Of course they are. The health insurance industry spent $86 million telling everyone how awful the bill would be, so it would be foolish to not get some return on their brainwashing investmentby jacking up rates. Don't let any crisis go to waste, right?

Your specific situation is atypical: market research suggests the average premium increase this year will be 8.8%, up from 6.9% last year. Of that 8.8% , only 1-2% can be directly attributed to provisions of the new law. (source)

It isn't the insurance company that is increasing the rates, it is my employer. Having between 150k-175k employees qualify for the Cadillac Tax would be a crazy hit on the bottom line that isn't really feasible in the current market where other companies in the same field are shedding employees and decimating internal budgets to try to make ends meet.

The so-called Cadillac tax (40% excise tax on insurance plans that cost more than $27,500 annually) doesn't kick in until 2018. Why would it be affecting your employer's costs now?

They said they were going to start increasing the costs for us now so it doesn't all hit at once. We already know that our plans are going to increase cost for two years, but don't know anything after that.

Part of it is trying to decrease their bill, of course. They are using the tax as an excuse for the tiered approach, though.

You would agree, then, that the 40% tax is ridiculous, just that it hasn't started yet? Probably not, I suppose, but that's not my point anyway.

We need to stop putting the "funding" for these programs in the future. Our country has over $50 trillion in unfunded liabilities because of this kind of thinking. Eventually those chickens come home to roost, and the best intentions of everyone to have these social programs eventually come against the reality of limited resources, made all the worse by the debt we've accumulated to put the problem into the future. Not to mention the incompetence, corruption and waste of governments.

Anyone who thinks this is going to cut costs is living in a different world than me. The TSA hasn't even existed for 10 years, and already there is corruption, vast excess, and egregious infringement on civil rights. The TSA position is that we "surrender our rights when we buy a ticket", but this is a complete misunderstanding of a "right". One can not be compelled to surrender their "right", or it is not a right in the first place. Rights, properly understood, are prior to laws, which exist to protect them. Not the other way around.

Certain individuals may pay less for health care (even large numbers of them), but the society overall will pay vastly more, and probably each individual will as well when you consider taxes they will pay for other things will increase. As Margaret Thatcher is credited with saying, "The problem with socialism is that eventually you run out of other people's money." If you aren't paying for it, someone is. That can't last forever with something that everyone, eventually, will need.

No. $27,500 is more than about 30% of the households in the US earn.

And the 40% tax is on the amount over that limit.

And people in dangerous occupations where there's a reason for high premiums (cops, firemen, etc.) are exempted.

Who decides whether this is excessive? A tyranny of democratic majority? Our system isn't supposed to work like that. It's supposed to protect minorities against the majority. Isn't how much to pay for your health insurance an individual choice? It is my money, after all. OK, not really, not any more, but it's supposed to be!

I'm back working in a field that pays fairly well, and I certainly have an option to opt for one of these "Cadillac" plans (look at the emotional rhetoric used!), but it's not given to me. I have 3 options or something, and the company pays a certain amount. I pick which of the 3 I want, and pay the difference above the company subsidized portion from my paycheck. It's been this way everywhere I've worked.

You know what will happen, of course. The "rich" people will have their compensation restructured to have a $27,500 health insurance allowance, exactly, and the balance will be given in other compensation to avoid the tax. Regardless of whether it's "fair", it won't work. It won't raise any money, because high-income employees will have their comp restructured. Happens all the time. If that doesn't work, they'll just opt for health insurance that costs $27,500 and relinquish the extra benefits, taking the balance in cash compensation. So we'll have another government liability that is going to result in a big deficit because how they intend to pay for it is naive, dishonest and stupid.

We saw a similar thing happen with the fuel economy mandates. Auto makers were required to get their average fuel economy up, and luxury cars were dragging down the average. Knowing that the American consumer was still going to demand a large vehicle, the manufacturers exploited a loophole that excluded trucks from the mandate, and the big luxury vehicles were all suddenly SUVs. The regulation *caused* the SUV craze because it changed the economics rather than what people actually wanted (which was big vehicles). These unintended consequences happen all the time, and the end result is that government grows, the regulation accomplishes little, except to make it more difficult to produce goods because of the cost of compliance.

Which, FWIW, is not in the law or coined by anyone in politics.


Which will be taxed at a normal rate, as opposed to the 0% tax that currently exists on health care benefits.

