17 ms·

I wish employers did not provide health insurance, even though I have a chronic medical condition. The choices of plans offered by companies is far, far smaller

• NoblePublius 4y ago
  There is no “tax break.” It’s unlawful for me not to buy health Insurance for my employees (more than 50) and you aren’t allowed to shop the open market if you work for me. Average cost per employee is $1150 this year (up about 11% over last year). Thanks Obama.
  • synaesthesisx 4y ago
    Dude $1150 per employee is literally nothing. That's less than $100/month, per employee, for health insurance. Individuals should still have an option to choose a plan on the open market if they desire, but they're highly unlikely to find a plan for $100/month.
    • NoblePublius 4y ago
      Sorry, that’s $1150 per month.
      • synaesthesisx 4y ago
        Ouch - that would certainly be a significant cost. Regardless, individuals should always have the option to buy a plan on the market. We really need to decouple health insurance from employment.
• TheRealNGenius 4y ago
  ah yes privatized healthcare. Spoken like a true American. https://www.reddit.com/r/PoliticalHumor/comments/u15pwv/universal_healthcare_americans_be_like/ https://www.reddit.com/r/PoliticalHumor/comments/u15pwv/univ...
• forty 4y ago
  I don't know the US system at all, but here in France employee health insurance ("mutuelle") are mandatory. The main benefit is that the cost is the same for all employees, no matter their health condition, age, etc. Basically it's a solidarity thing which allows everyone in the company to be covered well for a reasonable price.
  • mediaman 4y ago
    Is health insurance not provided by the state in France? I thought employer-provided health insurance was just was an odd Americanism.
    • yurishimo 4y ago
      There are a number of other western countries that have private healthcare systems. The difference between their and ours is tight regulation and cost controls, often combined with a robust public option for the unemployed to fall back on.
      • forty 4y ago
        I should add that in France, you can keep your employer health insurance for free for one full year, in many cases when you lose your job which limit the risk of a "hole" in the health coverage.
    • forty 4y ago
      There is a "baseline" provided by the state, and the employer health insurance adds extra coverage.
    • giaour 4y ago
      France has private supplementary insurance programs in addition to the state run health insurance program. A good corollary in the US is Medicare: everybody over 65 can enroll in Medicare Part A for free, but you can also choose Part B, Part D, and "medigap" coverage, each of which is optional and has a monthly premium.
    • 4y ago
• chromaton 4y ago
  Depends. If your employer doesn't offer health insurance, you can shop for plans on the government health insurance marketplace. These plans can have substantial subsidies.
  • heavyset_go 4y ago
    > These plans can have substantial subsidies. ACA subsidies disappear once you make $50k or more a year.
    • c-cube 4y ago
      Obama has not been in power in more than four years. If you want to blame someone, look towards those who refuse to vaccinate, die in the hospital after accruing huge medical bills that they don't pay.
• heavyset_go 4y ago
  > if companies did not offer health care as a perk, they would be able to offer higher salaries instead. Prices, including labor prices, are not determined by costs. There is no indication at all that companies would compensate employees more if they didn't have to pay for their health insurance. What is most likely to happen is that companies will pocket the difference, in the same way they've been pocketing the difference from increased productivity while letting wages become stagnant.
  • zaroth 4y ago
    Budgets are set by costs. When you run a business, you care about the “fully burdened” cost of each employee, and you hire as many as you can within your budget. One of the line items in that is my half of the payroll tax. Another line item is health insurance. Another may be an offset for office space and equipment. Whether my fully burdened cost budget has a line item for health insurance being paid to a 3rd party or to the employee is totally irrelevant. Tax law currently happens to make it much more efficient for me to pay that money to a 3rd party, so that’s where it goes. The reason I have that line item is due to a combination of market forces and regulation. By no means do I get to choose just not to pay it, if I expect employees to keep working for me, or the government not to shut me down.
