Starting with your first statement, "SO what happens if we enact a bare bones minimum for all employees of all companies no matter the size or hours worked..."
What happens is...
Who is going to pay for it?
The business owner?
The government?
Who?
That being said...
If you made the business owner pay for it, then you could expect most small businesses would not be able to provide the service AND keep up with their other overhead costs.
If you made the government pay for it, then you could expect a lot of red tape and other administration inefficiencies, plus an increase in EVERYONE's taxes, etc. for it .
Although I'm not knocking your idea in one iota - I hear what you're saying, my friend - I do believe there's another more effective way we can go about it....
I have GREAT health insurance - I'm married to a school teacher and that's one of the perks.
The INSURANCE COMPANY was charged about $10,000 when we had a baby a couple of years ago. It was a standard labor and delivery, with no complications, and two nights stay in the hospital for mother and son.
The INSURANCE COMPANY paid only $2,000 of that bill and the hospital wrote off the rest of it because that is the agreement they have with the insurance company. The hospital will accept pennies on the dollar and call it "PAID"...
Now, what if we had SELF-PAY patients who had the same sort of buying power? They would be allowed to pay the same rate that insurance companies pay - like one-fifth of the bill - and the hospital would still call it "PAID".
However, the reality of it is that a self-pay patient who also had a standard labor and delivery, with no complication, and a two night stay in the hospital for mother and baby would pay $10,000 out of her pocket for the service.
It's the SELF-PAY patients who can usually LEAST afford the services and yet they are the ones who get stuck with the ENTIRE bill.
What would happen is that every employer would have to pay about $600 per month per employee for the insurance. About $5 per hour per person. I know because I sign the check to the HMO for my employees. I consider myself lucky because one employee chooses to work part-time, making himself ineligible for insurance, one has better coverage under his wife's plan and one is a college intern with her own plan.
You can always start your own business. Then you can decide how much coverage you want to give your employees.
If you made the government pay for it, then you could expect a lot of red tape and other administration inefficiencies, plus an increase in EVERYONE's taxes, etc. for it .
How do you know this?
In fact, Single Payer medical coverage would do just the opposite. Sure, the myth of government bureaucracy is ever present. However, government has NO monopoly on bureaucracy. MOST private medical plans ARE bureaucracies, especially HMOs.
Having a Single Payer that is NOT obligated to keep 20% as budgeted "profit" only REDUCES cost. Other aspects of this type of system make it even more desirable. Standardized electronic medical records VASTLY speeds access between primary care and specialist providers; between labs/x-ray/EKG, and direct caregivers. Further, economies of scale in purchasing meds and other equipment/supplies will also greatly reduce costs. This type of system is ALREADY in place and in use in the US.
Now, I know there are people who can complain about it, but the fact remains that the VA Medical system works on a large scale. The fact that the vast majority of the costs are born by taxpayers means that there is the ever present need to bug Congress for adequate funding to meet the needs of all covered veterans. With a universal Single Payer system, with employer contributions comparable to what is being done today -- with a zillion different bureaucracies responsible for evaluating claims for payment -- costs would be drastically reduced from what they are today.
Actually the plan I outlined pays far far less than almost any company health insurance plan today. With the difference between what the insurance co pay now for the plans they fund and how much the bare bones plan would cost-I don't think that it would cost any more for a company to provide insurance for all their employees.
What it would do is prevent co's from only giving workers 30 hours a week, or declaring them on-call employees thus making said employees ineligible to be covered by medical.
Businesses attitudes of ^(*&%^&*^$ the employee lets see how we can get around providing benefits is why we are in this pickle.
Sorry, If you can't afford the cost of doing business and that includes adequate wages and benefits for ALL your employees--maybe you shouldn't be in business
*********the writer who is designated as an "on-call " employee wrking less than 32 hours a week just got through shelling out $850.00 for a mammogram, bone density scan, and routine bloodwork for her once a year physical --not to mention the 315 last week for said physical all this on 1700 a month (including money from the trust account my mom left)--which makes me lucky ----I still have money to live on**********
In fact, Single Payer medical coverage would do just the opposite. Sure, the myth of government bureaucracy is ever present. However, government has NO monopoly on bureaucracy. MOST private medical plans ARE bureaucracies, especially HMOs.
Having a Single Payer that is NOT obligated to keep 20% as budgeted "profit" only REDUCES cost. Other aspects of this type of system make it even more desirable. Standardized electronic medical records VASTLY speeds access between primary care and specialist providers; between labs/x-ray/EKG, and direct caregivers. Further, economies of scale in purchasing meds and other equipment/supplies will also greatly reduce costs. This type of system is ALREADY in place and in use in the US.
