The tax bill, sent to IBM's India unit on Monday, alleges the company underreported income for the financial year ended March 2009, said the official who decline to be named. He said tax authorities estimate IBM India reported only 20% to 30% of its actual income in India for that year.
IBM is in the process of appealing the tax bill, an IBM India spokeswoman said Friday. The U.S.-based company doesn't break out its results by country.
A court opinion [PDF] published today revealed why the US government picked Amazon over IBM for a $600m CIA cloud, why it felt IBM's protest was on shaky ground, and how IBM attempted to "manipulate" the procurement process to its favor.
Amazon was awarded the contract on February 14, 2013. IBM formally protested this decision, claiming its offer should be reconsidered because Big Blue staff had failed to properly understand a key data-processing requirement.
But, far from not understanding that requirement, the court opinion indicates IBM grasped the requirement yet decided to submit a flawed proposal to give itself a chance to force a second evaluation if the contract went to AWS, as it did. ...
"It is obvious that when IBM deviated from its initial approach, it did so as a way to manipulate the situation in its favor," the court ruled. "Such gamesmanship undermines the integrity of the procurement process." ...
Though IBM bowed out of the procurement, and issued a statement saying it had withdrawn its bid "in light of the government's recent submissions emphasizing its need to move forward on the contract," the company is pushing on with its cloud schemes by prioritizing recent acquisition SoftLayer, and applying for various crucial certifications to let it run federal workloads.
But the court opinion paints a picture of a company trapped in the old, cosy world of interminable procurement contracts with fuzzy pricing schemes. Now that Amazon has come along, IBM has apparently resorted to a series of tricks to try and get itself plugged into the federal government, rather than competing on merit. ...
IBM disagreed with the opinion, and in a statement email to El Reg, Big Blue said: "IBM respectfully but strongly disagrees with the court's unwarranted assertions. Our position remains the GAO's [Government Accountability Office's] findings were appropriate and the contract should have been rebid."
First up is news gleaned from the Twitter S-1 document that IBM has issues the company with a letter stating that they believe Twitter infringed upon at least three different US patents held by Big Blue and inviting the company to “negotiate a business resolution”. If the dialogue happened on a dark alley or with a Sicilian accent it would be called extortion but in IBM’s minds it is simply good business. Of course the fact that it happens on the cusp of Twitter’s IPO is a coincidence, right?’ ...
Anyway – seeing the “success” of Microsoft’s campaign, IBM decided to embark upon its own by launching a marketing campaign suggesting that IBM is in fact the leader in the cloud computing market and specifically calling out Amazon Web Services as a competitor. In among the juicy bits in the copy are some interesting statistics:
Whose cloud powers 270,000 more websites than Amazon? If your answer is IBM, you’re among the well informed. The IBM cloud offerings also support 30% more of the most popular websites than anyone else in the world.
Oh yeah IBM. And almost every startup under the sun uses AWS. And they just ate your lunch in the long convoluted process to winning the contract to build a $600M CIA cloud. Sigh. Sure IBM acquired SoftLayer recently for $2B inherited their customers. And yes they’ve been telling the world about some legendary cloud migration they’re doing moving IBM customers to SoftLayer (that IBM SmartCloud name seems ironic now right?) but that doesn’t constitute a win in my eyes.
Now obviously every vendor uses competitive differentiation in its marketing materials. But quite simply IBM is stretching the truth on this one and, frankly, it feels like a desperate move by a company that has failed to win the competitive battle based on innovation. It’s a sad thing to see and I’d have preferred to see IBM stay high brow. How the mighty have fallen huh?
Curious if any similar cases had come up, current or past that might where IBM allowed for a longer bridge, particularly around the 2/2009 resource actions.
Unfortunately, I know of many people in your situation who just missed being eligible for a bridge. It sucks that IBM does this to people. You have my greatest sympathies.
Excerpts: I have to believe that while the mass migration to private exchanges may start slowly, it will pick up speed faster than Apolo Ono in winter. There are a few reasons why I believe this to be the case, including the giant hassle and expense of being the health benefits administrator of record. Being out of the benefits administration business means less overhead cost, less drama as employees come to you when they want something covered, less lawyers to keep up with HR regulation.
But most importantly, transitioning to the private exchange means employers have the ability to fix their annual health benefit costs at a known and predictable amount that they control. They will give employees an allowance to purchase health plans and each year can choose to raise the contribution by a fixed, amount. If they are smart they will peg that increase at or near the consumer price index (CPI). CPI has been rising a few percentage points a year (e.g., it rose 1.7% in 2012) while health insurance costs have been rising 3-5 times faster.
Excerpts: Several years ago, a coworker asked our CEO during a staff meeting what kept him up at night. He responded with a single word: disintermediation. Merriam-Webster defines disintermediation as "the elimination of an intermediary in a transaction between two parties." So what my boss was saying was that sooner or later, Americans might reach the conclusion that private insurers are no more essential than travel agents (remember them?), and that by dispatching health insurers to the history books, we could reduce spending on health care by billions if not trillions of dollars.
Much of what I was paid to do in my former job was to create and perpetuate the impression that insurers are "part of the solution" and "add value" to the system. I put those words between quotation marks because they were used repeatedly by my CEO and other industry leaders and became our mantras, especially in conversations with policymakers and the media.
In addition to always working those words in our communications, we tried not to miss an opportunity to point the finger of blame for escalating health care costs at others: greedy doctors and hospital executives; medical device manufacturers, inventors of new whiz-bang diagnostic tools and even patients who demand the latest and most expensive drugs. They and the fact that our population is aging are the real "drivers" of health care costs, insurers insist.
Wendell Potter was chief spinmeister (VP of Communications) at Cigna.
There's a reason why large companies like IBM self-insure and only use insurance companies for administration/billing.
And, all the newest hospitals are located almost next door to prominent teaching hospitals as well.
Do not confuse VA healthcare issues with the ongoing backlog of disability claims. Two different things, really, for decades.
My *only* gripe is too many meds being issued for mental issues, but war is hell.
And consider this: the insurance market is also fragmented and each fragment only cares about its portion. If a patient has to switch blood pressure meds due to pharmacy insurance's formulary changes, and the switch requires that the doctor order additional labs and visits to make sure the change is successful and safe, does the pharmacy insurance company care about the cost of those extra labs and visits? NO!!! Not their problem. But it is a problem for the patient and for whatever insurance is paying for the extra labs and doctor visits.
An integrated system under the control of something other than greedy executives interested in profit but not patient well-being and cost-saving should lower complexity and health care costs. It has worked in numerous other countries. And maybe as a side effect we might end up with a healthier population if increased emphasis could be placed on lifestyle change, prevention, patient responsibility for their well-being, etc. That too will reduce costs.
So would a national formulary similar to the VA and Indian Health Service formularies, with much lower drug costs due to restricted formularies with prices negotiated on a national basis and processes in place to handle requests for exceptions where appropriate. This unfortunately is not going to happen, because there are too many vested interests who are making $$$$ off the current mess.
There is also a higher threshold of proof on the part of the selling drug company that a new medicine is better than existing formulary medicines, as determined by objective measures. In contrast, in the U.S., what proof of performance is required by Healthnet when they add a new drug to their formulary? None. If it is FDA approved and they can buy it cheap, or get a kickback, so it goes.
By constraining formularies, the volumes for a given medicine are higher, providing more leverage to buyers. All of these factors conspire to produce better prices for citizens in other first world countries.
I consider the competition argument in the U.S. to be sheer nonsense, nothing but unproven sloganism.
