8 ms·

We've got to separate healthcare from employers before this goes to far. Companies have no business in your health and we still tie health insurance to employm

We've got to separate healthcare from employers before this goes to far. Companies have no business in your health and we still tie health insurance to employment as a legacy error not a benefit. Many problems arise from healthcare provided from the job such as ageism, culling the sick, making it harder to change jobs or start companies, and losing healthcare as you change jobs, not to mention helping the fixed price / backroom market that is healthcare. We'll never fix anything until we unbind healthcare from employers and make it more consumer focused independently (single payer or completely independent/private). We don't get any other personal insurance from work. We need to outlaw allowing companies to facilitate the healthcare plans and go fully independent like all other insurance (auto, home, life etc). Benefits can be paid in extra money not false benefits that lead to invasions of privacy. Why would you want your company knowing anything about your health? We supposedly live in a free society but then work at mini feudal/sharecropper empires with dictators and barely any say in what is acceptable.

alanh 10y ago
I completely agree with your sentiment. “We don't get any other personal insurance from work” isn't quite true, though. Many companies include at least minimal life & disability insurance.
programmarchy 10y ago
The history behind our current nonsensical scheme started with FDR capping wages during the great depression, which spurred companies to offer "perks" like healthcare to recruit talent. An example of one market intervention leading to another, and another, ad nauseam. Totally agree that insurance should be decoupled from corporations. The way the "market" is regulated hampers people from working independently or starting small businesses because it's so damn expensive for individuals to pay for healthcare themselves.
- StClaire 10y ago
  Kaiser of Kaiser Permanente started out making ships during WW2
- AbrahamParangi 10y ago
  The specifics of the American healthcare system aside, what leads you to believe that the problem is regulation? By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Why is there any reason to believe that there's too much state intervention as opposed to, say, too little?
  - wyager 10y ago
    > By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Except things like, you know, quality of care or satisfaction. Single-payer healthcare beats the American implementation, which is not a high bar to clear. There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state healthcare (in quality and wait times) and American healthcare (in cost). I wouldn't want to get, say, complicated brain surgery in Mexico; in that case, the tens of thousands of dollars premium you would pay, uninsured, for US care is probably worth it. But for routine medicine (dental care, minor surgery, etc.) it's medical tourism all the way. For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
    - lisper 10y ago
      > There's a reason medical tourism to Mexico and India is so prevalent. Yes: health care in Mexico and India is cheaper. Not better. Cheaper. > I wouldn't want to get, say, complicated brain surgery in Mexico. I rest my case.
      - wyager 10y ago
        > Not better. Cheaper. Nope, it's also better for the vast majority of medicine. Have you ever used Mexican private healthcare? I have! Customer service and convenience is through the roof compared to US healthcare. > I rest my case. Not a very good case! The reason you wouldn't want to get complicated surgery in Mexico is that they don't have as many medical specialists, or as much equipment. The US is richer and has better schooling, so we have a huge supply of experts and medical technology. For the cutting edge of medicine, the benefit of having this outweighs the costs of receiving care in the US. However, almost all medicine is simple and doesn't require a particle accelerator or superconductors or whatever else you can find in cutting-edge American medicine. I wouldn't buy a radiation-hardened satellite microprocessor from China, but I'm perfectly happy to buy a Chinese laptop!
- rpedroso 10y ago
