Why Repeal Obamacare: One Perspective

    With John Boehner touting "Repeal and Replace" of health-care legislation to be a top priority of the next Congress and President Obama holding a veto, it may be useful to think about how great the surgery needs to be. I've asked frequent commenter Bill McCormick for his thoughts from a small business perspective.

    First, what does McCormick know about small business? He has some academic credentials - a Harvard Business School graduate program for small business owners - but, more importantly he has a 40 year history of starting successful small businesses from management recruiting and business travel agencies to innovative Hallmark shops, to off site electronic data storage. His "top 25" management recruiting firm in particular gives him insight into the thinking of a broad range of businesses large and small.  

    Some of his thoughts:

        1. The political system caters to the large corporations. That is where money for political campaigns is more easily raised, lobbyists are employed, and large blocks of voters can be found.  And the companies like General Electric, Bank of America, and Boeing are politically agnostic - whoever will address their needs. Small business owners on the other hand have not been of much interest to the Democrats.   

      2. With large scale, low skill manufacturing migrating overseas, we are left with an economy in which 75% of our 107 million workforce is employed in businesses averaging 10 or so employees - flower shops, builders, computer services, landscaping, and professional practices. Some do make stuff. This is a turbulent environment where most businesses last just a few years with many of the successful ones being acquired by larger firms. In the section of the economy served by small businesses Return on Investment is often too low, complexity is too great, customer interaction is too demanding, and change is too rapid for large corporations. But this is where job creation must happen.

        3. The 2010 health-care reform did not change the basic premise of employers bearing the cost of insuring most of the populace and did not do much of anything to reduce the costs in the system. Government funding pays for some of the expanded coverage, but popular mandates like "preexisting conditions" and covering children to age 26 fall back on to the insurance companies and to the people paying their bill. McCormick's company rates had an average annual increase of 9% for Bush's last three years and 25% for Obama's first three. It is a sample of one, but representative.

        4. Many of the features of the current system and Obamacare are particularly burdensome to small businesses: small insured pools which cause single large claims to cause rate spikes (A. allow large pools across state lines); disproportionate effects of a catastrophic illness or disability (A. let the government handle truly catastrophic illnesses); provisions which prevent older workers from relying primarily on Medicare (A. allow workers over 65 to use Medicare with a company-paid supplement); higher risk that the small business insurer will go out of business, leaving the insurer on the hook (A. see larger pools above); and burdensome federal reporting (A. as a start, get rid of the Obamacare requirement for reporting all company payments over $600.) More broadly, get beyond insurance and go after the real cost reductions - tort reform; competitive pricing for pharmaceuticals and equipment; nurse practitioners; neighborhood clinics.   

         5. Many of the answers are simple if the administration were to listen to small business owners. Instead, if one were cynical, one might think that the intent was to drive small business owners to eliminate their coverage (incurring a modest fine) with the result that the majority of American workers would obtain expensive individual policies and create a demand for the government to take over the health insurance industry.

    There are other things that would greatly invigorate small businesses - expand Small Business Administration-type loans for proven small businesses and promising start-ups; prevent higher interest rates or lower lines of credit for business borrowers who are current on payments; provide certainty on taxes; avoid union bias in government contracting - but eliminating the disincentive to hiring caused by the health-care legislation would go a long way toward getting the economy going.  Correcting Obamacare is a legitimate top priority.

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    This week's video is an interview with Joe Lieberman about the WikiLeaks fiasco. (I had thought about an article on this subject, but am just too bummed out.)

bill bowen - 12/3/10

Comments

[Bill McCormick]

WHAT A TURNABOUT-----

I never thought I would ever see President Obama in such a bind. But, that is what happens when you tell people what they want to hear to get your way and then go another way. And, that is what has happened to the President. Those who didn't believe in what he preached to get elected are not surprised at his current whip saw performances as he alternately lashes out at the right and then the left. Followed 24 hours later with eloquent speeches of justification of his changing positions as if the far left will ever accept the rationale. In the end the Tea Party has accomplished step one in it's goals: stop the madness. And, Obama has now turned his focus to the middle ground trying his best to become Bill Clinton. But, there is no equal to Bill Clinton--he truly had managerial experience and talent. He could accept compromise and mean it. Obama can only pretend to accept it. I can only hope he doesn't have a breakdown with both sides punishing him for his lack of competance and leadership. This could be a tough time for our nation--we could be truly leaderless. Brings the days of Jimmy Carter to mind for me.

[Bill McCormick]

GIVE US A BREAK!

These politicians can't get anything done even when they agree. Novemeber 29th--despite agreement between Republican leaders, Democratic leaders and the White House the US Senate, led by Democrats, voted down their agreed on bill to repeal the requirement for employers to report all expenditures of more than $600 required by the Healthcare Bill. This provision of Obamacare was thought by both sides to put an undue paperwork burden on America's small businesses. Americans are getting an incredible look at the inability of their government to function.

Even on the Tax/Unemployemnt compromise we really saw no cooperation or problem solving. We simply saw the two sides both get what they wanted at the expense of the deficit. While extending the tax cuts may avoid putting more negative pressure on the economy, it did nothing to spur economic growth except put the argument off until the 2012 elections. If indeed the tax increase for the top 2% was going to effect the economy then nothing has really been done because no company plans on a two year basis. Another crisis deferred by politicians. They have deferred us into a social security mess, a medicare mess and a debt crisis. It is time to SOLVE problems and stop deferring them.

