So I’ve been thinking about this healthcare bill… let me rant out loud to make sure I understand some of it.
Premiums will probably rise “only” for those families making over $88k a year. (** I’ll rant more about this part at the end) Everyone making less than $88k a year will be subsidized in different increments from the government, so they won’t have to pay the full amount those making over $88k do.
People who did not have health insurance before will start paying into the system soon, since having health insurance is now mandatory.
The idea is that these new people making new payments will offset the medical costs of those older members who are currently at their insurance limits. And since the new law says there are no limits for these older people, these older people will be treated as long as necessary.
If I understand it right, this sounds like a mix of car insurance and social security. There are going to be so many new people paying into the plan that are not sick and “don’t have wrecks”, that the insurance companies can completely cover those few who are very sick and who have “totaled their cars”. This healthcare plan appears to hinge on everyone not getting catastrophically sick at once and that “new blood” keeps rolling in to pay.
Hence the “mandatory” part of the insurance reform law. Ah-hah!
That alone may explain why there’s no public option and no single payer. The system needs to be self-perpetuating in order to work.
Going over the Reuters points one by one, I thought of a few things as well…
WITHIN THE FIRST YEAR OF ENACTMENT
* “A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.” — So tanning is the new smoking. This initial tax shows that the federal government can (and will) tax anything it thinks is bad for you. That’s going to be a rather slippery slope.
* “Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.” — That sounds like a bribe to me. Don’t pull a Walgreens on us, keep the system alive during it’s infancy, and we’ll cut you in on the action.
* “Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service.” — Those little traveling Volkswagens with doctor’s assistants labels all over them? About to become filthy rich.
* “Employers are required to disclose the value of health benefits on employees’ W-2 tax forms.” — The feds have given employers a way to count coverage participation as “bottom-line” compensation, effectively giving employers the option to reduce the overall gross wages they pay their employees.
* “An annual fee is imposed on pharmaceutical companies according to market share.” — Soooo this is going to motivate pharmaceutical companies how? By enticing them to move offshore? Or artificially keep their market share low to avoid this “fee”? And what is the “fee” exactly?
* “The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.” — This sounds bad. The government is going to track who keeps going back to hospitals and for what. In addition, the government is going to fine or tax (financial incentives!) whoever they need to fine or tax in order for these preventable readmissions to stop. Let’s say, for argument’s sake, acid reflux increases in 2 years. If more and more people go to the doctor to treat acid reflux, will the government tax foodstuffs that have high acid content? Maybe I’m misreading it, but that’s what it sounds like!
* “The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income.” — The government expects everything to level out at this point. New payees will have offset the old payees’ claims, so the tax adjustment can kick in right around here. Again, kind of like car insurance. There will be so many people staying healthy that the insurance companies can completely cover those few who are not. And like social security, this assumes the base will continue to expand to support the costs of who came before.
* “A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.” — Ouch! That to me means oxygen tanks, aspirators, standing (or self-propelled) wheelchairs, lifts and transfer devices, airway kits, and defibrillators off the top of my head. Walgreen’s doesn’t carry much in the specialty medical device field! Look out EMTs! So why is the government taxing necessary medical equipment here? And where is that money going to wind up? In the general US fund?
* “Most people will be required to obtain health insurance coverage or pay a fine if they don’t.” — And here’s the line in the sand. You’re either in or you’re out at this point.
* “Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren’t counted for the fine.” — I predict mass layoffs from small businesses when this comes to pass. “Full time” workers will be dinged down to “part time” to get under this legal barrier. I also predict many small businesses that are just surviving by this point will be pushed under with this enactment. Costs will be passed down to the consumer from medium and big businesses to offset these new increases at this point as well.
* “Health insurance companies begin paying a fee based on their market share.” — So the government is effectively saying “Great job having so many people guys! Now pay up!” I’m unclear on why this is good and/or necessary? Shouldn’t the government reward the strongest and most accommodating insurance company at this point?
* “An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.” — If you have something nicer than everyone else at this point, you’re going to pay a fine. Period.
So let me summarize my feelings about all this : Barf!
Maybe Obama is banking on this healthcare plan to pull the economy out of the recession / depression (re-pression?). Money has to circulate by law now, legislated out of the hands of those who were saving it or spending it for their own purposes. Once money starts circulating again, the economy may twitch back to life.
I still think this is a crap way to do it. And mandating insurance coverage to self-propagate this system? Enforcing the collection through the IRS? Hell no.
To paraphrase a line from Dennis Miller when he was actually funny, “of course all that is just my opinion, I could be wrong.”
** On a quick side rant, the administration keeps touting that $88k is 4 times the poverty level for a family. So it’s OK to tax the middle class since they’re making 4 times more than the poverty level? Or is $88k for a family now considered upper class? Show me the yachts and two mansions a family of 4 making $88k a year has, and I’ll sell you a bridge in Brooklyn. Cheap! $88k is very middle class IMO.