2010 health care: workers to pay more for less

[MsGuy]

The one thing that has me convinced that the U.S. will embrace a national health care scheme sometime in the next decade is that our current system has no effective way to control costs. Business, the keystone provider of health insurance under our current system, has been diligently trying to curb medical costs since the early 80's, with no visible success. From a business point of view, the cost of bundling health insurance into the employee compensation package is becoming unbearable. IMO the next decade will see a gradual retreat by American employers from the business of providing health care coverage.

WSJ forecasts health care insurance cutbacks

This post is in no way intended as a slam of American business practices. With health care costs running at 1/6 of GDP and climbing, business firms, particularly those exposed to foreign competition, are simply unable to tote the load.

[caeron]

Apparently doctors think it's a good idea. NPR had a story on some folks who surveyed doctors and found that by about a 3-1 margin they wanted a public options, and 10% wanted just a public option.

My father consults on health care quality controls world wide. He is in that 10%.

[BiBottomBoy]

I don't understand why it isn't easy to get health care passed now.

Think of all the shitty things the government does with our money every day.

For once they want to give us something useful in return for our tax dollars and we take to the streets and scream "no!"

It baffles me.

[Guest Conway]

well, I think that there are an awful lot of people who are extremely happy with their health care that they have now. We see the intervention of government in health care as something that will make the quality of our care worse rather than better.

To counter my argument, you might say, "Well, you don't have to accept government health care if you don't want it." And, directly speaking you're right. Indirectly speaking any insurance companies directly participating in government sponsored health care is going to hbave to make up for the inefficiencies of the big bureaucracy some way. Be it in terms of passing the costs oof those inefficiencies on to private payers or reducing the quality of cost of and/or qua;\lity of care to those private payers.

People like to tout the success of Medicare as an example of how well government can run health care. But, the truth is that our own Medicare system (as well as the retirement system that the government runs for us) is insolvent. Its broke.

If the government is so much more efficient at running health care than private industry, how is it that Medicare can no longer support itself. My fear is that by creating this quasi-governmental behemoth to serve the public good, the overall qulaity of health care in this country will falter while the cost for private payers like myself will rise precipitously while the qulaity of my own care that I receive declines.

Make no mistake about it. There are components of our health care system that can be reformed.

For example, too many doctors practice extremely expensive "defensive medicine" due to the out of control threat of tort claims. That is to say, unnecessary tests are ordered for the purpose of defending a potential lawsuit versus treating the patient's illness. That practice adds an extraordinary amount of cost to our system. Limiting tort claims is a preemptive, cost free application that could bring immediate savings to the system which could be passed on in the form of more affordable premiums for the average Joe who may not now be ablee to afford health insurance.

Another less costly would be to provide tax credits to employers that provide wellness benefits and education to their employees to encourage proper habits with regard to diet, lifestyle and exercise. Those credits could be passed on to employees as a meaningful incentive to eat right, stop smoking, curb alcohol consumption, and exercise more.

There are lots of things that we can do to reduce health costs other than turning over the entire American system to a government that has already proven that it doesn't have the ability to run a major health care program in a fiscally responsible manner.

[BiBottomBoy]

I'd argue that the insurance industry has proven that the government couldn't possibly do worse.

The entire industry is built around the business plan of denying people's claims even when they are valid and hoping people won't complain about it.

Also, with a government run system people wouldn't be looking at bankruptcy if they became ill.

Andrew Sullivan has a great article this week where he tells his own personal story of the US health care system and explains why we need a public option.

http://www.timesonline.co.uk/tol/comment/c...icle6832054.ece

[Guest Conway]

I'd argue that the insurance industry has proven that the government couldn't possibly do worse.

The entire industry is built around the business plan of denying people's claims even when they are valid and hoping people won't complain about it.

Also, with a government run system people wouldn't be looking at bankruptcy if they became ill.

