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- If you are on plain Medicare like seniors or disabled, you hope for no change. Some mythical cost control.
- If you are a senior on "Medicare Advantage", it sounds like they are planning to cut reimbursement to the insurance companies that run it. I would expect either benefit cuts, cost increases, or some way of shedding expensive customers.
- If you have Medigap insurance, I'm not sure what happens to it. It won't get cheaper, and might get more expensive due to mandated minimum coverage limits on all insurance. Or it might go away somehow, since I think they want maximum deductibles and minimum percentage payouts. On the other hand, AARP would really lay into Congress if they messed with this, so I doubt they cut coverage. If they increased the things it has to cover (like adding mental health coverage) it would get more expensive.
- If you are employed with insurance, you (or your employer) might also see increased costs due to mandated coverage and reduced deductibles.
- I'm not sure what happens if you are employed with insurance and lose your job. Is there still COBRA so you can pay your existing plan? Or are you immediately fined for not having insurance, just when you become unemployed? Or are you expected to get subsidized insurance then drop it again when you get a new job?
- If you are employed without insurance, there's an 8% penalty on the employer for not insuring you, and a 2.5% penalty on you for not having insurance. The problem is if you make $20K a year, that's a $1600 payment for the employer, which is cheaper than individual insurance (and a lot cheaper than family insurance), and a $500 penalty on you, which again, won't pay for insurance. So you might lose $2100 from your salary (employer share has to come from somewhere) and still not have insurance. You get some kind of subsidy, but it would have to be a lot to put a years health insurance under $500, especially for a family.
- If you are self-employed and have a Health Savings Account with high-deductible policy, it sounds like that goes away. The mandates for insurance make those policies impossible to write. Not sure if they eliminated the HSA program or not, but without the insurance policy behind it, it's kind of pointless. You pay more for more insurance.
- If you are unemployed and uninsured, you get a subsidized policy, but you of course have no money. I think you pay a penalty, but perhaps not if those are a percentage of income.
- If you are homeless or just the type that goes to the emergency room for everything and doesn't pay, then you probably continue to do this. They still aren't going to turn you away, and still won't be able to bill you. The only change is that costs which used to be padded onto the bills of the insured might now be coming from the Feds.
- Illegals still don't get insurance, and they are 8-10 million of the famous 45 million uninsured. Another big chunk are the unemployed, and as I said, I'm not sure what happens to them. A lot of the poor still can't afford insurance (esp. mandated gold-plated insurance) and so aren't covered. That's what happened under the Mass. plan.
So I can't see who benefits. The cost controls are an illusion at this point, and the
Feds run another 15% of the economy. Sounds like a losing proposition all around to me.
When push comes to shove and they run out of money, they will ration, the way Britain
is doing now. Except I don't think Americans will take it as well. The NHS was
government run from the start. Our system will still have lots of people who remember
"the good old days" of private care.
5:16pm Sunday July 26, 2009 (link)
I wrote my two articles on global warming over a year ago. Then I decided I didn't really want
to have anything to do with this global warming debate, since it's so strident. Fortunately
(or unfortunately), it just doesn't matter.
I'm a techie, and as they say "where you stand depends on where you sit", but I see technology as the main issue here. The warming models all assume an economic model, which assumes a certain level of technology. When that technology changes, all the predictions are out the window.
We can run around and scream at each other about warming, and institute various hair-shirt Green measures, and nothing will really change. The world economy has too much momentum for that. Instead, while all the shouting is going on, some guys in lab coats are working on better solar panels or batteries, nuclear reactors or geoengineering schemes. When they finish their work and produce something usable, the problem will start to be solved. Until they do, none of the rest of it matters.
Maybe Congress can force $10/gal gas down our thoats in the name of warming, but I doubt it. They can set up a cap and trade system, but politics requires them to give away all the permits and exempt agriculture. So there won't be much real conservation anyway. Europe has gone down the route of high gas prices and smaller cars, and carbon permits, but their total emissions of CO2 still have not dropped significantly. I don't expect any immediate crisis, which means that people will eventually lose interest in this. The economy will take precedence, and if any large number of jobs are lost or prices/taxes increase too much, there will be push-back against conservation measures. We're not an austere people and we don't trust government THAT much. Self-righteous Greens get on everyones nerves.
The third world will continue to tell us to stuff it (or "ok, you want green power plants in India -- pay for them.") Countries like China may do something about their smog and water pollution (just as we did, once we got rich enough to care), but CO2 is another thing. It doesn't stink the place up or do any obvious damage, and it's hard to pin down to any one source. So I expect enforcement of agreements, even if there are agreements, to be lax.
If things get bad enough, someone will start doing geoengineering measures. They can do it on their own without international agreement. If Bangladesh is being flooded, they will do something about it. Some of the geoengineering schemes are so cheap they are within the reach of even poor countries.
Finally, I seriously doubt global warming will be the top issue in 2100, even if we do nothing. Not because I'm skeptical of the science (though I am), but because the world will have other problems. They will be worrying about artificial intelligence, or how much to let parents genetically engineer their kids, or some other problem we've never imagined. I think computer networks have just started to change the world. Automation in manufacturing (and other areas) is still picking up steam. Biotech and nanotech are still in their infancy and have huge potential. And there will undoubtedly be new areas of technology opened up this century.
If Greens are looking for problems to solve, they should start with things like water scarcity and third world poverty. Turning away from some poor kid dying of malaria in favor of trying to keep the seas from maybe rising 100 years from now strikes me as deranged. But that's what the Greens want to do.
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