    • aYsY4dDQ2NrcNzA 4y ago
      > When you run a business [...] you hire as many as you can within your budget. It sounds like you’re saying that employers are always trying to hire as many people as possible. Which would be nonsense, of course.
      • zaroth 4y ago
        That’s not what I wrote. In fact, not even what you quoted me as writing. A bizarrely uncharitable non-takedown, and completely besides the point as well?
        • aYsY4dDQ2NrcNzA 4y ago
• jackconsidine 4y ago
  I was under the impression (from being on the public market and later self-employed, company subsidized insurance which is altogether cheaper and better) that companies have pooling power which allows them to cut deals with insurers. Is that not the case?
  • deleted 4y ago
    [deleted]
  • candiddevmike 4y ago
    There are two kinds of costs with health insurance for companies. The funding to pay claims and the administration of said funding to pay claims. The administration part is the money maker, and while ACA attempted to curtail what they can charge for this/profit from it, they do creative things like "outsource" IT or HR to a separate company (with the executives as ovepaid board members). It's kind of like tax evasion only instead of taxes it's reducing your premiums.
    • lotsofpulp 4y ago
      > they do creative things like "outsource" IT or HR to a separate company (with the executives as ovepaid board members) Source? I am seeing 10-K reports showing UHC, Anthem, CVS, Cigna, Humana, Molina, Centene, etc all with profit margins ~5% or less. Is the claim that executives at one or more of these companies is attempting to bypass ACA regulations (and violating fiduciary duties to their own employer) by overpaying for services to outside entities that the aforementioned executives control? Seems like a grand conspiracy theory.
      • candiddevmike 4y ago
        It's real. You won't see this on the 10-K, you need to look at the 990s (which tend to be hard to find). Here's Blue Cross Blue Shield Association from 2017: https://projects.propublica.org/nonprofits/organizations/135656874/201843179349307969/IRS990 https://projects.propublica.org/nonprofits/organizations/135..., under part 7, independent contractors, you see "HEALTH INTELLIGENCE CO LLC". This is Blue Health Intelligence (as in Blue Cross Blue Shield Intelligence): https://bluehealthintelligence.com/ https://bluehealthintelligence.com/. Their board is made up of a bunch of blue cross execs. They spent 20+ million with this company, how much do you think the execs on the board get paid? No one knows because they're private/for profit and don't have to publish annoying things like a 990.
• Spooky23 4y ago
  Never underestimate the evil of HR. It’s a way to offload headcount without a layoff. They probably agreed to not layoff Mailchimp employees in the sale, so they make them quit. Purging the sick, tbe pregnant, etc from the company is a way to cut costs, and doing so through some elaborate bureaucratic fuckup avoids government intervention.
  • bb88 4y ago
    If corporations are dictatorships, HR is the intelligence agency working against the population.
• morpheuskafka 4y ago
  > The choices of plans offered by companies is far, far smaller than the choices available to me on the open market. Maybe I wasn't searching correctly, but I was recently discussing healthcare and taxes with someone and briefly searched on the Healthcare.gov exchange to look at prices. There were only three PPO plans (where you can freely go to any doctor in network), and all three were HDHPs, all from the same company. There were many HMO plans, some HDHP and others with low deductibles, but often extremely small local networks and limited choice of both PCPs and specialists. > This makes health insurance cheaper to the employer than to individuals. One other thing to note in your analysis is that most large employers are not buying any insurance, but actually self-insuring (funding the claims out of their own pool of money). So the employers are actually acting as insurance companies for their workers, rather than simply buying and reselling commercial insurance. There would be additional considerations beyond taxes in analyzing whether this type of insurance is more economically optimal, for example, the fact that each company has a distinct risk pool which may not be similar to the general population, depending on the company.
  • DamnYuppie 4y ago
    What plans are available to you will depend on which state you are in.
  • heavyset_go 4y ago
    This was my experience, as well, with the individual market. It is virtually impossible to replicate an employer-provided plan at all with market plans. You, as an individual, do not have the leverage to buy what most would consider good health insurance plans on your own.