There are no direct transactions between buyers and sellers in the marketplace. Where is the marketplace? What we see is for-profit insurance company premiums, not provider prices. (What is the price of that last television set you bought? What was the cost of the last colonoscopy you had?) These companies churn and obfuscate. Buyers have no ideas what prices are being paid to sellers or, in many cases, what products/services are/are-not covered. The game is to appear to appear to insurance buyers as though you are offering the best thing for them. But in reality, buyers are subject to complexity that they do not comprehend, until it is too late and they find out that they aren't covered.
The proof of what I am claiming is in the results. The average, first-world "socialist" health care system provides for the needs of ALL of its citizens at about 12% of GDP. Or less. The U.S., in comparison, spends about 50% more (17%) of GDP. And 50 million(!) of our citizens aren't even covered by insurance; can you imagine what percent of our GDP would go to health care if we actually covered 100% of our citizens, like the socialists do? And the outcomes in the other first world countries are better, by any objective measure.
Is it really worth preserving private enterprise in health care if the best it can do is to *not* serve all of our citizens, spend 50% more in (not) doing so, have worse outcomes, and burden us with incredible complexity that nobody can sort out? What kind of system is this?
Medicare’s “donut-hole” — the coverage gap in which you must pay out-of-pocket for your drugs — continues to shrink. In 2013 and 2014, you will get a 52.5 percent discount on brand-name drugs, and the federal subsidy for generic medications will rise from 21 percent to 28 percent in 2014/
The 2013 coverage gap begins when your total drug cost exceeds $2,850 (that includes your share and the insurer’s share of the costs) and ends when combined spending is $6,455. After that, your Part D plan usually covers around 95 percent of your remaining drug costs for the year.
I have discovered that this drug (and others) is covered by Medicare directly - at 80%, I suspect. Documentation for this is in "Your Medicare Benefits" publication available in PDF format at www.medicare.gov, with a date of March 2013.
Hopefully this information will help some others with drug non-coverage issues.
I interpret this to mean that even though my Aetna Medicare Advantage PPO premium is $0/month, Aetna gets $2517.60 (Medicare Part B for both me and my spouse) plus the $3000 HRA from IBM = $5517.60 for the year.
It is more costly than going with MVP but less than any of the MediGap plans and part D...even after utilizing the HRA. Of course this is due to my own personal circumstances.
At least with Aetna I have access to many NYC hospitals and doctors over what MVP offers in their network. In addition, I do not want to lose the Cigna dental coverage that I have had with IBM group. That alone help makes up some of the price difference between Aetna and MVP.
There is so much confusion out there with EH, HRA and ACA. I'd rather wait for the dust to clear over the next two years. Also, once you are on an individual plan thru EH or other source what prevents the insurance company from canceling your policy because they decide not to meet the minimum standards of the ACA. Lots of seniors have lost their policies, including my wife who had her individual BCBS policy canceled recently. It is said that more policies will be discontinued this year and into 2014.
Nothing is guaranteed, but I feel a little more secure with IBM group for now...even with the overall higher out of pocket expense.
You have to keep in mind that you have two options:
If you are with a Medicare Advantage plan, Medicare has no visibility or anything else to do with you, other than to annually pay your bill to Aetna to take care of you. I hope this helps.
By the way I should have added that when Aetna runs out, you will be in the 'Special Election Period' as the rest of us are now and cannot be refused a policy. Once we make our decision, any changes will require us to go through 'underwriting requirements' which can refuse to write us or if they do can raise the rates based on our answers to the medical questions. So if you stay with the Aetna option this year, do use the time to determine what you will want to do next in a year or two. If you are in the Aetna PPO you do have a good insurance. If you are in the HMO, you may even want to think about changing.
One caution then; if you leave the IBM coverage, you will also lose the group plans for Dental and Vision. And dental plans on the open market are not very good. MetLife only writes group plans and are not available for individuals yet that I am aware of. They will need to change.
As has been mentioned here before, Medigap and Medicare Advantage plans are not affected by the ACA. No Medicare plans have been cancelled due to the ACA.
If an insurance company decides to stop offering the plan you are enrolled in for some other reason, you would have the right to enroll in a plan from another company without underwriting. http://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx
Q. I am enrolled in a medical or prescription drug plan on my own, can I get the HRA if I enroll in a dental or vision plan through Extend Health?
A. No you cannot. IBM is providing an HRA only if you enroll through Extend Health for medical or prescription drug coverage or are a current Kaiser member and enroll in a Kaiser plan. If you want to qualify for the HRA, please work with an Extend Health Benefit Advisor to find a medical or prescription drug plan option that meets your needs.
As a person who currently has few medical and prescription expenses (less than $500 per year), the zero premium Medicare advantage plan looks attractive. Then the HRA can be used to cover Part B, dental and vision expenses. Should I pay more for a Medigap plan even though the MA plan seems adequate? What am I missing?
The two years we were on the IBM Medicare Advantage PPO our out of pocket costs were, like yours, quite low. The risk was an acceptable amount (circa $4K in our area) since many people pay close to that amount up front to buy coverage. Now with the change in drug plan the risk for us doubles. And IBM has already decided for us how our subsidy will be spent. It all goes into paying for the plan with nothing left for us to manage our own out of pocket costs.
So we need to figure out the cost of alternative medical and drug coverage through EH, what the worst case out of pocket costs for that plan would cost, and whether there would even be any HRA $$ left for us to reduce potential out of pocket costs. And then compare that to the IBM group plan. Then somehow make a decision. First yes or no to the IBM plan between Nov 14 and Dec 6. Then, if no, choose an EH plan before Dec 31.
Perhaps we shouldn't complain about having more options than most other retirees even if the choices feel like a rock and a hard place. So much for enjoying this year's festive holiday season.
I think that the Advantage plans offer much better value for the dollar. I picked Medigap policies for myself and wife because of an expensive medical supply situation, combined with specific provider network problems that most retirees probably don't have. Otherwise I would have gone with Advantage plans. I have many friends and acquaintances who have Advantage plans, and none of them is dissatisfied.
I would make a couple of comments about the way I look at Advantage plans. First, people worry about the high out of pocket limits. This is what insurance is about - the willingness to accept more or less risk, in return for lesser or greater pooling of funds. The only real risk I see to Advantage policies, in this regard, is for repeated big ticket hits, such as hospital stays. I can hardly imagine that outpatient co-pays would eat up the premium savings, unless one has very large expenses for supplies or durable equipment, or some such.
Another concern that has been expressed is that CMS is reducing payments, and this will result and reduced services or higher premiums. Personally, I would not be concerned about this if I lived in a metro area or an area where there are a lot of Advantage policies written. The Advantage program isn't going to go away, and in the areas where there is heavy Advantage policy use there's probably plenty of competition to keep them ahead of the inevitable rise in Medigap premiums.
Advantage plans have the "advantage" of allowing you to pick a new plan with a new company during each annual enrollment period. You can shop! You can't do this as readily with Medigap policies, unless your state has guaranteed issue Medigap policies.
You have a one time offer of guarantee issue for Medigap (because of your loss of group coverage).
You can enroll in MA plans each open enrollment period, e.g. no guarantee issue questions.
MA plans come in many types, HMO, PPO, PFFS, and Cost. HMO are the majority making the network critical, especially the specialists, think cardiology, urology, oncology, etc.
Federal subsidies to MA plans are decreasing. Many speculate, and there is some evidence to support, that these plans will become less attractive as perks are removed and copays and deductibles rise.
You are planning for the future, maybe 10 to 20 years. Do you want a cap on total expense? Then you will need something beyond Medicare, either a MA or Medigap (see point 1)
Medigaps give you the option of selecting the optimum part D plan and changing it each year during open enrollment, while almost everyone with an MA plan gets there drug coverage within that plan.
