Changing Employment Laws in 2009: What You Need to Know
For many, the dawn of 2009 holds a great deal of uncertainty, while for others it represents a chance at a fresh start and the potential for improvement – whether personal, professional, financial, or some combination of the three. For the human resources industry, 2009 will undoubtedly be a year in which changes in our government and our economy will be noticeably reflected in changes to employment law. The election in 2008 played host to a huge number of ballot issues regarding hiring processes and worker benefits. Such issues are again at the top of the incumbent legislature’s agenda in 2009, and will have a direct impact on not only the American worker, but on the employers and HR professionals responsible for their pay and benefits.
After examining a number of the bills proposed and voted into action for 2009, leading research indicates some overall legislative trends emerging in three major areas of human resources:
Healthcare Reform
As the number of Americans without insurance continues to rise, finding a way to provide individuals with better access to affordable healthcare was at the forefront of heated issues in the 2008 election. While already a major issue in 2008, the incoming Congress has recently announced that healthcare reform will be among its top priorities this year. Just prior to the start of 2009, for example, Congress passed the Mental Health Parity Act, a measure requiring many employers to broaden their mental health and substance abuse coverage for employees.
Meanwhile, a number of states and municipalities introduced new legislation addressing employers’ responsibilities concerning the health of their employees. Washington, DC and Milwaukee, for instance, passed initiatives mandating that employers provide paid sick leave for workers. New Jersey joined the movement by signing into law a bill requiring employers to give six weeks paid leave to staff members caring for a sick relative or new child.
However, in light of the economic crisis, further healthcare legislation may not increase quite as dramatically as once expected – on the state level, at least. The Society for Human Resource Management (SHRM) predicts that in light of “widespread budget shortfalls predicted in nearly half of the nation, health care reform is likely to be less of a front-burner issue in the states.” Instead, SRHM predicts that cash-strapped state legislatures will be looking to the new administration to handle this issue on a federal level.
Immigration Reform
A hot-button issue with immediate implications for employers and HR professionals, immigration was the topic of a significant number of bills introduced in 2008. A total of 26 states passed new legislation addressing immigration concerns, many of which imposed new penalties on companies employing undocumented aliens.
Playing a large role in much of the new immigration legislation was E-Verify, the government’s Employment Eligibility Verification System. In 2009, all federal contractors and subcontractors will be required to use the system. Likewise on the state level, many immigration bills passed in 2008 require employers to use E-Verify or similar systems to ensure they are not hiring illegal workers.
Unlike the issue of healthcare reform, immigration legislation is predicted to continue occurring mainly at the state level while, according to SHRM, any sort of comprehensive reform at the congressional level is considered “unlikely.” Again, however, due to the budget shortfalls and the economic crisis it is difficult to predict whether states across the country will see a continued push for immigration reform. However, in some more conservative U.S. regions like the South and Midwest, employer penalties for hiring illegal workers may be more severe.
Workplace Safety
Concerns about workplace safety and efforts to increase employee health and wellness were evident in a number of new state laws put into effect in 2009. Safety concerns ranged from matters such as office air quality to more grave issues like gun control in the workplace.
On a federal level, increased attention to workplace safety was made clear in a large increase in government money directed toward the Occupational Safety and Health Administration (OSHA) for its 2009 fiscal year. OSHA received a budget increase of $15.7 million, part of which is being used to conduct increased workplace inspections in 2009. Likewise, the incoming presidential administration has touted workplace safety as a priority, and is predicted to take a second look at several previously failed workplace safety bills, including the regulation of combustible dusts in the workplace and mandating stricter ergonomics requirements for employees working in the healthcare industry.
On a state level, Oregon passed a law requiring all workplaces to be “smoke free,” prohibiting smoking within ten feet of the entrance to a building or worksite. In the meantime, eight other states, concerned with a growing number of gun-related incidents in the workplace, have enacted various laws concerning an employer’s right to limit the possession of weapons on company property.
While only time will tell how these potential changes to federal and state policies will play out over the course of the next year, staying aware and informed of proposed legislation can help employers and HR professionals prepare in advance for new regulations, develop appropriate contingency plans, and ensure a smooth and compliant transition if and when the changes occur.
Elizabeth Rice, SPHR
http://www.articlesbase.com/law-articles/changing-employment-laws-in-2009-what-you-need-to-know-747598.html
How to Find Cheap Student Health Insurance
Students are typically more prone to go without health care coverage than those who are older because of their perceived invincibility. However, students often place themselves and their family’s financial security in jeopardy because of this “devil may care” attitude.
