13 ms·

The sooner we can completely divorce healthcare from employment, the better.

throwaway_law 7y ago
I hear this statement all the time...but what does it mean? If employers didn't provide health insurance to employees wouldn't we just wind up with 40% of the insured uninsured? Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. Even if the employer's did make up the cash difference, its not like that will bring pricing down, individuals can't negotiate individual insurance rates, pools of employees can negotiate group rates, so if anything costs would probably go up. How will this help: 1) insured more people; or 2) bring costs down?
- ceejayoz 7y ago
  > individuals can't negotiate individual insurance rates, pools of employees can negotiate group rates, so if anything costs would probably go up This is why the exchanges exist. They're huge pools of people on a group rate. New York state negotiates with insurers on my behalf, and is additionally able to regulate their premium increases each year.
  - lotsofpulp 7y ago
    And the nice, healthy white collar lived are locked away in employer group health plans, resulting in fewer insurance companies being able to offer insurance on healthcare.gov, resulting in higher premiums for lives on healthcare.gov. Another advantage for big businesses over small businesses.
  - throwaway_law 7y ago
    Who is in charge of negotiating for this pool? Just as an example between 2017-2018 the average silver plan went up 32% and the average gold plan 20%, who the hell negotiated that? At least with the employer provided insurance the employer is negotiating, and you know who that is and you know they have a self-interest in keeping costs down.
    - ceejayoz 7y ago
      Plans jumped in 2017-2018 because insurers had to factor in the possibility of Obamacare repeal. Last year saw a drop (down 1.5% in the 39 states using Healthcare.gov), and 2020 looks small thus far as well. https://www.politico.com/story/2019/06/03/obamacare-rate-hikes-appear-modest-for-2020-1497115 https://www.politico.com/story/2019/06/03/obamacare-rate-hik... I, quite frankly, trust my state more than my employer in a fight against my insurer. I obtain coverage via the NY exchange.
      - makomk 7y ago
        The price of insurance jumped massively every year from the start of Obamacare to 2018. The fact that this has apparently mostly stopped now is the unusual thing; 2017-18 was a pretty typical year despite Trump's meddling. The article you linked suggests that this is because insurers have finally increases the cost of insurance to be in line with how much it actually costs them.
        ceejayoz 7y ago
        > The price of insurance jumped massively every year from the start of Obamacare to 2018. It was doing that for decades prior, too. Obamacare didn’t change it much in either direction.
    - donarb 7y ago
      Sure the employer negotiates the plan, but they are not negotiating on behalf of their employees, they are negotiating based on how much the employer is willing to spend. When the squeeze happens, the employer pays the same amount for a slimmer plan and the employees pay more in the form of wages and deductibles.
- tempsy 7y ago
  We would do what every other country does and offer healthcare as a basic right? The whole point of "Medicare for All" is to divorce employers from their employee's healthcare. The gov't negotiates on behalf of everyone.
  - throwaway_law 7y ago
    Its not exactly a chicken and egg problem then, and the solution doesn't start with divorcing insurance from employment. Put that "Medicare for All" into play first.
    - js2 7y ago
      MFA is a single-payer option but there are plenty of multi-payer healthcare systems in the world which achieve universal coverage and contain costs. Germany would be the prime example, but see also Switzerland and France.
      - throwaway_law 7y ago
        I like single payer, but I haven't had the luxury of living under either system of universal care. I think in the US we have different issues than face Germany/Switzerland/France, and for the US to contain costs my opinion is we would have to rip private insurance out completely. Our main Government provided system (Medicare for the elderly) is a combination of government and private, and to put that system in perspective, Germany spent 375B (not sure if $ or Euro) in healthcare total in 2017, and US Medicare spent $609B in 2017. Germany covered an entire country (82M people) Medicare covered 15% of the US (44M people).
