16 ms·

I really think that the sooner we can separate out pensions and healthcare from employers, the better. Businesses main area of expertise is not in pensions and

by zarro 7y ago

I really think that the sooner we can separate out pensions and healthcare from employers, the better. Businesses main area of expertise is not in pensions and healthcare, and they cannot provide these services as efficiently as if there were many different insurance companies on the market offering these services for sale, and instead the company paid you a fee for your services, and then you went out on the market and bought your own pension plan and health insurance.

orian 7y ago
You mean like in good, old Europe? No way!
- geogra4 7y ago
  Well, the european model sees these as natural monopolies and just provides them at the state level
- zarro 7y ago
  I'm not sure that the European version of outsourcing that responsibility to the government is the way to go for the same reason. Letting people set up private companies with competitive options I think would probably drive the best results.
  - throwaway2048 7y ago
    Why?
  - mankyd 7y ago
    Isn't that what American health insurance companies are?
    - Someone1234 7y ago
      Kinda yes. But it isn't competitive when you cannot even pick your own health insurance company nor see prices for medical care (or see what is in/out of network). Splitting employers from health insurance is one of several required changes that needs to happen before the supposed hand of capitalism can allow the market to get healthier. I have no idea if it would work, but the status quo is so unhealthy at the very least improvement competition/choice could improve that somewhat.
      - mankyd 7y ago
        >But it isn't competitive when you cannot even pick your own health insurance company There's plenty of employers that don't offer healthcare, and you are not obligated to take it if your employer does offer it. You can always buy your own health insurance.
        Someone1234 7y ago
        And pay substantially more for the same product. The individual insurance marketplace isn't competitive, plus you're also giving the federal government a free loan (since employer insurance is pre-tax dollars, individual plans get a refund after the tax return).
  - ljf 7y ago
    That has been shown to work well where? And by well I mean for the customer not for the business/insurer.
  - mrlala 7y ago
    >Letting people set up private companies with competitive options I think would probably drive the best results. Hello, please call * 910 if you think your fire is not urgent, and can wait 10 minutes to come for free * 911 if you think your fire is getting hotter, and can only way 5 minutes to come for $500 * 912 if you would like the fire department to come as soon as they possible can, and skip the queue of 910 callers for $10000
    - mhb 7y ago
      Are you suggesting that there are not places with private fire companies/insurance who will only put out your fire if you are a subscriber?
      - pastor_williams 7y ago
        They'll also put out your fire if it looks likely to spread to a subscriber's property.
    - pastor_williams 7y ago
      The private firefighter industry: https://www.npr.org/2019/06/27/736715592/the-private-firefighter-industry https://www.npr.org/2019/06/27/736715592/the-private-firefig...
  - bjourne 7y ago
    That's how it used to be in many European countries. Insurance is an old concept that predates the modern nation state. Problem is that in an unregulated market, private will not keep a big enough buffer to avoid ruination because that hurts profits. In the 19th century a lot of upper class people had such insurances for their businesses which turned out to be worthless because when disaster struck they found that the money wasn't there. Gradually such worthless insurance funds were nationalized and became the foundations of many European welfare systems.
- dang 7y ago
  Please don't post unsubstantive comments or foment regional flamewar here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
chooseaname 7y ago
I would love for this to happen. But I see a couple blockers. 1) It is some sort of badge of honor to get a "job with benefits". 2) What if more people decide to not get healthcare? If your job gives it to you and you "only" have to pay a few hundred a month for your family, you are more likely to get it than if you payed everything out of pocket each month (even if your compensation increased). People would see all the extra money and just not get healthcare. If enough people did this, healthcare would be too expensive for the rest of us. 3) People are just reluctant to big change. And this is a big change. There would be politicians on the news claiming someone was "taking away your benefits".
- deleted 7y ago
  [deleted]
- admiun 7y ago
  Regarding 2), you could just make healthcare insurance mandatory. We have that in The Netherlands.
  - lotsofpulp 7y ago
    It is currently mandatory in the US , however, this year, the penalty was reduced to zero. Which means it's basically not mandatory.
  - dx87 7y ago
    What if someone refuses to pay? Do they get a fine that's higher than what the cost of paying for healthcare would have been?
    - hocuspocus 7y ago
      Here in Switzerland if you don't give proof of insurance the state will pick one for you. Then if you don't pay, it's like with any other bill, you'll get into troubles really quick.
      - 7y ago
akvadrako 7y ago
That's easy and libertarian to do — just stop government from treating benefits as a special case in terms of taxation. It feels like a policy that should have cross party support among those who want smaller government or better social systems.
- Bartweiss 7y ago
  It's frustrating that employer-provided healthcare is treated as the standard alternative to single-payer, with very limited time spent on why even private insurance is specifically coming from employers. (When historically, as you point out, the answer is "tax reasons".) The current system drives all kinds of awful distortions independent of actual cost, and it wouldn't take much to improve. Swapping the tax exemption for a write-off would be a significant start to stop penalizing freelancers and part-time workers who have to buy their own insurance, and indirectly promote competitive not-employer-sponsored plans. I'm not sure if this just gets ignored because the issue is so contentious that small changes aren't worth the political price, or if there's something darker there, but it sure seems like it could be a bipartisan move.
nguoi 7y ago
It also incentivises propping up old, failing companies at the expense of the newer, innovative ones that would replace them in a healthy economy. For the same effect, get everyone to invest their entire private pension into their final employer.
ajnin 7y ago
It's not that they can't, more that they don't want to, because that gives them leverage on their employees. Look at the recent GM strike : not happy ? We're cutting your health insurance. They reversed it ultimately but I bet it'll make people think twice next time they're thinking about going on a strike. And you know what is even more efficient than market-based health insurance and pensions ? Socialist state-level monopolies. Yep, costs in Europe are about half of what they are in the US. Turns out governments are not more inefficient than companies, especially very large ones.
- stephen_g 7y ago
  We have basically 'Medicare for all' in Australia. Works well. We spend way less as a proportion of GDP than the US on healthcare and the hospitals in the big cities (where they send people for anything serious) are world class. Most things like GPs, physiotherapists, etc. are private but the Medicare system pays for something like 60% to 100% of the bill depending on various factors. You won't usually pay more than $30 for a standard GP consult, for example. Crazily, the private insurers (it's optional) are trying to push for tax breaks to employers if they pay for private health insurance for their employees (more like the US system but basically unheard of here), despite the fact that the private system is already heavily subsidised (big rebate on private health insurance and also tax benefits for moderate and high income earners), and despite the fact that our public system is more efficient (according to studies), so we'd actually be better off just investing that cash in the public system (because of underfunding there are waiting lists for a lot of elective surgery). But the private insurance industry is generally struggling because they've been raising premiums and reducing service (more exclusions and bigger excesses) and our public system is good.
deleted 7y ago
[deleted]

