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Before my father qualified for Medicare he figured out this hack. He has a severe chronic condition. Health insurance for him as a self employed person at the

Before my father qualified for Medicare he figured out this hack. He has a severe chronic condition. Health insurance for him as a self employed person at the time was $4k/month Tuition at the local public college at the time came with a senior discount for folks in his age group and insurance for $10k/year. He loved the classes and saved a bundle on health insurance. He needed a life flight and weeks of hospitalization related to his chronic illness. The insurance had him covered. I think it was a non-trivial payout for the insurance company. The following year the insurance company changed the terms with the university to charge more if you didn’t live on campus. My father went to a different school with a different insurer after that. He’s finally on Medicare. We shouldn’t tie healthcare coverage to employment in our country. It’s stupidly expensive.

thayne 6y ago
Tying health insurance to your employer is incredibly dumb. It means insurarers compete for your employers business, not yours, which influences their incentives. It means if you don't like your insurance company, your only option is to change jobs. It disincitives people from being self employed, because then health insurance is prohibitively expensive.
- sukilot 6y ago
  It's not dumb, it's smart for employers who want to trap employees.
  - tonyhb 6y ago
    So... it's dumb for 999/1000 people.
  - defnotashton2 6y ago
    This was by design. Didn't the dems do this in '96?
    - judge2020 6y ago
      All I see from '96 is HIPPA. What are you referring to?
  - gnicholas 6y ago
    How does it trap employees? If I’m considering switching jobs, wouldn’t my new employer offer the benefit also?
    - judge2020 6y ago
      Not all providers and plans are the same, so some treatment for some health condition you have that is 75% paid for by insurance might go down to 25% or even 0% (not covered) with your new employer's health insurance plan. You also might just not have another job to go to immediately, like what happened at the beginning of Covid-19, in which you'd either need to pay for your previous insurance in full or cancel treatment.
      - culturestate 6y ago
        This happened recently to someone I know. They were offered a significant pay bump and a leadership position in a well-respected organization that lines up with their personal goals, but the new employer doesn’t offer insurance. They eventually decided to take the job, but having to even consider healthcare access in that calculus is ridiculous.
    - indymike 6y ago
      Deductibles and max out of pockets have to be met again.
    - chongli 6y ago
      Suppose your employer is less than ideal but you’re not particularly confident in your ability to get another job should you be laid off. A lot of people feel trapped in this situation every day. Not everyone has the skills and experience to be in demand. A lot of people feel their current job is the only thing standing between them and the food stamp line. These people should not have to worry about getting sick and losing everything after losing their job.
    - robocat 6y ago
      If you have a health condition then you can be trapped, because a new insurer won’t cover existing conditions.
  - runamok 6y ago
    Exactly. I don't understand why people don't understand this. It's a huge chilling effect on employee turnover. Until ACA pre-existing conditions was a huge aspect of that. Even now IIRC when I changed jobs once I recall any existing conditions would not be covered for 1 month. And it's the biggest cost increase over the past 2 decades and has soaked up almost all the profits that could have gone to employee salaries. https://www.pewresearch.org/fact-tank/2018/08/07/for-most-us-workers-real-wages-have-barely-budged-for-decades/ https://www.pewresearch.org/fact-tank/2018/08/07/for-most-us... https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-nhe-trends_total-national-health-expenditures-us-billions-1970-2018 https://www.healthsystemtracker.org/chart-collection/u-s-spe...
    - thayne 6y ago
      If a company has to trap employee with health insurance to keep them from leaving, that suggests they aren't treating their employees very well.
- takeda 6y ago
  > It means if you don't like your insurance company, your only option is to change jobs. Well, a bit less effective, but sometimes works, you can also complain to HR about the insurance.
  - thayne 6y ago
    Let's say HR really does care about employees interests. It could be that they chose an insurance program that is best for 90% of employees, but is a terrible choice for you. HR is unlikely to change anything because of a few outliers.
  - Lio 6y ago
