Pride, Prejudice, Insurance

[LadyJeanne]

135,000,000,000

45 million * 3000 (the basic value of my health coverage , decent but not the best).


Sincerely,
ElSol

Does your coverage include your whole family, though?

 

[elsol]

Does your coverage include your whole family, though?

I'm single (I chose all the 'middle of the road' options), my girl is covered by her company.

If we had a child, we'd pick between my company and hers... whichever has the better coverage would be picked.

Proving Colleen's point... when you throw in kids the parents tend to shoot for an advantage.

Sincerely,
ElSol

 

[Boxlicker101]

Quote:
Originally Posted by LadyJeanne
Isn't there a way to work within the system? How much would it cost in taxes each year for the federal government to expand Medicare and Medicaid to cover the 45 million uninsured?

135,000,000,000

45 million * 3000 (the basic value of my health coverage , decent but not the best).

Sincerely,
ElSol

Actually, it would probably cost more than that. First, there is the built-in government inefficiency and then there would be all the employers dropping health insurance as a benefit to save themselves money and making all their employees go with Medicaid. There might be co-payment requirements and requirements that the beneficiaries pay part of the insurance, though, and that would reduce the cost somewhat.

Colleen Thomas Quote:
Originally Posted by yui
Sounds a great deal like public education in the US, eh? No child left behind sort of stuff.
Just an observation that struck me while reading your post, not an attempt to flame.

No offense taken. the public education in this country sucks. Has since teachers decided their primary job wasn't education but socialization.

However, people scrimp and save to send their kids to private schools now. Pretty much anyone who can does. So it kind of illustrates why socialistic schemes don't work too well. People are generally willing to do whatever it takes to give them (or their offspeing) an advantage. When you set a free public school education to fit the lowest common denominator, people will look for an alternative. No one really wants to be the lowest common denominator.


I don't usually think of myself as having been lucky but in one way I was. When I attended public elementary and high school, it was at a school in a small town. The teachers actually wanted to teach and the kids learned quickly that they were there to learn and that they had better do it. There were no social promotions; some kids flunked sometimes. When that happened, the kid was 100% at fault, never the teacher, because it was known the teachers were dedicated professionals and sometimes friends of the parents of the students. New math and other experimental crap was never tried and Johnny learned to read if he knew what was good for him (or her).

 

[Colleen Thomas]

Isn't there a way to work within the system? How much would it cost in taxes each year for the federal government to expand Medicare and Medicaid to cover the 45 million uninsured?

That's hard to say. Hard to research because the raw figures are of little help and those colated are generally done so by someone looking to prove a point.


The population of the us is about 295 million. For ease of use, you can round that up to 300 mil and those not insured to 50 mil. It gives you about one sixth of the population you would have to expand coverage to provide for. It's estimated the money for socialsecurty/meicare/medicade is going to run out sometime in the next 12 to 45 years, depending on who you listen too. Even if you go with the outside figure, expanding it to cover an additional 45 million people would probably break the bank in short order.

The only way around that is to generate more revenue. And with governemnt, that generally means raising taxes. Certainly you are going to have to do something to cover the costs of 45 million additional patients seeing doctors and getting scripts.

The last figures I've seen put 2.5 to 3% of the US population on welfare. Those figures are 1999. So you're talking about a jump from in the 2 to 3 percent range to sixteen or so percent. An increse in and around 8 fold. This is veryunscientific, but a quick look puts heatlh and human resources at about 34% of federal tax revenue. 34% is equal to about 722 Billion. That covers two to three percent of the population. A quick extrapolation means you would have to increase that to some 5.7 trillion. Currently the whole federal outlay is some 2.13 trillion.

It dosen't look very feasible from raw data.

Refined data migh make a big difference, but I don't know where you would find such refined data.

Edited to add, that should have been 6.05 trillion. Neither raw nor colated figures are muchhelp if your accountant is as bad at mathematics as I am

 

[elsol]

Actually, it would probably cost more than that. First, there is the built-in government inefficiency and then there would be all the employers dropping health insurance as a benefit to save themselves money and making all their employees go with Medicaid. There might be co-payment requirements and requirements that the beneficiaries pay part of the insurance, though, and that would reduce the cost somewhat.

Let's not talk government inneficiency... remember, we're talking a system where every cog does it's job perfectly!

