patrick.net

Crap? I don't agree with you there...

I did not like Bush at all. He did not lead with true conservative principles. He was a hypocrite too.

Trust me, the government taking over health care is NOT the answer you want. The government does not need more power, but less!

I pray this whole heath care agenda goes down a flames and fails miserably.

One thing is for sure, the current system isn't working. Too many uninsured people and companies rewarding staff for denials. It's not a bipartisan issue. It's a human issue.

I want a health care system run by Walmart & Haliburton... oh wait!

The current system is broke, but it will more then just a government sponsored health insurance to make it work. Regulation of the insurance industry, tort reform to cut down on malpractice lawsuits, etc. Japan has a pretty good system (not perfect) that we can model after. I think minimal coverage for life threatening and crippling diseases should be mandatory for everyone. My parents would've been over a million dollars in debt if there wasn't medicare to cover my family's triple whammy bouts of cancer. (my dad's insurance ran out because he couldn't work after the first... so don't think you are safe with your company health insurance)

Please explain to me how it is better to be paying twice as much per capita as canada despite having virtually identical levels of care by any metric.

"Government run" healthcare is a bullshit boogeyman. Switzerland has a far freer market economy than the US does, and they have universal coverage (via mandatory insurance with a very inexpensive government-backed option). In Canada, almost all hospitals are privately run, and the government simply acts as an insurer.

The government isn't going to 'run' anything under ANY proposed plan -- not even the ones proposed by the biggest of the big government lovers.

The root cause of the cost of health care in the United States today is insurance companies. Between deductibles, co-pays, and monthly premiums, the average American pays nearly double what the average Canadian pays in taxes to finance health care.

I have extremely good health insurance -- one of the best plans available, period. I still wound up paying almost $3000 when my son was born, and I get some piece of mail almost every single day with some random charge from a specialist or whomever. I spend several hours every single week just making sure that all the bills have been paid. When my wife needed an epidural, they made me pay over $2000 and I had to wait 3 months to get reimbursed for it.

Whenever ANYONE gets sick, they have to go the emergency room. The emergency room! For the flu! This is insane! Many hospitals don't even have "emergency" rooms anymore. We have people dying in the 'emergency' rooms because there is a 4 hour wait to see a doctor because 30 random people have the flu and can't see a regular doctor.

Small businesses can't attract decent talent to come work for them because they can't afford to pay upwards of $1000 a month per employee for the insurance. It costs the average small business owner over 25% more to employ someone as it does a big business -- and more than even the most pessimistic estimates of what it costs the government to do so.

More than half of the health care in this country is ALREADY being paid for by taxes, but it's being done in such a convoluted and broken way that we're actually spending more to cover half of the population than it would take the Canadian system to cover 100% of our population.

No system is perfect, but our current system isn't even in the running.

To anyone who actually thinks that the current system is 'good' -- why? Have you ever actually been significantly ill? Have you ever had a child, or a sick parent?

Can we PLEASE stop pretending like anyone is proposing to have 'some bureaucrat' deciding on your medical care? That just DOES NOT HAPPEN in ANY modern medical system. It doesn't happen in Canada, it doesn't happen in Switzerland, it doesn't happen in the UK, it doesn't happen in Germany, it doesn't happen in France, it doesn't happen in Japan, and it doesn't happen in Australia. Every single one of these countries pays less money per capita, and less money as a percentage of GDP than the United States of America.

You people arguing for the status quo don't even realize that you're just being used by Insurance companies and HMOs.

Also, lets drop the lie about 'competition' in health care. THERE IS NO COMPETITION! The only competition that exists is between the unnecessary insurance companies. Hospitals don't compete at all -- people go to whatever is nearest, because when you have a knife sticking out of your skull the last thing on your mind is whether you might save a few bucks across town.

By the way -- the title of the article is also pure bullshit. Government-provided health insurance isn't anything CLOSE to government-run health care.

To reiterate:

- The government isn't going to own the hospitals (the same companies and charities will continue to)
- The doctors won't work for the government (they'll work for the hospitals, clinics or private practices)
- The nurses won't work for the government (ditto)
- The hospital administrators won't work for the government (ditto)
- Nobody who is an employee of the government will at any point in time tell you how your condition will be treated (your medical professionals will)

The only difference that anyone is proposing is that we change how the bills get paid, and the majority of the proposals today barely even do that.