Health insurance for students is often quite cheap as one of the largest determining factors in pricing insurance rates is age. Everything else being equal, the older an individual is the more they will pay in monthly premiums. Cost should not be a deterrent for students in finding adequate health insurance coverage. Even on a tight budget there are low cost options for students to investigate.
Here are a few quick steps to take in searching for cheap student health insurance:
1. Look for a temporary health insurance policy. If a job offer with benefits is on the horizon then a temporary health insurance policy may be a good route until the job is realized. Temporary health care coverage is usually major medical only and does not come with copays and other extras – this will help to keep the monthly premiums low.
2. Check with the student’s college or university to see if they offer any health care plans or discounts. If the school offers a health plan then view the plan with a critical eye and be sure to compare its benefits and coverage to a few other comparable plans from reputable insurance companies.
3. Compare individual health insurance quotes from at least 3 different health insurance companies. Competition among insurance companies is the key to finding the lowest rates. (Watch out for fly by night insurance companies that you have never heard of and also steer clear of discount health plans which are not true insurance and are tremendously risky – leaving you unprotected for most of the cost of a large medical bill).
Joel
http://www.articlesbase.com/finance-articles/how-to-find-cheap-student-health-insurance-88970.html
Miracle Cup: The Health Benefits of Green Tea
For 4,000 years, the Chinese people have been using green tea as treatment for everything from headaches to depression.
Today, studies are conducted in Asia and the west in order to produce hard evidence of the health benefits of the tea. In the 1994 edition of the Journal of National Cancer Institute, the results of an epidemiological study stated that one of the health benefits of drinking this tea is that it can reduce the risk of esophageal cancer in Chinese men and women by up to 60%.
The rich presence of catechin polyphenols, particularly epigallocatechin gallate (EGCG) is the reason why this tea has so much health benefits. A powerful antioxidant, EGCG can not only inhibit the growth of cancer cells but can also destroy them without harming healthy cells.
The University of Purdue has also concluded a research on how a certain compound present in tea can stop cancer cells from growing. Still another health benefit of the tea is its ability to lower down cholesterol levels and improve the ratio between good (HDL) cholesterol and bad (LDL) cholesterol.
The EGCG in tea is a health benefit substance that can lower down LDL cholesterol levels and stop blood from forming abnormal clots (thrombosis), a leading cause of heart attacks and strokes.
herbal tea has more health benefits compared to other Chinese teas like oolong and black tea, all of which come from the plant Camellia sinensis. What makes thi green herbal tea different is the process by which it is made. The tea owes much of its health benefits to how the Camellia sinensis leaves are steamed. The steam process keeps the EGCG health benefit of the tea from oxidizing. With oolong and black teas, however, the leaves are fermented instead of being steamed, thus causing the EGCG health benefit to transform into another less medicinally potent form.
Aside from medicinal value, the tea can also offer other health benefits, especially in the fitness field. Drinking tea can cause a person to burn down more calories. A recent study on the health benefits of tea shows that the drink can help dieters. According to the American Journal of Clinical Nutrition in 1999, men who take both caffeine and tea burn down more calories than men who only take caffeine or a placebo.
Another health benefit of tea is its bacteria-destroying properties. The health benefit of tea in this area is that it can help prevent food poisoning and also prevent tooth decay. The substances found in tea kill the bacteria causing food poisoning and those that cause dental plaque to form.
Well known for its countless medicinal and health benefits, this tea is nothing short of a miracle.
John Pawlett
http://www.articlesbase.com/fitness-articles/miracle-cup-the-health-benefits-of-green-tea-91592.html
Group Health Insurance: 5 Reasons to Drop Your Plan
Group health insurance plans can be a blessing to many individuals and families. They provide essential insurance coverage and, depending on the employer, cost little or nothing to the employee. However, some blessings can be a burden in disguise. Many individuals and families can actually be much better off by getting an individual health insurance plans. There are countless reasons for this. However, we will dive into the top 5 reasons here:
1. Individual Health Insurance Plans Can Be Less Expensive:
Depending on the plan and how much of your money goes into paying for the plan there is a good chance you would pay far less for an individual policy for either the entire family or just your spouse and children. You can look at your pay stubs to see how much you pay each paycheck for your group health insurance plan. Then, simply comparing this to individual/family quotes can be extremely fast and simple. There are countless websites on the Internet that provide free quotes from multiple carriers. So why are group plans more expensive? Here are a couple of reasons among many:
- Group plans accept all employees, which increases the risk for the insurance company and in turn, increases premiums for the entire group. This also makes group plans very risky for individuals in the company. For example, if Karen in the finance department got a life threatening condition, this would affect everyone in the company with dramatically increased premiums and dramatically decreased corporate profits. Maybe, this is already happening now and you don’t know it.
