{"id":1047,"date":"2009-12-19T15:43:57","date_gmt":"2009-12-19T09:43:57","guid":{"rendered":"http:\/\/blog.stier.net\/?p=1047"},"modified":"2011-07-23T22:04:52","modified_gmt":"2011-07-23T22:04:52","slug":"the-house-plan-really-is-progressive-reform","status":"publish","type":"post","link":"https:\/\/marcstier.com\/blog2\/?p=1047","title":{"rendered":"The House plan really is progressive reform"},"content":{"rendered":"<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\"><em>See two notes at the\u00a0end, where I point to one unfinished part of this analysis and also show how my approach is similar to and different from that of Nate Sliver at 538.<\/em><\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">With the possibility that a public option won&#8217;t be part of the health care reform legislation passed this year, progressives are looking more closely at the rest of the legislation. And some of them have been worried by what they are seeing. For even when subsidies are applied in the Exchange, moderate income families will pay a substantial amount for health care in both premiums and out of pocket expenditures. Some progressive are asking how we can justify asking moderate income families to pay so much for health care?<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">But, in fact, the health insurance program that would be created under the House legislation would be highly beneficial to moderate income families. Subsidized insurance under the Exchange would be much cheaper than insurance now\u00a0received by families through\u00a0employer based insurance or throught he purchase of an insurance policy in the non-group market today. And while families who purchase insurance through the Exchange would pay more for their health care than those who are uninsured today, they would not only receive much more health care\u00a0 than the uninsured, they would have the peace of mind of knowing that that, because they have health insurance, they are protected from an economic or medical catastrophe.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">I want to demonstrate this by presenting some data for four median income families, one that receives employer based insurance today, one that purchares insurance in the non-groupo marekt, one that would purchase insurance under the exchange, and one that is uninsured today. After looking at these four\u00a0families, I will say a final word about why we are initially so shocked at the costs of health insurance under the House legislation.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\"><strong><!--more-->Family 1\u2014Employer Based Health Insurance<br \/>\n<\/strong><\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">The median household income in the United States is now about $52,000. So let&#8217;s begin with a family of 3 with that income. In 2009, the average cost of insurance for a family plan\u00a0is $13,375. On average, employees pay 27% of the cost of family health insurance plans, which comes to $3611 while my best estimate of the out of pocket expenditures for heath for such a family is $2300. So, it would seem initially that the family&#8217;s cost of health care is 4900 per year, the cost of the employee\u00a0share of the premium and the out of pocket expenditurs.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">But there is an important complication. Almost all economists, from all sides of the political spectrum, believe that employer contributions for health care are a form of compensation that substitutes for wages. So if we want to know how much this family is spending on health care, we have to consider the wages the family forgoes because it (or more likely, it&#8217;s union or employer) has decided to take\u00a0compensation in the form of health care benefits instead of wages. So we need to add both to the total income and the cost of health care paid by the employee, the employer&#8217;s share of the health insurance premium or $9764. But since the employer health insurance is untaxed\u2014which is a main reason that employers and employees seek compensation in health care costs rather than wages&#8211;we have to subtract the federal tax amount that would be paid by the employee if he received compensation in the form of wages which at a marginal rate of 22% leave the employer&#8217;s share of health insurance premium after tax at $7616.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">So the first family&#8217;s situation looks like this:<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Income\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $52,000<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Forgone wages due to<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">employer paid health insurance\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$7,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Total pre-health care spending income\u00a0\u00a0\u00a0\u00a0 $59,616<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Health care spending<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0 Employer paid premium (after taxes)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$7,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0 Employee paid premiums\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$3,611<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0 Out of pocket expenses\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $2,300<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0 Total\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$13,527<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Income after health care spending\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$46,089\u00a0\u00a0\u00a0\u00a0<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\"><strong>Family 2\u2014Individual Health Insurance<br \/>\n<\/strong><\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Now to compare the financial circumstances of a family that purchases health insurance on the individual market, we have to start with a family that has not an income $52,000 but, rather an income of $59,616, that is the income of the first family after we include foregone wages due to employer paid health insurance.