Triple level vouchers for health insurance (just a lame idea?)

One way to avoid mandates and to means test subsidization at the same time (means testing inherent with the mandate proposals) might be to force insurance companies to break coverage up into three (just for the sake of argument) components covering say, family doctor visits, specialist visits and catastrophic (a.k.a., house insurance) and issue vouchers for one, two or three according to means. Maybe you could even apply vouchers toward whichever component you wanted if you didn't get all three.

I don't know anything about health insurance structures but this might give somebody and idea. All this is until we get sense and go for Medicare for All...

...you know, Medicare for All: just the right program to take advantage of the (FDR/depression type) groundswell to do something, already first-choice in polls and fireproof against the usual Republican nonsense because everybody is already looking forward to it for their own old age (when they will need insurance the most)...

...that's right, Medicare for All: the program that frees up doctor's time to keep as current as possible with the explosion of medical knowledge instead of dribbling away their time dealing with 100+ provider sets of rules and fighting off 100+ care deniers.

For some reason all the above common sense is supposed to be impossible to slip past insurance interests. Funny; if Hill had just gone the Medicare for All route the first time (when the depression type groundswell had not even built up yet) she probably would have gotten it through. I suspect Obama knows all this; he hopefully being the first president we'll have with a real brain since Nixon (and going back through Hoover).

Medicare of All -- great groundswell, everybody's first choice, fire proof

Will somebody please explain to me what is so difficult about passing the health care plan that everybody (except the industry) loves the best: Medicare for All?

In my lifetime I watched LBJ ram through Medicare, Medicaid, a $10/hr minimum wage, etc., and yes, he could very likely have passed the Civil Rights legislation all on his own. Okay, that was on his own blackmail, bribery, cajolery or even reasoning together; LBJ the near tyrant -- but LBJ was working in a complacent period where he had to do it all on his own, unlike FDR who had vast public support for change.

There IS vast public support for universal health in this (Obama?) era and the broad preference is Medicare for All -- which Medicare happens to have much built-in flame proofing against the usual Republican flaming because it is already in place for our most vulnerable (the old who love it) and everyone understands exactly what it is.

Lets go over that: great groundswell, everybody's first choice and fire proof. Sounds like the path of least resistance to me -- but I've only been following American politics intensively since 1961 (age 17).

Arbitrary US and European poverty lines v. a rational (?) minimum needs line?

America is the only nation whose — official federal — poverty rate is set at three times the price of the cheapest possible diet (dried beans only, no canned) — of all arbitrary things (probably was an accidental fit around ‘55 when it was developed and still close enough around ‘65 when adopted).

Europe’s poverty line -- usually measured at 50% of median income -- is somewhat arbitrary too.

50% of median income may not be an accurate way to compare poverty in America and Europe as median income in America is a lower percentage of average income than almost anywhere else — maybe much lower!

From 1973 (the beginning of inequality here — which I grandly call the Great Wage Depression) to 2005 the 50 percentile wage in America grew from $12.99/hr to 14.29/hr — an increase of only 10% while average income grew 70%. [I got the wages from table 3.4, on p. 121 of the book The State of Working America 2006/2007].

Wages don’t perfectly parallel income of course — a lot more members per family went to work over those years — but wages may more precisely be the point as to what has happened to American labor.

Table 8.14 on p. 342 shows European manufacturing workers earning 20% more than American counterparts if you leave out Spain, New Zealand and Portugal (and is an OPTIMISTIC comparison because factories are the place in American private business where unions have hung on best). British book keeping just moved away from comparing factory workers only and came up with the conclusion that Americans families are now poorer than theirs: http://www.theglobalist.com/StoryId.aspx?StoryId=6369 .

Table 8.17 on p. 350 of State’ actually shows poverty in America higher than in any European state even using the 50% of median measure.

I have just worked out that 35% of American family incomes are below a “minimum needs line” (a rational poverty line? — using figures from the 2001 book Raise the Floor) without Food Stamps and other helps. Read that post here:

http://ontodayspage.blogspot.com/2008/02/are-38-of-american-families-living.html

Paul Krugman and friends -- report the world is flat :-)

Paul Krugman (justifiably world famous progressive economist, NYT op-ed writer) says (unbelievably): "[over 40 years] most American incomes have risen in real terms while the official poverty line HAS NOT." (my emphasis)

Denis Drew (high school educated, out of work -- rarely more than part time -- cabdriver and SSI recipient says (much more believably): the official poverty line has ACTUALLY DROPPED 60% over 40 years -- in real dollars.