I mean you want the doctor who is not being rewarded commensirate with his skill, talent, and amount of time he's putting in to try 110%, if that will happen then personally I believe that the government can run smoothly.

Remember... I've been put in charge and I'm shooting bureaucrats.

Sincerely,
ElSol

 

[LadyJeanne]

That's hard to say. Hard to research because the raw figures are of little help and those colated are generally done so by someone looking to prove a point.


The population of the us is about 295 million. For ease of use, you can round that up to 300 mil and those not insured to 50 mil. It gives you about one sixth of the population you would have to expand coverage to provide for. It's estimated the money for socialsecurty/meicare/medicade is going to run out sometime in the next 12 to 45 years, depending on who you listen too. Even if you go with the outside figure, expanding it to cover an additional 45 million people would probably break the bank in short order.

The only way around that is to generate more revenue. And with governemnt, that generally means raising taxes. Certainly you are going to have to do something to cover the costs of 45 million additional patients seeing doctors and getting scripts.

The last figures I've seen put 2.5 to 3% of the US population on welfare. Those figures are 1999. So you're talking about a jump from in the 2 to 3 percent range to sixteen or so percent. An increse in and around 8 fold. This is veryunscientific, but a quick look puts heatlh and human resources at about 34% of federal tax revenue. 34% is equal to about 722 Billion. That covers two to three percent of the population. A quick extrapolation means you would have to increase that to some 5.7 trillion. Currently the whole federal outlay is some 2.13 trillion.

It dosen't look very feasible from raw data.

Refined data migh make a big difference, but I don't know where you would find such refined data.

Edited to add, that should have been 6.05 trillion. Neither raw nor colated figures are muchhelp if your accountant is as bad at mathematics as I am

There's a huge difference betwen $135 billion and $5.7 trillion. Not that I can scrounge up either figure from the coins in the couch cushions.

 

[Colleen Thomas]

There's a huge difference betwen $135 billion and $5.7 trillion. Not that I can scrounge up either figure from the coins in the couch cushions.

My extrapolation is, without a doubt way high. The 34% I quoted is all human resources, much of which has nothing to do with welfare, medicare or medicaid. As I said, it' an unscientific extrapolation based on raw figures.

Sol's is, without doubt way low. It takes into account nothing beyond a multiplication of what his coverage costs times the number of people uninsured, ignoring administrative costs, ignroing that most workplace inurance is suplamented by the company and ignoring that most work places get a group rate from insurers that only an insane insurance company would assign to the population at large. Insurance is, in basic, no different than going to Las Vegas. When you purchase it, you're betting you will need it before the premiums you pay out strip the money you will need for an emergency. The insurer is playing the odds, while you may need it, the odds favor people not needing it. So you jack the figures on everyone a certain degree, and that creates the overage of income to cover those who do make claims. That is why insured people fall into different categories, with different prices.

For an extreme eample look at life insurance. You can purchase a whole life policy on your kid at age 2 for literally pennies a month. The same amount of coverage on your dad who is 90 would cost an arm and a leg. The odds of your child dying before the policy matures are terribly small, the odds of your dad making it to 115 before his policy matures are infestismal.

If your company employs mostly blue collar workers, your policy costs more than if your company is mostly white collar. Insurance companies have actuaries, who measure the probablitites to the nth degree Once a number is arrived at, the insurer adds a fudge factor to give themselves the advantage.

If you were using a private insurer all 45 million would fall into the assigned risk category. That's basically the category where premiums are the greatest, because risk is the greatest. The poor are more likely to, be malnourished, die or be injured by violence, abuse drugs, contract STDs, ignore symptoms that are early warning signs and thus show up with something already into the terminal stages, go through multiple pregnancies, etc. etc.

You have to look at it from the insurer's point of view. Which would you rather cover, the workers at Girl Friday, the workers in a steel mill, the workers in a coal mine, or a big lump of urban poor? The least risk is in girl Friday, clerical workrs, mostly educated, mostly making a living wage. Steel Mill workers face a good prospect of on the job injury. Mine workers face that, plus a host of long term illnessess associated with their work, I've already listed some of the risks of insuring the urban poor.

I would have to say offering healthcare coverage to the urban poor is a no win situation for the insurer. Outlays are coming, you know they are coming, and the poor can't afford to pay the kind of premium you would have to charge to mee tthose outlays and still turn a profit. If the government assumes that risk, they are basically opening a money pit, where the dollars spent just keep increasing over time.

