8 ms·

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).
nmhancoc 5y ago
The origin of the tie between US employment and healthcare was during the Second World War when wage controls were put into place. Employers competed for workers by adding benefits packages, which later became ossified and further entrenched with exemptions in the tax code.
- GauntletWizard 5y ago
  And it wasn't until the 90s that individually purchased health insurance become unviable for the average family. https://listwithclever.com/research/healthcare-costs-over-time/ https://listwithclever.com/research/healthcare-costs-over-ti...
- fellowniusmonk 5y ago
  I knew an individual named Ron Hillhouse, he sold life insurance and built a large insurance company in Texas twice. He sold it each time to a group in NY (MetLife each time if memory serves). He told me that his insight was that construction companies would have variable revenue and compensation requirements across TX building contracts (private vs government mostly) and to avoid discontent they would dump the difference into life insurance and other alternative compensation because as long as the take home paycheck was the same no one really complained about being put on lower compensation jobs. Not sure if that was a similar origin for health insurance but I've always assumed it was.
kube-system 5y ago
Health insurance is "tied to employment" because of wage controls that were implemented in WWII. Employers still had trouble hiring people, and because they were prohibited from raising wages, they had to find other ways to attract people: benefits. Health insurance then became a popular benefit. Also, note that you can buy your own health insurance in the US. You are not required to use health insurance provided by an employer.
- agentdrtran 5y ago
  You are free to buy your own (expensive, much worse) health insurance rather than through an employer, sure.
  - kube-system 5y ago
    Having had both, this is not my experience. My experience is that employer plans have fewer choices and similar or higher rates. They're cheap because my employer is paying most of the bill.
    - replygirl 5y ago
      I haven't had insurance for five years because the (major, national) providers who cover what I need aren't available on my state's marketplace (NY).
      - kube-system 5y ago
        Is it available off-market? That's how I bought my insurance (in another state). My state has a marketplace too, but I found better plans directly through the insurer's website.
        replygirl 5y ago
        The insurer I was after was offering neither marketplace nor off-market individual plans until this year
121789 5y ago
I think you are framing it as a top down objective, but I think it's the opposite. Employers themselves offer healthcare because it's a way to attract employees. You can get other health plans (e.g. Obamacare) but they are not as competitive as employer-sponsored plans. To not have employer-sponsored plans, you would have to either 1) ban employer-sponsored plans 2) offer other plans that are competitive. #1 seems unrealistic, #2 is possible but would have to probably be done by the state, which the US doesn't really love.
- rosndo 5y ago
  The real problem is how expensive healthcare is in the US. Compare Cignas global plan with and without US coverage. Somehow they can easily cover essentially all of the rest of the world for far less than the US. https://www.cignaglobal.com/ https://www.cignaglobal.com/
  - brimble 5y ago
    Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare. Some spend less total, per capita, than we do just from public spending that we already do (medicare, medicaid, CHIP, public employee healthcare plans, military care like VA and Tricare, et c.) without even having universal care like ~everyone else does
    - dragonwriter 5y ago
      > Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare. Per capita numbers can be misleading on healthcare as health is labor intensive, so countries with higher wages will have higher per capita costs with otherwise similar systems. OTOH, the US spends the second highest share of GDP on healthcare, globally, behind Tuvalu, and about a time and half the GDP share of the second highest large, developed state (Germany). [0] [0] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_recent_value_desc=true https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_...
replygirl 5y ago
Because previously all social services, including police and fire safety, were privatized, and were only taken over by the state when it became clear there wasn't enough economic incentive to keep such services running without the operators doing stuff like roughing people up, burning down buildings, etc. But everyone decomposes as they age, and people fear illness and death enough that you can charge them however much you like, so it stays private and eventually employers start pitching in to attract talent without having to offer better wages, more holiday leave, or a shorter work week. Now, there's a whole administrative system that drives up prices and puts a ceiling on availability and quality of care; with most Americans being (relatively) ill-traveled, ill-read, and fed a news product that beneath the packaging is some combination of entertainment and fear-mongering, it's easy for one to believe there's just something in the air that makes an NHS-style or even a German-style system impossible here. Then, if you were around for the 2008, 2012, and 2016 elections, you'd have seen presidential candidates arguing about whether someone should have to pay for someone else's well-being. And it's not a debate along the lines of class—it's tied up with identity politics and a broader debate around the welfare state. Advantaged and disadvantaged communities alike are full of people who see how things are, and, knowing that it takes a lottery win to move up the economic ladder and a bad week to fall down, are skeptical that next time it'll be different. Doesn't help that most Americans will never have the opportunity to get even an hour of education in macroeconomics, unless it's buried in disconnected lessons about individual economic downturns, nor that education on probability doesn't happen until second-year calculus (which is similarly rare in high schools), nor that most Americans don't learn about the mechanics of Medicare until their fifties or sixties
- replygirl 5y ago
  uh i cant edit this anymore but i wanted to clarify to all the ppl spazzing out over the police thing that i was speaking in a broader historical sense and only got specific to america in the transition to the second paragraph
- thegrimmest 5y ago
  > all social services, including police and fire safety, were privatized I think enforcing the law has been a government function from the times the first laws were laid down. Fire services were a private function, and this actually works fine in sparsely populated areas where fires are not likely to spread in temperate climates. The only reason fire services are public is because of the inherent risk to everyone that a fire poses in a dense, substantially flammable, city. If a fire affects you and only you, then why not cover it under normal, optional, property insurance like every other disaster? This is generally the model of government intervention I support - intervene when the actions of one group of people directly affect others. This covers regulation around rights of way, fire services, environmental protection, waste management, water supply, pandemic/disease control, police, and the military. It however does not cover supplying the personal necessities of life like food, shelter, clothing, medical care, entertainment, companionship, sex, fulfillment, etc. These are fundamentally individual needs, and I therefore hold that meeting them should be an individual responsibility. Any cooperation to meet these needs should be strictly voluntary and consensual, not compulsory. I think this is where, to greatly simplify, "the left" and "the right" fundamentally disagree. For instance, in spite of the now well-studied and crushing effects of loneliness, it would be absolutely tyrannical for the government to mandate friendship. Similarly it is tyrannical for the government to mandate participation in public health care/insurance. Let people figure out how to meet their needs for themselves, and let them figure out how to cooperate voluntarily. Charity is exactly the virtue of helping those in need, but mandatory charity is indistinguishable from slavery.
drewcoo 5y ago
It happened because under FDR there was a wage freeze. That's one of the tools a President has to fight inflation, last used by Nixon. Companies had to include extra benefits beyond wages to compete on hiring. One of those extras was health care. That's the original "design." https://thehill.com/opinion/healthcare/469739-the-employer-health-insurance-connection-an-accident-of-history/ https://thehill.com/opinion/healthcare/469739-the-employer-h...
goodpoint 5y ago
> keep the US population "on their toes" ...and obedient to corporations. Such mechanism give corporations the power to decide who gets terminated and loses health insurance. It's very effective at discouraging people from doing anything that goes again the grain, like getting into an union.

