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Comment by throwup238 | Hacker News Reader

I don’t remember the last time I had to wait more than a few days to see a GP or more than a week for a specialist on an employer’s PPO insurance plan. I’ve had them at several employers ranging from university to FAANG so it’s not exactly something only fabulously wealthy people have access to.

The problem is there is a huge bathtub curve in insurance quality between employers and the public market. It’s a rude awakening when you can’t afford COBRA rates and have to fall back to a “bronze plan” or whatever is available on the exchanges.

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FAANG employee health insurance? Something like 1% of American workers get that, if even that many. Then throw in my oil company friends here in Houston and a few other industries which give premium benefits and you still have a tiny subset of the American workforce getting exceptionally strong benefits. Not at all indicative of the experience of most Americans.

The universities I worked for (both public and private) provided the same level of PPO insurance, as did a random fitness startup, a clinical diagnostics company, and a construction company. I invite you to reread the part where I said “several employers [plural] ranging from university to FAANG”.

Here in Houston, my friend who works at UH has excellent insurance. A quick search online confirms that it is much better than average. Different structure for employees at Rice, my alma mater, but still excellent. Gemini describes these employees being in a kind of "benefits bubble" here in Texas, and they're getting something way better from what most Texans get.

You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA?

> You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA

That is definitely a confounding factor, although I’m curious how much of that is the urban vs rural split in other states. (The construction company was not in California but oil boom-town adjacent in Texas)

On the other hand, most states with significant tech workforces have Medicaid which most people will qualify for if they're laid off (I did!) and these are excellent. People pay for cobra despite a public option being available.

That’s not necessarily an insurance issue.

Part of ACA was the creation of regional health cartels. If you’re in a region with shitty networks, care may be hard to get. Where I live there’s a teaching hospital with a doctor focused medical network and a big Catholic hospital chain.

In my scenario, There is a good market for cardiac, OB, and some other specialties in each network. The rest is a monopoly— the catholic network doesn’t staff neuro for example, they just have consultants.

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