2009 Maximum HSA Contributions:
Individuals: $3,000
Families: $5,950
Allowable Additional Catch up Deposit for those 55 and older: $1,000
(Contributions can be made as late as April 15th for the preceding year.)
Max. HSA Out-of-Pocket Amount in 2009:
$11,600 family
$5,800 individual
Min. HSA Deductibles in 2009:
$1,150 Individual
$2,300 Family
Two polls have Senator John McCain up by one point. Both pollsters are generally viewed with a slight and opposite leaning bias, Rasmussen tilts Republican, and Zogby tilts Democratic. Each pollster would undoubtedly object to this characterization, but this is the perception on the street. The fact that both Zogby and Rasmussen have Senator McCain up by one point is politically relevant. More importantly, the Zogby poll is a complete poll of likely voters, and the Rasmussen poll is their daily tracking poll. (Gallup’s poll last week had McCain up four points among likely voters.)
Other than the result of the Zogby poll, the most significant finding is the increase in the number of undecided voters. This indicates more than just Obama not being able to make the sale — it foreshadows Obama could be losing a sale already closed.
In a related development, the most significant analysis done thus far of the Obama - McCain Presidential election, in my view, is the piece in yesterday’s Wall Street Journal, by Juan Williams. Williams has done his polling homework, and has picked out the results he cites in his piece from sifting through many other polls. As an African American, Williams brings a relevant and critical eye to the unfolding election contest.
The following are excerpts from William’s piece:
“The race issue is clearly not going away. And the key reason — to be blunt — is because there is no telling how many white voters are lying to pollsters when they say they plan to vote for a black man to be president. Still, it is possible to look elsewhere in the polling numbers to see where white voters acknowledge their racial feelings and get a truer measure of racism.
In a Wall Street Journal poll last month, 8% of white voters said outright that race is the most important factor when it comes to looking at these two candidates — a three percentage point increase since Mr. Obama claimed the Democratic nomination. An added 15% of white voters admit the candidates’ race is a factor for them. Race is even more important to black voters: 20% say it is the top factor influencing their view of the candidates, and another 14% admit it is among the key factors that will determine their vote. All this contributes to the idea that the presidential contest will boil down to black guy versus white guy.
Consider also a recent Washington Post poll. Thirty percent of all voters admitted to racial prejudice, and more than a half of white voters categorized Mr. Obama as “risky” (two-thirds judged Mr. McCain the “safe” choice). Yet about 90% of whites said they would be “comfortable” with a black president. And about a third of white voters acknowledged they would not be “entirely comfortable” with an African-American president. Why the contradictory responses? My guess is that some whites are not telling the truth about their racial attitudes.
A recent New York Times poll found that only 31% of white voters said they had a favorable opinion of Mr. Obama. That compares to 83% of blacks with a favorable opinion. This is a huge, polarizing differential.
But polling can be tricky. In May, a Pew poll asked voters about Mr. Obama but did not give them the option of saying they are undecided. In that poll, whites split on the candidate, 45% saying they had a favorable opinion, 46% unfavorable. When white voters had the option of being undecided, as they did in the Times poll, 37% of whites said they had an unfavorable opinion of him, but 26% said they were undecided….
In the Democratic primaries there were states, especially in the South, where blacks made up nearly half of the electorate. But in the general election there are no states where blacks make up so large a percentage. Even in Southern states such as Georgia and North Carolina, where blacks made up about a quarter of the vote in the last presidential election, it will be an upset if Mr. Obama manages to win. Those states have a history of Republican dominance in presidential contests. Even an energized black vote is unlikely to make Mr. Obama a winner anywhere in the South, although some Democrats hold out hope for Virginia.
In 2004, John Kerry had a 46% favorable rating among white voters, barely better than Barack Obama’s. But Mr. Kerry lost. Mr. Obama needs to do better with whites. But the white voters’ view of him is still clearly unsettled.
