"Affordable" Health Care or "the road to Neo-Feudalism"?

[inna]

This is based on several recent posts by Marcy Wheeler (blogger Emptywheel).

First, some numbers, based on the current Senate bill: consider these two working lower middle-class families.
(See http://emptywheel.firedoglake.com/2009/12/16/the-mybarackobamatax/ and http://emptywheel.firedoglake.com/2009/12/27/affordable-health-care/ for links and further info.)

Family 1: 301% of Poverty Level: $66,370 Total Income (for family of 4)

Federal Taxes (estimate from this page, includes FICA): $8,628 (13% of income)

State Taxes (using MI rates on $30,000 of income): $1,305 (2% of income)

Food (using “low-cost USDA plan” for family of four): $9,065 (14% of income)

Home (assume a straight 30% of income): $19,275 (30% of income)

Health Care: $14,477 (9.8% of income in health insurance premium + $7,973 out-of-pocket limit; totals 22% of income)

Total: $52,750 (79% of income)

Remainder for ALL other expenses (including utilities, clothing, transportation, education, existing debt, etc.):
$13,620 (or 21% of income)



Family #2: 401% of Poverty Level: $88,420

Federal Taxes (really rought estimate based on this page, includes FICA): $13,263 (15% of income)

State Taxes (using MI rates on $45,000 of income): $1,957 (2% of income)

Food (using “low-cost USDA plan” for family of four): $9,065 (10% of income)

Home (assume a straight 30% of income): $26,526 (30% of income)

Health care: $20,565 ($11,900 out-of-pocket limit + 9.8% of income in insurance premiums; totals 23% of income - though note there is no limit on premiums for this income level, so the total could be even higher)

Total: $71,376 (81% of income)

Remainder for ALL other expenses (including utilities, clothing, transportation, school, existing debt, etc.):
$17,044 (or 19% of income)

Now, add some additional expenses, assuming that these families have to pay utilities, gas, and child care:

Child care (average cost for just one pre-school child in MI): $6,216

Transportation costs (assumes 1 car, 12,000 miles/year, at IRS reimbursement rate of $.55/mile, and does not even include car insurance): $6,600

Heat, electricity, water: $1,500

Phone, cable, internet: $1,200

Total expenses for child care, gas and utilities: $15,516

**************************************

That leaves Family #2 with $1,528 left for ALL their other needs (such as clothes and existing debt, for example), and Family #1 with the negative balance of -$1,896 (in other words, they cannot afford this and would have to go in debt or give up the car or move in with relatives).

**************************************


Emptywheel calls it "an attempt to turn the middle class into serfs to the health care industry". Assuming these middle class families come close to hitting the max in a given year, it would leave them completely broke. That’s simply unsustainable and "would basically institutionalize a condition in which the middle class continues to fall further and further behind, paying far too much for health care and/or avoiding necessary treatment. It would keep the middle class drowning under debt. It would continue to force the middle class to choose between health care and things like college or fixing the roof on their house."

"Obviously, this does not take away from the fact that the poor will get health care, with subsidies more realistically set to income levels. ... For those, reform is a vast improvement.

But for the middle class–those above 300% of poverty–this remains unaffordable, and the mandate threatens to put those families into debt without giving them health care in exchange."



Excerpt from another post (read it all at: http://emptywheel.firedoglake.com/2009/12/15/health-care-on-the-road-to-neo-feudalism/ ):

Health Care on the Road to Neo-Feudalism

I believe that if the Senate health care bill passes as Joe Lieberman has demanded it–with no Medicare buy-in or public option–it will be a significant step further on our road to neo-feudalism. As such, I find it far too dangerous to our democracy to pass–even if it gives millions (perhaps unaffordable) subsidies for health care.

20% of your labor belongs to Aetna

Consider, first of all, this fact. The bill, if it became law, would legally require a portion of Americans to pay more than 20% of the fruits of their labor to a private corporation in exchange for 70% of their health care costs.

