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JANUARY 13, 2009 -- Free Market Conservatism?

One tenet of free-market conservatism is that private companies with a profit motive will always be more efficient than the government. It is certainly a compelling argument if you look at countries like Cuba or North Korea, or even at the U.S. government when it has ventured into businesses like running rail and mail systems. All of which makes opposition to a key part of President-elect Barack Obama's health reform plan curious. Obama — and former senator Tom Daschle, his point man on health care — want to provide a government-run option, modeled after Medicare, as a choice for people who don't get insurance through their employers. This public plan — presumably to be offered at cost — would compete with commercial insurers to provide better service and benefits.

Such a plan is a compelling idea for the simple reason that it tests the notion that private health insurance plans operate more efficiently than government. To its critics, however, the public plan would put private insurers at a disadvantage because, unlike the government, they have to earn a profit. What's more, critics argue, it could lead to an unraveling of employer-provided plans. That, too, is an interesting argument because many conservatives are trying to do just that, by ending the tax deduction enjoyed by employer-based plans.

Ultimately, the advantages of the government plan would be so strong, the opponents argue, that it would lead to a single-payer health care system like those in Canada and Europe. In other words, they seem to think private health insurance plans are so inept that they can't compete with Uncle Sam. Actually, they already do to some extent in the seniors market, where about 10 million people have opted out of traditional Medicare to take private coverage through a government-subsidized program known as Medicare Advantage. And if private plans can't compete in other markets, they will have essentially have validated the argument of those who want a single-payer system.

We've never favored single-payer, but there's no denying that private programs have higher administrative costs than public plans. According to the Urban Institute, public plans spend about 5% on administration, while large private group insurers spend about 12% and some niche insurers spend as much as 23%. What's worse, private insurers have shown little ability to restrain costs. Each year, they pass along increases to employers, which pass them on to employees or drop insurance altogether. This has not only resulted in medical costs rising much faster than inflation, it has also meant that governments at all levels have picked up more of the nation's health care tab. Government already accounts for about 46% of all U.S. health spending, according to a recent study in Health Affairs magazine. So for all the howling about "socialized medicine," the nation is already halfway there, and those who have it — Medicare recipients most notably — seem to like it.

As a matter of reality, the potential relationship between a government-run plan and private insurers is immensely complex and hard to gauge. On one hand, private insurers would see government as a potent competitor (too potent in our view if the government subsidizes its premiums). On the other, they could benefit from government's entry into the market by piggybacking on the cost savings that the government wrings out of providers.

Something must be done to get health care costs under control before they bankrupt the nation. So why not let people pick the plan they like? If commercial coverage becomes unaffordable to all but the few, the future of private insurance will be the least of everybody's concerns.

Also: Congress appears to be moving ahead quickly on a reauthorization of the State Children's Health Insurance Plan, which covers 6.7 million poor and low-income children nationwide and will expire in March.

President Bush twice vetoed expansions of the program that passed Congress with broad bipartisan support in 2007, saying they cost too much and expanded the program beyond its mission to serve as a last-resort option for the poorest kids.

A quick vote could provide momentum for President-elect Barack Obama, who supports the program and campaigned on a proposal to require all children to have some form of health insurance. Congress is not moving nearly so quickly to embrace the economic stimulus proposals Obama wants passed.

Senate Finance Committee Chairman Max Baucus today released an outline of his $31.5 billion, 4.5-year proposal, which he said his committee would take up tomorrow. The House is considering its own version.

Baucus's proposal would provide health insurance to 3.9 million additional uninsured, low-income children. The expansion would be paid for by increasing the cigarette tax by 61 cents to $1 a pack. The money would help expand the program at a time when states, which pick up a portion of the costs, are under serious budget constraints and the unemployment rate is at its highest level in 16 years. "The Children's Health Insurance Program is needed now more than ever," Baucus said in a statement. "In these tough economic times, more and more parents can't afford health coverage for their kids. But CHIP can get uninsured, low-income kids the doctors' visits and medicines they need to stay healthy."

Baucus's bill does not lift a ban on Medicaid and SCHIP for children and pregnant women who are legal immigrants during their first five years in the country, but he said he looks forward to discussing how to do that as the bill moves toward final approval.

COBRA

Laid-off employees trying to keep their family's job-based health insurance through COBRA often find it's no help financially: A new study found the coverage can cost more than they make in jobless benefits, especially in Florida. The average COBRA policy for a Florida family costs $1,037 per month, while the average unemployment check is $1,013 per month, the nonprofit advocacy group Families USA reported Friday.

Even the average individual policy under the federal Consolidated Omnibus Budget Reconciliation Act cost $371 per month in Florida, out of reach for a jobless person trying to pay rent and buy food, said Families USA Executive Director Ron Pollack. "COBRA health coverage is great in theory and lousy in reality," Pollack said.

