Intuit asked Mailchimp employees to pay medical costs out of pocket
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The only reason American employers are in the business of offering health insurance is because they get a federal tax break. This makes health insurance cheaper to the employer than to individuals. Given this, if my employer stopped offering insurance, they couldn't increase my salary enough for me to purchase the same plan myself. I think this is unfair - I would like to get the same tax break myself, or at least eliminate the tax break altogether so I am on an even playing field with businesses. This would allow me to purchase my own health insurance at rates comparable to what I'm offered at work.
Considering the tax situation, it's curious that Intuit would not choose to take this tax break. It seems like a short term move that allows them to cut costs while exploiting the economic stickiness of employment. This move makes them less competitive for employees in the labor market, but that only affects them in the long term. In the short term, the employees they have will be hesistant and slow to find new jobs.
A good corollary in the US is Medicare: everybody over 65 can enroll in Medicare Part A for free, but you can also choose Part B, Part D, and "medigap" coverage, each of which is optional and has a monthly premium.
ACA subsidies disappear once you make $50k or more a year.
Prices, including labor prices, are not determined by costs. There is no indication at all that companies would compensate employees more if they didn't have to pay for their health insurance. What is most likely to happen is that companies will pocket the difference, in the same way they've been pocketing the difference from increased productivity while letting wages become stagnant.
Whether my fully burdened cost budget has a line item for health insurance being paid to a 3rd party or to the employee is totally irrelevant. Tax law currently happens to make it much more efficient for me to pay that money to a 3rd party, so that’s where it goes.
The reason I have that line item is due to a combination of market forces and regulation. By no means do I get to choose just not to pay it, if I expect employees to keep working for me, or the government not to shut me down.
It sounds like you’re saying that employers are always trying to hire as many people as possible.
Which would be nonsense, of course.
A bizarrely uncharitable non-takedown, and completely besides the point as well?
If you believe this then what's your explanation for why Google hires a smaller number of expensive engineers, rather than a larger number of cheaper engineers? They could hire 10x if they went for only lower-tier college new-grads!
Obviously a business would not be particularly successful hiring janitors to write code simply because they could pay them less.
Leaders of this country really do not care about the healthcare of its citizens (just look how long people with diabetes have been screwed, how long people have been able to lose literally everything over medical debt, etc.), I can’t imagine leaving things to the individual would be helpful in any manner whatsoever.
There are a lot of jobs which do not offer benefits, or benefits are offered with no part paid by the employer. These places would not offer raises, but these people would end up with better choices of private plans.
Benefits are a huge burden for companies, especially smaller ones. Coordinating benefits is a seasonal full-time job that someone has to do. I've known of a few smaller family businesses that gave everyone a raise, and told them to get their own health care coverage on healthcare.gov.
Sounds like an excuse to me, and if they're this bitter about paying for benefits, something tells me they'd be just as bitter towards giving substantial raises across the board for, essentially, no reason.
I've never seen that happen, ever, in 25+ years of being in the working world in the US. Not saying it never happens, but I've not seen it, and after asking around, no one I know has seen that info.
In Australia minimum wage laws means that Starbucks locations rarely have more than two people on staff - that's just economic forces causing a rational business response.
Firstly companies don't shutter, they downsize. The most vulnerable employees are the first to go, the higher paid ones are typically the most valuable, remain. Owners go last.
Secondly, in my experience, all employees would rather forgoe a raise and keep everyone employed that insist on a raise. We saw this first-hand in 2020. Lockdown brought extreme uncertainty but employees agreed to 50% [1] pay instead of massive job cuts.
Yes it helps that we pay staff well. Yes it helps that they get a bonus in the good years. Yes it helps that we have their interests at heart. Yes it helps that they are skilled and we don't want to lose them.
Yes, over the years some people have become redundant, but there are swings between good times and bad times, and no we don't shutter just because there's a bad time. That's explicitly _not_ how it is supposed to work.
[1] we had a min threshold for 50%, those under got 100%. Also thanks to govt assistance, and our ability to back-pay later, they all ended up "whole".
[2] ps - I agree on the need for a minimum wage. In almost all cases it is too low by a lot. And I agree that if you can't pay minimum wage, then you can't afford an employee.
I've seen workers pidgeon-holed into low stagnant wages too often to accept it as a status quo when the companies employing them are posting profits - in the modern world we too quickly accept the fact that owners are supposed to take out lion's share salaries and profits need to continuously increase. A business can have a healthy existence just making the economic wheels spin and ensuring that employees are well compensated.
We usually set minimum increases based on inflation. Often we do higher. Occasionally we have wage freezes but they are not common. We adapt to conditions and circumstances.
Obviously we are one data point, but I have seen other small companies do the same. Big companies bad behaviour does make the news, good behaviour does not, so while bad actors certainly exist, I don't know if that is the norm, and I don't know if it is more prevalent in the US.
Also as a principle, regulating said free markets for QoL improvements (e.g. min wage, HI, disability, comp, soc sec, etc.) affect all participants - both efficient and destined-to-die businesses alike. If you can't exist through playing by the rules that everyone has set, why are you still in business?
This assumes that such "more efficient organizations" can even exist. If they are possible, why aren't they already around? Are those "Businesses that cannot afford to retain talent and remain competitive" that you speak of somehow preventing them from existing?
In most markets where efficiency is not achievable, then businesses are not entitled to exist. This is why things such as tax subsidies and other forms of funding are used to bootstrap new markets (e.g. green energy) that have a net social gain.
When you start a business there’s an expectation that you’re probably not taking a paycheck from it for a few years while you try to attract customers to provide steady cash flow.
While doing this, you somehow have to find a way to hire people to help you grow.
If it doesn’t work out, the business owner loses everything most likely and will probably be on the hook for the space they were leasing.
Now if you survive and make it past all that, hopefully everything stabilizes and you’re able to run a successful business that can return more to you than you put in…but it’s hard. Very very hard.
This “should that business even exist” stuff comes from not having any idea how hard it really is and how much is really on the line or the ups and downs along the way (which are even harder when you’re trying to make payroll).
If it was easy, everybody would do it.
I think this is only true for a newfangled SF business.
Traditional business gets a bank loan, has a business plan, and pays salaries from the start (including to the owner).
Make no mistake, the only reason a company closes is because they run out of cash. Old-style businesses have been doing that forever. SV businesses do the same when that "next round" fails.
Which leads me to conject that a VC business is just a bootstrapped business, where VCs are the customer...
>> While doing this, you somehow have to find a way to hire people to help you grow.
Where is that expectation coming from? It's fine if it's a side business you're looking to bootstrap or something, or if you have enough seed funding (which can be in the form of your own savings if you're okay risking that) to be revenue negative for a time, but if you have enough funding or revenue to consider hiring people, the first person you should be hiring is yourself.