Consider a family of 4 making $66,150–a family at 300% of the poverty level and therefore, hypothetically, at least, “subsidized.” That family would be expected to pay $6482.70 (in today’s dollars) for premiums–or $540 a month. But that family could be required to pay $7973 out of pocket for copays and so on. So if that family had a significant–but not catastrophic–medical event, it would be asked to pay its insurer almost 22% of its income to cover health care. Several months ago, I showed why this was a recipe for continued medical bankruptcy (though the numbers have changed somewhat). But here’s another way to think about it. Senate Democrats are requiring middle class families to give the proceeds of over a month of their work to a private corporation–one allowed to make 15% or maybe even 25% profit on the proceeds of their labor.

It’s one thing to require a citizen to pay taxes–to pay into the commons. It’s another thing to require taxpayers to pay a private corporation, and to have up to 25% of that go to paying for luxuries like private jets and gyms for the company CEOs.

It’s the same kind of deal peasants made under feudalism: some proportion of their labor in exchange for protection (in this case, from bankruptcy from health problems, though the bill doesn’t actually require the private corporations to deliver that much protection).In this case, the federal government becomes an appendage to do collections for the corporations.

Mind you, not only will citizens be required to pay private corporations. But middle class citizens may be required to pay more to these private corporations than they pay in federal and state taxes. Using these numbers, this middle class family of four will pay roughly 15% in federal, state, and social security taxes. This family will pay around $10,015 for their share of the commons–paying for defense, roads, some policing, and their social safety net share. That’s 15% of their income. They will, at a minimum, be asked to pay 9.8% of their income to the insurance company. And if they have a significant medical event, they’ll pay 22%–far, far more than they’ll pay into the commons. So it’s bad enough that this bill would require citizens to pay a tithe to a corporation. It’s far worse when you consider that some citizens would pay more in their corporate tithe than they would to the commons.

[Laelth]

1. k&r for the truth, however depressing. n/t

:dem:

-Laelth

[inna]

8. Depressing is right. And wait, here's more:

I'm sorry, but it actually gets worse.

As if the bill wasn't horrible enough already, now, apparently, they are gutting the consumer protection mechanisms (such as annual caps, limits on out-of-pocket expenses) and basically removing and reversing everything that was good about the House Bill (e.g., instead of taxing millionaires, as House Bill proposed, it is middle-class insurance benefits that will be taxed - which will dramatically worsen the quality of CURRENT insurance coverage for many millions, as shown in articles/links below).

The Senate Bill Is Designed To Make Your Health Insurance Worse

http://fdlaction.firedoglake.com/2009/12/15/the-senate-bill-is-designed-to-make-your-health-insurance-worse/

The sole defense of this massive corporate giveaway, formally known as the Senate health care reform bill, is that it would still do some “good,” helping millions of the uninsured. Unfortunately, the bill would dramatically worsen the quality of current insurance coverage for tens of millions Americans, thanks to the new excise tax on insurance plans. It is unlikely that any of the remaining “good” in this bill will outweigh the massive amount of harm.

Most of the “help” this bill will do is dubious at best. Help is being defined as giving insufficient subsides to Americans now forced by the government to buy extremely expensive, poorly regulated, junk insurance. Without banning annual limits and an extremely high out-of-pocket cap (which thanks to a massive loophole is not really capped at all), the insurance regulations are basically meaningless. Having this new, mandated “coverage” will not stop you from being bankrupted by accumulated medical debt should you get seriously ill. Insurance that does not protect you from financial ruin if you get sick makes a mockery of the entire concept health insurance.

The harm this bill will do thanks to the excise tax on employer-provided insurance benefits is enormous. The health care bill is designed with the goal of making millions of middle class Americans’ health insurance coverage much worse. That is not a bug, it is a feature.

The excise tax is meant to force your employer to cut back your insurance benefits, reduce your coverage, and increase your co-pays and deductibles. This is not the conclusion of partisan think tanks, bloggers, or activists, this is the conclusion of the non-partisan Congressional Budget Office (CBO) and the Center for Medicare and Medicaid Services (CMS). They CBO concluded:

-snip-

To translate, they both conclude the tax will effectively force employers to scale back the health insurance benefits they offer in order to avoid the excise tax. This can be done by reducing what benefits the plan covers and/or increasing cost sharing (i.e. higher co-pays, higher deductibles, higher out-of-pocket limits, and possibly lower annual limits). If you have a good employer provided health insurance plan, it will be dramatically scaled back. Contrary to Obama’s direct promise, you will not be able to keep the coverage you currently have, and that is by design.

