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Thomas Nast sums up the Globe series on municipal health-insurance abuse

By adamg on Mon, 03/01/2010 - 12:57pm

If you haven't read Sean Murphy's two-part series on health coverage for municipal workers - especially, the bonus coverage for volunteer officials, you should (here and here). But as Nast asked, what are you (meaning we) going to do about it?

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Politics
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health care


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Comments

By Karla Vallance on Mon, 03/01/2010 - 1:13pm.

That was a great series in the Globe, finally spotlighting an enormous problem that has no clear solution that won't take enormous political resolve. But -- not doing anything is worse.

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By anon on Mon, 03/01/2010 - 3:25pm.

California is a good example of letting things get out of hand with too-strong unions. Combine that with many constitutional amendments, passed on referendum, and they've locked in so much of the budget that less than 20 percent is "in play." As the California canoe heads for the Yosemite falls, the Bay State boat is only a little bit upstream. People need to pay attention to local government and learn how these benefits are created and awarded. They need to learn how to apply political pressure to change things. Otherwise the costs of insurance will cripple local governments, resulting in societal breakdown. Check out the Herald's list of the Boston city payroll on line.

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By Ron Newman on Mon, 03/01/2010 - 4:03pm.

which would abolish all health insurance companies and take an enormous financial burden off our cities and towns by standardizing benefits.

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By anon2 on Mon, 03/01/2010 - 6:46pm.

but that's all fascist socialist. This is 'merica.

I'm fine right now, so frak you.

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By Haviland on Mon, 03/01/2010 - 8:50pm.

That wouldn't relieve the burden, it would merely spread it amongst all taxpayers at the federal level. With that big of a honey pot to eat from methinks the problem would get even worse with public sector unions.

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By Marc on Mon, 03/01/2010 - 8:56pm.

which would abolish all health insurance companies and take an enormous financial burden off our cities and towns by standardizing benefits.

Citation Needed

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By Ron Newman on Tue, 03/02/2010 - 12:43am.

That's what a single-payer system is -- a system of uniform benefits for all, without parasitic health insurance companies taking money out of the system while providing no value.

With a single-payer system, employers (including local governments) would no longer be responsible for health benefits at all, which would end the problem being described in the Globe series.

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By Marc on Tue, 03/02/2010 - 10:40am.

That's what a single-payer system is -- a system of uniform benefits for all, without parasitic health insurance companies taking money out of the system while providing no value.

With a single-payer system, employers (including local governments) would no longer be responsible for health benefits at all, which would end the problem being described in the Globe series.

The problem being described in the Globe article is unions preventing transfer of employee health care to the new state plans.

Single-payer is a system of uniform benefits administered via the political process. It can be better in some ways and worse in some ways than our system, but experience in Britain and Canada among others indicates that it is NOT the panacea you glibly describe.

Your use of the word "parasitic" makes my hair stand up - do you think that competition among insurance vendors offers no value to the market at all?

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By Kaz on Tue, 03/02/2010 - 11:24am.

It can be better in some ways and worse in some ways than our system, but experience in Britain and Canada among others indicates that it is NOT the panacea you glibly describe.

I doubt you even know how to speak British or Canadian to have even asked them their opinions.

do you think that competition among insurance vendors offers no value to the market at all?

Value?! Do you think the insurance vendor cares about *you* or your *money*? Remember, this is all about healthcare, right? The *value* lies is in whether we're healthy. We're not...AND we're paying more than anyone else to NOT be healthy.

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By Sock_Puppet on Tue, 03/02/2010 - 11:29am.

You're dead wrong about the value, Kaz.
Value to the market, in the case of health insurance, is the inverse of the medical loss ratio.
Value is the amount the stock goes up because the insurance company stiffs its policyholders.
So the value lies in the amount to which we are _unhealthy_ and _untreated,_ but still forking over money we don't get back.

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By Marc on Tue, 03/02/2010 - 4:43pm.

Hi Sock_Puppet,

You're dead wrong about the value, Kaz.
Value to the market, in the case of health insurance, is the inverse of the medical loss ratio.
Value is the amount the stock goes up because the insurance company stiffs its policyholders.
So the value lies in the amount to which we are _unhealthy_ and _untreated,_ but still forking over money we don't get back.