I think it's a pretty safe bet if the government ever assumes that burden, they will have to have some form of natonalized medical providers. Maybe not a complete dismantleing of private doctors, but defintely some kind of program of providing doctors and facilities at a cost they can sustain.


So, while our estimates probably represent the very high and very low end, the point is obvious you're talking billions of dollars either way.

 

[BlackShanglan]

I think that R Richard had a good point back in the beginning of the thread. If we wanted to work this problem from both sides - some modest increases in public support and some modest attempts to control costs - we might look at reforming the legal end of things. I've known several doctors whose malpractice insurance is three to five times their take-home pay - particuarly in obstetrics. There is also the additional cost of "defensive medicine." If you're terrified that you're going to be sued out of your profession, you start ordering extra tests, more scans, triple-checks just ot make sure that you haven't missed some tiny hint of a different and more serious problem. That drives costs up considerably.

I would take issue with the contention that "someone is making a ton of money out of this"; that costs are high is not, I think, necessarily an indication that one group of people anywhere is becoming wealthy. Doctors make a good wage in most cases, but they also work very long hours with constant life-and-death decisions to be made - and they spent, typically, over a decade of their lives being trained to do their jobs while the rest of us were making money, starting families, and enjoying those wild and happy days of our youth. What would someone have to pay you to get you to surrender a decade of your life? I suspect it might be more than what's left of a doctor's fee after he pays the staff, the building owner, the malpractice insurance company, and providers of the machinery and testing equipment needed to do his job. While recognizing that health care is, indeed, expensive, it's largely expensive because of what we demand from it: swift, thoroughly accurate, highly technologically advanced, near-instantly available care that we believe should be infallible at the risk of being sued into the ground and the earth salted over it. That's an expensive thing to pay for; there's really no getting around it.

Shanglan

 

[Colleen Thomas]

I think that R Richard had a good point back in the beginning of the thread. If we wanted to work this problem from both sides - some modest increases in public support and some modest attempts to control costs - we might look at reforming the legal end of things. I've known several doctors whose malpractice insurance is three to five times their take-home pay - particuarly in obstetrics. There is also the additional cost of "defensive medicine." If you're terrified that you're going to be sued out of your profession, you start ordering extra tests, more scans, triple-checks just ot make sure that you haven't missed some tiny hint of a different and more serious problem. That drives costs up considerably.

I would take issue with the contention that "someone is making a ton of money out of this"; that costs are high is not, I think, necessarily an indication that one group of people anywhere is becoming wealthy. Doctors make a good wage in most cases, but they also work very long hours with constant life-and-death decisions to be made - and they spent, typically, over a decade of their lives being trained to do their jobs while the rest of us were making money, starting families, and enjoying those wild and happy days of our youth. What would someone have to pay you to get you to surrender a decade of your life? I suspect it might be more than what's left of a doctor's fee after he pays the staff, the building owner, the malpractice insurance company, and providers of the machinery and testing equipment needed to do his job. While recognizing that health care is, indeed, expensive, it's largely expensive because of what we demand from it: swift, thoroughly accurate, highly technologically advanced, near-instantly available care that we believe should be infallible at the risk of being sued into the ground and the earth salted over it. That's an expensive thing to pay for; there's really no getting around it.

Shanglan

The real problem with reforming the legal end is how do you place a price on death and suffering? It's the same problem that plauges the courts when these cases come up. Can a judge honestly say the life of someone's child isn't worth X amount of dollars, where ever X is the award the jury reccomends?

If you make sueing more difficult, you risk making the seeking orf redress unavialable to the poor. If you cap rewards, you are basically putting an upper limit on what a life is worth. Or a limb or didgeit. Ad that is going to be vicious when situations come up. Maybe loosing a finger is worth 20K, but if the patient is a concert pianist? Is it still only worth 20K even when it robs someone of their ability to earn? What if it robs us all of their genius? Capped rewards remove the ability of a judge and jury to exercise latitude in accordance to the particular circumstance.

No matter how you go, it gets messy quickly.

It's so complex it defies an easy answer. It may even defy any answer.

 

[R. Richard]

If you make sueing more difficult, you risk making the seeking for redress unavialable to the poor. If you cap rewards, you are basically putting an upper limit on what a life is worth. Or a limb or didgeit. Ad that is going to be vicious when situations come up. Maybe loosing a finger is worth 20K, but if the patient is a concert pianist? Is it still only worth 20K even when it robs someone of their ability to earn? What if it robs us all of their genius? Capped rewards remove the ability of a judge and jury to exercise latitude in accordance to the particular circumstance.

