{"id":1948,"date":"2019-07-01T09:26:37","date_gmt":"2019-07-01T13:26:37","guid":{"rendered":"https:\/\/dahlman.online\/?p=1948"},"modified":"2019-07-01T09:26:42","modified_gmt":"2019-07-01T13:26:42","slug":"paying-for-health-care","status":"publish","type":"post","link":"https:\/\/dahlman.online\/index.php\/2019\/07\/01\/paying-for-health-care\/","title":{"rendered":"Paying for Health Care"},"content":{"rendered":"\n

Paying for Health Care<\/h2>\n\n\n\n

Small Business<\/h2>\n\n\n\n

A friend of mine runs a small business, with about twenty employees.  He shared with me the costs of providing health insurance for his staff. <\/p>\n\n\n\n

 One employee, in their early thirties with a spouse and two children, costs $17400 per year for coverage, even with a $10000 deductible.  The cost is divided between the employer and employee, and has continued to rise at ten percent per year.<\/p>\n\n\n\n

While my friend didn\u2019t share the salaries of his employees, it\u2019s a small business, and no one is making a huge salary.  This insurance cost is $1450 a month, shared by the employee and the employer.  It\u2019s a big chunk, either out of the employee\u2019s pocket, or in money not available to my friend to use for pay-raises.  And the cost just keeps growing.<\/p>\n\n\n\n

For the past three decades, the United States has been debating the costs of health care.  As the nation has argued, the price we pay continues to escalate.  Today, the US has the most expensive health care in the world.  For those with good insurance, it is some of the best care in the world, but for those who don\u2019t have insurance, the cost of care makes it inaccessible.  <\/p>\n\n\n\n

The Problem<\/h2>\n\n\n\n

We know all of this.\u00a0 13.7% of Americans DO NOT have health insurance (VOX<\/a>.)\u00a0We know that some of those Americans choose not to purchase insurance, \u201crolling the dice\u201d and banking on their good health and luck.\u00a0\u00a0But many do not choose, they simply cannot afford insurance, and aren\u2019t \u201cpoor enough\u201d to qualify for government paid insurance, Medicaid.\u00a0\u00a0<\/p>\n\n\n\n

And what about the Affordable Care Act, \u201cObamacare\u201d?  If filled in some of the gaps, helping many of those caught in between having enough money for necessities, but not enough for insurance.  But it wasn\u2019t perfect in the first place, and the present White House is slowly cutting away the supports of the ACA.  The prime funding for it, \u201cthe individual mandate\u201d requiring everyone to either have insurance or pay a fine, is gone. And while the ACA is cheaper than competitive private insurance, it certainly isn\u2019t cheap.<\/p>\n\n\n\n

Medicare for All<\/h2>\n\n\n\n

Last week, twenty Democrats running for President debated health care.  All twenty agreed that changes should be made in how our nation provides it.  But that\u2019s where the agreement ended.<\/p>\n\n\n\n

The most \u201cradical\u201d plan calls for the end of private insurance.  Everyone would be enrolled in a government plan, \u201cMedicare for All.\u201d This is not the \u201cfree\u201d medical care Republicans decry.  Medicare for All costs, and would be paid for by increased taxes.  The difference for most Americans would be that instead of paying for private insurance, they will pay Medicare taxes, presumably less than the private costs.<\/p>\n\n\n\n

It has the benefit of \u201ceconomy of scale.\u201d  Everyone will be on some variation of the \u201csame plan.\u201d  Pharmaceutical companies can only negotiate with one entity, the government.  And private health insurance profits are gone.<\/p>\n\n\n\n

\u201cEveryone loves Medicare\u201d is the battle cry of the Medicare for all folks, and that\u2019s generally true. But there is a, perhaps fatal, flaw in the plan.  It would require that over two-thirds of the country (Census<\/a>) give up their private insurance, and switch over.  Many, perhaps most Americans, are pretty happy with their health plans, even if they complain about the rising costs.  To ask almost 218,000,000 to give up their insurance for an \u201cunknown\u201d plan would seem to be more than difficult, and definitely bad politics.<\/p>\n\n\n\n

Hybrid Plans<\/h2>\n\n\n\n

So there are multiple \u201chybrid\u201d plans, including a \u201cpublic option\u201d allowing government sponsored insurance to compete with private insurance plans.  It\u2019s difficult to see how this could be cost effective for the government, and has the drawback of folks paying for private insurance also paying taxes for government insurance (sort of like the parents who send their children to private schools, but still pay public school taxes.) <\/p>\n\n\n\n

Then there is the option of \u201cre-booting\u201d the Affordable Care Act. That allows the government to subsidize private plans. It also creates the incentive of requiring everyone to either have insurance or pay a fine, as the ACA was originally constituted.\u00a0\u00a0The ACA\u2019s biggest problem was getting insurance companies to participate in areas where there was little competition.\u00a0\u00a0That created areas (particularly rural) where ACA costs were extremely high.<\/p>\n\n\n\n

Republican Alternatives<\/h2>\n\n\n\n

While all of these ideas have their flaws, there is one thing for certain.  The President and the Republican political leaders haven\u2019t offered any alternatives.  Their choice seems to be to go back to the insurance era of twenty years ago, when insurance companies could refuse to cover pre-existing conditions, and simply not cover those with higher risks. That leaves many Americans \u201cbare\u201d of coverage, pushing the cost of their limited care onto hospitals and government.<\/p>\n\n\n\n

There doesn\u2019t seem to be a \u201cgreat\u201d option, but doing nothing isn\u2019t an option either.  My friend\u2019s business is struggling with the cost of insurance, and his experience is typical.  Insurance is absorbing more and more of the income available for both the business, and the employee:  ultimately it is unsustainable.<\/p>\n\n\n\n

One way or another, change will have to come.<\/p>\n","protected":false},"excerpt":{"rendered":"

Paying for Health Care Small Business A friend of mine runs a small business, with about twenty employees.  He shared with me the costs of providing health insurance for his staff.   One employee, in their early thirties with a spouse and two children, costs $17400 per year for coverage, even with a $10000 deductible.  The cost is … Continue reading “Paying for Health Care”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-1948","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nPaying for Health Care : Our America - Essays on Politics and American Life<\/title>\n<meta name=\"description\" content=\"Providing health insurance isn't just a cost for employees. 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