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Wednesday, September 28, 2016

New health insurance marketplaces will make affordable care accessible to millions, but low-wage employees of big businesses may be left out.

One of the biggest issues that the Affordable Care Act (ACA) is meant to tackle is the lack of health coverage among low-wage workers. While there is good news for many low-wage workers in the new law, many others will still find themselves locked out of access to affordable coverage. Solving their concerns will be one more part of the huge challenge of confronting the power of mammoth low-wage employers in the new economy.

There has been a lot of coverage about the potential for fast-food chains and other employers to cut the hours of some of their employees to under 30 a week in order to avoid having to offer them health coverage. To the extent that employers do cut back hours, it will accelerate a long-trend toward part-time low-wage work; part-timers increased from 17 percent to 22 percent of the workforce just from 2007 to 2011.

The surge in part-time work is one aspect of the broader increase in low-wage work. Most of the jobs coming out of the recession are low-wage, which has hastened a trend going back 30 years of a growing number of low-wage jobs with no health benefits. The powerful eroding of good jobs is the greatest threat to broadly-shared economic prosperity. It destroys any promise of people living a middle-class life style, creates a two-tiered society, and undercuts the consumer buying power needed to move the economy forward.

The low-wage economy means more than just low wages. Post-World War II jobs, which came with employer-provided health coverage and a pension, are fast disappearing. Now more than 4 in 10 workers do not get health coverage on the job. This includes many employees of small businesses that do not offer any health coverage. It also includes millions of employees of large businesses, who either are not offered health coverage or can’t afford the premiums.

Enter Obamacare. The good news in the ACA for low-wage workers who work for small employers (those with fewer than 50 full-time workers) is that many will have access to affordable health coverage for the first time through the new health insurance marketplaces. They will be able to sign up for subsidies that limit how much they pay in premiums to a percentage of their income and get plans with good benefits and moderate out-of-pocket costs. Those with incomes below 133 percent of the federal poverty level (about $15,000 for an individual) will be eligible for Medicaid in states that agree to expand coverage.

But for those who work for bigger employers – and some two-thirds of minimum-wage jobs are at employers of 100 or more – it is not clear whether the ACA will deliver on its promise of affordable coverage. Ironically, part-time workers may come out ahead, with a much better chance of affordable coverage, while full-time low-wage workers may find coverage out of their financial reach.

Millions of people who don’t work more than 29 hours a week for any one employer will be eligible for affordable subsidized coverage through the new marketplaces. And even if employers trim back some workers’ hours to get below the 30-hour mark, those workers may end up better financially and gain affordable coverage for the first time.

There will also be some employers who increase the hours of part-time workers to above 30 a week, as the Cumberland Farms stores, which employ 4,500 full-time workers and 2,700 part-timers, plan to do. Noting that full-time workers stay with the business three to four times longer than part-timers, the Cumberland Farms CEO explains, “Longer-tenured workers deliver a better experience for the customer.” According to the payroll-processing firm ADP, other businesses are also likely to encourage more workers to become eligible for employer coverage.

  • Lynda Groom

    There is nothing that keeps the leadership of Congress from addressing the shortcomings of the law…except the political will to try and accomplish something for the good of the country. ObamaCare is the law of the land, so why not put at least at much time into working to make improvements as worrying about the uterus and Planned Parenthood? Trying to repeal the program over, over and over again has accomplished nothing except the wasting of the taxpayers time and money. Supposedly we sent folks to Washington to solve problems, not make them worse.

    • Catskinner

      The only smart thing to do with the law is to repeal it.

      • CPAinNewYork

        Spoken like a true rich prick. Romney and Ryan would love you,as would Cheney and the rest of the scumbag rich.

        • Ima_Leftout

          I am in health care and it is
          true that Canadians come south for care using “supplemental private ” insurance! In spite of all fraud, corruption? of our system , it evolved into the best medical services in the world . Is anyone going to Cuba for Medical Care, except the leader of Venezuela and other small minded egotists….what ever happened to him anyway? A national Medicare type system would be the best where everyone pays through a national sales levy….meaning everyone tributes….not only workers. Insurance companies do make profits for huge buildings, and rallying money back to shareholders….pension plans ? Union and private….etc. it all comes out even…it seems. I would hate to see us have less available technology…it makes existence and dying more comfortable…..believe me!

  • Dominick Vila

    It will mean that people who currently don’t have healthcare insurance because they cannot afford the high premiums, and who depend who depend on Emergency Room care when they are in an accident or afflicted by a serious disease will be able to get the preventive care they need without depending on Reagan’s socialized ER freebies.
    I think it is important to note that in addition to those who cannot afford to pay for the coverage they need, people in higher income brackets who are currently paying astronomical COBRA insurance premiums, will also benefit from the establishment of exchanges. Moreover, seniors will benefit from the elimination of the nefarious “donut” hole.
    People who already have insurance provided by their employers, or as individuals, will not be affected. They can retain their current plans. ACA is designed to help those who don’t have coverage and those who are paying high premiums for the medical care they need.

    • Catskinner

      My employer cut back from 200 employees to under 50 and cancelled the healthcare coverage we used to have. You’ll see a whole lot of that.

      • CPAinNewYork

        Tell us who your employer is so that we can boycott his business. Hopefully, Congress will legislate that dodge outv of existence.

