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Comment by frde_me | Hacker News Reader

> He had a son with severe Autism and Microsoft's health benefits were very important to him.

This really sucks for him. Through should Microsoft _not_ layoff specific people due to health conditions? Is that something we require from companies?

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How about you nationalize your healthcare, so people like that are not depended on their work to get the care they need?

What role did you specifically play in your country's nationalization of healthcare?

Maybe not that person above, but I’ve continually voted in support of it and initiatives to expand it

Employer provided health care insurance came about during WW2 because Roosevelt froze wages. Companies discovered they could "raise" wages by paying for the insurance themselves.

The practice persisted because employer paid health insurance is tax-deductible, while it isn't if a person pays it out of pocket.

The obvious solution is to make it tax-deductible.

I don’t see how this addresses the comment you replied to.

I suggested an alternative solution to the one proposed by the comment I replied to.

I don’t understand how “make it tax-deductible” is an alternative to “nationalize healthcare so it’s not tied to employment.”

Sorry, I don't know how to make it any clearer.

It’s already tax deductible. Just saying “make it tax deductible” doesn’t explain what you mean.

It's complicated. From google:

* You must pay the premiums with after-tax money.

* Your total qualified, unreimbursed medical and dental expenses (including premiums and costs like co-pays, deductibles, prescription medications, etc.) must exceed 7.5% of your Adjusted Gross Income (AGI).

* You can only deduct the amount of expenses that exceeds this 7.5% threshold.

* You must choose to itemize deductions instead of taking the standard deduction.

Most taxpayers use the standard deduction as it is often larger than their total itemized deductions.

Oh, you’re suggesting making health insurance premiums tax deductible for the individual. I agree that’s a step in the right direction.

It would make insurance less tied to employment without nationalizing it.

It doesn’t. It’s part of a rosary of things people wield to stave off thinking about the topic. You can do other things besides nationalizing all care or insurance, but when you hear people talk about “open up markets to cross state competition”, or “everyone gets an HSA”, or “make insurance tax deductible/it’s fdr’s fault”, it’s rarely about the specific policy, those are liturgical texts / catechisms designed to give the impression of solutions without substance.

Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group (of people generally healthy enough to work) and that’s one way of getting balanced risk pool if you’re not doing community rating or a societ wide pool.

> Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group

From what I saw, the combination of "no exclusions for pre-existing coverage" and "penalty for not having health insurance" worked pretty well to balance the risk pools without nationalized healthcare.

I would still like nationalized healthcare, but I think there are other ways to fix the problem at hand of people being dependent on their jobs for healthcare.

Absolutely. I'm a fan of the ACA's patchwork of wonky choices including no pre-existing exclusions and community rating. Additionally the subsidies made it genuinely accessible for most, at least where they made it through attempts to hamstring them. It's been one of the most helpful practically advanced policy achievements of my lifetime, even with all the effort to destroy it (which has recently found new success and may even succeed entirely in the end).

Universal insurance could be better, and perhaps the day will even come when the American electorate recognizes priorities like this and candidates who will advance that kind of policy, contrary habits of the past notwithstanding.

> The obvious solution is to make it tax-deductible.

Or make employer paid health insurance count as income and therefore not tax-deductible.

True. Total employee compensation is around 145% of their salary. The government could tax that extra 45%, but I doubt that would fly politically.

Typical accounts of employee compensation only measure wages and salaries. I've only seen the WSJ using total employee compensation, which is a far more realistic figure.

That's how it works in the UK

Or lower the age for Medicare every year until everyone is covered.

We could just lower it once, to zero, and be done with it.

We could. Who is going to pay that bill?

Well you see it would free up a huge amount of money that employers are currently paying to insurers. If you take that money (by raising the Medicare premium on employees), plus the existing medicaid budget, existing medicare tax and payroll tax contributions America's healthcare system would receive over 40% more money to cover care per capita than the next leading contestant. Almost 2X the OECD average. In PPP dollars no less.

https://www.healthsystemtracker.org/chart-collection/health-...

"But where would the money come from" is one of the wildest questions to ask about a system that already costs double the average. I'd say, give or take, the same place its coming from now, but like, less.

would it actually be that different of a bill?

i imagine its already doing the most expensive part, treating people who are almost dead who have lots of procedures that could be done.

picking up people that need basically no care sounds pretty cheap by comparison

Estimates of Medicare errors, fraud and abuse are around $60 billion. Greatly increasing the scope of it will, inevitably, increase that figure.