Try running the cost estimator on medicare.gov for Medicare plans while setting your health on each setting of excellent, good and poor. this will give you a view of the cost of the MA plans then compare that to the Medigap plans.
This is not an easy exercise. Typically the more premiums you pay the less variance your Medicare and drugs costs will have between healthy years and sick years, but in general the average cost will also be higher. Remember the insurance companies are making profit and the premium reflects their expected cost of the pool and contract terms plus some profit.
Lots of homework.
The EH guy was pushing me very hard to select Medicare plus F Medigap plus a D Rx plan. I have historically been on Medicare Advantage here in S. California and have been very happy with it; big market for Medicare Advantage. In 2009/2010 I had 5 surgeries and paid almost nothing out of pocket. (Thanks, I am fine now). I take many costly prescriptions (I would be dead long ago without them) and have a pretty sizable co-pay bill each year.
In the end (read on) I selected the Medicare advantage plan closest to the one I have today. And I was very nervous that I chose wrongly.
Watching this discussion, I now feel better about my choice for 2014.
The EH guy had great trouble finding any D plan that would seem to be good, and whichever it would be very expensive and higher co-pays and a donut hole as well. And the Medigap F would be $168/month. I said I wanted the AARP UHC Secure Horizons Premier plan for $69 per month. That was the closest I could find to what I had. Decided to live with the risk I would want a Medigap F plan further down the road. I would guess I would only do that if I could no longer get my Advantage plan in which case I would be in the class of "canceled current insurance" and then could get F or N or K or whatever.
So then the EH guy said I could not keep my current providers (Scripps Health) and would have to find new doctors. So he went off to look at drug plans. While he left me on hold a long time, I went to United Healthcare website and found that the plan I wanted did provide access to Scripps Health and my current primary care doc.
When he came back he still could not find her. So finally I retraced my steps for him and gave him her ID number - and guess what - he found her.
So I signed up for the Advantage plan for $69/month knowing my copays will be going up for docs/hospital and for drugs and I will have a donut hole for the first time. In the fall of 2014 I will assess whether I did the right or wrong thing and go forward.
BTW, I checked for cardiology, urology and oncology specialists within a 50 mile radius. All zero.
The big problems that I and along with my disabled brethren are facing is that Medigap plans are either limited or not available at all depending on what state that you live in. Texas has only Plan A available from various insurers BUT none through the EH site. Why anyone would choose Plan A is a mystery to me. So, Medigap is out for me.
The Medicare Advantage plans are problematic for me in that some of my Doctor's do not participate. The copays are of some help but not really worth the premium. Two of my doctors take whatever Medicare Part B pays them and do not charge me anything else. UPDATE: One doc informed me that if they take the Medicare Advantage than I would have to pay a copay where I have no charge from Medicare! They collect less from MA than they would from straight Plan B. The drug portion of these plans are also not very good for me. So, this is not looking great.
Part D plans available to me thru EH do not cover injectable drugs. A bottle of Humilin U-500 insulin cost $750-840 retail depending on the plan. The cost to me on our previous plan was $70 for a 3 month supply of 4 bottles. Needless to say, I cannot afford that anymore and I will be changing my insulin type and going through Walmart ($25 a bottle for the 3 types that they offer with no insurance subsidy). I have found plans outside the EH site that are much better for me. I was thinking about getting the cheapest Part D from EH and then getting a Part D plan outside of EH. I am not sure if that is allowed by the Government and not sure who could give me the correct answer. Any opinions?
I have noticed that there is a difference in the copays between EH and Medicare.gov. Once I have narrowed down my choices, I will begin to call the various insurers and get THEIR version.
I want to get the best bang for my buck as does everybody. I figure that I will be able to recoup the Medicare Part B premiums and the other $1700 for drug costs and premiums from whatever EH offering that I choose from the $3000 HRA.
But, I just found out that I am eligible for SHAP from IBM which reimburses up to 80% of Plan B! I was eligible in 2011 but I screwed up. I sent the forms in today to get 2012 and 3 quarters of 2013 paid. No one knows (IBM and EH) how that is going to work with the HRA. I am thinking that I will not be able to claim Plan B premium deductions from my HRA. Any opinions?
HRA enrollment I have not received the form. I found info on this group messages and called Budco. They have no info on me. So, I call NetBenefits. At first I am told that since I am still an active employee, then I should not be going the EH route. They check and say yes I am going he EH route; drat. Then they tell me that but am not eligible for the HRA. After some back and forth, yes I am eligible for the HRA. Somehow my info was not forwarded by IBM to Budco. IBM said they would take care of it.
While I am grateful for ANYTHING from IBM, I know that they dropped the ball when it comes to disabled folks. Every local, state, and federal government agency, does this. We cost more because we are sick already. We don't make the money that even a retired person would make from pensions, 401K's and IRAs We had less time to contribute to our retirement. We might have the same income as a retired over 65 person would have but are not treated as such; rant off.
Any disabled folks in the group that would like to share their thoughts or experiences? I also welcome any comments from anybody!
Unfortunately, you can sign up for only ONE Part D plan. If you pick one through EH, you can't enroll in another Part D plan outside of EH.
Since you are eligible for SHAP, you will still be eligible for SHAP going forward. This reimbursement separate from the $3000 or $35000 HRA subsidy. If you have money left over in your HRA, you can use it to pay for the Part B premiums that aren't reimbursed via SHAP.
It sounds like you have a difficult choice to make in choosing a Part D plan that doesn't completely meet your needs or a Medigap or Advantage plan that doesn't completely meet your needs.
You also have the option of choosing an AARP plan through EH. These aren't advertised on their web site, but you can enroll in them when you talk with the EH representative. In the meantime, make sure you look into those plans through the medicare.gov or AARP web site.
It is just so simple to go look up the plans yourself. As for me, here in Dutchess County, NY, the Medigap choices were really just between the two AARP plans. The difference between the F and N plans is $660 a year. The F plan covering all copays. In order to be worth the F plan I would have to go to the doctors more than 30 times a year. I picked the N plan.
When I plug in the three drugs I take, 14 different plans appear, with the total yearly cost. I didn't put a lot of thought into figuring the least expensive plan. They were listed that way. It is the same matrix the "expert" looked at.
By the way, my first appointment with their "expert" didn't go well. A very pleasant woman, but her computer system was overloaded and stopped working. She claimed there were hundreds of people, in her building, using it. After an hour, she suggested a drug plan she thought would be best and wanted me to pick it. I broke off the session and said I would wait until I or she could see all the choices. It turned out that her choice was not the cheapest.
As for the eye plan, I pass. I bought two pairs of glasses this year, so I figure I could skip a year and pay the copay for my yearly checkup out of pocket.
The dental plan doesn't seem to be worth much. I went to the dentist two days ago. It looks like I need about $900 worth of work. They are going to give me a 15% senior discount. They said if I had a dental plan, I wouldn't get the discount. I don't believe there is a plan out there that would beat that.
Just my two cents.
Cons: IBM has become too top heavy; too many levels of executives; most time 5-6 layers of VPs between the CEO and field. This needs to be trimmed to a more controllable model similar to what Gerstner implemented on his arrival (2-4 layers). IBM also does not seem to practice one of the credos it had when I joined, "respect for the individual". They need to be focused on the bottom line, but not with sacrificing respect for its employees. There are still a few execs in IBM that carry the respect tradition on, and they seem to be quire successful; may some one needs focus on that again.
Advice to Senior Management: Trim the VP fat; focus on what is needed to improve the employees capability and affordability to perform their jobs mobility. Yes, I would recommend this company to a friend.
