I Pay Taxes On My Health Care Dollars. Why Shouldn't You?
More and more people are self-employed, and we get screwed in myriad ways come tax time. Yet, Bob Herbert from The New York Times is just aghast at the McCain health care policy:
...The McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on."It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money," said Sherry Glied, an economist who chairs the Department of Health Policy and Management at Columbia University's Mailman School of Public Health.
Well, boohoo. About time.
Ms. Glied is one of the four scholars who have just completed an independent joint study of the plan. Their findings are being published on the Web site of the policy journal, Health Affairs....Under the McCain plan (now the McCain-Palin plan) employees who continue to receive employer-paid health benefits would look at their pay stubs each week or each month and find that additional money had been withheld to cover the taxes on the value of their benefits.
While there might be less money in the paycheck, that would not be anything to worry about, according to Senator McCain. That's because the government would be offering all taxpayers a refundable tax credit -- $2,500 for a single worker and $5,000 per family -- to be used "to help pay for your health care."
You may think this is a good move or a bad one -- but it's a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?
The whole idea of the McCain plan is to get families out of employer-paid health coverage and into the health insurance marketplace, where naked competition is supposed to take care of all ills. (We're seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working.)
Taxing employer-paid health benefits is the first step in this transition, the equivalent of injecting poison into the system. It's the beginning of the end.
I can't wait. Next, how about evening out or abolishing a few of those other dings on the self-employed?
Diana Furchtgott-Ross explains the McCain plan in the New York Sun:
Mr. McCain would give Americans refundable tax credits of $2,500 per individual, $5,000 per family, to buy health insurance. He would pay for this by changing the current tax status of employer-provided insurance, and including employer-paid health premiums in workers' taxable income. The proposed tax credit would wipe out the new tax liability for nearly every worker.Workers in the 25% tax bracket pay an extra $5,000 in tax on an additional $20,000 of income. So a $5,000 credit would offset the federal tax on employer-paid premiums up to $20,000 -- and an average plan only costs $12,000 per year, according to the bipartisan National Coalition on Health Care.
The tax credit would also be available for individuals -- employed, self-employed, unemployed -- who buy health coverage independently, although not to seniors on Medicare. People with pre-existing conditions who could not get health insurance would be insured through new state Guaranteed Access Plans.
With the tax advantage shifting to individuals from employers, people would not have to worry about losing their insurance when they change jobs -- just as they aren't concerned about losing their auto or home insurance.
The tax credit would be "refundable," meaning that it would go to people who don't owe tax. If it exceeded the cost of a plan, the individual would get the difference credited to a Health Savings Account, whose balances could be used to pay for insurance premiums and other health care costs.
The McCain plan would knock down state-line barriers to private health insurance plans and expand Health Savings Accounts. The combination of tax credits, nationwide insurance, and savings accounts would lead to increased competition among insurance companies, potentially driving down premiums.
"Potentially." Hmmm...you met any health insurers? I don't foresee that happening.







Hmm. A "Health Savings Account". Precisely what George H. W. Bush was hooted at for suggesting years ago.
This is still a scheme that involves entirely too much governmental action.
Radwaste at September 16, 2008 2:30 AM
I think this is a great plan. It's about the only thing I can recall hearing from either major candidate that is innovative and makes sense.
1. As pointed out above, it ties health insurance to people rather than employers, so if people change jobs, they don't have to change insurance.
2. Making insurance nationwide is another huge improvement. People wouldn't have to change insurance if they moved to a different state. It also has the benefit of increasing competition.
3. To the degree that HSAs are more permissive than insurance in what they pay for it takes a little of the behavior distortion out of the system.
4. The socialism that's left in the system is directly allocated from government budgets, allowing for easier cost/benefit analysis.
I'm not saying this is a panacea - it would only fix one broken aspect of our hugely messed up health care system, but it would be a very nice step in the right direction. As such, I expect it to be soundly rejected by voters and vehemently opposed by rent seekers and socialists, which leads me to this...
The stupidity of that sentence boggles my mind.
Two points:
1. Free markets ("unfettered marketplace") are a profit and loss system. Companies that screw up badly enough are supposed to fail.
2. I don't know to what degree Lehman Brothers or Merrill Lynch were true free market entities, but Fannie Mae and Freddie Mac never were. They were quasi-governmental from their inception - a sort of worst of both worlds.
Shawn at September 16, 2008 3:05 AM
George Bush was good on health care. I believe it's because of Bush that I get to deduct something as a self-employed person, or something substantial. My accountant does that math, and I can't recall the specifics, but as I said in the above entry, I'm tired of the across-the-board demonization of people or parties. I'm not a George Bush fan, either. What I am is somebody who finds both parties troubling, disgusting, and inadequate in numerous ways and who votes for the best scumbag I can in any election.
