6 ms·

I don't really want universal healthcare but I would take it if it makes people stop talking about the obligation of employers to provide additional services an

I don't really want universal healthcare but I would take it if it makes people stop talking about the obligation of employers to provide additional services and benefits for their employees that fundamentally have nothing to do with the labor/payment relationship. If it's a fundamental right, the government should do it directly or subsidize it. Not lump it on employers just because it's convenient.

andybak 5y ago
Remind me not to work for you.
- bpodgursky 5y ago
  Deal
5350-uiop-1130 5y ago
You just want to ride the horse until its tired, then shoot it and eat it.
endisneigh 5y ago
Datavant should strip away all of your benefits since it fundamentally has nothing to do with your labor/payment relationship indeed! Cash only.
- HWR_14 5y ago
  It's strange for a site where most compensation is non-cash to hear people extolling their virtues of cash only for compensation
  - neon_electro 5y ago
    I don't know about you, but in my 10-year career so far, the amount of cash compensation I've earned is orders of magnitude higher than the actual liquid compensation I've received from equity actually becoming worth something. tl;dr I got lucky and won the startup lottery, but it didn't pay out nearly as much as the cash compensation I've earned. Am I in the minority here? I doubt it.
    - Cederfjard 5y ago
      They’re probably talking about RSUs at Big Tech, rather than startup options.
  - orangecat 5y ago
    RSUs are nearly as liquid as cash. Health insurance is very much not.
    - HWR_14 5y ago
      RSUs are liquid after they vest. Health insurance vests pretty much right away
- bpodgursky 5y ago
  Yes, I would much rather get more cash than a bunch of annoying FSA, life insurance, pet insurance, disability insurance, gym expense, home-office benefits.... all benefits I have to manually keep track of and optimize. This clown car of "perks" only exist because of a dumb tax regime that makes those benefits pre-tax, and that regime should end.
  - richbell 5y ago
    > Yes, I would much rather get more cash than a bunch of... benefits I have to manually keep track of and optimize. I've worked at a few large financial institutions that pay technical employees significantly below market rate, but aggressively and publicly boast about how competitive they are because of "total compensation". It's absurd, and often results in large dysfunctional teams where they have to hire 10+ junior people, for ~60k each, because they're unwilling to hire 1-2 experienced people, for ~150k each.
  - bogomipz 5y ago
    Have you actually asked your employer if they can do away with that 'clown car of "perks"' in exchange for more salary? I would think that would be something you could negotiate as part of any job offer. Accepting a company's employer healthcare and benefits is certainly not mandatory either.
    - bpodgursky 5y ago
      It's not advantageous to do this as an individual under the current tax code. I'd still rather take the perks than pay 35% of it as marginal tax. What I want is a revision to the tax code that stops making the benefits a tax-efficient vehicle.
- bogomipz 5y ago
  Who is Datavant? I'm not seeing it mentioned in the article or other threads in this post.
  - renewiltord 5y ago
    Google the username of the guy he’s responding to.
    - bogomipz 5y ago
      Ah I see. Datavant is healthcare tech.
HWR_14 5y ago
You know even if there is universal healthcare, you can pay private doctors yourself if you would like.
- sidlls 5y ago
  That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. Universal healthcare, done even as poorly as our government likely will, will go a long way toward decoupling basic needs like this from employment. If companies want to offer "luxury" plans to cover elective health procedures they'd be free to do so, but it would no longer be as effective a wage-depressing, servitude inducing cudgel as the current system is (however unintentionally).
  - unfocussed_mike 5y ago
    > That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. It is different, because in most countries where there is universal healthcare you can still cover that "private" care with a health insurance plan if you choose (e.g. BUPA or Nuffield in the UK) And then you can do the extra electives on top of that. So there are three tiers, rather than two. (In the UK there are a few situations where we effectively almost have only the US two tiers; opticians, dentistry, nutrition, physiotherapy all have much less NHS provision coverage, largely because the elective stuff is so easily upsold; professionals can leave the public sector for the private money. The worst being opticians; the idea that the market can provide that more cheaply has been proved wrong.)
    - sidlls 5y ago
      It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. Plenty of companies even provide tiered insurance for executives and their families. So whether insurance is all employer-provided, private, government provided, or a mix, in the US one is almost certain to be able to buy something above and beyond the basics out-of-pocket.
richbell 5y ago
> I don't really want universal healthcare but I would take it if it makes people stop talking about the obligation of employers to provide * additional services and benefits for their employees that fundamentally have nothing to do with the labor/payment relationship. Employers don't provide additional services for altruistic reasons: having perks outside of the "labour/payment relationship" is a tool for attracting and retaining employees. That said, basic access to healthcare should not be contingent on employment (with a specific company) because it gives companies a significant amount of power over their employees. Many companies abuse this to trap employees into unfavorable working arrangements.
JKCalhoun 5y ago