Let's look at the numbers directly. $40,000 was a number thrown about as the annual premium on a top-of-the line plan (the plan offered to some banking CEO, IIRC). A 40% tax on the amount over $27,500 is $5000. A $5000 tax on $40,000 is 12.5%, which sounds perfectly reasonable to me, especially for someone who is likely to be well within the top percentile of wage earners, and is almost certainly below the income tax rate they would be paying on that same income.

Also, part of the point is to get people to move from these plans to other forms of compensation. For the most part, these plans are seen as tax dodges with very little additional health-care benefit.

I know it sounds reasonable to you, but who decides where to draw this line? That's my fundamental objection to the whole thing. It's the majority imposing their will on a minority. We tend to think that's ok when the minority happens to be wealthy and have something we want. So, we take it by force. You may consider that justified in this situation, but you have to acknowledge that's what's happening here.

But we can't just keep going back to that well, or we run out of spending their money. Besides, being wealthy shouldn't be discouraged, and it certainly shouldn't mean that property rights don't apply to you. What we need in the world is more wealthy people, not fewer, since wealth is fundamentally created by production. We need more people in the world participating in that.

Your argument ultimately boils down to "no one should have to pay taxes", as any form of the government taking your money is going to be a "where do we draw the line" argument.

And that is an insane position.

Okay, to be less glib:

Should people pay taxes? At what level? Should government services be based on tax revenue or vice versa?

Should people at all income levels be taxed at the same rate?

From a different perspective, should health insurance be taxed at all? Should it be taxed at the same rate?

That's not really what I'm saying, but I'm not sure it's insane anyway.

This discussion can't occur without talking about the services themselves. I contend that government is the least efficient way to deliver services, and should only be used as an absolute last resort and to the absolute minimum extent. The goal should be to minimize the involuntary seizing of people's property to the maximum possible extent, not discuss what level is "fair".

So what is the minimum required services? Those needed to provide rule of law (protection of life, liberty and property) and common goods that are impossible to provide in any other way (such as defense). Yes, I realize that the common good thing is a slippery slope.

So, to answer directly:

Should people pay taxes? Only where it is absolutely necessary to protect life, liberty and property, and never at the disproportionate expense of other people's life, liberty and property.

At what level? Always at the absolute minimum possible level.

Should government services be based on tax revenue or vice versa? The service comes first, assuming it is justified within those very strict criteria, then the necessary revenue collected. However, the service should meet the requirement of being absolutely necessary and impossible to provide another way. I am advocating the ABSOLUTE MINIMUM GOVERNMENT POSSIBLE, just like our Founding Fathers did in the USA.

Should people at all income levels be taxed at the same rate? I don't care. The government our Founders had in mind, a Libertarian Republic, could be funded easily by small import duties, use fees, or whatever. Income tax is a tiny fraction of our government budget even today. As Ron Paul likes to point out, if we went back to the size of government in 2000, we could eliminate the income tax entirely.

Should health insurance be taxed at all/at the same rate? No. A Libertarian Republic, which our system is supposed to be, does not engage in central planning which uses tax code to encourage certain choices by citizens (whether to buy health insurance and what kind). A Libertarian Republic allows people to make these decisions as they see fit, without reward or punishment by the central planners.

Now, clearly this is my opinion. And I know we disagree on this point. You are a central planner: one who sees the role of government to make life better for everyone. I am a classic liberal, who sees making life better as *necessarily* up to the individual, because they have to define for themselves what "better" means. The role of government, in my opinion, is to maximize the freedom of individuals to the maximum possible extent in pursuing those goals. While we disagree, it is very clear that the founders of our system were much more aligned with my view. They were very outspoken in their opposition to things like a central bank, fiat money, taxation, all of which required constitutional amendments to make happen.

I also think you're very smart, and I like you, so none of this is personal for me. You have legitimate concerns and I agree with most of them. I just don't think the government can solve these things, and they have demonstrated that repeatedly throughout history. Government is not to be trusted. It is dishonest, corrupt, greedy, and self-serving. Our system acknowledges this, and was intended to keep the influence of government as small as possible.