        • Catskinner

          He’s just doing what he has to do to stay in business. He has to do it because all of his competitors are doing the same thing.

          • CPAinNewYork

            That’s the excuse that athletes use when they’re caught using performance enhancing drugs, i.e they have to use them to compete with the users. A former employer of mine used it to justify the company’s proposed change to a cash value pension plan from the defined benefit plan.

            If “all his competitors” are doing it then that’s a good reason for federal legislation removing the full versus part time distinction for mandating health benefits.

          • Catskinner

            It’s the same principle as athletes taking steroids. The difference being, taking steroids is either illegal or against the rules, and there’s no law or rule about downsizing your business.

          • bandrulz

            I call ‘bull shit’ on a story of someone who cuts his business from 200 employees to 50. That would essentially be giving up the business. If he needed 200 employees to get the job done, what will he accomplish with only 50 but destroying his own business?

          • CPAinNewYork

            He didn’t cut his entire staff to fifty. He put 150 who were full time and entitled to benefits on part time and screwed them out of their benefits. Do you still think that’s bullshit? Sounds like something that John Schnatter threatened to do when he was disappointed by Obama’s re-election and wanted to punish those of his employees who voted for Obama. The operator of Applebee’s threatened to do the same.

            The rich are definitely poor losers, but they are losers.

          • Catskinner

            You can call what you want. I suspect the laid off employees will form small groups of subcontractors, and he can do the same amount of work with subcontractors without having to fool around with healthcare.

          • Independent1

            Catkinner, studies have shown that had Obamacare not been enacted 4 years ago, healthcare and insurance costs would be 30-40% higher today than they are. These studies also show that the rise in healthcare/insurance related costs over the past 3 years has been at the slowest rate in 15 years. So any businesses that are using the excuse that they’re cutting back because of Obamacare are simply using that as an EXCUSE to shortchange their employees. Wal-Mart is trying to do that by claiming now that Obamacare has forced them to be a majority “part-time company”. When in fact, Wal-Mart has been a majority part-time company for more than a decade. We have several folks in our family who have worked at W-M for years and have never been allowed to work enough hours to be considered full-time and therefore qualify for benefits. Wal-Mart like many other companies are trying to pull the wool over everyone’s eyes so they can give the shaft to their workers and stuff more money into THEIR OWN POCKET!!!

          • Catskinner

            Yes, I agree, and I wouldn’t try to defend Wal-Mart. The whole healthcare mess is hard to navigate. You get different figures depending on who you’re listening to.

          • metrognome3830

            If these employees had enough business to support 200 employees, what happens to their business when they cut 75% of their work force? Won’t they lose business? Won’t someone else pick up that lost business? If there is not enough lost business to support someone else opening up and taking that business, wouldn’t it follow that perhaps the reason for the cutback is mainly a lack of business rather than avoiding healthcare benefits? Just asking. I, of course, don’t know what kind of business you are employed in.

          • Catskinner

            I bid jobs in the heavy construction industry–big iron doing heavy infrastructure and earth moving projects–the laid off employees will likely become subcontractors. It’s the wave of the future. Avoiding Obamacare is more important to some of these people than profit.

        • lana ward

          Obamacare is going to kill the middle class just as OHitler planned. It is so bad, Dems in congress want themselves and their staff exempt from it.

      • Dominick Vila

        If your employer cut staffing from 200 down to 50 it has to be for reasons completely unrelated to the Affordable Care Act. There is no logical explanation to tie the two. Consider mismanagement, foreign competition, lousy quality control, substandard products or services and other such probabilities as the most likely cause for your employer going downhill. Companies are not going belly up because ACA is going to be implemented next year.

        • Catskinner

          If you have less than 50 employees, you’re not subject to Obamacare. It’s happening all over. The other thing their doing is making sure part-timers don’t get more than 30 hours a week.

          • Dominick Vila

            http://www.healthcare.gov/law/information-for-you/small-business.html
            The website above highlights various benefits that will be available to small business owners when ACA is fully implemented in 2014. ACA will actually reduce the current healthcare costs incurred by the small business community. The only way a company would consider reducing staffing and getting out of business would be if they don’t offer a healthcare plan to their employees, and even that is shortsighted, if nothing else because business pass on additional costs to the consumers.
            I doubt there is a single entrepreneur, running a prosperous business, who would dismantle part of his/her business because ACA is going to be implemented in 2014. I realize that is one of the talking points advanced by the Tea Party and right wing pundits to justify their opposition to ACA, but it is simply not true and, furthermore, it doesn’t make sense.

          • Catskinner

            Personally, I don’t believe Obamacare is going to reduce costs to employers. But whether it will or not, whether it makes sense or not, will not stop employers from reacting in the manner I’ve suggested. And from what I’ve read, they’re doing it in large numbers all across the country.

          • Dominick Vila

            It is true that some companies – small and not so small – are taking advantage of all the confusion that exists about ACA to take away benefits, deny pay raises, replace permanent with part-time workers, and engage in widespread anti-labor abuses with impunity. Not that they needed any excuses to exploit their employees in the past, what is happening now has been going on centuries.
            The problem with ACA is that the administration has done a lousy job at explaining its benefits to the American people and to our business community, and have allowed the special interests that oppose it because it limits their ability to exploit their workers to get away with falsehoods that are not even close to reality.