Nationally, the cost of a family COBRA policy eats up 84 percent of the average jobless check. Like other health care advocates, the group called on Congress to include several billion dollars in its economic stimulus package to subsidize COBRA payments for jobless workers and to help states expand Medicaid programs to cover those uninsured because of layoffs. Both initiatives are considered likely to pass.

That would be great news to Fort Lauderdale widow Joanne Naujeck, 60, who said she can barely afford $300 per month for COBRA and has no good options for coverage when it expires Feb. 1. "Health insurance, ever since my husband died, has been like a knife in my back," said Naujeck, an idle hotel employee. COBRA, started in 1986, requires job-based insurance to offer continued coverage for 18 months to employees who lose their jobs. But the employee must pay the entire cost plus a 2 percent fee. The cost increase can be huge for the employee because employers normally pay three-fourths of the cost.

Hoy de Seguro de Salud Tema:: Libre Mercado conservadurismo?

Uno de los principios de libre mercado es el conservadurismo que las empresas privadas con ánimo de lucro y será siempre más eficaz que el gobierno. Es sin duda un argumento de peso si nos fijamos en países como Cuba o Corea del Norte, o incluso en el gobierno de los EE.UU. cuando se ha adentrado en las empresas como correr el ferrocarril y sistemas de correo. Todo lo que hace la oposición a una parte fundamental del Presidente electo, Barack Obama plan de reforma de la salud de la curiosidad. Obama - y el ex senador Tom Daschle, el hombre en su punto de atención de salud - quiere dar un gobierno a ejecutar la opción, el modelo de Medicare, como una opción para las personas que no tienen seguro a través de sus empleadores. Este plan público - presumiblemente para ser ofrecido a precio de costo - que compitan con los aseguradores de ofrecer un mejor servicio y las prestaciones.

Dicho plan es una idea por la sencilla razón de que las pruebas de la noción de que los planes de seguro privado de salud de forma más eficiente de gobierno. Para sus críticos, sin embargo, el público se ponga plan privado de seguros en una situación de desventaja, ya que, a diferencia del gobierno, tienen que obtener un beneficio. Lo que es más, sostienen los críticos, podría conducir a un empresario de unraveling proporcionado planes. Eso también es un argumento interesante, porque muchos conservadores están tratando de hacer precisamente eso, por poner fin a la deducción fiscal que disfrutan los empleadores basadas en planes.

En definitiva, las ventajas del plan de gobierno sería tan fuerte, los opositores argumentan, que llevaría a un solo contribuyente sistema de atención de salud como los de Canadá y Europa. En otras palabras, que parecen pensar los planes de seguro privado de salud son tan ineptos que no pueden competir con el Tío Sam. En realidad, ellos ya hacen, en cierta medida, personas de la tercera edad en el mercado, donde alrededor de 10 millones de personas han optado por no tradicional de Medicare para tener cobertura privada a través de un programa de gobierno-subvencionados conocidos como Medicare Advantage. Y si los planes privados no pueden competir en otros mercados, tendrán esencialmente han validado el argumento de aquellos que quieren un sistema de pagador único.

Nunca a favor de un solo pagador, pero no hay duda de que programas privados tienen mayores costos administrativos de los planes públicos. Según el Instituto Urbano, los planes de gasto público en alrededor del 5% sobre la administración, mientras que gran grupo privado de seguros gastan aproximadamente el 12% y en algunos segmentos de seguros gastan hasta el 23%. ¿Qué es peor, las aseguradoras privadas han mostrado poca capacidad para frenar los costos. Cada año, pasan a lo largo de los aumentos a los empleadores, que transmitirá a los empleados o descenso seguro del todo. Esto no sólo ha resultado en el aumento de los gastos médicos mucho más rápido que la inflación, que también ha significado que los gobiernos en todos los niveles han aumentado más de la nación ficha de cuidados de la salud. Gobierno ya representa aproximadamente el 46% de todos los EE.UU. el gasto en salud, según un estudio reciente en la revista Health Affairs. Así que para todos los aullidos de "medicina socializada", la nación está ya a mitad de camino, y aquellos que lo tienen - sobre todo los beneficiarios de Medicare - parece que le gusta.

Como cuestión de realidad, la posible relación entre un gobierno de gestión y plan de seguros privados es muy complejo y difícil de medir. Por un lado, los aseguradores privados que ver el gobierno como un potente competidor (muy potente en nuestra opinión, si el gobierno subsidia sus primas). Por el otro, que el gobierno podría beneficiarse de la entrada en el mercado combinado de los ahorros de costes que el gobierno wrings de los proveedores.