Consider our current predicament -- the near destruction of the financial system (which may yet occur). What almost nobody will admit is this was entirely caused by government interference. Government agencies recklessly pumped money into the economy for the benefit of their cronies on Wall Street and at the behest of politicians who saw easy re-election during the boom. The inevitable bust was someone else's problem. Most importantly, this boom would not have been possible with a legitimate ("hard"), commodity-based money. Central, fractional-reserve banking (another creation of the government) caused this crisis. Greedy people in the free market did what any rational person would do when offered essentially free money -- they borrowed and speculated. But the government itself created the conditions that allowed this to occur. Now people think we need more regulation to stop this kind of thing. Insanity! What we need is an objective standard for currency, completely beyond the power of politicians and Wall Street cronies. The Founding Fathers warned us about central banking, because they had seen this all before.

That's just one of hundreds of examples, though it's probably the most poignant one because it's going to land this country, and possibly the entire Western world in a gigantic depression.

Edit: PS, free markets are greedy too. The problem with greedy governments is there is no alternative. The market mechanism provides alternatives. I'm not talking about the crony capitalism we've had for at least 100 years. I'm talking about a actual free market.

Your ideal world is one in which people die on a regular basis due to preventable ailments, and the fortunate ones that survive are run roughshod over by amoral corporations that have millions of times more money than any individual.

Effectively, your ideal world is one in which companies replace government. Yes, government may be inefficient and corrupt, but I greatly prefer that to an equivalent entity that's efficient at its goals, which are the very things that in government we call corrupt. At least the government is supposed to be helping. The only thing a company is there to do is make money.

That's not a world I want to live in.

Some specific points:

Would your ideal government be in the business of issuing currency at all? I'm guessing not, and that we'd all be trading gold coins. Except that's a pain in the ass. So a bank would come along and offer to deal with your money for you, and people could trade their promissory notes. Then the bank realizes that, hey, we've got all this gold here, and not all of the people want their gold coins all at the same time; let's do something with that. So they start lending. Pretty soon, they've loaned over half of their gold coins, but things are going well, and it's all coming back in. Then a disaster occurs. Could be a huge storm, or a terrorist attack, or any number of things well outside the control of the bank, its depositors, or its borrowers. Suddenly a lot of the depositors need their gold back to pay for things related to the disaster. At the same time, the borrowers are defaulting on their loans, for the same reason that people need their coins back. All of a sudden, all of that house of cards of money that the bank "created" through lending more than it really had comes crashing down.

How is this situation different from your idea of how a government controlled fractional-reserve bank works? Well, other than the obvious part about how the government's not involved and therefore not requiring that the bank keep at least a certain percentage of cash on hand.

The traditional libertarian argument is "well, those depositors were stupid to deposit their money in a bank with such bad practices". Well, guess what? All the banks were doing that. And that assumes that everyone has a solid knowledge of relatively advanced economic issues. In other words, in your language, "perfect knowledge" is a crock.

Also, I guess, Alexander Hamilton doesn't count as a Founding Father.

I understand this is your fear, but I don't believe it is the case. As a matter of fact, governments have killed more people than religion, and ours is no exception. I contend that the costs for preventable ailments will fall dramatically were government regulation and prohibition to stop, and there is historical evidence for this. Meanwhile, the only thing that has increased life expectancies and improved the welfare of humanity at large is industrialization and innovation which has resulted in the very treatments you want to make available to everyone at no charge. People working for a profit motive, attempting to create something of value for humanity. Governments do not create anything. Enterprise creates wealth.



Now we're hard against it. You have an extreme anti-capitalist bias, and I believe this is based on a lack of understanding of money and profit and production of wealth in general. Yes, companies exist to make a profit. You consider that an evil motivation because you don't seem to understand where profits come from, which is wealth creation. Wealth is not just out there in the universe, waiting for us to divide it up. Wealth is created by labor, which turns raw materials into usable things. The things are the wealth, not the money. The money is simply the medium of exchange. Same goes for informational or financial products. The companies make profit by creating something of value that people voluntarily pay for. Through this mechanism, the wealth of humanity is increased by production. No creation of usable products, no revenues, and no profits. Profits are the measure of how efficiently people create things that society wants.

In our world of crony capitalism, we don't let the markets operate so well, and the health care bill is a perfect example of this. Rather than competing on the basis of delivering superior products and services at lower prices, companies now compete using special interest groups to get a regulatory advantage that effectively closes the market to competition or choice by consumers. Sometimes this is called regulatory lock, and indeed, the profits that come from this are immoral, because they are not based on the free choice of customers and a fair valuation of the worth of the product. Health insurance companies were behind Obamacare because it requires every citizen (under pain of taxation, which the government will collect at gunpoint if necessary) to purchase health insurance. No matter how expensive or shitty the product, we need to purchase it. Those profits are definitely ill-gotten, but that's not because capitalism is bad, companies are evil, or the market doesn't work, it's precisely because those things are not allowed to operate.