In the no illusions department (Fox Guarding The Henhouse Division) I just made a complaint to the Comptroller of the Currency this weekend about B of A, and then spoke yesterday to an expert in privacy law who told me that the Comptroller used to be head lobbyist of the Bankers' Association. Great. Luckily, I've sent my complaint around to various elected sellouts, and I'm hoping somebody will pick up on it.
Amy Alkon at September 16, 2008 6:03 AM
They were talking about this in New York about six months ago. I thought it died and now it's back to haunt me. I would be so screwed if this were enacted as it would tax me on income I don't have access to. I'd wind up poor from paying taxes on money I don't have.
I don't think I'd object if I had the option of taking the cash and spending it on my own insurance instead of having to pick one of the crappy insurance plans offered by my employer though this will only work out if I can get the premium individually they do at the group rate they pay. Why do I doubt this? I've been meaning to check with personnel actually to see if I can drop out but even if they do allow it, that just means I turn the benefit down. How's this gonna work if the employee refuses the benefit? Will they still be taxed on it because the employer offers it?
And that's only one of many questions this would raise. I get that it will be great for the self-employed and I'd like to disconnect my health insurance from my employer but I think carrying it out would be problematic. Should those who shop around and get a lower premium get the same tax rebate as those who don't? And if they get a different should it be more to reward them for shopping around or less because they're paying less?
I too don't see health insurers being that reasonable frankly. Especially not just because the government wants them to be and they don't have to be because their competitors aren't.
Also, I think the New York version of this wanted to tax on all benefits, not just insurance. Things as nonmonetary as leave time. If one benefit is taxable, you can bet they'll soon start taxing on others. I have a great benefits package and it would shoot my taxable income way up without also giving me the cash in hand to pay the increase. Again, it would wind up impoverishing me.
I think this would raise more problems than it would solve. Maybe those could be worked out but the first thing to be resolved before implementing is the first point I brought up. It'd be hugely unfair to tax people on money they aren't able to access. My job benefits are not cash in pocket and if I have to pay cash dollars on non-cash income, it is going to impoverish me. (And before anyone says it's balanced by my savings at the doctor's office, etc.; no, only if I use it and I, not my employer or the government, decide if I even go to the doctor. And even if I do use it, I'd have to have catastrophic illness or injury to see more of a return than the amount I'm being taxed on. For that matter, what if an insurer does pay out more on your behalf than you paid them? If benefits are an income, surely this is? Where the hell do you draw the line on defining income then?)
When all's said and done this move would just plain open too big a can of worms.
T's Grammy at September 16, 2008 6:54 AM
"We're seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working."
Shawn beat me to it - my head nearly exploded at the sheer, outright dishonesty of saying an "unfettered marketplace" had anything to do with this!
In a truly free market, there are people who would be paying credit card rates on their mortgages, due to bad credit. Don't like it, keep renting until your credit gets better and you qualify for a lower rate. Of course then the government chastises lenders for discriminating against minorities or some shit. What nonsense.
Shawn is right - Freddie and Fannie were quasi-governmental from the beginning, which is part of the problem. The federal government should never have been involved in the mortgage guarantee business in the first place. Not that anyone gives a crap whether the government adheres to its Constitutional limits anymore, but it certainly would have avoided a lot of problems.
Pirate Jo at September 16, 2008 6:59 AM
Good grief. Blaming the free markets for the current turmoil also made my head spin. George Bush wanted every American to have a home. The US is now living the consequences of his meddling.
Charles at September 16, 2008 7:03 AM
Charles, no.
The "free market" does not exist in housing. It's regulated within an inch of its life.
It's the regulation in this case that CAUSED the problem. Or, rather, the THREAT of regulation.
Activist groups like ACORN were "concerned" that not enough minorities were getting mortgages. They threatened banks, they petitioned Congress, and the banks came up with new ways to give out mortgages.
Which led to the realtors pushing people to sell houses for more than they were worth, and con people into buying more house than they could afford.
The realtors and the mortgage brokers had a symbiotic relationship going.
As a result, millions of people of all racial backgrounds that had no business buying houses (or at least the houses they bought) wound up under water.
Which is, of course, somehow the fault of George Bush. Not.
In a nutshell, the way this went down was mortgage brokers lying to mortgage banks that couldn't be bothered to do due diligence on the loans they were making. The mortgage banks then sold these mortgages to remortgage outfits. Some of the larger ones bundled all the mortgages together, understating the risk of the worst of them, and sold them as "mortgage backed securities" (CDOs). Others (FNMA et. al.) bought the bad loans and never bothered to report the risk, and the shareholders relied upon an implied government guarantee that the loans would be covered. Companies like AIG and Bear-Stearns bought these CDOs, and FNMA stock.