    Think about the state of the software rolled out for HR. i.e. speed, UX, cross platform support. I think from that alone you can safely conclude that HR departments don’t or can’t deliver things that employees need. Employees are not the customers of HR departments and they won’t or can’t fix your health insurance.
- capdeck 6y ago
  No, it works exactly as it was designed. Health insurance keep s costing more, cover less and not care about helping people in the time of need. That is not an accident. It is a result of concentrated effort of lawyers, lobbyists, salesmen, etc... - a whole system that maximizes profits and market share at all costs, and not the quality, breadth and affordability of healthcare. It is like that by design. So the results are logical - we pay more and get less. And will continue paying more and getting even less. There will be a point in future when this approach will "meet its maker", the hope is that will happen sooner rather than later.
  - TheOtherHobbes 6y ago
    It's an efficient market. It's efficient at collecting money from customers who little or no choice, and at not providing those customers with a service - because providing a service costs money, which takes a cut out of profits. This is what markets do. They amplify political and financial inequality. Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work.
    - username90 6y ago
      > Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work. If you allowed foreign doctors to come and practice in USA the problem would get fixed extremely quickly. Competition is the solution. The problem isn't the free market here, but that the incumbents gets to control legalization and hence stifle competition. I'm not sure why private money has so much more influence in USA than other western countries, but it is the main source of this problem.
      - oblio 6y ago
        Aren't drugs very expensive in the US, too?
        username90 6y ago
- m0zg 6y ago
  As is not allowing interstate competition, and not requiring pricing to be published, and not paying rebates for seeking out less expensive treatments. I'm my own employer, and the exchange choices are shitty beyond belief. I pay $15K/yr for a family of 3 (that's excluding the considerable deductibles), and I'm not even sure to what extent I will be covered if I e.g. break a leg. The premiums go up every year like clockwork, and will likely go _way_ up this year, due to C19. I'm thinking of just finding a clinic somewhere abroad if shit really hits the fan, and going without insurance in the US at all, covering my yearly physical out of pocket. It boggles the mind that politicians are proposing to sink trillions more into the bottomless money pit that is the US "healthcare" system.
  - devonkim 6y ago
    I was paying about $1.5k / mo for a terrible plan for just a family of two in NC under ACA. The public risk pool is completely terrible and large corporate employers’ risk pools are separated from the general public and self employed.
- godzillabrennus 6y ago
  More and more employers are now self insured. Making your employer your negotiate with healthcare providers directly for care. They might also us a TPA (third party administrator). Thing is, your boss may know way more about your health than you’d expect. The entire system is broken.
perl4ever 6y ago
In my experience, when I was unemployed, an ACA plan doesn't cost $4K or even $800. I'm not sure even COBRA was that expensive. Perhaps your anecdote is from before the ACA, but is it really productive to still be complaining about the way things were? Maybe spend more time making sure we vote for people who will keep it going.
- sukilot 6y ago
  It varies based on pre-existing conditions. COBRA is just regular health insurance.
  - perl4ever 6y ago
    I have had an ACA plan during two separate periods of time over the last decade and it was on the order of $400/month, with no consideration of pre-existing conditions. I've also had the opportunity for COBRA, which was too expensive, but still under $800. Where do you get your "information"?
    - rxhernandez 6y ago
      I think you need to consider your age and zip code as well. I have a family member who is an insurance broker and she had to factor in age and zip code to give me quotes on insurance.
      - perl4ever 6y ago
        Maybe the original anecdote was about a family plan. I interpreted it as not, but then reconsidered. Currently, in an urban area of NY state where I am, a basic family plan is ~$1600 and an individual plan is ~$550. You may say "what about the deductible", but it looks to me like the deductible is effectively only a payment plan. Even if you have a chronic condition, and you know you will go through the deductible for sure, you don't gain anything by paying for a lower deductible. The deductible is nowhere near the difference between $1600 and $4000 anyway.
      - 6y ago