          • Catskinner

            I agree, Dominick, there is a lot of confusion.

          • 4sanity4all

            So your boss doesn’t want to grow his business? It sounds like he is cutting off his nose to spite his face.

          • Catskinner

            Growing a business in an Obama economy is like playing Russian Roulette.

          • 4sanity4all

            Businessmen who claim that they must fire workers, or cannot invest in their business because the ACA is going to bankrupt them, or Obama is ruining the economy do not know what they are talking about. Successful businessmen get the facts, then act. They do not stand around, wringing their hands and whining. They find a way to make conditions work for them. If you want loyal workers, then you find a way to compensate them fairly, including helping them to earn benefits. But if you do not respect your workers, and you don’t want them to be loyal, then you treat them like disposable, interchangeable parts, you pay them peanuts, and you thus drive your business into the ground. All the while moaning about your business failure being someone else’s fault.

          • Catskinner

            My daughter-in-law manages and extended care facility. Yesterday the company that owns the facility–based in another state–announced they are ending healthcare for management personnel and cutting staff back to 28 hours a week so they won’t have to cover the workers. That’s what Obamacare is doing all over the nation.

          • 4sanity4all

            Obamacare is not doing that; it was created to avoid that. It is ignorant employers who are too lazy to find out how the plan will benefit them and their workers. Don’t blame a program that was created to help; blame close minded people who would rather whine than find out how it can work to their benefit.

          • Catskinner

            Obamacare is the reason employers are forced to do that.

        • Lynda Groom

          Exactly my friend. Any company that cuts from 200 to 50 has bigger problems than management of a health care plan.

      • charleo1

        I’ll join the others here and say, if your employer cut his workforce
        by 75%, there is a lot going on besides dodging healthcare reform.
        Because, there are only two possible circumstances that would
        account for laying off 3 out of every 4 employees. One scenario
        would be, business is so slow, that one employee could do the
        work he is doing now. Plus, the work of those 3, that are being
        laid off. Or, the employer had been so optimistic about the growth
        of his company. He hired 150 additional employees, in anticipation
        of work that never materialized. Something that happens in probably
        zero cases.

        • Catskinner

          As stated earlier, I suspect the laid off employees will become subcontractors.

          • metrognome3830

            So then it would be important that these subcontractors and companies who dispose of employees to get around the insurance requirement would be somewhat concerned that their employees be able to buy affordable insurance, wouldn’t it?
            Of course those employees would then be seeking higher wages to pay for that insurance, so I think it would be a good thing to have options. Pay for health benefits or pay a sufficient wage so the employees could buy their own. Then analyze which is the most beneficial economically.

          • Catskinner

            They can seek higher wages, but in an economy like this, they probably won’t be successful.

          • Independent1

            So effectively, the owner of your company is just like every other greedy entrepreneur – let’s game the system by either paying help under the table, calling them subcontractors, or whateveer, just so we can get around playing the game fairly. That’s typical of people in the 1-5% of income suckers. (Grab the money as quick as you can even if you have to cheat to make it.)

          • Catskinner

            My employer certainly isn’t in the 1%-5% bracket, but isn’t that the way the game has always been played, by everybody? If they change the tax laws businesses hire CPA’s to find a way around them. They feel they are just adjusting to circumstances. They don’t feel like they’re cheating.

          • 4sanity4all

            I hope that when the economy picks up, all of the people who had to become subcontractors will join another company or form their own company, and tell your boss to take a long walk on a short pier.

      • ralphkr

        I saw the same thing happen with a local hospital. They cut their full time staff from over 500 to less than 75 (mostly administrators left as full time employees) with absolutely no degradation of services. The secret…hiring temps. The temps got more pay per hour than the regular employees BUT the hospital did not provide any benefits (pension, insurance) and that is where the big savings came into play. Oh, by the way, this was done in 1980 so they were getting ready for ObamaCare well ahead of the curve.

        • Catskinner

          As you say, Ralph, a lot of this has been going on for a very long time, but in this case it seems like small business people are particularly worked up over it. In the first place, many of them hate Obama, and they’d like to see Obamacare fail, and then when they found out what the IRS has been up to, they really came unglued. A lot of them hate the IRS as well, in many cases for good reason.

        • Dominick Vila

          The trend to replace full time employees with part timers and temporaries has been going on since at least the 1980s. The main reason for that is foreign competition. American companies are desperately trying to find ways to remain competitive by eliminating benefit packages, using elusive charitable donations to reduce their tax liabilities, accelerating depreciation and amortization, and other tactics. The irony is that the Affordable Care Act is likely to reduce corporate costs. The healthcare contributions that employers incur when they offer that benefit to their employees has been huge and a significant part of their operating costs. I was affected by a benefit reduction measure taken by more former employer when they decided to get corporate-provided healthcare insurance to retirees about 6 years ago, long before Obamacare was even an issue.
          Regarding the hospital cuts you mentioned, obviously, foreign competition is not an issue – although a lot of Americans are going to countries like India to get exceptional medical care for a fraction of the cost. Their goal is, obviously, to reduce operating costs. The cost of medical equipment is huge, the cost of subsidizing Emergency Room care to the uninsured is substantial, and the cost of malpractice insurance is too. Obamacare has become the easiest excuse to justify staffing and benefit reductions that have been going on since Barack Obama was wearing diapers.

