The Case for Taxing “Cadillac” Healthcare Coverage

With President Obama’s plan for healthcare reform recently being dealt a tough blow by the Congressional Budget Office over soaring federal deficit projections, I am beginning to wonder if it is time for the President to modify his stance against taxing “Cadillac” healthcare coverage offered by employers.  It’s no secret what Senator Max Baucus, the Democratic Chairman of the Senate Finance Committee and one of the most powerful people in the healthcare reform debate, thinks President Obama should do.  Senator Baucus has been a vocal advocate of taxing healthcare benefits.  He recently told reporters that taxing employer-sponsored benefits is “the best way to raise money for an overhaul of the healthcare system.”  He has also been somewhat critical of President Obama’s decision to not tax healthcare benefits by saying, “Basically, the president is not helping us.”

In recent days, the Congressional Budget Office (CBO) estimated that the House Democratic legislation would add more than $230 billion to the federal budget deficit.  On the Senate side, Senator Baucus, who has been working with Senate leaders to formulate another plan, has pointed out the difficulties his committee has had with funding reform without some other type of significant revenue.

One way that raises enough revenue to cover well over the $230 billion figure projected by the CBO is through taxing employer-sponsored health benefits.  The nonpartisan Joint Committee on Taxation estimates that taxing employer-sponsored benefits above the value of the Federal Employees Health Benefits Plan (FEHBP), adjusted for inflation, would generate nearly $420 billion over the next 10 years, which would easily fund the difference in the budget gap.  Many other estimates place this number considerably higher.  Furthermore, many experts believe that this policy is a key way to reduce costs, because tax-free benefits encourage more spending on health care.

About 18 months ago, as I worked with a committee that I chaired in Tennessee called the Rolling Hills Group to create a structural model for national healthcare reform, I ran into the same problem that President Obama is facing today.  How do you pay for reform?  After considering several options on how to finance universal insurance, our group kept coming back to the same, single solution – the same one that Senator Baucus is a proponent of, taxing “Cadillac” healthcare benefits.

Under our proposal, we created a basic level of coverage similar to what members of Congress are offered today, known as the FEHBP standard option plan.  This plan is very generous and has been successful in holding down costs compared to other plans.  In order to make sure our plan was budget neutral, we decided we would no longer allow what we consider “Cadillac” coverage benefits to be tax free.  For example, in 2009, under our proposal, any individual policy worth more than $5,871.84 or any family policy worth more than $13,445.64 would be subject to a tax.  Anything less than this amount would be tax free.  For individuals, any amount above the base value of the plan would be considered income.  While for companies, any amount above the base value of the plan would no longer be deductible as a business expense.

We had this idea vetted by the Moran Company, who said that our plan is actuarially sound and budget neutral for the federal government once fully phased in.  Just as a note, in our plan we also derive revenue from Disproportionate Share Payments (DSH) and hold down up front costs by phasing in the reform over a 10 year period.  Disproportionate Share Payments is funding that hospitals receive for treating indigent populations.  Thus, it is reasonable to decrease DSH payments as the uninsured population decreases.

If taxing “Cadillac” coverage raises enough revenue to make healthcare reform budget neutral and encourages less spending on healthcare, why has such an attractive option for reform been pulled off the table amidst the President’s insistence on urgency?  As is usually the case with healthcare reform, the answer may be in the politics.

In recent weeks, several articles have outlined strong opposition by labor unions to the taxation of their healthcare benefits. In the Washington Post, the AFL-CIO stated its opposition to taxing “Cadillac” coverage.  Michael Sullivan, the President of the Sheet Metal Workers Union, has also adamantly stated his opposition to taxing healthcare benefits by saying, “Any bill that taxes health care benefits is dead on arrival.” Understanding these political difficulties, but still seeing the taxing of benefits as a viable way forward, lawmakers have demonstrated that there may be room for compromise.  Senator Baucus himself has hinted that he might consider grandfathering in the taxation of health benefits that are part of a collective-bargaining agreement, which would allow union plans to remain tax-free until new contracts can be negotiated.

