The Amazing Maze of US Health Care

In an article in Employee Benefit News, Nancy Bolton expressed some of the concern, confusion, and questions of many in the employee benefits profession right now.

Where are we going?

Will health care reform be good for employee benefit plans?

Readers familiar with my musings and rants will know that I will not mourn the demise of employer sponsored health coverage.  But I am also no fan of an individual mandate.

Good guys

Nevertheless, Bolton’s perspective is an interesting one.  Like me, she administers a public plan.  She asks the question, “Aren’t employers the good guys?”

Why didn’t the politicians who loudly proclaimed support for employment based health care, do more to underwrite its cost. Read the rest of this entry »

For all of the fuss about “big government” and about 2,000 page pieces of legislation, you might think there would be more pressure for legislators to take the simple route.

Not!

Take the provision in the Patient Protection and Affordable Care Act that extends care to dependents up to age 26.

HR 676 – the single payer legislation that is still before the House of Representatives – has this to say about eligibility:

All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care.

Compare that with language in the Patient Protection and Affordable Care Act (PPACA) regarding eligibility just for those young adults up to age 26 who are children of parents with employer sponsored health insurance. Read the rest of this entry »

“If you are among the hundreds of millions of Americans who already have health insurance through your job, … nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”

How much longer?

President Barack Obama used these words on September 9, 2009 before a joint session of Congress.

On other occasions the President has stated more bluntly, “If you have insurance you like then you will be able to keep that insurance.  If you have a doctor that you like, you will be able to keep your doctor.”

Read my lips

I predict that within five years these words will be tacked up along side, “Read my lips!  No new taxes!”  as examples of presidential overstatements. Read the rest of this entry »

Mr. Gay Burke, writing for the Denver Post asks the question, “Why should employers pay for health care?”

To Mr. Burke:

An upside down world

Right question.

Wrong answer.

Employers tend to be a smart group.  Otherwise they would not be running successful businesses.  But on health care, they have been stupid, blind and stubborn.

I can say that, in part, because I have spent nearly thirty years in the employee benefits profession.

The stubborn follows from the blind and stupid.

So let’s look at stupid first

Mr. Burke is onto something when he questions the role of employers in providing health insurance to employees.  This is an admittedly illogical system.  For starters, the doctor patient relationship is one that relies on continuity.  Fostering that continuity is one of the major ingredients in proposals for health care delivery reform. Read the rest of this entry »

Will health care reform support or undermine the employer-based system that provides health care coverage for the majority of working age adults?

Employer sponsored health care

According to a report by Fortune, several Fortune 500 employers have considered dumping the health care coverage they now offer to their employees.

Caterpillar, Deere, Verizon, AT&T, Bayer, and some other Fortune 500 companies have weighed the fines levied by the Patient Protection and Affordable Care Act (PPACA)against the cost of offering health insurance.

The fines win.  It’s cheaper to pay than to play.  Billions of dollars cheaper.

It’s not just the fines.

Fortune uncovered this story by combing through documents the companies submitted to Congress when Congress questioned the big tax write offs the companies took after after passage of PPACA.

The write offs, Congress learned, were legitimate.   Accounting rules require companies to account as a liability the future costs of retiree health care.  Those accounting rules are a big reason why the number of retirees covered by employer sponsored health insurance has dropped from over 40% to near 20% in the last twenty years. Read the rest of this entry »