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Decades ago the U.S. tied healthcare to employment. It had some big positives at the time. I think it has proven to have more negatives as time has unfolded. He

Decades ago the U.S. tied healthcare to employment. It had some big positives at the time. I think it has proven to have more negatives as time has unfolded. Here is one of them. If you reduce hours per worker by, say, 10% you just pay each worker 10% less and hire 10% more workers, right? It's not so simple. If you try to cut the health insurance premium of each worker by 10% the policy becomes unattractive. If you keep the same policy, you increase your health insurance costs by 10%. For this and other reasons, it's time to separate health insurance from employer.

bitwize 5y ago
It's time to tie health insurance to being alive.
- chapium 5y ago
  But that means the poor would have affordable healthcare.
sokoloff 5y ago
It’s slightly worse than that. If you have 90 units of work to be done you might hire 9 workers at 10 units each. If the standard work goes down by 10%, you now need 10 workers at 9 units each. Your workers have increased by 11.1% (given by 1-1/(1-0.1)) A reduction from 40 to 32 would reduce hours per worker by 20% but increase workers and total health care costs by 25%.
- ceejayoz 5y ago
  The research around shorter work weeks and productivity indicates "units of work" don't work that way. https://www.npr.org/2021/07/06/1013348626/iceland-finds-major-success-moving-to-shorter-work-week https://www.npr.org/2021/07/06/1013348626/iceland-finds-majo... > Now, research out of Iceland has found that working fewer hours for the same pay led to improved well-being among workers, with no loss in productivity. In fact, in some places, workers were more productive after cutting back their hours.
  - sokoloff 5y ago
    If the task is coverage-related (“be available to run a cash register” or “answer any phone call that comes in” or “watch this area for security purposes”), it’s exactly that ratio.
    - dragonwriter 5y ago
      > If the task is coverage-related (“be available to run a cash register” or “answer any phone call that comes in” or “watch this area for security purposes”), it’s exactly that ratio. But no task that actually needs done is purely coverage related. If you want someone to watch dor security purposes, you want them to actually effectively secure it to some level, and if average ability to do that drops from overwork you need more people; if you want someone to run a cash register, just having a body next to it isn't enough, they have to actually perform correctly.
      - plorkyeran 5y ago
        Many coverage-related jobs don't require a person's full potential productivity, so the fact that their productivity goes down with hours worked is irrelevant. If a cashier at a low-volume store only rings up a customer every 10 minutes but you've decided that they need to stay parked by the register all day rather than doing other tasks between customers, it doesn't matter if it takes them twice as long to ring up a customer at the end of their shift as at the start.
  - jon-wood 5y ago
    That's true in the sort of desk jobs most of the people who inhabit Hacker News do. It's patently not true of things like manufacturing line work, delivery drivers, chefs, and call centre operators. A chef can't drop 8 hours a week and still expect to serve the same number of meals because of efficiency gains, and a call centre needs to be accessible at the times people are calling. For the record I fully support any push to reduce the amount of work people are expected to do, but claiming there's no impact because of productivity gains just doesn't add up in many cases.
- eloff 5y ago
  It's worse because you have more management overhead all the way to the chain, more HR and support needs, and more office space required. A rule of thumb is a worker's full cost is 2x their salary in the US. This varies, but it makes the math easy. So costs would increase about double that. But if your workers are doing creative work, they might be more productive now per hour and that might offset the costs.
- sam0x17 5y ago
