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Comment by watertom | Hacker News Reader

Health insurance is also part of the rigged labor market.

The only reason big companies offer health insurance is because it limits employees's freedom. It would be easy for the Fortune 100 or 200 in unison agree to eliminate health care and provide a higher salaries. It would make the companies more competitive globally and it would free them from a whole lot of other nonsense, but they don't drop healthcare. The reason they don't droop healthcare is because healthcare and pre-existing conditions limit employee options and it suppresses wages. Also if there was universal healthcare it would be easier to start small companies and attract employees, those small business would be competing for employees against big companies on equal footing.

Healthcare is a racket limiting not just healthcare but freedom.

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Employer-provided healthcare got started in the US because of wage and price controls (employers were allowed to improve healthcare benefits but not increase salaries directly), and continued because it's exempt from income tax.

Some big companies may prefer it this way, but a lot of others with plenty of political clout (e.g. carmakers) don't. On the whole, that's not a major reason employer-provided healthcare is still afflicting us.

> Healthcare is a racket limiting not just healthcare but freedom

The fact that Healthcare is tied to employment is downright shocking to virtually all developed countries.

As an American, I'm routinely disappointed every time they announce "healthcare reform" and this issue isn't even part the conversation. Both major parties have failed on this.

McCain tried in 2008: http://www.commonwealthfund.org/publications/fund-reports/20.... The Democrats immediately attacked it as "taking away your existing insurance".

It really is baffling. Everybody would understand that it would be terrible if employers were the primary providers of housing, food, or transportation. But for some reason with health insurance, we not only accept but demand it.

Allegedly, the "Cadillac tax" on expensive employer provided plans was supposed to phase out employer coverage. That portion of the law purposefully wasn't indexed to inflation so that eventually more and more plans would be subject to the tax.

> we not only accept but demand it

Hey, leave me out of it. Plus, polling is misleading. There are certainly options we could settle for, like grandfather clauses and gradual phase-ins.

Healthcare is absolutely available to those without employment. Where have you heard otherwise?

In fact I wouldn't be surprised if the majority of the healthcare burden in the US is from patients without employment. Medicare and Medicaid are some of the largest funds out there.

Oh, I'm not saying it's not available to those without employment, I'm saying it's sickening that it is very often tied to employment, for those that have employment.

Ones employment and ones health should not be linked in anyway whatsoever, lest bad things happen.

I agree entirely. Student debt and healthcare have evolved to be a means of keeping people trapped in industry. After dealing with health care in other countries, I wrote a post on what I found returning to America:

http://fightthefuture.org/article/returning-to-america-and-t...

America wants you to work. Work work work work work. Our European neighbours can save up and take a few months off every few years and not have to worry about health care. In America, we only get socialised healthcare when we're too old to work and are no longer useful to society.

To be fair, Americans work. Work work work work[1]. Americans love work and elect politicians who love work.

Europeans hate work. Hate hate hate hate[2]. They hate work and elect politicians who also hate work.

That major (cultural? economic? social? political?) difference between American and European attitudes towards work might explain these statistics:

American vs EU unemployment rate: 4.7% vs 8.2% American vs EU youth unemployment rate: 9.4% vs 17.3% American vs EU GDP per capita: $56k vs $35k

And so on.

Point being, things are only the way they are because we want them to be that way--and elect politicians who do as well.

That said, I agree with the core premise: corporate-sponsored healthcare is a lousy drag on the economy...

[1] http://www.projecttimeoff.com/news/press-releases/americans-... [2] https://www.etui.org/Topics/Trade-union-renewal-and-mobilisa...

One thing about EU vs US comparisons: EU is not a monolith, it is an organization with 28 different member countries.

Some of EU members are on the same level as US (e.g. GDP per capita is $51k for Netherlands, $48k Germany), and then there are poor, post-communist countries like Romania and Bulgaria which have GDP of $20k, which brings EU average down.

Same goes for unemployment: Germany -> 3.9%, Netherlands -> 5.1%, Spain -> 18.75%

Plus, there is no such thing as "European attitude towards the work", because Europe is very diverse in that regard.

The USA is likewise not that monolithic. More so than Europe, for sure. But still.

+1 true. I only grouped EU together for simplicity. It also makes sense since they, by their own political and economic admission, are a unified trade bloc and should share some responsibility for EU-wide economic indicators.

That's strange... I spent 6 years living and working in America and I never met anyone who loved work, with the exception of some founders, perhaps.

