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Comment by zyang | Hacker News Reader

I think this is a tempting solution but a bad idea in the long run. Just like how employer provided medical insurance sounds good on the surface, but it gave employers an incentive to lobby against socialized medicine, which reduces worker mobility and hurts the economy.

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Depends very much on the employer. I've spoken at length with a small sample (13, to be exact) leaders of companies from SMBs to mid-sized enterprises and they're all for national healthcare, as taxation is a relatively predictable expense and reduces overhead in other ways (like paying for benefit management services). Its also likely a shared tax, and in some cases is a net benefit for them because it makes recruitment easier (this in particular with blue collar businesses and those that aren't what would be considered traditionally technology companies. Benefits is a big part of the recruitment tactics still)

I think health insurance companies run the biggest two faced business of all time, extracting money out of companies and individuals while line driving the cost down as much as possible without benefit to those who use their plans. Cigna[0] even uses automatic denials based on automated heuristics, a human doesn't even look at the file, for instance.

I know "Medicare For All" programs aren't a silver bullet either, but I think it would at least put everything and everyone on a playfield that is even enough to have smaller reforms over issues that get missed in these proposals

[0]: https://www.propublica.org/article/cigna-pxdx-medical-health...

Speaking from personal experience Cigna's line employees will also lie directly to your face on a recorded phone call while you're taking notes because their policies are geared toward following the letter of the law vis a vis retention while ensuring that their arbitration process effectively blocks you from suing them effectively unless you sue them before trying to work with them.

We've been quoted 6 weeks to have a manager listen to a phone call, which is the exact period of time that their call recordings are retained. They're the worst health plan I've ever had the displeasure of using.

They will also from time to time edit your explanation of benefits, which is against the law. Don't trust them and keep all the paper copies of everything they send you.

Minor point that you also have the non-profit Blues (i.e. Blue Cross Blue Shield) in the US health insurance marketplace, who are literally obligated to return healthcare savings to customers in the form of rates.

They have their own problems, but profit-mongering is not one of them.

how do you get these conversations?

Networking. I also work for a place that has a research division focused around these companies and we do surveys

What companies lobby against socialized medicine? Employer based health insurance is ridiculously expensive and the cost is usually hidden from the employee. You get quoted a salary net of benefits. And a lot of jobs are required by law to provide insurance which means the mandate could be a huge percent or the employees overall cost to the employer.

This is closer to employee 401k since you take it with you if you leave, which has been very beneficial even compared to pensions as you don't have to bet on your current employer being around and able to support the benefits 30 years from now

The law should require this disclosure upfront, or at least the proportion of premium of the metal level, such as employer will pay 50% of silver level plan within x network.

The employer is required to disclose total premium cost on the W-2 however, line 12 code DD I believe.

White collar employees that have marketable skills really benefit from being able to silo their risks in employer pools, because their healthcare costs are lower than those of blue collar workers.

I specifically remember people complaining about increasing premiums after Affordable Care Act because they would have to subsidize sicker people who simply did not have insurance in the first place, and I believe former Senator Lieberman from Connecticut, home to many health insurance companies, was able to capitalize on this and strip the “public option” from the Affordable Care Act.

https://en.wikipedia.org/wiki/Public_health_insurance_option

The whole thing is an exercise in splitting the populace into various tribes of haves and have nots and pitting them against each other.

Another handout to big businesses by government is the pre tax purchase of health insurance premiums by a business for employees, but if an employee of a business that does not offer insurance subsidies buys it themselves, they have to pay with post tax income.

>What companies lobby against socialized medicine

The health insurance companies? Both Ds and Rs collect millions in lobbying efforts from the healthcare industry; it's the 6th largest industry in terms of campaign contributions, more than the oil and gas industry.

https://www.opensecrets.org/federal-lobbying/sectors/summary...

> What companies lobby against socialized medicine?

The ones who want cheap labor.

Just like how employer provided medical insurance sounds good on the surface

It doesn't even sound good on the surface.

it gave employers an incentive to lobby against socialized medicine

I continue to be baffled at the common assumption that the only two possible sources of health insurance are employers or the government.

Do you have a viable suggestion for an alternative provider?

