Health Insurance Shouldn't Be Tied to Employers | Hacker News Reader

Health Insurance Shouldn't Be Tied to Employers

nytimes.com

110 pointsaaronbrethorst51 comments

I'm European, and I think that healthcare should be considered a human right. Not giving someone in need a potentially life-saving medical treatment is completely unfair, and a big red flag honestly. Life doesn't give the same opportunities to everyone, some people have been born in better environments or have simply been less fortunate then others, and I think it's the state's responsibility to create a system where these things are taken into account. Denying this is plain greed from the richest who don't want to subsidize healthcare for the poorest, without realizing that a society where people are less worried about their future would benefit them too; it puzzles me that so many people on the other side of the pond think of this almost as if it was some form of bolshevism while it is instead just plain and simple basic human decency.

This is not about the rich subsidizing the poor. That's not how healthcare works in Europe. Y pay my share as everybody else for our healthcare. If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us.

The problem with the healthcare in the US goes beyond that. Everything is insanely corrupt to make things expensive. That's why they spent way more per capita that many other countries but get almost nothing in return.

> If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us.

That’s exactly what it means. The person who couldn’t pay has their costs subsidised by those who do. If nobody in the system pays more than they use, and anyone uses more than they pay, the system tends de-stabilises.

It’s not ‘the rich’ paying in that case. It’s ‘the majority’.

If it's paid for by income tax, people with high income will pay proportionately more. High income people tend to be rich.

But those with high income are very outnumbered. Most of people are not rich and most of the taxes come from them. You get way more money from taxing 20% all working class families than from taxing 50% the wealthiest ones.

My point is, healthcare is being funded by everybody who works (also everybody who consumes, as you have to pay VAT) not only the rich.

I get your point but people with high income are paying proportionately more than people with lower income. In some sense this is a subsidy.

This becomes even more pronounced if you take into account who is using the health care system as low income tends to be tied with bad health (diabetes, smoking related issues, hard physical labour, etc).

Note that I'm not saying this is wrong. Broadest shoulders should bear the largest burdens.

Walked into doctor for a weekly shot. That’ll be $60.00 copay. Balance billed to insurance.

Me: how much without insurance? $15 dollars out the door.

Okay...

Few years later. I need an MRI. I call and ask how much. 750 dollar with insurance. (Deductible) Or $500 without insurance.

I pay 1300 a month, and it’s often still cheaper to not use it.

We need to change the questions that are asked.

  Not just who will pay for it.   Because the same procedure at the same location can have drastically different costs depending on who is paying

The point is that if the reasoning these people do were actually coherent, a person who doesn't have a car should not have to pay taxes for road maintenance, or only people with children should pay for schools, and so on, but I never heard them arguing for this.

To describe healthcare as a human right misunderstands what a right is. You don't have a right to a doctor's time. You don't have a right to a nurse's time. What you want is a free healthcare plan, calling it a right makes it unworkable.

Couldn’t you say same thing about right to lawyer or a trial?

That's a legal right, not a human right. A human right is something you already have, it just cannot be restricted by someone else.

For example, free speech is a human right. You will always have it innately unless a third party deliberately infringes on that right. If they do so, they are violating your basic human rights.

Following your reasoning having a dwelling, schooling, food or water access are not human rights because they're not innately part of a human being. I understand why you are arguing for a literal application of the term, but I think that doing so fails to capture the intent behind it, that is, that those things might well not be parts of a human being, but they are still an inseverable part of being human.

There are some human needs that inherently depend on resources whose access should be guaranteed to every human being, preferably by the state itself, and I'm deeply convinced that failing to do so is intrinsically a failure at being human. History has shown multiple times that a society that forgets those who are in need is a society where peace is just impossible, plagued by unrest and disparity.

Following this reasoning, justice also should not be a right either, because the same applies (I don't have a right to a police officer's time, I don't have a right to a judge's time, and so on). Obviously everyone should be paid, and everyone deserves to be rewarded for the job they do, it was not what I meant. I think everyone should have the right to access the health care they need without fearing for their financial security or their future. I think it is not unreasonable to call this a basic human right.

