By SENATOR BERNIE SANDERS
The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people. Meanwhile, we spend about twice as much per capita on health care and, in a wide number of instances, our outcomes are not as good as others that spend far less.
It is time that we bring about a fundamental transformation of the American health-care system. It is time for us to end private, for-profit participation in delivering basic coverage. It is time for the United States to provide a Medicare-for-all, single payer health coverage program.
Under our dysfunctional system, 45,000 Americans a year die because they delay seeking care they cannot afford. We spent 17.6% of our GDP on health care in 2009, which is projected to go up to 20% by 2020, yet we still rank 26th among major, developed nations on life expectancy, and 31st on infant mortality. We must demand a better model of health coverage that emphasizes preventive and primary care for every single person without regard for their ability to pay.
It is certainly a step forward that the new health reform law is projected to cover 32 million additional Americans, out of the more than 50 million uninsured today. Yet projections suggest that roughly 23 million will still be without insurance in 2019, while health-care costs will continue to skyrocket.
Twenty-three million Americans still without health insurance after health reform is implemented? This is unacceptable. And that is why, this week, Representative Jim McDermott and I are announcing the re-introduction of the American Health Security Act, recognizing health care as a human right and providing every US citizen and permanent resident with health-care coverage and services through a state-administered, single payer program.
Let’s face it: until we put patients over profits, our system will not work for ordinary Americans.
It is incomprehensible that drug companies still get away with charging Americans twice as much, or more, than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still often hike premiums 20%, 40% and 60% a year on individual policy holders; and some insurers still spend 40 cents of every premium dollar on administration and profits while lavishing multimillion-dollar payouts on their CEOs.
It boggles the mind that approximately 30% of every health-care dollar spent in the United States goes to administrative costs, rather than to delivering care. We must do better. Taiwan, for example, spends only a little over 6% of GDP on health care, while achieving better health outcomes on some key indicators than we do; yet they spend a relative pittance on administrative costs.
I am very proud that my home state of Vermont is now taking big steps to lead the nation in health care by moving forward on a plan to establish a single payer health-care system that puts the interests of patients over chasing profits. The American Health Security Act would make sure every state does the same — taking profits out of the equation by implementing a single-payer system, but letting each state administer its own program, according to strict standards, in a way best suited to its needs.
The goal of real health-care reform must be high-quality, universal coverage in a cost-effective way. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of health care, not to paper-pushing, astronomical profits and lining CEOs’ pockets.
Bernie Sanders is the U.S. Senator (I) from Vermont, and the longest serving independent member of Congress in American history. He is a member of the Senate’s Budget, Veterans, Environment, Energy, and H.E.L.P. (Health, Education, Labor, and Pensions) committees.
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I would like to see a system that makes serious health care a true public good. …Ie there would be no way to charge for it. By serious I mean conditions that could result in death or disability, or could result in bankruptcy. “Could” means in the near term or in the far term .This means roughly that society would take care of folks without billing or charging who had in-patient types of problems, not ambulatory conditions. … With plenty of exceptions. It would be a county or hospital district or US Representative-sized operation to avoid the dangers of big government. It would be financed by local taxes and federal grants–without strings–and would be hospital based. Expert triage would have to occur., the question being “could this patient have something that might kill him or disable him or cause him to go broke? Lupus would be a yes. A hemorrhoid would probably be a no. The folks turned away could manage their minor illnesses anyway they desired. They could use indemnity insurance, cash, health savings accounts, whatever. The hospitals would only maintain medical records. There would be no billing activity or records therefrom whatsoever. All provider people and administrators would be on salary. Patients would be kept as long as their condition warranted. The intellectual
thrust of the personnel would be continuing medical education, not cost saving, and arriving at the correct diagnosis would be god like. Cost saving would be from the tug and war of global district budgets and county/federal taxpayers.
Many other countries use insurance mandates. Switzerland, Japan,
Austria, Germany uses premiums or tax directed to health funds, France could be better described as private-public rather than single-paye, as most French carry some additional private health insurance to complement the program.
