Vacation Time...How much do you have?

JLD said:

A public option would not necessarily cost most individuals more. First, it would help reign in the run-away cost of health care as services could be better negotiated. Second, while most Americans would see an increase in taxes, there would be a decrease in overall cost for lots of folks as they wouldn't find themselves paying $1600 a month for health insurance.

Click to expand...

After factoring in all costs, please show me something the government does less expensively than the private sector. How many hundreds of thousands of government employees will need to be hired to administer this program? How many tens of Billions of dollars, per year will this program be able to misplace (not account for) because it's to big and important? We currently have this problem with the recent Pentagon audit. If you think government healthcare is going to be so great, review the current healthcare system the government completely controls. That would be the Veterans Administration healthcare program. The government is doing such a wonderful job with it that Veterans are now allowed to see private sector doctors when they can't be seen in a timely manner. I'm trying to imagine the cost of a new hospital built to federal specifications. The only thing more expensive than private sector healthcare is federal government healthcare with zero financial accountability.

Ted

A couple of thoughts.....

If only we could reduce the average cost of healthcare to $7000 or $8000 per person, think how much further what employers contribute would go and how much closer we would be to affordable healthcare. Now, if we could hit Canada's number and reduce our cost from $10,224 to $4,826, just imagine.

Medicare provides better coverage to a more aged and sick group of people for the same price (government and individual cost) as other plans providing far less and covering a healthier, younger group. That's even with fraud and abuse that takes place. Yes, the government does it better than private insurance. But then the government doesn't have to turn a profit.

One key difference in the US System vs others is the extent of Capitalism. There is profit built in for the drug maker, drug distributor, drug retailer, doctor's group, doctor, hospital company, hospital, doctors groups in hospital, emergency room group, ambulance services, insurance companies, equipment manufacturers, equipment distributors. We aren't truly talking "cost" but we're talking "price" for the services. The actual cost probably isn't all that much higher than other countries, maybe 40-50% instead of 110%, but the actual cost is buried very deep in the picture and is unknown to any of us.

A link between vacation time and medical costs. Our lack of leisure time definitely contributes to our health problems. So, lack of vacation increases average medical costs. How much, I can't quantify, but it's the major difference that can explain why we're less healthy than other countries.

Yes, I can afford it, but many can’t, and that’s a big problem.

And your “I’ve got mine so screw everyone else” credo greatly annoys me, and it’s bad for our country.

Merry Christmas!

BandB, following your logic, why doesn't the government take over all aspects of food and remove all profit from growing and distribution. If we could eliminate all the profit we could lower the consumer costs 25 to maybe 50%. Just think how much healthier people would eat and we could eliminate all forms of hunger and malnutrition in our country. While I'm glad my step grandchildren had a wonderful Christmas today, I don't believe in Santa Claus, the Easter Bunny or reduced costs through government efficiency.

While we're at it, make all forms of insurance government run and not for profit. After all, the national flood insurance program seems to be so financially sound.

Ted

Vacation time.

O C Diver said:

First, I don't have the answer.

The part of what you wrote that annoys me is that apparently you can afford it, but you feel somebody else should be paying part of your cost in the the form of what they pay in taxes. It annoys me that I pay a lot in taxes and healthcare is expensive because a significant portion of people in the USA pay little or nothing for healthcare.

While it's often pointed out that the Canadian system is cheaper as a healthcare cost, one needs to look at how few in Canada get a free ride. Also, the other number that's quite telling is the taxes paid by the bottom 50% in that counrty (much higher than in the USA).

Ted

Click to expand...

well don't know about Canada but in the U.K. The normal tax rate is about on a par with here in the USA but as they pay a lot less for drugs etc and don't pay for medical insurance (unless they want get private healthcare) then the gross cost is much less.

cardude01 said:

Yes, I can afford it, but many can’t, and that’s a big problem.

And your “I’ve got mine so screw everyone else” credo greatly annoys me, and it’s bad for our country.

Merry Christmas!

Click to expand...

Please be so kind as to show me where I said or even implied that.

I want affordable healthcare for everyone. Unfortunately, when 35% of the population below 65 (Medicare threshold) don't participate in private insurance, a substantial amount of the costs of public healthcare and the uninsured, get built into the private sector costs. When the uninsured and underinsured don't pay we all bare those cost whether in insurance premiums or taxes.