The real problem with this excise tax on what are dubbed “Cadillac” plans is that it is not indexed to health care inflation. In the first few years, it will only affect high-end plans, but, after a decade, it would force employers to make the vast majority of employer-provided health insurance plans much worse. A decade after reform starts most Americans will have much worse health insurance coverage as a result.

Instead of paying for reform with a tax on the richest one percent of Americans, like the House bill, the Senate bill pays for reform by worsening the insurance coverage for the vast majority of Americans. Ruining the coverage of most working class Americans to get the money for a huge corporate boondoggle that will only enrich the insurance companies while not stopping medical bankruptcy in this country does not sound like a good trade.

...


So Much For Health Care Consumer Protection: Reid Guts Ban On Annual Limits
http://fdlaction.firedoglake.com/2009/12/11/so-much-for-health-care-consumer-protection-reid-guts-ban-on-annual-limits/
For all those apologists who say we should absolutely pass a health care bill, even without a public option, because it still “has so many great consumer protections,” I have a rude awakening for you. The AP is reporting that Harry Reid quietly gutted one of the most important consumer protections in the bill, the ban on annual limits...

...

Health-care reform: Senate bill leaves coverage loopholes
http://blogs.consumerreports.org/health/2009/12/healthcare-reform-senate-bill-leaves-loopholes-for-coverage-caps-and-outofpocket-maximums.html

...

Health care loophole would allow coverage limits
http://www.google.com/hostednews/ap/article/ALeqM5iY4N1OnmEl-p6kEdB_ROs6toazbQD9CH3T100
A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

....

There is more, but... it's just too depressing.

:(

[Uncle Joe]

18. Kicking the thread with an honor recommendation for this post.

Thanks again, inna.

[nightgaunt]

26. Just another tendril to ensnare us in a web we can't get out of

Just like in Texas--mandatory car insurance but not mandatory low fees for those of us too poor to afford any more coverage or any at all. It is all part of the system that if you don't have car insurance then you can't renew your driver's license or inspect your car. Devious because once interrelated you are caught on all sides with no recourse. The onus is all on you to pay and they will do nothing to help you. Fines and jail time too if you violate it. So we may be seeing the growth of debtors prisons again. Yet another boon for corporations. (The old Scrooge that Dickens' wrote so eloquently about in the work horrors of 19th century England.) Health care, pharmaceuticals, prisons, (private) police and of course a legion of clerks to handle the increased paperwork as the "more efficient" corporate model gains an even greater strangle hold on our collective throats.

The coming Age of Corporate Capital is here and getting deeper into all our societies and it will be ugly for 80% of humanity.

[Delphinus]

28. How can anyone,

Democrat or Republican, vote for a piece of shit like this?

[OttavaKarhu]

58. My question as well. n/t

[Nikki Stone1]

40. May I encourage you to make a clear and usable chart with all this information?

So many charts have been posted, but yours would be based on the latest information. For example, many people have been arguing that the bill will be good because of annual caps, limits on out-of-pocket expenses, etc. But you say these are now going by the wayside.

We need to know what is in and what is out.

[Vermontgrown]

83. Quite simply: Our newly elected

messiah, will drive it in deep and dry baby. So bend over and get ready cause here it comes. The only alternative is to take them to court or, flat out, every able body person, grab your guns, and march down to the corruption capitol of the world and start a brand new war on the terror that is spreading acrossed our lands.

[mmonk]

2. These figures need to be sent to every one of our representatives.

The bubble of Washington has them totally enthralled and OUT OF TOUCH.

[AllentownJake]

3. They don't really care

They like the President, passed a bill which is what they wanted.

[mmonk]

4. Then our job is to make them care.

[Nikki Stone1]

38. YES

!

[blindpig]

5. k&r n/t

[Walk away]

6. As a 55 yr old woman from NJ (where ther are tons of regulations in place..

for the insurance business) I am currently living on the razor's edge financially and paying for a bare bones policy. This bill will literally break me. Because I am a cancer survivor and over fifty my premiums could increase 500%.

