Businesses main area of expertise is not in pensions and healthcare, and they cannot provide these services as efficiently as if there were many different insurance companies on the market offering these services for sale, and instead the company paid you a fee for your services, and then you went out on the market and bought your own pension plan and health insurance.
1) It is some sort of badge of honor to get a "job with benefits".
2) What if more people decide to not get healthcare? If your job gives it to you and you "only" have to pay a few hundred a month for your family, you are more likely to get it than if you payed everything out of pocket each month (even if your compensation increased). People would see all the extra money and just not get healthcare. If enough people did this, healthcare would be too expensive for the rest of us.
3) People are just reluctant to big change. And this is a big change. There would be politicians on the news claiming someone was "taking away your benefits".
Here in germany you can actually kind of get away with not paying for a while when not consuming. But coverage has to be continuous, so if you need insurance since you want to go to the doctor a few years down the line, you have to pay up for the entire period.
Just think of them as "overhead".
Spend a little on "enforcement", because rules are important. Call it audits, compliance, metrics, or whatever.
But not more than would be saved without enforcement. Because diminishing returns.
And at some tipping point, ratcheting up cost of compliance backfires, leading to more cheating.
So strive for some happy equilibrium. So that the general population (taxpayers) feel the system is reasonable, if not exactly fair, and overall friction is minimized.
(Technically speaking, it was a tax rather than a fine. That mostly mattered for legal reasons, but it did also work that way in practice. It applied to everyone, so insured people had the obligation waived, but the people paying it weren't in violation of any law or regulation.)
ACA had a solution to this, it was an extra tax for not purchasing health insurance. Because health insurance premiums are basically a tax to provide healthcare to everyone. Because US voters don't want to directly pay the government to provide healthcare to everyone.
2) Make it truly mandatory like in all developed countries.
There are a few exceptions, like Google.
> and premiums are paid post tax anyways.
But they're deductible from your income when you're filing taxes.
This is exactly what happened under the ACA. This is also the main reason many major health care companies like Aetna and UHG dropped out of the exchanges:
Insurers need young people to, in a basic sense, pay into the system, since they tend to be healthier and use fewer healthcare services — thus partially subsidizing the older and less healthy people that cost more to cover than they pay in.
Since the rollout of the exchanges, the number of young, healthy people signing up has not been enough to offset the sicker population, leading to millions of dollars in losses for many insurers.
https://www.businessinsider.com/millennial-uninsured-rate-ob...
We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave?
I'm a US freelancer, so I don't get health insurance through my employer. I get most of my healthcare directly from doctors and pay for visits and lab tests in cash. It works especially well when you tell them in advance you'll be paying with cash and haggle a price before walking through the door. I pay for a high deductible plan through a christian co-op for unforeseen events. This has proven to be considerably cheaper and more effective than paying for a plan through the obamacare marketplace.
Sadly, I have, and it is invariably from people who basically say those who don't work don't deserve healthcare. It is disturbing to hear people say this. They don't want to "pay" for someone else's healthcare. They don't get that they already are.
> We're at an unusual social state in this country where nobody trusts the government and nobody trusts big business. What does that leave?
Where did we go so wrong? Is it because we treat government like football games? One side has to dominate the other; all or nothing? What happened to compromise for the greater good?
[0]: the political systems, not the political parties
Curiosity, because you seem to have first hand experience and I do not- what happens when you present that they already are paying for peoples' healthcare?
If you want more affordable healthcare, you should make it cheaper, not force other people to pay overpriced bills for random strangers.
None of those countries are the size of the US. Just like in Physics, you can't expect a 1/10th scale model to behave the same as the life sized version.
The EU has 511 million people. Sure it is multiple systems, but they all work much better than ours does.
Source, lived there six years and spouse was in that system for over 25 years.
Japan, unlike the USA, has a health insurance plan for those who can’t get it through their employers (NHI, hence their system is considered universal).
Japan does also have NHI, but most are insured through their employers, as nearly everyone in Japan either works or is insured by someone in their family who works.
> Where did we go so wrong?
False premise. Merchants and governments have been widely distrusted as far back as records exist. Merchants in particular are commonly the subject of some kind of official orthodoxy noting how evil they are.
Even among people who work and have a lot of money, having healthcare based on employer causes all kinds of headaches. It makes a brief lapse between switching jobs unreasonably risky, especially before pre-existing conditions were covered. It punishes self-employment by denying people the major discounts big employers can negotiate. It punishes part-time work, because one 40 hour/week job with insurance might "pay" better than two equal-wage 30 hour/week jobs. And it makes long vacations or early retirement far less accessible; if you make in 6 months what someone else does in 12, you're not free to take those 6 months off without paying a steep premium on insurance.
And none of that is news, but it's always confused me that there's so little drive to delink healthcare from "being actively employed". Even for someone who wants to shut down Medicaid, the current system is bizarrely hostile to all kinds of high-earning people who could pay their own healthcare costs, but get punished for looking anywhere except full-time work at a big company.
Realistically, I think it's just ignored because the larger debates over cost and government care overshadow everything else. But in my more cynical moments, I can't help noticing that while the current system doesn't serve workers or entrepreneurs well, it's great at driving them to become a predictable labor supply.
The straightforward answer is to replace it with self-paid insurance plans. Even without redesigning our awful system of medical payments in the US, we could easily get rid of the “employer pays” part.
