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Tilting at Windmills

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January 9, 2007
By: Kevin Drum

UNIVERSAL HEALTHCARE IN CALIFORNIA....Arnold Schwarzenegger unveiled his universal healthcare plan for California on Monday and it looks....okay. Just. But I'd say that about any plan that keeps insurance companies in the healthcare business, so take it with a grain of salt. Given the political realities of California and the nation, it's probably about as good a plan as we could hope for.

(So does that mean I support it? I think so. Frankly, I go back and forth on whether cobbled-together plans like this one actually help things much, or whether they should all be opposed in favor of an eventual big bang. I may change my mind tomorrow, but for now I figure that a step in the right direction is a step in the right direction. I'll take it.)

Overall, the plan is about what you'd expect. Basically, it's an individual mandate (i.e., everyone is required to buy health insurance, the same way everyone who drives is required to buy auto insurance) with state subsidies for those too poor to afford coverage. There's a new tax on doctors and hospitals, and small employers are required to either provide insurance for their employees or else pay a 4% payroll tax. Insurance companies, for their part, are required to offer insurance to everyone, regardless of medical history, age, or occupation (aka "community rating," meaning everyone in a particular community gets the same rate.)

Problems? Sure. California Republicans are already lining up to oppose it, and this matters since tax and budget issues require a two-thirds majority to pass. (Apparently some Democratic supporters are claiming the plan needs only majority support, but this seems pretty iffy to me.) Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax. Finally, although I haven't seen an independent analysis of the numbers, my gut tells me they look lowballed. I have a feeling the plan is going to cost more than Schwarzenegger is fessing up to.

Overall, I'm not a big fan of individual mandates. On the other hand, I am a big fan of community rating, and the whole plan might be worth passing simply to get that enshrined into law. Once community rating becomes established, I suspect there's no going back, and that might eventually lead to a more rational system all by itself.

So two-and-a-half cheers for Arnold's plan. It's not perfect, but few things in life are. For now, it's probably about as good as we're likely to get.

Kevin Drum 1:00 AM Permalink | Trackbacks | Comments (109)

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Comments

And everyone will comply, just as they do with auto insurance. So... you show up at the ER with chest pain and no insurance. What does the plan say about that?

Posted by: DOW on January 9, 2007 at 1:29 AM | PERMALINK

And everyone will comply, just as they do with auto insurance. So... you show up at the ER with chest pain and no insurance. What does the plan say about that?

Since the plan makes it illegal not to have insurance, then you should be fined or imprisoned for not having it because you're violating the law.

Al

Posted by: Da Al on January 9, 2007 at 1:35 AM | PERMALINK

By suggesting that insurance companies should be taken out of the equation, you are suggesting that professional risk assessment is not important. The idea that a bureaucracy can evaluate risk better than a firm whose existence depends on it, well...

Lowballed is almost certainly right, but mostly due to the extraordinary waste that comes from blanket mandates like this.

Also, why would we tax doctors and hospitals? Seems to me they should be rewarded instead of punished.

Posted by: Matt S on January 9, 2007 at 1:44 AM | PERMALINK

It seems like your concern

I go back and forth on whether cobbled-together plans like this one actually help things much, or whether they should all be opposed in favor of an eventual big bang

meshes nicely with

Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax,

in that if Burd is right, this enemy of the perfect will be unsustainable. So perhaps the perfect will replace it. (And I am the Queen of Bulgaria...)

By suggesting that insurance companies should be taken out of the equation, you are suggesting that professional risk assessment is not important. The idea that a bureaucracy can evaluate risk better than a firm whose existence depends on it, well...

Matt S, if we're insuring everyone, then there's no assessing to be done. You can get up to speed by looking at how much better care and outcomes are in France on half the money we spend, while covering everyone.

Posted by: Allen K. on January 9, 2007 at 1:47 AM | PERMALINK

"Since the plan makes it illegal not to have insurance, then you should be fined or imprisoned for not having it because you're violating the law.

Al"

Actually Al, you and I agree here. If a California citizen shows up who doesn't have insurance, then there should be a fine (or whatever) since the state provides money for you to purchase it. HOWEVER - what does a California hospital do when I, an Arizona (or wherever) citizen show at your hospital without insurance?

This is why single payer coverage is necessary. Too many loopholes and whatifs otherwise.

Posted by: An Anonymous Patriot on January 9, 2007 at 1:48 AM | PERMALINK

Is care really that much better in France? Or is it the fact that we don't live longer than people in France, Germany, Japan or the UK, yet spend a lot less than we do

Posted by: Ghost of Tom Joad on January 9, 2007 at 1:50 AM | PERMALINK

Anyone here think that Health Insurance companies eye all the money that's allocated for raises and cost of livings each year and say, "any dollar that goes to a raise instead of to higher premiums is a dollar I am losing!"

I sure think so.

Posted by: david on January 9, 2007 at 1:52 AM | PERMALINK

Allen K, you seem to be assuming that under blanket care that no judgments of priority must be made. Costs matter and hard decisions need to be made, unless resources are infinite.

Do we spend $100,000 to sustain a 90-year-old for two months, or do we spend it on a risky procedure to save an infant? Who makes that call?

Regarding France, although this seems like an odd connection, their model results in riots in the suburbs. The waste is extraordinary, and the result is an economy that can't -- and doesn't -- sustain.

Health care is an enormous part of any economy, and to nationalize (Californize?) it is to ensure that costs are separated from benefits. That's a recipe for waste of perhaps our most important resource.

Cost-benefit decisions must be made by those who are affected by them most directly. The more difficult the decision is, the more important that this be the case.

Posted by: Matt S on January 9, 2007 at 2:06 AM | PERMALINK

Regarding France, although this seems like an odd connection, their model results in riots in the suburbs.

Yes, indeed, that does seem like a ridiculous thing to bring up in a health care discussion. I am sure there is much we can agree on.

Posted by: Allen K. on January 9, 2007 at 2:10 AM | PERMALINK

The goal of the Democrats seems to be to make it impossible to do business in California.

Damn right there's "no going back," and after the private health care system has been destroyed, there isn't going to be a lot of choices left except bailing out of the state when the costs of yet another government social program turn out to be several times higher than promised, like they always have.

Posted by: clark on January 9, 2007 at 2:12 AM | PERMALINK

My plan would be that Arnie just adopts everyone in California. Then we could all go to the doctor as his dependents.

Problem solved.

Posted by: craigie on January 9, 2007 at 2:13 AM | PERMALINK

Don't know what the plan says.

Know what will happen.
Family buys mandated insurance.
Pays monthly.
Paycheck decreases/stops temporarily.
Family thoughtlessly decides that rent, food or fixing car so can drive to work takes precedence
over mandatory insurance.
Someone gets sick.

Cannot go to doctor's office/clinic as without insurance: would have to pay $60-$100 up front, perhaps other costs, and if had that money would not be in this mess in first place.
Patient shows up in dire straits at ER w/ chest pain, cut, fever, vomiting, intractable something, sky high blood pressure, blood sugar, etc., etc.