All these systems are admired by reformers and none of them properly qualifies as a true sngle payer. .I would ratrherr have us form any of the above systems than radical single-payer. I say this as a former resident of a nation that refused to treat or even diagnose me,or help me find a private pay alternative in their over-praised single payer system.
Sanders has no proof that 23 million will not be covered. Here in CA they would most t likely be undocumented workers who are generally well treated in our very generous safety net health system.
Best for us: Obama’s Reform Law ; It is similar to the successful and universal but (thank goodness) not fully sngle-payer systems I mention above.
My deepest admiration, and wishes for success, Senator Sanders. We need a CHANGE and our hope is in you success.
“Let’s stop wasting time squabbling over what ‘liberal’ or ‘conservative’ policy is better or worse and instead abandon those terms in favor of policy that actually works.”
Get rid of the failed liberal policies and we will be there.
It is disheartening to read comments from educated and thoughtful individuals who constantly use the term ‘liberal’ as a slur toward programs or policies they do not agree with (and with glee if the program proves to be unsucessful.)
Only when we are willing to set aside our egos and this ridiculous obsession with being ‘right’ rather than setting policy that makes social AND fiscal sense will we as a country become whole again. As much as we want to resist, removing the profit motive from health care is change that is long-overdue.
Let’s stop wasting time squabbling over what ‘liberal’ or ‘conservative’ policy is better or worse and instead abandon those terms in favor of policy that actually works.
http://www.city-journal.org/html/16_2_welfare_reform.html
“How should progressives respond to what we know so far about welfare reform and children?” he asked. “By progressives, I mean leftist/liberal and feminist scholars and observers, who, based on past experience, probably constitute 80 to 90 percent of this audience.” His answer suggests some serious soul-searching. “[T]here may be something to the idea that long-term dependency on public assistance is detrimental,” he conceded, though he had always “rejected this idea out of hand prior to 1996.”
That sums up the problem with liberals.
They reject logical answers out of hand becuase it doesn’t fit their dogma. Despite Wendells claims otherwise facts mean nothing to them, neither does destroying generations of lives.
Whats amazing is even after these over the top claims not one of these people paid any price for being wrong? TANF was unquestionable success, these people could not have been more wrong yet they suffered no accountability, Liberals never do get held accountable.
“So it seems a good time to remember the drama—make that melodrama—that the bill unleashed in 1996. Cries from Democrats of “anti-family,” “anti-child,” “mean-spirited,” echoed through the Capitol, as did warnings of impending Third World–style poverty: “children begging for money, children begging for food, eight- and nine-year-old prostitutes,” as New Jersey senator Frank Lautenberg put it. “They are coming for the children,” Congressman John Lewis of Georgia wailed—“coming for the poor, coming for the sick, the elderly and disabled.” Congressman William Clay of Missouri demanded, “What’s next? Castration?” Senator Ted Kennedy called it “legislative child abuse,” Senator Chris Dodd, “unconscionable,” Senator Daniel Patrick Moynihan—in what may well be the lowest point of an otherwise miraculous career—“something approaching an Apocalypse.”
Other Washington bigwigs took up the cry. Marion Wright Edelman of the Children’s Defense Fund called the bill “national child abandonment” and likened it to the burning of Vietnamese villages. Immediately after President Clinton signed the bill, some of his top appointees quit in protest, including Edelman’s husband, Peter, who let loose with an article in The Atlantic Monthly titled, “The Worst Thing Bill Clinton Has Done.” No less appalled, the Chicago Tribune seconded Congresswoman Carol Moseley Braun’s branding the bill an “abomination.” And while in 2004 the New York Times lauded the legislation as “one of the acclaimed successes of the past decade,” the editors seem to have forgotten that they were irately against it before they were for it, pronouncing it “draconian” and a “sad day for poor children.”
To top it off you can find thousands of stories in the media how welfare reform was going to lead to dead bodies in the street then when it turned out not to be true a fraction of the stories with the true outcome.
