WASHINGTON -- House health-care-overhaul legislation would impose hefty penalties on employers who didn't offer their workers health insurance, and would tax wealthy households to help pay for covering the uninsured.
Those are two of the major tax changes businesses and individuals would see under the House bill, and are among the most contentious issues Democrats will face as they try to craft a final bill in conference negotiations with the Senate.
A House vote on the health-care bill could come as early as Saturday.
Business groups are looking toward conference negotiations to try to eliminate or water down the House employer penalties.
Firms that didn't offer health insurance up to minimum standards spelled out in the House bill would face penalties up to 8% of payroll. The smallest businesses, up to $500,000 in payroll, would be exempt from the penalties.
Companies that have high proportions of low-paid and part-time workers are likely to be hit hardest by the penalties.
"If you currently cover 20% of workers, and 80% are part-timers you don't cover, you will have a very different situation than an IBM, that covers everybody," said John Sheils, a health-care analyst at the Lewin Group, a consulting firm owned by insurer UnitedHealth Group Inc.
Some private studies have found that many small businesses now insuring their workers would see their health-care costs go down under the House bill, particularly as a result of efficiencies in the small group market.
Individuals with income over $500,000 and married couples making in excess of $1 million would face a 5.4% surtax on income above those amounts. After taking into account the expiration of the Bush tax cuts, those people would face a marginal tax rate of 45%.
The tax would affect 0.3% of U.S. taxpayers, and 1.2% of small businesses. About one-third of the $460.5 billion raised by the surtax over 10 years would come from business income, the Joint Committee on Taxation said.
House leaders scaled the surtax back from an earlier proposal at the behest of a group of rank-and-file Democrats worried about its impact on small businesses.
Some of those House Democrats are holding out hope for further changes in conference. For instance, the $500,000 and $1 million thresholds aren't indexed for inflation, meaning they will affect more and more Americans over time, said Rep. Michael McMahon (D., N.Y.)
The choice between the House's surtax on the wealthy and a Senate funding mechanism -- an excise tax on expensive or "Cadillac" insurance plans -- promises to be one of the toughest issues House and Senate negotiators will have to solve.
"The first thing they may try is, what if we take a little bit of each bill," said Clint Stretch, a principal in the national office of Deloitte Tax LLP. "But it's going to be hard to sell the House on the Cadillac plan tax," which is opposed by unions.
Beyond the surtax on the wealthy, the House bill would impose a new $2,500 annual cap on contributions to flexible spending accounts, and change the rules so pretax dollars in those accounts cannot be used to purchase over-the-counter drugs.
On the business side, the bill would impose a new 2.5% tax on the sale of medical devices, paid by medical device makers like Medtronic Inc. and Boston Scientific Corp. and wholesalers.
It also limits certain tax deductions foreign multinationals are now eligible for through tax treaties. And it shuts down a tax credit that could have yielded as much as $24 billion to paper companies that produce biofuels using "black liquor," a byproduct of the pulping process.
