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> The way to protect workers is to shift the burden of health care and other costly benefits onto the government, supported by taxes Yes, it's clear that our p

> The way to protect workers is to shift the burden of health care and other costly benefits onto the government, supported by taxes Yes, it's clear that our prosperity hinges on how quickly we decouple health care from our employers. Employers don't want to be in the business of providing healthcare to their employees and its painfully obvious. I just don't understand why smart people think it's a good idea for anyone other than me decide what my healthcare needs are! I would like to have a separate discussion whether the government is the best party to handle this. If you look for my writing here and on Quora, you will see that I have for over a decade being campaigning the government was the best party, but after having really worked on it (thanks to people getting in touch with me from my writing), I no longer believe the government is the best partner. Instead, I think the government managed marketplace where people choose private insurance is actually a brilliant solution and ACA already provides that, so we already have that in place. The value the government brings here is extreme negotiating ability with the private insurance providers that individual citizens lack. > The US public does not want this I strongly disagree. I have spoken with far too many (thousands) of people to know that majority of the U.S. hate their employer provided insurance and are worse off for it. I can give you specific instances where an employee was worse off due to the employer provided insurance and had to declare bankruptcy due to medical bills than if they were unemployed to begin with and were on welfare instead! I seriously believe: 1. the tax incentives to provide employer provided insurance should be abolished. They made sense at a time that's past us now. 2. employers instead should be required to pay a premium for choosing to provide primary insurance to employees instead of letting employees continue with the coverage they have or get one from the marketplace 3. Employers are free to provide secondary and supplementary care insurance if they chose to, not due to regulation. This leaves behind only those employers who genuinely care about their employees instead of pretending to do something because someone forces them to. I support the individual mandate in the ACA because it ensures negative self selection in the marketplace. This will allow people to gain control of their own healthcare, get a benefit package that's more transparent and gain better control of their own lives. As software engineers, we are in the top tier of employment. We earn in the top tier of the population and handle levels of complexity in the top tier of the population. Our personal experiences don't reflect that of the general population. Even then, the engineer making $180k/yr at Microsoft might have a very different healthcare experience compared to the engineer making $180k/yr at Google depending on the choices that the benefits administrators at Microsoft and Google have made! That's just insane and a level of complexity that's just unnecessary.

defterGoose 7y ago
If the government has "extreme negotiating ability" that citizens lack, then why does it continue to allow price gouging on drugs?
- subhobroto 7y ago
  > If the government has "extreme negotiating ability" that citizens lack, then why does it continue to allow price gouging on drugs? Because regulations have been put in place to disallow the U.S. government from negotiating with pharma companies on drug pricing. The regulations were put in with good intentions (and some healthy doses of lobbying) in ensuring pharma companies would have financial incentives to carry out R&D but hindsight is, as they say, 20/20. Even in the face of these drug price regulations, though, the government still has a much higher negotiating ability than you or I do. Check the drug prices one pays with Medicare Part D vs. the prices on "free market" Amazon or eBay.
  - defterGoose 7y ago
    If the regs were put in place due to "good intentions", and a "healthy[sic] dose of lobbying", then functionally this "negotiating ability" does not exist, because the government is not acting in the best interest of consumers, nor does it currently have the capability: its hands are tied.
    - subhobroto 7y ago
      I can see you are getting too tied up in the existing perspective you have, so I recommend you step back and revisit our discussion with a third person's perspective. If you have a point to make instead, say it. I don't know what you're thinking but it feels like you seem to believe that only direct actions have effect. That's not true. Indirect actions have effect too. Just because the government's hands are tied in drug pricing does not mean the drug companies can charge the government whatever they want (like they can charge you or I). For one, it has sheer size and it's pretty powerful overall. It will take an extremely risk seeking drug company to try and exploit the government and drug companies are extremely risk averse. Let me give another example - if you interviewed for a front end job this week at either of the coasts and refused to negotiate or name a number, most companies, if not all, would still offer a six figure number because that's the market. I WOULD be surprised if anyone offered you a minimum wage even if you were actually willing to take it! Another example - say you are driving properly on the freeway following all rules like a perfect citizen and a cop car drives by - in general you're likely to take notice of that and be more careful in the way you drive even if the cop car in no way signalled to you or otherwise expressed any interest. Even if you knew this cop was not allowed to pull you over, you still would modify your behavior. In general for the better. Compare your change in response to all other cars driving by you - one even might have flashed its lights at you and you showed them your middle finger. You probably wont do that to this specific car though. Or if you went to an fancy event where the organizers explicitly asked you not to bring any gifts because they knew you were going through a tough time but you saw everyone else bring in expensive gifts, you would probably go out and try and get something reasonable, despite being explicity directed otherwise. Just because one does not actively signal, or might even be obstructed from signalling, does not mean there is a complete lack of signal. Drug companies have more to gain from keeping the government happy than making it unhappy. To that end, they are willing to forgo some profit. They dont have any reason to do so for you or I. We are at a natural disadvantage: If you needed drug "GiveLife" to not die tomorrow, you would probably give up a significant amount of your worth or even go into debt to pay for GiveLife.