          • Independent1

            Replacing productive, higher paid workers, with less experienced, lower paid workers did begin in the 1980s during Reagan’s presidency primarily for one reason – Reagan busting the Air Traffic Control union and laying off all the controllers without even negotiating with them once, showed CEOs and entrepreneurs around the world that if the President of the U.S. could show that little respect for people trying to negotiate a living wage – SO COULD THEY!! Not only that, but Ronnie appointed two union haters to the US Labor Relations Board which reinforced the message – unions are not to be respected. That’s when CEOs across the nation starting to pay more attention to the bottom line and what stockholders thought, than in honoring their company’s committment to workers that had worked long and hard for them. I can recall quite vividly noticing that many of the workers in my company that I had respected for their work ethic and loyalty over the year to the company, were getting let go one by one and replaced with younger, less experienced workers who could be paid much less – gone was the bond between a worker and his/her employer- and it has only gotten worse over the years; workers no longer feel a loyalty to a company and companies obviously feel no commitment to providing a living wage to their employees. It’s all about how big a bonus the CEO, department managers and others can get by cutting expenses, including employee benefits in order to increase the bottom-line.

    • lana ward

      Catskinner is right. Employers everywhere are cutting full time employees’ hours back to 30 hours a week so they don’t have to pay for that God-awful Obamacare. You need to start reading some reliable news.

      • dtgraham

        Lana, do you believe that all Americans should have complete access to health care regardless of the state of their private coverage, or their ability to pay privately otherwise? If you don’t believe that, fair enough. No need to explain. This is a philosophical question lana. If you do, then tell us which system you would prefer that would give all Americans 100% health care coverage no matter what their income level is.

  • Catskinner

    It will ensure that people who thought they had healthcare now won’t, and people on MediCare will go broke paying for supplemental policies in order to get a doctor to see them.

    • Dominick Vila

      Yes, but for reasons that have little to do with ACA. There is absolutely nothing in the Affordable Care Act that would result in an employer reducing staff from 200 to 50. They are either in the wrong line of business, their products are poorly built, over priced, being slaughtered by foreign competition, or mismanagement. Blaming potential bankruptcies on ACA is a stretch.

      • TZToronto

        You’re right. Would an employer cut staff from 200 to under 50 just to avoid paying healthcare benefits under ACA? If it’s true, then Catskinner’s employer must be one of the dumbest people on the face of the Earth–or a Tea Partier who’d rather see his company die than give in the ACA (maybe both). . . . Of course, I live in Toronto, so I have none of these problems.

        • CPAinNewYork

          So you’re gloating eh, Canuck? From what i’ve heard, Canadians are not getting necessary healthcare because there are so many applicants for needed surgeries. England has the same situation.
          I’ve heard stories of Canadians travelling to the United States for necessary surgery and paying the full price for it.

          • TZToronto

            The simple fact is that required care in Canada is provided expediently. My wife required cancer treatment and got what she needed right away. She had 24 radiation treatments over the course of five weeks soon after her surgery. People are not denied prompt medical treatment when they need it. In fact, in some cases the Canadian system sends people to the U.S. (and pays for it) when the treatment is not available when needed in Canada. You are correct, though, that some Canadians will go to the U.S. for treatment, but these are generally people who can afford to do so, not simply people who can’t get treatment in Canada. There have been a few horror stories about individuals who didn’t get treatment in Canada and spent huge amounts of money in the U.S. for the treatment they wanted, but usually the “wanted” treatment is not warranted by the diagnosis. In other words, they didn’t really need the treatment but wanted it anyway. If you want unnecessary treatment in Canada, you will have to take your place in the line and wait until the people who really need treatment get it.

          • CPAinNewYork

            That’s not what I heard. I’ll stick to my story, despite what you’re saying, which I think is just a nationalistic reaction to criticism.

            As to what I think about stingy employers like Papa John, Walmart and the like: I think they stink. I also think that the federal government should eliminate the part time – full time distinction. While on the subject, I would like to say that I think that health coverage should be the exclusive domain of the federal government, i.e. get the private insurers out of the business.

          • TZToronto

            I’m glad to see that you’re one of the progressive thinkers in terms of healthcare. Health should not be a for-profit industry. Why can’t employers see that a single payer system (even if operated state-by-state, the way it is in Canada–i.e., province-by-province) would save them a lot of money and result in generally healthier employees? As for sticking to your story, go ahead. I know what my experience is, and I’ve never considered going to the U.S. for treatment of anything. The only recent experience I’ve had with the U.S. healthcare system was both good and bad. I had to go to a private hospital emergency room for treatment that lasted 3 hours–$8200, which my private travel insurance in Canada eventually paid for. No waiting, great care, but old-looking facilities. In Canada, I’ve been treated just as well in modern, state-of-the-art facilities–and absolutely no wait. And yes, there is plenty of criticism within Canada about wait times, but wait times are improving. And if you need something right now, you get it. That’s my experience, not hearsay.

          • CPAinNewYork

            Employers in the United States are fighting healthcare benefits because they’re a bunch of cheap bastards whose focus is solely on the bottom line. This includes John Schnatter of “Papa Johns”, the Walton family, the scumbag who owns that Ohio coal mine and in general the Republican Party. They want to eliminate all benefits, except for corporate welfare benefits.