> I'm European, and I think that healthcare should be considered a human right.

The problem here isn't healthcare as a human right but healthcare cost. Who should pay for what at first place and how much.

There are all sorts of problems with the US healthcare industry, to me the biggest one is the near impossibility to compare cost between hospitals for instance. In any other sector, a business would give the client some quote before hand instead of billing the client after the service is provided, that's insane.

Obviously, it's not a problem for people with good coverage.

> it was some form of bolshevism while it is instead just plain and simple basic human decency

Should Healthcare be for profit? or not on the other hand is an interesting matter only Americans themselves can answer.

> plain greed from the richest

Health care is cheaper when it is single payer due to the overhead/collusion of the insurance industry. This overhead is bigger than the inefficiencies of public run hospitals.

So paying only for yourself ends up being more expensive than paying for other people too.

Single payer is literally just health insurance, but it's provided by one entity (the government) which has a monopoly. The way they reduce costs is by rationing care.

That’s not the full story. Insurance companies today already ration care : they won’t pay for expensive brand-name medicines and they often won’t approve surgeries without requiring extensive pre-qualifications and alternate treatments. Which is mostly for the best.

Single-payer would have other effects. One, by ensuring that everyone has access to preventive and non-emergency care, it would reduce the overall cost of care. Today, the uninsured wait until they are horribly ill to show up at the ER where they are treated as public charges. Those people are also not effective at their jobs, and die earlier, which is an added cost. Net-net, a healthier population will be less expensive to care for and will be more productive.

Second, a single-payer system will replace hundreds of independent insurance companies that compete with each other with a single system, increasing efficiency,

Third, a single-payer monopoly can negotiate with providers to reduce cost. When you represent all of the patients in the country, you can demand the lowest rates. The government already does this today with Medicare, which is why many people call this plan “Medicare for All.”

There will undoubtedly be some care rationing, but I expect that as in the UK there will be the option to buy private insurance on the retail market, or to pay cash for procedures that you want but which aren’t covered - as it is today for cosmetic surgery. Insurers dont cover plastic surgery, but that business seems to be booming.

> the inefficiencies of public run hospitals

What inefficiencies? What makes you think that a publicly run hospital is less efficient than some other kind?

In Australia, health insurance isn't related to employment at all.

It seems a strange idea that it should somehow be connected to your employer. I can't see any reason why it would, only reasons why that would make things problematic and complex for no gain.

IIRC, It was a tax benefit introduced to the employer back during WW2, those who were offering health benefits to their employees.

It was in response to a national wage freeze. Due to WW2 too few workers existed for the jobs available as such any one worker had incredible bargaining power. Wages were frozen by law[0] and firms found other benefits to offer in order to attempt to compete with each over for workers.

[0]https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942

The impact to labor mobility is significant: people who rely on employer-provided health care would be more reluctant to change jobs if there is any risk of discontinuity of health care for chronic conditions, or a higher cost for any conditions pre-existing before the new job starts. The US has not had indenture by name for decades, but we still have it via health care.

This biggest problem with employer paid health insurance is that the people who receive it are sheltered from a lot of the problems with the current system. It’s easy to say everything’s fine when you are happy with your current situation.

Imagine if senators and congress had to buy their own individual plans.

this is the answer to why so many things are the way they are. Those with enough money to make something not be a problem, don't tend to even think about it again after writing the check/swiping the card.

> But employer-based insurance is heavily subsidized by the federal government.

I don't know enough about how the health insurance beast works, but it would seem that if the federal government stopped giving an unfair advantage to organizations, then the unfair advantage would stop existing for these organizations that were given the unfair advantage and fairness would somewhat return for individual persons.

When the current health insurance system was created in the 1950’s, there was a very specific family structure in the United States where the man would work for a wage, and the woman would stay at home with the children. So if the health insurance was attached to the man’s job, then she was dependent on him for healthcare. So you have to understand that on the American right wing, the current health care system is seen as a lynchpin of the “American way of life”.

