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The article talks about free food. But the most bizarre perk is how health insurance is linked to one's employer. Whatever system we have in 20 years, pretty

The article talks about free food. But the most bizarre perk is how health insurance is linked to one's employer. Whatever system we have in 20 years, pretty much anything will be better than this one.

atemerev 7y ago
In Switzerland, health insurance is still expensive and obligatory (which is bad), but can only be paid from after-tax money, which is good and delivers at least some market pressure to the system. In the US, how do freelancers and individual consultants even work?
- gvd 7y ago
  The obligatory part is the good part. In the Netherlands it is obligatory and costs are lower than in the US.
  - atemerev 7y ago
    No, the obligatory part leads to less competition, less market pressure, and therefore costs spiral. Our costs are almost on par with the US, and raise every year.
    - alex_young 7y ago
      How does the obligation to buy insurance cause there to be less competition? If someone doesn't have to have insurance, wouldn't the pool of possible customers be smaller? I agree with you on the cost comparison side - I've lived in both places and find the systems quite similar in many respects outside of costs. I think one key difference between the Swiss / American model and that of other western EU countries is the cost of billing and processing. In the US a full third of the cost of care is this part of the system, something that doesn't need to happen when there is a single universal payer for all care.
      - atemerev 7y ago
        We don’t have a singe payer healthcare here, there are many insurance companies. Obligatory insurance destroys competition (and insurance companies are lobbying hard to support it), because obligatory customer is a perfect customer — you can be as bad as you wish to them, and they still won’t leave you. With multi-payer insurance, they can still leave to other company (but it still enables bad behavior in the insurance industry in general). With single-payer, no such luck, you are at the complete mercy of the single-paying entity.
        akerl_ 7y ago
        I think you may be misunderstanding “single-payer”. That term refers to there being a single entity paying for the care (generally speaking, this is the government), vs the US system which is multi-payer (you pay part of it, public or private health insurance pays another). In a single-payer system, there can still be many healthcare providers, and the single entity doing the paying is incentivized to push aggressively for low prices from providers, because that keeps their own overhead low. Likewise, they’re incentivized to keep their premiums low, because when you’re the government, if people think you’re screwing up their healthcare they vote you out of office. As an example of this in the US, take the Medicare system, which can negotiation super aggressively on pricing from healthcare providers because a provider who lands a contract for Medicare knows they have a massive pool of humans to provide care (and thus receive payment) for/from.
        atemerev 7y ago
        I believe understand it right. What _motivation_ this single entity will have to always have the best customers interests in mind? What will prevent it from being sloppy, or even corrupted and colluding with healthcare providers?
        akerl_ 7y ago
        What stops any group of people from being sloppy or corrupted? I called out the things that keep single-payer systems in check in my original comment, which you’ve replied to: pressure from constituents keeps premiums low (in the same way that the government is pressured to keep taxes low by their electorate), and they’re incentivized to negotiate low rates with providers because it improves their ability to keep premiums low without having them be lower than expenses. That said: the US’s current privatized system is sloppy and corrupt in a multitude of ways, because their incentive structure includes turning a profit, and they can’t negotiate costs as hard as a single-payer system can, because their pool of customers is smaller. So we’ve got the worst combination of traits.
- lazerwalker 7y ago
  In the US as a freelancer, you generally either: (a) Have a plan bought on an ACA marketplace (pretty expensive and not very good) (b) After you leave a full-time job, a government program called COBRA means you can still maintain your relationship with your old health care provider for 18 months, except you have to pay all the premiums your employer formerly paid (generally better coverage than an ACA plan, but way more expensive) (c) Have a spouse whose plan you can be on, or be on your parents' plan if you're under 26 It's not great.
- SkyPuncher 7y ago
  > In the US, how do freelancers and individual consultants even work? Comparing plans is complex, but the actual purchase process is extremely easy. Not much different than getting home or auto insurance. "Expensive" is a relative term. I'm paying about twice as much freelance as I was an employ for comparable coverage levels. That really comes down to not having an employer cover part of the cost. After having done it for a couple years, I actually prefer non-employer insurance. We're able to go with an insurer that fits our needs (particularly with physician network coverage) without breaking the bank.
- solarengineer 7y ago
  In India, health insurance is not obligatory, but is paid from pre tax income by the individual. This helps reduce the overall taxable income.
ggm 7y ago
I was told by an American the linkage to be the employer was a decision grounded in a hypothetical efficiency goal. It was thoughtm it would distribute the cost burden of administration. It was not designed to become a differentiator between employers.
- zrail 7y ago
  It wasn’t designed at all. It’s an accident of history. After WWII the government didn’t remove wage controls right away so businesses started offering health insurance as a differentiator. They wrote it off their taxes as a business expense. Over time through lobbying and tax code rewites this expense became enshrined and untouchable, to the extent that the foregone taxes are the single greatest annual tax expenditure outside of the military.