- Group plan groups are usually much smaller than the actual “group” participating in individual policies. This is because an individual’s group is all the insured individuals for the entire health insurance company group. This can be hundreds of thousands to multiple millions. Most individual insurance providers offer and insure people throughout your entire state. This affects the cost of the plan because the risk for an individual plan is spread against dramatically more people. The more people, the less risk and the lower the premiums.
2. Losing Your Job, And Your Health Insurance
Losing your job can be tough, but the stress of losing your health insurance can be even tougher. There is always the option for COBRA, but COBRA can be extremely expensive as it carries the exact same plan that you had with the group. To make things even scarier, if you or one of your family members were to get sick before losing your job it would be very difficult and expensive to get insurance due to pre-existing conditions. However, individual policies are not affected in anyway by your employment. So, if you were to lose your job, you can simply stay with your individual plan indefinitely regardless of work. If you and your family are healthy, this is the best time to get an individual policy. The plans will still be inexpensive and you will not have to worry about losing coverage due to job loss, or not getting coverage due to pre-existing conditions. And, if you or a family member develops a condition the premiums cannot be raised or coverage dropped. Group plans do not offer that protection. Employers are free to cut benefits, raise contribution amounts, or drop coverage entirely.
3. Shopping Around
Shopping around to get the best deal is a no-brainer, right? Well, group health insurance plans are often limited to one provider, or possibly two if your company is large enough. With individual plans, you can pick from any provider (often 10 or more) in your state. This means you can pick from scores to hundreds of competing plans, and find the one that fits best for you and/or your family, allowing you to actually shop around. With an individual policy, if you don’t like the chosen provider you can switch at any time.
4. Plan Flexibility
Group health insurance plans not only limit you to the number of provider options; they also limit the number of plan options. This includes anything from riders like dental, vision, chiropractic, co-payment options, HSA plans, deductible amount, and total out of pocket costs. Plan options are the way you customize a plan to fit your needs. Group plans are almost always set with no flexibility.
5. HSA HSA HSA
HSAs, or Health Savings Accounts, are the next best thing in the world of health insurance. HSA plans allow contributors to enroll in high deductible, but very inexpensive individual/family plans. These plans also provide tax-deductible savings accounts to help pay for deductibles and other eligible health expenses such as dental, vision, and over-the-counter medication. The contributions accrue and grow tax-free and can be used tax-free for any eligible medical expenses or withdrawn penalty-free after age 65 for any purpose. These plans are excellent options for individuals and families healthy or not and a great way to save money for retirement by saving now on insurance premiums.
Brad Miller
http://www.articlesbase.com/non-fiction-articles/group-health-insurance-5-reasons-to-drop-your-plan-136978.html
The Health Insurance Racket
Forward this video to your friends and watch all the videos at www.sickforprofit.com
CIGNAs Edward Hanway spends his holidays in a $13 million beach house in New Jersey. Meanwhile, regular Americans are routinely denied coverage for the care they need when they need it most.
Welcome to the American health insurance industry. Instead of helping policyholders attain the health security they need for their families, big insurance companies get rich by denying coverage to patients. Now theyre sending lobbyists to Washington, DC to twist the arms of lawmakers to oppose reform of the status quo. Why? Because the status quo pays.
Learn more at www.sickforprofit.com about the glamorous lives of billionaire health insurance executives and tell us your story of being victimized by their greed.
Duration : 0:5:48
Health Care Reform – Why Do We Need Health Reform?
http://www.staysmartstayhealthy.com
Health care reform is a hot topic these days. What is health care reform? The President, Congress and people like you are talking about it. The simple answer is well, there is no simple answer.
For more information about healthcare reform, please visit https://www.myhealthreform.org/ .