        js2 7y ago
        I am a U.S. citizen. Yes, cost is a huge issue. We would not have to rip out private insurance, but we would probably have to regulate pricing, which is how it works in Germany. Folks should be welcome to buy supplemental insurance as they do with Medicare. There's basically four models[1] for providing health care, and the US has all of them: The Bismarck model like Germany with multiple payers, but they are non-profit and pricing is regulated. Doctors and hospitals are private, and there is still supplemental private insurance. Financing is a combination of employer and taxes, where the government takes over the employer portion if the person is unemployed. This is sorta what the U.S. has for those with employer subsidized health care except for the insurers being for-profit and unregulated pricing. The Beveridge model like in the U.K. financed through taxes and where the government provides care. This is so-called socialized medicine. In the U.S. we have this system for veterans in the form of the V.A. The national health insurance model, with private doctors and hospitals but the government is a single-payer. Canada. Medicare. And lastly, out-of-pocket. We use all of these in the U.S. and it's insane. We could in theory adopt a Bismarck system. Force the insurers to be non-profit. Make everyone work off Medicare pricing. Supposedly existing Medicare pricing is too low. Fine, let the doctors and hospitals negotiate that with Medicare. Allow supplemental insurance for those who want it. MFA polls badly when you ask Americans what if they had to give up their current insurance. But I think this is misleading. Of course it's going to poll poorly if you ask someone to give something up. That's basic loss aversion. Turn the question on its head and ask a bunch of 65+ year olds how they'd feel about giving up Medicare in return for their Medicare withholdings back to buy their own private insurance. Guessing that wouldn't poll too well. I don't think MFA is necessarily the best option. Americans value choice. But it seems to be the universal care option with the most political momentum right now. I'll take it. But I'd be happy with a Bismarck-type system too. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/
- throwaway66920 7y ago
  Getting insurance as an individual is expensive because you’re not part of a group plan. With a group plan the insurance company has some reason to believe you’re not collectively a bunch of dying people committing moral hazard, you’re just one of a generally similar looking company workforce. If employers stopped providing it, I think it is presumed that the mentality towards individual plans would change
  - 2sk21 7y ago
    Well, one way of looking at it is that the general population is the biggest group possible :-)
    - throwaway66920 7y ago
      Sort of. This is true if everyone is required to participate in the system. And there’s only one provider. If you imagine there being a cheap plan and an expensive plan, you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down (because poor people are likely to have more health issues). True meaning it averages out to a reasonably healthy person
      - throwaway_law 7y ago
        >you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down It is unfortunately true in the US (probably everywhere) there is worse health/higher incidences of chronic conditions in the poor (mostly because all chronic conditions are diet related). However, in the US the biggest weight would be the elderly who have chronic conditions at a higher rate than any other demographic (generally due to a lifetime of poor diet combined with irregular care over their life to treat the conditions until they are Medicare), but thats the irony these are the people already covered by Government healthcare (and they seem fairly happy with it. Its time to extend it to everyone.
  - erichocean 7y ago
- tschwimmer 7y ago
  I think the implication of the GP's comment is that we still provide it, we just don't tie it to employment. There are a lot of nasty side effects of this coupling, including decreased employee mobility.
- sampo 7y ago
  > I hear this statement all the time...but what does it mean? Something like this https://en.wikipedia.org/wiki/Health_care_in_the_United_Kingdom https://en.wikipedia.org/wiki/Health_care_in_the_United_King...
- deleted 7y ago
  [deleted]
- cascom 7y ago
  1 - If my company buys health insurance for me, its tax deductible(pre-tax), if I buy it myself it is after-tax. Now companies are can just gross-up pay, and don't have to compete on healthcare... 2) Pooling remains an issue, but as it stands now, consumers have little to no choice, one would imagine that once a 125m households start shopping for insurance there is going to be competition on price... in most circumstances
  - war1025 7y ago
    I believe the pre-tax post-tax thing is actually wrong. The difference is that you pay for the plan with post-tax money until tax season rolls around, when if I remember correctly (from having an individual plan for several years) you get to deduct those costs. So really, it's just the typical American thing of people being terrible at understanding tax codes and adjusting their withholdings correctly.
