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People Lose Their Employer-Sponsored Insurance Constantly

162 points by mkane848 7y ago

TopHand 7y ago
If you want a good example of government supplied health insurance, go to your local VA hospital, and see if that is the kind of health care you really want.
- mkane848 7y ago
  The goal is for government-funded, not government-run. At least in the context of M4A.
intopieces 7y ago
Am I correct in understanding that Medicare for All plans to abolish private insurance? I prefer there be a system where you can get private insurance if you want, but if you go without you are automatically on Medicare.
timbit42 7y ago
Silly Americans.
terryschiavo22 7y ago
Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Is the argument that switching insurance plans is stressful? What's stressful is remaining uncovered. Switching plans is hardly comparable to the transition to a Medicare-for-all program.
- pnutjam 7y ago
  With the current love for High deductible plans, it can get much riskier. I just walked away from a plan where I had paid the full Out of pocket max for the year (around $7k), in January. That hurt, but the other offer was good enough. None of that money translates to the new plan, I'm back to paying deductibles for everything.
- zrail 7y ago
  > Switching plans is hardly comparable to the transition to a Medicare-for-all program The big stressor is having to pay two deductibles in one year. That said, from an individual perspective I don't see what would be different. Before you had an (Aetna|Cigna|BCBS|UHC) card, now you have a M4A card.
- crooked-v 7y ago
  > Is the argument that switching insurance plans is stressful? It absolutely is stressful, because every single time you have to carefuly inspect the documentation to figure out what conditions and care (if any) you're "allowed" to have without going bankrupt.
  - identity-haver 7y ago
    For non-Americans and confused Americans reading this, this isn't precisely true. Any employer with over 50 employees has to cover all pre-existing conditions from your previous employer. But there is no guarantee that your old providers will be in your new network, so you may have to switch providers, with all the bureaucratic headache that entails. Also, if you are getting care for that condition that isn't 100% standard and established you may not get it, or have to spend a bunch of extra money while it gets re-approved. Also, your deductible will reset, so if you switch jobs in the middle of the year you could potentially be paying thousands more out of pocket.
- gorbachev 7y ago
  If you switch to another insurance provider, you might have to change doctors, pharmacies and other service providers, because your previous service provider is no longer in-network or too costly. Also your coverage may completely change for better or worse. The worst case scenario is just as disastrous as losing insurance entirely. This is particularly bad for people with chronic/ongoing medical needs.
- midnightmonster 7y ago
  They lose their insurance for other reasons, too. Their employer changes plans; they get dropped from full time to part time; they lose their job and don't immediately get another. And switching insurance plans at almost any time can be very costly, even if you go straight to a new one, as all your deductibles and out-of-pocket limits get reset. And then you have to hit them again when the plan year starts again, almost certainly sooner than a year later.
  - fwip 7y ago
    My employer switched health insurers 3 years in a row. First because we became a new company (understandable), second because they thought they could get a better deal at another place (okay...), and thirdly reverting the 2nd change except some of the numbers and coverage is different now. I really am considering leaving if they switch a 4th time.
- naravara 7y ago
  >Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Unless they lose their jobs. Or change to a job that doesn't offer coverage/start a new business. Or have their hours cut to be <40 hrs/wk and are no longer eligible. . . >Switching plans is hardly comparable to the transition to a Medicare-for-all program. Why? It would be a one-time switch. Switching costs would be exactly the same as the switching costs you pay every time you change jobs, except you only pay it one time in your life and you don't have to shop around in some silly healthcare exchange or open enrollment process where you get to weigh which absurdly high premium you want to pay despite deductibles being so high that barely any of your routine health costs will be compensated. And then there is the joy of making sure all your care providers are covered by your new plan. AND hoping your providers don't drop your plan because of insurance company negotiations.
  - dd36 7y ago
    It’s not just when you change jobs. My wife handles large employer groups and the insurance companies ask for a 15% rate increase every year so the employers have to threaten to switch every year to negotiate down then actually switch every other year. It’s a wasteful, useless game. Even if you stay at same employer, your insurer and networks will regularly change.
- benatkin 7y ago
  How about having to switch doctors, or having to go a couple weeks without an insurance card, but hey, you still have insurance and you can pay up front and get reimbursed later? Big fucking deal, right?
- dragontamer 7y ago
  > Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Lets say you payed for insurance, but were healthy for the 90s. So ~10-years of paying insurance. Around 2005, you are diagnosed with Diabetes, so your insurance pays for your care. Around 2007, the recession happens and you lose your job. You immediately find a new job, but you need to get new insurance. Diabetes is now a "pre-existing condition", so your insurance no longer covers your condition. Its important to recognize that changing health-plans is a regular event, that shouldn't punish people with chronic conditions. Diabetes is lifelong, once you get it, you live with it for the rest of your life. Insurance companies don't want to pay for that kind of issue. With all talk about "Repeal and Replace", its important to recognize the tradeoff. As long as "pre-existing conditions" are banned in the USA, I don't think its a big deal to lose employer sponsored health care (at least, compared to pre-Obamacare). We should build a world where it is easy to lose (and regain) health coverage... compared to the pre-Obamacare world where it was a big risk to lose coverage. Hopefully laws of the future make it easier to switch health care plans without problems.
  - conanbatt 7y ago
    The problem with covering pre-existing conditions at all times is that you need to make insurance mandatory, due to the adver selection problem. If insurance is optional, then only people that know they are sick or will get sick will dominate the insurance, making it more expensive, and pushing the healthy-low risk out. Its a well known economics problem that has no silver bullet. What is crazy to me is that insurance is involved in paying primary care doctors. That is a terrible application of health insurance, and have full faith on high deductible plans bringing sanity back into this.
  - scarface74 7y ago
    If you find a new job and you’re eligible under group insurance, the insurance company can’t deny a claim under pre-existing conditions. This was true before the ACA. What the ACA changed was that insurance companies couldn’t exclude treatment based on preexisting conditions if you go on the open market.
- will_brown 7y ago