  • Rebelgecko 4y ago
    Are you in a state that has pushed back against ACA? Or maybe you're only looking at the "bronze" tier, which will be skewed towards low cost HMOs and HDHPs? FWIW, in California I see like 5 different options for HMO across all of the tiers, a couple are local ones I've never heard of, but there's also some like Kaiser that are fairly large networks.
• inportb 4y ago
  > I would like to get the same tax break myself, or at least eliminate the tax break altogether so I am on an even playing field with businesses. This would allow me to purchase my own health insurance at rates comparable to what I'm offered at work. Maybe not. Businesses have more negotiating power because they're bigger buyers, so they would still have access to more competitive rates. Unless you got together with a lot of people to negotiate together (and this might be a startup opportunity).
• troupe 4y ago
  It is not just the tax break that makes it cheaper for corporations to buy insurance. Companies with a lot of employees pay a lot less than individuals because they pool the risk. Back before ACA you used to be able to get in a pool with, for example, other small business owners and pay an amount similar to what companies pay but as an individual. ACA made those plans illegal and insurance that used to cost $500 per month jumped to $1800.
  • matwood 4y ago
    I wasn't aware the ACA made pooling illegal. Awhile back I tried to form a group with small tech companies in my town to do this, but the insurance companies all wanted a larger anchor company. None of the bigger tech companies in town wanted to participate b/c they saw their benefits as a competitive advantage. This was post ACA, and I don't remember anyone mentioning legality. Small companies get crushed by insurance. Giving employees extra money in their check and telling them to use it on the ACA is probably most effective for all parties at the moment.
• bushbaba 4y ago
  Better yet. The government should require all health prices be published online, with the same rate charged to all patients regardless of insurance provider. Make this similar to gym membership. Let each person decide where to go based on cost and needs. With insurance remaining their for catastrophic events only.
  • heavyset_go 4y ago
    People don't decide to have heart attacks or get hit by cars outside of a hospital that's in their network. Surviving heart attacks can cost half a million to over a million dollars if care was received out of network. Disability can easily costs millions over a lifetime, too. Price transparency won't suddenly make that affordable.
    • bushbaba 4y ago
      That’s the point of insurance. If your house burns down and you incur huge expenses. Insurance kicks in.
      • heavyset_go 4y ago
        Insurance doesn't kick in when you're out of network.
• businesscasual 4y ago
  But why do you have to think about this at all? Wouldn't it just be easier that this was provided by the state, so that all citizens could afford getting necessary health care. At the same time it would relive you of having to compare coverage, copays, deductibles or in general understand the full fine print of your insurance agreements. Most comparable industrial countries have found a pretty decent solution to this where you move the financial burden of many basic services (health care, schooling, etc.) from the public, over to the government - allowing all citizens to benefit from these, without having to wonder if the can afford it.
  • macinjosh 4y ago
    Wouldn't it be easier if we all jumped into the vat of jelly with the matrix connection jacked into the back of our necks!? We wouldn't have to eat or poop or sleep. We could just trust the powerful to make every decision for us. It would be soooo much easier. Forgive me, but when it comes to my healthcare I want the most choice and control as I can have. I don't want to be stuck with whatever some bureaucrat decides is worth it. Lastly, people make stupid decisions and they get hurt. They go rock climbing or skydiving, they ride their bikes on busy streets. Why should I shoulder the responsibility for people's poor life choices.
    • MomoXenosaga 4y ago
      The rest of the world needs a country to send all the crazy asshole libertarians to. America has gracefully accepted that burden as this commenter points out.
    • lbotos 4y ago
      > Why should I shoulder the responsibility for people's poor life choices. You do know how private insurance works right? Someone makes an insurance company. Then they sit down and figure out the probabilities of things happening to people. They then put a price to join the group. They then divvy up that money to people in the group that have had things happen to them. With insurance you will always be paying for other peoples "poor life choices"... that's the way it works. Maybe one day it will be your poor life choice (or accident.) Having state healthcare by default does not necessarily mean a ban on private healthcare. Both can coexist.
