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Just ran some arbitrary numbers. Someone earning $190k in mid Ohio would have take home of around $140k, between state/federal. That's before any other retire

Just ran some arbitrary numbers. Someone earning $190k in mid Ohio would have take home of around $140k, between state/federal. That's before any other retirement savings or anything else. A 'fantastic' insurance plan from blue cross anthem will be around $2400/month for a family of 3. With a 'modest' deductible of $4k. $2400*12=I around $29k. This person is having to spend ~ 21% of 'take home' just on medical insurance. Not any medical expense, just insurance. Assuming working independently, some of that is deductible, and one might argue how much left over is "a lot" or not. There's still food, shelter, utilities, transportation, education, etc. they need to account for, as well as saving for the future. Actually, looking at it, if the person is 'independent', they'd pay another ~$10k or so on FICA, or have some LLC structure set up. Or they might be lucky enough to have an employer who pays for some/most of this 'fantastic' insurance... until they don't. Perhaps in terms of raw dollars, there's some advantage, but there's a pervasive threat of "what if" scenarios that is hard to shake for a lot of folks.

ericmay 4y ago
But if you are earning that you are likely working for a large corporation where your actual out of pocket expenses are much closer to something like $1000/month for that family (varies by situation). Far better scenario then a much lower European salary (probably closer to $80,000) with higher taxes and the same (at best) quality care. If you are working independently yea it may be more expensive, but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. Though worth noting providing a way to untie healthcare from employers and still make it affordable so that you can more easily start a company is a good idea. It’s really difficult to do good analysis here. If you were in Ohio making $190,000 your family is automatically in the top 10% or so. If you worked remote you could buy a house outside of a major city for your salary equivalent, or in a city like Columbus for 2x your salary with some fantastic public schools. Also a nitpick while I think you get much more efficient and cheaper healthcare with the government running it, at the end of the day it’s never free so you have to actually compare taxes to premiums to get a fair assessment of cost.
- mgkimsal 4y ago
  > untie healthcare from employers This 1000 times. I don't think we'll see a meaningful change in my lifetime, but it's an existential burden that we, collectively, have had for generations. So much so, really, that hundreds of millions of people seemingly can not envision meaningful change. The constant "just get a great job with great benefits!" refrain irks me to no end, and demonstrates a privilege that people often deny exists. Even if/when I can get that "great job with great benefits", I still only have it at the pleasure of the employer. I grow old? You're gone. Employer makes bad decisions? They "take responsibility" by letting me go. The notion of having access to health care, regardless of my employment status, should be such a basic thing to grasp. If I'm unemployed for a year or so (illness, family issues, whatever), having to upend specific doctors/medicines/hospitals/treatments because "insurance change" is life altering for many. Seen it myself in dozens of personal connections over the years. Want to change jobs? Whether abusive working conditions or just need to be with family? "Can't do it... I need my health care... the only doctors that take my health care are in this area...". Or... "I won't have health insurance for 6 months if I take that new job". There's 1000 different examples I could find why "employer/insurance" connection is bad, and very few I can think of that are good for all parties, yet, we continue in this mess. > but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. I know a growing number of folks doing this, and many more who would love to, but ... "health insurance" keeps them tied to "employers". argh...
  - ericmay 4y ago
    Great post and I do apologize if I came off as 'not caring' about people working independently it's just if we do broad characterizations we have to compare broadly and so few work independently. Maybe an idea there to start an independent business owners healthcare association or something that redistributes profits via lower premiums or something? How the hell do you start something like that?
    - mgkimsal 4y ago
      FWIW, there are orgs that do that, but they almost always end up being somewhat regional, and... it ends up being a lot of work. FreelancersUnion, in New York, I believe did/does something like that. Some chambers of commerce and similar groups do too, but... it doesn't really end up changing much of the price at all, especially since ACA. (oh, misread, I initially read that as simply just offering a buyers group to get 'group' rates). You've generally always been able to buy health insurance independently. I started... 14(?) years ago. The ACA, well-intentioned, was hobbled from day one, and my $220/month high deductible plan has morphed in to a $1300/month plan which is still high deductible ($14k/year), has fewer options, and ... well... some pregnancy services will be covered (cis male here). You want a 'low' deductible? You're looking at probably $2k or more for 2 adults. And yes, I know health insurance has an age component - I'm years older than I was then too. $3k/year in exchange for taking on some risk (higher deductible) makes some sense. But base price of $15k/year in health insurance, plus another $14k/year in deductibles means this is essentially catastrophic only, but not really priced as such). It's all region-based, and even where I'm at, I get measurably fewer options because I live 2 miles over a county line, and 'no one' insures out here. It got worse for several years - I know in NC, there are ~100 counties, and I believe there were more than 30 at one point who had only one insurer even selling health insurance in those counties. Also.. FWIW, I didn't take it as you didn't care, but yes, freelance workers are generally overlooked, even as the ranks grow. They just tend to be growing on the lower-end of the spectrum - rideshare drivers, door dash delivery, etc. Much easier to just ignore growing segments of society while we pride ourselves on our ability to "get a better job with great benefits!". I'm not in a position of having to choose food over medication, but having to decide between medication or surgery today over funding retirement savings? I've been there, as have some friends of mine. Yes, it comes across as a bit privileged, but privileges are all relative.
deleted 4y ago
[deleted]

