If it's a fundamental right, the government should do it directly or subsidize it. Not lump it on employers just because it's convenient.
“I can’t quit my job, I need my food insurance so I can eat!” That’s the situation we’re in today with healthcare.
https://www.griffinbenefits.com/blog/history-of-employer-spo...
Employers don't provide additional services for altruistic reasons: having perks outside of the "labour/payment relationship" is a tool for attracting and retaining employees.
That said, basic access to healthcare should not be contingent on employment (with a specific company) because it gives companies a significant amount of power over their employees. Many companies abuse this to trap employees into unfavorable working arrangements.
Most common definitions of "universal healthcare" say it is a system that assures that all citizens of some political grouping (country, region, state) have access to healthcare without it being an undue financial burden.
If you also use such a definition, then I'm curious what citizens you think should not be assured of such access?
If you are using a different definition, then I'm curious what that is.
Dunno what you'd call that.
If the later two it would be universal healthcare. Not sure how the first would be classified.
In broad strokes, that’s how I’d define it as well but, as with many things, there are devils in the details.
Should it be only “citizens” or should it cover all “lawful, permanent residents”, “anyone lawfully present”, or “anyone who can get themself into the covered territory”? If it’s only citizens and excludes mere residents, is that “universal”? [and in that case, this puts non-citizen residents at a huge disadvantage]
Should all care be covered, in unlimited amounts? Only well-accepted, standard care? Or experimental treatments as well? Should expected life outcomes (either absolute or relative among the possible care plans) be factored into the approval process?
Should public-paid care be metered in some way, with supplemental or elective care being paid out of pocket?
Should healthcare-adjacent services be covered? (independent living, assisted living, or nursing homes, or travel to medical care [routine commute, ambulance, or medevac])
Who defines what “undue financial burden” is?
It’s easy to imagine two people both strongly being “for universal healthcare” and disagreeing on many critical details.
Your caveats and “details” also move the administrative and management burden into some weird place based on factors that are difficult to manage and track (need, quota, citizenship etc).
The answer is simple: everyone in the administrative region gets covered for everything. Anything else is discriminatory. Planning of care services can then respond to the medical and health need of the population at large rather than arbitrary permissions banding.
That leads to rampant abuses. For example in certain East Asian city states with "universal" healthcare people would use ambulances as taxis because they were free. You need copays to prevent this kind of abuse.
And you also forget that the US has a big illegal immigration problem. By and large illegal immigrants make minimum wage or lower, generally under the table (i.e. not paying taxes on it). By covering healthcare for them you are automatically subsidizing illegal immigrants at the cost of citizens and permanent residents. Is that fair?
If you think these aren't legitimate outcomes of allowing everyone to have free healthcare then you're naive.
The taxi issue seems trivial compared with the cost of actual healthcare. I’ve no objection to some light-touch system for reducing this risk, but it hardly seems worth worrying about. You (your government) could attempt to fix this by sorting out their transport networks and taxi legislation too. This isn’t a flaw in a healthcare system, it’s a symptom of a broken transport system.
Those immigrant workers “avoiding tax” are doing the worst jobs in your society, and living in the worst conditions. The very least you can do is pay their healthcare .
There may be an “immigration problem”, but it’s that national borders create an arbitrary and discriminatory barrier to free movement people and enforce QoL disparities across the world.
Nobody wants to sit next to piss/weed/cig smelling people and get their shit robbed on public transit (see: BART) if they can afford a car instead. Plus, US light rail runs at much slower speeds than places like China due to NIMBYism, so it also takes longer than driving to get places.
> The very least you can do is pay their healthcare .
The very least they could do is come into the country legally. And by the way, a lot of the really crappy jobs are done by legal residents, like garbagemen, sewer maintenance, lineman, etc. Guess what? My local taxes pay for those workers to have good salaries and I'm happy to pay. The US also has a visa for farm workers to come to the US as well.
> national borders create an arbitrary and discriminatory barrier to free movement people and enforce QoL disparities across the world.
Spoken like someone who is privileged and wealthy enough to be unaffected by open borders. Globalization has destroyed the American factory job, along with its high wages, and you still claim open borders are the way forward? Pro tip, don't claim to be morally superior when you work as a software engineer making $$$ that has a huge demand supply imbalance. If you really believe what you're saying then go work in India in a bodyshop making $10k and working 80h weeks, but pay your US cost of living. That's what millions of blue collar workers are facing when you open borders.
Please exit your bubble and talk to some real working class people for once. People like you are like the engineers I meet who openly talk about how self driving cars are going to disrupt the industry as they get into an Uber. Zero self-awareness.
