<p>“We cant have a free market for health care because the unprofitable people will not receive health care. And lets not play too many games here. We have a subsidized employer based market. We have medicare. We have medicaid.”</p>
<p>To be honest we didn’t have a free market prior to Obamacare. We had Medicare and Medicaid which under-reimbursed providers below their costs and forced cost-shifting onto the private market. We had artificial barriers so insurance couldn’t be sold across state lines. We had many states impose very expensive insurance mandates which were unaffordable to most people. Finally, we shielded most people from the true cost of medical care, hardly an exemplar of a free market system.</p>
<p>Again, I am not proposing a Darwinian free-for-all in our healthcare system. There will need to be high risk pools and subsidies for the poor. But a healthcare system that is built to accommodate competition and provides many choices for consumers will deliver the lowest prices and better access than a govt-controlled system. Switzerland, Singapore, etc are examples of a hybrid free market system which does allow for competition and choice. Are these systems perfect, heck no. I know we can do a much better job designing a system to allow for a marketplace where consumers and providers can find some kind of price equilibrium for elective procedures. To say that it has been tried and has failed is absolutely wrong.</p>
<p>Dstark, since you were in the securities business maybe you will appreciate this analogy. What if the govt passed a law which said only securities firms that agreed to sell stocks for a price lower than the intrinsic worth of the security (not determined by any valuation analysis) were allowed to be conduits between the corporations and the public markets. If companies had to sell their securities for less than their true worth, I would bet you they would find other ways to finance their growth. Perversely, you would end up with a shortfall of stocks and pension funds and other buyers would need to find other ways to meet their investment needs.</p>
<p>By restricting networks to impose fiat prices, we are doing the same thing in health care. </p>
<p>The problem arises when one is media-dependent in forming his or her education and opinions. </p>
<p>The info commonly available isn’t coming from respected sources who devoted years to studying, developing background, honing (and rounding) their understanding by arguing positions with other “experts.” It’s no more than sound bites provided by inexperienced, insufficiently educated middlemen. (In some cases, profiteers. Or, as we know too well, arguing based on put-downs.) Their roles do not yield them “authority.” And yet, so many put so much trust in them. The sky is falling because “she” said so. Or, “I heard it.” </p>
<p>And then too many never get beyond these sound bites and mental images they pass along on their own. The accuracy problem magnifies as more and more hold to media-based opinions. Nice to sound savvy. Doesn’t always mean one really is. Opinions, in themselves, are not enough. Surveys. Anecdotes. Bread lines-- ya sure.</p>
<p>We have a situation where too many were without adequate insurance or a health care safety net. Press on one ends and things bulge out somewhere else. What to do? We have to stop thinking like 17 year olds. Be a little humbled by the limits of our knowledge. Not keep throwing out what “sounds” good. And go seek a truer understanding.</p>
<p>I don’t know the ins and outs of benefits plans, how various rules affect what an employer can do. (Or really, enough at all.) But it suggests different details need to be legitimately based on job classes, offered equally to all in those categories, not given to Mary and Bill because they can’t afford what others can. ???</p>
<p>“Some companies might want to pay directly for an employee’s individual health insurance plans without utilizing an ERISA and HIPAA-compliant defined contribution health plan, but doing so will put the employer out of compliance with federal regulations and increase the employer’s (and employee’s) tax liability.”</p>
<p>Apologies if this IS what you were communicating, ds, and I just repeated it.</p>
<p>Actually you are correct. We still want them insured but when we pay them to buy it on their own some may be tempted to keep the money which we would like to prevent. </p>
<p>maybe dstark has it right - we will need to control it some way (show proof) if it is illegal to buy insurance for some but ignore the rest.</p>
<p>LaaMa, you are right. The bottom line is some people dont care about universal health care. They dont want to pay for universal health care.</p>
<p>GP, </p>
<p>If there is enough demand for wider networks, and people will pay up, (wider networks cost more and you hate rising costs), you will get wider networks. Nobody is stopping anybody from offering wider networks except the consumer who wont pay for them.