We disagree, of course. The problem is the doomsday scenario you describe is not accurate, because your premises are not sound. You blame free markets and capitalism for problems that are more often than not caused by government.



It is not necessary for the government to issue currency, and gold can be traded electronically in arbitrarily small (or large) amounts. There is absolutely nothing less convenient about a system based by a hard commodity. All of our electronic banking conveniences would still work. In fact, there is nothing special about gold. The ONLY thing that using gold money does is make the total amount of money a relatively fixed quantity -- beyond the reach of politicians to inflate it, thus stealing from savers. Any relatively stable commodity can be used. The point is that it is an objective, non-fluctuating, medium of exchange.



It's not different at all. It's stealing. That's precisely what fractional-reserve banking is, whether a dishonest bank does it or the government. It's also something that could be regulated and managed (a legitimate case of regulation as it serves to protect property).



That's not the traditional libertarian argument at all. The argument is that lending out property placed on deposit in your warehouse is stealing. The banks violated the contract with the depositor when they lent out his money. With a 100% reserve system, which would prevent all of these problems, including the asset bubbles we've seen, a bank is nothing more than a warehouse for your money. The paper deposit certificate is a warehouse receipt. For convenience, and to avoid the impractical nature of using gold coin for everything, you and I can exchange our receipts with each other, rather than the actual commodity. Those receipts could be electronic.

We have warehouse companies today that store extremely valuable things and they do it without stealing them. This is another common scare tactic argument that has no real basis. What actually causes bank runs is when the government allows fractional reserve banking to happen in the first place, to inflate the currency to pay for its unfunded liabilities. Then the scenario you outlined happens. It's not corrupt companies that cause it, it's inflationary government monetary policy.



Almost any modern libertarian, including myself, would support a Hamilton-style central bank, because it was exactly what I'm talking about. He explicitly forbade the bank to buy government debt (a terrible sign for a country, and which just happened in the US the day after our elections), and he required 100% capitalization. In fact, his bank was established explicitly to get rid of fiat currency then in circulation.

Our objection is what inevitably happens afterward. Now in possession of the money supply, there is a relatively low barrier for the government to start using that money on deposit for its special projects. The government is the organization most likely to create the doomsday scenario you describe, and they are doing it. Please put aside your prejudice against capitalism long enough to look at what they're doing!

First, you bring up religion and I have no idea why.

I do not have an anti-capitalist bias. I have an anti-laissez-faire bias. I also think that there are certain things that the government should provide if at all possible. These things, to me, provide liberty. I understand your argument that taxation is a removal of liberty, and I agree. But I think it's less egregious than the ones caused by poverty. I also think that the benefits from reducing poverty are far greater than the benefits of letting the rich get richer.

First, the idea that government-run business cannot make wealth is absurd. The TVA is a great example. Not only did its direct employment keep people off of welfare, its public works created a huge amount of wealth and laid the groundwork for even more.

Second, you use the loaded term "evil" where I said "amoral". Businesses as entities are amoral. Their sole goal is to profit. They may create wealth as a means or as a side effect, but this is not required by the nature of business. See Enron.

You're going to have to define "crony capitalism" for me.


HAHAhahaHahaha! Haha! HA! Ha.

Oh, wait. You're serious.

Um, you're going to have to provide some evidence that this is the case.


Uh, allow? Now you want the government interfering? What happened to the free market?

The banks aren't stealing your money. It said right in the contract that the depositors signed with the bank that they would leverage your money and that there were risks involved.

Are you saying that the government should actively disallow people from entering into contracts with their bank?


I think your facts about the First Bank are somewhat questionable. The Bank acquired its money by selling $10 million of stock in itself. 20% of that was purchased by the Federal Government using money loaned from the Bank itself. The rest of it was sold to the public, requiring only 25% hard currency, the rest of it fiat, bonds, or whatever. Interestingly, 25% of 80% is 20% of the whole. So what really happened is that the Bank took $2 million in hard currency from the public and immediately loaned it to the Federal Government, while claiming that they still had $8 million, which was all in fiat currency, and then still lent money up to the $10 million total, less the amount loaned to the Federal Government.