Labor unions are not the only ones who have come out against the taxation of “Cadillac” plans, as many large corporations have exhibited significant opposition as well.  However, if healthcare reform is going to happen this year, Congress and President Obama may want to take a harder look at taxing “Cadillac” healthcare benefits as a means of raising revenue and achieving their other healthcare priorities.  I think it is fair to say that if Obama explains to the American people that the Government is only going tax the most lavish of benefits, he might find greater support from the American public for the change in health care that he promised to bring and that this nation so desperately needs.

Clayton McWhorter is a former President and chairman of HCA and current chairman of Clayton Associates and the Rolling Hills Group.  He is the founder of the group SHOUTAmerica, a Nashville based organization that uses social networking and other internet-based technologies to push for change in the healthcare system.

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39 replies »

  1. The problem that I see is that the lawmakers, who by the way get their healthcare paid for by their constituents and come to think of it don’t pay into social security either have no good reason to care who gets penalized. None of these laws affect them individually. National healthcare sounds great but what happens when my monthly health insurance goes from $210 / mo to $630/ mo because I’m considered “Cadillac”. I’ll tell you that I won’t be able to afford my mortgage or savings etc. I live modestly and have a tight budget. Where is any of this reform equitable????

  2. This is typical redistributive b s from a lefty progressive. How is that for progress. I work hard for an employee benefit and I get taxed so some do nothing bone head can go to the doctor when he has a tummy ache. How cool is that?? What happened to this country? What happened to free enterprise? The problems in this country started with pointy headed pseudo intellectuals who have never done anything but go to college taking control back around 1900. This Obama guy is a perfect example.

  3. Biotech Analyst (Aug 4) says somebody else’s health insurance “is my business, because I, as a taxpayer, am subsidizing your choice of health plan. And the more expensive the plan (i.e., the more “Cadillac” it is), the more I subsidize you”.
    Please explain because I don’t see it. Are you talking about employer provided insurance? I buy private health insurance and pay a premium each month to an insurance company. How am I getting subsidized by the taxpayer?

  4. “But if you want to keep health benefits untaxed then give me a tax break for buying my own policy or paying for my own care.”
    If the tax deduction really bothers you that much spend the $100 and start a business and pay your premium through there. It takes all of 1-2 hours and will pay for itself.

  5. The federal Health Care Financing Administration, which oversees Medicare, is taking a hard look at hospital over billing because they estimate that the government loses 30 cents to every dollar from fraudulent practices in the medical community. The medicare budget for 2010 is $675 Billion so that is more than $200 billion lost to fraud!
    If the government is losing 30% of it’s TOTAL medicare budget to fraud, should they be allowed to increase our taxes and take over the whole healthcare system?

  6. “I’m moving my money off-shore.”
    You’re a little late, haven’t you noticed out trade deficit.

  7. “Within 2 to 3 years after enacting this “tax”, employers will take the premium paid right up to the level to NOT get taxed and only offer the amount of benefits that those premiums will buy.”
    Common Sense?, I would tax the employee not the company, as with a company car. But if you want to keep health benefits untaxed then give me a tax break for buying my own policy or paying for my own care. Why should there be preferential treament (I know, there always is) for certain taxpayers?
    Even if companies reduce benefits which causes many more to be uninsured because their company cannot or does not offer health insurance then I say; welcome to the world the rest of us live in. I don’t want companies responsible for providing healthcare anyway.

  8. This plan makes quite a bit of sense. There needs to be a new source of revenue to help ease the fiscal strain healthcare is currently causing the government. Taxing healthcare benefits is very logical, especially when it is done on a corporate level. This way individuals rarely actually experience a change in their premiums.
    While some corporations may resist this tax increase, those that are most aware of the crisis at hand will be willing to make the necessary sacrifices. This initiative could potentially save the country from spiraling into deeper debt that–if left uncontrolled–could leave our country in ruins.