The media has no problem carrying water for liberal dogma and doing everything they can to burry the truth. Some point the america public will wake up to what they are doing and tear them both down once and for all. The wizard can’t hide behind the curtain forever.
“Failure has never detered progressivism”
Nate –
This has always bugged me as well. I’ve never heard of a government program that failed when liberals / progressives said something like this: We believed in this program, we fought for it; we got it passed into law and implemented. We thought it would work but it didn’t. Let’s kill it and try something else. Instead, they are likely to say if we just put some more money into it, maybe then it will work. That’s their basic approach to primary and secondary education in the inner cities where failure has long been pervasive.
Conversely, when President Clinton signed welfare reform in 1995 after vetoing it twice, liberals claimed it would be a disaster and people would starve. Some senior officials even resigned in protest. Instead, states used their new block grants to innovate and design programs appropriate for their population. The welfare rolls are two-thirds lower now than they were then, spending in real terms is down 31% and people didn’t starve. Several states want to now try the same block grant approach with Medicaid but they need CMS waivers. Those won’t be easy to get from this Administration.
If the ERISA exemption is for residents of VT would someone not living in VT but covered by VT still have ERISA protection? What about residents that live in VT but work over the border outside VT? We have clients that avoid hiring people that live in NY because of their terrible legislation, VT might find its self in the same boat.
Not that it all can’t be accomplished it will just be a blast watching politicians that don’t know anything about insurance try to do it.
If they try to fund it all with payroll taxes that would create a huge incentive for service or professional companies with high labor cost and younger work forces to look at moving somewhere else. It removes all incentive for employers to manage healthcare cost.
If you were Dartmouth why settle for Medicare rates? They would have the plan over the barrell, the plan either starts already restricting access to providers people are use to seeing or they reimburse more.
Like you said, better to experiment with 650,000 lives then 300 million. The problem I see is when it fails like all other Liberal reform has they wiull blame it on the small size. Like the already claim with Medicare, if it covered everyone magically it would work. Failure has never detered progressivism
Nate –
People who work in VT but live in a neighboring state will likely be covered under VT’s insurance if it’s financed by a payroll tax which is probably the most likely approach. By the way, if VT chooses the payroll tax option, it will likely take a tax rate of at least 15% of wages or about the same as current FICA taxes. This is Germany’s rate though it only applies to wages up to €43,000 or about $62K at current exchange rates. Depending on the reimbursement rates, I wonder if providers in other states, like Dartmouth-Hitchcock Medical Center in NH, will accept the insurance. If VT pays Medicare rates, it probably won’t be a problem, but then that will significantly raise the cost of covering people currently on Medicaid as they transition to the single payer insurance. Ah, life is complicated, isn’t it?
“Opposition is largely based on false assumptions in any case.”
Wow does this sound like your typical liberal. Any opposition to their idelogy means your ilinformed, they are never wrong the public just doesn’t know what is right.
This will have some interesting ramifications. Going to make VT very unattractive for some employers. VT will need an ERISA exemption like HI has. This will allow them to have single payor for their residents. What about someone that lives in another state on the border and works for someone in VT? If a company has only 1-2 employees that live out of state how do they get insurance now? Or will the VT plan be open to residents of other states that work for VT companies? What happens when they have some multi million dollar claims from non VT residents?
I disagree regarding the premise that employees at companies such as IBM oppose single-payer. It may be true. It may not be. Opposition is largely based on false assumptions in any case.
Single-payer is a superior system to the current system in the USA for all people. Nothing is lost, much is gained to all.
Otherwise I agree on the other points. I also agree that Vermont, given its size and the willingness of the population to experiment with alternative means of achieving social benefits, is a good place to institute some version of single payer, although as I note elsewhere, a single payer system works within the largest national entity by far the best rather than within a given state.
Wendell –
I mentioned IBM as an example of a large FOR PROFIT employer. Employees of such companies are probably more likely than others to oppose a single payer healthcare system. By contrast, hospital systems, colleges and universities, state and local government entities, and the like may be more inclined to favor the approach. The small business sector and individuals who cannot afford to buy insurance under the current system are also more likely to support single payer if the requisite taxes don’t put them out of business first.