  >Is the argument that switching insurance plans is stressful? I think it’s clear the article is promoting universal coverage, and simply highlight how ridiculous it is that healthcare is a benefit of employment by highlighting nearly 1/3 of employment based plans are discontinued within 12 months. I’m not sure how you can conclude switching private insurance plans is hardly comparable to a transition to Medicare-for-all, when millions of people make the jump from private insurance to Medicare every year and you don’t hear much complaining from that group. Not to mention a 1 time transition compared to nearly 33% of the workforce going through this annually.
- maxsilver 7y ago
  > and then immediately sign onto their new plan Nope. Employer-provided insurance plans often have blackout dates. If you quit your job on June 2, and start your new job on June 3, your new job's health insurance might not actually take effect for up to 30, 60, or even 90 days after your start date. To cover that gap period, you either have to switch to a new plan with your old employer (commonly called COBRA) at ridiculous high rates nobody can afford, or you have to get temporary blackout insurance coverage (which cover nothing at all, and are almost identical to having no insurance). This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insurance/short-term-plans https://www.priorityhealth.com/individual-family-health-insu... for example). In America, to switch jobs once, requires three concurrent interactions with three different health insurance plans, simultaneously. (Your old employer plan, your intermediate temporary plan/COBRA, and your new employer's plan). For obvious reasons, this is incredibly error prone, risky, and fraught with stress. > Is the argument that switching insurance plans is stressful? Yes! Literally every single interaction with every single health insurance provider is painful and stressful and complicated and intentionally obfuscated, for absolutely no valid reason whatsoever.
  - intopieces 7y ago
    >This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insu.. https://www.priorityhealth.com/individual-family-health-insu.... for example). This doesn’t even cover pre-existing conditions. So, if you are on medication for high blood pressure, or have diabetes, or are just one of the 55 percent of Americans who take prescription drugs... you are out of luck. That these plans are even legal is a monumental failure of the American system.
  - nogridbag 7y ago
    As I painfully found out, transitioning between jobs also requires competent HR people on both ends. Our insurance was accidentally terminated a week early so our claim was denied and we got a massive bill. Not only do you have to then deal with the insurance company but you have to deal with your previous employer to fix the situation.
- a3n 7y ago
  When I started my current job I wasn't eligible for benefits for 90 days. This is not uncommon.
  - Glyptodon 7y ago
    One time I switched jobs the company I left was so small (I think ~ 15 to 18 people) it turned out that COBRA wasn't available and new job benefits didn't kick in for 90 days. This was between when the ACA was passed and took effect so getting private insurance for the gap was scary. (Going without coverage was not an option, I have serious medical history.)
  - nogridbag 7y ago
    My wife recently worked for a startup and had them change the company policy to start benefits on day 1 simply by asking. No one really knew why the benefits started after N days and no one cared enough to change it previously.
- gwbas1c 7y ago
  I don't understand why you're downvoted. It's an important observation. In my case, my employer was bought and sold 3 times. All three cases involved a sudden and abrupt termination of my insurance. It was "okay" when I was single, but once I carried my wife, and then my entire family, it became a huge problem. Throughout my tenure at my job, I had major surgery and two children. Sudden insurance changes immediately before or during any of those events would be a huge problem. (Fortunately, the timing worked out.)
  - tialaramex 7y ago
    Europe also has a broader fix for this, called Transfer of Undertakings rules, the UK version is "TUPE" the "Transfer of Undertakings (Protection of Employment) Regulations". The broad overview of TUPE is that employees whose actual job doesn't change shouldn't have to put up with any negative consequences at all for the fact that at some higher level their employer changed. e.g. the office building switches from Ace Cleaning Corp. to Best Cleaning Limited, but it's still Jenny and Achmed actually doing the cleaning, just in blue overalls instead of yellow now. It makes no sense to be allowed to tell Jenny now she's only getting minimum wage because Best Cleaning Limited doesn't pay as much as Ace Cleaning Corp, she's doing the same job so she should continue to get the same pay. But I don't mean just obvious stuff like they can't cut your pay, it's everything - your seniority is preserved, shift priorities, rules for how much paid leave you get, or how pensions are paid - if it was part of the job, then it moves with the job. If employment-based health insurance was a big thing here, that would undoubtedly be covered.
aNoob7000 7y ago
Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.
- bluejekyll 7y ago
  > The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this. I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
  - dd36 7y ago
    If Bernie wins running with it as his primary issue, it’s a lot easier to get Congress on board.
    - conanbatt 7y ago
      Its definitely a boon for the cause, but I would be surprised if it passed the senate. OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
  - dv_dt 7y ago
    After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats. It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
benatkin 7y ago
When I quit my job in SF in November 2017, I had $1200 on my FSA. When I switched to COBRA, my FSA account kept its balance, but my VISA card associated with it immediately and unexpectedly stopped working. I was seeing a psychologist at the time and it was awkward when I didn’t pay him right away because I thought it would be fine to try and fix my card and pay him the next day (which I did). It felt awkward enough to me that I stopped my therapy sessions with him, because I felt like it had become strained. Anyway, the company stopping my card from working was intentional. It was the same company and the same account but my card didn’t work anymore and I had to go through the trouble to submit a claim, and they acted like this was by design that my FSA card would stop working when I quit and switched to COBRA. Now I’m working remotely and am in a new state (Florida) and not sure I’ll stay here long enough to switch everything to this state. I needed to get a fever checked out and ended up paying out of pocket because I was told over the phone that they accepted my out of state insurance, but when I got there in person, they didn’t. What a mess.
jwildeboer 7y ago
People [in the US] … ;)
- guitarbill 7y ago
  As much as your comment might be taken in the wrong way, it is important to point out first world countries have this sorted. I simply don't get it. When did patriotism become about military might and waving flags instead of making sure your fellow countrymen don't live in agony, fear, and poverty?
  - TheSoftwareGuy 7y ago
    I'd say about 1946, or whenever the cold war is said to have officially begun. Or maybe even earlier during WW2. That being said the sentiment was never a good one, and we do need to move on from it.
usermac 7y ago
Healthcare finance is a mess in the US.
helen___keller 7y ago
