More employers to drop employee health insurance [View all]

[eridani]

http://healthblog.ncpa.org/the-crown-jewel-of-obamacare-failures-2/

In February, 2011 McKinsey & Company did a large (1,329) survey of employers asking about their intentions with the Affordable Care Act and found that 30% said their company would 'probably' or 'definitely' drop coverage as a result. McKinsey is an extremely credible firm, but that didn't stop supporters of ObamaCare from lambasting the survey because it was not consistent with other economic analyses. McKinsey had to issue a statement explaining it was not intended to be an economic analysis, it was an opinion survey. I would argue that such a survey is probably far more accurate than an economic analysis that must rely too much on assumptions. Indeed, it likely understated the situation. As employers learn more about the requirements of the new law they are more likely to run away from it.

These employees are also likely to find at the Exchange:
* A clunky web site run by the state or federal government laying out the coverage options.
* Overpriced insurance options. (Because insurers can no longer ask medical questions, they will have no idea what kind of risks they are enrolling, or the premiums needed to cover those risks. They will err onthe side of caution and charge higher premiums.)
* Confusion about how much they will be charged for their share of the premium. (They will be subsidized, but the amount of the subsidy will vary according to their age, income, geographic location, family size, and choice of plan.)
* Insurance plans that cover a bunch of stuff they don't want or need.

Finally, they will realize that they don't need to go through all this. They can delay making a decision until they really need to get health care services:
* Exchange coverage is guaranteed to accept them at any time with no questions asked.
* They can save a whole lot of money by not paying premiums and using that money for more pressing needs.
* There is no meaningful penalty for failing to enroll. What penalty there is applies only to people who make enough money to pay income taxes, and it can be collected only by seizing whatever tax return is due the taxpayer. This can be easily avoided by upping deductions at the start of the year.

Most people have very few medical expenses in the course of a year. 50% of the people in the United States consume only 3.9% of all health care expenses each year, while the top 20% consume 78.3%. People in the top 20% will certainly want to be covered but the bottom 50% get no advantage from insurance coverage. They spend far less on services than they would on insurance premiums.

Comment by Don McCanne of PNHP: Greg Scandlen is a very well informed and respected member of the policy community who has been associated with conservative/libertarian organizations such as the National Center for Policy Analysis, Cato Institute, Galen Institute and Heartland Institute. This article for NCPA is presented in its entirety to demonstrate how much agreement there is with those of us at Physicians for a National Health Program in defining some of the problems with the highly flawed Affordable Care Act (Obamacare). This article could have been written by one of us at PNHP.

He does not offer any solutions in this particular article, though had he, it would undoubtedly be from his area of expertise and advocacy - consumer-driven health care, including health savings accounts and health reimbursement arrangements. That, of course, is quite a contrast from the single payer solution advanced by PNHP.

When there is so much agreement on what is wrong, why can't we agree on the solution? Perhaps it's our respective goals. We at PNHP want everyone to have affordable access to all essential health care services, as a matter of social justice. The advocates of consumer-driven health care seem to place the will of the individual consumer above that of society's collective will for health care justice. But the divide is not quite that simple.

Supporters of an improved Medicare for all still agree that the patient (health care consumer) should make the ultimate decisions on his or her individual health care, after being informed on the options. The role of the government is to remove the financial barriers to that care.

The consumer-driven advocates would add to the health care consumer (patient) the responsibility of making spending decisions so that they would shop for higher quality and greater value. The role of the government would be to ensure access to basic health care services for those who lack the financial resources to pay for that care.

The problem with the consumer-driven approach is that is what we have now, and it isn't working. Except for a marginal tax benefit, it doesn't matter whether the patient's share of cost comes from a health savings account orfrom other personal funds. The system perpetuates uninsurance and under-insurance which exposes far too many to financial hardship in the face of medical need.

An improved Medicare for all would eliminate financial hardship for individual patients while using public policies to reduce the excessive escalation of our collective health care spending. The latter is a task that our private insurers cannot master, but is ideally suited to a single, national, publicly-administered insurance risk pool.

Greg Scandlen understands this. He understands the inadequacies of his consumer-directed approach. I wish he could explain to us better, in terms devoid of ideology, just what is wrong with our approach - an approach that would provide everyone the care that they need in a progressively-financed system that we can all afford.

My comment: The following quote is from a slide show I saw a few years ago. “Chicago has 17,000 different plan designs” Allan M. Korn, MD, medical director of BlueCross/BlueShieldinterviewed on amednews.com by Robert Kazel Sept. 20, 2004. How in fucking HELL can people like Scandien say that we just don't have enough competition and still keep a straight face?

The whole POINT of insurance is sharing risk. We all pay for the fire department despite the fact that few will ever see their property burn. Effective health insurance amounts to forcing the healthy majority to pay for the sick minority--which is perfectly fair, as no one ever knows which group they will wind up in over a lifetime. The only purpose of private insurance in this country is to avoid doing that.