>> If it doesn’t work out, the business owner loses everything most likely and will probably be on the hook for the space they were leasing.
This is why you create a -business-. A legal entity separate from yourself. An LLC at the minimum. So that your personal liability is (wait for it) limited. If you're doing a sole proprietorship or something, where you'd be on the hook for everything, WTF are you doing hiring people and signing leases?
Creditors and lenders are not fools. They'll often require the owner of an LLC to personally sign for the note.
Owners get pais last, not first. Sure you make enough income to pay yourself first, then you hire. Time passes, there's a bad month or 3, employees still get paid, owners start accumulating loan accounts.
LLC's and other structures are designed to limit downside, but some creditors will end-run this with personal sureties. This is really common with leases, but also other forms of credit. Inexperienced business owners may not push back against these as hard as they should (you can push back, but most starting out don't know that they can...)[1]
Building a business from scratch is hard work, and most fail within 5 years because failing is really really easy, and success requires someone to do a lot of different tasks well, and almost always some "luck" [2] as well.
[1] most bootstrappers try once, and are thus inexperienced. The folk they are dealing with (landlords and suppliers) are very experienced. This imbalance leads to contracts that are very often one sided.
[2] the best luck is advice from an experienced bootstrapper, ideally for free. They can help you avoid the most common mistakes. Of course you'll ignore some of their advice because "experience doesn't work like that".
Reads like maximalist statement with zero clues about the subject.
However if you reject this ideal which is the western worlds baseline, then you really have to provide some info on what framework you are arguing from…
Yes some companies will optimize for profit - some already do that, amazon makes a killing while warehouse staff are low paid. Uber makes everyone a contractor specifically to avoid benefits and so on.
Other companies pay a living wage, and cost a "cost to company" for each employee. These may choose to pay the benefit as cash.
Where I live the tax benefit of health care applies to companies and individuals alike. Some companies have mandatory health cover, others have optional health cover, others have no health cover. Since there is no tax implication it's not hard for prospective employees to compare one with another.
Ultimately, some companies pay low wages, some pay high wages, that's somewhat tangential to health cover or not.
Speculating on what most employers would "most likely do" is, well, just speculation[1]
[1] large companies like amazon known for screwing employees? Yeah, I'm with you there - but I don't think most employers are like that.
The leadership at my employer talks big about how much they care about their employees, and indeed, the vacation and benefits are very good. Yet even in the face of record profits they gave me a 1.5% raise this year, despite the 8.5% inflation. I'll believe that they'd pass benefits package savings onto me when I see it.
If the company is paying it it’s just a business expense they can deduct from their income.
If only someone had some sort of working template on how this could be done in a cost effective way. I'm sure everyone, regardless of where they fall on the political spectrum, would rally round such an obvious net good in that case.
(I know that bit of sarcasm is a bit of a tangent, it just feels like this whole subthread is missing the obvious)
I think we just skipped over the part that we already know is never going to happen, however much that might be the ideal solution.
I personally think a model like this is pretty fair, if somebody is making 50k a year then pulling in 1M annual is pretty silly - but it makes sense to account for that difference with taxation rather than the arbitrary choices of private employers.
https://www.cnet.com/tech/tech-industry/apple-google-others-...
That said, depending on the splits, it's much more probable that the cost to "employee salaries" will be less than their typical OOP expenses anyways.
That’s very much not the case for 99.9% of goods and services.
Prices for labor, i.e. wages, are set by the demand for labor, and workers’ opportunity costs.
If you're a company, unless you were already planning to do some mass layoffs, you're going to give most of them that raise because the alternative is having a bunch of people quit. And if you don't increase your offers for new hires, you probably won't be hiring anyone either.
This is false: they would pay a lost less in additional income taxes. Americans overpay for the same services as every other developed country. They are being fleeced.
And yet price stickiness is a thing that exists!
https://www.investopedia.com/terms/p/price_stickiness.asp
This is the problem with a lot of "econ 101" stuff, it makes these big sweeping assumptions like "markets are price-efficient and operate at market-clearance prices" and after spending econ 101 building it all up, econ 102 and 200 and etc etc will spend semesters telling you why it's all crap.
Markets are not price-efficient, real-world prices are very sticky, and that includes the price of labor (actually labor tends to be far stickier than most other products). For example, vanishingly few real-world employers are going to offer automatic raises to cover cost-of-inflation, which is the same mechanism that you would be relying on to increase wages after removing health-care benefits.
A lot of people in retail/food are still making the same $11 or $12 they were hired on at, despite much higher salaries often being paid to new hires (guess the efficient market hypothesis says their on-the-job experience has... negative value?).
Tech is its own little thing, competition for tech labor is much much tighter, of course, but that much is obvious. In the real world, you can already see that labor prices are very very sticky and owners will almost never choose to pass these savings along.
Without increases in compensation, workers will suddenly have thousands of dollars in new yearly expenses just to maintain coverage, and many will be forced to go without coverage at all.
This wouldn't be a problem, though, if employer-provided healthcare was replaced with a universal healthcare system that most first world nations have had for ages.
I have pretty good insurance, when I started, a few weeks before the end of a year, some of the folks I was working with were bitching about how it didn't cover anything and was expensive (the employee premiums were tiny at the time and are still low).
The company could:
* immediately raise people's salaries
* or hire in more people (which increases demand)
* they could take the extra profit and distribute that to shareholders
* or drop the price of their products and services and pass the savings on to the customer
* or they could make capital investments.
In most cases, I would expect salary prices to increase for labor (even if not immediately) or make people's current salaries more effective in purchasing power.
Also, you forgot the popular option:
* give (bigger) bonuses to their execs
They also had pension plans, but these days, those are rare outside of government jobs. I wouldn't be surprised if companies clawed them back as the threat from unions dwindled.
https://www.latimes.com/archives/la-xpm-2005-may-11-fi-unite....
A 401k is probably better since the company is paying funds directly to your account, IOW they can't underfund it.
That said, Raytheon ended up fucking over their 401k plan. Raytheon matched in company stock and required that 401k owners held the company stock for 3 years once it was put into the plan. It worked great until 2005 when Raytheon's stock dropped to 1/3 of the price on news of gross of mismanagement. Employees couldn't get out of the stock, and were forced to swallow the loss.
So even on a 401k details matter.
They tend to reward long tenures at companies. Even with government sort-of guarantees they have risk of insolvency. And ultimately it's just not your money.
I also really think that congress should forgo the Roth IRA contribution limits for most people. They're arbitrary and limiting.