And when the shit hit the fan, and all these mortgages started to be defaulted on (especially when they adjusted from their "teaser" rates) the investments that Bear and AIG made wound up falling faster than a Milken bond issue.
Which is where we are today. Three investment houses fail in six months time, a major insurer derated, and banks failing all over the place.
Because of liberals.
brian at September 16, 2008 7:23 AM
Exactly, Brian. And the liberals are still scrambling to place the blame anywhere else but where it belongs - on themselves. The problem is that while Activist groups like ACORN were "concerned" that not enough minorities were getting mortgages, and they threatened banks, they petitioned Congress, and the banks came up with new ways to give out mortgages, the reality was that the people that were given these mortgages really shouldn't have gotten them. In the real world, they were far from qualified.
Flynne at September 16, 2008 7:39 AM
If the tax credits are going to offset the new taxes for virtually all employees, how is that "new tax" going to fund the system for non-employees? Who is the money coming from?
Diane at September 16, 2008 7:48 AM
T's Grammy, the New York plan as you describe it sounds pretty lousy.
Read Amy's post again, though. Every single one of the problems you mentioned is not an issue with the proposed plan.
brian, it's a plausible story you tell about ACORN, etc., but do you have any hard evidence to back it up? I mean about the lending institutions actually acting based on their pressure and those actions actually leading to x percentage defaults. I don't doubt the pressure was there, but I'd like to see documented and quantified cause and effect.
Shawn at September 16, 2008 9:03 AM
Good grief. Blaming the free markets for the current turmoil also made my head spin. George Bush wanted every American to have a home. The US is now living the consequences of his meddling. - Charles
Activist groups like ACORN were "concerned" that not enough minorities were getting mortgages. They threatened banks, they petitioned Congress....
While GW does bear some blame, Congress and activist groups were major players in getting this ball rolling.
These activist groups got passed into law various requirements (CRA, etc.) that so much new housing be "set aside" for sub-prime (dubious credit) folks.
Then they started calling honest credit evaluation "redlining" and threatening to sue banks for redlining minorities out of the housing market.
And banks didn't simply one day out of the blue "come up" with new ways to loan good money to bad credit risks. They were required by the government to find ways to do so.
Once "regular" folks discovered they could use these programs to purchase a more expensive house than they could sensibly afford, they got an Adjustable Rate Mortgage (ARM) and "moved on up." They were counting on their equity increases to outpace any rate increases. They figured they could sell or refinance in two or three years. Little did they know....
When Fannie and Freddie kept purchasing these loans, banks got greedy. Underwriting standards went out the window. Oversight of mortgage brokers (never very thorough) was thrown out the window in the rush to make money.
Cost reduction efforts had already eroded what were frighteningly minimal applicant verification requirements (calling an applicant's employer, reviewing past tax returns, etc.). These requirements were further reduced to the point that "stated income" was acceptable. Anything to get that loan through and on to Fannie and Freddie.
Brokers saw they could get anything through the express underwriting ("paperless") system. They went from discouraging full disclosure on loan documents to encouraging outright fraud.
Fannie and Freddie, of course, were required by the government (again by activist-backed regulations) to purchase these dubious loans as if they were solid.
Seeing there was lots of money to be made, Wall Street got in on the act with mortgage-backed securities. With the fiction that they were backed by hard-working people who would eat Ramen noodles and walk to work rather than default on their house, these securities were the hottest thing on Wall Street.
When the economy hiccuped and interest rates went up, the ARM rate went up, and the bottom fell out.
Sound familiar. It's the dot-bomb all over again.
Conan the Grammarian at September 16, 2008 9:31 AM
> Because of liberals.
1. Preposterously, comically reductive.
2. Given your personal conduct, you are not to be trusted in discussions of health care finance, even as regards ancillary topics.
Crid [cridcridatgmail] at September 16, 2008 9:40 AM
Amy-- try to get a hold of someone in Pete Stark's office. He used to be a banker, and is active on those committees.
KateCoe at September 16, 2008 9:51 AM
Yeah, Crid, but what about what Conan just posted? Seems Brian might have gotten it somewhat right, this time. I mean, if it wasn't the liberals outright, well, Conan's "activist-backed regulations" seem to fill the bill, eh? o_O
Flynne at September 16, 2008 9:53 AM
Amy,
I think you might ask, "Why does anyone pay taxes on their health care costs?" I think that's just as valid as asking why you have to, and other's don't. When I worked for myself, I was pretty annoyed that I couldn't deduct my health care costs.
Some of us pay no taxes on our housing, and others do.
Sometimes we pay tax on food, but not at other times.
The tax system is pretty crazy. The health system is even worse in how its been tossed together.
The complaint, as I understand it, of the McCain proposal, is not the taxes themselves, but how the refund changes over time.