• lowercased 4y ago
  > The only reason American employers are in the business of offering health insurance is because they get a federal tax break The cost of paying me is also tax deductible, so they get a 'tax break' by paying me more money. > This makes health insurance cheaper to the employer than to individuals. I don't think that's the root. Large insurance companies seem to want to sell to larger companies - groups of people - vs selling insurance to individuals. Selling to a group is where it seems some price reduction happens. And... by and larger, if you're selling insurance to people who are already healthy enough to be working regularly/fulltime, your costs for insuring that 'pool' will be somewhat cheaper than the costs of insuring any random individual. > they couldn't increase my salary enough for me to purchase the same plan myself If the cost of my health insurance was deductible from my individual taxes, then the entire market would be turned upside down. There are certain thresholds that need to be met re MAGI (IIRC) before health insurance insurance premiums are deductible by individuals. I'm "self employed" so the entirety of my premiums are tax deductible, but for the average person working a W2 job someplace that doesn't provide health insurance for them, it's not a deductible expense, which is a total sham.
  • bombcar 4y ago
    It's a tax break for the employee and hence for the employer - they can spend $X on insurance and give the employee $x+tax rate in benefits. What should be done is entirely decouple it so that health insurance AND medical expenses are above the line deductible - or make none of it such. And then let employees pick whatever they want.
  • flatiron 4y ago
    Those healthy people have sick spouses and children though. That part doesn’t add up.
  • sterlind 4y ago
    I am increasingly disabled, but I'm still managing to keep my job and its amazing health insurance, thank God. Insurance this past year has paid for like, a couple dozen specialist visits, 6 MRIs, weekly rehab, a reclining desk and a power wheelchair. I maxed out my deductable in February :D My health would be better if I could go on disability but that pays like, $1K a month and is ridiculously hard to get.
• efficax 4y ago
  They could offer higher salaries, but would they? And employers are able to negotiate better plans than you can get in the individual market. There's no way i could get the plan i have through my work for the about $12000 they spend on it. But I agree, healthcare should be provided by the federal govt like in every other advanced nation
• gamblor956 4y ago
  The only reason American employers are in the business of offering health insurance is because they get a federal tax break. This makes health insurance cheaper to the employer than to individuals This is wrong on so many levels. First, employers get a tax break because compensation expenses are generally deductible as "ordinary and necessary business expenses" required for the employer to be competitive in the labor market. Second, employer policies are cheaper because the risk pool is cheaper to insure than the individual pool, so the insurers can make the same or more profits despite charging lower premiums. The combined effect is to make employer-based health insurer significantly cheaper on both a pre-tax and post-tax basis than individual plans. But even without the tax benefit employers would still be incentivized to provide health benefits in a labor-competitive market. For example, many still provide free meals and parties to employees, even though meals are only partially deductible and parties are not deductible at all.
• smsm42 4y ago
  1. You can get some of the tax break if you use HDHP plan + HSA. It's limited to about 7K though, because if everybody would take big tax breaks, who'd pay for those trillion dollar bills they're passing every year now? 2. US healthcare system is incredibly hostile to people trying to pay their own costs and designed to be maximally obscure and confusing. Imagine buying a car where your car dealer, tire manufacturer, window glass manufacturer and upholstery supplier bill you separately. Now imagine when you come to the dealer and ask how much the car would cost, they shrug and tell you you'd know when the bills come, just relax and sign on the dotted line. If you really insist, they could give you an estimate - something between 1K and 100K dollars - but they don't guarantee anything, it's just an estimate. And no, you can't choose the suppliers upfront or know which ones they'd use - this you'd also know only when the bills come. And no, there's no way to know when or how it happens - they bills would just show up one day as a surprise. Sounds like a nice experience? That's how the healthcare system works, day to day. 3. The frustrating part is that most of the people think it's the only way to manage it, and those that don't think that the only way to fix it is to nationalize the whole thing. I mean we can create insanely complex supply chains (think how many people cooperated on making a car? And you still can come to a single place and pay for it with a simple transaction at cost known in advance - magic!) - but somehow healthcare is where it all disappears and figuring out the separation of labor thing becomes the problem of the end user.
