The Wall Street Journal recently connected a few more dots, although they could have gone further. The Journal reported that the Senate’s five-year budget plan allowed the government ten years to cover the cost of reform, so it could spread out the costs while not adding to the deficit. This would also give the government time to generate savings from changes to the system, and “allow it to rely less on new taxes or other revenue increases.” The Journal’s interpretation: lawmakers are hoping they can make health care reform pay for itself, even though it’ll likely take years before they see any substantial savings. My question: where will the money come from to pay the costs of reform incurred today if the savings will only be realized years from now?
The Journal speculated that these future savings would come in various ways: reducing incentives to stop providers from performing unnecessary medical procedures; addressing regional cost differences; letting providers know about effective treatments; and promoting prevention. Will all this really yield the trillion or so dollars needed to subsidize health insurance?
Then I thought of a New York Times story from last week, which offered an ominous take on one way the future savings would be generated—using information technology to cut costs and improve quality and efficiency. The Times reported on two articles published in the New England Journal of Medicine that, according to the Times, “point to formidable obstacles to achieving the policy goal of not only installing electronic health records, but also using them to improve care and curb costs.”
Now I ask you, dear reader, what does this add up to? A president backtracking on a campaign promise? Taxing workers instead of wealthier people? Causing more people to be underinsured? Letting insurers off the hook? Budget games? Banking on future savings that may not materialize? What a good story this will be when the dots are connected!
your dots do not add up to anything so far
there has been a change in the political environment
ideas of taxing employer health benefits can be spoken
employers still want to hold on to their control of employee health insurance even though they tell us that the cost of health care is making them uncompetitive
beyond what the administration has said we do not have a definitive picture of how the economics of health reform will be constructed,
the ball is in play
it is a big political issue and the administration and the congressionals are working on it
i think your hopes for the press on this story are unrealistic
the washington post and the new york times do not what it takes
think about it
the new york times seems to rely on reading the new england journal of medicine articles for points of view,
#1 Posted by jamzo, CJR on Mon 30 Mar 2009 at 06:02 PM
In Massachusetts, the petri dish for health care reform (it's really
difficult to use the words care or reform for the MA terror), the agenda
for taxing health benefits in the national plan was already set up.
MA employees must file a 1099-HC with their state tax return since the
mandated health insurance law kicked in two years ago. This is
verification that the employee is insured because in Massachusetts, it's
a crime to be uninsured, and such criminals are fined by a tax penalty
enforced by the MA Dept. of Revenue as income tax evasion. Imagine that.
You can't afford what the state decided you could afford, so you are
penalized at a rate as high as the maximum fine for domestic assault and
cruelty to or malicious killing of animals. Chances are, you can't
afford that either. Cheer up. If you can't afford it, you can go on the
D.O.R. payment plan complete with a Notice of Assessment, interest and
late fees. Eventually, your property will be liened, your bank account
seized or your paycheck garnished. If it's the latter, you probably
won't be able to afford to heat or eat, or worse, if you're already in
that boat.
Well, one afternoon, a friend pulled a copy of his wife's 1099-HC out of
his briefcase and said, "You know, they didn't pull this number out of
thin air especially for use in MA - 1099 is the standard number for
supplementary income." And it hit me smack between the eyes that what
was going on with this 1099 business was far-reaching. I had already
realized that the MA "experiment" was slated for the nation, not because
it was something that would work, but it was something that could be
marketed as the solution to America's health care crisis (although it
has little to do with access to care and everything to do with profits
for the insurance industry).
I then remembered that a neighbor told me a few weeks prior she had
signed up for a Tufts plan (I believe she said Tufts) a year ago - she
is always shopping around for something cheaper beause it's so
expensive. This plan had no copays. Wow! But, after the first of the
year - 2008 - she had received a 1099 from Tufts for a rather large
amount but didn't know why. So, she got on the hooter and inquired.
Turns out this was the amount of her "no-copays" and was taxable income.
Was she told about this at point of purchase? No. If she had been, she
wouldn't have had to make that call or might not have purchased this
policy. Did it occur to her to ask about this at point of purchase? No.
Who would have thought that they were going to receive a 1099 from a
health insurance company?
Nothing our government does - state or federal - surprises me anymore. I
just get more disgusted everyday. And Obama's hope and change piece? Too
many 180s already. Just last week, he was telling people at his virtual
town hall meeting that mandated health insurance is the same as mandated
motor vehicle insurance. Whoa! Romney tried that one already, and our
response was, "If you can't afford motor vehicle insurance, then you
don't drive. If you can't afford health insurance, do you move out of
the state?" So, President Obama, should we start making plans to get out
of Dodge?
#2 Posted by Dianne, CJR on Thu 2 Apr 2009 at 11:12 PM