WASHINGTON — Those tax-free spending accounts that you and your co-workers use to help pay for dental work, insurance copayments or over-the-counter drugs face a hit under the health overhaul bills in Congress — unless a coalition that includes a powerful union, insurers and others can stop it. Bills in the House and Senate would cap at $2,500 an employee's allowable annual contribution to a health care flexible spending account. There is no federal cap on contributions now, though companies that offer the accounts — more than 80 percent of companies employing 500 or more workers do — typically impose their own limits, usually around $5,000. Workers can use the accounts to save pretax income, which then can be used to reimburse a range of medical expenses, including dental and vision costs, prescription and over-the-counter medications and copays and deductibles — again without being taxed. Capping contributions to the accounts would raise more than $13 billion over 10 years to help pay for Democratic health care legislation because it would limit the amount of employees' income that is exempt from taxation. But an unlikely bedfellows coalition that is characteristic of this health care debate — where common interests can unite groups that might typically be at odds — is mobilizing to try to stop the change. A limited print ad campaign declaring "Flexible spending accounts work!" appeared this past week in Capitol Hill publications. It's paid for by a group called Save Flexible Spending Plans that is backed by insurers, companies that administer consumer spending accounts and other businesses with a financial stake in the outcome. The United Food and Commercial Workers International Union endorsed the campaign and its logo appears on the ads. "Our concern is that a cap of $2,500 is a definite tax on the middle class, particularly those with chronic illnesses," said Jody Dietel, executive director of Save Flexible Spending Plans and chief compliance officer at WageWorks, Inc. of San Mateo, Calif. Advocates say the typical flexible spending account user makes $55,000 annually. Although some lawmakers are sympathetic, the opposition appears unlikely to succeed in getting the flexible spending account cap out of Congress' health care bill. Unlike the initial Senate proposal, though, House members want to allow the cap to be adjusted so it would rise along with inflation. That would be a welcome improvement for advocates. Aides to the Senate Finance Committee, which proposed the cap, defend it by saying it would help curb overuse of medical care. Money deposited in the tax-free accounts must be used within 2 1/2 months of the end of the plan year. That may create an incentive for people to spend all the money even if they don't have pressing needs. In addition, committee spokeswoman Erin Shields said the impact of the cap would be limited. Data compiled by the consulting firm Mercer shows that the average flexible spending arrangement contribution in 2008 was $1,385, much lower than the one contemplated by Congress. Mercer said that 27 percent of all employers offered health care spending accounts in 2008 — small businesses are much less likely to do so than large ones — and that 37 percent of eligible workers signed up for the accounts. "The provision, in addition to helping reduce the overutilization of care, also affects only a limited number of people," Shields said. Dietel said those averages are no comfort to people using the accounts to cover extreme costs of a chronic condition — say a single dad whose child has a peanut allergy requiring special treatment. "The reality is that an average is an average," Dietel said. "It's the only tool out there that allows an individual to tailor coverage to their own individual need."
FWers, if you were ever contemplating LASIK or any other type of surgery, get your max in your Flex Spending Account this year. I have no idea why they would do away with this, but take advantage of it while it lasts.
Krazen1211 said: the House bill would impose a new $2,500 annual cap on contributions to flexible spending accounts, and change the rules so pretax dollars in those accounts cannot be used to purchase over-the-counter drugs.Strange... wish they'd include information on the sections of the bills they're referring to, instead of just "the bill."
tazzy531
Senior Member - 4K
posted: Nov. 9, 2009 @ 3:58p
DevilMonkey said: Krazen1211 said: the House bill would impose a new $2,500 annual cap on contributions to flexible spending accounts, and change the rules so pretax dollars in those accounts cannot be used to purchase over-the-counter drugs.Strange... wish they'd include information on the sections of the bills they're referring to, instead of just "the bill."
SEC. 442. DISTRIBUTIONS FOR MEDICINE QUALIFIED ONLY IF FOR PRESCRIBED DRUG OR INSULIN.
(a) HSAs- Subparagraph (A) of section 223(d)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following: ‘Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.’.
(b) Archer MSAs- Subparagraph (A) of section 220(d)(2) of such Code is amended by adding at the end the following: ‘Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.’.
(c) Health Flexible Spending Arrangements and Health Reimbursement Arrangements- Section 106 of such Code is amended by adding at the end the following new subsection:
‘(f) Reimbursements for Medicine Restricted to Prescribed Drugs and Insulin- For purposes of this section and section 105, reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin.’.
(d) Effective Dates- The amendment made by this section shall apply to expenses incurred after December 31, 2009.
SEC. 532. LIMITATION ON HEALTH FLEXIBLE SPENDING AR9 RANGEMENTS UNDER CAFETERIA PLANS. 10 (a) IN GENERAL.—Section 125 of the Internal Rev11 enue Code of 1986 is amended— 12 (1) by redesignating subsections (i) and (j) as 13 subsections (j) and (k), respectively, and 14 (2) by inserting after subsection (h) the fol15 lowing new subsection: 16 ‘‘(i) LIMITATION ON HEALTH FLEXIBLE SPENDING 17 ARRANGEMENTS.— 18 ‘‘(1) IN GENERAL.—For purposes of this sec19 tion, if a benefit is provided under a cafeteria plan 20 through employer contributions to a health flexible 21 spending arrangement, such benefit shall not be 22 treated as a qualified benefit unless the cafeteria 23 plan provides that an employee may not elect for 24 any taxable year to have salary reduction contribu25 tions in excess of $2,500 made to such arrangement.