    - lotsofpulp 7y ago
      Source? IRS specifically states: https://www.irs.gov/taxtopics/tc502 https://www.irs.gov/taxtopics/tc502 >You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. You figure the amount you're allowed to deduct on Form 1040, Schedule A. It’s another subsidy for big business in the US. If you work for a small employer that doesn’t offer health insurance, you’re paying with after tax money.
      - deleted 7y ago
        [deleted]
      - war1025 7y ago
        My reading of this [1] seems to match up with what I said: """ - If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy. - If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the cost out of pocket, then the whole amount is deductible. """ [1] https://www.insurance.com/health-insurance/health-insurance-basics/are-health-insurance-premiums-tax-deductible.html https://www.insurance.com/health-insurance/health-insurance-...
- mywittyname 7y ago
  Having a critical mass of uninsured people is the foundation we need to resolve the healthcare crisis in America. Those uninsured people still need healthcare. If enough people start calling up small clinics asking for pricing, a cottage industry of small health providers will pop up to service these people with transparent pricing. The insurance industry has perverted our healthcare system. The major reason doctors moved from private practice to being associated with hospitals is to simplify billing because health insurance companies look for any reason to refuse payment. To reverse this trend, we need more people willing to bypass insurance and buy healthcare directly. Health insurance is a failed experiment. People should pay for their healthcare directly, and the government should provide for those who require serious, expensive treatments (after a payment that is some percentage of their income).
  - bryanlarsen 7y ago
    > People should pay for their healthcare directly, and the government should provide for those who require serious, expensive treatments (after a payment that is some percentage of their income). It's cheaper for the government to pay for everything. If you incentivize skipping check-ups and minor treatments they turn into large expensive care. The rest of the western world has had universal health care for ~50 years now and it works better in every other western country than it does in the US. The US should just choose a country and copy it.
    - reroute1 7y ago
      > The US should just choose a country and copy it. Just because X policy works elsewhere doesn't mean it would have the same effect in another country.
      - bryanlarsen 7y ago
        No, but the fact that it does work somewhere gives it a huge advantage over completely untested plans.
  - throwaway_law 7y ago
- weberc2 7y ago
  > Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. They may not have compensated in cash (although surely some did), but they compensated elsewhere in the total compensation package. Benefits got better or salaries grew or vacation improved or 401K matches were introduced or etc etc. As for insurance pools, what is stopping people from forming groups that can negotiate their own rates? If there is a law, why can it not be changed?
- zjaffee 7y ago
  There's two proven paths to do this on different ends of the spectrum. The first is single payer which has proven implementation and is able to lower costs by directly controlling prices. The second is what Switzerland does which is where much of the inspiration for the ACA came from, except every single person would be required to buy from the exchanges rather than using some employer program. The ACA failed to properly acknowledge the negotiation power of certain large employers who often have large numbers of healthy young employees and have a deep understanding of their own risk pool, leaving the ~3% of people who use the exchanges paying more simply because they are a higher health risk population. Additionally, the ban/tax on "cadillac" plans absolutely needs to go into effect as it's an important mechanism for controlling costs in a market health insurance solution, as in demand doctors could just require patients have said cadillac plans that pay out more. There are handfuls of solutions in the middle of this, but they generally involve the government controlling prices to a certain degree, but only single payer would be effective at both bringing costs down and insuring more people, as you absolutely have to create short term shortages in order to solve both problems at once.