Healthcare costs are expected to rise much much faster than the refunds that will change with COLA (I think.) The end result is thought to be to destroy employer provided healthcare. I actually agree with that end for other reasons, but if that's the desire result, the Straight Talk candidate should come out and make that proposal and not claim otherwise.
About ten years ago, I spent a week in an ICU. That cost $50,000. In two days, I plan on spending $200,000 in healthcare costs. Because I work at a company that has a) unions and b) 150,000 employees, my costs (apart from about $70 in copays, and time out of work) are going to be precisely zero. Though I am not unionized, I am positive that my engineer's health care plan uses as a minimum the benefits of the unionized assembly line workers and our mechanics. And since we are 150,000 strong, we've got a big group, and a lot of buying power. That will go away, if the financial incentives are such that companies ditch health insurance and make everyone find their own, which I am told, but have not verified, is the basic end result of the McCain plan.
I grew up in the Kaiser System, I have used completely independent doctors, and now I am part of an HMO/PPO where there are many many outside referrals. All I see now is paperwork and enormous staffs dedicated to processing paperwork.
Independent doctors used to have on secretary and probably no nurse. I haven't seen anything on that scale for a decade. Now everyone has two or three people at least just to process all the extra paper.
I'd like to see those costs go away, and that's one reason I favor a more universal system. I do want to get it out of the employer's hands, mainly because I think it will make our companies that much more competitive with their offshore counterparts.
(Anyway, I owe unions, and those people who have gone out on strike, tons and tons and tons, and I've never been a member.)
jerry at September 16, 2008 10:04 AM
crid:
Yeah? Show me the conservative that supported the idea that the banks oughtn't check up on the people they were loaning to in the name of "diversity".
crid:
Fuck you.
brian at September 16, 2008 10:22 AM
Brian,
I'm almost insulted at you insuating that I am a liberal ;) Of course the market is too highly regulated. And of course the mortgage brokers and banks were all passing the buck and putting people into houses they could not afford and then securitizing all that crap and selling it to investors. Liberals organization such as ACORN are also a big part of the problem The Republicans however, were doing everything they could to drive homeownership to new heights in the US through Fannie and Freddie (do not forget the huge part these two institutions played in this). I don't think its all liberals (although they usually are the most economically inept) ... it's politicians trying to "help". As I've said before, I believe very few politicians really believe in free markets. They believe they know better ... and then make us suffer the consequences.
Charles at September 16, 2008 10:28 AM
Here’s an opinion piece from City Journal published in 2000 - after the CRA was "strengthened" in 1995 and before it was again "strengthened" in 2005.
http://www.city-journal.org/html/10_1_the_trillion_dollar.html
Conan the Grammarian at September 16, 2008 10:33 AM
Here's an editorial from February 2008 on the mortgage crisis by an economics professor at UT-Dallas, published in the New York Post:
http://www.nypost.com/seven/02052008/postopinion/opedcolumnists/the_real_scandal_243911.htm?page=0
I especially liked the quotes from the Countrywide CEO on relaxed underwriting standards.
Conan the Grammarian at September 16, 2008 10:38 AM
Charles:
That's simply untrue.
The top five recipients of Fannie and Freddie's largesse (whether organizational or at the employee level) are all Democrats.
Dodd, Kerry, Obama, Clinton, Kanjorski (all Democrats).
16 of the top 25 are Democrats.
Also - Clinton signed the repeal of Glass-Steagal.
Republicans? No. Liberal Democrats all.
This is what happens when you replace financial risk management with political risk management.
brian at September 16, 2008 10:40 AM
Shawn, I did read it.
I'd get a $2,500 credit. I don't have any idea what my employer pays for my health insurance so I don't know if this would make up the difference or not. I do know they get a group rate which means if I went after my own instead, I might pay more. (This is what's stopping me now.)
The New York plan talked about other benefits but c'mon when it really comes down to it, how can you say tax one non-cash benefit and not another. Even if limited only to health insurance, it'd be less in my pay unless I played around with my deductions and that could land me in trouble. I just can't afford to take that kind of hit in the wallet.
Ummm, did I mention that I am not CPA material? Because my finances are simple as hell, I do do my own taxes but that's because I've only my pay as income and no deductions to speak of.
This could get real complicated real fast and raises more questions than solutions. How is the monetary worth of the benefit determined? What my employer pays in a premium (and since it's most likely a group rate how does that divide out over my employers thousands of employees, do single employees only covering themself get the same "income" assigned as those with family coverage even though they actually derive less of a benefit) or the money I save at the doc's office and on prescriptions, etc.?
Since you probably can't call one benefit income and not another, what about sick leave? Is that income based on my pay when I accrue it or when I take it? If it's the later, it's gonna encourage sick leave abuse since it'd be a lower rate before a pay raise goes through. And I also get vacation and personal leave. What about my pension plan? My dental? My eyeglass? Hell, I even get my monthly buss pass at a reduced rate through the union. Should I get taxed on the difference?