Also the penalty for large employers is much smaller than the cost of health insurance (50% to 18% depending on individual vs group coverage), assuming that if companies didn't provide health insurance they'd pocket the difference means companies should still pay the fine.
[1] https://en.wikipedia.org/wiki/High-Tech_Employee_Antitrust_L...
Amazingly, fantastically useful.
What really matters is how the government policies would change when it's moved from employers to people. The government is likely to pay the costs for low income people, which will also mean their wages are likely not to rise.
If employers are already compensating employees as little as they can get away with then if they stopped compensating via insurance, they'd be required to compensate via salary.
Of course. And the employee negotiates for as much as he can extract from the company. That's how markets work.
Even when we talk about redistributing this increase, we mostly talk about redistributing it from the professional-managerial employees, who populate the higher personal income tax brackets, not from the companies themselves (corporate tax) or their owners (wealth tax). If you are right that companies and their owners are pocketing it, then we are looking for it in the wrong places. But it seems like it really is largely going to the PMC.
Employers use a figure called "total compensation" for what it costs them to employ someone. This includes salary and the cost of all the benefits, including all the so-called "employer paid" taxes and benefits. The WSJ ran an article long ago that showed employee productivity matched total compensation, not salary compensation.
Employers certainly do care about the cost. They don't care what percentage of those costs go to employee takehome pay. But offering pre-tax health insurance means the employer can offer less total compensation.
Any economic article that talks about salary instead of total compensation is either ignorant of accounting reality or is trying to mislead.
Source?
I am seeing 10-K reports showing UHC, Anthem, CVS, Cigna, Humana, Molina, Centene, etc all with profit margins ~5% or less.
Is the claim that executives at one or more of these companies is attempting to bypass ACA regulations (and violating fiduciary duties to their own employer) by overpaying for services to outside entities that the aforementioned executives control?
Seems like a grand conspiracy theory.
They spent 20+ million with this company, how much do you think the execs on the board get paid? No one knows because they're private/for profit and don't have to publish annoying things like a 990.
They probably agreed to not layoff Mailchimp employees in the sale, so they make them quit. Purging the sick, tbe pregnant, etc from the company is a way to cut costs, and doing so through some elaborate bureaucratic fuckup avoids government intervention.
Maybe I wasn't searching correctly, but I was recently discussing healthcare and taxes with someone and briefly searched on the Healthcare.gov exchange to look at prices. There were only three PPO plans (where you can freely go to any doctor in network), and all three were HDHPs, all from the same company. There were many HMO plans, some HDHP and others with low deductibles, but often extremely small local networks and limited choice of both PCPs and specialists.
> This makes health insurance cheaper to the employer than to individuals.
One other thing to note in your analysis is that most large employers are not buying any insurance, but actually self-insuring (funding the claims out of their own pool of money). So the employers are actually acting as insurance companies for their workers, rather than simply buying and reselling commercial insurance.
There would be additional considerations beyond taxes in analyzing whether this type of insurance is more economically optimal, for example, the fact that each company has a distinct risk pool which may not be similar to the general population, depending on the company.
FWIW, in California I see like 5 different options for HMO across all of the tiers, a couple are local ones I've never heard of, but there's also some like Kaiser that are fairly large networks.
For comparison, I am on my mom's insurance from Belk Stores which is self-insured, offering three different HDHP PPO plans with a pretty good network and a range of deductibles within the HDHP window. Premiums are pretty bad. My dad worked for a SP500 semiconductor company before retiring, about five years ago they switched to HDHP-only, which just two options both at the higher end of the HDHP range. Premiums were better, but actual coverage not much better.
Maybe not. Businesses have more negotiating power because they're bigger buyers, so they would still have access to more competitive rates. Unless you got together with a lot of people to negotiate together (and this might be a startup opportunity).
Small companies get crushed by insurance. Giving employees extra money in their check and telling them to use it on the ACA is probably most effective for all parties at the moment.
Make this similar to gym membership. Let each person decide where to go based on cost and needs. With insurance remaining their for catastrophic events only.
Forgive me, but when it comes to my healthcare I want the most choice and control as I can have. I don't want to be stuck with whatever some bureaucrat decides is worth it.
Lastly, people make stupid decisions and they get hurt. They go rock climbing or skydiving, they ride their bikes on busy streets. Why should I shoulder the responsibility for people's poor life choices.
You do know how private insurance works right?
Someone makes an insurance company. Then they sit down and figure out the probabilities of things happening to people. They then put a price to join the group. They then divvy up that money to people in the group that have had things happen to them.
With insurance you will always be paying for other peoples "poor life choices"... that's the way it works. Maybe one day it will be your poor life choice (or accident.)
Having state healthcare by default does not necessarily mean a ban on private healthcare. Both can coexist.
Like being born with a certain combination of genes which aren't as healthy a combination as others. Or being hit by a car, and losing a limb. Or being shot in the head by someone and persisting in a vegetative state for years.
Yeah, the nerve of these freeloaders and their 'poor life choices'.
Personally I haven't done that well and could not afford my costs if they weren't pooled with other people. I'm happy that in my case this is publicly funded, so I don't have to deal with profit-maximizing private insurance companies who are at every turn actively trying to find reasons not to cover me.
I'm also glad that people where I'm from who are less fortunate than me don't have to go without needed health care because they aren't able to get good enough jobs. In fact, I care much more about the latter than you or me being able to choose between a bunch of options. And if you're doing so well and that's what you want, private health care is typically still an option even in countries with publicly funded systems.
How much choice and control do you really have by having a private insurance? If you get hit by a car on the street, your kid trips in the stairs, you walk into a wall and crack a rib, the difference between your and mine is that: 1) I don't have to think about what it will cost me 2) I don't have to fully understand every aspect of my insurance agreement in order to understand what I am entitled to 3) I don't have to fight a insurance company if they don't want to pay for it 4) I can just relax, have a beer, and know that I will be taken care of if something happens
I am not completely sure where you want to go with this argument. But as a Scandinavian I am very much comfortable with the state ensuring my access to health care, knowing I do not ever have to ever have to think about medical costs, health insurance or access to one of the better health care systems in the world for me or my family. We could very much bear the costs of having private health insurance, but its just one less (big) worry...
I do think that production of food is very much a state matter - and unless you knew taxes in the US today go towards ensuring safe and predictable production of food through i.e. agricultural subsidies. I would expect the state to ensure that the country have a viable and thorough plan to ensure food supplies.
The cost of paying me is also tax deductible, so they get a 'tax break' by paying me more money.
> This makes health insurance cheaper to the employer than to individuals.
