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奧巴馬的健保改革真是拿“富人”開刀嗎？
除了“富人”以外，誰不願意拿“富人”開刀？
奧巴馬和支持他的國會和媒體們每天向美國人民灌輸的健保改革方案標題都是讓“富人”給“窮人”保健買單。
這種馬克思主義的階級鬥爭哲學在今天的美國如此受到推崇，說明什麽問題？
我認為除了說大部分美國人民是一群白癡以外沒什麽可以解釋得更清楚的了。
相比之下，民主黨可以說跟黑道老大一樣，想怎麽樣就怎麽樣，看你們誰敢吭氣兒？
奧巴馬說，GIVE ME HEALTHCARE REFORM BILL NOW！怎麽樣，民主黨國會議員們屁顛兒屁顛兒地緊忙活兒。巨額赤字算什麽，這次是“富人”買單。
誰是“富人”？
按民主黨國會的提案，家庭收入$350，000。00，個人收入在$280，000。00的都是“富人”。
這也算“富人”？笑話！
他們是高收入者，但決不是“富人”。 這些人承擔著50%的聯邦所得稅負。把地方各種稅加一起，他們收入的50%到60%，全部被政府拿走。這些人很多是小業主，是美國經濟的支柱。
拿他們開刀會是什麽後果？
很簡單，一是破壞美國經濟的大動脈，二是製造通貨膨脹。在經濟衰退的大環境下，增加小主的稅負無疑是雪上加霜。業主要麽裁員,關門，要麽提高物價。裁員,關門就是增加失業，提高物價就會造成通貨膨脹。
但問題還不在這裏。
奧巴馬所謂的保健改革最根本的是個人醫療保險由誰來買單的問題。
有醫療保險，是你的權力(RIGHT)還是你的責任(RESPONSIBILITY)，這才是關鍵。
奧巴馬和他的民主黨國會認為，每個人有權力有保險。那麽請問，你有權力擁有的保險是你自己拿錢來買還是讓別人掏腰包？
你不認為你個人的健康你個人不該負責嗎？如果你願意買保險，你不認為你該自己掏腰包嗎？
我想，這個問題我們每個勤勞的華人都會說，自己的身體健康自己負責，自己的保險自己買。
很可惜，奧巴馬和支持奧巴馬的人不這麽認為。他們認為個人的健康要別人負責，自己的保險要別人掏腰包。
你會說，反正我沒那麽多的收入，這事兒跟我沒關係。
也許沒直接的關係，間接的絕對有。當你的醫生不接受你的保險，或你的病要等等再看因為看病的人太多的時候，當你無法選擇你的醫生的時候，您再說這事兒跟你沒關係，那就是掩耳盜鈴了。
再說，由政府管理的醫療保健事業有那個是成功的？ 政府照顧老弱病殘的MEDICARE和MEDICAID已經破產了你知道嗎？政府給退伍軍人的保健也要破產了你知道嗎？
有人拿加拿大的全民保險來跟美國個人保險來比，說美國落後，你聽說加拿大政府自己都承認全民保險失敗嗎？ 你知道加拿大人有人生病要來美國人看嗎？
當人把個人責任和權力混為一談的時候，基本上就是胡攪蠻纏了。當政客利用人們貪婪懶惰的心理，打著公平的旗幟要劫富濟貧的時候，正直的人民要問一個為什麽，要懷疑政客們真實的目的。
很遺憾，大部分美國人民對政治麻木不仁了，不了解也不關心了。就像一個俄羅斯作者寫的那樣，美國人關心的是明星們的八卦，而對華盛頓在侵犯他們真正的自由權力根本不關心。
當有這麽多好吃懶做的美國人和大量不納稅非法移民的存在，當政府懲罰有生產能力的人, 獎勵沒生產能力的人，這個社會是不會公平的，這個國家是不會有什麽競爭力的，這個製度是要土崩瓦解的。
很可惜，世界最強大的國家美國正在朝這個方向走。
更可悲的是，NOBODY CARES。
By 魯克
奧巴馬及其民主黨正在力推全民健保法案，不知道打算到美國看病的歐洲人如何想，據說這是美國曆史上最大的醫療改革方案，至少要耗資一萬五千億。眾議院議長佩洛西甚至驕傲地說，這將是一個“曆史性及轉變性的”時刻。
讓每位美國民眾擁有一份負擔得起的優質健保，不論他們的收入多少及健康情況，一切都交給政府計劃，讓政府保障你一切的健康隱憂。
奧巴馬確實夠“偉大”，在他任內居然要把醫療保險變成美國公民的基本權利。我想天堂裏的托馬斯-傑弗遜也要懊悔，為什麽當初不在《獨立宣言》的生命權、自由權和追求幸福的權利，補上醫療保險權。這樣兩百年多前，美國人就可以擁有健康保障了。而且當時，美國政府沒有這麽大的財政壓力，也不這如此巨額的花費，推行起來會方便很多。
奧巴馬象所有政府領導人一樣，認為自己政策是具有“前瞻性”的。他自以為這不僅防止了未來美國出現哀鴻遍野，改變了窮人就醫無門的狀況，而且他自以為果斷推行“碳限額交易”新能源政策，不僅可以拯救動物，植物，昆蟲以及看不見的微生物，而且可以讓地球重新煥發“青”春，人類從此不再擔心地球因為發燒發熱而自殺。
而且從搖籃到墳墓，即使是窮人也都可以享受到政府免費供應的 “全民健保”，這是一塊多麽也好用的成人“紙尿布”啊，那麽如此一來人們是不是就真的安全了呢？難道這一切都是天上掉的餡餅？政府免費贈送的午餐？
當然不是，一萬五千億誰來買單？奧巴馬競選時說給富人加稅，不給中產家庭加稅。他的確是給富人加稅了，比如全民健保草案對年收入逾百萬的人的所得稅增加5.4%，對“所謂的富人”（年收入超過28萬美元的人）也增加了所得稅。
那麽他是不是窮人期待的俠盜羅賓漢呢？除了對富人下手，他對窮人也沒有閑下手，隻不過把他們所得稅換成其他形式的稅費來盤剝窮人罷了。
