steinberg, as a strong single payer supporter, kept the bill “on call” until the absolutely last moment, January 31 by which time legally it had to pass or die.
Over the weekend senators Leno and Steinberg asked the abstaining members for a “courtesy vote.” This is a vote that occurs when a member with reservations still moves a bill to keep it going.
Those votes were getting pinned down when on January 30th the grassroots advocates started a massive phone campaign to senators. The results were shocking. Office after office including Leno’s and Steinberg’s were flooded with calls — angry, berating, nasty, threatening, and bullying calls. These were not from opponents of single payer. These were from supporters.
When callers could not access senators or their top staff, they lambasted lower-level staff right down to the receptionists. One young woman, new to the Capitol, was shattered by the vicious attacks on her and her senator. She was absolutely devastated by the personal assaults on her character and politics. Other, older staff were tougher, but every one of them was shaken to their foundations by how incredibly violent and abusive the calls were from supporters.
What the enraged supporters did not realize — because they never asked — is that yes, the requisite number of courtesy votes were being gathered. But after the barrage of abuse, these senators, all with reservations due to the absence of information on financial impacts, withdrew those votes in disgust. Senator Leno then pulled the bill rather than having it die on the floor.
We are aware that these calls did not involve the faith community. Insofar as people identified themselves, those from faith groups were not the source of the harassment. It did not matter enough, however, to prevent the massive meltdown from other less responsible groups and individuals.
At this moment so much damage has been done from the barrage of nasty calls that it is seriously doubtful any legislator will ever work with any of the single payer supporters again, not even in the faith community.
I was certainly one who encouraged people to contact their State Senators regarding SB 810. When I do so, I usually tell them to be polite; I also tell them that they should tell their stories.
Here’s one of their stories: I was recently asked, through my work for the Occupy movement, for help by a woman I’ll call Alice. She is a cancer survivor — or at least in remission. She recently received notice of a premium increase for her individual policy. She’s now expected to pay $830 per month — $10,000 per year — just for herself. She’s disabled by her illness, can’t work enough to make ends meet, too young for Medicaid — and she’s concerned that she will have to give up her insurance altogether. For her, that could be a fatal outcome.
You know what? She’s pissed off. She’s going to meet with Correa’s office today — at my urging — in the hope that perhaps they’ll be able to find some angle that can keep her insured, keep her alive — keep her, by the way, from burdening the state with emergency room bills that she would not be able to pay.
I told her — other strong activists told her — “don’t lobby him. Don’t make a statement. Just find out how to help yourself. We don’t want you to die.”
She said “I just want to ask him some questions about why he voted against single payer.”
“Don’t do it,” a chorus of us said. But it’s probably in vain. Do you know why? It’s because she is a very intelligent woman, she knows that a bill like SB 810 would possibly save her life if it were now in effect, she has her dignity, she has enough pride to think that others should honor her dignity — and she’s pissed!!!
That’s how people are — we in the 99%. If you act unreasonably towards us, and thereby threaten our lives and our families’ well-being, we get uppity. Some of us are hard to calm down. Some of us get impolite — because this is not some abstract enterprise for us, but this is our lives.
Now I should make clear that I don’t entirely believe Ms. Sholes’s story. I’m not saying that she’s lying; I’m saying that perhaps she was counting chickens, when it comes to these “courtesy votes,” that were not quite hatched. I’d like to know which two Senators among the four Democratic holdouts — Padilla, Vargas, Rubio, and Wright — were the ones who had tentatively committed to the courtesy vote. (I presume that it wasn’t Correa or Calderon, who voted “no.”) Oh, I know that I won’t be told this — I know that I’m supposed to just accept that this must be kept secret, but I do really want to know.
Here’s why I want to know.
Let’s presume for the moment that Ms. Sholes’s story is correct. Let’s, just because we could use some examples, say that the two who were in the bag and then jumped out of the bag, were Vargas and Rubio. (I choose Vargas because this website has taken an interest in his campaign; I choose Rubio because he’s retiring from office.)
What Ms. Sholes is asking us to believe is that Vargas and Rubio (or whoever) had been convinced that sending the bill to the Assembly was worth doing — presumably because it would allow time to investigate the financial aspects of the bill that 19 members either didn’t care about or (more likely) didn’t find lacking — but they changed their minds because individual citizens alerted to the situation called up and were (allegedly) abusive to their staff.
And, what’s more, the abusiveness of citizens to these staff members was so awful that “it is seriously doubtful any legislator will ever work with any of the single payer supporters again.” It was THAT BAD!
Well, now. I would take all of the anguish of all of the staffers who answered all of the calls on January 30 and 31, roll it up into a ball, and set it on one pan of a scale in which the other pan held only Alice’s anguish about the idea of her dying because she can’t afford health insurance. And then I would let go.
My strong suspicion is that the anguish of Alice would outweigh all of the anguish of these staffers, and all of the anguish of their bosses, and all of the anguish of the members of California Church Impact over this event, combined.
And that is how it should be.
I’m planning on running for State Senate this year. If I should win, I will tell my staffers this:
If you can’t handle being abused by angry citizens, who may or may not have legitimate grievances and may or may not have a couple of screws loose, then you should not be answering the phones. If you are abused, I will feel bad for you, and I might even call up some of those constituents and give them a piece of my mind on your behalf. But there is one thing that I will never do: I will not vote against an otherwise worthy bill, or vote for an unworthy one, because people were mean to you … or to me.
Ms. Sholes’s depiction of our legislators, as people who are not willing to put aside their personal emotions and do what they think is right every single time they vote, is insulting and, I would like to think, inaccurate. People will suffer and die — the low-income mothers and children and the elderly served by California Church Impact will continue to suffer and die — due to the lack of affordable health insurance and adequate health care in this state. To say that this solution of this problem should be put aside forever because they were mean to legislators is breathtaking in its temerity. It fundamentally misconstrues the role of legislators as masters rather than servants. I’d expect better of a church group.
Beyond this, Ms. Sholes’s story is insulting to Majority Leader Steinberg and Senators Leno. If the votes were truly in the bag — which I doubt — and they knew that calls were coming in, those figures should have raised the alarm immediately to tell supporters to get out the word for people to STOP CALLING! If things were really taken care of, they just had to give the word — that’s a lot easier than people trying to control the message that someone might have seen five steps removed from the sender, alerting them to call. But no such word came out — and yet proponents of single-payer take the blame.
