8 ms·

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

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.
    - rumanator 7y ago
      Sounds like it would be far simpler and easier for everyone if the state provided healthcare services paid by everyone through taxes.
      - hocuspocus 7y ago
        Yes of course, but that's beyond the point. Americans cannot argue that mandatory healthcare couldn't work in a multi-payer, private system.
        rumanator 7y ago
        It really depends on your definition of "work". Being forced to subscribe to a paid service is not the same as getting access to healthcare. Your examples only show that if a state resorts to authoritarian measures then it can force everyone to subscribe to a paid service.
    - seanmcdirmid 7y ago
      And if you are a foreigner, you have to provide proof of insurance when you renew your residence permit at the control de habitant.
  - Faark 7y ago
    Its send to collections. So you're only fine if you are poor enough to not have anything they can take from you. And at that point you are eligible for gov support to your healthcare bill anyway. Here in germany you can actually kind of get away with not paying for a while when not consuming. But coverage has to be continuous, so if you need insurance since you want to go to the doctor a few years down the line, you have to pay up for the entire period.
    - seanmcdirmid 7y ago
      Hospitals already charge higher rates to those without insurance because of those payers high default rate. Collections is expensive, and they might not be able to collect anything at the end, so they price that risk into the prices.
      - jki275 7y ago
        Cite? Generally people without insurance are able to negotiate significantly lower bills - or the bills simply aren’t paid at all.
        seanmcdirmid 7y ago
        They can negotiate afterwards if they say they can’t pay, but that also is already built into the higher non-insured price list...
  - specialist 7y ago
    There's always stragglers, hold outs, conscientious objectors, cheats, freeloaders, randos, or whatever. Just think of them as "overhead". Spend a little on "enforcement", because rules are important. Call it audits, compliance, metrics, or whatever. But not more than would be saved without enforcement. Because diminishing returns. And at some tipping point, ratcheting up cost of compliance backfires, leading to more cheating. So strive for some happy equilibrium. So that the general population (taxpayers) feel the system is reasonable, if not exactly fair, and overall friction is minimized.
  - Bartweiss 7y ago
    Before it was stripped from the ACA, the price for not having insurance scaled with income. At the lowest end it was irrelevant because of Medicaid eligibility; above that it gradually increased from below-healthcare-price to above. So some people could still save money by opting out, but it pushed them towards the market by making the effective cost of insurance smaller. (Technically speaking, it was a tax rather than a fine. That mostly mattered for legal reasons, but it did also work that way in practice. It applied to everyone, so insured people had the obligation waived, but the people paying it weren't in violation of any law or regulation.)
lotsofpulp 7y ago
>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. ACA had a solution to this, it was an extra tax for not purchasing health insurance. Because health insurance premiums are basically a tax to provide healthcare to everyone. Because US voters don't want to directly pay the government to provide healthcare to everyone.
hocuspocus 7y ago
1) Employers could still cover the premium as a benefit. You'd just get to choose how and where to use the money. 2) Make it truly mandatory like in all developed countries.
- seanmcdirmid 7y ago
  In Switzerland, employers don’t cover premiums, and premiums are paid post tax anyways. The USA is weird because employer provided health insurance is paid pre tax while individual policies are paid with post tax money (unless your expenses hit 10% of income).
  - hocuspocus 7y ago
    > In Switzerland, employers don’t cover premiums There are a few exceptions, like Google. > and premiums are paid post tax anyways. But they're deductible from your income when you're filing taxes.
at-fates-hands 7y ago
>> What if more people decide to not get healthcare? This is exactly what happened under the ACA. This is also the main reason many major health care companies like Aetna and UHG dropped out of the exchanges: Insurers need young people to, in a basic sense, pay into the system, since they tend to be healthier and use fewer healthcare services — thus partially subsidizing the older and less healthy people that cost more to cover than they pay in. Since the rollout of the exchanges, the number of young, healthy people signing up has not been enough to offset the sicker population, leading to millions of dollars in losses for many insurers. https://www.businessinsider.com/millennial-uninsured-rate-obamacare-problem-isnt-going-away-2016-9 https://www.businessinsider.com/millennial-uninsured-rate-ob...
ScottFree 7y ago
