This video comes from the Henry J. Kaiser Family Foundation, and outlines the coming health care reform (Obamacare). Take a few moments and watch it. The notes that follow are a collection of points I picked out of the video, along with my thoughts and impressions. The comments section is open, so feel free to jump in with your views.
PHASE 1 - Now until 2014
1. The government will stipulate how insurance companies spend the premiums collected. If "too much" is spent on administrative costs and profit, then a rebate to the consumer will be required. This raises several questions. First, other than taxes levied, does the government have the constitutional authority to determine how private businesses spend their revenues? Secondly, who makes the determination that "too much" was spent on administrative costs and/or profit? What is the definition of "too much"?
2. Under the new plans, "free services" will be offered by providers and insurance companies. Certainly, if a service could be rendered at absolutely no cost to a provider, would not that provider already be delivering those services, in the interest of promoting better health to their customers? We know this isn't the case, as personnel, utilities, and supplies have a cost to the provider. Business cannot simply give away their product or services, without facing certain closure when funding from investors dries up. Skilled personnel have, at personal expense, invested in their education and continued certification. What right does society have to demand they share their skill without compensation?
3. Medicare will provide greater coverage for medications. Where does Medicare get its operating funds? If greater coverage is planned, doesn't that necessitate an increase in funding?
4. "Children" can remain on their parent's insurance until the age of 26. I'm sorry, but once my children have graduated college and are on their own, they will be responsible for their own bills, and thus responsible for their own money management skills. Additionally, by the time they're 26, if I'm retired, who's to say that I'll have the disposable income to continue to carry them on insurance? This is passing the buck, and denies the opportunity to learn responsibility.
5. Tax breaks will be given to businesses, presumably to encourage them to provide or expand health insurance coverage for their employees. This isn't a bad idea, but wait...there's another point coming later.
6. No lifetime limit on benefits. This, again, is the government dictating business practices to the insurance companies. Every insurance policy I've engaged represented a contractual relationship with the insurer. Policy standards are communicated as part of that relationship. If I have entered into a poor contract, then shame on me. Certainly there is the need for consumer protection in cases that insurance companies don't live up to their end of the agreement. It is incumbent on the buyer to fully understand the terms of the policy.
7. No pre-existing conditions can be used to deny coverage for children. As with the previous point, an insurance policy is a contract, negotiated by private entities. This means the insurance company has the right to not offer coverage if a condition already exists.
8. Those who can't get coverage due to pre-existing conditions or for being high-risk can get coverage from a government-run "high risk pool." As with the expansion of Medicare/Medicaid, where will the funds come from to pay for this coverage?
PHASE 2 - Starting in 2014
1. Medicaid will be expanded to cover all low-income people. States currently budget huge sums of money to Medicare/Medicaid. When new people come onto the rolls, where will the funds come from to provide coverage? Will they come from other areas of state budgets (cuts to other agencies, programs)? Or will there be tax increases?
2. Depending on level of income, tax credits will be given to individuals who lose their job or are under-insured. This, in effect,
3. If you have no insurance, you'll be able to shop for insurance through an exchange. This exchange will be set up and managed by the government. Presumably, the exchange will be an open market (with government supervision) for you to get "fair" access to various policies. The question for this: does not the market currently provide for open shopping of policies? It does, but it does so with relatively little influence (read: school-yard bully) from the government. Having the government police, and possibly approve, the policies offered on the market is an effective limit to the market.
4. The "no pre-existing conditions" provision for children will expand to include adults. We've covered this previously.
5. If you have no insurance, or choose not to have it, then you will be subject to paying a "fine" to the government. One can only assume this is a form of revenue to offset costs associated with expanded coverage in other programs. (Side note: how much will it cost just to administer all of this? As opposed to what insurance company revenues are? Something tells me the net cost of government administration will be greater than that of insurance profits annually.)
HOW TO PAY FOR IT ALL
1. It is estimated this will cost $938 billion over a ten-year period. In 1966 at its start, Medicare cost $3 billion. Estimated costs by 1990, including adjustments for inflation, showed Medicare costing $12 billion. In reality, the 1990 cost was $107 billion - almost 9 times more than estimated. (source link)
2. "Savings", or ways for the government to spend less money on healthcare, will come from healthcare providers. Most would use the term "indentured servitude" for this (working for free, or less). While not supporting the history of indentured servitude, there was some exchange for services rendered, however paltry and unequal the payment was. These "savings" are not defined in the video provided above, but the implication is there will be pressure from the government to providers to reduce costs. Low-bid healthcare isn't something that thrills me as I grow older.
3. Government will limit the escalation or rise in fees paid to providers and hospitals by Medicare/Medicaid. Skilled and knowledgeable labor, and the technology they employ, will seek more lucrative markets for their trade. They'll be replaced with less skilled, or less motivated personnel, and inferior or out-of-date technology.
4. Government will "create experiments" to explore different ways to pay doctors/providers to be more efficient. Again, what can the government do here that the market cannot do on its own? When the government finds a solution that works in one area, they attempt to standardize that solution across a wide spectrum of issues and areas. One size does not fit all, not in politics, nor in healthcare and the administration thereof.
5. High income earners will pay higher Medicare taxes. These taxes, as revenue, will be used (distributed) to those who fall under the newly-expanded Medicare/Medicaid coverages. This is simply taking from those who have earned their pay, and passing it through to those who earn little or none.
6. New taxes will be assessed against businesses and insurers that offer "high-end" insurance plans. If we go back to Phase 1, point #5, this seems to punish the efforts that were supposedly encouraged by offering a tax break so businesses could offer better plans. It is a classic "catch-22" where the government gives you a tax break to offer your employees more, then tax you for offering them more.
7. Tax on those using tanning beds? I'm at a loss. The Fourteenth Amendment to the U.S. Constitution dictates that "no State...shall deny to any person within its jurisdiction the equal protection of the laws." Obviously the use of a tanning bed is a decision, and not a required activity. However, taxing one small portion of the citizenry for engaging in a private activity?
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