There was a time when employers were happy to offer health care, pensions, and other enticements to get workers. It's an "employers' market" now as we are competing with the poorest nations on earth — a race to the bottom. Nice for shareholders I guess? People turn to their tax-paid, elected government for the things that Capitalism decides not to provide.
- richbell 5y ago
  > It's an "employers' market" now as we are competing with the poorest nations on earth — a race to the bottom. Ironically, many poorer nations have more affordable Healthcare than the United States. There's a whole "medical tourism" industry built around people from the US going to other countries for basic procedures and medication.
- bpodgursky 5y ago
  Healthcare was only ever offered as a perk because employers could pay for it pre-tax instead of post tax, but individual employees could not do the same with their own money. That was always stupid and didn't make sense, it's not because the labor/employment relationship used to be different.
  - bogomipz 5y ago
    >"Healthcare was only ever offered as a perk because employers could pay for it pre-tax instead of post tax, but individual employees could not do the same with their own money." This is completely false. Employer-based healthcare was a consequence of World War 2. The US Congress passed 1942 Stabilization Act in order to combat inflation. As a result of this legislation employers could not compete for workers using wages alone. Employers then began to offer health benefits a perk and since that perk was not compensation it was not taxed. This fact is actually well-documented.[1][2]. It was offered in lieu of compensation and pre-tax vs post-tax status had nothing to do with the birth of this. [1] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 [2] https://www.chicagotribune.com/opinion/commentary/ct-obamacare-health-care-employers-20170224-story.html https://www.chicagotribune.com/opinion/commentary/ct-obamaca...
tzs 5y ago
> I don't really want universal healthcare [...] Most common definitions of "universal healthcare" say it is a system that assures that all citizens of some political grouping (country, region, state) have access to healthcare without it being an undue financial burden. If you also use such a definition, then I'm curious what citizens you think should not be assured of such access? If you are using a different definition, then I'm curious what that is.
- bpodgursky 5y ago
  I would create a per-capita federal refundable tax credit which is commensurate with the average cost of "comprehensive" market health coverage for an individual, but not mandate people to buy anything other than catastrophic care coverage. Dunno what you'd call that.
  - tzs 5y ago
    If the tax credit based on comprehensive coverage was $1000/month, and catastrophic coverage cost $400/month, would someone who chooses to only have catastrophic still receive the $1000/month (giving them $600/month they could use on anything regardless of whether or not it is related to healthcare), or just receive $400/month, or receive whatever their insurance and medical costs actually are each month up to $1000/month? If the later two it would be universal healthcare. Not sure how the first would be classified.
  - plasticchris 5y ago
    High deductible health plans are a thing, and fulfill the current (weak) insurance requirement in the US so the last half of that is here today.
    - sokoloff 5y ago
      I’d wager that a lot of people using HDHPs are doing so in order to be allowed to use HSAs as a stealth (but best) additional retirement account. https://www.madfientist.com/ultimate-retirement-account/ https://www.madfientist.com/ultimate-retirement-account/
TulliusCicero 5y ago
I want universal healthcare, but otherwise I agree. It’s stupid that we’ve developed a model where healthcare is tied to employment. Imagine if the only sane way to buy groceries was through a food insurance plan because buying them a la carte was insanely expensive, but also food insurance was super expensive so you needed to get it through a job. “I can’t quit my job, I need my food insurance so I can eat!” That’s the situation we’re in today with healthcare.
- sokoloff 5y ago
  It amuses me that our current health insurance situation traces pretty directly back to World War II era government price controls on labor. https://www.griffinbenefits.com/blog/history-of-employer-sponsored-healthcare https://www.griffinbenefits.com/blog/history-of-employer-spo...
orangecat 5y ago
Agreed. Either full socialism or an actual market in health care would be better than the idiocy we've gotten ourselves stuck with.
spaetzleesser 5y ago
Employer based health insurance should be abolished. Same for things like 401k or pensions where a company decides what services the employee can get (and probably not the employee's benefit but for the company's benefit). Everybody should have access to the same plans when it comes to retirement and health insurance.
cyberpunk 5y ago
Seems to work okay in Spain and the UK, and even in Germany we have a kind of hybrid system. Americans hate their poor, vulnerable. It’s one of the many reasons I would never even visit there. Land of the free? Yeah ok.
pessimizer 5y ago
Health insurance is associated with employment because originally, unions and other social organizations started providing it. They wanted to break the unions. So the government heavily subsidized employer-provided insurance through a tax break. It was not "lumped on" employers. It was another attack on working people. Tax it just like other wages, and I promise you'll start to see it disappear.
- erik_seaberg 5y ago
  Employers offered perks like insurance to compete for workers because the feds foolishly made it illegal to offer higher wages during World War II.

andybak 5y ago

Remind me not to work for you.

bpodgursky 5y ago
Deal

5350-uiop-1130 5y ago

You just want to ride the horse until its tired, then shoot it and eat it.

endisneigh 5y ago

Datavant should strip away all of your benefits since it fundamentally has nothing to do with your labor/payment relationship indeed! Cash only.

