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I've often wondered this. We already know that individuals by and large hate employer-based healthcare coverage but at what point to employers relvolt? The cost

I've often wondered this. We already know that individuals by and large hate employer-based healthcare coverage but at what point to employers relvolt? The costs on employers are large and getting larger in terms of contributions to premiums as a benefit needed to attract talent, not to mention considerable time and manpower spent sourcing and managing coverage for employees.

maximinus_thrax 2y ago
> but at what point to employers relvolt? Why would they? They often pass the cost increases to the employees and employer-tied healthcare it's a useful retention tool as people are far less likely to quit if their treatments would suddenly become very expensive.
- alephnerd 2y ago
  > They often pass the cost increases to the employees Up to a limit. In well compensated white collar industries like Software, Life Sciences, and even Hardware, a good health plan can be a major differentiator or ensure strong employee retention, because a $20-30k raise is basically $12-18k after tax (not bad, but not worth the amount of headaches) I know some larger companies in the Bay Area that don't pay as competitive as Netflix but provide BCBS at a very low cost.
- no_wizard 2y ago
  This assumes every business shares this vision. I'm sure big fortune 500 companies that can absorb these costs over competitors might see some value here[0][1] but I don't think the vast majority of businesses see it this way, most would seemingly benefit[2][3][4] by being able to attract talent more reasonably, and particularly helps small business and other smaller entities. Though I imagine there is an other components that drive support or resistance[5], I don't think its uniformly beneficial for business writ large to keep the current system [0]: Though it wasn't broadly employers that opposed both the public option for the ACA or Medicare 4 All, but insurance companies and adjacent services most specifically. [1]: Though, there is some notion (though no hard evidence) that bigger businesses can use it as retention and recruitment tool (https://www.marketplace.org/2021/06/10/why-dont-u-s-businesses-show-more-support-for-single-payer-health-care/ https://www.marketplace.org/2021/06/10/why-dont-u-s-business...) I don't think their ability to recruit top talent rests solely on healthcare options, however. [2]: https://www.epi.org/publication/medicare-for-all-would-help-the-labor-market/ https://www.epi.org/publication/medicare-for-all-would-help-... [3]: Though Automakers and other manufacturing companies likely benefit regardless of size: https://www.autonews.com/article/20050328/SUB/503280747/japan-s-health-care-gives-toyota-edge https://www.autonews.com/article/20050328/SUB/503280747/japa... [4]: https://www.blhct.org/about https://www.blhct.org/about [5]: Such as business owner(s) political ideology (in either direction), tax policy implications and the like.
  - maximinus_thrax 2y ago
    This is a very well written comment, so thank you :) What I'm saying is obviously speculation, but it's based on the following: - large fortune 500 companies are the ones with actual political power. The vast majority of businesses are far less likely to be able to lobby for significant policy change. - that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo. - their ability to recruit kinda stopped after ACA. Before that, major players had 100% free healthcare, which was an actual recruitment advantage. Nowadays, it's pretty uniform so it does not matter. HOWEVER, I personally have some anecdata about folks who stay in big tech because they have kids with special needs, care which would be super expensive if they wanted to move to some small startup or even a government job.
    - no_wizard 2y ago
