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Insurance premium rise 2022-2025 is costly for employee wages with employers slow to increase wages when so much money is going into healthcare premiums for their employees. Each year employee premiums in the US have increased by 7% for the last 3 years. $27000 is the cost of health insurance premium for American family in 2025 which is exorbitant and shows a breakdown in the health system that is affecting the cost of living, the wages of workers, and the money left in the economy for other essential needs.

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Health insurance premiums for family plans increased by 9% in 2011 according to a survey by Kaiser Family Foundation. A similiar survey by Mercer showed premium increases around 6%. Another change is that health insurance plans are becoming less comprehensive and deductibles are higher, with higher copays and employees contributing more to premiums.

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Walmart is going to require employees to use certain hospitals for costly spine surgeries, an effort to weed out unnecessary procedures and lower healthcare costs. The retailer earlier used a voluntary scheme to get employees to use the hospitals offering lower cost quality care, but found that half of the people needing spine surgery who volunteered to travel decided not to undergo expensive spine surgery. A spinal fusion surgery costs $77,000 at Mayo Clinic which tries to first see if other options of physical therapy can do the job. Walmart has insurance coverage for 1 million people.

Costs are going up and up. The average cost of family health plans from employers is up 5% this year to $20,000, with workers paying one third of cost, a survey by Kaiser Family Foundation shows. 

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US president Biden's 2024 Budget places great emphasis on aid to workers and families in the US and shores up the Medicare hospital-insurance trust fund. He will do this by raising taxes on the wages, investment gains and self-employment income of people making more than $400,000 a year. Additional savings come from increasing the drugs on which Medicare can negotiate prices from 20 to 50 drugs.  Childcare- families making less than $200,000 a year will get subsidized child health care, the lowest income families paying nothing. Housing- Building and preserving 2 million housing units. Series of tax credits to make buying homes more affordable. College education- Reducing the cost of going to education with $12 billion allocated for this. Offering tution free community college. Family and Medical Leave- Federal paid family and medical leave program. Retirees- a $2000 cap on out of pocket cost of prescription drugs for retirees. Reduced taxes for under $400,000 income households- This would be done without increasing the deficits to extend the tax reduction from the 2017 tax cuts to households making less than $400,000 a year.     ...

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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...

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The U.S. House of Representatives votes to repeal and replace the Affordable care Act 217-213. Moderates were won over by an addition of $8 billion  to add coverage for a popular feature of the ACA that covered people for pre-existing conditions.  The bill that passed gives credits of $2000 to $4000 a year, depending mostly on age, upto $14,000 for a family. Credits are reduced for individuals making over $75,000 a year or families making over $150,000. There is no mandated insurance coverage. This trims the federal budget deficit, yet also is expected to keep 24 million more Americans without health coverage after 10 years. The bill now goes to the Senate where moderate Republicans are worried that this may increase premiums for older people, one of the drawbacks of the earlier version of the House Republican bill.

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AARP shows 29 million Americans working and taking care of older parents. Many work 40 hours a week and work an additional 20 hours helping elderly parents. About six out of ten people of this 29 million work full time. In 2024 a lot more people are living longer and older people prefer staying in their own homes and need help from family members. A simple fall or a cancer diagnosis can lead to long hospital stay, months of treatment, and worrying for family members. Company benefits in 2024 do not include senior or eldercare support or even accomodating employees caring for their parents. In America today federal and state laws do not protect people caring for elderly parents from discrimination in the workplace. Consider how this is affecting companies, as about one third who are caregivers say they are going to leave, and half of the employees leaving are senior manager and executives with much experience. This comes to about 5 million senior managers and executives that American industry can ill afford to lose as it competes with China, India and Europe. About half of all companies are making this a priority in 2024, according to Care.com. Citigroup added 2 weeks of paid leave to care for immediate family member. Companies allow employees to add older parents on their health insurance. These benefits are being added to maternity and paternity leave. The fact that Congress and state legislatures have failed to enact laws protecting caregivers is one more reason for the discontent and unrest in the US after the pandemic. ...