I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. The reluctance comes when nobody has any idea what we're going to replace it with. We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave? I'm a US freelancer, so I don't get health insurance through my employer. I get most of my healthcare directly from doctors and pay for visits and lab tests in cash. It works especially well when you tell them in advance you'll be paying with cash and haggle a price before walking through the door. I pay for a high deductible plan through a christian co-op for unforeseen events. This has proven to be considerably cheaper and more effective than paying for a plan through the obamacare marketplace.
- chooseaname 7y ago
  > I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. The reluctance comes when nobody has any idea what we're going to replace it with. Sadly, I have, and it is invariably from people who basically say those who don't work don't deserve healthcare. It is disturbing to hear people say this. They don't want to "pay" for someone else's healthcare. They don't get that they already are. > We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave? Where did we go so wrong? Is it because we treat government like football games? One side has to dominate the other; all or nothing? What happened to compromise for the greater good?
  - ScottFree 7y ago
    Despite all our democratic and republican[0] efforts, we still wound up with a ruling class. Ruling classes aren't necessarily bad, but in order for that to work, the ruling class need to care about the welfare of the people they rule. That is not the case in the US right now. Our ruling class has turned parasitic and doesn't care that they are killing their constituents. The opioid crisis proves that. [0]: the political systems, not the political parties
    - 7y ago
zarro 7y ago
Contrarian argument regarding point 2: I find it weird and misguided how people think that using coercion to force people into buying healthcare is somehow acceptable. To those that think it will make the cost of healthcare more expensive for the rest of us, I think that is a dubious assertion, in fact I think it will get much cheaper. The presumption that they are in contentious debate with is the necessity that different people have to get different tiers of service based on how much they pay. It makes all the sense in the world when you compare it to any other business. You wouldn't expect for someone who paid $1M to get the same level of treatment as someone who paid $100. People would buy insurance according to different tier levels of quality and risk profile, with their being astronomically high costs of insurance for old wealthy rich people, who in their desire to prolong life will incentivize creation of new modes of treatment to cure themselves (Which in the short run the development of which will help them, but in the long run, everyone, as after it gets discovered and scaled it will get cheaper). People would also buy cheaper level of tiers, from which naturally the quality of treatment, and queues will get lower/longer. You will also have people that don't buy insurance, and this should be their prerogative to do, as it would be the healthcare providers prerogative to decide whether to provide them with free treatment (they are not slaves, they are not obligated to provide a free service, and what makes the people that don't pay more important or a higher priority than those that willingly pay and fund these services). I'm not saying that this is the BEST solution, I'm saying that this is BETTER than anything else proposed which leads to things like the "cobra effect" in which you make the initial problem way worse by the implemented solution, than by what it would have been without it.
- lotsofpulp 7y ago
  >It makes all the sense in the world when you compare it to any other business. You wouldn't expect for someone who paid $1M to get the same level of treatment as someone who paid $100. Currently, society does not find it acceptable for someone to die from a heart attack if they cannot pay for healthcare. And people already get different levels of care.
  - zarro 7y ago
    I don't see how you can justify without using a double standard the idea that its okay to use coercion to take advantage of a minority to enforce an idea of "acceptable" that they might not agree with.
seanmcdirmid 7y ago
Europe has mostly already figured out all of these things. Jobs can still provide some benefits like accident insurance and transit cards, but healthcare and pensions are heavily regulated by the state apart from who you are working for. Your points are American only and stem from a bunch of perverse decisions made during the wage controls of WW2.
antisthenes 7y ago
1. Maybe I just haven't had a job with good benefits, but for me, the biggest and the only benefit I care about is the amount of PTO. Other countries seem to be doing fine with that model, I'm not sure what it is about the US culture that prevents it from working. 2. Single payer. 3. This statement always seems like a cop-out to throw hands up in the air and do nothing. There are things you can achieve with a multitude of small steps. There are things where you can't, and you have to take a few large leaps. To just say oh let's ignore the latter category forever, because people people don't like it, is simply giving up.

