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President Obama decided that three pressing issues require attention this year – healthcare, energy and education; curiously, each sector is among the best performers in the current economic climate.

With regard to healthcare, we’re spoon-fed the idea that our healthcare costs are out-of-control, that we have too many uninsured among us, that we spend an astronomical amount compared to other nations ($7,439 per person on average), and that we need to overhaul the entire system to not only deliver healthcare to all but to also reduce costs.

For a while now I’ve been trying my best to fully understand why this is now a centerpiece issue for the new administration. While many are quickly concluding that this is due to Obama looking to socialize medicine in the United States, I think it’s something else.

Something that few are willing to seriously discuss.

Why exactly might the government be pressing so hard to reform healthcare now?

The most compelling reason may be the fact taht while government programs provide coverage to 27.8% of the population, government spending accounts for 45% of all healthcare expenditures in the United States.

Basically the government is in a terrible financial position at the moment, and the situation isn’t getting better, it’s getting worse.

One quick and clever way to fix the problem is to make the issue a crisis for all of us, make it appear we’re all paying too much, getting too little and the government is able to resolve this problem.

And the way they’re going to attempt to resolve this is by sucking healthy people into the government system, to capture dollars that would otherwise be spent in the private sector – where private insurance is held by 67.5% of the population with expenditures toward healthcare costs at about 43% of the total expenditures in the United States and the remaining 12% are out-of-pocket as either co-pays, deductibles and/or those without insurance paying for their medical services.

So here we have:

Government programs – 27.8% of population; 45% of spending
Private insurance – 67.5% of population; 43% of spending
Out-of-pocket – 12% of spending

The government obviously has a problem and despite lowering reimbursements, shifting administration costs to the private sector, increasing compliance requirements for reimbursement and a host of other ways to frustrate the system, it has not, and can not reduce its financial load without healthy individuals contributing toward its ever increasing burden with our aging population.

Some interesting statistics that you won’t find all in one place, but need to go searching to bring the puzzle pieces together for a look at the bigger picture here:

80% of Americans utilize less than $1200 a year in healthcare services
10% of Americans utilize $1200 to $3500 a year in healthcare services
10% of Americans utilize more than $3500 a year in healthcare services

5% of Americans utilize more than 50% of all healthcare costs each year
1% of Americans utilize more than 27% of all healthcare costs each year

In 2007, medicare spent an average $5,694 per beneficiary on healthcare, medicaid spent $6,120 per beneficiary. That’s just “average” though and does not include that medicare spends an average $22,107 per beneficiary in their last year of life or the $14,858 for blind/disabled beneficiaries with medicaid and $14,058 on aged beneficiaries with medicaid in addition to medicare!

Is it any wonder seniors and senior advocacy groups are concerned about how various changes will impact those 65 and older?

As it is right now we have about 40 million seniors in the United States – in ten years it’s projected we’ll have 55 million, and even if we increase the age of eligibility for medicare, the projected 25% increase of eligible seniors is untenable – unless the government can convince us to suck healthy individuals into its system to capture those dollars.

When we begin to look at the even bigger picture – the $5,400 average for an individual health insurance policy and the $12,500 for a family policy, the bucks start to add up very quickly as we realize that if that money is captured by the government, effectively taken out of the private sector, it’ll be a boondoggle for the government financially – especially when you consider that 80% of the population needs less than $1,200 a year in healthcare.

When you do the math, it’s a no-brainer why the government is so hot on reforming healthcare – taking control of the current flow of money that’s within the private health insurance sector, capture those dollars to cover their butts since they’re going to go broke without those dollars and creating a crisis now is an effective way to convince us the entire system is broken and needs fixing.

Could our entire system need some reform? Sure – but it’s certainly not the crisis the government is making it out to be, except for the government programs themselves right now.

In future posts I’ll attempt to tease out changes that can make a difference and delivery better for the American public – and I can say, it’s not through expanding government programs!

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And this one is a potential doozy!

As reported in Reuters, some Dems are open to the idea of taxing healthcare insurance benefits, currently paid by employers, as income!

“I think that tax provision should be on the table,” said Senate Finance Committee Chairman Max Baucus, who will play a major role in writing the legislation to revamp the U.S. healthcare system as promised by President Barack Obama.

“It’s too aggressive. It skews the system,” he said of the tax benefit.

Think about that for a moment. 

Then consider your own situation. 

If your employer currently provides your health insurance, even if you currently contribute something toward the policy premiums through payroll deduction, you do not pay taxes on the cost of your health insurance policy total cost.

Today, the average cost of a policy for an individual runs somewhere in the neighborhood of $5000, and for a family policy an average $12,000. 

