BNA Pension and Benefits Blog

Automakers' Insolvency Opens All the Benefit Cutback Targets and Problems

    The insolvency (whether or not in Chapter 11 reorganization) of the three automakers brings “legacy costs” back to the center stage of ERISA cutback negotiation and litigation. 

    The automakers have already put themselves on the cutting edge of many of these issues outside of bankruptcy.   

    They have litigated retirees’ medical benefit cutbacks, arguing that retirees were not vested (Sprague v. General Motors Corp., 133 F.3d 388, 21 Employee Benefits Cases 2267 (6th Cir. 1998)). 

    They have negotiated VEBAs with the UAW and then sought to bind the retirees by class action settlements and court approval after a fairness hearing. International Union, United Auto., Aerospace, and Agr. Implement Workers of America [McKnight] v. General Motors Corp., 497 F.3d 615, 41 Employee Benefits Cases 1692 (6th Cir. 2007)   Still, further developments are inevitable, particularly in light of the recent VEBA history. 

    Some of the key “legacy cost” questions are these:

        1.  The first question, logically, is this: Are the retirees’ medical benefits “vested”?   The “vesting” of retiree medical benefits is certainly possible, and it depends on the words of the plan, the magic of language such as “for your lifetime,” the admissibility of parole evidence to clarify “ambiguities” in the plan and SPD, and so on. UAW v. Yard-Man, Inc., 716 F.2d 1476, 4 Employee Benefits Cases 2108 (6th Cir. 1983), cert. denied, 465 U.S. 1007 (1984); Sprague v. General Motors Corp., 133 F.3d 388, 21 Employee Benefits Cases 2267 (6th Cir. 1998); Yolton v. El Paso Tennessee Pipeline Co., 435 F.3d 571, 36 Employee Benefits Cases 2217 (6th Cir. 2006); Bland v. Fiatallis, 401 F.3d 779, 34 Employee Benefits Cases 1875 (7th Cir. 2005); Doubtless the rules need clarification, and the various circuits’ positions need reconciliation.

        2. If the case reaches the bankruptcy court, does “vesting” really matter?  The answer ought to be obvious, but if you read the actual language of the Bankruptcy Code (11 U.S.C. section 1114), the statute on its face never mentions vesting, instead requiring continuation of a “program” of  “retiree benefits” that was “maintained” before the bankruptcy filing (Sec. 1114(a)).

        3. If a union makes a cutback bargain, how does the union get to "represent" its retirees, when unions legally only represent actives? Allied Chem. & Alkali Workers v. Pittsburgh Plate Glass Co., 404 U.S. 157, 1 Employee Benefits Cases 1019 (1971).  A retirees’ medical benefit program would not be a mandatory bargaining subject under the NLRA if the bargaining issue did not affect any currently active employee. But that may be a non-problem because the bargaining topic frequently includes benefits for current employees, payable when they retire (which is certainly a mandatory bargaining subject). And in any event, there is an overriding reality in distress situations – the union has at least a little “muscle,” and the retirees ordinarily do not.

        4. In any event, how do you bind the retirees?  Typically, the court certifies a group of retirees as a Rule 23 class action representative.  International Union, United Auto., Aerospace, and Agr. Implement Workers of America [McKnight] v. General Motors Corp., 497 F.3d 615, 41 Employee Benefits Cases 1692 (6th Cir. 2007)

        5. What standard is used by the court to decide whether to force retirees to give up their claim against the employer in exchange for reliance on the VEBA? See the GM and Ford rulings. And while the Ford/GM standards are not (yet) actually under the Chapter 11 cutback devices (sections 1113 and 1114), the VEBA settlements previously approved by the district court were based on findings that the VEBA deals were less severe than the cutbacks the retirees might have lost in bankruptcy (497 F.2d at 628).  And yet only recently GM has backed out of its VEBA funding commitment.

        6.  How can you VEBA-ize a solution to legacy costs, when a VEBA can only accumulate one year’s worth of benefit costs?  A “garden variety” VEBA is allowed only a very limited pre-funding accumulation, but a collectively bargained VEBA is not so restricted. IRC §§ 419(c), 419A(f)(5)(A), 501(c)(9).

        7. What if the employer buys this deal in exchange for payments into the VEBA, and then the employer defaults or goes bankrupt before full payment?

