Isn't the basic unfairness in hcr that some people have employers who can get great value and

[dkf]

Some can't? The government should have been more interested in pooling small business and individuals to create parity with large employers. This could have been done under Medicare or some other government program. Then there would be better bargaining power too. Keeping small business in small pools but subsidizing them does nothing to create the large pools that allow the law of large numbers to work properly.

[NightWatcher]

1. I still dont "get" why health insurance is tied to your job

that's like having the color of your home determined by your birthday

and yes I do "get" that it is because unions bargained for certain benefits which spread to non-union jobs and benefit packages, but that is outdated and those of us who are self employed, employed by small companies, or unemployed deserve insurance too.

[dkf]

4. Individuals have no power to bargain.

And large pools make it easier to predict outlays because things average out over time. The most important thing in insurance is underwriting properly to account for risks. A single freak occurrance in a small pool is more relevant than a freak occurrance in a larger one where it can be absorbed.

Of course the best pool is the entire US population. That would also make things the most fair.

[levander]

9. The individual-based plans I've seen make the pool your geographic region.

n/t

[levander]

7. Unions should bargain for replacement benefits...

and stop demanding the rest of us do thing their way.

The Healthy Americans Act was a bill that replaced the employer-based system with an individual one. It required that businesses replace what they were spending on health care with raises for employees. I have no idea why that wasn't good enough for the unions.

[mkultra]

10. because its the law

[SpartanDem]

21. I agree the current system screws over without employer coverage

and they get what amounts to subsidy for their insurance because it's not counted as compensation.

[Hello_Kitty]

2. Your job or your relationship.

And only certain legally defined relationships at that. I couldn't put my own sister on my health plan but I could get drunk and marry some random dude in Vegas and he would be automatically entitled to be on my insurance.

[levander]

3. The last company I worked for was a small company, about 40 people...

and, they had two people get really sick. Mortally sick. They were going to suffer for a year or two, then die.

This skyrocketed my companies health care costs so much, they went and got a cheap policy that we all had to take - because our health insurance was tied to our job, as is how the American health system works.

After a couple of years, a couple of stories of people getting coverage denied for their kids health problems starting circulating around the office. And, a few key people quit, citing health insurance concerns. That was the beginning of the end of that company. You lose key people, things start not getting done, others get frustrated, and 5 years after the health care switch, ~3 years after the 2 sick people died, the company sold for about 30% of the value of what our stock options were priced at.

If all health insurance were individual and premiums based on geographical regions, you wouldn't have to care what health insurance your company wanted you to have. This unnatural bonding of the two doesn't make any sense. It's not your company's business what health care or insurance you have.

[drm604]

5. This is exactly why I don't understand why more businesses don't lobby for single payer.

It's in the interest of just about any business other than insurance companies.

[treestar]

20. Exactly

Even those huge corporations what are so evil! They are only about the bottom line, so why don't they want to get rid of this major expense? Defies explanation (or there's something I don't know).

[karynnj]

8. Small businesses of this size will be able to get insurance

from the exchange where they are pooled with others. That was one of the major pluses of the Senate bill.

[dkf]

11. These are state based and too small

http://fdlaction.firedoglake.com/2009/12/28/the-small-state-based-exchanges-in-the-senate-bill-will-not-control-costs/

[karynnj]

14. The pools are as big as most large companies - even at the state level

I think the states are allowed to combine as regions, but am not sure if that is in the bill or was simply a proposal. The article is not comparing small businesses to large businesses, but to some ideal - it clearly would be better at the federal level, which it was even in the Finance bill. Only the final bill shifted to state level - I guess to deal with abortion and for some conservative Democrats who were happier with that.

[karynnj]

6. The Senate bill does something like what you are asking

But it is done via the exchange.

You said:
"The government should have been more interested in pooling small business and individuals to create"

[dkf]

12. Ah but I said nationwide. Big difference.

[frazzled]

13. Well, we don't know if it will be state or national (Senate v House) at this point, but ...

Even in the Senate bill, each state's exchange will have to have at least two multi-state exchanges, one of which must be a not-for-profit. The state exchanges will be managed on the federal level by the Office of Personnel Management (which oversees the entire Federal Employee's insurance system).

[dkf]

15. Just think if it had been a federal program though.

The mind boggles. All the people that can't afford the current system could get a leg up. That would have been revolutionary.

[frazzled]

18. Well, one would think so ...

But the CBO score on the Public Option actually predicted it would cost a little bit more than private plans, at least in the beginning. I'm not quite sure why, except that it was not going to be big enough (and maybe older and sicker population) ... but it still somehow would have a downward pressure on insurers as a whole.

[dkf]

19. Wasnt the public option only for those with no plan though?

What happens if you take all employers under a 100 workers and get them into this plan? That sounds like a bigger pool than cbo was looking at.

[frazzled]

24. Well, any private-market plan, but that wasn't what was in the House bill.

But weak and insignificant as it was, I guess it was something that, once established, could have been grown legislatively over the years. Of course, with a miniscule pool of only older and sicker workers, it may have backfired--because it would not have shown cost savings or many benefits.
But let's face it: the bill barely squeaked by the House (220 out of 218 votes needed) anyway, and now we've got the razor-thin Senate votes to contend with.

I've given up with the "what ifs." I just want something to pass, and then on to the next steps to get more things added later.

[dkf]

25. Except if we go down the wrong path that would not make sense to expand on

[frazzled]

27. True, but if we go down no path

We'll never get there. Not in my lifetime. It's not like some better bill will be taken up next year (face it, we'll lose seats next year to Republicans--not enough, I believe, to lose majorities in the House or Senate, but enough to make legislating even more difficult than it is now)... or even in five years.

Even the most progressive Democrats in Congress know this, and that is why something will pass: flawed as it may be. All the grandstanding has been to try to get the most possible--which is a good thing-- but I never believed for a second that members of the Progressive Caucus who signed this letter would really ever vote against an eventual bill that didn't contain a public option. I was out there with my signs and telephone calls pushing for a public option right through the fall. But I know when to cry uncle, and when to drink the half-full glass. Or some other metaphor ... I'm having metaphor aphasia.

[karynnj]

16. Big difference, yes - but, it still pools employees from small businesses

and individual businesses to spread the risk better than individually. It is a quantum leap from the status quo.

[dkf]

22. But still not on par with many big business employees.

Still not fair.

[flpoljunkie]

17. House national exchange would be better as it combines individual, small group markets into one pool

[blueworld]

23. You call that unfair? How's this for kicks?

If you have sucky health care insurance that pays for little, you have to spend a personal fortune out-of-pocket or ignore the festering boil on your butt. Ouch!

If you have DECENT health care (instead of the raises they promised you 4 years ago), you can have a smooth butt, but you still have to pay premiums, out-of-pocket expenses PLUS a new tax:) Congress kicks your Cadillac butt.

You can't negotiate with your employer, so you have to take WHATEVER benefits they offer you or pay a big fine:) Insurance kicks your employer, employer kicks your butt.

They can't refuse your pre-existing condition anymore but if it's one of those health care plans where the EMPLOYER actually pays benefits (to keep premiums down) they can certainly limit the amount of benefits they pay YOU. Your butt is really in a sling now, but Big Insurance will kick you anyway.

If even those sucky plans are eliminated under this hcr, please kick yourselves in the butt & go back to sentence one with your wallets open.

[dkf]

26. Damn that does suck!