Ted

yamabuki said:

well don't know about Canada but in the U.K. The normal tax rate is about on a par with here in the USA but as they pay a lot less for drugs etc and don't pay for medical insurance (unless they want get private healthcare) then the gross cost is much less.

Click to expand...

On average, what percentage of their income do the bottom 50% pay in taxes in the UK? Think you will find that number much higher than in the USA. The money comes from somewhere.

Ted

O C Diver said:

BandB, following your logic, why doesn't the government take over all aspects of food and remove all profit from growing and distribution. If we could eliminate all the profit we could lower the consumer costs 25 to maybe 50%. Just think how much healthier people would eat and we could eliminate all forms of hunger and malnutrition in our country. While I'm glad my step grandchildren had a wonderful Christmas today, I don't believe in Santa Claus, the Easter Bunny or reduced costs through government efficiency.

Click to expand...

Healthcare is quite different from food. With food, the middlemen do add value. There's a value of packaging and distributing to stores and then a value of the retail store making it available. Each of those intermediaries also gets a relatively small profit percentage.

In healthcare, the insurer's profits and their high overhead add no real value. The profits of the pharmaceuticals are far more than anyone in the food chain.

I never said the government should run healthcare, just that they do so at a lower cost than the alternatives do today and that we do need to figure out a way to reduce what we're paying for healthcare. Medicare doesn't eliminate insurance companies but gives them different roles.

Ted: I believe there is a lot of misinformation peddled by the lobbyists and self interests in the US about the evils of the Canadian health care system, so be careful of your sources of information in that subject. Certainly I’m aware of no one up here facing bankruptcy, because they are facing a “holy $h!t” health care cost because of some uninsured illness. And I don’t find the taxes I pay up here especially burdensome. A bigger issue by far up here is the very high cost of housing in many communities, Vancouver, Toronto for examples. That’s another topic altogether!

As for the inefficiencies in government healthcare, you at least get rid of the middleman insurers who serve no useful purpose in a public health care plan.

Jim

JDCAVE said:

Ted: I believe there is a lot of misinformation peddled by the lobbyists and self interests in the US about the evils of the Canadian health care system, so be careful of your sources of information in that subject. Certainly I’m aware of no one up here facing bankruptcy, because they are facing a “holy $h!t” health care cost because of some uninsured illness. And I don’t find the taxes I pay up here especially burdensome. A bigger issue by far up here is the very high cost of housing in many communities, Vancouver, Toronto for examples. That’s another topic altogether!

As for the inefficiencies in government healthcare, you at least get rid of the middleman insurers who serve no useful purpose in a public health care plan.

Jim

Click to expand...

I had a long talk with a former Canadian businessman over several days who was trying to bring me around to his way of thinking on the Canadian healthcare system. Some interesting points came out. Please correct me on any points that are incorrect.

The Canadian system only covers their citizens. Foreigners pay fee for service.
Canada doesn't have 35% of its population paying little or nothing for their coverage.
The Bottom 50% of Canadians essentially pay little or no income tax.

The point that was being made is that the tax rate in Canada isn't excessive, but it's my understanding that the bottom 50% do pay taxes. Secondly, Canada's healthcare isn't being overwhelmed by illegals and the lower income citizens who aren't contributing.

Ted

BandB said:

Healthcare is quite different from food. With food, the middlemen do add value. There's a value of packaging and distributing to stores and then a value of the retail store making it available. Each of those intermediaries also gets a relatively small profit percentage.

In healthcare, the insurer's profits and their high overhead add no real value. The profits of the pharmaceuticals are far more than anyone in the food chain.

I never said the government should run healthcare, just that they do so at a lower cost than the alternatives do today and that we do need to figure out a way to reduce what we're paying for healthcare. Medicare doesn't eliminate insurance companies but gives them different roles.

Click to expand...

A large part of the increase in healthcare costs has to do with government mandates as opposed to letting the paying consumer choose what they want. Back before the government interfered, my exwife and I could purchase health insurance without pregnancy coverage for about 2/3 of the cost of coverage including pregnancy coverage. My wife and I at age 60 don't need pregnancy coverage. But because this coverage mandated by the government, I have to have it and pay for it. Same thing is true for smoking cigarettes. We use to buy health insurance where a company accessed your potential cost to the company based on lifestyle choices, and charged you accordingly. Now we have healthcare without incentives to improve your lifestyle. It should be no surprise that we consume a lot more healthcare, and we're in much worse shape on average. What we have now is shared cost healthcare without the incentives to live a healthier lifestyle to lower our insurance costs.

