6 ms·

If health benefits didn't have tax breaks, employers would probably stop giving them and would be able to pay a bit more in salary (benefit cost - increased tax

by walkon 17y ago

If health benefits didn't have tax breaks, employers would probably stop giving them and would be able to pay a bit more in salary (benefit cost - increased taxes). I personally would prefer to be paid more and use that to select my own health plan, that way it would be portable.

potatolicious 17y ago
Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. I'm of the opposite opinion, having grown up in Canada (now in the US). I'd much rather have a public plan, even if it means worse care for a moderately well-to-do individual like myself. The whole American health care debate appears to me as a matter of the haves vs. the have-nots, with the added complexity that a lot of have-nots seem to incorrectly identify themselves as haves.
- orangecat 17y ago
  Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. There definitely needs to be a solution for those who are uninsurable, but employer coverage is a lousy mechanism for that. I'd much rather have a "public option" that charges a reasonable multiple of what the premium for a healthy person would be. That would ensure that you could always get coverage, and provide a guaranteed ceiling on your expenses.
- walkon 17y ago
  The game would be significantly changed if employers stopped offering it as part of a benefit package. I'm sure the housing hazard insurance industry would look much different if it was a standard employment benefit. Ultimately, insurance of any kind is a financial risk mitigation pool. The financial risks are spread over those in the pool instead of just one. Everyone in the pool shares the cost of everyone else. I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it.
  - abstractbill 17y ago
    The financial risks are spread over those in the pool instead of just one. Everyone in the pool shares the cost of everyone else. I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it. This uniquely American attitude is honestly one of the very few reasons I occasionally consider moving back to Britain.
  - potatolicious 17y ago
    > I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it. This may seem innocuous to Americans, but for us Canadians this sentence epitomizes why American health care is in the mess it is today. The lack of concern for your fellow man is disconcerting at best - and based on people I've talked to here in the US people generally don't feel that other people being sick and dying will negatively affect them. IMHO this is the big difference: in socialized medicine countries we acknowledge that when a large swathe of the population goes without basic medical care, we all lose - lost productivity, general misery, etc. There's at least the general notion of paying up "for the greater good". In America I get the feeling it's more treated as "meh, maybe you should work harder". The level of apathy demonstrated for people less fortunate is frankly the one thing that has shocked me ever since moving here, and nowadays is part of my "definition" of the American consciousness. It's always someone else's problem, not our collective problem.
    - DanielBMarkham 17y ago
      I accidentally upvoted you, so I feel I have to weigh in here. I find you greatly oversimplify in order to prevent your own understanding of the greater issues involved. Let's assume for a moment that every American is totally dedicated to helping his fellow man as much as possible. Would that necessarily result in free public healthcare? It's a perfectly reasonable (yet unpopular view) to think that helping other people means doing the things that result in the greater, longer-term good, and that might mean make life miserable. Humanity that struggles is humanity that innovates, adapts, and evolves. Humanity that stagnates does not. There is a very good case to be made for inaction. It's also quite ludicrous to think that, given the inclination to take some sort of direct action in my fellow man's affairs that _you_ get to define what the appropriate sort of action might be. Perhaps instead of a free doctor, I feel that a cash stipend might be best, where the recipient gets to choose how it is spent. Or, perhaps because I think poor people have poor spending habits, I choose to provide free shelter. To even start thinking along the lines that one solution would fit all problems is to engage in the most wide over-generalizations. And to think that you (or anybody else) gets to decide what this one solution would be and basically try to shame everybody else into accepting this one answer is a non-starter. Reasonable people are going to tell you to go jump in a lake. Finally, it's completely disconnected to think that my actions have a direct result on other people's lives. People have a dignity and respect that is part of who they are, foibles and all. My writing a check doesn't make a person into a better one, doesn't necessarily improve their life, and might actually make their problems worse. People are who they are. Even when I'm committed to action, even when I've decided to take direct action, even when I think I know what the best action is, I take action because it is the right thing to do for me, not because I'm expecting some sort of miracle result from it. Having said that, I think there is a strong moral case for some sort of catastrophic health insurance -- mainly because people cannot be allowed to forfeit their life savings because they had the misfortune to die from expensive diseases. However, I respect that others might choose to let each man fend for himself. This country was founded by people braving the wilds, not hanging out at the soup kitchen. As a species, in my opinion, the more comfortable we make our cave, the less likely we ever are to venture out of it (travel to the stars)
