Fact Checking Factcheck.org

The unions were bought off when they dropped their opposition to the "Cadillac tax" provision when their members received a 4 year exemption.  I loathe the me-me-me type of progressive where it is all about how I (or my group) is directly impacted with no consideration given to the other progressives within the tent.  Unions have a powerful role at the table that quite frankly most American middle class people do not.  The middle class did not have lobbyists or representatives at the table, and the Democratic party sure as hell was not lookign out for their interests.  The unions rolled over on this one once their members were somewhat taken care off.  I mean it's all good to say that the union role is to protect their membership and not be concerned about others, but then why expect middle class Americans in Wisconsin or elsewhere to stand up for unions when unions don't stand up for them?  And might I add the brief 4 year break was a mind-numbingly stupid deal for the unions to agree to. 

High quality union health benefits were already under attack in most negotiations due to the severe economic pressures of rising health costs.  Every time at the negotiation table the primary issues are beginning premium cost sharing (or increasing the % for the members who are not already contributing) and/or reduction of benefits, higher deductibles, less choice.  This concession to the Cadillac tax is the final nail in the coffin for high quality healthcare for union members.  I'm the daughter of a union member who became severly disabled in her 50s and access to high quality union healthcare benefits meant her illness did not bankrupt her.  I wonder how many union members will be able to say the same after 2018.

re: I guess I understand it.

For me, reading that link was helpful in that I saw the logic of what the writers of the provision were trying to do. It looks like the intent is not just a socialist punishment of those getting more, but an attempt to get insurance companies offering those plans that are feeding health care inflation to cut it out, to put some reins on it.

I get it because even though I don't have health insurance for reasons I'd rather not go into, the spouse just recently got a "Cadillac" plan, it's "Cadillac" because he can have also have a health care savings account to pay for stuff not covered by his basic high-deductible plan  I had to help him figure out how it works and after doing that, I can see how it could easily fuel health care inflation and use of services that are not necessary or might be harmful (in the manner of studies written about by Atul Gawande, etc.) If it's not covered by the insurance company, he can just use the health savings account to get it, and currently that's just as fully tax deductible as insurance premiums (is actually more like a tax credit than a deduction!) That includes his deductibles and co-pays, and theoretically that includes plastic surgery, designer eyeglasses or botox shots, or an MRI of his back  if he wanted one even if 4 of 5 doctors said he didn't need one, whatever his heart desires that can show receipts to the IRS that says "health care." This has the same flaws as fee-for-service, where the consumer feels free to access all kinds of health services like a kid with his parents' credit card in a candy store. Nobody with any health care training co-ordinating the spending or the wisdom of the treatments.

BUT like a lot of laws Congress writes with intent to affect behavior, I strongly suspect what they've done here is not going to work like they thought it would! Right away on this thread you guys are bringing up just one example of something they apparently have not foreseen--that people in areas with high cost of living are not getting the same plan for "Cadillac" price levels as people in areas with lower cost of living How to separate out what is true inflation of health care services and what part is just because the coverage is in Manhattan with lots of other, non-health-related inflators? And I am sure there will be other problems that they have not foreseen along the lines of "that's not what we meant to happen"

Back to the intent. Overall, people are upset that "Obamacare" has given the start of a project to rein in our health care costs to private insurance companies and not given people an option to chose the government as the one who does the reining in (i.e. a "public option.") The bill's writers felt that they have taken care of one of the main concerns there by instead regulating the amount of profit a private insurance company can take.

I got to give them that one, there seems to be little realization about this part, that if there had been a public option, that it would also be trying to rein in costs and spending. That there is no pony about that, that getting control of our health care costs was the main project, not giving everyone more surgery and tests and brand name drugs and growing the health care sector of our economy further, and that insurance companies offering the plans are going to be regulated as to profits.

I just don't see why people think a bureaucrat of a public option would necessarily be sooo much smarter and kinder about what costs were being reined in than someone working for a insurance company whose profits were regulated by the government. Again, there is no pony, reform was not meant to give everyone current Cadillac, but to change the system.  If the same people are complaining now that congressional staffers writing laws are incompetent, why are they so sure an administrator of a public-option health insurance plan would be sooo much better than an administrator from a regulated  private insurance plan?

What I see is that we are going to be going through a long process of trial and error, and that the intent is to see lots of solutions attempted, lots of losers as well as winners in the meantime,  much pain to many unfortunately, and that eventually most buyers will go with the solutions that work out best for people, and the ones that don't will go out of business. As the field winnows and narrows, to a few companies that find out how to do it in a popular manner,  we will then be on our way to single payer. Yeah it sucks to have to do it that way, but single payer was not going to pass in this country, not until more users and providers learn up close and personal what has to go on to bring that 17% of the economy number down.

Edit to add: going to a university dental clinic for major treatment over the last few years, I met working class people in line who had plans with a different kind of health savings account provided by their employer, and they loved 'em because they could use it for dental  if they wanted, when other people like them with regular insurance had to pay for their own dental care, and furthermore they got a tax credit for their part of the savings account.

Uh, Candidate Obama's proposal was to increase taxes on people making over $250,000 a year.  That sounds fair.  But apparently Obama and the Democrats would rather reduce high quality employer based health insurance than follow through and raise taxes on the wealthy.