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Nebraskans already pay hidden health care tax

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Saturday, Jun 07, 2008 - 12:42:56 am CDT

A point made last week at the Nebraska Health Summit deserves to be shouted from the rooftops.

Nebraskans already are paying a hidden tax to cover the health care costs of the one out of nine Nebraskans who are uninsured.

Remember that the next time the topic of health care reform comes up.

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Maybe then the price tag for reform won’t seem quite as daunting.

The hidden tax is collected when hospitals and physicians pass on the costs of providing care to uninsured and underinsured patients to private insurers, who in turn pass the costs along to businesses and individuals who pay premiums.

The hidden tax is massive, according to the Nebraska Health Care Reform Task Force.

In 2007 the task force estimated the hidden tax for hospital care at almost $1 billion, or 7.7 percent of total health care costs in Nebraska.

And that’s not all.

“If one assumes that physicians shift costs proportionate to those of hospitals, this would amount to $545 million in 2007 for a total cost shift of $1.485 billion or 12.2 percent of total personal health care costs of Nebraskans,” the task force report said.

Task force co-chairman Dr. Richard O’Brien said the hidden tax added $918 to an insured family’s yearly health insurance premiums.

Although almost everyone agrees that the nation’s health care system is dysfunctional and unsustainable, consensus on the right approach has proved elusive.

But, as the recent Nebraska Health Summit showed, pressure for reform continues to build at the grass-roots level.

Three states — Massachusetts, Maine and Vermont — have gone ahead with their own plans for providing universal coverage.

The task force concluded that of the three alternatives for universal coverage — government-provided care, tax-funded insurance coverage, or mandatory private health insurance — Nebraskans are most likely to support the latter.

The task force suggests that all the state’s residents be required to have a basic health insurance plan that includes preventive services, mental health care, dental care and long-term care. The insurance plan could be purchased by either employers or individuals.

The Nebraska Medical Society released a poll at the summit showing that three out of four Nebraskans say they favor state-mandated private insurance.

Nonetheless, the looming sticking point is the price tag that likely is to be attached to the plan because of the need to offer subsidies to low-income residents.

That’s why the point that Nebraskans already are paying a hidden tax deserves to be emphasized.


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universal coverage wrote on June 7, 2008 6:39 am:
" The status quo only helps the health care businesses. We need a new system in this country. "

 Hank wrote on June 7, 2008 7:52 am:
" Let's just stop beating around the bush with these partial solutions and establish a full universal single-payer national health system. If other developed countries can provide better healthcare to their entire populations at costs that range from two-thirds to one-half what we now pay for our much worse average health outcomes, why don't we look at how those countries approach healthcare? Oh, that would be socialized medicine, some people might argue. Yes, and so what? We already have socialized medicine in the form of Medicare, Medicaid, and the Veterans Health system, not to mention the implicit subsidy of the tax-exemption on contributions to health insurance. It is just silly that Americans refuse to recognize that the government is already involved in about 60 percent of U.S. healthcare expenditures. It is ironic that that 60 percent is also about what it would cost for a universal healthcare system (let's call it Universal Medicare) that covers everyone, offers better preventive, and adds the several years of life expectancy to bring us up to high income country standards. Heck, just getting the useless and costly insurance bureaucracy out of the way will save us 10-20 percent of healthcare expenditures. Of course, that industry will keep fear mongering about why we don't need "socialized medicine." Isn't it time Americans stopped accepting that deadly story? "

 Mom of wrote on June 7, 2008 8:27 am:
" I think it great that they want everyone to have health coverage but how to you "require" that. You have to have car insurance and you can lose your license if you don't, what are they going to take away from people who don't make enough to pay for the state mandated insurance? There will be assistance for low income but there is a growing number of middle class who are living paycheck to paycheck who cannot add one more thing to their budget and yet somehow they will be required to purchase this. Will those people be denied care if they don't? Is that really where we want to go as a society? And by the way, I HAVE health insurance through my employer and probably am paying extra for uninsured people and I'm OK with that because I think everyone in this country should have equal access to health care. I just believe we need to find a way to finance it so that people aren't pushed over the edge financially. "

