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Oregon's two largest public employee unions just settled with the state on a contract for the next two years. Health insurance benefits often play a significant role in negotiations between unions and employers. But companies, especially small businesses, are becoming increasingly burdened with the rising costs of providing health care. It's unclear how the health care system will change if President Obama signs a new bill into law. It's hard to keep track of all the health care proposals working their way through Congress, but all of them would affect the way employers provide health insurance to some degree.
A bill proposed by Democrats in the House would mandate employers cover employees but it would exempt small employers. A Republican plan does not include mandates but does provide tax credits to small businesses. If a public option is part of whatever plan is ultimately adopted, it's certain to impact employers, though there's little agreement about what that impact would be.
Are you happy with your health insurance? Are you covered by your employer? Are you self-insured? Are you a small business struggling to provide health insurance to your employees? Do you work in the insurance industry? How would changing the role of employers in health care affect you?
GUESTS:
- Paul Ginsburg: President of the Center for Studying Health System Change
- Max Israel: President of Customerville
- Tom Leedham: Secretary-treasurer of Teamsters Local 206
Tagged as: employment · medicine · reform · rx
Photo credit: nima+ / Creative Commons
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Everytime I hear the discussion about healthcare reform, the topic is always dominated by employer provided insurance. No one even talks about the large percentage of the American public who are self-employed or unemployed. If they do, it's barely a passing mention. It makes me want to scream!!
A large segment of society makes their living without having any employer. They are artists, authors, handymen, dog breeders, food cart owners, gardeners, tiny shop owners, musicians, B&B operators, e-bay sellers, house cleaners, and hundreds of other little entrepreneurs. And there are so many people who are just plain un-employed.
What is being done to help these folks get affordable health insurance? They are no group plans for them. The rates for these people who don't even have a steady income are astronomical. I know. For many years as an artist I paid outrageous prices for $2500-deductable insurance for myself and my son,and there were times when I couldn't even afford that. Self employed people are not welfare cases that qualify for Medicare, how are we going to cover them?
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Hello,
I understand that employer involvement in health insurance began during WWII when wages were froze and employers, not able to attract the employees they wanted by offering a helath insurance benefit to circumvent a wage freeze.
It seems like it was a bad idea that we have lived with for the last 60 years.
Wouldn't any employer want to get out of the private health insurance business? Particularly when we pay doulbe what the rest of the developed world does with the worst results.
Medicare for all would be a simple deductin like FICA, cost society at least 30% less, not create employees distressed when they lose their job that their family loses health care.
Shouldn't every employer be pressing for Medicare for All?
Joel Spinhirne
The Serano Group
A nonprofit analyzing persisting health conditions
Hood River, OR
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I'm an emergency room physician in Stayton, Oregon. Last shift I worked I had three patients who are insulin-dependent diabetics, lost their jobs, have no health insurance, can't get a physician to see them, and can't afford their meds (their average meds were over $500/month). What am I supposed to do for them? OK, here's your insulin for today, good luck tomorrow! This should not happen in America.
After the third one, my nurse, a good friend and compassionate liberal democrat, and I were discussing this mess and she said, "I think Obama will fix this -- just so it's not socialized medicine!" Somehow that term has become an evil thing, despite the fact that private medicine has done such a horrible job of providing health in this country. In "socialized medicine", the 30% of health care costs that currently are going to stock holders of insurance companies would go to owners of the socialized insurance company -- the u.s. citizens. Health insurance should not be tied to employment. Thanks for exploring the history of that development, which makes no sense at all. Jeanne Fitzpatrick, M.D.503-391-4230
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During all of my working years I enjoyed excellent health and dental insurance and, in fact, rarely even thought about it. I just went to the doctor when I needed to and the bills were paid. I have led a very active lifestyle including backpacking, cross county skiing and several bicycle/camping tours exceeding 1000 miles.
When I retired early five years ago I had a wake up call. I was not able to obtain health insurance because I was taking blood pressure medication which had been very succesfully controlling my pressure for over ten years. I was forced to buy insurance from my former public sector employer through COBRA at a very high monthly rate. My wife and daughter also obtained a very inadequate insurance policy with a $5000 annual deductable. Very high cost but no coverage for routine doctor visits.
After a few months of paying for my coverage I realized that as a 10% disabled veteran I was eligible for VA health services. As soon as I started with the VA I received a very complete exam in which they discovered a congenital heart problem that had never been detected by any doctors before. After four years with the VA I suddenly experienced severe breathing problems that were diagnosed as congestive heart failure. The VA scheduled surgery and repaired a damaged heart valve.
I feel extremely lucky to have a very good outcome from all of this. I feel a little guilty that it cost me practically nothing. But most of all I am extremely grateful to the doctors and staff at the VA for their life saving care.
