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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 a

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
  - turk73 7y ago
    Well said, and this is exactly why we should murder all of them.
- SolaceQuantum 7y ago
  "They don't want to "pay" for someone else's healthcare. They don't get that they already are." Curiosity, because you seem to have first hand experience and I do not- what happens when you present that they already are paying for peoples' healthcare?
  - FireBeyond 7y ago
    They state that they shouldn't be, and that the sooner the "government" stops that, the better off they think they'll be, like they imagine that their paycheck will rise directly and imminently as a result.
- throebd 7y ago
  Would the free healthcare include only US citizens, all people who live in US, or everyone who comes to US on holiday? If you want more affordable healthcare, you should make it cheaper, not force other people to pay overpriced bills for random strangers.
  - guitarbill 7y ago
    Naturally, it would include US citizens and permanent residents, and not holidaymakers. They already need travel insurance. By the way, those plans are more expensive with US coverage than without.
  - seanmcdirmid 7y ago
    Other countries have already figured this out. And no one ever calls it “free healthcare” except for a few naive American libertarians. They don’t provide free healthcare, and if you aren’t in the system (and paying via taxes or otherwise covered via tax revenue redistribution), you’ll get a bill one way or the other (unless there is an agreement between two socialized health systems).
    - ScottFree 7y ago
      > Other countries have already figured this out. None of those countries are the size of the US. Just like in Physics, you can't expect a 1/10th scale model to behave the same as the life sized version.
      - seanmcdirmid 7y ago
        Japan has what...126 million people? So according to your math, America must have 1.26 billion people? Australia is as big as the US if you meant by area, plenty of other countries approach 100+ million besides Japan. The EU has 511 million people. Sure it is multiple systems, but they all work much better than ours does.
        deleted 7y ago
        [deleted]
- thaumasiotes 7y ago
  >> 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? False premise. Merchants and governments have been widely distrusted as far back as records exist. Merchants in particular are commonly the subject of some kind of official orthodoxy noting how evil they are.
- Bartweiss 7y ago
  It seems like "healthcare linked to employment" is a nutty system even if you don't want healthcare for people who can't pay, though. Even among people who work and have a lot of money, having healthcare based on employer causes all kinds of headaches. It makes a brief lapse between switching jobs unreasonably risky, especially before pre-existing conditions were covered. It punishes self-employment by denying people the major discounts big employers can negotiate. It punishes part-time work, because one 40 hour/week job with insurance might "pay" better than two equal-wage 30 hour/week jobs. And it makes long vacations or early retirement far less accessible; if you make in 6 months what someone else does in 12, you're not free to take those 6 months off without paying a steep premium on insurance. And none of that is news, but it's always confused me that there's so little drive to delink healthcare from "being actively employed". Even for someone who wants to shut down Medicaid, the current system is bizarrely hostile to all kinds of high-earning people who could pay their own healthcare costs, but get punished for looking anywhere except full-time work at a big company. Realistically, I think it's just ignored because the larger debates over cost and government care overshadow everything else. But in my more cynical moments, I can't help noticing that while the current system doesn't serve workers or entrepreneurs well, it's great at driving them to become a predictable labor supply.
amluto 7y ago
> The reluctance comes when nobody has any idea what we're going to replace it with. The straightforward answer is to replace it with self-paid insurance plans. Even without redesigning our awful system of medical payments in the US, we could easily get rid of the “employer pays” part.
- jartelt 7y ago
  Self-paid insurance plans only work if you require every one to buy a plan. Otherwise many healthy people choose to go uncovered and the insurance pools get a higher portion of sick folks. Obamacare tried to get around this by using the individual mandate penalty. However, that was taken apart by the republican congress, so I think it's safe to say that self-pay insurance was/is not straight forward. The most straightforward way is to have a universal coverage provided by the government (funded by tax revenue). Then we get rid of the whole problem of some people skipping out on coverage and free riding on the system.
  - seanmcdirmid 7y ago
    It works in Switzerland. They do, however, have high healthcare costs second only to the USA (but much better results overall).
  - amluto 7y ago
    > Self-paid insurance plans only work if you require every one to buy a plan. The US did this until very recently. It should IMO be reinstated. In any event, this is more or less orthogonal to the issue at hand. As far as I know, nothing stops employees with employer-sponsored healthcare from opting out.
refurb 7y ago
I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. You should talk to some union members then. Some unions have negotiated such generous healthcare benefits that they’d either never find on the private market or could never afford. They don’t want to give those up.
- maximente 7y ago
  a smaller and smaller minority though, and the smart strategic choice is understanding that it actually creates classes within the union (same as those w/ pensions grandfathered in vs. those that don't) which weakens the union generally. sort of like the two tiered GM setup currently under strike. for example, new Washington DC transit workers aren't on the old health plan, which means there's basically a 50/50 split (trending upwards) for people who don't have the benefit. probably not a great strategy to lean on those should the union want to strike over that benefit. since all that money comes out of wages anyway, it'd be more beneficial to just eliminate the variable vs. trying to salvage a legacy class of workers fortunate enough to have the benefit.