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.
  - rumanator 7y ago
    Sounds like it would be far simpler and easier for everyone if the state provided healthcare services paid by everyone through taxes.
    - hocuspocus 7y ago
      Yes of course, but that's beyond the point. Americans cannot argue that mandatory healthcare couldn't work in a multi-payer, private system.
      - rumanator 7y ago
        It really depends on your definition of "work". Being forced to subscribe to a paid service is not the same as getting access to healthcare. Your examples only show that if a state resorts to authoritarian measures then it can force everyone to subscribe to a paid service.
  - seanmcdirmid 7y ago
    And if you are a foreigner, you have to provide proof of insurance when you renew your residence permit at the control de habitant.
- Faark 7y ago
  Its send to collections. So you're only fine if you are poor enough to not have anything they can take from you. And at that point you are eligible for gov support to your healthcare bill anyway. Here in germany you can actually kind of get away with not paying for a while when not consuming. But coverage has to be continuous, so if you need insurance since you want to go to the doctor a few years down the line, you have to pay up for the entire period.
  - seanmcdirmid 7y ago
    Hospitals already charge higher rates to those without insurance because of those payers high default rate. Collections is expensive, and they might not be able to collect anything at the end, so they price that risk into the prices.
    - jki275 7y ago
      Cite? Generally people without insurance are able to negotiate significantly lower bills - or the bills simply aren’t paid at all.
      - seanmcdirmid 7y ago
        They can negotiate afterwards if they say they can’t pay, but that also is already built into the higher non-insured price list...
- specialist 7y ago
  There's always stragglers, hold outs, conscientious objectors, cheats, freeloaders, randos, or whatever. Just think of them as "overhead". Spend a little on "enforcement", because rules are important. Call it audits, compliance, metrics, or whatever. But not more than would be saved without enforcement. Because diminishing returns. And at some tipping point, ratcheting up cost of compliance backfires, leading to more cheating. So strive for some happy equilibrium. So that the general population (taxpayers) feel the system is reasonable, if not exactly fair, and overall friction is minimized.
- Bartweiss 7y ago
  Before it was stripped from the ACA, the price for not having insurance scaled with income. At the lowest end it was irrelevant because of Medicaid eligibility; above that it gradually increased from below-healthcare-price to above. So some people could still save money by opting out, but it pushed them towards the market by making the effective cost of insurance smaller. (Technically speaking, it was a tax rather than a fine. That mostly mattered for legal reasons, but it did also work that way in practice. It applied to everyone, so insured people had the obligation waived, but the people paying it weren't in violation of any law or regulation.)

lotsofpulp 7y ago

>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. ACA had a solution to this, it was an extra tax for not purchasing health insurance. Because health insurance premiums are basically a tax to provide healthcare to everyone. Because US voters don't want to directly pay the government to provide healthcare to everyone.

hocuspocus 7y ago

1) Employers could still cover the premium as a benefit. You'd just get to choose how and where to use the money. 2) Make it truly mandatory like in all developed countries.

seanmcdirmid 7y ago
In Switzerland, employers don’t cover premiums, and premiums are paid post tax anyways. The USA is weird because employer provided health insurance is paid pre tax while individual policies are paid with post tax money (unless your expenses hit 10% of income).
- hocuspocus 7y ago
  > In Switzerland, employers don’t cover premiums There are a few exceptions, like Google. > and premiums are paid post tax anyways. But they're deductible from your income when you're filing taxes.

at-fates-hands 7y ago

>> What if more people decide to not get healthcare? This is exactly what happened under the ACA. This is also the main reason many major health care companies like Aetna and UHG dropped out of the exchanges: Insurers need young people to, in a basic sense, pay into the system, since they tend to be healthier and use fewer healthcare services — thus partially subsidizing the older and less healthy people that cost more to cover than they pay in. Since the rollout of the exchanges, the number of young, healthy people signing up has not been enough to offset the sicker population, leading to millions of dollars in losses for many insurers. https://www.businessinsider.com/millennial-uninsured-rate-obamacare-problem-isnt-going-away-2016-9 https://www.businessinsider.com/millennial-uninsured-rate-ob...