The government has zero interest in lowering healthcare costs. If they did they would start with simple things like like taxing cigarettes at $20 a pack so that only the rich could afford to get lung cancer. They would limit the saturated fat and salt contents in food. While it may not be cause and effect, in the last 50 years, the more that government has changed health insurance into healthcare, the worse the health of the average American seems to be.

Ted

Ted, you're mixing healthcare costs and the costs of health insurance. Two entirely separate things. Healthcare costs are what I compared in one post and for them it doesn't matter who is paying or how. You can look procedure by procedure and it's more expensive in the US. You can look at medications and they're more expensive. The cost of insurance is another issue, but the biggest issue is that healthcare itself is so costly. Now, many factors contribute to the high healthcare costs and it's not something I want to debate here, just leave it at the fact they're high and with employers covering a portion, that's fringe benefit money that limits the amount employers can spend on other things. Simply, compared to other countries, we spend more on healthcare and we have less time off. The work routines certainly contribute to the healthcare costs and the levels of heart attacks, strokes, and other major illnesses as we don't take care of ourselves mentally and physically.

Many employers are abusive and take advantage of employees who feel they have no choice. They have policies and practices regarding work time and vacation that would be illegal in many places. There is no other major country that doesn't even require employees be given any vacation or holidays.

SeaMoose said:

IMHO the problem in the US is not the cost of healthcare, it is the lack of transparency in provider pricing. Much of this occurred because of well intentioned regulations that resulted in unintended consequences.

Imagine if you went to get your car fixed and they refused to give you a quote until after the car was fixed? That’s exactly how healthcare works!

Click to expand...

I don’t necessarily disagree with you but...

A patient can come in to my office and say “My vision is blurred. How much will it cost for me to see clearly?”. That is an impossible question to answer. We can tell them how much an exam will be, and that will take care of many problems, but if the problem isn’t something that can be diagnosed and dealt with in that exam, then we have no idea how much it will cost the patient to even find the proper diagnosis. Here in the US their is added confusion between vision plans and medical plans. Vision plans only cover routine, refractive exams. Non-routine medical eye exams aren’t covered by the vision plan but by the medical plans. Their deductibles are likely different between the two plans.

BandB said:

Our vacation policy....now we actually don't separate vacation from holidays from sick and personal. We only grant Paid Time Off. Even sick time up to 3 days illness or injury counts against PTO. Greater than 3 days is "Disability" and requires those documents.

Click to expand...

As a small employer we do not have a generous vacation policy. 3 weeks is the max that an employee can earn in addition to the 6 or so Holiday vacation days. We also have given 6 days of sick leave to each employee that was front loaded at the their hire date.

We had been considering changing to a PTO system whereby the employee could use the PTO for either vacation or illness/emergency. Washington State has a new law that went into effect this year that mandates an accrual system for sick leave as well as allowing employees to carry over up to 40 hours from one year to the next. Due to the hassles of meeting the state requirements, we have given up the idea of moving to a PTO system.

I have three types of employees. 1) Those that show up to work unless they are sick, 2) Those that show up for work unless they are dead, 3) Those that magically are sick the same number of days that they have sick time. I really, really despise the 3rd type. Generally, they don’t last as long as the other two types and it never is related to their sick time usage.

JLD said:

A public option would not necessarily cost most individuals more. First, it would help reign in the run-away cost of health care as services could be better negotiated. Second, while most Americans would see an increase in taxes, there would be a decrease in overall cost for lots of folks as they wouldn't find themselves paying $1600 a month for health insurance.

Click to expand...

The biggest advantage problem I see with the US system (remember that I earn my living in that system) is that it is inefficient. The last time I looked in Washington State, private insurance companies had higher overhead than Medicaid. This means that more of the health care dollar actually goes to providing health care through the public system than the private system.