Now, I know there are people who can complain about it, but the fact remains that the VA Medical system works on a large scale. The fact that the vast majority of the costs are born by taxpayers means that there is the ever present need to bug Congress for adequate funding to meet the needs of all covered veterans. With a universal Single Payer system, with employer contributions comparable to what is being done today -- with a zillion different bureaucracies responsible for evaluating claims for payment -- costs would be drastically reduced from what they are today.
NO doubt about it, indeed.
Rocky,
I work in healthcare quality management, which includes the contracts we have with all the big health insurance providers, including Medicare and Medicaid.
To the patient, there might not be much redtape. To the hospitals and providers, there's a TON of it. We have to gather and report statistics, make sure patients meet the criteria for their stay - which isn't always black and white, as Medicare or Medicaid try to dictate, and bill within the parameters of the program. We have to have special inspections to make sure we meet the standards of their program, etc., etc., Those are the broadstrokes of the program. There's much more to it.
[A side note about the VA system - it's better than it used to be. I don't mind one bit that it's tax dollar driven - those military folk put their lives on the line for my freedom. The least I can do is pay for their health care! However, I have a brother who's a Vietnam vet who won't use the system because he can't understand the forms and redtape. He won't be bothered with it, I'm sorry to say.]
Part of my job includes being a patient advocate - that's the part I love. I'm the person who reads and responds to the letters that patients and/or families write when they have problem with their hospital stay or a provider in our network. I research the complaint and respond.
The letters that rip my heart out are the ones where people with no insurance, just Joe Doe, who has a wife and kid, no medical insurance, has a little accident at work and ends up in the ER, and with a huge medical bill he can't afford. I try to hook him up with as many programs as possible and refer him to a social worker to help them, etc. - but I know it won't be enough. Chances are, he'll end up in bad debt because of the bill - and he doesn't deserve it. Our hospital has a policy where if you pay $1 per month they won't report you to collections - even if your bill is $20,000.
I'm glad for that, but on the other hand, the hospital has costs of it's own, doesn't it? It has employees to pay, insurance and benefits to pay for those employee, plus operating costs, etc. If hospitals don't get their money, then they have to figure out how to collect it. Bad debt accounts can really hurt a hospital - I've seen it. We had a huge layoff about four years ago because we were so in the red - think about it - a hospital? with layoffs? And it wasn't the office staff they were cutting, either....
And guess what? I'm also a business owner. If I ever had enough work where I could take on an employee, I wouldn't be able to afford health care for that person, most likely. The costs of my services would have to go way up for that. Then what? It would create quite a problem if it was manditory
The problem with insurance companies is that they have stockholders - and EVERY year they turn a profit over to those stockholders. Every year, insurance costs go up. Insurance companies call the shots in healthcare more than you might think. It is NOT consumer driven, like you might think.
No, I don't have all the answers - I never did - but I think if hospitals billed at a better rate for self-pay patients AND perhaps if there was a health insurance Co-Op - where MANY people could buy insurance as a group - in a package - then, perhaps, that would help.
--------------------
Templelady -
I hope you don't think I was taking a shot at your initial post. I mean it when I hear what you're saying - I really do. I agree with your point about how people who should have benefits don't have them but I also wonder if there's not a way that it could be provided without putting small businesses out of business. I understand BOTH sides of the coin - from the providers' to the insurance companies' positions - and add the patients' point of view to it. It's painful when you see someone slip through the cracks who really could use the help. The tough part about your plan would be getting providers to accept the contract, to be honest. I'm not saying its a bad idea - but I am simply offering information about the field I've worked in for several years now, and perhaps showing ways other cuts can be made to make the WHOLE thing better for all.
It all comes back to something has to change, doesn't it? This country is amazingly backwards when it comes to healthcare. It's an embarassment.
To the patient, there might not be much redtape. To the hospitals and providers, there's a TON of it. We have to gather and report statistics, make sure patients meet the criteria for their stay - which isn't always black and white, as Medicare or Medicaid try to dictate, and bill within the parameters of the program. We have to have special inspections to make sure we meet the standards of their program, etc., etc., Those are the broadstrokes of the program. There's much more to it.
[A side note about the VA system - it's better than it used to be. I don't mind one bit that it's tax dollar driven - those military folk put their lives on the line for my freedom. The least I can do is pay for their health care! However, I have a brother who's a Vietnam vet who won't use the system because he can't understand the forms and redtape. He won't be bothered with it, I'm sorry to say.]