The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months? Start a new job at a startup, need to go to trainings to understand the health care options and choose one, get new cards and website logins, update my info at every provider New dentist is having difficulty getting my routine care billed to insurance and calls me every week asking for my insurance information again. Wifes doctor didn't do something correctly when I updated insurance so now I need to call and deal with this big medical bill that I shouldn't have gotten. Startup got acquired so I get another training for the new insurance options. And get new cards and logins and update with all providers again Planning to get a surgical operation but nobody can tell me how much it will cost, doctor says "probably whatever your deductible is" except I have a high deductible plan so is it really going to cost me $2500? Etc cetera. There's no end to the nuisance. If I could choose to just pay more in taxes (hell I'll pay way more than my current premiums) and never deal with insurance again, I would do it in a heartbeat.
- ThrustVectoring 7y ago
  >So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months? It's friction costs for splitting up the decision-making process into multiple entities. For any bill, the insurance company pays $X, the patient pays $Y, and the provider has $Z in costs. The $X that the insurance company pays is what they optimize for, not $Y and certainly not $Z. This has the side effect of somewhat optimizing $Z, since $Y is limited by how much money people have and if $Z is consistently bigger than $X + $Y, the healthcare provider loses money and goes out of business. Honestly, the way to go is to treat the entire process as interaction with hostile bureaucracy. Document everything, and look like you'll generate a regulatory incident if you don't get what you're legally entitled to. Otherwise the insurance company will happily reduce their costs by offloading it onto you or the healthcare provider through pulling bullshit stunts.
pnathan 7y ago
One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. It's not just plain $$$ and career risk, it's the "suppose you will go bankrupt and your family has permanent medical issues now" risk. That game is for the wealthy or healthy single people In addition, each insurance plan has slightly different doctors that sign on, so when there are changes, you might wind up needing to use different doctors or worse, health systems. It'd be much better for me, personally, to require providers to all accept some US Public Single Payer plan (or whatever you call it) as part of opening a practice and seeing patients. (I don't speak in any sense for my employer, who is in the health care space: this is just an engineer's personal musings)
- toast0 7y ago
  When I worked for a startup, they were affiliated with a "professional employer organization", which allowed access to major PPO and HMO insurance plans, and also handled some of the payroll obligations.
- henrikschroder 7y ago
  > One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. I joined a startup once, but it was in Europe, so these issues weren't even on my radar or the company's radar. With government healthcare and government unemployment insurance, it's a no-brainer. The only risk is to your lifetime earning potential. Stay at a solid job with a solid salary, or take a shot at the startup lottery. Your health or your family or your home are just never on the line by taking that risk. The amount of time and worry you have to spend on healthcare for yourself and your family in the US is absolutely off the charts, and this cost is completely hidden! Time that companies have to spend on acquiring healthcare insurance for their employees is wasted time. Time that employees have to spend on researching the insurance options their company is offering them is wasted time. Time that you spend dealing with healthcare providers to ensure that you're covered by your insurance is wasted time. In Europe the time spent on this is, for the most part, 0. Companies don't spend time on this. Employees don't spend time on this. But noone in the US seems to regard this waste, this cost, as something fixable. Noone seems to think of the competitive edge this gives EU companies, or want to have the same competitive edge. Why? Why are US companies and US employees just completely resigned to the thought that healthcare just is a massive necessary headache for everyone?
Glyptodon 7y ago
Employer sponsored health insurance is an outpost of neofeudalism. Swear your fealty to a lord or go without.
- paulddraper 7y ago
  Yes. And it was made even worse by the ACA which effectively required employers to be feudal lords, whether they wanted to or not. Before, the possibility of sane choose-my-health-insurance-like-I-choose-my-car-insurance was at least on the table.
  - deleted 7y ago
    [deleted]
- jkingsbery 7y ago
  Employee sponsored health insurance is a result of "centrally planned" economics - https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th... ... it has nothing to do with feudalism or even what employers wanted, but has a lot more to do with government officials who thought they could design an economy.
  - dredmorbius 7y ago
    The reasons things start, and the reasons they persist, are often quite different. The US doesn't seem to have subscribed to strongly-cenralised economic policy for nearly 70 years. And yet the employer-feudal healthcare system continues. Preponderance of evidence suggests that dominant economic, financial, and power structures prefer it that way. The origin story is an interesting footnote, no more.
    - jkingsbery 7y ago
      While it's true the reason things start and persist are different, many would disagree about the level of central planning in the US, with healthcare being an example odd where there is a good deal of government control (everything from pricing of procedures, drug approval, and licensing to name a few). Whether that's a good thing is another question, but I think it's oversimplifying to conclude that the problem is all due to corporate feudal overlords and not at all due to government policy. Further, there is a lesson to be learned concerning unanticipated co sequences in the origin of the current system that we're in danger of repeating by having further government control of healthcare.
camelNotation 7y ago
Medicare-for-All is some sort of "far left" fantasy in the United States, but single-payer healthcare is center-right dogma in every other developed country. I have no idea why this is so hard for the American right to grasp: single-payer healthcare is a social program, but it's not the same as socialism. We aren't trying to steal the means of production from you in some sort of revolution, we just don't want people to die from preventable things. It is entirely possible to have a single-payer healthcare system alongside a thriving capitalist economy. This sort of foundational public service actually makes economies better, not worse. It's not a burden on the market to have healthy workers.
- conanbatt 7y ago
  Doesn't really help that M4A is pushed by someone that calls himself a socialist and outspokenly disapproves of capitalism.
- maxxxxx 7y ago
  "single-payer healthcare is a social program, but it's not the same as socialism" American politics is geared towards appealing to the extremes. Social programs are "socialist" and get connected to the Soviet Union, cuba and Venezuela. If you say something that's even slight politically incorrect you are immediately labeled as a "racist" that should be removed from your job and all public discussion. There is no interest in discussing problems and finding solutions. It's all about anger.
  - otaviokz 7y ago
    Couldn't agree more.
- TOGoS 7y ago
  > We aren't trying to steal the means of production from you I mean, workers created them in the first place, so I'm all for "stealing" them back. But I also wouldn't mind single-payer healthcare in the meantime.
sairahul82 7y ago
