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Comment by Tichy | Hacker News Reader

That's so weird. As if there was some kind of conspiracy between health care providers and employers. I mean you probably take it for granted that health care is tied to a job, but that really isn't the case at all. Where I live (Germany) it is organized in a completely different way. If you lose your job, social insurance will keep paying your health insurance.

It's ironic because "your way" actually seems to be taking freedom away from you, yet the US seems to consider a model like the German one to be the ultimate slavery (socialism).

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Yeah, the thing is the USA is the flip side of the USSR. One was the definition of socialism, the other capitalism. Here in Europe we consider both systems as tools to use, rather than rules for running a state.

Part of me wonders if the US obsession with uber capitalism is some sort of historic anti Europe thing, or a way that they remain different and separate. Its US identity. Having booted the Europeans and gained independence, the last thing they want to do is embrace European ideals.

I don't really understand the logic, because it seems to me that as long as they pay taxes in the US, they are just as "socialist" as, say, Germany with their health insurance. What is the difference if you build roads for the common good or buy health insurance for the common good.

Also I don't understand how capitalism makes health care tied to employment. In theory shouldn't there be health insurers who are willing to ensure you just as long as you pay your rates? What do they care if you are employed or not - except perhaps for some statistics like "employed people are less/more healthy on average", which could be factored into the rates.

In theory shouldn't there be health insurers who are willing to ensure you just as long as you pay your rates?

There are, in actual fact, insurance companies in the US that will do this. Some make it a business to cater to self-employed folks who don't have company insurance.

It's been a while since I thought about this, but (IIRC) the 'private companies pay for insurance' deal got started in World War II, as a perk. Companies could not compete for scarce labor (salary freeze) so they offered basic health insurance to attract workers. From there it just grew.

So why do so many of us accept it, when there are free-market alternatives? I think it's the convenience.

Take my dental plan at work. For about $10 a month I'm covered for all routine stuff at the dentist. Extraordinary work will cost me a bit off the top, but not _that_ much, for the care I'm getting.

Which is pretty much the plan I'd get if I eschewed the work plan and bought one on my own.

The convenience is that work has a team of guys who deal with the insurance companies, getting deals, selecting plans, negotiating rates, basically dealing with a lot of hassle so I don't have to.

Now, I could get a better rate on my own, and I probably _should_ if I were really worried about being laid-off but .. it's just easier this way. A trade-off.

For a lot of us, this is okay: the plans our employers offer are pretty good. For some people, who have sucky employers and rotten plans ... it's sub-optimal.

I think it's the convenience.

I think its because employers for large companies get the only reasonable health care rates in the country. If you work for a large employer and you have a way as an individual to get comparative coverage for the same cost ignoring any pre-existing conditions, I'd love to hear it.

Hm, let me guess: does it work because the employer pools all of his employees, and the insurance can account for that? Like one employee gets seriously ill, but 10 stay healthy, so the costs average out? I think private insurance here in Germany just forms arbitrary pools of people, but the don't just insure anybody. If you have some risk indicators, they won't insure you. Maybe the employers in the US simply have a good bargaining chip, they can say "if you insure our one risky employee, you'll also get to insure our other ten non-risky employees".

That is exactly what happens. There are so many tiers of issues its hard to dissect.

1. Big corporations get much better rates by pooling all their employees together and then negotiating for coverage. 2. The insurance companies pool all their subscribers and use that as leverage to negotiate better rates with the hospitals.

As an individual, you don't get the diversification effect of #1, so you end up paying a premium rate. If you are an individual the system is basically setup to vet you biasing toward no coverage.

Its hard to keep up with the state of the laws in my own country. (US) There are talks of market exchanges to basically give individuals back bargaining power, but I've heard that the insurance industry has managed to hobbel them pretty badly. I'm not sure where we are headed on this issue.

As an individual, you don't get the diversification effect of #1, so you end up paying a premium rate.

Hmm.

USAA quoted me $350.81 per month (same plan provider!) for two adults, two children, one adult 'healthy as a horse', one adult with preexisting conditions.

Just one pass, without shopping around.