The problem with insurance companies is that they have stockholders - and EVERY year they turn a profit over to those stockholders. Every year, insurance costs go up. Insurance companies call the shots in healthcare more than you might think. It is NOT consumer driven, like you might think.
No, I don't have all the answers - I never did - but I think if hospitals billed at a better rate for self-pay patients AND perhaps if there was a health insurance Co-Op - where MANY people could buy insurance as a group - in a package - then, perhaps, that would help.
Peace,
Krista
You did a good job of describing some of the issues I also mentioned... indeed government has no monopoly on bureaucracy. Do you suppose that if there were to be only ONE set of program guidelines to deal with, it would be any more simple for a hospital (or doctor's office) to deal with? Indeed, that was one of the points I was trying to make. And a good job also on describing that pesky cost component -- shareholder profit. Wouldn't it be nice if we didn't have to include that in the cost estimates used to determine insurance premiums, or hospital service rates?
Oh, and when I brought up the point about electronic medical records I forgot to mention how that would help reduce the incidence of medical mistakes. The mistakes which give rise to what some consider "frivolous" lawsuits, that is.
It's too bad your brother won't use the VA medical benefits... it really IS better than it used to be.
On a side note about the electronic medical records...
That's going to be a hard program to integrate into healthcare mostly because there's many non-profit hospitals out there, like the one I work at, where we're still using Office 97 and Windows 98 and working on PCs that are over 10 years old. Technology is low on the cost agenda - finding more physicians, especially those who specialize in geriatric medicine, is a much higher priority for us right now. We've only just begun looking at barcoding for patients - where the barcode would be on the ID bracelet and would have to be scanned every time a medication would be given (where the medication would also have a matching barcode) or perhaps a dressing change would be done on a surgical site - and that package would have to be scanned as well. Barcoding would be the bigger picture of less medical errors, with electronic medical records following closely behind it.
Electronic medical records would do so much more than eliminate errors but would improve continuity of care - patients couldn't hop from ER to ER seeking pain medication, for example. Getting an accurate medical history from a patient would mean no longer relying on their memory or their spouse or family to provide what they "think" might be the history. It would help doctors provide a faster diagnosis and treatment, plus you would have something as important as knowing the patient's allergies, right at your finger tips.
There's a great movement going on in healthcare right now called the 100,000 LIVES CAMPAIGN - if you have a moment, check it out. My hospital is a part of this program. It's made a HUGE difference for us already. I would say that we've probably saved over 40 lives that might not have made it, if we hadn't implemented this at our hospital - and that's within the year we've been doing it. (My hospital is a small rural hospital - 90 beds.)
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ChasUFarley
Starting with your first statement, "SO what happens if we enact a bare bones minimum for all employees of all companies no matter the size or hours worked..."
What happens is...
Who is going to pay for it?
The business owner?
The government?
Who?
That being said...
If you made the business owner pay for it, then you could expect most small businesses would not be able to provide the service AND keep up with their other overhead costs.
If you made the government pay for it, then you could expect a lot of red tape and other administration inefficiencies, plus an increase in EVERYONE's taxes, etc. for it .
Although I'm not knocking your idea in one iota - I hear what you're saying, my friend - I do believe there's another more effective way we can go about it....
I have GREAT health insurance - I'm married to a school teacher and that's one of the perks.
The INSURANCE COMPANY was charged about $10,000 when we had a baby a couple of years ago. It was a standard labor and delivery, with no complications, and two nights stay in the hospital for mother and son.
The INSURANCE COMPANY paid only $2,000 of that bill and the hospital wrote off the rest of it because that is the agreement they have with the insurance company. The hospital will accept pennies on the dollar and call it "PAID"...
Now, what if we had SELF-PAY patients who had the same sort of buying power? They would be allowed to pay the same rate that insurance companies pay - like one-fifth of the bill - and the hospital would still call it "PAID".
However, the reality of it is that a self-pay patient who also had a standard labor and delivery, with no complication, and a two night stay in the hospital for mother and baby would pay $10,000 out of her pocket for the service.
It's the SELF-PAY patients who can usually LEAST afford the services and yet they are the ones who get stuck with the ENTIRE bill.
Something has GOT to change - no doubt about it.
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Jim
What would happen is that every employer would have to pay about $600 per month per employee for the insurance. About $5 per hour per person. I know because I sign the check to the HMO for my employees. I consider myself lucky because one employee chooses to work part-time, making himself ineligible for insurance, one has better coverage under his wife's plan and one is a college intern with her own plan.
You can always start your own business. Then you can decide how much coverage you want to give your employees.
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Danny
Great for a Friday night.