• majormajor 4y ago
  > The choices of plans offered by companies is far, far smaller than the choices available to me on the open market. On the flip side, the cost my employer pays for my plan is far lower than they would bill me for it on the open market. Last time I looked at the individual market it was amazing how bad even plans for $500-1000 were! They could give me a raise exactly matching what they'd stop paying and I'd still lose out. Edit to clarify: That's not a "this is cheaper to us after we account for the tax break." That's a "this is the rate it costs us" vs "this is the rate it would cost you" difference. The negotiation power difference is real. Private market health insurance would need to be well-regulated or we'll all just get screwed even more. Employers like this because it gives them power over employees and makes it more attractive than being an entrepreneur not just to save money on taxes.
  • amarshall 4y ago
    Indeed, and the commenter you’re replying to said just that.
    • majormajor 4y ago
      Edited to clarify that I was bringing up negotiation power because I think that is the difference here, not anything about tax preference. And this benefits companies because it locks employees in.
• Supermancho 4y ago
  > I wish employers did not provide health insurance, even though I have a chronic medical condition. I've had multiple open heart surgeries. My medical events are relatively rare (every couple years) and I recently went completely septic for 4 days (started to have multiple organ failure ~3 days from no-return) due to a cascade of underlying issues. I know my medical coverage and it's been critical to my survival for my entire life. I have NEVER used employer health insurance and anyone with major medical conditions would be foolish to depend on employer coverage in most cases. The offered plans are basically a big deductible with some minor coverage for non-catastrophic, no surgical coverage, nothing chronic. More expensive plans cover more dependents. Gee thx. It's all but useless and I have simply declined it everywhere for the last 25 years to keep the ~25$/mo, as I have paid my own (car payment-sized) platinum level health insurance plan everywhere I've gone (and my wife's). The type of company - Finance, Medical, Marketing, Retail, Consulting (ironically the best I've found), doesn't make much of a difference. Every now and then you find some employer that will "cover your healthcare 100%" which is inevitably code for "cover the plans we choose, which aren't different than anyone else".
  • rmatt2000 4y ago
    What kind of car do you drive?
    • Supermancho 4y ago
      I lease a 2020 Subaru. My medical coverage is greater than that payment, as healthcare has risen very quickly in the last 10 years.
  • seattle_spring 4y ago
    My health insurance costs me $0 (fully employer paid), has a $300 deductible, and a $3k annual maximum. Last year they covered more than $100k worth of expenses without even a small amount of fight. This is a similar plan to my last 3 employers, companies of various sizes HQd in either SF or Seattle. If I had "multiple open heart surgeries," it would cost me a max of $3k in a calendar year. Where are you working that you are not being provided similar plans?
• capdeck 4y ago
  There is also another differentiator - companies buy insurance for all employees (i.e. in "bulk") when if everyone were to buy it privately, insurance companies will have to sell it in "retail". As is always the case with any business - bulk customers have preferential treatment, lower prices, better terms, you name it. Retail always pays it in full. While current employer based insurance model is broken, I don't think goin "full retail" will change the situation much. We'll end up in a situation similar to wireless service market - 3 major players with overpriced plans and lots of cheap MVNOs that stop having any coverage 5 miles down the highway.
• WalterBright 4y ago
  The reason for employer-offered health care plans is they are paid from pre-tax earnings. If the employee paid for it themselves, it would be paid by post-tax earnings, making it much more expensive.