          • 4sanity4all

            What I find irritating is that these big shots do not even educate themselves on how the ACA will work- they just keep repeating baloney from right wing rabble rousers. I read an account of a small businessman’s plan to implement the ACA, and he saw a lot of good in it, both for him and his employees. The government has failed to get the word out, though, and they really need to get ahead of this thing. I would like to be reassured that my hopes for liking the ACA will be justified.

          • Bill

            Sounds like the VA, the best health coverage I’ve ever had.

          • TZToronto

            What’s odd is that the United States already has a number of very large “socialized” healthcare plans in operation–VA, Medicaid, and Medicare, for example. So healthy American taxpayers are already paying for sick seniors, veterans, and poor people can have access to medical care, and the various systems are working. I’m sure there are a large number of seniors who would revolt if their Medicare were taken away but who hate the ACA because they don’t understand it–not to mention the negative propaganda and disinformation they soak up watching Fox News.

          • elw

            I am not from Canada, but will back up TZToronto’s story. The Canada has better outcomes than we do and they people there live longer simply because they get the healthcare they need. No one goes hungry to pay for medical care to keep them alive.

          • TZToronto

            The number of comments in response to this article suggests that the topic is very important to Americans, whether they support ACA or oppose it. I don’t mean to extol the virtues of the Canadian system because it’s simply not relevant in the context of America today. The reason America has ACA is because something better wasn’t going to get through Congress. The medical BUSINESS in the United States is not ready to throw in the towel on their profits, which is why the insurance industry is still deeply involved in healthcare. But it’s possible to wean the insurance industry off healthcare. For a number of years after Canada got universal coverage, health insurance was actually administered by private insurers. Gradually the administration shifted to provincial governments. A similar transition might work in the USA, too, but there has to be a will to make the shift.

          • elw

            You should be proud of your healthcare system, it is a good one. In the US healthcare is both a very controversial subject and a very important topic simply because our current system is failing and has been steadily increasing the numbers of Americans who do not have the financial or health status to get coverage. I agree ACA was the best we could get through Congress at this point in time. My greatest hope is that it is the first step towards taking the profit out of health care coverage. Our biggest problems are all the myths the opponent of government controlled health care spend millions on to spread and their followers who shout very loud and say nothing that contains any facts. But this war has been ongoing since the early 1900s, so my guess it will continue for a while longer and those of us who believe in single payers system will continue to push that way one step at a time.

          • Bill

            The worst thing to happen to ACA was when they allowed the GOP to take the single payer option out and then they still didn’t vote for it. I hope people will wake up to the GOP and see they have nothing to offer the middle class or the poor.

          • elw

            The GOP has been losing membership ever since they sold out to the radical Right. It is one of the reasons that they have not won on a National basis for the last three elections. Their days are numbered. This Country has always rejected Radicalism whether it be from the left or right.

          • Independent1

            When ACA was passed universal healthcare really wasn’t an option financially. The country had just lost 14 million jobs and countless companies and was running up deficits like no tomorrow. Enacting healthcare legislation that would have thrown hundreds of thousands of more people out of work, those associated with the insurance industry, and trying to get the country to then pick up the costs associated with increased unemployment and the crossover from our current system to a single payer would have simply swamped the government and easily thrown the country into depression. Although I too would like to see an eventual single-payer system. When ACA was enacted was not the time for that.

          • dtgraham

            I hear you TZ. I’ve left a couple of postings about my wife being in a Canadian hospital since March 23rd for spinal and, recently, knee surgery. She’ll finally be coming home on June 28th. She got the treatment that she needed right away, and all of the rehab that was required afterwards. She’ll be sent home with medical equipment and a visiting home care worker (daily) and nurse (monthly), all of which will be provided free of charge. Her entire hospital stay and post care is all free of charge. There is no bill and no co-pays and no monthly health care premium. I’m glad to pay the taxes required to support such a system for everyone.

            I’ve also recently worked with an older gentleman who beat cancer with the help of the health care system and had nothing but praise for it. I’m only one person with just one person’s experiences, but I’d have an argument with anyone who’s too down on the Canadian system. It’s just what I’ve personally seen, read, and heard, although I know there have been exceptions.

            I’m glad your wife got the cancer treatments that she needed and has recovered. I’m not surprised TZ.

          • 4sanity4all

            When I read things written by actual Canadians, they are happy with their healthcare. When I read comments about Canadian healthcare by Americans, they say it is awful, so I think I will listen to the actual Canadians opinions.

          • TZToronto

            Merci!

          • bandrulz

            And from what I have heard, Canadians are pretty happy with their health care system. None of them are going bankrupt trying to pay their health-care bills and when they are sick, they just go to the doctor. I live with a number of Canadians in Arizona during the winter – that’s who I have talked to. Who did you talk to? Canadians?

          • CPAinNewYork

            Yes. I talked to Canadians.

          • elw

            I am sure you talk to Canadian, but like all people like you, only the ones that say what you want to hear.

          • elw

            Sorry but not true. Most Canadians are very proud of their healthcare system and it rakes higher than our’s in quality of care and costs. It is true that at one time England had a problem with wait times, but that was a couple of decades ago. They have corrected those problems and rakes higher than us in quality of care and costs.

