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Eric Novack has a few questions….

1. In California, where the SEIU is attempting to forcefully merge with the United Healthcare Workers, I can’t seem to find the focus on, you know, health care. “What it does is allows them to have the strongest voice possible in Sacramento,” said Mary Kay Henry, SEIU executive vice president.

2. Should the new administration be looking at Massachusetts as model to follow for health reform, or as a model of what must, at all costs (and they are extremely high), be avoided?3. How can we reconcile the fact that on Thursday the President-elect spoke about the importance of spending more on healthcare while on Sunday explaining that he intends to recommend spending less?4. In 2005, the association health plan bill (aka small business health plan) was killed, in large part, because advocates for specific disease conditions believed that state mandates and state lobbying efforts would be hampered if more people were covered under ERISA (i.e. national mandates—which are much harder to pass)— how will the administration propose to address this issue of state mandates in sweeping health care reform? 5. If health and health care are ultimately the most personal part of our lives, is it possible that more nationalization of health care will result in a greater role of lobbying bureaucrats and elected officials to seek and obtain care?6. How much would Medicare taxes be, and Part B and D premiums be, if the system actually needed to be self supporting, and the government had to keep adequate financial reserves like private insurers?

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JimEric NovackjdNateTom Leith Recent comment authors
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jd
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jd

Note to Eric: a “trust fund” by that very name does exist for Medicare and Social Security, as used by the Social Security Administration in their 2008 annual report. I was using their term. The term is used all over the place by government agencies, including Treasury. I’m not sure why this point needs repeating, but: Social Security and Medicare provide cash and in-kind benefits to nearly forty million people each year. These social insurance programs are financed largely through payroll contributions, income taxes on benefits received, premiums, and federal general fund revenues that flow into federal trust funds for… Read more »

Jim
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Jim

1 – I see your point here. American Culture and the American workplace has evolved over the years and unions have not evolved to meet the needs of workers. They have morphed into business and that serves no one. In this instance SEIU is doing what any reasonable business would do, consolidate their revenue base in to a leaner more controllable entity. In effect A power Base for the leaders of SEIU. It serves no one but them. 2 – Well, I have seen many instances of the media and Dems not associated with the administration using the word “Model”… Read more »

Eric Novack
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Eric Novack

jd-
Medicare Part A — 100% general fund (and we have $400+ billion deficit this past year)
Medicare Part B — 75% by the general fund, 25% from premiums (see above re: funds) —
Medicare Part C — this is the Medicare Advantage plan and the funds to ‘overpay’ private insurers also comes from the general fund
Medicare Part D — >$100 billion from the general fund
Note to jd— no “trust fund” exists for Medicare or Social Security
Remember, we have Medicare Part P right now— that is Medicare-for-All, the Medicare- Part Ponzi

Tom Leith
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Tom Leith

Nate asks:
> What if you have employees in all 50 states
Then you suffer a diseconomy of scale — decide whether the upside is worth it to you. There is no particularly good reason to favor bigness, and lots of good reasons to favor local enterprise and control.
t

jd
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jd

To answer Eric’s last one: who says Medicare isn’t adequately reserved at the moment? Seriously, is this founded on anything other than ignorance? Medicare has four main parts, A-D. I’ll ignore Part C (Medicare Advantage) and Part D (drug coverage). For part A, the hospital fund has a much, much larger reserve than private insurers are required to have. The problem with the hospital fund isn’t that the reserves aren’t adequate to present payments, it’s that they won’t be adequate years from now if we keep bringing in lower revenues from dedicated taxes and premiums than is paid out in… Read more »

Peter
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Peter

Nate, if we could all opt in and out of coverage as you suggest then we would reduce size of group and make the cost for each group larger. Who then could afford insurance? As usual the “choice” group hasn’t any social solidarity. Why is it that single-pay countries cover everyone with no opt out option and do it for less than half what we do it for?

Nate
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Nate

The AHP bill has been beaten for 12 years now and concern about mandates are a red herring. Number one reason for Democrat opposition is the Union’s told them to do it. Small employers able to join AHPs would be major competition to Union Taft Hartley Plans. Unions can offer benefits considerably cheaper and more efficiently then small employers because they can pool them together. Take this away and one of their main organizing tools is gone. The second is Tax revenue. States can’t tax claim payments by self funded plans as easily as they can carriers with a premium… Read more »

Tom Leith
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Tom Leith

1) Was there a question in there? 2) Depends on what you mean. This gets to a comment Matthew made a few days back: what in the world is wrong with 50 universal insurance plans? Why must there be one? Why is it that states induce “vagaries” by their own small-d democratic processes, but the feds don’t? Oh Wait!!! They do, but at an practically inescapable international scale. Personally I think it ought to matter where you live, and if you really prefer another set of policies, you can move. As from England or Canada to America. But maybe it… Read more »

Matthew Holt
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1. Small picture Eric’s right. Big picture, the evisceration of unions over the last 30 years was a big part of the reason for a) the collapse of Democratic organization (and political success) and b) the reduction in real wages and increase in real profits (and financial games) that caused the beggarment of the lower middle class and the current economic crisis. So I’m torn. 2. Mass is partially a cop-out and was done without upsetting the providers. We’ll see if that’s a national model, but I doubt it’ll be that pretty 3. He’s a politician, just learning this stuff…… Read more »

Peter
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Peter

1. No, the strongest voice is by health industry lobbyists in DC. 2. The MA plan is nothing more than a bailout of providers by the taxpayers. It does not control costs as a true single-pay plan would. 3. Maybe spending less on waste and overutilization (profits) while spending more on those that don’t have coverage. 4. Sure, let’s cut costs by denying some diseaes coverage. Typical insurance tactic; raise deductibles, raise co-pays, reduce coverage, then tell people how much money they’re saving – now that’s inovative thinking. 5. Yes lobbying by votes of individuals not money from corporations, and… Read more »

rbar
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rbar

Re. #3 – reading Pres. el. Obama’s preelection statement in the NEMJ, I had the impression that he and/or his advisors have an idea about the problems with medical inflation, and that not only coverage is needed, but cost control as well. I am not a studied health economist, but plan would be: 1) he and his advisors should stress the facts that US healthcare is the most expensive one and that medicare and medicaid face serious trouble in the midterm OVER AND OVER, for at least 6-12 month. 2) and stress the need for reimbursement reform. Say over and… Read more »

tcoyote
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tcoyote

Great questions, Eric! Number 1 deserves a lot more focus, as SEIU has targeted healthcare as a major organizing priority, if Congress passes the Employee “Free Choice” Act (which looks like at least a 50-50 chance). The approach SEIU took in New York was to ally with the Greater New York Hospital Association to shake down the legislature for more Medicaid funding, and to grab a big chunk of the proceeds from privatizing the Empire Blue Cross Plan to earmark for wage increases for their workers. The main agenda was, in Samuel Gompers’ immortal phrase, MORE. MORE taxpayer dollars, and… Read more »

Deron S.
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Eric – I’ve been trying to get #3 and #6 answered for quite some time.
3. We shouldn’t need to throw money at an already expensive system. We must look for inequities and start reallocating the current spending to accomplish the goals we need to achieve.
6. That is a very important question. I hope Medicare for All proponents aren’t resting solely on the fact that Uncle Sam has the power of taxation, the ability to print money, and almost unlimited borrowing power to make up any shortfalls.