If I took Ms. Sholes’s story seriously, this would have to be the lesson I’d take: don’t ask people to call the government.
Don’t ask people to call the government because some of them may at some point be mean and mess everything up. And you can’t even say “don’t call the government anymore if we tell you to stop,” because by then it might be too late. So the only thing to do, if you want people to support the bill, is to carefully control which voters do call in — make sure that they’re all polite and charming and well-spoken. (And then you have to hope that your opposition doesn’t engage in a “false flag” operation of calling in and being abusive while claiming to be proponents, because from the looks of Ms. Sholes’s letter that would work wonderfully.)
Taking Ms. Sholes’s teaching at face value means a commitment to abjuring popular activism because someone might not be as well-bred as a lobbyist or constituent called on behalf of California Church Impact. It is advice not to get people riled up, to “shut up and leave it to the pros.”
Indeed, Ms. Sholes’s advice is very comforting to those legislators who would prefer not to have to deal with hoi polloi at all. I am also struck — gobsmacked, in fact — by the fact that these six Democratic State Senators, let alone their fifteen Republican counterparts, are entirely exculpated from the failure of this bill. Nope! It’s the activists’ fault, and only the activists’ fault!
Sadly for Ms. Sholes, and for me, and for progressive Senators and Assemblymembers and activists everywhere, the estimable level of decorum she sees as critical simply is not going to be met in the future — because income distribution is getting worse, and times are getting tougher, and people are getting mad. They’re going broke and they’re dying and they see their government not quite accomplishing what it needs to do.
I’m sorry for the staffers who, to credit Ms. Sholes’s story, received such abuse from constituents (or from non-constituents.) That should not have happened to you. But if the lesson you gleaned from it is that it is OK to change your vote in a life-or-death matter against the interests of people who are worked up into righteous indignation, then I am doubly sorry for you, because you have learned a false and corrosive lesson.
As for Ms. Sholes — I’d like to introduce her to Alice. Another bill, AB 52 — already passed by the Assembly — would give the Insurance Commissioner the ability to regulate unreasonable premium rate increases of the sort that might soon kill Alice. These same six Senators (plus one other, whom I won’t name) are believed to be the ones blocking its passage. If you can tell me which Senators are just being coy, but who really would vote for the bill if people are just nice to them, I’ll try to spread the word to people not to vent their anguish at them. (Following the example of the very polite Insurance Commissioner Dave Jones, I already do this, but I’ll try even harder.)
Please, someone, get me their names. Then it can be only those Senators who can’t be moved to vote to respect the lives of people like Alice who will receive holy hell — because that’s what we have to deliver to them.
Update: How did I gloss over the best paragraph of Sholes’s letter, right after what I copied above?
This means single payer likely is dead in California. The most important point is that SB 810 died NOT due to the insurance industry or even from Senate opposition — the votes were ready for passage – but due to the obnoxious and outrageous actions of its supporters.
Yes, it’s pretty easy to say that the insurance industry and Senate opposition killed SB 810 — what with the actual evidence at hand suggesting it at all. But it’s also getting easier to say that Ms. Sholes is mostly carrying water (and body armor) for one or both of the above players. One wonders, given her protestations of progressivism: why?
********
UPDATE: Thom Hartmann explains “how the leeches won.”
(Well worth your time.)
And Lawrence O’Donnell from the other night, tying it in with Obamacare and the contraceptive controversy:
Visit msnbc.com for breaking news, world news, and news about the economy
“.. the requisite number of courtesy votes were being gathered. But after the barrage of abuse, these senators, all with reservations due to the absence of information on financial impacts, withdrew those votes in disgust.”
And you BELIEVE that horseshit?
As I said in the story: no, I don’t — but I’m trying not to call anyone a liar. Taken at face value, the story still stinks and its barely implicit message stinks even worse.
Greg,
What killed and will continue to kill single payer healthcare (for which I am a HUGE proponent). Is a lack of understanding bythe public. SIMPLE.
Now why they don’t understand is a job for those on Madison Avenue, K Street in Washington, J Street in Sacramento and some REALLY REALLY big drug companies in Deleware.
Until, the AVERAGE person, who is not protected and provided for by a public employee health benefit, a generous union (hard fought) health care package or the elected official who serves two terms as an Assemblyman (fewer than five years) but reaps incredible benefits understand the importance of this, the answer is NEVER! It will never become a valid option.
I must admit that I am one of those who does not understand. I would really like to. I do believe that everyone should have access to healthcare. I also believe that it is not up to the state/feds to provide everything in a preshaped cookie cutter. I guess it is the details that I don’t understand. I also believe those details should be able to be explained prior to approving of a such large change in the system.
Even after reading the bill, I don’t understand it. How is it going to be paid for? How will it impact me and my family? How will it impact my ability to choose my providers? How will it impact others that, as an employer, I pay for their insurance? How will it work? Yes, I am selfish and want to know the personal impact. How will it impact the ability of certain companies and medical providers to make a living in CA? How will it impact their ability to provide the highest quality of services?
It would stabilize and rationalize premiums. It would make reasonable cost controls more possible, as it has done elsewhere in the world.
It would free business from the burden of having to provide health insurance here, thus dramatically increasing the benefit to companies of locating jobs in California.
As in Europe and first-world Asia, doctors will still do very well.
If these questions weren’t yet satisfactorily answered — and I think that 19 State Senators would attest that they were — there would be plenty of time remaining to address them in the Assembly.
Thanks Vern for your general response. Hopefully you can provide some details:
How much will the premium be for me, my employees, my neighbor? Where can I find that…right now, I don’t think anywhere. I want to know DETAILS…How are the premiums calculated? In running a business, I generally don’t enter into a contract until I know details. I may make a decision to go in a certain direction, but it is non-binding and usually exploratory.
If it is some sort of X% of payroll, what is that X%? Where does it start kicking in (i.e. exclusion for low income), is there a max wage base, only on in state earnings or all earnings for those who earn income out of state? What about self-employed earners, what is their base? What about investors, what is their base?
Will this be a tax or a health care premium paid? Can it be a company sponsored plan? Are the premiums paid tax deductible from wages? It makes a big difference from a tax perspective. Right now, a company sponsored plan is a business deduction for the company. It also allows self-employed and S Corp owners some benefits. If it is a tax, there are many people who will receive no federal benefit due to AMT which by in large hits more the middle income now than high income taxpayers- especially true in CA where we have a high state income tax rate.