ER required by law/inspired by common humanity (your choice) treats whatever.
Social worker will see those who get admitted, hopefully find/apply for/get some funding to pay.
Everyone else will get dunned, sent to collections, for nose-bleed inducing ER costs, thereby decreasing money patient/family has to buy mandated insurance.
Patient cannot afford meds/follow up/therapy.
Patient gets sicker.
Patient cannot go to doctor's office/clinic...

But you get the idea.

Hospital/doctors get stuck with unpaid costs and close money losing ERs, clinics and trauma services or refuse to treat so revenue producing,equipment and services, and, even less admirably, administrators' and CEO's salaries are maintained. When things get really bad they dump patients on Skid Row of otherwise forcibly discharge them.

Insurance plans make out like bandits with state subsidies and no decrease in rates.

Just what we've got now except that since the patient was mandated to have health insurance can add whole new layer of guilt/shame/possible legal troubles to horrors of illness.

Sorry, Kevin. This is just another give away to the insurance industry. Until the private sector is willing to administrate for 3-7% the way Medicare does, mandatory private insurance is just another insurance scam.

Posted by: clio on January 9, 2007 at 2:13 AM | PERMALINK

Medicare can "administrate" for 3 to 7 percent because the health care providers are doing all the bureaucratic work for them. Ask any doctor how much paperwork is associated with Medicare and Medicaid work.

Posted by: elwin on January 9, 2007 at 2:17 AM | PERMALINK

Until the private sector is willing to administrate for 3-7% the way Medicare does, mandatory private insurance is just another insurance scam.

This is pretty much the truth. The reason US healthcare is broken is because gigantic surplus rents are being sucked out of the system and into the pockets of 6 rich guys who run the insurance companies. Get rid of those parasites, and you have plenty of money to treat the uninsured.

And Matt S, spare us the "healthcare is just like appliances" model of economics. Someday, possibly not in my lifetime, but someday, the US will join civilization and decide that healthcare is too important for capitalism.

Posted by: craigie on January 9, 2007 at 2:19 AM | PERMALINK

Ask any doctor how much paperwork is associated with Medicare and Medicaid work.

Then compare how many secretaries doctors must employ in this country to handle private insurers, their incompatible filing systems and their idiosyncrasies, vs. the vastly more efficient single-payer systems found elsewhere.

There are lots of numbers here, for those who are willing to approach this with a mind more open then "If France does it then I'm agin it".

Posted by: Allen K. on January 9, 2007 at 2:23 AM | PERMALINK

elwin, my dear, I know.
We do it for the private insurers as well. And they're at least as difficult as Medicare.
My father ran the biggest practice in 3 counties with a receptionist, nurse.
Don't see that these days.

Posted by: clio on January 9, 2007 at 2:23 AM | PERMALINK

...someday, the US will join civilization and decide that healthcare is too important for capitalism.

Come to think of it, so is food, shelter, transportation, energy, telecommunications, and all the rest.

Let's just bite the bullet and nationalize the whole mess. Look at Chavez--he's on the ball. After all, once the government is in charge, you can kiss waste and corruption goodbye.

Posted by: dnc on January 9, 2007 at 2:24 AM | PERMALINK

Isn't this plan similar to what Massachussetts has started on? Is that working out? How far have they gotten on it?

Posted by: harry on January 9, 2007 at 2:28 AM | PERMALINK

I agree with most of the critiques presented; however, isn't Kevin's point that no one can be denied or up-rated (community rating) is a massive step in the right direction, still valid? I am self employed, and where I live, most carriers will not even insure my family because my 11 year old daughter has asthma and allergies (and not even a particularly severe case of either). The few insurers that will provide coverage charge outlandishly high premiums. I guess the argument could be made that this could be achieved without the other trappings (failiings?) of the "universal coverage" provisions of the California plan, by some stand alone legislation, but why not cause as big a stir as possible to get the ball rolling?

Posted by: bmaz on January 9, 2007 at 2:31 AM | PERMALINK

Damnit, dnc, stop it!

No one who isn't in the top 1/2% can afford what good medical care, not cutting edge, but good medical care costs these days. Medical costs have sky-rocketed, and not because doctors and hospitals are charging so much more, although fees have risen, but because medicine does so much more.

I mentioned my father. The kids in his practice who got leukemia? They died in 2-6 months. Wasn't much to do. Occasional transfusions so they didn't get too breathless, morphine for the bone pain, and lots of hand-holding by my dad as the inevitable happened. I well remember accompanying him on Sunday afternoon house calls when he would say. "Don't come in here. It's too hard on Patient parents." Leukemia has an 80% cure rate these days. Care to go back?

Or hypertension. Used to be the only medicine was thiazides. Control problematic. Stroke, heart disease, early dementia common. Not true any more.

Diabetes. Remember when blood sugars were measured once a week and insulin control, I use the term loosely, was done by urine sugars? The dark ages.

I could go on and on. One last one: remember when a heart attack meant dead heart muscle? That's within my son's lifetime, and he's 20. Now with thrombolytics, cath labs, bypass surgeons, a heart attack can be just a bad dream. (Cheney, who has end stage heart failure, would have been dead years ago in the 80's or even early 90's)

My dad did a lot of hand holding. It was often all he had to offer. Today that is not so. Medicine can do something to prevent/cure/help.

Medicine and our expectations of it have changed. And it's just getting started. Stem cells and gene therapy will revolutionize it again, even more than antibiotics, in the next 10-20 years. The way we deliver and pay for it must change also.

Or are you going to say that only some Americans deserve good health?

Don't do it.

Posted by: clio on January 9, 2007 at 2:52 AM | PERMALINK

I wonder how this will affect those of us with good health who go for the low premium-high deductable insurance--will we be forced to pay higher premiums for care we don't need?

And to those who fear that we're about to slide down the slippery slope towards socialism, if government-run police and fire departments, and all those government subsidies for failing corporations, haven't done us in, why would this this be any more dangerous to our American Way of Life? It does put a chink in the armor of crony capitalism, I suppose, but that doesn't make it the enemy of the free market. Not everything was meant to be privatized.

Posted by: Jess on January 9, 2007 at 2:59 AM | PERMALINK

bmaz,

It is a step in the right direction, and any one with half a brain strongly approves. But it's a step that can be taken without shoveling public funds to private insurance companies and rewarding their inefficiencies.

It will be even better when everyone is covered by insurance. Then the whole country will be your neighborhood.

Imagine not being any more scared of getting sick that the the illness itself warrants.

Must go. Have some baking to do. Hope your daughter is doing well, and that whatever Cal. does helps you.

Posted by: clio on January 9, 2007 at 3:05 AM | PERMALINK

clio, with respect, I can only ask how these breakthroughs came to be? By and large, they are not coming from places with socialized health care. Yes, you can cite rare exceptions, but if you were to eliminate the breakthroughs that come from our "broken" system, you'd be taking years of life.

How many diabetes treatments come from for-profit firms? Something near 100%. Can we do without 'em? We've turned HIV from a death sentence to a manageable condition.