HWR_14 5y ago
It's strange for a site where most compensation is non-cash to hear people extolling their virtues of cash only for compensation
- neon_electro 5y ago
  I don't know about you, but in my 10-year career so far, the amount of cash compensation I've earned is orders of magnitude higher than the actual liquid compensation I've received from equity actually becoming worth something. tl;dr I got lucky and won the startup lottery, but it didn't pay out nearly as much as the cash compensation I've earned. Am I in the minority here? I doubt it.
  - Cederfjard 5y ago
    They’re probably talking about RSUs at Big Tech, rather than startup options.
- orangecat 5y ago
  RSUs are nearly as liquid as cash. Health insurance is very much not.
  - HWR_14 5y ago
    RSUs are liquid after they vest. Health insurance vests pretty much right away
bpodgursky 5y ago
Yes, I would much rather get more cash than a bunch of annoying FSA, life insurance, pet insurance, disability insurance, gym expense, home-office benefits.... all benefits I have to manually keep track of and optimize. This clown car of "perks" only exist because of a dumb tax regime that makes those benefits pre-tax, and that regime should end.
- richbell 5y ago
  > Yes, I would much rather get more cash than a bunch of... benefits I have to manually keep track of and optimize. I've worked at a few large financial institutions that pay technical employees significantly below market rate, but aggressively and publicly boast about how competitive they are because of "total compensation". It's absurd, and often results in large dysfunctional teams where they have to hire 10+ junior people, for ~60k each, because they're unwilling to hire 1-2 experienced people, for ~150k each.
- bogomipz 5y ago
  Have you actually asked your employer if they can do away with that 'clown car of "perks"' in exchange for more salary? I would think that would be something you could negotiate as part of any job offer. Accepting a company's employer healthcare and benefits is certainly not mandatory either.
  - bpodgursky 5y ago
    It's not advantageous to do this as an individual under the current tax code. I'd still rather take the perks than pay 35% of it as marginal tax. What I want is a revision to the tax code that stops making the benefits a tax-efficient vehicle.
bogomipz 5y ago
Who is Datavant? I'm not seeing it mentioned in the article or other threads in this post.
- renewiltord 5y ago
  Google the username of the guy he’s responding to.
  - bogomipz 5y ago
    Ah I see. Datavant is healthcare tech.

HWR_14 5y ago

You know even if there is universal healthcare, you can pay private doctors yourself if you would like.

sidlls 5y ago
That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. Universal healthcare, done even as poorly as our government likely will, will go a long way toward decoupling basic needs like this from employment. If companies want to offer "luxury" plans to cover elective health procedures they'd be free to do so, but it would no longer be as effective a wage-depressing, servitude inducing cudgel as the current system is (however unintentionally).
- unfocussed_mike 5y ago
  > That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery. It is different, because in most countries where there is universal healthcare you can still cover that "private" care with a health insurance plan if you choose (e.g. BUPA or Nuffield in the UK) And then you can do the extra electives on top of that. So there are three tiers, rather than two. (In the UK there are a few situations where we effectively almost have only the US two tiers; opticians, dentistry, nutrition, physiotherapy all have much less NHS provision coverage, largely because the elective stuff is so easily upsold; professionals can leave the public sector for the private money. The worst being opticians; the idea that the market can provide that more cheaply has been proved wrong.)
  - sidlls 5y ago
    It isn't different: you can get insurance for those things in the US or pay for them directly (no employer or government subsidy). That's exactly the same as what the GP suggests. Plenty of companies even provide tiered insurance for executives and their families. So whether insurance is all employer-provided, private, government provided, or a mix, in the US one is almost certain to be able to buy something above and beyond the basics out-of-pocket.

richbell 5y ago

> I don't really want universal healthcare but I would take it if it makes people stop talking about the obligation of employers to provide * additional services and benefits for their employees that fundamentally have nothing to do with the labor/payment relationship. Employers don't provide additional services for altruistic reasons: having perks outside of the "labour/payment relationship" is a tool for attracting and retaining employees. That said, basic access to healthcare should not be contingent on employment (with a specific company) because it gives companies a significant amount of power over their employees. Many companies abuse this to trap employees into unfavorable working arrangements.