  Not all companies are going to decrease wages in response to this legislation. In fact I'd be willing to bet it's less than 50% of companies. Right now we are already in a huge labor shortage because employers aren't paying enough to attract the workers they need. Companies that don't decrease wages in this situation will out-compete companies that do decrease wages if the primary scarce resource right now is workers. This is similar to what's happening right now with companies that try to do locality adjustments for remote workers -- they get out-competed by companies willing to pay full price regardless of location. Eventually this will cause locality adjustments to vanish completely imo.
- dragonwriter 5y ago
  > If you have 90 units of work to be done you might hire 9 workers at 10 units each. If the standard work goes down by 10%, you now need 10 workers at 9 units each. Assuming per-hour productivity is constant, which it is not; productivity goes down with more hours worked (both in a “full work week” and in the annual number of full work weeks.)
- paxys 5y ago
  "Unit of work" is not really a thing for anything other than repetitive physical labor. There's a reason why putting 2x the resources on a problem won't get it solved twice as fast.
  - dragonwriter 5y ago
    > "Unit of work" is not really a thing for anything other than repetitive physical labor. Declining marginal productivity by hours worked per unit time definitely applies to repetitive physical labor past, too.
Mountain_Skies 5y ago
It's interesting that my ACA (Obamacare) premiums are lower than the premiums were at my last employer for similar coverage (using COBRA numbers for comparison). This might be because my last employer was bad at negotiating but I think it's mostly because they had an aging Rustbelt workforce and lots of people in roles that were unhealthy long term (linesmen and call centers). Because rates are set based on the pool's group risk, the risk in the public ACA pool is lower than the employer's pool of employees. So even though my job was white collar work at a desk, my premiums were based on an unhealthy pool of workers. If I went to work for a startup made up mostly of 20 somethings, I (and my employer) would likely be paying less than my old employer and less than ACA. So this is another way that tying health insurance to employment creates pockets of unfairness and undesirable outcomes. While I'm not sold on having a government run healthcare system (the pandemic only reinforces this), there are plenty of hybrid systems out there in other industrialized nations that might (must recognize each country's situation is unique) have better outcomes.
- bluejekyll 5y ago
  > While I'm not sold on having a government run healthcare system (the pandemic only reinforces this) Would you mind elaborating on that? From my own perspective the federal government’s ability to help fund and drive the vaccine development and then to purchase in quantities to get the entire population vaccinated is actually proof of how powerful a single payer system could be. I’m curious as to what I might be missing.
  - supportlocal4h 5y ago
    You offer two examples of value: 1. Fund and drive vaccine development 2. Purchase large quantities Neither of those is what I want from my insurance company. How much are those two things costing me? If my taxes just went up $100/year for the next 3 years to pay for that vaccine, that maybe wasn't ideal. If my taxes went up $10 total, that was an awesome deal. If I have no idea how much that vaccine cost me, and nobody else seems to have a way to figure it out, that's really bad. One of my biggest complaints about health insurance in general is the lack of transparency. If government control reduces transparency, that would be bad.
ncallaway 5y ago
> you just pay each worker 10% less and hire 10% more workers, right? While the rest of your comment is a fair concern, I want to push back on this default assumption. While I'm sure there are roles that are pretty much 1:1 with output to hours worked, I don't think it's always true. I think for software developers, for example, I get 90% of the productivity out of the first 32 hours of work that I would get out of 40 hours of work.

