tag:blogger.com,1999:blog-5806884.post4251888071338706008..comments2023-10-31T03:18:26.963-07:00Comments on Great Guys Weblog: Heading Clovis's DirectionBrethttp://www.blogger.com/profile/15063508651955739056noreply@blogger.comBlogger50125tag:blogger.com,1999:blog-5806884.post-52923791798333173322013-10-18T10:36:34.592-07:002013-10-18T10:36:34.592-07:00I see. The health insurance you don't have wou...I see. The health insurance you don't have would be portable.<br /><br />Got it.<br /><br />Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-70503619117309206192013-10-18T10:32:38.347-07:002013-10-18T10:32:38.347-07:00I one worked for a woman who had a business (not t...I one worked for a woman who had a business (not the one I worked for) staffed entirely by single women, mostly divorced or abandoned with young children; mostly ones who had been out of the work force for a while.<br /><br />In other words, women who had a hard time finding jobs.<br /><br />She provided reasonably good benefits, including health care, and when offering a job would hand out a sheet showing her total costs: SSI etc.<br /><br />In some cases, the pay was less than half the total.<br /><br />It worked for her because the takehome pay she offered was very low.<br /><br />It baffles me that the advocates of deregulation do not seem to understand the friction introduced into the system by avoiding single payer.<br /><br />Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-59432105052595033742013-10-17T14:05:48.080-07:002013-10-17T14:05:48.080-07:00Clovis asked: "...do you know how much would ...Clovis asked: "<i>...do you know how much would he pay to have a comparable coverage in the private (or ACA?) market?</i>"<br /><br />I'm not sure about the ACA, but in the private market he'd pay more-or-less the same for the insurance. ***BUT***, he would do it with at least some after tax dollars whereas when I buy it for him, I do it with pre tax dollars. On a $23,000 salary increase, an engineer in California would lose more than $10,000 to federal, state, and other miscellaneous taxes. That's why so many people get their health insurance through their employer rather than buying it on their own where it would be more portable. There are ways to minimize the tax hit some (Health Savings Accounts and things like that).<br /><br />Yes, it is way cheaper to hire a young single person. Their salary tends to be way lower as well. But experience does have some value. And young, single people often become young married people with children remarkably quickly and the whole birth process is really expensive for an employer as well.<br /><br />One of my partners seems to avoid hiring young people who seem likely to want to start a family for that very reason. I like families and children so I'm the opposite (but don't tell my investors!).Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-28217640520428522522013-10-17T12:30:55.286-07:002013-10-17T12:30:55.286-07:00AOG,
So maybe you've read the ACA enough to a...AOG,<br /><br />So maybe you've read the ACA enough to answer me: why is it that you have no way to keep your old insurance, but big companies can keep providing their own self-insurance for their employees as before? Or they can't?<br /><br /><br />Bret,<br /><br />Were you to cancel health insurance and give your employee the $23,000 increase in salary, do you know how much would he pay to have a comparable coverage in the private (or ACA?) market?<br /><br />I find it interesting that you cover the employee's family too. So hiring young single people is cheaper for you than older ones with families? The experience the older ones bring is enough to justify the higher costs? Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-8907653453134781552013-10-17T08:10:33.052-07:002013-10-17T08:10:33.052-07:00I was going to disagree with "premiums have b...I was going to disagree with "premiums have been going up 25% or so for years and years" but I realize it's so ill defined as to have no meaning. Our premium increase was 168% but I'm sure that was just a coincidence.<br /><br />Eagar once again demonstrates that he has no idea what "rightist" means in the USA - "I'll bet nobody can find a rightwinger speaking in favor of portability".<br /><br />Every right winger I know who speaks on the subject goes on about that. <a href="http://www.cato.org/sites/cato.org/files/serials/files/cato-journal/2011/1/cj31n1-2.pdf" rel="nofollow">Here is one counter-example</a> from CATO. Eagar doesn't believe this because the proposed solution to portability is less government, not more, especially since the lack of portability in our current system is a direct result of the New Deal.<br /><br />Let me also say, as a small business owner, my experience is basically like Bret's.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5806884.post-38507400314141801652013-10-16T22:07:03.717-07:002013-10-16T22:07:03.717-07:00Yes, premiums have been going up 25% or so for yea...Yes, premiums have been going up 25% or so for years and years. To blame it on Obamacare is like raising a flag that says, 'I don't know the first thing about health insurance.'<br /><br />Even smallish companies self-insure. For example, when I worked for a company with slightly over 100 employees, it self-insured.