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Comment by erentz | Hacker News Reader

Another example of how Medicare for All would help business. Just remove healthcare as an employee benefit entirely.

Not sure why you're getting down voted - tying health care to employment is a burden on both companies (at least small ones) and workers.

I'm sympathetic but I'm not sure how it's related.

Probably because he didn't make it clear that the reason he brought up Medicare for All was because the whole reason contractors are so prevalent is so you don't have to pay for healthcare for them, effectively separating your workers into two classes.

Medicare for All would be beneficial in this example as it would totally remove the burden on company to provide a healthcare plan.

Without that crucial context, it sounds like he's just randomly bringing up hot-button political issues.

In countries with socialized medicine already, how many people are covered by private health insurance and is it paid for by the employer?

The answers are "lots" and "mostly"

> In countries with socialized medicine already, how many people are covered by private health insurance and is it paid for by the employer?

> The answers are "lots" and "mostly"

I would appreciate citations for this statement. As it is here, I suspect the 'lots' actually are a wealthier subset of the overall population; indeed, I imagine the subset of employer-paid insurance beneficiaries is smaller in most other countries.

If you'd like to read more about this topic, NEJM has published a series on the healthcare systems of many countries[1].

1. See 'Related Articles' here: https://www.nejm.org/doi/full/10.1056/NEJMp1413937

The difference is that it's a perk, not a necessity. If you get diagnosed with cancer and then subsequently fired, you don't have to remortgage your home (if you have one) in order to pay for your treatment.

Yeh but its shit (in the UK) from experience I had a major operation and having Bupa gave me zero benefits.

All it means is you have a" benefit" that is supposedly worth "800 quid) costs you 400 in tax I would rather have had an extra £800 in my pension.

Its interesting my current employer does not do private health for this reason.

I would like to see some facts back that up.

Perhaps for the richest quartile, but surely not the poorest quartile...

The point of socialised healthcare is to provide some cover to the otherwise least fortunate in your society.

I'm in NZ, it's not too common. There is private health insurance, but it mainly is for extra beyond what the state provides and to short circuit wait lists for certain elective medical procedures. It's also pretty cheap, a few companies will pay for it, mostly employees get a discount through their work places. Most small small businesses wouldn't offer it at all. According to stats around 35% of NZ adults ( from 2015 ) have private insurace.

My private health insurance in NZ costs $1650 USD a year, including dental and optical, and nearly unlimited hospital care.

On earnings of $~100K USD, you'd pay $26.5K USD in income tax, $1.2K in compulsory accident insurance, for a total tax rate of 28.12% (https://www.paye.net.nz/calculator.html).

In Australia it's ~50% and I've never heard of anyone getting it paid by the employer, it's an alien concept.

Even that 50% is with the government abusing the tax system to force people to take out basic private insurance.

My company does actually give a subsidy to health care, so it's not a totally alien concept in Australia. But it's pretty rare.

"The answers are "lots" and "mostly"

Where would that be? Name examples. In Germany you certainly don't get it paid by the employer.

> Another example of how Medicare for All would help business. Just remove healthcare as an employee benefit entirely.

The problem there is that the existing Medicare system is predicated on paying less for the same things than private insurance and then letting high private insurance premiums subsidize the Medicare system. Which obviously doesn't work when everyone is on Medicare, so the cost per Medicare patient would go up at the same time as you're adding hundreds of millions of people to it.

So the Medicare tax would have to increase dramatically, but the Medicare tax is pretty regressive. Meanwhile a lot of companies would then get away with discontinuing their private insurance coverage without increasing employee compensation by the same amount. So you're basically talking about a huge transfer of wealth from the middle class to corporations.

We should probably look into some other method of dismantling the employer-provided healthcare system. Maybe something that involves primarily catastrophic coverage as a baseline.

Presumably we would still have private insurance, just like Medicare patients have private insurance now. You'd use your private insurance to do things like skip ahead in line or not see your primary care provider first or getting drugs that aren't on medicare's schedule.

We would also presumably still have doctors who don't take Medicare and can charge whatever they want, and then you'd want private insurance to see those doctors, who presumably would be the best doctors, and the ones that could get away with such things.

You can't get the same amount of cross-subsidy out of that because nobody is going to want to pay a ~20% Medicare tax plus $5000/year for $1000 value in supplemental insurance with $4000 in cross-subsidy.

I'm not sure that's how Medicare is 'predicated' - the fundamental assumption is that you get to a) reduce administrative overhead due to a centralized system, and b) using the power of a single-payer system to negotiate lower fees - it's reducing the profit margin of private insurers, not relying on them to subsidize Medicare.

> I'm not sure that's how Medicare is 'predicated' - the fundamental assumption is that you get to a) reduce administrative overhead due to a centralized system, and b) using the power of a single-payer system to negotiate lower fees

This fundamental assumption is wrong, because Medicare doesn't negotiate. Medicare sets rates by fiat, and providers don't have the ability to negotiate rates with Medicare the way they negotiate with private payers. Medicare reimburses rates that are below COGS, which means that providers actually lose money on Medicare patients and have to cover their losses with the margins they make on privately-insured patients. (Medicare acknowledges this, and in fact will pay separate stipends to providers who don't see enough privately-insured patients to cover the losses on Medicare patients).