[Bill McCormick]

Harrycat: You are correct that under Bush Congress spent entirely too much money. However from 2006 until now Congress which controls the spending was under the control of Democrats not GWB. The Perscription drug program was one of the few bipartisan programs to be enacted in a decade sponsored as I recall by Ted Kennedy and Bush. As was no child left behind. As for the wars you can argue that neither needed to be fought. One massive attack followed by drone actions might have provided much the same result. As for arguing which is a "better" war that will be left to historians. All I know is that most of the Democratic leadership supported both of them until it became more politically expedient to go for Afghanistan and then Obama picked that war to justify. Now he is stuck with it while Bush's war in Iraq winds down. It will be nearly impossible to tell how much taking out Saddam has modified the behavior of Iran and North Korea's behavior. Or even that of China. Bush was percieved differently than Obama is in the world. It remains to be seen where that leads us. I don't just blame Democrats but I do blame the Democrats for the housing crisis and the incredible run up of the national debt since 2006. And, I blame the Democrats for the refusal to fix the budget problems of California, New York, Illinois and for the incredible lack of compentancy in running America's large cities where they have had a virtual monopoly on power for more than 25 years (Detroit, Chicago, LA, etc.) And, I blame the Democrats for most of the continuous social policy of tax and spend. I could fill several chapters of a book on the "hidden taxes" Americans pay and American businesses are saddled with while they try to perform and create jobs. As a businessman all my life I have seen my life's work, as do most small business owners, as creating companies that fill a legitimate need in society. The reward for doing so on a long term basis is a decent living, a return on my investment in dollars and time and the enjoyment and satisfaction of watching the people I create jobs for grow and prosper as they and their families move on with the companies when they outgrow my comfortableness and core competancy. I believe that American business if motivated and inspired by minimal government leadership and regulation will create much greater opportunity for Americans than the government can ever provide. Thanks for the commentary--I appreciate your thoughts and your support of Bill's website.

[Harrycat]

Bill M.: Why in the world so you blame Democrats (I am an indy) for spending too much and leave Reps out of the picture. Bush inherited a surplus, blew a chunk on the Medicare Drug Benefit, started two wars (one was entirely a choice), and left the economy in tatters. We will not be able as a nation to have an adult conversation until we come to recognize where we have been and stop characterizing the "other" without ever an inward look.

[Bill McCormick]

By tonight I expect that the first work of Congress after getting the "message" from the people to work on the economy, cut government spending and reduce the deficits will have been completed. And, what will that first effort be? The taxes will remain the same deffering the same fight for a few years and unemployment benefits will be extended another year with no way to pay for them. Net to the people? Another increase in the deficit and further incentive for unemployed people to wait for a better deal to go to work. Last week we had another unemployed person turn down a job of well over $100k a year. Not exactly a job picking crops in the field that we need another illegal to do. I am sympathetic to some unemployment help but not endless benefits or some people just give up becoming part of the cronically unemployed. I also believe many people drawing benefits are actually engaged in internet and/or cash businesses running out the string so to speak. When bill Clinton reduced welfare as many Governors have found out people actually began to take care of themselves. Lesson learned? Evidently not.

[Bill McCormick]

In reality your employer pays for long term care as a part of the Medicare/Medicaide tax. The problem, Harrycat, is that along the way the actuarial stats were not updated and the government stole the funds so they did not get the benefit of compounded interest growth. That is the reason Republicans have suggested from time to time that the social security and Medicare funds be privately invested--so the Congress can't spend them and leave a note in the cookie jar. Of course that idea is like treason to Democrats who have never seen a dollar they don't already have a mandated expense for. They've already comitted our great grandchildrens' tax dollars for.

[bbowen7]

Harrycat: This is probably the most difficult aspect of health care. At the extreme - everybody kept on ventialtors for months - there is no way that society can afford it, yet it is not acceptable to say that life should be terminated, voluntarily or not. In your specific question, I do not favor the government forcing people to buy insurance - or any other product or service.

[Harrycat]

How about one more thought from a very personal point of view. One of the great expenses in the health care system is Medicaid, and one of the big problems regarding Medicaid is end of life care. Nursing homes are very expensive and a large part of Medicaid's problem. We were very lucky to have long-term care insurance, but many (if not most) do not, and expect Medicaid to cover the bill.

What if everyone on reaching a certain age (21?) were required to take out a long-term care insurance policy. The weekly cost wouldn't be all that much and Medicaid could then tend to its other priorities. Any thoughts?

[Harrycat]

Agree with Nona on all points. Great suggestions.
re: Bill M. Way too cynical by far on point 5. If dems got what they really want it would be a national plan for all.

Off point: Listening to McCain rant on Don't Ask Don't Tell reminds me again why I feared for the country if he were elected.

[~ Nona]

Wonderful article.

Other suggestions for reform that would improve the system and do not involve the government include:

1. Allowing a deduction for employed persons' individual health insurance premiums (and making the deduction simpler for the self-employed).

2. Allowing a tax deduction for the value of a medical professional's time treating the indigent.

3. Removing government restrictions on the permissible kinds of supplemental plans.

4. Allowing associations of small businesses to buy group policies for their employees.

5. Allowing fraternal organizations to contract with medical groups for treatment of their members.

6. Limiting tort liability to true negligence.

Of course, one of the elephants in the room is the last: tort reform. Funny how politicians never, never want to touch that one.