And, in effect, wouldn't being taxed on job benefits make them fairly worthless? I'm sorry but I took a job where I did because of them. If I've got to pay for job perks that employers use to lure people to work for them instead of someone else, they become meaningless. Frankly, if I get taxed on them, I'm better off taking a lower paying job or cutting down to part-time. Shoot, tax the fucking hell out of me then. Good luck.
Seriously, this could get crazy quickly. Wouldn't it be easier to just maybe offer some kind of credit to the self-employed or those buying their own? Instead of taxing us for job benefits? Again, I'm no CPA but aren't the self-employed a business? Don't they have all kinds of credits and deductions as such? Amy, as a free-lance author don't you get to deduct part of your rent as office space, for instance? Seems to me it'd be simpler to give you a tax credit for buying your own insurance. But if we want to say how come I'm taxed on insurance when you're not, in that respect, the self-employed get credits I don't. I don't care just saying...
T's Grammy at September 16, 2008 11:04 AM
TG - they already DO offer a tax credit for self-employed people who buy insurance.
But for a number of reasons, I can't get the same insurance you can.
And your employer gets a 100% tax break on the money they spend on your insurance bennies. That's on top of you not paying taxes.
Of course, this leads to other problems, like being unable to price to risk, or offer "a la carte" insurance.
What we get is one size fits all, gold-plated health insurance plans for everyone in employer-provided plans, and a choice between gold-plated and nothing for everyone else because there's no economic incentive for the insurance companies to even think about offering anything better.
brian at September 16, 2008 11:16 AM
Because of liberals.
No. It is the result of people who couldn't get mortages complaining enough, liberals, conservatives and folks in between. It is the result of (mostly rather conservative) greedy lenders who believed that they could actually cash in on this. I didn't see a lot of republicans fighting against allowing lenders to use declared income (not many dems either).
Mostly, this is the result of fucking morons who actually believed that the housing market would just continue to inflate indefinitely. Everyone who fell for it figured that they could manage to get theirs and move along. Don't make enough to cover a potentially higher rate, no problem - by the time it goes up the value of the property will have risen enough to turn a tidy profit when they have to sell. Only problem - prices inflated out of the range of folks looking to buy a home to, you know, actually live in.
This fiasco was brought to us by every fucking moron who thought the bubble would never burst, or figured they could get out before it did. They thought wrong and the economy in the U.S. has taken a tremendous hit. So don't blame the liberals, it was every fucking moron's fault.
DuWayne at September 16, 2008 11:34 AM
As far as healthcare goes, I am of the belief that every cent one spends on it (whether insurance, co-pays or out of pocket) should carry no tax burden.
DuWayne at September 16, 2008 11:38 AM
DuWayne - While you haven't said anything incorrect in the near term, the removal of Glass-Steagal and the pressure from interest groups to increase lending to underqualified (and unqualified) people that led directly to the vultures descending upon the carcass.
Too many vultures, not enough carcass, and the vultures die off.
Which fucks everyone. Especially those of us who borrowed prudently.
brian at September 16, 2008 11:45 AM
Actually, unless we try to bail everything out, it will be a great boon to me. The housing market inflated way out of my reach - this could actually make it possible for me to buy a house.
You should also note that one of those "interest" groups was the mortgage industry lobby. Not exactly a bunch of raving liberals them. It is just plain silly to try to peg this on liberals. It's not like there were any more republicans railing against it, than there were dems.
I have two sibs who were mortgage brokers in Michigan (they had to get out before the bubble really burst, being in Michigan). Believe me, it wasn't liberals trying to get more than their income could cover. And the hundreds of lenders they dealt with, well they were happy to write the loans. Nearly all of them supported legalizing declared income.
And the folks who lost their asses, well they hit the spectrum too. Equal opportunity morons to boot. I have worked for a number of fix 'em and sell 'em kind of guys, most of whom buy houses for cash, out of foreclosure. It is mind boggling, the number of people who are literally days from the deadline, who refuse to sell out (usually in a deal that leaves a couple grand in their pockets), believing in the miracle that will let them keep their homes. Meanwhile they don't rid themselves of the sexy car, big screen tee vee and other sundries they couldn't afford but bought with the house.
DuWayne at September 16, 2008 12:01 PM
Especially those of us who borrowed prudently.
Brian, didn't you forego paying for healthcare in order to "borrow prudently" and buy a bigger house?
Conan the Grammarian at September 16, 2008 12:10 PM
That's a good point, but based on my experience (I paid about $1,600 over the last year for my health insurance) and the numbers they're claiming in the article above, you would have to be a bad risk before you would exceed the $2,500/year cost. That's where the state-funded programs would need to kick in and of course the devil is in the details. It's pretty simple. They just pass a law that says so. I think it would be more fair to tax all money that an employer spends on an employee equally, but that doesn't happen now and there's nothing in the proposed plan calling for it.