The official poverty rate has been adjusted for the price of food only for 40 years now. A more accurate poverty rate (described as a minimum needs level) for a family of three in my 2001 version of the book Raise the Floor is $41,111 (in 2005 dollars) including $10,000 for today's typical family health insurance policy. The official poverty rate for a family of three is $17,000 in 2005 dollars.

This means that the official poverty rate has been discounted over time to now represent only 40% of the actual rate -- and w/o any improving standards stuff.

I very simply calculated that $41,111 is 36 percentile American family income (on Census family income tables) -- meaning the incomes of 36% of American families may be below a more accurately drawn poverty line, at least without food stamps and other helps.
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There is no mystery to why Americans (working 50% more hours per capita) endure so much poverty while Europeans (working 33% fewer hours per capita) see so little -- and why Europe's lower 90 percentile families get a much fairer share of the economic pie -- EUROPEAN WORKERS TAKE CARE OF THEMSELVES.

Progressive economists are to first to jump and point out that Europe has the same or better productivity and access to technology as we do. The difference in pay levels can only be due to lack of broadly accepted cultural understanding in America of how absolutely vital it is for labor to actively look after its own interests (too simple).

Looking after its own interests means wide awake to the need for checks and balances in the labor market which with today's super bean counter ownership means labor law set up to mandate sector-wide labor agreements, a sensible minimum wage (HIGHER than than the nearly $10/hr of 40 years ago -- reflecting that average income DOUBLED since), setting up universal health care, etc., etc. ...
...all the things that European workers have set up for themselves; nobody did it for them...
while American workers have slept complacently at the bargaining switch only to wake up and go to work for whatever is shoveled in front of them (notice: I am not blaming any big, oppressive capitalists here).

I may blame our progressive economists -- the only folks in our economically deaf and dumb nation who understand what is going on -- for not telling everybody else how low their pay has gone (they have no idea): beginning with shouting far and wide that the official federal poverty rate has been based on three times the price of an emergency diet (dried beans, no canned) for 40 years now and now might be the time to stop quoting it without qualification.

Krugman likes to complain that if the Republicans asserted that the world was flat that the next day the media would treat the assertion evenly and try to quote both sides. Well, when he -- and the rest of his progressive pro friends -- continue to quote the official poverty line as gospel, he and his progressive friends ARE asserting the equivalent of "the world is flat" in their field of study.

As in Columbus' time, the false assertion make fewer waves than explaining truth -- and informed people know otherwise. But, in Columbus' time it did no harm for most people to believe the world is flat. In America today the greatest hindrance of all to alleviating poverty (a.k.a., paying American workers like other modern O.E.C.D. workers) may be endlessly under reporting the official poverty line by what may be as much as 24%!

10 Myths About Canadian Health Care -- and My New Number 1 Reason for Supporting Single Payer

Having read the "10 myths of Canadian health care" article, my NUMBER ONE reason for supporting single-payer health care is now:

"One unsurprising side effect of [not struggling with 100 insurers] is that the doctors [in Canada are] more up-to-date in their specialties."

In any doctor level profession -- maybe even with bloggers -- you can spend half your life keeping up with what's new. American doctors dealing with 100 sets of rules and fighting 100 sets of care deniers, cannot keep up with their specialties they way they really want to...
...what can you, mandate supporters, ever say again in favor of your position -- except maybe craven fear of insurance company lobbying? Just add the specter under training (!) to over charging brought about by (100+) private insurance outlets and the plea for single payer (Medicare for All) simply becomes unbeatable.

Can "37%" wake up wonks and workers?

Just an extra thought on near to 37% of American families living below a believable minimum needs (a.k.a. poverty) line: I hope it can give some perspective to $500/wk being our 40 percentile wage (State of Working America).

It should wake us up (shake us up?) to the concept the the 40 percentile wage in 2008's rich America should be a middle class wage but is not even near that mark. Who could live a middle class life on $500/wk before taxes. Most would be gone on rent (no utilities) for one person.

It doesn't seem to wake anybody up either that $400/wk was the MINIMUM WAGE in 1968 -- when AVERAGE INCOME WAS HALF WHAT IT IS TODAY.

Hopefully a more accurate 37% poverty stat can finally make the 40 wage percentile stat look like what it actually represents: a state of working America that is basically that of being taken totally to the cleaners (mostly due to their own complacency about going back to collective bargaining in the labor market I hasten to add -- see [http://ontodayspage.blogspot.com/2007/12/french-canadian-labor-setup-seamless.html on how American can easily adopt today's all but international standard of "collective-collective" bargaining) -- but the "37%" stat may wake up the wonks who in turn may wake up the media who may wake up working America -- could work).