The fundamental problem is no body knows the cost of anything beforehand. Neither insurance company not doctors tell the cost of the care. Its really frustrating ! The first step to fix the problem is getting the cost of the care transparently. Without this i am not sure how any of the scheme works whether it is done by govt or private insurance companies !
- EamonnMR 7y ago
  I think the problem is that hospitals can use the price of procedures as a bargaining chip. They can jack up the price for the uninsured (on paper) then lower it if they're actually going to bill a person. Then they take the jacked up number and use it to negotiate with insurance companies, and insurance companies can likewise point to the number and say "look what will become if you if you don't stick with us!" The first step should be disallowing this negotiation. That should massively lower the on-paper prices, or let insurance companies at least make the tough decisions about what procedures are actually worth it, which is supposed to be one of their functions anyway. If that isn't their function, I'm not sure what their function is.
- rootusrootus 7y ago
  There is no single cost. It depends entirely on who asks, which is why you cannot get an answer beforehand.
- pnutjam 7y ago
  This also translates to the cost for labor. How much your company is paying for insurance seems to have little correlation to how good your insurance is, so Company A could be paying an extra $5k per employee because they don't have a good HR department. It also means that every job offer has to be examined not only for salary and culture, which are usually pretty easy to see; but also benefits cost. I've had offers that were an over 20% raise which would have all been eaten by insurance costs. I've looked at my "benefits cost breakdown" at similar companies only to see that one is paying $90k for me and one is only paying $70k, on similar salaries of around $60k. These insurance costs are not something usually shared outside the company, and they are hard to get until the last stages of your job offer.
mnm1 7y ago
Pelosi is a moron who doesn't even know how the current insurance system works. Of course people lose their insurance. And ACA insurance often doesn't cover the same things as the employer-based insurance. If people need to get on Medicaid, they need to wait months before it starts, months without coverage. Everyone needs healthcare and few people can afford to pay the exorbitant costs of it in this country. And of course, if you get injured on the job, you have to fight a whole different system that shouldn't exist either. Of course Pelosi has her own insurance and plenty of money so like so many rich assholes in congress and elsewhere doesn't care and doesn't want to improve healthcare coverage for the rest of us. Let us get sick and die. Even with insurance this is often the case. Pelosi's a moron on this issue and many others. She's almost as clueless as the Republicans who get off on kicking people off of Medicaid and watching them get sick and die. How can the US even be considered a developed country anymore when we let our own people get sick and die so a few rich assholes can get richer?
SonicSoul 7y ago
it's a shit show. I had "great benefits" at my last job accept when i needed them 1. when something happened and i needed physical therapy it turned out my copay was like 6k so i just DIY my own therapy.. 2. when changing jobs i had a month gap, so i bought COBRA and 3 things went wrong. a. it cost $1300 for a month of coverage (even with a 2k deductible) b. since my last day was before a weekend, they actually covered my only until that same day next month, so i still had a gap of coverage (might be my employer but still sucks people have to be faced with this bs) c. when i did go to a routine physical healthcare provider still denied the claim and i was sent a full bill. after hours of calling it turned out they initially rejected it, but then accepted months later and i was left with _*some*_ expenses ?! all this BS while dealing with expensive benefit package.. i can only image what self employed people must go through..
pbnjay 7y ago
These numbers are super misleading. 72% were continuously enrolled, but 16% switched to a different employer plan! We don't know how many of those were the same employer or if the spouse just had access a better deal that year or what. Either way, 88% were covered by their employer plan. 12% is entirely different from 28%. We all have to do open enrollment, but that's entirely different from losing coverage and finding something new! I'm totally on board with Medicare-for-All but we don't need smoke and mirrors and misleading statistics.
- pnutjam 7y ago
  This is still important. I changed insurance with no gap, but it reset my fully paid deductible.
jkingsbery 7y ago
One thing this article doesn't discuss: at least some of the times where I "lost" my employer-sponsored insurance (either because I switched jobs or because my start-up decided to switch providers), it went to something better than what I had before, and most of the time it was a change that was a matter of indifference (from one major plan provider to another where everything was pretty similar). In most universal health care proposals I've seen, "leaving," isn't really an option, you're just stuck with The Healthcare Option. Whatever the merits of the more general arguments for or against, it seems like we should at least not put a finger on the scale.
- qqqwerty 7y ago
  It is highly unlikely that you will be left with no options. Under most universal health care systems, private insurance plays a complementary role[1]. Also, if we go the public option route, it would compete against, rather than replace, the private insurance market. [1] https://www.vox.com/health-care/2019/2/12/18215430/single-payer-private-health-insurance-harris-sanders https://www.vox.com/health-care/2019/2/12/18215430/single-pa...
mlthoughts2018 7y ago
I don’t understand why the article uses labor turnover or health plan churn. Why would that be relevant to the original bolded premise that people like their better coverage sponsored by employers? If I leave a job or get laid off, usually I’ll get a similar job that has similar insurance. Now maybe you could argue that there’s a big risk of an insurance gap or that something like COBRA is unfairly priced, etc., but that would have more to do with unemployment insurance and virtually nothing to do with the basic structure of health insurance. When I “churn” in the insurance market, it is almost always going to be a super short-term switch from Insurance A to Insurance B (both via employers) where A and B are incredibly similar. That seems perfectly consistent with saying that people love employer-provided insurance quality. The employers have to offer the same high quality insurance everywhere, or else people won’t switch. As a result, they do provide the same high quality insurance everywhere, to ensure insurance is not a sticking point that creates job movement friction. Of course there are outliers offering bad insurance and classes of labor like Wal-Mart retail staff that get screwed by deliberately bad corporate actors, and I’m sure anybody reading this with a personalized anecdote will angrily try to refute me. But in the aggregate, these are exceptions, and most people like their insurance for the most part and find that almost all possible employers (for them) offer such a nearly fungible set of insurance plans that they can churn jobs without significantly worrying that the insurance they like will be very different at company A vs company B. There could be many arguments for nationalized healthcare, but this article seems pretty much wrong from its main thesis. People “keep” the private insurance they like all the time, because “churning” the coverage is not at all similar to giving up the coverage or making concessions or compromises for the next plan of insurance you accept from an employer.