Cons: First line management most of the time is good about protecting their developers but upper level management doesn't always seem like their vision is aligned with their lower level management. Morale is not so great right now, poof performance has caused the company to make some decisions that are not always the best ones.
Advice to Senior Management: Need to rethink its long term strategy, seems like currently everything that is being done is being done for the sake of achieving the next goal. Yes, I would recommend this company to a friend.
Advice to Senior Management: There is no real way to arrest the decline in IBM as it's so big to change the culture now is a massive task; they are losing contracts to smaller more nimble players and are filling companies with disgruntled ex-IBMers who'll never award them contracts. No, I would not recommend this company to a friend. I'm not optimistic about the outlook for this company.
Cons: Requirement to work 60+ hours weekly. Target employees for resource action (firing) once they turn 50 regardless of performance, and contribution to the business. Too many layers of executive management and the executive perks are bordering on criminal. Latest 401K modification (paid only once a year so if they RA you one day prior to the annual payment day you get no IBM matching.) HR focused. In the future I expect IBM will default on the pension plan.
Advice to Senior Management: THINK Respect for the individual. Toss the 2015 plan and give new CEO an opportunity to run the ship. Invest in the core company and stop buying revenue streams (from corporations you acquire). Stop former CEOs from using corporate jets for personal travel—they have enough stock to pay for their own personal travel. No, I would not recommend this company to a friend.
Cons: The culture produces an explicitly zero-sum game, with battles over money and promotions. IBM's attitude towards money is extremely tight. Usually, interactions with upper management about money are negative; travel arrangements, office perks, etc. are all very closely controlled and costs are minimized. This tends to produce a less-than-enthusiastic response among employees, at least at the lab I was in. This is in stark contrast to newer companies (Google, Amazon) that are more bottom-up driven. IBM can be very stifling.
Advice to Senior Management: The company culture is that "since we've always been doing it this way and have been making a lot of money, it must be right." There is some truth to that, but not as much as it seems management thinks. In any top-down company, the culture of climbing the ladder will tend to be set strongly, because the people setting the culture are at the top, and the people at the top have a strong desire to climb. In companies like that, not climbing is explicitly seen as failing. Yes, I would recommend this company to a friend.
Cons: The pay structure is generally lower than peer organizations (unless you're an executive). The "pay philosophy" will keep it this way for a long time. The bureaucracy can be maddening at times and the speed of decisions can be glacial, so a healthy sense of humor and a lot of patience is a must. Global roles can amplify this issue through the lens of cultural dynamics.
Advice to Senior Management: Get closer to the ground and understand your people. Lofty vision statements and strategies are worth nothing if people don't see how they fit in and help the march forward. Paying people competitively won't hurt, either. "Pay for performance" when the only KPIs are the stock price or artificially exaggerated growth metrics shows a healthy disconnect from the real world of your employees lives and the world they live in every day. Yes, I would recommend this company to a friend.
I am also wondering if anyone here has opted out of the Extend Health suggestions and found their own supplemental, even the ACA?
Any assistance would be helpful. We plan on calling EH tomorrow, but were working on it Sunday and didn't have access to a live person. Thanks for any guidance. Sharon.
If she is 65 or older she does not have access to the ACA, so forget that. You can put her zip code and any prescription drugs into a search at Medicare.gov to see what plans are available in her area. Many of us find a better medical plan here, and buy the Part D Rx plan through Extend Health. If she does not take any drugs now, many find the Humana Walmart Rx Part D plan best as it has a really low premium of $12.60 a month. If she does take a drug, let the Medicare,gov search tool guide as to what is the best Rx plan for her.
After you decide what medical and Rx plans you want, go to Extend Health and do the same search there is see which of the plans are available at Extend Health. There will be fewer plans on Extend Health as insurers decide if they have all, some or none of their plans on the Extend Health (or any) exchange. They do not want to pay commission on standardized Medigap plans so there are very few of these, but usually a lot of the Rx plans, which is why many of us buy the Rx plan through Extend Health.
Some of us like the Medigap plan F because that pays for everything. Others like the Plan N or the high deductible Plan F because these plans can have a very a low premium with some minor cost sharing for Part B things (doctor). With Medigap plans she can go to any doctor or hospital that accepts Medicare It is only the Medicare Advantage plans that have networks that can be very restrictive and a cost sharing for everything including hospital costs.
Some states like NY and some insurers do not have underwriting that charges you a premium based on your health status. Because IBM is closing their plans this year, you do not have to worry about that at all for year 2014, but in the future it can be a concern if you decide to later change the Medigap plan - you may be rejected or have a high premium.
What state are you in?
Call your Mom's doctors to see if they accept the plan you want, and as it is blue cross I am sure all do. I went with Blue Cross, they are great in my state.
“Out of Pocket” – also known as OOP – is just the expense that your mother would pay herself, after insurance paid their portion. If she has a Medicare plan and a supplemental plan, then OOP expense is usually minimal.
By “network doctors,” are you referring to doctors that take Medicare (which is most of them), or are you referring to an Advantage plan, HMO-type, where there are only certain doctors that the plan uses? Easiest way to find out is to call the doctors, and/or the plan itself to check this. Personally, I’d call both the plan and the doctors; as we’ve been reading in this newsgroup we’re finding all sorts of contradictory information everywhere.
Lots of us have partially “opted out” of Extend Health (EH), although there’s no formal “opted out” process, we just don’t use them for some things. But your mother does need to have either (or both) a supplemental plan (Medigap) or a prescription drug plan (PDP – this is a Medicare Part D plan) purchased through EH to receive the HRA subsidy ($3000 or $3500) from IBM.
After a couple months experience with EH, I’d say that the majority of the IBM retirees using this newsgroup believe that you CANNOT trust most advice you will receive from EH. Beware. Ask questions on this group and compare our answers to those from EH. Also be aware that there’s still some controversy as to whether we’ll receive the subsidy if we purchase only a Part D plan – many of us do believe that (if you search the archives on this group, you’ll see a lot of discussion about Dr. Rhee’s statement to group members). But some die-hards don’t believe that, especially since IBM itself has made no written statement through a legal document (lots of discussion about that, too).
Finally, the ACA does not apply to Medicare enrollees. Ernie.
I was scheduled at 6 pm, but nobody picked up the phone on the other end until 6.47.
Then the person who did the enrollment told me that he did not know anything about the plans, that he was a data reader, that if I had any questions he had to transfer me to somebody else.
Well, we started with the dental, the Humana plan for 21.99. He asked me maybe six or seven times the same questions including my gender and that of my wife. Then he said that he had her to be enrolled on Dec 1st. this year. When I said that that was not the case, he had to call a supervisor. That took maybe 20 minutes between wait time and a repetition of the same questions.
Finally we proceeded to the MC. He was there to enroll me on the AAR UHC PPO. I asked him if he knew this plan, and he said no, that if I had any questions he had to transfer me to someone else.
I said I did and he transferred me to a woman, saying to her on an open line that I could listen to that I had questions "about every thing" even if it was my first question. So I asked her 2 questions:
A, if she had had training on this plans or if she was going to read from the same source that I had access to, and B if CVS Caremark was on the network.
To question A she said that she did not know what information I had access to, a very dumb answer as they were both reading my preregistration on the EH page but that she had to read from a computer and B, that CVS Caremark was NOT on the list.
So, having had confirmation that neither one of them was capable of giving me any type of advise we continued with the repetition of questions ad nauseam until 7:45.
Supposedly a company name BEDCO or something similar will contact me about setting up the HRA account. And that was it.
Obviously EX got this fat contract from IBM and ran to hire a bunch of part timers that will be laid off after December 31st.