I don't think that's the root. Large insurance companies seem to want to sell to larger companies - groups of people - vs selling insurance to individuals. Selling to a group is where it seems some price reduction happens. And... by and larger, if you're selling insurance to people who are already healthy enough to be working regularly/fulltime, your costs for insuring that 'pool' will be somewhat cheaper than the costs of insuring any random individual.
> they couldn't increase my salary enough for me to purchase the same plan myself
If the cost of my health insurance was deductible from my individual taxes, then the entire market would be turned upside down. There are certain thresholds that need to be met re MAGI (IIRC) before health insurance insurance premiums are deductible by individuals. I'm "self employed" so the entirety of my premiums are tax deductible, but for the average person working a W2 job someplace that doesn't provide health insurance for them, it's not a deductible expense, which is a total sham.
What should be done is entirely decouple it so that health insurance AND medical expenses are above the line deductible - or make none of it such. And then let employees pick whatever they want.
Insurance this past year has paid for like, a couple dozen specialist visits, 6 MRIs, weekly rehab, a reclining desk and a power wheelchair. I maxed out my deductable in February :D
My health would be better if I could go on disability but that pays like, $1K a month and is ridiculously hard to get.
But I agree, healthcare should be provided by the federal govt like in every other advanced nation
This is wrong on so many levels.
First, employers get a tax break because compensation expenses are generally deductible as "ordinary and necessary business expenses" required for the employer to be competitive in the labor market.
Second, employer policies are cheaper because the risk pool is cheaper to insure than the individual pool, so the insurers can make the same or more profits despite charging lower premiums.
The combined effect is to make employer-based health insurer significantly cheaper on both a pre-tax and post-tax basis than individual plans. But even without the tax benefit employers would still be incentivized to provide health benefits in a labor-competitive market. For example, many still provide free meals and parties to employees, even though meals are only partially deductible and parties are not deductible at all.
2. US healthcare system is incredibly hostile to people trying to pay their own costs and designed to be maximally obscure and confusing. Imagine buying a car where your car dealer, tire manufacturer, window glass manufacturer and upholstery supplier bill you separately. Now imagine when you come to the dealer and ask how much the car would cost, they shrug and tell you you'd know when the bills come, just relax and sign on the dotted line. If you really insist, they could give you an estimate - something between 1K and 100K dollars - but they don't guarantee anything, it's just an estimate. And no, you can't choose the suppliers upfront or know which ones they'd use - this you'd also know only when the bills come. And no, there's no way to know when or how it happens - they bills would just show up one day as a surprise. Sounds like a nice experience? That's how the healthcare system works, day to day.
3. The frustrating part is that most of the people think it's the only way to manage it, and those that don't think that the only way to fix it is to nationalize the whole thing. I mean we can create insanely complex supply chains (think how many people cooperated on making a car? And you still can come to a single place and pay for it with a simple transaction at cost known in advance - magic!) - but somehow healthcare is where it all disappears and figuring out the separation of labor thing becomes the problem of the end user.
On the flip side, the cost my employer pays for my plan is far lower than they would bill me for it on the open market. Last time I looked at the individual market it was amazing how bad even plans for $500-1000 were! They could give me a raise exactly matching what they'd stop paying and I'd still lose out.
Edit to clarify: That's not a "this is cheaper to us after we account for the tax break." That's a "this is the rate it costs us" vs "this is the rate it would cost you" difference.
The negotiation power difference is real. Private market health insurance would need to be well-regulated or we'll all just get screwed even more.
Employers like this because it gives them power over employees and makes it more attractive than being an entrepreneur not just to save money on taxes.
Individuals should still have an option to choose a plan on the open market if they desire, but they're highly unlikely to find a plan for $100/month.
I've had multiple open heart surgeries. My medical events are relatively rare (every couple years) and I recently went completely septic for 4 days (started to have multiple organ failure ~3 days from no-return) due to a cascade of underlying issues. I know my medical coverage and it's been critical to my survival for my entire life.
I have NEVER used employer health insurance and anyone with major medical conditions would be foolish to depend on employer coverage in most cases. The offered plans are basically a big deductible with some minor coverage for non-catastrophic, no surgical coverage, nothing chronic. More expensive plans cover more dependents. Gee thx. It's all but useless and I have simply declined it everywhere for the last 25 years to keep the ~25$/mo, as I have paid my own (car payment-sized) platinum level health insurance plan everywhere I've gone (and my wife's). The type of company - Finance, Medical, Marketing, Retail, Consulting (ironically the best I've found), doesn't make much of a difference. Every now and then you find some employer that will "cover your healthcare 100%" which is inevitably code for "cover the plans we choose, which aren't different than anyone else".
This is a similar plan to my last 3 employers, companies of various sizes HQd in either SF or Seattle. If I had "multiple open heart surgeries," it would cost me a max of $3k in a calendar year.
Where are you working that you are not being provided similar plans?
You're in a very fortunate position, but still dependent on the largesse and good fortunes of an employer (or multiple over the years), and when they have no use for your services, you'll be in the same boat as many others.
> I have NEVER used employer health insurance and anyone with major medical conditions would be foolish to depend on employer coverage in most cases. The offered plans are basically a big deductible with some minor coverage for non-catastrophic, no surgical coverage, nothing chronic
Which is just completely untrue unless the best employer you've been with is a regional fast food joint.
https://www.reddit.com/r/PoliticalHumor/comments/u15pwv/univ...
https://www.npr.org/templates/story/story.php?storyId=114045...
https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...
In South Korea the healthcare premiums are split between employees and the employers: https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea They don't have to negotiate group plans and maintaining coverage when switching jobs is pretty seamless.
There has to be a plan if employers stop providing insurance en masse, and I'm not sure it's a good idea to stop getting premiums from the source of personal income entirely. That seems to be a convenient place to get the kind of money that healthcare demands.
The amount of time we have to spend each year sorting out our healthcare for the entire company is mind blowing. You are totally correct, it becomes a full time job for 3 or 4 weeks for myself and another partner. So much effort and knowledge required for something that isn’t even our core business! And it inevitably causes drama with employees who don’t like some part of the group plans we end up with. Very stressful.
We only offer it as our employees all say that this benefit is really important to them. I didn’t know it was a tax break for us to be honest.
I wish more employees thought like you did. Our average monthly cost per employee is about $500 for a “silver” PPO plan, and about $110 for dental. Average age of our employees is below 30.
I’d gladly pay employees the $610 extra a month just so we don’t have to deal with it and the drama that comes with it. This would actually save us money from the energy wasted dealing with insurance companies. And no one who’s dealt with our insurance plans over the years has had a positive experience. My brother (who worked for my company) cut his chin while out of state. Required 2 stitches, and he just walked to the closest ER to get them. $3500 it ended up costing him, even with our insurance and countless hours fighting the insurance companies too. Didn’t even see a doctor, a nurse did the stitches. It’s a joke.