Do I have to go to a primary care provider prior to going to a specialist? Under this plan, it seems like I do unless I pay out of pocket.
What if my doctor, who may be the BEST, decides that he does not want to receive the same payment as those who are not as good, so now I can’t go to him/her b/c of the rules set forth that they can’t charge me extra? Cash or no service…
What does a doctor who will “do very well” make? The same as now? $50K, $100K, $200K, $1MM…??? What about those who take out $250K of med school debt in hopes of being one of those who make $500K+ only to now have the deal changed. Are we changing the opportunity to make money for the best doctors?
I don’t feel that people who are not adamantly in favor of a single payer system will be in favor of it until they know the personal impact. As a business owner, I want to make sure that my family and my employees are protected on both the provider side and the premium/payment side. Give us the DETAILS…I don’t trust politicians on either side to just work it out in the future. I want to know what the deal is BEFORE I am in favor of it.
Is that selfish? Absolutely. Do I care first and foremost about my family? Yes. Do I care next about my employees? Yes. Do I want everyone to have access to health care? Yes. Do I trust politicians to determine how to change my and my employees’ health care services and the fees charged without KNOWING THE DETAILS? Not really.
I think the 19 who voted for it are in favor of the IDEA of single payer, but I highly doubt any of them can answer the above in detail with real life examples. If they all voted to explore the IDEA of single payer, fine, but from reading the bill, they voted for the implementation with a lot of “trust us, we will work it out in the future” ideas in place.
Believe me, I am not one who has shut the door on this…I just want to know the details of the plan. I also don’t think it is out of line to vote “no” on a plan because details are not known.
TJLocalSA,
You can look to the VA to see how it would work, it’s our best example of “socialized medicine”.
For the last 5 or 6 years my uncle was in and out of Loma Linda VA Hospital, it was clean, well run and he had a good doctor.
Good article on VA hospitals;
http://findarticles.com/p/articles/mi_m1316/is_1-2_37/ai_n9525385/
Thanks Anonster for the article link…very long article but skimmed it. I think most in the VA system would agree that Loma Linda VA provides good service. I have friends who go to other VA’s and it is riddles with super long wait times, different doctors every visit, doctors and nurses who may not be the at the top of their profession….VA’s have drastically improved over the years which is great. Hopefully they have continued to improve in the 7 years since the sited article was posted.
As I posted above, I want to know the details of how the premiums are calculated and paid….I am also concerned about what it will do for the “for profit doctors”. The ones who are driven to provide great service & charge a premium for that great service- a premium that often with good insurance may be available to those who can budget for it.
I know what I currently have…I want to know what I will have in the future.
VA is “single provider.” Medicare is an example of single-payer. Most of the questions about single-payer can be answered with reference to how Medicare works. Do people on Medicare still get to see expensive physicians, though it may require Medigap insurance? That’s my impression!
I would love to know how the premiums would work…that would be a great start! Seems like it should be one of the top 3 items to explain. I don’t think anyone has addressed this and I would love to see the details…wouldn’t you? shouldn’t you? shouldn’t everyone?
I am not sure if your impression is correct on the expensive physician route unless someone is wanting to pay 100% out of pocket (i.e. no insurance reimbursement). Per Para 36 of the Bill: “36.Allows providers to choose to be compensated by the system or by persons to whom they provide services, in which case they may establish charges for their services. Prohibits providers who accept any payment from CHS from billing a patient for any covered service.” This means that a provider cannot get reimbursed from CHS (i.e. the insurance company in today’s language) AND charge a premium for seeing their practice. A provider must choose whether to accept the insurance payment OR charge the patient- not both due to the prohibition on doing both. So, if a provider determines that under their practice they should be paid $500 for a visit but the CHS only determines that they should get $300, the provider cannot even accept the $300 from CHS and charge the patient $200 for choosing their service. They must accept either the $300 from CHS OR choose to charge the patient the $500.
This essentially means that those who want to go to a “elite” provider has to pay full out of pocket with no insurance reimbursement if their provider determines that the uniform payment is not sufficient to reimburse them for their services. This would significantly increase the cost for those who love their existing doctor and are able to currently utilize some insurance reimbursement for their services. This is a big deal, assuming I am reading it correctly. As one would presumably still have to contribute to the premiums as yet to be determined but would not be utilizing the services of it except for the most expensive of services (acts more as catastrophic insurance) OR it would force people to providers who do not charge separately and may or may not provide the desired level of service.
Additionally, most everything (except dental and eye services) has to go through a primary care provider instead of what a lot of people are used to today if they have a PPO. Typical HMO vs PPO. HMO- everything through primary to get a referral. PPO- patient can self refer. For someone who has an HMO, not much change but if you have ever had to force someone to go from a PPO to an HMO and tell them that they have to make an appointment with their primary care provider BEFORE they can get an appointment to a specialist that they know and trust, you know exactly what this means. This can add a long time before someone is able to see a specialist. This is in Para 16 of the Bill.
Thanks for the discussion…I truly am intrigued by this.
I will be passing along your questions to proponents. We have to learn to deal with intelligent and measured opposition as well as disingenuous and pernicious opposition, and you’re certainly asking valid questions. I suspect that they have reasonable answers.
Your discussion about wanting to ensure that you’re well-protected, though, disturbs me a little. How far are you away, if you don’t mind my asking at least rhetorically, from a medical bankruptcy? We’re very focused on how we can get what we prefer in normal times; less so on what might happen in times of economic upheaval where we might, for example, just be flat out scammed by a company that goes bankrupt and/or pledges to draw out a lawsuit for a longer time than you could possibly afford.
Part of the lesson of Occupy is that people who think that they’re safe may not be. As you weigh this alternative versus the status quo, I hope that that factors into your equation.
Thanks for passing along my questions…I highly doubt that I am the only one who has them. If proponents are going to get people who already have coverage on board with this, I think they will need to be able to explain it.
Maybe you misinterpreted my “well protected” comment or I poorly typed it. I want to know what the economic impact of this will be. I know what I currently have. I can budget for what to expect in the future based on recent history. I do not know what to expect from this new process as the Bill does not explain it and neither can anyone else. If my costs go up a lot (i.e. my contribution to CHS) then in my mind, I need to know in order to protect my family and would prefer to have that money in the bank. Hopefully that still does not disturb you, but maybe I just don’t understand what someone else may find disturbing. I would hope that everyone would want to first prudently protect their family.