        8. Is there some hidden logic in this -- an assumption that the VEBA only has to remain solvent for a few years, and then National Health will arrive in all its glory and bail out everyone?   How many years?  And in the meantime, what sort of “booking” treatment is allowed, in such situations, for financial statements of public corporations?

        9. Do the rules really change after a filing in Chapter 11?  Chapter 11 bankruptcy reorganization has its own collective bargaining provisions, which apply to changes in labor agreements (11 USC 1113) and even to retirees medical benefits (11 USC 1114). This special “last offer” bargaining lowers but does not ordinarily wipe out retirees medical benefits, because the court’s approval of the “bargain” depends upon a finding that the cut-back is the least severe change necessary to save the debtor.

        10.  And then there is the whole array of issues arising under the defined benefit pension plans.  Termination of these plans (“distress” or involuntary termination under ERISA 4041(c) or 4042), inevitably generates losses by surprise.  Employees and retirees are often surprised that they are not eligible for funded benefit levels as high as they expected, because of the calculation of “PC3" priority benefits under ERISA 4044(a)(3)), particularly after the funding level of the terminated plan is recalculated by the PBGC.  And even the guaranteed benefit level may not be as high as anticipated, given the obscure rules for ERISA Title IV guaranteed benefit calculations.  And the liability of the plan debtor/employer/sponsor may be higher than expected, given PBGC’s determination to argue and re-argue questions concerning their priorities in bankruptcy, even though PBGC seemingly has lost these arguments repeatedly.

    The core problems, however, concern conflicts of interest – conflicts by the union, by the employer, and by the PBGC – and these conflicts abound. 

    The union’s conflict:  It does seem clear that the UAW – now as in the past, all the way back to the seminal Studebaker case – will inevitably be faced with a terrible Hobson’s choice:  Save jobs by lowering costs (“selling out” the retirees)? Or fighting tenaciously for protection of retirees, and risk destruction of the enterprise?  Section 1114(c) of the Bankruptcy Code recognizes the conflict of interest of the incumbent union, but presumes that the conflict may be avoided or ignored.  And yet, inevitably, it is still there.

    The employer’s conflict: ERISA by its express terms makes the employer a presumptive fiduciary – even a named fiduciary – and plan administrator.  ERISA §§ 3(16)(A)(ii), 402(a)(2)(A).  The existence of the conflict is assumed by the statute, but the employer, even with a conflict, is prohibited from acting on the conflict (wearing “two hats” but not at the same time).  And in chapter 11, the employer has three hats – employer, fiduciary for the plan, and fiduciary for the creditors.  Again, the conflict is inherent in the situation.  In the ordinary course, the situation is manageable.  But the puzzles described above are not ordinary.

    And the PBGC’s conflict: The PBGC was invented to protect employees and retirees.  In recent years (decades?), however, the PBGC has often seemed more interested in protecting its balance sheet than its natural constituents.

    We shall see.

Frank Cummings

Is it time to require all employers to provide health care for their employees?

Having just returned from a conference at Oxford University in England where we were discussing the effect of pension and health liabilities on global competitiveness, I have been thinking about the question of how our current voluntary benefits system affects intra-business competitiveness within the US, an often overlooked aspect of the problem. 

Instead of fussing with the question of what, if anything, should the states be able to do to reduce the number of uninsured individuals and getting all tangled up in ERISA preemption questions, is it time for Congress to consider the question of whether all employers should have some responsibility for financing a portion of health care costs for their employees?  Should Congress, as part of a broader health care reform proposal, consider adopting a Federal "pay" or "play" approach whereby all employers would have the choice of providing benefits that cost X (e.g., X cents/hour, X percentage of payroll) or contributing an equivalent amount to a public insurance pool under which all individuals without insurance would obtain coverage?  If employers should continue to be in the mix at all in the future, would that be a fairer way to equalize the funding of the system, rather than letting employers that voluntarily provide coverage for their employees continue to subsidize other employers that don't through cost-shifting?

Phyllis Borzi

Health Care - Is Anyone Asking the Hardest Question?

In a matter of a few days, here are some headlines from the Pension & Benefits Reporter: "Report Says Health Costs Hurt U.S. Firms, Advocates End of Employer Financing System"; "CRS Says Price Transparency May Drive Down Costs"; "Reform Efforts Should Combine Options in Public, Private Sector, Health Group Says"; "Democrats Pounce on GAO Study Finding Taxpayers with HSAs Have Higher Incomes"; "Measure of Family Medical Spending Has Lowest Increase in Past Five Years" and the list goes on and on.