America can NOT afford to continue spending more than twice as much per capita on health coverage as every other developed nation. We're flat-ass broke!

Very good points, Kevin.
My only issue is comparing Switzerland, Canada, and Japan to the US relative to health care. These 3 nations do not have large populations of overweight individuals nor large numbers of foreign nationals who have entered the country illegally and who would access gov't-provided health care with the blessing from politicians and organizations interested in votes, contributions, and funding from sympathetic sources.
In Canada and other commonwealth nations, only those who are in the country legally, and visitors such as on a visa, can access gov't health care. This is how they are able to provide healthcare for the citizenry without it being a fiscal burden.
~Misstrial

"Your republicans had complete control over Washington, and had their chance to make everything work perfectly and let the free market reign supreme with no government interference. How’d that work out, by the way?"

Actually regarding the housing mess, the GOP wanted to put in regulations and SEC audit review on GSE but the Dems blocked it. Look at how the Dems are going after the regulators.

http://www.youtube.com/watch?v=_MGT_cSi7Rs

I do agree that the insurers are the biggest part of the problem. Jon Stewart made a great point about healthcare - both sides have those who disagree about government-run/sponsored healthcare, but the people voting have the best coverage available in this country.

The only thing that makes sense to me is Catastrophic Insurance which should be run by the government.

The rest of it is bogus. Most routine stuff done in Western Medicine does more harm than good. The drug lobby has a good grip on us and EVERY drug has side effects making most of them toxic in the long run. The longer term healing effects of homeopathy and chiropractic, naturopathy etc. are ignored these days, but will emerge as the stuff that helps people the most.

I am employed in Western Medicine, but my longstanding chest pain, insomnia, high blood pressure, etc. have been resolved by Alternative Medicine.

Screw the Japanese system. It's headed for insolvency. If you want to model a universal health care system, model the Singapore one. They provide better care and spend half of what the Japanese do. The US Government alone spends more money per person than the Japanese Government on health care. The US Government already runs our health care system. There is no free market in health care. I'd say the US Government has an awful track record. And a single payer system is a god awful idea. Not only is it highly flawed from a practical standpoint, you don't give the US government a trillion dollar cash cow to borrow from.

Singapore requires citizens to save money in private accounts for their health care from their paycheck. They have the option of obtaining government health care or a competing private industry health care. Government health care has extensive copays to prevent waste. Everyone is covered 100% if they want to be. They have the option for pursuing additional private insurance. They also provide 100% coverage for catastrophic care for the government side. Private physicians are required to publish their prices. And for the flat out broke people who don't even have a job, the government provides them with a safety net from the government. Bottom line, the patient has complete freedom to choose the doctor they want. Market forces prevent abuse of the system that is commonly seen in single payer systems. Each citizen is in direct control of how their money is spent rather than some jackass in the government.

All the proponents of universal health care like to cite infant mortality rates and percentage of GDP. Well, Singapore is the lowest in both. But you won't hear anyone in Washington promote this type of system. They stand to make no money from it and it doesn't involve some totalitarian government run health organization. Oh yeah, and it would put an end to those big political contributions they get from these giant HMOs that they've been subsidizing for 40 years.

Some Guy said - "Oh, I see. It works o.k. for you, therefore everything’s fine. **** the millions of people who can’t afford health insurance, right?"
No, there are answers to help people get affordable health insurance, it's just not down the road of a true nationalized / public system. There are other ways to create opportunities for cheaper coverage other than this. Those currently in power just need to be willing to be reasonable and truly consider other options instead of pushing a public model that would drastically change things for everyone. And why is it that it has to be done yesterday... fast, fast, fast (like everything else recently)? Is it not worth some serious time and contemplation to make sure we don't make a huge mistake? How was it they are saying we will pay for this? That's another pandora's box...

What people need to understand is that the President is not being completely honest in his press conferences. He states that you can keep your private insurance if you want. Here's why that isn't going to work, at least not for long.

Suppose your employer realizes that the government's plan will be "good enough" for their employees. They soon realize that they can save money by scrapping the portion of the premium that they pay for private insurance. They will simply say we are no longer providing any private insurance and employees should now use the government plan. I see no reason why any corporation would not go this route.

This would lead to a slow death spiral for private insurers. The government can out-muscle any private company when it has the power to tax. And that is why I find the President's chiding of the reporter yesterday so disgusting. Either he thinks we're incredibly stupid or he really doesn't understand the consequences of a public health plan - how it will drive private health insurers out of business.