As to how far I am away from medical BK- no one ever truly knows, but I can tell you where I am at (don’t hold your breathe, while I spew this off): I am very financially conservative. I do not consider myself rich- yet. I live well below what I make. I save as much as I possibly can. Some would call me super frugal- I call it prudent. I have skills that I can sell to others. I will own my home outright before the kids are in college. I did not inherit money. I had some student loans coming out of school and now they are paid off. I have no debt other than the house right now. I pay for cars with a check not a loan. All my cars have over 100K miles on them and I am fine with that. I worked while in college. I worked for myself in college- fun and rewarding. I established good money habits early on. I drove a beater old truck for a long time to save money. I do not carry credit card balances. I negotiate. I do not buy things that I cannot pay for- I now pay cold hard cash for a lot of items. I read contracts. I understand contracts prior to signing them. I get copies of loan agreements prior to signing them so I know what they say. I ask questions (duh, obviously). I balance my check book. I am the one that salesmen probably do not like to have across from them. I invest in a mix of products and try my best to know what I am investing in. I give a lot of money away to charity- it is good for my soul and helps others. I drive around with kits of water, socks, granola bars, & bandages to hand out to those in need. I have lots of life insurance. I have lots of umbrella insurance. I have lots of business liability insurance. I have disability insurance. I made sure my parents had long term care insurance. I am a decision maker on our health insurance plans. I made the wisest financial decision of my life by marrying the right person. I probably work too much right now. I seek information prior to making a decision. I need to lose some weight and exercise more. I am trying my best to raise the kids so that they know what it takes to succeed. I want them to know how to succeed and then go achieve- no matter what that means for them. I don’t feel that my family needs to spend every last penny saving my life for one more day- I would rather they enjoy each day that we have now. I strongly feel that personal finance should be taught in school starting early on- financial illiteracy is a HUGE problem in my mind. I am not tooting my horn, but I think all of those things are prudent to do and help to protect my family and I. All of these things also decrease my chances of a medical BK.
How far away could I be from a medical bankruptcy from the unimagined? Statistically farther away than most I have to believe, but closer than others I am afraid. I am driven to be set up in such a way that will lessen the chances of any bankruptcy or hardship on my family by the choices made by me or those of others.
My status quo is what I have made it- with the support and assistance of others. If I am going to have another status quo forced upon me, I want to know what it is.
I just wanted to pick out one point for comment: can you imagine a world where no one faces medical bankruptcy? (It already exists — just not here.)
Being motivated to avoid medical BK can help people make good & healthy decisions and being financially prudent, etc….just sayin’.
No, that argument is far outweighed by the expensive and disastrous outcomes that result from folks avoiding care they can’t afford (including preventive care) until they can’t put it off.
First and foremost, hopefully someone will answer the originally posted questions about the bill which was not passed…just keeping it on the top of mind.
You can disagree with that argument which is fine. However, for me and some others that argument holds true. We are strive to be financially prudent and are motivated to limit our exposure to risk- the risk of foreclosure, the risk of bankruptcy, the risk of losing our job, the risk of medical catastrophe, etc…I know that not everyone is tooled up that way. I also know that there has to be a safety net for those who are unable to get even a minimum level of care. Would I like for others to help pay for my care and I pay for their care- depends on the details of the plan, like I indicated earlier.
If people are avoiding care because they cannot pay, then they have to make it an absolute priority to get to a spot that they can afford the basics: get a job that provides insurance, save money to pay out of pocket, form their own company and make enough so that it will provide them insurance, etc…I am more referring to those who can afford to, but choose not to or those who could afford to if they made different choices, but again, choose not to. There are obviously cases that we as a compassionate society needs to provide for those who simply are incapable to be able to provide for themselves. It amazes me how many people would choose to have cable TV (w/ a big new TV to go with it), expensive cell phones, take vacations, drive too much of a car, live in too much of a house, shop for new clothes, eat out at restaurants, drink liquor, smoke cigs, etc…instead of cutting all of that out in order to provide a necessity. Yes, I know that is not everyone, but it is some people. I am teaching my kids the difference between a need and a want right now…
Those who are at most risk for a medical BK that has some teeth are those who are trying to do the right thing with their money and have actually saved some assets, but unfortunately for one reason or another they don’t have insurance yet they incur large med expenses. They actually have something to lose in their BK as their hard earned assets will be liquidated for the most part during the pre-BK or actual BK. Those without assets certainly lose a lot of dignity and deal with tremendous headaches (and still probably did not get the necessary full care they need), but since they don’t have assets, if they can afford the BK attorney, then they have not lost a lot financially at that point. And yes, that forces the price of my insurance and care up higher. I am not as black and white and in-compassionate as this post makes it sound- at least I don’t think I am. I am interested in finding a way to make it work, but want to know the facts going into it- that is only being prudent.
Go ahead, flame on…sorry for rambling by the way.
I will go get California’s Single-Payer expert and champion, Dr. Don McCanne of San Juan Capistrano. He’ll answer all your questions better than anyone can.
TJLocalSA’s questions are certainly important, but it is difficult to answer them specifically as they apply to SB810. In order to pass the bill with a simple majority, the specific financing had to be left out; otherwise it would have required a two-thirds majority in each house. The bill would have established the California Healthcare Premium Commission which would have worked out the details, and then would have submitted a recommendation to the governor and the legislature. Thus further action would have been required before a single payer system were to be established.
There were many other issues that were not really resolved, such as how to fold Medicare funds into the state program, how to to fold Medicaid funds in beyond the limited existing waiver provisions, what might be permitted by the waiver process in the Affordable Care Act other than the limited use that could be made of the insurance exchange subsidies for premiums and for cost sharing, how the large employer self-funded plans could bypass ERISA restrictions and deposit their funds into the state accounts, etc. Major federal legislation would have been required, which likely would not be forthcoming in the near future.
To try to get an idea of what a financing system might look like, the federal Expanded and Improved Medicare for All Act – HR 676 – can give us a rough idea. HR 676 “Establishes the Medicare for All Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% income earners; (3) by instituting a modest and progressive excise tax on payroll and self-employment income; (4) instituting a modest tax on unearned income; and (5) by instituting a small tax on stock and bond transactions. Transfers and appropriates to carry out this Act amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP, formerly known as SCHIP).”
What this says is that each person’s financial contribution to the health care system would be equitable, based on ability to pay. The total national health expenditures are not expected to increase since the major administrative efficiencies and other cost saving measures of the single payer model would be more than enough to pay for the care of the uninsured and underinsured. Since the financing would be more equitable than it currently is, most people would be paying less than they now are. The wealthy would be paying more, but not an amount that could in any way impact their lifestyles.