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The Dec. 2013 CBS/NYT poll showed only 39% overall support the Obama health care law, a majority say it increases their health care costs. 57% of the uninsured without health coverage say it increases their costs and only 20% say it decreases their costs, for the very group it was designed to help. For the uninsured a third say they will not sign up for the law and pay the penalty. Annie Lowrey of the NYT looks at these numbers and says part of the reason for the lack of enthusiasm for the law is the sharp increase in deductible costs of insurance coverage- the percentage of Americans in health insurance plans with deductibles over $1000 has jumped to 38% in 2013 from 18% in 2008, according to a survey by the Henry Kaiser Family Foundation. During these 5 years the average deductible has increased to $1097 from $735. This is happening as incomes are stagnant or declining in inflation adjusted terms for many working Americans.

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The Trump administration is preparing direct aid to Americans and American industries hurt by the coronavirus epidemic. Each check will be based on family size and income, according to a Treasury Department memo seen by WSJ. The direct payments in two rounds will be on April 6 and May 18. This is part of a $1 trillion stimulus program. $50 billion lending facility is being setup for the airlines. Another $150 billion goes to distressed sectors in the economy. $300 billion will go to a small business interruption loan program, which will go to temporarily cover payroll costs for employees. The idea is to put a safety net and support workers who will need help while they are not working. The measures include two weeks of paid emergency leave for a large number of people. Money also goes to additional Medicaid funding, more money for food stamps, and for unemployment insurance program. Congress has passed the bill and president Trump is expected to sign it into law. Other bills will follow in Congress. A third economic package will cover additional needs of agencies of government, with $11.5 billion for Department of Health and Human Services, and Departments of Defense, Veterans Affairs, Homeland Security. All this is being done in Congress and by the Trump administration at top speed. ...

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The Census Bureau reports that 46.2 million Americans were living in poverty in 2010. This is an increase of 2.6 million over 2009. This is the highest number of Americans living in poverty since 1958, when this statistic was first measured. Poverty is defined for 2010 as income at or below $22,314 for family of four. Also relevant is the median household income which went down to $49,445 in 2010, a decline of 2.3% from 2009. The typical household earned less in 2010 than in 1997, in inflation adjusted terms. The Census Bureau reports 16.3% of Americans had no health insurance coverage in 2010, the same as 2009.

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What is theaverage income of a Ohio plumber and how many have health insurance? Is he a working class man? Well it turns out that Joe the Plumber Republican candidate for President 2008 refers to could be an exception but the average plumber makes $47,930 according to the Bureau of Labor Statistics occupational earnings report for May 2007 for plumbers in Ohio. And the Ohio plumbers income was only 15% higher than in the 2000 report when the consumer prices in midwest rose by 17%. According to the Kaiser Family Foundation in 2007 only 45% of companies with fewer than 10 employees offered health benefits, down from 57% in 2000. And 2007 was a good year, the statistics for 2008 and 2009 would look much worse as the downturn takes shape. As Chapman another Nobel prize winning economist wrote in the WSJ oped pages the stimulus checks were spent on more purchase of consumer goods merely continuing a high debt low savings spendthrift pattern of consumer behaviour and delayed the economic crisis for 6-12 months. Underlying incomepatterns like the one above where working class Americans were actually more and more worse off in an accelerating pattern may have become glossed over in consumer debt and housing boom behaviour....

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Research from Australian National University shows steadily improving conditions for migrant workers in China. Migrant workers were able to spend more time in cities- an average of 8.9 years. The hukou sysem ensures migrants return to rural areas when they have to raise a family. About 252 million migrant workers work in factories and construction jobs in urban areas. Migrants with children leave them with grandparents back home. Improving the conditions of these workers is important to reduce the wage and income disparities in China and to reduce inequality. About a fifth of the migrant population now has pension and health benefits. Creating a balanced economy with domestic consumer spending making a larger share of GDP also requires improving wages and benefits of migrant workers. Incoming prime minister Li Keqiang says in a statement on a government website: China "must take migrant rural workers and gradually change them into urban residents. This requires that we push forward household registration reform." If done seriously this will create a new kind of China as these migrant workers are integrated into urban society after years of being shunned and ignored by China's educated middle class. Professor Meng's research at Australian National University of migrant workers shows the proportion of migrant workers with unemployment insurance increased from 11% in 2008 to 21% in 2012. The research shows similiar figures for health and pensions. Improving their living standards also make it attractive for more young people from rural areas to migrate to cities increasing urbanization....