I'd be shocked if any of this actually happened, so if I were you, I wouldn't worry too much.
Shawn at September 16, 2008 12:32 PM
No. I pay cash for my health care. I am not paying for "health insurance" (scare quotes because it is no such thing). Buying a house was not my primary reason for doing that. Not being interested in having my wallet hoovered to the tune of 2,000-4,000 dollars a year for a mostly useless product was my primary reason.
I don't have flood insurance either. Why? Because it's highly unlikely that I'm going to end up with a flood problem, so why pay massive rates for a useless service?
brian at September 16, 2008 1:09 PM
It seems to me that if we want to fix the system, and make health care affordable and easily accessable to the greatest number of people, we need to apply a little common sense to it.
First: Healthcare is EXPENSIVE.
Second: We expect INSURANCE to pay for it.
Third: Healthcare is expensive because those charging these sums know that Insurance companies have DEEP POCKETS.
See how that works, the people we expect to pay, have alot of money, so care providers don't have to bat an eye at charging 200,000 dollars for a week of bad food and a few hours a day of some form of treatment.
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First: Insurance companies are COMPANIES, not CHARITIES. Their goal is to make money.
Second: Because care is costly, it is in their best interest to offer as little of it as possible, and restrict who they will insure, to limit potential costs.
See how that works, the people we expect to pay are expected to pay alot, so in order to make money, they must find a way to pay for less...unfortunately leaving us high and dry.
Third: Because these 6 conditions apply to all insurance companies, all resort to similar tactics to maintain profits, employment, expansion, and so on, this means the normal free market forces of quality of service to higher profits are effectively neutered. Too, because the "service" in question is something only used on occurance of unfortunate events, there is no way to vett whether or not a company is doing as it should or not. Thus limiting another normal free market force that affects most other industries.
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Solutions:
My first impulse is to generate what I call "artificial competition".
Create individual city run hospitals, with greatly reduced costs, compliment that with low cost insurance through the city which offers substantial care in simple plans for children, adults, elderly, families, working, not working, etcetera. In this way we force market forces to come back into play, insurance companies & private hospitals will both be compelled to respond to the market change...or go under.
Why at the city level? The reason is simple, it is much easier for a city to eliminate a program, make changes, and adapt, than it is for the federal government to do so. Too, Federal involvement will probably mean Federal control, which removes by nature, the control from the people it is meant to support.
How does one staff such a system properly? Old saying that I like...it goes, "Borrow from success." The army uses as one of its enlistment incentives, the offer to pay for 75% of student loans in trade for a certain number of years service.
Why shouldn't cities make a similar offer to highly qualified graduates from nursing or medical schools?
Draw the talent...provide a place to put it into practice, provide competition, create market forces that, properly regulated, will ensure the greatest good for the greatest number, and keep it in the hands of the people most directly affected.
YES this would mean an increase in taxation in most places, but I should think it would be modest compared to the cost of paying for a massive federal system spanning 50 states.
(For that matter, one could change "city" to "state" and lose very little from the suggestion)
Seems like it might be better than things as they are presently.
Robert at September 16, 2008 1:21 PM
Brian,
I am too incompetent with computers to link you up with some relevant quotes (from Bush and a few WSJ articles) so for now I will simply agree to disagree ...
Charles at September 16, 2008 1:50 PM
The issue of whether Republicans or Democrats are to blame for this mortgage crap seems like a side issue to me. I keep getting hung up on something that 'brian' alludes to:
"Too many vultures, not enough carcass, and the vultures die off.
Which fucks everyone. Especially those of us who borrowed prudently."
I'm one of those carcasses who borrowed prudently, but I have this idea that we are still in the majority. I don't know anyone who is losing their house - when I look around at friends and co-workers, everyone is still making their mortgage payments. Please tell me if I am wrong, but aren't the people defaulting on their mortgages still a very small minority of the total mortgage population?
When I hear the horrible reports about what the average household credit card debt is, I start to think maybe there really ARE just too many morons, but that's still an average. Nine people with a zero balance and one person with a $100,000 balance still average out to $10K in debt per person. And for all I know, maybe the guy carrying $100K makes enough money for that.
Anyway, I am wondering how the (what I perceive as) small portion of the people trying to get mortgages and not qualifying managed to wield such political power. Clearly, as Flynne says, they never should have gotten a mortgage in the first place. Someone should have told them 'No.' (Or 'NO NO NO NO NO!') How about with a 'But maybe, if you keep your job, pay down your debts, save a down payment, and improve your credit rating, you can talk to us again in a year,' added at the end. Or maybe a 'Move to the Midwest where houses are affordable and buy a house there.' I could go on.