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">The second problem in determining the situation of this family is that I don&#8217;t have a good estimate of the cost of a family insurance plan bought in the individual market that is comparable to the kind of plan bought by the average business. So, I&#8217;m going to assume that the costs would be the same although we know that non-group rates tend to be higher, and sometimes substantially higher than that available to businesses. (Or, in many cases, people purchase substantially worse insurance policies that have much higher out of pocket costs.) But because the family cannot take advantage of tax break given to employer sponsored insurance, they pay the whole cost of the premium.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">So the second family&#8217;s situation looks like this:<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Income\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $59,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Total pre-health care spending income\u00a0\u00a0\u00a0\u00a0$59,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Health care spending<br \/>\n\u00a0 <\/span><span style=\"font-family:Arial; font-size:12pt\">Family paid premiums\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $13,375<br \/>\n\u00a0 <\/span><span style=\"font-family:Arial; font-size:12pt\">Out of pocket expenses\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $2,300<br \/>\n\u00a0 <\/span><span style=\"font-family:Arial; font-size:12pt\">Total\u00a0\u00a0\u00a0\u00a0$15,627<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Income after health care spending\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$43,941\u00a0\u00a0\u00a0\u00a0<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">A comparison of family 1 and family 2 clearly shows the benefit of employer sponsored insurance as family 2&#8217;s income is lower by $2148.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\">\u00a0<span style=\"font-family:Arial; font-size:12pt\"><strong>Family 3\u2014Subsidized insurance under the House plan<br \/>\n<\/strong><\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Again, to make a fair comparison, we need to begin with an income of $59,616. Under the House plan, a family purchasing insurance in the Exchange would pay $6248 per year and have $3657 in out of pocket expenses.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">So the third family&#8217;s situation looks like this:<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nTotal pre-health care spending income\u00a0\u00a0\u00a0\u00a0$59,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Health care spending<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Family paid premiums\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$6,248<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Out of pocket expenses\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $3,657<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Total\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $9,905<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Income after health care spending\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$49,711\u00a0\u00a0\u00a0\u00a0<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nHere we see the tremendous benefit of the subsidized insurance that would be available under the House plan. Family 3, with insurance under the House plan, is better off than the family that has employer paid insurance by $3622 and far better off than the family that has to purchase insurance itself in the non-group market by $5770.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\"><strong>Family 4\u2014no health insurance<br \/>\n<\/strong><\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Again we start with a family with an income of $59,616. But let&#8217;s assume that the family cannot purchase health insurance because they all have pre-existing medical conditions.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Now the problem is to figure out what their medical spending is. We know that, on average, the uninsured receive less medical are than the insured. The best estimate I can find is that an uninsured adult on average receives about $1590 in medical care each year and an uninsured adult receives about $915. The question then is how much of this medical care do they pay for as opposed to receive for free. I think it is reasonable to assume that at a family income of $59,616, most families pay for most of the are they receive out of pocket, unless they are one of the unlucky few who have massive medical expenditures, much of which they is uncompensated. To be conservative, I&#8217;m going to assume that 90% of the usual medical care received by families at this level of income is paid for out of pocket.<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">So the situation for this family looks like this:<br \/>\n<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Income\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $59,616<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Health care spending<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Family paid premiums\u00a0\u00a0\u00a0\u00a0<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Out of pocket expenses\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0$3,644<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Total\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $3,644<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\">Income after health care spending\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 $55,972<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nAs we would expect a family that does not pay for health insurance and only pays out of pocked medical expenses will have more income after health care spending than those who pay for health insurance.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nBut is such a family better off? Of course, not.