atemerev 7y ago

In Switzerland, health insurance is still expensive and obligatory (which is bad), but can only be paid from after-tax money, which is good and delivers at least some market pressure to the system. In the US, how do freelancers and individual consultants even work?

gvd 7y ago
The obligatory part is the good part. In the Netherlands it is obligatory and costs are lower than in the US.
- atemerev 7y ago
  No, the obligatory part leads to less competition, less market pressure, and therefore costs spiral. Our costs are almost on par with the US, and raise every year.
  - alex_young 7y ago
    How does the obligation to buy insurance cause there to be less competition? If someone doesn't have to have insurance, wouldn't the pool of possible customers be smaller? I agree with you on the cost comparison side - I've lived in both places and find the systems quite similar in many respects outside of costs. I think one key difference between the Swiss / American model and that of other western EU countries is the cost of billing and processing. In the US a full third of the cost of care is this part of the system, something that doesn't need to happen when there is a single universal payer for all care.
    - atemerev 7y ago
      We don’t have a singe payer healthcare here, there are many insurance companies. Obligatory insurance destroys competition (and insurance companies are lobbying hard to support it), because obligatory customer is a perfect customer — you can be as bad as you wish to them, and they still won’t leave you. With multi-payer insurance, they can still leave to other company (but it still enables bad behavior in the insurance industry in general). With single-payer, no such luck, you are at the complete mercy of the single-paying entity.
      - akerl_ 7y ago
        I think you may be misunderstanding “single-payer”. That term refers to there being a single entity paying for the care (generally speaking, this is the government), vs the US system which is multi-payer (you pay part of it, public or private health insurance pays another). In a single-payer system, there can still be many healthcare providers, and the single entity doing the paying is incentivized to push aggressively for low prices from providers, because that keeps their own overhead low. Likewise, they’re incentivized to keep their premiums low, because when you’re the government, if people think you’re screwing up their healthcare they vote you out of office. As an example of this in the US, take the Medicare system, which can negotiation super aggressively on pricing from healthcare providers because a provider who lands a contract for Medicare knows they have a massive pool of humans to provide care (and thus receive payment) for/from.
        atemerev 7y ago
        I believe understand it right. What _motivation_ this single entity will have to always have the best customers interests in mind? What will prevent it from being sloppy, or even corrupted and colluding with healthcare providers?
        akerl_ 7y ago
        What stops any group of people from being sloppy or corrupted? I called out the things that keep single-payer systems in check in my original comment, which you’ve replied to: pressure from constituents keeps premiums low (in the same way that the government is pressured to keep taxes low by their electorate), and they’re incentivized to negotiate low rates with providers because it improves their ability to keep premiums low without having them be lower than expenses. That said: the US’s current privatized system is sloppy and corrupt in a multitude of ways, because their incentive structure includes turning a profit, and they can’t negotiate costs as hard as a single-payer system can, because their pool of customers is smaller. So we’ve got the worst combination of traits.
lazerwalker 7y ago
In the US as a freelancer, you generally either: (a) Have a plan bought on an ACA marketplace (pretty expensive and not very good) (b) After you leave a full-time job, a government program called COBRA means you can still maintain your relationship with your old health care provider for 18 months, except you have to pay all the premiums your employer formerly paid (generally better coverage than an ACA plan, but way more expensive) (c) Have a spouse whose plan you can be on, or be on your parents' plan if you're under 26 It's not great.
SkyPuncher 7y ago
> In the US, how do freelancers and individual consultants even work? Comparing plans is complex, but the actual purchase process is extremely easy. Not much different than getting home or auto insurance. "Expensive" is a relative term. I'm paying about twice as much freelance as I was an employ for comparable coverage levels. That really comes down to not having an employer cover part of the cost. After having done it for a couple years, I actually prefer non-employer insurance. We're able to go with an insurer that fits our needs (particularly with physician network coverage) without breaking the bank.
solarengineer 7y ago
In India, health insurance is not obligatory, but is paid from pre tax income by the individual. This helps reduce the overall taxable income.

ggm 7y ago

I was told by an American the linkage to be the employer was a decision grounded in a hypothetical efficiency goal. It was thoughtm it would distribute the cost burden of administration. It was not designed to become a differentiator between employers.

zrail 7y ago
It wasn’t designed at all. It’s an accident of history. After WWII the government didn’t remove wage controls right away so businesses started offering health insurance as a differentiator. They wrote it off their taxes as a business expense. Over time through lobbying and tax code rewites this expense became enshrined and untouchable, to the extent that the foregone taxes are the single greatest annual tax expenditure outside of the military.