The Kaiser Family Foundation has an handy calculator to help you determine how much you’ll be required to pay for health care circa 2013/4 (in 2009 adjusted terms) — depending on your age, income, and other variables — if you’re on the individual market.
December 28, 2009
Economic Human Rights
The Washington Post has recently published what can only be described as a Red Baiting editorial accusing the Obama administration — and Hillary Clinton in particular — of Communist thought crimes. Apparently the Obama administration is “Redefining Human Rights.” How, you ask?
The Obama administration, she said, would “see human rights in a broad context,” in which “oppression of want — want of food, want of health, want of education, and want of equality in law and in fact” — would be addressed alongside the oppression of tyranny and torture. “That is why,” Ms. Clinton said, “the cornerstones of our 21st-century human rights agenda” would be “supporting democracy” and “fostering development.”
This is indeed an important change in U.S. human rights policy — but the idea behind it is pure 20th century. Ms. Clinton’s lumping of economic and social “rights” with political and personal freedom was a standard doctrine of the Soviet Bloc, which used to argue at every East-West conference that human rights in Czechoslovakia were superior to those in the United States, because one provided government health care that the other lacked. In fact, as U.S. diplomats used to tirelessly respond, rights of liberty — for free expression and religion, for example — are unique in that they are both natural and universal; they will exist so long as governments do not suppress them. Health care, shelter and education are desirable social services, but they depend on resources that governments may or may not possess. These are fundamentally different goods, and one cannot substitute for another.
Got that? After the impressive democracy promoting agenda of the Bush administration — which courageously spoke up for democracy in places like Saudi Arabia, suspended aid to dictatorships like Pakistan and Egypt, and supported democratic elections unless it didn’t like the outcome — we are in the age of Crypto-Communist-Muslim Obama now embracing a completely alien concept of human rights, a “Soviet” idea of human rights which considers economic welfare to be vital for human freedom and efflorescence.
Except of course the editorial board of the Washington Post apparently hasn’t heard of something called the Universal Declaration of Human Rights, which Eleanor Roosevelt helped write, and which the United States adopted after the Second World War. Let’s quote at semi-random from this (by the Post’s standards Communist) document:
Article 22.
Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.
Article 23.
(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.
(4) Everyone has the right to form and to join trade unions for the protection of his interests.
Article 24.
Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.
Article 25.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
Article 26.
(1) Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.
(2) Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.
(3) Parents have a prior right to choose the kind of education that shall be given to their children
I guess maybe economic rights are also a kind of human rights, universal rights, after all. Perhaps human rights are just the rights that humans get together and decide are most important to a dignified life. Or did the Soviet Union or China or some other UnAmerican nation perhaps slip these alien concepts into the Universal Declaration of Human Rights against the will of the United States? Nope.
As Elizabeth Borgwardt documents in her history, A New Deal for the World, the impetus for enumerating economic rights partly originated with Franklin Roosevelt’s Four Freedoms, which always had an international orientation. Indeed, Roosevelt originally proposed what he called a “Second Bill of Rights,” concerned specifically with economic rights, to address what the postwar world might look like for the United States. As Borgwardt writes:
Early 1940s pronouncements about rights, including economic rights, drew upon the immediate experiences of Depression and war; they did not prefigure a Cold War orientation. The Economic Bill of Rights created a bridge between the economic aspirations of the Four Freedoms and wartime attempts to institutionalize a developing culture of human rights by means of New Deal-style institutional planning.
Let’s list these proposed rights — radical, Communist rights! — in toto.
The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;
The right to earn enough to provide adequate food and clothing and recreation;
The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
The right of every family to a decent home;
The right to adequate medical care and the opportunity to achieve and enjoy good health;
The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;
The right to a good education.
All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.
America’s own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for our citizens.
If this is Communism, we should perhaps open our minds to its message. In our finance-mad age of boom and bust; persistent economic insecurity; a weak, deunionized labor movement; increasing levels of economic inequality; and debt-dependent standard of living, we have a long way to go before the reality of life in America lives up to the rights ambitiously enumerated in the Universal Declaration, almost seventy years ago.