by zarro 7y ago

orian 7y ago

You mean like in good, old Europe? No way!

geogra4 7y ago
Well, the european model sees these as natural monopolies and just provides them at the state level
zarro 7y ago
I'm not sure that the European version of outsourcing that responsibility to the government is the way to go for the same reason. Letting people set up private companies with competitive options I think would probably drive the best results.
- throwaway2048 7y ago
  Why?
- mankyd 7y ago
  Isn't that what American health insurance companies are?
  - Someone1234 7y ago
    Kinda yes. But it isn't competitive when you cannot even pick your own health insurance company nor see prices for medical care (or see what is in/out of network). Splitting employers from health insurance is one of several required changes that needs to happen before the supposed hand of capitalism can allow the market to get healthier. I have no idea if it would work, but the status quo is so unhealthy at the very least improvement competition/choice could improve that somewhat.
    - mankyd 7y ago
      >But it isn't competitive when you cannot even pick your own health insurance company There's plenty of employers that don't offer healthcare, and you are not obligated to take it if your employer does offer it. You can always buy your own health insurance.
      - Someone1234 7y ago
        And pay substantially more for the same product. The individual insurance marketplace isn't competitive, plus you're also giving the federal government a free loan (since employer insurance is pre-tax dollars, individual plans get a refund after the tax return).
- ljf 7y ago
  That has been shown to work well where? And by well I mean for the customer not for the business/insurer.
- mrlala 7y ago
  >Letting people set up private companies with competitive options I think would probably drive the best results. Hello, please call * 910 if you think your fire is not urgent, and can wait 10 minutes to come for free * 911 if you think your fire is getting hotter, and can only way 5 minutes to come for $500 * 912 if you would like the fire department to come as soon as they possible can, and skip the queue of 910 callers for $10000
  - mhb 7y ago
    Are you suggesting that there are not places with private fire companies/insurance who will only put out your fire if you are a subscriber?
    - pastor_williams 7y ago
      They'll also put out your fire if it looks likely to spread to a subscriber's property.
  - pastor_williams 7y ago
    The private firefighter industry: https://www.npr.org/2019/06/27/736715592/the-private-firefighter-industry https://www.npr.org/2019/06/27/736715592/the-private-firefig...
- bjourne 7y ago
  That's how it used to be in many European countries. Insurance is an old concept that predates the modern nation state. Problem is that in an unregulated market, private will not keep a big enough buffer to avoid ruination because that hurts profits. In the 19th century a lot of upper class people had such insurances for their businesses which turned out to be worthless because when disaster struck they found that the money wasn't there. Gradually such worthless insurance funds were nationalized and became the foundations of many European welfare systems.
dang 7y ago
Please don't post unsubstantive comments or foment regional flamewar here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