Estimates of health insurance fraud is also around $30 billion, so same order of magnitude, and considering the margins of error and the fact that they are estimates, by definition, it makes it hard to say public health insurance is more fraud ridden then private. Plus due to the inherent differences there are probably differing avenues of research and estimating possible between private and public insurance, and heck whole different forms of draining money that might affect ease of uncovering the level of fraud between private and public, which would make it have an even larger margin of error.

I pay $2k a month through work for a plan. I could pay that plus the payroll deduction plus the pittance my employer kicks in. I’d make that trade all day every day.

The US healthcare system is like the Titanic: it turns slowly, and you don't want to fuck around with hitting icebergs.

So fucking sink it. All heath "insurers" do is just delay and deny coverage anyway.

> So fucking sink it

Let's think through the implications of that.

The US healthcare system is non-functional for a month: what happens?

Hospitals and providers start running into cash flow problems and begin having difficulties providing service.

Fraud skyrockets because everything is getting blanket-approved because none of the data used for verification is available.

And about a month after that, people start dying from lack of care, after the last financial reserves of the system are exhausted.

Because that's the path the system was on when Change went down for several weeks, only averted by HHS/CMS saying 'Here's money, just do procedures, we'll worry about it later.'

You say this as if people aren't already dying of lack of care. And it's already disintegrating. Check back up in your estimated month as the realities of ACA subsidy drops start to kick in.

I can't tell if you're being intentionally obtuse, or you really don't understand orders of magnitude.

Are you okay with 1000x as many people dying to make a point?

Maintaining the status quo just keeps killing people at an increasing rate. The sooner the system is unfucked, the fewer senseless deaths there will be overall.

Wouldn’t that leave out the set of people who have no income? For example, long term unemployed, adults switching careers and needing to take a long time off for education, etc? While the solution gets close, I don’t think it’s strictly the same thing. Add on top of that our unnecessarily complicated tax system and this sounds even less equivalent.

Note that a freshly laid off person will usually qualify for generous Medicaid benefits, including in WA state.

What does 'usually' mean? In my experience 'usually' has never worked in my favor. Say it does, does it kick in immediately? What do they have to do to switch over providers? Does all currently being coveraged treatment just move over to being covered by Medicaid automatically or will they need re-approvals?

If you are saying they are covered either way, why not just have consistent healthcare coverage for them and for everyone, all the time?

In my state it would kick in immediately. You would report your current income, which is now $0 since you just lost your job.

Virtually every provider in my state is in-network for the various Medicaid options to choose from, so you would not need to "switch over providers". It's usually better than private insurance.

As far as "why not just have consistent healthcare coverage for them and for everyone, all the time", because it would be very expensive to do so? Medicaid covers poorer Americans (including people who just lost their jobs), not the entire population.

(Looking at this from an American centric point-of-view):

The Czar of health-care in the US today is a brain-worm addled, drug-addicted, vaccine-denying, conspiracy mongering, incompetent jackass. And the overall current administration has shown itself to be hostile to basically anyone who isn't a cis-gendered, white, heterosexual, Christian male.

How many of us really trust these people to make good decisions regarding our health-care? A position that they (or their delegates) would find themselves in if we "nationalize health care".

I think this is a classic example of an idea that sounds good on paper, but doesn't survive contact with reality.

I would imagine individual states would manage their own health services, with the federal government acting as more of a coordinating and standard setting body. At least that's how it works in UK, Spain etc.

There's probably no federal agency less related to the issue of nationalized healthcare than the DHHS.

You know CMS is under HHS, right?

Even so, the issues I am referring to go all the way to the top (POTUS) and descend down through everybody in the reporting chain to various degrees. And even for people who are Trump supporters, just ask yourself the question "What happens if the ONE PERSON I HATE MOST gets elected POTUS in a world where I depend on the federal government for health care?"

I know in years past we all though the US government was somewhat immune for really radical swings in direction and what-not, but I think now we have an existence proof that really sudden and radical changes can happen.

You mean like Jeremy Hunt in the UK?