- cactus2093 7y ago
  It's not mutually exclusive with a Universal Healthcare plan, for one thing. But I think it's still a worthwhile goal with or without a separate initiative for universal healthcare. It brings costs down, because many more people are now on a level playing field. If we stick with the current market-based system, this would make a big difference in actually having it start to function like a market. The average, middle class American will actually have to evaluate the costs of their plan and shop around for the best value, and they will also be very aware of how much they're spending and push for measures to bring down costs. If we do also build up a universal healthcare system, then working, middle class people will end up actually using the universal healthcare system, and again will be incentivized to push to make it work well. As things stand today, people on the "open market" plans are clearly being treated as second class citizens, they're paying more and getting worse coverage than people who have a special connection (whether that's a company plan, union, etc). The taxing is also wonky and unfair, at least if I understand this correctly if I pay for a marketplace plan I'm paying with after-tax money, but if my company pays for my plan it's untaxed. In my opinion there are also additional reasons this would be a net good thing, even if it were merely neutral on the two criteria that you call out. It will give people more freedom to do what they want to do -- right now if you want to quit a job or work only part-time, even if you have a source of income or savings to make it feasible, healthcare is a major hurdle. If you want to start a small business and need to offer healthcare for your employees, it's an even bigger hurdle. I would rather live in a world where it's as easy as possible to make your own path, and people are not beholden to a full-time job to have access to healthcare.
- adolph 7y ago
  I think the concept of separating healthcare coverage from employment is an important first baby step to bringing costs down in that it makes healthcare consumers more aware of how much they are spending instead of hiding it as off-paycheck compensation. This awareness can be raised in other ways. For example, some employers have added a chart in HR websites that outline how much is spent on each employee (it is personalized for each employee) in categories of wages, taxes, retirement, healthcare and the like. It is a way of communicating how much money is expended on an employee. If one were to know how much was spent on one's healthcare coverage, would the average person think "ok, need to be efficient to get that number down" or "gosh, I better get what I'm paying for?" In the sense that healthcare plans are transfers from the healthier to the sicker, one would hope the former. In the sense that healthcare plans are almost-all-you-can-eat buffets of medicine, I think the latter is more likely.
- christkv 7y ago
  You should have both public and private options at the same time. In Spain you have a good public system but you also have a parallel private system. It keeps a check on the price rise of private insurance as people have the option. For a family of four I pay 300 EUR a month for the best plan. Most people pay about 180 EUR for four people.
ihm 7y ago
Hear, hear. That's one of the biggest reasons I've been knocking doors for Bernie.
Pfhreak 7y ago
Do you think that companies would give you a raise equivalent to what they were paying on your behalf for healthcare? I suspect not. I mean, it's one thing if we moved to a single payer system, which would be great, but just moving out of the employer's hands and into the general public seems like a disaster. (Also, I am not a fan of the employer healthcare model.)
- cascom 7y ago
  that's a fair point, but which is easier for an employee to compare, wages between two companies or job offers when they buy their own insurance and know the cost, or to compare wages AND benefits of two different jobs/offers
- alkonaut 7y ago
  If you add a payroll tax equal to the average cost of insurance, then it’s neutral for employers as a group. The payroll tax could be used either to fund a single payer system or to fund deductions for employees helping them buy insurance.
- kaibee 7y ago
  > Do you think that companies would give you a raise equivalent to what they were paying on your behalf for healthcare? I suspect not. Its anecdotal, but my company and the company my mom works for, both already do this if you choose to opt out of the employer plan. Total compensation is not a foreign concept to most businesses.
  - Pfhreak 7y ago
    Sure. But how many people know how much their employer is paying on their behalf, and could use that to effectively have the same earning power? I know I had no idea until the Affordable Care Act put it on my tax documents.
- bluGill 7y ago
  That depends on the details. I'm sure to have missed a many important details below (I doubt anyone even knows them all). For an instant raise to happen: companies must not only lose their tax deductions on what they contribute to insurance, they also need to count that contribution to employee's wages even if the employee doesn't take it. As soon as young childless employees realize that they are paying taxes on what amounts to the insurance payments to their co-worker who has a lot of kids they will demand they get the cash.

