6 ms·

Tying health insurance to your employer is incredibly dumb. It means insurarers compete for your employers business, not yours, which influences their incentive

by 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.
    - lotsofpulp 6y ago
      This has not been true since Jan 1, 2014: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co...
      - zaroth 6y ago
        Before 2014 plans were required to cover pre-existing conditions as long as you had “prior credible coverage” and didn’t have a lapse in coverage for more than a short period of time. If you let coverage lapse, plans were allowed to impose a waiting period before coverage for the existing condition would start. Since 2014, the “fix” is that now it’s just required to always have insurance, or else you pay a penalty. Then for the last couple years the penalty was repealed but the coverage for pre-existing conditions is still guaranteed, which does open up a hazard that people will only buy insurance after they get sick... but really the risk of a sudden health issue is still high enough that most healthy people will still want coverage.
  - Broken_Hippo 6y ago
    No. They offer what they offer. Even when plans seem similar, are you willing to pay out of pocket for a $4k/month medicine that you've been taking for years and only paying $250/month now for, all because the new insurance doesn't cover it? This is even more pronounced with lower-wage employees. I didn't switch jobs for years because of benefits: At best, I'd have to pay for COBRA for 60-90 days, which would basically take all of my money and then some. But mine was also fairly cheap and I had good coverage, something that similar jobs usually didn't match.
  - fires10 6y ago
    I do not leave my current employer specifically because of health insurance. No other employer in the area provides comparable coverage. It would take about a $30,000.00 per year premium to get me to even consider leaving. Healthcare is my number one consideration on all employment decisions.
- 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.

by thayne 6y ago

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.
  - lotsofpulp 6y ago
    This has not been true since Jan 1, 2014: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co...
    - zaroth 6y ago
      Before 2014 plans were required to cover pre-existing conditions as long as you had “prior credible coverage” and didn’t have a lapse in coverage for more than a short period of time. If you let coverage lapse, plans were allowed to impose a waiting period before coverage for the existing condition would start. Since 2014, the “fix” is that now it’s just required to always have insurance, or else you pay a penalty. Then for the last couple years the penalty was repealed but the coverage for pre-existing conditions is still guaranteed, which does open up a hazard that people will only buy insurance after they get sick... but really the risk of a sudden health issue is still high enough that most healthy people will still want coverage.
- Broken_Hippo 6y ago
  No. They offer what they offer. Even when plans seem similar, are you willing to pay out of pocket for a $4k/month medicine that you've been taking for years and only paying $250/month now for, all because the new insurance doesn't cover it? This is even more pronounced with lower-wage employees. I didn't switch jobs for years because of benefits: At best, I'd have to pay for COBRA for 60-90 days, which would basically take all of my money and then some. But mine was also fairly cheap and I had good coverage, something that similar jobs usually didn't match.
- fires10 6y ago
  I do not leave my current employer specifically because of health insurance. No other employer in the area provides comparable coverage. It would take about a $30,000.00 per year premium to get me to even consider leaving. Healthcare is my number one consideration on all employment decisions.
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.