Duration : 0:3:19
Save Up To 50% or More On Your Company’s Group Health Insurance and Receive More Health Benefits
We make it easy and simple for your company to select group health insurance for your employees. Saving You Tons of Money and Time! Find out how you can keep your current Health Insurance Agent and Health Insurance Carrier too!
Duration : 0:4:46
Why We Need Government-Run Universal Socialized Health Insurance
A cartoon explanation of why we need a public health insurance option.
If you agree that a public option should be part of the health care reform bill, make sure you let your representatives know!
And take action at http://www.YoungInvincibles.org
Animated by Andy Lubershane. More comics at http://www.earthlycomics.blogspot.com
Note: The data in this cartoon is supported by this report: http://www.ourfuture.org/healthcare/hacker, which includes a lot more detail on current proposals for a public option.
Duration : 0:4:38
Inexpensive Car Insurance – Get the Best Rates With the Best Companies
Searching for inexpensive car insurance with a top-rated company? Here’s how to find it quickly and easily.
Inexpensive Car Insurance
Finding inexpensive car insurance used to be an overwhelming task. You either had to call a number of insurance companies to get quotes (if they’d even give them to you over the phone), or visit insurance offices and talk to a number of agents to get quotes.
My how times have changed. Now, thanks to the Internet, you can get quotes from A-rated companies, choose the best one, and even buy your policy online all in the comfort of your home.
Best Rates
All major insurance companies have websites where you can get car insurance quotes, but they only give you one quote, or quotes from just a few of their competitors.
Comparison websites, on the other hand, give you quotes from a number of top-ranked companies so you can compare them and choose the best rates. The top comparison sites even have a chat feature that allows you to get answers to your insurance questions online from an insurance professional. (See link below.)
The difference in rates between insurance rates can be amazing. When I recently compared the insurance I got a few years ago to the exact same insurance from company that was reputed to have the best rates in the country, I found my insurance was $800 cheaper. Quite a difference. That’s why it pays to comparison shop.
Best Companies
After you choose a car insurance policy you like, you can check out the company by going to the following websites:
J.D. Power’s Website
J.D. Power (jdpower.com) rates companies based on customers’ overall experience, policy offerings, policy pricing, and insurer contact. This is a good site to see how actual customers like a company’s service, policies, and prices.
Your State’s Department of Insurance Website
All States have a Department of Insurance website and most states list the complaints filed against insurance companies. If your state doesn’t list company complaints, go to the California Department of Insurance website – http://www.insurance.ca.gov – to get this information.
Bottom Line
It only takes a few minutes to find inexpensive insurance rates online, and a few minutes more to find out if the company you choose is reputable. Those few minutes comparing prices and comparing companies could save you hundreds of dollars in premiums and give you peace of mind knowing that your insurer is reliable.
Visit http://www.LowerRateQuotes.com or click on the following link to get inexpensive car insurance quotes from top-rated companies and see how much you can save. You can get more insurance tips in their Articles section.
ryan@thesatellitetvguide.com
http://www.articlesbase.com/insurance-articles/inexpensive-car-insurance-get-the-best-rates-with-the-best-companies-140188.html
Healthcare Managing Change
Healthcare Managing Change
I consider the question of the managing change with the healthcare issues in a way of curtain problems and they’re solutions. First of all, let’s see some current issues in the USA health care system today. New diagnostic and treatment procedures flourish in the United States. Our medical schools are of the best, our physicians of the first rank. And why not, since we spend some 15 percent of our GDP on health care? Few would argue that there’s a better place to get sick than in the United States if you can penetrate the system. Our system is the problem, and it’s only going to get worse. At dinner party, if you listen to people on the subway, if you talk with physicians, and if you talk with leaders of small business and big business, they’re all very unhappy and confused. Private insurance companies are happy about current trends, if not happy about where we are. In the present, they’re making money. Drug companies were happier six months ago. They think they’ve been taken aback by the bad press that they’ve been getting, and they’re searching for how they can do better. But by and large, until relatively recently, I think they were feeling again comfortable. The more-affluent people that are also fully insured. While they grouse about the paperwork, they have reasonable ways of accessing the tremendous advances that have taken place in the biomedical sciences, which are increasingly translated into better diagnostic care, therapy, drugs. I use the word “access” advisedly, because it isn’t always easy for them either to get to the right places because of the bureaucratic constraints, because of the third-party payers who say you’ve got to have your primary-care physician refer you before you can see a specialist. But when they do gain access to the system, this group feels reasonably satisfied.