I hear this statement all the time...but what does it mean? If employers didn't provide health insurance to employees wouldn't we just wind up with 40% of the insured uninsured? Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. Even if the employer's did make up the cash difference, its not like that will bring pricing down, individuals can't negotiate individual insurance rates, pools of employees can negotiate group rates, so if anything costs would probably go up. How will this help: 1) insured more people; or 2) bring costs down?

ceejayoz 7y ago
> individuals can't negotiate individual insurance rates, pools of employees can negotiate group rates, so if anything costs would probably go up This is why the exchanges exist. They're huge pools of people on a group rate. New York state negotiates with insurers on my behalf, and is additionally able to regulate their premium increases each year.
- lotsofpulp 7y ago
  And the nice, healthy white collar lived are locked away in employer group health plans, resulting in fewer insurance companies being able to offer insurance on healthcare.gov, resulting in higher premiums for lives on healthcare.gov. Another advantage for big businesses over small businesses.
- throwaway_law 7y ago
  Who is in charge of negotiating for this pool? Just as an example between 2017-2018 the average silver plan went up 32% and the average gold plan 20%, who the hell negotiated that? At least with the employer provided insurance the employer is negotiating, and you know who that is and you know they have a self-interest in keeping costs down.
  - ceejayoz 7y ago
    Plans jumped in 2017-2018 because insurers had to factor in the possibility of Obamacare repeal. Last year saw a drop (down 1.5% in the 39 states using Healthcare.gov), and 2020 looks small thus far as well. https://www.politico.com/story/2019/06/03/obamacare-rate-hikes-appear-modest-for-2020-1497115 https://www.politico.com/story/2019/06/03/obamacare-rate-hik... I, quite frankly, trust my state more than my employer in a fight against my insurer. I obtain coverage via the NY exchange.
    - makomk 7y ago
      The price of insurance jumped massively every year from the start of Obamacare to 2018. The fact that this has apparently mostly stopped now is the unusual thing; 2017-18 was a pretty typical year despite Trump's meddling. The article you linked suggests that this is because insurers have finally increases the cost of insurance to be in line with how much it actually costs them.
      - ceejayoz 7y ago
        > The price of insurance jumped massively every year from the start of Obamacare to 2018. It was doing that for decades prior, too. Obamacare didn’t change it much in either direction.
  - donarb 7y ago
    Sure the employer negotiates the plan, but they are not negotiating on behalf of their employees, they are negotiating based on how much the employer is willing to spend. When the squeeze happens, the employer pays the same amount for a slimmer plan and the employees pay more in the form of wages and deductibles.
tempsy 7y ago
We would do what every other country does and offer healthcare as a basic right? The whole point of "Medicare for All" is to divorce employers from their employee's healthcare. The gov't negotiates on behalf of everyone.
- throwaway_law 7y ago
  Its not exactly a chicken and egg problem then, and the solution doesn't start with divorcing insurance from employment. Put that "Medicare for All" into play first.
  - js2 7y ago
    MFA is a single-payer option but there are plenty of multi-payer healthcare systems in the world which achieve universal coverage and contain costs. Germany would be the prime example, but see also Switzerland and France.
    - throwaway_law 7y ago
      I like single payer, but I haven't had the luxury of living under either system of universal care. I think in the US we have different issues than face Germany/Switzerland/France, and for the US to contain costs my opinion is we would have to rip private insurance out completely. Our main Government provided system (Medicare for the elderly) is a combination of government and private, and to put that system in perspective, Germany spent 375B (not sure if $ or Euro) in healthcare total in 2017, and US Medicare spent $609B in 2017. Germany covered an entire country (82M people) Medicare covered 15% of the US (44M people).