What I haven't seen for example, is a study of how the system will make the hardest decisions about health care: who gets care and who doesn't, especially at the beginning and ending of life, where a large portion of our health care dollars are spent?

In other systems, much of the care we hold so dear is not available to the very young or the very old and sometimes in the middle.  Some European cultures take a much more practical view of the end of life and focus more on dying in comfort rather than fighting a very costly, but losing battle using the most sophisticated (and usually expensive) methods to prolong life.

If a nationalized system is so much better, why is it that U.S. hospitals along the Canadian border have so many Canadians getting heart surgery for example?  Or why is there a three or four month wait in some areas of Canada to have a hernia repaired, when not emergency status?  I can imagine the response of a U.S. parent if he/she were told her/his son could not participate in school athletics because of a hernia and there would be a three month wait to have the repair done on an elective basis.  I have 4 married children living with their own children abroad and all of them are provided by their employers' medical care insurance that allows them to opt out of the national system, because they demand more access to specialists and quicker care than is available in the local system.  I have a close friend who is a physician who complains that people come into his office having decided they have a certain condition and demand a pill which they have seen advertised on TV.  There may be a less expensive alternative but if they don't get what they saw on TV they will go to some other physician down the road who will give it to them.  While these examples are anecdotal and by no means scientific, they do represent the reality that I live in.

Most of us remember well the public outcry when the HMOs and PPOs were first introduced and they had strong mechanisms to regulate access to health care.  State laws were passed to assure access to certain types of care and plaintiffs lawyers had a heyday.  State laws are filled with provisions that guarantee access to certain providers and types of care, at least some which add unnecessarily to the cost of health care.

I believe that without a mechanism to control what care is available and to whom and at what time, costs will continue to be a problem.  We have more technology than we can afford.  In national health care systems care is rationed by either long waits or guidelines that restrict access.  There is no political will in America to suggest that we really can't afford to give everyone everything they want when they want it.  As a result, no one asks the hard question, who is going to decide what care and when?

The Intersection of Federal and State Health Care Reforms

Massachusetts enacted its health reform requiring individuals to purchase health insurance or benefits under a plan that meets certain minimum standards in order for the individual to avoid a tax on the uninsured.  Massachusetts also imposes a tax or penalty of sorts on employers of individuals who incur more than a minimum amount of uncompensated care to fund the state's cost of health care that is not reimbursed or paid elsewhere. 

There is a collision between the federal initiatives to move employers toward offering high deductible health plans and health savings accounts and the Massachusetts initiative toward requiring the individuals to purchase minimum levels of health insurance coverage and to indirectly pressure employers to conform their benefit plans to satisfy the minimum level of coverage.  The Massachusetts rules do not accommodate a high deductible health plan as defined in federal tax law. 

There is a collision for employers operating in Massachusetts with high deductible health plans. If the employer's employees covered by the high deductible health plan do not pay for their care that is subject to the high deductible, then that care is uncompensated care for Massachusetts law purposes.  Such care which is not paid for by the employee can fall in the very broad definition of uncompensated care in Massachusetts resulting in a surcharge on the employer if the limits on uncompensated care for either the individual employee or their employees as a whole in Massachusetts are exceeded. 

Employers have a deadline to file their cafeteria plan documents with the "Connector" in Massachusetts by July 1, 2007; however, the form which must be filed with the cafeteria plan document and how all this is to occur has yet to be disclosed. 

There are many questions related to the Massachusetts legislation and its impact on employers and their plans that are still unanswered, including the most important one ...ERISA preemption.

Greta E. Cowart

The Future of Health Care

I read the other day that 20% of the income of a typical medical office is spent on insurance claims administration. Then there's the insurance company cost of administering the claims, plus the cost of the darned ERISA lawyer who brings those class actions.  A billion here, a billion there, pretty soon it starts to add up (Thanks Ev Dirkson).  I read the other day that most of the Democratic candidates for Preident are not only afraid of suggesting single-payor health plans, but are afraid of suggesting expanding employer coverage.  In other words, despite everyone being miserable with the present system, it's become like the weather - everyone complains, no one can do anything about it.  Then I read that some were proposing that ERISA preemption of health care matters be lifted so that the states could be freed to try what the states are supposed to do -- experiment with different ideas so we can get a handle on a national solution.  But the ERISA wags say "no no no. National uniformity is far too important for big corporations.  After all, these corporations can't even keep up with the laws of the tens or hundreds of nations in which they do business so . . .  wait a minute, yes they can and do quite well at it."  And the wags win, because we don't want to upset big corporations.  So the most logical means of finding the answer is removed.  And we are left with nothing.