- Dove 17y ago
  Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. That's a bug in how the contracts are written. Things don't have to be done that way. Standard insurance pays by the treatment, but a reasonable contract would pay by the disease. In my ideal world, I'd be able to walk into Allstate and say, "Hi, I'd like an insurance policy against lung cancer." "Okay. At your age, health, and risk level, your risk level is X over six months. We offer a six month contract covering treatment plan A, averaging $Y for $XYProfit or treatment plan B, averaging $Z for $XZProfit." "Only six months? If I'm still sick after six months, my rates go up?" "Actually, $Y is the lifetime cost of Plan A. In the event you are diagnosed with lung cancer, we are contractually obligated to pay for the treatment strategy outlined there for the rest of your life." "Even if I can't keep up with the premiums?" "It doesn't work that way. This is a one time contract designed to mitigate risk over the coming six months; if you fall ill, you have no further obligation to us." "Can I change from Plan A to Plan B after I get sick?" "You can, but it'll cost you $Z - $Y. At that point, though, it's not really insurance -- more like a financing and payment plan, so the cost is much higher. You're best off selecting the level of coverage you want in advance, or arranging financing at the time." "So, if I do develop lung cancer, my acute injury contract with you is unaffacted?" "Right." "Or I could even switch to State Farm for that, and you'd still be obligated to pay for lung cancer treatment." "Right, though where synergistic treatements are possible, we offer a significant discount if you buy all your health insurance through us..." This seems to me like the omly mathematically sensible way to do it, and I find it perverse that it's done any other way. Let alone that the other way is standard practice. You buy insurance to mitigate risk. I buy a fire insurance policy that covers the cost of repairs to my house in the event of a fire. I would never buy a fire insurance policy that covered any repairs to be made within a month of the fire's occurance (after which the company might drop me or my rates might go up), nor would I expect a company to offer "insurance" that covered any repairs to be made in the current month as a result of previous fires. That would be mathematically insane. And yet it is the default case with health insurance. It mitigates the cost of this month's treatments, not this lifetime's diseases. "So . . . I need to disclose something. I'm actually shopping for lung cancer insurance because I already have lung cancer, and I can't afford the treatment." "The situation is very different, then, but we can still help you manage the overall cost of treatment. Plan A costs $Y and Plan B costs $Z, and comes with these options--" "Whoa, whoa, whoa. Those are hundreds of thousands of dollars, and you want it up front? I can't possibly afford that." "Oh, that's just the total price of the contract. Our financing department typically offers 15 to 30 year payment plans, with some risk premiums." "Paying for two years of treatment over three decades? It still looks expensive." "Yes, it's better to have insurance up front, so you can pool risk with others who match your risk profile. But even after the fact, you can still pay for predictability. You may have an easy and successful treatment, or you may suffer a costly and prolonged process followed by even a relapse. The cost to you is $Y either way." "Okay, well, so . . . not only am I uninsured and already sick, I'm also poor and don't really have any assets. You'd have be crazy to loan me money to cover even the most bare bones treatment plan. Am I just SOL?" "Well . . . we can't do much for you. At this point, you're not trying to mitigate risk, you're trying to get other people to pay for an already incurred cost. That's not insurance anymore, that's charity, and we can refer you to St. Joseph's Hospital. . ." If you want to offer universal treatment to the poor, it is a noble charitable goal -- on par with offering universal food or universal education or pursuing world peace. Establish a fund or program for that purpose and go for it. But leave the people who are buying actual insurance alone! I want a health insurance contract that is portable, customizable, and that does not give me or the insurer or the doctor perverse contractual or treatment incentives. In particular, I want a plan that actually mitigates the risk I'm trying to mitigate. I want the cost to be reactive to my personal risk level -- I don't want to pay for anyone else's health care, and I don't want anyone else to pay for mine. The lung cancer insurance cost should go up if I smoke. The cost to cover kids against genetic disease should go up if my spouse and I are both cystic fibrosis carriers. The costs in general should go down if I can pass a bi-annual athletic test. I want to be able to self-insure at whatever level I think is financially appropriate, and I want to expect to pay cash for routine or elective procedures. I don't want to be denied vaccination, required to vaccinate, or even vaccinated for free; I want to be offered a $17 tetanus shot in exhange for $4 off my monthly insurance bill. Right now, employment is insurance and health care is partly charity and insurance is partly charity and charity is largely employment. I'd love to live in a world where employment was employment, health care was health care, charity was charity, and insurance was insurance.