How, exactly, does this jibe with your idea of how a bank should work?

This is the bit about gold-standard currencies that I don't understand. You and I agree that the total amount of wealth in the world steadily goes up, as people and industries become more productive. But if the total money supply is fixed to the total gold supply, which is essentially fixed (give or take the small amount of "new" gold mined each year), then the money supply as a fraction of all wealth must steadily decrease.

Eventually there's (say) twice as much wealth in the world, but still only the same amount of gold. Doesn't that mean that one gram of gold now buys you twice as much stuff, in other words that prices expressed in terms of a quantity of gold, will have halved? I don't see how a fixed-commodity currency can do other than cause long-term deflation, and deflation is very damaging to investment and production, as it becomes more economically sensible to hold on to gold than to invest it in new enterprises.

Put differently, if the money supply is constrained, the laws of supply and demand tell us that its price goes up. So if a ton of grain used to buy a gram of gold, eventually two tons will buy a gram of gold. That is, the gold currency has deflated.

Clearly a fiat currency is a temptation to governments to print too much money and cause inflation. But the reason they need to be printing extra money in the first place, is to stave off deflation.

Peter

I just wanted to chime in and say that I'm thoroughly enjoying this conversation even if I'm not contributing

To that end, I'll put in some of my feelings about government, some more related to this conversation than others:

-I don't know how you can consider banks "stealing" money by using it for investments- it's not like people don't realized this is what the bank is going to do when they make a deposit. Short of the government prohibiting this practice, it isn't going away, and why would the government step in and tell people what they can't do like that? The "warehouse" type bank will have to charge customers to hold their money- I think most people will be willing to allow the banks to use their money in order to gain interest and not be charged for the warehousing.

-While creating wealth and free market tend to be closely aligned, they are not in lock step. There ARE professions that can generate money without creating wealth. Professional gamblers (to pick a profession close toe hime), for instance. A gambler does not add anything to society except for providing people the entertainment value of losing money to him; he merely redistributes the medium of exchange to be in his favor (assuming he is good at it). Just because self interested people tend to create wealth does NOT mean that EVERYTHING that a person might to do out of self interest will benefit the common good.

-People tend to be motivated by self interest, which is why harnessing that tendency can benefit the whole of society. That doesn't, however, mean unfettered free market leads to the best possible society. Rather, it seems better to me to promote self interest competition where it benefits society and enacting restrictions where it is harmful. The problem, of course, is that there is a ton of disagreement over what is beneficial and what is harmful.

-I personally falter when it comes to certain policies that intellectually make sense to me for the betterment of society, but end up harming individuals in order to serve the greater good. It's quite easy to talk about things at a high level, but if I had to be the one to deliver the bad news to someone that they cannot get what they need because of a greater good policy, I don't know that I could do it- and if I support those policies but would be unwilling to enact them myself, I feel like that makes me a coward and is my problem with a lot of conservative politics (I'm not a liberal- but I don't really think I'm conservative politically anymore either).

-I DO think the government is too big and spends too much money on stuff it ought not to (and I'd bet a lot of people would agree); the problem is that we don't agree on what areas to cut.

-Health care in its current state is broken. As someone who has a wife with a disability that requires thousands of dollars worth of medications per year, I can't believe how ridiculous the system is. I don't like the government getting involved, but something's got to give.

After living outside the US for a bit, I've observed that decent quality private health care can be done much more inexpensively than it is being done in the US. Perhaps in addition to a public option, it's not a bad idea to figure out why a 'majority-world' country like Belize can have good private hospitals and medications at a fraction of the cost. Obviously, doctors and nurses make less here, but not enough to account for the disparity.

I'd like to add a few anecdotes of my own here. They don't offer any ideas for solutions, but they support what you said.