I think I'll stop reading.

U.S. Health Care Costs

In today’s WSJ, Justin Lahart observes that the United States spends a much larger portion of its GDP on health care than other countries, yet seems to get little for its extra spending. I wonder whether this is true, which is not to say that I disagree with his larger point: that we are spending too much on health care for what we get.

But here are some thoughts:

1. Lanhart points out that both infant mortality and life expectancy are higher in Japan and France, which spend (on average) approximately 55% of what the United States spends on health care. But critics of our system have noted that a large part of what we spend money on is spent on expensive care for people during the very last part of their lives. So a relevant question might be: do people who reach, say, age 60 in the United States live longer and/or more comfortably than members of their comparable cohort in Japan and France. And we can refine that question bit more by limiting the comparison to people in the United States who have access to good health care.

Is there a free-rider problem here? Some have argued that drug costs are high in this country to pay for research, which produces important advances in medical science. Do Americans thus fund new medications (and other medical technologies) whose value other nations can import without paying their share of developing these technologies?

What is the infant mortality rate and the life expectancy rate for people in this country who have access to good health care, and how does that compare to the infant mortality and life expectancy rates to people in Japan and France? Do we know if our insured, or at least those of our insured who have good coverage, fare as well or better than the Japanese or French participant in the national health care systems in those countries?

There are certainly other questions we can ask along these lines and the answers might show that we are getting something for the extra resources we expend. It might not be purchasing what we should be purchasing, and our choices might be critiqued on moral grounds (as the folk song goes, if religion were something that money could buy, the rich would live and the poor would die), but I would be hesitant to conclude that we don’t get much for our extra spending.

And of course, there is the extraordinarily important point Frank Cummings makes on his recent post, that the employer system has faults of its own, apart from aggregate costs and quality of medical delivery. Making some employers bear the costs of our imperfect system is itself a serious imperfection in our system.

I intended to end the post two paragraphs up, but let me make two additional points related to the employer system. Two related arguments for the system are: 1) the employer is an efficient purchasing agent for its employees; and 2) the employer pools risk (which is part of the reason it might be an efficient purchasing agent for its employees). But national health care pools risk far more effectively than individual employers and can anybody seriously argue today that the employer has been a good purchasing agent except for its ability, though risk pooling, to create access to the health care market for its higher risk employees? Well I suppose you can say that the employer forcing employees to take part of their compensation in health care coverage is good, but national health care also takes care of this problem.

Health Care’s Game of “Let’s Pretend” – Rearranging Deck Chairs on the Titanic?

Health Care’s Game of  “Let’s Pretend” – Rearranging Deck Chairs on the Titanic?

    The game of health care consensus and “let’s pretend” continues:

        Consensus view #1: We have the best medical system in the world, for those who can afford it.

        Consensus view #2: The “best” is unaffordable, or almost unaffordable, for most people.

        Consensus view #3: The U.S. is the only advanced economy without a National Health system.

    Put that all together, and you get an inkling of an unexpected consensus among big business and big labor:

        Consensus view #4:  Unless the U.S. gets universal health care, U.S. businesses, already paying huge health care costs for their employees, will be non-competitive with Asian and European companies in any (every?) nation where health care costs are paid from general governmental revenues.

    What’s the fix?  As almost always, a real fix must be preceded by a long string of pretenses.  Consider these:

        Pretense #1: At least current employer-provided insurance is workable.  Really?  The employee-paid premium shares, plus deductibles, plus co-payments, are growing to the point where “coverage” is becoming a sham, and at the tipping-point the young and healthy will opt out, leaving the system unaffordable and therefore unsustainable if it only insures the bad risks.

        Pretense #2: Let the poor pay for themselves -- the emergency room, or medicaid, or other state-financed benefits, are “free”.   Really? Look at any hospital bill and pretend that the huge number for each item is its real cost, and then recognize that this is just cost-shifting to the payers from the non-payers (the poor).  The payers pay for everyone else.