  There are a few problems with this explanation: 1. FDR did not propose a wage cap until 1942, 3 years after the Great Depression had ended. It was a temporary wartime fundraising effort (and was quite popular with the public). In fact, health insurance really first came into existence during the Great Depression (mostly to ensure physicians and hospitals got paid). 2. FDR's wage cap did not pass. What actually happened was the passing of the the Stabilization Act of 1942, which gave FDR a power (that he invoked) to freeze wages and salaries during the war. The freeze was deeply unpopular with the labor movement, who threatened mass strikes. As a compromise, congress exempted health insurance (and other benefits like PTO and pensions) from the freeze. This was certainly a contributing factor (proportion of US population with healthcare roughly doubled from 1940 to 1945), but ignores the other factors that prompted the rise of employer sponsored healthcare. Indeed, by 1945, less than a quarter of Americans had health insurance. Rather, the two largest contributors to employer-sponsored health insurance was the demand of health coverage by labor unions and the 1954 legislative change that made health insurance tax exempt.
- james1071 10y ago
  There are many things that started 70 years ago which have long since gone. So, there must be forces which sustain the US model, where the employer pays for medical insurance. Also, I fail to see how employers offering medical insurance should make insurance for an individual any more expensive. So, while I appreciate the sentiment that something is clearly wrong, the two things that you mentioned are not the cause.
  - maxerickson 10y ago
    A big one is that there is a tax deduction for employer provided health insurance. So offering a decent health plan is more compensation than just handing over the cost of the plan (which would be taxed). As far as how employer coverage can drive up individual costs, there are a couple of factors. One is that people with good health plans often don't pay attention to how much they cost, and often don't have much of a deductible, so they just use the medical system without paying too much attention to costs. That at least has the potential to drive medical prices up. The other is that people in the group insurance market tend to be somewhat healthier than the individual market. So the pool for individual insurance is more expensive to insure. Setting aside discussions about whether it is fair or not, it does result in higher costs for the individual market.
    - james1071 10y ago
      The reasons that you have given might be part of the explanation, but on their own they do not explain it. Yes, it is true that there is a tax benefit to employers purchasing healthcare insurance, which is tax deductible, and providing it as a benefit in kind. However, it does not follow at all from that the insurers should benefit: their costs are not affected and in a competitive market, they would price at marginal cost. Yes, it is true that people in employer plans could be perceived as being a better risk than those who are do not have them. They would still be better risks (and 'deserving' of a lower premium) however they obtained their health insurance. So, as I said before, there must be something else going on. Similar arguments apply to your claim that employers are less price sensitive than consumers - that really is implausible, given their buying power and incentives to maximise profits.
yummyfajitas 10y ago
In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs) had no noticeable effect on startup formation or job separations. I've seen similarly no effect from Romneycare. https://images.washingtonpost.com/?url=http://img.washingtonpost.com/news/on-small-business/wp-content/uploads/sites/40/2015/02/Kauffman1.jpg&w=1484&op=resize&opt=1&filter=antialias https://images.washingtonpost.com/?url=http://img.washington... https://www.bls.gov/opub/ted/images/2010/ted_20100816.png https://www.bls.gov/opub/ted/images/2010/ted_20100816.png Do you have any evidence (as opposed to hypothetical anecdote) suggesting this is actually a significant factor?
- dragonwriter 10y ago
  > In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs) The ACA doesn't all that significantly affect the healthcare-related impact of switching jobs (it slightly mitigates the healthcare related cost of being a difficult-to-insure individual and moving from a job that provides a group plan to one that doesn't), and the parts of it that did have some impact on that were have not been in place long enough to have substantially affected people's expectations and behavior.
  - yummyfajitas 10y ago
