Health Care: Who Pays?
Posted by Peter Cutler
As discussed in a previous column, health insurance mainly falls into three categories: Job-based Coverage, Individual Policies and Government-funded Programs. In addition, Maine hospitals are required by law to provide free care for those who fit low-income parameters.
With Job-based Coverage, the cost of premiums is shared by the employer and the employee. Businesses consider their share of these costs to be part of the employee's compensation package. Such plans provide a variety of benefits and costs vary according to the level of coverage an employee chooses. The size of a company may also influence the type and extent of benefits made available.
State and Federal employees have programs that may require some contribution by the employee, but the majority (or in some cases all) of the premium expense is borne by the taxpayer. Generally these plans provide extensive non-elective coverage and therefore are more costly per enrollee.
Premiums for individual policies are paid in total by the policy holder. These plans offer a wide range of benefits and their cost will depend upon what options are selected by the policy holder. Individual policies are usually the most expensive choice and are one of the few opportunities available for the self-employed and those not covered by government programs.
All government entitlement programs are mostly paid for by taxpayers, although in many cases a "co-pay" is required for selected medical services and in addition the enrollee frequently is required to pay a percentage of total costs.
Dirigo Choice was originally intended to be funded by "savings" created by implementation of new regulations governing health care providers and insurance companies, extracted from consumers and private health insurers and then used to subsidize coverage for selected enrollees. This program was passed into law in June 2003 and touted by Gov. Baldacci, who promised that Dirigo would never require an increase in taxes. Currently, Dirigo is not available for new enrollment. On April 15, 2008, a slim majority of the Maine Legislature passed a tax increase estimated at $57-72 million to fund the ballooning costs of the Dirigo Health program.
Until the 1930's, the cost of health care was relative low. Prior to 1920, most patients were treated in their homes. The state of medical technology at that time imposed severe limitations on what could be done for many patients and even surgery was often performed in private homes until the 1920's. Hospitals had not assumed their modern form until the turn of the century, when antiseptic methods were well established.
Enormous strides in medical technology since the 1930's have resulted in longer, healthier life spans for the public in general along with huge increases in medical costs and the birth of health insurance to help pay for these benefits.
Since each state independently regulates health insurance programs, and there are so many options available to the general public, it is difficult to define the average cost of health insurance on a state by state basis. One study, conducted in 2005 by the Association of Health Insurance Plans, pegged the average yearly cost of health insurance in Maine at approximately $3,700 for an individual and $10,700 for a family of three. The results of this study placed Maine costs in the top ten of the states considered.
So, can we deduce that, in general, Maine citizens all have some level of health care available?
The question might then become, what could be the best most inclusive health care plan for Maine citizens and how much would we be willing to pay for it? And one more question: how can we get the best deal?
Posted by Peter Cutler
at 10:54 AM
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1) It is a very loaded statement to write that the employer's premium for health care for state employees is paid for by tax payers since that is the cost of government. You might as well have written that the cost of the health care for Hannaford employees is paid for by the shoppers.
2)And then you attempt to misinform us by writing: "So, can we deduce that, in general, Maine citizens all have some level of health care available?" Mr. Cutler, where on earth have you been during the last five years as Americans have become aware that at least 43 million Americans have no health coverage?
Hospitals only have to give free coverage to those whose income is below 150% of the Federal poverty limit.Others run a tab of services rendered at costs that are greater than those charged to Anthem or Aetna.
NO, we CANNOT deduce that, in general, Maine citizens all have some level of health care available.
According to this very newspaper, "[Per the Census Bureau: "About 9.5 percent of Mainers [124,000] went without insurance in 2006."
http://pressherald.mainetoday.com/story.php?id=130538&ac=PHnws
When you write a piece like this, you should have your facts correct and keep your politics out of it.
Posted by
Peter HAugust 13, 2008 08:17 PM
1. The State is an employer. The State pays the employer's share of its employees' health insurance costs. The State receives its revenue for operating costs and other expenditures from taxpayers in the form of taxes collected from numerous sources. Does it not follow that taxpayers fund the State's payment for its employees' health insurance costs?
2. Health insurance is the means by which many people can afford the costs of health care. The two terms are not synonymous, although there can be a tendency to lump them together.
3. There are, by estimate, 40 to 50 million people in the United States who do not have health insurance of some sort. This does not necessarily mean that they do not have access to rudimentary health care. My articles were designed to address the issue in Maine only, not the entire United States. Yes, there are an estimated 124,000 people in Maine who do not have health insurance, but that does not mean that they have absolutely no access to health care of some sort. Or is there proof to the contrary?
Facts, please.
Posted by Peter Cutler
August 23, 2008 09:37 AM
1) Macy's is an employer; likewise it pays the employer's portion of it employees health premium. Macy makes its profit (to pay its share) from selling to its customers). Therefore, by Mr. Cutler's reasoning, customers pay the health care premiums of Macy's employees.
2) Health insurance pays for discounted health care costs. If one has no health insurance and has to go to the emergency room, the hospital only has to stablilize you. If you break a leg, they set it, if you cut off a finger, and you have the finger with you, they simply sew up the stump. If you promise to pay for the finger to be re-attached, you will pay the full charge of the operation. Medicare only pays 1/2 of that charge; Insurers negotiate payment of charges, but typically pay only 60% of what the Hospital charges those without income.
Mr cutler writes "Yes, there are an estimated 124,000 people in Maine who do not have health insurance, but that does not mean that they have absolutely no access to health care of some sort. Or is there proof to the contrary?"
As I explained above, they may go to emergency rooms in an emergency, but their access to health care is limited to what they can afford to pay -- and the way medical charges work, the gvt and the insurance companies pay a fraction of the listed charge while the uninsured is charged the listed price.
Sure, they can walk into a doctor's office, but now, doctor's offices charge the uninsured BEFORE they can seeing the doctor.
Posted by
Peter B HaywardOctober 27, 2008 08:37 PM
"One study, conducted in 2005 by the Association of Health Insurance Plans, pegged the average yearly cost of health insurance in Maine at approximately $3,700 for an individual and $10,700 for a family of three." Where can I buy these plans????? Have you shopped for insurance lately?
Posted by
October 28, 2008 05:49 AM
to Anonymous, I lost my job in February, before Mr Cutler's blog post. We are a healthy family. We were quoted $2,000 a month or $24,000 a year for the same, vanilla flavored health coverage I had.
Not hardly the $10,700 Mr Cutler quoted.
Posted by Mary Casey, Biddeford
October 28, 2008 03:09 PM
As I made clear in the article, the referenced study, conducted by the Association of Health Insurance Plans, took place in 2005.
Thank you for the updated information, Ms. Casey. I am sorry to learn that you lost your job and health coverage.
Are there any programs offered by the State available to you and your family?
Posted by Peter Cutler
October 28, 2008 08:34 PM
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