With Vermont’s economy based mainly on agriculture, tourism, state and local government and the education and medical sectors, it’s probably fertile territory to give single payer a try as compared to other states with a more robust for profit sector. So, good luck with the effort. I look forward to seeing the financing mechanism, how the state determines provider reimbursement rates, the extent to which medically needy people move into the state and how well VT controls both fraud and legitimate utilization of healthcare services without rationing.
There needs to be a way to report people like Wendell and have their right to vote taken away. If your this detatched from reality and facts you shouldn’t be allowed to elect leaders. This is almost as bad as the women that said voting for Obama he will pay her mortgage and gas bill. Why are these people allowed to participate in democracy?
Good ole Peggy Joseph
” You clearly have shown through this weblog no ability to do the most basic research on any relevant topic. The lack of facts and research”
so all the facts about how many employers self fund and how many people have insurance through these plans and the factual fraud rate of Medicare and how that relates to the cost of private insurance are not facts because?
I have posted numerous facts, all you have posted is opinion supported by nothing.
Let me make it really simple for you. How will your single payor proposal resolve the 10%+ fraud rate inherant in plans ran by the US government?
Wendell,
1. You can’t find a successful single payer system anywhere
2. For single payer to survive, rationing access is a requirement
3. Vermont lack the funds to keep a single payer system going without a strict diet of healthcare rationing and tax increases
4. If Vermont wants to do what has succeeded nowhere else, it’s fine with me. I don’t live there anymore. You can just continue with the great lie.
5. Regarding commentators on this blog, please understand that you are the one who started issuing the insults. While I don’t know anyone writing here, it is clear from reading what has been written by various writers that you are least informed. You are hardened to your ideaology; reality is not your concern.
6. Your writings on your web do not align with what you say on this blog. You are clearly partisan.
7. Get a medical consult. Do yourself a favor.
“To be anywhere near effective, a single payer system must be universal for the largest relative national entity, i.e. the entire USA.”
So NHS is no where effective? Can you name any effective single payor system in the world?
As the saying goes, Mr. Valliere, I have forgotten more about the USA healthcare system than you will even learn. I have zero desire to communicate with you privately.
If you need a fellow traveler in your knowledgeless commentary, please ask Nate or Mr. Turpin for their e-mail addresses.
” which is why it went nowhere during the healthcare reform debate.”
Its why it has gone no where the past 100+ years democrats have been proposing it. I think 1904 was the first time they tried.
Nate: Please keep your idiotic comments to yourself. And stop insulting me. You clearly have shown through this weblog no ability to do the most basic research on any relevant topic. The lack of facts and research is matched by the profusion of commentary that is both insulting and nonsensical.
I have extensive done research. None of what I have learned reflects any political viewpoint whatsoever. Only political extreme rightists such as yourself or Mr. Turpin constantly make factless assertions, then claim that anyone who points out the lack of facts must be some sort of “leftist”, whatever that term is supposed to mean.
Whether the 25% figure you cite represents any reality or not, such as figure is meaningless in regard to anything.
The average USA resident or citizen has so fully been propagandized against the idea of single payer that any reference to aggregate public opinion only reflects the pervasive propaganda. It reflects next to zero understanding of the choices that individuals might make intelligently of how the USA healthcare system should be structured.
I do not know how large an employer IBM currently is, but it is not even listed among the top 50 employers in the State, so why mention IBM? The hospital system in the Burlington area is the largest employer with about 5,000 employees.
Single payer, if implemented well and not undermined by the influence of private insurers or their representatives in the USA Congress, will work in whatever form it is instituted in Vermont. No question about that. There are limitations concerning the efficacy of any state-only system. To be anywhere near effective, a single payer system must be universal for the largest relative national entity, i.e. the entire USA.
” A single payer system would accomplish the same at a far lower cost in a aggregate.”
Then why is Medicare, a single payor system, the most expensive and inefficent in the country?
