This is just insane. I suppose people in the US are so used to this being "the way it is" they're desensitized, but from the outside perspective of the civilized, developed world, this is insane.
"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."
https://news.ycombinator.com/newsguidelines.html
The classic flamewar topics are like black holes that suck in everything that comes close to them.
https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
Topics this generic never produce unpredictable discussion—doubly so when they're also divisive and inflammatory, which most are. On HN we want intellectually curious conversation. To get that, we need topics that are specific and unpredictable, not generic and well-trodden.
https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
I'd love to hear from Americans on the matter. Have you ever made career choices based on the effects it would have on healthcare coverage? Have you ever tolerated a bad job or bad employer because of access to healthcare coverage? Have you ever decided _not_ to take a risk starting your own small business because of loss of healthcare coverage? Have you ever had a family crisis and through it been forced to continue working in order to keep healthcare coverage?
I'm sure there are an assortment of remedies, but the fact that access to healthcare _EVER_ factors in to your career is manifestly wrong.
I was always fascinated that the US simultaneously had this health care system, and also a cultural obsession with small business (this may have faded over the years, but was a huge talking point in the 90s and noughties, especially on the right).
“People should start small businesses! Oh, also, if you do that you may die” was just such a perplexing message.
Being from a developed English-speaking country, where we get a lot of American media, it’s very easy to just assume that America is pretty much like a bigger version of what I’m used to. Until it comes to the jarring, utterly alien things, like healthcare.
This was actually much better than the job before that because at least the company paid for my coverage (may be confusing but that's still $800/mo out of my pocket to cover my family).
So yes, just the job you choose can be rather drastic changes in take home pay due to insurance coverage, so a huge impact on what companies you decide to work for.
You can imagine the headache each year when it comes time to have to choose insurance plans again.
These migraine meds expect that you take it on the onset of the headache, often before you know it's even a migraine otherwise they don't work. So you are left with this decision, do I possibly suffer for the rest of the day or use up my stock for something that may not need it.
Adding insanity to insult and injury.
I wouldn't stay in a bad job for the benefits, but I'm a technical employee, who happens to have lots of choice.
I want to say that maybe the fast food job simply paid more if you factored in the healthcare, but maybe it's that the fast food company can get way better insurance rates than you alone?
For example, even if plan A and plan B cost the same amount out of my pocket, but Plan B does not cover my medications until after a $5,000 deductable, it really isn't helping me because all of my medications added up over a year come to just under $5,000.
There are so many layers of bureaucracy and complexity and institutional inertia keeping this exploitative system moving, it really needs to just be burnt to the ground so we can start fresh.
ABSOLUTELY. I should be able to independently choose my healthcare coverage. I purchase my home/renters insurance, my car insurance, my liability insurance, my life insurance, etc. separately from my employer. Why not health insurance???
Employer-tied health insurance is literally federal law in the U.S.
It still boggles my mind how widely supported the ACA employer mandate ("Obamacare") was by my fellow Americans.
And disappoints me that the mandate wasn't repealed in 2017-2018 when it appeared the right politicians were in place.
It's fine to not like it, but it was probably one of the less disruptive options for collecting more health care dollars.
As far as I can figure, there's really only 2 paths forward for the US system. Dump more money into it or train lots more providers. People don't seem to think we are short on doctors, but the market looks sort of exactly supply constrained, where everyone is busy and prices go up up up. Of course, because we are stupid, some of the most significant healthcare regulations...limit supply.
It's not a tax though. It's finding, choosing, paying for a particular insurance plan for their employees.
Thus, insurance being tied to employment.
For many people, "A good job" has long been one that came with health coverage (and given the expense of insurance, this continues to be the case).
It would be excellent for us to have a situation where people bought their health insurance individually. I think requiring more employers to provide insurance probably was an incremental step in that direction, as counter intuitive as it is, because it addressed the situation that existed in an achievable way.
It's not really linked to employment. Employers pay for it, yes, but anyone can go on the open market and get their own insurance. I'm a consultant and have been paying for my own insurance for me and my family for a decade.
In addition to this, there's something called cobra, that allows you to pay for health insurance for awhile after you leave an employer. Unless the person in this article went over a year between jobs and never even tried to buy his own insurance, his lack of coverage is an exaggeration.
"I'm sure there are an assortment of remedies, but the fact that access to healthcare _EVER_ factors in to your career is manifestly wrong."