thayne 6y ago

Tying health insurance to your employer is incredibly dumb. It means insurarers compete for your employers business, not yours, which influences their incentives. It means if you don't like your insurance company, your only option is to change jobs. It disincitives people from being self employed, because then health insurance is prohibitively expensive.

sukilot 6y ago
It's not dumb, it's smart for employers who want to trap employees.
- tonyhb 6y ago
  So... it's dumb for 999/1000 people.
- defnotashton2 6y ago
  This was by design. Didn't the dems do this in '96?
  - judge2020 6y ago
    All I see from '96 is HIPPA. What are you referring to?
- gnicholas 6y ago
  How does it trap employees? If I’m considering switching jobs, wouldn’t my new employer offer the benefit also?
  - judge2020 6y ago
    Not all providers and plans are the same, so some treatment for some health condition you have that is 75% paid for by insurance might go down to 25% or even 0% (not covered) with your new employer's health insurance plan. You also might just not have another job to go to immediately, like what happened at the beginning of Covid-19, in which you'd either need to pay for your previous insurance in full or cancel treatment.
    - culturestate 6y ago
      This happened recently to someone I know. They were offered a significant pay bump and a leadership position in a well-respected organization that lines up with their personal goals, but the new employer doesn’t offer insurance. They eventually decided to take the job, but having to even consider healthcare access in that calculus is ridiculous.
  - indymike 6y ago
    Deductibles and max out of pockets have to be met again.
  - chongli 6y ago
    Suppose your employer is less than ideal but you’re not particularly confident in your ability to get another job should you be laid off. A lot of people feel trapped in this situation every day. Not everyone has the skills and experience to be in demand. A lot of people feel their current job is the only thing standing between them and the food stamp line. These people should not have to worry about getting sick and losing everything after losing their job.
  - robocat 6y ago
    If you have a health condition then you can be trapped, because a new insurer won’t cover existing conditions.
- runamok 6y ago
  Exactly. I don't understand why people don't understand this. It's a huge chilling effect on employee turnover. Until ACA pre-existing conditions was a huge aspect of that. Even now IIRC when I changed jobs once I recall any existing conditions would not be covered for 1 month. And it's the biggest cost increase over the past 2 decades and has soaked up almost all the profits that could have gone to employee salaries. https://www.pewresearch.org/fact-tank/2018/08/07/for-most-us-workers-real-wages-have-barely-budged-for-decades/ https://www.pewresearch.org/fact-tank/2018/08/07/for-most-us... https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-nhe-trends_total-national-health-expenditures-us-billions-1970-2018 https://www.healthsystemtracker.org/chart-collection/u-s-spe...
  - thayne 6y ago
    If a company has to trap employee with health insurance to keep them from leaving, that suggests they aren't treating their employees very well.
takeda 6y ago
> It means if you don't like your insurance company, your only option is to change jobs. Well, a bit less effective, but sometimes works, you can also complain to HR about the insurance.
- thayne 6y ago
  Let's say HR really does care about employees interests. It could be that they chose an insurance program that is best for 90% of employees, but is a terrible choice for you. HR is unlikely to change anything because of a few outliers.
- Lio 6y ago
  Think about the state of the software rolled out for HR. i.e. speed, UX, cross platform support. I think from that alone you can safely conclude that HR departments don’t or can’t deliver things that employees need. Employees are not the customers of HR departments and they won’t or can’t fix your health insurance.
capdeck 6y ago
No, it works exactly as it was designed. Health insurance keep s costing more, cover less and not care about helping people in the time of need. That is not an accident. It is a result of concentrated effort of lawyers, lobbyists, salesmen, etc... - a whole system that maximizes profits and market share at all costs, and not the quality, breadth and affordability of healthcare. It is like that by design. So the results are logical - we pay more and get less. And will continue paying more and getting even less. There will be a point in future when this approach will "meet its maker", the hope is that will happen sooner rather than later.
- TheOtherHobbes 6y ago
  It's an efficient market. It's efficient at collecting money from customers who little or no choice, and at not providing those customers with a service - because providing a service costs money, which takes a cut out of profits. This is what markets do. They amplify political and financial inequality. Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work.
  - username90 6y ago
    > Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work. If you allowed foreign doctors to come and practice in USA the problem would get fixed extremely quickly. Competition is the solution. The problem isn't the free market here, but that the incumbents gets to control legalization and hence stifle competition. I'm not sure why private money has so much more influence in USA than other western countries, but it is the main source of this problem.
    - oblio 6y ago
      Aren't drugs very expensive in the US, too?
      - username90 6y ago
m0zg 6y ago
As is not allowing interstate competition, and not requiring pricing to be published, and not paying rebates for seeking out less expensive treatments. I'm my own employer, and the exchange choices are shitty beyond belief. I pay $15K/yr for a family of 3 (that's excluding the considerable deductibles), and I'm not even sure to what extent I will be covered if I e.g. break a leg. The premiums go up every year like clockwork, and will likely go _way_ up this year, due to C19. I'm thinking of just finding a clinic somewhere abroad if shit really hits the fan, and going without insurance in the US at all, covering my yearly physical out of pocket. It boggles the mind that politicians are proposing to sink trillions more into the bottomless money pit that is the US "healthcare" system.
- devonkim 6y ago
  I was paying about $1.5k / mo for a terrible plan for just a family of two in NC under ACA. The public risk pool is completely terrible and large corporate employers’ risk pools are separated from the general public and self employed.
godzillabrennus 6y ago
More and more employers are now self insured. Making your employer your negotiate with healthcare providers directly for care. They might also us a TPA (third party administrator). Thing is, your boss may know way more about your health than you’d expect. The entire system is broken.

perl4ever 6y ago

In my experience, when I was unemployed, an ACA plan doesn't cost $4K or even $800. I'm not sure even COBRA was that expensive. Perhaps your anecdote is from before the ACA, but is it really productive to still be complaining about the way things were? Maybe spend more time making sure we vote for people who will keep it going.

sukilot 6y ago
It varies based on pre-existing conditions. COBRA is just regular health insurance.
- perl4ever 6y ago
  I have had an ACA plan during two separate periods of time over the last decade and it was on the order of $400/month, with no consideration of pre-existing conditions. I've also had the opportunity for COBRA, which was too expensive, but still under $800. Where do you get your "information"?
  - rxhernandez 6y ago
    I think you need to consider your age and zip code as well. I have a family member who is an insurance broker and she had to factor in age and zip code to give me quotes on insurance.
    - perl4ever 6y ago
      Maybe the original anecdote was about a family plan. I interpreted it as not, but then reconsidered. Currently, in an urban area of NY state where I am, a basic family plan is ~$1600 and an individual plan is ~$550. You may say "what about the deductible", but it looks to me like the deductible is effectively only a payment plan. Even if you have a chronic condition, and you know you will go through the deductible for sure, you don't gain anything by paying for a lower deductible. The deductible is nowhere near the difference between $1600 and $4000 anyway.
    - 6y ago