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Comment by arandr0x | Hacker News Reader

This is one thing I thought was nice about the US healthcare system, that it aligns the economic incentives of companies with having healthier employees relative to other companies. Maybe countries that have a more efficient single payer system should nevertheless add a "Healthy Workforce Tax Credit" of some sort?

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People don’t work at jobs for life any more. It’s common for younger people to switch jobs every 2-3 years. In this environment, it makes more business sense to work employees hard because the company doesn’t need to consider long term health. This creates a kind of prisoner’s dilemma where’s its only advantageous to invest in employee’s long term health if other companies do so as well.

I know the former CEO of one of the big U.S. health insurers. He has mentioned that on one side, as a doctor, he wanted to do good for patients long term, but, with shareholders on the other side, it can be very difficult to align incentives for long term health when most plan members will only be plan members for an average of 5-10 years.

Does it though? The most I see is mere lip service towards health with things like counting steps competitions and the like. The plans are whittled away each year (whether thats really under or outside the control of the purchasing company), or they just make you pay more and more if you want to include your partner/kids.

>This is one thing I thought was nice about the US healthcare system, that it aligns the economic incentives of companies with having healthier employees relative to other companies.

In what way do companies have an economic interest to have healthier employees?

Heck, in the US they can even just fire them when they get sick.

Heck, in the US they can even just fire them when they get sick.

Well, they could, yes. But wouldn't company counsel advise them to just settle the inevitable lawsuit? (Serious question, BTW; not like this IANAL follows the case law.)

The FMLA covers specific things you may take unpaid leave for and must have your job when you come back.

There are a couple problems with this:

1) It's only for fairly serious conditions. If it's just "I feel like crap all the time because I've been stressed out for years" then in most states they can fire you.

2) It's unclear to me (IANAL as well) if they are required to extend non-pay benefits to you in that time, but I think not. So if they do not extend health insurance to you in that time, then you might be able to come back, but you'll be bankrupt.

If profit is involved, they likely don't.

Premiums reflect the insurers experience with the company.

Some companies self insure and only have the insurance company handle the billing. This provides arm's length from employee's confidential health care.

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