Call your friend at Anthem and suggest to him that Anthem should offer wider network plans.</p>
<p>LF, I have no idea what is legal and or what is non-compliant. I think those are great links but what do I know? That is why I asked calmom if what texaspg wants to do is legal. Texaspg needs a lawyer or somebody that specializes in this area.</p>
<p>Wait, what labor law requires a tiny employer to provide health insurance for all?</p>
<p>It’s not uncommon for a very small shop owner to insure a couple of management people only. Most of those “everyone else” people would probably be part-time or non-management or some distinction beyond just that you like them less, but does it matter? As to wanting them to be insured; while that’s very nice, I don’t really see how it’s an employer’s business. You either give them insurance or you don’t. If you give them cash and they spend it on pizza and beer instead, that is their choice. </p>
<p>All of this love ACA or you’re a “meanie” is just silly. It has huge problems. Personally, I think those who are stomping their feet and insisting it’s wonderful despite growing evidence to the contrary are the ones who need to do more “vetting”.</p>
<p>Texas -That seems impossible, since you are certainly allowed to higher someone highly desirable and give them a giant compensation package while everyone else gets peanuts if you feel like it. They should probably keep quiet, but it happens. Maybe, Calmom can clarify. </p>
<p>Everyone vets is fine with me. Had everyone vetted a few years ago it wouldn’t have passed in the first place. “Some people just don’t care,” is what I was referring to, LF. That is not the case. Everyone cares. </p>
<p>No, LF. This is a non-profit with under 20 employees unaffected by ACA… It may surprise you to learn that compensation packages for people doing virtually the same job can vary considerably in one organization. There is no law that I’m aware of that requires everyone who sits as the same desk to receive the same paycheck for their efforts. If there is, a whole lot of small businesses are breaking it… </p>
<p>What I am asking for is different. The premiums for everyone are a large percentage of the salaries (lets say no one makes over 40k but some have premiums totalling 18k because of family coverage). When we drop everyone, some will be able to get it down to a very low number through subsidy but others have no subsidy which means we will need to cover all of it through a salary increase. In order to ensure eveyone gets it, we want to purchase insurance only for those who don’t qualify for subsidies rather than pay them and expect them to buy for themselves.</p>
<p>Just to remove any misconceptions, my salary is a big fat zero although I spend 25-30 hours a week!</p>
<p>“With a defined contribution health plan in Texas, an employer may choose to give employees different contributions based on classes of employees. Federal regulations state that “a plan or issuer may treat participants as two or more distinct groups of similarly situated individuals if the distinction between or among the groups of participants is based on a bona fide employment-based classification consistent with the employer’s usual business practices.” </p>
<p>This is exactly what I mean about vetting. </p>
<p>And I said, This particular question - Texaspg’s question about encouraging health coverage. You can offer a different “compensation package” to certain employees (eg,that high-power exec) as long as it can be justified as “consistent with the employer’s usual business practices.” And there are likely tax ramifications for what you give away.</p>
<p>Beyond that, you have to wrap your head around it. Not think of individual cases, but look at the whole. Oh, that sounds familiar…</p>
<p>ps. The Zane links are good and an easy read- because most of this is based on the same core regulations. Worth reading. It doesn’t satisfy what you ideally want, Tpg, but it’s background.</p>
<p>Well, he’s talking about changing business practices because of ACA isn’t he? So, what is “usual”. And, I suppose an employer can encourage health coverage if he wants to do that but it’s not really his business what a worker chooses to do with his paycheck. “Classes” of employees I suspect also comes with plenty of wiggle room.</p>
<p>I think you are overcomplicating. If I have 2 assistants and I want to pay one of them a lot more than the other for whatever reason and they both take the job at what I offer, that is allowed. It just is. </p>
<p>LF- It is pay if he’s planning to cancel their insurance dump them into the exchange and pay them more. How is that not pay?</p>
<p>CC keeps logging me out and this is quickly getting to be not fun.</p>
<p>I like you, too,. Although between all the “vet” and “whack”, sometimes I have a hard time figuring out what you are trying to communicate. lol.</p>
<p>I don’t mean to over-simplify, Texas, but if you just took your former plan cost and divided it by the number of employees and gave a straight raise, you’d be done.
I know you’d like to force some of the ones your worried about to maintain a policy, but really, at the end of the day, that’s not your call. It’s what you INTENDED the money to do, but it ends there ;)</p>
<p>But don’t forget, by forcing healthy people to pay more, they will have less disposable income to spend on other things, which will hurt other industries/businesses, whether they be groceries, movie theaters, dry cleaners, home maintenance, and the like. Of course, those now covered may have a little more money in their pocket. So the macro question is whether the increased taxes, and insurance premiums on the healthy – both of which decrease output – offset the benefits gained by the uninsured – increased output.</p>
<p>I don’t see where the CBO says nets it as a positive.</p>