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
- turk73 7y ago
  Well said, and this is exactly why we should murder all of them.
SolaceQuantum 7y ago
"They don't want to "pay" for someone else's healthcare. They don't get that they already are." Curiosity, because you seem to have first hand experience and I do not- what happens when you present that they already are paying for peoples' healthcare?
- FireBeyond 7y ago
  They state that they shouldn't be, and that the sooner the "government" stops that, the better off they think they'll be, like they imagine that their paycheck will rise directly and imminently as a result.
throebd 7y ago
Would the free healthcare include only US citizens, all people who live in US, or everyone who comes to US on holiday? If you want more affordable healthcare, you should make it cheaper, not force other people to pay overpriced bills for random strangers.
- guitarbill 7y ago
  Naturally, it would include US citizens and permanent residents, and not holidaymakers. They already need travel insurance. By the way, those plans are more expensive with US coverage than without.
- seanmcdirmid 7y ago
  Other countries have already figured this out. And no one ever calls it “free healthcare” except for a few naive American libertarians. They don’t provide free healthcare, and if you aren’t in the system (and paying via taxes or otherwise covered via tax revenue redistribution), you’ll get a bill one way or the other (unless there is an agreement between two socialized health systems).
  - ScottFree 7y ago
    > Other countries have already figured this out. None of those countries are the size of the US. Just like in Physics, you can't expect a 1/10th scale model to behave the same as the life sized version.
    - seanmcdirmid 7y ago
      Japan has what...126 million people? So according to your math, America must have 1.26 billion people? Australia is as big as the US if you meant by area, plenty of other countries approach 100+ million besides Japan. The EU has 511 million people. Sure it is multiple systems, but they all work much better than ours does.
      - deleted 7y ago
        [deleted]
thaumasiotes 7y ago
>> 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? False premise. Merchants and governments have been widely distrusted as far back as records exist. Merchants in particular are commonly the subject of some kind of official orthodoxy noting how evil they are.
Bartweiss 7y ago
It seems like "healthcare linked to employment" is a nutty system even if you don't want healthcare for people who can't pay, though. Even among people who work and have a lot of money, having healthcare based on employer causes all kinds of headaches. It makes a brief lapse between switching jobs unreasonably risky, especially before pre-existing conditions were covered. It punishes self-employment by denying people the major discounts big employers can negotiate. It punishes part-time work, because one 40 hour/week job with insurance might "pay" better than two equal-wage 30 hour/week jobs. And it makes long vacations or early retirement far less accessible; if you make in 6 months what someone else does in 12, you're not free to take those 6 months off without paying a steep premium on insurance. And none of that is news, but it's always confused me that there's so little drive to delink healthcare from "being actively employed". Even for someone who wants to shut down Medicaid, the current system is bizarrely hostile to all kinds of high-earning people who could pay their own healthcare costs, but get punished for looking anywhere except full-time work at a big company. Realistically, I think it's just ignored because the larger debates over cost and government care overshadow everything else. But in my more cynical moments, I can't help noticing that while the current system doesn't serve workers or entrepreneurs well, it's great at driving them to become a predictable labor supply.

amluto 7y ago

> The reluctance comes when nobody has any idea what we're going to replace it with. The straightforward answer is to replace it with self-paid insurance plans. Even without redesigning our awful system of medical payments in the US, we could easily get rid of the “employer pays” part.

jartelt 7y ago
Self-paid insurance plans only work if you require every one to buy a plan. Otherwise many healthy people choose to go uncovered and the insurance pools get a higher portion of sick folks. Obamacare tried to get around this by using the individual mandate penalty. However, that was taken apart by the republican congress, so I think it's safe to say that self-pay insurance was/is not straight forward. The most straightforward way is to have a universal coverage provided by the government (funded by tax revenue). Then we get rid of the whole problem of some people skipping out on coverage and free riding on the system.
- seanmcdirmid 7y ago
  It works in Switzerland. They do, however, have high healthcare costs second only to the USA (but much better results overall).
- amluto 7y ago
  > Self-paid insurance plans only work if you require every one to buy a plan. The US did this until very recently. It should IMO be reinstated. In any event, this is more or less orthogonal to the issue at hand. As far as I know, nothing stops employees with employer-sponsored healthcare from opting out.

refurb 7y ago

I have yet to meet a single person who hasn't enthusiastically agreed that we should separate healthcare from employment. You should talk to some union members then. Some unions have negotiated such generous healthcare benefits that they’d either never find on the private market or could never afford. They don’t want to give those up.

maximente 7y ago
a smaller and smaller minority though, and the smart strategic choice is understanding that it actually creates classes within the union (same as those w/ pensions grandfathered in vs. those that don't) which weakens the union generally. sort of like the two tiered GM setup currently under strike. for example, new Washington DC transit workers aren't on the old health plan, which means there's basically a 50/50 split (trending upwards) for people who don't have the benefit. probably not a great strategy to lean on those should the union want to strike over that benefit. since all that money comes out of wages anyway, it'd be more beneficial to just eliminate the variable vs. trying to salvage a legacy class of workers fortunate enough to have the benefit.