[inna]

10. Have you tried this calculator?

http://healthreform.kff.org/SubsidyCalculator.aspx

I usually criticize this "reform", but in some situations, believe it or not, it may actually provide some help, from what I've seen! For example, they would not be allowed to charge you more than 400% in premiums compared to a healthy young person (if I understand this correctly), and then subsidies and out-of-pocket limits may help!

I wish you all the best and hope that this reform will help you! :hug: Our health system is so screwed up, only in America corporate profits are more important than people's health, lives and well being. :cry:

[Lydia Leftcoast]

23. I just ran the calculator figures, and I'd be WORSE OFF

under the Senate plan.

Great bill they've put together. Screw them.

By the time this goes into effect, I may have the wherewithal to move to a country (not in Europe, unfortunately, but some of the Latin American and Asian countries welcome foreign retirees) that has affordable health care. I sure hope so.

[emsimon33]

29. My retirement money is already in European banks in euros and pounds

I haven't trusted any of these bastards since Clinton! Congress should have to live under the same rules that they impose on use, both health care and retirement!

[Nikki Stone1]

43. That was smart.

.

[Goldstein1984]

47. How do I do that?

Do you worry about reporting out-out-of-country money?

I've been looking into this.

[Nikki Stone1]

39. +1

.

[OttavaKarhu]

59. Great. Another "got mine and ran" liberal.

[Wednesdays]

64. Yeah, liberals get under your skin, don't they?

nt

[Statistical]

7. How many people hit annual max every single year.

Using an average out of pocket medical expense would be more realistic.

Remember after deductible most plans have co-insurance so $11,900 out of pocket is more like $30K-$40K in medical costs.

Not that $40K in medical costs is impossible to obtain but most people won't have $40K in medical costs every year.

[Lydia Leftcoast]

9. So that means that they're paying thousands of dollars a year for NOTHING

I have never hit my deductible, and yet I'm paying thousands per year to an insurance company NOW.

Deductibles are EVIL. They're a license for the insurance companies to print money. They prevent people from getting needed diagnostic tests and preventive care. (Ask me: I know this from experience.)

When I sprained my ankle, it hurt so badly that I was afraid it was broken, and yet I hesitated to go get it looked at, even at my local urgent care clinic because I have a $5000 deductible. I finally went, but I REALLY hurt when I saw the bill.

As far as I know, the U.S. is the only country with deductibles. Some have co-pays, but the co-pays are modest, less than $50 for an office visit or test.

There's this idiotic myth (undoubtedly spread by insurance companies) going around that if there are no deductibles, people will suddenly turn into hypochondriacs and go to the doctor for every little sniffle.

What percentage of people would suddenly turn into hypochondriacs and attention seekers versus the number NOW who are postponing or just not getting needed care because they're afraid of not being able to meet the out-of-pocket costs?

One reason I hate the new bill is that it forbids me to drop insurance. When I consider the amount of medical care that I didn't get and could have gotten if it weren't for having to pay my monthly premiums, I get more and more tempted to dump the whole thing.

Far from seeing this as "our last chance," I believe that the proposed system is set up to be such a nightmare for the average person that it discredits the idea of health care reform for another generation. Already the right-wingers are referring to the current plans as "government-run health care" and "just like the Canadian system" (both nonsense of course).

In a way, I'm lucky. I'm pretty healthy, and my work is totally portable. If the burdens of insurance became too intolerable, I could move to a Mexican beach town or something, but a lot of people are going to be HURT by this bill.

[OttavaKarhu]

61. So your dream future is being the overclass in Mexico?

Wow.

[Lydia Leftcoast]

66. If it's my only hope for survival under this shitty health care system, yes

But no, I have no intention of living in a gated community with a bunch of drunken Libertarians who think they're oppressed because they have to pay taxes at all.

