They are, and they don’t know it. Because of the perverse attachment of health benefits to employment, most people never even think of the big chunk of their pay packet that is the employer contribution.

* Due to reasons that are outside your need-to-know.

So precisely when do you start the job in Europe, you lucky bastard?  Or is it Canada?

This is why the “But our taxes will rise!” argument holds no water for me.

I always tell people that no matter how high the taxes go, they can’t possibly be worse than what I am expected to shell out now.  Except now, I get to live in fear that every time I go to the doctor, some bureaucrat in a cubicle somewhere is tallying up my “expenses” and hitting the Panic button to start the researchers down the long history of my time with doctors in order to find some miniscule reason to deny me coverage and I’ll go bankrupt from the bills.

Oh, and for those who say competition keeps prices down, I give you this.

This article expounds on this increased swallowing of the middle-class income down the health care hole.
However, it was written by some elitist from Princeton w/ a foreign-sounding name who may very well be a socialist, so watch out for some hidden death panels and whatnot as you read.

Most of those jackasses are either on Medicare (SOCIALIZED MEDICINE!!1!) or have employer paid insurance.  Nobody has explained to them that one of the reasons (other than rapacious corporate greed) that they haven’t gotten a real raise in the past 5 years is the increasing price of that insurance.

And I have a weird feeling you’re going to get your secret, masturbatory desire for massive civil unrest a long time before that happens

THIS.  The Second American Civil War is coming.  I expect it to be short and ugly—a lot of terrorist attacks with homemade bombs, since even inbred dipshits in pick-up trucks don’t want to fuck with the the actual army.

But it’s coming.  And somehow, that will vindicate the right.  “See? we told you the people wouldn’t stand for this!”

Until now, when relief is in sight*, I’d never really stopped to do the exact math. I’d guessed at it, sure, but I didn’t have the hard numbers.

That’s why they make *me* put the money on the dresser before hand.

Wait, what were we talking about?

“Our outcomes are terrible, and the “customer service” - in a free market, shouldn’t customer service be paramount? - is one step above being beaten to death with a payphone receiver.”

I learned a very instructive way to look at this relationship between “customer”, “consumer”, and “vendor” a few years back.

The “customer” pays for the services/goods provided by the vendor.  The “consumer” receives those services/goods.

In most cases, the customer and the consumer are one in the same.  As customer, if the service you received as a consumer sucked, you can use the power of the purse to threaten the vendor and (in functioning market) get better service.  And all is well with the world (no pun intended).

the problem is when it comes to healthcare, we are almost never the “customer” — the insurance company is because they are paying most of the costs.  we are merely the “consumer”.  Since we aren’t the party paying the bills, we are not in a position to demand better care.

We should be the “customers” of the insurance cos.  But often our employers are paying most/all of the cost of premiums (even if we all know it de facto comes from our paychecks).  So even there we are screwed.  The employer gets the health insurance they paid for.

In both cases we’re not in a position to demand changes in our favor.  And because the health insurance and job markets are not so competitive, here we are.

The one avenue of change we have is through politics.  And we all know where that’s headed…

Jesus, I just thought of something: 19% is a lot, right? I mean, it’s only 3% lower than most peoples’ marginal tax rates.

Well… sorta.  Most people fall into the $25k-$75k bracket which taxes at 25% of your Adjusted Gross Income (AGI).  But that’s not gross.  You get to take out all your deductions - standard and personal exemptions, losses from investments, small business expenses, foreign taxes paid, etc etc.  But then you should probably include the Medicare tax (1.2% of gross) and the SS tax (6.2% of gross).  So taxes usually come in at mid to high twenties or low thirties.

All that said, holy fuck!  19%!  I pay something in the area of $100 / month.  What on earth are they charging you?

Zifnab, you should add in the amount your employer pays for your premiums, too. If they weren’t paying most of your premiums for you, you’d be seeing that money in your paycheck. Auguste’s premiums are probably for a family—is your $100/mo for an individual?

Auguste, the traditional guideline was that you shouldn’t pay more than 35% of your income for housing (rent/mortgage). 19% is a gigantic chunk of change for insurance coverage! Especially 19% with a chance of massive bills on top of that.

All that said, holy fuck!  19%!  I pay something in the area of $100 / month.  What on earth are they charging you?

If you are only paying $100 per month, I would guess that you have one of two things:

a) a private high-deductible catastrophic policy that doesn’t cover shit; or

b) an employer-subsidized group healthcare plan, in which case your premium is much higher than $100 per month, but you don’t know that because 75-80% of it is coming from the employer contribution, which you probably don’t see on your paycheck stub (but it is, in fact, coming out of your total compensation).  If you lose your job and go on COBRA, you’ll find out just how damn expensive your insurance actually is.