These things come from for-profit firms whose survival rests on their delivering them. It's not about greed, it's about prioritizing resources toward successful science. Concepts like "greed" are about personal piety, not progress.

The argument essentially says that because our system has created miracles, we need to change it.

craigie, "too important for capitalism" means "too important to let people make their own decisions". Value judgments need to be made, all day every day, the question is who makes them. Sorry that you mistake consenting adults for appliances.

Posted by: Matt S on January 9, 2007 at 3:40 AM | PERMALINK

Matt S,
You are rdw's bitch aren't you, spouting off about France with zero knowledge about the damn place. (Except that suckled from from Fox News teats.)
You talk from your arse and this is from someone who has lived in France, Britain and most of Asia.
I don't care what anyone told you spewing lies and ignorance is nothing to be proud of. So either get some real knowledge of the world outside of your parents house or get the hell off an adult oriented site like this.

Posted by: Matt S on January 9, 2007 at 4:47 AM | PERMALINK

Incremental gains in making us a healthier society are better than the backwards slide into feudalism we have seen over the past 12 years....

Posted by: The Conservative Deflator on January 9, 2007 at 5:36 AM | PERMALINK

Hey, if you had a healthcare system that didn't generate a multi-million population of retirees desperately searching the web for prescription drugs at prices that would leave them food money, we'd all get so much less spam...

Posted by: Alex on January 9, 2007 at 5:51 AM | PERMALINK

I'm not so sure about community rating. What if you live in a poor community? Wouldn't your premiums be higher? This would make a system in which the poorest and sickest populations would pay the most for health care.

Great plan.

Posted by: Arbitrista on January 9, 2007 at 6:25 AM | PERMALINK

Is there any expectation that this CA plan will result in lower premiums or at least contain their growth? It seems to me that individual mandates without tight regulation of premiums will accomplish nothing but to generate more "gigantic surplus rents" for the health care fat cats to rake in.

Posted by: Donna Q on January 9, 2007 at 7:15 AM | PERMALINK

We could insure every child in the country tomorrow if people would just get over their unfounded fear of million dollar deductible plans.

Posted by: ex-communist plutocrat on January 9, 2007 at 7:57 AM | PERMALINK

What does the plan say about that?

It should say that if you are not insured, then you pick a plan at the hospital, get enrolled, and get billed for premiums back to the onset of the program.

Posted by: jayjackroyd on January 9, 2007 at 8:07 AM | PERMALINK

If government programs for health care are so bad, why is the VA healthcare system the best in the U.S. today while also being remarkable cheaper? Medicare is good, but the VA system is a lot better.

Posted by: Rick B on January 9, 2007 at 8:10 AM | PERMALINK

By suggesting that insurance companies should be taken out of the equation, you are suggesting that professional risk assessment is not important. The idea that a bureaucracy can evaluate risk better than a firm whose existence depends on it, well...

Universal coverage provided by a single payer (state or federal) removes the need for risk assessment. The insured population is the entire population, and is funded by taxation.

This is a much cheaper and more efficient way to deliver health care services--it's the one that the rest of the OECD uses.

BTW, did you see the recent article in the NYTimes which compared health care expenditures in the US to those in other countries? Not only do we spend more than twice as much per capita as any other country, our government spends more per captia than any other country. Government pays about 45% of health care costs in the US, the smallest fraction in the OECD, but, per capita, it's the largest expenditure.

This is precisely because of the insurance companies and HMOs introducing inefficiencies and taking out money.

Posted by: jayackroyd on January 9, 2007 at 8:12 AM | PERMALINK

Damn right there's "no going back," and after the private health care system has been destroyed, there isn't going to be a lot of choices left except bailing out of the state when the costs of yet another government social program turn out to be several times higher than promised, like they always have.

Under the current "private" system, government pays more per capita than public systems. The overwhelming evidence is that the best way to provide health care is through universal coverage funded by the government.

Oh, and by the way, the largest government social program in the US is Social Security, which is run at very low cost.

Posted by: jayackroyd on January 9, 2007 at 8:15 AM | PERMALINK

How are they insuring people who are undocumented?

That's a big policy question, because there's no federal Medicaid match for undocumented people, meaning that the state has to pay twice as much for their coverage as they do everyone else's.

Is it happening through the employer mandate? What's the enforcement mechanism on that?

Posted by: anonymous on January 9, 2007 at 8:17 AM | PERMALINK

This plan would be better if 1) the payroll tax were higher than the average insurance contribution and 2) if California established an insurance plan to compete with the private sector plans.

As with Medicare HMOs*, the insurance companies would soon be driven out of the state, creating a de facto single payer plan.


--------------------------
Strictly speaking, as should have happened. When Medicare HMOs were not allowed to cherry pick members, they became unprofitable. In order to keep them from leaving the Medicare program, they have been subsidized. One more thing for the Democrats to attend to...

Posted by: jayackroyd on January 9, 2007 at 8:18 AM | PERMALINK

"This would make a system in which the poorest and sickest populations would pay the most for health care. "

But that IS the US economic system. Try reserving a hotel room as a small company employee or as a Microsoft employee. The less powerful pay more.

Posted by: lining my pockets on January 9, 2007 at 8:20 AM | PERMALINK

Al is stupid:

Since the plan makes it illegal not to have insurance, then you should be fined or imprisoned for not having it because you're violating the law.

Al

Hey, Al--there's no federal support for people in jail. So, if you sign this person up for Medicaid, the federal government will pay half the bill. But if you put them in jail and make the prison system provide their healthcare, then California taxpayers have to cover the full cost of this patient's cardiac care.

Um, not to mention the lost tax revenues for California of not having this person in the workforce anymore (most uninsured people are working) and, um, the cost of housing and feeding this person. And the lost productivity in the workforce of taking a productive person and turning them into a dependent of the state.

Idiot. Probably wants to bring back debtors' prison, too.

Posted by: anonymous on January 9, 2007 at 8:21 AM | PERMALINK

How many diabetes treatments come from for-profit firms? Something near 100%. Can we do without 'em? We've turned HIV from a death sentence to a manageable condition.

By "come from" do you mean "manufactured by"?

For insulin, the process of discovery through the first successful clinical trial was completed by academics at public institutions (University of Strasbourg, University of Toronto, University of Bucharest). Only then did Eli Lilly get involved to research mass producing the purified protein. The first patents for the treatment were held by the universities.

I think you'll find that academics have played a pretty large role in HIV/AIDS research too. Particularly in understanding the biology of the virus and developing the theory behind the antiviral drugs we currently use as treatment.

Posted by: B on January 9, 2007 at 8:33 AM | PERMALINK

As an OSU alum, I admit...speed kills. Congrats Fla.

Go Bucks!

Posted by: Keith G on January 9, 2007 at 8:34 AM | PERMALINK

What does the average insurance contribution have to do with anything?

Companies on the verge of dropping coverage are probably paying a lot more than "average."