  9. I think people are overestimating the effect that taxing “Cadillac” coverage would have on the average policy holder. As stated in the article, it’s only policies exceeding the norm that are taxed. Chances are, those who have excessive plans are either the ones who incur the most healthcare costs (and should therefore be putting money back into the system), or those who can afford the tax. I know the public tends to be unwilling to accept any new taxes, but the current bills being proposed are lacking sufficient funding, and something is going to have to give if we want to change a system that is exponentially increasing in spending every decade. In my opinion, it’s more important to fund reform that could potentially keep our healthcare system afloat for the whole country than to preserve the tax-free status of lavish coverage for certain individuals. I think that while the details need to be further explored and hammered out, taxing cadillac coverage is not the disaster that these comments make it out to be.

  10. Within 2 to 3 years after enacting this “tax”, employers will take the premium paid right up to the level to NOT get taxed and only offer the amount of benefits that those premiums will buy. This in turn means that the government now collects no additional tax revenue, that lower income indiviuals now have to pay a higher percentage of premium which causes many to opt-out thus increasing the number of uninsured, and finally causes deductibles, coinsurance, and co-pays to increase to a point that they become unaffordable for lower income individuals – kind of like a tax increase on those who can least afford it and the group democrats claim to “care” so much about.

  11. To those of you complaining that fixing health care would mean more people trying to access care – would you really rather stick with the current model where we keep demand down simply because some people can’t pay??? That is horrifying. It is rationing of the worst kind. That is how China addresses its shortage of medical practitioners. Do we want to be like China when it comes to medical care, where people abandon handicapped babies in the street because they can’t afford to pay for surgery? Why don’t we instead try to address the shortage of primary care physicians?

  12. MD as HELL – The shortage of primary care can, I think, be attributed to Medicare payment policy, which drives payment policy for the private payers and to the doctors lobby for opposing optimal use of NP’s. It takes a lot less time to train an NP than a doctor, they’re trained to follow rules and use decision support tools, and, at least according to one expert I heard a year or so back, can handle up to 85% of primary care encounters. Of course, we would have to raise the pay for nursing faculty to reduce the bottleneck there. With more NP’s, coupled with fewer uninsured people, the demands on the ER should decline over time.
    Margalit – I would be OK with a commission too assuming it were independent, had sufficient expertise and staffed by people from both political parties to ensure that the full ideological spectrum was represented. It’s likely that we would get a sensible approach that forged a uniquely American solution to our healthcare and health insurance mess.

  13. Barry, I would be content if Congress decides to pass the healthcare buck to an independent, expert commission or board. I don’t think Congress has the required expertise to define all the cost containment measures needed, nor do they have what it takes to resolve the “coverage” conundrum. Maybe an independent body (a.k.a. FHB) would fare a little better.
    As to mortgage benefits, Matthew, your suggestion is practically blasphemy in this country, particularly now… 🙂
    Since everybody has a pet peeve here, can we seriously do something about global warming too? It’s sort of related to health… and Cadillacs….

  14. In probably everyone’s perfect world (or at least Barry Carol’s and mine) there should be no tax exemption for health benefits. And they should be eliminated in a budget neutral way.
    Same too for mortgage benefits.
    But of course we need to get beyond crisis points here to do such a thing.
    However the UK eliminated mortgage benefits over 5 years in the late 1980s early 1990s. Of course they had a parliament not a Congress….

  15. Does anyone out there remember TennCare? Gore’s present to Hillary near bankrupted Tennessee while nearly chasing every doc out of the state.

  16. MD as HELL
    You have it exactly on the money. The inconvenient truth was played out in Massachusetts.
    Coverage does not equal Access. Lack of capacity trumps coverage every day. And as you point out … capping reimbursements kills capacity some more. Witness the disappearing primary care sector.

