6 ms·

A better idea would be to quit linking health insurance to employment. Ban employer-provided health insurance and let everyone buy their own (reasonably regulat

A better idea would be to quit linking health insurance to employment. Ban employer-provided health insurance and let everyone buy their own (reasonably regulated) health insurance as individuals. The link between employment and health insurance is, from my perspective as an external observer, America’s worst idea.

Matticus_Rex 7y ago
I don't know about "worst," but it's up there.
fallous 7y ago
And that link was the result of government wage and price controls during WW2.
usaar333 7y ago
Isn't this what ACA does? Employers just happen to offer health insurance as a benefit, but I'm not sure why it needs to be banned.
- sp332 7y ago
  ACA plans can be subsidized, but as I understand it, if your employer offers a qualifying plan, then you are not eligible for the subsidy if you buy one from the marketplace instead.
- brianlweiner 7y ago
  Employers have significant tax advantages when offering health insurance that individuals do not have access to.
  - usaar333 7y ago
    Only if you are unemployed. If you are self employed (e.g. a 1099 contractor), you can write off health insurance. (Basically letting you pay with pretax dollars, the same as if you are employed)
- appleshore 7y ago
  One of the largest county government insurances in CA reimburses $28,000 for an endoscopy at an outpatient center. Which should cost around $2000 in a hospital. And in reality, could cost $500. Not sure why the AHA didn’t fix things like this.
  - pfranz 7y ago
    AHA? You mean the ACA? The US pays more for healthcare for a whole host of reasons split between different categories. The ACA only took on a very small aspect. The idea that getting close to 100% coverage means incentives like jacking up the prices because nobody covers the other guy's ER bill would get much smaller. I imagine the idea was changing other things made more sense to them after most everyone was covered. https://en.wikipedia.org/wiki/Health_care_prices_in_the_United_States#Reasons_for_higher_costs https://en.wikipedia.org/wiki/Health_care_prices_in_the_Unit...
- jfengel 7y ago
  Full-time employers don't just "happen" to offer health care. It's a requirement of the ACA. That codifies a longstanding set of rules that make health care cheaper when offered by an employer, including tax breaks. The ACA does encourage state "exchanges" at rates comparable to the ones that employers provide, there's still a lot of focus on employer-provided health care. This is the result of a longstanding bargain between unions and employers to provide some compensation as health care rather than salary, which was win-win for both sides until health care costs soared. Now there's no way to break that link without throwing off those negotiations. The ACA wasn't actually a huge change, except in the sense that any change at all was nearly impossible given the stability of that equilibrium. It's widely agreed that there are many better ways to do it -- all of them dispensing with the link between employers and health care -- but there's no way to get to wide agreement on any one plan.
squish78 7y ago
Which nation had a better model at that point in history?
- keenmaster 7y ago
  We spend 17.4% of GDP on healthcare. The OECD average is 9.5%, and we don't have better outcomes to show for it. That's ~$1.2-1.7 trillion of waste annually that could be used to improve our society instead of lining crony pockets. Employer-provided healthcare is one layer of the Kafka baklava that obscures the cost of healthcare and prevents better cost controls and price discovery in America. It also makes employees more reliant on their company, literally for their wellbeing. Our economy is less dynamic as a result, so my $1.2-1.7 trillon estimate might understate the problem. I got the OECD data directly from the OECD's website: https://www.oecd.org/media/oecdorg/satellitesites/newsroom/48294761hd2011fr.png https://www.oecd.org/media/oecdorg/satellitesites/newsroom/4...
  - squish78 7y ago
    Thank you for the data. Which nation had a better model for health insurance that point in history?
    - Matticus_Rex 7y ago
      The US, before it implemented that bad idea.
    - keenmaster 7y ago
      The NHS/universal healthcare was introduced in Britain in 1948, after WWII. The NHS isn't perfect, but it's much better than the American system. If we want a more flexible healthcare model, we can have universal healthcare to cover necessary + preventative care, with the option to purchase supplemental insurance for expedited and/or non-medically necessary care. Several other countries have that model.
      - squish78 7y ago
geddy 7y ago
If we're paying on an individual basis, I want to pay based on my physical health. We'd still pay out the ass because people don't take care of themselves here - it's not healthcare, it's sickcare. People go to the hospital when their bodies start to die and that's why your hospital bill is enormous until the insurance company comes back and says "$25,000? We'll allow $1,200. And we'll pay $800 of it. Here's your bill for $400 - you're welcome." I'm tired of this model too. People should pay what they're costing. It's just that, the costs should be reasonable. I work out, I eat extremely healthy, I'm never sick, and I don't require medication to keep my heart pumping. Why am I still paying a fortune on healthcare, including premiums and deductibles? I have a great insurance plan, ffs!
- NeuNeurosis 7y ago
  You might do and be all those things but none of that will prevent a unforeseen life changing accident from completely debilitating you. This is the true reason for what you say is "sickcare" we are all healthy until we are not. You pay into an insurance system, private or public, to offset the risk of this occurring.
- claudeganon 7y ago
  So all people born with or that develop disabilities are now destined to penury and death? Congratulations, you just invented eugenics.
  - geddy 7y ago
    Nice strawman argument. Because I don't want to pay a lot to offset the most expensive, I want people to die. Not what I said at all. But half the country either smokes or is obese, and I shouldn't have to incur the cost of other people's conditions.
- AnthonyMouse 7y ago
  This is a misrepresentation of why healthcare costs so much in the US. There are a lot of reasons, but "you're paying for people who don't take care of themselves" barely makes the list -- insurance companies already give major discounts for not smoking etc. The biggest problem is that the entire existing system is so convoluted and bureaucratic that the cost of everything is ten times what it ought to be. They should just delete every single piece of federal healthcare law with two years of notice for the states to be ready to pick up the ball. Then let fifty states try fifty different ways to clean up the mess. Some will get it right and some won't, and then the losers can copy the winners, but even the screw ups can't be much worse than the status quo.
Reedx 7y ago
Disconnecting healthcare from employment would be such a boon to small businesses too. I'm not sure it's a good idea to ban other options, but it'd be great if everyone was covered by default.
cmxch 7y ago
Then what benefits would you offer in place to attract talent, especially at the lower end(where economies of scale help more)?
- bpt3 7y ago
  Higher pay? Also, what happens when nationalized health care is implemented, since employers will stop offering medical insurance in many cases?