December 25, 2009
Am I a Cadillac-driving Health-care Queen?
I have employer-based health insurance. Like most Americans, you probably do, too. One question I’ve been asking myself — given the anger that exploded over the last week between progressives who favored and those who opposed the Senate health-care reform bill — is what the excise tax in this version will do to those of us who have employer-provided plans.
The Senate excise tax will tax employee health care benefits 40% for plans valued over $8,500 for individuals and $23,000 for families. The tax is indexed to inflation (+ 1%). Right now, this tax will affect 3% of premiums. Multiple people call this a tax on “Cadillac” health care plans. Over time, more and more plans will be affected by this tax, given the current rate of medical inflation, which far exceeds the general rate of inflation. If you aren’t affected by the 40% excise tax today, you will be tomorrow.
A substantial group of progressives who support the tax claim that it’s one of the Senate bill’s primary means of controlling medical inflation. Ezra Klein lists it among his “five cost control mechanisms in the Senate health-care bill,” arguing that the excise tax “is, essentially, a tax on the unchecked growth in premiums.” Klein and many health care economists say that the excise tax will control costs by making plans below the threshold much more appealing, and will increase worker salaries because health care plans more expensive than the cap will be taxed at a higher rate than income. That is, it’ll be cheaper for employees to give you a dollar in salary than a dollar of health insurance.
Unions have objected to the excise tax because it will affect their health care plans, which are often negotiated for knowing that a dollar of health care coverage is worth more than a dollar of income. At Fire Dog Lake, Jon Walker has objected that the tax will “reduce the quality of millions of Americans’ health insurance coverage, will technically ‘bend the cost curve’ by just barely 0.3% in 2019. All that for a measly 0.3% reduction in national health expenditures,” i.e., that companies will tend toward cheaper plans but that an increasing number of workers will find that those savings will come out of the benefits their plans provide. At the Web site of Physicians for a National Health Program, Leonard Rosenberg is quoted as saying that the tax will give employers “a strong incentive to cut back on their benefits. Instead of reducing underinsurance, this part of the Plan will increase it.” My — and your — health insurance will get worse over time. We pay relatively lower premiums, health inflation remains unabated, and we get less coverage.
The crux of the argument seems to be based on different ideas about the causes of differences between health care costs. What’s responsible for this difference? Overly generous (“Cadillac”) benefits? Lazy insurance companies? Inefficient medical providers? The clearest case I’ve found against the excise tax is available on Slate. Timothy Noah goes over the facts — including a peer-reviewed study in Health Affairs — and concludes that “benefit design” had little to do with the variation between different plans: “excess” or wasteful health care doesn’t have much to do with why expensive plans are expensive relative to less expensive plans. Health care inflation, meanwhile, will continue, sucking in more and more employer-based plans into the grip of the excise tax. In fact, “[i]t’s therefore easy to imagine the Cadillac tax squeezing patients between ever-lowering benefits and still-rising prices for medical care”; a growing number of people may “see the value of their health insurance decline relative to doctor and hospital fees.” It’s worth reading the whole thing.
Addressing some of the same facts, Klein comes to an opposite conclusion (referencing what I think is the same Health Affairs study): “if the insurance market is really so mysterious and inefficient that we can’t confidently say why one plan is pricier than the next, that’s good evidence that there’s a place for strong cost controls penalizing fast growth in premiums. It is, at least, worth a try.” And: “I don’t deny that the excise tax might fall flat. But right now, we need to err on the side of trying cost controls, not ruling them out. I have no doubt that if the excise tax proves overly aggressive, it will quickly be declawed.” But this seems to go back to the point of my previous post. The “wonky” case for the excise-tax is based on the decidedly non-wonky admission that it may very well not work to do what it’s supposed to do, since we don’t have a very good idea what causes variation between plans, but the ultimate reassurance that if it doesn’t work, well, some political incentive magic will undo what’s bad about the policy.