 Jeff wrote on June 7, 2008 9:32 am:
" But covering everyone is just the tip of the iceberg. It is necessary, and it can be done in a cost neutral fashion. But we still have to address the fact that our healthcare system is by far the most expensive of industrialized countries. Our free market capitalistic system allows for double digit profit margins for drug companies, technology companies, and HMO's/insurance companies. And we watch as our co-pays, premiums, and out-of-pocket costs all increase. And jobs head overseas or out of the country. "Savings accounts" are not the answer. You aren't going to be able to shop around when you need that gall bladder taken out. But we do need to be smarter consumers of healthcare. Use generics whenever possible. Utilize our primary care physicians before we got straight to a specialist. Get second opinions. And we need to STOP direct to consumer advertising of prescription drugs. This promotes overuse of medications. They tend to be for drugs that are expensive, and frequently not first line medications. Let's demand that the drug companies take that advertising money and invest it in better research. And not research for erectile dysfunction, insomnia (we have enough choices), etc. We don't want our government making medical decisions, but we've got to have some controls. Free market forces alone will not serve society's best interests, and in fact only create a situation where Americans pay top dollar for prescription drugs so that other countries can get them at half price. When are we going to do something about this situation? If you can invest money in drug companies, maybe you don't care? "

 Dan wrote on June 7, 2008 11:58 am:
" Having lived in Europe, Asia and Canada, I will tell you that the American medical system is far superior to any I have witnessed. The overall level of care; particularly the promptness of care and availability of advanced systems is unparalleled. From my experience, government provided universal health care is not able to provide the current level of care we have in the U.S. For those who may not believe my personal account, ask someone from a universal health care country how they feel about the level of care they receive. These programs are not popular. The rich in these countries often opt out of the universal program and either have private physicians, or travel out of country for medical care. It appears to me that what you end up with is poor quality medical care for everyone.

The biggest problem with the American medical system is the cost. One of the forces driving costs up are the liability insurance premiums physicians and hospitals must pay. Some form of legislation limiting medical liability would go a long way to lowering the cost of medical care in the US. "

 Link wrote on June 7, 2008 12:24 pm:
" The countries that have universal care DO NOT have better care. It is rationed and substandard. Try to get required care in England or Canada. It is much easier here. Look at Massachusetts. They have already ran way over their 'estimate' by $200 million. That is only the tip of the iceberg.

When you have so called free health care, people will drive up demand, and the costs will skyrocket. Then the governemnt bosses will have to ration the care. You won't get it unless you go pay extre. Twice. Just like getting a good education for your kid at a private school while you are also paying for the public school. In a free country, you can't make a person a slave of the state by mandating they pay for insurance. You can make them pay for services rendered, but you can't make them a slave of the state before hand. If you let real market forces work, and get the government regulations and trial lawyers out of the way that are driving up costs, you can reduce the overall costs of healthcare. Make it easier for people to shop around for the best deal and make them pay the cost of their own health care. You'll see costs go down. "

 Missing Link wrote on June 7, 2008 1:12 pm:
" Lifespan in Canada and England beats the US. In the academic world, that what we refer to as outcomes. If those countries had "substandard" health care, you would not expect to see that kind of figure. The systems are run more efficiently with less emphasis on elective surgeries etc. as opposed to priorety surgeries etc. If you don't have money or great insurance in this country, you are out of luck. Even decent insurance does not assure you of the best care. Insurance companies deny claims every day for things they think are too expensive to pay for.
The system is based on business and profit rather than providing care to all people. Your insurance runs out, better hope you don't get sick. "

 ted wrote on June 7, 2008 1:33 pm:
" And how else will this get funded? Either a hidden tax, or those few of us who actually pay taxes will pay higher taxes. My daughter is 25, earned 15,000 last year, and she buys her own health insurance. "

 Zoomie wrote on June 7, 2008 3:08 pm:
" Sad how ignorant people are of the heathcare systems in other nations (and yes, Dan, if you really lived overseas, that includes you). There are at least 15 different systems in use in the world's industrialized nations. They,and our, systems are rated on OUTCOME and COST every year. Conclusion? The French system (not socialized) provides 100% coverage to every citizen WITH NO WAITS (unlike the English or Canadian systems), and does it for less than half the per-person cost we spend here in the US! In fact, almost every western nation's system ourperform ours, with no waits (and by the way, why to you assume there are no waits here in the US? When I needed surgery 2yrs ago, it took 5 weeks wait to get it...and in most European nations you can see a GP on weekends or evenings...I can't here, unless I go to a hospital ER -- the most expensive medical care). "

 Jeff wrote on June 7, 2008 5:52 pm:
" About 30% of the cost of our system goes for administrative costs and paperwork. It's ridiculous. "