      >that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo. On this specifically, what I have read on the subject suggests that most businesses simply aren't evaluating this to begin with, even big ones, but the ones that have, such as the big 3 Automakers, are actually for universal health care (since it significantly reduces their costs for employee benefits, especially for retired workers) and other big businesses with manufacturing interests. Many large employers like state governments would really benefit from federally implemented universal healthcare as well and they do lobby for this. I simply think that the insurance and adjacent industries have such targeted lobbying on this that other lobbying is more easily ignored, since GM for instance, isn't spending millions to specifically lobby for universal healthcare, while insurance companies and adjacent industries that benefit from the status quo directly lobby consistently spending millions against it, quite specifically
vladgur 2y ago
short of act of congress, there is no alternative. Access to healthcare is part of your compensation in the US. I would have to quit if my company wasnt providing a reasonable medical coverage because these costs can otherwise bankrupt a person in this country
- ribosometronome 2y ago
  >Access to healthcare is part of your compensation in the US. Which is, itself, due to acts of Congress. Our system is the product of intentional design.
  - Domenic_S 2y ago
    Sort of. The Stabilization Act of 1942 (act of Congress) authorized FDR's Executive Order 9328 [0], which was a price/wage stabilization Order meant to keep the economy stable during WWII. Because companies could no longer compete via wages, they began competing with fringe benefits -- health insurance being chief among them. It's been that way ever since. [0] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942
- zamfi 2y ago
  > I would have to quit if my company wasnt providing a reasonable medical coverage because these costs can otherwise bankrupt a person in this country Your insurance would be functionally quite similar if you purchased it in the private market, and its relative cost compared to your company's premiums depends on your age (and smoker status) compared with the average at your company. But the upshot is that your cash compensation is probably quite a lower because your employer is paying for your healthcare bills. This bundling doesn't necessarily serve you or your employer, though if you're an older employee with dependents who are also covered, you may be benefitting from an implicit subsidy by younger employees without dependents.
  - pixl97 2y ago
    >, you may be benefitting from an implicit subsidy by younger employees without dependents. And they in reverse benefit from me paying a higher tax bracket because of my higher income. This is one of those tradeoffs we all make in a society. We'd all be better off at the end of the day if healthcare was separated out from work and we'd just pay it out of taxes directly, like every other reasonable country out there.
s1artibartfast 2y ago
I wonder if it would be considered illegal age discrimination to offer a cash alternative to employer Healthcare. It may be the case that the insurers would heavily penalize the employer for doing this as well
- gangstead 2y ago
  I had one employer that offered that years ago. If you opted out of the healthcare plan they gave you $100 / pay period instead. I think the goal was to get married people to choose their spouses plan if they could. It seemed to me that the amount offered was too low to tempt anyone to actually take it. In my case it would have added like $300 per month to my spouses plan.
HumblyTossed 2y ago
> but at what point to employers relvolt? They won't. Sure it's expensive, but it gives them control over employees. Losing benefits is a fear for a lot of people. Gaining benefits is a badge of honor for some people. No, employers like it this way.