The majority of this cost is paid by employers so few employees have any idea how much it really costs for their policy, they just know they’re happy they have coverage, even if they have to contribute toward the premium which is in pre-tax dollars.

If all of a sudden the paradigm changed and now you’re on the hook for paying taxes on that policy, as if the premiums are now part of your taxable income, how does that impact your personal finances and tax burden each year?

Each day it’s looking more and more like the policy makers in Washington are playing a big game of sleight-of-hand with the American taxpayers; as in, no we won’t increase your taxes by way of raising marginal rates falling below the current 33% level, so don’t pay attention to the stealth increases we’re going to hit you with, like cap-and-trade and including your health insurance premiums as taxable income!

As I noted in a post yesterday, a couple with an adjust gross income of $150,000 will not see their income taxes increase.  But what happens when their taxable income now includes a family health insurance policy worth $12,000 a year that’s primarily paid for by one of their employers?

Well, for one thing, today their federal income tax is $25,732 with personal and standard deductions only.

If this type of proposal moves forward and becomes the new standard to calculate income, this same couple now faces a tax increase, taxed on an AGI of $162,000, making their federal income taxes rise to $29,092 – an increase of $3,360 in federal income taxes.

But wait you say – they can deduct medical expenses and medical expenses includes insurance premiums.

Well now, let’s do math.

If their taxable income is $162,000, they can deduct medical expenses which exceeds 7.5% of their AGI – so at this new higher taxable income level, they can only deduct medical expenses exceeding $12,150. 

Ooops, they can’t deduct the cost of premiums that are driving up their tax burden – nope they just have to suck it up and pay, it is, afterall, for the greater good, right?

We see and hear a lot of reasons presented why we need to adopt a universal healthcare model in the United States.  The most frequently cited is that if we look at other developed nations, they have universal healthcare and spend less of their GDP on healthcare than we do; that if we adopt a model similar to theirs, our healthcare costs will be lowered and the delivery of healthcare will improve.

The Walker Report makes the case using the newly signed stimulus package as a cost comparison:

If we adopt any one of the health care systems used by the dozens of first world nations with universal health care, we would save the equivalent of one stimulus package a year.

The article above even goes so far as opining that if we could only be as efficient as Luxembourg or Finland, our healthcare system would be great…but that might not be an attainable goal, so maybe doing as well as  Germany, France, or Switzerland might be our best goal for now.

One thing I love about the internet is quick access to numbers and statistics.  While GDP serves as one measure, perhaps a better one is actual dollars spent per capita in US dollars?  That way we’re comparing real dollars to real dollars rather than an abstract percentage of gross-domestic-product.

Nation Master is a neat site that lets you define out statistics by category and includes the category “health” for the nations in its database.  When we do a search for across the board “health” and then  “total expenditure in US$” we are returned statistics that reveal that in 2004 (latest data available for all reporting countries) the following was spent, in US-dollars, by each country in the list, sourced from the World Development Indicators Database:

United States:  $6096 per person annually

Luxumborg:  $5904 per person annually

Finland:  $2664.30 per person annually

France:  $3464 per person annually

Germany:  $3521.4 per person annually

Switzerland:  $5571.90 per person annually

I’m left scratching my head about why Luxembourg is considered more efficient when they only spend $194 less per person each year?  I mean Finland is obviously spending less – with only $2664.30 per person each year, that’s $3,431.70 less spent per person each year.

How do they do it?

Well, another interesting statistic can be had on Nation Master – how often a population visits the doctor, and in the United States we average 8.9 consultations with physicians each year per person; in Finland they consult with a doctor just 4.3 times a year per person. 

So in Finland they use their system about half as often as we do across the population, thus spend about half as much as we do.  Interesting.

Are they really “efficient” as Walker Report thinks they are?

If we spend $6096 on average, for each person each year, and they see the doctor 8.9 times on average in a year, then we’re spending an average $684.94 per doctor visit (or whatever encounter you have – ER visit, hospitalization, etc.)….compare this to Finland, spending $2664.30 per year, per person for 4.3 doctor visits each year – or $619.60 per doctor visit…..now it’s only a difference of $65.33 per doctor visit – not significantly different or more efficient than the United States, huh?

Yet we won’t see these numbers in the media, nor will we hear them on the radio – but the numbers and statistics are out there if you want to find them!

No doubt our healthcare system can be improved – but let’s not rely on myths to reform the system. 

We need facts and data to be able to make good decisions, not myths!

The word “profit” comes from the Latin, to make progress. 

Profit is the difference between the price something sells for and the cost of bringing to market whatever is sold, be it a product or service. 

Within the healthcare debate, we’re told profit is bad, it is a dirty word, it must be eliminated from our healthcare system so that we can deliver quality healthcare to all Americans.

