Hacker News Reader

Coming from the UK, I'm always amazed at how important health insurance is in the US, and what a broad range of quality of healthcare there is. Our company provide a free, private healthcare (BUPA), but I've never felt the need to use it.

Recently, I had surgery for an ACL tear. Unfortunately, for some reason, it later went septic. The day the consultant found it was septic he rushed me into surgery that afternoon and I spent the next 6 nights on IV antibiotics, followed by a course of oral antibiotics. At no point did I have to worry about how much all this cost - and I didn't ring BUPA just because I couldn't be bothered and it was all perfectly satisfactory care.

When I was a kid I had extremely bad asthma. A new respirator type device had just been invented and I was one of the first in the North West to have one. These things cost thousands of pounds at the time and there's no way my parents would have been able to afford it, but they got it loaned to them completely free. It quite possibly saved my life.

I used to think how lucky I was that I wasn't born in some third world country where I would probably not have survived, but recently I've started to be glad I wasn't born in the US.

You guys really need to sort this out.

All that would likely have happened in the US also. Most people have health insurance. The ones who don't still get medical care, it just costs them money. If they don't have the money, they can settle with the hospital on a payment plan they can afford. It's definitely not perfect, but it's not as bad as it seems at first glance. I'll see posts about people's 30,000 dollar hospital bill, but in reality they'll never end up paying that much.

But, still, medical bills are a major (#1?) cause of bankruptcy. And our health outcomes are significantly worsened by how many people never get preventative care.

Health insurance in the US is highly variable. Many plans expect consumers to pay a substantial portion of their medical bills. The term "underinsured" tries to capture this segment of the population that is nominally insured but in reality would incur huge bills if they took advantage of their insurance. And while some people manage to get out of paying their bills by exploiting HIPAA, most just take the massive hit to their credit and walk away from it. So no they don't end up paying that much, but the stress and economic fallout they endure is nothing to wave away either.

I work for one of the top 10 hospitals in the United States. Our health insurance, ironically, isn't all that great. Co-pays are relatively high, certain things not covered, etc. So it got me thinking about health insurance and how it affects us (US residents), in comparison to our European counterparts.

One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown). Possibly. However, their view of healthcare (education, and other items) as a BASIC human right is one I strongly believe in. Healthcare should NOT be a luxury item. Yet, it is treated as such in the US. Almost exactly a year ago, I had a bike accident right off the Golden Gate Bridge. For 10 minutes I was limping my way to Sausalito until I happened to run into a police officer who thought I should be picked up by an ambulance to taken to the hospital (although they suspected that I had a concussion, broke my arm and shoulder, I came out with just scratches). I HAVE insurance, but for weeks after this injury, I was opening my mailbox at home, expecting a $20K bill (just the 15 minute ambulance ride was $2000). I was absolutely terrified. Imagine... and I HAVE insurance. Luckily, I ended up paying just a few co-pays, and the issue was resolved.

One of the benefits of a great employer in the US (like you have -- Microsoft, for example) is "Health insurance, Dental covered" etc. That's how they post it in job boards. Shouldn't health insurance be a given??

To your argument that things are settled through loans, etc: I am utterly against it. Obviously, statistics show that these things don't work. The hospital I work for serves an under-served population. People suffering from chronic diseases and who should be seeing a doctor on a regular basis do not. Why? Cost. They end up showing up in the ER with a MAJOR issue months later. Their condition is much more complicated to treat, and significantly costlier. So, we "saved" on a silly, cheap follow-up, but ended up spending a huge amount later. And guess what? These patients can't pay their bill anyhow, so we have to write the expense off.

I am familiar with quite a few people who would have loved to change their jobs, or even start their own business, but are too worried about losing their health insurance benefits. Is that the right way to go for the US? Probably not.

[edited: put it initially under the wrong parent. text left as is]

>One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown).