Posted by: B on January 9, 2007 at 8:46 AM | PERMALINK

average is in quotes to signify that my coffee is still brewing

Posted by: B on January 9, 2007 at 8:47 AM | PERMALINK

By suggesting that insurance companies should be taken out of the equation, you are suggesting that professional risk assessment is not important. The idea that a bureaucracy can evaluate risk better than a firm whose existence depends on it, well...

I'll mainly repeat what JayAckroyd said because it's important.

Universal health care has nothing to do with insurance. The word is entirely a misnomer. This logically follows from two facts:
1) Insurance companies make money by charging patients slightly more than their expected health care cost, in exchange for agreeing to pay for catastrophic super-high costs that have some small probability of coming up;
2) There are people in the U.S. who cannot afford their expected health care costs.

What do you do for those people? You could tell the insurance agency to charge some lower price to them, but that's like mandating that insurance companies shoot themselves in the foot. It breaks the entire business model of insurance. In truth, there is no longer any rationale (at least none that I see) for risk assessment.

That's because universal means we don't care about the risk profile of the patient, and we don't care how much money the patient has. The patient has a right to health care.

(In truth, I think we should set up incentives something like the "negative income tax" idea, to make sure that patients have to pay a little more when they get more sick, etc. So people don't do too many self-destructive behaviors.)

Posted by: mk on January 9, 2007 at 9:01 AM | PERMALINK

(In truth, I think we should set up incentives something like the "negative income tax" idea, to make sure that patients have to pay a little more when they get more sick, etc. So people don't do too many self-destructive behaviors.)(In truth, I think we should set up incentives something like the "negative income tax" idea, to make sure that patients have to pay a little more when they get more sick, etc. So people don't do too many self-destructive behaviors.)

Whether or not you engage in public health programs, like the very successful crackdownon drunk driving, is entirely independent of how the health care system is financed. Governments (federal, state and local) should all be looking for programs to reduce obesity and tobacco use.

But the rest of your post was a very nice amplification of mine, so thanks very much.

I'm finding it harder and harder to deal with this kind of fact-free wingnut argument. I know somebody who got his dissertation under Milton Friedman. In a post-mortem conversation, he remarked that it was very difficult to win an argument with Friedman. He had a prodigious memory and a very sharp wit. Where have all the Friedman's gone? When did the entire conservative program become slogans and bumper stickers?

Posted by: jayackroyd on January 9, 2007 at 9:14 AM | PERMALINK

We've turned HIV from a death sentence to a manageable condition. . . These things come from for-profit firms whose survival rests on their delivering them. It's not about greed, it's about prioritizing resources toward successful science.

For-profit firms didn't know what the hell HIV was until a french government employee isolated the virus and a US government employee helped demonstrate it's connection to AIDS.

In the reality based world most fundamental health research is academic and government funded. These researchers live in a high-pressure competitive world and have systematic peer reviewed process for prioritizing resources for scientific advancement. The number of scientists working for for-profit firms who have been trained within this system: 100%.

Posted by: B on January 9, 2007 at 9:40 AM | PERMALINK

2) There are people in the U.S. who cannot afford their expected health care costs.

What do you do for those people?

and to further mk's point, just to point out this thing about diseases - that are in fact contagious and so let alone being beneficient, it's in nobody's self-interest to have a large portion of the population outside the health care system.

(and why do the wrongies have to pretend to reinvent the wheel each time health care comes up; other countries have systems that actually work; nor is the US quite the sole research engine that you like to paint)

Posted by: snicker-snack on January 9, 2007 at 9:42 AM | PERMALINK

that are = that many are

(excising words my forte)

Posted by: snicker-snack on January 9, 2007 at 9:45 AM | PERMALINK

and to further mk's point, just to point out this thing about diseases - that are in fact contagious and so let alone being beneficient, it's in nobody's self-interest to have a large portion of the population outside the health care system.

Specifically, tuberculosis and STDs.

Posted by: jayackroyd on January 9, 2007 at 9:46 AM | PERMALINK

First, a Medicare drug program that ensures growth and profits for drug companies, now a program that ensures the continued growth and profits of insurance companies. Maybe that why the CEO of United Health Care got mega-millions (I'm sure it will be argued he is worth it because of his care and concern for his customers).

Within 10 years, the phoney solution of "universal" health care will be exposed by the bankruptcy of the states and the bloated wealth and size of the insurance companies.

Posted by: Neal on January 9, 2007 at 9:47 AM | PERMALINK

Dear California,

I am sending you my needy grandmother to take care of for the rest of her life. She needs full time care along with a boatload of prescription medicines. Thank you for so generously offering to pay for her care. Your decision has made my life so much easier.

Sincerely,
Every person in every other state and Mexico.

PS. If you could send air fair so that I can regularly visit her it would be greatly appreciated.

Posted by: Orwell on January 9, 2007 at 10:25 AM | PERMALINK

I welcome the new plan since it is an opportunity to experiment on a large scale without going national.

A few comments, however. The 4% tax seems like it is going to be too low by a significant factor. Every study of health insurance costs that I have seen suggests that the % of payroll devoted by employers for health care is about twice that number, or greater. If I had a business in CA that offered health insurance, I would drop it the moment the law is passed if the tax (and it is a tax) is lower than my previous costs.

Also, I really don't understand the purpose of the new tax on providers. It seems to me that if you wish to cap costs, and I can see this as the only justification for such an additional tax, then the tax needs to be much higher, and needs to be progressive with regards to gross revenue. Otherwise, you are simply collecting in one hand what you are paying out with the other.

I expect this experiment to be a complete failure if enacted, but it will be interesting to watch.

Posted by: Yancey Ward on January 9, 2007 at 10:34 AM | PERMALINK

Private companies ruin healthcare. They pillage government research and then charge outlandish sums for the drugs they develop because of it. They refuse to cover anyone who they might possibly have to pay out to someday. They force the poor to die earlier than the rest of us. People who support them are bad people. This has been going on too long to pretend you've had your heads in the sand. You just don't give a flying fuck about anyone but yourselves. Don't expect anyone to treat you like this is some deeply held belief. You're scum, you don't deserve respect of debate.

Posted by: Soullite on January 9, 2007 at 10:35 AM | PERMALINK

B:

When Bill Gates walks into a room filled with 39 homeless men, the "average" net worth of everyone in the room becomes $1 billion. Averages are skewed by outliers.

Neal:

If the U.S. can piss $2 billion per week down our collective legs in Iraq, we can easily afford universal health care coverage for all Americans. It is a matter of will and priorities. We are the only industrialized country in the world that does not provide it.

TCD

Posted by: The Conservative Deflator on January 9, 2007 at 10:38 AM | PERMALINK

B-52 runs over Hartford, CT.

Anything less is a private insurance preservation program.

Bob

Posted by: rmck1 on January 9, 2007 at 10:38 AM | PERMALINK

Oh, if only all companies could be like Google - Fortune Mag just picked Google as the best employer in the land - Of the many perks provided to their employees, they have five physicians on site to provide free medical attention to any employee.