On Hillary's $9.50/hr minimum wage proposal

The 2008 BLS numbers are in and the 1968 minimum wage would now be (da,da): $9.91/hr. http://minneapolisfed.org/Resear...h/data/us/calc/

And don't forget that average income, per capita output, or whatever is now double 1968's.
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I doubt our chicken hearted Dems would go for a one-time jump to $9.50/hr. Hill switched sides on the same type Bankruptcy bill that she talked her lame duck husband into vetoing. Can't pin her down completely since she was the only Senator who was too embarrassed to vote.

John Edwards was reported promising $9.50/hr by 2012 (adjusted for inflation -- presumably after reaching that level). Figure 12-15% off for inflation by then: Back to more like $8/hr or about where Eisenhower's 1956 minimum wage was (does the concept of "red-shift" suggest itself at some point?). http://blog.aflcio.org/2007/07/0...02/

edwards-says-push-for-higher-minimum-wage-must-start-now/
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A reality based insight into whether jobs are at meaningful risk may be gained by looking at minimum wage job turnover. Business Week reported in 1991 that McDonald's turnover was 70% every 90 days -- at $6.75/hr (unless that was before the raise from $6/hr).

At the recent $5.15/hr I saw the same smiling Mexican faces behind the counter in Chicago and San Francisco -- also Chinese in San Francisco -- year in and year out. Since Illinois raised its minimum to within fifty cents of Eisenhower's I have slowly begun to see a few American born employees behind the counter of my neighborhood McDonalds again.

Since the minimum wage is a free market demand (nobody is forcing anybody to hire anybody) made for those who have no other bargaining mechanism -- maybe we should not trouble ourselves too much about the unlikely potential for job loss if it doesn't worry the people who are in for the raise (at all!).

I think they would rather have HALF as many jobs that paid twice as much -- wouldn't you?

How close to 36% of American families are below a realistic poverty line?

How close to 36% of American families are below a realistic poverty line?

The 50 percentile American family income in 2005 was $61,032. (http://www.census.gov/hhes/www/income/data/historical/families/ Table F-3, Mean Family Income, All Races)

The "minimum needs" table (3-2) on p.44 of the 2001 book Raise the Floor maps out a minimum needs line for a family of three at $45,476 in 2012 dollars -- including $8,786 cost of medical insurance. * The Raise minimum needs line is computed by totaling up a comprehensive list of needs -- not the half-century old federal formula that multiplies three times the cost of an emergency food budget (dried beans only please; no expensive canned!).

(Raise provides extensive explanations for its minimum needs parameters in Appendix B -- its tables cite Solutions for Progress. Average family size is 3.13 persons.)

The difference between second and third quintile average family incomes ($37,556 and $61,032) runs approximately $1,200/percentile. So, adding about $6,000 to $37,556 (the 30 percentile mark -- the second quintle mean) gets us to Raise's minimum needs line -- demarking 36% of American families below minimum needs if they have to buy their own health insurance and 29% if they do -- and excluding government helps like food stamps.

[* "Raise's" tables allot $3,000 to yearly medical expenses for a family of three even if insured.]

REVERSE Ponzi schemes: S.S. and Medicare

Just as S.S. retirement benefits constitute a REVERSE Ponzi scheme because the doubling of per-person income over every two generations means your grandkids can soak their grandkids for even more than you are soaking yours for (the sucker generation may be the one destroyed by the alien invasion)...

...the medical REVERSE Ponzi is even more spectacular because scientific knowledge doubles every decade (!) and presumably medical knowledge keeps up something like the same pace (the sucker generation may be the one in which all diseases are eliminated).

Ergo, somebody has to pay for the medical miracle show. Luckily, by 2080 -- almost FOUR generations out -- average income should have almost quadrupled while medical care's share of GDP has only tripled (according to the above chart: meaning care in 2080 cost may twelve times as much in absolute terms (4 X 3) per-person.

Today -- 2008 -- medical care's share of GDP is 3X what it was in 1968 while average income has jumped 2X: making per-person care cost 6 times what we used to spend in absolute terms: anybody want to turn back that clock?

PS. The real crisis is that 25% of American workers now earn less in real terms than LBJ's 1968 minimum wage -- and that a 25% of Americans now live below a real poverty line (not the phony poverty line computed solely as multiple of the cheapest nutrition), up from 15% in 1968 -- after that doubling of average income over two generations. Labor market, labor market, labor market -- a completely unbalanced in management's favor American labor market: that should be the signature economic issue on today's progressives' lips; not some imaginary non-problem at the end of the century.