<br /><br />Basically, it contracted Blue Cost to administer billing and settled up differences at the end of the year.<br /><br />One year, there were 7 employees pregnant, and I asked the boss what would happen if one had a million-dollar premie?<br /><br />His answer: the company would go broke.Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-7190411384308132542013-10-16T19:48:22.762-07:002013-10-16T19:48:22.762-07:00Clovis wrote: "For the typical worker in your...Clovis wrote: "<i>For the typical worker in your company, to pass on the 25% of increase in health care costs means to decrease his salary by how much?</i>"<br /><br />The following numbers are off the top of my head, but I think they'll be within 10% one way or the other.<br /><br />Let's take a 50-year-old employee with a family of four. His health insurance (for the whole family which we cover) is $1,800 per month, or roughly $21,000 per year. A 25% increase means his premiums go up a bit over $5,000 per year. The employee would have otherwise expected to see a $2,000 cost-of-living salary increase, so the difference that he'll have to pitch in is $3,000. But no matter how you slice it, he'll be getting $5,000 less per year than he otherwise would have. So he'll probably start looking for other jobs.<br /><br />I think I need to make a few things clearer:<br /><br />1. Three years ago, before Obamacare was law, we had an 18% increase, which is comparable to a 25% increase, so I have no idea how much of the increase we get this year will be due to Obamacare. The broker implied that a lot of it will be, but that could easily just be an excuse. I just don't know and have no way of finding out.<br /><br />2. These large premium increases are being experienced by every small and medium size business in San Diego, maybe in the rest of the country too, so at least I'm not alone.<br /><br />3. A 25% increase may be survivable. A 100% increase is not without dropping insurance. The good news is that when we got the 18% increase three years ago, the broker predicted 20% - 25% so I'm hoping he just overestimated again.<br /><br />4. Large companies often self-insure. Their costs are going up much, much more slowly. I don't know the relevant parts of Obamacare legislation, but I'm guessing they have a huge and increasing competitive advantage over everybody else because they only have to pay for their own workers and those payments don't have to subsidize the costs of anybody else. Assuming I lose my employees, they will go to large companies, where their total compensation package will be better, at least in the short term.Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-67257522059899478552013-10-16T14:59:55.911-07:002013-10-16T14:59:55.911-07:00Bret,
Thanks for sharing your experience - this ...Bret,<br /><br /><br />Thanks for sharing your experience - this kind of information is worth a hundred pieces of the NYT, and I would still be less informed then.<br /><br />For the typical worker in your company, to pass on the 25% of increase in health care costs means to decrease his salary by how much?<br /><br />And to drop the insurance at all means to increase his salary by how much?<br /><br />Depending on the answers for those questions, it may be very easy to decide. And it may even happen that it will not imply anyone dropping the job. <br /><br />I, for one, would probably prefer to pass on to ACA and have a good increase in salary, than to have it diminished just to have the same health coverage as before (one case is a new situations with a plus, the other an old - hence not funny - situation with a minus).<br /><br />It may be worth to assign how much of your employees are older and younger, and see their profiles for decision making (if they play always safe or take risks) before making the decision.<br /><br />All in all, it is a wonderful problem in game theory. I envy you for that, Bret :-)<br />Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-32574951101070424052013-10-16T14:37:46.617-07:002013-10-16T14:37:46.617-07:00Bret, great minds really do think alike (see comme...Bret, great minds really do think alike (see comment above). I proposed hiring people stating up front that you do not provide health insurance and let them deal with their health needs themselves. It may just be what saves the economy.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-47517991952997852232013-10-16T14:17:33.167-07:002013-10-16T14:17:33.167-07:00Harry wrote: "Idiots who decide to screw over...Harry wrote: "<i>Idiots who decide to screw over their workers because of a hissy fit over the ACA will end up selecting from a pool of second-raters.</i>"<br /><br />That may well be true. It may also be true that my company will lose its employees and end up selecting from a pool of second-raters.<br /><br />We re-up for health insurance for the employees every fall for 12-months starting in January. Our broker is currently unable to get us a quote as all the insurance companies that will insure us are very busy with Obamacare and the exchanges. But he said to estimate an increase of 25% to 100% in premiums over this year.