Personal note: listening to the disdain and the sarcasm in his comments, it is clear that he has no love for free markets whatsoever. I guess that can be expected from a lifelong academic and government figure.

I lived in Scotland and England for a while and found the National Health Service to be wonderful. I want public health care as does most people I know. I am sick and tired of being a slave to insurance companies and my employers for coverage. When I was laid off I was totally screwed if I had to pay my own health insurance. $1800 a month unemployment check, one third going to taxes, another third going to a health insurance premium!!
We have so much LESS freedom here in America as slaves to insurance companies. Everything I do I have to consider it. Go back to school? Take time off? Change jobs? Always a consideration is the hundreds a month I will have to spend on insurance.
And it makes our companies less able to compete as well, and the insurance companies gouge employers.
We are supposed to be the greatest country in the world, yet so many excuses as to why every other Western Nation can have public or universal coverage by we CANT? What a joke.

I lived in Scotland and England for a while and found the National Health Service to be wonderful. I want public health care as does most people I know. I am sick and tired of being a slave to insurance companies and my employers for coverage. When I was laid off I was totally screwed if I had to pay my own health insurance. $1800 a month unemployment check, one third going to taxes, another third going to a health insurance premium!!

We have so much LESS freedom here in America as slaves to insurance companies. Everything I do I have to consider it. Go back to school? Take time off? Change jobs? Always a consideration is the hundreds a month I will have to spend on insurance.

And it makes our companies less able to compete as well, and the insurance companies gouge employers.

We are supposed to be the greatest country in the world, yet so many excuses as to why every other Western Nation can have public or universal coverage by we CANT? What a joke.

Just curious... how old are you? Do you have any serious medical issues or are you in good health? The young and healthy generally do not have a problem with their experiences in a nationalized system (they don't cost the government very much to take care of).

<blockquote>
Just curious… how old are you? Do you have any serious medical issues or are you in good health? The young and healthy generally do not have a problem with their experiences in a nationalized system (they don’t cost the government very much to take care of).
</blockquote>
I am 39 years old. Half my family lives in England, as do many of my friends. I have had grandparents live into their 90s in England, and they have enjoyed MUCH better elderly care than any grandparents that lived here. One of my best friends has had 4 children in the last 10 years, enjoying the best pre-natal care, and choices for birth people in the US could only dream about. I was there for the birth of one of her children, she was set up for a home birth, but when it turned out she needed to go to the hospital I witnessed a care and kindness you would never find here (with the exception of the extremely rich who can pay for individualized care). I also know of people who when faced with the care and cost here in the US, chose to retire back in England. My husband holds a British passport, and we are considering it if things do not change.

Pre-conditions...

My gf lost her job (as well as her health care). After a month or so of no coverage (while figuring out her finances), she started paying the ~$250/month for health insurance. Apparently birth control is no longer covered since she was on it when she started health insurance back up.

I don't know the details of any of the proposed government based plans (similar to the rest of the ignorant majority), but the way things are now sucks.

Kevin,

your insurance plan must not be group PPO.

If you have the so-called best group PPO plan, you wouldn't be paying $3000 at all. You also don't need to deal with reimbursement, the insurance company deals with it all. Even when I go out of network, the doctor's office handles that for me, billing insurance first then me.

At today's inflated rate of around $35000 (best hospital and best doctors) for child birth, your insurance contract rate is about 30-40% of that, and the max you need to pay out of pocket will only be $1000 or so (10% co-pay for group PPO).

I want public healthcare because that decreases the rate of private healthcare. If you have ever lived or traveled to countries with co-existing systems, you will understand.

I do not plan to use the public hospital at all. But because of the existence of public hospital and public doctors which will take care of lots of patients, the private system is suddenly facing far less demand, which causes the private system to collapse in price, which is what I want.

Then, the insurance premium for the "gap" between the public and private becomes very low. I will pay the gap and use the private system.

Many big companies in countries with co-existing systems provide "gap" insurances as a part of the benefit package. Even if they don't the gap insurance is very affordable. So the fear of losing private insurance is ungrounded. I would rather buy my own gap insurance than being chained to my employer, which will definitely let me go if I have cancer or something, meaning that my premium employer medical insurance is really not useful at all in such situations.

As someone who grew up in Canada but now lives in the United States, I just wanted to add my two cents.