Mandate SUBSIDES are indistinguishable from VOUCHERS (remember vouchers?)

If we absolutely must base universal coverage on private insurance: wouldn't VOUCHERS (remember vouchers) be more practical than mandates?

If you don't get a voucher you really deserve one in of your peculiar economic circumstance (at X income level) at least you are not forced to pay for something you cannot afford; you may just land back in the old ER -- fewer mandate suicides.
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Come to think of it: SUBSIDES for low-income mandatees are indistinguishable from VOCHERS -- both tax paid.

If the REAL poverty line (as the informed are aware -- sort of as the informed were aware the earth is round before Columbus) is more like $40,000/yr for a family of four -- and median family income is tragically something like $55,000/hr -- and we want to be very careful that mandates do not put some families into impossible binds (I would argue life's little complications make that undoable): we may plausibly need to give as much as 100% subsidy for up 1 1/2 X the real poverty line (approx. median family income)?

The majority of families would probably get some level of subsidy -- equivalent to a means tested vouchers. Obama and Hill are half way to vouchers already!
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Basically, mandates make the issue about HOW we achieve UHC -- advantage Repubs: "garnishing wages!?" Vouchers have the Dem advantage of being the Repubs' eternal answer for everything -- how can they object to mandates as the HOW part of UHC?

Red shifting minimum wage?

Does the concept of "red shift" suggest itself?

Ike's 1956 minimum wage: $7.93/hr ($1.00/hr adjusted)
at 40% of today's average income.
LBJ's 1968 minimum wage: $9.91/hr ($1.60/hr adjusted
at 50% of today's average income.

Nixon's 1974 minimum wage: $8.75/hr ($2.00/hr adjusted)
at 60% of today's average income.

http://minneapolisfed.org/Research/data/us/calc/

G.H.W.'s 1981 minimum wage: $6.72 ($4.25/hr adjusted)
at 70% of today's average income.
Bill's 1997 minimum wage: $6.92/hr ($5.15/hr adjusted)
at 90% of today's average income.

Dem's 2009 minimum raise: $7.00/hr? ($7.25/hr adjusted)
at 103% of today's average income?

Why American labor slept

Regardless of government policy (had there been no Reagan) America's (uniquely) one-sided labor market -- disappearing unions and naive and complacent American labor -- would have brought on catastrophic inequality anyway (so catastrophic, if you live under 50 percentile income, that "inequality" seems a weak, under-descriptive term).

Naive and complacent labor is the root of all American inequality (or great wage depression) -- lack of simple understanding of relentless labor market squeeze that has to be deliberately met. America -- having a much better labor history than Europe -- has not developed the same over-defensive labor ethic that Europe has developed. We instead have our pioneer cult of the self-reliant individual. Ironically this leads our labor force to NOT take care of itself in the market place but to just trust unseen forces to fairly set labor's price. The latter might be a good angle to sell properly taking care of themselves to Americans once they wake up to the prosperity they (uniquely) have been missing out on.

American's might wake up if their media ever gets around to informing them that a true poverty scale (not one made up of a multiple of cheap meals) might show 25% of Americans living below the poverty line -- up from 15% in LBJ's era; double the average income since. They might also wake up of the media ever informed them that 25% of our workforce is now earning less than LBJ's $9.90/hr minimum wage, ditto doubled income. The media itself might wake up if progressives ever make enough stink over these two all telling stats.

How health mandates could land more in the ER

Imagine a future in which families were mandated to buy a health plan -- some purchase the one with the $10,000 deductible (the cheapest legal option?) -- okay; they have obeyed the law -- but now those families end up in the emergency room MORE OFTEN, instead going to their family doctor's office, because they were forced to use up their family doctor money buying what Obama correctly calls "home insurance."

Subsidies tend to be set at a multiple of what -- in reality -- should be a doubled fed poverty line: $20,000 a year for a family of four (the official line based on three times the price of an emergency diet). $40,000/yr is more like the -- real -- barely above poverty line for a family of four, while $55,000/yr is roughly median family income these days. Most families are not far from poverty -- though their numbers might sound just fine -- as med insurance climbs and climbs. Forcing rising premiums down the throats of families with shrinking real world incomes is flirting with disaster in many cases -- and would impose disaster outright upon many hanging by a thread families.

I really believe our academic liberals have much trouble envisioning the existences of anyone below 50 percentile income -- why you almost never hear Dem candidates so much as mention the average Americans' most desperate economic need, massive re-unionization -- nor criticize a ridiculous minimum wage raise that may end up nearly a dollar below 1956's minimum wage ($7.93 adjusted) in real 2009 buying power -- and here we go again.