SEC. 531. DISTRIBUTIONS FOR MEDICINE QUALIFIED ONLY 9 IF FOR PRESCRIBED DRUG OR INSULIN. 10 (a) HSAS.—Subparagraph (A) of section 223(d)(2) 11 of the Internal Revenue Code of 1986 is amended by add12 ing at the end the following: ‘‘Such term shall include an 13 amount paid for medicine or a drug only if such medicine 14 or drug is a prescribed drug or is insulin.’’.
There's some debate to be resolved whether this goes in for 2011 or 2013. Either way, it's best to be prepared.
tazzy531 said: (c) Health Flexible Spending Arrangements and Health Reimbursement Arrangements- Section 106 of such Code is amended by adding at the end the following new subsection: ‘(f) Reimbursements for Medicine Restricted to Prescribed Drugs and Insulin- For purposes of this section and section 105, reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin.’. (d) Effective Dates- The amendment made by this section shall apply to expenses incurred after December 31, 2009. Yikes! Open Enrollment for my husband's employer is ending this Friday, and I'd be specifying my 2010 FSA allocation under the assumption that OTC drugs are qualified expenses. So if this passes, I could end up unable to use up my 2010 FSA funds!
beethovengirl said: tazzy531 said: (c) Health Flexible Spending Arrangements and Health Reimbursement Arrangements- Section 106 of such Code is amended by adding at the end the following new subsection: ‘(f) Reimbursements for Medicine Restricted to Prescribed Drugs and Insulin- For purposes of this section and section 105, reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin.’. (d) Effective Dates- The amendment made by this section shall apply to expenses incurred after December 31, 2009. Yikes! Open Enrollment for my husband's employer is ending this Friday, and I'd be specifying my 2010 FSA allocation under the assumption that OTC drugs are qualified expenses. So if this passes, I could end up unable to use up my 2010 FSA funds!
I think that's an older version of the bill, when they hoped to pass it by August.
No, this is VERY good - the only way to fix the problem is to make sure that everyone that is currently enjoys perks offered by their employers or their swiftness while thinking "It would be nice if EvilCapitalist paid more in taxes to provide freelance writers and artists with insurance so I could enjoy their art" has a choice of paying more for medications themselves or subsidizing said writers.
Xnarg
Senior Member - 5K
posted: Nov. 9, 2009 @ 5:42p
EvilCapitalist said: Xnarg said: This is not good.No, this is VERY good - the only way to fix the problem is to make sure that everyone that is currently enjoys perks offered by their employers or their swiftness while thinking "It would be nice if EvilCapitalist paid more in taxes to provide freelance writers and artists with insurance so I could enjoy their art" has a choice of paying more for medications themselves or subsidizing said writers.It would be fine with me if the tax breaks given for FSA-type accounts were cut back completely. However, doing so should not be used as an excuse to fund socialized medicine, which is what is going on now.
Changes should be enacted long before the start of the year. Most company-sponsored insurance plans are in open enrollment periods right now, so if the law is going to be changed dramatically about how much FSA-type money can be used, that would affect the decisions of a lot of people.
Of course FSA and HSAs are getting neutered. This legislation is designed to help the extremely poor only. Anyone middle class and up has to make sacrifices to help those in need. Why should middle class people continue getting tax deductions for over-the-counter medicine when poor people can't get basic health care?
Xnarg
Senior Member - 5K
posted: Nov. 9, 2009 @ 5:55p
tripleB said: Of course FSA and HSAs are getting neutered. This legislation is designed to help the extremely poor only. Anyone middle class and up has to make sacrifices to help those in need. Why should middle class people continue getting tax deductions for over-the-counter medicine when poor people can't get basic health care?That is exactly the plan as put forth by those who will profit most from the plan.
My FSA is a limited use FSA, only for dental and vision purpose. I put only a little bit money in it.
I don't know if contact lens solution and such is counted there, but that goes away.
