The Amazing Maze of US Health Care

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 »

The old saw, “The devil is in the details” does not seem to apply in the discussion on taxing health care benefits.  While there appears to be a certain momentum behind this idea, the details of the consequences (other than raising revenue) are barely discussed.

Jonathan Cohn, a writer I generally admire, gives high praise to a new report by the Center for Budget Priorities, arguing that this report should prompt people like me to rethink our opposition to the idea.

So perhaps their latest message will get through to liberals and liberally inclined interest groups that oppose tinkering with the tax exclusion for health benefits. The title of their new report says it all: “Limiting the Tax Exclusion for Employer-Sponsored Insurance Can Help Pay for Health Reform: Universal Coverage May Be Out of Reach Otherwise.”

I recently detailed  the devils that I was concerned about.  The CBP attempts to address some of them.  So let’s take a closer look at their arguments, using the reports own headings.

The Exclusion is the nation’s costliest tax subsidy.

Duh?  Health care is one of the fastest growing expense items in the federal budget.  It is also one of the fastest growing cost items for private business.  Which costs less, the loss of tax revenue or paying the full freight for the health care now provided by the private sector? Read the rest of this entry »

I realize writing a letter to the president is like writing to Santa Claus.  Yes, Jim, there really is a Santa Claus; but the elves read the letters.

Short letter.

Dear President Obama:

Taxing benefits is a bad idea!

It is bad politics

It is not just that you thought it was a bad idea during the campaign and now you have flip flopped.  You are allowed to flip flop on some issues. Read the rest of this entry »

The blogosphere is buzzing with discussions about the promise of health care reform.  For a weekly poster like me, it is impossible to keep up.  As 2009 approaches, and more importantly, as 1.20.09 approaches, I thought I would offer my insights into the topic from the perspective of the administrator of an employer and union sponsored health benefit plan

If there is one thing that unites the comments it is their oppositional posture.  Insurance companies are the most common enemy, but hardly anyone escapes.

So I would like to go on the offensive and tick off a few positives that I would like to see in health care reform.  Please indulge my autocratic use of the term “will”.  

1. Every individual will be required to have health insurance.  Read the rest of this entry »

I support a simpler health care system.  That is my number one priority.   Thus I am unimpressed with the health care reform platform of our newly elected president.  I do share the hope and optimism of many that meaningful change can and will happen. 

But getting a simpler health care system means that some of the stakeholders need to be cut lose from the system.  That is a politically daunting task. It is why most health care reform proposals try to add more patches to what is already a shabby patchwork quilt of private and public programs.

One effort does try to simplify a small part of our current system.   Read the rest of this entry »