I am strongly in favor of a "public option" in the pending healthcare legislation; in fact I strongly favor a single payer approach to health care. I am very afraid of a health insurance industry that puts profits first. I am not afraid of a government run healthcare system and believe that the health insurance industry and the fee for service system are the major reasons that healthcare in this country is failing us.
Sincerely,
Dennis Maxwell
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The discussion should be reframed.
First, why are we not just adopting one of the health delivery systems the rest of the civilized world uses? The only problem seems to be health insurance corporations would lose their profitable, ineffective, dysfunctional businesses.
This is not raidal. Doing the wrong thing for 60 years is radical.
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First, I'm not sure how our employers became the people responsible for our full time health care.
Second, I'm just plain suspicious of being able to fix a system where a third party (insurance) functions as the gatekeeper between me and my own health care. I'm not opposed to for profit health care. I am opposed to a for profit middle man. Their primary goal is always going to be profit, not my best health care.
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Americans are being extorted for health care coverage. I'm surprised that there haven't been street demonstrations in support of health care reform.
I have worked for employers that provide health care coverage, but the level of coverage keeps being reduced almost annually. Now I pay more than $500 out of pocket for healthcare for myself & my daughter, while my employer covers about $350.00.
We are both very healthy, and the healthcare industry is making over $850 per month off of us. I see the elaborate clinics, with their expensive architecture and furnishings, and wonder why my health care dollars are going to make other people rich instead of providing basic health care for those in need in this country.
Let's get out on the streets with our signs & placards to support the work the president has initiated for the citizens.
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I have two words for everyone:
Single Payer
Too bad Obama and the other sellout democrats cannot hear that over 70% of us know this is what we want.
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We need to eliminate private insurance companies from our health care system.
How can we do this?
The United States is currently the only high-income industrialized country in the world that does not have some version of a single payer, public health insurance.
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Here is why employer-provided insurance is a bad idea:
1. It costs 30 to 50% more for the service provided.
2. Medical decisions are made by insurance company employees dedicated to maximizing profit.
3. Health insurers are nearly monopolistic. They manage nearly nothing except their revenue stream. They invest resources in denying benefits, keeping seemingly bad risk people off their policies, and analyzing how much they can raise their rates without having mass, dramatic exodus of customers.
Until at a minimum, everyone can buy into Mediare, their is no practical alternative.
4. There is no transparency. Employees cannot tell what is covered until they get sick or injured. Medical decisions are made behind closed doors by health insurance employees. Employers have no idea how much their premiums will go up next year.
We should all be planning a graceful death or transformation of the U.S. healh insurance industry.
Joel Spinhirne
The Serano Group
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This March I was diagnosed with breast cancer. It was caught early and small and I am insured through my employment with a staffing agency. I would have surgery and radiation and be done with it. I continued working while waiting for the treatment to be pre-approved and scheduled. Then the woman who handles those tasks for my surgeon called to tell me my insurance carrier told her I was only covered in the one mid-western state where the insurance company and staffing agency are located. About the same time I started receiveing judgements from the insurance company on my earlier medical bills and they were all coming back as out-of-network. I had been very carefull to locate providers who were on the approved list linked from my employer's website. Worries. I called the Plan Administrator who is also an HR administrator with the staffing agency. She admitted she did not understand the very complicated coverage and network system. She pointed me to the insurance company who were also unable to discern the problem. After several calls over several days the Plan Administrator raised her voice so loud I had to hold the phone away from my ear. She told me it was MY problem, she had spent too much of her time trying to help me and she would not spend any more. I was trying to get surgery for breast cancer! I finally got help from the woman who does the scheduling for my surgery. She was able to locate a network specialist deep within the insurance company. The Plan Administrator at my previous place of employment also did not understand the duties of her task and was unable to provide me with a certificate of credible coverage. Employer based health care is not working well. The Plan Administrators do not understand their duties. I was also faced with the threat of loosing the insurance if I did not maintain a certain number of hours per week, difficult to do when your are experienceing illness. This is not a good way to provide health care.
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When I started my current job 12 years ago, insurance cost $4500 per year for my whole family. This year it costs 14,000. That's crazy!
My policy includes prescription drug benefits that we hardly use. Many have said that's part of why the price is so high.
**But here's one issue that I haven't heard people talking about: How much of the cost increase is directly related to prescription drug advertising? We are inundated with drug ads on TV. That's got to cost a lot! A nurse practitioner I know says that more and more people come in asking for a particular drug they've seen on TV. Maybe they need it but maybe they don't. If we get health care for all, and I hope we do, what regulations can be enforced to keep these ads and their high costs from polluting our new system.