162 points by mkane848 7y ago

If you want a good example of government supplied health insurance, go to your local VA hospital, and see if that is the kind of health care you really want.

mkane848 7y ago
The goal is for government-funded, not government-run. At least in the context of M4A.

intopieces 7y ago

Am I correct in understanding that Medicare for All plans to abolish private insurance? I prefer there be a system where you can get private insurance if you want, but if you go without you are automatically on Medicare.

timbit42 7y ago

Silly Americans.

terryschiavo22 7y ago

Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Is the argument that switching insurance plans is stressful? What's stressful is remaining uncovered. Switching plans is hardly comparable to the transition to a Medicare-for-all program.

pnutjam 7y ago
With the current love for High deductible plans, it can get much riskier. I just walked away from a plan where I had paid the full Out of pocket max for the year (around $7k), in January. That hurt, but the other offer was good enough. None of that money translates to the new plan, I'm back to paying deductibles for everything.
zrail 7y ago
> Switching plans is hardly comparable to the transition to a Medicare-for-all program The big stressor is having to pay two deductibles in one year. That said, from an individual perspective I don't see what would be different. Before you had an (Aetna|Cigna|BCBS|UHC) card, now you have a M4A card.
crooked-v 7y ago
> Is the argument that switching insurance plans is stressful? It absolutely is stressful, because every single time you have to carefuly inspect the documentation to figure out what conditions and care (if any) you're "allowed" to have without going bankrupt.
- identity-haver 7y ago
  For non-Americans and confused Americans reading this, this isn't precisely true. Any employer with over 50 employees has to cover all pre-existing conditions from your previous employer. But there is no guarantee that your old providers will be in your new network, so you may have to switch providers, with all the bureaucratic headache that entails. Also, if you are getting care for that condition that isn't 100% standard and established you may not get it, or have to spend a bunch of extra money while it gets re-approved. Also, your deductible will reset, so if you switch jobs in the middle of the year you could potentially be paying thousands more out of pocket.
gorbachev 7y ago
If you switch to another insurance provider, you might have to change doctors, pharmacies and other service providers, because your previous service provider is no longer in-network or too costly. Also your coverage may completely change for better or worse. The worst case scenario is just as disastrous as losing insurance entirely. This is particularly bad for people with chronic/ongoing medical needs.
midnightmonster 7y ago
They lose their insurance for other reasons, too. Their employer changes plans; they get dropped from full time to part time; they lose their job and don't immediately get another. And switching insurance plans at almost any time can be very costly, even if you go straight to a new one, as all your deductibles and out-of-pocket limits get reset. And then you have to hit them again when the plan year starts again, almost certainly sooner than a year later.
- fwip 7y ago
  My employer switched health insurers 3 years in a row. First because we became a new company (understandable), second because they thought they could get a better deal at another place (okay...), and thirdly reverting the 2nd change except some of the numbers and coverage is different now. I really am considering leaving if they switch a 4th time.
naravara 7y ago
>Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Unless they lose their jobs. Or change to a job that doesn't offer coverage/start a new business. Or have their hours cut to be <40 hrs/wk and are no longer eligible. . . >Switching plans is hardly comparable to the transition to a Medicare-for-all program. Why? It would be a one-time switch. Switching costs would be exactly the same as the switching costs you pay every time you change jobs, except you only pay it one time in your life and you don't have to shop around in some silly healthcare exchange or open enrollment process where you get to weigh which absurdly high premium you want to pay despite deductibles being so high that barely any of your routine health costs will be compensated. And then there is the joy of making sure all your care providers are covered by your new plan. AND hoping your providers don't drop your plan because of insurance company negotiations.
- dd36 7y ago
  It’s not just when you change jobs. My wife handles large employer groups and the insurance companies ask for a 15% rate increase every year so the employers have to threaten to switch every year to negotiate down then actually switch every other year. It’s a wasteful, useless game. Even if you stay at same employer, your insurer and networks will regularly change.
benatkin 7y ago
How about having to switch doctors, or having to go a couple weeks without an insurance card, but hey, you still have insurance and you can pay up front and get reimbursed later? Big fucking deal, right?
dragontamer 7y ago
> Yes, people do lose their insurance constantly when they switch jobs...and then immediately sign onto their new plan. Lets say you payed for insurance, but were healthy for the 90s. So ~10-years of paying insurance. Around 2005, you are diagnosed with Diabetes, so your insurance pays for your care. Around 2007, the recession happens and you lose your job. You immediately find a new job, but you need to get new insurance. Diabetes is now a "pre-existing condition", so your insurance no longer covers your condition. Its important to recognize that changing health-plans is a regular event, that shouldn't punish people with chronic conditions. Diabetes is lifelong, once you get it, you live with it for the rest of your life. Insurance companies don't want to pay for that kind of issue. With all talk about "Repeal and Replace", its important to recognize the tradeoff. As long as "pre-existing conditions" are banned in the USA, I don't think its a big deal to lose employer sponsored health care (at least, compared to pre-Obamacare). We should build a world where it is easy to lose (and regain) health coverage... compared to the pre-Obamacare world where it was a big risk to lose coverage. Hopefully laws of the future make it easier to switch health care plans without problems.
- conanbatt 7y ago
  The problem with covering pre-existing conditions at all times is that you need to make insurance mandatory, due to the adver selection problem. If insurance is optional, then only people that know they are sick or will get sick will dominate the insurance, making it more expensive, and pushing the healthy-low risk out. Its a well known economics problem that has no silver bullet. What is crazy to me is that insurance is involved in paying primary care doctors. That is a terrible application of health insurance, and have full faith on high deductible plans bringing sanity back into this.
- scarface74 7y ago
  If you find a new job and you’re eligible under group insurance, the insurance company can’t deny a claim under pre-existing conditions. This was true before the ACA. What the ACA changed was that insurance companies couldn’t exclude treatment based on preexisting conditions if you go on the open market.
will_brown 7y ago
>Is the argument that switching insurance plans is stressful? I think it’s clear the article is promoting universal coverage, and simply highlight how ridiculous it is that healthcare is a benefit of employment by highlighting nearly 1/3 of employment based plans are discontinued within 12 months. I’m not sure how you can conclude switching private insurance plans is hardly comparable to a transition to Medicare-for-all, when millions of people make the jump from private insurance to Medicare every year and you don’t hear much complaining from that group. Not to mention a 1 time transition compared to nearly 33% of the workforce going through this annually.
maxsilver 7y ago
> and then immediately sign onto their new plan Nope. Employer-provided insurance plans often have blackout dates. If you quit your job on June 2, and start your new job on June 3, your new job's health insurance might not actually take effect for up to 30, 60, or even 90 days after your start date. To cover that gap period, you either have to switch to a new plan with your old employer (commonly called COBRA) at ridiculous high rates nobody can afford, or you have to get temporary blackout insurance coverage (which cover nothing at all, and are almost identical to having no insurance). This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insurance/short-term-plans https://www.priorityhealth.com/individual-family-health-insu... for example). In America, to switch jobs once, requires three concurrent interactions with three different health insurance plans, simultaneously. (Your old employer plan, your intermediate temporary plan/COBRA, and your new employer's plan). For obvious reasons, this is incredibly error prone, risky, and fraught with stress. > Is the argument that switching insurance plans is stressful? Yes! Literally every single interaction with every single health insurance provider is painful and stressful and complicated and intentionally obfuscated, for absolutely no valid reason whatsoever.
- intopieces 7y ago
  >This need is so common, that most insurance companies have special advertising just for it (like https://www.priorityhealth.com/individual-family-health-insu.. https://www.priorityhealth.com/individual-family-health-insu.... for example). This doesn’t even cover pre-existing conditions. So, if you are on medication for high blood pressure, or have diabetes, or are just one of the 55 percent of Americans who take prescription drugs... you are out of luck. That these plans are even legal is a monumental failure of the American system.
- nogridbag 7y ago
  As I painfully found out, transitioning between jobs also requires competent HR people on both ends. Our insurance was accidentally terminated a week early so our claim was denied and we got a massive bill. Not only do you have to then deal with the insurance company but you have to deal with your previous employer to fix the situation.
a3n 7y ago
When I started my current job I wasn't eligible for benefits for 90 days. This is not uncommon.
- Glyptodon 7y ago
  One time I switched jobs the company I left was so small (I think ~ 15 to 18 people) it turned out that COBRA wasn't available and new job benefits didn't kick in for 90 days. This was between when the ACA was passed and took effect so getting private insurance for the gap was scary. (Going without coverage was not an option, I have serious medical history.)
- nogridbag 7y ago
  My wife recently worked for a startup and had them change the company policy to start benefits on day 1 simply by asking. No one really knew why the benefits started after N days and no one cared enough to change it previously.
gwbas1c 7y ago
I don't understand why you're downvoted. It's an important observation. In my case, my employer was bought and sold 3 times. All three cases involved a sudden and abrupt termination of my insurance. It was "okay" when I was single, but once I carried my wife, and then my entire family, it became a huge problem. Throughout my tenure at my job, I had major surgery and two children. Sudden insurance changes immediately before or during any of those events would be a huge problem. (Fortunately, the timing worked out.)
- tialaramex 7y ago
  Europe also has a broader fix for this, called Transfer of Undertakings rules, the UK version is "TUPE" the "Transfer of Undertakings (Protection of Employment) Regulations". The broad overview of TUPE is that employees whose actual job doesn't change shouldn't have to put up with any negative consequences at all for the fact that at some higher level their employer changed. e.g. the office building switches from Ace Cleaning Corp. to Best Cleaning Limited, but it's still Jenny and Achmed actually doing the cleaning, just in blue overalls instead of yellow now. It makes no sense to be allowed to tell Jenny now she's only getting minimum wage because Best Cleaning Limited doesn't pay as much as Ace Cleaning Corp, she's doing the same job so she should continue to get the same pay. But I don't mean just obvious stuff like they can't cut your pay, it's everything - your seniority is preserved, shift priorities, rules for how much paid leave you get, or how pensions are paid - if it was part of the job, then it moves with the job. If employment-based health insurance was a big thing here, that would undoubtedly be covered.