    The parent poster said this: ...start companies [without loss of health care], and losing healthcare as you change jobs... Obamacare does in fact solve both these problems. According to you, how long will it take for potential startup founders to figure out that Obamacare actually gives them the ability to do a startup without losing health insurance? 10 years? 20 years? Is a person who is unaware of Obamacare after many years (and unable to adapt to changing conditions with years of warning) really a plausible startup founder?
    - patrickaljord 10y ago
      We have single payer here in France and we are way less entrepreneurial than the US. In fact most entrepreneurs here hate single payer as it imposes huge taxation on them for something that would be cheap under a private insurance system because most startup founders are young.
jedberg 10y ago
Places I've worked have provide life, health, AD&D, pet, dental, vision, and lawyer insurance. So yeah, it's a lot more than health. But I still agree with you -- we need to figure out a way to separate insurance from a job. Although I don't like the idea of just precluding them from offering it. If a company wants to offer insurance we shouldn't stop them. We just need to make it so they have little advantage to do so.
- gambiting 10y ago
  I work in the UK with excellent national health service, but I still get private health insurance from my employer - mostly so that I can see a specialist quicker than through NHS. But it's really not too much of a perk for my employer to provide, we have the highest tier of insurance and it costs about ~$400/year.
- XorNot 10y ago
  "figure out" - the rest of the first world has implemented this. Pick a model, deploy, tweak for circumstance. There's not a learning problem here.
codecamper 10y ago
In the US many have a very flawed way of thinking: if we give more power to companies, than we won't need government. I've met so many bright & creative programmer types who even believe this. Government should exist to protect it's people and environment. It should have the long term in mind & work with other governments to do the same, creating a level playing field for the companies to be within.
- enraged_camel 10y ago
  >>I've met so many bright & creative programmer types who even believe this. I would posit that they aren't very bright if they actually believe it.
  - lumberjack 10y ago
    Just because somebody is very apt at one particular kind of mental skill, doesn't necessarily make them immune to believing very silly things.
- seanp2k2 10y ago
  Yeah, I was just having a conversation with someone today about how it never works out in practice. There is no free market, and in anything approaching it, companies simply e.g. collude to keep prices high or make things unnecessarily complex. Look at cell phone plans and what "unlimited" means, for example. Not that the wireless ISP industry is unregulated (far from it), but why not just start your own and fix it? Free market, right? Start a healthcare company and undercut everyone because free market. Start an ISP and take down Comcast, etc. The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned. I guess there is still debate around if a modern society should let people suffer and die because they did not generate or inherit enough money to pay for medical care. It saddens me that our baseline of giving a shit about other people in our society is pretty low in America, even though we have far beyond the means to do so. Enough people with enough power here would rather have a few extra % in their shell company bank accounts instead of increasing the standard of living for the people of the society in which they exist. "A rising tide lifts all boats"
deleted 10y ago
[deleted]
emodendroket 10y ago
I get the sentiment but a lot of people do get life insurance through work.
dalbasal 10y ago
Employer coupled insurance has certain pathologies. But, I think that insurance as a funding model has is a bigger problem. "It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy." Genetics is just another way of getting useful information for pricing insurance efficiently, guessing future medical expenses more accurately. To the extent that pricing becomes efficient it ceases to be insurance. This is basically the case for sick people. Their medical costs are known and high. Price efficiency puts more people in that boat. Known high costs expensive. Known low costs cheap. In an insurance based system, information is priced in. Insurance is good for costs that are unlikely but high. In medicine, we're looking for a system that caters to all medical scenarios regardless of likelihood. Insurance only makes sense for some.