We don't advertise hard alcohol on TV anymore so why do we allow prescription drugs?
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Hello,
Last year the State of Oregon made schools join OEBB for there health care insurance. Well, this year the rates went up 15-22%. Being put into the state plan was suppose to reduce cost. My part for this years cost is almost $400.
If the goverment wants to help me with health care then how about a $3000 tax credit for what we pay out of pocket. I like my insurance provider and doctors.
Thanks
Steve
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I am a retired, widowed woman. I have a daughter who is still in college. I was allowed to continue my insurance coverage through my employer after retirement, but the policy (which is very good) costs me $520 per month. I have my daughter, still in college, insured on a separate policy thorugh the Oregon Medical Insurance Pool because she was rejected by other insurance companies due to an existing condition. This coverage costs me $297 a month. Luckly I can afford to pay for these premiums, but it is a huge chunk of my income. I live a pretty simple life financially, partly due to choice and partly due to the huge amount I have to pay for insurance.
Kay
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Around 1900 it was considered immoral to take profit from healthcare, now Conservative Republicans consider it immoral to not profit from the disease, sickness, suffering, and dying of American citizens.
Let's bring back traditional morality!
Let's get Insurance Corporations out of healthcare. Let's go straight to single payer, just like the other industrial nations of the world.
We consider Socialism to be great for our military healthcare and for our Congressional healthcare, why aren't the American People deserving of the same, after all, we taxpayers pay the bills!
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No. Ginsburg is wrong.
The profit motive is the root cause of the U.S. Health Care diaster.
Simply, health care is not a societial area where there should be any knd of profit based, market model.
Joel Spinhirne
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Coops are not a solution. This is simply a government supported market place for unworkable, wrong-mindied inefficient businesses, health insurers.
Joel Spinhirne
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Consider how the discussion is framed as "employer based". Why don't we talk about "People based" healthcare?
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I don't feel a bit of guilt about demanding that I get good, fully paid health insurance as a part of my compensation package. I work hard and make the demands I feel are appropriate for my labors.
That's all that employer health care is--a part of the compensation. If others don't make those kinds of demands of their employer, either independently or as a collective group, they are suckers.
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There is a fundamental dicotamy between 'for profit' insurance companies and 'product' they provide. It cannot provide a 'quality' product and still make a profit. In addition, morally, isn't it just wrong to profit off other's misery?
A single-payer system with centralized record's system (like all other industrialized countries) IS the only solution. Why are we trying to recreate the wheel?
A employer-based system has proven itself not to work. Why? Today, a person only works an average of three years for any company. Everytime, you change companies, you change medical insurers. The constant changing from insurer to insurer, with all the requisite inclusions & exclusions, itself, is a huge cost.
One cost not being discussed is the cost to the employee if you get REALLY sick. Not only are you a patient trying to discover why you are sick and get well, you're having to manage the slough of bills that come in your mailbox. A single-payer system resolves this.
Regards,
Russ J
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With Max Baucus in charge, the people will get max "Bupkus" on healthcare reform, and the Insurance Corporations will get max **** kiss for re-election money.
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Ginsburg is wrong.
Health care is already heavily subsidized. The goverment pays for over half of our heallth care. A big portion of this is income for private insurance companies who protect this system.
Can anyone trace where the dollars in Ginsberg's paycheck come from?
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A "yes" to thinkingone.
If Mr. Obama cannot accomplish a single payer system, then he has truly and fully failed as President before he even got out of the gates. There are times to appease "folks" for your career and times to do what as right. This is a time to do what is right---no matter the opposition. I would rather Mr. Obama makes "real change" and is hated for it and only serves one term, then he panders to everyone and changes nothing. As nice as it to have someone "making nice" (in a somewhat eloquent fashion) that stuff is superficial tripe and in the long run getting single payer health-care passed is what is really going to matter.
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Why is it that Single Payer is immediately dismissed as "unworkable"?
I agree with your assessment of Obama. I am trying real hard to like the man and what he is trying to accomplish. I am having a very hard time with him and his administration's policies. So, he was going to end the war in Iraq. Big deal. He has meerly shifted the death and destruction to Afghanistan. The military/industrial complex wins. The rest of the world loses.
Now, health care. They will all sell out to some crazy, mixed up plan and we will all lose again. I wish those that profit from insurance would all disappear and go get a real job. They are leeches.
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As a manager of a medical practice if you want to control the cost of health care, one needs to eliminate the for profit health insurance industry. They add absolutely NO VALUE to the delivery of health care yet those who pay premiums are paying for outrageous salaries for health insurance executives. Bill McGuire of United Healthcare was paid over $300 million in salary in 2006. Insurers devise as many ways as possible to deny care to members in order to save themselves money. Wendell Potter, previous executive at Cigna, spoke about this on the July 10 Bill Moyers Journal on OPB. Now the health insurance industry is giving million of dollars to politicians in order to preserve the status quo, which greatly favors them.
