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It truly is shocking that health insurance is tied to employment status. I really think this is a large part of the trend towards overt ruthlessness in the USA

• rootusrootus 5y ago
  > It truly is shocking that health insurance is tied to employment status. I think "annoying" is a better description. It's not shocking at all, it was a fairly predictable outcome given the situation. It is really annoying that we haven't managed to walk it back to something more reasonable since then.
  • AYBABTME 5y ago
    Candidly, do you mind flushing out what you mean here by a fairly predictable outcome given the situation?
    • uoaei 5y ago
      Not GP, but: historically Protestant work ethic + unrestrained pursuit of profit + weak labor protections and domination of corporate interests in the halls of legislation = predictable outcome.
      • kansface 5y ago
        This is not historically accurate. Insurance through employers came out of the federally mandated price controls during WW2, and was later solidified by massive tax breaks for corporations for providing said insurance (under the eager endorsement by unions among others). Changing the system would require changing the tax incentive. Changing the deduction to apply to individuals could be a path forward.
        • uoaei 5y ago
          Federal mandates and tax incentives are created in the halls of legislation. This was mentioned above, albeit concisely. You even mention "massive tax breaks for corporations" which really only happens with intense pressure (backchannel or otherwise) on Congress. We call that "corporate lobbying" today, just as we called it back then. Recall the intense pressures on FDR from both sides. Eventually the unions won some important concessions, but the corporations still had sufficient representation to ensure the system calcified into one that continues to funnel capital upward.
    • seabird 5y ago
      Wages were frozen during WWII (Stabilization Act of 1942), and insurance was exempt from this freeze. At the time, it was a way to compete for employees. Eventually, you just weren't in the running if you weren't providing insurance.
  • nine_zeros 5y ago
    Maybe annoying to you. American shit hole healthcare is a matter of life and death for some.
  • epgui 5y ago
    “Annoying” for me would be stepping on a small LEGO. As a Canadian, I think that the US healthcare system exists in a first world country is absolutely “shocking”.
    • refurb 5y ago
      As someone who has experienced both systems, the fact Canada covers all is great but there are big issues with wait times and coverage gaps (in some provinces).
      • epgui 5y ago
        Oh absolutely. If you don't have an emergency you will have to wait. But man, when you do have a medical emergency, it's great not having to think about whether you're going to have to remortgage your house, sell your kidneys, put your kids up for adoption or reconsider all of your life plans. Personally I think Canada is a little bit over-dogmatic about rejecting a parallel private system entirely: I know there are problems with running two systems (mainly around inequity and brain-drain incentives for healthcare workers to move out of the public system), but IMO, nothing that can't be fixed by sufficiently high prices/taxes.
        • refurb 5y ago
          The US system is a huge mess, but but the reason why it hasn't changed is because it works "barely" for most people. Keep in mind that medical bankruptcy isn't unknown in Canada either - not being able to work is a bigger cause of medical bankruptcy than medical bills themselves.
  • mdldldl 5y ago
    • fellowniusmonk 5y ago
      I am old enough to remember families (my own included) being destroyed by this same reality pre-ACA. Insurance being tied to your job was a pre-aca reality. I was born with heart defects, pre-aca it was literally impossible for me to get private, non-corporate coverage, I tried for years. At least denying coverage for pre-existing conditions means that getting diagnosed between jobs isn't a complete family destroying death sentence like it was for mine.
    • brimble 5y ago
      The ACA ossified the existing system a bit, but employer-provided care was the norm before the ACA. That or just not having any insurance, especially for young people working for small companies.
      • lotsofpulp 5y ago
        ACA did not ossify it. If anything, ACA allowed non employers to purchase insurance. Previously, the options were to work for a deep pocketed employer or just not have insurance.
        • ghaff 5y ago
          Plans that would cover pre-existing conditions was one very important change for a lot of people. What ACA didn't really solve was the "affordable" part for people who aren't fairly high income. Between the marketplaces in most states and COBRA for those in between jobs or near 65, insurance is available but it's expensive with no one else chipping in a big chunk of the premium.
          • lotsofpulp 5y ago
            Nothing will solve the affordable part other than massive wealth transfers (which ACA did, but obviously not massive enough), and increased supply of healthcare (more docs, hospitals, medication manufacturers - or medicines in public domain), and tort reform. But ACA did what it could with the political compromises that had to be made at the time. It provided out of pocket maximums, maximum age rating factor (age 64 only pays 3x age 21), and required coverage for all applicants (removing risk of disqualification from pre existing condition). It is unfortunate the mandate was repealed and state level participation in functioning marketplaces was politically hampered.
  • faller 5y ago
    > I think "annoying" is a better description. Tying your personal health and that of your loved ones to your employer gives your boss unduly leverage over yourself, particularly when there are life and death decisions to be made.
• AYBABTME 5y ago
  I'm assuming this is by design to keep the US population "on their toes" and at work doing productive things. Otherwise why would it be tied to employment?
  • nopenopenopeno 5y ago
    That’s right. Bosses love it so it’s not going to change until workers force it to.
    • ghaff 5y ago
      Bosses absolutely do not love healthcare costs if that's what you're suggesting. But even legal mandates for larger firms aside, if you're trying to hire white collar workers while not having a decent healthcare plan, you're going to find it's a challenge.
      • nopenopenopeno 5y ago
        Give me a break. Bosses can add and subtract, and so can employees. They both know healthcare is getting paid for from the paycheck regardless. And with company plans, bosses may pay less or may pay more. Probably less. Either way, bosses love that employees know quitting their job is going to require switching health insurance plans, which is a dicey process. Bosses like holding that power in the same way they like holding visas over H1B visa holders heads. And the most obnoxious part of it all is that you knew this.