It really doesn't. The majority of companies provide healthcare for their employees. I've even worked for a company of 10 people and had fantastic healthcare.
"Have you ever decided _not_ to take a risk starting your own small business because of loss of healthcare coverage?"
No. You can pay for your own insurance, which includes doctor prescription, checkups, and you won't go bankrupt in an emergency (or paying for the insurance).
"Have you ever had a family crisis and through it been forced to continue working in order to keep healthcare coverage?"
Even if you have 0 coverage, a hospital will be forced to take you. If you get bills, you can negotiate with the hospital and you can get your bill down 90%. There are some nonprofits that will actually pay your bills for you if you really have no money.
Most of these articles are FUD to push everyone to go to Universal healthcare. Sure our system has problems, but a government takeover will not solve the issues.
Insurance was never meant to be used for everything. We need to get rid of the insurance companies and allow hospitals to actually charge patients the true value of things (which would immediately bring the costs of most things down).
Surgeries and procedures that happen often would be brought down due to competition and the ones that don't happen that often could be covered under some sort of insurance.
Platic surgery and Lasik eye surgery are good examples of this in action. A decade ago, they were both very expensive. Competition has brought the costs down considerably. My parents both got Lasik surgery without insurance and paid under $1000. 10 years ago, it was $10,000.
I also really never got the 'not being able to start a business' mentality. Sure you have more risk, but it will take you much longer to actually have a running business if you have an increased amount of taxes due to universal healthcare.
In most European countries, you need to involve the unions after a certain amount of employees. This combined with large amounts of taxes impedes growth.
I would be interested to see how many larger companies in Europe actually started and grew there or grew large in another country and then opened up an office/location there. I'm guessing more of the latter than the former.
>You can pay for your own insurance, which includes doctor prescription, checkups, and you won't go bankrupt in an emergency (or paying for the insurance).
I know somebody who got in a car accident out in the hilly area of town, had to be airlifted to a hospital, and have his skull and spine reconstructed. The guy's a doctor who runs a private practice and he was buying his own insurance, the insurer decided what they were going to cover and what they weren't going to cover, and now he is literally 2 million dollars in debt (2 occupants in the car). And that's somebody who makes a hell of a lot of money compared to fast food workers, who are equally likely to get in car accidents!
You are either naive or fooling yourself if you don't see that this system is broken and exploitive.
No. Actually we are not used to that being the way it is, the US has had a solution in place for this very problem since 1985 [1,2] - it's called COBRA and it extends your health care coverage after you leave a job that provides it.
Make no mistake - you pay for it. But by US employment law, HR is required to inform you about how to get COBRA to continue your health care coverage after you separate.
So author either had a company violating labor laws - or he declined COBRA coverage.
1 - https://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Re...
The system is not even that complicated. I am not sure what holds the US back to have a humane care system.
A huge industry (almost 18% of US GDP) that has a lot of lobbying power and influence, combined with with decades of anti-socialism messaging.
It's simple greed, people want to be healthy, rich people can interject themselves into that desire and 'tax' health/wellness.
Yay capitalism!
Fortunately, my act of loudly demanding they make the benefits retroactive to the 1st got things sorted very quickly. But, this is because I knew how things worked.
I would also recommend to US-persons to not switch jobs around a month boundary.
The employer-linked healthcare system is burdensome to both employers and employees. It’s not going to change without a dramatic change to the group insurance model.
When you quit your job that offers healthcare benefits, you can temporarily continue coverage under COBRA. This is a required program for any employer with more than 20 employees:
https://www.dol.gov/general/topic/health-plans/cobra
Essentially, if something happens where you need healthcare services, you have your previous insurance billed and retroactively fill out some COBRA forms and pay your premium (which will be higher because your employer isn't contributing anymore, but the price is capped to 102% of the overall cost).
If you don't end up needing any healthcare services, your previous employer's plan just ends automatically.
Also, a loss of coverage (i.e. by job loss) is a qualifying life event for a coverage change. This author could have enrolled in an insurance marketplace ("Obamacare") plan immediately, although the alternative of using COBRA for a small employment gap is usually preferable.
It's expensive, but that isn't a good excuse in this situation.
(it's been in place since Reagan...my point isn't really to defend the shitty system, it's to say, people should fully understand the options they do have)
I'm convinced that the only way heslthcare will get better in the US is if a president sacrifices re-election and forces sweeping changes that hurt employment (insurance companies, employer-provided healthcare, etc.)