But I'm gathering that a small, noisy little group of people, who don't like being told they aren't entitled to something, managed to overhaul the entire free market process and get the government to step in and fuck things up for all us hard-working carcasses on their behalf. Is that this 'ACORN' group I've heard mentioned?
Having seen this process work in other areas of my taxpaying life, I am still missing a vital link somewhere in the middle of it.
Pirate Jo at September 16, 2008 4:37 PM
11 Simple rules for staying out of debt.
Rule 1: If you can't afford it...don't BUY IT.
Rule 2: If you can afford the best...but the 2nd best is plenty good enough...buy the SECOND BEST.
Rule 3: Have money automatically removed and put into a savings or investment account. If you never see it, you get used to doing without it.
Rule 4: If you want an big vacation, earn it by saving up for it, if you're filling out a loan application so you can afford your vacation, NO NO NO NO NO.
Rule 5: Keep your credit card limit minimal, 3-500 dollars, for holidays, birthdays, and the occasional treat for yourself, in short, a limit you can pay off quickly and easily.
Rule 6: Don't pay someone ELSE'S bills.
Rule 7: Don't date someone deeply in debt, its like putting a millstone around your neck and jumping in the ocean. Bad habits spread.
Rule 8: Don't date someone with poor life skills, that's a love that won't last. See rule 7.
Rule 9: A dream house is rarely bought at 22, if you want it that badly, start saving then, not shopping.
Rule 10: You don't need as many credit cards as fingers...unless you're missing 8 fingers.
Rule 11: Pay for clothing...not the name on the clothing, nothing wrong with generic brand anything.
Robert at September 16, 2008 5:12 PM
PJ -
What I'm alluding to is the idea that somehow we prudent borrowers are going to be taxed more heavily to bail out those who were imprudent.
This is, we are told, preferable to them being forced out of the house they've become attached to and going back to renting.
Which is, of course, bullshit.
To answer your quandary about the missing step?
1) Find a statistical fact about a socioeconomic group.
2) Form a group to attribute that statistical fact to the actions of a second group.
3) Petition the Congress for retributive justice.
4) Complain that the consequences are further proof of the second group's continued oppression of the first.
5) Profit!
In short, we are to be punished because of perceived racism in the banking system. And when the people who fell victim to the shysters and hucksters lose their houses, we are to be blamed again for taking advantage of them, on account of we're all racists.
brian at September 16, 2008 5:59 PM
> Fuck you.
Aw little feller, I just think that if you're gonna to sit at the grownups table while they talk about responsible car ownership, you shouldn't interrupt with tales from the tricycle set, e.g.:
> we prudent borrowers are going to
> be taxed more heavily to bail
> out those who were imprudent.'
Too ironic to be believed
Crid at September 16, 2008 6:06 PM
Pirate Jo -
They are still a minority, but becoming a larger and larger minority by the day. I highly recommend that you check out the foreclosure auctions - you will be surprised at the numbers. Keeping in mind that this happens every month (weekly in some locals) and is not representative of everyone who has lost their house to foreclosure. Most states make it really easy for buyers to come and buy your house out of foreclosure - which doesn't save one's credit entirely, just keeps them from totally fucked.
It doesn't take a much of a minority to really fuck things up and this is becoming more than a small minority. Millions of people are in foreclosure. Even here in Portland (which has fared better than most places), there has been a significant spike in foreclosures - most notably among the very high end home owners.
DuWayne at September 16, 2008 6:43 PM
Shawn, let's see: 51 in a few months, overweight, high blood pressure, high colesterol, osteo arthritis in both knees, plantar fascia and heel spurs on both feet, and one operation so far to remove a colon polyp that has left me with digestive problems since (and healthy food gives way more problems than the crappy stuff, ironically; fiber damned near kills me). And a family history of heart disease, cancer, diabetes, Alzenheimer's, mental illness and glacoma. Yep, think I fall into that damned high risk category. Also, my point was that once they institute taxing an obvious benefit like health insurance and succeed in doing so, the next legislation they hit will be other job benefits.
Brian, how'd you like being me? Screwed either way. Taxed to bail out mortgages I can't get for fools that should have been denied but really screwed as a renter for the foreclosures that do happen creating a supply and demand problem in the rental market that's making rents soar.
DuWayne, I'm keeping a real eye out for those auctions. My city gives them on a regular basis and I may just try and pick up something on the cheap for cash. I've known people who have picked up a house for $1 that no one else wanted. Problem there is I do not have your handyman skills and it would wind up being a round-about way of qualifying for a mortgage as I'd have to put the house up to get a loan to hire people like you to do the work bringing a house someone poor enough to lose it (if they can't pay the mortgage or taxes, they sure as hell didn't maintain it properly) up to snuff. And I think I hesitate because I don't know if I'd be biting off more than I could chew with that. If I didn't hesitate because of not knowing expenses, I'd be one of those fools with an ARM in danger. One reason I've never got a mortgage is because I wasn't willing to go that route. But I'm going to be paying attention to auctions all the same.