aNoob7000 7y ago

Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.

bluejekyll 7y ago
> The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this. I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
- dd36 7y ago
  If Bernie wins running with it as his primary issue, it’s a lot easier to get Congress on board.
  - conanbatt 7y ago
    Its definitely a boon for the cause, but I would be surprised if it passed the senate. OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
- dv_dt 7y ago
  After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats. It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.

benatkin 7y ago

When I quit my job in SF in November 2017, I had $1200 on my FSA. When I switched to COBRA, my FSA account kept its balance, but my VISA card associated with it immediately and unexpectedly stopped working. I was seeing a psychologist at the time and it was awkward when I didn’t pay him right away because I thought it would be fine to try and fix my card and pay him the next day (which I did). It felt awkward enough to me that I stopped my therapy sessions with him, because I felt like it had become strained. Anyway, the company stopping my card from working was intentional. It was the same company and the same account but my card didn’t work anymore and I had to go through the trouble to submit a claim, and they acted like this was by design that my FSA card would stop working when I quit and switched to COBRA. Now I’m working remotely and am in a new state (Florida) and not sure I’ll stay here long enough to switch everything to this state. I needed to get a fever checked out and ended up paying out of pocket because I was told over the phone that they accepted my out of state insurance, but when I got there in person, they didn’t. What a mess.

jwildeboer 7y ago

People [in the US] … ;)

guitarbill 7y ago
As much as your comment might be taken in the wrong way, it is important to point out first world countries have this sorted. I simply don't get it. When did patriotism become about military might and waving flags instead of making sure your fellow countrymen don't live in agony, fear, and poverty?
- TheSoftwareGuy 7y ago
  I'd say about 1946, or whenever the cold war is said to have officially begun. Or maybe even earlier during WW2. That being said the sentiment was never a good one, and we do need to move on from it.

usermac 7y ago

Healthcare finance is a mess in the US.

helen___keller 7y ago

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months? Start a new job at a startup, need to go to trainings to understand the health care options and choose one, get new cards and website logins, update my info at every provider New dentist is having difficulty getting my routine care billed to insurance and calls me every week asking for my insurance information again. Wifes doctor didn't do something correctly when I updated insurance so now I need to call and deal with this big medical bill that I shouldn't have gotten. Startup got acquired so I get another training for the new insurance options. And get new cards and logins and update with all providers again Planning to get a surgical operation but nobody can tell me how much it will cost, doctor says "probably whatever your deductible is" except I have a high deductible plan so is it really going to cost me $2500? Etc cetera. There's no end to the nuisance. If I could choose to just pay more in taxes (hell I'll pay way more than my current premiums) and never deal with insurance again, I would do it in a heartbeat.

