Wednesday, January 13, 2010

More on Cadillacs

The rumor today is the Congressional conferees will go with the tax on "Cadillac" plans. Presumably some Senate "moderates" (I guess it's all relative) object to the idea of taxing families with incomes over $1,000,000. Remember when a millionaire was someone with a million dollars in net worth? Even today, having a net worth of a million dollars puts you somewhere in the top 10% of American families (according to the Fed's Survey of Consumer Finances). But we've become so jaded that when people in Congress talk about a "tax on millionaires," they're talking about families with annual income above a million dollars. And taxing even those people is apparently too much for some Democrats.

Meanwhile, I'm still (see December 28, 2009) trying to figure out what these wasteful plans are. I've hunted around the Internet trying to find some evidence that patient choices are a big contributor to waste in health care, and so far I haven't been able to find it. If you know, please tell me. There's a lot about doctor choices, but...

My concern (speculative at this point), is that a lot of the higher-priced plans are ones whose "extras" include dental and vision coverage. But, as I said before, that's clearly a part of basic health care. Being able to go to the dentist or get glasses is not a big deal to the middle class, but for some people it's a very big deal.

For those of you who like true-life stories, take a look at this article by the AP. [Note 3/13/10: The article, "Lessons of a weekend of free health care," by Adam Geller, 1/3/10, has been archived by the AP. If you don't want to pay $1.50, try this instead.] It describes people in Tennessee who drive for hours (and sometimes arrive the night before to get a good place in line) to get into a one-day free medical clinic. The most telling point in the story is that, although almost all of them have medical problems, many don't mention them for fear of losing their chance to get dental or vision care.

Those of you who are more statistically inclined might want to take a look at this information from the CDC. Here are some statistics for people age 45-54 (I chose one age cohort because there were no totals).

Untreated tooth decay: Poor 45%, Near-poor 40% Non-poor 17%
Loss of all natural teeth: Poor 12%, Near-poor 11%, Non-poor 4%

For the woman who was the protagonist of the AP story, having all her teeth pulled was the happy ending. That meant she no longer had to live with constant throbbing pain. (What's even more maddening about this story is that she probably votes Republican.)

Addendum: The Times health blog reports on January 14 that as of 2015 (why 2015?) dental and vision costs will not count toward the threshold for the tax. That's good news, but leaves me more mystified than ever about what's in the high-priced plans. So far, no stampede to include vision and dental as part of what's required for all plans. That's intended humorously--we won't see that in the near future.

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