Polls show white voters struggling to identify with him as a fellow American who, to quote Bill Clinton, is able to “feel your pain.” When the New York Times poll asked whether Mr. Obama cares about “the needs and problems of people like yourself,” 70% of whites answered “a lot” or “some.” But 28% of whites said Mr. Obama cared about them “not much” or “not at all.” Compare that with the 72% of black voters who said Mr. Obama cared about them “a lot.” The same Times poll had Mr. Obama leading Mr. McCain by six percentage points, 45-39, but trailing by nine points among white voters, 37-46.”
Finally, the kinda, sorta, maybe, anti-endorsement endorsement by former President Bill Clinton is historically important. Using my own electoral impact translator Bill’s statement is really a message to the Hillary voters, the women over 40 (Fox News has them breaking for McCain by 3 or 4 points) and the white working class voters: don’t break your pick or your leg trying to vote for Obama, he is not really ready to be President. Bill Clinton said: “You can argue that no one is ready to be President.” In other words, on the key point of weakness for Obama, experience and readiness, Bill refused to give Obama cover. Hmmmmmmm. This may or may not foreshadow what is in store for Obama if he does not, as is being widely reported, pick Hillary Clinton as his running mate.
In short, the Williams piece clearly illuminates the race problem for Obama. The Clinton statement compounds the Obama experience and readiness problem, and reinforces the doubts among Hillary’s key constituents in the Democratic Party — women and working class whites.
In a social science experiment, a moment like this could be easily labeled the tipping point.
One of my basic working theories about health care reform is that Americans cannot stand, and will not stand for, having access to care being rationed or their choices limited by any system designed to do just that — which in the case of HMOs — has meant their demise.
If on the other hand, you offer Americans real help to access health care services they need, cover them against big bills and serious health conditions, but let them have control over their own health care needs by helping them have the financing and resources to get the care, then you have a winner — people get help and they get it in a form that fits the American psyche.
This is why Indiana’s HSA program for the working Medicaid population is attracting huge numbers of applications, a little more than 10,000 a month since January of this year.
The plan has a health insurance policy with a $1,100 deductible, and then 100% coverage after that up to $300,000 in benefits.
Each plan participant has a debit card with access to $1,100 cash for spending on their health care needs. They make their own choices and decisions.
The plan includes a minimum of $500 in preventive care services. If the insured does not spend the $1,100 in the account that year, the money rolls over into their account for the next year if the insured has completed all of the preventive care services that have been identified by Medicaid as necessary for the age, sex and health status of the insured.
Herein is an example of a government financed HSA for the poor, that is popular, puts incentives around making sure the insureds actually get the preventive care prescribed, and that allows those being helped to have the dignity of making their own decisions about what is best for their health, when they consult their doctor. This is the anti-nagging, anti-bureaucrat health plan.
It gives the insureds cash if they do the right thing. It also is not a cultural affront to Americans, who just want and need some help.
So let’s get right to the point: I predict Sen. Obama will lose the Presidential election. Secondly, HSAs will continue to be the fastest growing type of health insurance and the fastest growing type of bank account and the fastest growing type of investment account.
Senator McCain’s win will cause shock and awe world-wide, and in the councils of the Democratic Party, but it will bring political balance to a precarious economic and political time in the United States.
McCain’s win will also cause a serious, bi-partisan approach to health care reform. But before we get to that, let’s set the playing field: The fight over health care reform can be broken down, in general, into two camps: the Democrats want to give control over your health care to a government run entity, for example, like Medicare. The Republicans want to give you control of your health care by giving you cash to help you buy the care you want or you need.
Republicans say the Democratic plans will cause rationing and a loss of control by the individual, just like the HMOs tried to do, which caused a public back lash. Americans, unlike Europeans, hate being told what to do by a corporate or government bureaucrat.
Democrats say the Republican plan will not give enough money to families. (McCain wants every family to get $5,000 to purchase health insurance). To the Democrats, the Republican plan is like lowering a ten foot rope into a fifteen foot hole.