ThrustVectoring 7y ago
>So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months? It's friction costs for splitting up the decision-making process into multiple entities. For any bill, the insurance company pays $X, the patient pays $Y, and the provider has $Z in costs. The $X that the insurance company pays is what they optimize for, not $Y and certainly not $Z. This has the side effect of somewhat optimizing $Z, since $Y is limited by how much money people have and if $Z is consistently bigger than $X + $Y, the healthcare provider loses money and goes out of business. Honestly, the way to go is to treat the entire process as interaction with hostile bureaucracy. Document everything, and look like you'll generate a regulatory incident if you don't get what you're legally entitled to. Otherwise the insurance company will happily reduce their costs by offloading it onto you or the healthcare provider through pulling bullshit stunts.

pnathan 7y ago

One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. It's not just plain $$$ and career risk, it's the "suppose you will go bankrupt and your family has permanent medical issues now" risk. That game is for the wealthy or healthy single people In addition, each insurance plan has slightly different doctors that sign on, so when there are changes, you might wind up needing to use different doctors or worse, health systems. It'd be much better for me, personally, to require providers to all accept some US Public Single Payer plan (or whatever you call it) as part of opening a practice and seeing patients. (I don't speak in any sense for my employer, who is in the health care space: this is just an engineer's personal musings)

toast0 7y ago
When I worked for a startup, they were affiliated with a "professional employer organization", which allowed access to major PPO and HMO insurance plans, and also handled some of the payroll obligations.
henrikschroder 7y ago
> One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. I joined a startup once, but it was in Europe, so these issues weren't even on my radar or the company's radar. With government healthcare and government unemployment insurance, it's a no-brainer. The only risk is to your lifetime earning potential. Stay at a solid job with a solid salary, or take a shot at the startup lottery. Your health or your family or your home are just never on the line by taking that risk. The amount of time and worry you have to spend on healthcare for yourself and your family in the US is absolutely off the charts, and this cost is completely hidden! Time that companies have to spend on acquiring healthcare insurance for their employees is wasted time. Time that employees have to spend on researching the insurance options their company is offering them is wasted time. Time that you spend dealing with healthcare providers to ensure that you're covered by your insurance is wasted time. In Europe the time spent on this is, for the most part, 0. Companies don't spend time on this. Employees don't spend time on this. But noone in the US seems to regard this waste, this cost, as something fixable. Noone seems to think of the competitive edge this gives EU companies, or want to have the same competitive edge. Why? Why are US companies and US employees just completely resigned to the thought that healthcare just is a massive necessary headache for everyone?

Glyptodon 7y ago

Employer sponsored health insurance is an outpost of neofeudalism. Swear your fealty to a lord or go without.

paulddraper 7y ago
Yes. And it was made even worse by the ACA which effectively required employers to be feudal lords, whether they wanted to or not. Before, the possibility of sane choose-my-health-insurance-like-I-choose-my-car-insurance was at least on the table.
- deleted 7y ago
  [deleted]
jkingsbery 7y ago
Employee sponsored health insurance is a result of "centrally planned" economics - https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th... ... it has nothing to do with feudalism or even what employers wanted, but has a lot more to do with government officials who thought they could design an economy.
- dredmorbius 7y ago
  The reasons things start, and the reasons they persist, are often quite different. The US doesn't seem to have subscribed to strongly-cenralised economic policy for nearly 70 years. And yet the employer-feudal healthcare system continues. Preponderance of evidence suggests that dominant economic, financial, and power structures prefer it that way. The origin story is an interesting footnote, no more.
  - jkingsbery 7y ago
    While it's true the reason things start and persist are different, many would disagree about the level of central planning in the US, with healthcare being an example odd where there is a good deal of government control (everything from pricing of procedures, drug approval, and licensing to name a few). Whether that's a good thing is another question, but I think it's oversimplifying to conclude that the problem is all due to corporate feudal overlords and not at all due to government policy. Further, there is a lesson to be learned concerning unanticipated co sequences in the origin of the current system that we're in danger of repeating by having further government control of healthcare.

camelNotation 7y ago

Medicare-for-All is some sort of "far left" fantasy in the United States, but single-payer healthcare is center-right dogma in every other developed country. I have no idea why this is so hard for the American right to grasp: single-payer healthcare is a social program, but it's not the same as socialism. We aren't trying to steal the means of production from you in some sort of revolution, we just don't want people to die from preventable things. It is entirely possible to have a single-payer healthcare system alongside a thriving capitalist economy. This sort of foundational public service actually makes economies better, not worse. It's not a burden on the market to have healthy workers.

conanbatt 7y ago
Doesn't really help that M4A is pushed by someone that calls himself a socialist and outspokenly disapproves of capitalism.
maxxxxx 7y ago
"single-payer healthcare is a social program, but it's not the same as socialism" American politics is geared towards appealing to the extremes. Social programs are "socialist" and get connected to the Soviet Union, cuba and Venezuela. If you say something that's even slight politically incorrect you are immediately labeled as a "racist" that should be removed from your job and all public discussion. There is no interest in discussing problems and finding solutions. It's all about anger.
- otaviokz 7y ago
  Couldn't agree more.
TOGoS 7y ago
> We aren't trying to steal the means of production from you I mean, workers created them in the first place, so I'm all for "stealing" them back. But I also wouldn't mind single-payer healthcare in the meantime.

sairahul82 7y ago

The fundamental problem is no body knows the cost of anything beforehand. Neither insurance company not doctors tell the cost of the care. Its really frustrating ! The first step to fix the problem is getting the cost of the care transparently. Without this i am not sure how any of the scheme works whether it is done by govt or private insurance companies !