年初，奧巴馬和民主黨掌控的國會通過了擴大SCHIP法案，大幅增加了煙草稅，把香煙稅增加到156%，讓煙民平均每包香煙多付六毛二。而受煙草稅影響最大的就是窮人。按照哈佛大學的經濟學家Kip Viscusi說法，香煙稅的承擔對象主要是窮人，根據九十年代的調查，年收入一萬元的比年收入五萬以上的人在香煙稅上多繳一倍的稅。而且，奧巴馬又在六月簽署了反煙的法案，授權美國食品藥物總局管製煙草行業，而這項計劃，估計在十年內會給煙草行業增加五十億的稅費，這些稅費最終恐怕還是由消費買單。
煙草稅是所謂道德君子眼中的“原罪稅”，但是即便提高了煙稅，並沒有證據說明，煙民會因此減少，而更多證據表明煙草黑市卻因此繁榮，黑社會的暴力事件因此而增加。
還有一個原罪稅就是給酒精類飲料稅，奧巴馬政府出台的草案包括了對酒類加稅，而且計劃十年內為政府征收六百二十億的稅收，甜飲料也在不例外，奧巴馬計劃十年內為政府增加五百二十億的稅收。但是，根據麻省理工以及全美經濟研究所的經濟學家調查，雖然這裏沒有明顯的對個人加稅，但是實行國民零售稅的政策，衝擊巨大的就是窮人，相當於加重了窮人的稅負。根據Tax Foundation的2001年估算，聯邦酒稅相當於給盤剝了窮人家庭0.37%的收入，中產家庭0.12%的收入，而對於較高收入的家庭隻相當於 0.02%。
（注:D. Feenberg, A. Mitrusi and J. Poterba, “Distributional Effects of Adopting a National Retail Sales Tax,” Tax Policy and the Economy 10 (1996).）
奧巴馬的政策有的不是直接加稅，但同樣加重了中產階級以及窮人生活的負擔。由眾議院通過旨在減少溫室氣體的奧巴馬新能源計劃將增加美國家庭的電費支出，根據國會預算局（CBO）的統計，平均每戶家庭每年平均多支出一百七十五美金。
而對於中產階級，那些年收入超過二十萬美元的美國人，奧巴馬還計劃將他們的兩項所得稅稅率分別提高至36%與39.6%，並限製部分可扣除項目的金額，例如取消因為慈善捐贈而抵稅的情況。這項計劃又將為聯邦政府十年內征收到兩千七百億的稅收。
加圖學者Michael D. Tanner說，奧巴馬的醫改等於給每個美國人增加了相當於收入的2。5%的稅。把所有由於醫改法案造成的新稅加起來，相當於給全美納稅人增加了5000多億的稅。
奧巴馬說要讓前總統布什實行的減稅政策2010年期滿後自動失效之外。而且，他另外計劃提高資本利得稅和公司稅。經濟學家斯維亞（John Silvia）指出，提高資本利得稅和公司稅，必然抑製外國資本流入美國，減緩經濟成本及減少工作機會，“如果外國投資者預期我們的稅率將會上升，他們在這個國家的投資，就不會像在預期不增稅的情況下那麽多。這不隻對華爾街來說是個壞消息，對整個美國都是。”
奧巴馬稅富勒貧的政策，猶如胡佛總統的在世。上世紀，美國就是因為胡佛各類加稅政策，造成美國投資銳減，民間百業凋零，資本大量湧入腐敗的官僚體係，美國經濟才從此一步一步滑向了經濟大蕭條。
by 標-尺-網
you got it!
民主黨真虛偽!
http://www.freerepublic.com/focus/f-news/2295751/posts
NO, NO, No! Obama's so call "rich" people who make more than 250k a year are including many small business owners, prefessional, doctors and lawyers. They are the people who work hard and study hard.
Most of rich people I know, my friends, are not born in rich. they are the ones habitually working more than 60 hours a week. They go to school until they are close to 40 yrs old, got doctorate degree and getting paid well. They are the ones getting married late and having kids late because they have to sacrifice they personal life to be successful.
It's not fair to take their hard earned money and give to someone else. Unless you are the one that is waiting for the Free Meals.
http://www.freeourhealthcarenow.com/
Being a Canadian doesn't mean you understand the health care system there better than any of American, just like they are too many idiots American here too.
