Uncategorized

PODCAST/POLICY: A frank exchange of views with David Gratzer

So I tried really hard to be nasty to David Gratzer. I’ve complained bitterly on THCB about his op-ed posts which I think just misrepresent Canadian and American health care, and I still think that his book The Cure misrepresents both the prospects of his solutions fixing the US mess, and the desire of foreigners to implement US-style solutions. But as I was interviewing him, he was just so nice and reasonable!

That is not to say that we agreed on virtually anything. Listen to the pod-cast.
It’s long but you’ll enjoy it. (Transcript is up here)

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: ,

20
Leave a Reply

20 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
7 Comment authors
TimMatthew HoltJack E. LohmanBarry CarolPeter Recent comment authors
newest oldest most voted
Barry Carol
Guest
Barry Carol

Peter — My understanding of all of these efforts — the CHCF paper, the Massachusetts experiment, and a paper I recently heard about that explores financing options for the state of Georgia all have the goal of achieving universal coverage. All three options explored in both the CHCF and the Georgia papers involve mandates under three different financing mechanisms — individual mandate, employer play or pay into a state fund, and full taxpayer financing (premium support / voucher approach). Furthermore, I understand that the Democrats have a Medicare for All proposal that would be financed by an 8.7% payroll tax… Read more »

Peter
Guest
Peter

Barry, again, I don’t think we are all talking about problems in healthcare due to younger workers opting out of company plans. I’m not worried about opting out but those who can’t afford to opt-in. I would be interested to know how a group health provider handles companies where half the workers are not participating as opposed to one where 90% participate. The situation in this country where if you get health insurance is determined where and who you work for is unfair to workers and business. A universal plan should cover everyone with the same plan. “I read with… Read more »

Tim
Guest
Tim

Barry,
I sent you an email. No sense giving away all the answers just yet. 8^P

Barry Carol
Guest
Barry Carol

Tim,
Thanks. Can you provide a sense for whether these companies generally buy stop loss protection, and, if so, how much does it cost? Also, how much do they typically save vs buying conventional risk coverage from an insurer and, are these groups primarily young, relatively healthy people? Any color you can provide regarding small groups that choose to self-insure vs those that don’t (other than generalized appetite for risk or lack of it) would be interesting and helpful, at least to me.

Tim
Guest
Tim

Barry,
Acually, the self funded plans work for anyone from groups of 2 and up, not just from 100 employees and up. I have about 100 companies in varying sizes from self-employeed to groups of 100 doing this.

Barry Carol
Guest
Barry Carol

Peter — While I am certainly not an expert on employment law, I don’t believe an employer can force an employee to participate in its insurance and pay a significant contribution toward its cost. Employee cost sharing for most large employer plans these days ranges from 15%-30% of the estimated employer cost and averages in the low 20’s, I believe. The federal government requires 25% cost sharing. I believe John Fembup mentioned that his company requires 20% cost sharing. Furthermore, some employees are covered under a spouse’s plan and decline their employer plan to avoid wasteful double coverage. Finally, under… Read more »

Peter
Guest
Peter

Posted by: Barry Carol | Oct 26, 2006 8:44:09 AM “However, my understanding is that the vast majority of uninsured with incomes above $50K could get insurance through their employer but choose not to. This is because most are young and healthy and would prefer to spend their income in other ways. If their employer offered a high deductible plan as one of its insurance options, these people could buy catastrophic coverage for a much lower out-of-pocket contribution than the comprehensive plan would cost them.” Barry, I don’t believe your understanding is actually happening. If I were an employer with… Read more »

Peter
Guest
Peter

Posted by: Stuart Browning | Oct 26, 2006 8:08:45 AM
“Gee Peter, I’m not sure I know what you’re talking about. – And I’m not sure you do either.”
Well Stuart correct me if I’m wrong but my interpretation of your post about “forcing things on others” was a about those here that would like to see a single pay government run system. If I did misinterpret you then please clarify.

Matthew Holt
Guest
Matthew Holt

Natalie–that is just bizzare. Denmark has a capitalist health care system? The Danes, all of who’s doctors work for the state, would be surprised to find that out. And if you advertise your site or your service once more in my comments, you’ll be banned.

Matthew Holt
Guest
Matthew Holt

Barry–All very well. But in the totality of things, we are the pool….so when everyone doesn’t contribute enough, and the costs of the sick exceed what they can pay, and what’s in the pool–it has to be made up somewhere. The Gratzers of the world’s response to this is that the current system is broken, so encouraging those outside to buy int with a HDHP is better than nothing–even though the really sick can NOT buy them due to underwriting. BUT if you encourage that, you’re actually encouraging a move within the pool by those who are putting in a… Read more »

Barry Carol
Guest
Barry Carol

Jack, Draining the pool is not a problem for self-funded plans. Virtually all large plans of 5,000 employees or more are self-funded, and the self-insured model can work down to as few as 100 employees, at least with stop loss protection. Say an employer who self-insures pays $800 per month for comprehensive family coverage with a $500 per covered adult deductible ($1000 OOP) and requires the employee to contribute $200 per month toward that premium. A young healthy person thinks $200 is too much and declines to participate. Now suppose the employer offers, as an option, a $5000 per person… Read more »

Jack E. Lohman
Guest

My problem with this, Barry, is that these young and healthy people draw financial resources away from the overall pool, and then when they need it, they want into the pool. I guess you can’t blame them for wanting to maximize their incomes, but it sure detracts from the concept of sharing risks. I am constantly amazed at how much time and money we are spending trying to do an end-around of what many believe is the right way: a universal system. Perhaps we need to come up with some combination that lets people opt out but then pay a… Read more »

Barry Carol
Guest
Barry Carol

Peter — I’m sure that Matthew and others know more about this than I do. However, my understanding is that the vast majority of uninsured with incomes above $50K could get insurance through their employer but choose not to. This is because most are young and healthy and would prefer to spend their income in other ways. If their employer offered a high deductible plan as one of its insurance options, these people could buy catastrophic coverage for a much lower out-of-pocket contribution than the comprehensive plan would cost them. For those with incomes below 250% of the FPL, the… Read more »

Stuart Browning
Guest

Gee Peter, I’m not sure I know what you’re talking about. – And I’m not sure you do either.

Peter
Guest
Peter

Barry, I’m trying to put to paper your example to see how it would fair in actual practise. 2006 FPL for family of 4 = $20K 250% = $50,000 Less Taxes 25% = 37.5K Less Housing 30% = 26.25K Less Transportation 20% = $21K Less Food 20% = $16.8K Less Healthcare premiums of $7500 = $9300 My numbers are assumptions but maybe we could get a few to fill in gaps and other expenses to arrive at a final figure. My guess is that no one will bank the $5K deductible or be able to keep up with the co-pays… Read more »