Comment by toomuchtodo | Hacker News Reader

Comment by toomuchtodo | Hacker News Reader

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I'm actually in the middle of a job search right now (in Chicago). Employers ask what my current medical is (100% covered, myself and my wife, BCBS PPO). If potential employers don't offer a comparable plan, I ask them to make up the difference with cash (and, of course, cash costs the employer more vs something you can expense like health insurance).

The problem is that the game is rigged until health insurance can be completely decoupled from employment.

EDIT: Keep in mind, I can still want excellent healthcare but not be a wasteful healthcare consumer. I needed a non-controlled substance prescription that was very expensive in the US, even with insurance, but its offered inexpensively over the counter in Canada, Mexico, etc. Guess where I bought it from.

"The problem is that the game is rigged until health insurance can be completely decoupled from employment."

This is the biggest problem in the US.

> cash costs the employer more vs something you can expense like health insurance

I don't think that's how it would work. The company would include the extra cash payment in the employee-compensation category of its profit-and-loss statements. The extra cash payment would likewise be tax-deductible for the company (that is unless your salary is over $1 million).

Cash costs both the employer and employee more than premiums or HSA contribution. Since cash is considered to be income for employees:

- Employers have to pay payroll taxes on the cash (~10-12% in taxes) - Employees have to pay income taxes on the cash (~25%+ in taxes)

So an employer would effectively need to give $1.50 in cash to equal the same spending power as $1.00 in HSA contributions.

Ah -- good point; I forgot about the employer's payroll tax liability (Social Security and Medicare), and also about the fact that the employer's liability is effectively the employee's liability (because otherwise the employee would get all the cash including the employer's tax payment). Thanks for the correction.

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