 Lisa wrote on June 7, 2008 6:20 pm:
" I don't get it. My doctor actually charges me more now because I'm uninsured. If I were insured, my charge for the exact same doctor visit is less, due to the prices worked out with the individual insurance companies. So how is it that insurance companies are paying for people like me? I am self-pay. I do not have anybody helping me pay for my dr. visits. "

 whatever wrote on June 7, 2008 6:57 pm:
" Dan, I have a cousin living in a Universal Healthcare country, his experience is that the care he receives is more timely and superior to that of the states. Ok, I've asked someone, now on to the next question. "

 Don wrote on June 7, 2008 10:15 pm:
" I have relatives who live in Canada. Unless it is an absolute emergency, you will have to wait months sometimes to see a surgeon. Once you get the care it is ok, but it is not quick. "

 Social Worker wrote on June 7, 2008 11:36 pm:
" Lisa- If you are self-pay and actually pay for your bill, then you one of the few. Usually we see self-pay patients come to the Emergency Department, they don't bother with the Dr's office because they would have to pay that day. This increases the cost of the hospital stay for those that are insured so this is when the insurance company has to pay more for their clients so they in turn raise the cost of the premiums. So it is your counterparts that do not pay a cent causing these issues. I praise you for paying your share and I am so thankful Lincoln has the People's Health Center that provides sliding fee scales to those without insurance- they are a life saver and a great resource for those of us trying to help people out. "

 Ellie wrote on June 8, 2008 1:15 am:
" Being able to afford medical insurance does not translate into being able to afford medical care. There are still co-pays and deductibles to be met on top of premiums. And these days many doctors and hospitals don't want to take monthly payments but prefer to be paid in full and, sometimes, up-front, as well. "

 uninsured wrote on June 8, 2008 3:33 am:
" That is absurd. I don't have health insurance because I'm low income, hospitals scare the living day lights out of me, and simply because I don't want to pay. If I get ill I play it out. I don't want others to pay for what I don't want. I'll die a natural death without pain killers or other meds. Now if we had a choice of medical marijuana that would be a different story. The citizens of Nebraska should not suffer because of my negligence to take care of myself. If doctors were really worried about low-income families being unable to pay for health care then they should make they're rates far more affordable. I mean, if everyone in the U.S. could afford health care wouldn't doctors and hospital's see far more money than they are now? They shouldn't need to even try to force a "hidden" tax. I'm just trying to say sorry Nebraskans. As long as money talks health care will never get better. "

 Zoomie wrote on June 8, 2008 1:22 pm:
" Conservative opponents of a national healthcare plan (like Dan) keep harping on the UK and Canada because they DO have waits. And they used to be really long (the waits are down sharply in both counties in the last few years as they've increased spending, as both nations had some of the lowest spending on healthcare in the industrialized nations). But why do they ignore France or Sweden or Finland or Switzerland, all of whom have better care, NO waits, and costs half (or less) what we pay? Perhaps because those systems actually work? And I repeat: why do people pretend there are no waits here in the US? My spinal surgery took 5 weeks from surgeon diagnosis to surgery, dispite being bedridden until the surgery. In the US, NOT Canada or the UK! And have you ever gone to a hospital ER with anything less than a life-threatening problem? I have, and usually had to wait 2-5 hours for treatment! "

 Carol wrote on June 8, 2008 1:45 pm:
" Wow, you waited 5 weeks? That is nothing. My dad in Canada waited 8 months for a hernia operation. He only got it that soon because two people in line ahead of him bit the dust. It is true that in Nebraska, people with insurance and the ability to pay receive better care and we need to do something to make sure that the other 1/9th of the population gets up to a decent level of care. But think of it this way: right now, 8/9 of the people are getting a lot of quality health care quickly. In other countries everyone is getting a minimal amount of quality health care slowly. I agree we need to boost the other 1/9, but not at the expense of 8/9 of the population. "

 Josh wrote on June 9, 2008 11:36 am:
" I really don't understand the 3rd option- mandatory private medical insurance. The reason most of the uninsured are in that situation is because they either don't have access to medical insurance through work, or simply can't afford it at all. So what good does it do to just sit back and make it illegal not to have it? I don't think that option would work at all, all it would do is put those people in an even worse position. We are the only developed country that does not have some sort of government funded/controlled medical coverage, and that is why though we are the richest country by far, our medical system is not even in the top 5. "

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