  17. Why not provide individuals a tax credit up to a limit for purchase of health care coverage? Government buys coverage tax-free for those in its traditional Medicare… and states buy coverage tax-free for those in Medicaid. So why not make all those purchases whether by the individual, employer, or government on equal footing… and tax free?
    Also… need way for a new employer to make the Part125 payment to the plan an employee had through his/her past employer. That provides portability.
    If someone buys coverage through whatever exchange gets set up… what happens when they get a job where the employer contributes? Do you stick with your individual plan… or do you switch to a better group program? Only way these individual exchange plans work is if you keep working for small businesses that don’t have their own group program.

  18. You are still only talking about “coverage” and not about “care”. Bring any coverage into my ED tonight and you will wait…. Bring more of you in and you will wait longer… Go to a clinic with anything dicy at all and you will be sent here where you will wait…
    Adding coverage will not increase the availability of care. It will raise the price. Cap the price and the availability goes down.
    What is it you are trying to do? Win a game?

  19. Margalit,
    I’m as frustrated by the politics as you are, but it’s always been that way until the situation reaches the crisis level and just can’t be ignored any longer. Even then, however, I note that Congress passed the buck to an independent commission headed by Alan Greenspan in 1982 to come up with a package to reform Social Security after it looked like the checks were going to start to bounce soon. Also, when Congress couldn’t reach a consensus on how to downsize our military force structure and figure out which bases to close after the collapse of the former Soviet Union, it passed the buck to the Base Realignment and Closure Commission (BRAC) to determine which bases should be closed and Congress would then have to vote up or down on the entire package.
    With respect to healthcare, trial lawyers and labor unions have always been key Democratic constituencies. It would be a tall order to expect the Obama Administration to demand any substantive sacrifice from either group. They don’t want to take on the doctors either. It’s much easier to just demonize insurers and Big Pharma. In the case of insurers, with the exception of their strong opposition to a public insurance option, the inconvenient fact is that they support all of the other reforms including modified community rating and guaranteed issue coupled with mandatory participation, the establishment of insurance exchanges and a minimum benefit package. Under that approach, though, reform advocates don’t like to talk about the fact that young, healthy people who can pass the underwriting screens would wind up having to pay several times what they do now for health insurance. It will be a pretty lousy deal for them, but any reform approach will create both winners AND losers.

  20. Barry,
    Why is everything a “political nonstarter”? Why do we always have to bring into account “political realities”?
    On every side of the aisle there is a multitude of these non starters. Part of making hard decisions and solving problems is to tackle these “non starters”.
    It is going to cost us money to fix health care.
    Somebody is going to have to pay for it.
    A compromise will be necessary.
    It’s going to hurt.
    By definition, that means that some “non starters” are going to have to be reclassified.
    Or maybe it’s not as bad as it’s going to get.

  21. Peter – I agree with you on this one. While conservatives would prefer to afford individuals who currently buy health insurance with after tax dollars the same tax break that people with employer provided coverage get, it would make much more sense to just tax the full value of employer health insurance as income. The current tax benefit originated during World War II era wage and price controls when employers couldn’t give raises but could give benefits to attract employees. The IRS later ruled that neither the employer nor the employee had to pay payroll taxes on the value of the benefit and the employee didn’t have to pay income taxes either.
    To be fair, if we were to tax health insurance benefits, we would probably have to lower income and/or payroll tax rates to ensure that the middle class and lower middle class don’t pay any more income and payroll taxes than they do now. Higher income people would bear the burden of higher taxes on their health benefits in addition to the pending expiration of the Bush tax cuts at the end of 2010 for those in the 33% and 35% income tax brackets. Those brackets would revert to 36% and 39.6% that existed during the Clinton Administration since 1993.
    Of course, I realize that steadfast opposition from labor unions, along with Obama’s pledge during the campaign not to raise taxes on people who earn less than $250K make this a political non-starter. However, it is disingenuous and wrong to suggest that people can have all these health insurance subsidies and other benefits while only the top 5% or so of the income distribution will have to pay for it. Income is volatile at the high end and economic behavior changes as tax rates and tax burdens rise. California learned this in spades when, during the boom period, 144,000 wealthy taxpayers paid 50% of the state’s income taxes. The CA population is 38 million and income tax collections are down over 25%. I’ve said many times that the broad middle class will have to pay for the broad middle class. Look for a VAT within the next few years when we get serious about starting to pay our bills with current tax revenue rather than borrowing.