So, how will this health care debate, post-McCain victory, turn out? Don’t hold your breath, even if my prediction is wrong, and Obama wins, there are serious economic and political structural problems with any legislative attempts at health care reform.
When voters are confused about the details or merits of competing plans, voters as a block generally default to the dominant cultural characteristics of America. The most recent instruction on American’s cultural and political views on health care rationing and corporate or bureaucratic control to access to care Americans want, is the example of what happened to HMOs. HMOs tried to ration and control. They are in full retreat. The HMOs and their philosphy were, as von Clauswitz would say, defeated “in detail” by the average American. This is why, when Democratic staffers on the Hill open up, they make reference to an Americanized version of government health care.
Furthermore, Americans do not like to innovate with their health care. This tendency translates into a collective decision to simply not to change anything.
The Republicans are, in general, not inclined to conduct a massive health care reform because of the lack of political benefit they received from the Medicare Prescription Drug reform, and the Democrats have had two massive attempts at health care reform fail, the first being the Clinton Health Plan, and the second being the Patient Bill of Rights. It is also instructive to look at the California experience, where the Republicans and Democrats joined hands, labored mightily for state-wide health care reform, and in the end, no bill even emerged from Committee. Not to put too fine a point on it, but health care reform’s political history is littered with failures and serious political consequences for those who have failed. The Democratic party lost control of the U.S. House after the Clinton plan failed.
Then there is the most serious problem, the one that tied the shoe laces of reformers in California, cash.
This year, the combined spending on Medicaid (for the low income), Medicare (for the seniors) and the tax break for employer provided health insurance is close to, if not above, the one trillion dollar a year mark — and the baby-boomers have not even begun to seriously hit the rolls of Medicare.
By 2017, Medicare will be adding 11 million seniors. In nine years (in 2017) there will be 55 million seniors in Medicare.
The thing about reality is that it is hard to avoid. Eventually, even the most ardent attempts at convincing the public that the King has a beautiful flowing gown fail, and eventually reality catches up with the wide-eyed desires of “change.” California wanted change. They just could not afford the sort of change they wanted. Reality hit hard. The bill did not make it out of Committee. The bi-partisan alliance failed. The result is their will be no change in California in health care at the state level for some time.
Ninety some odd Democrats in the U.S. House of Representatives want Medicare for All. Notwithstanding the fact that the Republicans would rub their hands with glee at the prospect of the Democrats attempting to pass that legislation, the Democrats are going to have to try and meet the effective veto these House members will have on the Democratic House Leadership’s reform proposals.
It is very easy to see the House Democrats over-reaching politically, and going for what they really want the next time health care reform is readied for legislative action. This is going to create serious tensions within the Democratic party between those who want something that will pass, and those who want to be pure. Ninety members is a big number. If even a third of them banded together to force their caucus to accept their version of health care reform, the Democrats would be tied up in knots for a very long time. Why would the Medicare for All crowd want to delay any action? By waiting, more and more Americans (i.e. baby boomers) will be in Medicare — government run health care. Why not wait until those numbers grow substantially to push for Medicare for All? Time makes their constituency grow.
Then, of course, there is the fact that $1 trillion of government spending attracts $1 trillion worth of special interests. By the time every interest that could derail or materially alter any deal is satisfied, the end result may be worse than the current state of affairs.
Other than the:
health care reform’s future is, well, um, uncertain. Each one of these seven points represent a high degree of difficulty for any reforms to overcome and be passed into law. Taken together, there is an extremely high level of difficulty. Add into the seven points above that changing the tax code is the most difficult of all types of legislative action to achieve, and the level of difficulty of health care reform just became the most difficult type of legislation to pass of any kind in the United States.
This is why the “believe in change” slogan rings hollow for many Americans — it is just like wishing the King did have clothes.
The latest Gallup poll, in the aftermath of the glowing media coverage of Senator Obama’s European World Tour, has McCain up 4 points among likely voters — that is, McCain has a 4 point lead among voters who are most likely to actually go to the polls and vote.