chooseaname 7y ago

I would love for this to happen. But I see a couple blockers. 1) It is some sort of badge of honor to get a "job with benefits". 2) What if more people decide to not get healthcare? If your job gives it to you and you "only" have to pay a few hundred a month for your family, you are more likely to get it than if you payed everything out of pocket each month (even if your compensation increased). People would see all the extra money and just not get healthcare. If enough people did this, healthcare would be too expensive for the rest of us. 3) People are just reluctant to big change. And this is a big change. There would be politicians on the news claiming someone was "taking away your benefits".

deleted 7y ago
[deleted]
admiun 7y ago
Regarding 2), you could just make healthcare insurance mandatory. We have that in The Netherlands.
- lotsofpulp 7y ago
  It is currently mandatory in the US , however, this year, the penalty was reduced to zero. Which means it's basically not mandatory.
- dx87 7y ago
  What if someone refuses to pay? Do they get a fine that's higher than what the cost of paying for healthcare would have been?
  - hocuspocus 7y ago
    Here in Switzerland if you don't give proof of insurance the state will pick one for you. Then if you don't pay, it's like with any other bill, you'll get into troubles really quick.
    - 7y ago

akvadrako 7y ago

That's easy and libertarian to do — just stop government from treating benefits as a special case in terms of taxation. It feels like a policy that should have cross party support among those who want smaller government or better social systems.

Bartweiss 7y ago
It's frustrating that employer-provided healthcare is treated as the standard alternative to single-payer, with very limited time spent on why even private insurance is specifically coming from employers. (When historically, as you point out, the answer is "tax reasons".) The current system drives all kinds of awful distortions independent of actual cost, and it wouldn't take much to improve. Swapping the tax exemption for a write-off would be a significant start to stop penalizing freelancers and part-time workers who have to buy their own insurance, and indirectly promote competitive not-employer-sponsored plans. I'm not sure if this just gets ignored because the issue is so contentious that small changes aren't worth the political price, or if there's something darker there, but it sure seems like it could be a bipartisan move.

nguoi 7y ago

It also incentivises propping up old, failing companies at the expense of the newer, innovative ones that would replace them in a healthy economy. For the same effect, get everyone to invest their entire private pension into their final employer.

ajnin 7y ago

It's not that they can't, more that they don't want to, because that gives them leverage on their employees. Look at the recent GM strike : not happy ? We're cutting your health insurance. They reversed it ultimately but I bet it'll make people think twice next time they're thinking about going on a strike. And you know what is even more efficient than market-based health insurance and pensions ? Socialist state-level monopolies. Yep, costs in Europe are about half of what they are in the US. Turns out governments are not more inefficient than companies, especially very large ones.

stephen_g 7y ago
We have basically 'Medicare for all' in Australia. Works well. We spend way less as a proportion of GDP than the US on healthcare and the hospitals in the big cities (where they send people for anything serious) are world class. Most things like GPs, physiotherapists, etc. are private but the Medicare system pays for something like 60% to 100% of the bill depending on various factors. You won't usually pay more than $30 for a standard GP consult, for example. Crazily, the private insurers (it's optional) are trying to push for tax breaks to employers if they pay for private health insurance for their employees (more like the US system but basically unheard of here), despite the fact that the private system is already heavily subsidised (big rebate on private health insurance and also tax benefits for moderate and high income earners), and despite the fact that our public system is more efficient (according to studies), so we'd actually be better off just investing that cash in the public system (because of underfunding there are waiting lists for a lot of elective surgery). But the private insurance industry is generally struggling because they've been raising premiums and reducing service (more exclusions and bigger excesses) and our public system is good.

deleted 7y ago

[deleted]