That sounds pretty steep - it is - but it's only twice what you could expect to pay for car insurance.

I'll bet if I shop around I could find a deal. Wonder what would happen if more of us did so?

it doesn't seem steep to me, but where you live and your ages are two factors you didn't mention (deductible amount is another factor).

I live in fly-over country, in a drive-past town. Cost of living here is pretty low, all things considered. So I've gotten used to stuff being far less than it cost when I lived in the city.

I wonder if I could negotiate a salary increase from my employer in return for opting out of the plan.

USAA is an exceptionally good company.

I love USAA to pieces.

For years my time in the Marines was good only for memories (good and bad), cynicism, and a career in IT.

Which isn't bad. But then they let me in the club and my insurance cost dropped like a rock.

Plus they're super easy to deal with. Had some hail damage and where my neighbors were fighting _their_ insurance provider months later USAA couldn't get me the money fast enough.

"Overnight .. is that soon enough? We can borrow an F-18 and air drop in about 90 minutes it if that would be more convenient."

Well not that good. But pretty close.

Anything analogous, at least qualitatively, to USAA for folks with no military connections, in California?

If you work for a large employer and you have a way as an individual to get comparative coverage for the same cost ignoring any pre-existing conditions,

Twelve or thirteen years ago I looked into this hard - had a family, had a kid and a wife with a pre-existing condition or two.

It was available and comparable in costs. The biz failed before it left the ground, so I didn't need to go that route.

A few weeks ago this link came into my mailbox, from a mailing list.

http://www.techinsurance.com/

Recommended by the originator, who is a customer.

I also see that USAA offers health insurance. I'm a member, I should look into that.

Having been a contractor previously, I can tell you that the main reason I moved over to being a full time developer for a company (complete with 1.5 hour commute) was that no private plan would cover both myself and my wife, mostly due to various medical reasons associated with my wife that I won't get into here. Suffice it to say that the only way we could get her covered without a ridiculous deductible and per-month cost was for me to get a full time job. She works as the director of a local teen drop-in center and as an HR secretary as a sheet-metal plant, and of course, since those are part time jobs, neither offers any benefits whatsoever. We were previously paying over $500 a month to cover myself and her on two private plans.

There are a lot of holes in the US healthcare system when you're doing something that's not what the majority is doing. I'd say this creates an argument for single-payer healthcare, but that's a debate for another thread. (Plus, I'm a little biased as a Canadian immigrant.)

This comes recommended to me from an email thread a few weeks ago on this topic ...

http://www.techinsurance.com/

Not a customer, but the fellow who sent it along is.

Not every system will catch every person. I didn't have a problem obtaining coverage for my family a dozen years ago, but a) it was a dozen years ago and b) perhaps our pre-exisitings were not so bad.

Insurance rates are based on the risk pool you fall into. When companies are purchasing plans for health insurance, the company as a whole is placed into a risk pool. Since you are dealing with a large group of people, in general the risk pool is lower for the company, then if each person was evaluated individually. Hence a company can achieve lower rates then an individual. And generally the bigger the company, the lower the rates. An individual purchasing would have to pay significantly higher rates for comparable coverage that they would if they were in a large company.

White America developed out of freehold farming, whereas Europe developed out of a feudal peasant-farming class that was later enclosed off its land and forced into wage-labor.

Now, moves similar to enclosure were pulled in the US, but the culture developed around "self-reliance" and what you might call Yeoman Capitalism. These people hold a strong, bizarrely strong, idea that any time you like you can quit your job and go homestead some open land, so you're Free.

Minority populations tend to be significantly more left-wing for a reason. We were usually discriminated against in the public or private sphere, or even just allowed into the country as exploited labor (Asians, blacks). We have no thoughts of homesteading the Midwest meaning Freedom; we think worker ownership or unionization means Freedom.

Thanks for this insightful post. As an outsider, I wondered how the US associated itself so strongly with "freedom".

They've tried to change the health insurance problem. I'm not sure how much Obamacare will do in that regard, as a practical matter, but we'll eventually find out one way or another, assuming it's not repealed or struck down first.

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