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> I can't stress enough how uneven and cruel the US healthcare system is. Yes, and there is no doubt healthcare is expensive. I won't rehash the reasons it's p
by zamfi 5y ago
> I can't stress enough how uneven and cruel the US healthcare system is.
Yes, and there is no doubt healthcare is expensive. I won't rehash the reasons it's particularly expensive in the USA; they're well-known, though there isn't strong consensus. But:
> I feel the only way to survive long-term is to have a career that enables access to jobs (or unions) that offer health care as a benefit. Without it, paying for family-level premiums is similar to a mortgage.
"Obamacare" tried to remedy this by capping healthcare costs at 8.5% of income. Yes, there are holes (in particular, before 2021 this only applied to those earning under 400% of the federal poverty line FPL) and healthcare is even more egregiously expensive in those special cities where 400% of the FPL is below the local poverty line.
But whether you get subsidized by the state, a union, or your employer, the thing to keep in mind is that the costs of healthcare are ultimately still borne by "you": really, we, collectively, employees, union-members, taxpayers -- yes some of us are privileged enough to work for companies that are not financially constrained, but for most employers an extra $1000-3000/mo going to healthcare (you did say "family-level premiums") just feeds in to their total cost of employing you. Offering that benefit to employees means the pay they can offer you as an employee is constrained by its cost as well.
If having employer-based care is the only way to survive, then what that really means -- since money is fungible, really -- is that having the privilege of being well-compensated is the only way to have effective healthcare.
I think that's worse, honestly.
- adamredwoods 5y ago>> If having employer-based care is the only way to survive, then what that really means -- since money is fungible, really -- is that having the privilege of being well-compensated is the only way to have effective healthcare. Anecdotally, it seems to be the current and foreseeable future. I had a co-worker a couple years ago that had an undiagnosed condition (lupus) for many years because he couldn't afford healthcare. Once he had insurance, he was able to pursue various doctors for help. This is the pattern I've seen. >> the costs of healthcare are ultimately still borne by "you" Yes, and always will be, but costs have ben obfuscated for years. For-profit health insurance is one of the big issues, in my opinion [1]. Profit-making is largely apathetic to patient outcomes. I have no idea how to realistically change this current structure. [1]: https://stanmed.stanford.edu/2017spring/how-health-insurance-changed-from-protecting-patients-to-seeking-profit.html https://stanmed.stanford.edu/2017spring/how-health-insurance...
- zamfi 5y ago> Yes, and always will be, but costs have ben obfuscated for years. For-profit health insurance is one of the big issues, in my opinion [1]. I have no kind words for for-profit health insurance, having been burned by the industry myself. Being for-profit definitely doesn't help, but the non-profit insurers in the US are not much better. The truth is, the incentives are terrible all around, including -- and you won't read this in Stanford Medicine's quarterly magazine -- the fact that we train far too few doctors, nurses, and other medical staff, work them far too hard while not using their time well, and pay them very, very generously. Then again, the cost of higher education has grown tremendously too, without (that many) for-profits taking a cut, and that's an industry where we face no shortage of qualified professors, work them harder (oddly) the less they get paid, and pay the ones teaching the most classes, well, let's just say it's not "very generously". Perhaps the major commonality is that the people getting the service are often not the ones paying (at least, up front) -- either insurers or lenders are? That and also these are both highly human-capital-intensive industries.