ericmay 4y ago

But if you are earning that you are likely working for a large corporation where your actual out of pocket expenses are much closer to something like $1000/month for that family (varies by situation). Far better scenario then a much lower European salary (probably closer to $80,000) with higher taxes and the same (at best) quality care. If you are working independently yea it may be more expensive, but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. Though worth noting providing a way to untie healthcare from employers and still make it affordable so that you can more easily start a company is a good idea. It’s really difficult to do good analysis here. If you were in Ohio making $190,000 your family is automatically in the top 10% or so. If you worked remote you could buy a house outside of a major city for your salary equivalent, or in a city like Columbus for 2x your salary with some fantastic public schools. Also a nitpick while I think you get much more efficient and cheaper healthcare with the government running it, at the end of the day it’s never free so you have to actually compare taxes to premiums to get a fair assessment of cost.

mgkimsal 4y ago
> untie healthcare from employers This 1000 times. I don't think we'll see a meaningful change in my lifetime, but it's an existential burden that we, collectively, have had for generations. So much so, really, that hundreds of millions of people seemingly can not envision meaningful change. The constant "just get a great job with great benefits!" refrain irks me to no end, and demonstrates a privilege that people often deny exists. Even if/when I can get that "great job with great benefits", I still only have it at the pleasure of the employer. I grow old? You're gone. Employer makes bad decisions? They "take responsibility" by letting me go. The notion of having access to health care, regardless of my employment status, should be such a basic thing to grasp. If I'm unemployed for a year or so (illness, family issues, whatever), having to upend specific doctors/medicines/hospitals/treatments because "insurance change" is life altering for many. Seen it myself in dozens of personal connections over the years. Want to change jobs? Whether abusive working conditions or just need to be with family? "Can't do it... I need my health care... the only doctors that take my health care are in this area...". Or... "I won't have health insurance for 6 months if I take that new job". There's 1000 different examples I could find why "employer/insurance" connection is bad, and very few I can think of that are good for all parties, yet, we continue in this mess. > but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. I know a growing number of folks doing this, and many more who would love to, but ... "health insurance" keeps them tied to "employers". argh...
- ericmay 4y ago
  Great post and I do apologize if I came off as 'not caring' about people working independently it's just if we do broad characterizations we have to compare broadly and so few work independently. Maybe an idea there to start an independent business owners healthcare association or something that redistributes profits via lower premiums or something? How the hell do you start something like that?
  - mgkimsal 4y ago
    FWIW, there are orgs that do that, but they almost always end up being somewhat regional, and... it ends up being a lot of work. FreelancersUnion, in New York, I believe did/does something like that. Some chambers of commerce and similar groups do too, but... it doesn't really end up changing much of the price at all, especially since ACA. (oh, misread, I initially read that as simply just offering a buyers group to get 'group' rates). You've generally always been able to buy health insurance independently. I started... 14(?) years ago. The ACA, well-intentioned, was hobbled from day one, and my $220/month high deductible plan has morphed in to a $1300/month plan which is still high deductible ($14k/year), has fewer options, and ... well... some pregnancy services will be covered (cis male here). You want a 'low' deductible? You're looking at probably $2k or more for 2 adults. And yes, I know health insurance has an age component - I'm years older than I was then too. $3k/year in exchange for taking on some risk (higher deductible) makes some sense. But base price of $15k/year in health insurance, plus another $14k/year in deductibles means this is essentially catastrophic only, but not really priced as such). It's all region-based, and even where I'm at, I get measurably fewer options because I live 2 miles over a county line, and 'no one' insures out here. It got worse for several years - I know in NC, there are ~100 counties, and I believe there were more than 30 at one point who had only one insurer even selling health insurance in those counties. Also.. FWIW, I didn't take it as you didn't care, but yes, freelance workers are generally overlooked, even as the ranks grow. They just tend to be growing on the lower-end of the spectrum - rideshare drivers, door dash delivery, etc. Much easier to just ignore growing segments of society while we pride ourselves on our ability to "get a better job with great benefits!". I'm not in a position of having to choose food over medication, but having to decide between medication or surgery today over funding retirement savings? I've been there, as have some friends of mine. Yes, it comes across as a bit privileged, but privileges are all relative.

deleted 4y ago

[deleted]