That took about 90 minutes, which included about 15 minutes of actual conversation with EH employees, 70 minutes of listening to various versions of their hold music and 5 minutes navigating their automated welcome system twice (when I first called in and when I had to call back after they hung up on me). They probably did detect some exasperation in my attitude after the first 30 minutes.
Most of the EH employees were so highly compartmentalized that they only had one narrow area of responsibility and were unable or unwilling to answer anything else. (Is this what it takes to become one of their licensed professionals?)
I found repeating my name, gender, SSN, birthday, etc., multiple times to the same agent within a few minutes to be a deliberate waste of my time.
In this forum it was mentioned there was a 5% discount if both husband and wife purchase the same plan. I was told that is not available in New York. I asked why and no one knew. Has anyone in NY received the 5% discount??
It was also mentioned you can change plans mid-year if you are not happy with the plan you are on. The EH rep told me if I change I am subject to underwriting for the change. I don’t remember underwriting being mentioned as a requirement if I change mid-year.
The first EH rep said I could use my credit card for auto payment of my plan k premium. The licensed rep said they would have to send me a bill and I could then pay by credit card. No auto pay using a credit card. I arranged for my premium to be deducted from a credit union account and the HERA will send the reimbursement directly to the credit union account.
For drug plan I am staying with SilverScript for 2014.
I will probably use Costco for vision. At 72 my primary doctor send me to an Ophthalmologist for Cataracts and Glaucoma and eye tests as medically necessary. Friends who have used Costco say their glasses are very well made and reasonably priced.
I am going to the dentist Thursday and I will get the names of the discount dental plans they work with. I have spoken with a few plans and for an upfront premium of $150 - $200 total for my wife and myself the dentist provides services at discounted prices. One example from my dentist was a cleaning is $101 and the discounted price is $61. My dentist checks my mouth after a cleaning and charges $35 and if I get my teeth cleaned 3 -4 times a year I can refuse the checkup every other visit.
I will get more cleanings at just about the same cost when the premium and dental expenses from the IBM dental and the discounted dental plans are compared.
I was concerned as earlier this year I had lost a vision reimbursement because I followed a verbal instruction and was later told the advice was wrong and I was out of luck. Spent 2 months trying to rectify/escalate and finally just gave up in frustration.
After having to escalate I talked to a very cooperative person who after listening to me and contacted EH directly. EH was not able to provide any formal documentation.
She then told me she would call her IBM contact and that I would either get a phone call or email directly from IBM regarding my concerns,
I waited a week+ and did not here from IBM. I called back early last week and while I did not talk to the same representative (they had some phone issues connecting me) the person on the phone was in contact and told her that I had not heard from IBM.
The latest SPD available on NetBenefits is USHR 0012, effective January 1, 2013. You should write to the Plan Administrator and ask for a copy of the updated SPD and Legal Plan Document, since you have to make a choice of health care plans with incomplete information and January 1, 2014 is too late for you to make any changes to your choices.
The Plan Administrator can be reached at:Office of the Plan Administrator
Also, the assumption that IBM *wants* you to have the HRA subsidy is probably not a good assumption. Back in 1999, it became crystal clear that IBM wanted to take away all the retiree pension and medical benefits they could get away with, and they have continued to do so ever since.
As you say, it is sad. But that is the IBM of today. IBM changed to a cold hearted company over 20 years ago.
Last week, I called to ask a simple question, when a benefit adviser answered and persuaded me to go ahead and choose my options. I had already filled out my doctors and prescriptions on the website.
I knew I wanted a Medigap Plan F plan. The advisor recommended AARP United Health Care for my Medigap plan and AARP Drug Plan. I did tell the advisor that I am also covered by my husband's medical and drug plan. My husband has an excellent health plan since he retired from the Federal government.
I am eligible for IBM's Future Health Account, which is a lump sum that I draw from to pay my health premiums. I retired in 2007 and became Medicare eligible in 2008. The only reason I signed up for IBM plan previously and Extend Health now is because being in a plan is the only way I can draw from my FHA. Previously the FHA could only be used to pay health premiums. It does not go to my heirs. If I don't use it, I lose it.
I told the BA that I was also covered by my husband's plan both medical and drug and asked if there was any problem being covered by both plans. He told me many IBM retirees have more than one coverage and it is not a problem. I called my husband's plan and asked the same question. She told me that by having 2 drug plans, I would have very limited options with his drug plan and probably would not receive any benefits from his drug plan even for charges my drug plan does not pay.
I then called back Extend Health and asked another BA is it OK to have 2 drug plans. He went away to check then returned and told me that you can only have 1 drug plan if you have a Medicare D Plan. If I am signed up for 2 drug plans, the Medicare D plan would be my only drug plan and I would automatically be dropped from my husband;s plan. I immediately cancelled the drug plan from Extend Health since my husband's plan is much better. He told me that I will have to have either the medical or the drug plan from Extend Health in order to get reimburse from my FHA. Also, I can get reimbursed from my FHA for my husband's plan premiums, my Medicare Plan B costs and any other medical expenses that I have to pay out of pocket.
The Vision and Dental plans are a joke. I signed up for both initially. Then I read the fine print and discovered that with the Dental, I would be paying $50 a month; $600 a year and the max I can receive is $1000 a year. I would pay $600 to receive $400. I normally only have 2 cleanings and maybe 1 filling a year, that does not cost $600. My dentist advised that I would be paying more in premiums than what I actual use. I cancelled the dental. I am about to cancel the vision plan also.
Personally, I feel the canceling of IBM retirement plans and forcing us to switching to individual plans is totally selfish and uncaring to seniors, who at this time in their life, most likely have difficulty making decisions. This is a serious decision and it is confusing and upsetting to most of us. If I took the Medical, Drug, Vision and Dental, I would be paying much more than I pay now with less coverage. Individual plans can not be as good as a group plan. We lose the power of numbers to acquire better coverage. BTW, I live in Northern California.
Thank you all for sharing your experiences. I hope my experience helps others. I hope all of you enjoy good health and don't need these crappy plans. Good luck to you in making the best choice for you and your family. Brenda Nickelson
While Republicans plot new ways to sabotage the Affordable Care Act, it’s easy to forget that for years they’ve been arguing that any comprehensive health insurance system be designed exactly like the one that officially began October 1st, glitches and all.
For as many years Democrats tried to graft healthcare onto Social Security and Medicare, and pay for it through the payroll tax. But Republicans countered that any system must be based on private insurance and paid for with a combination of subsidies for low-income purchasers and a requirement that the younger and healthier sign up. ...
Thirty years later a Republican governor, Mitt Romney, made Nixon’s plan the law in Massachusetts. Private insurers couldn’t have been happier although many Democrats in the state had hoped for a public system.
When today’s Republicans rage against the individual mandate in the Affordable Care Act, it’s useful to recall this was their idea as well.
In 1989, Stuart M. Butler of the conservative Heritage Foundation came up with a plan that would “mandate all households to obtain adequate insurance.” ...
Romney’s healthcare plan in Massachusetts included the same mandate to purchase private insurance. “We got the idea of an individual mandate from [Newt Gingrich], and [Newt] got it from the Heritage Foundation,” said Romney, who thought the mandate “essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”
Now that the essential Republican plan for healthcare is being implemented nationally, health insurance companies are jubilant.
Last week, after the giant insurer Wellpoint raised its earnings estimates, CEO Joseph Swedish pointed to “the long-term membership growth opportunity through exchanges.” Other major health plans are equally bullish. “The emergence of public exchanges, private exchanges, Medicaid expansions … have the potential to create new opportunities for us to grow and serve in new ways,” UnitedHealth Group CEO Stephen J. Hemsley effused.
So why are today’s Republicans so upset with an Act they designed and their patrons adore? Because it’s the signature achievement of the Obama administration.