I know quiet a few canadian doctors who migrated to United States. They think universal health care system may work in Canada, but it sure will not work as well in America. For example, in Texas, 1/3 of population is black, 25% of population is hispanic, and who knows how many more illegals are here. Most of them are under-educated and heavily depend on governement support. In Cananda, people are better educated and not as lazy.
Our tax payers are paying for food stamps, wigs, medicaid and medicare of those people already, why should we pay more?
Can you please read the author's article more throughly? It's the author who mistakely critized Canada's medical system first. As a Canadian who knows more about our own system than some ignorant Americans, I feel like to tell the truth.
Leave us alone, and we'll leave you alone.
Our boarders are so close. Some of our people go to USA to get medical treatments and tons of American seniors have crossed the boarder to buy medicines in Canada. There are also Americans who don't have medical insurance coming here for treatments and we helped them.
Don't take me wrong. I actually like Mrs. Palin who is so funny and make me laugh so many times. If you think her so high, you must wish your children have her IQ and go to the same or simiar level of college she went, what's the name? North Idaho College? who knows where it is?
If you are a canadian, then mind your own business and leave us along. We people here know how to decide what we want or what we don't want at our home. The last thing we want is a lousy healthcare system like yours. If your system is so "good", your politicians or rich people wouldn't have come US for healthcare,period.
BTW, don't mock Sarah Palin like your loony liberal US friends here, they just love to hate Sarah, because Sarah scares the sh*t out of them. Is Sarah your nightmare too??? Yikes!!
If you are a canadian, then mind your own business and leave us along. We people here know how to decide what we want or what we don't want at our home. The last thing we want is a lousy healthcare system like yours. If your system is so "good", your politicians or rich people wouldn't have come US for healthcare,period.