OP is correct - Medicare's funding model is not sustainable without private insurers to provide the difference.

> it's reducing the profit margin of private insurers, not relying on them to subsidize Medicare

Uh, where do you think that extra money goes?

Medicare for all would get rid of high private insurance premiums, but it would also raise payments by people who are currently uninsured, and would have higher payment levels than Medicaid. So the decrease in provider payments would, in total, be something like 10%, which could be compensated by lower administrative costs, since hospitals would have fewer insurance companies to deal with.

> Medicare for all would get rid of high private insurance premiums, but it would also raise payments by people who are currently uninsured, and would have higher payment levels than Medicaid. So the decrease in provider payments would, in total, be something like 10%, which could be compensated by lower administrative costs, since hospitals would have fewer insurance companies to deal with.

Your numbers are completely out of whack. First of all, Medicare pays rates that are below COGS. That means that, at the current reimbursement rates, providers wouldn't want to see more Medicare patients; the more Medicare patients they see, the faster they lose money.

I have no idea where you're pulling this 10% number from. But administrative costs due to private insurance companies are nowhere near 10% of total reimbursements - that's an absurd figure. Most administrative costs have nothing to do with the number of insurance companies you're dealing with; it's to do with the overhead of providing care and billing[0]. Reducing the number of payers doesn't reduce that fixed cost.

[0] Yes, billing is still an issue with Medicare. How do you think Medicare knows how much to pay providers in the first place?

the Medicare tax would have to increase dramatically

Would it? It already covers all the old people who suck down almost all the healthcare expenses already. Expanding it would cover younger and healthier people. I don't know the numbers...that's just my quick take.

> So the Medicare tax would have to increase dramatically, but the Medicare tax is pretty regressive.

So, if you need to change it anyway, make it less regressive at the same time.

Countries with socialized medicine still have jobs with private health insurance benefits. The publicly funded health care ends up being mediocre for some reason or another. For example, about 60% of Canadians are covered by some form of private health insurance.

If it's anything like France, the private insurance hooks you up with "perks" compared to basic, or even shared room care.

Edit: Found what is covered by private insurance in Canada:

>About 27.6% of Canadians' healthcare is paid for through the private sector. This mostly goes towards services not covered or partially covered by Medicare, such as prescription drugs, dentistry and optometry. Some 75% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.

I've heard that the UK does this as well, still get insurance from work because the free one is terrible.

No, that's not how it works.

The free one is all you have. The insurance from work covers drugs, massages, eyeglasses and dentistry.

Not in my experience the UK isn't like the European ones where they are dual funded from general taxation and compulsory employer and employee contribs.

You can, I had BUPA for a while earlier in my life. IMNSHO It's basically just a waste of money unless you really care about aesthetics. I put up with it because my mother insisted, she worries.

With a public system right there, it makes no sense for private providers to waste a penny on anything that doesn't generate profit. So e.g. if you have an emergency while you're physically at a private hospital, they will almost certainly phone for an NHS ambulance, because the NHS does emergencies and they don't. Heart attack? Not their problem. Broken arm? Not them. Car accident? Nope. Those can all go to the NHS. But if you need a routine or even cosmetic minor operation, they're happy to take your money and offer you a slightly nicer experience, air-conditioned room with fresh flowers, branded products instead of whatever was cheapest for the NHS to source, that sort of thing.

Some of the private schemes are literally insurance. So you get the exact same NHS treatments as everybody else, but your insurance means e.g. you get a $50 cheque for the inconvenience of seeing a doctor to treat that nasty infection, that sort of thing. This is a bit trickier for them to implement since obviously the NHS doesn't want its doctors doing paperwork for some insurance company on tax payer time, and the insurer isn't keen to pay a doctor's hourly rate to fill out a form saying "Yup, your customer had a nasty infection, I prescribed ointment". But if you really wish you got a cheque every time you spent time in a doctor's waiting room I guess it's an option.

So you're saying the socialized insurance isn't terrible, just private insurance is supplementary to provide things you really could probably live without?

Since I don't care about these supplementary things I never made any use of my insurance at all in the years I had it, I just paid the fees because it kept my mother quiet and continued as a normal NHS patient. I know friends who've had stuff done privately, but I didn't see any meaningful benefit. I'm sure mileage may vary.

I had cancer when I was younger, the NHS fixed that. Again what would private providers do differently? Better wallpaper or whatever versus the worry of imminent death? Who cares? I used to buy myself a BK Double Whopper as a treat before chemotherapy do you think a private insurer would throw in a free burger?

We actually have employer sponsored health insurance because of unions, and the effect that has had on the insurance market is part of why insurance on the individual market is so dang expensive. Not entirely, as it's expensive no matter how you get it, but it is a factor.

Heck, the Affordable Care Act ruined a lot of insurance policies held by union members because they covered too much. My best friend's employer was stuck with the Faustian choice of massive increases to employee contributions, paying massive penalties to the government, or renegotiating for shittier coverage.

A good set of strong unions could make that a reality

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