There’s a deep irony to all this. Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler, and more widely accepted by the public. And Republicans would be hollering anyway.
The template for the Affordable Care Act was the Heritage Foundation’s 1992 report for expanding the health insurance marketplace. Their plan had tax credits, while Obamacare has income-based subsidies paid directly to insurers to make it affordable to the poor, working class and middle class. As former Secretary of Labor Robert Reich points out, this was the Republican’s and insurance industry’s plan, not the Democrats, who wanted to expand existing government programs. Its reliance on the private sector was flawed from the start and is at the core of its current troubles. ...
All insurers didn’t have to cooperate—and didn’t. Not every health insurance company decided to participate in the ACA, which left many small states with very few options for uninsured residents. That means Obamacare is not offering a range of plans, in which competition is supposed to lower costs, in states like Maine and New Hampshire. That’s left state legislators wondering if they will have to create interstate compacts with neighbors to create coverage pools to attract private insurers to give residents more choices. Again, insurers did what was best for their bottom lines, not for the public health. ...
“Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler, and more widely accepted by the public,” wrote Reich. “And Republicans would be hollering anyway.”
Instead, Obama and the Democrats trusted the private insurance industry, thought it would do its part, and not keep stabbing them—and policyholders—in the back. That doesn’t mean the ACA doesn’t have positive features, as Obama keeps saying in speeches, but with the President as a punching bag the industry can keep doing what it has always done: put its profits first.
The US system is a stark testament to the fact that, at least when it comes to health care, more competition doesn’t lead to lower prices or better outcomes.
Three facts are indisputable. First, the $8,500 we spent per person on health care in 2011 was around $5,000 more than the average among developed countries in the Organization for Economic Cooperation and Development (OECD) — and almost $3,000 more than the average in Switzerland, which was the next highest spender.
Second, multiple studies have found that we have significantly poorer health outcomes than most developed countries (see here, and here) – by some measures, we rank dead last. And it’s not just because we have higher rates of poverty and inequality — a study conducted by the National Research Council and the Institute for Medicine accounted for those factors and found that, as Grace Rubenstein summarized for The Atlantic, “even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere.” (American men are also becoming shorter relative to men in other highly developed countries – the average height of a population is a proxy for the quality of prenatal health care and nutrition.) ...
And in health care, competition often drives costs up rather than down. According to Adam Linker, a policy analyst with the Health Access coalition, Medicare costs are highest where there are the most treatment facilities competing for patients. He writes:
More competition drives up the cost of care because when several hospitals are competing for patients and doctors they feel more pressure to build more beds, provide more amenities, and purchase the latest expensive gadgets. Instead of focusing on patient preference and improving care, hospitals are in an arms race to gain market share. That makes health care more expensive for everyone. ...
It may sound obvious, but the biggest reason we spend so much on health care is not only because insurance companies take out profits and overhead — it’s that health care costs us more than citizens of other wealthy countries. Everything from pharmaceuticals to surgical procedures to tests costs us more than citizens of other rich countries (the linked study found only a single exception: cataract surgeries cost more in Switzerland). Even a basic checkup is more expensive here than in other highly developed states. ...
Conservatives believe that more government involvement in health care will lead to less freedom and personal liberty, but when it comes to health care, the opposite is true. Why? First, because private insurers aren’t in the business of liberty. They set rules on what they’ll cover and give you lists of doctors you can see without paying extra out-of-network costs. Until new regulations were enacted under the Affordable Care Act, they shopped for the cheapest customers, denying coverage for people with preexisting conditions and using fine print to deny payments to those they did cover.
“If you're an insurance company, you're trying to hang onto the consumers you have at the highest price you can get them,” health policy analyst Laura Etherton told TPM. “You can take advantage of the confusion about what people get to have now. It's a new world. It's disappointing that insurance companies are sending confusing letters to consumers to take advantage of that confusion. The reality is that this could do real harm.” ...
Washington isn’t the only state where this is happening. Kentucky officials have fined the insurance company Humana for sending out misleading letters that say that rates could increase under Obamacare plans, and that they should renew their company plans. And regulators in Colorado and Missouri have seen similar letters from health insurance companies.
The justifiable scrutiny of Obama’s veracity has melded seamlessly into a second and very different claim: That Obama’s broken promise is not merely a violation of trust, a fair enough charge, but an act of unfairness to those who have lost their plans.
The health-care debate has suddenly come to focus almost obsessively on the alleged victims of Obamacare, who have lost their cheap individual insurance. Here’s Matthew Fleischer mourning the loss of his bare-bones plan in the Los Angeles Times; here’s David Frum doing the same for the Daily Beast. Mary Landrieu, a vulnerable red-state Democrat, is introducing legislation to ensure that nobody can lose their individual health-care plan.
The idea underlying this notion, while facially appealing, is in fact misguided and morally perverse. No decent health-care reform can keep in place every currently existing private plan.
The New York Times has a helpful graphic displaying the structure of the insurance market:
The left and top-right squares show the four fifths of Americans who get coverage through the government. Those on the left who get covered through their employer get tax-subsidized insurance, and those in the top right get insured by the government directly. Obamacare leaves that structure in place (though it has a series of mechanisms designed to hold down their cost inflation).
The main coverage provisions affect the people in the bottom right quadrant. Most of that quadrant lacks any insurance at all, which points to the dysfunctionality of buying individual insurance before Obamacare. Some of them — 5 percent of the population — have a health-insurance plan. Health-care reforms have always thought of the people within that segment as being essentially the same group of people. Those are mainly healthy, non-poor people who have been skimmed out of the insurance pool, leaving behind those too poor, or too likely to need medical care.
Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.
I say that, appreciating that Obamacare will eventually bring health coverage to tens of millions of uninsured people, that it will end the cruelty of denials of coverage based on "pre-existing conditions" (we all have the pre-existing condition of mortality); that it will allow young adults to stay on their parents' insurance to age 26; and that it will require free preventive care under all insurance plans.
But there was a much simpler way of achieving this. We could have extended Medicare to everyone. Or if that was politically unthinkable, we could have extended Medicare a few years at a time -- first to 60 year olds, then to 55 year olds, then to the young, and so on until everyone was covered. ...
But the president, facing the legislative fight of his life, decided to build onto the existing commercial system rather than battling to supplant it with something more public and straightforward. He decided to cut a deal with the big insurance and drug companies, rather than defining them as the problem that they are. ...
By creating something of a Rube Goldberg system rather than battling to supplant commercialized health coverage, Obama courted avoidable political damage multiple ways.
First, consumers blamed the government when the sheer complexity created system failures. No fewer than 55 separate private technology contractors have been involved in the creation of the software that beckons consumers to sign up for Obamacare. No wonder the thing is falling of its own weight. By comparison, Medicare is simplicity itself.
Second, since the president was not willing to finance the Affordable Care Act with broad taxes on the wealthy, he proposed to find something like a trillion dollars in unspecified savings from Medicare, scaring seniors silly and losing the votes of older Americans in the disastrous mid-term elections of 2010.
And third, because the mandated insurance coverage establishes minimally decent standards for acceptable private coverage, the unintended consequence was that a lot of people with really lousy but inexpensive insurance are furious at having to give up what they have. Telling them that they will soon have something better doesn't fix the political damage. ...
One other piece of really bad design: Because it was more expedient (and Republican-friendly) to pay for Obamacare with tax credits rather than a straight subsidy or an expansion of Medicaid, that decision got the IRS involved. Some genius made the decision to have the Obamacare software link directly to the IRS database in order to calculate the precise tax-credit and net cost to the consumer, rather than letting people window shop based on estimated incomes, as is done in the Massachusetts system. (You can window shop on the Kaiser Foundation's website) Because of the need for very high security in the linkage to the IRS database, that feature made the system even buggier.