Colly:
The caps are for punitive damages and pain and suffering. Actual damages are not capped. If a concert pianist lost a finger due to malpractice, the loss of his/her lifetime earnings would be actual damages and would be uncapped.

It may be easier to see the problems with the current system by looking at a recent Texas jusry award in a Vioxx case. The patient had take Vioxx for only a few months when he had a fatal heart attack. The proven heart attack risk is ONLY for those who have taken Vioxx for over 18 months. Thus, the jury award of some 250 million [???] is insane.

 

[Colleen Thomas]

Colly:
The caps are for punitive damages and pain and suffering. Actual damages are not capped. If a concert pianist lost a finger due to malpractice, the loss of his/her lifetime earnings would be actual damages and would be uncapped.

It may be easier to see the problems with the current system by looking at a recent Texas jusry award in a Vioxx case. The patient had take Vioxx for only a few months when he had a fatal heart attack. The proven heart attack risk is ONLY for those who have taken Vioxx for over 18 months. Thus, the jury award of some 250 million [???] is insane.

I saw. I know also there are "magic" jurisdictions in mississippi. Lawyers are always looking for someone int hese areas who have taken drug X. they get that person to file a class action suit so it can be heard in these districts. Kinda slimy, but that's what lawyers are for.

Capping punative damages is only going to work if you start revoking liscences. And that is a whole new mess.

It's such a complex problem, and there are so many variables from case to case.
I think it would take a complete re writing of the codes and a complete redefining of liability in such cases. I don't think quick fixes like capping damages or making frivilous lawsuits actionable are going to really adress the deep seated problems.

 

[BlackShanglan]

The real problem with reforming the legal end is how do you place a price on death and suffering? It's the same problem that plauges the courts when these cases come up. Can a judge honestly say the life of someone's child isn't worth X amount of dollars, where ever X is the award the jury reccomends?

If you make sueing more difficult, you risk making the seeking orf redress unavialable to the poor. If you cap rewards, you are basically putting an upper limit on what a life is worth. Or a limb or didgeit. Ad that is going to be vicious when situations come up. Maybe loosing a finger is worth 20K, but if the patient is a concert pianist? Is it still only worth 20K even when it robs someone of their ability to earn? What if it robs us all of their genius? Capped rewards remove the ability of a judge and jury to exercise latitude in accordance to the particular circumstance.

No matter how you go, it gets messy quickly.

It's so complex it defies an easy answer. It may even defy any answer.

I agree wholly on the complexity. You're right; there is no easy answer, especially when the right to sue is such a crucial defense against many forms of misconduct. Much as I despise some of the arrant abuse of our systems of litigation, there are times when we see their good results. Take the recent moves to get transfats out of food products. There's no doubt in my mind that the companies are moving swiftly out of fear of lawsuits if they don't. When it works that way, it's really not such a bad thing.

That said, I think you've put your finger on the central problem. There is no cost of human life. No quantity of money could possibly repay its loss. Personally, I think that this is an argument in favor of capping suffering damages - although I should like to see the cap set fairly high. What I mean is that in truth, there is no quantity of money capable of replacing a human life. We should therefore acknowledge this and not attempt to find a value by awarding more and more staggering quantities of money. Given that it's not possible for any sum to recompense the loss, we have to set some limit or we're at the "all the money in the world won't make up for my loss" stage. It's true, it won't - and therefore there is no sense in awarding it. We need to set a limit that both recognizes the grievous loss and yet also acknowledges that we can't bankrupt the medical system in order to attempt to quantify it in dollars. If we do, then many other lives - equally priceless - are put at risk as health care costs soar and increasing numbers of people are priced out of the market.