Not only that but as many black people work the kinds of low wage jobs that don’t offer health care. If we created a public system for everyone, then taxes on white income and property would be used to pay for black people to have health care, something which in the United States is a hard sell. That’s why you will often see people holding signs saying something to the effect of “racial equality is communism”.

Please do something useful and fund a movement to dissociate the two. People are imprisoned to their employers that provides decent health care, especially those with family and children.

Health care costs should be completely 100% tax deductible.

When I go to the dentist, I have no clue what he is going to charge me. He could price a procedure at $1000 or $5000. I, as an individual, have no ability to negotiate with him about his price. I just know that I have a damn root canal, and I’m dying in pain, so fix it! And then, you’re slapped with the expensive bill.

Rather than health care costs being completely 100% tax deductible, you just need the health insurance premiums to be covered, and you can index the deduction against taxable income if you want.

The kicker, and this is where the US mindset gets hung-up is that you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance so there are enough healthy people (who don't make claims) in the system to make it profitable.

> you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance

There’s a stupid simple workaround. Everyone gets taxed equal to the lowest-tier health insurance. When a health insurer signs someone up, they can claim from this kitty. Insurers can’t deny signing someone up for the lowest tier. When insurers breach certain actuarial limits, for example, if their pool of insured proves unusually old or sick, they can claim from this kitty.

If the limits are properly set, healthy people foregoing insurance becomes a non-issue. They’re pre-paying for a benefit they fail to claim.

Isn't this basically what Obamacare tried to do? Except with a lower tax?

The mandate under ACA was probably already too weak. Unfortunately it has been further weakened.

I believe they tried but couldn't get it to pass.

This is the Australian model. If you don't have insurance there's a Medicare surcharge based on your taxable income. The Gov gives you a tax rebate if you do have insurance.

https://www.ato.gov.au/Individuals/Medicare-levy/Private-hea...

Premiums go up each April within an allowable increase and are published on a Gov site.

I worked on integrating this for a comparison site years back - the market is pretty competitive, but has been broken to an extent in recent years by providers signing up as preferred partners with various insurers and insurers just buying up providers.

An interesting side is the APRA regulations regarding how many policies an insurer is allowed to issue based on the capital they hold. They needed monthly caps on how many policies they wanted (we got feeds back on leads that signed up) and some of the smaller ones occasionally asked to be removed from the panel when they were hitting their limit.

> I have no clue what he is going to charge me.

That's weird. My dentist in Norway has a price list.

Dentistry is not covered by the national health systems in Norway (where I live) or the UK (where I come from) but at least in Norway it still seems to be reasonably priced.

I think employer based healthcare works fine in more corporatist countries. Here in Germany we have a multi-payer system that includes the option for employer-based plans, but it's embedded in a culture that isn't going to throw you on the street in a pandemic, and there is of course the rest of the public healthcare system to catch people. In federal states purely national systems are hard to realise.

The US has the same issue I think, not to mention that the federal government doesn't always seem to be in good shape. Maybe better to go deeper than just healthcare and ponder whether the liberal capitalism needs to taken down a notch in favour of putting other stakeholders first instead of centralising healthcare further.

Just like the US system, the German one has a lot of inefficiencies.

How many people are employed in the health insurance sector? It is a _large_ industry, and someone has to pay their salaries. How much paperwork do have to deal with regarding health insurance?

Having lived in Canada and Sweden, both which have a single payer system, I can tell you that the life improvement is very real.

That being said, I can only assume the German system is less broken than the US one. People with no jobs do have access to health insurance here.

That's incorrect. German health insurance is not tied to your employer. Losing your job has no impact on your coverage, and your employer has no say on how you are insured.

If you are curious about how German health insurance works, I wrote a long, detailed, thoroughly verified guide about it for expats. It's a good intro to the system.

https://allaboutberlin.com/guides/german-health-insurance

I am German and you're not correct. There are several types of public insurance. If you've chosen to be a member of a Betriebskrankenkasse or Innungskrankenkasse, your insurance status is tied to your job, because that insurance is provided by your employer.