Medicare loses more per member in fraud then the entire administrative cost of private insurance per member.
“The fact that some companies, particularly large companies, self-fund”
Some meaning the majority of people with private insurance are in fact covered by a self funded plan that does not have the claim dening driven by competition you claim.
How can you claim insurance company competition is the root of all evil and means private insurance will never work when the majority of private insurance doesn’t have an insurance company then say its meaningless? You got caught making a stupid statement and are now trying to spin it. Your like Maggie Maher, you spend a couple hours reading propoganda on the internet then claim your an expert. Actually work in it every day for 20 years then tell me you know something.
” the Canadian system of insurance is an excellent starting point for revamping the USA system.”
The same Canadian system that is being reformed and made more like the US? Oh so your one of those time traveling liberals that want to implement some other health system of 10 years ago and pretend their current austerity measures, budget shortfalls, and crisis won’t happen becuase you have your magic liberal wand that makes everything turn out just like the title of your bills. How did your Medicare Budget from 1965 turn out clown? Wendell your nothing but a ranting liberal hoping if you repeat your dogma enough someone might believe you.
“Extreme rightists politically seem to forget that they too can do some basic research and learn some facts rather than depending upon extreme rightist ideology as a basis for thinking, abut alas no expectation that that will ever happen.”
So non partisan their buddy
You have not presented one verifiable fact other than Vermont continuing to repeat the same mistake every six years. Worse, you are out of touch with your own reality, and fail to grasp the fact that the information on website is leftist dogma. You appear to choose to have relaity hidden from you so you can cling to your stronly held beliefs. My offer to get you mental health assistance still holds. Just let me know how to reply to you privately.
Wendell Murray –
You can advocate for single payer health insurance all you want. The fact is, though, that there is not more than 20%-25% support for single payer in the U.S. which is why it went nowhere during the healthcare reform debate. We already have Medicare which many single payer advocates want to extend to the entire population, yet it hasn’t been able to control costs either despite supposedly low administrative costs and dictated prices. It also has significant fraud which some estimate at as much as $60 billion per year or more than 10% of total program costs.
I actually think Vermont is probably the perfect place to give the single payer approach a try. The population is only around 625,000 and, aside from IBM, it doesn’t have many large, for profit private sector employers. Vermont’s legislature and governor think they can make it work. Go for it. Be the laboratory. Let’s get some real world experience with insuring the under 65 population and learn from it. In the meantime, a little civility and respect toward others who don’t share your viewpoint would improve the tone of the discussion.
Mr. Valliere might make an attempt to learn the most basic facts about the USA healthcare system, about Vermont, about single payer, etc. rather than make the usual offensive comment to me personally.
He has a brain. He should attempt to use it once in a while. Extreme rightists politically seem to forget that they too can do some basic research and learn some facts rather than depending upon extreme rightist ideology as a basis for thinking, abut alas no expectation that that will ever happen.
Thank you for your interesting and uninformed comments. My I recommend one of my psychiatrist colleagues in Vermont to assist you with some reality therapy?
It would be helpful if Mr. Valliere made a modest attempt to gather some of the most basic information regarding the USA’s and other countries’ healthcare systems. Further Mr. Valliere knows nothing about Vermont nor about Vermonters. Vermont voters as a whole would normally be considered quite conservative in the traditional sense of the world. They are not extreme rightwingers ideologically, as I assume Mr. Valliere and his cohort of fellow idiots are.
Bernard Sanders has repeatedly been elected to state-wide office in Vermont because he pays attention to the true needs of Vermonters of any political opinion. He knows whereof he speaks when talks about the interests of Vermonters. Mr. Valliere has no clue given that he presumably is utterly blinded by extreme rightist ideology.
Regarding items that I have made available, Mr. Valliere might read among many the excellent research by the McKinsey Institute which is completely non-partisan.