bitwize 5y ago

It's time to tie health insurance to being alive.

chapium 5y ago
But that means the poor would have affordable healthcare.

sokoloff 5y ago

It’s slightly worse than that. If you have 90 units of work to be done you might hire 9 workers at 10 units each. If the standard work goes down by 10%, you now need 10 workers at 9 units each. Your workers have increased by 11.1% (given by 1-1/(1-0.1)) A reduction from 40 to 32 would reduce hours per worker by 20% but increase workers and total health care costs by 25%.

ceejayoz 5y ago
The research around shorter work weeks and productivity indicates "units of work" don't work that way. https://www.npr.org/2021/07/06/1013348626/iceland-finds-major-success-moving-to-shorter-work-week https://www.npr.org/2021/07/06/1013348626/iceland-finds-majo... > Now, research out of Iceland has found that working fewer hours for the same pay led to improved well-being among workers, with no loss in productivity. In fact, in some places, workers were more productive after cutting back their hours.
- sokoloff 5y ago
  If the task is coverage-related (“be available to run a cash register” or “answer any phone call that comes in” or “watch this area for security purposes”), it’s exactly that ratio.
  - dragonwriter 5y ago
    > If the task is coverage-related (“be available to run a cash register” or “answer any phone call that comes in” or “watch this area for security purposes”), it’s exactly that ratio. But no task that actually needs done is purely coverage related. If you want someone to watch dor security purposes, you want them to actually effectively secure it to some level, and if average ability to do that drops from overwork you need more people; if you want someone to run a cash register, just having a body next to it isn't enough, they have to actually perform correctly.
    - plorkyeran 5y ago
      Many coverage-related jobs don't require a person's full potential productivity, so the fact that their productivity goes down with hours worked is irrelevant. If a cashier at a low-volume store only rings up a customer every 10 minutes but you've decided that they need to stay parked by the register all day rather than doing other tasks between customers, it doesn't matter if it takes them twice as long to ring up a customer at the end of their shift as at the start.
- jon-wood 5y ago
  That's true in the sort of desk jobs most of the people who inhabit Hacker News do. It's patently not true of things like manufacturing line work, delivery drivers, chefs, and call centre operators. A chef can't drop 8 hours a week and still expect to serve the same number of meals because of efficiency gains, and a call centre needs to be accessible at the times people are calling. For the record I fully support any push to reduce the amount of work people are expected to do, but claiming there's no impact because of productivity gains just doesn't add up in many cases.
eloff 5y ago
It's worse because you have more management overhead all the way to the chain, more HR and support needs, and more office space required. A rule of thumb is a worker's full cost is 2x their salary in the US. This varies, but it makes the math easy. So costs would increase about double that. But if your workers are doing creative work, they might be more productive now per hour and that might offset the costs.
sam0x17 5y ago
Not all companies are going to decrease wages in response to this legislation. In fact I'd be willing to bet it's less than 50% of companies. Right now we are already in a huge labor shortage because employers aren't paying enough to attract the workers they need. Companies that don't decrease wages in this situation will out-compete companies that do decrease wages if the primary scarce resource right now is workers. This is similar to what's happening right now with companies that try to do locality adjustments for remote workers -- they get out-competed by companies willing to pay full price regardless of location. Eventually this will cause locality adjustments to vanish completely imo.
dragonwriter 5y ago
> If you have 90 units of work to be done you might hire 9 workers at 10 units each. If the standard work goes down by 10%, you now need 10 workers at 9 units each. Assuming per-hour productivity is constant, which it is not; productivity goes down with more hours worked (both in a “full work week” and in the annual number of full work weeks.)
paxys 5y ago
"Unit of work" is not really a thing for anything other than repetitive physical labor. There's a reason why putting 2x the resources on a problem won't get it solved twice as fast.
- dragonwriter 5y ago
  > "Unit of work" is not really a thing for anything other than repetitive physical labor. Declining marginal productivity by hours worked per unit time definitely applies to repetitive physical labor past, too.

Mountain_Skies 5y ago

It's interesting that my ACA (Obamacare) premiums are lower than the premiums were at my last employer for similar coverage (using COBRA numbers for comparison). This might be because my last employer was bad at negotiating but I think it's mostly because they had an aging Rustbelt workforce and lots of people in roles that were unhealthy long term (linesmen and call centers). Because rates are set based on the pool's group risk, the risk in the public ACA pool is lower than the employer's pool of employees. So even though my job was white collar work at a desk, my premiums were based on an unhealthy pool of workers. If I went to work for a startup made up mostly of 20 somethings, I (and my employer) would likely be paying less than my old employer and less than ACA. So this is another way that tying health insurance to employment creates pockets of unfairness and undesirable outcomes. While I'm not sold on having a government run healthcare system (the pandemic only reinforces this), there are plenty of hybrid systems out there in other industrialized nations that might (must recognize each country's situation is unique) have better outcomes.

bluejekyll 5y ago
> While I'm not sold on having a government run healthcare system (the pandemic only reinforces this) Would you mind elaborating on that? From my own perspective the federal government’s ability to help fund and drive the vaccine development and then to purchase in quantities to get the entire population vaccinated is actually proof of how powerful a single payer system could be. I’m curious as to what I might be missing.
- supportlocal4h 5y ago
  You offer two examples of value: 1. Fund and drive vaccine development 2. Purchase large quantities Neither of those is what I want from my insurance company. How much are those two things costing me? If my taxes just went up $100/year for the next 3 years to pay for that vaccine, that maybe wasn't ideal. If my taxes went up $10 total, that was an awesome deal. If I have no idea how much that vaccine cost me, and nobody else seems to have a way to figure it out, that's really bad. One of my biggest complaints about health insurance in general is the lack of transparency. If government control reduces transparency, that would be bad.

ncallaway 5y ago

> you just pay each worker 10% less and hire 10% more workers, right? While the rest of your comment is a fair concern, I want to push back on this default assumption. While I'm sure there are roles that are pretty much 1:1 with output to hours worked, I don't think it's always true. I think for software developers, for example, I get 90% of the productivity out of the first 32 hours of work that I would get out of 40 hours of work.