Politicians trumpet that they are only taxing stingy businessmen, who should be offering health care as a matter of simple morality.

Employees Receive Health Insurance Or Cash

The message from the main stream media is that "capitalism" has led to stagnant or even lowered take-home pay, while it is really the government which taxes employment as much as it can.

Government has the nerve to charge businesses 5% of wages for "unemployment insurance". Workers don't figure out that all wages are 5% less to pay for this tax supposedly on employers.

Social Security is supposedly only 7.65% paid by the worker and 7.65% paid by the employer. Wages are 7.65% less to provide for the employer's part. Workers are paying the full 15.3% taxed by the government, half in declared taxes and half in lower wages which they never receive.

The IRS and the Obama administration are scrambling to interpret ObamaCare so that it doesn't lead to massive layoffs and business failure. The government cannot indirectly force employees to pay much more for health insurance. Employees end up paying almost all of the increased taxes and penalties supposedly placed upon employers. The employee is fired if he cannot pay, and the business fails if it needs those employees.

Taxes supposedly on employers from employing people are almost entirely paid by decreasing the wages offered. If the employer increases the price of its product, then the customers pay part of the tax, and the employer usually sells less product and fires some people. If the customers will not pay more, and the employees will not work for less, then the business fails and everyone in the company goes out of work.

EasyOpinions

I used to joke that I should go see the vet instead of my regular doctor. When I take my cat in, the vet is very friendly and excited to see him. When I go to see my doctor, it's like, "Ugh! It's you again!"

The key to the contrast is the cost-hiding.

For many Americans, generations of health-care-by-insurance, coupled with gold-plated insurance in which they are entirely insulated from costs, has lead to 'insured' health-care as a way of life. Around here (Detroit) we all know many people in this category - workers and retirees from the Big 3 who have never spent a dime out-of-pocket on their healthcare, and so consume massive amounts of it. In this environment, costs can only rise, and the quality of delivered care can only fall.

By contrast, my large-animal vet is keenly aware that every dime she bills is coming out of my pocket, and that there are other vets in town. And so she comes the same day - or night - she does top-notch work, and she engages with me frankly about costs and benefits. When a horse is cut, she doesn't reach for the cheap-and-easy staple gun - she threads up a needle and puts in tiny, delicate stitches that will ensure that there is no scar. Horse owners demand this, and they're paying the tab. Why do we let ER physicians mutilate us with a Bostitch stapler? Because we're not paying for it, that's why.

The US healthcare system will not get itself onto a better path until it breaks the Gordian knot that is the 'insurance' model. Car insurance doesn't cover brake jobs and oil changes - why do we expect health insurance to cover flu shots and contraception? But that knot will be a long time a'breaking - too many people are too-heavily invested in the current model, both as consumers and as providers.

llater,

llamas

How about shop around for a doctor who's not so busy. Doctor businesses are like other businesses. Some are long established and/or very popular and are booked solid for the next three months. Others are new or expanding and are accepting new customers now.

Try getting into any sort of pediatric specialist's office - minimum 2 months unless you are DAMNED lucky and call 2 seconds after somebody cancels or when the new month's schedule goes up. For this reason, many only allow bookings a few months out or they will NEVER see new patients.

Of course, my primary's office is pretty good. They have several PAs who can handle the "do I have strep" type problems and free up the doctors a bit.

"Why, Until Recently, Ari Armstrong's Cat Got Better Medical Care Than He Did"

Simple: he paid for it. If you don't pay, you have no say!

"How about shop around for a doctor who's not so busy. Doctor businesses are like other businesses. Some are long established and/or very popular and are booked solid for the next three months. Others are new or expanding and are accepting new customers now."

In my town (50,000), there are exactly TWO medical providers - one is a huge clinic that was just swallowed up by the equally huge hospital and the other is a teaching clinic staffed by rookie doctors still learning and practicing on guinea pigs...I mean patients. We do not have the luxury of "shopping around." If you want to shop around, you have to drive anywhere from 50 to 200 miles. Plus you are penalized by your insurance if you use an out-of-service provider even for non-routine visits. I routinely pay an extra amount to see a specialist, whom I was referred to by my primary doctor, who's practice is 2-1/2 hours away.

Because we conflated healthcare with health insurance, we turned healthcare into a bureaucratic nightmare of legal issues, paperwork, and assembly line medical care.

How did we get there?

In 1973, the Health Maintenance Organization Act, sponsored by Ted Kennedy, was passed. The Act required employers to offer an HMO as an option in their health insurance plan offerings.

Conceived during the Nixon Administration as a response to escalating healthcare costs, the idea behind the HMO was that covering preventative care would reduce long-term costs through early detection of diseases.

It didn't work. People started using medical care more often and for routine ailments (colds, joint aches, rashes, etc.) that used to treated with OTC medications. Costs, which the HMO was supposed to lower over the long run, increased at a more rapid rate than before.

Even worse, the HMO created an expectation in people that their health insurance would cover routine medical treatments for those minor ailments with the same low co-pay charged for tests and specialist visits.

Health insurance providers created networks of hospitals and doctors to try and control costs. They bought hospitals and set up large medical clinics to vertically integrate the provision of healthcare (Kaiser, Humana, etc.), hoping the economies of scale would help lower costs.

Health insurance became less an actual insurance policy and more a comprehensive healthcare management program. Costs started going up because the company was now paying for sniffles as well as surgery. So, premiums started going up. And people panicked. And Obamacare was born.

Unfortunately, Obamacare took the cost escalating closed-loop sniffles-to-surgery assembly line medicine delivery model and encased it in government-hardened bureaucratic cement.

Kima, there's a saying that covers your and many others' situation: it sucks to be you. No medical facility is required to move to be near you - it sounds like you should move to be closer to a good doctor.

There is a national insanity: talking about health care CANNOT make it happen for everyone. Period.

"Because we conflated healthcare with health insurance, we turned healthcare into a bureaucratic nightmare of legal issues, paperwork, and assembly line medical care."

Have you noticed that nobody wants to say what is actually required to get health care? Doctors have to be paid. If you do not do that, no one is going to be treated. This applies to imaging centers and their technicians, PAs, nurses and the associated professionals. People with their hand out for your money do not want you to notice when your money goes to those who do NOT treat you!

Like a government agency.

Being one of the small minority of Americans who've always lived within 100 miles of an urban center I've been fortunate to have never experienced the brokenness of the American healthcare system. I guess I am out of touch with the experience of the vast majority who live in small towns and sparsely populated rural areas where healthcare choices are few and access limited.

I guess I am out of touch with the experience of the vast majority who live in small towns and sparsely populated rural areas where healthcare choices are few and access limited.

Switching over to Obamacare is not going to suddenly populate those areas with doctors, hospitals, and medical laboratories.

Scarcity of those things is not a feature of a "broken" healthcare system, but of living in small towns and sparsely populated rural areas.

Ken R,

You are incorrect in your assumption that the "vast majority" of Americans live in rural areas. That was true in the past, but in 2000 over half the population lived in "urban areas" with population over 200,000.

http://www.fhwa.dot.gov/planning/census_issues/archives/metropolitan_planning/cps2k.cfm

Shannon - that's a super example of how little the people arguing about health care actually know about the nation, regardless of who runs it or a health care system.

I bet there are thousands of ordinary Americans who are blinded by glaucoma, not because of an inability to pay or even remoteness, but because they do not know it can be treated!