To begin with, let me start by playing devil's advocate: the Canadian health care system is by no means perfect. There is not a Canadian that would disagree with that notion. The system is bloated, expensive and has long waits associated with it for treatment of various diseases, like cancer. Primary care physicians like my brother generally have to work long hours since the system is entirely free which encourages every hypochondriac mother to bring their little angel to the doctor anytime they have the sniffles. And naturally, being that it is a government run entity, it is going to be inefficient.

That being said, as someone who lives in the USA now, I would take the Canadian health care system over the US version any day of the week and twice on Sunday.
The US system has even more drawbacks than the Canadian one. It is just as bloated and beuracratic. But what is fascinating is that even though it is not government run, it is EXTREMELY inefficient and un-necessarily complex.

Choosing a primary care physician requires one to scan through a list of 'available providers' which may or may not include all doctors in a given area. Also, with my insurance carrier, Aetna, their designations of what type of plan one has (PPO, HMO, etc) generally have confusing terminilogy and its difficult to determine if your plan matches the physician you are currently looking at. I AM JUST TRYING TO FIND A FRIGGEN DOCTOR, NOT DESIGN A FUSION REACTOR!

Now here is the ultimate rub with the current health care system: those that are uninsured merely just go to the ER anytime they have problems. This creates a MASSIVE backlog in the ER and reduces the necessary service and critical required for the patients that actually have life threatening issues. And furthermore, who do you think has to absorb the costs of the uninsured? THE TAX PAYER! So in the current system, not only do I have to pay into my company's insurance plan, I have to pay taxes to cover the additional insurance needed for those that get service for free. So I am, in fact, paying double. Explain to me HOW that makes sense?

Now I am not going to degenerate this conversation into a democratic versus republican thing. The fault for the problem lies on both sides. In fact, I would say the fault is MORE on the democratic side strictly from the standpoint that at least the republicans are champions of the private system while the democrats are SUPPOSED to be the champions of the public system. Yet now, even with an extremely popular democratic president and a majority control of the congress and senate, these idiots STILL can't come to a consensus on the new plan because they are all in the back pockets of the lobbyists from Metlife, Aetna and the like.

And that is ultimately the problem with the politicians. They tout their core ideals to get elected but once in power, they merely act like the corrupt, bloated fat cats that they serve.

And this is the kind of crap that makes my blood boil. Not only am I supposed to save a million or more (in the rigged and corrupt "stock market" of course, so the wall streeters can skim their share), now I am supposed to save another half a million for health care so the health care industry can have their share.

http://finance.yahoo.com/focus-retirement/article/107225/retirees-may-well-worry-health-care-reform.html

This country, and anyone outside the top 5% income wise, is DOOMED.

It cost a million if you want to extend life at all costs. It doesn't cost a million if American elderly are willing to accept medical treatment available to British, Canadians, Australians, Japanese and all other developed countries who actually have more savings.

Medicare is very bloated, and elderly at other countries just watch in awe what kind of world class treatment our elderly is getting. For example, in this country, any elderly can subscribe to in-home oxygen delivery just by complaining, that cost about $1.2K a month. In other countries, you will have to be on advanced stage cancer or COPD to get that treatment, and there is an upper spending limit. There are tons of abuses in Medicare, because there is NO out-of-pocket for our seniors.

I will tell you a true story. My neighbor, 84 yo, lives with his wife. His wife checked into the hospital for some breathing issues, so he was left home alone and he didn't want to cook or go out to eat. Guess what he did? He went to emergency room complaining about chest pain, and then the hospital admitted him for a whole week, providing 3 meals a day, which is exactly what he wanted. Cost to us taxpayers? $80K. Cost to him? ZERO.

In all other countries, seniors have to commit a certain portion of out-of-pocket expenses so that they don't abuse the system. Not here. So I don't buy that million-dollar argument at all. If we manage our senior care the way the British do it, you don't even need half.

Only to say about is:

Whatever business run by U.S. Govt., it will have the same result, "Bankruptcy".

Theoakman sez:

>> Private physicians are required to publish their prices.

OO sez:

>>At today’s inflated rate of around $35000 (best hospital and best doctors) for child birth, your insurance contract rate is about 30-40% of that, and the max you need to pay out of pocket will only be $1000 or so (10% co-pay for group PPO).

Both of these points are very important. Transparency is crucial, also in healthcare. The 30%-of-list-price negotiated rate is one of the main reasons insurance makes sense in the first place.