There is no such problem with Medicare, of course. Everyone simply qualifies once they turn 65. You are enrolled automatically and your card comes in the mail.
Some of those people – mostly younger, healthier people who, because they’re in the top third of the income distribution aren’t eligible for subsidies – will have to pay higher premiums for more comprehensive coverage, even if they don’t want to. This can cause real economic hardship, and that’s a legitimate issue.
But it’s still an issue that will affect only a small slice of the population. Jonathan Gruber, a health care expert at MIT, estimates that around half of those six percent won’t experience any real change. “They have to buy new plans, but they will be pretty similar to what they had before,” he told Ryan Lizza. “It will essentially be relabeling.”
Gruber adds that most of those plans being canceled run afoul of a provision of the law banning any policy that requires people to pay more than $6,000 per year in health care expenses – plans that may lead to medical bankruptcies, the number one type of bankruptcy in the US.
That leaves about three percent of Americans who may face that tough situation where they have to pay more for coverage they may not want. ...
The reality, according to a 2012 study by the Urban Institute, is that “95 percent of those with some type of insurance coverage (employer, nongroup, public) without reform will have the same type of coverage under the ACA .” Maybe a different plan name, but the same type of coverage.
Yet one can be certain that Roy’s claim that 93 million Americans will be harmed when their insurance policies are “canceled,” while misleading on its face, will be ricocheting around the conservative media, taken as prime evidence that Obamacare is ruining millions of lives when, as Jonathan Gruber puts it, 97 percent of Americans are either untouched by the law or are clearly winners.
In the meantime, the health care crisis continues. Fewer people, even those with health insurance, can afford the health care they need because of out-of-pocket costs. The ACA continues that trend by pushing skimpy health plans with low coverage and restricted networks.
This is what happens in a market-based system of health care. People get only the amount of health care they can afford, rather than what they need. The ACA takes our failed market-based system to a whole new level by forcing the uninsured to purchase private health plans and using the government to sell and subsidize them. ...
If all US residents were in one plan, Medicare for all, rather than the ACA's tiered system that institutionalizes the class divides in the United States, not only would the health system be fairer and improve health outcomes, but it would be less bureaucratic, less costly and easier to implement. The Medicare-for-all approach considers health care to be a public good, something that all people need, like schools, roads and fire departments.
Rather than being distracted by the problems of the exchanges, the more pressing issue is whether we want to continue using a market-based approach to health care or whether we want to join the other industrialized nations in treating health care as a public good. This conversation is difficult to have in the current environment of falsehoods, exaggerations and misleading statements coming from both partisan directions, echoed by their media supporters and nonprofit organizations. ...
The Institute of Medicine issued a report in 2013, US Health in International Perspective, that documents the failure of the US health care system. In summary: "Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, 'peer' countries."
Obama was wrong to promise that everyone who liked their insurance could keep it. For a small minority of Americans, that flatly isn't true. But the real sin would've been leaving the individual insurance market alone.
The individual market -- which serves five percent of the population, and which is where the disruptions are happening -- is a horror show. It's a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed.
The result, all too often, is a market where the people who need insurance most can't get it, and the people who do get insurance find it doesn't cover them when it's most necessary. All that is why the individual market shows much lower levels of satisfaction than, well, every other insurance market:
Those numbers, of course, don't include the people who couldn't get insurance because they were deemed too sick. Consumer Reports put it unusually bluntly:
Individual insurance is a nightmare for consumers: more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell plans with ‘affordable’ premiums whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.
Jonathan Cohn puts a human face on it:
One from my files was about a South Floridian mother of two named Jacqueline Reuss. She had what she thought was a comprehensive policy, but it didn't cover the tests her doctors ordered when they found a growth and feared it was ovarian cancer. The reason? Her insurer decided, belatedly, that a previous episode of “dysfunctional uterine bleeding”—basically, an irregular menstrual period—was a pre-existing condition that disqualified her from coverage for future gynecological problems. She was fine medically. The growth was benign. But she had a $15,000 bill (on top of her other medical expenses) and no way to get new insurance. ...
If people have a better way to fix the individual market -- one that has no losers -- then it's time for them to propose it. But it's very strange to sympathize with the people who've benefited from the noxious practices of the individual market while dismissing the sick people who've been victimized by it.
Obama is rightly taking flack for making a promise he wasn't going to keep, and he's right to apologize for it. But he shouldn't apologize for blowing up the individual market. It needed to be done.
No, far more serious is the kind of catastrophe facing people like Richard Streeter, 47, a truck driver and recreational vehicle repairman in Eugene, Ore. His problem isn’t Obamacare, but a tumor in his colon that may kill him because Obamacare didn’t come quite soon enough.
Streeter had health insurance for decades, but beginning in 2008 his employer no longer offered it as an option. He says he tried to buy individual health insurance but, as a lifelong smoker in his late 40s, couldn’t find anything affordable — so he took a terrible chance and did without.
At the beginning of this year, Streeter began to notice blood in his bowel movements and discomfort in his rectum. Because he didn’t have health insurance, he put off going to the doctor and reassured himself it was just irritation from sitting too many hours.
“I thought it was driving a truck and being on your keister all day,” he told me. Finally, the pain became excruciating, and he went to a cut-rate clinic where a doctor, without examining him, suggested it might be hemorrhoids.
By September, Streeter couldn’t stand the pain any longer. He went to another doctor, who suggested a colonoscopy. The cheapest provider he could find was Dr. J. Scott Gibson, a softhearted gastroenterologist who told him that if he didn’t have insurance he would do it for $300 down and $300 more whenever he had the money.
Streeter made the 100-mile drive to Dr. Gibson’s office in McMinnville, Ore. — and received devastating news. Dr. Gibson had found advanced colon cancer.
“It was heartbreaking to see the pain on his face,” Dr. Gibson told me. “It got me very angry with people who insist that Obamacare is a train wreck, when the real train wreck is what people are experiencing every day because they can’t afford care.”
Dr. Gibson says that Streeter is the second patient he has had this year who put off getting medical attention because of lack of health insurance and now has advanced colon cancer.
So, to those Republicans protesting Obamacare: You’re right that there are appalling problems with the website, but they will be fixed. Likewise, you’re right that President Obama misled voters when he said that everyone could keep their insurance plan because that’s now manifestly not true (although they will be able to get new and better plans, sometimes for less money).
But how about showing empathy also for a far larger and more desperate group: The nearly 50 million Americans without insurance who play health care Russian roulette as a result. Families USA, a health care advocacy group that supports Obamacare, estimated last year that an American dies every 20 minutes for lack of insurance. ...
The Institute of Medicine and the National Research Council this year ranked the United States health care system last or near last in several categories among 17 countries studied. The Commonwealth Fund put the United States dead last of seven industrialized countries in health care performance. And Bloomberg journalists ranked the United States health care system No. 46 in efficiency worldwide, behind Romania and Iran.
The reason is simple: While some Americans get superb care, tens of millions without insurance get marginal care. That’s one reason life expectancy is relatively low in America, and child mortality is twice as high as in some European countries. Now that’s a scandal.
Yet about half the states are refusing to expand Medicaid to cover more uninsured people — because they don’t trust Obamacare and want it to fail. The result will be more catastrophes like Streeter’s.
“I am tired of being the messenger of death,” said Dr. Gibson. “Sometimes it’s unavoidable. But when people come in who might have been saved if they could have afforded care early on, then to have to tell them that they have a potentially fatal illness — I’m very tired of that.”