by walkon 17y ago

potatolicious 17y ago

Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. I'm of the opposite opinion, having grown up in Canada (now in the US). I'd much rather have a public plan, even if it means worse care for a moderately well-to-do individual like myself. The whole American health care debate appears to me as a matter of the haves vs. the have-nots, with the added complexity that a lot of have-nots seem to incorrectly identify themselves as haves.

orangecat 17y ago
Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. There definitely needs to be a solution for those who are uninsurable, but employer coverage is a lousy mechanism for that. I'd much rather have a "public option" that charges a reasonable multiple of what the premium for a healthy person would be. That would ensure that you could always get coverage, and provide a guaranteed ceiling on your expenses.
walkon 17y ago
The game would be significantly changed if employers stopped offering it as part of a benefit package. I'm sure the housing hazard insurance industry would look much different if it was a standard employment benefit. Ultimately, insurance of any kind is a financial risk mitigation pool. The financial risks are spread over those in the pool instead of just one. Everyone in the pool shares the cost of everyone else. I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it.
- abstractbill 17y ago
  The financial risks are spread over those in the pool instead of just one. Everyone in the pool shares the cost of everyone else. I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it. This uniquely American attitude is honestly one of the very few reasons I occasionally consider moving back to Britain.
- potatolicious 17y ago
  > I don't want the government creating a super large public pool that I am required to pay for, even if I'm allowed to choose not to be a member of it. This may seem innocuous to Americans, but for us Canadians this sentence epitomizes why American health care is in the mess it is today. The lack of concern for your fellow man is disconcerting at best - and based on people I've talked to here in the US people generally don't feel that other people being sick and dying will negatively affect them. IMHO this is the big difference: in socialized medicine countries we acknowledge that when a large swathe of the population goes without basic medical care, we all lose - lost productivity, general misery, etc. There's at least the general notion of paying up "for the greater good". In America I get the feeling it's more treated as "meh, maybe you should work harder". The level of apathy demonstrated for people less fortunate is frankly the one thing that has shocked me ever since moving here, and nowadays is part of my "definition" of the American consciousness. It's always someone else's problem, not our collective problem.
  - DanielBMarkham 17y ago
    I accidentally upvoted you, so I feel I have to weigh in here. I find you greatly oversimplify in order to prevent your own understanding of the greater issues involved. Let's assume for a moment that every American is totally dedicated to helping his fellow man as much as possible. Would that necessarily result in free public healthcare? It's a perfectly reasonable (yet unpopular view) to think that helping other people means doing the things that result in the greater, longer-term good, and that might mean make life miserable. Humanity that struggles is humanity that innovates, adapts, and evolves. Humanity that stagnates does not. There is a very good case to be made for inaction. It's also quite ludicrous to think that, given the inclination to take some sort of direct action in my fellow man's affairs that _you_ get to define what the appropriate sort of action might be. Perhaps instead of a free doctor, I feel that a cash stipend might be best, where the recipient gets to choose how it is spent. Or, perhaps because I think poor people have poor spending habits, I choose to provide free shelter. To even start thinking along the lines that one solution would fit all problems is to engage in the most wide over-generalizations. And to think that you (or anybody else) gets to decide what this one solution would be and basically try to shame everybody else into accepting this one answer is a non-starter. Reasonable people are going to tell you to go jump in a lake. Finally, it's completely disconnected to think that my actions have a direct result on other people's lives. People have a dignity and respect that is part of who they are, foibles and all. My writing a check doesn't make a person into a better one, doesn't necessarily improve their life, and might actually make their problems worse. People are who they are. Even when I'm committed to action, even when I've decided to take direct action, even when I think I know what the best action is, I take action because it is the right thing to do for me, not because I'm expecting some sort of miracle result from it. Having said that, I think there is a strong moral case for some sort of catastrophic health insurance -- mainly because people cannot be allowed to forfeit their life savings because they had the misfortune to die from expensive diseases. However, I respect that others might choose to let each man fend for himself. This country was founded by people braving the wilds, not hanging out at the soup kitchen. As a species, in my opinion, the more comfortable we make our cave, the less likely we ever are to venture out of it (travel to the stars)
Dove 17y ago