  22. Agreed, Peter.
    Also, if there really is a regulated exchange with a FEHBP style public plan at a reasonable price, people may want to switch to the public option and forgo the employer plan. There should be no disincentive to do that in the form of loss of tax breaks.
    If everybody needs to pitch in for this reform to happen, I’m fine with taxing health benefits for all.
    Did anybody do any calculations to see if such taxing will indeed cover the foreseen costs of the proposed “reform”?

  23. To me, any employer paid health insurance should be taxed as any company benfit would be – “cadillac” or not.
    This from AEI link of John Ballard:
    “The special tax treatment of employer-based health insurance substantially advantaged this type of insurance over policies sold to individuals. An individual insurance policy must be purchased with after-tax dollars; but, if you get your health insurance through your employer, you do not have to pay taxes on the premiums your employer pays on your behalf. This means that tax policy ends up giving a discount on your insurance coverage that is approximately equal to your marginal tax rate. For most workers who pay both income and payroll taxes, this ranges from about 25 percent to over 50 percent, a substantial discount. This discount is greater for higher-income workers than it is for lower-income workers.”
    I don’t get a tax break if I purchase individual insurance or pay for my health costs – why should you?

  24. Am still trying to figure out what the emergency is all about.
    Administration’s contention that there are 47mil uninsured Americans is flat WRONG.
    Per Census report from last August effective March 2009… uninsured AMERICANS is far less than 47 million.
    By my quick calculation from Table 6 on page 22 … there are 45.657million uninsured PEOPLE in the U.S. … including 9.737mil non-citizens. That brings the number of AMERICANs without health insurance for at a minimum part of the year down to …
    35.920million Americans.
    Also included in the 45.657 million are 17.60million who earned over $50k/year (9.115mil over $75k).
    President’s speechwriter pulled the number applicable for March 1, 2007 off the table instead of the lower March 1, 2008 number.
    So before we go race off and try to pay for something that only 36mil AMERICANs don’t have … lets figure out what the 17.20mil are spending their money on first.

  25. But even going by deductible doesn’t make sense. One plan with a $2000 deductible may have really good in-network specialists and another may not. One plan with a $2000 deductible may cover out of network at 70% after meeting a $10,000 out of pocket, another may cover at 90% after meeting a $5000 out of pocket. Some plans cover hearing aids (my son needs hearing aids that cost $6000 each, so the fact that our plans do not cover this is annoying). Some plans are really good about covering PT, others are not. There is just no simple way to define a “Cadillac plan”.

  26. defining a Cadillac plan by cost is terrible idea. You could have two people with the exact same benefits but because one is older or sicker and pays a higher premium they get taxed. These are the types of ideas people that never worked a day in healthcare come up with.
    If you want to tax rich plans then you do it by benefit level. Anything with a deductible under $2000 or some amount would be taxed.
    The rational approach and easy way to pass this is to only allow tax deductions for insurance. $250 deductibles and $10 co-pays aren’t insurance. Only allow deductibility when there is true transfer of risk. In all other lines of insurance it’s considered fraud to pay a premium when there is no risk involved. AIG and Berkshire got in trouble selling phony insurance policies to help companies cook their books. They got busted because their “insurance” wasn’t insuring anything.
    BKM so you advocate Medicaid for all? Since some people can’t have great coverage we should all have poor coverage?

  27. On a very basic level I have to agree with Clayton McWhorter.
    Like many commenters here, I have no idea what a “Cadillac” plan is. I am assuming that it covers executive physicals and plastic surgery sort of things. But why stop there?
    If we mandate that all employers (and exchanges) must offer the FEHBP equivalent, or better, would those plans qualify as “Cadillac”? Maybe just “Lexus”. I don’t see much value in minimalistic plans. Sooner or later, the tax payers are going to have to pay for whatever those skimpy coverages do not pay.
    So how about covering everybody with the FEHBP, taxing the coverage progressively, regulate the private insurers, offer a public alternative, change the reimbursement model and start work on guidelines and evidence based practice on a federal/state level in order to contain costs? I may be wrong, but I think Dr. Emmanuel would go for something like that instead of the VAT, which is as much of a hardship, if not more, particularly on low income folks.