HSA penalty for nonqualified distributions is now 20%, up from 10%. The same drug restrictions (no OTC drugs, insulin and prescription only) that apply to FSAs apply to HSAs.
narshe14
Senior Member
posted: Nov. 9, 2009 @ 6:06p
Phew, almost switched my plan over to HDHP/HSA for this year's enrollment.
JoeFriday
Senior Member - 1K
posted: Nov. 9, 2009 @ 6:11p
tripleB said: This legislation is designed to help the extremely poor only. Except for the provisions prohibiting insurance corporations from rescinding your policy after you get sick, prohibiting insurance corporations from denying you coverage if you have a preexisting condition, prohibiting insurance corporations from charging discriminatory premiums, and other provisions favorable to others who are not "Poor".
Anyone middle class and up has to make sacrifices to help those in need. Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward.
Krazen1211 said: nycll said: Any change to the HSA related perks?
My FSA is a limited use FSA, only for dental and vision purpose. I put only a little bit money in it.
I don't know if contact lens solution and such is counted there, but that goes away.
HSA penalty for nonqualified distributions is now 20%, up from 10%. The same drug restrictions (no OTC drugs, insulin and prescription only) that apply to FSAs apply to HSAs.Yes, I am pretty sure contact lens solution is eligible for both HSA and limited purpose FSA. But OTC drugs are only good for HSA, not limited purpose FSA.
I am currently use HSA as an IRA type of account. I am sure when I grow older eligible medical expenses will have no problem exceed the HSA balance. So the most important feature of HSA is the ability to compound the pretax dollar and accumulate claims but not withdraw the money through the years.
JoeFriday said: Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward. Not true: http://www.cbo.gov/ftpdocs/103xx/doc10311/06-16-ConradLetter.htm "Broader insurance coverage might lead to less cost shifting in the health care system, but that effect would probably be relatively small and would not directly produce net savings in national or federal spending on health care.
If more people had insurance, then the amount of uncompensated care would decline. Some government payments designed to pay for part of that care (such as “disproportionate share” payments to hospitals that treat many poor patients) could be trimmed accordingly. And, to the extent that costs of uncompensated care are currently shifted to private payers, some offsetting savings could arise. However, undoing any current shifts of spending among different payers would not change the growth rate of federal spending beyond the first few years.
Moreover, uncompensated care is less significant than many people assume. According to one study, hospitals provided about $35 billion in uncompensated care nationwide in 2008—less than 2 percent of national health expenditures—and the estimates are much smaller for other providers.4 The extent to which such costs are shifted to other payers is also uncertain; well-structured studies have found modest effects.5 Further, some proposed expansions of insurance coverage would broaden eligibility for Medicaid, which might lead to additional cost shifting given Medicaid’s low payments to providers."
"People uninsured for all or any part of 2008 receive approximately $86 billion in care during the time they lack insurance coverage. The uninsured pay for $30 billion of their care out of pocket and receive about $56 billion in uncompensated care. Uncompensated care represents 2.2 percent of health spending in 2008.
We estimate that government spends nearly $43 billion—roughly 75 percent of total uncompensated care costs—through Medicaid DSH and supplemental payment programs, Medicare DSH and IME payments, various direct care programs, and state and local tax appropriations. Given the magnitude of government payments, we estimate that cost shifting to private insurance finances a relatively small amount of uncompensated care.
Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurers in the form of higher charges.26 Providing full-year coverage to all Americans currently uninsured for any part of the year would increase their medical spending by $122.6 billion in 2008, over and above their current spending (while uninsured) of about $86 billion."
i.e. Overall health care spending among the uninsured will be higher if they get health insurance.
I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
I hope this doesn't pass, I want to get LASIK this coming year. It's going to cost more than $2.5k.
Xnarg
Senior Member - 5K
posted: Nov. 9, 2009 @ 6:22p
JoeFriday said: ...Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward.Does that "everybody" include illegal immigrants, who number in the range of 12-20 million people and represent a large percent of the uninsured?
JorgeBurrito said: I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
No, but people should be prepared for tax changes.
For instance, people needing insulin might want to stock up a bit in December 2010, which means you need to set your FSA contributions appropriately today.
Krazen1211 said: JorgeBurrito said: I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
No, but people should be prepared for tax changes.