Do you have family coverage?

B/c if it’s any good, your real premium under COBRA will be $500-800/month.

No shit.  You’ll be unemployed and asked to shell out $500-800 or more to keep your coverage.  Should you decide you can’t afford to pay that, seeing as you no longer have a job, and something bad happens…well, that was your choice and you deserve to die slowly and without pain management.

Do you have family coverage?

B/c if it’s any good, your real premium under COBRA will be $500-800/month.

LOLOLOLOLOLOL!!!

Try $1200/month.  That’s what it was the last time we had to COBRA.

And that was for the “family” of me and my husband.  No kids.

Oh, and if you stay unemployed for a length of time, those pre-existing conditions can come back.  Most insurance, should your employer choose to switch plans, accepts conditions the previous plan covered.  That’s why it’s important to COBRA, b/c if you go without coverage for 6 months, anything that was previously covered is now an official “pre-existing” condition.

Got diabetes?  Fuck you.

Got high blood pressure?  Fuck you.

Ever see a shrink, perhaps to deal with the depression of unemployment and financial woes?  Fuck you.

You can’t get covered for that shit ever again.

For comparison purposes, here in the socialist hell-hole that is the UK, my combined income tax and NI contributions total a massive 22% of my gross salary, according to my most recent payslip.

Sorry, I last COBRA’d 3 years ago.  Should have realized it would have increased by half at least.

Again, thank GOD for Rod Blagojevich.  Mike Madigan fucked him for financing AllKids by refusing to pass the business tax increase that Rod ran on, but Rod forced the services through anyway.

Yes, my state’s finances are a mess, but Rod followed through on his promises and provided health care for all the children in Illinois and all the pregnant women as well as providing free preschool for 3-4 year olds.

He was a crook, but he was a crook that looked out for the People as well as his own pocket.

Sarah in Chicago, there’s HOPE.  Call your sens and congresspeople.  Srsly.  We are a majority, we’re just not the ones screaming the loudest—we have to make sure our elected reps hear from US, not just the wingnuts.

This is the time when I’m annoyed I live in MD.  I called Cardin and Mikulski to be told they unequivocally support a public option, and my my Rep (Donna Edwards) has signed the Congressional Pact of No vote without a public option.  I wish I lived in PA or VA or IN where my voice might change someone’s mind, but for those of you who DO live in strongly purple states, call call call call call.

It MATTERS.

Well, I know it has made a difference, since I sent nasty emails to Durbin and Obama’s folks started asking ‘Why do you think anything has changed (just b/c Sebelius said it had)?”

I wrote a nice one to my new Rep, Mike Quigley, Rahm’s replacement.  I’ve seriously moved up in the Congressional representation dept.  I hated Rahm.  Voted Green uselessly just b/c I couldn’t in good conscience vote for him.

Mike put out a strong statement the other day for the repeal of DOMA.  He’s also pushing for health care reform.  I pushed him to sign the letter refusing to vote for a bill without a public option.  We’ll see.

There’s faint hope.  Mostly, I think we’re fucked, but there’s still a faint glimmer.

I had a debate where I was defending the public option to my wingnut cousin the other day…

Wingnut Cousin: I don’t want the government trying to run a public option healthcare plan, because everybody knows that a government plan will be filled with waste!!!

ME: Do you consider private sector health insurance to be less wasteful than a government-run program would be?

Wingnut Cousin: Damn straight I do!

ME: Would you consider it wasteful if Congress decided that a public healthcare administrator should be paid $11,538 per hour just to oversee the program?

Wingnut Cousin: I would call that tyranny!

ME: So let me get this straight, just so we’re clear. You are saying that you think it would be extremely wasteful for a healthcare coverage administrator, someone who is more likely an MBA than an actual MD, to be taking home a paycheck that equates to $11,538 per hour for their work?

Wingnut Cousin: That’s what I said.

ME: Okay, just wanted to make sure that we agreed on that.

Wingnut Cousin: We agree on nothing when it comes to healthcare reform.

ME: Actually, you are wrong. I completely agree that it would be almost criminally wasteful for a healthcare coverage administrator to get paid anything like $11,538 per hour for their work. Which is why I’m sure you must be just as offended as me by the fact that Ronald Williams, the CEO of Aetna, was paid $24 Million for his work as a private healthcare coverage administrator in 2008. $24 Million for one year’s compensation just happens to work out to $11,538 per hour in compensation. And it’s borderline criminal that a healthcare coverage administrator could ever make that kind of money, when they do nothing personally to help make sick people healthy.