  28. The whole notion of a “cadillac plan” is ludicrous.
    Thanks to extreme overconfidence and excessive hubris in modern bio-medicine we don’t even know yet what works and what is safe?
    We(ALL THE INSURED AT ANY LEVEL)have been both duped and swindled by organized bio-medicine.
    Also for those out there who believe that a cadillac plan” can “beat death” – Sorry it can’t
    Dr. Rick Lippin

  29. I have not seen much discussion around the facts that (1) the high cost of these so-called “Cadillac” plans are likely to be as much (or more) based on age/health status of the covered population (under-65 retirees, watch out!), or that (2) fifty percent or so of employer-based insurance is self-funded, so it would be directly hitting the employers, not the supposed villains in the insurance companies.
    Having some portion of employer-based plans be taxed is a very reasonable idea that should stay on the table, but this Cadillac tax is just pandering.

  30. Actually, I tend towards the liberal side on this. I would like to see the proposed health exchange, with a good public option and tight regulation of the private plans, open to EVERYONE. That way, I or my husband could switch to jobs that made more sense for us, or even go out and start a little business – you know, do something good for the economy – instead of worrying about our coverage. If you have never been in the situation of having a child with a very serious medical condition, you have no idea how scary our current insurance system is. And the conservative ideal of simply throwing everyone into an unregulated private market is just nuts. We would end up with everyone dumped into high risk pools while the insurance companies cherry picked the few. Sort of the way certain states auto insurance markets were for a while… Sometimes I think the Republican plan is a secret weapon for single payer, because the outcome would be so bad that in 10 years everyone would be screaming for single payer.

  31. I don’t think anyone disagrees that we do need health care reform. But I think many are truly concerned about the cost of a completely new system versus fixing the problems in the system we have. Also many believe when the USA became a free country it embraced an ideology of free market enterprise and small government.
    At the time the constitution was written the damage that can be caused by letting a government become too big and too powerful was all too apparent. I think this is a valid concern today. In government the most powerful senators are the ones that control the largest budgets. Obviously healthcare is huge! Management systems in Washington work in reverse of the free market system. In Washington budgets are reduced if they are not spent in the previous year, so the emphasis is to grow your budget. Larger budgets equate to more power and control for that department. In the free market system CEO’s are rewarded for reducing costs and saving money, while continuing to maintain a health budget for research and development. Free market system is more efficient and more likely to achieve the results we need in our healthcare system.

  32. I don’t understand why they intend to tax the public to raise funds to feed into a system that is riddled with inefficiencies.
    The federal Health Care Financing Administration, which oversees Medicare & Medicaid (the parts of the healthcare system which are run by the government), estimates that the government loses 30 cents to every dollar from fraudulent practices in the medical community. This is a huge problem that must not be ignored; especially when you consider that the combined total spending that is projected in 2010 for Medicare & Medicaid is $675 billion!
    That is over $200 billion of taxpayer’s money that is being wasted in the current government run healthcare system!

  33. President George W. Bush’s ambitious second-term agenda includes proposals to reform the tax system and, more specifically, to use it to make our increasingly costly health-care system more efficient. After explaining the decisive influence of tax policy in shaping the current system, with its preference for employer-based health insurance, this essay discusses the main options for altering the tax treatment of medical expenses and identifies three measures that could lead the way toward more comprehensive health-care reform.
    That’s from an essay by Robert Helms written in 2005. I found it at the AEI website. They don’t get more conservative than than without toothpicks sticking out.
    Open Congress website posts a searchable copy of H.R.3200.
    ►A poll in the sidebar is only running twelve percent “I favor this bill.” Somebody needs to do something quick or this thing will go down in flames like past efforts.◄
    Alain Enthoven weighed in briefly at Health Affairs.
    And I put together a post about exchanges.