Andrew Sullivan has a great article this week where he tells his own personal story of the US health care system and explains why we need a public option.

http://www.timesonline.co.uk/tol/comment/c...icle6832054.ece

I don't think that anyone could argue that our current insurance system couldn't stand some improvement. Nationalization of it is the wrong answer in my opinion.

[caeron]

I don't think that anyone could argue that our current insurance system couldn't stand some improvement. Nationalization of it is the wrong answer in my opinion.

US doctors disagree with you 3-1.

[Guest Conway]

US doctors disagree with you 3-1.

With all due respect, that NPR piece that you refer to wasn't based on a poll that meets the rigors required to qualify as statistically accurate. It was an unscientific poll performed by some doctors of their colleagues. About the same time that the NPR piece came out, Investors Business Daily came out with a similar statistically inaccurate poll, performed by a marketing company, that showed something like 65% of doctors are opposed to the proposed plan in Congress and that 48% of those doctors would quit practicing medicine if Obamacare was made law.

http://www.investors.com/NewsAndAnalysis/P...ng&caption=

So, what to these two "polls" prove? That you can make a poll say anything that you want it to if you use statistically corrupted respondent groups. I was particularly disappointed to see NPR engage in such chicanery because, over the years, I have come to rely on them as a relatively unbiased source of news and information.

In my mind, neither "poll" addresses my own concern that I stated earlier. Nor do statements like "Doctors disagree with you 3:1":

How are we going to pay for this as a nation? As a taxpayer, I think that this is a reasonable question to ask of our lawmakers and that it deserves a reasonable (and truthful) answer before we potentially commit trillions of dollars to this program. To date, I haven't heard that reasonable answer. Instead, I have heard political babble (like the WH statement on no taxes on anyone making under $250,000 a year) which defies my own common sense and logic.

This is far too important and costly an issue to generalize and turn into a campaign of misinformation.

[caeron]

Somehow I don't think these boards are going to be a place for deep insight into health care reform.

Once the debate turned into death panels what very little hope I had about rational discourse died.

The NPR poll was about a public option. It isn't necessarily in conflict with the one you cite.

I believe based upon the expert I know that a single payer system with add-ons would be the best choice. That isn't going to happen, because for whatever reason socialized medicine = death here in the US, despite the fact that it delivers better quality of care. (infant mortality for instance in the US blows)

People seem to be of the impression that letting every doctor do whatever leads to better care. I think the evidence suggests that centralized treatment policy gives better results. True experts can lay out guidance for less experienced doctors to implement. Horrors.

[JKane]

Fuck, even the great bloviator gets it.

We live in a world where the average American is convinced they aren't average. We've been coddled and told we're special all our lives, so most of us can be easily tricked into railing against anything that could be seen to limit our potential options in the future. Sure, gov't healthcare is good enough for my parents--but what if I need House, M.D. one day???

My god, there's millions of sheep happily paying more in their own personal taxes because they backed the fight against the evil DEATH TAX that would never have affected them, their family, or anyone they knew (unless you count Hannity, O'Reilly, et. al. as people they know!).

[MsGuy]

"My god, there's millions of sheep happily paying more in their own personal taxes because they backed the fight against the evil DEATH TAX that would never have affected them"

I can't count the number of times I've had to explain that to people who not only are not affected but who could never conceivably be affected by the estate tax (short of hitting the lottery big-time). The Dems should just give up on the wrong headed notion that an estate tax is primarily for the purpose of generating revenue and set the threshold at a simple, round, easily remembered high number ($10 million, $20 million, who cares?) and kill "death taxes" as a political issue. The estate tax never has been, never will be, was never intended to be a significant source of revenue for the government.

[BiBottomBoy]

I'm a democrat and I still see the estate tax as insane and unfair.

It's taxing money that has already been taxed when it was earned.

And, it can be very, very unfair in some situations.

For example, my family is far from wealthy (both teachers) but they inherited a large piece of land in New Hamshire from my grandparents.

If, when they die, this piece of land ends up valued at more than $2 million (which is possible) then my brother and I would have to pay estate taxes. But, neither of us makes enough money to pay the estate tax (and my parents would probably leave us very little cash) so we'd end up having to sell the land we inherited just to pay the estate tax on the land.