On the topic of Singapore, I have heard good things about their system as well. Someone I know has said that the Singapore government is run by a bunch of bad-ass engineers that know how to optimize the cost of just about anything. We need that here as well, instead of a bunch of lawyers being elected to represent us.

Diomedes,

I have similar gripes about the current state of affairs. I have had a situation where certain doctors in one clinic were in-network, but others weren't. Talk about confusing - I picked the wrong doctor (actually physical therapist) and I ended up paying an out-of-network "surcharge". That being said, it doesn't follow that these types of problems are better than having to wait for long periods of time to start getting cancer treatment.

When I think of government-controlled health I think of all the problems that exist in other sweeping government programs. Social security and medicare face huge shortfalls in funding. Social security was essentially set up when birthrates were much higher and do not work with lower birthrates. So now the government has to tell people they can't retire yet (as they were planning to based on previous S.S. retirement ages). With medicare, government accountants are going to be deciding that people in their 70s or 80s who need expensive procedures like joint replacements are too expensive and they will not cover those options any more.

I think of the 13% of each paycheck that is paid into social security between myself and my employer and how I'm not even going to get 0% total return on that money. I know enough about investing to know that I can do better than that. At least Al Gore recognized the government's failure to properly separate that 13% tax from the rest of the revenue with his "lockbox" idea. Why not let me say "no thanks" to social security and do my own investing with that 13%. I'm willing to accept some personal risk in order to do better than 0%.

So why should I believe the government will do better than this with healthcare? And shouldn't we try to fund our current obligations before adding new ones?

I prefer the government to provide the basics of national defense, roads and bridges, a court system, etc. I can't help but feel that the government doesn't know when to stop when it comes to inserting itself in our daily lives and decisions.

OO,

Medicare is a real problem. They seem to spend money willy-nilly on electric scooters and oxygen supplies, rather than proper health care. Medicare needs to be tightened up so that money gets spent on the right things and not fluffy profit-center type activities.

Medicare is how government gets run when Republicans are in charge of it: They get to waste taxpayer money, so they can complain about the inefficiency and argue for lower taxes (the technical term is "starve the beast"), At the same time, the waste ensures that it is their cronies that get the wasted cash in the form of aforementioned scooter sales, fancy brand-name drugs and whatnot.

They are having it both ways: Complain about and profit from it. Great work if you can get it..

Now, what Obama wants to do is to tighten up how the system works, and in a big way. We should all express our support.

If someone called me and asked about reform, I would agree. The actual question is what kind of reform do we want. A simple blog post would come up with a lot of good ideas. Nobody wants to reform the whole system. They just want dole favours to their voting base.

I would like to hear the President start including tort reform as a way to control health care costs. For every time it is said that republicans cater to big business I would like to add that democrats cater to trial lawyers. Let's be fair.

Justme -

"Now, what Obama wants to do is to tighten up how the system works, and in a big way. We should all express our support."

I would express my support. However, I don't mind the system I have in place through my employer. The analogy here might be that because 1 out of 10 Americans has a car that doesn't work, we should replace all 10, not just the one. Everyone gets a Corolla, whether it's better or worse than what they had.

>> I’m willing to accept some personal risk in order to do better than 0%.

Yeah, but how about all those who did -45% the last year or so? I cannot support this type of plan.

rhvonlehe1,

Your healthcare "works", but you (through your employer) are overpaying for it by 30%.
Obama wants to give those 30% of waste to someone who needs it.

Justme - “Now, what Obama wants to do is to tighten up how the system works, and in a big way. We should all express our support."

rhvonlehe1 - "I would express my support. However, I don’t mind the system I have in place through my employer. The analogy here might be that because 1 out of 10 Americans has a car that doesn’t work, we should replace all 10, not just the one. Everyone gets a Corolla, whether it’s better or worse than what they had."

Very well put rhvonlehe1. That's what I am afraid of... losing what I have because my company opts to go the cheaper route and put us on the government plan.

rhvonlehe1,
Your healthcare “works”, but you (through your employer) are overpaying for it by 30%.

Obama wants to give those 30% of waste to someone who needs it.

And then your company goes with the government plan which may not include your current Dr. and coverage.

So, how can Obama promise that "If you like your coverage keep it. No one is going to force you to change."?????

Tenpoundbass - I think it's a little disingenuous to claim that anyone against Obama's plan works for the health care industry. And the sweeping judgement against the entire population working in health care (my wife is a nurse) as "greedy and corrupt" is a bit too much.