In addition, there are a lot of inefficiencies that occur at the clinic and hospital level. It takes a lot of staff and time to negotiate the various insurance companies that we have to deal with. If we only had to deal with one insurance program, I could reduce my employees by 25%. As with most service oriented businesses, employee costs are a HUGE portion of my overhead. Reducing that by 25% would mean I could reduce my fees accordingly. It is no coincidence that we offer a time of service discount of 20% (ie they pay when they are in the office instead of us having to bill anyone).

Finally, since every insurance payer uses a different set of rules for determining what is covered, when it is covered, and for what conditions, it means that often appropriate care is delayed while we figure out what will be covered.

So far, none of the proposals in the US that I’ve seen (including the ACA) address these three problems. Unfortunately, the insurance lobby is so influential that very few in Congress are willing to address them. Instead we are given platitudes based on dogma.

O C Diver said:

After factoring in all costs, please show me something the government does less expensively than the private sector. How many hundreds of thousands of government employees will need to be hired to administer this program? How many tens of Billions of dollars, per year will this program be able to misplace (not account for) because it's to big and important? We currently have this problem with the recent Pentagon audit. If you think government healthcare is going to be so great, review the current healthcare system the government completely controls. That would be the Veterans Administration healthcare program. The government is doing such a wonderful job with it that Veterans are now allowed to see private sector doctors when they can't be seen in a timely manner. I'm trying to imagine the cost of a new hospital built to federal specifications. The only thing more expensive than private sector healthcare is federal government healthcare with zero financial accountability.

Click to expand...

The last time I looked at it, I think that the Federal Government pays for over 40% of the health care in the US. The VA is one system, the military is another system. Add to that all the federal employees with health insurance as well as Medicare and the non-state portion of Medicaid. That is just what the feds are paying for. If you add in what state and local governments are paying for, the total amount of health care that is paid for by government is around 70%.

Yeah, the VA has problems because they are a very large organization. In my region we have Boing, Microsoft, Weyerhaeuser, and Google to just name a few large private corporations. Because of this, I know lots of folks that work for those companies. My son is a financial analyst who has worked for IBM and American Airlines, two very large corporations. I can tell you with complete certainty, that they have as many inefficiencies as equally large public organizations. FWIW, the VA generally provides outstanding healthcare to a high risk population.

We all know that there are economies of scale. However, when an organization gets too large they can become less efficient. As such, I don’t think that a UK type national health service would be the best for the US. We are simply too big. However, a single payer system would work. Rather than multiple insurance companies with a multitude of plans, we could have a single plan to cover everyone. Providers and hospitals would still be competing in the marketplace to attract patients.

I was a consultant for a while for the WA state Medicaid program. I was astonished to discover that the private insurers spent twice as much administering their plans as the state of WA spent administering Medicaid. This was before the advent of the ACA.

O C Diver said:

While I'm glad my step grandchildren had a wonderful Christmas today, I don't believe in Santa Claus, the Easter Bunny or reduced costs through government efficiency.

Click to expand...

I think that may be part of the problem we face. When looking at such issues we rely on our “belief”. Belief certainly is important when asking what is the meaning of Christmas or Easter, but has little place when it comes to public policy.

O C Diver said:

I want affordable healthcare for everyone. Unfortunately, when 35% of the population below 65 (Medicare threshold) don't participate in private insurance, a substantial amount of the costs of public healthcare and the uninsured, get built into the private sector costs. When the uninsured and underinsured don't pay we all bare those cost whether in insurance premiums or taxes.

Ted

Click to expand...

I agree with you. I don’t view healthcare as a “right”. However, I don’t want to live in a community where my fellows can’t get access to healthcare. Because of this, I’d really like some form of universal health care. Figuring out how to actually do it is the hard part.

Two other ways where the uninsured and underinsured costs us are the unreimbursed care that is provided by providers and hospitals. I try to not end up with patients owing me money. However, it happens. Sometimes when that happens, I never get paid. The cost of that unpaid care is inevitably passed on me, my employees, my patients, my patients insurance companies, and eventually onto their employers and governmental payers.

The other place is costs us all is in medical bankruptcy. If someone goes bankrupt because of medical bills, a lot of folks never get paid. We pay for those trickle down costs as well.

O C Diver said:

The government has zero interest in lowering healthcare costs. If they did they would start with simple things like like taxing cigarettes at $20 a pack so that only the rich could afford to get lung cancer. They would limit the saturated fat and salt contents in food. While it may not be cause and effect, in the last 50 years, the more that government has changed health insurance into healthcare, the worse the health of the average American seems to be.