          • ralphkr

            Canada’s biggest health care problem seems to be the many beds that have been closed down by a conservative government. The Canadians that I have seen in our hospital have been sent here by the Canadian government because their government had shut down their hospital. The Canadians pay NOTHING for their health care in the US because their government covers the cost and even for the cost of housing & feeding a woman’s husband when she was sent here to give birth. I also noted that the Canadians were ticked off because the government would not pay for all of the relatives to be present for the birth (They sounded just like the uber-conservatives I grew up with who complained bitterly about government spending and even more bitterly that they weren’t being given enough by the government)

          • dtgraham

            The federal Conservative government has cut all funding to the Health Council of Canada, which measured and coordinated health care at the federal level. Ottawa is still providing all funding to the Provinces, but it’s left at a splintered level now.

            All I can say is that we have the NDP (the socialists) and the Liberal Party (your Democrats…sort of) both in power, and controlling the balance of power, in Provincial legislators across Canada, who are trying to maintain the highest standards possible. The Green Party also gives moral support.

            I might also add ralph, that there are Progressive Conservative Provincial Parties that don’t agree with the federal party on the Health Council of Canada issue, including my home Province. Here, they’re just the official opposition to the NDP government but at least they feel as such.

            Funny, we had a Progressive Conservative government from 1984 to 1993 who felt the need to tinker with the universal health care system. Canadians felt the need to tinker with them in 1993, reducing them to 3 seats in the House of Commons. Biggest wipe out in history. You’d think we would have learned our lesson. All of the polls show the Conservatives going out big time in 2015. It’s just a question of who will replace them at this point.

          • ralphkr

            You know, dtgraham, the thing that most puzzled me was the Canadian attitude towards privately run health care. Everyone seemed to scream bloody murder about certain doctors only taking private patients so the patients had to pay 100% of the costs. Since these private clinic/doctors received absolutely no money from the Canadian government and the patients still had to pay into the government system I would have thought that Canadians would welcome private pay health that would release more money for your real health care system.

          • dtgraham

            In the short term you’re right. If you’re still paying all required taxes needed to support the public system, but you’ve got so much disposable income afterwards that you can still afford to pay for any additional private service, then what’s the problem?

            Philosophically I agree with that. It doesn’t seem right on the surface of it, that you should be put into a system that you could afford to get out of if you had unlimited income (and one that you already paid for).

            The Canada Health Act precludes that and the thinking on that goes two ways in Canada. First, it just seems immoral that some people should be able to “jump the que” and obtain health care before someone else, just based on their personal wealth. I know that sounds crazy in America, but that thinking on health care fairness is very, very prevalent in the Canadian psyche. Trust me on that Ralph.

            I think the main thing though, is the so-called slippery slope argument. It’s always said up here that this would be the fast track to the American system, which is loathed and feared by so many people in Canada. If you open up the system to the private market for those who can afford it, the argument goes that eventually the pressure will build from those wealthy people to eliminate their tax contributions to the health care system…because they don’t need it. What will that do to the system? “Two tiered medicine” is a phrase that has tremendously negative connotations in Canada and no political party wants to be smeared with that even if they secretly want it (Harper…I think).

          • ralphkr

            I sincerely doubt that having private pay health care providers available would lead to two tiered medicine or the collapse of your current system. It is my understanding that in Germany (the originator of public health care in the 19th Century) if you make more than a certain amount of money you may opt out of the public health care system and buy your own insurance on the open market. I have also read that very few of the wealthy do opt out because the government system is so good. It appears to me that if you wish to have a viable public health system you must make it far more attractive than any private system. It also appears to me that the US has tried privately funded open market health care system and that we have proven that it is far more expensive and far more inefficient than ANY public health care system. The only advantage that our system has is that those with wealth, no matter what their nationality, can go to the hospital of their choice and get a luxury suite of rooms complete with private chef & servants while they would have to wait their turn at a nationally run system and be treated the same as the hoi polloi.

          • dtgraham

            Yes that’s the thing. I don’t necessarily disagree with what you’re saying Ralph. While there is an acknowledgement in Canada of other health care systems, I’m telling you that the specter of “private pay health care providers” is a major turn off up here.

            Perhaps like the British, we think of others who couldn’t possibly pay for their own health care. As much as newspaper articles are published in Canada about the Swedish or French health care models for example, the first thought that’s always expressed up here highlights those who couldn’t pay for their own health care. You know, how do they pay for it? If some of them can’t, then it’s not worth doing. That’s just the way it is even if someone’s overall system might be better.

            There is this tremendously egalitarian streak in Canadian health care that prevents us from closely examining the European experience and leaves us constantly fearful of our American neighbour’s health care practices. I’m a socialist, and agree with that in principle but I’m also practical enough to see the downside, and where improvements might be made.

          • ralphkr

            Your comment, dtgraham, “As much as newspaper articles are published in Canada about the Swedish or French health care models for example, the first thought that’s always expressed up here highlights those who couldn’t pay for their own health care.” leaves me rather puzzled as I was under the impression that ALL citizens of Sweden, France, Germany, Switzerland, etc. have public health care available to them Your comment as to what your fellow citizens think of other countries health care systems sounds very much to me what we term the NIH syndrome, i.e. Not Invented Here. I could recount some really stupid and sometimes horrible stories of the results of NIH Syndrome in the US.