Other than salaries, health insurance is the largest expense for our business. Think about that at the scale of the entire economy and its mind blowing the wasted energy/effort on this “system”.
I’m originally from Australia. We have “socialized” healthcare there. My brother is back visiting family currently and got an x-ray and ultra sound for $310. The American system is absolutely embarrassing.
Aren't there insurance brokers that provide tools to compare simply. Would a system that allowed employees to vote/order the cover they would like in the plan and then you to adjust the price point until you get matching policies that provides an acceptable level of cover.
Brokers will educate you on specific plan mechanics but will avoid explicit recommendations because they don’t want to take blame for choosing the “wrong plans” for a company.
Each plan is optimized for specific scenarios, e.g. young person with no medical risks or chronic conditions, middle aged person with chronic conditions and established doctor affiliations, so on and so forth. But they aren’t explicitly labeled that way, so people have to figure out what makes sense for them.
If you’re an employer who cares a lot about this process, you basically need to mind read the healthcare needs of each of your employees and offer a menu of options that satisfies their needs, while trying to avoid offering options that nobody should rationally choose.
If you know nothing about health insurance it makes the whole process much harder.
Source: worked in American health insurance for years.
Intuit did provide health insurance to these employees and take the tax break. There was a small gap between when the previous MailChimp insurance ended and MailChimp employees were placed on the Intuit offered health insurance. Once on the Intuit provided plan coverage was retroactive to the date the MailChimp plan ended. The employees could submit claims to the Intuit plan for reimbursement of medical expenses paid during the gap. The issue is that floating the money during this time could significantly impact the finances of the employee or that the employee may not have the funds to do so at all.
Would it? The employer can still call up an insurer and say "if you can give me a better deal than X, I'll buy insurance for 1,000 people" whereas you have maybe 5 potential customers to bargain with.
https://slashdot.org/story/21/11/11/1634237/intuit-slashes-p...
https://www.businessinsider.com/mailchimp-employees-shocked-...
> In the US, your health insurance is tied to your job.
Why on earth is it that it doesn't matter which party gets elected, you can't seem to get universal health care? Pick California for example, it's a rich state with a massive homelessness problem. What do the homeless mostly suffer from? Addiction and mental health.
Living in Europe and not having to worry about any kind of random health issue is great. If you have some problem, you get it seen to as soon as possible and not worry about whatever it may cost. As an employer things are simpler too, and in the long run, likely cheaper.
It just seems incredibly backwards and I'm not sure it really actually serves anybody. If you're big Pharma, you want your patients to live longer, as they'll get older and have more issues that you can sell products for. If they lose their job, that's lost income.
Not having a home.
> Not having a home.
There are typically quite some homeless programs running, but many get rejected for not abiding by the rules they (understandably) must have, i.e. don't be violent or do drugs. It's not enough to give these people a home, you must also address the reason they are homeless.
Most people tend to fall into moralistic behaviour regulation, but the reality is, quite often the barrier to improvement is homelessness and not drug addiction. Mental health is another thing, but it's much easier to provide care once they have a home/fixed address
Because Republicans can tie-up such laws in committee to prevent it.
Obamacare is a huge improvement over what came before. It's rather absurd to complain it isn't enough.
> Pick California for example, it's a rich state with a massive homelessness problem. What do the homeless mostly suffer from? Addiction and mental health.
California spends a considerable amount on generous public health programs. A great many homeless have health insurance from the public programs in California now. Tearing down all barriers would leave California at risk of medical tourism draining public funds.
But this doesn't explain why it hasn't been achieved on the state level.
> Obamacare is a huge improvement over what came before. It's rather absurd to complain it isn't enough.
Not really, you can appreciate an improvement whilst looking forward towards further improvements.
> California spends a considerable amount on generous public health programs. A great many homeless have health insurance from the public programs in California now. Tearing down all barriers would leave California at risk of medical tourism draining public funds.
This sounds like a solvable problem. You could have an upfront tax or medical availability delay of a few years to make health tourism really unattractive.
Blaming other people sounds like a great way to not deal with the issue.
I look forward to seeing how you fix it.
Given the mandates on insurance there are some reasons it should continue, but they are not really good reasons.
Many of those reasons are legislature that allows insurance companies to do/demand things that they really shouldn't be able to. Even if the goal isn't public healthcare, America still needs a major healthcare insurance restructuring.
Also, get it out of the employers hands - as in make it illegal to offer any benefits and let the employee get paid 100% of their salary instead. Also make it so that employers can't legally collect taxes without consent.
Just drop the rebates, and make any secondary insurance be primary. That would make sure the insured group for the public system includes the healthy rich (which makes the pool for those that actually need and can't afford their health).
This is sort of a hot take, but there are plenty of examples of things like this in the US that have the unstated parenthetical "(because poor and minority populations were ignored by the system completely)"
We may need more wealth transfers to the needy so that they can pay for healthcare! You will note, however, that the recent approach to reforms, which tried to turn the vehicle of “insurance” itself into such a wealth transfer, has not exactly solved the problem!! Nor has it achieved its stated goal of making healthcare and health insurance more affordable to the general population, a mission always contradictory to its goal of being a wealth transfer!
Besides the fact that there doesn't seem to be any better or viable alternative available in the marketplace what are the other reasons?
Serious question, right now it’s legally mandated to have. What would happen to medical prices if that requirement was reversed?
Just food for thought. If you model it you’ll find interesting results.
If it was illegal to pool health prices via insurance (instead of just not legally mandated for everyone to be insured) then the effect would be that those who went bankrupt under the old system would instead be dead.
And for pre-existing conditions and long term health disabilities - the individual would need to somehow justify the profitability of their existence to a private underwriter who was willing to bear the cost - in most cases those people "aren't worth the cost of keeping them alive" (assuming you're looking strictly at numbers).
Hence - a lot of people would end up dead.
No one would sell insurance that would fix your already destroyed roof.
But they will sell you homeowners insurance in areas prone to wildfires or hurricanes. The difference is that you are expected to know the amortized cost of disasters for your property and either insure against it or simply accept the risk. Either way, you as a homeowner are supposed to make an informed decision. If disaster is too likely to occur in a certain area, you can either move or not purchase a property in the first place.
Science still hasn't figured out how to let us move into healthier bodies or choose our bodies prior to birth, so, alas, we are forced to seek fairness through other means.
And in areas with wild fires, tar roofs aren't legal for new construction! Roofs have to be built out of something non-flammable.
Lessons to be learned perhaps.