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The stories of Dylan Roberts, 32 years, in Rockford, Illinois and Alfred Butt, 42 years,in Hohenlockenstedt, Germany. Roberts lost his job at aChrysler plant in Belvidere, near Rockford, Illinois, and Butt lost his job a German auto parts maker. Roberts gets a $64,000 severance package, and 59 weeks of unemployment insurance, with apossible additional 13 weeks, with monthly check of $1426 that is 27% of his income of $64,000 a year when employed. attribute 33 weeks of the 59 weeks to the stimulus measures of President Obama. Butt has 4 months as atransfer worker at full pay, which can be as long as 1 year, then he has till May 2010 at 80% of his pay when employed full time of 2700 euros amonth. The transfer company gives job training and job hunting advice. He continues getting his medical insurance benefits which are provided by the state. Roberts loses his health insurance with his job, and hopes to pay his expenses for a2 bedroom apartment with his girlfriend who makes close to $1500 as an elementary school teacher. He will take a2 year electronic engineering course with a local college using $6000 from Obama's Dislocated Worker's Program. But he isn't sure if he can do his studies after one year when his unemployment benefits expire. Butt can afford to take a vacation to Cyprus and his lifestyle is not much affected he says. His wife works as a nurse at a rheumatism clinic. Butt is like the 64% of Germans who say the crisis is not affecting them personally. Roberts is like the 87% of Americans who say this crisis id hurting them in their persdonal lives. To pay for the state funded benefits the total wage tax burdenas a percentage of labor costs for Butt is 52% in Germany. FOr Roberts it is 30% in the USA. France is at 49% Spain at 39% and the UK at 34%. Germany's public expenditures for these labor benefits are 2.97% of GDP in 2006, the USA's are 0.38%. Spain and France are at 2.32% and the UK at 0.61%. This also explains why the impact in countries like Germany and Spain is not felt so badly as in the USA. In SPain there is also the lower mobility and the safety net of family support helping people cope making it possible to cope with 20% unemployment without serious distress and hardships. See the link to Spain's unemployed....

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The health care system is designed to encourage procedure based specialist practices and discourages the patient understanding education and monitoring that occurs with a well designed preventive family physician practice. As a result a patient only spends 30 minutes ayear on average with family physician compared to one hour in other developed nations. In the USA there has been a steady decline in the level and quality and extent of family care and the close one on one rapport with well trained family physicians who enjoyed their work and understood their patients and kept up with their health conditions and provided good and regular advice on these conditions. There is no money in this care as a result first you provide an environment where a whole range of medical conditions can flourish and expand, and then you hit them with a whole series of tests to rule out specific medical conditions. It is a perfect way to expand the testing and let testing flourish, so it would appear that if someone had wanted to start with a goal of letting testing proliferate unhindered then this would be the perfect way to design it. ...

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U.S. health insurance company WellPoint Inc. will offer higher payments to primary care physicians. This is part of new strategy to reduce emergency room visits and costs after deterioration in a patients condition by relying on primary care physicians for better care at the outset. Payments to primary care physicians will be increased by 10%, with higher payments when the results show better quality and preventive care. WellPoint has a network of 100,000 primary care doctors. Physicians who meet certain goals such as lowering the overall cost of a patient's health care costs will be given an incentive of 20-30% of the savings realized. The new effort will add 1-2 percentage points to the 6-8% of the $100 billion that Wellpoint pays for claims processed each year. WellPoint's management sees a reduction in medical costs of about 20% by 2015 as a result of such efforts.