  34. I have to agree with BKM and Bob Kellum. There’s a lot of talk about so-called “Cadillac” health plans and no definition of just what one looks like.
    Does a “Cadillac” plan have higher annual premiums? Does it have lower cost-sharing for the member in terms of deductibles and copays? Or is it one where the employer is paying a greater percentage of the premium, and the worker, little or nothing? Does it have ultra-broad networks, or is it perhaps even an indemnity plan?
    The fact that the terms are undefined tells me that the person taking aim at these ill-defined straw men (straw Cadillacs?) has an agenda.
    I talk to health plan brokers all the time, for clients small, large and individual. They tell me that the days of unionized labor in the industrial sector getting the best benefits are over. The plans with the lowest cost-sharing these days are the public-employee groups. I suppose you could target them, but most of them are 10 and 12 dollar an hour clerks. Can they really afford to be pinched more? Meanwhile, in the C-suites of the Fortune 500, the guys and gals in the suits usually have indemnity plans, one of the last bastions of this design, with premiums that would certainly qualify as “Cadillac”, perhaps even “Bentley.”
    So who, exactly, are we targeting when we say “Tax the ‘Cadillac’ health plans”?

  35. “I really don’t understand why it is anyone’s business what plan I have, how much I pay, or what the provisions are.”
    Actually, it is my business, because I, as a taxpayer, am subsidizing your choice of health plan. And the more expensive the plan (i.e., the more “Cadillac” it is), the more I subsidize you. And you in turn have a subsidized prepaid health plan where you have no incentive to be cost-conscious. Are you seeing a problem here?

  36. I really don’t understand why it is anyone’s business what plan I have, how much I pay, or what the provisions are. As I drive by, you might think about why I would need to drive an old Hyundai, or a BMW. The question is what is it to you, and what do you really have to say about it.
    Most questions in life are really simple at their core. In your analysis that my health plan is a “Cadillac”, the assessment is not about my health plan, but about how much money I have to pay for it. If I have the money to pay for really nice provisions, then I am greedy. I’m a pig who needs to be reigned in.
    How did we get here? Do you know whether I’ve worked hard for forty years, building my little business into something that provides for me and my family? Do you have a count on the number of peanut butter sandwiches I’ve eaten to keep from firing an employee that I couldn’t afford?
    Let’s get down to brass tacks. What gives you the right to judge whether I can keep my money or not?
    We are told that there are 30 million uninsured. How does this number break down? Is this a problem?
    No, this whole situation is a pig in a poke. It’s the equivalent of a land grab in the old west.
    Why not use point fixes for the real problems we have in the healthcare system? Tort reform, administrative complexity, standards of care. These are not sexy, but they are where the problems and the savings are at. Each one can be tackled individually.
    WHY DO WE NEED 1000 PAGES OF CRAP!!!!!!!!

  37. What is a “Cadillac plan” exactly? Is it simply a plan that is comphrehensive enough that you don’t go bankrupt when a major illness strikes? I have a son who was treated when he was 2 for a rare pediatric cancer with a pretty poor survival rate. We were insured, but we had to go out of network because the plan had no hospital or oncologist with much experience treating the cancer. I am glad we did because our son just passed his 5 year ned mark, but we ended up oweing 100K in unreimbursed costs.
    Since then, we have made all employment decisions based on the insurance offered (and for your information, most employers only offer one plan). We only work for employers with Cadillac coverage, so we won’t lose everything should my son relapse. I don’t mind paying taxes on these plans – but what happens when employers start dropping good plans to escape the tax consequences? If we could buy insurance on the proposed exchange, especially if there is a public option, it wouldn’t be so bad. But I have heard that the plan will not allow people with coverage through their employer to bypass it for the exchange. So we could be trapped with lousy employer-based coverage and no options if the tax encourages employers to only offer “underinsurance”.

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