<br /><br />Even the lower end, 25% is big enough that I'll have to pass the vast majority of that on to workers (I simply don't have the money not to) and that will be the same as a substantial pay cut for them. I suspect at least some of them will leave and I won't be able to replace them with people talented enough to do the job. So my company will shrink again. Bummer!<br /><br />The alternative that were seriously considering is to completely drop health care insurance. Then I can actually raise their salaries significantly. The younger ones probably will just pay the fine and won't worry about health care, the older ones can get insurance on the exchanges. In this case, the younger ones might stay and the older ones are more likely to leave to get health care insurance from a big company.<br /><br />Of course if we drop health care insurance, I won't have insurance (I may be able to be covered under my wife's plan, we're not sure yet - we're nearly certain that the kids can be covered and that's what counts). Oh well. I'll just pay the fine and if I get sick I'll sign up on the exchanges then - if they're working.Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-52447244355635419142013-10-16T13:53:26.914-07:002013-10-16T13:53:26.914-07:00It costs so much because so much money spent on he...It costs so much because so much money spent on health care goes to support the federal bureaucracy. it certainly isn't going to doctors who are planning to retired in droves... and you may not have noticed, but it's a buyer market for labor. <br /><br />I wish I was in a position to advertise for workers at every level and state categorically that the salary does not include health insurance and then watch the avalanche of applicants.<br /><br /> You still haven't explained why Medicaid didn't do the job it was supposed to do.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-81642800792294915232013-10-16T12:54:04.924-07:002013-10-16T12:54:04.924-07:00I explained that in my comment just before.
I cou...I explained that in my comment just before.<br /><br />I could go further and try to explain that Skipper's conniption fit about the imaginary part-timing of the workforce hasn't happened in Massachusetts or Hawaii and isn't going to happen in the other states because of health insurance.<br /><br />Most (but not all) good workers want fulltime, secure jobs and will apply where they can get them. Idiots who decide to screw over their workers because of a hissy fit over the ACA will end up selecting from a pool of second-raters.<br /><br />You know why medical costs seem higher now than back in the days when the indigent (if lucky) went to the county hospital? Artificial knees.<br /><br />And so on. <br /><br />Until 1945, medical care was basically palliative and therefore cheap. Now doctors can fix things, but it costs money.<br /><br /> <br /><br /> Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-75710874979707513172013-10-16T12:00:39.041-07:002013-10-16T12:00:39.041-07:00What does hiring people have to do with health car...What does hiring people have to do with health care?erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-64718366362601482902013-10-16T09:50:59.129-07:002013-10-16T09:50:59.129-07:00Because they need to hire people?Because they need to hire people?Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-29482836676867744492013-10-16T04:34:45.636-07:002013-10-16T04:34:45.636-07:00Harry, Your take is as usual totally skewed. Cons...Harry, Your take is as usual totally skewed. Conservatives don't endorse employer paid health insurance in the first place, so why would we have a position on portability.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-28216875982946024492013-10-15T20:22:50.213-07:002013-10-15T20:22:50.213-07:00'Sub-optimal' is kind. It's crazy.
Yo...'Sub-optimal' is kind. It's crazy.<br /><br />You are right that government is not the source of the craziness.<br /><br />One of the results of 'no coverage for pre-existing conditions' and 'no portability' has meant that people with coverage from an employer are locked into that job.<br /><br />This violently contradicts one of the principle points of the rightwingers, which is that complete job insecurity and mobility are required for an efficient, innovative economy.<br /><br />They don't really believe that, but they say they do.<br /><br />So you'd think they would welcome anything that encouraged worker mobility. I'll bet nobody can find a rightwinger speaking in favor of portability.Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-83596271109246580432013-10-15T18:10:01.401-07:002013-10-15T18:10:01.401-07:00Harry,