Robert, we have a city hospital. Despite its bad reputation (I think mostly because it doesn't focus on touchy-feely but rather sound science), it's at least in the sense of being most up to date the best hospital in our area. (Even if that butcher of a surgeon who operated on me was some young pup on staff.) It is the only one in the area that has all the latest technology, equipment and ongoing education and is a teaching hospital. Don't know how its rates are compared to others in the area but it's still steep for anything. Something's got to pay for the latest and the greatest (they are innovative in this, people come from all over for treatment and a hotel was just built next door to accomodate families of patients). We also partially have the second half of your suggestion in New York. There is cheap insurance available through the State for kids and for the small businesses and I think they just extended it to families whose employers don't offer insurance. Not seeing it make a considerable difference in New York. Those free market forces still aren't coming into play. Good suggestion but it will only work if you somehow do away with those insurers and how's that gonna happen? It is a difficult, difficult question to address and more difficult still to resolve fairly to all concerned.
T's Grammy at September 17, 2008 6:02 AM
I don't like the idea. Why should we have to pay taxes on money we never see? Our company pays our healthcare as a perk to us. How is that the government's business? It's like wanting someone to pay taxes on the value of a company-provided car. They're both perks given to recruit and retain talent the company wants.
I have little sympathy for people without insurance. We all make choices in life. You prefer being a freelance writer? Great, you're living the dream. People punching a time clock don't get the same "set your own hours" perks you get, you shouldn't expect the same perks they have.
momof3 at September 17, 2008 7:52 AM
Amy Alkon
http://www.advicegoddess.com/archives/2008/09/16/i_pay_taxes_on.html#comment-1591092">comment from momof3You prefer being a freelance writer? Great, you're living the dream. People punching a time clock don't get the same "set your own hours" perks you get, you shouldn't expect the same perks they have.
I work, same as people who work for an employer. As for how I "set (my) own hours," yes I do -- which is why I work seven days a week. Last night at 10:30, I was sitting at a cafe writing my book -- after working from 5 a.m. to 5:30 p.m., and taking an hour and a half out to go to my French class before hitting the computer again. Why that should come with a punishment of more taxes than any other worker pays is twisted logic I can't get my head around.
Perhaps you can explain, with something other than envy for my independence, as to why I should be taxed more than any other citizen.
Amy Alkon
at September 17, 2008 9:50 AM
momof3 - your company (and you) DO pay taxes on that car.
Every mile you drive a company car that is for personal use is taxable as compensation.
If we are to tax people on "income", then we ought to tax ALL income equally.
Of course, in a perfect world the 16th amendment would be repealed, and the federal government would not be allowed to lay taxes upon individuals at all.
brian at September 17, 2008 9:51 AM
Amy Alkon
http://www.advicegoddess.com/archives/2008/09/16/i_pay_taxes_on.html#comment-1591107">comment from brianBrian to the rescue. Thanks so much for making that point. I wanted to, but I have pages to blacken in hopes of making my book deadline.
Amy Alkon
at September 17, 2008 10:15 AM
There just has got to be a better way.
I just got off the phone with my daughters' doctor's office. I called to make "wellness appointments", i.e. yearly physicals. Number 1 volunteered at the VA Hospital this year, so she had a TB test done in June, but, according to her chart, hadn't had a physical since December, 2006. The intake nurse said, oh you have to get her in here before the end of the year. Insurance purposes, you know. I said, okay, when? Heh. November 24th. Okay she's set, now for #2. Seems she had her last physical in January this year, so she can't go in until January of next year. Insurance, you know, says the intake nurse. Yeah, I know. Then she told about how she went to renew one of her kids' subscriptions, and was told she "filled her quota for this year" and now either had to pay out of pocket or forego the child's medication! Of course, she paid for it, but it's still frustrating.
Flynne at September 17, 2008 10:45 AM
Look, our governmental finances are in the shithole, and the taxes have to come from somewhere. Taxing benefits seems as likely a place as any to get a little extra pocket change.
But if that's what McCain wants to do, he shouldn't go around and say that his opponent is going to tax the middle class, but he isn't. That's what this tax is... a tax on the middle class. So it's very dishonest for McCain to talk about how much tax lowering he's going to do for us, when he's actually going to raise them.
NicoleK at September 18, 2008 5:42 AM
So if a company provides season tickets to the Met as a perk, is that taxable as income? If so, that sucks. And if not, why should healthcare be different than box seats? If a company thinks I'm worth paying that for, they should be able. I shouldn't have to pay for it.
momof3 at September 21, 2008 2:48 PM
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