BTW, don't mock Sarah Palin like your loony liberal US friends here, they just love to hate Sarah, because Sarah scares the sh*t out them. Do Sarah is your nightmare too??? Yikes!!
It's not true that the government to tell the patient when to see the doctors. You can see your family doctor any time and the family doctor refers you to see specialists if needed. Depending on the schdule of the specialists and surgeons, patients may have to go on a waiting list, but it's fair to everyone, only the ones in imediate life-critic conditions can get ahead on the list.
My friend with lung cancer got his chemo treatment pretty quick. Some cancer patients who can afford to pay private doctors go to USA or Europe to get quick treatments or treatments with advanced/newest technologies some of which are not availabe in Canada. I am not wrong to say that those patients must have some money because those special cancer centers in USA are very expensive and not every middle-class American can afford it. And lots of company medical insurance may not pay for this kind of treatment. But it's understandable to get better treatments if you have the money. The public medical system takes care of the basic medical needs of everybody, but not in the most advanced form.
If Canada were a 3-rd world contry, like you called it, and all 3rd-world contries were like Canada, what a wonderful world we would live in. No war, no hunger, no Wall street.
Yes, Canada is a third-world country, Hongkong is a small city and Russia is a tiny picture looked out from Sarah Palin's bedroom widnow. And God bless USA, ONLY USA.
這也是為什麽我說美國人大部分是白癡的原因之一。
很遺憾，香港隻是一個小城市，跟美國能比的隻有美國。
奧巴馬的公立方案將使私人保險非法化，隻有白癡們像吸了大麻似的會擁護它
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT
When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.
It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage.
The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether."
What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.
The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.
With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed.
The public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.
Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives.
It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It's scary to think how many more breaches of liberty we'll come across in the final 1,002.
1. 雇主可以因為有全民保險而不給雇員提供好的private insurance。
2. 於是大家隻有兩個選擇： 去公立醫生那裏，或者自己掏腰包。
3. 對大多數中產階級來說，自己掏腰包還是負擔不起，隻好去公立醫生。
4. 於是中產階級和沒有收入的或是低收入的junkie接受同樣的公立醫療。
5. 公立醫院和公立醫生的醫療質量隻會隨時間而越來越差，因為你和低收入人群同樣接受近於免費的醫療服務，那些提供服務的人會覺得你跟領救濟差不多，既然是免費，給你差不多看看就行了，談何質量。而且這些醫生等於是給政府工作，懶散，低效，cut corners，各種問題都會出現。小病等三年，大病治不了。--我親身經曆過美國的私立保險製度，和另一國家地區的公立醫療製度，這麽說吧，公立醫療係統中我見到的誤診病例和各種frustration真比私立係統多得多。很多人並不知道公立醫療怎麽回事，就想當然的以為它好，支持它。不了解情況沒有發言權。
not true. cancer patients from Canada who can't wait any longer for the government to tell them when to see doctor come to US to save their life. No just some people with money.
As a canadian, you should know the socialism practice in your country is the key factor that makes Canada a third-world country in a second-world country cloth.
All big canadian business are making money in the US, not in Canada.
very good point, thanks.
thanks.
another misunderstanding case. Poor people has Medicaid from the Ferderal government and no hospital can reject any patient in life-threatening situation.
I don't think you have any idea about US healthcare system. For the poor and elderly, the Federal government has Medicaid and Medicare program. Please get your facts streight.
The problem is,Obama is so ambitions to get everything done (health care bill, enviornmental bill, education, carbon trade, etc) , not only the so call "rich people" has to pay more, everybody eventally has to pay more too.
the result is, bigger government, poor people. Geeze, that is just like chinese government.
everybody knows why health care cost has increase so much over last a few years: illegal immigrant! They are flooding in every major or minor hospitals in the states while we flipping the bills. oh no, they are the potential voters, Obama will only help them to get more health care coverage.
老美一開始寄希望於一張黑色的臉和它所代表的朝氣,把美國從經濟政治內外交困的泥潭中拔出來,還沒過6個月的蜜月期,他們就已經失望了.