I get that people don't love work in America in the way you're saying. I think the idea is that in America you're less likely to get a positive reaction to things such as you're the man and the primary breadwinner:

- You opt to cut your hours from 45-30 and live on less - You take a few months vacation - You take a year paternity leave

I know from experience that those can seem irresponsible to many.

It's irresponsible because social welfare in the U.S. is poor compared to what is available in Germany, France, and Scandinavia.

No one in my American family prefers to work. For many of them they have no choice. The job is a job -- not a career or a calling. It is simply what pays the bills and keeps the kids feed.

For many of them, the job is very physically demanding and the body starts failing apart at age 40 (construction, health care).

unemployment rates and youth unemployment rates sound interesting, but what about measures of happiness? depression? In America we tend to select metrics which also enforce the work, work, work, mentality by making it look like a good thing.

Unemployment figures are people who aren't employed but are searching for work, so I'm not sure it says exactly what you're trying to say.

People who don't want to work, don't show up in unemployment.

The people who count these figures _have_ thought of this, you know - this is called "mid-brow dismissal". They publish more than one number.

>I wrote a post on what I found returning to America:

http://fightthefuture.org/article/returning-to-america-and-t...

I just read your post and my mind boggled at a $200 premium, $6,000 deductible and something about co-pay.

I am 35 and don't even understand that last term, because I should not have to.

Healthcare should be about health, not money.

The US gov already pays about $5,500 per person per year. That's about a thousand more per year than Canada. The statistically average household (2.58 people) will pay an average of $27,000 EVERY SINGLE YEAR on average for healthcare ($10.3K/person/yr).

If Americans already pay more to the gov for healthcare than countries with universal healthcare, why doesn't it exist in America?

> The only reason big companies offer health insurance is because it limits employees's freedom.

It's more complicated than that. Offering healthcare in large groups which are likely to be diverse agewise, has considerable benefits for insurers. If people have to privately insure there's a tendency to forgo insurance unless you're in higher risk of being sick. Which increases average costs. Hence the ACA non-insurance tax etc.

> Also if there was universal healthcare it would be easier to start small companies and attract employees

Yea, absolutely. I really miss that after having moved to the US from Germany.

Health insurance, unlike additional wages, is not taxed. Buying their employees health insurance instead of paying them higher wages allows companies to transfer more money to their workers for the same cost.

the problem is not in insurance itself, then, but taxation

This seems a bit irrational. If there was universal health care than Big companies could just pay their employees more in lieu of health care.

The advantage of being at a small company is you have greater growth opportunity. The advantage of being at a big company is greater steady state benefits and salaries.

It's been shown that statistically, it makes more sense to work at a big company from the perspective of expected value. But not a very exciting way to live :)

The other thing is, and i don't disagree it limits freedom btw, but if you're not in a pool of other people shopping for healthcare you have no bargaining power.

10 tries at an answer, and you got closest to reality:

Employment creates a 'risk pool', specifically one that people are unlikely to join just to get insurance. It is one of very few ways to mitigate the "adverse selection" problem, i. e. only old and/or sick people getting insurance, thereby raising prices, and repeat. The other way is an insurance mandate, or, if you want to cut the chase, single-payer tax-funded healthcare for all.

Single payer needs to be what happens, it's like infrastructure projects/militaries if it's privately owned it can be well above the quality or well below quality that a publicly owned entities but being privately owned for profit kinda defeats the purpose of these institutions.

I wouldn't say it's the only reason. I'd argue the only they reason they offer it is because employees expect it. Private insurance is super expensive, and the government doesn't offer healthcare to most working professionals.

If companies didn't offer Healthcare, there would be more social pressure for a public option. As it is, too many people saying, 'got mine, don't care about yours'.

Employers are in a unique position to offer group health plans. This used to be more relevant before Obamacare and is becoming relevant again. There is no equivalent to a group health plan one can buy individually.

Another problem with "group plans" is that large companies are actually self-insured. The insurance provider is just handling the paperwork, but you are part of a group of people separate from other plans and the employer is on the hook to cover all costs (it's not always what the actuary predicts). The advantage is that working people are generally healthier than the average, so this results in lower costs vs plans that cover the general public.

The purpose of insurance is to amortize the cost of unpredictable things across time and population. Group plans are just another way to select higher quality (lower cost) people for the plan. Of course this means higher than average cost for programs like medicare.

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