I have a small co.
I have no insurance for my employees.
Wish I could provide it for them.
My insurance is 880 a month I pay 5000 ded.
So almost 15000 before the first dime is paid by the insurance.
I fell today off a roof today broke or injured all four corners.
I have a very bad attitude
right now.
Yes I think things or out of wack. Besides my broken parts.
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Rocky
How do you know this?
In fact, Single Payer medical coverage would do just the opposite. Sure, the myth of government bureaucracy is ever present. However, government has NO monopoly on bureaucracy. MOST private medical plans ARE bureaucracies, especially HMOs.
Having a Single Payer that is NOT obligated to keep 20% as budgeted "profit" only REDUCES cost. Other aspects of this type of system make it even more desirable. Standardized electronic medical records VASTLY speeds access between primary care and specialist providers; between labs/x-ray/EKG, and direct caregivers. Further, economies of scale in purchasing meds and other equipment/supplies will also greatly reduce costs. This type of system is ALREADY in place and in use in the US.
Now, I know there are people who can complain about it, but the fact remains that the VA Medical system works on a large scale. The fact that the vast majority of the costs are born by taxpayers means that there is the ever present need to bug Congress for adequate funding to meet the needs of all covered veterans. With a universal Single Payer system, with employer contributions comparable to what is being done today -- with a zillion different bureaucracies responsible for evaluating claims for payment -- costs would be drastically reduced from what they are today.
NO doubt about it, indeed.
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templelady
Actually the plan I outlined pays far far less than almost any company health insurance plan today. With the difference between what the insurance co pay now for the plans they fund and how much the bare bones plan would cost-I don't think that it would cost any more for a company to provide insurance for all their employees.
What it would do is prevent co's from only giving workers 30 hours a week, or declaring them on-call employees thus making said employees ineligible to be covered by medical.
Businesses attitudes of ^(*&%^&*^$ the employee lets see how we can get around providing benefits is why we are in this pickle.
Sorry, If you can't afford the cost of doing business and that includes adequate wages and benefits for ALL your employees--maybe you shouldn't be in business
*********the writer who is designated as an "on-call " employee wrking less than 32 hours a week just got through shelling out $850.00 for a mammogram, bone density scan, and routine bloodwork for her once a year physical --not to mention the 315 last week for said physical all this on 1700 a month (including money from the trust account my mom left)--which makes me lucky ----I still have money to live on**********
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ChasUFarley
Rocky,
I work in healthcare quality management, which includes the contracts we have with all the big health insurance providers, including Medicare and Medicaid.
To the patient, there might not be much redtape. To the hospitals and providers, there's a TON of it. We have to gather and report statistics, make sure patients meet the criteria for their stay - which isn't always black and white, as Medicare or Medicaid try to dictate, and bill within the parameters of the program. We have to have special inspections to make sure we meet the standards of their program, etc., etc., Those are the broadstrokes of the program. There's much more to it.
[A side note about the VA system - it's better than it used to be. I don't mind one bit that it's tax dollar driven - those military folk put their lives on the line for my freedom. The least I can do is pay for their health care! However, I have a brother who's a Vietnam vet who won't use the system because he can't understand the forms and redtape. He won't be bothered with it, I'm sorry to say.]
Part of my job includes being a patient advocate - that's the part I love. I'm the person who reads and responds to the letters that patients and/or families write when they have problem with their hospital stay or a provider in our network. I research the complaint and respond.
The letters that rip my heart out are the ones where people with no insurance, just Joe Doe, who has a wife and kid, no medical insurance, has a little accident at work and ends up in the ER, and with a huge medical bill he can't afford. I try to hook him up with as many programs as possible and refer him to a social worker to help them, etc. - but I know it won't be enough. Chances are, he'll end up in bad debt because of the bill - and he doesn't deserve it. Our hospital has a policy where if you pay $1 per month they won't report you to collections - even if your bill is $20,000.
I'm glad for that, but on the other hand, the hospital has costs of it's own, doesn't it? It has employees to pay, insurance and benefits to pay for those employee, plus operating costs, etc. If hospitals don't get their money, then they have to figure out how to collect it. Bad debt accounts can really hurt a hospital - I've seen it. We had a huge layoff about four years ago because we were so in the red - think about it - a hospital? with layoffs? And it wasn't the office staff they were cutting, either....
And guess what? I'm also a business owner. If I ever had enough work where I could take on an employee, I wouldn't be able to afford health care for that person, most likely. The costs of my services would have to go way up for that. Then what? It would create quite a problem if it was manditory
The problem with insurance companies is that they have stockholders - and EVERY year they turn a profit over to those stockholders. Every year, insurance costs go up. Insurance companies call the shots in healthcare more than you might think. It is NOT consumer driven, like you might think.