[inna]

12. True, but... that's not the point. The point is that...

1) ...when and/or IF one hits annual max (in the event of major illness or accident, which is not unlikely to happen at some point in life, believe it or not), they are screwed. Insurance won't protect them from going broke, as shown in examples in the OP.

and

2) Even paying premiums alone (9.8% and more of total income) can be an extreme hardship for many struggling middle class families.
For them, getting actual health CARE may be prohibitive because of high deductibles/copays, especially if they have a lower cost bronze plan.
Case in point and an illustration: mandated health insurance in MA. Although Romney care is way better than the current Senate bill, almost one quarter of people in MA forgo necessary medical care because of cost:
http://emptywheel.firedoglake.com/2009/12/17/21-of-people-in-ma-still-forgo-necessary-medical-care/


Bottom line: many people will be forced to pay for unaffordable health insurance that does not even provide them an access to actual health care, and this overpriced insurance won't help them or protect them from bankruptcy when they need it most - i.e., when/if they become sick.


This so-called "reform" is an absolute travesty. It's just another forced upward transfer of wealth from working people to corporations and elites, Wall Street bailout style.

(See my signature.)

[Uncle Joe]

11. Kicked and recommended.

Thanks for the thread, inna.:thumbsup:

[inna]

13. You're very welcome.

:hi:

Have you seen "the update"? It's even more disheartening, but a "required" read, IMO: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7338574&mesg_id=7339021

[Uncle Joe]

17. Yes, I read the entire thread up to my post and I would've recommended your post #8 on it's own

merits, but D.U. won't let me so I will come back later to kick that post with an honor recommendation.:)

Peace to you.:hi:

[WeCanWorkItOut]

14. You've told us what Paul Krugman should have

His claim was that this program really helps
lower-income and lower-middle-income families.
Some in the 135-percent-of-poverty range it will help
in a few years time
(although it will hurt the states and schooling).
Others, like the working lower-middle-class people
in the example, will be hurt.
Krugman should have done the math.
It's good that we have others to think it through.

[jgraz]

15. Oh come on. It's not "Neo-Feudalism".

That assumes regular feudalism stopped at some point.

[inna]

20. Hey there, nice avatar! :)

(Sorry, I just HAD to comment on it.) :D

:pals:


We skipped feudalism. Feudalism precedes capitalism; Neo-Feudalism, at least in theory, may be a result of unsustainable Post-Capitalism. I hope we won't go that way.

[jgraz]

21. I just go with whomever's being attacked by the Rahmpologists

Last week it was Dean, now it's Ms. H.

[amborin]

34. +1000

[TheKentuckian]

45. I'm going to go with hammer this piece of crap and bash Hamsher

but I literally laughed out loud and needed it.

[Romulox]

16. Our multimillionaire "representatives" have NO IDEA what it is to live as a common person. nt

[laughingliberal]

35. Nor do they much care. nt

[amborin]

19. K&R thanks for posting this!

[clear eye]

22. This is why wanting House Dems to vote against this cannot be called

playing into the hands of the Republicans. There is life-altering substantive reasons to oppose this catastrophe of a plan.

[amborin]

33. +1000

[ipaint]

24. k&r.

[leftstreet]

25. K&R

[icee]

27. Excellent post. I've printed it and will copy it for the get-together

at my house next weekend. The people in my neighborhood are furious about Obamacare. The vast majority of them will not vote for Obama again even if he's running against Little Kim. This healthcare abortion just increases the constant fear we all live under. Soon, suicide will become a viable option for some. In France had this happened, the French would have shut down the city with clubs and rocks. Here, we post on bulletin boards because violence is soooooo bad. It's as if we've turned in a bunch of monks. Even to die for a cause you believe in would be better than this.

[emsimon33]

30. This bill is Obama's "read my lips" moment!

He never had the right nor will he ever, and with this bill his lost his base, the left, and the middle.

Way to go, Barack!

[Nikki Stone1]

31. A "corporate tithe": EXACTLY.

"But middle class citizens may be required to pay more to these private corporations than they pay in federal and state taxes."

[Echo In Light]

32. K&R

[laughingliberal]

36. Thanks for posting this. I just don't think people see how much this is a major

victory in the war the wealthy declared on workers and middle class Americans. I see it as stripping the last of what's left to people at these levels right out of their pockets and destroying any shot at upward mobility for workers ever again.

[inna]

44. Here's a fitting quote:

"The class warfare is over -- we lost. I want to make that announcement today. Working people lost. The middle class lost."