<\/span><span style=\"font-family:Arial; font-size:12pt\">For one thing, the uninsured typically get less health care on average than the insured. The last survey I could find suggested that the uninsured get about 40% less health care. Unless we have reason to believe that the uninsured are better than anyone else at knowing what medical care is useful and what not, we can assume that they are missing out in some care that they need to be comfortable, happy, and to avoid long term medical difficulties.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nAnd, second, the uninsured live with an enormous risk of developing a very serious illness that they won&#8217;t be able to treat and from which they will suffer and die. Most of us recognize just how scary that situation is, which is why we are willing to pay substantial sums of money for health insurance.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\nA final comparison: the PA Single payer plan<br \/>\n<\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nI want to make one more comparison. Pennsylvania advocates for single payer claim that they can provide health insurance for all Pennsylvanians with no deductibles and no co-pays with a 3% tax on income and a 10% payroll tax. They claim that the payroll tax would be paid by business, but we know that this claim is false. Like the cost of employee paid health insurance, a payroll tax comes out of wages.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nSo, if we could actually provide health care for everyone with the single payer plan that would tax income at 13%, what would it cost a Pennsylvanian with a family income of $59,616? It would be $7750, leaving the family with an after income of $51,866. This is, of course, better by a little over $2000 than the result under the House health care plan.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nBut, we should note that the PA Single Payer plan makes assumptions about the costs of health are that are fanciful. According to one of their organizers, Pedro Rodriguez, Pennsylvanians now pay $100 billion for health care. And, single payer advocates expect that they can cover the million Pennsylvanians who are uninsured while offering totally comprehensive insurance to everyone while only spending $80 billion. How do they do this? By, they say, radically reducing administrative costs.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nThis whole notion is fantastic. As I&#8217;ve argued elsewhere, not only is it doubtful that single payer advocates can eliminate as much in the way of administrative costs as they claim, many of the programs that we all know are needed to reduce unnecessary medical spending, such as doing moare research on the effectiveness of medical spending\u00a0or encouraging doctors to use best practices, will require more not less administrative spending.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nSo, let&#8217;s assume that a single payer plan would cost the same amount of money to provide much better insurance at the same total cost of providing health care in Pennsylvania today. To raise $100 instead of $80 billion, the tax rate would have to be 16.25%. At that rate, a family of $59,616 would pay $9300 in taxes, and their after health care income would be $50,316, which is just $600\u00a0 under the House plan. Given all the uncertainties of these estimate\u2014and that it is highly unlikely that we can insure an additional million people Pennsylvania without spending any more money&#8211;the difference is no more than a rounding error.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\nWhat does this analysis show us?<br \/>\n<\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nThis analysis shows us four\u00a0very important things about health care.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\n<em>Health care is expensive and we all have to pay<\/em><br \/>\n<\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nFirst, it shows us something we knew, that health care and health insurance are\u00a0very expensive. And people are going to have to pay for health insurance if they want it. It would be nice if we could pay for all of it with a tax on the rich. But, while I would like to see much more progressive taxation than we have now\u2014or than is politically feasible\u2014 there really are not enough rich people to rely on taxing them to provide health insurance care for all. Everyone is going to have to pay something.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nMany progressives look to the advanced welfare states of France, Germany, and Sweden and imagine how much better life would be in the United States if we could adopt their politico-economic system. I share that view. But I would point out that there is a cost to it: everyone, not just the rich, pay higher taxes for a cradle to grave social welfare state. That would be a good thing to achieve some day, but we won&#8217;t do it right away.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nAnd so, if you are shocked by how much middle income money people have to pay to secure health insurance under the House plan, recognize that this is simply the price of health insurance everywhere.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\n<em>The House plan does provide a progressive subsidy for working people and the middle class.<\/em><br \/>\n<\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nBut while everyone has to pay under the House plan, it does provide a substantial subsidy to people\u00a0just above the median income. (The subsidy for people lower down the income scale is even greater.) Compared to purchasing insurance in the non-group market, families under the House plan, people will save almost $6000 a year. Compared to employer based insurance, they will save almost $4000 a year. And, under the House plan, the new taxes will come from millionaires.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nWhen was the last time we adopted a public policy that provided this kind of help for the middle class in America?