It's so weird how in the US, health insurance is tied to your job, so if you lose your job you lose access to health care.
The medical system in the U.S. is awful, and it really is broken that it is tied to a job.
A system where you need to be well enough to work to get care to work is obviously not ideal.
Means-testing is just a very inefficient, clumsy way of providing benefits to people and functionally operates as a tax on those who would benefit from the service but would fail the test.
My wife runs a business and employs, typically, only 1 or 2 people; when they started asking for health insurance we found that getting insurance (as a business) was actually not terribly expensive; at the same time my insurance plans have gotten progressively more crappy.
I can't remember, or be bothered to find out -- how expensive is it these days to just get private insurance in the USA if you've got 3 hideously expensive pre existing conditions? I have some vague recollection that the obamacare thing requires that insurance companies offer coverage to people without regard to those preexisting conditions, and intuitively that seems "fair" but it's all such a pile of crap it's frustrating to dig through and demotivating. I assume "that's the way they like it."
Take a look at your state's healthcare marketplace site. You should be able to browse plans if you put in your county/zip code and participant ages. Marketplace plans can't charge based on health history, and at least in my area, they all seem to cover the minimum required services and nothing else; they compete on networks and copay/coinsurance.
It's not the giant morass of pain that it used to be, but it's still somewhat of a pain, and often employer based plans are better; especially in terms of networks and out of area coverage.
Most Americans (roughly 70%) are happy with their health insurance. That's a reason to be defensive other than it "being the status quo".
And I pay more for this, just in terms of my monthly premiums, not to mention all of the out of pocket and deductible costs, than I would in taxes for healthcare in just about any other developed country.
I don't know what metric people are using when saying that they are "happy" with their health insurance, other than comparing it to being uninsured in this country, in which case, sure, it beats that.
[1]: this arrangement is also technically illegal in California, but worked around with a Three Corporations In a Nonprofit Trenchcoat sort of deal. The seams mostly don't show.
It’s not really “easy” to reform/change anything this significant in the US. It is not like a European country with a functioning modern parliament that can make laws. In the US system both major parties have to agree in order to pass anything of substance, which due to hyper-polarization means essentially nothing gets passed.
Besides decoupling the insurance from employment to facilitate career changes and even quitting, it would also bring down the average price of insurance for people who currently get it on the individual market as the average corporate worker is statistically healthier than the rest of the population.
Eliminating the tax deduction is not enough as even at break even the company offering health insurance is a net win from the lower risk pool. It had to be an additional penalty / tax.
There are enough “easy” solutions if the only goal is well-being of the citizen. That’s not always the priority for some obscure reason
The US healthcare system is stuck in a deep local minima. The cost of transitioning to a different equilibrium is so high that it is obviously politically infeasible any most if not all States. I don't like the current system but if there was a viable path to a different model, at least some States would have taken it.
Oh, and then you get denied. Multiple times.
This country would rather "useless" (read: cant make money for capitalists) people die.
I don't know anything about Pennsylvania, maybe it's easier there.
I'm sure the bar is higher without a disability, but the asset tests in PA are reasonable, considering they exempt your residence and 1 vehicle.
There's probably horror stories of people falling through cracks, but I just find it disingenuous when people breathlessly proclaim that the US callously let's people die on the street from a loss of employer health care.
My father had MS, and he was considered a fraud (back in the 70s). Of course, such is easily said if there are no repercussions (I, parent of two young children, have been called a pedophile by my neighbors ...). It is very likely he also had autism, like me, a burden to function in society and a mark on your forehead cause "you're weird".
I've been suffering from a burnout (related to my neighbor's behavior) since start last year and when I applied for benefits because I got fired I've been told I should've reported myself fully healed earlier. I've also been asked questions to which the answers weren't written down because (and I quote) "I'm not allowed to ask that question".
If you apply for any social benefits, society considers you a fraud and you have to prove you're not. This is immense work, more so for people who suffer from disabilities (likely those who rightfully apply).
They just usually cannot afford it, even though there are subsidies available, most people will not earn or save enough to pay the deductibles / out of pocket max.
I ended up waiting for Medicare eligibility anyway which, with supplemental and prescription drug coverage is probably not nearly as much cheaper as a lot of people assume.
In the 1960s when healthcare costs began to rise there was a conversation around changing it, but by 1970s it was concluded that on balance tying it to employment had benefits in reducing labor action (strikes), which was a big concern back then. We've stuck with it since.