alanh 10y ago

I completely agree with your sentiment. “We don't get any other personal insurance from work” isn't quite true, though. Many companies include at least minimal life & disability insurance.

programmarchy 10y ago

The history behind our current nonsensical scheme started with FDR capping wages during the great depression, which spurred companies to offer "perks" like healthcare to recruit talent. An example of one market intervention leading to another, and another, ad nauseam. Totally agree that insurance should be decoupled from corporations. The way the "market" is regulated hampers people from working independently or starting small businesses because it's so damn expensive for individuals to pay for healthcare themselves.

StClaire 10y ago
Kaiser of Kaiser Permanente started out making ships during WW2
AbrahamParangi 10y ago
The specifics of the American healthcare system aside, what leads you to believe that the problem is regulation? By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Why is there any reason to believe that there's too much state intervention as opposed to, say, too little?
- wyager 10y ago
  > By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Except things like, you know, quality of care or satisfaction. Single-payer healthcare beats the American implementation, which is not a high bar to clear. There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state healthcare (in quality and wait times) and American healthcare (in cost). I wouldn't want to get, say, complicated brain surgery in Mexico; in that case, the tens of thousands of dollars premium you would pay, uninsured, for US care is probably worth it. But for routine medicine (dental care, minor surgery, etc.) it's medical tourism all the way. For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
  - lisper 10y ago
    > There's a reason medical tourism to Mexico and India is so prevalent. Yes: health care in Mexico and India is cheaper. Not better. Cheaper. > I wouldn't want to get, say, complicated brain surgery in Mexico. I rest my case.
    - wyager 10y ago
      > Not better. Cheaper. Nope, it's also better for the vast majority of medicine. Have you ever used Mexican private healthcare? I have! Customer service and convenience is through the roof compared to US healthcare. > I rest my case. Not a very good case! The reason you wouldn't want to get complicated surgery in Mexico is that they don't have as many medical specialists, or as much equipment. The US is richer and has better schooling, so we have a huge supply of experts and medical technology. For the cutting edge of medicine, the benefit of having this outweighs the costs of receiving care in the US. However, almost all medicine is simple and doesn't require a particle accelerator or superconductors or whatever else you can find in cutting-edge American medicine. I wouldn't buy a radiation-hardened satellite microprocessor from China, but I'm perfectly happy to buy a Chinese laptop!
rpedroso 10y ago
There are a few problems with this explanation: 1. FDR did not propose a wage cap until 1942, 3 years after the Great Depression had ended. It was a temporary wartime fundraising effort (and was quite popular with the public). In fact, health insurance really first came into existence during the Great Depression (mostly to ensure physicians and hospitals got paid). 2. FDR's wage cap did not pass. What actually happened was the passing of the the Stabilization Act of 1942, which gave FDR a power (that he invoked) to freeze wages and salaries during the war. The freeze was deeply unpopular with the labor movement, who threatened mass strikes. As a compromise, congress exempted health insurance (and other benefits like PTO and pensions) from the freeze. This was certainly a contributing factor (proportion of US population with healthcare roughly doubled from 1940 to 1945), but ignores the other factors that prompted the rise of employer sponsored healthcare. Indeed, by 1945, less than a quarter of Americans had health insurance. Rather, the two largest contributors to employer-sponsored health insurance was the demand of health coverage by labor unions and the 1954 legislative change that made health insurance tax exempt.
james1071 10y ago
There are many things that started 70 years ago which have long since gone. So, there must be forces which sustain the US model, where the employer pays for medical insurance. Also, I fail to see how employers offering medical insurance should make insurance for an individual any more expensive. So, while I appreciate the sentiment that something is clearly wrong, the two things that you mentioned are not the cause.
- maxerickson 10y ago
  A big one is that there is a tax deduction for employer provided health insurance. So offering a decent health plan is more compensation than just handing over the cost of the plan (which would be taxed). As far as how employer coverage can drive up individual costs, there are a couple of factors. One is that people with good health plans often don't pay attention to how much they cost, and often don't have much of a deductible, so they just use the medical system without paying too much attention to costs. That at least has the potential to drive medical prices up. The other is that people in the group insurance market tend to be somewhat healthier than the individual market. So the pool for individual insurance is more expensive to insure. Setting aside discussions about whether it is fair or not, it does result in higher costs for the individual market.
  - james1071 10y ago
    The reasons that you have given might be part of the explanation, but on their own they do not explain it. Yes, it is true that there is a tax benefit to employers purchasing healthcare insurance, which is tax deductible, and providing it as a benefit in kind. However, it does not follow at all from that the insurers should benefit: their costs are not affected and in a competitive market, they would price at marginal cost. Yes, it is true that people in employer plans could be perceived as being a better risk than those who are do not have them. They would still be better risks (and 'deserving' of a lower premium) however they obtained their health insurance. So, as I said before, there must be something else going on. Similar arguments apply to your claim that employers are less price sensitive than consumers - that really is implausible, given their buying power and incentives to maximise profits.

yummyfajitas 10y ago

In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs) had no noticeable effect on startup formation or job separations. I've seen similarly no effect from Romneycare. https://images.washingtonpost.com/?url=http://img.washingtonpost.com/news/on-small-business/wp-content/uploads/sites/40/2015/02/Kauffman1.jpg&w=1484&op=resize&opt=1&filter=antialias https://images.washingtonpost.com/?url=http://img.washington... https://www.bls.gov/opub/ted/images/2010/ted_20100816.png https://www.bls.gov/opub/ted/images/2010/ted_20100816.png Do you have any evidence (as opposed to hypothetical anecdote) suggesting this is actually a significant factor?

