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> 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 fair

> 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

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.