This represents a 10 point swing in McCain’s favor. Gallup had him down 6 points among likely voters a month ago. Women over 40 are responsible for three or four points of this lead. They are breaking to McCain over Obama by electorally significant margins.
In a time of economic, political and military uncertainty and tumult, Americans will, I predict, go with the safer choice of experience — Senator John McCain.
Click on the link below to watch the video, and the following is the transcript of the 38 second clip:
“I happen to be a proponent of a single payer universal health care program.” (applause)
“I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out.”
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The word on the street in Washington, D.C. among Democratic Hill staff is that Obama is going to lay low on his advocacy for a single payer system, but as soon as he becomes President, it is the first thing he is going to tackle — passing single payer health care in the United States.
The Security and Exchange Council (SEC) could not believe the central fact behind a new mutual fund called The Congressional Effect Fund, a public, registered mutal fund.
What fact? This one:
So, with complete disbelief in this fact, the SEC had it checked.
And, based on 43 years of market performance and more than 11,000 data points, the above statement is true.
The SEC then allowed The Congressional Effect Fund to be set up, which is in the market on days Congress is out of session, and out of the market on days Congress is in session.
What is causing this effect on the market? Primarily, when Congress merely proposes new legislation or takes some limited action on some legislation, even it does not pass or become law, the market discounts the value of the companies in the industry that the law could, if it passed, impacts.
This sounds like a great fund to put your HSA investment funds in, and I am going to — since the inescapable conclusion, according to the founder of the fund, Eric Singer, is that “Congress destroys wealth.”
This fund is the way to protect your wealth from the highly negative effects of being in the market when Congress is in session.
You can contact the fund at 888.553.4233 or write the Congressional Effect Fund at c/o Matrix Capital Group, Inc. 630 Fitzwatertown Road, Willow Grove, PA 19090, or visit them on the web at www.congressionaleffect.com.
Craig Barrett, Chairman of Intel Corp. told the U.S. Senate Finance Committee it would be spending $1 billion a year on health care soon, and that “we’ve just been writing checks,” and that those days are coming to an end.
The President of the Blue Cross Blue Shield Association noted that the employer has been “a heretofore passive partner in this.” This, of course, is the ever expanding cost of health care — and it is clear, or should be clear, that there are some in the health industry that do not want the rate of increase of health care costs to decrease.
Am I saying everyone is not for affordable health care?
Yes.
Really?
Really, really.
Prove it.
OK, from Forbes Magazine: “Wellpoint’s earnings would suffer if the upward march of health care costs (and the corresponding insurance premiums) collapsed from its 8% annual rate to the 2.5% inflation rate,” said Wellpoint’s finance chief.
If the lion’s share of health care inflation comes from hospitals jacking up their prices because they market will pay whatever they charge, since no one knows what medical goods and services actually cost, why would the insurers want the hospitals to bring down their prices?
If Craig Barrett of Intel wants to focus on cost, he should look at the report done by CalPERS and the Pacific Business Group on Health on hospital pricing. Here is what the study concluded:
“A new study designed to uncover the key to understanding hospital prices confirms what large purchasers have long suspected: A disturbing number of hospitals appear to be grossly overcharging and not being held accountable.”
If employers are waiting for insurers to contain hospital costs, effectively, the employers really are “just writing checks.”
This health care economy exists in the real world, with real prices and real paying customers who pay for a service when they get it and with real competition over service, privacy and, yes, prices.
Yes, this mythical health care economy does really exist.
There are more than 60 Any Lab Test Now franchises in the United States. Founded by Dr. David Perlow in Atlanta, Georgia in 1992, they perform accurate and cost-effective lab tests in a “fast, efficient and discreet manner.”
In another related development of an actual health care economy with prices for services, by the end of this year, between 1,500 and 1,800 in store health clinics will open in Wal-Marts, Targets and grocery and pharmacies, according to Sarah McIntosh, writing in the Wichita Eagle.