maximinus_thrax 2y ago

> but at what point to employers relvolt? Why would they? They often pass the cost increases to the employees and employer-tied healthcare it's a useful retention tool as people are far less likely to quit if their treatments would suddenly become very expensive.

alephnerd 2y ago
> They often pass the cost increases to the employees Up to a limit. In well compensated white collar industries like Software, Life Sciences, and even Hardware, a good health plan can be a major differentiator or ensure strong employee retention, because a $20-30k raise is basically $12-18k after tax (not bad, but not worth the amount of headaches) I know some larger companies in the Bay Area that don't pay as competitive as Netflix but provide BCBS at a very low cost.
no_wizard 2y ago
This assumes every business shares this vision. I'm sure big fortune 500 companies that can absorb these costs over competitors might see some value here[0][1] but I don't think the vast majority of businesses see it this way, most would seemingly benefit[2][3][4] by being able to attract talent more reasonably, and particularly helps small business and other smaller entities. Though I imagine there is an other components that drive support or resistance[5], I don't think its uniformly beneficial for business writ large to keep the current system [0]: Though it wasn't broadly employers that opposed both the public option for the ACA or Medicare 4 All, but insurance companies and adjacent services most specifically. [1]: Though, there is some notion (though no hard evidence) that bigger businesses can use it as retention and recruitment tool (https://www.marketplace.org/2021/06/10/why-dont-u-s-businesses-show-more-support-for-single-payer-health-care/ https://www.marketplace.org/2021/06/10/why-dont-u-s-business...) I don't think their ability to recruit top talent rests solely on healthcare options, however. [2]: https://www.epi.org/publication/medicare-for-all-would-help-the-labor-market/ https://www.epi.org/publication/medicare-for-all-would-help-... [3]: Though Automakers and other manufacturing companies likely benefit regardless of size: https://www.autonews.com/article/20050328/SUB/503280747/japan-s-health-care-gives-toyota-edge https://www.autonews.com/article/20050328/SUB/503280747/japa... [4]: https://www.blhct.org/about https://www.blhct.org/about [5]: Such as business owner(s) political ideology (in either direction), tax policy implications and the like.
- maximinus_thrax 2y ago
  This is a very well written comment, so thank you :) What I'm saying is obviously speculation, but it's based on the following: - large fortune 500 companies are the ones with actual political power. The vast majority of businesses are far less likely to be able to lobby for significant policy change. - that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo. - their ability to recruit kinda stopped after ACA. Before that, major players had 100% free healthcare, which was an actual recruitment advantage. Nowadays, it's pretty uniform so it does not matter. HOWEVER, I personally have some anecdata about folks who stay in big tech because they have kids with special needs, care which would be super expensive if they wanted to move to some small startup or even a government job.
  - no_wizard 2y ago
    >that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo. On this specifically, what I have read on the subject suggests that most businesses simply aren't evaluating this to begin with, even big ones, but the ones that have, such as the big 3 Automakers, are actually for universal health care (since it significantly reduces their costs for employee benefits, especially for retired workers) and other big businesses with manufacturing interests. Many large employers like state governments would really benefit from federally implemented universal healthcare as well and they do lobby for this. I simply think that the insurance and adjacent industries have such targeted lobbying on this that other lobbying is more easily ignored, since GM for instance, isn't spending millions to specifically lobby for universal healthcare, while insurance companies and adjacent industries that benefit from the status quo directly lobby consistently spending millions against it, quite specifically

vladgur 2y ago

short of act of congress, there is no alternative. Access to healthcare is part of your compensation in the US. I would have to quit if my company wasnt providing a reasonable medical coverage because these costs can otherwise bankrupt a person in this country

ribosometronome 2y ago
>Access to healthcare is part of your compensation in the US. Which is, itself, due to acts of Congress. Our system is the product of intentional design.
- Domenic_S 2y ago
  Sort of. The Stabilization Act of 1942 (act of Congress) authorized FDR's Executive Order 9328 [0], which was a price/wage stabilization Order meant to keep the economy stable during WWII. Because companies could no longer compete via wages, they began competing with fringe benefits -- health insurance being chief among them. It's been that way ever since. [0] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.wikipedia.org/wiki/Stabilization_Act_of_1942
zamfi 2y ago
> I would have to quit if my company wasnt providing a reasonable medical coverage because these costs can otherwise bankrupt a person in this country Your insurance would be functionally quite similar if you purchased it in the private market, and its relative cost compared to your company's premiums depends on your age (and smoker status) compared with the average at your company. But the upshot is that your cash compensation is probably quite a lower because your employer is paying for your healthcare bills. This bundling doesn't necessarily serve you or your employer, though if you're an older employee with dependents who are also covered, you may be benefitting from an implicit subsidy by younger employees without dependents.
- pixl97 2y ago
  >, you may be benefitting from an implicit subsidy by younger employees without dependents. And they in reverse benefit from me paying a higher tax bracket because of my higher income. This is one of those tradeoffs we all make in a society. We'd all be better off at the end of the day if healthcare was separated out from work and we'd just pay it out of taxes directly, like every other reasonable country out there.

s1artibartfast 2y ago

I wonder if it would be considered illegal age discrimination to offer a cash alternative to employer Healthcare. It may be the case that the insurers would heavily penalize the employer for doing this as well

gangstead 2y ago
I had one employer that offered that years ago. If you opted out of the healthcare plan they gave you $100 / pay period instead. I think the goal was to get married people to choose their spouses plan if they could. It seemed to me that the amount offered was too low to tempt anyone to actually take it. In my case it would have added like $300 per month to my spouses plan.

HumblyTossed 2y ago

> but at what point to employers relvolt? They won't. Sure it's expensive, but it gives them control over employees. Losing benefits is a fear for a lot of people. Gaining benefits is a badge of honor for some people. No, employers like it this way.