I'll add an advance answer, as well, to what I think the most likely objection: won't this encourage large corporations to accept a rate of attrition in staff, knowing that the capped cost of a life might be low enough to make it worth their money to continue putting workers at risk? I would answer that I would cap punitive damages much higher. I would still cap them, for the same reason as above; it's impossible to ask a jury to make a rational decision on how much a human life is worth, because the question does not have a dollar figure answer. Perhaps a cap that was calculated on a percentage of the company's net worth or net profits might be the best route. At any rate, this would be coupled with this specification: that punitive damages are not awarded to the victim. His or her suffering does not increase with the size of the corporation or its payroll, and therefore she or he should not receive awards whose primary purpose is to punish the company in a way that it feels regardless of size. I would like to see punitive damages go to funding either in support of legal aid or justice system funding, or - because I know that the former would almost certainly be shot down as conflict of interest - perhaps to fund related governmental programs. If you're paying punitive damages as a result of workplace safety violations, your funds go to help supply OSHA with more inspectors. If your punitive damages are for malpractice, they go to help fund Medicare and Medicaid, or similar. I realize that there would be much to work out - the devil is in the details - but I think that cutting the victim/punitive damages connection would help reduce the number of "lottery"-style lawsuits filed.

Shanglan

 

[Boxlicker101]

I think that R Richard had a good point back in the beginning of the thread. If we wanted to work this problem from both sides - some modest increases in public support and some modest attempts to control costs - we might look at reforming the legal end of things. I've known several doctors whose malpractice insurance is three to five times their take-home pay - particuarly in obstetrics. There is also the additional cost of "defensive medicine." If you're terrified that you're going to be sued out of your profession, you start ordering extra tests, more scans, triple-checks just ot make sure that you haven't missed some tiny hint of a different and more serious problem. That drives costs up considerably.

I would take issue with the contention that "someone is making a ton of money out of this"; that costs are high is not, I think, necessarily an indication that one group of people anywhere is becoming wealthy. Doctors make a good wage in most cases, but they also work very long hours with constant life-and-death decisions to be made - and they spent, typically, over a decade of their lives being trained to do their jobs while the rest of us were making money, starting families, and enjoying those wild and happy days of our youth. What would someone have to pay you to get you to surrender a decade of your life? I suspect it might be more than what's left of a doctor's fee after he pays the staff, the building owner, the malpractice insurance company, and providers of the machinery and testing equipment needed to do his job. While recognizing that health care is, indeed, expensive, it's largely expensive because of what we demand from it: swift, thoroughly accurate, highly technologically advanced, near-instantly available care that we believe should be infallible at the risk of being sued into the ground and the earth salted over it. That's an expensive thing to pay for; there's really no getting around it.

Shanglan

As usual, the people making the tons of money are the lawyers, in this case, the ones bringing bogus malpractice claims, such as those described in posts later than the one I am quoting here. Normally, they get a big percentage of the amount collected from the defendants.

Colly, you mentioned something about steel mill workers or miners being hurt on the job. I believe most insurance companies won't pay those claims since the employer has to have some otheer insurance for on-the-job injuries.

 

[elsol]

Personally, I think we should cap human life awards.

Given: We cannot replace the person that died for the people that survived.

Need: To make companies take VERY seriously a life or death decision. (Translation: When you're making a cost analysis of what it would cost to recall or payout... I want the recall option to be more reasonable VERY quickly.)

Merck made 2.5 billion from Vioxx... who believes that they would have so voluntarily pulled the product if the threat of bankruptcy were not real?

Companies do make life/death decisions (I've watched my company make the decision and have to testify before Congress about it... In the end, Congress litigated every customer MUST acknowledge the risk in a provable fashion by us or we had to cut them off.)

When we've got millions on the table, I'm not going to trust someone to make the best decision other than for themselves... but billions, that's the number where I KNOW people are going to be looking for a way to get their hands on the pile and willfully ignore problems or come up with 'shaped evidence'.

Sincerely,
ElSol

 

[Colleen Thomas]

As usual, the people making the tons of money are the lawyers, in this case, the ones bringing bogus malpractice claims, such as those described in posts later than the one I am quoting here. Normally, they get a big percentage of the amount collected from the defendants.

Colly, you mentioned something about steel mill workers or miners being hurt on the job. I believe most insurance companies won't pay those claims since the employer has to have some otheer insurance for on-the-job injuries.

Workers comp is insurance. Working on the same principals I mentioned.

PS, got your mail, forgot to reply. Apologies for that, been fighting headaches.

 

[BlackShanglan]

As usual, the people making the tons of money are the lawyers, in this case, the ones bringing bogus malpractice claims, such as those described in posts later than the one I am quoting here. Normally, they get a big percentage of the amount collected from the defendants.