In the UK, it's operated as trusts separate from day to day government. In Canada it's provincially administered. In Australia, Medicare is a national, tax-funded system with independent statutory authorities overseeing parts of it. Germany, France, Japan have social insurance systems.

How about you do some research on the kind of healthcare that people in countries with socialized healthcare receive. 6 month waitlists for a cancer screenings, multi day emergency room waits for broken bones, maybe you've heard of the oh so wonderful death pods in Canada? Our system is by no means the best, but I'll take it any day over socialized systems.

Can you cite the sources you researched? I’ve known people from all over the world and none of them found that to be true: the American healthcare system was commented on in disbelief over both the cost and difficulty of getting treatment compared to where they had previously lived.

The first result when you Google Canada's healthcare waiting lists: https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/

Yes it is. The system has some very deep issues due to government involvement/meddling with both healthcare and insurance, but at least you can still receive life saving treatment in a timely manner.

They can be in disbelief all the want, but when people in countries with socialized healthcare get cancer or other life threatening medical conditions they come to the US and a private healthcare to get treated.

5 million people in the OECD come to the US every year to get created for their cancer?

That’s one country, and I note that the authors of that paper directly contradict your thesis: “the Commonwealth Fund’s survey results show that other universal health care systems (eg, the Netherlands, Switzerland, Germany, Australia, and France) have much shorter wait times than Canada does”

The American system is also not looking so good as our wait times have been going up and access has been worsening for much of the country, especially over the last year.

Yeah, but those systems won’t hide breaking research like checks notes antioxidants and high-dose Vitamin D from cancer patients, so…

This is not my experience in Canada. It is not the experience of anyone I know. There are often long wait times in ERs for things that are non urgent. I waited 5 or 6 hours my last visit after initial assessment. I’ve known a few people that had life threatening cancers here: they were treated quickly, and compassionately by the health care system. There are bad wait times for some things: a hearing assessment took 6 months (there are private options for this but many people would rather wait - they trust the system more). There is a shortage of family doctors. Medications are not fully covered. But I promise you we have no death pods in our hospitals. If you get hit by a car, diagnosed with cancer, need an X-ray, a breathing test, etc. You get that care. It’s nowhere near perfect, but I’m thankful for it and most people I know feel similarly.

I did: Greece, UK, France, Saudi Arabia, Japan and now Norway.

Never paid a single dime out of pocket as a diabetic.

> so wonderful death pods in Canada?

propaganda at it's height.

Legally, Microsoft, or any company, cannot use any personal factors in determining who to lay off. If they do, they risk a very real lawsuit. All one needs to do is show some evidence of discrimination, and the EEOC doesn't charge a dime, the worst they will do is deny to pursue. If that happens, most private lawyers will take the case on contingency.

This is the reason you see sweeping cuts without regard to age, sex, etc.

There have also been lawsuits in the past that have settled out of court where a company's layoffs appear to overly inflict damage on one class vs. another, even if the intent was not to do that.

I am not defending these companies at ALL btw. I just have a bit of experience in this area due to the legalities, and I wanted to share it.

I am also not saying that companies don't do this, but the smart ones don't, and the smart ones at least try to at least avoid making it look obvious.

> the EEOC

Which—for the folks not following along aghast at everything—has been sabotaged by recent federal political changes.

https://www.epi.org/blog/trump-is-making-it-easier-for-emplo...

> Is that something we require from companies?

In Germany, yes. For mass layoffs, this absolutely has to be considered. In general, the older the employee is, or if the employee has dependents, the more difficult it gets to both fire them or lay them off.

Germany's GDP is shrinking.

The regulations that make it hard to lay off someone have an equal and opposite effect of making companies very reluctant to hire. This impedes the efficient allocation of labor, resulting in a poorer GDP.

It looks like Germany's GDP has increased every year in recent memory except 2009 and 2020.

https://en.wikipedia.org/wiki/Economy_of_Germany#Data

google [german gdb growth] says: "-0.2% annual change (2024)"

The "GDP Growth (Real)" column in the wikipedia article GP linked agrees, but it doesn't tell a story that justifies "Germany's GDP is shrinking".

See the graph "G7 Real GDP % change compared to pre-Pandemic level":

https://commonslibrary.parliament.uk/research-briefings/sn02...