Sounds great - Except in none of the photos showing many merry, happy workers did anyone over the age of 30 appear. When I see any company providing free health care to older workers, say in their 50s and 60s, I will be more impressed.

Posted by: thethirdPaul on January 9, 2007 at 10:39 AM | PERMALINK

Schwarzenegger's mandatory insurance plan (its not really a universal health care plan, as far as I can tell, because while there are required expenditures, none of the descriptions describes a guaranteed level of health care coverage) is simply a gimmick designed to serve as an excuse for (and take media attention from) his welfare cuts.

Posted by: cmdicely on January 9, 2007 at 10:54 AM | PERMALINK

Clio, your example about what happens when a family loses the ability to pay premiums gets right to the heart of the problem, and is exactly why Kevin should come out the other way on what is admittedly a close question.

We levy taxes for general services primarily based on ability to pay. Why isn't medical care such a service? Where is the evidence that people respond to financial incentives be being "weller"? It's lunacy, I tell you, lunacy.

Also, Kevin, could we stop with the "Oh, we'll never get real universal care, so this is the best we can do" nonsense? Why don't we at least try to do the right thing. If we have to accept half a loaf, so be it. But let's take a page from the Right's playbook and ask for more than we would accept.

Posted by: Jim Pharo on January 9, 2007 at 11:00 AM | PERMALINK
Every study of health insurance costs that I have seen suggests that the % of payroll devoted by employers for health care is about twice that number, or greater. If I had a business in CA that offered health insurance, I would drop it the moment the law is passed if the tax (and it is a tax) is lower than my previous costs.

Uh, why? Chances are, if you are free to do that, you were under no mandate to provide health insurance before, which means that the expense was voluntary and quite likely part of a conscious decision of what was necessary to attract and maintain health (and morale) of the workforce you needed.

Why would you then cut it in favor of paying a tax which, unlike your own expenditures, would not be focussed on your employees, and would, in particular, most hurt your employees most able to leave?

Posted by: cmdicely on January 9, 2007 at 11:01 AM | PERMALINK
Is there any expectation that this CA plan will result in lower premiums or at least contain their growth?

No, its a combination of a subsidy with a mandate-to-buy with no cost controls, it will, clearly, accelerate the rise of premiums.

It's designed to either fail to pass and take the idea of universal healthcare with it for years, or to pass along with welfare cuts notionally to pay for it, and then fail spectacularly in practice and be repealed (doing an even better job at discrediting universal healthcare) while the welfare cuts remain.

It is not, at all, even remotely designed to be a successful universal coverage system.

Posted by: cmdicely on January 9, 2007 at 11:04 AM | PERMALINK
Also, Kevin, could we stop with the "Oh, we'll never get real universal care, so this is the best we can do" nonsense?

Especially in California, where the only reason we don't have real universal healthcare is (surprise, surprise) the Governator's veto.

Posted by: cmdicely on January 9, 2007 at 11:06 AM | PERMALINK
however, isn't Kevin's point that no one can be denied or up-rated (community rating) is a massive step in the right direction, still valid?

A step from what? The universal health care plan that Arnold vetoed that this new planned failure is designed to prevent from resurfacing by blowing up and taking the idea of universal healthcare with it? No. The status quo? Sure, that one idea is a step forward, but its included in a plan designed to fail. ITs a political gimmick.

Posted by: cmdicely on January 9, 2007 at 11:09 AM | PERMALINK

Matt S. - you are way off base about medical breakthroughs being the fruit of profit-making companies. Pharmaceutical and medical device companies base their profit-making efforts on the basic scientific research funded by government and non-profit agencies. Universities and research institutes do all the stuff that make those breakthroughs possible. It's only when a profit-making opportunity arises that a company will fund the technical part of bringing the breakthrough to market. Profit-making companies are also far more interested in producing "me too" drugs to stretch out their patent protection then they are in producing new, affordable treatments that actually benefit people. Capitalism benefits capitalists, not society as a whole.

Posted by: Buffalo Gal on January 9, 2007 at 11:09 AM | PERMALINK

cmdicely,

I never wrote that all employers will drop it, but many will with the state standing ready to tax and subsidize the individual purchases. It may even be cost beneficial to drop coverage, pay the tax, and pay some employees more to purchase their own coverage with state subsidy. I just don't see how a 4% tax can do anything other than cause a decrease in the number of existing employer-sponsored plans. If California enacts this, we will see the magnitude of the effect.

Posted by: Yancey Ward on January 9, 2007 at 11:12 AM | PERMALINK

I'm bettin that the insurance forced on the working poor will have so many deductibles as to make the insurance virtually worthless in any situation short of catastrophe and even then leaving the recipient devoid of any material possessions. The mandate part of it being a cosmetic coverage really subsidizing the middle class. Low income single non-breeders will be treated worse than illegal aliens.

Posted by: Michael7843853 G-O in 08! on January 9, 2007 at 11:15 AM | PERMALINK

Americablog, atrios, digby, glenngreenwald are all down! Blogger is failing. Time to get on the horn and make some noise.

Google is not a reliable enough platform to host so much of the blogsphere. It's time to migrate away from google. It's too important to have a single point of failure.

Posted by: patience on January 9, 2007 at 11:20 AM | PERMALINK
I never wrote that all employers will drop it, but many will with the state standing ready to tax and subsidize the individual purchases.

Oh, sure I was objecting to the generalization "If I was an employer, I would..."

There are certainly cases where dropping private insurance would be encourage, particularly (I would say "ironically" if I thought the plan was intended to work) where an employer is already providing better coverage to a largely-poorly-paid workforce that isn't particularly mobile.

Posted by: cmdicely on January 9, 2007 at 11:20 AM | PERMALINK

Well, the way things are going, pretty soon most of us will qualify for Medicaid anyway :(

Posted by: Prior Aelred on January 9, 2007 at 11:35 AM | PERMALINK

cmdicely,

How was what I wrote a generalization? I told you what I would do. Now, I don't expect I would be unique, but I never wrote I would be in the "general" class.

Of course, it is rational to "expect" the plan to work if enacted; and, in any case, if it doesn't, I can always reoffer insurance to my employees if I view it beneficial to do so.

Posted by: Yancey Ward on January 9, 2007 at 11:44 AM | PERMALINK

It's not just blogger that's down. TPM isn't loading either.

Posted by: jayackroyd on January 9, 2007 at 11:47 AM | PERMALINK

Kevin will never stop saying we will never get universal healthcare because he doesn't want universal healthcare. He knows he's just fine, and anything else would raise his taxes.

Posted by: Soullite on January 9, 2007 at 11:49 AM | PERMALINK

All: Learn the difference between "universal" health care (funded through insurance companies) and "single-payer" health care ( no insurance companies with care for all funded through taxes and admistered by government). Single-payer is inevitable-insurance companies gobble up so much for waste, processing, and profits that losing them would free up about 40% of health care funding. All that we are doing by going through universal healthcare is mandating more and more money to flow through insurance companies, making sure the US will go bankrupt sooner and be noncompetive in the worlds markets. And don't give me any BS about how the government is so uncompassionate and impersonal while insurace companies are your best friend.