I think that the problem goes deeper than just deliberately bogus suits and claims. I think that some of it has to do with expectations as well. There are, undoubtedly, cases in which doctors are negligent. But there are also cases in which they have applied their best skills and knowledge in a conscientious fashion and have not achieved the desired result. Of course, that's much easier to take from an author than from a doctor. But the truth of it is that, however little we like to admit it, medicine is not a perfect and precise science and human knowledge and ability have not supplied an answer to every medical condition. A doctor might very honestly and with all good practice in place look at a set of symptoms and believe it to be the most common, 99.9% of the time cause that is relatively innocuous. What happens if it's the .1% of the time that it's a rare and extremely dangerous disease? Is it right to crucify someone who acted to the very best of his ability and knowledge, even if the end result was failure?

Unfortunately, there's no easy way to answer that when someone is dead and the doctor in question didn't interpret the symptoms correctly - however unlikely it might be that s/he could or would. The person is still dead, and in all likelihood the doctor is facing a lawsuit despite being guilty of nothing other than lacking divine inspiration.

This, in the end, drives our costs up. It's not just the cost of defending the lawsuit and paying the damages if awarded, which drives up insurance premiums; it's the cost of every doctor who hears about that case now ordering a full round of tests on every patient with those symptoms, just to make sure that it's not the .1% killer. Of course they must. One can't, after all, place a value on human life - certainly not a value so low as the cost of those tests, even if they run to a thousand dollars. But that's a false economy; someone, somewhere, just lost a thousand dollars of treatment for something else, because that money had to go to defending the doctor against even the slightest chance of a multi-million dollar lawsuit. As Colly says, that's what makes it so damned complex - everything to attached to everything else, and while the value of human life is limitless, the number of dollars available is not.

Shanglan

 

[elsol]

Who says the value of human life is limitless?

We make the decision every day that's its actually worth nothing.

It's the lives closest to us that seems to have value.

Sincerely,
ElSol

 

[SeaCat]

I honestly don't know if there is an answer. Is there a way to have universal healthcare without soaking everyone? Is there a way to make the Insurance Companies cover everyone? I don't know. Yes I do know that it will take money, a lot of it.

One thing I do know is this. The corporation I work for, which owns my hospital, which owns hospitals all over the United states, today made an announcement. They are laying off all housekeeping staff and bringing in a contractor. The reason for this move is to cut down costs, because they will not have to pay for the Health Insurance for these fifty plus people. (This after changing our Health Insurance for one which doesn't cover nearly as much as our older one, and costs us over twice as much.) These fifty plus people must now find new jobs, ones hopefully with Health Insurance. I can look down the road, and although my crystal ball is foggy I can see a time in the near future where our corporation will cut it's costs even further by denying Health Insurance to it's employees. Scary thought.

Cat

 

[Colleen Thomas]

I honestly don't know if there is an answer. Is there a way to have universal healthcare without soaking everyone? Is there a way to make the Insurance Companies cover everyone? I don't know. Yes I do know that it will take money, a lot of it.

One thing I do know is this. The corporation I work for, which owns my hospital, which owns hospitals all over the United states, today made an announcement. They are laying off all housekeeping staff and bringing in a contractor. The reason for this move is to cut down costs, because they will not have to pay for the Health Insurance for these fifty plus people. (This after changing our Health Insurance for one which doesn't cover nearly as much as our older one, and costs us over twice as much.) These fifty plus people must now find new jobs, ones hopefully with Health Insurance. I can look down the road, and although my crystal ball is foggy I can see a time in the near future where our corporation will cut it's costs even further by denying Health Insurance to it's employees. Scary thought.

Cat

They'll never deny it. Eventually, they'll put you all on an HMO that will deny it for them. That's how corporations work. Or they'll got to all contract labor, which is another way to keep costs down.

 

[R. Richard]

Some of you apparently think that the government should act to provide universal heath insurance. OK, let's review the government's masterful handling of a much simpler item.

Rent Snafus Plague Hurricane Evacuees

WASHINGTON - Only $114 a month stands between Shawn Williams, a Hurricane Katrina evacuee, and eviction from her temporary apartment in suburban Houston. Williams can afford to pay out of her own pocket and is willing to do so to make up the difference between the $633 voucher she gets in federal housing aid and the apartment's $747 rent. But a bureaucratic snag prevents her from closing the gap on her own.