But for those of us who think the health security the Affordable Care Act provides marks a fundamental advance in America’s social contract, these White House failures don’t come close to the vices of Obamacare’s adversaries. Let’s just say it: To judge by their behavior, the Affordable Care Act’s enemies couldn’t care less about helping millions of low-income workers achieve health security, and every time they open their mouths, it shows.
When conservatives rant about the latest mess-ups attending the rollout, they never add the obvious empathetic refrain. It would be simple, really. They’d just need to preface or append to their daily attack a line like this: “Of course we all agree we need to find ways to get poor workers secure health coverage that protects their family from ruin in the event of serious illness.”
That’s all it would take. But they don’t say that. None of them. At least none that I can hear. A single omission might seem an oversight. A few might be a sign of distraction. But when day after day you wait in vain to hear such empathy amid the torrent of anti-Obamacare venom being spewed, you realize something bigger psychologically is at work.
Obamacare foes are more than just angry with the “lying” and the bungling they disdain. They are Very Well-Insured People. We all know about “VIPs.” Well, these are VWIPs. Or at least, a certain conservative species of VWIP.
"But dependency on government has never been bad for the rich. The pretense of the laissez-faire people is that only the poor are dependent on government, while the rich take care of themselves. This argument manages to ignore all of modern history, which shows a consistent record of laissez-faire for the poor, but enormous government intervention for the rich." From Economic Justice: The American Class System, from the book Declarations of Independence by Howard Zinn.
As a member of that committee, I realize that our $17-trillion national debt and $700-billion deficit are serious problems that must be addressed. But I also realize that real unemployment remains close to 14%, that tens of millions of Americans with jobs are paid horrendously low wages, that more Americans are now living in poverty than ever before, that wealth and income inequality in the U.S. is greater than in any other major country and that the gap between the very rich and everyone else is growing wider. ...
How did we go from healthy surpluses to terrible deficits? It's not that complicated. In 2001, President Clinton left office with a $236-billion surplus. The nonpartisan Congressional Budget Office foresaw a 10-year budget surplus of $5.6 trillion, enough to erase the national debt by 2011. It didn't work out that way.
Instead, under President George W. Bush, wars were launched in Afghanistan and Iraq without paying for them. The cost of those wars, estimated at up to $6 trillion, was tacked onto our national credit card. Then Congress passed and Bush signed an expensive prescription drug program. It also was not paid for. Then Bush and Congress handed out big tax breaks to the wealthy and large corporations. That drove down revenue. So did the recession in 2008, which was caused by a deregulated Wall Street. All that turned big surpluses into big deficits.
Interestingly, today's "deficit hawks" in Congress — Rep. Paul D. Ryan (R-Wis.), Sen. Jeff Sessions (R-Ala.) and other conservative Republicans — voted for those measures that drove up deficits. Now that they're worried about deficits again, they want to dismantle virtually every social program designed to protect working families, the elderly, children, the sick and the poor.
In other words, it's OK to spend trillions on a war we should never have waged in Iraq and to provide huge tax breaks for billionaires and multinational corporations. But in the midst of very difficult economic times, we just can't afford to protect the most vulnerable people in our country. That's their view. I disagree. ...
Instead of talking about cuts in Social Security, Medicare and Medicaid, we must end the absurdity of corporations not paying a nickel in federal income taxes. A 2008 report from the Government Accountability Office found that was the case with 1 in 4 large U.S. corporations. At a time when multinational corporations and the wealthy are avoiding an estimated $100 billion a year in taxes by stashing money in tax havens like the Cayman Islands, we need to make them pay taxes just as middle-class Americans do.
While Congress in January finally ended Bush's tax breaks for the richest 1%, lower rates were left in place for the top 2%, those households earning between $250,000 and $450,000 a year. That must end. ...
And frankly, Congress must listen better. Some Republicans learned a hard lesson when the American people said it was wrong to shut down the government because some extreme right-wing members of Congress did not like the Affordable Care Act. Well, there's another lesson that I hope my Republican colleagues absorb. Poll after poll shows that Americans overwhelmingly do not want to cut Social Security, Medicare and Medicaid. ...
In fact, according to a recent National Journal poll, 81% do not want to cut Medicare at all, 76% do not want to cut Social Security at all, and 60% do not want to cut Medicaid at all. Other polls make it clear that Americans believe that the wealthiest among us and large corporations must pay their fair share in taxes
It is time to develop a federal budget that is moral and makes good economic sense. It is time to develop a budget that invests in our future by creating jobs, rebuilding our crumbling infrastructure and expanding educational opportunities. It is time for those who have so much to help with deficit reduction. It is time that we listen to what the American people want.
Gross capital investment by the public sector has dropped to just 3.6 per cent of US output compared with a postwar average of 5 per cent, according to figures compiled by the Financial Times, as austerity bites in the world’s largest economy.
Republicans in the House of Representatives have managed to shrink the US state with their constant demands for spending cuts, even though their uncompromising tactics have exacted a political price, with their approval ratings in Congress at record lows.
They needed us for their roads, for their businesses, for their communications, for their transportation, as their customers, and for their overall success.
The super-rich rode on the same trains as us, and flew in the same planes as us. They went to our hospitals and learned at our schools.
Their success directly depended on us, and on the well-being of the nation, and they knew it.
But times have changed, and the super-rich of the 21st century no longer think that you and I are needed for their continued success. ...
The Society of Civil Engineers says that it will take a staggering $3.6 trillion investment by 2020 - or $450 billion per year - to bring the American infrastructure into the 21st century, and to avoid risking a complete infrastructure collapse.
But the super-rich don't care about how much funding is needed to save this country, as long as they have their private schools, private hospitals, private airports and private places. ...
No matter what Jamie Dimon, Charles Koch, or Shelly Adelson will tell you, America's wealthy elite did not make their fortunes on their own. Without a strong economy and infrastructure, America's millionaires and billionaires would not be where they are today. It's that simple. ...
Right now, the burden for rebuilding America is on the backs of working-class Americans, and that's just wrong. It's ridiculous that working-class Americans struggling to survive day-to-day are paying more in taxes than billionaire banksters and oil tycoons.
The billionaires who received the subsidies or owned companies that did include the Microsoft co-founder Paul G. Allen; the investment titan Charles Schwab; and S. Truett Cathy, owner of Chick-fil-A. The billionaires who got the subsidies have a collective net worth of $316 billion, according to Forbes magazine.
The Working Group said its findings were likely to underestimate the total farm subsidies that went to the billionaires on the Forbes 400 list because many of them also received crop insurance subsidies. Federal law prohibits the disclosure of the names of individuals who get crop insurance subsidies, the group said.
The report is being issued as members of the House and Senate are meeting to come up with a new five-year farm bill. The authors of the report said it is timely, given that lawmakers are debating a House proposal that would cut nearly $40 billion over 10 years from the food stamp program, which helps provide food for nearly 47 million people. A Senate provision would cut $4.5 billion over the same period. ...
“The irony is that farm subsidies are going to billionaires at the same time that there are proposals to kick three to five million people off of food stamps,” said Scott Faber, vice president for government affairs at the Environmental Working Group. “This clearly highlights the need for reform to our farm programs.” ...
Mr. Faber said that one of the proposals he found most disturbing in the farm bill would shift money from farm subsidy programs like direct payments, which have income limits, to those like crop insurance, which do not. Other measures would subject food stamp recipients to drug testing, work requirements and income means-testing.
Unlike traditional farm subsidies, crop insurance premium subsidies are not now subject to income requirements, payment limits or conservation compliance, the Working Group found.
“So basically the bills would allow billionaires to get even more in subsidies, all without taxpayers knowing who they are, while imposing draconian requirements on low-income people,” Mr. Faber said.
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