Wendell,
I don’t understand how you can claim that you’re not partisan. I clicked on your name and read some of the stuff on your site. It reads like a page from the Democrat party playbook. And really, private insurers don’t need government subsidies and sadly, Medicare and Medicaid are contributing significantly to national and state insolvency. Let Vermont go single payer and go broke. They can lead the way. Oh, and watch state residents leave the Green Mountains. Ethan Allen would be disgusted.
Nate: I am neither partisan nor a hack. I know more about the USA healthcare system than you do. I am also sick of the nonsense that you keep spewing.
The fact that some companies, particularly large companies, self-fund and use outside companies to handle claims and similar is meaningless. A single payer system would accomplish the same at a far lower cost in a aggregate.
To repeat the obvious and oft-repeated in most venues, the Canadian system of insurance is an excellent starting point for revamping the USA system.
The per capita cost of healthcare – all considered – is half that in the USA, outcomes are better, administrative hassle and costs are significantly lower, coverage is universal.
No reason why any defects in the Canadian system need to be carried over into a revamp USA system. Any errors made by Canada would be obviated if politicians made the slightest attempt to use their brains to objectively evaluate alternatives rather than make proposals based on complete nonsense funded by private interests.
You can assert continually all the irrelevant nonsense you want, but that and similar facts are unassailable and are the most relevant in regard to reform of the USA system.
“private health insurers ultimately can only survive through government subsidy and through the exclusion of the infirm or potentially inform from coverage.”
This is not true at all. Private insurance is more capable of survival without government then government is without private insurance.
Wendell appears to be ignorant of his facts and history no matter how many times he claims otherwise.
Wendell why does PPACA require private insurance to cover dependents till age 26 and why do numerous states require private insurance to cover dependent to age 28 or 30? Apparently you don’t know what you write about.
Medicaid is killing state and federal budgets, to push cost off to private insurance they passed these laws so sick young adults would be eligible for their parents plans and thus get off public assistance.
Medicare Secondary payor was passed to push seniors off Medicare and back onto private insurance.
Private insurance is almost always primary over Medicare, Medicaid, and VA why is that Wendell if Government doesn’t need them?
” the exclusion of the infirm or potentially inform from coverage. ”
You mean like how Medicare only covers so many hospital days? How Medicaid usually doesn’t cover dental and vision? Government plans in american ration care far more then private insurance and are still unsustainable unlike private insurance.
” That is the history of all private insurance because that is how the overall market forces individual companies to “compete”.”
LOL wow are you trying to come off as stupid? What sort of idiot doesn’t know most employer private insurance, more then 50% of all private insurance is not sponsored by insurance companies but self funded plans, thus there is no competing and thus more proof you have no idea what your talking about you partisan hack.
“I normally avoid the dog pile but you are too big a target”
This is apparently all the Mr. Turpin is able to muster in support of his nonsense. Does this mean that I personally am too big a target of dogshit?
I am afraid to write that no one with the slightest grasp of facts or with a non-ideology-based perspective will agree with me not Mr. Turpin.
Unfortunately I happen to know what I write about. I have no ax to grind one way or another regarding any aspect of the USA healthcare system. I am neutral in regard to any actual or potential feature of any healthcare system. I am indifferent to which politician or political group advocates which policy to any aspect of the healthcare system. I advocate what the facts indicate, nothing more or less. I have written many times before that a single payer financing scheme is in fact consistent with core Republican policy positions. However xtreme rightist political ideology holds complete sway in any Republican proposal, practicality and representation of traditional, mainstream Republican thinking play no role whatsoever.
The essay by Senator Sanders is about the efficacy of single-payer/single-insurer financing of medical expenses. Senator Sanders’ arguments are impeachable and accurate. No amount of justification from any perspective regarding the USA system of financing has any factual basis to warrant its recommendation as an alternatively efficacious means of financing.