For instance, people needing insulin might want to stock up a bit in December 2010, which means you need to set your FSA contributions appropriately today.Wait, isn't insulin one of the things that won't change?
JoeFriday
Senior Member - 1K
posted: Nov. 9, 2009 @ 6:29p
beethovengirl said: JoeFriday said: Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward. Not true You overlooked the part where the CBO stated that most insurance plans cost more than $1,000/year more because of costs shifted by the uninsured.
narshe14
Senior Member
posted: Nov. 9, 2009 @ 6:30p
nycll said: Krazen1211 said: JorgeBurrito said: I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
No, but people should be prepared for tax changes.
For instance, people needing insulin might want to stock up a bit in December 2010, which means you need to set your FSA contributions appropriately today.Wait, isn't insulin one of the things that won't change?Yep, they're excluding non-prescription medication except for insulin.
Why should you get tax breaks for getting cosmetic surgery?
Trust me, they will not pass any FSA reform bill effective for 2010. You are looking at old reg text. The 2010 limits are set already, and it would be suicidal to monkey with them now. Federal employee open enrollement is in like 10 days (and the limit is still 5K)... Congress ain't gonna bait and switch themselves... so take a collective chill pill.
If it gets us universal coverage... I'll gladly cap my FSA benefits at 2.5K. The optomotrists/podiatrists/chiro lobby (which is surprising effective in D.C.) will be pulling strings here to raise the cap to 5K. I'd be shocked if it is any lower than that.
JorgeBurrito said: I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
Senate does not even need to vote on a bill to make it a law. The only thing that is stopping this from going through is that democrats do not have 60 votes to end the debate... but that's not needed at all to shove the bill through:
Find -any- bill that passed Senate and passed House in a slightly different version. Go to the conference. Attach House bill to that as an amendment. Sign off. You're done.
JoeFriday said: beethovengirl said: JoeFriday said: Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward.Not trueYou overlooked the part where the CBO stated that most insurance plans cost more than $1,000/year more because of costs shifted by the uninsured. Where does the CBO say that? Exact quote?
I posted: "Private insurance premiums are at most 1.7 percent higher because of the shifting of the costs of the uninsured to private insurers in the form of higher charges.26 Providing full-year coverage to all Americans currently uninsured for any part of the year would increase their medical spending by $122.6 billion in 2008, over and above their current spending (while uninsured) of about $86 billion."
Cashman said: I hope this doesn't pass, I want to get LASIK this coming year. It's going to cost more than $2.5k.
I got LASIK from my job last year. It cost exactly $5k the cap of my FSA and I quit my job midway through the year to attend grad school full time so my employer paid for half of my LASIK. The federal government paid for 10% of it since the part I did pay was a tax-writeoff.
Xnarg
Senior Member - 5K
posted: Nov. 9, 2009 @ 7:18p
It is completely uncreative to think that the only way to address unreimbursed health care costs is to enact the proposed legislation.
Surely there are other ways to address the problem.
For example, if an illegal immigrant goes to an emergency room for treatment, that would be their ONE time they could do that.
They would be turned away next time. That would encourage them to bring enough money to pay for service or to go home. Also, ICE should be notified.
Xnarg said: It is completely uncreative to think that the only way to address unreimbursed health care costs is to enact the proposed legislation.
Surely there are other ways to address the problem.
For example, if an illegal immigrant goes to an emergency room for treatment, that would be their ONE time they could do that.
They would be turned away next time. That would encourage them to bring enough money to pay for service or to go home. Also, ICE should be notified.
Illegal immigrants aren't the ones freeloading. It's clearly people like me who exercise, eat well, are young, have no medical history, and don't wish to pay $5k per year for a health insurance policy that would subsidize the policies of obese couch potatoes.
nycll said: Krazen1211 said: JorgeBurrito said: I really wouldn't worry about any immediate changes for the next year. Even if some version of the bill actually is enacted into law (it certainly won't be the current bill as the senate version is more than likely going to be quite different), the changes won't take place until at the minimum 2011 and more likely 2013. Very little of the bill would actually go into effect any time soon.
No, but people should be prepared for tax changes.