EamonnMR 7y ago
I think the problem is that hospitals can use the price of procedures as a bargaining chip. They can jack up the price for the uninsured (on paper) then lower it if they're actually going to bill a person. Then they take the jacked up number and use it to negotiate with insurance companies, and insurance companies can likewise point to the number and say "look what will become if you if you don't stick with us!" The first step should be disallowing this negotiation. That should massively lower the on-paper prices, or let insurance companies at least make the tough decisions about what procedures are actually worth it, which is supposed to be one of their functions anyway. If that isn't their function, I'm not sure what their function is.
rootusrootus 7y ago
There is no single cost. It depends entirely on who asks, which is why you cannot get an answer beforehand.
pnutjam 7y ago
This also translates to the cost for labor. How much your company is paying for insurance seems to have little correlation to how good your insurance is, so Company A could be paying an extra $5k per employee because they don't have a good HR department. It also means that every job offer has to be examined not only for salary and culture, which are usually pretty easy to see; but also benefits cost. I've had offers that were an over 20% raise which would have all been eaten by insurance costs. I've looked at my "benefits cost breakdown" at similar companies only to see that one is paying $90k for me and one is only paying $70k, on similar salaries of around $60k. These insurance costs are not something usually shared outside the company, and they are hard to get until the last stages of your job offer.

mnm1 7y ago

Pelosi is a moron who doesn't even know how the current insurance system works. Of course people lose their insurance. And ACA insurance often doesn't cover the same things as the employer-based insurance. If people need to get on Medicaid, they need to wait months before it starts, months without coverage. Everyone needs healthcare and few people can afford to pay the exorbitant costs of it in this country. And of course, if you get injured on the job, you have to fight a whole different system that shouldn't exist either. Of course Pelosi has her own insurance and plenty of money so like so many rich assholes in congress and elsewhere doesn't care and doesn't want to improve healthcare coverage for the rest of us. Let us get sick and die. Even with insurance this is often the case. Pelosi's a moron on this issue and many others. She's almost as clueless as the Republicans who get off on kicking people off of Medicaid and watching them get sick and die. How can the US even be considered a developed country anymore when we let our own people get sick and die so a few rich assholes can get richer?

SonicSoul 7y ago

it's a shit show. I had "great benefits" at my last job accept when i needed them 1. when something happened and i needed physical therapy it turned out my copay was like 6k so i just DIY my own therapy.. 2. when changing jobs i had a month gap, so i bought COBRA and 3 things went wrong. a. it cost $1300 for a month of coverage (even with a 2k deductible) b. since my last day was before a weekend, they actually covered my only until that same day next month, so i still had a gap of coverage (might be my employer but still sucks people have to be faced with this bs) c. when i did go to a routine physical healthcare provider still denied the claim and i was sent a full bill. after hours of calling it turned out they initially rejected it, but then accepted months later and i was left with _*some*_ expenses ?! all this BS while dealing with expensive benefit package.. i can only image what self employed people must go through..

pbnjay 7y ago

These numbers are super misleading. 72% were continuously enrolled, but 16% switched to a different employer plan! We don't know how many of those were the same employer or if the spouse just had access a better deal that year or what. Either way, 88% were covered by their employer plan. 12% is entirely different from 28%. We all have to do open enrollment, but that's entirely different from losing coverage and finding something new! I'm totally on board with Medicare-for-All but we don't need smoke and mirrors and misleading statistics.

pnutjam 7y ago
This is still important. I changed insurance with no gap, but it reset my fully paid deductible.

jkingsbery 7y ago

One thing this article doesn't discuss: at least some of the times where I "lost" my employer-sponsored insurance (either because I switched jobs or because my start-up decided to switch providers), it went to something better than what I had before, and most of the time it was a change that was a matter of indifference (from one major plan provider to another where everything was pretty similar). In most universal health care proposals I've seen, "leaving," isn't really an option, you're just stuck with The Healthcare Option. Whatever the merits of the more general arguments for or against, it seems like we should at least not put a finger on the scale.

qqqwerty 7y ago
It is highly unlikely that you will be left with no options. Under most universal health care systems, private insurance plays a complementary role[1]. Also, if we go the public option route, it would compete against, rather than replace, the private insurance market. [1] https://www.vox.com/health-care/2019/2/12/18215430/single-payer-private-health-insurance-harris-sanders https://www.vox.com/health-care/2019/2/12/18215430/single-pa...

mlthoughts2018 7y ago

I don’t understand why the article uses labor turnover or health plan churn. Why would that be relevant to the original bolded premise that people like their better coverage sponsored by employers? If I leave a job or get laid off, usually I’ll get a similar job that has similar insurance. Now maybe you could argue that there’s a big risk of an insurance gap or that something like COBRA is unfairly priced, etc., but that would have more to do with unemployment insurance and virtually nothing to do with the basic structure of health insurance. When I “churn” in the insurance market, it is almost always going to be a super short-term switch from Insurance A to Insurance B (both via employers) where A and B are incredibly similar. That seems perfectly consistent with saying that people love employer-provided insurance quality. The employers have to offer the same high quality insurance everywhere, or else people won’t switch. As a result, they do provide the same high quality insurance everywhere, to ensure insurance is not a sticking point that creates job movement friction. Of course there are outliers offering bad insurance and classes of labor like Wal-Mart retail staff that get screwed by deliberately bad corporate actors, and I’m sure anybody reading this with a personalized anecdote will angrily try to refute me. But in the aggregate, these are exceptions, and most people like their insurance for the most part and find that almost all possible employers (for them) offer such a nearly fungible set of insurance plans that they can churn jobs without significantly worrying that the insurance they like will be very different at company A vs company B. There could be many arguments for nationalized healthcare, but this article seems pretty much wrong from its main thesis. People “keep” the private insurance they like all the time, because “churning” the coverage is not at all similar to giving up the coverage or making concessions or compromises for the next plan of insurance you accept from an employer.