When you try to figure out exactly what you would be paying under HR 676, you see that there are so many variables that it would be difficult to determine a precise amount. But clearly the policies show that most people would be better off under single payer. And many of the wealthy believe that it would be worth paying more to be reassured that we would have a health care system that takes care of everyone.
Don- I am moving my response to this to a new post at the bottom along with a couple of responses on the new posts as this one is running out of “reply” space…thanks!
As is the case with many debates in America, there is a tendency to see this issue as another false choice…either we have single-payer where the government pays everything, or we just keep the status quo.
Personally, I like the system that The Netherlands has developed. It’s a hybrid, single-payer/private market, whereby each person receives basic coverage, but there is also a private insurance market where one can buy policy add-ons.
Interesting and I would agree- the right answer is usually to where each side is not compromising their ethics yet is still not getting everything they want.
anon,
“The Netherlands has developed. It’s a hybrid, single-payer/private market, whereby each person receives basic coverage, but there is also a private insurance market where one can buy policy add-ons.”
We have the same thing right now with Medicare, many people have Medicare and also choose to carry a supplemental policy.
TJLocalSA,
“If people are avoiding care because they cannot pay, then they have to make it an absolute priority to get to a spot that they can afford the basics: get a job that provides insurance, save money to pay out of pocket, form their own company and make enough so that it will provide them insurance, etc…”
Most of the people who declare bankruptcy due to medical costs HAD INSURANCE. I know you think you can plan for these costs, but keep in mind the average family income in this country is $50,000 a year, furthermore I think tying healthcare to employment is archaic and actually limits our economy by making it too risky for people to change jobs or start their own business.
Here’s some excerpts from a couple of articles on the subject;
“Study Links Medical Costs and Personal Bankruptcy
Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance
By Catherine Arnst
Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid. …
But medically bankrupt families with private insurance reported average out-of pocket medical bills of $17,749, while the uninsured’s bills averaged $26,971. Of the families who started out with insurance but lost it during the course of their illness, medical bills averaged $22,658. “For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”
http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm
By the Numbers: Out-Of-Pocket Costs for Cancer Treatment
Written by Lisa Riordan Seville • Published on August 18, 2011
Today’s number: $1,266
That’s the average cancer patients pay out-of-pocket every month for their care, according to a new study out of the Duke University Medical Center. (For you nerds, the mean among patients was about $700). Those polled were, on average, about 64 years old. All were insured, either privately, through Medicare, or both. Most of their uncovered expenses–41 percent–come from prescription drugs, though medical equipment, travel, special diet and non-prescription drugs also were factors.
Patients reported the out-of-pocket costs forced them to cut back not only on dining out and trips to the movies, but also on food and clothing. It affected their care, too. Some didn’t fill prescriptions, others skipped prescribed medicine and (not surprisingly) whittled down their savings or went into debt in order to make ends meet. Nearly half of those polled saw the financial impact of these out-of-pocket costs as “significant or catastrophic.”
http://clearhealthcosts.com/2011/08/by-the-numbers-out-of-pocket-costs-for-cancer-treatment/
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You’ve also asked about your specific costs associated with single-payer, Vermont passed single-payer in May, but they too have not figured out the specifics. I did find an article about the architect of Vermont’s plan,Harvard health economist William Hsiao;
… “Called “Green Mountain Care,” the single-payer system outlined in the 203-page Vermont plan that became a 102-page law in May is a public-private hybrid. It envisions a state-organized system of universal coverage for all residents funded by payroll taxes and administered under contract by a large private enterprise, probably an insurance company.” …
… “He notes that when the system is implemented in the next several years there will be winners and losers. “Some — like the uninsured and underinsured — will gain. We recommend that primary physicians also gain in income,” he said. “But there’s no free lunch. Somebody has to pay and some will lose. Private insurance companies, for instance — particularly those outside Vermont. Another group to lose will be employers who do not offer health insurance or offer very shallow insurance. Their costs will go up.” Couples who both have high-income jobs will also pay more, and specialist physicians will see a decline in income.”
http://ldihealtheconomist.com/he000015.shtml
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One would think with all the different healthcare models available here and abroad, that there would be more concrete information on individual costs, but I have to believe that single-payer would be cheaper in the long run, both from an individual standpoint as well as for employers.
Remember why Medicare came about in the first place; old people were too costly, they required a lot more medical care and private insurance companies didn’t want them.
If we were able to fold in all the young and healthy people into Medicare it would go along way towards making Medicare’s costs more sustainable, as that is the exact same model that private insurer’s use; the healthy offset the sick and the larger the pool, the lower the costs.
Sorry about the length of this comment, hope it helps.
Well, The Netherlands system differs in an important way. With their system, long-term, chronic, semi-permanent and ongoing health care needs are covered by the state policy. It’s short-term needs that are covered by private market policies. In other words, the government provides coverage that would prevent a person from suffering a catastrophic financial loss by a long-term health crisis.
With Medicare, it’s more the other way around. You kinda HAVE to have the supplemental policies when you’re on Medicare because it just doesn’t cover enough. It wouldn’t be enough to cover a major health crisis.
Thanks for the clarification, I didn’t know that was how their public/private plan worked.
Anonster (and Doug too as somewhat related)- I do not think that it is very difficult for a $50K per year family to buy insurance on their own and to plan for health care costs…I also think that the average $50K per year home has a couple of TV’s, cable, multiple cell phones, take a vacation here and there, drink soda, eats out instead of cooking at times, etc…My point being, if it is an absolute priority, then they can be moving towards the goal. I agree that tying insurance to employment can be very risky- it gives your employer a lot of levergage if they choose to take advantage of it especially for those who do not have transferable skills. However, from starting my own business, if you go out on your own, it generally is not that too terribly difficult to find someone to provide the insurance- I know that not everyone is tooled up to go out on their own though.
I am now going to put my statistics manipulation hat on…regarding the 62% of BK caused by health problems. Note that this does not say casued by out of pocket medical costss and as such also includes if I get ill and am no longer able to work- whether it is short term or long term. This is a big difference…it is income replacement issues versus medical care costs. If someone does not have income it is very easy to get into debt problems. Would single payer also provide income replacement?