The US has 13.3% growth and Germany 0.1%.

Because of AI and it's indirect effects, such as electricity demand.

Two points:

1) GDP is, while very important, not the only measure of country's prosperity

And

2) how much of those 13.3% is being hoarded by a single-digit amount of companies?

> hoarded

Productive companies do not hoard wealth. They invest it. GDP is not a measure of wealth, it is a measure of production.

Softbank -> OpenAI -> Oracle -> Nvidia -> Intel -> Microsoft.

Over 1 trillion dollar invested in total. Where is the production?

I (and most of the people I know) are happily paying for ChatGPT (or one of its competitors) every month. The value I get from it dwarfs the tiny fee.

I'm a paying subscriber to both ChatGPT and Grok and am a satisfied customer. It's fun to compare the output of both.

> They invest it.

Where? Where is the growth in other sectors then?

> The US has 13.3% growth

Without the incestous web of the AI bubble, the US would actually be in a recession, especially due to the tariffs.

Yes, if you overlook the productive companies, the economy is unproductive.

I would 100% chose to live in Germany than the USA. GDP is one consideration, but QOL more important.

Live wherever you want to!

That’s an odd response. My point was GDP alone is a poor way to measure a country.

It's a measure of the economy.

Or a measure of quality of life. But it sounds like you’re only interested in pro-American talking points.

It's nearly impossible to measure quality of life, because everybody has a different idea of what that means.

You mean like the human development index and various other measurement techniques?

Which is more important to your quality of life - central heating, or indoor plumbing?

Germany has all three. I’m not sure what your point is.

I asked which was more important - i.e. what's your weighting of these?

It is irrelevant, if both are available as base package.

I guess you want to point out that choices are subjective.

That subjectivity is relevant within their classes (air—food-water, security-health-plumbing-heating, smartphone-car-vacation, yaht-designerBrands) Definitely there will be one person who choses to die, just to get latest smartphone, but most people will not.

These classes get less clear/useful as you go up, but most people will agree on the basics.

Tangent: it is important for me personally for my neighbour to have the basics (and more), as that increases my basics like security, sanitary conditions.

GDP is an objective metric, while quality of life is subjective and is inevitably based on arbitrary weightings by the people trying to calculate it.

GDP PPP per capita is better measure of quality of life.

it's not. An economy where only a select few benefit from the GDP (e.g. via stocks - the richest 10% of Americans own 93% of the stocks!) is not a "quality of life" measure at all.

[1] https://markets.businessinsider.com/news/stocks/stock-market...

You can select yourself as a beneficiary by buying stocks. With Robinhood, you can do so with less than a C-note.

> the richest 10% of Americans own 93% of the stocks

Most prolly got that way by buying stocks!

It's not a good one though, because weird effects like the AI bubble incest investment web artificially blow up the GDP, and because it doesn't reflect the economy "feeling" the population experiences.

To expand on the latter point - say you have automation enabling more economic growth. A significant amount of people lose their jobs, others are afraid they'll be the next ones on the chopping block, and people hold their money together as a result - if you ask general people on the street or in representative surveys, you'll get the feedback that the economy is going to the dogs, but "the numbers" don't reflect that.

Here in Washington state, they are heaping taxes on us in unprecedented amounts. That's not going to help affordability at all.

https://www.wsj.com/opinion/washington-states-tax-blitz-497e...

Wouldn't that be awesome?

I enjoyed living in Germany for a while as an Air Force brat.

Good for you.

"The Stupidity of GDP per Capita"

https://www.youtube.com/watch?v=eiymTzsZfoA

How much of this years GDP growth in the USA went to average citizens? What does GDP growth matter if your citizens have zero access to healthcare, can't improve their conditions, can't innovate, can't try new ideas because they are tied to healthcare via their current job?

How much of American GDP growth goes to Billionaires and isn't a useful health metric?

See: Billionaires added record $2.2tn in wealth in 2025 https://www.theguardian.com/news/2025/dec/31/billionaires-ad...

Billionaires become billionaires by making and selling things people want. Obviously, a lot of people want what they are selling, and think it is worth buying.