Private healthcare insurance is and always has been a poor system due its very nature: private health insurers ultimately can only survive through government subsidy and through the exclusion of the infirm or potentially inform from coverage. That is the inevitable result of private insurance: exclusion of the infirm and avoidance of even paying legitimate claims. That is the history of all private insurance because that is how the overall market forces individual companies to “compete”.
we have this discussion with employers all the time, the problem is a defined contribution plan isn’t as valuable of a benefit as insurance. Employers offer insurance by choice, because of that they are very cosanent of value. This is usually to a fault, they worry more about the 2% of employees that have large claims and thus ignore the 98% of the group that has minor claims. This is how the dreaded death spirals start. If an employer is seeing such high cost that they look at DC then they would usually be leaving a handful of employees unable to get insurance. Not to say its not done, cost have got to the point that some employers just don’t have a choice any more but it is usually a benefit of last resort.
Its very realistic becuase it would kill the exchanges. Very quickly people are going to figure out they are further ahead paying the penalty then waiting till they are sick to buy a policy from the guarantee issue exchange. Pocket the cash when healthy and stick it to the system when your not.
Very quickly government is going to be confronted with the decision to scrap guarantee issue or go all in with mandatory insurance no exceptions, system is not sustainable in the middle.
I don’t know whether exchanges are the right thing and am not an advocate for or against.
And I agree that employers haven’t tried to exit before, but there are a couple of reasons for that … competing for quality employees has required they offer health insurance (in fact some like Microsoft and Starbucks have used their HC benefits as a differentiator when recruiting).
But if I am an employer and I have been able to hold overall wage increases to 1-3% per year and my health insurance costs have been increasing at 7%+ per year, I would find it interesting to be able to deliver a defined contribution $ amount that I increase at 1-3% per year and let the employee take on the increased risk associated higher medical costs. The employee doesn’t feel the issue for a year or two and by then I (the employer) have already transferred the risk.
All I am saying is if they head that direction, there may be implications that we haven’t thought of and reliance on the exchanges could grow.
Time will tell if it is a realistic concern.
Wonder why this survey is so far off all the others?
I did notice the 9 million people underreported in Government plans.
I see they also included 10 million illegal imigrants, should they be included in discussions on uninsured Americans? If we include all of South America then our uninsured population is closer to 200 million.
“The $4-5K per year is from the Kaiser Foundation and it is the average cost of employer insurance — which is what COBRA is”
Why would a healty person who can buy a $1500 policy take COBRA? COBRA was designed for people that couldn’t buy cheaper individual insurance. The discussion was about healthy people, roughly 70-80% of the population.
“albeit with a $3500 deductible … which means that he’s paying $5K per year out of his own pocket …”
Again you were talking about healthy people who don’t meet their deductible. In fact 80%+ of all insured people don’t meet their deductible, I don’t see how the $5K should even be discussed.
“family of four living on a HH income of $75,000 paying $4500 a year for health insurance and then a $17,000 deductible”
Why would they have a $17,000 deductible instead of a $3500 deductible each? Are you assuming every family member is going to hit their deductible every year? Statistically that just doesn’t happen. Your worry about the exception, the very very rare exception.
“And with the average US income at ~$55,000 per year,”
Average which includes those 10s of millions of people on Medicaid, what is the average income of people who are not given government insurance at little or no cost? And your also not taking into account that insurance is most expensive in the metro areas like MA, NJU, NY etc where the average income is also much higher.
“, is that at some point they will figure a way to exit offering insurance.”
They have had 50 years to exit insurance and have not. Inspite of never ending government efforts to force them out of it they have continued to offer it. Contrary to finding a way to exit they keep finding ways to continue offering it.
Examples of Anti Employer legisltion and regualtion would be COBRA, HIPAA, MSP. Its not even what the bills tried to accomplish that is a problem its the punative way the bills were written that destroy businesses for no benefit.
I don’t see exchages being successful or long term, they build on everything that is wrong instead of the things that are actually working
Wendell, have you lived abroad? Have you accessed a different healthcare delivery system ? Have you worked in any capacity in the healthcare system – payer, provider, medical devise manufacturer, male nurse, perhaps a ward of the criminal justice system for the self aggrandizing, criminally insane?
I normally avoid the dog pile but you are too big a target. Checked your BMI lately?
No need to reply. Best go back on the Nickolodeon chat room with the kids.