          • dtgraham

            People here have just gotten used to “free health care” I think. No insurance policies, no out of pocket. Many of the European health care models are mixed systems and not completely public like the Canadian one. There is an element of private insurance and out of pocket co-pays in those systems that aren’t popular in Canada. For example, French residents may consume as much health care as they like; however, to increase their price sensitivity, they pay for their care upon receipt and do not receive full reimbursement. That begs the question, what if you don’t have the money upfront? Even if the government covers those down on their luck, it’s not a pleasant scenario for the poor and strips them of their dignity by turning them into health care beggars. I can’t even imagine a political party here going into an election with that as part of their platform. It wouldn’t happen.

            Still, Canada does struggle with administrative efficiencies in health care and waiting lists for non emergency services are a point of dissatisfaction for some, although it’s generally tolerated. The aging of the baby boomers is going to place new strains on the single payer system over the next 20 years and minor modifications of it may yet take place as a result. I like the system as it is but we’ll see.

            As to your observation of the NIH Syndrome, it’s not so much that Ralph. I’ll tell you what it is. As fortunate as Canada is to have the United States of America as a neighbor, and as much goodwill as there is for our American friends; being on the border with America seems to prevent any rational health care discussion from taking place here. Whenever certain aspects of some other nation’s health care delivery system are brought up in a positive way, invariably the conversation skews to the American private system and the implication of “Americanizing” the Canadian system effectively shuts the debate down. Writers have to start out their piece with something to the effect of, “Now I’m not talking about the American system.” To no avail though, because the bloggers under the story all want to discuss how they don’t want the private American system even though that wasn’t the point of the story at all.

          • ralphkr

            I can certainly understand a Canadian’s fear of converting your health care system into the US primitive system where we are ALL “health care beggars” (I love that description) unless we are fortunate enough and wealthy enough to be able to afford private insurance.

            Anytime government health care is discussed here in the US the first thing that is brought up is waiting time in more civilized nations. I remember a few decades ago when I infuriated my ophthalmologist. My doctor was in the waiting room talking to another patient and myself when the other patient mentioned that his brother lived in Sweden and had just had a knee replaced and he had not had to pay anything. My doctor then asked him how long the man’s brother had to wait for the procedure and the answer was nearly a year. My doctor very smugly said that he could have had it done in less than a month in the US. I then asked the doctor, “How long an American would have to wait for a knee replacement if he had no money?” and answered my own question by saying, “However long the patient had left to live.”

            The second point is usually “People from those countries come to the US for health care because they realize how much better our system is.” Actually, the US does have excellent health care for those who have the wealth to afford it and it is just as obvious that those people who do come here from Europe or Japan for medical care are wealthy and come here to bypass any waiting period and for the luxury care available only to the rich in the US.

            A third point is that “free public health care” would bankrupt the US while completely ignoring the fact that health care expenditures per capita far exceed the expenditures in ANY “free public health” system. The last figures I have seen was that Switzerland had the most expensive system (probably because it is run by health insurance companies) and they still only spend about 75% as much per capita as the US.

            I agree that every country faces a health care cost crisis and much of that problem stems from the fact that no politician wants to raise taxes or premiums to pay the actual upcoming costs.

            In considering administrative costs I must say that Taiwan seems to have absolutely the most efficient system. I don’t think much of their health care delivery system but their administrative system is a miracle of efficiency. However, I do not expect the US to ever adopt that system because of NIH. Everyone carries a ‘Smart Card’ that contains their entire medical history and that also immediately pays the health care provider which certainly beats the US insurance companies practice of taking from 8 weeks to 6 months to pay the bill. Taiwan’s administrative costs are between 2% & 4% which compares to the US administrative costs of from 20% to over 40% with the cheapest overhead being the self-insurer systems such as Kaiser and the most expensive being providers dependent up collecting insurance. My wife’s doctor and his partner owned some clinics that employed over 75 doctors and he told us that over half of their employees spent all of their time processing insurance claims.

          • dtgraham

            Some further posts came through in my in box from this thread, which led me here. The only reason I’m replying is your anecdote of the man whose brother in Sweden had knee replacement after waiting “nearly a year”. I just found out yesterday that my wife will be getting full knee replacement instead of knee surgery. That will take place on July 18th, which is about 6 weeks after the original tests and scans on her knee. Ralph, your post was about the first thing I thought of after the news. If you’re in no real pain, then one year seems acceptable to me for such a procedure, but 6 weeks is pretty impressive I thought.

      • elw

        As alway you are right on Dominick. I have one small addition to your comment. Just for the “myth pushers” out there, senior are not required to buy supplementals, it is one of the many choice they are given. It was Ronald Reagan that put those programs in place not ACA.

        • Dominick Vila

          You are right, seniors are not required to have supplemental insurance to pay for the 20% that MEDICARE does not cover, but as you know that 20% can amount to a lot of money in the case of major surgery, extensive testing, or a prolonged illness. That is why most of us get various types of supplemental insurance plans. Some are expensive, others with high deductibles and coverage limitations are a little more affordable. All place a burden on seniors on fixed income. The “doughnut” hole made things even worse for those afflicted by serious medical problems.