On the other hand, as long as you have that card everything is really cheap, which is definitely not true in the US.
Gradually these perks started to become as important of a consideration as the salary itself. Unfortunately health insurance is easily misused. We started relying on it to pay for all health care, rather than to actually mitigate the risk of a sudden medical bill. The result has been a rapid and continual increase in the price of health care over the last 70–80 years caused directly by the fact that nobody pays for the services they use, but instead pays into insurance plans that then pay for the care.
In fact, I think this guy overstated the risk to his health. If you get fired you don’t actually lose your insurance. You sign up for continuation of coverage from COBRA, taking over payments for the insurance from your employer, and then purchase an individual or family insurance plan of your own before COBRA runs out. Or get hired somewhere else and sign on to one of their insurance plans. Either way you’ve lost nothing, at least in terms of health care.
I don't think it's as simple as that. Empirically, lots of countries have health insurance systems whose incentive structure could be described in the same way, yet the US is an extreme outlier in healthcare costs. Something else must be going on.
- top-skill, top-paid specialists
- world-class research hospitals with near-luxury-level amenities
- cutting edge pharmaceuticals, including absurdly expensive novel biologics
that is enjoyed by, say, a junior Microsoft developer and her family in Seattle.
One example of how this plays out as GP described is childbirth: There’s something like a 5X cost disparity for a typical birth process between a perfectly competent regional hospital and an elite research institution. But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food.
Obviously, this is not every American’s experience with the system, but for the portion of outlier costs that aren’t related to outlier US population health trends (e.g. obesity), it’s an important part of the story.
Your definition of "typical" apparently is very different from my own, or we are thinking about "well insured" very differently. Every pregnant person that I've ever talked to, if they have a choice at all, has weighed the projected cost heavily in their decision on where to give birth.
The typical person in the US has a deductible that runs well past several thousand dollars and then they have to pay a coinsurance amount, which could be up to 25% of the cost, up to absurdly high out of pocket maxes.
And yes, the cost weighs highly in mind every time we make a decision about whether we need to go to the doctor or not. Not knowing if this trip to the doctor is going to be the one that bankrupts us (cancer diagnosis?), I tend to simply not go unless a limb is falling off. My wife on the other hand came from a country with socialized health care, and can't shake the habit of just going to the doctor whenever she feels ill or injured. Then I have to be the bad guy with the "honey I know you feel sick but do you feel that sick? We're looking at a minimum bill of many hundreds of dollars out of pocket every time you go."
Just a new source of income to pay the rent, or a free place to sleep since you can’t afford rent anymore, now that you’re paying for health insurance instead.
It can easily be dispensed of and nothing would change, people would simply need to go to healthcare.gov.
Health insurance and healthcare is NOT tied to your employer in the US.
However, many employers pay 50% to 70% or even 100% of the health insurance premiums for their employees, and employees can use pre tax income to pay health insurance premiums if purchased by their employer.
The problem has always been this tax advantage of your employer purchasing it, AND most Americans opting to not purchase it due to cost.
Note that there are significant subsidies available if you earn less than 400% of the federal poverty level, although that may still leave many unable to purchase it (or the deductible/oop max is so high it would not make any difference).
> If you end up needing a hospital stay, you could be in trouble if the "wrong" doctors do a drive-by.
This is not true since the No Surprises Act went into effect Jan 1, 2022. Everything is considered in network in an emergency, and if a doctor works in an in network hospital, then the doctor is considered in network too.
Usually in an emergency I don't have the presence of mind to direct the ambulance to the right hospital (in case the emergency turns into an overnight stay), and it's all the more important if the plan doesn't have good (or any) out of network benefits.
By "insist," I mean that leaving would be against medical advice -- and I know some insurance will refuse to pay for the preceding stay.
I wish this stuff weren't so hard to make sense of.
Who knows how well it works in practice.
Also, the age rating factors being capped at 3 allows older people’s health insurance premiums to be much lower before age 65, although I maintain that this young to old wealth transfer is not beneficial for society.
COBRA is good insofar that it lets people know the real cost of health insurance.
Thats the cost for covering everything under the sun + every bad habit + risky behavior. Instead of you know: emergencies, no fault accidents, and unexpected genetic problems. (Like, say car insurance)
Not only is this a strange opinion, that you want some kind of entity to decide whether or not each of our health conditions are at-fault, your analogy to car insurance isn't even true in no-fault states, of which there are many.