I’m not in the US. I do live in a bubble, you’re right about that.
You didn’t read deep enough what I was saying and assumed I was only talking about borders. Borders permit (demand) national currencies. National currencies and their exchange reinforce arbitrary value disparities between countries. Value disparities between currencies are deep systemic racism, and work with border controls to limit QoL improvements and reinforce racial and cultural division. Globalisation as it has been thus-far implemented has been a scourge across the human world, and probably deeper into the material fabric we share. I’m unsurprised to hear your frustration with what it’s done: it’s the sickening profiteering tool of the already-powerful.
A human world that shared more information, allowed easier cultural and people flow, wasn’t gouged by currency exchange value extraction schemes, and focused more on local resource management and honestly dealing with externalities would have some chance of fixing the bigger issues.
I’m a dreamer. The bubble I live on is called Earth.
I think those conditions are met. With doctors having legalized limits on their numbers etc. I don’t think we’ll see a requisite increase in healthcare outcomes for the money spent.
Given that, my preference is market-driven outcomes with deregulation of medicine, then the status quo, and finally the worst option: simply paying everyone who is doing the current job 10 times as much and expecting this to mean everyone can go see them.
It is different, because in most countries where there is universal healthcare you can still cover that "private" care with a health insurance plan if you choose (e.g. BUPA or Nuffield in the UK)
And then you can do the extra electives on top of that.
So there are three tiers, rather than two.
(In the UK there are a few situations where we effectively almost have only the US two tiers; opticians, dentistry, nutrition, physiotherapy all have much less NHS provision coverage, largely because the elective stuff is so easily upsold; professionals can leave the public sector for the private money. The worst being opticians; the idea that the market can provide that more cheaply has been proved wrong.)
Plenty of companies even provide tiered insurance for executives and their families. So whether insurance is all employer-provided, private, government provided, or a mix, in the US one is almost certain to be able to buy something above and beyond the basics out-of-pocket.
I'm not saying that none of those things are impossible in the USA -- obviously, surely!? Nor is your GP.
You replied to:
> You know even if there is universal healthcare, you can pay private doctors yourself if you would like.
By saying:
> That's not really different from care outside of insurance coverage that exists today, e.g., elective plastic surgery.
But it is different. Because it happens on a third rung, not the second.
The difference is that you do not need private health insurance for the provision of basic things. In the UK (and in countries with even better healthcare) you have three tiers providing substantially the same services. (Even in the case of elective plastic surgery.)
(And the second rung is more affordable as a result.)
In the USA, there is no bottom rung for the majority of healthcare; if there was, there would not be an opioid epidemic. Medicare and Medicaid do not provide a universal bottom rung.
Americans hate their poor, vulnerable. It’s one of the many reasons I would never even visit there. Land of the free? Yeah ok.
It was not "lumped on" employers. It was another attack on working people. Tax it just like other wages, and I promise you'll start to see it disappear.
Am I in the minority here? I doubt it.
This clown car of "perks" only exist because of a dumb tax regime that makes those benefits pre-tax, and that regime should end.
I've worked at a few large financial institutions that pay technical employees significantly below market rate, but aggressively and publicly boast about how competitive they are because of "total compensation".
It's absurd, and often results in large dysfunctional teams where they have to hire 10+ junior people, for ~60k each, because they're unwilling to hire 1-2 experienced people, for ~150k each.
What I want is a revision to the tax code that stops making the benefits a tax-efficient vehicle.
It's an "employers' market" now as we are competing with the poorest nations on earth — a race to the bottom.
Nice for shareholders I guess?
People turn to their tax-paid, elected government for the things that Capitalism decides not to provide.
Ironically, many poorer nations have more affordable Healthcare than the United States. There's a whole "medical tourism" industry built around people from the US going to other countries for basic procedures and medication.
That was always stupid and didn't make sense, it's not because the labor/employment relationship used to be different.
This is completely false. Employer-based healthcare was a consequence of World War 2. The US Congress passed 1942 Stabilization Act in order to combat inflation. As a result of this legislation employers could not compete for workers using wages alone. Employers then began to offer health benefits a perk and since that perk was not compensation it was not taxed. This fact is actually well-documented.[1][2]. It was offered in lieu of compensation and pre-tax vs post-tax status had nothing to do with the birth of this.
[1] https://en.wikipedia.org/wiki/Stabilization_Act_of_1942
[2] https://www.chicagotribune.com/opinion/commentary/ct-obamaca...