The person themselves? Certainly better than the employer, and some argue that it would be better than the government.

Many other OECD states feature private insurance that's (at least largely) not employer-provided. Private coverage may be the main coverage for a large proportion, or even majority, of the population.

How does it differ from the US?

1) Less emphasis on or no norm of employers providing healthcare (and this may not be encouraged through tax law, leaving little reason to do it versus just paying more money)

2) These are often more tightly-regulated than in the US—coverage minimums (we kinda have these now, in the US, sort of, so that's nice), disallowing for-profit insurance, et c.

3) There's often a government fallback plan

4) AFAIK every single other OECD state leverages price controls in some fashion, whether de facto or de jure (usually de jure, in the countries with strong private insurance markets), which affects everything, including the price of private health insurance.

ACA definitely moved us closer to that model.

The biggest misses were providing a government fallback plan (aka Medicare-if-no-other, which I don't think is part of it?) and regulating negotiations between providers and payers (so as to avoid payer combination into a few large companies, who can then get the best prices from payers).

I feel like a broken record, as I’m always saying what you’re saying when people discuss health insurance. Most folks want to trash public health care under the quick quip of “that’s socialism” or trash “privatized health care” with the current employer-provided system as a proxy for “privatized health care”. People get so caught up defending “their side”, that they forget the objective is to get a better health care system.

IMO, a huge number of the problems that exist with US health care (non-portability between jobs, people stuck with plans ill-suited to their needs, lack of access to affordable health care) could be easily addressed by a ban on employer-provided healthcare with a provision to ensure the costs are forwarded to the workers as monetary compensation. Workers can go choose a plan that works for them.

Two forms that are widely used right now (ie hundreds of millions of people covered):

- Private personal insurance (You pay the premium and that's it)

- Guild insurance (Same as above, but these companies only insure people within a specific industry)

One example is Medi-Share (https://www.medishare.com). I'm sure plenty people will find some reason to hate it due to the explicitly Christian theme and I'm sure there are some downsides I am not aware of. I do not use it myself, but I know several people who do, and they have used it to cover their bills. To a person, they are quite pleased with the cost and idea behind it. I haven't dug into it, but I find no issue on the surface. Maybe they refuse to cover sex change surgery or something and that makes them Literally The Worst, I don't know. The idea of "everyone puts in a bit and when someone needs help they take some out" is the basis of insurance as a concept, and it seems to work if there's just a little bit of gatekeeping. ACA and coverage of preexisting conditions under the insurance model really fucked things up imo. Not that preexisting conditions shouldn't be cared for, but as an entirely separate model.

Car insurance model. You go buy your own in a competitive marketplace.

Or just makes it harder to move jobs which inevitably makes people more exploitable.

It's not exactly bad ideas getting us into this situation but a rapid shift in power from workers to owners.

yeah very true. I don't think anyone could disagree with this but somehow many people seem to be missing this perspective entirely

It because a lot of people are already struggling with the cost of housing. It's hard to tell people they should be worried about this company exploiting them, when their only other option is to pay someone else even more money to keep a roof over their head.

> I think this is a tempting solution but a bad idea in the long run.

The best part about this plan is it sounds like the company doesn't want to be in this for the long run. Selling the homes rather than renting them, and having a fairly limited term on restrictions means in the long run, these will end up being just regular homes with a historic tie to the company. IMHO, this looks like the company doing something good for itself and its employees in a way that's hard to manage otherwise. Building the housing as a bulk project makes it less costly and easier to manage shared costs, but it would be hard for the employees to organize that on their own.

Perhaps in theory. But how hard are we-don't-build-housing employers currently lobbying in favor more housing for their workers? And how many orders of magnitude would employers providing housing have to grow by, before any cutbacks in that lobbying could have a meaningful effect?

couldn't someone have said the same thing about health insurance when it was new and only a few companies were doing it?

Sure. But "if this was scaled up several orders of magnitude, and continued for years, then there would likely be bad side-effects" is a argument against doing pretty much anything. Ever.

It's also a really good argument for not putting all our eggs in one basket and for avoiding total homogenization of the systems by which we live. This is not currently practiced at scale, as anyone who has boarded a plane in one state and lands in identical surroundings in another state can attest.

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