If you want to know why doors in public places have to open toward the outside in modern countries and why "panic bars" are often mandatory, the answer is large piles of dead children (literally). Depending on who you ask and the country they live in, they will refer to a different disaster, but the common element in all of them is 70 - 600 people stuck in hallways unable to escape due to bad exit designs (eg. people piling up against doors that open towards the inside).
You can virtually ramp up building codes ad-infinitum, until the house is as safe as can humanly be built, if your expense is to hurt a lot of children by bankrupting families of expenses to take care of other necessities in life.
I think it's more a question of whether we'd be willing to install and maintain a roof on a building that had been designed without a roof in mind or whether we'd tear down the building to make room for a new one. You'd probably rationally lean in the second direction for a house - but when we're talking about a human life the math changes for a lot of people.
Either way, a return to an insurance-less situation would leave people with preexisting situations out in the cold, unless your definition of insuranceless involves government subsidies for all preexisting conditions and at that point you're basically talking about medicare for all.
In my mind, it's not charity because it's
- For everyone. Maybe not for you today, but maybe tomorrow
- For the benefit of society as a whole. If we let everyone who got sick just die, our society would be worse for it.
If you are thinking of something that is for literally anyone, you are most likely thinking of universal healthcare or some other like system.
We've seen how the judgement of those receiving aid has affected US policy in the past - a handful of people are marked out as undeserving of the aid (maybe someone with a long term physical disability commits murder or something else) and then the full category of people are painted with suspicion (ala "welfare queens") and that suspicion is used as a justification to cut spending drastically under the guise of oversight. There are a fair number of people clamoring today for UBI for the reason, in my view at least, that it's the only way to undo all the complicated conditions on various forms of governmental aid.
I'd personally be quite in favor of keeping it dry, cold and governmental - healthcare is, IMO, an important enough topic that we can't let emotions override treatment. If we're going to put a bunch of money into a big pot we should have some very deliberate rules about how that money comes out and what it gets used for and posing it as a charity is going to get all sorts of rules applied to it (i.e. it can't be used for anything Planned Parenthood related, it can't be used for contraception, it can't be used by trans identifying individuals, you need to have a full time job to access it, it is unavailable to felons, etc...) - some of those rules might make sense, others might not. At the end of the day I think posing it as a charity will make it a lot harder to come up with a fair set of restrictions on it.
There's also the Chinese model, where you or your family are expected to have substantial cash savings on hand for any medical emergencies.
My uncle spent $1.7 million in 3 years to care for my aunt, and that is with excellent insurance.
My mom is fighting cancer and her medication is better than 25K a month, but she pays 200. That’s closer to my definition of good insurance.
The people who went bankrupt before were generally those without insurance. You've not said anything that explains to me why they wouldn't do the same under this supposed new system.
I think I laid that out pretty clearly in the prior comment, is there some part of it that's unclear?
I feel like we’re talking past each other. Sorry if I’m being dense.
Yes, emergency care has been essentially free in the US for those who can never pay for it, but that doesn't cover, say, chemotherapy. If you don't have insurance and don't have any way to generate significant cash (no house to sell and no wealthy generous friends) it's not that you're going to get chemo and it'll bankrupt you; you just won't get chemo at all (and you'll probably die). This is a little better now with the medicaid expansion, but not perfect, and not all states expanded medicaid.
Even today we have people dying of complications related to diabetes -- a serious but very treatable affliction -- because they can't afford supplies. In the US! The world's richest country!
While everyone in America can receive emergency treatment no questions asked it isn't necessarily going to happen very quickly and can result in more health issues than being able to pursue medical care through more standard means.
It wasn’t great. HMOs were being introduced (top down) and a lot of people had no idea how to use them.
The prices were nowhere near as high. The huge jump happened in the 2000s. It was nuts.
Regarding the bit about “health insurance companies could reject preexisting conditions” - most people got insurance through employers whose contracts required pre existing conditions be covered.
There were absolutely some places you could get totally stuck and screwed.
But things didn’t get bad until the 2000s, and it was mostly price that was the issue.
No, we won't. The results are entirely predictable. Without medical insurance people die and/or go bankrupt.
The main problem is that most Americans for some reason cannot imagine a system other than the US system, and equate all medical insurance with that.
My understanding of the mandate was that(theoretically) by more people being insured the population be healthier and that would someone how drive prices down. Obviously that's a farce as prices go up year over year. It would be interesting to see how much more basic procedures would be now after being adjusted for inflation compared to what they were in say the 90's.
Why have health insurance at all? It's just a middle-man for profit scheme between patient and health care.
Just have mandated health CARE for all and do away with health insurance altogether. Lots of companies would lose billions, but average people on the street would be the ones not spending that money.
From there, insurance would likely break down into high cost / high coverage, mid cost / mid coverage, low cost / legally mandated minimum coverage.
The poor would end up with the low cost / minimum coverage plans as cost would likely end up being the main motivating factor. Given that 6-in-10 Americans can not afford an unexpected $500 bill (https://www.cbs19news.com/story/34248451/6-in-10-americans-d...), this would likely be the coverage level chosen by about half of Americans. These policies would be affordable, but I expect the deductibles and co-pays would be high enough to make it prohibitively expensive for policy holders to actually get much utility from them.
The other half would end up with the better plans, unless they were more comfortable with risk and elected for the cheaper plans. Their lot is probably pretty similar to today.
Americans can afford a $500 expense just fine. The median American household has ~$1000/month left over after all ordinary living expenses, per the US Bureau of Labor and Statistics.
I think they're drawing on this series of studies: https://www.bankrate.com/banking/savings/survey-how-american...
Start from the well-sourced fact that median American households have ~$1000 per month to spend without sacrificing anything, and work from there. This can't be true at the same time all of those breathless headlines about broke Americans is also true. Without fail, if you dig into the details, the headlines are grossly misleading. The percentage of Americans that truly have no capacity to deal with significant unplanned expenses -- per Federal Reserve studies -- is 10-15%. A not inconsiderable number of people but far less than implied by the clickbait.
Average Americans have extraordinary amounts of discretionary income compared to almost anywhere else in the world. Americans both have a low savings rate and they have large amounts of money available to save.
Like if your contribution to your insurance is a few hundred a paycheck there is a pretty good chance that the employer is paying in quite a bit more than that.
https://www.kff.org/health-costs/report/2021-employer-health...
In most cases there is not an avenue to recover any lost compensation if you opt out of health insurance. If an employer offered a higher base pay for those not on their insurance plan, you probably WOULD see a much higher rate of those securing their own plans in the open market.
A more rational phrasing may be: "I can buy insurance isolated from my employment, but I am priveleged to have the benefit and OPTION of taking advantage of employer benefits."