Wingnut Cousin: <crickets>

ME: Yeah, I thought so.

He then stormed off in a huff and said, “Fine, enjoy the new United Socialist States of America.  I’m glad you hate your country so much!!!”

You know, that’s interesting - I wonder why no-one is pushing the “You know, people, if we had public option health care your employer could pay you $x more an hour/year because they wouldn’t have to pay as much for health care.”  Health care costs are invisible to the employed.  If someone could make a cogent argument that wages would rise as employers were freed from subsidizing health care, perhaps even with a slight rise in taxes the average worker might be better off…but that’s math, and math is hard, I guess.

OK not to derail the many very exceedingly good points, and I’m as furious with Obama as the next leftist, BUT:

OBAMA DID IN FACT FIX COBRA.

If you were laid off within the last 12 (or maybe even 14) months, you pay subsidized COBRA premiums. Currently my Cobra payment is $183 a month, which is only slightly more than what I paid for it under my employer-subsidized arrangement.

If you are still paying astronomical COBRA bills, PLEASE go to their website and request paperwork for the reduction. It’s easy to do, it goes through fast.

/town crier.

I point a finger of blame at whomever actually wrote HR3200. If you take all of the posts above this one, extract the point the poster is making, and then try to figure out how the provisions of HR3200 would solve the problem, you wind up with a big “I don’t know!”. HR3200 is going to wind up as a bone in the throat of the administration. The President could do us all of huge service by getting Waxman/Rangell to drop this thing, take all they have learned in the last month, and start fresh. I just think HR3200 is so bad that an amendment fest will only make it worse. Try and find a progressive source you trust that does an analysis of this bill, and see for yourself. Then start in on the Senate bill that is just out of committee, and try to imagine reconciling the two. What a challenge!

I pay 44% of my monthly income. This is for myself and my three children.

I wonder if part of the opposition (not the sheer deluded wingnut side, but the vague “I dunno what it is but I, in my grumbly incoherent way, don’t like it” side) comes from the glimmering awareness of just how badly we’ve all been screwed for so long.

If you fix it, you admit it’s broken. You admit that your own country has been, essentially, conspiring to bankrupt and kill you for the last 30 years.

You then have to take a good hard look at all our individual tens of thousands of wasted dollars over time. And know that you will never get them back.

And face the fact that you might love your nation, but it hates you, or at best considers you an inconvenient cockroach.

Small wonder most people want to bury their heads in the status quo.

Correction. That is based on net. Not gross. I pay about 39% of my income for health care premiums based on my gross income.

Why? Because I cannot get my three kids on a consolidated family plan. They each have their own policies at about $180 a month (with a 1000 dollar deductible each.)

The kids are all healthy, so this was the only way I could get them underwritten was to not include me. I make too much to qualify for medicaid (and the CHIP program in my state just uses the federal dollars to take care of the waiting list of poverty-level folks from the Medicaid roles.)

I have a disability and pre-existings…a mild kidney disease specifically and have also had several eye surgeries and a couple of female-parts type surgeries. The only insurance I can get that is affordable is Medicare (which I have to be qualified “disabled” to get, which also restricts my earning power.) So, I also pay for Medicare Part B (a bit less than $100), Part D (Around $30) and a Medigap BCBS plan which many doctors require in order to take Medicare (Around $180). I have 6 insurance cards in my wallet for the whole family.

Total comes to about $850/month.

Yes, I’m always looking for other options. So far, this is the best I’ve come up with for our situation to stay insured.

At a certain point when I was unemployed back in 2001-2002, I’d gone from an employer-provided executive health plan to a bare-bones plan that would basically cover me if I got hit by a bus (the Know-Nothing morons apparently believe that Jeebus will prevent such accidents from befalling them). The only reason I felt remotely comfortable doing that was because I was in good health with no pre-existing conditions, and even the payments on the basic plan cut majors swathes out of my savings.

I loathe the idea of being tied to “company store” health insurance, and can only imagine what it’s like for someone with few employment options to begin with. And the days of “we’ll keep you on until your wife’s radiation therapy is finished” (as portrayed the other night on Mad Men) are long gone.

Once, before the first round of layoffs during W’s wonderful economy, we had gold-plated BCBS coverage.

We had to use doctors in network, or they paid NOTHING.  If we went in network, WE paid NOTHING.  For anything.  Having a baby?  FREE.  Visiting a chiropracctor?  FREE.  Just so long as they were in network, and damn near everyone (and all of my previous docs) is in BCBS.