Three years ago when I was visiting here in Ajijic, Mexico, I had an insect bite on my arm. It itched, I scratched it and broke the skin, and the next morning my arm was pink from wrist to elbow. I went to the local clinic (a small, 8-bed hospital with, I believe, one full-time doctor) without an appointment or any advance notice. I had to wait eight whole minutes before I finally got to see the doctor. He looked at my arm, looked where I scratched the bug bite, said "Yes, it's infected, this prescription will take care of it." It did. The bill was 200 pesos, about $15 US. The prescription was about $16 at the pharmacy across the street. I learned later that I could have gone a quarter mile down the road to the less "fancy" pharmacy and gotten it for $12. Next morning the arm looked no better, so I went back, was told that it would take another day for the antibiotics to knock down the infection, and he was right. He refused to accept any more payment "You've already paid," he said. He asked me to stop by the clinic one more time before I left, just be sure everything was OK. I did, everything was OK, and I had to force him to take a second $15 payment. Now, if this experience had taken place in my home town of Fairbanks, Alaska, I would have gone to the clinic (easily 20 times the size and staff of the one in Ajijic) and been told that yes, I could have an appointment, how about a week from this Tuesday. Had I still been alive then, I'd have shown up on time, and waited at least 45 minutes to an hour to see the doctor, who would have looked at my arm and said "Yes, it's infected, but we'd better run some tests to be sure." After $600 worth of tests he would have written up about $200 worth of prescriptions. The 10 minutes of actual visit time would have cost another $135, ditto for any followups. The same service in the US would have cost about 20 times as much as I paid in Ajijic (30 times as much if I hadn't insisted on making that second payment) with highly qualified doctors in each instance.

Second anecdote: Now that I have permanent residence here, we have set up a plan with a different clinic wherein for a flat fee of about $225 for each of us my wife and I have unlimited office visits for one year plus two home visits from the doctor. These doctors are not rustic witch doctors making sacrifices to the gods or anything like that. They are trained in the medical schools of Guadalajara which are recognized as being among the finest in the world. This is not to say that all services are covered by that $225. Things like MRIs and cat scans cost extra. SWMBO had an MRI of her sinuses at the request of her allergist, and the cost was something around $150.

The third anecdote is not first person, but taken from a local newspaper. A local man became hypoglycemic and passed out in the dining room of a hotel. The management called an ambulance which transported him to a hospital about 30 miles away where he was held 24 hours for observation. The hospital made accommodations so that his wife could stay in the room with him. The doctor assigned to him visited him several times, and nurses checked on him every hour. When he was released, he was presented with a bill for $400.

My wife and I have found the medical services here to be so good and so inexpensive that we don't submit the bills to our insurance company. When she was still working in California, she went to Guadalajara for dental work (two tooth implants) and the cost including the round trip plane tickets was less than her insurance co-pay would have been had she done the work in California. This was before we realized that our retirement insurance actually was valid in Mexico. It's too late now for getting the dental work paid for, and the other bills are so small as to discourage fighting with the insurance company for reimbursement, because the paperwork provided by Mexican clinics is...informal at best.

When I look at the cost and quality of Mexican health care compared to the US, I can only assume that someone in the US is making a great deal of profit.

tanstaafl.

My experiences in Taiwan pretty much mirror yours in Mexico. They also have all the cutting edge equipment. Coming back to the US kind of felt like going back to stone age medicine, for an astronomical price.

There's a lot of clinics in Taiwan open 24 hours, no waiting for the docs to roll out of bed if you're sick at night.

I'm convinced we have the worst health care system of any country that actually has one...

I'll reply at length tomorrow, but first a clarification. When I said the insurance companies where "behind" Obamacare, I meant they supported it, not that they instigated it. There was an excellent PBS Frontline (not exactly Fox News!) about how Obama made a secret deal very early with the leader of the insurance lobby to basically buy them off so they wouldn't oppose. The price? A mandate that every American buy insurance. It's disgusting, and certainly not "change I can believe in". It's also a perfect example of so-called crony capitalism, which I'll elaborate on when I have more time. In the meantime, try to find that Frontline episode.

Jim

My experiences are completely different here. I haven't had to wait more than 24 hours for any non-emergency appointments (I haven't had anything qualifying as an emergency to compare). When my orthopedic doctor wanted MRIs of my knees, I had an appointment within the hour. The cost of that was $10 (for a scan on both knees, so it took a while).

Overall, I have no complaints about the care I receive. But, I guess my plan is atypical (hence the increases).

For the record, I have no problem paying taxes. I don't go through and figure out how much I need to donate to charity to drop me down a bracket or anything, I pay what I end up owing. Maybe it is because I grew up in the military and realize that those taxes are partially being used for folks like my parents. Maybe it is because I'm not smart enough to care about it. What does bother me is when people say that the health care plan won't affect me since I'm already covered and then getting hit with increases like we are.