I see that the average of those who go BK are in the range of $18K-$27K, that is a good chunk of change but I would be advising everyone to be saving for that…yes, idealistic but it is also prudent. Just as we should all be saving for retirement, education, paying off the house, etc…we also need to be planning for the disaster that could be coming around the corner.
In Anon’s post, it is indicated that included in the average monthly cost of $1266 it includes non-presription drugs, special diet, travel, etc…are those thing generally covered in a single payer system?
I will try to do some research on it also as you both have brought some good points to consider but also a lot of information to try to dig into. By the way, I am probably more in favor of Health Savings Accts or high deductible insurance plans as they often are cheaper up front, give some spending power to the consumer, but limit the downside risk of a catastrophe…it would help limit the $18K-27K medical costs of those in Med BK. There has been a push to get these going, but they really have not caught much traction yet- it would help if CA got on board with it a little more and provided the tax savings that the Feds provide.
“However, from starting my own business, if you go out on your own, it generally is not that too terribly difficult to find someone to provide the insurance- I know that not everyone is tooled up to go out on their own though.”
Well how long has it been since you started your own business? If a person has employer-based insurance, and they want to strike out on their own and start a business, but they have a pre-existing condition, they know damn well these days that they will be turned down for coverage. There are LOTS of people who would like to launch their own venture, follow a dream, but they know that they simply can’t afford to let go of their employer-based insurance.
I’m self-employed and pay $600 a month for individual health insurance. How much do you think that a family of 4 who has no employer-based insurance that’s taking in 50K a year is paying for health insurance? Do you think that paying 12K or more a year, and rising, is a sustainable model?
Hey, try getting approved for a catastrophic, high-deductible plan with a pre-existing condition. You can’t do it.
Although I appreciate your open-mindedness, my sense (and I realize that this is speculation on my part) is that neither you nor someone close to you has been touched by the growing number of harrowing experiences people are having with health insurance. Until these experiences are made very real for some people, they simply can’t empathize with what people are going through.
January 2010 is when my business started. I believe health insurance started in June of 2010 or so. We shopped and changed insurance again in Dec 2011 effective last month. I am a new business. If it is a group plan, I don’t remember them really have any pre-existing condition issues that even were asked. I believe you only had to have 2 people for the group plan model…owner plus 1 other (even a spouse who works for you). I guess I can only speak from my own experience in that when I left and started a company, that I did not find it terribly difficult to get insurance. It definitely was a consideration in me leaving though.
If someone has employer provided insurance, they are able to utilize COBRA also…it is obviously a little more expensive, but can cover the gap between leaving and setting up the new plan. That is exactly what I did. I started from scratch on setting up the plans and paid for COBRA at my prior company until the new insurance was set up. Worked well for me.
I personally pay approximately $520/mo for med, dental, vision. I know that is low and I am fortunate. Again, I am not intimately familiar, but I believe that the new PCIP program would allow a one person plan in OC at Kaiser for about $420/mo (assuming age 35-39) although I am unsure as to copays and deductibles and such.
My fear for that family of 4 making $50K/yr and no employer provided insurance is them paying zero for health insurance as they may feel they cannot afford it. I do not know how much it would cost for them to get coverage- let’s say $1K/mo from your figure. That family of 4 assuming, both kids are under age 17, would take home after tax about $45,600 or about $3800/month. (Taxes: Fed Inc- $700, CA Inc- $100, SS- $2100, Medi- $725, SDI- $550).
If I had to put together a personal budget off of $50k/yr with no provided inurance it would be extremely difficult. I would probably be trying to be about: Rent/Util ($1350), Med Insurance ($1K), Auto ($400), Food ($500), Church ($75), “Target” ($100- yes I line item that out), “Stuff” ($100), Phone ($50). Savings ($150), Clothing ($50), Copays ($50). I would be on an all cash budget using the envelope system. I would also be doing everything I can to make extra income. Very very very difficult and no room for disasters- I am sure that someone will pick apart where I am short. It also means choosing to not to live in a high rent district and driving 1 car with next to no loan on it (drive only what you can). I understand that, which is why I say that my fear would be that they are paying zero and would struggle significantly. This is why I pay for my employees’ health insurance costs. I could give them a raise and say “do it on your own” but I want healthy and productive people in the office and would be afraid that it will not fit into someone’s budget.
PCIP I believe now covers the prexisting condition coverage issues- at least that was my impression although that is a state program and I think it is supposed to go away after 2013 under the federal provisions. Unfortunately, I believe PCIP indicates that you must not have coverage in the past 6 mos or so, which is difficutlt for those with a preexsiting condition- not impossible, just very difficult.
I do also know that there are certain current state and federal programs especially for the uninsured kids. I am not knowledgable about them, but my fear would be that this hypothetical family of 4 making $50k would make too much for those programs.
I fortunately have not had a harrowing personal experience in my immediate family that lives under my roof. There are others in my family who have had them and so I am sympathetic to the issue and desire a good outcome. Again, I don’t know why I have been so lucky when others have not- it scares me about what is coming down the road which also motivates me to be super prepared.
I’m very happy that others pointed out that the vast majority of people whose bankruptcies were caused by medical expenses were insured. The millions whose finances were destroyed when they became sick (a truly despicable outcome) are most often not to blame for their own predicament. It is easy to claim they should have read their health insurance contracts, but in reality the language of these contracts is often open to interpretation, and if there is a dispute, insurers have the lawyers their customers cannot afford.
An important part of the Affordable Care Act is its creation of minimum standards for health care plans. Soon, insurers will no longer be allowed to offer people “junk insurance”. Of course, the right wing is claiming that these regulations will take away consumer choice, which is a lie. This claim is akin to saying that our laws should allow car companies to sell cars which they know have a high chance of exploding at highway speeds- pure B.S.
There’s something completely absent from TJLocalSA’s “rational self-interest” argument: other people. TJ, other people’s health affect you and your family in many ways.
If your neighbors go bankrupt from obscene health care bills, it is much more likely their homes will be foreclosed on, which can lower your property values in addition to destroying your neighbor’s lifestyle.
If you and your family are exposed to people whose communicable diseases have not been treated effectively because they are unable to afford to see a doctor, it increases your family’s chance of getting sick.
Finally, TJ, there is a rationalism in your posts which, in reality, is not rational at all, because it ignores the America you now live in. You may compensate your employees well, or perhaps you do not. You should be aware by now that for many decades the largest American corporations have systematically undermined the common workers’ bargaining power, which has led to poorer and poorer compensation, both in wages and benefits.