"Don't tell me about class warfare. Come to my neighborhoods in Cleveland. I will show you class warfare. I’ll show you hollowed out areas. I’ll show you businesses that went down because they don’t have access to capital. And on Wall Street it is fat city. Don’t tell me about class warfare."

"All across this country people are starved for capital. Small businesses are failing, you have shopping centers that are becoming vacant because people can’t afford the rents anymore because the people who own the malls the developers are getting cash calls and credit is tightening."

"The separation between the finance economy and the real economy is real. This is not some fake idea. You can’t call that class warfare. That’s a fact."

"The wealth of this nation is being accelerated upward."


- Dennis Kucinich, December 16, 2009, before the Committee on Oversight and Government Reform

http://www.alternet.org/workplace/144650

Personally, I was startled when I read this today. I want to believe that things are not quite as bad, that we haven't lost YET (but clearly we're IN THE PROCESS of losing). And the most unbelievable, almost surreal thing about it is the fact that this ACCELERATED process of upward transfer of wealth is taking place under a Democratic president and Democratic congress. :wtf: :banghead:


Like Bill Moyers said (another fitting quote I saw today, thanks to Nikki: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7339469&mesg_id=7341796 ),

Something's not right here. One year after the great collapse of our financial system, Wall Street is back on top while our politicians dither. As for health care reform, you're about to be forced to buy insurance from companies whose stock is soaring, and that's just dandy with the White House.

Truth is, our capitol's being looted, republicans are acting like the town rowdies, the sheriff is firing blanks, and powerful Democrats in Congress are in cahoots with the gang that's pulling the heist. This is not capitalism at work. It's capital. Raw money, mounds of it, buying politicians and policy as if they were futures on the hog market.

On edit: and while i'm at it... another highly germane quote, to complete my "harrowing quote collection of the day" :) :

The escalation of the looting and the cooperation of our government which they are not even bothering to try and hide is frightening. Unless they know something we don't know, it makes no sense to bring the entire country, let alone the planet to it's knees. The question I fear the answer to is, what do they know that we aren't seeing yet? My usual thoughts run along the lines of knowing we are already a failed state and they are looting everything they can before the population is aware.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7337458&mesg_id=7339121

(i hope you don't mind that i quoted you here... :hi: )

[amborin]

56. +1000

[OttavaKarhu]

62. This is my heartbreak too.

Was reading to my partner some stuff about this absolute yak fart of a "health reform" bill, and I observed that, though I didn't vote for Obama (too Republican for me), and think I have no illusions about the parties, it still chokes me up that this is happening on the Democrats' watch.

SUNSET CORPORATE CHARTERS!

poclad.org

[Enthusiast]

78. For a good while now

I have been afraid they know something we don't know.

It is as if President Obama could give a fuck if he is re-elected. Why is this?

[MisterP]

37. we're all 19th-century Russian serfs now

or maybe the VOC's corporate Bandanese nutmeg slaves

[Greyhound]

41. Indentured to corporations with no requirements from them other than to take your money.

Brilliant...
:eyes:

[amborin]

80. +1000

[Greyhound]

82. Thanks. n/t

[madrchsod]

42. over the last 12 years i have filed bankruptcy twice on medical bills

both times i had medical insurance but the first 1000`s and the 20% the insurance company did`t pay. i`m filing the second one in two weeks.

there`s nothing in any of these plans that stops the majority of bankruptcies of people who have medical insurance

[Lydia Leftcoast]

48. That's where I'd be if I ever got really sick

:-(

[Lorien]

55. Oh geez, I've had the same experience with my former insurance company

they wouldn't cover a damn thing when I needed surgery, nor did they cover any of my ER visits ("out of network"). I didn't file for bankruptcy but I did lose my entire life savings. :grr:

[inna]

70. This is so sad and messed up, our current system is FUBAR on all levels.

:hug:

But! Check this out, this may actually be useful for you!