Is this a risk we want to take? It looks like one we’ll be asked to take. Did I mention the title of the Health Affairs study? It’s “Taxing Cadillac Health Plans May Produce Chevy Results.”
December 18, 2009
Smacking the Pragmatic President in the Face?
Let’s begin with a quote from the New York Times:
In the great health care debate of 2009, President Obama has cast himself as a cold-eyed pragmatist, willing to compromise in exchange for votes. Now ideology — an uprising on the Democratic left — is smacking the pragmatic president in the face.
Stung by the intense White House effort to court the votes of moderate holdouts like Senator Joseph I. Lieberman, independent of Connecticut, and Senator Ben Nelson, Democrat of Nebraska, liberals are signaling that they have compromised enough. Grass-roots groups are balking, liberal commentators are becoming more critical of the president, some unions are threatening to withhold support and Howard Dean, the former Democratic Party chief, is urging the Senate to kill its health bill.
This description of the debate over the Senate version of health insurance reform reproduces conventional journalistic wisdom about politics in America. On one side are the moderates, the compromisers, the policy wonks. These are the good guys.
On the other side of the ledger, are the lefty villains: the unreasonable, the unserious, those who are moved more by ideology than understanding.
Meanwhile, Joe Lieberman is never an ideologue; neither is Ben Nelson. They’re moderate centrists resisting the vicious Hard Left. It’s grass-roots groups, unions, and complainers like Howard Dean who are thwarting the pragmatism of the president.
The problem with this narrative is that — if you judge based on the conversations happening in the blogoverse — both groups claim to be wonky, pragmatic, clear-eyed undeceived realists; both sides accuse the other of not seeing the forest for the trees. As Steve Benen argues, this is a serious debate.
Serious is fine, but who’s right?
* * *
For me, the bottom line is this: if you’re an anti-corporate liberal — and I’m probably more in this camp, though I am willing to be convinced to support the Senate version of the bill — who thinks that the system in Washington is oriented toward the interests of large companies, at the expense of the needs of people, then the Senate version of this bill will confirm all your fears about how Washington works.
Those who argue — as most who advocate for the bill do — that yes the technical details of the Senate bill are more or less as bad as everyone is saying but that it will be improved over time have the harder argument to make. Take Ezra Klein, who argues:
In a world with an individual mandate, large premium increases are Congress’ problem. It focuses the mind on cost control. Given a choice between passively letting people become uninsured and taking on providers and insurers, Congress will choose the path of inaction. But given a choice between voting to take people’s insurance away and taking on providers and insurers? That’s a harder decision. Right now, the pressure in the political system comes from organized interests. The mandate levels the playing field.
Advocates of imperfect reform assume what they need to argue for: that when it comes time to reform the inadequate bill, to address its lingering structural problems, there will be no choice but progressive change, or an increased likelihood for improvement. Instead of stripping care from people, serious cost cutting measures will be implemented. But why? What will have changed in Washington? The main difference will be that health care corporations will earn more income — their stocks are rightly soaring now — Democratic politicians will depend more than ever on donations by the insurance and Pharma industries to win reelection, and there will be companies on the exchanges that are now “too big to fail.”
Klein offers the most detailed and persuasive case for supporting the bill that I have found, but I think his claims are based on a lot of supposition and incorrect analysis. After all, wouldn’t a private exchange system packed with high-deductable, low-care “coverage” be cheaper, a very plausible way to control costs? What if this is what universal “coverage” will ultimately look like? Is there anything in the Senate bill that does anything to undermine this outcome?
If I had to put on my speculative hat, I would guess that insurance companies on the exchange will cut costs by technically following the letter of the law, and lobbying to make coverage universal but effectively meaningless for many poor people. If you have insurance but can’t afford to pay your high deductible, aren’t you back to square one in some sense? No, haven’t you been pushed back a few squares, since you’re out of that money you’re being forced to pay for inadequate care?