I start to understand why the US has such ...Harry,<br /><br />I start to understand why the US has such an expensive health care.<br /><br />In a system where most of the insured people only pay a small fraction of the costs of drugs, Big Pharma is in effect setting the rules to extract money from the insurance pool. In the end everyone is paying for those high medicine prices.<br /><br />Maybe it explains why the asthma medicine (and others) price can go so high in the US, while the same medicine (with the same new non-CFC gas) remains cheap here and in other places.<br /><br />Contrary to AOG's belief that govts. are to blame, I think this is not the main explanation here.<br /><br />In Brazil, it is uncommon for health insurance plans to pay for medicine - even the very good ones have strong caps on that in most cases.<br /><br />So, as the medicine is usually paid for by the people directly, their prices can not grow unbounded, by simple demand dynamics.<br /><br />It is an interesting case of very sub-optimal dynamics obtained in a completely private system with few refulations (of course, I am talking about the pre-ACA period).<br /><br />Now, with the ACA enteing in this scenario, it is a very good question if the dynamics may change. In principle, it should not, since in the previous configuration Big Pharma already dominated the dynamics within a insurance market place.<br /><br />But if it changes, and the prices of medicine go down, I imagine one of the paths would be by... well, govt. being more intrusive, to the dispair of Libertarians. This is a topic I will follow from time to time to see how it evolves...<br />Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-60452129051292404642013-10-15T12:21:54.067-07:002013-10-15T12:21:54.067-07:00'I was taking a general look at the prices I c...'I was taking a general look at the prices I can find in our online drug stores, and I can not possibly imagine how Harry's wife spends $36.000 a year in asthma medicine (is it a joke?).'<br /><br />No joke. It's a new product, she's had it only about 10 days.<br /><br />The first month ($3,000) is a gift from the manufacturer. Who could afford to try it out at that price?<br /><br />We have a gold-plated insurance plan which will pay 99% for the first year. No certainty after that.<br /><br />I have no idea (too busy to try to find out) where this new drug came from, or why its price is what it is.<br /><br />We were less shocked than we might have been since Tricia has another prescription (not for asthma) that costs $24,000 a year.<br /><br />Our co-pay on that is about 10%.<br /><br />Altogether, our 2-person household consumes (at American prices) something like $80,000 a year in prescription medicines and a couple thousand more in prescription medicines that are also sold over-the-counter.<br /><br />The insuror waffles. Sometimes it covers OTC ones, as prescriptions, sometimes not.<br /><br />Like I say, it's a good thing we are rich.<br /><br />My share of the costs this year will probably be $4,000-$5,000.<br /><br />It's better than being dead, which is one alternative.<br /><br />Quite a few working Americans have gross pay in the $250/week range, so even if they had insurance (many don't), the co-pays for even ordinary-priced drugs would be a serious burden.<br /><br />Instead of railing against Obamacare, every American not in that position should be on his knees thanking whatever deity he worships.Harry Eagarhttps://www.blogger.com/profile/04196202758858876402noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-70095415249988830022013-10-15T10:26:58.818-07:002013-10-15T10:26:58.818-07:00Bret,
You have made a good set of hypothesis. I w...Bret,<br /><br />You have made a good set of hypothesis. I would go for 2 and 3.<br /><br />You daughter probably grew up taking the old inhalers and, as she was very young, it may be her body adapted to the CFC action in some optimal way. Now her body is less malleable and, by comparison, the action of the HFA is less fine tuned.<br /><br />In the few people in family with ashma I know of, the pattern is to have it diminished when passing to adult life, with a worsening after the 60s. Maybe you won't need to worry much from now on.<br />Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-20353120757184689932013-10-15T07:21:33.843-07:002013-10-15T07:21:33.843-07:00Clovis wrote: "I also do not find studies tha...Clovis wrote: "<i>I also do not find studies that point to worsened action of the new non-CFC inhalers.</i>"<br /><br />First, I want to thank you for offering to send the old style inhalers (if they had been still available there). That was very, very kind.<br /><br />I know that the studies show equal efficacy. I also know other asthma sufferers that match the studies in that they found no difference in the inhalers.<br /><br />However, I know some asthma sufferers other than my daughter that also respond poorly to the new inhalers.<br /><br />I have no good explanation, but some guesses.<br /><br />Explanation 1: It's all in her mind. Unfortunately, even if so, it would still be helpful to have the old inhalers!<br /><br />Explanation 2: It may be that the efficacy at 10+ minutes or even less might be similar even for my daughter and others like her, but in those first seconds after the attack, when she can't breathe and is totally panicked, the old inhalers would work enough to take the panic away almost instantaneously, and that relaxation would then be a positive feedback loop that would also help the attack subside. The new inhaler may not work quite as fast for anybody. It doesn't get her going on the positive feedback loop as quickly, and even a minute is a long time when you can't breathe. Even worse, she then remembers it didn't work last time, so next attack it ends up being sort of an anti-placebo ("nocebo") effect. In other words, a mix of a subtle difference and it being mostly in her mind. The difference of some number of seconds may not be measurable in a trial.