        Pretense #3: Fix it with tax deductions?  Really?  Tax deductions for the lower paid, who don’t take deductions – indeed often don’t pay taxes – is trading one sham for another.

        Pretense #4: Solve the problem by mandating benefits, instead of enacting national health.  Really?  It’s just shifting the burden to employers who are already non-competitive because of the current burden, or to employees, many of whom cannot afford what we have now.

    Bottom line: The consensus, stripped of its pretenses, will eventually force something like “national health.”

    Is National Health a “fix”?  National Health has its own pretenses:

        Pretense #1: National Health is a “good” health delivery system.  Really?  Please!  It’s terrible.  Only it’s better than anything else that’s feasible, except for those who can afford completely private top-of-the-line medical care.

        Pretense #2: Good private medical care would be wiped out by National Health.  Really?  Not so in Britain (the “Harley Street” alternative).

    Bottom Line: Sooner or later (and sooner is a better bet) private insurance will not be provided by employers (in which case the private system itself may be non-viable), and will not be affordable by employees, and at that point, like it or not, “let’s pretend” gambits will run out, and National Health will run in.

    Not a happy prospect, but then, rearranging deck chairs on the Titanic is the ultimate pretense.  Rearrange them or not, sinking is still sinking.

States take the lead in health care access initiatives

Faced with growing numbers of uninsured, rising Medicaid costs, and no likelihood of timely federal leadership, states have -- again -- taken the lead in expandingn health coverage. Following 2005 implementation of Maine's "Dirigo" voluntary health purchasing pool, in 2006 Maryland, Massachusetts and Vermont passed laws to expand access to health coverage. Policy makers in California are drafting universal coverage bills and similar initatives are under discussion in several other states, such as Colorado and Wisconsin.

As the level of government constitutionally responsible for the "health, safety, and welfare" of their residents, state governments have long provided health care and health coverage to vulnerable (e.g., poor, disabled and elderly) populations, preceding, for example, federal programs like Medicaid and Medicare. Recognizing that the uninsured are not only the low income unemployed but also low and moderate income working people, for almost three decades, many states have tried to assist low wage workers to obtain coverage through both public and private sector sources. In the late 1980s and early 90s, several states (including Massachusetts, Minnesota, Oregon and Washington) enacted programs to make insurance available to most state residents, but these laws were never fully implemented and most were eventually repealed. Because 2/3 of Americans receive health coverage through the workplace, state programs typically include a role for employers as financers and/or providers of coverage in order to retain employer dollars currently spent on health care and not disrupt existing employee benefit programs and expectations. But ERISA's preemption clause complicates state policy development -- for example, shortly after ERISA was passed, courts held that it preempted Hawaii's law requiring employers to offer and pay for health coverage (eventually restored by a 1983 ERISA amendment).

Last July, a federal court struck down Maryland's law requiring large employers (i.e., Wal-Mart) to spend at least 8% of payroll on health coverage or pay the difference to the state's Medicaid program. Whether the much smaller employer taxes in Massachusetts or Vermont will face and survive preemption challenges remains to be seen.

Proposals recently outlined by California Governor Schwarzenegger and the heads of the state's Senate and Assembly contain elements of the Massachusetts and the Maryland laws, including assessments on employers to partially fund a public coverage program while allowing employers to offer health coverage if they choose. Because it seems undeniable that states can tax employers for such public purposes, the issue will be whether a state law allows multi-state employer-sponsored health plans the type of choice Supreme Court decisions indicate are the primary objective of ERISA's preemption clause. And this outcome will likely depend on the precise language of a final legislative compromise -- if the myriad and contentious stakeholders can craft one.

More Mandated Benefits? Stop! Think!

More Mandated Benefits?  Stop!  Think!

    ERISA regulates and mandates a system that is, above everything else, voluntary.  In my view, mandates have no place in it, not because they are not good objectives, but because they are not voluntary, not free, and inevitably counter-productive.

    Why not mandate?  Because mandates undermine the voluntary market - a market that produces for the employees of most participating employers a package of benefits that is better than anything a government could or would mandate .  The voluntary market is not universal (like Social Security or Medicare).  It is a result of business decisions to provide these benefits because they are good business.   Universal mandates (for example, so-called “Mandatory Universal Pensions” or “MUPs”) are always just a devious way of making private employers pay for a safety net that should be paid by taxes.  A mandate will always be minimal, like the minimum wage, because it is a national, universal, rock-bottom benefit.  That is not what private employee benefits are about.