Your long description of how you were able to save money to hedge against financial disaster is admirable. It is also largely unreachable for a large section of Americans, not because they lack your work ethic, knowledge and discipline, but because they were unable to gain access to a lucrative job, or lost their job and now cannot find a good job, or any job at all, in our deteriorated economy.
Implied in your story is that anyone could do what you have done. You’ve done many things right, but you have also been quite fortunate, whether you sense that or not. For example, what would have happened to your life if you had become very ill when your were in debt from your student loans, and had not yet had the opportunity to establish savings fom your saleable skills? That scenario are among the thousands which have happened to others less lucky than you and I.
Sure, others have been irresponsible, lazy…pick your adjective for why you think they have placed themselves in their health-caused predicament. Do you care nothing about their circumstance? I know that the quality of my life goes down when people around me are suffering, and that my life improves when we are able to help alleviate the problems of others. Are you affected by others outside of your own family? Wouldn’t it be better if we figured out ways to help them, however imperfect our governmental help might be?
The biggest failure of your rationality is the fact that ALL of the other first-world national economies have MUCH less expensive health care per capita, and most of them enjoy better quality care and access for the average person than Americans do. Yet you wish to withhold your support for a policy move in the direction of those other nations, while their models are operating better than ours right this minute, until you’re shown what your health plan would be in great detail?
That is not very sensible.
.
I just want to chime in with my admiration for the discussion between DougJones and TJLocalSA here over the past several days, which has been informed, incisive, and exemplary. It makes me wish that this had been a policy-based post rather than a politics-based one, but I’ll take this sort of discussion where and when I can get it!
Doug- See above reply to Anonster on some BK thoughts also. First, thank you for pointing out all of my failures of rationalism…hopefully there are a couple of items that you think are worthwhile (sorry, I felt pretty poor for myself after reading your comments).
Other people impact all of our lives in many ways. Not just in insurance and med bills. The fact that I cannot control others is exactly why I must be so financially prudent. The value of every house in my neighborhood does not matter one bit unless one of a few things happens: 1. I have to sell, 2. I have to refinance, 3. The neighborhood goes so far down that safety is a concern. As long as I can make my mortgage payment, I should be safe regardless of the home value. In fact, declinging home values help me pay less in ppty taxes which of course also mean less services from the city/county, so not really much help there. I obviously would rather see a nice steady increase to home value instead of declines, but again, I have to plan for those contingencies.
Great point on the communicable disease item…although, there are so many uninsured people right now from what I have read, that I would think if this was a huge threat that we would already be seeing major impacts. Obviously, if things regress and we go the wrong way instead of making progress, this certainly will have to be dealth with. Additionally, since I cannot control others, I guess again this is why doing what I consider the right things may be so prudent in my mind.
I do compensate my employees well, although that is just an opinion,…I had a detailed explanaton of why I think that, but just deleted it as I don’t want to get into a compensation discussion. I can tell you all full time employees receives fully paid insurance (med/dental/vision), 3% retirement funding, vacation/sick, training and education, etc…plus they get to work with a great group of people. Our part timers are those who choose to work part time for their own lifestyle reasons. We recently just hired 3 people in January, so there is starting to be some light out there.
I do know that I am quite fortunate, although I do not believe that I have blessed with anything extraordinary. I look at myself and my family and sometimes ask myself “why”? There is almost a sense of “success guilt” on my part. I definitely am not someone who would say that everyone can do it, but I would say that anyone can do it- hopefully that makes sense, essentially meaning that I did nothing extraoridinary but I also did not have any catostraphic events happen either.
Our current economy is certainly a hinderance for many right now…very difficult to enter the workforce yet along succeed upwardly. I am of the age group that ALL of my investment gains were wiped out during the downfall…I was fortunate that I had saved, yet unfortunate that I did not make any money on those savings. I was also fortunate that I was not of the group that lost so much more. I cannot imagine not having a job at this time…although I will say that I quite my job and started on my own, which although not the same, but still very difficult.
I certainly care a lot about others- hopefully you are not implying otherwise. Often the circumstances that they put themselves in impact how much I may care- right or wrong on my part. I choose to care more for those who have no control over their circumstances than those who make poor choices. Maybe “care” is not the right word- I care for them, yet I am probably not as likely to choose to provide directly to them. Yes, rising tides raise all boats.
Yes, I choose to withhold support for a policy move until someone can explain to me how it is paid for and what the premium is? Not just mine, but yours, my employees, my neighbors, and the guy at the corner who I give food and socks to. I am not looking for you or anyone else to tell me what my direct dollar amount is, but just the methodology used so that I can determine that. I generally choose to hold a lot of my support for things until I know the financial impact- I chose to not buy a house until I knew the price and the terms; I chose not to go to the school that I did until I knew how much it was and how I was going to pay for it; I choose not to give my charity money to organizations before I know they spend it wisely…I find this to be pretty consistent in my life. I find nothing wrong with setting direction and then finding a way to achieve it. For example, I knew I wanted to buy a home and then set out to find the right one and the method to pay for it. As such, I don’t have a problem saying that as a policy matter, I desire for everyone to get the medical care that they need. Now, lets figure the details out.
Our leaders, either purposefully or inadvertently, seem to be withholding the premium/tax information for the policy move that is so desired, which would help me get on board. You can say that I withhold my support for this bill until the details are known and you would be correct, yet you would be incorrect in saying that I withhold support of the overall goal that everyone should get needed medical care. Hopefully you can see the difference in the two.
All- First and foremost, thank you for the educated discussion. Secondly, and most importantly, I always reserve the right to get smarter about a topic (sorry, I just love that saying and it is so anti-political it seems these days), so hopefully I do continue to become more educated on this topic which self-admittedly is very difficult to understand.
Believe me, I am not one who is whole-heartedly opposed to this and I am not on a political soap box- hence, I reserve the right to get smarter on the topic. Although, I know that those who have posted may have their mind made up on this, I do not. I am a very compassionate and generous person who wants to treat everyone fairly. I do feel that my thoughts are not all that out of the main stream of those who currently make a decent living and currently have insurance. We are seekers…If you want to get single payer passed, I imagine that you would want to be convincing someone like myself…thanks again!
Don- Thank you very much for taking the time to respond. I especially appreciate the incite as to why the premium figures could not be included in SB810, although it seems like it is a backdoor way to get a tax increased pass, I understand the politics of the 2/3 tax vote. Thank you also for the HR676. A few comments:
1. HR676 Financing- Unfortunately unless I am missing something in HR676, it also does not provide any specifics as to the %’s. Yes, it gives theory, which is great. That theory essentially says that there is a flat % that everyone with earned income will pay and then a % that will be progressive for those in the upper 5% of earners.