Click to expand...

Federal and State government agencies have a huge interest in lowering healthcare costs. Medicare has been a leader in this area. Many of the initiatives that CMS has undertaken over the past 30 years have been adopted by private insurers because they provide good ways to control costs.

Your equating that with taxing cigarettes is actually silly when you think about it. It is us, not “they” that approve taxes. If we as voters wanted to tax cigarettes at $20 a pack, we could do it. There hasn’t been the political will to do it. In other words we (collectively) don’t want to.

Mortality and morbidity rates have dropped over the past 50 years. I think that lost work days due to illness have decreased. Interestingly, self-reported healthy days has decrease over the past 30 years. It seems we are living longer, are healthier, have less disability, fewer overnight hospitals stays, but we think are we less healthy than folks thought in the past.

Back to the vacation hours....

So I work for a municipal government as a first responder. We work 24 hour shifts and a 56 hour work week of straight time. There are no holidays off per se.

With my time on, I get 17 shifts off per year. That includes the “holidays” we don’t get, vacation, sick, and personal time. We have one bank of PTO we call AL (annual leave.)

However, because of the way the rotating shift schedule works out, I get two “weekends” every 28 day cycle, one is four days, the other is six days.

The boat is about 10 minutes away from the house, and we’re about 4 hours cruise away from the Channel Islands, so we tend to spend a lot of time there. The wife is a teacher, so she has the summer off, and weekends during the fall.

Unfortunately the late summer and fall is our busy time at work, and I’ve been deployed over 45 days during the season each of the last two years. That really cuts into the cruising time. But we still manage to run island trips, and we do a two week multi-family trip to Catalina every year.

However, the real perk to my job is the ability to trade shifts without restriction. So we’re leaving at the end of January to cruise the sea of Cortez for half a season, and I’ve already banked four of the six months off. It’s not really vacation, as I’ve already worked those hours. My wife has taken the time off as an unpaid leave, as they wouldn’t let her use the time off she’s accrued over a 25 year career.

I spent over a decade in IT before I changed careers. With one exception, everyone in my office thought I was insane for taking a huge pay cut and changing jobs to follow a childhood dream. It was a rough first few years, but it was the second best choice I’ve ever made (behind marrying my wife, definitely married up.)

Josh

questionmark said:

Back to the vacation hours....

So I work for a municipal government as a first responder. We work 24 hour shifts and a 56 hour work week of straight time. There are no holidays off per se.

Click to expand...

Could you elaborate a bit on the 24 hour shifts totaling 56 hours?

BandB said:

Could you elaborate a bit on the 24 hour shifts totaling 56 hours?

Click to expand...

Sure. We work on a 28 day cycle (actually a 24 but they crib it a bit to make 28) instead of a standard 7 day work week. We work one out of every three days, 24 hour shifts. So if you were to average it out it’s 8 hours per day average, so 56 hours in the normal 7 day week. Some weeks we work 96 hours, some less, just depends on how the shifts fall. Our payroll department has a “salary adjustment” line item to keep the paychecks even, adding and subtracting (deferring really) hours from one paycheck to the next to make it all work out.

We’re on a different schedule, but lots of departments run a “48/96” style commuter schedule where they work a repeating pattern of two days on, four days off. That’s probably the easiest example. In that one, taking two shifts off (48 hours) gets you ten days off, and 4 shifts off gets you 16 days off. So burning 96 hours of leave is basically two weeks plus, which is similar to a 40 hour work week vacation.

The cool part is that we can trade shifts amongst ourselves. So every month for almost the last year I’ve worked a minimum 4 shifts (96 extra hours) for other people and lined them up for this coming year as days they will work for me. I haven’t run the actual numbers, but with the exception of August when we cruised Catalina, I’ve been averaging way over 100 hours per week worked.

Josh

Obviously you know what you are talking about but if we didn't pay our California hourly employees for every hour they work in a week as well as overtime for work over 8 hours in a day and 40 hours in a week we would be descended upon by Dept. of Labor types. Defer hours from one week to the next? Not going to happen for long. Maybe it is the type of municipal/on call shift work you are involved with but I have never heard of anything like what you describe anywhere much less California.