奧巴馬不是救世主,那些聽到他當選時哭得亂期八糟的黑人,印尼人,韓國人,日本人都沒有意識到這一點.
===
奧巴馬當然也有道理:
1) "富人"賺錢多,也需要其他人的支撐...
2) 這些醫藥保險費比起打伊拉克的軍費比,是很少的! 支持應無問題.
Oops, you just proved yourself a brainless liberal.
Get a reality check before spewing nonsense. moron.
對沒錢看病人來說，可看病，比選醫生更緊迫，更需要。
Noso：你如果也是小業主的話，那一定是不給雇員健保福利的那種。知道其它小業主為什麽支持Obama？因為Obama帶給他們降低健保支出的希望。
BO is nothing but a radical S.O.B.
"有醫療保險，是你的權力(RIGHT,here using entitlement may more accurate)還是你的責任(RESPONSIBILITY)，這才是關鍵。
exact my point. thanks.
Thank you for sharing your story with us.
agree with you!
intersting point, can you explain more in detail?
The problem with the health care system now is too much regulation. my husband is a cancel survivor and he is very against the new "health care reform". people need to wake up and stop this country from spinning out of control!
美國有句名言：“ when you are 20's and you ain't a democrat, you have no heart. But when you are 40's and you ain't a republican, you have no brain. "
The sad thing in the US is that too many people can only see today and cannot see tomorrow, too many people believe in theory (which sounds good) even though this theory does not work in real like (look at Medicare & Medicaid!).
很有意思的觀察。
I have just one question for him:
who is going to pay for all this?
Before the U.S. Senate Committee on Commerce, Science and Transportation
June 24, 2009
Mr. Chairman, thank you for the opportunity to be here this afternoon.
My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick - all so they can satisfy their Wall Street investors.
I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand--or even to obtain--information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.
When I left my job as head of corporate communications for one of the country's largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry's charm offensive--which is the most visible part of duplicitous and well-financed PR and lobbying campaigns--may well shape reform in a way that benefits Wall Street far more than average Americans.
A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA's health care division was one of three industry executives who came here to assure members of Congress that they would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton's proposals, they said they enthusiastically supported several specific goals.
Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn't be here today.
Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.
The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ?benefit? ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.
To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later
To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.(1) The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.
They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether - leaving workers uninsured. The practice is known in the industry as ?purging. The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.
An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust's members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.
Purging through pricing games is not limited to letting go of an isolated number of unprofitable accounts. It is endemic in the industry. For instance, between 1996 and 1999, Aetna initiated a series of company acquisitions and became the nation's largest health insurer with 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to ?identify and dump unprofitable corporate accounts, as The Wall Street Journal reported in 2004.(2)
Armed with a stockpile of new information on policyholders, new management and a shift in strategy, in 2000, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna lost 8 million covered lives due to strategic and other factors.
While strategically initiating these cost hikes, insurers have professed to be the victims of rising health costs while taking no responsibility for their share of America's health care affordability crisis. Yet, all the while, health-plan operating margins have increased as sick people are forced to scramble for insurance.
Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer's premium dollars for care the year before.
It's little wonder that insurers try to hide information like that from its customers. Many people fall victim to these industry tactics, but the Houston employer might have known better - it was the Harris County Medical Society, the county doctors' association.
... A study conducted last year by Pricewaterhouse Coopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients.
There are many ways insurers keep their customers in the dark and purposely mislead them - especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage.
An estimated 25 million Americans are now underinsured for two principle reasons. First, the high deductible plans many of them have been forced to accept - like I was forced to accept at CIGNA - require them to pay more out of their own pockets for medical care, whether they can afford it or not. The trend toward these high-deductible plans alarms many health care experts and state insurance commissioners. As California Lieutenant Governor John Garamendi told the Associated Press in 2005 when he was serving as the state's insurance commissioner, the movement toward consumer-driven coverage will eventually result in a ?death spiral? for managed care plans. This will happen, he said, as consumer-driven plans ?cherry-pick? the youngest, healthiest and richest customers while forcing managed care plans to charge more to cover the sickest patients. The result, he predicted, will be more uninsured people.