I love going to the MinuteClinic in the CVS near my house. The last time I was there I had bronchitis and I signed in, got a flu shot (even though you really are not supposed to if you are sick — don’t worry, I’m fine) and got the prescription in about 10 minutes. All-in, the visit, with the flu shot cost about $70. And I walked into the clinic. I did not wait. It was a Friday and I did not want to wait until I could get a doctor’s appointment on Monday, and be even more sick, and then get the prescription. Filling the prescription took longer than going to the MinuteClinic. This is how the real health care market place works, it is cheaper, it is faster, and it is more convenient.
The New York Times ran an op-ed by Dr. Sandeep Jauhar, a cardiologist on Long Island, who is the canary in the mineshaft for doctor discontent.
Doctors are not happy with the state of medicine in the United States. Here is a short and partial list of general complaints:
“Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges. Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.”In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.
“The dissatisfaction would probably not have reached such a fever pitch if reimbursement had kept pace with doctors’ expectations. But it has not.
“Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.”
This may explain why 65% of doctors in the United States want a single payer system. Not being paid for your work, having to fill out paperwork and chase claims would frustrate any doctor, especially if they went hundreds of thousands of dollars in debt to become a doctor, just to fight with a managed care voice on the phone to treat their patient.
Patients with an HSA should pay their doctor cash from the account at the time of the service, and the doctor should give the patient a price that takes into account the fact the doctor is getting paid the day of the visit and that the doctor does not have to chase their payment from the insurance company.
This would go a long way to helping doctors understand why a cash paying patient with an HSA is better for their bottom line, and that the patient is the one making the decision with the doctor, not an insurance bureaucrat who is looking at a computer screen, not the patient.
Democrats love the health care issue because the public trusts them more on health care.
Democrats can pound away verbally at the problem without providing a systemic solution that has the legs to actually become law.
In fact, in the past two decades, every major Democratic led health initiative has failed, while two major Republican health initiatives have passed Congress and become law.
Before people get up in arms about the statement above, HillaryCare failed, the Patient Bill of Rights failed, while the Medicare Prescription Drug benefit with the Health Savings Account (HSA) provision became law, and HIPAA, with the Medical Savings Account (MSA) pilot, became law. Democrats were in control of both Houses of Congress, and controlled the White House, during the HillaryCare fight.
One of the reasons that Democratic health care initiatives fail is because the Democrats themselves are divided between those who want a Canadian style health care system, and those who want to use the tax code and other such mechanisms to reform health care. This division contributed to the explosion on the launch pad that was the California health care reform effort.
But ultimately, all health care reforms must pass the “Where is the money going to come from?” test, and the fact is, the most spending by the U.S. government on any single thing is on health care — specifically on Medicare, Medicaid and the tax break for employer health plans. The total expenditure on those three items is north of $1 trillion a year.
The fact of the matter is that the money for health care reform, will most likely come from the money the U.S. government now spends on health care.
This will make the job of any health care reform plan, even more difficult, and is likely to result in no reform becoming law anytime soon.
Hospital prices must be made transparent, because no market can work without clear prices for goods and services.
Can you walk into a Wal-Mart without seeing the price of anything for sale? No. Jiffy Lube? Giant? Safeway? Mejiers?
America has been lulled into accepting invisible pricing and huge insurance premiums for health care, which have driven the cost of health care to heights unseen, and made health care unaffordable for many — which has provoked the political system into relieving the costs for employers and individual by expanding government control of health care.
The United States government already spends 50% of the money spent on health care every year.
Why with more government control will health care be less expensive or higher quality?
The market, which can change and react, which has proven itself in every other market in the United States, has increased quality and lowered prices in one health care sector that is without insurance, Lazik eye surgery. What started out as $5,000 an eye has become $500 an eye, with higher quality results.
Until hospitals start acting like businesses which sell goods and services and price them for all to see, and to compete with, then we will be constantly at the mercy of radically increasing health care prices.
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