That's such an excessively naive, childlike take that it's hard to know where to start. You don't become a billionaire by "making and selling things". That doesn't scale beyond the low millions. You become a billionaire by leveraging existing capital to rearrange bits of the economy in such a way that money flows towards you [note]. Productive output, be it goods or services (which you seem to have forgotten exist) is strictly optional. You think Warren Buffet sits in his garage cranking out widgets? What planet are you on?

[note] For example, you might contrive to purchase the entire supply of some valuable resource with inelastic demand, and then sell it back to people, perhaps at an inflated price.

> You don't become a billionaire by "making and selling things".

See Microsoft, Walmart, Amazon, Apple, Tesla, SpaceX, Pixar, Lego, and on and on.

> you might contrive to purchase the entire supply of some valuable resource with inelastic demand, and then sell it back to people, perhaps at an inflated price.

Example?

It is, but more generally. In many other countries, it is not so easy to lay off employees as it is in the US. It is also not necessary that your access to healthcare be contingent to your employer's whims.

Not at all - it's legal, but it doesn't garner goodwill either.

Yes

Companies don’t have agency. People do. Compassion is a cross cultural value. Including amongst those that run companies.

For the most part none of us has any “required” obligation to anyone else.

Is it something we require of companies? No. But being a responsible, compassionate human being that considers the totality of circumstance is something I expect of that company’s leaders. Especially a company that has the money and need for technical skills elsewhere in the org.

The golden rule does not stop being true just because you are at work.

Preemptively: duty to shareholders is broader than short term profit maximizing. Avoiding bad PR like this is also in the service of MS shareholders.

As a side note: Nadella moved his home to Canada, while working at MS, so his special needs kid could go to a specialist school. That is absolutely the right choice. The argument that MS should not consider the health of their employees children is horseshit when they allow the CEO to set up house hours away in a different country for that exact reason.

At the end of the day, a kid suffered unnecessarily through no fault of his parents or his own.

Yes I’d say that such people should get extra protections

In europe (at least in Germany), they do get extra protection.

And that's why people think 5 times before hiring such. It's already super hard to fire people unless they make gross mistakes. It's nearly impossible to fire someone like that. It's stupid.

Its not stupid rather humane, just very ineffective from economical perspective.

You want society where its everybody for themselves, fuck the rest, be lucky with ie your health so you and your family can have a decent life and one problem big enough can wipe you out? The benefit is more money, economy works better, is more agile to ever-changing situation. Just those extra money often go to that healthcare (since we all end up with various issues over time, the only exception is early death), or university for kids, or cost of properties.

Or something glacial, without real pressure to improve, more poor, but with additional safety nets.

I keep saying it over and over - EU should take over system (and mindset, good luck there) of Swiss folks. They strike the best balance between predatory capitalism that often grinds unlucky individuals and various safety nets (free top notch public education, almost free public healthcare, very good but not ridiculous social system etc). Unsurprisingly, mix of European competency and a bit of proper capitalism creates one of best stable living standards in the world, and arguably still The most free nation in the world (TM).

Its a place that french or germans just can't swallow - neighbor showing them how much better a similar society can end up functioning with few rather minor tweaks.

In a thread about US company firing QA (in USA) we see an anti EU rant that sounds like russian propaganda.

Read my comment history if you care, you couldnt be further from the truth.

What I wrote is reality about EU, whether you like it or not is another topic. I dont mention russia at all, that medieval shithole has (hopefully) no say in how European future will look like.

it is stupid because it leaves the company holding the bag.

The state can take over for such cases but instead, once a company hires such a person, they can become permanent leeches. Even when the company is having trouble with market/financials, it is difficult to cut.

> You want society where its everybody for themselves

Never said that.

> be lucky with ie your health so you and your family can have a decent life and one problem big enough can wipe you out?

How about working hard and taking care of health? How about not drinking/smoking, not doing drugs, and eating healthy?

> fuck the rest

Yes, fuck the ones who don't take care of health (and I'm not talking about homeless people) and then overburden the healthcare system. Why should we have to carry the weight of the trash humans? Why should one have to pay €1000+ every month for insurance, get cigarette smoke on face (of infant) while walking around in public places, and then watch these people drain healthcare?

In the US at least, there are needs-based high-risk insurance programs run by states that do just that.

Even so, while it's not a good argument against layoffs, the fact that it's even considered as such is in itself a reasonable argument against health care being tied to specific employment.

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