In selling consumer-driven plans, insurers often try to persuade employers to go ?full replacement,? which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them.
Secondly, the number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance. The industry is insistent on being able to retain so-called ?benefit design flexibility so they can continue to market these kinds of often worthless policies. The big insurers have spent millions acquiring companies that specialize in what they call ?limited-benefit? plans. An example of such a plan is marketed by one of the big insurers under the name of Starbridge Select. Not only are the benefits extremely limited but the underwriting criteria established by the insurer essentially guarantee big profits. Pre-existing conditions are not covered during the first six months, and the employer must have an annual employee turnover rate of 70 percent or more, so most of the workers don't even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don't pay any of the premiums--the employees pay for everything. As Consumer Reports noted in May, many people who buy limited-benefit policies, which often provide little or no hospitalization, are misled by marketing materials and think they are buying more comprehensive care. In many cases it is not until they actually try to use the policies that they find out they will get little help from the insurer in paying the bills.
The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders--those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay--are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.
Thank you, Mr. Chairman, for beginning this conversation on transparency and for making this such a priority. S. 1050, your legislation to require insurance companies to be more honest and transparent in how they communicate with consumers, is essential. So, too, is S. 1278, the Consumers Choice Health Plan, which would create a strong public health insurance option as a benchmark in transparency and quality. Americans need and overwhelmingly support the option of obtaining coverage from a public plan. The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a ?government-run system. But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.
_____________________
1 Samuel Zuvekas and Joel Cohen, "Prescription Drugs And The Changing Concentration Of Health Care Expenditures," Health Affairs, 26 (1) (January/February 2007): 249-257.
2 "Behind Aetna's Turnaround: Small Steps to Pare Cost of Care," Wall Street Journal, August 13, 2004.
Thanks. FYI:
House Democrats on Tuesday rolled out a far-reaching $1.5 trillion plan that for the first time would make health care a right and a responsibility for all Americans, with medical providers, employers and the wealthiest picking up most of the tab.
The federal government would be responsible for ensuring that every person, regardless of income or the state of their health, has access to an affordable insurance plan. Individuals and employers would have new obligations to get coverage, or face hefty penalties.
Health care overhaul is President Barack Obama's top domestic priority, and his goal is to slow rising costs and provide coverage to nearly 50 million uninsured Americans.
Democratic leaders said they would push the measure through committee and toward a vote in the full House by month's end, while the pace of activity quickened on the other side of the Capitol.
Senate Majority Leader Harry Reid said he wanted floor debate to begin a week from Monday. Other officials said that timetable was likely to slip. Even so, it underscored a renewed sense of urgency.
The House legislation unveiled by Speaker Nancy Pelosi and other Democrats would slow the growth of Medicare and Medicaid payments to medical providers. From big hospitals to solo physician practices, providers also would be held to account for quality care, not just ordering up tests and procedures. Insurance companies would be prohibited from denying coverage to the sick. The industry also would face stiff competition from a new government plan designed along the lines of Medicare.
The liberal-leaning plan lacked figures on total costs, but a House Democratic aide said the total bill would add up to about $1.5 trillion over 10 years. The aide spoke on condition of anonymity to discuss the private calculations. Most of the bill's costs come in the last five years after the 2012 presidential election.
The legislation calls for a 5.4 percent tax increase on individuals making more than $1 million a year, with a gradual tax beginning at $280,000 for individuals. Employers who don't provide coverage would be hit with a penalty equal to 8 percent of workers' wages with an exemption for small businesses. Individuals who decline an offer of affordable coverage would pay 2.5 percent of their incomes as a penalty, up to the average cost of a health insurance plan.
With Obama pressing Congress to act on health care this summer, House leaders want to move their bill quickly through three committees and to a floor vote before the August congressional recess. But a group of moderate and conservative Democrats has withheld support, and no Republican votes are expected.
The House bill seemed unlikely to win broad backing in the Senate, where the Senate Health, Education, Labor and Pensions Committee was expected to finish its version of the legislation Wednesday in what was looking to be a party-line vote. Another panel, the Senate Finance Committee, was striving to unveil a bill by the end of the week.