    Why not mandate at the state level (like Maryland’s Pay or Play)?  Same reason, only worse: It’s not even a universal mandate.   It’s still ultra-minimal.  And it guts the private employee benefit system’s cornerstone – federal preemption.  It just balkanizes the system.

    But why not abandon federal preemption?  Take a look at 14(b) of the National Labor Relations Act (the so-called “right to work” provision).  The supporters of non-preemption are, these days, at the liberal end of the political spectrum – and there they are supporting the same theory as “right to work” laws (which they have always opposed).  Those who ignore past experience are condemned, of course, to repeat it.

    Once that preemption door is opened, what, inevitably, also comes through it?  How about these: Each new unpreempted state law will come with a new unpreempted state remedy (without which, of course, the state law is meaningless).  And that state remedy – bet on it – will come with compensatory and punitive damages – the very thing that ERISA preemption sought to head off. 

    What’s wrong with that?  If you don’t know, you won’t care, but it’s the death knell of the ingenuity and further development of the private voluntary system.  It just converts the floor into a ceiling.

    The moral to the story?  If you want to pass a federal benefits law (“National Health” for example), OK.  Go for it.  But do it as a governmental benefit with governmental financing and governmental control.  Don’t pretend it is or should be part of the private voluntary ERISA system.  In the private system, it’s pure poison.

String Theory of Healthcare - The Solution to Everything.

Tell me why this isn't a good idea

a. There should be National Health Insurance to cover basic insurance for everyone; employed, unemployed, uninsured and people like me. Employers would contribute to it based on a percent of payroll. There would be no problems with adverse selection or horrible bookkeeping problems about who's in and who's out, since this National Plan would cover everyone for these "basic" needs. It is a policy choice as to how far basic coverage should go. But suppose we use current Medicare as a base.

b. Employers may also provide "wrap around" policies in addition to the Basic policy. Like Medicare supplements (or private retirement plans supplementing social security), they can be as stingy or as generous as the employer desires. These wrap around policies could be self-insured or be provided by insurance companies. The policy would pay supplemental coverages (supplemental charges above what the National Plan determines to be "average" (see below), long term/catastrophic care, additional days of hospital stays, dental, dog and cat medical, whatever). In this way, the private industry can continue to provide benefits on a less than universal basis, and can play their exclusion and denial games, yet the right to fundamental basic medical care will not be diminished.

c. This is the part I like the best. Under this Plan, when you go to the doctor that doctor has to tell you (a) what services are covered under the National Plan and which are not (e.g., experimental, beyond the basics, etc.); and (b) how much more, as a percentage, that doctor will charge over that allowed by the National Plan. So, for example, the doctor may say "I will be charging you 10% more than what the National Plan pays me" and that will be a binding commitment. It has the following charms: (1) Doctors, not patients, have the expertise to know this information; (2) Doctors, not patients, have the expertise (and resources) to challenge the National Plan on determinations they believe are incorrect.

If a doctor finds that the National Plan will only pay $100 for a procedure but the doctor feels $150 is appropriate, all he has to do is tell patients, "I will charge you 50% more than the National Plan." If other of the doctor's charges are identical to that paid by the National Plan the doctor will simply average it out and tell people "I charge 5% more than the National Plan." The doctor cannot say that a particular procedure, test, exam, etc. will cost x% more -- the percentage must apply to all services supplied by that doctor to that patient. In this way the patient can doctor shop and compare apples with apples; the doctor can determine her own fees (within a narrow range) by using a multiplier of the National Plan; and disputes as to what the National Plan should pay can be resolved between those with the expertise and knowledge.

Presently the payor says $100 is reasonable, the doctor says the payor is full of it and that $150 is reasonable, and the patient winds up losing $50 and having no idea of who's right -- or any simple means of finding out. No wonder people are mad as hell and just won't take it anymore. I think this has the elements everyone needs. People are happy because they'll at least have guaranteed access to basic medical care; employers/employees are happy because they can have greater coverage than the basic plan; patients are happy because they will have a pretty good idea going into the doctor as to how much it's going to cost them. More important, there aren't going to be any surprises like "pre existing condition" and "we don't cover that" and "we only pay 50 cents for that procedure."

So whaddya think?