No, I don't have all the answers - I never did - but I think if hospitals billed at a better rate for self-pay patients AND perhaps if there was a health insurance Co-Op - where MANY people could buy insurance as a group - in a package - then, perhaps, that would help.
--------------------
Templelady -
I hope you don't think I was taking a shot at your initial post. I mean it when I hear what you're saying - I really do. I agree with your point about how people who should have benefits don't have them but I also wonder if there's not a way that it could be provided without putting small businesses out of business. I understand BOTH sides of the coin - from the providers' to the insurance companies' positions - and add the patients' point of view to it. It's painful when you see someone slip through the cracks who really could use the help. The tough part about your plan would be getting providers to accept the contract, to be honest. I'm not saying its a bad idea - but I am simply offering information about the field I've worked in for several years now, and perhaps showing ways other cuts can be made to make the WHOLE thing better for all.
It all comes back to something has to change, doesn't it? This country is amazingly backwards when it comes to healthcare. It's an embarassment.
Peace,
Krista
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Danny
Templelady May I ask have you ever run any kind of business (small or large).
Do you know that no company in my state offers insurance for a small business
like mine?
I am mandated to have WC and do have that.
I think I did state that I wish I could provide the other.
Maybe I took your comment wrong (maybe I should Not be in business).
Could you tell what you mean.
Small business employ more people than Large.
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Rocky
You did a good job of describing some of the issues I also mentioned... indeed government has no monopoly on bureaucracy. Do you suppose that if there were to be only ONE set of program guidelines to deal with, it would be any more simple for a hospital (or doctor's office) to deal with? Indeed, that was one of the points I was trying to make. And a good job also on describing that pesky cost component -- shareholder profit. Wouldn't it be nice if we didn't have to include that in the cost estimates used to determine insurance premiums, or hospital service rates?
Oh, and when I brought up the point about electronic medical records I forgot to mention how that would help reduce the incidence of medical mistakes. The mistakes which give rise to what some consider "frivolous" lawsuits, that is.
It's too bad your brother won't use the VA medical benefits... it really IS better than it used to be.
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templelady
If insurance companies won't fund small business then that needs to be changed by law
WE are the ONLY industrialized nation that does not have a medical plan for all it's citizens
pretty pathetic
And the fact that a business is small in no way changes the needs of its employees for medical care
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Danny
I agree I'm on your side.
But when you say a company should not be in business
when they can not provide that kind of thing Where does it put me?
I can't provide something that is not sold.
My WC is 50 % my General is 25 % so before any thing else out the door I' at 75%
out the door of ever dollar I pay in wages.
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ChasUFarley
SLIGHTLY
Rocky --
On a side note about the electronic medical records...
That's going to be a hard program to integrate into healthcare mostly because there's many non-profit hospitals out there, like the one I work at, where we're still using Office 97 and Windows 98 and working on PCs that are over 10 years old. Technology is low on the cost agenda - finding more physicians, especially those who specialize in geriatric medicine, is a much higher priority for us right now. We've only just begun looking at barcoding for patients - where the barcode would be on the ID bracelet and would have to be scanned every time a medication would be given (where the medication would also have a matching barcode) or perhaps a dressing change would be done on a surgical site - and that package would have to be scanned as well. Barcoding would be the bigger picture of less medical errors, with electronic medical records following closely behind it.
Electronic medical records would do so much more than eliminate errors but would improve continuity of care - patients couldn't hop from ER to ER seeking pain medication, for example. Getting an accurate medical history from a patient would mean no longer relying on their memory or their spouse or family to provide what they "think" might be the history. It would help doctors provide a faster diagnosis and treatment, plus you would have something as important as knowing the patient's allergies, right at your finger tips.
There's a great movement going on in healthcare right now called the 100,000 LIVES CAMPAIGN - if you have a moment, check it out. My hospital is a part of this program. It's made a HUGE difference for us already. I would say that we've probably saved over 40 lives that might not have made it, if we hadn't implemented this at our hospital - and that's within the year we've been doing it. (My hospital is a small rural hospital - 90 beds.)
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templelady
Exactly -you can't have what doesn't exist
And that needs to be changed-insurance companies need to be compelled by law to provide insurance packages for small business
May be a package deal that would cover several area business-such as a group of laundromat owners getting a group policy for their employees
So the first step would be to make sure that there was affordable insurance available for ALL companies
Step two would be to make sure all companies had said insurance for their employees after it existed
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