Is it not possible to purchase your own healthcare independently of an employer? And opt-out of employer healthcare? Or are only employers allowed to insure you?
If it's a matter of scale could a buyer's union buy it bulk like an employer but not linked to your employment?
Yes, it is possible to purchase your own healthcare independently. Prior to the ACA, however, things like preexisting conditions were not covered, which is how I know a Symbicort asthma inhaler costs about $700/ea.
In some ways, having a union provide healthcare makes more sense than having the employer do it. In industries with many small firms, and fewer large unions (like construction), the union will probably have better bargaining power. Members of a given union also probably have more (means and needs) in common with each other than employees of a given company.
There's even a YC company that offers ICHRA functionality for employers[2].
This is a common refrain, but it's actually not true. Individual plans operate as a giant "group" with other individuals, and the size of that group is often larger than most employer groups.
There are a host of reasons why healthcare is expensive in the US, and the "bulk purchasing" is not really one of them.
Source: I work in health insurance.
The ICHRA[1], which came into effect on January 2020 is an interesting step in this direction. It allows employers to provide a pre-tax cash monthly allowance to buy health insurance on the individual market in lieu of the monthly premiums they would pay anyway as part of the employer mandate to provide group health insurance directly.
There's even a YC company that offers ICHRA functionality for employers[2].
I work in health insurance.
Have you priced outside insurance?
If you are making the wages Uber is paying drivers, it is not possible to purchase healthcare independent of your employer and pay rent.
The ICHRA[1], which came into effect on January 2020 allows employers to do just that.
There's even a YC company that offers ICHRA functionality for employers[2].