If i am freeing the employer of that burden....should that not reflect back on my compensation? Surely you dont mean the employer should then be able to save more and basically lower their compensation for employees and expect the same return?
There are plenty of packages on the open market that are generally better than what an employer offers. But you are essentially making extra sacrifices by opting out with no benefit to you and all the benefit of the company.
It would make more sense for a company to even offer a HSA where they contribute as much as they would to a plan to a savings account and allow the employee to also contribute their share pre-tax. And apply that to plans available on the open market.
>It would make more sense for a company to even offer a HSA where they contribute as much as they would to a plan to a savings account and allow the employee to also contribute their share pre-tax. And apply that to plans available on the open market.
Agreed
Do you want our health insurance plan, or an extra $1500/month to find your own on the open market would be an interesting way of looking at it.
But either way, both your employer and your cost for health insurance should show up on everyone's pay statements. Most have no idea what their employer pays for insurance.
> During World War II, wage and price controls prevented employers from using wages to compete for scarce labor. Under the 1942 Stabilization Act, Congress limited the wage increases that could be offered by firms, but permitted the adoption of employee insurance plans. In this way, health benefit packages offered one means of securing workers.
> In the 1940s, two major rulings also reinforced the foundation of the employer-provided health insurance system. First, in 1945 the War Labor Board ruled that employers could not modify or cancel group insurance plans during the contract period. Then, in 1949, the National Labor Relations Board ruled in a dispute between the Inland Steel Co. and the United Steelworkers Union that the term "wages" included pension and insurance benefits. Therefore, when negotiating for wages, the union was allowed to negotiate benefit packages on behalf of workers as well. This ruling, affirmed later by the U.S. Supreme Court, further reinforced the employment-based system.
- Health Insurance in the United States, Melissa Thomasson, Miami University (https://web.archive.org/web/20110903053358/http://eh.net/enc...)
> if anything, employer-based health insurance strengthened the unions' ability to negotiate for their workers.
In what way does having more that needs to be negotiated strengthen unions? You've heard the punchline without hearing the joke: why were unions prevented from negotiating pension and insurance benefits before 1949?
If you reversed the original sin of sheltering wages paid in the form of health insurance from taxes, you'd see stronger unions the next day. The biggest battle fought during the ACA war was about the possible taxation of "Cadillac" health plans, and ACA lost.
edit:
Strike wave of 1945–1946
https://en.wikipedia.org/wiki/Strike_wave_of_1945%E2%80%9319...
Taft-Hartley Act
https://en.wikipedia.org/wiki/Taft%E2%80%93Hartley_Act
Exclusive Union Control of Pension Funds: Taft-Hartley's Ill-Considered Prohibition [PDF]
https://scholarship.law.upenn.edu/cgi/viewcontent.cgi?articl...
Before someone says "but the healthcare marketplace", it's a joke. The individual plans we have today are ridiculously expensive because: A) the government will pay for folks who can't pay for them, so easy money for the insurance companies and B) the folks who can pay really need it (healthcare is inelastic), they're so few though so there really is no downward price pressure to compete for them.
This depends on your state. Some states, like Wisconsin, won't offer medicaid for income reasons alone. I'm unaware of health insurance policies being cheaper in Wisconsin, though perhaps it's the case.
Because Democrats’ plans for universal healthcare rely on forcing employers to pay for it.
It incentivized employers to compensate with benefits, not cash.
Around the same time, unionization became much more popular, and with it negotiated compensation (more benefits).
These were big issues in the North. In the South, the economy has was still largely rural, and many states provided publicly funded hospitals - so the dynamics were different.
There was a move for employers in to provide health insurance pre Great Depression. That was because larger employers could use their size to negotiate deals with hospitals. So health coverage was worth $individualPrice to an employer, but $negotiatedPrice to the employer.
In general, insurance providers preferred going through employers because employed people are healthier and file fewer claims.
Geico was an acronym for “Government Employees Insurance Corporation” which was a thing because government employees were a pretty safe bunch to insure.
So even back then, many of the dynamics we see now existed: negotiated prices, grouping, etc.
Employer’s cost per employee is much much lower than an employee’s cost directly from insurer. The employer “sells” the benefit to the employee at a higher perceived cost because of this.
Without an employer’s discount, an employee simply cannot get the same insurance coverage.
Thus, the employee agrees to working pay and conditions which would not be agreeable without the pressure to get health coverage.
Hence, lower cost of labor to the employer and pressure to keep the current structure in place.
It was published on Nov 11, 2021 so perhaps consider a (2021) tag in the submission title?
I feel like the title is missing that bit.
Doesn’t make it ok, but the situation is dramatically different with even the limitations of a single tweet compared to the title.
I don't think I can edit the title anymore, but one of the mods can edit it.
Shorter and as I understand it more correct.
Like when someone at Mailchimp sold out the users of various Mailchimp customers to criminals (https://twitter.com/Trezor/status/1510558771944333312).
https://www.businessinsider.com/mailchimp-insiders-react-to-... > When employees were recruited to work at Mailchimp there was a common refrain from hiring managers: No, you are not going to get equity, but you will get to be part of a scrappy company that fights for the little guy and we will never be acquired or go public.
The concept that you make (bad bad) companies pay out of their (outrageous) profit is a delusion.
Companies just take part of your salary and with that they pay medical cost.
I actually prefer paying it myself and having this thing called "free market" or competence work for me.
But in places like the US the system is extremely corrupt and designed to make it impossible for the free market to exist. This is inherited by the political system making mandatory for business to handle that instead of individuals.
In other countries you have things like mutuality organizations of people to provide healthcare, much much better and cheaper that what I see in the US.
> […] As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.
https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...
- NHS takes care of emergencies. There is no stress of payment in these situations.
- I have private medical insurance through work. Its done by salary sacrifice so I can choose to take the money instead.
- I can buy private medical insurance separately. Providers like Vitality[1] offer things like Apple Watches and discount gym membership. Private medical insurance is generally quite cheap (Vitality just quoted me £40/month) as emergency care is done by the NHS.
- You can use private healthcare to speed up things that might take a while or you might not get an NHS referral for.
Of course there's some problems with the NHS in terms of wait times, but I believe that's more of an issue of funding. In the UK I feel like I have choice that won't break the bank and I'm also not going to die because I can't pay.
[1] https://www.vitality.co.uk/rewards/partners/active-rewards/a...
I'm not sure if your claim about most Americans being happy with their healthcare is right or wrong, but that doesn't mean it can't be significantly improved nor that it compares that well internationally:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2071992/
Personally I'd choose the Swedish system over the American system any day. The US healthcare system is probably one of the main things giving me pause about moving back to the US actually.
edit: Americans perception of their healthcare is kind of interesting actually:
https://news.gallup.com/poll/327686/americans-satisfaction-h...