National medical errors database hits one million records milestone. Medmarkx, nongovernmental database of medication errors, has received over one million medication error records to date, the U.S. Pharmacopoeia (USP) announced recently. Medmarx is an anonymous, Internet-based program used by hospitals and other healthcare organizations to report track and analyze medication errors. Since the program began in 1998, more than 900 HCOs have contributed data to use an historical review of Medmarx data reveals that approximately 46 percent of the medication errors reported reached the patient; 98 percent of the reported errors did not result in harm. JCAHO Creates IT Panel. The Joint Commission on Accreditation of Healthcare Organizations has created an advisory panel to recommend ways the Oakbrook Terrace, Ill.-based organization can use its accreditation process to increase the role of IT in healthcare. The panel will conduct a benchmark survey on the existing state of IT adoption in healthcare, and track progress annually. The 39-member panel, chaired by William Jessee, M.D., president and CEO of MGMA, includes provider representatives and reps from health insurers, academia, think tanks, IT vendors and government agencies.
The Council of Smaller Enterprises is putting its considerable weight behind a push by the National Small Business Association for health care reform on a national level. The National Small Business Association, of which COSE is a member, has developed three ideas it plans to take to the federal government as ways to reform the ailing health care system, said William Lindsay III, immediate past chairman of the association, during a recent visit to Cleveland. Those ideas are fair sharing of costs, empowering and focusing on the individual, and reducing costs while improving quality. “The fundamental problem in America is the cost of health care and the cost of insurance,” he said. “We’ve got to get everybody insured.” The Washington, D.C.-based association already has begun to lobby lawmakers to adopt the three basic principles, and they’ve been receptive so far, Mr. Lindsay said. For its part, COSE soon will lobby Ohio lawmakers on the same issues, said COSE president Jeanne Coughlin. Under the association’s proposal, all Americans would be required to obtain basic health care coverage, a package that would be designed and mandated by the federal government, Mr. Lindsay said. The basic package would cost the same for anyone in a given market, regardless of their health condition, he said. For that proposal to work, insurance companies would need to accept everyone into one insurance pool, which would spread costs broadly and reduce uncompensated care, Mr. Lindsay said. If companies provide health care coverage above the basic federal level, they would need to pay taxes on the money spent on those benefits, he said. Those additional tax dollars then would be set aside for health insurance subsidies for people who don’t qualify for Medicaid but can’t afford their own insurance.
It is ironic that Mrs. Jeannie Lacombe received so much attention after her death; she didn’t receive much of it immediately beforehand. On the morning of February 1, the Montrealer suffered chest pains and went to the nearest hospital emergency room. Four hours later, a physician finally looked at the 66-year-old woman, who lay on a stretcher in the hallway. She was dead. On that early February morning, Maisonneuve-Rosemont Hospital was crowded with 63 patients in a ward designed for 34. Only three of Montreal’s 24 emergency rooms were not overflowing with double or triple their capacity. The problem isn’t confined to Montreal. Two weeks later, in Toronto, a five-year-old boy died in an ER five hours after arriving, without having seen a physician. At times this February, Toronto nurses have fought with ambulance attendants over the stretchers patients were brought in on. A Toronto Ambulance official commented last week that the hospitals have been refusing ambulance patients more often, and for longer periods, than at any time in the last 27 years. In Winnipeg, hospitals have been routinely on “redirect,” meaning that they accept only critical patients, and “critical care bypass,” meaning they are too crowded even for those. In Calgary, a physician arrived for work at Rocky View Hospital one day to find emergency patients lined up in the parking lot. The ER and the foyer were already filled. “I have never seen anything like that in all the years I have been practising,” he says. Calgary’s regional health authority openly contemplated cancelling all elective surgeries, and near month’s end, health officials in Edmonton did so. Somehow, in the “best healthcare system in the world,” patients are waiting hours to be examined. The sickest lie on stretchers for days, awaiting admission. Some argue that a combination of winter storms and flu have placed an unusually great strain on the system. These two factors surely contributed, but how