Not much here to disagree with … my principal concern with the employer market, however, is that at some point they will figure a way to exit offering insurance. They may still be willing to pay for it … but it will be a defined contribution plan where the user goes out on to the free market to buy with the $ their company gives them. The exchanges will be an enabler for this … the unknown is what the consequences will be from it.
Can you provide a link to this?
http://www.census.gov/hhes/www/cpstables/032010/health/h01_001.htm
Second column … not covered at any time during the year.
Back to facts, the premium for a healthy 18-34 year old is $1800 a year not 4-5K, again I sell this all day so I know that for a fact,
The $4-5K per year is from the Kaiser Foundation and it is the average cost of employer insurance — which is what COBRA is … the continuation of employer insurance … age has nothing to do with it when you purchase COBRA. You are right with respect to individual insurance, if there is no pre-existing condition, according to eHealth a male aged 33 in my state could purchase a policy for $1,512 per year … albeit with a $3500 deductible … which means that he’s paying $5K per year out of his own pocket …
I wouldn’t consider a family of four living on a HH income of $75,000 paying $4500 a year for health insurance and then a $17,000 deductible on top of that as being high income … The premium alone is 6% of their gross income … if they really needed to use that policy in a given year, they would be forking out 29% of their income before the real policy kicked in — and that’s a family with a good health insurance policy. And with the average US income at ~$55,000 per year, that challenge becomes even greater. Household income between $50-$75K per year is NOT high income unless you live outside of the major population centers.
Finally, with a close to 10% unemployment rate … choosing employers based on your individual health risks (e.g healthier people choosing to work for larger employers) is becoming more and more difficult. Many people are working multiple PT jobs to make ends meet and don’t have the option of employer provided insurance.
I use census data a lot business planning purposes. Here is the release (a summary) of the American Community Survey Data. The BOC conducts surveys in above the Constitutionally required census.
http://www.census.gov/newsroom/releases/archives/american_community_survey_acs/cb10-cn78.html
“According to the US Census bureau, in 2009 50.1 million citizens did not have health insurance “at any time during the year”. ”
Can you provide a link to this? I have never seen a number any where close to that. Further never once have I heard the census bureau claim they asked who was uninsured all year. Further their have been numerous studies to measure the number of people that were uninsured all year and that number is always substantially lower then the USCB number. For example;
“For instance, while last year’s Census report found 46.3 million uninsured in 2008, a separate study by the Centers for Disease Control found that 31.1 million Americans were uninsured for one year or longer in 2008, and a survey of health spending conducted by the Department of Health and Human Services found 40.7 million Americans lacked coverage for all of 2008.”
“These aren’t abused numbers Nate, they are real and they are reported by the US Census bureau.”
I can’t find any study anywhere that supports 50 million went a full year without insurance.
http://www.american.com/archive/2008/july-august-magazine-contents/what-do-we-know-about-the-uninsured
“The widely cited CPS statistic is considered closer to an estimate of those who were uninsured at the point in time surveyed, rather than of the total number of people uninsured for the entire year. The Survey of Income and Program Participation (SIPP), also handled by the Census Bureau, suggests that roughly half of those counted as “uninsured” remain without health insurance for the entire year.”
“however, they cannot afford the cost of COBRA.”
By who’s measure? Does someone with three cars, and a 3000 SqFt house and debt to income of 80% qualify as not being able to afford COBRA? COBRA is not a priority so people choose not to afford it. THey have the ability not the desire.
Further as someone that actually administers COBRA and benefit plan eligibility I know for a fact a large chunk of uninsured times is during job change. Someone leaves a job to take another job so their is no break in income. Instead of paying for COBRA during the waiting period for their new job they go bare for 60-90 days. These people are working and clearly able to afford it, they choose not to.
” they are healthy and gambling that they will remain that way instead of paying $4-$5K per year in health premiums”
Back to facts, the premium for a healthy 18-34 year old is $1800 a year not 4-5K, again I sell this all day so I know that for a fact, ple