<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\n<em>We don&#8217;t always see the costs of health insurance<\/em><br \/>\n<\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nThird,\u00a0this analysis shows us that many of us who have health insurance don&#8217;t see how much it really costs us, because much of our health insurance is paid for by our employers. Even though what our employer pays for our health insurance actually does reduce our income, it doesn&#8217;t come directly out of our pockets. So if the premiums and out of pocket expense in the House plan seem high to you, remember that this is because much of what you pay for health insurance is hidden from you.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><strong><br \/>\n<em>The real cost of insurance is to collectively protect ourselves from the risk of catastrophe.<br \/>\n<\/em><\/strong><\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nFinally we can see that the reason health insurance is so costly is not that most of us spend so much on health care every year but that some of us are unlucky enough to have major health problems and, when that happens, the health care system spends money on us by the bucket full.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nWe would all be better off if we didn&#8217;t have to pay every year to have health insurance that will cover us when we are really sick. But we need that insurance, because the risk of going into debt or bankruptcy when we fall ill or, even worse, not getting the health care we need, is too great.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nHealth insurance, in other words, really is a sharing of risks and burdens with our fellow citizens. The new regulations under the House bill, and the tax and subsidy program for health insurance in the Exchange is meant to return health insurance to that noble idea.<br \/>\n<\/span><span style=\"font-family:Arial; font-size:12pt\"><br \/>\nFor all its limitations, and even without a public option, the House plan goes a long way to achieving that goal.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Note 1: the following analysis remains incomplete in one respect: I am using 2009 figures for health insurance costs in my analysis of group and non-group insurance while the figures for costs of insurance under the House plan use numbers provided by HCAN&#8217;s analysis of the bills. I believe taht this analysis is based on a project of health insurance costs when the Exchange begin in 2013. But I&#8217;m not sure about that. As soon as I find that out, I&#8217;ll re-do this analysis with corrected number. Note, however, that inflation adjusted numbers would show that the House bill is even more progressive than I show here.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Note 2: My analysis here is similar to that provided by Nate Silver on the Senate Bill. <a href=\"http:\/\/www.fivethirtyeight.com\/2009\/12\/why-progressives-are-batshit-crazy-to.html\">http:\/\/www.fivethirtyeight.com\/2009\/12\/why-progressives-are-batshit-crazy-to.html<\/a>. But there is one important difference, I compare the House bill to what insurance looks like if you purchase it through an employer based plan today.\u00a0I do that for two reasons. First,I want to\u00a0deal with the &#8220;sticker shock&#8221; that comes with looking at what health insurance costs under the House bill. It looks high because those of us who purchase insurance by contributing to an employer based plan have no idea how much money we pay in foregone wages as well as premiums for our health insurance.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-family:Arial; font-size:12pt\">Second, Silver&#8217;s analysis is based on the cost of family plan&#8217;s in the non-group market. They are far less than the cost of employer based family insurance, for the simple reason that employer based insurance is much better, with lower deductibles and co-pays. Since I have good data on what out of pocket expenses are for an average employer based plan but the out of pocket expense for non-group family plans vary all over the place, looking at employer based insurance gives us a fairer comparison. It also understates how much better the House plan is than purchasing insurance yourself in the non-group market since insurance similar to the average employer-based plan would probably cost thousands of dollars more than what I assume here. I hope to come up with a good estimate of the difference in a revision of this.<\/span><\/p>\n<p><span style=\"font-family:Arial; font-size:12pt\">\u00a0<\/span><\/p>\n<p style=\"text-align: justify\">\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"<p>See two notes at the\u00a0end, where I point to one unfinished part of this analysis and also show how my approach is similar to and different from that of Nate Sliver at 538. With the possibility that a public option won&#8217;t be part of the health care reform legislation passed this year, progressives are looking more closely at the rest of the legislation. And some of them have been worried by what they are seeing. For even when subsidies are applied in the Exchange, moderate income families will pay a substantial amount for health care in both premiums and out of pocket expenditures. Some progressive are asking how we can justify asking moderate income families to pay so much for health care? But, in fact, the health insurance program that would be created under the House legislation would be highly beneficial to moderate income families. Subsidized insurance under the Exchange\u2026 <a class=\"continue-reading-link\" href=\"https:\/\/marcstier.com\/blog2\/?p=1047\">Continue reading<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[45],"tags":[],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_shortlink":"https:\/\/wp.me\/p35YuU-gT","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/posts\/1047"}],"collection":[{"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1047"}],"version-history":[{"count":5,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/posts\/1047\/revisions"}],"predecessor-version":[{"id":5759,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=\/wp\/v2\/posts\/1047\/revisions\/5759"}],"wp:attachment":[{"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1047"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1047"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/marcstier.com\/blog2\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}