Ok, little scenario for those of you who prefer us to stay with the insurance companies rather than universal, please let me know how the following is a business plan that is worth a damn.
We all remember I hurt myself a few months back. Worthless neighbors sat around gawking like a bunch of slackjawed hillbillies and insisted on me taking an ambulance rather than drive me. City of Houston has a set fee of $1050 for the priviledge of sitting in this vehicle(and recently has now added mileage). Submit my insurance info as my policy is supposed to pay 80%. Find out, the catch is that it is 80% of "Allowable" fees. Because the city wants only one set of rules, one set fee, the insurance company decided that they only allow $500, and therefor only paid 80% of what they deemed allowable.
I'm paying the insurance company to pay for these services, and the insurance company decideds what they want to pay, even if it comes back at my expense.
Seriously, how do you who don't want universal, defend a practice like this?
Why is this done in the first place?
(1) Blame FDR. Wage and price controls during WWII basically meant no raises for anyone who worked for someone else. People didn't like this and employers skirted these rules by keeping wages frozen but increasing in-kind benefits as a de facto raise (health insurance).
(2) Prior to the above, giving employees health insurance had started to become de rigueur among industrialists, particularly the Kaiser steel family (as in Kaiser Permanente and the Kaiser Family Foundation). Usually it was basically the ability to go to company-owned hospitals and company-paid doctors at a subsidized rate. Of course, if someone gets injured at work, there's a lot of incentive for the doctor to find a way to claim they aren't hurt that badly or that it wasn't related to their job (which did and does happen).
Actually, the original Kaiser "business model" was to collect a set monthly fee per covered person and pay for all patient treatment from that pool of money. That also removed the company doctor scenario because the employer's costs were controlled, and the doctor had no direct incentive to under-diagnose work related injuries.
The WWII increase in non taxed "fringe benefits" had a whole lot more to do with the federal income tax rates passed by Congress to pay for the war than the Roosevelt Administration's Wage & Price controls. The CEO of one aircraft company, Consolidated, actually sold out and retired when he discovered that with the huge increase in sales and income resulting from military aircraft orders, he would net less money than he made during the Great Depression.
I'm talking about benefits for rank-and-file workers, not the upper management people in the higher marginal brackets.
You ever seen what those old timey income tax rates worked out to? And remember, this was in the days when the Social Security tax was a whole 2% on the first $3,000 dollars. In 1940, the federal income tax rates started at 4.4% of the first $4,000 of taxable income. In 1942, the federal income tax rates started at 19% of the first $2,000 of income.
Note, that even at the bottom of the tax rates, not only did the income tax rate nearly quintuple, but the marginal rates kicked in at a much lower level.
And the plutocrats got hosed even worse. 1940, top marginal rate was 81.1%, on everything over $5,000,000. In 1942, to marginal rate was 88%, on everything over $200,000. While the top rate only went up about 8.5%, the income level where that rate kicked in got lowered 96%.
That's why "fringe benefits" became a huge labor issue during WWII. The government took huge chunks of relatively modest income increases, but didn't tax things that didn't physically give more cash to the worker.
A quick online search provides the average US annual income in 1940 was $1300, for 1942 it was $1420. (Both numbers rounded upto the nearest $10.)
Paul, I think you just hit on my biggest problem with our current model.
I honestly don't see where it is the employers responsibility to insure the overall health of not only the employee but their whole family. I also see it as a major bar to small firms in being able to compete with actual products and services.
Where we might split some, I see health as a societal concern rather than an economic perk, which is why I say that I would like it treated like the Police, Fire, education and so forth.
Your coverage sucks. If it's not employer based I'd price some different coverage with another company.
If it is employer based I'd look in to getting a supplemental policy. Cue the duck.
Seriously, everyone keeps telling me that my coverage sucks.
I really want all of you to check on this. Apart from this one thing, my coverage I haven't been able to find an equal to my coverage. And since talking to people in other Texas cities who have had to call 911 for an ambulance, their insurance did the exact same thing.
One "dirty little secret" of medical insurance is that reimbursement rates are hugely influenced by the Medicare and MedicAid reimbursement tables. So it's likely what insurance in Texas pays is 80% of what Medicare pays. the other thing that influences the city ambulance rate is that those of us with jobs and medical insurance get to foot the bill for the indigent and otherwise uninsured folks the city is obligated to transport via the ambulance service.
So far, in most California counties, the ambulance bills are based on what one's medical insurance will pay.
It's because it does.
I defend it by saying that it is your responsibility to understand what insurance policy you are purchasing, that it is not everyone elses' responsibility to provide a service for you, that your insurance company sucks and next time you need to actually read the policy before you agree to pay for it and understand what it is that you are paying for.
Since I had nothing better to do, I looked up this little nugget. Y'all have a bargain in Houston. The San Francisco Fire Department (Emergency Medical Services) charges a flat $1,642.00 for an ambulance ride. That rate went in a couple of years ago. Does make me sort of glad I don't live or work in "The City That Knows How."