Except non-employer health plans rarely cover pre-existing conditions, which ultimately is what ails most people and contributes most to prolonged suffering in quality of life. That's a bug in how the contracts are written. Things don't have to be done that way. Standard insurance pays by the treatment, but a reasonable contract would pay by the disease. In my ideal world, I'd be able to walk into Allstate and say, "Hi, I'd like an insurance policy against lung cancer." "Okay. At your age, health, and risk level, your risk level is X over six months. We offer a six month contract covering treatment plan A, averaging $Y for $XYProfit or treatment plan B, averaging $Z for $XZProfit." "Only six months? If I'm still sick after six months, my rates go up?" "Actually, $Y is the lifetime cost of Plan A. In the event you are diagnosed with lung cancer, we are contractually obligated to pay for the treatment strategy outlined there for the rest of your life." "Even if I can't keep up with the premiums?" "It doesn't work that way. This is a one time contract designed to mitigate risk over the coming six months; if you fall ill, you have no further obligation to us." "Can I change from Plan A to Plan B after I get sick?" "You can, but it'll cost you $Z - $Y. At that point, though, it's not really insurance -- more like a financing and payment plan, so the cost is much higher. You're best off selecting the level of coverage you want in advance, or arranging financing at the time." "So, if I do develop lung cancer, my acute injury contract with you is unaffacted?" "Right." "Or I could even switch to State Farm for that, and you'd still be obligated to pay for lung cancer treatment." "Right, though where synergistic treatements are possible, we offer a significant discount if you buy all your health insurance through us..." This seems to me like the omly mathematically sensible way to do it, and I find it perverse that it's done any other way. Let alone that the other way is standard practice. You buy insurance to mitigate risk. I buy a fire insurance policy that covers the cost of repairs to my house in the event of a fire. I would never buy a fire insurance policy that covered any repairs to be made within a month of the fire's occurance (after which the company might drop me or my rates might go up), nor would I expect a company to offer "insurance" that covered any repairs to be made in the current month as a result of previous fires. That would be mathematically insane. And yet it is the default case with health insurance. It mitigates the cost of this month's treatments, not this lifetime's diseases. "So . . . I need to disclose something. I'm actually shopping for lung cancer insurance because I already have lung cancer, and I can't afford the treatment." "The situation is very different, then, but we can still help you manage the overall cost of treatment. Plan A costs $Y and Plan B costs $Z, and comes with these options--" "Whoa, whoa, whoa. Those are hundreds of thousands of dollars, and you want it up front? I can't possibly afford that." "Oh, that's just the total price of the contract. Our financing department typically offers 15 to 30 year payment plans, with some risk premiums." "Paying for two years of treatment over three decades? It still looks expensive." "Yes, it's better to have insurance up front, so you can pool risk with others who match your risk profile. But even after the fact, you can still pay for predictability. You may have an easy and successful treatment, or you may suffer a costly and prolonged process followed by even a relapse. The cost to you is $Y either way." "Okay, well, so . . . not only am I uninsured and already sick, I'm also poor and don't really have any assets. You'd have be crazy to loan me money to cover even the most bare bones treatment plan. Am I just SOL?" "Well . . . we can't do much for you. At this point, you're not trying to mitigate risk, you're trying to get other people to pay for an already incurred cost. That's not insurance anymore, that's charity, and we can refer you to St. Joseph's Hospital. . ." If you want to offer universal treatment to the poor, it is a noble charitable goal -- on par with offering universal food or universal education or pursuing world peace. Establish a fund or program for that purpose and go for it. But leave the people who are buying actual insurance alone! I want a health insurance contract that is portable, customizable, and that does not give me or the insurer or the doctor perverse contractual or treatment incentives. In particular, I want a plan that actually mitigates the risk I'm trying to mitigate. I want the cost to be reactive to my personal risk level -- I don't want to pay for anyone else's health care, and I don't want anyone else to pay for mine. The lung cancer insurance cost should go up if I smoke. The cost to cover kids against genetic disease should go up if my spouse and I are both cystic fibrosis carriers. The costs in general should go down if I can pass a bi-annual athletic test. I want to be able to self-insure at whatever level I think is financially appropriate, and I want to expect to pay cash for routine or elective procedures. I don't want to be denied vaccination, required to vaccinate, or even vaccinated for free; I want to be offered a $17 tetanus shot in exhange for $4 off my monthly insurance bill. Right now, employment is insurance and health care is partly charity and insurance is partly charity and charity is largely employment. I'd love to live in a world where employment was employment, health care was health care, charity was charity, and insurance was insurance.