did Medicare erode to the point where minor stresses can wreak such havoc? And is ER overcrowding such an isolated phenomenon? Last year at this time, with neither flu nor ice storm, Montreal’s emergency wards were filled to 155% capacity. And the problems with Canada’s emergency rooms are only the tip of the iceberg. In truth, Medicare has been languishing for years. Consider the plight of Jim Cullen of Winnipeg. Mr. Cullen has a potentially life-threatening abdominal aneurysm. He could bleed to death without warning unless the aneurysm is surgically repaired. Mr. Cullen has waited five long months for that surgery. Despite his optimism, he wonders every day: “How long will that (artery) wall hold out?” But because of the ER crisis, Mr. Cullen’s surgery is on hold indefinitely. Once Canada’s pride and joy, Medicare is marked by long waiting lists for life-saving surgeries, inaccessible diagnostic equipment, dwindling standards of hospital care, and an exodus of good physicians. Meanwhile, Canada’s population is aging. Over the next 40 years, the percentage of senior citizens will double. More seniors require more services; if we can’t meet today’s demand, how will we meet tomorrow’s? To improve Medicare, Canadians must first answer one question: what ails the system? Some-opposition politicians, professional associations, and public-sector unions-argue that the system is simply under funded. Others-cabinet ministers, economists, and policy experts-maintain that the system has enough money: we just have to spend it better through greater government control. If Medicare is under funded, people should pay more into the system. But according to a study by the Fraser Institute, working Canadians already spend 21 cents of every dollar they earn paying for Medicare. How much more do we need to spend? How much higher must taxes rise? The aging of the baby boomers will almost certainly bankrupt us: the Canadian Actuarial Society estimates that taxes will need to rise to an average of 94% of income in the next 40 years to sustain the system.
If greater control is needed, governments must take a larger role in the healthcare system. This has been the trend over the past two decades, but has any government ever managed to browbeat part of the economy into efficiency? Governments are increasingly involved in hospital decision-making, but if Moscow central planning didn’t work in Moscow, what makes us think it will work in Victoria, Edmonton or Toronto? When healthcare is “free,” people do not hesitate to use the system. They request too many tests. They stay in hospitals too long. They consult too many physicians. The costs add up. Millions of Canadians suffer from problems such as insomnia, back pain, chronic fatigue, severe headaches, and arthritis: there is a great potential for them to spend vast resources to little proven benefit. In 1977, a joint Ontario government-medical association committee reviewed patients’ use of the system and concluded that “demand for medical care appears infinite.” Canadians assume that in a “free” system there are no tough decisions to be made. If the doctor suggests that you need an X-ray, you get one. But while you don’t need to think about the cost of the X-ray, the folks at the Ministry of Health do. You don’t worry about the cost of visiting walk-in clinics, or lengthy hospital stays, but these costs still add up. According to the Ontario Task Force on the Use and Provision of Medical Services, Ontario physicians billed $200 million in 1990 alone for “treating” the common cold.
In Canada, the provinces have achieved cost control by restricting access to health services. They have downsized medical schools, restricted access to specialists, and reduced the availability of diagnostic equipment. In many ways, Canada has opted for the old Soviet method of rationing-everything is free, and nothing is readily available. And so Canadians must line up for tests. For surgery. For the basic healthcare they need. Provinces have been busily “reforming” health care, but what are the long-term results? Patients are discharged earlier from hospitals, often too early. Patients wait for treatment; some develop complications. Hospital beds are closed, reducing doctors’ ability to admit patients. All these factors played a role in the ER crisis this February. To make matters worse, bureaucrats have developed elaborate spending controls, reducing the system’s ability to react. Canadians have assumed that if we make health care “free” (and pay the consequent high taxes), no one will ever need to worry about getting quality care when they need it. It seems that this assumption is false. Making health care “free” means everyone must worry about getting quality care. And yet the so-called experts continue to try to make Medicare work-against the odds, against human nature. This dooms us to longer waiting lists and more horror stories.
Isn’t it time we had a meaningful public discussion about health care? Lives are at stake.