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7338574&mesg_id=7345572

[Bette Noir]

46. The neo-feudalism of it all can be shown without any math--

We can't buy from any exchange that might be made available until we have been without insurance for 6 months, if rumors of the content of the health reform bill are accurate. That means the risk-averse among us can't quit our jobs, if they offer health insurance, until we're old enough for Medicare. We're stuck, indentured to our employers even if we have money, because no one has enough money to self-insure against cancer or a major auto accident.

[JDPriestly]

73. You get COBRA for some months after leaving a job. You get to pay

for the insurance that your employer previously paid for. Of course, the insurance company gets to set a new rate for you. That is probably why you are not allowed to sign up for the insurance in the exchange until after a certain time period has passed.

[Goldstein1984]

49. Very ugly numbers

"Neo-feudalism" -- I haven't seen it put better.

The working class is bound for serfdom and peasantry.

[Johnboi70]

50. This is great work! n/t

[ProgressIn2008]

51. Neo-Feudalism -- a depressing yet truthful ring to it. nt

[WillyT]

52. Big K & R !!!

:mad:

:kick:

[hay rick]

53. Out of pocket costs- update?

This from Sen. R. Menendez' web site (http://menendez.senate.gov/newsroom/press/release/?id=BB76AC27-8C40-4288-A9A5-19AE60569615):

Under the heading MENENDEZ PROVISIONS INCLUDED IN THE LEGISLATION-
"Out-of-pocket cost limit for families between 300-400 percent of the federal poverty level - IMPORTANT FOR HIGH COST OF LIVING STATES. For those between 300-400 percent of FPL, within the same actuarial value, the benefit will include an out-of-pocket limit equal to two-thirds of the Health Savings Account (HSA) current law limit."

The HSA contribution limit for 2010 is $6150, which would make the out-of-pocket limit $4100 for the 301% family in the example given above. This would reduce total health care spending in the above example to $10,604- almost exactly 16% of income.

The Menendez post is dated 12/24 while the Wheeler post is dated 12/16.

[inna]

60. Actually...

The calculations above DO reflect the provision that you mentioned, namely: "For those between 300-400 percent of FPL, within the same actuarial value, the benefit will include an out-of-pocket limit equal to two-thirds of the Health Savings Account (HSA) current law limit."

For reference, the calculations in the OP are based on Senate Leadership Bill Patient Protection and Affordable Care Act (H.R. 3590) (reflecting the manager’s amendment announced December 19, 2009) which, to quote:

Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:

100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).

However, note that an out-of-pocket limit equal to the HSA current law limit equals $5,950 for individuals and $11,900 for families in 2010.

In other words, unsubsidized out-of-pocket maximum will be $11,900 for Family 2 (401% FPL),
and two-thirds of that amount, i.e. $7,973, for Family 1 (301%). Which is exactly what the charts in the OP say. :)

(Apparently, you were thinking in terms of a single individual, not a family.)

What's interesting though is that the OOP maximum for a single individual that you quote is slightly higher than the one used in the calculations. Unfortunately, I've seen those higher OOP # as well in different versions of the bill. I have little doubt that by the time the final bill is passed, they will use those higher numbers. Anything to pass up the costs to taxpayers, as always. :(


Anyway, thanks for the link. :hi:

[hay rick]

63. Out-of-pocket limit.

Sorry, I mistook the contribution limit ($6150 for a family in 2010) for the out-of-pocket limit ($11,900 for a family in 2010).

[Lorien]

54. I'll say it once again; for the self employed buying their own insurance, deductibles

run 8-12k depending on the plan. After that there's a 20% copay on everything. So, assuming that I make 35k a year I'll lose 35% of my income even before calculating my monthly insurance payments should I become ill. How is that sustainable?

[inna]

68. Dear Lorien - You really should check this out!

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7341458&mesg_id=7342555

You might find this info useful!

I'm a huge critic of this inadequate pseudo-reform, but believe it or not, it may actually provide certain relief to some people (especially, those with income under 300% of FPL and those who are being totally gouged and raped by their current insurance).

From the subsidy calculator tool in the link...

Assuming that you make $35,000 (which is 323% of FPL), and live in a "medium-cost area" (whatever that might mean... note that costs may vary +/-20% based on geographical location), and assuming that you are single...

you DO qualify for premium subsidies, and your out-of-pocket premiums will be capped at $3,500, independent of age!