      - js2 7y ago
        I am a U.S. citizen. Yes, cost is a huge issue. We would not have to rip out private insurance, but we would probably have to regulate pricing, which is how it works in Germany. Folks should be welcome to buy supplemental insurance as they do with Medicare. There's basically four models[1] for providing health care, and the US has all of them: The Bismarck model like Germany with multiple payers, but they are non-profit and pricing is regulated. Doctors and hospitals are private, and there is still supplemental private insurance. Financing is a combination of employer and taxes, where the government takes over the employer portion if the person is unemployed. This is sorta what the U.S. has for those with employer subsidized health care except for the insurers being for-profit and unregulated pricing. The Beveridge model like in the U.K. financed through taxes and where the government provides care. This is so-called socialized medicine. In the U.S. we have this system for veterans in the form of the V.A. The national health insurance model, with private doctors and hospitals but the government is a single-payer. Canada. Medicare. And lastly, out-of-pocket. We use all of these in the U.S. and it's insane. We could in theory adopt a Bismarck system. Force the insurers to be non-profit. Make everyone work off Medicare pricing. Supposedly existing Medicare pricing is too low. Fine, let the doctors and hospitals negotiate that with Medicare. Allow supplemental insurance for those who want it. MFA polls badly when you ask Americans what if they had to give up their current insurance. But I think this is misleading. Of course it's going to poll poorly if you ask someone to give something up. That's basic loss aversion. Turn the question on its head and ask a bunch of 65+ year olds how they'd feel about giving up Medicare in return for their Medicare withholdings back to buy their own private insurance. Guessing that wouldn't poll too well. I don't think MFA is necessarily the best option. Americans value choice. But it seems to be the universal care option with the most political momentum right now. I'll take it. But I'd be happy with a Bismarck-type system too. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596027/
throwaway66920 7y ago
Getting insurance as an individual is expensive because you’re not part of a group plan. With a group plan the insurance company has some reason to believe you’re not collectively a bunch of dying people committing moral hazard, you’re just one of a generally similar looking company workforce. If employers stopped providing it, I think it is presumed that the mentality towards individual plans would change
- 2sk21 7y ago
  Well, one way of looking at it is that the general population is the biggest group possible :-)
  - throwaway66920 7y ago
    Sort of. This is true if everyone is required to participate in the system. And there’s only one provider. If you imagine there being a cheap plan and an expensive plan, you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down (because poor people are likely to have more health issues). True meaning it averages out to a reasonably healthy person
    - throwaway_law 7y ago
      >you would probably expect that the expensive plan is a way better return on the dollar because there are fewer poor people on it weighing it down It is unfortunately true in the US (probably everywhere) there is worse health/higher incidences of chronic conditions in the poor (mostly because all chronic conditions are diet related). However, in the US the biggest weight would be the elderly who have chronic conditions at a higher rate than any other demographic (generally due to a lifetime of poor diet combined with irregular care over their life to treat the conditions until they are Medicare), but thats the irony these are the people already covered by Government healthcare (and they seem fairly happy with it. Its time to extend it to everyone.
- erichocean 7y ago
tschwimmer 7y ago
I think the implication of the GP's comment is that we still provide it, we just don't tie it to employment. There are a lot of nasty side effects of this coupling, including decreased employee mobility.
sampo 7y ago
> I hear this statement all the time...but what does it mean? Something like this https://en.wikipedia.org/wiki/Health_care_in_the_United_Kingdom https://en.wikipedia.org/wiki/Health_care_in_the_United_King...
deleted 7y ago
[deleted]
cascom 7y ago
1 - If my company buys health insurance for me, its tax deductible(pre-tax), if I buy it myself it is after-tax. Now companies are can just gross-up pay, and don't have to compete on healthcare... 2) Pooling remains an issue, but as it stands now, consumers have little to no choice, one would imagine that once a 125m households start shopping for insurance there is going to be competition on price... in most circumstances
- war1025 7y ago
  I believe the pre-tax post-tax thing is actually wrong. The difference is that you pay for the plan with post-tax money until tax season rolls around, when if I remember correctly (from having an individual plan for several years) you get to deduct those costs. So really, it's just the typical American thing of people being terrible at understanding tax codes and adjusting their withholdings correctly.