One of the ways many ways in which the system is broken isn't at all about the quality of care we've recieved, but how insurance drives people to be less selective about the care they obtain. Doctors prescribe medication and people get it without asking any questions. People don't take ownership over this stuff, and the result is spending without regard for who is paying (ultimately, it's us, but it's deferred in the form of rising rates).

My wife and I just got forced into a high deductable plan, and this, at least, feels like a step in the right direction. Most people end up having to pay for their basic medical needs (and therefore have to be responsible with their spending), while serious medical issues are handled. Of course for us, we hit outlr high deductible early in the year so it's not much different for us in practice than our PPO was, but almost everyone else I know is having to be more responsible with their medical expenditures. My company also gives us 1K into a HSA every year so most employees don't end up shelling out for medical stuff as long as they are careful and ask questions when doctors star prescribing expensive medication. I'm sure this is playing right into the evil insurance companies desires, but I have to say it feels like movement in the right direction. Of course, it seems from talking with friends and family, our plan is better than most high deductible plans, so I count myself blessed.

We still have to wait for hours sometimes to see certain doctors, and one of my wife's doctors told her she can no longer be a patient at her practice after she showed up to two appointments 15 minutes late (first one due to an appointment with a different doctor she had scheduled earlier in the day keeping her in the waiting room for an hour and a half, and the second due to bad traffic). It's a wonderful double standard these doctors have.

I haven't had a chance to watch it yet, but it's called "Obama's Deal", and it's available online.


The lobby is not the industry, and the industry certainly spent huge amounts of money convincing the American public that this was a terrible idea.


I understand your problem with this, but the only way that this has a chance of reducing health care costs is if everyone has health insurance. I'd personally prefer it if the government provided basic healthcare insurance as part of being a US citizen, with private expanded coverage available at cost. My point is that, assuming he wasn't going to push for single-payer health care, which he probably wasn't, as it's politically unfeasible, he made a deal by giving them something he was already going to do.

If you limit "most people" to being the relatively wealthy (you and me and above), I won't (in theory) disagree, but those are the people I'm least concerned with.

The working class and below can't afford maintenance health care now, and that's one of the things that is driving costs up.And the lack of insurance drives people to be far more selective than they should be.

That said, I can't come up with a reasonable set of things for a high deductible to apply to. Certainly regular office visits should be exempted. Despite your implication otherwise, I don't think that doctors arbitrarily prescribe unneeded medications, and the costs there are very high, so it doesn't really make sense from either side. I haven't really thought about it, but maybe a system where the second thousand dollars is out of pocket, or something like that, might make sense, but I still disagree in my gut.

That happens quite a bit, actually. You would be amazed at some of the kickbacks doctors are offered from drug companies for prescription numbers. Hell, not even the kickbacks but just the dinners that are thrown (I was in awe when my father was describing them) to talk about what drugs are available. Of course, not all doctors go for that. My doctor regularly loads patients up with the sample packs when the drug is needed and the sample is available.

My current plan is exaclty that- the first 1K is payed for and the next 2K is on us. After that everything is covered. Most people don't make it past the first 1K if they are selective about their doctors, where they get prescriptions filled, etc.

By "most people", I mean the majority of the people on this plan.

I don't think doctors are nefarious- it's a complicated system and they have little motivation to find the most cost effective treatments. I've definitely had doctors prescribe us some very expensive medication when other medication would do- often the insurance company pushes back, which DOES end up with a more cost efficient treatment, but meanwhile the patient is caught in the middle waiting for the treatment while the doctor and insurance get their ducks in a row.

How many people do you know that factor in price when picking a pharmacy? I don't know of anyone who does, yet they do not all charge the same. When consumers become responsible for the choices they make, they will start making better choices.

Only because of the HSA, which is not part of the insurance, and which would not be included in the plans of the less well-off, which is to whom, IME, most of these high-deductible plans are being pushed.

I understand that. Most people I know who have a high-deductible plan do NOT have the HSA and it is a lot more painful for them, so I'm under no illusions that my situation is typical. I know I have it good.

I am largely uninformed about what is being pushed to whom, so I'm not making a political statement here or saying that high-deductible plans are the answer to anything. The extent of my point is that I see good things coming out of this system and people who are on it making better choices.It feels less broken than my previous health care plan and therefore a step in the right direction.