Posted by: Neal on January 9, 2007 at 12:02 PM | PERMALINK


Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance

He may be right but, compared to the Mass. scheme it's a major step forward. Under the MA plan companies which don't provide health insurance have to pay $295/employee/year. And the penelty for individuals who don't buy insurance is that they lose their personal income tax exemption, which as a deduction comes out to close to the same amount. Since those come to ~5% of the cost of insurance there's a strong incentive to accept the penalty. One gets the impression that either the people choosing those values have no idea of the cost of health insurance, or they are deliberately trying to make the plan fail.

Posted by: dan on January 9, 2007 at 12:07 PM | PERMALINK

the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax.

This is a Republican corporate welfare reform package to encourage employers to stop providing health insurance, not a proposal to ensure every Californian has access to healthcare. My guess is the first companies to utilize it will be Wal Mart, Lockheed and Chevron.

Posted by: Brojo on January 9, 2007 at 12:11 PM | PERMALINK

what, no bcs thread?? c'mon kev, there's some gators out here who deserve a platform!

vladi?

Posted by: travy on January 9, 2007 at 12:22 PM | PERMALINK

Once community rating becomes established, I suspect there's no going back, and that might eventually lead to a more rational system all by itself.

Not necessarily. Lots of auto insurance deregulation has occured which allowed insurers to consider various non-driving related factors. It took a long time, and bipartisan consensus, but it eventually happend.

Posted by: Nicholas Beaudrot on January 9, 2007 at 12:26 PM | PERMALINK

Sometimes half-measures are better than no measures at all. Sometimes half-measures are worse.

This particular half-measure has "clusterfuck" written all over it. The single biggest problem in our health care system is the dominance of for-profit health insurance. Any system that tries to maintain this system is going to just be dicking around the margins and adding additional expenses for the working class and small business.

There is only one appropriate philosophy for dealing with the US health insurance industry. Trotskyism. Smash it, burn it to the ground, and warm your hands by the soft, glowing embers.

Posted by: ajl on January 9, 2007 at 12:35 PM | PERMALINK

Here's an item that appeared a few weeks ago.

http://www.usatoday.com/news/nation/census/2006-12-22-census-figures_x.htm

you can go to the Census Bureau for the original.

Migration out of California now definitely dominates migration into California, and California's population is growing because the new birtsh more than make up the difference. Migration into CA is mostly from Mexico, and migration out of CA includes entrepreneurs and other people who make the economy go.

The new insurance plan, if it places new burdens on entrepreneurs and businesses, will most likely increase the rate at which those people leave CA. Contrasting CA with TX, CA will probably continue to reduce its international share of manufactuing, while TX continues to increase its international share of manufacturing (along with its share of wind-generated electricity.)

Time for somebody to check on the net migration of physicians. I read that the net flow was out of CA rather than into CA, but I don't have a recent source.

Posted by: MatthewRMarler on January 9, 2007 at 12:45 PM | PERMALINK

MatthewRMarler: Migration into CA is mostly from Mexico

The article you cited didn't say this. Other sources?

migration out of CA includes entrepreneurs and other people who make the economy go

I'm sure it does, but what's the net migration? Any hard numbers?

Contrasting CA with TX, CA will probably continue to reduce its international share of manufactuing, while TX continues to increase its international share of manufacturing

Any figures? Frankly, with a current account deficit approaching 7%, I wasn't aware there was much of any manufacturing left in the US. Oh, we'll sell them services! (which are generally more labor intensive than manufacturing, and hence where the US and its high labor rates often have a comparative disadvantage).

The new insurance plan, if it places new burdens on entrepreneurs and businesses, will most likely increase the rate at which those people leave CA.

True, but if UHC were done correctly, it would make businesses more competitive. Ask Toyota about Canada.

P.S. As someone from the US (one of the original states - not one of those new probationary ones) I don't know enough bout this specific plan to judge it. Nevertheless the principle remains.

Posted by: alex on January 9, 2007 at 12:59 PM | PERMALINK

Nicholaus, and it is a wildly unpopular policy. Believe me, a candidate could get more than a few votes by opposing auto insurance companies practices in this.

I get the feeling most of you don't actually like Democracy, you'd rather live under a totalitarian system wherein you are the rules.

Posted by: Soullite on January 9, 2007 at 1:21 PM | PERMALINK

I'm in favor of any plan that ships all insurance industry executives and managers to a forced labor camp in China.

Posted by: Extradite Rumsfeld on January 9, 2007 at 1:21 PM | PERMALINK

I cannot think of one single reason why medical insurance should be tied to employment in any way.

Posted by: SecularAnimist on January 9, 2007 at 1:23 PM | PERMALINK

If I were a typical Republican I would be in favor of this-guaranteed profits enforced by the government for private companies who happen to be major campaign contributors to Republicans. Look at Minnesota, the Democratic candidate Mike Hatch, who was a bulldog against the insurance companies was defeated narrowly by Republican Tim Pawlenty. Pawlenty is now proposing "universal" health care through the same insurance companies who spent big money to defeat Mike Hatch. The insurance companies also are now running a PR campaign for "universal" health care. I wonder why, perhaps it's from altruism, or is it from the additional billions running through teir hands? What do you think? Those people who laugh at the statement "I'm from the government and I'm here to help" should be doubly wary about that statement from the health insurance companies. Like I said, if I were the typical Republican looter, I would be in favor of this, after buying the stock of the insurance companies.

Posted by: Neal on January 9, 2007 at 1:25 PM | PERMALINK

If it is a compulsary plane managed by private insurance companies then the state has to have strict rules to control the insurance industrie, otherwise they will hold the consumers and taxpayers over the coals.

Posted by: Renate on January 9, 2007 at 1:27 PM | PERMALINK

Tied to employment and paid out of the paycheck like SS it would move from one employer to another with the insurance holder.

Posted by: Renate on January 9, 2007 at 1:33 PM | PERMALINK

If it is a compulsary plane managed by private insurance companies then the state has to have strict rules to control the insurance industrie, otherwise they will hold the consumers and taxpayers over the coals.
Posted by: Renate on January 9, 2007 at 1:27 PM | PERMALINK

There are already some pretty strict rules on HMO's.

And HMO's are some of the worst abusers.

No matter how strict you make the rules, people will find loopholes, and they will bribe the right people to make sure that the rules are weakly enforced on them.

I don't know what the solution is - but currently, at my employer, there's two choices of provider. If there were 10 choices, there'd be real competition. And those 10 providers would also have to compete with the bribes as well.

I cannot think of one single reason why medical insurance should be tied to employment in any way.
Posted by: SecularAnimist on January 9, 2007 at 1:23 PM | PERMALINK

From the point of view of the employer, it's in their best interest to ensure that their workers remain healthy so they can keep working.

My employer's provider does not effectively do this. Care is rationed through them, as surely as it would be in a single-payer system. We pay premiums, they do - - - nothing.