It was amazing…if you didn’t feel well, you went and had someone check you out.  Having a baby wasn’t a frightening ordeal.  Should a child fall, you didn’t have to check their eyes obsessively for dilation, praying that there’s no concussion.

It was amazingly stress free.

I imagine that’s what life is like in civilized countries.

If you fix it, you admit it’s broken. You admit that your own country has been, essentially, conspiring to bankrupt and kill you for the last 30 years.

Exactly.

Ours isn’t 19% of our gross, but we do now pay $3K more in taxes per year on it than we did last year.  Add that to the $7K (growing) portion we pay extra to the feds…

I only pay 6.25 percent, but I’m single and childless.  Although one thing that chaps my ass about my premiums is that I pay a higher percentage of my income toward premiums than my boss, our salespeople, our publisher.  They pay the same dollar amount, which likely amounts to 1-2 percent of their income.  Even a flat tax (perhaps with exemptions for the destitute) to pay for single payer health care would be better than the shitty setup we have now.

Oh, I know, wingnut, you have your personal physician, and ze’s practically House in the way ze diagnoses your kid’s chicken pox. How could we ever have that under Obamacare?

I’m starting to think that the only way to get a public option right now is to get Hugh Laurie and other TV doctors who have experienced government-run health care systems to testify in front of a joint session of Congress.  Does anyone have Kal Penn’s email?

Have House testify.  Considering what the right-wing is considering “true,” no one will even notice.

The other unfair thing is that the people most likely to be able to reverse their insurance company’s denials are those people who are upper income or well connected. People who are lawyers, can hire lawyers, whose parent is a lawyer, etc. Ditto relatives of politicians. Ditto relatives of well-known health reporters at major outlets.

Many insurance cos. will reverse themselves once they get a letter from a reputable law firm.

Have House testify.  Considering what the right-wing is considering “true,” no one will even notice.

And listen to the wingnuts screaming for weeks about his birth certificate proving he’s not actually American?

Oh, and if you stay unemployed for a length of time, those pre-existing conditions can come back.  Most insurance, should your employer choose to switch plans, accepts conditions the previous plan covered.  That’s why it’s important to COBRA, b/c if you go without coverage for 6 months, anything that was previously covered is now an official “pre-existing” condition.

I have a friend who was laid off from her print job a few months ago and now is a wildly successful freelancer. She also is recovering from cancer. If health care reform doesn’t pass soon, she will have to look for a 9 to 5 job when her COBRA runs out (thank you Obama for extending the subsidized COBRA for her) because of the dreaded “pre-existing condition” would preclude her from finding any reasonable coverage.

You know, the more I think about this, the more I see all of these guys dressed up in Victorian outfits shouting “If they would rather die, they had better do it, and decrease the surplus population. ... It’s enough for a man to understand his own business, and not to interfere with other people’s. Mine occupies me constantly. Good afternoon, gentlemen!”

Hell, I’ve gotten hit with the “pre-existing condition” bullshit when I’ve had a gap of one month between work coverage and student coverage.  And before that I was hit with the exclusion for a year after a gap of three months. 

God, I can’t wait until Aetna files for Chapter 7.

all of these guys dressed up in Victorian outfits

I think it’s time for the Billionaires for Bush to come back.

My employer picks up most of the cost.  OOP is like 3% of net income (single, no dependents).  Total including the employer contribution is closer to 20% of my total compensation.  Kinda insane.

PiaToR:  Hugh Laurie is British.  House is all-American.

Yeah, and our conservative friends are so good at distinguishing these things?

Our conservative friends have no idea House is a fictional character.

You know, if Laurie uses his American accent during the testimony, our conservative friends might not even notice we’re hearing testimony from a British actor instead of an American physician, as long as the nightly news show clips the “The American health care system doesn’t WORK” bit instead of the “My father was a general practitioner at a clinic in a council estate - what you’d call public housing - near Oxford” bit.

Plus, it might get “Stephen Colbert” on board with the public option, and our conservative friends think he’s one of them.

“If they would rather die, they had better do it, and decrease the surplus population. ... It’s enough for a man to understand his own business, and not to interfere with other people’s. Mine occupies me constantly. Good afternoon, gentlemen!”

Quick!  Let’s scare up some ghosts of Christmases past, present, and future.

Living in the Pacific wilderness at the end of the world (New Zealand), where there’s a lot of bitching and complaining about our health system. 

Doing the math, I pay 23% of my gross in income taxes, a further 2.8% in council rates (equivalent, I think, to property taxes) and a whopping 1.7% for a rather good private health insurance policy.  Of my myriad of pre-existing conditions the only one they won’t cover is hayfever.  But, as it affects my asthma, my doctor can prescribe antihistamines and nasal spray and as long as the products are on the Pharmac list I am forced to cough up the princely sum of $3 per prescription.