defterGoose 7y ago

If the government has "extreme negotiating ability" that citizens lack, then why does it continue to allow price gouging on drugs?

subhobroto 7y ago
> If the government has "extreme negotiating ability" that citizens lack, then why does it continue to allow price gouging on drugs? Because regulations have been put in place to disallow the U.S. government from negotiating with pharma companies on drug pricing. The regulations were put in with good intentions (and some healthy doses of lobbying) in ensuring pharma companies would have financial incentives to carry out R&D but hindsight is, as they say, 20/20. Even in the face of these drug price regulations, though, the government still has a much higher negotiating ability than you or I do. Check the drug prices one pays with Medicare Part D vs. the prices on "free market" Amazon or eBay.
- defterGoose 7y ago
  If the regs were put in place due to "good intentions", and a "healthy[sic] dose of lobbying", then functionally this "negotiating ability" does not exist, because the government is not acting in the best interest of consumers, nor does it currently have the capability: its hands are tied.
  - subhobroto 7y ago
    I can see you are getting too tied up in the existing perspective you have, so I recommend you step back and revisit our discussion with a third person's perspective. If you have a point to make instead, say it. I don't know what you're thinking but it feels like you seem to believe that only direct actions have effect. That's not true. Indirect actions have effect too. Just because the government's hands are tied in drug pricing does not mean the drug companies can charge the government whatever they want (like they can charge you or I). For one, it has sheer size and it's pretty powerful overall. It will take an extremely risk seeking drug company to try and exploit the government and drug companies are extremely risk averse. Let me give another example - if you interviewed for a front end job this week at either of the coasts and refused to negotiate or name a number, most companies, if not all, would still offer a six figure number because that's the market. I WOULD be surprised if anyone offered you a minimum wage even if you were actually willing to take it! Another example - say you are driving properly on the freeway following all rules like a perfect citizen and a cop car drives by - in general you're likely to take notice of that and be more careful in the way you drive even if the cop car in no way signalled to you or otherwise expressed any interest. Even if you knew this cop was not allowed to pull you over, you still would modify your behavior. In general for the better. Compare your change in response to all other cars driving by you - one even might have flashed its lights at you and you showed them your middle finger. You probably wont do that to this specific car though. Or if you went to an fancy event where the organizers explicitly asked you not to bring any gifts because they knew you were going through a tough time but you saw everyone else bring in expensive gifts, you would probably go out and try and get something reasonable, despite being explicity directed otherwise. Just because one does not actively signal, or might even be obstructed from signalling, does not mean there is a complete lack of signal. Drug companies have more to gain from keeping the government happy than making it unhappy. To that end, they are willing to forgo some profit. They dont have any reason to do so for you or I. We are at a natural disadvantage: If you needed drug "GiveLife" to not die tomorrow, you would probably give up a significant amount of your worth or even go into debt to pay for GiveLife.