Hay que hacer algo para conseguir la atención de la salud los costes bajo control antes de que la quiebra de la nación. Entonces, ¿por qué no dejar que la gente elegir el plan que les gusta? Si la cobertura comercial se convierte en inaccesible a todos, pero unos pocos, el futuro de los seguros privados será el menor de las preocupaciones de todos.

También: El Congreso parece estar avanzando rápidamente en una reautorización de la State Children's Health Insurance Plan, que abarca 6,7 millones de pobres y de bajos ingresos y niños de todo el país terminará en marzo.

El presidente Bush vetó dos veces la expansión del programa que aprobó el Congreso con un amplio apoyo bipartidista en 2007, diciendo que cuesta demasiado y amplió el programa más allá de su misión de servir como una opción de último recurso para los niños más pobres.

Un voto rápido podría proporcionar el impulso para el presidente electo, Barack Obama, que apoya el programa y la campaña sobre una propuesta para exigir a todos los niños tienen alguna forma de seguro de salud. Congreso no se mueve casi tan rápido a abrazar la propuesta de estímulo económico Obama quiere pasar.

Presidente del Comité de Finanzas del Senado Max Baucus publicó hoy un resumen de su $ 31,5 millones, 4,5 años de propuesta, que dijo que su comisión se ocupará de mañana. La Cámara está considerando la posibilidad de su propia versión.

Baucus, la propuesta de brindar seguro de salud a 3,9 millones de personas sin seguro médico, los niños de bajos ingresos. La expansión sería pagado por el aumento del impuesto sobre el cigarrillo por 61 centavos a 1 dólar por paquete. El dinero ayudará a expandir el programa en un momento en que los estados, que recogen una parte de los costos, se encuentran en graves limitaciones presupuestarias y la tasa de desempleo está en su nivel más alto en 16 años. "Los niños del Programa de Seguro de Salud que se necesita ahora más que nunca", dijo Baucus en una declaración. "En estos difíciles tiempos económicos, más y más padres de familia no pueden pagar la cobertura de salud para sus hijos. Pero puede conseguir sin seguro CHIP, los niños de bajos ingresos a los médicos las visitas y los medicamentos que necesitan para mantenerse saludables."

Baucus del proyecto de ley no se levante la prohibición de Medicaid y SCHIP para los niños y las mujeres embarazadas que son inmigrantes legales durante sus primeros cinco años en el país, pero dijo que espera con interés discutir cómo hacer que el proyecto de ley que avanza hacia su aprobación final.

COBRA

Despedidos empleados tratando de mantener a su familia basada en el trabajo de seguro de salud a través de COBRA a menudo no es de ayuda financiera: Un nuevo estudio encontró la cobertura puede costar más de lo que hacen en las prestaciones de desempleo, especialmente en la Florida. El promedio de COBRA para una política de la Florida familia cuesta $ 1037 por mes, mientras que la media de desempleo cheque es de $ 1013 por mes, el grupo de defensa sin fines de lucro Familias EE.UU. informó el viernes.

Incluso el individuo promedio en virtud de la política federal Consolidated Omnibus Budget Reconciliation Act costo de $ 371 por mes en Florida, fuera del alcance de una persona sin trabajo tratando de pagar el alquiler y comprar alimentos, las familias EE.UU. dice Ron Pollack, Director Ejecutivo. "COBRA cobertura de salud es en gran mal en la teoría y la realidad ", dijo Pollack.

A nivel nacional, el costo de una familia política COBRA come el 84 por ciento de la media de desempleados cheque. Al igual que otros defensores de la atención de la salud, el grupo llamado al Congreso para incluir a varios miles de millones de dólares en su paquete de estímulo económico para subsidiar los pagos de COBRA para los trabajadores desempleados y para ayudar a ampliar los programas de Medicaid de los estados para cubrir los no asegurados a causa de los despidos. Ambas iniciativas se consideran probable que pase.

Eso sería una gran noticia a Fort Lauderdale viuda Joanne Naujeck, 60, que dice que apenas puede pagar $ 300 por mes para COBRA y no tiene buenas opciones para la cobertura de febrero cuando se vence 1. "El seguro de salud, desde que mi esposo murió, se ha sido como un cuchillo en mi espalda ", dijo Naujeck, un empleado del hotel de inactividad. COBRA, que se inició en 1986, requiere de trabajo basados en los seguros para ofrecer cobertura continuada durante 18 meses a los empleados que pierden sus puestos de trabajo. Sin embargo, el trabajador deberá pagar la totalidad de los costes, más una tasa de 2 por ciento. El aumento de los costos puede ser enorme para el empleado porque los empleadores suelen pagar las tres cuartas partes del costo.

 

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