        • LordDragonfang 5y ago
          >Bosses can add and subtract, and so can employees. They both know healthcare is getting paid for from the paycheck regardless. It's not clear to me that most employees do know that, actually. I see a ridiculous number of people that oppose nationalized healthcare "because they'd have to pay taxes", not realizing that there is already a deduction from their total compensation to pay for their healthcare (i.e. a tax).
  • 5y ago
• jdavis703 5y ago
  As people age they do get “free” insurance from Medicare. And if a white collar worker experiences downward mobility they can qualify for free or cheap insurance through the Medicaid and Affordable Care Act provisions.
  • agentdrtran 5y ago
    Every single one of those programs comes with a laundry list of asterisks that make them far worse than any employer provided insurance I have ever had.
    • discardedrefuse 5y ago
      Also, medicare doesn't kick in until 65, which pretty much guarantees that most workers won't be able to retire until then; even if they're otherwise eligible / able.
    • LordDragonfang 5y ago
      To offer a contrasting anecdote, my government health insurance (MediCal) was the best I ever had, including my current 6-figure job. It can be done well.
      • agentdrtran 5y ago
        BadgerCare (in Wisconsin) I've heard good things about too (considering they're insurance)
• sidewndr46 5y ago
  As an American who has worked closely with the Federal government, I'm significantly more afraid of the idea that the government would be responsible for my medical care.
  • jakelazaroff 5y ago
    What issues with government-run health insurance are you worried about?
  • colinmhayes 5y ago
    That's not what anyone in the US is proposing though. Even medicare for all would still have the same private companies responsible for your care, they would just be paid by the federal government.
  • dangerlibrary 5y ago
    Medicare (single payer healthcare in the US for everyone over age 65) has a lower fraud rate than private insurance, serves millions of seniors and has for decades, and as an American there is a big discontinuity in actuarial data where your life expectancy literally goes up at 65 because you get access to it. Maybe don't generalize from a few personal anecdotes to the functioning of the entire 4 million employee federal government?
    • deleted 5y ago
      [deleted]
    • sidewndr46 5y ago
      Why would I care about the fraud rate of anything? I'm not a fraudster.
      • dangerlibrary 5y ago
        A common right-wing criticism of Medicare that I was trying to pre-empt is that it is rife with waste, fraud, and abuse. But to directly answer your question: if you want your dollars spent effectively, you should care about fraud rates in services you pay for (public or private).
• lotsofpulp 5y ago
  Health insurance is not tied to employment status. Anyone can go to healthcare.gov and buy an equivalent BCBS or Kaiser or whatever gold/silver/bronze insurance. Unless you are in a particularly shitty state. What employers do have is the ability to sell you health insurance with pre tax dollars, which is also available to self employed individuals. But the people who are screwed are those who are employed by employers that do not offer health insurance. They have to buy insurance with post tax dollars. There is similar bullshit with retirement funding, where employer sponsored retirement account limits are drastically more than individual ones (401k vs IRA), and especially if you are a married couple with 1 spouse with 401k access and one spouse without.
  • kaesar14 5y ago
    This just feels like a ‘well ackshually’ retort to health insurance being tied to employment. This is an extra added expense and often times the barebones insurance is garbage with high deductibles and out of pocket maximums.
    • lotsofpulp 5y ago
      How is it an “extra added expense”? Just because you do not pay for 50% of the premium out of your own pocket directly does not mean you are not paying implicitly. Your employer is obviously counting it in the total cost of employing you, and the figure is given to you in box 12 code DD on your W-2. You can also buy a platinum level BCBS health plan yourself, without an employer, and get the same low deductible and low oop max. https://www.healthcare.gov/choose-a-plan/plans-categories/ https://www.healthcare.gov/choose-a-plan/plans-categories/ It is evident then that health insurance is NOT tied to employment. Buying it with pre tax dollars is tied to the type of employer you have. NJ has a very nice pdf where you can basically see how much your insurance will cost based on your age and level do coverage you want: https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates2022.pdf https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...
  • nebula8804 5y ago
    >Health insurance is not tied to employment status. Anyone can go to healthcare.gov and buy an equivalent BCBS or Kaiser or whatever gold/silver/bronze insurance. Unless you are in a particularly shitty state. Out of curiosity, I went and looked up the plans in NJ for a 32 year old person(56k salary). This is someone in a lower risk pool. The bronze plans are in the upper ~280$/month and include a $6000 deductible. There are three plans out of 36 that are ~380 a month that have a $2500 deductible. Everything else is more. This is NJ, one of the better states and definitely not a shitty state. These plans are garbage. Every time someone on HN extols the virtues of Healthcare.gov, I recheck my options and they always come back much worse than what I get working for a private employer (typical S&P 500 corp). I wish people would look up their possible plans on Healthcare.gov before tossing it out as something other than a scam.
• jseban 5y ago
  In that case, why should your home be tied to employment status? Food? It's at least as important for your survival as health insurance.
  • beaconstudios 5y ago
    it shouldn't be! From an ethical standpoint, housing should be guaranteed as a human right. Obviously if you're living in a mansion paid by an executive job and you get laid off you might have to downsize, but nobody should have to fear homelessness in the wealthiest countries on earth.
• escapedmoose 5y ago
  THIS is for real. If I don’t have a job with good benefits, I can’t pay our medical bills anymore, and we could lose everything. So even though I’ve had the “team player” personality from birth, I cannot allow myself to put my faith in any employer. The moment they start turning the screw on benefits, I’m out.