Now, after paying the entire rent herself for months because the landlord cannot accept the voucher, Williams says she is running out of money and fears losing the two-bedroom apartment where she has lived with her disabled husband and teenage son since fleeing New Orleans more than two months ago.

The government's disaster relief agency says help is on the way for Williams and other evacuees caught in the frustrating tangle that prevents landlords from accepting more rent money than what Washington is willing to cover.

It is a problem in Houston and elsewhere where rents set by the market outpace the government's gauge for determining aid levels. For families, it is making it harder to find long-term housing. For cash-strapped cities, it is adding to their financial woes and depleting their resources for helping hurricane victims.

"These vouchers are pretty much worthless because they don't cover the full amount of the rent," Williams, 40, said in a telephone interview from the Tranquility Bay apartment complex in Pearland, Texas.

Federal officials said they could not say how many Katrina victims have been affected. Houston officials said as many as 6,000 additional rental units could be opened to families using federal vouchers if they were allowed to pay part of the rent.

Since Katrina hit on Aug. 29, the Federal Emergency Management Agency has provided $3.4 billion in housing assistance to evacuated victims. The money goes directly to victims or to state and local governments as reimbursement for their costs in housing hundreds of thousands of evacuees.

Housing officials say FEMA reimburses only as much as a federal measure of average rental costs, which differs by city. In some cases, local officials are unwilling to accept extra payments from tenants for fear that FEMA will not pick up its share.

The agency now is allowing some flexibility for reimbursements, including increasing the level of local rental costs and letting evacuees contribute to rental payments, spokeswoman Nicol Andrews said.

Last month, FEMA circulated an internal e-mail clarifying the policy; it is not clear whether the information went to local housing officials.

The agency is preparing a statement to assure Houston housing officials, and FEMA's acting director, R. David Paulison, has told the city that FEMA will "pay a fair price, but would not be gouged," Andrews said.

The city is awaiting official word. Until then, Houston will not pay the rent for people in apartments that cost more than FEMA will subsidize, said John Walsh, deputy chief of staff to Houston Mayor Bill White.

Houston has issued vouchers for long-term housing to about 18,000 of an estimated 40,000 families who will need it by the year's end, but the city anticipates that another 14,000 evacuees soon will move out of hotels.

Houston has received $37.2 million from FEMA to repay initial housing costs for evacuees, and it expects to get an additional $101 million for expenses through Jan. 31. Even so, Walsh fears the city will not be reimbursed for payments above the voucher levels. "Until we get a written confirmation, we're not going to expose ourselves," he said.

In Atlanta, FEMA provided $5.7 million in housing aid for hurricane evacuees, said Sandra Allen Walker, deputy chief of staff to Atlanta Mayor Shirley Franklin. The city contributed an additional $400,000, Walker said, but that still does not cover the total expenses.

"What we are seeking is for the federal government to pick up the gap," Walker said. "The amount that they offer is not commensurate with the market rate for living in Atlanta."

In Baton Rouge, La., dozens of people are on a waiting list for housing where they can pay part of the cost, said Robert McNeese, the city's director of community development.

"There are not any apartments that fall under fair market rents anymore, so the clients have to make up the difference," McNeese said.

Compounding the problem is FEMA's Dec. 1 deadline to move all evacuees out of hotels and into apartments or other long-term housing. Housing advocates estimate that more than 157,000 evacuees still are in hotel rooms in Texas, Louisiana, Arkansas and Oklahoma alone.

In Los Angeles, at least 96 percent of the metropolitan area's estimated 2 million rental units are full, and advocates are scrambling to find homes for at least 4,000 evacuees asking for help.

As of last week, evacuees were living in about 600 hotel rooms, said Tara Bannister, executive director of the California Apartment Association. She said FEMA's cap on rental assistance in Los Angeles was "far below" what units cost.

Moreover, "if a unit were going that cheap to begin with, it's usually already full," she said.

The problem is particularly prevalent in Texas, where landlords are beginning the eviction process against evacuees, some of whom have been unable to pay rent for the past two months.

"I have a lot of residents who are very angry with me," said Kirk Tate of Orion Real Estate Services in Houston, who manages about 16,000 apartment units in Texas. "But we may wake up six, seven months down the road and we would still have this."

 

[Boxlicker101]

This is a description of a bureaucracy. The Feds are probably the worst, being the biggest, but they're all bad.

 

[thebullet]

R Richards 'analogy' is apples and oranges.

Compare instead Medicade.