I'm not sure Greece in particular went too far, as such; isn't the problem that they've got a massive epidemic of tax evasion, and no political will to tackle it? If they were enforcing the tax laws on the books, maybe they'd have the money to pay for the services they're providing.

>So, we "saved" on a silly, cheap follow-up, but ended up spending a huge amount later. And guess what? These patients can't pay their bill anyhow, so we have to write the expense off.

Hear, hear.

> One may argue that Europe went too far with their "social" expenses (hence, the current financial meltdown)

One may argue that if she has no understanding of the European financial meltdown, and just wants to find evidence for the failure of the welfare state where there is none. The crisis happened primarily because of the Spanish real estate crisis, and it became exacerbated because of (1) structural flaws in the monetary union and (2) imposition of rapid austerity.

As for the rest, I agree.

> One may argue that if she has no understanding of the European financial meltdown, and just wants to find evidence for the failure of the welfare state where there is none

There there. Relax. I was not arguing that the social measures were the only cause of the financial meltdown. They are, probably, a contributing factor. You brought up Spain, which in particular, I am quite familiar with due to personal relations with a Spanish. Real estate was the major factor (as it was in the US), that is true. However, when Spanish citizens tell me they show up at the ER for a sore throat because the ER is closer to work/fit their schedule/whatever instead of setting an appointment with a doctor, I think that's a big "social" expense that could and should be avoided. Why do they do that? Because it's free! So who cares, right? There's nothing wrong with providing free health insurance (and I'm a big advocate for it), but showing up to the ER without a reason should be penalized.

Also, when I hear that people who have no desire to work (because they're homemakers, for example) show up at the unemployment office simply to collect unemployment or just to be eligible to "fun" courses (to fill up their days), that's a social expense (in Spain, if you're unemployed, even for an extended period of time, the government will pay for all kinds of courses, be it knitting, accounting, or something else). Those are expenses that affect a country's well-being. I AM all for these things. But that's what I meant that they may have gone too far.

N.B. I use the term employer throughout where it really can also mean manager or generally anyone responsible for figuring out what employees would value as compensation/perks.

One thing I've noticed being an employee is that when employers try to get feedback in how to compensate their employees or what kind of perks they can additionally offer the question asked is usually, "Is there anything I can do to make you happy?" That question is vague and oftentimes sounds like it should be answered in the negative. The employee doesn't want to look needy of course. Instead, the employer should ask, "Hey, are you happy with your hardware? You've been messing a lot with databases lately. Do you have enough RAM? Do you want some extra disks to mess with different RAIDs or filesystems?" or maybe, "Do you think we should get developers a second monitor? I really don't mind spending the money, it just never occured to me until now that it might be useful." Once an employer actually opens up a dialogue with an explicit offer or idea, the feedback the employer wants to hear will much more likely flow naturally.

More specifically with a topic such as health insurance, I as an employee need to be given some idea of what options are on the table when it comes to "improving" my health insurance plan. Are we talking about the employer paying more of the insurance or perhaps am I concerned about the lack of a plan that offers an unlimited lifetime benefits clause.

I feel my job as an employee is to do work that adds value to the company. If the company wants to genuinely add value to my well-being, but wants it to be more thoughtful or mutually beneficial than a raise, the ball's in their court to be creative and come up with a list of starter ideas. Now I'm not averse to thinking of what would be useful, but a vague email, or even a 1 on 1 asking me what can be improved is unfortunately not going to get any feedback because my mind really won't turn its attention to thinking about that for the time necessary. A personal anecdote offered in lesson form:

A CEO of a startup may hold a discussion on company offered stock options, to fill in people on how it works on a compensation level. When questions come up that the CEO does not feel comfortable answering (considering he's not a certified accountant), a normal CEO will advise you to ask an accountant (accountant? I'm 22 years old, I don't have an accountant, should I take off work hours to find an accountant, go to an accountant and ask him/her?). A creative CEO will get an accountant in the office for a day and schedule those with questions to have a 1 on 1 meeting.