2. Your Thoughts on Financing- Since you are so very knowledgable (yes, I am mean that sincerely), what do you think those %’s will be? Payroll- X%, Income- X%. For me and a lot of others the devil is in the details- what is “modest and progressive”? what is “small”? I have seen some sites tossing around 3.5% on both employer and employee on the earned income side (effectively 7%) but not anything on the income tax increase on the top 5%…Additionally, I do not believe that the tax would be structured so that it would be “tax deductible” as it would just be taking money from one pocket out of another and the difference to the losing pocket has to make it up somewhere…do you agree?
3. Wealthy- You indicate that the wealthy would pay more, but not in an amount that will impact their lifestyle…I disagree with that statement for those that make probably somewhere in the ballpark of $200K to $2MM (+/-). I will give an example under the next point. In general, people in that income range (maybe the $2MM might be a little high, but certainly $200K-$1MM) that I work with make their lifestyle by what is left over after they hit their savings goals. Essentially, they spend what is left of their cash flow after they pay taxes, give money away (charity), and save according to their goals. If cash flow goes down, often they will try to not change their savings until last resort…instead, they change their spending. This means that if their taxes go up, they continue to try to save the same amount, but choose to spend less on discretionary items. Discretionary items are lifestyle related and hence I do believe that they will have a change. Obviously, for those impacted they generally do not have to choose to put food on the table or gas in the tank, but it still is lifestyle related. There is also a point to where they change their savings goals but this also impacts lifestyle in that they are not able to save as much for school for the kids or retirement of which both are huge concerns of most Americans.
4. Example $200K Income- I will use the 3.5% on both sides for discussion (combined 7% for a self employed person). For someone that makes $200K, their insurance tax will be approximately $14K ($200K x 7%). Their insurance premiums currently may be in the ballpark of $700 per month and out of pockets say another $600 per year for a total cost out lay of $10K per year. Their net out of pocket would increase by $4K per year. For someone who makes $200K a year, I do think that $4K per year makes a difference, especially here in So Cal- it could be the difference between funding a retirement account further, taking a vacation, giving an employee a raise, giving more to church, buying new clothing, saving for a second home, saving to pay down existing debt or refinancing their home, going out to eat more often, putting the kids in private school, kids expensive hobbies, etc… This person likely would not be impacted by the tax on the top 5% although I am unclear where the 5% threshhold is at as one that I just found indicates top 5% is at $160K of income (per IRS 2010), so possibly a bad scenario. It is an even bigger impact assuming that those insurance tax premiums would not be tax deductible b/c under HR676 it would be an additional medicare tax. This would mean that this same $200K self-employed person would lose a $8400 Fed/CA tax deduction…this deduction reduces this persons income by about $3K per year ($8400 current premium x 36% combined Fed/CA marginal rate), so now this person who makes about $200K per year now has seen his disposable cash flow go down by about $7K per year. I am not sure if the CA plan would have the same tax impact but I would bet it would at least not be deductible for CA purposes. Yes, he has some additional benefits and safety and his neighbors may be better protected also, but where I come from, $7K per year is a lot of money and can have impact on people. Obviously, these figures drastically change for someone who makes $400K a year because the tax would double, but what they are used to paying would be about the same.
5. Difficulty- Yes, this is very difficult to understand the variables. It is even more difficult to calculate because both the Fed and State proposals do not provide any way of calculating them because the %’s are conveniently left off and we all have a different definition of “modest”, “increasing”, “small” and “progressive”. From a marketing perspective, the more simple things are, the easier they are to understand, and the easier it is to convince others- not everyone agrees on that, but I find it to be true most of the time.
Thank you for the discussion.
TJ, I do see that you are suportive of the goal of a better health care system while withholding support for a specific bill, and understand the difference between the two. I also share your appreciation for the very informative and civil discussion on this thread; your contributions have been most important here.
Like you, I’ll also be closely following the details of our State’s discussions regarding this reform, from the position of someone inclined to support reform. Given the good motivations and solid information the most important reform advocates bring. I think that’s the more helpful place to come from. Withholding support for reform unless ALL my detailed questions are answered at this moment is a position which supports the destructive status quo.
I absolutely retain the ability to withdraw my support if a reform bill goes in the wrong direction; I’d describe the State Senate’s final proposal from the 2007-early 2008 reform discussions as being on the edge of unacceptable to me. It’s very important that reform is seen as helping people; otherwise, reform gets a bad name and it becomes more difficult to expand on the reform, as will certainly be necessary. Social Security, Medicare, and other major legislation which has helped Americans started smaller, and have been improved on over the years.
I’d raise one quibble: it’s extremely apparent that rising tides do not raise all boats. The financial powers are, and have been, using their power diligently to see that future tides continue to place them at the top of the wave and smash you, I, and others less fortunate on the rocks. Thesedays, they’re not even trying to hide their desire to bury the middle and lower class under a pile of cash and influence.
Doug, Thank you for the kind words.
Did I say that I would withhold support until all of my detailed questions were answered? If I did, I must have been caught up in the moment and will take the opportunity to “get smarter” on the topic. I do feel that there are certain items that should be able to be answered prior to lending support and one of those is the financial funding. Another probably would be the ability to choose to pay up for other service and knowing whether there is a baseline funding to those providers (current bill- not allowed from what I can see). The 3rd is probably whether a primary care provider has to be consulted prior to going to a specialist…I believe the last 2 were in the bill where as the funding was not. This is all from the patient side. There are probably a handful of FAQ’s from provider side also. I don’t want to keep the status quo due to analysis paralysis, but certain questions should be able to be answered
Regarding your quibble, which I am going to play semantics (don’t you love discussing with someone who negotiates against themselves)- by definition if not all boats are raised then the tide is not rising. Variations in the swell should be acceptable but sinking boats are not a good thing for anyone. We seem to be in a time that certain groups are rising much faster than others- you illustrated that as a smashing wave. I would much rather philosophically raise up the bottom than cap off the top, but only if that is possible to do.
I for one would love to get all the cash out of politics, both on the business and labor side. Make good policy because it is the right thing to do instead of being influenced by lobbyists, donors, backers, and those who can spend the most money on advertising. I am afraid that is too much to ask anymore.