dragonwriter 10y ago
> In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs) The ACA doesn't all that significantly affect the healthcare-related impact of switching jobs (it slightly mitigates the healthcare related cost of being a difficult-to-insure individual and moving from a job that provides a group plan to one that doesn't), and the parts of it that did have some impact on that were have not been in place long enough to have substantially affected people's expectations and behavior.
- yummyfajitas 10y ago
  The parent poster said this: ...start companies [without loss of health care], and losing healthcare as you change jobs... Obamacare does in fact solve both these problems. According to you, how long will it take for potential startup founders to figure out that Obamacare actually gives them the ability to do a startup without losing health insurance? 10 years? 20 years? Is a person who is unaware of Obamacare after many years (and unable to adapt to changing conditions with years of warning) really a plausible startup founder?
  - patrickaljord 10y ago
    We have single payer here in France and we are way less entrepreneurial than the US. In fact most entrepreneurs here hate single payer as it imposes huge taxation on them for something that would be cheap under a private insurance system because most startup founders are young.

jedberg 10y ago

Places I've worked have provide life, health, AD&D, pet, dental, vision, and lawyer insurance. So yeah, it's a lot more than health. But I still agree with you -- we need to figure out a way to separate insurance from a job. Although I don't like the idea of just precluding them from offering it. If a company wants to offer insurance we shouldn't stop them. We just need to make it so they have little advantage to do so.

gambiting 10y ago
I work in the UK with excellent national health service, but I still get private health insurance from my employer - mostly so that I can see a specialist quicker than through NHS. But it's really not too much of a perk for my employer to provide, we have the highest tier of insurance and it costs about ~$400/year.
XorNot 10y ago
"figure out" - the rest of the first world has implemented this. Pick a model, deploy, tweak for circumstance. There's not a learning problem here.

codecamper 10y ago

In the US many have a very flawed way of thinking: if we give more power to companies, than we won't need government. I've met so many bright & creative programmer types who even believe this. Government should exist to protect it's people and environment. It should have the long term in mind & work with other governments to do the same, creating a level playing field for the companies to be within.

enraged_camel 10y ago
>>I've met so many bright & creative programmer types who even believe this. I would posit that they aren't very bright if they actually believe it.
- lumberjack 10y ago
  Just because somebody is very apt at one particular kind of mental skill, doesn't necessarily make them immune to believing very silly things.
seanp2k2 10y ago
Yeah, I was just having a conversation with someone today about how it never works out in practice. There is no free market, and in anything approaching it, companies simply e.g. collude to keep prices high or make things unnecessarily complex. Look at cell phone plans and what "unlimited" means, for example. Not that the wireless ISP industry is unregulated (far from it), but why not just start your own and fix it? Free market, right? Start a healthcare company and undercut everyone because free market. Start an ISP and take down Comcast, etc. The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned. I guess there is still debate around if a modern society should let people suffer and die because they did not generate or inherit enough money to pay for medical care. It saddens me that our baseline of giving a shit about other people in our society is pretty low in America, even though we have far beyond the means to do so. Enough people with enough power here would rather have a few extra % in their shell company bank accounts instead of increasing the standard of living for the people of the society in which they exist. "A rising tide lifts all boats"

deleted 10y ago

[deleted]

emodendroket 10y ago

I get the sentiment but a lot of people do get life insurance through work.

dalbasal 10y ago

Employer coupled insurance has certain pathologies. But, I think that insurance as a funding model has is a bigger problem. "It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy." Genetics is just another way of getting useful information for pricing insurance efficiently, guessing future medical expenses more accurately. To the extent that pricing becomes efficient it ceases to be insurance. This is basically the case for sick people. Their medical costs are known and high. Price efficiency puts more people in that boat. Known high costs expensive. Known low costs cheap. In an insurance based system, information is priced in. Insurance is good for costs that are unlikely but high. In medicine, we're looking for a system that caters to all medical scenarios regardless of likelihood. Insurance only makes sense for some.