• philwelch 4y ago
  Group health insurance is inherently cheaper than individual health insurance, regardless of any tax incentives.
• devoutsalsa 4y ago
  USA employers started offering health insurance during World War 2 as a means of enticing women to come to work, as there weren’t enough men to fill the positions. And once that trend started, it simply never stopped. https://www.npr.org/templates/story/story.php?storyId=114045132 https://www.npr.org/templates/story/story.php?storyId=114045...
  • tallanvor 4y ago
    It's true that they started offering health insurance during WWII, but it wasn't specifically to entice women into the workforce, rather it was to be competitive when Roosevelt created the Office of Economic Stabilization, which froze wages. Offering health insurance was a way to get around this. https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...
• benatkin 4y ago
  I don't quite understand what you're envisioning. Our system depends on many employers paying for health insurance. You would have to change a lot of things about our system for it to be decoupled. In South Korea the healthcare premiums are split between employees and the employers: https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea They don't have to negotiate group plans and maintaining coverage when switching jobs is pretty seamless. There has to be a plan if employers stop providing insurance en masse, and I'm not sure it's a good idea to stop getting premiums from the source of personal income entirely. That seems to be a convenient place to get the kind of money that healthcare demands.
• drewrbaker 4y ago
  I run a 20 person digital agency in Los Angeles. The amount of time we have to spend each year sorting out our healthcare for the entire company is mind blowing. You are totally correct, it becomes a full time job for 3 or 4 weeks for myself and another partner. So much effort and knowledge required for something that isn’t even our core business! And it inevitably causes drama with employees who don’t like some part of the group plans we end up with. Very stressful. We only offer it as our employees all say that this benefit is really important to them. I didn’t know it was a tax break for us to be honest. I wish more employees thought like you did. Our average monthly cost per employee is about $500 for a “silver” PPO plan, and about $110 for dental. Average age of our employees is below 30. I’d gladly pay employees the $610 extra a month just so we don’t have to deal with it and the drama that comes with it. This would actually save us money from the energy wasted dealing with insurance companies. And no one who’s dealt with our insurance plans over the years has had a positive experience. My brother (who worked for my company) cut his chin while out of state. Required 2 stitches, and he just walked to the closest ER to get them. $3500 it ended up costing him, even with our insurance and countless hours fighting the insurance companies too. Didn’t even see a doctor, a nurse did the stitches. It’s a joke. Other than salaries, health insurance is the largest expense for our business. Think about that at the scale of the entire economy and its mind blowing the wasted energy/effort on this “system”. I’m originally from Australia. We have “socialized” healthcare there. My brother is back visiting family currently and got an x-ray and ultra sound for $310. The American system is absolutely embarrassing.
  • helsinkiandrew 4y ago
    Why is this? (I'm used to European 'socialized' healthcare). Is it just the amount and type of cover offered by different policies is wide and opaque, the age/health of the employees effects the price/cover? Aren't there insurance brokers that provide tools to compare simply. Would a system that allowed employees to vote/order the cover they would like in the plan and then you to adjust the price point until you get matching policies that provides an acceptable level of cover.
    • gen220 4y ago
• tssva 4y ago
  "Considering the tax situation, it's curious that Intuit would not choose to take this tax break." Intuit did provide health insurance to these employees and take the tax break. There was a small gap between when the previous MailChimp insurance ended and MailChimp employees were placed on the Intuit offered health insurance. Once on the Intuit provided plan coverage was retroactive to the date the MailChimp plan ended. The employees could submit claims to the Intuit plan for reimbursement of medical expenses paid during the gap. The issue is that floating the money during this time could significantly impact the finances of the employee or that the employee may not have the funds to do so at all.
• thfuran 4y ago
  >This would allow me to purchase my own health insurance at rates comparable to what I'm offered at work. Would it? The employer can still call up an insurer and say "if you can give me a better deal than X, I'll buy insurance for 1,000 people" whereas you have maybe 5 potential customers to bargain with.