          • elw

            Yes, I know I use to provide classes to seniors on medicare. However, on a national basis only about 25% of Medicare recipients choose to join an Advantage plan and even less buy the Medigap plans. For anyone with serious medical expenses those plans can save them a lot of money – but it their’s to decide if it is beneficial for themsleves not a mandate. The exception of course is the drug benefit which does have a mandate on it (by Republican design). I personally take an Advantage Plan, simply because I do not want to pay the 30-50 dollars for a drug plan since I do not take any prescription drugs on a regular basis. I may change my mind in the future as my health status changes. Nothing like choice.

      • Bill

        Don’t forget it was the GOP that got rid of the single payer system in order to protect Insurance Companies, which will really hurt ACA in the future.

    • bandrulz

      the answer, then, is to go to universal government health care. Then the employers don’t have to worry about how many employees they have. Would that do it for you, Skinner?

      • TZToronto

        Skinner would probably complain that it’s creeping socialism. The bottom line, according to the article, is that some people will pay more, some will lose their current coverage, but most will get health insurance that they couldn’t afford before. And don’t forget about the elimination of pre-existing conditions. That’s a biggie!

        • elw

          People like Skinner have been yelling socialism since the early 1900, all you have to say is universal care and it triggers the reponse.

        • Lynda Groom

          The elimination of pre-existing conditions is indeed a biggie. My grandchild is now covered for the first time in his twelve years. It is expensive, but at least they can’t refuse to cover him anymore.

      • CPAinNewYork

        It works for me.

      • elw

        I agree, we should have universal health care. The biggest mistake we have made as a Nation was in the 1920’s when the opponent of government sponsored universal health care worked hard and got tax-breaks for Insurance companies that offered private policies to cover health care. It help build the private employer base system we have and started the rapid rise in the cost of medical care that no one has been able to get under control. It is also why the cost US medical care is the highest in the World and almost double what the Country coming in second spends. I personal think Obamacare is the first step towards universal government health care.

      • Catskinner

        And that was the sensible thing to do from the start, bandrulz. It would especially be helpful for companies who ship products out of the country. They wouldn’t have to add the cost of healthcare to their product. But…

    • elw

      Catskinner, no one on Medicare is required to buy supplemental policies, no one. On a national basis over 80% of doctors accept Medicare, but the rate varies according to state and can be as high as 99% in some state and as low as 69% in others. In addition if someone chooses to buy a medigap plan, or supplements as you call them, there are many under 100 dollars a month to choose from; Medicare recepients also have the choice to choose one of the many Advantage plans some of which do not cost them an additional dollar over the monthly premium they pay for Medicare. Do you even know the difference between Medicare and Medicaid? I doubt it. Stop spreading lies.

      • Catskinner

        Like the man said, “All I know is what I read in the newspapers.” But when I signed up for MediCare, I was told that the Advantage programs were all being discontinued in January–so they wouldn’t let me sign up for them and told me I had to buy supplemental insurance to get that kind of coverage. I live in a community of something like 80,000 people, and as far as I know, there is only one doctor in town right now accepting MediCare patients who do not have supplemental insurance. My brother-in-law shopped for a week to find him.

        • elw

          It is true that many of the Advantage plans will not provide coverage in rural areas with limited amounts of people unless it is closely located to a large urban area. CMS is working on trying to correct that. It is also true in a few small communities the doctors have coordinated and refused to accept HMOs; however they have also applies that restriction to the private employee based HMOs as well. However, your experience is connected to where you live not what is going on in the overwhelming majority of the Nation; when it comes to Medicare doctors are easy to find and the Advantage Plans contracted with medicare are numerous. My Advantage plan is still available to me along with a dozen or more others. Remember for insurers it about the numbers people they can cover, the more – the better the profit.

  • charleo1

    What I think would help, like what I think, is going to effect the price of eggs in
    China. But, I believe it would clear up a lot of the cost shifting going on by
    employers like Walmart. Who’s hiring policies actually exploits, what is intended
    to be part of our traditional social programs, to make sure we’re not allowing
    people, especially those with children, who have fallen on hard times, to slip
    through the cracks, and a child goes unnecessarily hungry, or a young Mother
    dies from a very treatable illness. Many Americans, myself included, feel these
    safety net programs are a matter of moral principal, or religious direction. But,
    they were certainly never meant to be used as a cost saving measure for multi
    billion dollar corporations like Walmart. These types of practices are becoming
    more commonplace, and account for much of the public debt that continues to
    increase. What we are hearing from the Right is to simply end these programs.
    And to my dying day, I will tell these heartless, tight fisted bastards to go to Hell.
    What we need is a baseline amount, of what the costs are for each individual to
    exist in any particular community, in every State in the Country. Then, establish
    wages according to that. Or, if the employer prefers, levy taxes accordingly.
    If this Walmart Super Center is costing taxpayers in the community where it’s
    located say, 900,000 dollars in healthcare, schooling, law enforcement, and
    housing, beyond what it’s employees are being paid in any given community.
    What is wrong with sending them the bill? I heard one of my favorite nuts,
    Louie Gomert say something I actually agreed with. He said, “Be a giver.”
    “Send us your tired, and hungry masses, and we’ll put you to work.” But he said,
    “Don’t be a taker, be a giver.” And I thought, thank you, Louie. I could not have
    said it any better than that. I wonder if Walmart was listening?