ScottFree 7y ago

I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. The reluctance comes when nobody has any idea what we're going to replace it with. We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave? I'm a US freelancer, so I don't get health insurance through my employer. I get most of my healthcare directly from doctors and pay for visits and lab tests in cash. It works especially well when you tell them in advance you'll be paying with cash and haggle a price before walking through the door. I pay for a high deductible plan through a christian co-op for unforeseen events. This has proven to be considerably cheaper and more effective than paying for a plan through the obamacare marketplace.

chooseaname 7y ago
> I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. The reluctance comes when nobody has any idea what we're going to replace it with. Sadly, I have, and it is invariably from people who basically say those who don't work don't deserve healthcare. It is disturbing to hear people say this. They don't want to "pay" for someone else's healthcare. They don't get that they already are. > We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave? Where did we go so wrong? Is it because we treat government like football games? One side has to dominate the other; all or nothing? What happened to compromise for the greater good?
- ScottFree 7y ago
  Despite all our democratic and republican[0] efforts, we still wound up with a ruling class. Ruling classes aren't necessarily bad, but in order for that to work, the ruling class need to care about the welfare of the people they rule. That is not the case in the US right now. Our ruling class has turned parasitic and doesn't care that they are killing their constituents. The opioid crisis proves that. [0]: the political systems, not the political parties
  - 7y ago

zarro 7y ago

Contrarian argument regarding point 2: I find it weird and misguided how people think that using coercion to force people into buying healthcare is somehow acceptable. To those that think it will make the cost of healthcare more expensive for the rest of us, I think that is a dubious assertion, in fact I think it will get much cheaper. The presumption that they are in contentious debate with is the necessity that different people have to get different tiers of service based on how much they pay. It makes all the sense in the world when you compare it to any other business. You wouldn't expect for someone who paid $1M to get the same level of treatment as someone who paid $100. People would buy insurance according to different tier levels of quality and risk profile, with their being astronomically high costs of insurance for old wealthy rich people, who in their desire to prolong life will incentivize creation of new modes of treatment to cure themselves (Which in the short run the development of which will help them, but in the long run, everyone, as after it gets discovered and scaled it will get cheaper). People would also buy cheaper level of tiers, from which naturally the quality of treatment, and queues will get lower/longer. You will also have people that don't buy insurance, and this should be their prerogative to do, as it would be the healthcare providers prerogative to decide whether to provide them with free treatment (they are not slaves, they are not obligated to provide a free service, and what makes the people that don't pay more important or a higher priority than those that willingly pay and fund these services). I'm not saying that this is the BEST solution, I'm saying that this is BETTER than anything else proposed which leads to things like the "cobra effect" in which you make the initial problem way worse by the implemented solution, than by what it would have been without it.

lotsofpulp 7y ago
>It makes all the sense in the world when you compare it to any other business. You wouldn't expect for someone who paid $1M to get the same level of treatment as someone who paid $100. Currently, society does not find it acceptable for someone to die from a heart attack if they cannot pay for healthcare. And people already get different levels of care.
- zarro 7y ago
  I don't see how you can justify without using a double standard the idea that its okay to use coercion to take advantage of a minority to enforce an idea of "acceptable" that they might not agree with.

seanmcdirmid 7y ago

Europe has mostly already figured out all of these things. Jobs can still provide some benefits like accident insurance and transit cards, but healthcare and pensions are heavily regulated by the state apart from who you are working for. Your points are American only and stem from a bunch of perverse decisions made during the wage controls of WW2.

antisthenes 7y ago

1. Maybe I just haven't had a job with good benefits, but for me, the biggest and the only benefit I care about is the amount of PTO. Other countries seem to be doing fine with that model, I'm not sure what it is about the US culture that prevents it from working. 2. Single payer. 3. This statement always seems like a cop-out to throw hands up in the air and do nothing. There are things you can achieve with a multitude of small steps. There are things where you can't, and you have to take a few large leaps. To just say oh let's ignore the latter category forever, because people people don't like it, is simply giving up.