Matticus_Rex 7y ago

I don't know about "worst," but it's up there.

fallous 7y ago

And that link was the result of government wage and price controls during WW2.

usaar333 7y ago

Isn't this what ACA does? Employers just happen to offer health insurance as a benefit, but I'm not sure why it needs to be banned.

sp332 7y ago
ACA plans can be subsidized, but as I understand it, if your employer offers a qualifying plan, then you are not eligible for the subsidy if you buy one from the marketplace instead.
brianlweiner 7y ago
Employers have significant tax advantages when offering health insurance that individuals do not have access to.
- usaar333 7y ago
  Only if you are unemployed. If you are self employed (e.g. a 1099 contractor), you can write off health insurance. (Basically letting you pay with pretax dollars, the same as if you are employed)
appleshore 7y ago
One of the largest county government insurances in CA reimburses $28,000 for an endoscopy at an outpatient center. Which should cost around $2000 in a hospital. And in reality, could cost $500. Not sure why the AHA didn’t fix things like this.
- pfranz 7y ago
  AHA? You mean the ACA? The US pays more for healthcare for a whole host of reasons split between different categories. The ACA only took on a very small aspect. The idea that getting close to 100% coverage means incentives like jacking up the prices because nobody covers the other guy's ER bill would get much smaller. I imagine the idea was changing other things made more sense to them after most everyone was covered. https://en.wikipedia.org/wiki/Health_care_prices_in_the_United_States#Reasons_for_higher_costs https://en.wikipedia.org/wiki/Health_care_prices_in_the_Unit...
jfengel 7y ago
Full-time employers don't just "happen" to offer health care. It's a requirement of the ACA. That codifies a longstanding set of rules that make health care cheaper when offered by an employer, including tax breaks. The ACA does encourage state "exchanges" at rates comparable to the ones that employers provide, there's still a lot of focus on employer-provided health care. This is the result of a longstanding bargain between unions and employers to provide some compensation as health care rather than salary, which was win-win for both sides until health care costs soared. Now there's no way to break that link without throwing off those negotiations. The ACA wasn't actually a huge change, except in the sense that any change at all was nearly impossible given the stability of that equilibrium. It's widely agreed that there are many better ways to do it -- all of them dispensing with the link between employers and health care -- but there's no way to get to wide agreement on any one plan.