The most straightforward way is to have a universal coverage provided by the government (funded by tax revenue). Then we get rid of the whole problem of some people skipping out on coverage and free riding on the system.
The US did this until very recently. It should IMO be reinstated.
In any event, this is more or less orthogonal to the issue at hand. As far as I know, nothing stops employees with employer-sponsored healthcare from opting out.
You should talk to some union members then. Some unions have negotiated such generous healthcare benefits that they’d either never find on the private market or could never afford.
They don’t want to give those up.
for example, new Washington DC transit workers aren't on the old health plan, which means there's basically a 50/50 split (trending upwards) for people who don't have the benefit. probably not a great strategy to lean on those should the union want to strike over that benefit.
since all that money comes out of wages anyway, it'd be more beneficial to just eliminate the variable vs. trying to salvage a legacy class of workers fortunate enough to have the benefit.
I find it weird and misguided how people think that using coercion to force people into buying healthcare is somehow acceptable. To those that think it will make the cost of healthcare more expensive for the rest of us, I think that is a dubious assertion, in fact I think it will get much cheaper. The presumption that they are in contentious debate with is the necessity that different people have to get different tiers of service based on how much they pay.
It makes all the sense in the world when you compare it to any other business. You wouldn't expect for someone who paid $1M to get the same level of treatment as someone who paid $100.
People would buy insurance according to different tier levels of quality and risk profile, with their being astronomically high costs of insurance for old wealthy rich people, who in their desire to prolong life will incentivize creation of new modes of treatment to cure themselves (Which in the short run the development of which will help them, but in the long run, everyone, as after it gets discovered and scaled it will get cheaper).
People would also buy cheaper level of tiers, from which naturally the quality of treatment, and queues will get lower/longer.
You will also have people that don't buy insurance, and this should be their prerogative to do, as it would be the healthcare providers prerogative to decide whether to provide them with free treatment (they are not slaves, they are not obligated to provide a free service, and what makes the people that don't pay more important or a higher priority than those that willingly pay and fund these services).
I'm not saying that this is the BEST solution, I'm saying that this is BETTER than anything else proposed which leads to things like the "cobra effect" in which you make the initial problem way worse by the implemented solution, than by what it would have been without it.
Currently, society does not find it acceptable for someone to die from a heart attack if they cannot pay for healthcare. And people already get different levels of care.
If voters came out and changed the requirement for hospitals to provide healthcare, or let people forego healthcare, then we can perhaps treat healthcare like any other business.
Of course the majority (if its poor and sick) is going to pick the path of least resistance - which is to vote short term to get a subsidy from the healthy and rich (instead of pursuing to long term path toward developing skills to provide valuable services so that you could get rich and afford valuable services, such as healthcare, not to mention living life in a way to minimize chance of getting sick/ill in the first place.)
But in the end this sort of "take from the rich and minority" mentality just leads to the dissolution of thevalue that they create, and unfortunately only after they are gone, to the dissolution of the principle architects of that mentality.
Your points are American only and stem from a bunch of perverse decisions made during the wage controls of WW2.
Other countries seem to be doing fine with that model, I'm not sure what it is about the US culture that prevents it from working.
2. Single payer.
3. This statement always seems like a cop-out to throw hands up in the air and do nothing. There are things you can achieve with a multitude of small steps. There are things where you can't, and you have to take a few large leaps.
To just say oh let's ignore the latter category forever, because people people don't like it, is simply giving up.
The current system drives all kinds of awful distortions independent of actual cost, and it wouldn't take much to improve. Swapping the tax exemption for a write-off would be a significant start to stop penalizing freelancers and part-time workers who have to buy their own insurance, and indirectly promote competitive not-employer-sponsored plans.
I'm not sure if this just gets ignored because the issue is so contentious that small changes aren't worth the political price, or if there's something darker there, but it sure seems like it could be a bipartisan move.
And you know what is even more efficient than market-based health insurance and pensions ? Socialist state-level monopolies. Yep, costs in Europe are about half of what they are in the US. Turns out governments are not more inefficient than companies, especially very large ones.
Most things like GPs, physiotherapists, etc. are private but the Medicare system pays for something like 60% to 100% of the bill depending on various factors. You won't usually pay more than $30 for a standard GP consult, for example.
Crazily, the private insurers (it's optional) are trying to push for tax breaks to employers if they pay for private health insurance for their employees (more like the US system but basically unheard of here), despite the fact that the private system is already heavily subsidised (big rebate on private health insurance and also tax benefits for moderate and high income earners), and despite the fact that our public system is more efficient (according to studies), so we'd actually be better off just investing that cash in the public system (because of underfunding there are waiting lists for a lot of elective surgery).
But the private insurance industry is generally struggling because they've been raising premiums and reducing service (more exclusions and bigger excesses) and our public system is good.
Letting people set up private companies with competitive options I think would probably drive the best results.
Splitting employers from health insurance is one of several required changes that needs to happen before the supposed hand of capitalism can allow the market to get healthier.
I have no idea if it would work, but the status quo is so unhealthy at the very least improvement competition/choice could improve that somewhat.
There's plenty of employers that don't offer healthcare, and you are not obligated to take it if your employer does offer it. You can always buy your own health insurance.
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