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).

nmhancoc 5y ago

The origin of the tie between US employment and healthcare was during the Second World War when wage controls were put into place. Employers competed for workers by adding benefits packages, which later became ossified and further entrenched with exemptions in the tax code.

GauntletWizard 5y ago
And it wasn't until the 90s that individually purchased health insurance become unviable for the average family. https://listwithclever.com/research/healthcare-costs-over-time/ https://listwithclever.com/research/healthcare-costs-over-ti...
fellowniusmonk 5y ago
I knew an individual named Ron Hillhouse, he sold life insurance and built a large insurance company in Texas twice. He sold it each time to a group in NY (MetLife each time if memory serves). He told me that his insight was that construction companies would have variable revenue and compensation requirements across TX building contracts (private vs government mostly) and to avoid discontent they would dump the difference into life insurance and other alternative compensation because as long as the take home paycheck was the same no one really complained about being put on lower compensation jobs. Not sure if that was a similar origin for health insurance but I've always assumed it was.

kube-system 5y ago

Health insurance is "tied to employment" because of wage controls that were implemented in WWII. Employers still had trouble hiring people, and because they were prohibited from raising wages, they had to find other ways to attract people: benefits. Health insurance then became a popular benefit. Also, note that you can buy your own health insurance in the US. You are not required to use health insurance provided by an employer.

agentdrtran 5y ago
You are free to buy your own (expensive, much worse) health insurance rather than through an employer, sure.
- kube-system 5y ago
  Having had both, this is not my experience. My experience is that employer plans have fewer choices and similar or higher rates. They're cheap because my employer is paying most of the bill.
  - replygirl 5y ago
    I haven't had insurance for five years because the (major, national) providers who cover what I need aren't available on my state's marketplace (NY).
    - kube-system 5y ago
      Is it available off-market? That's how I bought my insurance (in another state). My state has a marketplace too, but I found better plans directly through the insurer's website.
      - replygirl 5y ago
        The insurer I was after was offering neither marketplace nor off-market individual plans until this year

121789 5y ago

I think you are framing it as a top down objective, but I think it's the opposite. Employers themselves offer healthcare because it's a way to attract employees. You can get other health plans (e.g. Obamacare) but they are not as competitive as employer-sponsored plans. To not have employer-sponsored plans, you would have to either 1) ban employer-sponsored plans 2) offer other plans that are competitive. #1 seems unrealistic, #2 is possible but would have to probably be done by the state, which the US doesn't really love.