If we had no for profit health insurance companies and had a single payer system, employers (and employees) could pay an employment tax rather than monthly insurance premiums and their employees could be covered by a government funded, privately delivered health plan. At a monthly cost of approximately $400 - $500 for each employee for health insurance premiums, a payroll tax LESS THAN CURRENT PREMIUMS would help small business and large business as well. Many manufacturing firms complain they can't be competitive with foreign companies because of the cost of health care. If they had a smaller expense via a payroll tax they could be more competitive, create more jobs, etc etc.
When one compares how Medicare functions compared to for profit health insurers, I know they pay claims faster, more accurately and don't deny coverage for services that are considered covered benefits. Their payment policies are published. Their administrative costs are between 3% and 4% while for profit insurers are 15% to 20%. Medicare IS A GOVERNMENT RUN PLAN and functions very efficiently, much more so than for profit insurers. That is why the insurers are so afraid of a government run plan because they know it can be less costly (as long as not only the sickest of the sick are allowed to join a "public plan.")
Governor John Kitzhaber has some great ideas for health care reform that get at the delivery of and payment for health care. Unfortunately he is not nationally prominent in this debate. I'm disappointed OPB has not involved him and his ideas in their conversations.
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The Teamster was right - we need a national health care program and rid ourselves of the insurance companies. Too bad there wasn't a thorough discussion of single payer.
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It looks like most of us who have responded on this blog are in favor of a single payer system, or at least something that would help to eliminate the role insurance companies play in the delivery of healthcare. We are all frustrated and baffled why this option is not being discussed by the Congress. But due to the big money and huge influence these corporations have on our congressional leaders, we should probably not be surprised.
Please take the opportunity to write a letter to your senators Wyden and Merkley and let them know how you feel. I'm sure they are NOT reading the OPB blog to get opinions of constituents.
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We talk about the costs of health care and the reform of health care provision. This is just treating a symptom. The problem, as many Americans percieve it, is that we live unhealthy lives and we therefore incure great health care costs.
I advocate a tax on unhealthy consumables like sugars and fats. We would aim to diminish demand for the very elements in our diet that makes us less healthy and more costly as well as provided the government sorely needed revenue to cover health care expenditures.
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There is nothing inherently unhealthy about "sugars" and "fats" to warrant a tax. You can consume reasonable amounts of sugar and fat and still be perfectly healthy. Would you tax olive oil or just Twinkies?
Beside the ridiculous conceptual idea of taxing them, in a functional sense it would be impossible.
Whether or not Americans are unhealthy because of diet still speaks nothing to the issue of why America's health-care is currently so inefficient. There are not too many sick people, the system itself is sick and needs revamping. Diet is a separate issue.
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Healthcare ought to be paid for by the government. No bills, no paper. Doctors are all salaried. No windfalls for anyone.
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I appreciate the fact that Think Out Loud produced a show on health care reform. Clearly Single Payer is the most efficient, ethical and least costly health care system that has been proposed. (but barely covered by the mainstream media) Judging from the comments, your listeners clearly understand this. Please have a follow up show on Think Out Loud that focuses on the merits of single payer.
Peter mahr, MD
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Comments are now closed.
I was involved as a staff member in the negotiations for Health Care in the 1980's and 1990's. Intially the available insurance companies consisted of Blue Cross, Kaiser Permentte, Capitol Health Care, and several east coast based Insurance firms. By 1990 Capitol Health Care had been swalled by Blue Cross and the East Coast firms had exited our market.
As a small business we made use of a Broker who took on the tasks of searching for suitable insurance providers. I assme that a profile of our staff by sex and age as well as the nature of our business. Over the years irealised that the methodolgy for determining premium ampiunts varied. One used age and gender while most used categorical distinctions (ie self, self & Spouse, self & children, and family)
From the point of view of a small business you must face the fact that you have no purchasing muscle.
I think we would all be better off with a comprehensive system that emphasized health not cost control. If one totals the membership of Medicare, Medicaid, State Welfare Programs, State employees, Local Government Agencies and Institutions employees , prisoners and the Veterans Administration Goverment is already a significant entity in providing health care.
Business is burdened with excess Human Resouce staff, Insurers are tempted to drop individuals or reduce coverage, Congress passed a law against using DNA information, individuals can attempt to premium payments until they are sick.These are just some of the problems of the current structure.
I actually think that all the fear of change problems being highlighted can be fixed if we have the courage to deal with the problems & solutions rather than preserving the status quo of the big health care industry lobbyist.