In the UK they have “managed care”. This means that if the government decides you are too old, you don’t get the care. Are you sure this is what you want?

A single fraud case in Medicare a while back cost the government as much as all the private insurance premiums paid for that year. So sure, they can manage it, right?

Each procedure you get has a code, either an ICD or DRG9. How much does it cost? Exactly what the health insurance company will pay. This, in theory, would drive costs to the minimum. But it doesn’t work, because both the health insurance companies and the providers are in cahoots, plus they bribe, er, contribute to the politicians to write the rules in their favor. Then, along came the ACA, which was the biggest bribe paid to the insurance companies by the politicians probably in the history of mankind. Don’t believe it? After the ACA insurance profits skyrocketed.

You’re being sold a bill of goods.... That’s how the system works...

firstbase said:

Obviously you know what you are talking about but if we didn't pay our California hourly employees for every hour they work in a week as well as overtime for work over 8 hours in a day and 40 hours in a week we would be descended upon by Dept. of Labor types. Defer hours from one week to the next? Not going to happen for long. Maybe it is the type of municipal/on call shift work you are involved with but I have never heard of anything like what you describe anywhere much less California.

Click to expand...

Nearly all Firefighters/EMS work this way. 24 hours on duty then 48 off or 48 hours on duty then 96 off.

Yes, I am aware of the work schedules, it is the manner of pay that throws me off.

firstbase said:

Yes, I am aware of the work schedules, it is the manner of pay that throws me off.

Click to expand...

There are specific exceptions that allow for such pay. They're technically not considered to be "working" all 24 hours as they are allowed to eat, sleep, relax. They just have to be on sight and ready and perform some work duties during the day. It's an acceptable industry norm.

There are many wage and hour law exceptions for specific groups. One that is used most widely is "seasonal."

California exempts all government employees.

Here's a list of the California exemptions.

https://www.dir.ca.gov/dlse/faq_overtimeexemptions.htm

BandB said:

There are specific exceptions that allow for such pay. They're technically not considered to be "working" all 24 hours as they are allowed to eat, sleep, relax. They just have to be on sight and ready and perform some work duties during the day. It's an acceptable industry norm.



There are many wage and hour law exceptions for specific groups. One that is used most widely is "seasonal."



California exempts all government employees.



Here's a list of the California exemptions.



https://www.dir.ca.gov/dlse/faq_overtimeexemptions.htm

Click to expand...

The FLSA law that governs things like OT pay has a special exemption for public safety, in that overtime pay doesn’t start until after 53 hours per week (for fire) have been worked. It’s sometimes referred to as the 7(k) exemption after the section in the FLSA law. It’s actually listed as 212 hours worked in a 28 day period for fire, and 171 hours for police.

questionmark said:

The FLSA law that governs things like OT pay has a special exemption for public safety, in that overtime pay doesn’t start until after 53 hours per week (for fire) have been worked. It’s sometimes referred to as the 7(k) exemption after the section in the FLSA law. It’s actually listed as 212 hours worked in a 28 day period for fire, and 171 hours for police.

Click to expand...

Yes, I was addressing the California exemptions and you've hit on the Federal ones.

Vacation time

SeaMoose said:

In the UK they have “managed care”. This means that if the government decides you are too old, you don’t get the care. Are you sure this is what you want?

A single fraud case in Medicare a while back cost the government as much as all the private insurance premiums paid for that year. So sure, they can manage it, right?

Each procedure you get has a code, either an ICD or DRG9. How much does it cost? Exactly what the health insurance company will pay. This, in theory, would drive costs to the minimum. But it doesn’t work, because both the health insurance companies and the providers are in cahoots, plus they bribe, er, contribute to the politicians to write the rules in their favor. Then, along came the ACA, which was the biggest bribe paid to the insurance companies by the politicians probably in the history of mankind. Don’t believe it? After the ACA insurance profits skyrocketed.

You’re being sold a bill of goods.... That’s how the system works...

Click to expand...

Where do you get your info about the U.K. System, Fox News.
The U.K. Government do not make those kind of decisions about patient care the hospitals and doctors do. If there is a need to share resources and I have an ingrowing toe nail and you need a transplant should I go first ? And if I have to wait a while it's better than having no possibility of health care like a lot of people here in the US. Please just get on your computer and get the truth about how health care works elsewhere.