From my perspective, a true free market system does a better job of providing checks and balances to the greedy and corrupt than a socialist model. If company A tries to overcharge, one of company A's competitors will get more business because their pricing is more fair. So I would argue that having Pfizer competing with a Merck is usually good. Having Allina compete with United Health is good. Having Boston Scientific competing with Medtronic is good.

If you're greedy and corrupt (or incompetent) but work in the government as the sole provider of a service, does the consumer have a choice?

Hansolo,

>>Very well put rhvonlehe1. That’s what I am afraid of… losing what I have because my company opts to go the cheaper route and put us on the government plan.

But will not the invisible hand of free market lead your company to keep offering you a plan, lest they will lose your services to a competitor that is willing to do so? Or give you more cash to pay it yourself?

>> I’m willing to accept some personal risk in order to do better than 0%.

"Yeah, but how about all those who did -45% the last year or so? I cannot support this type of plan."

Many asset classes didn't drop by 45% (or 38%, which is what the actual S&P 500 drop was). Gold, money markets, and government bonds all performed well. Last year's results do not happen every year. The long-term average for the stock market is still 10%.

rhvonlehe1,
Your healthcare “works”, but you (through your employer) are overpaying for it by 30%.

Obama wants to give those 30% of waste to someone who needs it.

Where is this 30% number coming from?

See a report by the California Medical Association on HMO administrative spending in California, where Blue Cross spends over 20% of every dollar on overhead (download the 2005 report or visit CMA’s website).

http://www.masscare.org/uploads/2007/05/CMAMedicalExpendituresReport05.pdf

I can't find the 30% number at the moment. It may not be direct overhead, but rather how much more we pay than country X which has the same level of quality of health care. can anyone help?

"Over 70% of American want Govt. run health care…"

Bullshit. That's not what the poll said. 70% want a government run *****OPTION***** for health insurance to exist alongside private run health insurance.

Is this distinction really so hard to understand?

“I would express my support. However, I don’t mind the system I have in place through my employer. The analogy here might be that because 1 out of 10 Americans has a car that doesn’t work, we should replace all 10, not just the one. Everyone gets a Corolla, whether it’s better or worse than what they had.”
Why would that be an appropriate analogy? Millions of Americans lack health insurance. Several people here have said that they do not favor changing the system in any way. So the analogy would be that those who have a non-working car are just SOL. Sadly, that seems to be the new way of looking at things in America: “I got mine; fuck the rest of you”. If there were a way to make health insurance work for everyone and not just for the wealthy, that would be great. But right-wingers don’t even want to TRY; they just want to leave the current broken system in place.

A) I like my analogy just fine - I'm saying the guy who's car is broken should get a working Corolla. But let me keep my Taurus, or Jeep, or Lexus or whatever I have right now that I like. I'm not opposed to studying and trying to find a solution for the 10%. But I think we should include options that democrats usually don't like: tort reform (stopping massive payouts for emotional damages that cost practitioners millions in unnecessary insurance premiums), and cracking down on illegal immigration for instance. But that goes against their constituency so that waste is usually ignored.
B) Not that its any of your business, but I am not wealthy whatsoever. It's a myth that republicans are all wealthy. I am a working stiff squarely in the 15% bracket. I came from a blue collar family. My wife's family is blue collar and she works in a union. Her father works in a union. We all vote republican because of various issues that are important to us (right to life, limited government, protection of individual liberties, etc)
C) You may not trust republicans, or drug companies, but what about the doctors themselves? The American Medical Association recently came out against Obama's plan: http://www.nytimes.com/2009/06/11/us/politics/11health.html.

With the way that the medical cost is going, your employer will soon find you too expensive to keep.

People here who love their company plans and think they will keep it forever must not have done budgeting or managed budget before. To get a perm headcount on the budget, the typical load factor is 65-85% on your base salary nowadays without T&E, and the bulk goes to medical care and benefits. So, when medical insurance forces the load to go above 100%, I tell ya, the department head is going to look real hard on who to cut. Medical insurance cost to companies have been going up 20+% in each year in the last few years. Do you think your employer can justify paying you double-digit increase each year? You don't see that increase in your pay, but your employer is certainly feeling the pain.

Or, alternatively, many companies are now already NOT taking on perms. They just pay a contractor rate and not offer medical benefits at all. You are already on your own.