Posted by: Extradite Rumsfeld on January 9, 2007 at 1:43 PM | PERMALINK

Extradite Rumsfeld: I'm in favor of any plan that ships all insurance industry executives and managers to a forced labor camp in China.

Cuba, dammit, Cuba. We can't outsource everything to China.

Posted by: alex on January 9, 2007 at 1:44 PM | PERMALINK

Why not take just *one* element of the package that has the least controversy such as "community rating" and push it through? Perhaps a quick easy success. Then next year take the next one.. make it a work in progress. Comprehensive reforms are desirable, but all the opponents or proponents of the various elements of the package are going to war it out and possibly end up with a flawed package that could get torn up later or no package at all...

Posted by: Doc at the Radar Station on January 9, 2007 at 1:56 PM | PERMALINK

Extradite, there will always be abuse. There is no way to eliminate it completely. Maybe a lid on the profit margin could help. I know of no sector in the economy without abuse.

Posted by: Renate on January 9, 2007 at 1:57 PM | PERMALINK
Of course, it is rational to "expect" the plan to work if enacted

Uh, what?

Posted by: cmdicely on January 9, 2007 at 2:14 PM | PERMALINK
Why not take just *one* element of the package that has the least controversy such as "community rating" and push it through?

Who is this directed at?

Why don't the Democrats do it? Because Arnold will veto it and use the opportunity to criticize them for half-measures; if they want to pass something that Arnold will veto, they might as well pass the UHC plan Arnold vetoed once again, and criticize him for half-measures.

Why doesn't Arnold do it? Because that particular element doesn't have the costs and flash to provide both the balanced budget and media attention cover for cutting children off welfare that the full plan has.

Posted by: cmdicely on January 9, 2007 at 2:22 PM | PERMALINK

So far, the most stinging rebuke of Schwarzie's plan is that it isn't sufficiently "friedman-esque" - this from the right-wing-wackos who think that money equals citizenship.

Posted by: fiskhus jim on January 9, 2007 at 2:39 PM | PERMALINK

Since I came to California in 1936, I have never known of anyone to be denied needed medical care. Arnie has just proposed a new tax that will enable another herd of civil service democrat voters.

Posted by: Walter E. Wallis on January 9, 2007 at 2:56 PM | PERMALINK

How many diabetes treatments come from for-profit firms? Something near 100%. Can we do without 'em? We've turned HIV from a death sentence to a manageable condition.

How much of the science leading to the treatments came from publicly financed medical research? The private sector cannot sustain a real research program. You have to close your eyes to history to think that capitalism and the market alone would have led to all the breakthroughs we've had.

Posted by: gq on January 9, 2007 at 3:27 PM | PERMALINK

There is a huge amount of taxpayer funded research on diabetes and AIDS which gets published in peer reviewed journals and presented at scientific meetings. Companies generally take the results of taxpayer funded basic science and try to apply them to disease remedies. There is nothing wrong with this per se, but the pharmaceutical companies have been riding on taxpayer funded research for years. To take one other example, the role of an enzyme known as HMG coreductase in cholesterol biogenesis was explicated quite a few years ago; the drug companies looked for and developed specific inhibitors such as lipitor which now account for huge profits. I am not aware that any drug company has willingly donated part of its profits back to NIH or NSF.

To respond to the main question: Health insurance should not be linked to any particular employment as it is now, but employers can be taxed (not unreasonably) to cover some of the costs of a more universal plan. Likewise, private insurance companies which continue to discriminate against applicants could be taxed to create the equivalent of the high risk pool. In this way, the insurance companies might not necessarily go out of business, but they would be less profitable at the very least.

One issue that nobody seems to be addressing is the current problem for part time workers. Companies have a strong incentive to limit their numbers of full timers because they can deny benefits to part time employees. If we were to require something as simple as a tax proportional to wages (or even perhaps to hours worked), this would allow part timers to cover some of their health insurance costs. Right now the system is mostly all or nothing.

All of the above presupposes that people are actually allowed to purchase insurance. The Los Angeles Times recently pointed out what so many people had already discovered the hard way: Many people cannot buy health insurance at any price because the insurers have such a long list of reasons to ding you. Non-fatal conditions such as asthma make you ineligible, as do lots of other elements of one's medical history. This problem adds to the incentives for people to keep that government job or corporate position instead of starting a private business or working for a small business.

Posted by: Bob G on January 9, 2007 at 3:54 PM | PERMALINK

Single-payer is definitely the way to go, unless you forbid people who are willing to spend more for preferential treatment, the opportunity to do so. If you insist on holding back people with extra money and the willingness to spend it on themselves, you will have rationing (ie. Canadian health care). The demand for health care has a very real tendency to exceed what people are willing to collectively pay (ie. be taxed for). To keep up the salaries and pay for the fancy equipment, someone has to be allowed to put in more money than government revenues can provide.

If you have a single public insurer covering most of the catastrophic needs of the population (and even some of the routine needs) and let high earners inject more money by choice into the care delivery system by accessing a second, privileged tier of care, you will probably succeed.

Posted by: VRWC on January 9, 2007 at 5:58 PM | PERMALINK

Forgive me, but I don't actually see "community rating" in the Governor's proposal. Here's what it says:

Requiring insurers to issue health insurance: Insurers will be required to guarantee coverage, with limits on how much they can charge based on age or health status, so that all individuals have access to affordable products.

There are undefined "limits" based on age and health status, but that in no way ensures the same rate for everyone regardless of age or medical history. What am I not seeing?

Posted by: dday on January 9, 2007 at 6:44 PM | PERMALINK

Instead of the individual mandate, how about a "health tax" on non-healthful items & services --- e.g., 25 cents on a bag of chips or box of donuts, 50 cents on a bottle of beer, etc. The funds pay for emergency care for the uninsured.

Someone proposed a similar tax on gasoline for car insurance but the insurance lobby torpedoed it.

Posted by: H-Bob on January 9, 2007 at 6:52 PM | PERMALINK

Gosh, H-Bob, who ever said 1 bottle of beer is twice as bad for you than a bag of chips or a box of doughnuts?

And why confine the tax raised to paying for uninsured?

OK. But in principle I would support your idea if it wasn't for the steady proliferation of rising charges and sales taxes, property taxes, etc., etc. that are totally regressive with no target except to relieve the "burden" on the rich.

Posted by: notthere on January 9, 2007 at 8:14 PM | PERMALINK

You could always try the norwegian model:
-Free education (yes, including universities)
-Free healthcare (well, we do have to pay a nominal fee (approx. $20) when we see a doctor, but this is limited to a maximum of about $200/year).

Sure, we have high taxes. So what?

Posted by: F.Bauge on January 9, 2007 at 10:43 PM | PERMALINK

notthere: who ever said 1 bottle of beer is twice as bad for you than a bag of chips or a box of doughnuts?

It might not be exactly twice, but the alcohol is an additional insult besides the carbohydrates in beer, and it significantly raises the auto accident rate compared to the carbos.