[MsGuy]

BBB: The current (2009) exempt amount for estate taxes is $3,500,000 (couple = $7,000,000). It's unlikely that the permanant threshold amount will be significantly less. If estate taxes have become a concern for your family, please consider consulting a reputable estate planner. There are a number of inexpensive estate planning tools which should resolve your problems.

By the way, it's a misconception that the estate tax is a double tax on earned income. When you're talking of estates large enough to be subject to the tax, you're not talking about taxing savings from earned income. The bulk of such estates are composed of assets representing untaxed capital gains.

[BiBottomBoy]

Well, as a single guy what do I do if the land is valued at $3.6 million? Estate planning only helps if it's cash you are trying to avoid paying taxes on.

And while it's not worth that much now, my parents could live another 20 years and who knows what a thousand acres of land in new hampshire will be worth by then.

[MsGuy]

I was trying to be helpful. I still am. Sincerely.

With a little pre-planning, the tax code has more than enough loopholes to cover 1000 acres in rural New Hampshire. If your parents are worried over how to preserve your grandparent's legacy & pass it on to you and your brother intact, some inexpensive estate planning will both relieve their minds and solve any estate tax problems. Some CPA's make a specialty of dealing with this sort of problem as your family's situation is not uncommon.

Concerns like yours are the reason I wish the Dems would just give way on the estate tax issue and set a high enough threshold that regular peolple could stay out of the tax planner's office.

[BiBottomBoy]

Concerns like yours are the reason I wish the Dems would just give way on the estate tax issue and set a high enough threshold that regular peolple could stay out of the tax planner's office.

Word. If I knew that my brother and I wouldn't have to sell our legacy to condo builders I'd feel so much better.

It's not so much us losing the land (since it belongs to our dad so it's not ours to lose) it's the idea of this thousand acres of nice land becoming a bunch of condos on Lake Winiepsake that bothers me.

[MsGuy]

it's the idea of this thousand acres of nice land becoming a bunch of condos on Lake Winiepsake that bothers me.

Something about your first post gave me the idea that your concern was more for the land itself than for the finantial issues. That's what moved me to reply.

[BiBottomBoy]

Yes,

It is the idea of the land that bothers me a lot more than the money.

[RA1]

MsGuy-

Where do you get the idea that the land or estate increase in value is untaxed captital gains? Oh, I get it; it is unrealized gains. Well, I hope you get the Dems to agree with you that families should not be taxed for promoting the US dream. It is silly to have to have a "tax shelter" to provide any relief and I hope that is not among the near term goals.

When all of our farm land is converted into "living quarters" I hope we all learn how to digest concrete.

Best regards,

RA1

[JKane]

Well, as a single guy what do I do if the land is valued at $3.6 million?

You can pay the taxes due on $100,000 and realize how fortunate you are!

[caeron]

As others have said, estate planning is your friend. Ask the questions now. There are ways to manage it if you do it before your parents die. After they die, not so much.

[BiBottomBoy]

My parents have looked into it.

The advice from an estate planner: "Hope the land isn't worth too much money when you die."

[caeron]

I think you need a second opinion.

[BiBottomBoy]

The problem is that they can't transfer title or just sell it to us for a dollar in advance (which is one way to get around it) because my brother is in law school and has serious school loan debts and unfortunatly I was married at one point and my ex wife not only didn't let me have dick she also put me into debt.

While I'm paying that off now there's not much the creditors can do to me because I don't have any property to seize and if my brother went behind on his school loans again he doesn't have any real property to grab.

But, if the title of the land was put into our names if he got into debt trouble finishing law school or my creditors decided to be dicks they could try to put liens on the land.

[Guest Conway]

You should confer with an attorney about having the property transferred into a trust with you and your brother as beneficiaries of that trust. It would be up to the executor of the trust to sell it and/or pay any proceeds of the income it may be throwing off to you.