Most Americans are insured through their jobs. Employers used to buy the insurance from a third party, typically the local Blue Cross/Blue Shield not-for-profit plan. Recently the Blues have lost ground to more aggressive for-profit insurers. But their strongest competitor is now employers themselves, stung by rising health-care costs and the state authorities’ burdensome regulation of the insurance industry. Federal law allows employers who “self-insure” (usually through an arm’s-length intermediary) to escape state regulation. Over half of America’s biggest employers have now made the switch, in effect paying their workers’ medical bills themselves. The other main insurer in America is the government. The old and the disabled are covered by a federal programme, Medicare. Medicare, which will spend about $110 billion this year roughly twice the cost of Britain’s NHS , is divided into two parts: the first pays for most hospital care out of payroll taxes; the second pays for doctors’ fees out of general taxation and a premium paid by the patient. Medicaid, a state-federal programme that will cost nearly $90 billion this year, pays all the medical bills of the poor, including those for long-term care. Retired and serving soldiers are covered by the Veterans’ Administration, which has a network of inefficient hospitals, and by a special programme with the colourful acronym champus. This patchwork quilt (see chart 4 on next page) has two gaping holes. One is that it leaves a large and growing number of people currently around 35m without any insurance at all. The plight of the uninsured is bad, but not as bad as it sounds: most get care from hospitals that are, in theory, not allowed to turn anyone away. Figures from the census bureau and the American Hospital Association suggest that overall spending on the uninsured is comparable to spending on the insured, though it is unevenly distributed. Uninsured people can be bankrupted by big medical bills. And the bills they cannot or will not pay are a time-bomb passed among others involved in the system. The hospitals try to pass it to the insured in higher premiums; insurers try to pass it back in lower hospital profits, or to offload it on to state and local governments. The other flaw in the American way is caused by costs that are spinning out of control. At over $600 billion, the cost of health care in America now absorbs 12% of GDP. And whereas in other countries it has roughly stabilised, in America the share has been rising throughout the 1980s. Employers have reacted by trimming the health benefits they offer, especially undertakings to cover staff who have retired. Those undertakings will knock a $200 billion hole in profits when they have to be shown in company accounts from next year. One result is that in four-fifths of labour disputes in the past two years, the main fight has been over health benefits.
Foreigners like to blame the tribulations of American health care on excessive reliance on the free market. In fact, government policy has played a big part. Instead of improving equity, well-intentioned state regulation of the insurance market has made insurance all but impossible for small employers to buy. Two-thirds of the uninsured work, many for employers who would like to offer insurance if they could find it. The other third ought to have Medicaid cover, but budget cuts and a diversion of cash into long-term care for poor, old people mean that the programme now covers only 40% of those below the federal poverty line. As for costs of treatment, the biggest source of inflation has been reliance on expensive fee for-service medicine that gives doctors and hospitals an incentive to treat people in the most expensive possible ways. This might look like a market fault. But another prime contributor is the government’s decision to exempt employer-paid insurance premiums from federal and state income taxes amounting to an annual subsidy of nearly $60 billion. It is bad enough that this subsidy is biased to the better-off; worse, it destroys any incentive for employees to choose cheaper insurance. The government is also partly to blame for a legal system that has produced astronomical awards to patients in malpractice suits. These feed straight into the costs of health care through malpractice insurance taken out by doctors. High premiums and the fear of being sued have also made some types of care hard to get (try finding an obstetrician in Florida to deliver a baby). Even more expensively, they encourage doctors to practise defensive medicine such as ordering unnecessary tests.
Not everything about American health care is bad. Its quality is widely thought to be high which is why one opinion poll had 90% of respondents favouring “major changes” in the system, but over half satisfied with their own care. There is plenty of choice of doctors and hospitals: European indifference to patients is rare in America. America has made the biggest progress in developing quality assessment and output measures for health. It remains the world leader in innovation, experiment and new technology, both in medical care and in different ways of delivering and paying for it.