  - lotsofpulp 7y ago
    Source? IRS specifically states: https://www.irs.gov/taxtopics/tc502 https://www.irs.gov/taxtopics/tc502 >You may deduct only the amount of your total medical expenses that exceed 7.5% of your adjusted gross income. You figure the amount you're allowed to deduct on Form 1040, Schedule A. It’s another subsidy for big business in the US. If you work for a small employer that doesn’t offer health insurance, you’re paying with after tax money.
    - deleted 7y ago
      [deleted]
    - war1025 7y ago
      My reading of this [1] seems to match up with what I said: """ - If you buy health insurance through the state- or federally run health insurance marketplaces, you can deduct only the portion of the premium you pay out of your own pocket. You cannot deduct the amount of any subsidy. - If you buy an individual or family health insurance plan, either on the open market or through a marketplace, and you pay all of the cost out of pocket, then the whole amount is deductible. """ [1] https://www.insurance.com/health-insurance/health-insurance-basics/are-health-insurance-premiums-tax-deductible.html https://www.insurance.com/health-insurance/health-insurance-...
mywittyname 7y ago
Having a critical mass of uninsured people is the foundation we need to resolve the healthcare crisis in America. Those uninsured people still need healthcare. If enough people start calling up small clinics asking for pricing, a cottage industry of small health providers will pop up to service these people with transparent pricing. The insurance industry has perverted our healthcare system. The major reason doctors moved from private practice to being associated with hospitals is to simplify billing because health insurance companies look for any reason to refuse payment. To reverse this trend, we need more people willing to bypass insurance and buy healthcare directly. Health insurance is a failed experiment. People should pay for their healthcare directly, and the government should provide for those who require serious, expensive treatments (after a payment that is some percentage of their income).
- bryanlarsen 7y ago
  > People should pay for their healthcare directly, and the government should provide for those who require serious, expensive treatments (after a payment that is some percentage of their income). It's cheaper for the government to pay for everything. If you incentivize skipping check-ups and minor treatments they turn into large expensive care. The rest of the western world has had universal health care for ~50 years now and it works better in every other western country than it does in the US. The US should just choose a country and copy it.
  - reroute1 7y ago
    > The US should just choose a country and copy it. Just because X policy works elsewhere doesn't mean it would have the same effect in another country.
    - bryanlarsen 7y ago
      No, but the fact that it does work somewhere gives it a huge advantage over completely untested plans.
- throwaway_law 7y ago
weberc2 7y ago
> Its not like Corporate America is going to make up the difference and start paying cash to compensate for the lost benefit, at least thats what happened as pensions got stripped away from the workplace. They may not have compensated in cash (although surely some did), but they compensated elsewhere in the total compensation package. Benefits got better or salaries grew or vacation improved or 401K matches were introduced or etc etc. As for insurance pools, what is stopping people from forming groups that can negotiate their own rates? If there is a law, why can it not be changed?
zjaffee 7y ago
There's two proven paths to do this on different ends of the spectrum. The first is single payer which has proven implementation and is able to lower costs by directly controlling prices. The second is what Switzerland does which is where much of the inspiration for the ACA came from, except every single person would be required to buy from the exchanges rather than using some employer program. The ACA failed to properly acknowledge the negotiation power of certain large employers who often have large numbers of healthy young employees and have a deep understanding of their own risk pool, leaving the ~3% of people who use the exchanges paying more simply because they are a higher health risk population. Additionally, the ban/tax on "cadillac" plans absolutely needs to go into effect as it's an important mechanism for controlling costs in a market health insurance solution, as in demand doctors could just require patients have said cadillac plans that pay out more. There are handfuls of solutions in the middle of this, but they generally involve the government controlling prices to a certain degree, but only single payer would be effective at both bringing costs down and insuring more people, as you absolutely have to create short term shortages in order to solve both problems at once.