For instance, people needing insulin might want to stock up a bit in December 2010, which means you need to set your FSA contributions appropriately today.Wait, isn't insulin one of the things that won't change?
Err, that was a mental mistake on my part. That should be things other than insulin (ie people needing claritin and such).
That said, if your 2011 health expenses will be greater than $2500, there's still a reason to buy it in 2010.
Illegal immigrants aren't the ones freeloading. It's clearly people like me who exercise, eat well, are young, have no medical history, and don't wish to pay $5k per year for a health insurance policy that would subsidize the policies of obese couch potatoes.
You are both potential freeloaders. Most illegals exercise, eat well, are young, and have no medical history as well. Just because you do these thing you can still get sick, get cancer, break a bone, get appendicitis, exc. and if it requires any hospitalization at all you will end up freeloading off of everyone else because you won't be able to pay your bill. You seem to have a problem subsidizing the policies of obese couch potatoes, but have no problem with them potentially having to pay for your health care. That seems a little hypocritical, no?
Did you notice that it said if employer contributions to a flex spending plan.... then it would not be a qualified (read special tax treatment) benefit.
My employer offers an FSA but puts no money in it. All money is from the employee.
So I don't think this applies to plans that are 100% employee funded even if they are above $2500.
For purposes of this section, if a benefit is provided under a cafeteria plan through employer contributions to a health flexible spending arrangement, such benefit shall not be treated as a qualified benefit unless the cafeteria plan provides that an employee may not elect for any taxable year to have salary reduction contribu25 tions in excess of $2,500 made to such arrangement
mlayu
Senior Member
posted: Nov. 9, 2009 @ 10:56p
Krazen1211 said: Some of those House Democrats are holding out hope for further changes in conference. For instance, the $500,000 and $1 million thresholds aren't indexed for inflation, meaning they will affect more and more Americans over time, said Rep. Michael McMahon (D., N.Y.)
Why the are people talking about illegal immigrants on a discussion about potential future caps on FSAs?
olegos
Senior Member
posted: Nov. 9, 2009 @ 11:10p
beethovengirl said: JoeFriday said: Except we're all already paying for the uninsured, but at Rolls Royce (emergency room) prices. Having everybody insured will eventually bend the cost curve downward. Not true: http://www.cbo.gov/ftpdocs/103xx/doc10311/06-16-ConradLetter.htm "... Moreover, uncompensated care is less significant than many people assume. According to one study, hospitals provided about $35 billion in uncompensated care nationwide in 2008—less than 2 percent of national health expenditures—and the estimates are much smaller for other providers.4 The extent to which such costs are shifted to other payers is also uncertain; well-structured studies have found modest effects.5 Further, some proposed expansions of insurance coverage would broaden eligibility for Medicaid, which might lead to additional cost shifting given Medicaid's low payments to providers." Please explain why self-payers are often asked to pay many times more than the negotiated insurance rates. I've seen it explained that the cost of the uninsured are shifted to the self-payers a lot more than to the insurance companies and Medicaid/Medicare (note that your cites mostly talk about cost-shifting to these entities, conveniently forgetting about self-payers).
Why does everyone focus on the way healthcare is paid for instead of how much is being paid? Electronic records are a start but how about moving doctors and hospitals to cheaper neighborhoods, reducing pharmaceutical spending on advertising, etc? Why not just put a little pressure on them so that health care the health care industry, like everyone else, is encouraged to innovate in cost? If you guarantee them a profit, then they have no need to look for ways to save money.
Another big problem that we have with healthcare right now is that we expect to be able to get any treatment without regard to the benefit to society so companies are encouraged to create increasingly expensive services without any matching improvement in productivity from workers. Fixing healthcare as a percentage of GDP and letting everyone in the industry compete over that share of money makes more sense, skipping the difficult details of course.
Skipping 11 Messages...
xerty
Senior Member - 2K
posted: Nov. 16, 2009 @ 8:58p
VerbalK said: Why should you get tax breaks for getting cosmetic surgery? At least everyone around you can appreciate the outcome of your cosmetic surgery. This is unlike most of the overpriced health care going to someone else that they're asking tax payers to foot the bill for.
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