In 1915 a labour pressure group looked forward to national health insurance as the “next great step in social legislation”. Truman tried and failed to introduce it in 1948. In the mid-1960s Johnson managed to push through Medicare and Medicaid. Richard Nixon encouraged the spread of HMOS (in which patients pay a fixed fee to cover all their health care) and managed care. But when he suggested a national health programme based on a mandate for employers to provide health insurance for their workers, it died partly because Democrats like Edward Kennedy wanted government insurance instead. Ironically Senator Kennedy now supports something like the Nixon plan, but it is opposed by George Bush. There is a host of other ideas on offer: Insurance reform. Some want to ban “experience rating” (skimming the cream of insurance risks) and insist on community rating. Others want to encourage the small-employer insurance market, perhaps by pooling risks. A third idea is an “all-payer” system such as Maryland’s, under which all insurers agree to pay the same price to hospitals an attempt to create the monophony power among purchasers that is common in most other countries. But the insurance market already suffers from too much regulation. And an all-payer system could stop the move towards cheaper selective contracts with providers. Medicaid expansion to cover more of the uninsured. This might include letting people above the poverty line, but who cannot otherwise find insurance, buy into the public programme. An alternative is to expand Medicare to cover the whole population. But in deficit-ridden, taxophobic America, neither the federal nor any state government is in a position to take on a new spending commitment that could add up to $250 billion a year (even if it saves more in private spending). State governors have repeatedly asked Congress to stop expanding the coverage of Medicaid. Price and volume controls. The most successful of these has been Medicare’s prospective budgeting for hospitals, where payments are based not on the costs incurred but on fixed prices per case (known in the jargon as diagnosis-related groups, or DRGS). This has been copied by many private insurers. The average patient now stays in hospital for a shorter period in America than in any other country, and a recent Rand Corporation study confirmed that the quality of patient care has not been affected. A new set of Medicare price and volume controls on doctors comes into force next year. But though such controls might hold down spending in one place, bills have a nasty habit of popping up somewhere else as providers fight to maintain incomes. Alain Enthoven of Stanford University has put forward the most sophisticated single reform plan. TO encourage managed care (of which more below) he would cap the tax exemption for health insurance at the cheapest insurance policy available. He would create state insurance pools under healthcare “sponsors” for those who cannot get coverage. Employers who did not give their workers insurance would have to contribute to a state pool an idea known as “play-or-pay”. Congress’s Pepper commission, which reported in 1990, also wanted a play-or-pay plan. But such employer mandates would increase business costs, and without firm cost controls they might lead to more overall spend on health care. Individual mandates. The Heritage Foundation, a right-wing think-tank based in Washington, DC, is touting a plan that would replace the employee-tax exemption by a tax credit to help people buy their own health insurance. The government would require everyone to take out “catastrophic” health insurance a long-stop protection against the biggest medical bills. Potting the burden on individuals sounds attractive, but it would make it harder to avoid adverse selection by both insurer and insured. As a variant, a government commission headed by Deborah Steelman has been considering replacing both Medicare and Medicaid with catastrophic coverage for all. More patient charges or what are known in the jargon as “co-payments”. But these are already high, in both the private and the public sectors (on some estimates, old people now pay as much out of their own pockets for health care as they did before Medicare). And if they are pushed too far, people simply take out extra private insurance. Managed care in HMOS or PPOS (preferred-provider organisations that offer more choice of doctor and hospital than most HMOS). This still looks the most promising option. About 70m Americans now belong to a managed-care plan. Some plans do little more than insist on second opinions before surgery. But the best of them offer patients all the care they need for an annual prepayment, reversing fee-for-service medicine’s incentive to excessive treatment. HMOS have been touted as the answer for American health care since Paul Ellwood, a health economist, coined the phrase in 1972. But after a one-off cut in costs, their spending growth has since matched the inflation of the fee for-service sector. Many HMOS have lost money; some have gone bust. No wonder Bob Evans of the University of British Columbia says that “HMOS are the future; always have been and always will be.”
Is America ready to make any changes to its chaotic system at all? One day, it must: the uninsured are a growing embarrassment; spending cannot rise for ever; growing paperwork will become intolerable; increasing interference in doctors’ clinical judgments will provoke revolt. But the short-term prospects for reform are poor. The White House appears to think that any change would be politically riskier than letting the system bumble along as it is. As for the Democrat-controlled Congress, it was badly burnt when it expanded Medicare to cover catastrophic health-care costs in 1988, only to be forced to retract it in 1989 when the better-off elderly objected to paying extra taxes. In recent months the Democrats, especially in the Senate, have gingerly begun to discuss changes in health care. Some hope to make a version of national health insurance a big issue in the 1992 election campaign. The biggest problem for Republicans and Democrats alike is the mulish conservatism of America’s powerful interest groups. John Ring, president of the American Medical Association, says his organisation is firmly against national health insurance, or any plan that involves a single payer. (It might horrors reduce doctors’ incomes from their present average of $150,000 a year.) Insurers and private hospitals similarly guard against invasion by “socialised medicine” especially of the iniquitous British variety.
Produced by ProfEssays ( www.professays.com ) – professional custom essay writing service: custom essays, custom term papers, custom academic papers, custom admission essays, custom research papers, compositions, book reports, case study. No plagiarism, high quality, prompt delivery.
Andrew Sandon
http://www.articlesbase.com/medicine-articles/healthcare-managing-change-75487.html