The problem is one of semantics; any business endeavor, whether it is classifed as “for-profit” or “non-profit,” must generate enough revenue to meet its financial obligations like operating expenses and salaries. 

In the for-profit business model, revenues that exceed the cost of doing business are “profits”, whereas the same excess in the non-profit sector is termed “surplus”. 

No matter what you call it, it’s the same thing, more money in than money going out. 

The damning of profit however is an extremely effective way to terminate any discussion of alternatives or options to the current system we have because no one from within the healthcare system is going to step up and say “but profits are good” or anything related to money.

It’s manipulation pure and simple – carefully crafted and designed, then repeatedly executed well, by those who wish to keep the focus on establishing a single-payer universal healthcare system in the United States.

How can anyone have a meaningful discussion of the state of our healthcare system if you don’t talk money?

There is indeed much discussion on the demand side of the equation, that is the cost to those who need healthcare and virtually no discussion about the supply side of the equation, the costs to those delivering healthcare.

We absolutely must open the discussion up, take it beyond its cost to patients, and look at all sides if we are going to fix the areas in our healthcare system that need fixing and address the issues that are important to us all – the quality of our healthcare, how and where to better manage costs, and how to reach out to and provide affordable coverage to those uninsured among us.

Share your thoughts on this matter in the comments!

The framing of the debate about private health insurance is that it is too costly because it exists as a for-profit business model.  Insurance companies, we’re told make huge profits and pay exorbitant executive salaries; worse, they waste money on overhead, marketing and administrative expenses!

For example, an article on the Physicians for a National Health Program, Upgrading To National Health Insurance (Medicare 2.0), has us consider the following:

The private insurance industry spends about 20 percent of its revenue on administration, marketing, and profits. Further, this industry imposes on physicians and hospitals an administrative burden in billing and insurance-related functions that consumes another 12 percent of insurance premiums. Thus, about one-third of private insurance premiums are absorbed in administrative services that could be drastically reduced if we were to finance health care through a single non-profit or public fund.

The first question must be, is this true? 

How about we take another look, from another source?

Two years ago, the Council for Affordable Health Care issued a paper detailing Medicare administrative costs, many which are not accounted for or paid by employers or other government agencies.

Just because the government doesn’t reflect all of the various costs of doing business in its official estimates of Medicare administrative costs, that doesn’t mean they don’t exist. Or that taxpayers don’t pay those costs. They do. A hidden cost is still a cost, even if taxpayers don’t know they are paying it.

The CAHC found that “Medicare’s method of calculation makes administrative costs, albeit unintentionally, appear to be lower than they really are.”

On the laundry list of unaccounted for, or hidden administrative costs, we find:

1. The “cost of capital” isn’t included; that capital comes from the government on an as needed basis

2. Cost of developing policy is not included, but Congress, that sets those policies costs taxpayers money

3.  The salaries of those professionals at the Centers for Medicare and Medicaid Services (CMS), are excluded from Medicare’s administrative cost estimates

4. The cost of the buildings that house that part of the leadership team are not included

5. The cost of collecting payroll taxes is not included because it’s part of the administrative costs paid by employers and the IRS

6. The cost of marketing various programs, like Medicare Part D, are excluded from the tally

7. The cost of collecting premiums from seniors is not included, but is part of the administrative costs of the Social Security Administration which deducts those premiums from social security checks

8. The cost of signing up for Medicare is borne by the social security administration since they handle the paperwork when a senior is eligible

9. In the case of fraud, enforcement costs are paid by the Department of Health and Human Services

10. Premium taxes are paid by businesses in each state, by employers who include health insurance as part of their benefits package; Medicare system has no equivalent expense on its bottomline.

The above help to highlight the insurance industry’s administrative costs are not because the private sector is inefficient or wasteful – instead government is taxing it and imposing regulations and unfunded mandates (that is, it tells the private sector to do something, but doesn’t reimburse its costs – like collect payroll taxes for us).

There is something a little disingenuous about imposing unwanted taxes and regulations on an industry and then criticizing it because its administrative costs are higher than the untaxed government program.

But this isn’t really about having an open and honest discussion about how to fix our current system to really do better. 

As the Physicians for a National Health Program article says,

In sum, we will not be able to control health care costs until we reform our method of financing health care. We simply have to give up the fantasy that the private insurance industry can provide us with comprehensive coverage when this requires premiums that average-income individuals cannot afford. Instead, the U.S. already has a successful program that covers more than forty million people, gives free choice of doctors and hospitals, and has only three percent administrative expense. It is Medicare, and an expanded and improved Medicare for All (Medicare 2.0) program would cover everyone comprehensively within our current expenditures and eliminate the need for private insurance. This is the direction we must go.

Medicare for all?

Share your thoughts in the comments!