The US has long spent much more per capita than the rest of the world and has had worse outcomes than most (all?) comparable nations. Americans are good at rationalizing away this sort of thing ("we can't have better healthcare because we're fat"), but that's always just seemed to me a psychological defense mechanism more than a rational argument.
But yeah I guess you're right that Americans probably won't go on strike because they're happy enough. I can't really understand why they're happy enough, but I guess they are.
Why do you think this?
It doesn't end up with people paying tens of thousands out of pocket, people just don't pay the bills that come in during that period, and kick them to insurance later. It sucks but is not really uncommon or possibly even something Intuit has a ton of control over.
IIUC, COBRA rates are more or less the total employee and employer rate, maybe plus a limited administration fee? Also, I don't think COBRA pricing varies by age, but marketplace plans do, so if my spouse or I were older, COBRA might have been a good deal.
All that said, I think most people switching jobs keep the COBRA paperwork in case something big happens before they get new coverage in place. There's a grace period on the first payment, if you need coverage, you can pay until the grace period and get retroactive coverage; if you don't need coverage, don't pay. Some people even prepare the payment but leave instructions to send it in if they're incapacitated.
Not really surprised. Both Intuit and MailChimp have been carcinogenic to their customers, vendors and employees for ages now. People should strike and/or complain to their local authorities especially when stuff like this is usually put out black and white in their employment contracts. It will be far more effective than just lashing out on Twitter.
If you go to the hospital and didn't know that your insurance expired, you probably won't even see a bill for a month, after the hospital gets the denied claim from your previous insurer. At which point, you'll give them the updated information, and they'll file the claim with the new insurer.
Considering there were no more publicity about this since tweet date (November 2021), it wasn't a big deal.
So how do I get that 30-day+ float?
What sort of service provider asked you to pre-pay?
As for this guy complaining about his acquisition bonus. Why didn't he negotiate for stock when he was hired? I have always negotiated for a lower salary and more stock, as I wish for the lottery ticket and potential upside. If he wanted to trade off cash for stock, he could have done that. And it that was not on offer at Mailchimp then why didn't he go work somewhere else? Seems like they had some inducement, right? Or did he not understand the terms of his employment.
People are so TERRORIZED by the fact that they are only paid the amount they negotiated in their employment contract. YES, capitalism sucks if you just naively enter into employment without understanding what the compensation entails.
What would you like instead? Employment at a Public Sector Unit? I can assure you PSUs suck BAD for engineers. My father and uncles worked at PSUs before immigrating to the US and improving their fortunes 20X to 50X (no exaggeration).
Mailchimp didn't offer stock options, only yearly profit sharing. They claimed they were never going to sell the company.
https://www.moneycontrol.com/news/business/why-intuits-12-bi...
I know nothing about this area, but why _isn't_ it as simple as flipping a switch? When the tweet mentions their insurance becoming retroactively available, this sounds very similar to the experience everyone has when starting with a new employer -- even if you're eligible for their insurance program with coverage starting your first day, it takes a bit for your benefits selection to end up in the insurance company's system.
Why? Why can't this be instant? Is something happening other than a couple writes in a DB somewhere? Why can the new employee not fill out the registration form online, and be immediately covered, and given a digital insurance card?
My advice is if you're still working for them find a new job.
It sucks. But it’s far from the worst pitfall of our system.
I wonder what the state of this situation is now. Have they actually managed to smooth the transition or is it still a bad deal for Mailchimp employees that stayed on post merger?
I guess the overhead of setting up such an organization plus the fact that said corporation wouldn't actually have any revenue are big issues.
Whereas with statutory employees anything the employer purchases in that regard is not included in the tax base for the payroll tax or the income tax, i.e. is basically tax free. Self employed folks are treated better than they were a few years ago (no deduction basically), but that is still a big difference.
Calling them a 'tax write-off' makes it sound like something sinister is going on - just about everything a business pays to run their business is deductible, and thus a 'tax write-off'.
Do we call buying paper for the xerox machine a 'tax write-off' and thats the only reason business buy paper?
Its a cost of doing business - just like rent, payroll, heat, electricity etc - there is no special 'write-off' for providing health insurance for a typical company.
The biggest drawbacks to such an approach are that you have to deal with the quirks and rules of your organization -- read the terms carefully -- and that you have to deal with the paperwork from the medical system yourself. That doesn't sound so awful until you experience it. You can find reasonable primary care as a cash patient -- direct primary care is everywhere now, and almost certainly what you want: a monthly payment for someone on call to deal with your issues. Urgent care is generally reasonable, too, being an up front single bill at a fixed price per type of issue. But Lord have mercy on you if you need to visit a hospital. The paperwork is stunning. A couple years ago, I went in for some observation and antibiotics for a couple of days, and came out with a dozen bills, all of which have to be called on, paid, negotiated, and some of which are possibly fake.
John Oliver covered Health Care Sharing Ministries (often called Health Shares or HCSMs) a while ago https://www.youtube.com/watch?v=oFetFqrVBNc
Why can't individuals negotiate premiums?
Why can't individuals switch to another insurance provider at any time?
Why can't insurance providers cover 100% over anything prescribed by medical practioners?
Seriously, why does any medical treatment in America have to be so opaque and stressful? We are regressing as a society if life is not becoming easier.
This article presents your viewpoint along with quite a few others which mostly point toward Obama’s ineffectiveness and lack of effort toward accomplishing this while having a clear Democrat majority in both houses.
No surprise though as Obama era is not the only failure to move toward single payer … look at what California managed to accomplish with a vast majority of liberal Democrats a couple months ago …
https://m.northcoastjournal.com/NewsBlog/archives/2022/02/01...
Obama’s senate majority was not really a majority. Leiberman was basically yesteryear’s Manchin, and maybe there was a couple others, but either way, having 50 or 51 or 52 Democrats is not a clear path to victory that would make it reasonable to blame the Obama admin for anything.
Best way I can judge their performance/intentions is to note that ACA resulted in more healthcare for more people than any other legislation in recent decades.
This seems like many responses on HN are over reacting. Employees are not on the hook for previously insured medical expenses.
Almost all medical offices are happy to work with patients if the situation is explained before hand. For example my HMO has printed signs at every intake counter reading “Can’t pay? Call this number to discuss payment options.”
This situation sucks, but it’s really not much different from forgetting your insurance number and needing the front desk to front you the copay or deductible.
In the other hand consider that Mailchimp employees probably fared much better working on a digital all online product and getting their above average salaries than the average person, who actually lost their jobs, savings and health insurance due to covid