Should you lose your job you are entitled to a month or so of additional coverage called nachgehender leistungsanspruch and you can obtain public health insurance through a non jon-related public insurer.

That's why the German system is universal (you're never going to be uninsured), but the option for employer-based insurance exists and is quite popular.

Fair point. This is a blind spot in my research, and I will amend the article when I find the time. They at least deserve a mention. There are no notable differences: same price, same coverage, and no particular gotchas.

That being said, I can't think of a scenario where you'd want to keep a specific job for health insurance reasons. In that sense, your health insurance is not tied to your job. If you were with a BKK, you'd fall back into the public system, which should provide equivalent coverage.

It's not really tied to employers. There's no law stopping you from purchasing it yourself. The government just gives a tax break to companies who give it as a benefit. So they hugely incentivize it.

You seem to be being deliberately obtuse. Yes, you could literally go buy the exact same amount of coverage as an individual as you’d get from an employer-sponsored group plan. But, since even employer-sponsored plans are frequently quite expensive, especially if you have children, that effectively prevents most people from doin so.

You actually can't really do that since workplace health insurance plans actually cover some of the costs that insurance bills. Like, your work literally pays a bill.

This isn't something that you can replicate.

I'm pretty sure given enough money, you can replicate it, but that's also exactly the problem -- given enough money. More and more these days it seems there's no amount that's enough.

You're actually agreeing with me, I think.

I said you can buy the exact same amount of coverage as the workplace plan, but the price will be so high as to be prohibitive.

As someone who has been buying my own health insurance for 15 years, you absolutely cannot buy the same exact coverage as an employer. They have MUCH better plans than what are available to individuals (in the three states I've lived in, anyway).

As someone who buys their own insurance, I have to say there are so many problems with the process. You make it sound like it's as simple as ordering a pizza...

Firstly, the major insurance companies don't want to talk to you, so you need to buy through a broker. The broker is suppose to help you pick the plan that's right for you, but realistically they will email you a few PDFs with 5-7 plans that are all extremely similar, full of jargon, and difficult to understand.

Find a better broker? Hah, good luck...

So after you become an expert on insurance jargon, and ask your broker lots of question, you're now ready to start paying. For small plans with fewer than 5 people, get ready to pay anywhere from $700-1k per month for the most basic high deductible plan.

Then after about a year, you'll get an email and phone call from your broker because your plan is no longer available. So you need to pick a new one, that has slightly different features and costs $20-100 additional per-year.

The American health insurance is a parasite.

> You make it sound like it's as simple as ordering a pizza...

It is as simple as going to healthcare.gov

You don’t need a broker and it takes 15 minutes at most. It’s just as expensive as any employer sponsored insurance, except for a handful of self funded plans from white collar companies which might be able to offer cheaper insurance since the employees skew young and higher socioeconomic class.

This is completely false. Insurance is far cheaper for large companies since the risk is being spread amongst a very large pool of individuals.

The pool of lives of a whole state is large enough. Where some large companies benefit is having younger workers who are in a higher socioeconomic class, which usually means healthier and therefore less expensive.

Checkout code DD of box 12 on your W-2 and compare to the same metal level plan for your state here:

https://www.kff.org/health-reform/state-indicator/average-ma...

I’ve compared it with a few different people working in Fortune 100 companies and it’s almost the same.

Well you can now look for plans on the state health insurance webpages. That does provide some amount of transparency but not for actual service pricing. But it is a bandaid on the original problem that you need to disassociate healthcare from employment and income level.

Also the ambulance services in this country are a total racket and can charge whatever they want. https://khn.org/news/taken-for-a-ride-ambulances-stick-patie... This is not a free market system it’s 100% corporate welfare enforced by taxpayer subsidies to the insurance companies. Ugh.

I never said you could do it in the sense that it's easy or cheap. I very specifically pointed out that you could do it in the sense that it is not illegal to.

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