Posted by: calibantwo on January 9, 2007 at 11:02 PM | PERMALINK

Calibantwo: It might not be exactly twice, but the alcohol is an additional insult besides the carbohydrates in beer, and it significantly raises the auto accident rate compared to the carbos.

I assume you do not have a medical background? I certainly hope not... One beer will do miniscule, if any at all, damage to your body. A bag of chips or a box of doughnuts contain, amongst other things, trans-fats. Trans-fats increase the risk of cancer.

I do have a medical background.

Posted by: F.Bauge on January 9, 2007 at 11:45 PM | PERMALINK

"Non-fatal conditions such as asthma make you ineligible, as do lots of other elements of one's medical history. This problem adds to the incentives for people to keep that government job or corporate position instead of starting a private business or working for a small business."
Posted by: Bob G on January 9, 2007 at 3:54 PM

Yes, it creates a market *distortion* regarding propensity to hire of the employer and the propensity of a employee to seek a better job. If the employer wasn't focusing much of their energy limiting health care risk and employees were focusing their job-seeking efforts on maximizing their potential talent the economy as a whole would benefit.

Posted by: Doc at the Radar Station on January 10, 2007 at 1:00 AM | PERMALINK

Kevin writes: Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax.

I regard this as a good thing.

Nearly everybody -- from the far left of the political spectrum to the far right -- agrees that mixing employment and health insurance is a bad idea. If Arnie's (or Mitt's) plan ends up causing the "negative" side effect of nudging some firms out of the health insurance business (if large numbers opt to pay the tax) I say it moves us closer to truly comprehensive reform. We're all hearing about the disastrous consequences of health insurance costs for the automobile industry. Why anybody thinks that perpetuating this system is a good idea is beyond me. I hope Arnie's plans causes firms to get out of the business of being buyer's agents of health insurance.

Posted by: Jasper on January 10, 2007 at 1:18 AM | PERMALINK

Know what's going to lead to universal coverage? It's bird flu or whatever epidemic finally takes hold in our shrinking world. When it finally is made obvious to self-centered Republicans that they can catch something deadly from the hired help, they'll discover their compassionate side and demand that everyone have affordable access to basic health care.

Posted by: Rick Alber on January 10, 2007 at 2:41 AM | PERMALINK

One beer will do miniscule, if any at all, damage to your body.

If people drank one beer at a sitting, the breweries would go broke. Alcohol also increases cancer risk; whether the increase in risk is the same, per mg, as with trans-fat I do not know. But nationwide, the health costs of beer are much greater than the health costs of transfat.

That doesn't imply that a beer should be taxed at exactly double the rate as an order of fries or a 3 oz. bag of potato chips, to provide funds for health insurance, but that ratio isn't a totally unreasonable guess. Drivers who have eaten too many potato chips do not increase the auto risk of other drivers nearly to the degree that drivers who have drunk too much beer increase that risk.

Posted by: MatthewRMarler on January 10, 2007 at 3:11 AM | PERMALINK

MatthewRMarler: If people drank one beer at a sitting, the breweries would go broke. Alcohol also increases cancer risk; whether the increase in risk is the same, per mg, as with trans-fat I do not know. But nationwide, the health costs of beer are much greater than the health costs of transfat.

As for the breweries, you are probably right. At the very least there would be fewer breweries (not good in my opinion, as I like variety...).

Alcohol does increase cancer risk, but not in the concentrations found in beer. Spirits, however, do increase the risk of cancer.

Cost to society, well, I can assure you that fatty foods are more expensive - obesity causes all kinds of health problems. As for health costs specifically related to trans-fat, this hasn't been documented properly as far as I know.

Everything in moderation is generally a good rule of thumb.

Posted by: F.Bauge on January 10, 2007 at 7:28 AM | PERMALINK

Ironic that these major advances toward universal health insurance are occurring during the reactionary, Bush/Republican ascendancy.

Posted by: bob h on January 10, 2007 at 7:56 AM | PERMALINK

You know, coming back to Kevin's original post after a little bit, it occurs to me that it follows his initial support for Bush's war in Iraq; its got an element he likes and he has bought into the "this or nothing" dichotomy that was the centerpience of the political theater pushing the proposal, so he'll overlook the fact that lots fo the details are bad and a support it.


Posted by: cmdicely on January 10, 2007 at 12:19 PM | PERMALINK
Ironic that these major advances toward universal health insurance are occurring during the reactionary, Bush/Republican ascendancy.

Er, except that the Republicans (and especially Bush) are not ascendant, and that the "steps forward" that Republicans are participating in are attempts to preempt popular Democratic proposals.

Posted by: cmdicely on January 10, 2007 at 12:20 PM | PERMALINK

The plan is dreadful. First it does not achieve universal health care, but universal health insurance. These are not the same. Bad policies (the plan calls for dedductibles of 5,000 per person and 10,000 per household)will not be used except in castastrophic circumstances. Many Californians have insurance now, but do not visit physicians regularly for routine medical care due to costs. This is a protection for providers and a windfall for insurers.

Second, as pointed out in other posts, it will provide an incentive to drop current plans for employees in favor of the much cheaper (and poorer) state version moving the state inexorably towards the very "socialized medicine" the Gov. so deplores. Indeed they often do not seek medical cre for their children.

Third, it shall be a bureaucratic nightmare requiring significant hiring for supervision and enforcement - a cost the Gov. will not speak about nor will he explain how the mechanism will work.

Fourth, he intends to use the Healthy Families program to extend insurance to children. This to will be a cost factor and insuring children while underinsuring parents is both immoral and illogical. Sick parents do not take proper care of their children.

Fifth, he has taken to calling his payroll taxes and income taxes associated with the proposal "fees." A standard definition of a fee includes that it has some degree of "voluntary" compliance. His "fees" are taxes by any definition and they represent a predictable break of his pledge never to raise taxes. It is an infantile ploy.

Finally, the complex mechanisms that must conjoin to make this work and new monies he is demanding from the Feds. doom it from the start. There should be no discussion of the proposal; it should be junked immedaitely, and our energies should be focused on making "routine medical care" available to all. My choice is single payer, though it does not go far neough to satisfy me. The Gov. vetoed such a plan last year saying it was socialized medicine (a falsehood) and that socialized medicine does not work (another falsehood). Apparently those in Europe, Scandanvia, Canada and on have a failed system. Who knew?

There is much else to criticize in the plan and virtually nothing redeeming save perhaps the requirement that insurance companies accept everyone. This is largely a political ploy by our man-child Gov. designed to promote his notion of California as an independent nation and favor him as King while he pursues his Senatorial ambitions.

Sheila Kuehl will bring forward her superb - as such plans go - "single payer" initiative soon and if the Gov. really wished to make a "splash" he would signal that he favors it and agree to sign it upon passage therby thwarting the divisivness and wasting of resources that debating this proposal will bring. The plan is almost sure to fail in present form, and even with many alterations, it is likely to be a failure for Californians in its final form.

Posted by: Russ Lindgren on January 10, 2007 at 1:59 PM | PERMALINK




 

 

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