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A study by Dr. McCormick of the Harvard Medical School and professors at the City University of New York School of Public Health at Hunter College, shows that the anticipated savings from conversion to medical records may not materialize to the extent expected. This study of data from 1100 doctors of 28,000 patient visits shows that with access to digital records doctors actually increased the number of tests ordered- from 12.9% of visits without digital records to 18% of visits with digital records. For more advanced tests such as MRI and CT scan the rate was 70% higher. Dr. McCormick says this may be because the new digital technology may have made it easier to order tests.

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Porter cites a report by Kai Daniel Schmid and Ulrike Stein of the Macroeconomic Policy Institute in Dusseldorf. The report shows the top 10% of Germans having 26% of the country's income before taxes and transfers in 1991. This increased to 31% by 2010. For the same period of about 20 years the bottom half of the population took in 17% in 2010 dropping by 5% from 22%. The growing income inequality in Germany is comparable to what has happened in the U.S. over this period.

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Jerry Muller, professor of history at the Catholic University of America, offers some useful insights into the nature of inequality in advanced capitalist societies and other parts of the world, and a clear eyed way to tackle the problem of inequality. Tackling the problem should be done in a way that preserves the economic protections for the middle class and the poor which are needed for capitalism to work- unemployment insurance, Medicare, Medicaid, Social Security, Earned Income Credit, and the Affordable Care Act. Much of this system is already in place in advanced capitalist societies. Incremental gains in this area will be much smaller and it is important to recognize the need for strengthening the economic engine that supports these benefits, says Muller. Economic dynamism has to be preserved and nurtured with human capital deployed in the best possible way, and competitiveness of countries increased. Each country and society has to find its own way of achieving this. The family matters, and matters a lot in taking advantage of educational opportunity, says Muller. The culture of different ethnic, immigrant groups, also matter. These differences were present in earlier periods in the nineteenth and twentieth century and are likely to remain. Strengthening the pool of human capital and deploying it is essential to progress. In an earlier book "Adam Smith In His Time and Ours- Designing a Decent Society," Muller emphasized the importance Smith placed on the civic duty of citizens to promote the welfare of the whole society, and the importance of education, family and moral character, with no substitute for the "general prevalence of wisdom and virtue." ...

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A new West Coast Model is emerging with ballot measures in the states of Washington, California and Oregon. The model is to make up for decades of faulty income distribution which favored tech communities in west coast states leaving behind people from minority communities and the working class outside tech hubs such as San Francisco, San Jose and Seattle. During this period budgets for education and healthcare, social services and essential infrastructure suffered as budgets were squeezed for local governments. Minimum wage also lagged behind and communities struggled to keep up. Washington votes for a ballot measure that raises the minimum wage to $13.25 statewide and mandate paid sick leave for workers. In California a ballot measure makes permanent an income tax surcharge on millionaires to use these funds for education. In Oregon measure 97 places a gross receipts tax on corporations with annual sales in Oregon over $25 million, raising $3 billion a year for schools, health care and other programs. The California and Washington measures are likely to pass, Oregon uncertain, say experts. And even in Oregon supporters have learned from the experience to put forward new proposals on the ballot. The Washington measure is supported by Nick Hanauer, and Zach Silk, president of Civic Ventures in Seattle, who say it is essential to put more money in workers wages to increase growth and to bring better lives outside the tech hub areas. Most of the tech booms of the last two decades have not touched the areas outside tech hub metropolitan areas. The conservative approach adopted in Louisiana and Kansas of reducing taxes first and then when holes in state budgets developed to cut education, health and other service expenditures has not worked, and it has led to the backlash in the form of the new West Coast Model, which is expected to be brought up in other states in the east and midwest. The tech hub areas have grown with the boom in tech but this has largely ignored the rural areas, communities just outside of the tech cities, and led to uneven and distorted growth shortchanging the working class and the middle class, and hurting investment in education and healthcare across each state. Bill Whalen, a research fellow at Stanford University's Hoover Institution conservative think tank ,says that its hard to deny that the balanced growth for all communities across the state has lagged far behind as the tech booms boosted growth in the economies of California, Oregon and Washington. An article in the German online site Zeit on Silicon Valley described this vividly showing how this can happen in communities sitting side by side in the San Jose area, with minority Hispanic communities and working class communties seeing very little of the benefits of growth. ...