squish78 7y ago

Which nation had a better model at that point in history?

keenmaster 7y ago
We spend 17.4% of GDP on healthcare. The OECD average is 9.5%, and we don't have better outcomes to show for it. That's ~$1.2-1.7 trillion of waste annually that could be used to improve our society instead of lining crony pockets. Employer-provided healthcare is one layer of the Kafka baklava that obscures the cost of healthcare and prevents better cost controls and price discovery in America. It also makes employees more reliant on their company, literally for their wellbeing. Our economy is less dynamic as a result, so my $1.2-1.7 trillon estimate might understate the problem. I got the OECD data directly from the OECD's website: https://www.oecd.org/media/oecdorg/satellitesites/newsroom/48294761hd2011fr.png https://www.oecd.org/media/oecdorg/satellitesites/newsroom/4...
- squish78 7y ago
  Thank you for the data. Which nation had a better model for health insurance that point in history?
  - Matticus_Rex 7y ago
    The US, before it implemented that bad idea.
  - keenmaster 7y ago
    The NHS/universal healthcare was introduced in Britain in 1948, after WWII. The NHS isn't perfect, but it's much better than the American system. If we want a more flexible healthcare model, we can have universal healthcare to cover necessary + preventative care, with the option to purchase supplemental insurance for expedited and/or non-medically necessary care. Several other countries have that model.
    - squish78 7y ago

geddy 7y ago

If we're paying on an individual basis, I want to pay based on my physical health. We'd still pay out the ass because people don't take care of themselves here - it's not healthcare, it's sickcare. People go to the hospital when their bodies start to die and that's why your hospital bill is enormous until the insurance company comes back and says "$25,000? We'll allow $1,200. And we'll pay $800 of it. Here's your bill for $400 - you're welcome." I'm tired of this model too. People should pay what they're costing. It's just that, the costs should be reasonable. I work out, I eat extremely healthy, I'm never sick, and I don't require medication to keep my heart pumping. Why am I still paying a fortune on healthcare, including premiums and deductibles? I have a great insurance plan, ffs!

NeuNeurosis 7y ago
You might do and be all those things but none of that will prevent a unforeseen life changing accident from completely debilitating you. This is the true reason for what you say is "sickcare" we are all healthy until we are not. You pay into an insurance system, private or public, to offset the risk of this occurring.
claudeganon 7y ago
So all people born with or that develop disabilities are now destined to penury and death? Congratulations, you just invented eugenics.
- geddy 7y ago
  Nice strawman argument. Because I don't want to pay a lot to offset the most expensive, I want people to die. Not what I said at all. But half the country either smokes or is obese, and I shouldn't have to incur the cost of other people's conditions.
AnthonyMouse 7y ago
This is a misrepresentation of why healthcare costs so much in the US. There are a lot of reasons, but "you're paying for people who don't take care of themselves" barely makes the list -- insurance companies already give major discounts for not smoking etc. The biggest problem is that the entire existing system is so convoluted and bureaucratic that the cost of everything is ten times what it ought to be. They should just delete every single piece of federal healthcare law with two years of notice for the states to be ready to pick up the ball. Then let fifty states try fifty different ways to clean up the mess. Some will get it right and some won't, and then the losers can copy the winners, but even the screw ups can't be much worse than the status quo.

Reedx 7y ago

Disconnecting healthcare from employment would be such a boon to small businesses too. I'm not sure it's a good idea to ban other options, but it'd be great if everyone was covered by default.

cmxch 7y ago

Then what benefits would you offer in place to attract talent, especially at the lower end(where economies of scale help more)?

bpt3 7y ago
Higher pay? Also, what happens when nationalized health care is implemented, since employers will stop offering medical insurance in many cases?