I am curious whether it is your opinion that this understanding applies equally to all insurance markets, or only to medical insurance?

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By Marc on Tue, 03/02/2010 - 4:41pm.

Hi Kaz,

I doubt you even know how to speak British or Canadian to have even asked them their opinions.

Value?! Do you think the insurance vendor cares about *you* or your *money*? Remember, this is all about healthcare, right? The *value* lies is in whether we're healthy. We're not...AND we're paying more than anyone else to NOT be healthy.

I need to ask for some clarification: When authoring this comment, were you indicating an interest in having a serious discussion, and thus prompting me to marshall facts and arguments? If so, I'd be happy to discuss it but would ask you to relax and not insult me out of hand.

Or alternatively, was this the sort of involuntarily uncivil outburst at which I ought simply to smile and nod?

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By david_yamada on Tue, 03/02/2010 - 12:36am.

When I read these pieces, I thought "This is what an excellent newspaper can do."

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By Sarvey on Tue, 03/02/2010 - 10:58am.

I strongly favor having single-payer national health care like most of the rest of the civilized world. However, I don't see that coming any time soon. So, back to the issue at hand -- the high cost of municipal health care.

I doubt this will be solved through legislation. It will probably require a proposition. So, here are some thoughts for comprehensive, perhaps radical, public employee health care and pension reform:

  • Allow municipalities to design their own health plans without needing approval through collective bargaining.
  • Provide greater flexibility for municipalities to move employees to the GIC.
    • Change the 70% union approval requirement to a simple majority vote of the city council, town council, board of aldermen. In other words, remove it from collective bargaining.
  • Eliminate health insurance benefits for retirees. If they are under 65, they should get health insurance from their current employer. After 65, they can enroll in Medicare.
  • To the extent that some retirees continue to receive health insurance benefits in retirement prior to age 65, add the following provisions:
    • Allow municipalities to charge co-pays on deductibles for their retirees.
    • Allow municipalities to require retirees to move to Medicare at age 65.
  • Eliminate health insurance and pension benefits for part-time elected/appointed officials.
  • Substantially pare down the number of positions eligible for defined benefit pensions -- perhaps limit to just police and firefighters. Move all others to defined contribution.
    • For those that do earn defined-benefit pensions,
      • Calculate pension payments based on their lifetime earnings in the position (not counting overtime), not their highest paid day/year of work. It should also factor in years of full-time service, prorated based on 40 years. In other words, if someone worked for an agency for 20 years, they should earn half a pension (20/40).
      • Change pension benefits so that they only begin to get paid out at age 65. (In some cases, we currently have government employees “retiring” at age 42.)
    • To the extent that some employees are able to “retire,” and collect a defined-benefit pension prior to age 65, include a provision that they cannot simultaneously work for that city/town or the Commonwealth while collecting pension payments (double-dipping).

    What would you add?

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By Sock_Puppet on Tue, 03/02/2010 - 11:26am.

As you note, the fundamental problem with health care costs is the lack of a single-payer system, which results in higher administrative overhead and the perpetual stockholder-impelled drive to reduce the "medical loss ratio" (i.e. the part where they actually pay up).

Here's one basic suggestion: don't have the municipalities design a multiplicity of different plans. That increases administrative costs and diminishes the power of collective bargaining. Have a single, unified, state government-run health care insurance system for all state employees. That can bring significant muscle on drug makers, reduce administrative duplication, and also universally peg costs to a standard (e.g. a couple years get you 0.2 of the full plan, a long and distinguished career gets you 1.5 of the full plan). It also matches the collective of municipalities (i.e. the state) on a better footing to negotiate with the collective unions, rather than having a statewide union be able to beat the snot of one little town by itself. Collective bargaining is great, and the foundation of the modern middle class, but it's a two-way street.

For pensions, avoid having to renegotiate pensions repeatedly by pegging them to a national defined standard, such as the poverty level. The pension should be calculated based on years of service X by importance of position Y by poverty level standard.

And one simple definition: if you have a full-time job, you are not retired. You do not get retirement benefits. If you want to double-dip, work two complete 35-year careers and then retire at 90 and get retirement benefits from both.

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