cactus2093 7y ago
It's not mutually exclusive with a Universal Healthcare plan, for one thing. But I think it's still a worthwhile goal with or without a separate initiative for universal healthcare. It brings costs down, because many more people are now on a level playing field. If we stick with the current market-based system, this would make a big difference in actually having it start to function like a market. The average, middle class American will actually have to evaluate the costs of their plan and shop around for the best value, and they will also be very aware of how much they're spending and push for measures to bring down costs. If we do also build up a universal healthcare system, then working, middle class people will end up actually using the universal healthcare system, and again will be incentivized to push to make it work well. As things stand today, people on the "open market" plans are clearly being treated as second class citizens, they're paying more and getting worse coverage than people who have a special connection (whether that's a company plan, union, etc). The taxing is also wonky and unfair, at least if I understand this correctly if I pay for a marketplace plan I'm paying with after-tax money, but if my company pays for my plan it's untaxed. In my opinion there are also additional reasons this would be a net good thing, even if it were merely neutral on the two criteria that you call out. It will give people more freedom to do what they want to do -- right now if you want to quit a job or work only part-time, even if you have a source of income or savings to make it feasible, healthcare is a major hurdle. If you want to start a small business and need to offer healthcare for your employees, it's an even bigger hurdle. I would rather live in a world where it's as easy as possible to make your own path, and people are not beholden to a full-time job to have access to healthcare.
adolph 7y ago
I think the concept of separating healthcare coverage from employment is an important first baby step to bringing costs down in that it makes healthcare consumers more aware of how much they are spending instead of hiding it as off-paycheck compensation. This awareness can be raised in other ways. For example, some employers have added a chart in HR websites that outline how much is spent on each employee (it is personalized for each employee) in categories of wages, taxes, retirement, healthcare and the like. It is a way of communicating how much money is expended on an employee. If one were to know how much was spent on one's healthcare coverage, would the average person think "ok, need to be efficient to get that number down" or "gosh, I better get what I'm paying for?" In the sense that healthcare plans are transfers from the healthier to the sicker, one would hope the former. In the sense that healthcare plans are almost-all-you-can-eat buffets of medicine, I think the latter is more likely.
christkv 7y ago
You should have both public and private options at the same time. In Spain you have a good public system but you also have a parallel private system. It keeps a check on the price rise of private insurance as people have the option. For a family of four I pay 300 EUR a month for the best plan. Most people pay about 180 EUR for four people.

ihm 7y ago

Hear, hear. That's one of the biggest reasons I've been knocking doors for Bernie.

Pfhreak 7y ago

Do you think that companies would give you a raise equivalent to what they were paying on your behalf for healthcare? I suspect not. I mean, it's one thing if we moved to a single payer system, which would be great, but just moving out of the employer's hands and into the general public seems like a disaster. (Also, I am not a fan of the employer healthcare model.)

cascom 7y ago
that's a fair point, but which is easier for an employee to compare, wages between two companies or job offers when they buy their own insurance and know the cost, or to compare wages AND benefits of two different jobs/offers
alkonaut 7y ago
If you add a payroll tax equal to the average cost of insurance, then it’s neutral for employers as a group. The payroll tax could be used either to fund a single payer system or to fund deductions for employees helping them buy insurance.
kaibee 7y ago
> Do you think that companies would give you a raise equivalent to what they were paying on your behalf for healthcare? I suspect not. Its anecdotal, but my company and the company my mom works for, both already do this if you choose to opt out of the employer plan. Total compensation is not a foreign concept to most businesses.
- Pfhreak 7y ago
  Sure. But how many people know how much their employer is paying on their behalf, and could use that to effectively have the same earning power? I know I had no idea until the Affordable Care Act put it on my tax documents.
bluGill 7y ago
That depends on the details. I'm sure to have missed a many important details below (I doubt anyone even knows them all). For an instant raise to happen: companies must not only lose their tax deductions on what they contribute to insurance, they also need to count that contribution to employee's wages even if the employee doesn't take it. As soon as young childless employees realize that they are paying taxes on what amounts to the insurance payments to their co-worker who has a lot of kids they will demand they get the cash.