I’ve just been referred to a private back specialist, which was covered by the national Accident Compensation scheme (ACC).  I had to pay a contribution for the x-rays (done on the spot) of $84, which I can claim back on my insurance.  My ongoing physiotherapy sessions will be partly covered by ACC and partly by insurance.

I just had a really eye-opening back-of-the-envelope realization. Our son was born seriously premature, spent six weeks in NICU, my spouse spent a week in the hospital with her side of the interesting situation. Total bill (list prices, not the negotiated ones insurance actually paid) somewhere north of $150K. The kind of whopping bad outcome on a family plan that you’d expect an insurance company to need a bunch of healthy families to counterbalance. But even if our premiums don’t go up any more (ha!) BCBS will be ahead of the game by the time he’s 12.

I’d love to see House (not Laurie) testify to Congress.  He’d dry-swallow 5 Vicodin then call them all a bunch of morons.

think it’s time for the Billionaires for Bush to come back.

They did, in Phoenix.  Billionaires For Wealth Care http://billionairesforwealthcare.com/BillionairesForWealthcare.html

This is the time when I’m annoyed I live in MD.  I called Cardin and Mikulski to be told they unequivocally support a public option, and my my Rep (Donna Edwards) has signed the Congressional Pact of No vote without a public option.  I wish I lived in PA or VA or IN where my voice might change someone’s mind, but for those of you who DO live in strongly purple states, call call call call call.
It MATTERS.

Honey, please call Harry Mitchell or Gabby Giffords in AZ. 

Mitchell:  (202) 225-2190

Giffords:  (202) 225-2542

I am living in the UK now.  I moved here from the US in Jan 2008.

People, as far as health care is concerned, this place is Shangri-La.  Shortly after I first moved here, I got really sick and was hospitalized for 3 days.  I didn’t have any health insurance and I wasn’t a UK citizen yet, so I was very scared about what the bills were going to be like. I asked the nurse if I could speak to a bursar or someone about payment plans, and she looked at me like I was crazy.  It turned out that for me, even though I wasn’t a citizen at the time, Emergency Room visit + 3 days hospitalization + numerous tests = I don’t have to pay a dime.  I was scheduled for surgery to address the issue that hospitalized me, and a few weeks later, went in for the surgery.  Cost?  Nada. I even got a HOME VISIT from a nurse for the aftercare!  For free! And prescriptions? Unbelievably cheap! You can get a 3-month pre-paid prescription card for £14, and that pays for ALL of your prescriptions for those 3 months!  ALL OF THEM!

There’s more! Even though they’re considered the worst in the EU, the worker protection laws here in the UK (mandated vacation time: 28 work days, statutory maternity pay up to 39 weeks, virtually unlimited paid sick leave, etc. etc.) make working here in the UK unbelivably great.  I’m so used to having to come in to work even when I’m sick, it took a while to get used to the policies here.  My last job in the US gave us 10 days of “PTO”, which was both vacation time and sick leave time rolled together, meaning that of course people came in sick all the time, because they didn’t want to lose their vacation days!

I tell my UK colleagues here this kind of stuff and they just can’t believe it.  They’re like, “That’s barbaric!” And they’re right.

It’s so nice to be living in a country that has sane healthcare and labor laws.

Um….sorry, didn’t mean to rub it in.  :/

There’s more! Even though they’re considered the worst in the EU, the worker protection laws here in the UK (mandated vacation time: 28 work days, statutory maternity pay up to 39 weeks, virtually unlimited paid sick leave, etc. etc.) make working here in the UK unbelivably great.  I’m so used to having to come in to work even when I’m sick, it took a while to get used to the policies here.  My last job in the US gave us 10 days of “PTO”, which was both vacation time and sick leave time rolled together, meaning that of course people came in sick all the time, because they didn’t want to lose their vacation days!

Let’s see - mandated in NZ is 28 days annual, five days sick, three days bereavement (per annum), and 14 weeks paid parental/maternity leave, 2 weeks for partners, and up to 52 weeks unpaid.  My civil service contract has 5 weeks annual leave, and unlimited sick leave - they trust us to act responsibly, and start asking for explanations when we go over 10 days per annum.  Very few people abuse that.

I can’t imagine working to “10 days PTO”.  That’s just plain wrong.

I think that the US suffers from early-adopter syndrome here. We were doing 10 and 8-hour days and paid vacation back when most of europe was still partly feudal. Then came ww2, and we got incremental improvement while the europeans got a soft revolution.