Archive | 8:28 AM

I have a few questions

8 Oct

 

Let us do the math, $461 billion to give tax credits to low and middle income Americans to offset cost of health insurance, $345 billion to expand Medicaid. 

It cuts $404 billion from Medicare and other programs (by reducing waste, but not benefits) and it raises $201 billion by placing a 40% excise tax on “generous” health insurance plans. 

What is it?  

No commentIt is the Senate Finance Committee version of health care reform

I have a few questions: 

  1. If all that waste was in the Medicare program, how did it get there in this efficiently run public plan?
  2. Given the financial trouble ahead for Medicare, why wasn’t this waste cut from the program before we even got into health care reform?
  3. Now that we have found a way to save $404 billion for a government that is heavily in debt and getting more so, why are we spending the savings on something new?
  4. Will companies with “generous” health benefit plans keep them generous just so they can pay a 40% excise tax?
  5. I see the words Medicare and Medicaid as they are cut, expanded and made more “affordable” but I don’t see those same words applying to private and employer based coverage and I don’t see any words that indicate the rate of increase in health care costs will change in the future.
  6. What is changing to make health care for the Americans not enrolled in Medicare or Medicaid affordable?

 

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How to negotiate a great contract

8 Oct

 

Let’s say you just negotiated a new union contract for a ten year period. During the first five years, there were productivity gains, new work rules to save money, the union agreed to pay more for health care and to switch to a cash balance pension from a traditional plan. There were no wage increases until the beginning of year six. Does that seem like a pretty good deal for the employer during the life of the contract? You bet it does. Welcome to the accounting for health care reform.

Of course, there is one big difference. It is unlikely that the company will agree to modification to the union contact during its ten year term while Congress is unlikely to leave things alone during the next ten years. The planned elimination of the Medicare Part D donut hole is one good example. Here is a program that while modest (but better than before it existed) in some ways, actually came in under budget but now in the guise of health care reform is being “improved” or as we simple folk say, made more expensive and less manageable.

According Sen. Baucus, his committee’s bill will lower the burden of health care spending on the federal government which is one of the President’s top objectives. Silly me, I thought the objective was to reform health care or is it reform health insurance or is it to cover all Americans or is it to make health care “affordable?”

What was it he said?  Oh, right, assume medical inflation is 2%

What was it he said? Oh, right, assume medical inflation is 2%

Has anyone else figured out that to achieve the above stated top objective that all the rest of us are going to pay more whether it be higher taxes, higher out of pocket medical costs, higher premiums, or in the case of ten million seniors higher everything if they are enrolled in a Medicare Advantage Plan?

It’s not that we should not find a way to cover the uninsured, it is the convoluted way we are trying to do that, the absurd assumptions, the lack of candor in telling the American people what is actually going on and the lack of anything that will truly reform health care or manage the future rate of increase in health care costs in any reasonable period or maybe ever that is most troublesome.

Once again Congress is demonstrating its inability to understand the law of unintended consequences.

 

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