I think the data you're looking for has to come from having good relationships with your employees. For example, did you know the following about your ex-designer:

1) Is he married or looking to get married? 2) Does he have kids or plan to have them soon? 3) Has he had any serious health issues in his family (e.g. history of heart disease)?

Obviously, those type of questions can get you in trouble if they are asked on an employer->employee basis. But in the course of really getting to know someone, those types of things will come up. It's then on you to think about what you'd want in that situation and do it for them.

So if ex-designer was planning on having kids, you might consider the cost of the family plan and be willing to splurge on that at the expense of the beer and snacks budget (or something focused on single people).

My main problems with employers have been their ignorance and/or lack of concern about what is important to me. I had one company that bragged about fully paying for our health insurance. Well, the owners of the company all had several kids. I didn't even have a girlfriend at the time. Health insurance as a young, healthy, single guy was barely even on my radar. That was easily accessible data (which they had), and yet they didn't act on it at all.

Simply, put yourself in their shoes and ask, "What would I want in this situation?" Considering you were friends with the ex-designer, my thought would be that you could have probably spent more time thinking about what he wanted instead of just asking. For some reason, many people won't speak up about what they want. Many times they themselves don't know until someone shows it to them.

My 2 cents.

Getting people to open up is a skill. It's also much easier to do with peers.

Honestly, it's enough of a skill that I can't give you "quick pointers"-but check out the book The Charisma Myth, and pay special attention to Focus Charisma. That's the skill that you need to get people to open up about all their problems & concerns.

Elicit anonymous feedback. It's hard (for me, at least) to complain face-to-face, especially to someone who writes your checks.

Ditto. Also, from previous managers they may have learned that criticism, even constructive criticism, is a great way to bag a negative performance review. Such effects need to be accounted for.

Cultivate a less intimidating environment. I jabber all week and clam up in a 1, even with a nice manager. ask people to write down their thoughts during he week, email them to you or jot down notes, then discuss the notes in the 1:1. And if you ever show a hint of condescension or retaliation for feedback, it will never appear again.

Sounds like your guy left because he wanted to leave, and the insurance was a made-up excuse.

Oh, I see. People just randomly leave. Of course! No need to look further, nothing that could have been done.

That's a big load off my mind. Thanks for pointing this out :)

Not sure why this sounds so incredulous. I have left (or even better, been laid off and happy to collect severance) more than once. It's not strictly "random" of course, it usually comes down to boredom and need for change but the bottom line is that indeed nothing could have been done.

Yeah, there's also "an excellent opportunity arose," and "time for a new challenge," or "looking for a bigger/smaller, riskier/stable team/company/toaster/product.

I'm sure I'm just telling you things you already know, but I think it's worth reminding. When you want to try to understand the thought process behind someone's actions, put yourself in their shoes.

Okay. So now you're an employee who has been asked by his employer what he needs. Maybe you'd like higher pay/greater compensation. Do you have the bargaining power for greater pay? Would asking for greater pay indicate dissatisfaction to your employer? Maybe you don't want to communicate dissatisfaction. So maybe it's best to just say that everything is fine and keep working until you find a better position.

So maybe now you've found another position with more compensation. Do you hold a proverbial gun to your employer's head and say "greater compensation or I leave"? Is there any acceptable way of asking for more with no real way of promising anything in return?

I appreciate your efforts in trying to keep the lines of communication open, but maybe if you want information, you should give some in return. Something like "we still have $100k left to spend in employee benefits. How would you like this allocated? Pay? Insurance plan? Company party?" Or maybe you can offer choices. "Would you rather we increase 401k matching by 3%? Increase pay by 1%? etc" And obviously give them time to respond (so that they can consider things, discuss things, etc) It might be a pain, but if that's still not acceptable, and you still want more data, I doubt you'll get data asking directly from your employees what amounts to "do you want more stuff?" and "what more stuff do you want?".

If you find success with something though, whether it was something I suggested or not, please let us know!