Standing before a banner that read "Quality Affordable Care for the Middle Class," Pelosi, D-Calif., called the moment "historic and transformative." The bill would provide "stability and peace of mind" by braking costs and guaranteeing coverage, she said.
"We are going to accomplish what many people felt wouldn't happen in our lifetime," said House Energy and Commerce Committee Chairman Henry Waxman, D-Calif., one of the main sponsors. Obama, who issued a statement hailing the measure, plans to keep up the pressure on Congress by delivering remarks in the Rose Garden on Wednesday.
Speaking in Warren, Mich., where he was promoting new spending for community colleges, Obama anticipated a congressional confrontation over health care.
"There's going to be a major debate over the next three weeks," he said, deviating from his prepared text. "And don't be fooled by folks trying to scare you saying we can't change the health care system.We have no choice but to change the health care system because right now it's broken for too many Americans."
Separately, Obama spoke by telephone with Sen. Charles Grassley, the Iowa Republican viewed as critical to the fate of bipartisan negotiations in the Senate.
House Democrats said the income tax increase in their bill would apply only to the top 1.2 percent of households, those who earn about one-quarter of all income. The wealthiest 4 percent of small business owners would be among them. The tax would start at 1 percent for couples making $350,000 and individuals earning $280,000, ramp up to 1.5 percent above $500,000 of income, and jump to 5.4 percent for those earning above $1 million.
The tax would raise an estimated $544 billion over 10 years.
Business groups and the insurance industry immediately assailed the legislation. In a letter to lawmakers, major business organizations branded the 1,000-page bill a job-killer. Its coverage mandate would automatically raise the cost of hiring a new worker, they said.
"Exempting some micro-businesses will not prevent this provision from killing many jobs," the letter said. "Congress should allow market forces and employer autonomy to determine what benefits employers provide, rather than deciding by fiat."
The business groups also warned that the U.S. health care system could be damaged by adding a government-run insurance plan and a federal council that would make some decisions on benefits, as called for in the legislation. Thirty-one organizations signed the letter, including the U.S. Chamber of Commerce, the Business Roundtable representing top corporate CEOs and the National Retail Federation.
The House bill would change the way individuals and many employers get health insurance. It would set up a new national purchasing pool, called an exchange. The exchange would offer a menu of plans, with different levels of coverage. A government plan would be among the options, and the exchange would eventually be open to most employers. Insurers say that combination would drive many of them out of business since the public plan would be able to offer lower premiums to virtually all Americans.
But backers of a public plan ? including Obama ? say it would provide healthy competition for the insurance industry.
Under the House bill, the government would provide subsidies to make coverage more affordable for households with incomes up to four times the federal poverty level, or $88,000 for a family of four and $43,000 for an individual. Medicaid ? the federal-state health program for the poor ? would be expanded to individuals and families up to 133 percent of the poverty line. About 17 million people would remain uninsured ? about 6 percent of the population ? and half of them would be illegal immigrants.
The legislation also would improve the Medicare prescription drug benefit by gradually reducing a coverage gap known as the 'doughnut hole.'
The individual and employer coverage requirements would raise about $192 billion over 10 years, the Congressional Budget Office said.
Even before the bill was unveiled, the House Ways and Means Committee announced it would vote on the proposal beginning on Thursday. The panel is one of three that must act before the bill can go to the full House, probably later in the month.
Some House Democrats privately have expressed concern that they will be required to vote on higher taxes, only to learn later that the Senate does not intend to follow through with legislation of its own. That would leave rank-and-file House Democrats up for re-election next year in the uncomfortable position of having to explain their vote on a costly bill that never reached Obama's desk or became law.
by 2009 Associated Press.
您起碼有一天沒看報了吧，對了，我說的是英文報。: )
就您這破英文，免了吧。
受階級鬥爭學說流毒不潛啊。我就不信你有機會話不想當資產階級。
what a great quote! thanks!
thanks. : )
too bad, that's not my point.