I'm assuming this is by design to keep the US population "on their toes" and at work doing productive things. Otherwise why would it be tied to employment?
Also, note that you can buy your own health insurance in the US. You are not required to use health insurance provided by an employer.
As someone who purchases insurance from the NY marketplace, that hasn't been my experience.
Initially, I had a plan from one of those (Anthem/BCBS), which provided pretty good coverage because they increased my premiums by more than 50%.
Now I have a local (New York State) provider (Fidelis Care) which costs less and has a (fairly) low deductible through the state's marketplace.
That said, many providers are actively hostile to marketplace plans. Back when I still had an employer-based plan, my company changed insurance providers. I called up my GP to make sure they accepted insurance from the new company, but before I could even describe the scenario, the office person at my doctor's office raised her voice and said, "We don't take any Obamacare plans!"
Which was quite interesting, since back then many of the major national insurance companies were offering such plans, including the companies (both old and new) my employer was contracting with.
All in all, I've been fairly satisfied with Fidelis Care, although I wish I could do database queries of their "Explanation of Benefits" records rather than having to wade through PDFs for each visit to a provider.
All that said, I don't know your circumstance (none of my business) so you may have needs that I don't. I wonder what those might be that a "national" insurer might offer than an in-state provider doesn't, especially since the ACA specified requirements for all health insurance plans, not just those on marketplaces.
Although I'm not sure how no insurance could be better than some, unless you're against medical care in general. But my use case isn't yours and I'm sure you make decisions that are best for you.
Edit: Added a few thoughts to address parent's issues, clarified my point about coverage to be more clear that I'm emphatically not calling anyone a liar.
So have I, and I stopped purchasing insurance because I cannot find the coverage I want. I need a specific variant of a certain operation which is only performed by a few surgeons in the country, and the one surgeon in New York who offers it only takes Aetna for that operation. Aetna reentered marketplaces starting 2022, but I'm moving and the operation has a year-plus waitlist, so I'm SOL. It has made a ton of sense for me to have no insurance because I'm fairly young and in fantastic health, making it cheaper to just pay out-of-pocket for primary care once or twice a year. Please don't call people liars.
That seems reasonable. As I said, "my use case isn't yours and I'm sure you make decisions that are best for you."
>Please don't call people liars.
My intent wasn't to call you (or anyone else) a liar. My apologies if you felt I was attacking you. Nothing could be further from the truth. I've edited my comment to explicitly reflect that.
I'm glad.
My initial statement was categorical and not specific only to me. You were right to call me out on that. Thanks.
It's sad that we have to jump through all sorts of hoops just to get the medical care we need. Which is often the case even when it isn't an edge case like yours (or mine with my PT -- my situation was, of course, much less consequential since there are many PT providers out there).
And yes, it's a red state.
Pre-ACA, I was once a much healthier early-twenty something applying for private coverage. I have a genetic condition that has never manifested in a health consequence that has required treatment, and technically it was illegal even at the time to reject someone based on their genetic information. Despite that, I was denied coverage by every private insurer in the market because I had a preexisting condition. The only reason the private market functions at all for anyone with so much as a history of a sprained ankle is because of the ACA.
Insurance companies would routinely (and retroactively!) deny coverage and payment based on preexisting conditions. They would accept premium payments for years, then when you came down with breast cancer would dig up an old photo of you with a cigarette in your mouth and refuse to pay for your treatment because you claimed to be a non-smoker when you applied for coverage. This was considered normal.
If that was the only or even dominant reason, then the removal of those controls in 1945 would have seen that tie rapidly unravel, instead, health care has become more, not less, tied to employment since the end of that policy, reinforced by deliberate policy choices like tax policy and explicit mandates.
The historical reason a thing first became common and the reason the thing is still common are often not all the same.
One might rationally assume that, but human brains are weird: https://en.wikipedia.org/wiki/Loss_aversion
Now, there's a whole administrative system that drives up prices and puts a ceiling on availability and quality of care; with most Americans being (relatively) ill-traveled, ill-read, and fed a news product that beneath the packaging is some combination of entertainment and fear-mongering, it's easy for one to believe there's just something in the air that makes an NHS-style or even a German-style system impossible here.
Then, if you were around for the 2008, 2012, and 2016 elections, you'd have seen presidential candidates arguing about whether someone should have to pay for someone else's well-being. And it's not a debate along the lines of class—it's tied up with identity politics and a broader debate around the welfare state. Advantaged and disadvantaged communities alike are full of people who see how things are, and, knowing that it takes a lottery win to move up the economic ladder and a bad week to fall down, are skeptical that next time it'll be different.