<br /><br />Explanation 3: The new inhalers may work better for some people and worse for others like my daughter so it averages out to similar efficacy.<br /><br />Explanation 4: While not common, there have been cases of fraud in FDA trials. There's some small chance that they fudged the results in order to get the older inhalers banned so they could reap the benefits of the repatent. If the new inhalers were shown to be less effective, the FDA would've had a very hard time prohibiting the old ones.<br /><br />Explanation 5: Some combination of the above.<br /><br />Explanation 6: Something else.<br /><br />The good news is that she's been taking Singulair (montelukast sodium) for nearly two years now and it's helped a lot. No hospitalizations since she's started taking it and I don't think we've even had to use the nebulizer. The lack of inhaler efficacy is still an issue, but she hasn't turned blue since she started Singulair either. So I'm annoyed with the whole inhaler thing, but no longer panicked.Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-43710438791152152322013-10-15T06:25:23.151-07:002013-10-15T06:25:23.151-07:00It's crony capitalism aka fascism -- the pol...It's crony capitalism aka fascism -- the polar opposite of competition and the purpose is to fill the pockets of the participants with our money while gaining power on to themselves, scaring us plebes into believing that we are incapable of making our own decisions and making the world, not safe for democracy, but for tyranny.<br /><br />If anyone had any doubts prior to the last several weeks, those doubts must have been resolved.<br /><br />The stage has been set, the actors are on stage and the play is about to begin. The last act has only been penciled-in and there is still a small chance it can end well, but it doesn't look at all promising.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-88397745125690809162013-10-15T05:38:24.679-07:002013-10-15T05:38:24.679-07:00Oh, a a last one to AOG:
----
[Me] The guys at FD...Oh, a a last one to AOG:<br /><br />----<br />[Me] The guys at FDA are obeying rules devishly devised by Big Pharma.<br /><br />[AOG] Do you have any evidence for that beyond paranoia?<br />---<br /><br />Look how other people are paranoid too:<br /><br />http://www.motherjones.com/environment/2011/07/cost-increase-asthma-inhalers-expensive<br /><br />One quote: <br /><br />" It set up shop in the K Street offices of Drinker Biddle, a major DC law firm. Between 2005 and 2010, it spent $520,000 on lobbying. (It probably spent even more; as a trade group, it's not required to disclose all of its advocacy spending.) Meanwhile, IPAC lobbied for other countries to enact similar bans, arguing that CFC-based inhalers should be eliminated for environmental reasons and replaced with the new, HFC-based inhalers."<br /><br />It looks like the lobbying worked here too. Or, well, this must be only a coincidence and I am following my paranoia believing otherwise...Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-56713911688610907142013-10-15T05:28:04.649-07:002013-10-15T05:28:04.649-07:00Bret,
I also do not find studies that point to wo...Bret,<br /><br />I also do not find studies that point to worsened action of the new non-CFC inhalers. <br /><br />Have you guys asked a doctor about it? Or asked him for other substances that could bemore effective?Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-51084272195782113402013-10-15T05:23:22.762-07:002013-10-15T05:23:22.762-07:00Oh, boy. We do need to copy you guys all the time....Oh, boy. We do need to copy you guys all the time.<br /><br />I've just found out that our "FDA" also prohibits the CFC inhaler since 2011.<br /><br />Interesting though that our prices for those inhalers did not inflated like yours. An interesting study case if I could gather more information...Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-37045304818076933122013-10-15T05:12:18.080-07:002013-10-15T05:12:18.080-07:00Bret,
I truly hope not to see my son turning smur...Bret,<br /><br />I truly hope not to see my son turning smurf either.<br /><br />I did a fast research and found one typical inhaler with this substance.<br /><br />It costs near $10 a 200 dosis inhaler. It is in portuguese, but you can see the specifications here:<br /><br />http://www.medicinanet.com.br/bula/317/aerolin_spray.htm<br /><br />The gas it uses is HFA134a, which is a substitute for CFC ones:<br /><br />http://www.wikigenes.org/e/chem/e/13129.html<br /><br />So it is probably something very much alike your daughter buys.<br /><br /><br />I do not know if the non-CFC are still commercialized here. I also do not know if CFC based ones are forbidden. I doubt it, more probably the market here is only adapting to the standard outside, since most laboratories are multinationals.<br /><br />If you want, I can take a closer look to find the old CFC ones - I have no problem in packing and sending it to you.<br /><br />AOG: the price above is almost 50% below the ceiling price ruled by our govt. regulations.<br />Clovishttps://www.blogger.com/profile/08921327103613284595noreply@blogger.com