JKCalhoun 5y ago

There was a time when employers were happy to offer health care, pensions, and other enticements to get workers. It's an "employers' market" now as we are competing with the poorest nations on earth — a race to the bottom. Nice for shareholders I guess? People turn to their tax-paid, elected government for the things that Capitalism decides not to provide.

richbell 5y ago
> It's an "employers' market" now as we are competing with the poorest nations on earth — a race to the bottom. Ironically, many poorer nations have more affordable Healthcare than the United States. There's a whole "medical tourism" industry built around people from the US going to other countries for basic procedures and medication.
bpodgursky 5y ago
Healthcare was only ever offered as a perk because employers could pay for it pre-tax instead of post tax, but individual employees could not do the same with their own money. That was always stupid and didn't make sense, it's not because the labor/employment relationship used to be different.
- bogomipz 5y ago
  >"Healthcare was only ever offered as a perk because employers could pay for it pre-tax instead of post tax, but individual employees could not do the same with their own money." This is completely false. Employer-based healthcare was a consequence of World War 2. The US Congress passed 1942 Stabilization Act in order to combat inflation. As a result of this legislation employers could not compete for workers using wages alone. Employers then began to offer health benefits a perk and since that perk was not compensation it was not taxed. This fact is actually well-documented.[1][2]. It was offered in lieu of compensation and pre-tax vs post-tax status had nothing to do with the birth of this. [1] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 [2] https://www.chicagotribune.com/opinion/commentary/ct-obamacare-health-care-employers-20170224-story.html https://www.chicagotribune.com/opinion/commentary/ct-obamaca...

tzs 5y ago

> I don't really want universal healthcare [...] Most common definitions of "universal healthcare" say it is a system that assures that all citizens of some political grouping (country, region, state) have access to healthcare without it being an undue financial burden. If you also use such a definition, then I'm curious what citizens you think should not be assured of such access? If you are using a different definition, then I'm curious what that is.

bpodgursky 5y ago
I would create a per-capita federal refundable tax credit which is commensurate with the average cost of "comprehensive" market health coverage for an individual, but not mandate people to buy anything other than catastrophic care coverage. Dunno what you'd call that.
- tzs 5y ago
  If the tax credit based on comprehensive coverage was $1000/month, and catastrophic coverage cost $400/month, would someone who chooses to only have catastrophic still receive the $1000/month (giving them $600/month they could use on anything regardless of whether or not it is related to healthcare), or just receive $400/month, or receive whatever their insurance and medical costs actually are each month up to $1000/month? If the later two it would be universal healthcare. Not sure how the first would be classified.
- plasticchris 5y ago
  High deductible health plans are a thing, and fulfill the current (weak) insurance requirement in the US so the last half of that is here today.
  - sokoloff 5y ago
    I’d wager that a lot of people using HDHPs are doing so in order to be allowed to use HSAs as a stealth (but best) additional retirement account. https://www.madfientist.com/ultimate-retirement-account/ https://www.madfientist.com/ultimate-retirement-account/

TulliusCicero 5y ago

I want universal healthcare, but otherwise I agree. It’s stupid that we’ve developed a model where healthcare is tied to employment. Imagine if the only sane way to buy groceries was through a food insurance plan because buying them a la carte was insanely expensive, but also food insurance was super expensive so you needed to get it through a job. “I can’t quit my job, I need my food insurance so I can eat!” That’s the situation we’re in today with healthcare.

sokoloff 5y ago
It amuses me that our current health insurance situation traces pretty directly back to World War II era government price controls on labor. https://www.griffinbenefits.com/blog/history-of-employer-sponsored-healthcare https://www.griffinbenefits.com/blog/history-of-employer-spo...

orangecat 5y ago

Agreed. Either full socialism or an actual market in health care would be better than the idiocy we've gotten ourselves stuck with.

spaetzleesser 5y ago

Employer based health insurance should be abolished. Same for things like 401k or pensions where a company decides what services the employee can get (and probably not the employee's benefit but for the company's benefit). Everybody should have access to the same plans when it comes to retirement and health insurance.

cyberpunk 5y ago

Seems to work okay in Spain and the UK, and even in Germany we have a kind of hybrid system. Americans hate their poor, vulnerable. It’s one of the many reasons I would never even visit there. Land of the free? Yeah ok.

pessimizer 5y ago

Health insurance is associated with employment because originally, unions and other social organizations started providing it. They wanted to break the unions. So the government heavily subsidized employer-provided insurance through a tax break. It was not "lumped on" employers. It was another attack on working people. Tax it just like other wages, and I promise you'll start to see it disappear.

erik_seaberg 5y ago
Employers offered perks like insurance to compete for workers because the feds foolishly made it illegal to offer higher wages during World War II.