rosndo 5y ago
The real problem is how expensive healthcare is in the US. Compare Cignas global plan with and without US coverage. Somehow they can easily cover essentially all of the rest of the world for far less than the US. https://www.cignaglobal.com/ https://www.cignaglobal.com/
- brimble 5y ago
  Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare. Some spend less total, per capita, than we do just from public spending that we already do (medicare, medicaid, CHIP, public employee healthcare plans, military care like VA and Tricare, et c.) without even having universal care like ~everyone else does
  - dragonwriter 5y ago
    > Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare. Per capita numbers can be misleading on healthcare as health is labor intensive, so countries with higher wages will have higher per capita costs with otherwise similar systems. OTOH, the US spends the second highest share of GDP on healthcare, globally, behind Tuvalu, and about a time and half the GDP share of the second highest large, developed state (Germany). [0] [0] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_recent_value_desc=true https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_...

replygirl 5y ago

Because previously all social services, including police and fire safety, were privatized, and were only taken over by the state when it became clear there wasn't enough economic incentive to keep such services running without the operators doing stuff like roughing people up, burning down buildings, etc. But everyone decomposes as they age, and people fear illness and death enough that you can charge them however much you like, so it stays private and eventually employers start pitching in to attract talent without having to offer better wages, more holiday leave, or a shorter work week. Now, there's a whole administrative system that drives up prices and puts a ceiling on availability and quality of care; with most Americans being (relatively) ill-traveled, ill-read, and fed a news product that beneath the packaging is some combination of entertainment and fear-mongering, it's easy for one to believe there's just something in the air that makes an NHS-style or even a German-style system impossible here. Then, if you were around for the 2008, 2012, and 2016 elections, you'd have seen presidential candidates arguing about whether someone should have to pay for someone else's well-being. And it's not a debate along the lines of class—it's tied up with identity politics and a broader debate around the welfare state. Advantaged and disadvantaged communities alike are full of people who see how things are, and, knowing that it takes a lottery win to move up the economic ladder and a bad week to fall down, are skeptical that next time it'll be different. Doesn't help that most Americans will never have the opportunity to get even an hour of education in macroeconomics, unless it's buried in disconnected lessons about individual economic downturns, nor that education on probability doesn't happen until second-year calculus (which is similarly rare in high schools), nor that most Americans don't learn about the mechanics of Medicare until their fifties or sixties

replygirl 5y ago
uh i cant edit this anymore but i wanted to clarify to all the ppl spazzing out over the police thing that i was speaking in a broader historical sense and only got specific to america in the transition to the second paragraph
thegrimmest 5y ago
> all social services, including police and fire safety, were privatized I think enforcing the law has been a government function from the times the first laws were laid down. Fire services were a private function, and this actually works fine in sparsely populated areas where fires are not likely to spread in temperate climates. The only reason fire services are public is because of the inherent risk to everyone that a fire poses in a dense, substantially flammable, city. If a fire affects you and only you, then why not cover it under normal, optional, property insurance like every other disaster? This is generally the model of government intervention I support - intervene when the actions of one group of people directly affect others. This covers regulation around rights of way, fire services, environmental protection, waste management, water supply, pandemic/disease control, police, and the military. It however does not cover supplying the personal necessities of life like food, shelter, clothing, medical care, entertainment, companionship, sex, fulfillment, etc. These are fundamentally individual needs, and I therefore hold that meeting them should be an individual responsibility. Any cooperation to meet these needs should be strictly voluntary and consensual, not compulsory. I think this is where, to greatly simplify, "the left" and "the right" fundamentally disagree. For instance, in spite of the now well-studied and crushing effects of loneliness, it would be absolutely tyrannical for the government to mandate friendship. Similarly it is tyrannical for the government to mandate participation in public health care/insurance. Let people figure out how to meet their needs for themselves, and let them figure out how to cooperate voluntarily. Charity is exactly the virtue of helping those in need, but mandatory charity is indistinguishable from slavery.

drewcoo 5y ago

It happened because under FDR there was a wage freeze. That's one of the tools a President has to fight inflation, last used by Nixon. Companies had to include extra benefits beyond wages to compete on hiring. One of those extras was health care. That's the original "design." https://thehill.com/opinion/healthcare/469739-the-employer-health-insurance-connection-an-accident-of-history/ https://thehill.com/opinion/healthcare/469739-the-employer-h...

goodpoint 5y ago

> keep the US population "on their toes" ...and obedient to corporations. Such mechanism give corporations the power to decide who gets terminated and loses health insurance. It's very effective at discouraging people from doing anything that goes again the grain, like getting into an union.