Now, in addition to premiums, you will have to pay deductibles and co-pays of course (i.e., "out-of-pocket" expenses or "cost sharing"). Well, the good news is that you will also qualify for "cost-sharing" subsidy, and your OOP limits (i.e., the maximum you will ever have to pay in deductibles and copays per year) will be capped at $3,987.


Wow, all of a sudden it looks a LOT better than your current plan! :bounce:

Let's see: premiums fixed at $3,500 (independent of age) plus OOP limit of $3,987 --> equals $7,487 a year total (which is 21% of your income). Still expensive, but it's a whole lot better than what you mentioned in your post.


Wow! I'm far from becoming a fan of this reform, but I'm happy that it (apparently) will help your current situation. I think I understand Krugman and other supporters of this reform better now. It's clearly not completely worthless, after all.


Of course, there is a caveat - this is not a final bill yet, and they still can f*ck it up beyond all recognition (let's hope not, but you never know). Still, I feel much better about this bill, and I have to reconsider whether or not it should be killed at this point.


Interestingly, this doesn't really contradict Marcy's OP:

Obviously, this does not take away from the fact that the poor will get health care, with subsidies more realistically set to income levels. ... For those, reform is a vast improvement.

But for the middle class–those above 300% of poverty–this remains unaffordable, and the mandate threatens to put those families into debt without giving them health care in exchange.

Hmmm... Well, in your case (assuming that you make $35,000 as a single individual), you are above 300% of FPL, and still the reform will be a big improvement compared to your current policy.

I don't know, what do you think?.... :hi:

[OttavaKarhu]

57. Agree entirely. K&R for the numbers, n/t

[scentopine]

65. There could be money left over? How the blazes did they miss that?

The damn fools!

- Montgomery Burns

[David Zephyr]

67. Kick.

Excellent post and observations.

[Matariki]

69. This has been the obvious problem all along

and whenever I've brought it up certain people scream 'SUBSIDIES' at me.

It's great if the bill helps those in the lowest income brackets, but it can't be at the expense of the middle class. It will end up creating a lot of poverty.

It's good to see the math laid out clearly. I don't expect that it will have much impact on the supporters of the bill however.

[debbierlus]

71. Thanks Inna!

[debbierlus]

72. And, two income families may very well decide it makes more sense to just have one earner

Save the money for child care...travel...all work related expenses and have one parent stay home...

20 + percent of income is enough of a factor to drive some people out of the work force to gain coverage through government subsidies. It will become a very real calculation.

Why kill yourself to give every extra (HA!) penny to the corporations?

And, who on earth could blame any family who comes to this conclusion?

They are pushing what is left of the middle class right over the cliff with this bill. It really is akin to spitting right in their faces.

[ima_sinnic]

76. & single, self-employed people can simply cut back on work

a very real possibility for me, at somewhere between 300% and 400%. I make a "comfortable" living, but under this bill it would become uncomfortable, not to mention my strong aversion to paying money (a lot of money) for absolutely nothing, with no limit on additional amounts for copays, to insurance company PIGS. I'd rather live poorer than make them richer.

I spend the little I make above and beyond my needs on various home improvements (supporting local tradespeople) as well as helping a family in need in Jamaica and for donations to various charities. Charitable contributions can then be expected to drop off if middle-class people are going to strategically cut back income.

So the bill ends up indirectly harming those most in need, the beneficiaries of charities, and it works wonders for the economy, too.

[autorank]

74. Proud # 100!!! This is is

This is the type of information we need about the health care bill.

The issue isn't the damn bill, it's flat wages for 10 years, flat job stats - no growth - and people can't afford the damn costs if it's the new bill, an even better bill with a public option, or the current system --- it's too damn expensive.

Thank you!

[Blasphemer]

75. K&R... Depressing but informative... nt

[ima_sinnic]

77. excellent work, thanks so much

now I am furious that even the progressive Dems sold us out by voting in favor. For the first time EVER, I am actually thankful my senator is Olympia Snowe. Does that make me a bad person?

[DemReadingDU]

79. afternoon kick

[defendandprotect]

81. Corporate/Fascism . . . they will now have a controlling interest in people's government ...