Doesn't help that most Americans will never have the opportunity to get even an hour of education in macroeconomics, unless it's buried in disconnected lessons about individual economic downturns, nor that education on probability doesn't happen until second-year calculus (which is similarly rare in high schools), nor that most Americans don't learn about the mechanics of Medicare until their fifties or sixties
I think enforcing the law has been a government function from the times the first laws were laid down. Fire services were a private function, and this actually works fine in sparsely populated areas where fires are not likely to spread in temperate climates. The only reason fire services are public is because of the inherent risk to everyone that a fire poses in a dense, substantially flammable, city.
If a fire affects you and only you, then why not cover it under normal, optional, property insurance like every other disaster?
This is generally the model of government intervention I support - intervene when the actions of one group of people directly affect others. This covers regulation around rights of way, fire services, environmental protection, waste management, water supply, pandemic/disease control, police, and the military. It however does not cover supplying the personal necessities of life like food, shelter, clothing, medical care, entertainment, companionship, sex, fulfillment, etc.
These are fundamentally individual needs, and I therefore hold that meeting them should be an individual responsibility. Any cooperation to meet these needs should be strictly voluntary and consensual, not compulsory. I think this is where, to greatly simplify, "the left" and "the right" fundamentally disagree. For instance, in spite of the now well-studied and crushing effects of loneliness, it would be absolutely tyrannical for the government to mandate friendship. Similarly it is tyrannical for the government to mandate participation in public health care/insurance. Let people figure out how to meet their needs for themselves, and let them figure out how to cooperate voluntarily. Charity is exactly the virtue of helping those in need, but mandatory charity is indistinguishable from slavery.
Edit: also a much more significant factor only in densely populated areas
The idea that people who set bones and cure cancer should be included in this category is a more modern take, one that requires much more careful discussion of what should and should not be a "public service".
> people feeling entitled to a service they previously resented as soon as it's useful to them
I think we should expect people to prefer suffering and death with dignity, rather than greedily and desperately peering into the pockets of strangers, but that's just my take.
There were only private police until 1838 in Boston:
https://time.com/4779112/police-history-origins/
And only private firefighters until 1853 in Cincinnati:
http://www.fireserviceinfo.com/history.html
Ben Franklin offered America's first fire insurance. Privatized insurance and firefighters in Phili in those days:
https://www.investopedia.com/articles/financial-theory/08/am...
Edit:
> The duties of the Watch, as appears by the order, were to be performed in turn by the inhabitants; they were not "citizen soldiers," but citizen Watchmen, and having an interest in their work, no doubt did it well.
- A chronological history of the Boston watch and police by Savage, Edward H.[2]
Savage seems to indicate that the night watch was performed in turn by the inhabitants of the community, by order of the government, and there is no mention they were paid. This doesn't seem like a private service to me.
1. https://en.wikipedia.org/wiki/Boston_Watch
2. https://archive.org/details/achronologicalh01savagoog/page/n...
He sold it each time to a group in NY (MetLife each time if memory serves). He told me that his insight was that construction companies would have variable revenue and compensation requirements across TX building contracts (private vs government mostly) and to avoid discontent they would dump the difference into life insurance and other alternative compensation because as long as the take home paycheck was the same no one really complained about being put on lower compensation jobs.
Not sure if that was a similar origin for health insurance but I've always assumed it was.
Compare Cignas global plan with and without US coverage. Somehow they can easily cover essentially all of the rest of the world for far less than the US.
Per capita numbers can be misleading on healthcare as health is labor intensive, so countries with higher wages will have higher per capita costs with otherwise similar systems.
OTOH, the US spends the second highest share of GDP on healthcare, globally, behind Tuvalu, and about a time and half the GDP share of the second highest large, developed state (Germany). [0]
[0] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_...
Canada? Switzerland? Germany? Yes they pay a lot worse for some jobs (software developer, and, more relevantly, doctor) but ordinary fully-loaded employee costs aren't that different from the US. Admittedly, the countries more comparable to the US tend to be more in the 60-70%-of-US-spending range, than on the lower end.
That does mean that even allowing a generous premium over the most-comparable peers, we should be able to cut total healthcare spending 20% while covering everyone and removing a major drag from our economy, and a major factor reducing overall US QoL. As it is, we're struggling (and largely failing) to even keep cost increases to merely the inflation rate.
I could get approximately equivalent insurance for about 40% cheaper if I went on the individual market. But, my employer pays 75% of my employer sponsored plan.
Companies had to include extra benefits beyond wages to compete on hiring. One of those extras was health care.
That's the original "design."
https://thehill.com/opinion/healthcare/469739-the-employer-h...
...and obedient to corporations.
Such mechanism give corporations the power to decide who gets terminated and loses health insurance. It's very effective at discouraging people from doing anything that goes again the grain, like getting into an union.
And the most obnoxious part of it all is that you knew this.
It's not clear to me that most employees do know that, actually. I see a ridiculous number of people that oppose nationalized healthcare "because they'd have to pay taxes", not realizing that there is already a deduction from their total compensation to pay for their healthcare (i.e. a tax).