
People Lose Their Employer-Sponsored Insurance Constantly - mkane848
https://www.peoplespolicyproject.org/2019/04/04/people-lose-their-employer-sponsored-insurance-constantly/
======
helen___keller
The point of health insurance is to pay into a risk pool as a collective so
that the small percentage of people who end up needing the largest percentage
of health care, nobody dies or goes into monumental debt. This can be done via
taxes but insurance is a private market solution which should in theory make
it more efficient for the sake of maximizing profit.

So then if it's supposedly more efficient, why do I waste multiple hours
dealing with insurance bullshit literally every few months?

Start a new job at a startup, need to go to trainings to understand the health
care options and choose one, get new cards and website logins, update my info
at every provider

New dentist is having difficulty getting my routine care billed to insurance
and calls me every week asking for my insurance information again.

Wifes doctor didn't do something correctly when I updated insurance so now I
need to call and deal with this big medical bill that I shouldn't have gotten.

Startup got acquired so I get another training for the new insurance options.
And get new cards and logins and update with all providers again

Planning to get a surgical operation but nobody can tell me how much it will
cost, doctor says "probably whatever your deductible is" except I have a high
deductible plan so is it really going to cost me $2500?

Etc cetera. There's no end to the nuisance. If I could choose to just pay more
in taxes (hell I'll pay way more than my current premiums) and never deal with
insurance again, I would do it in a heartbeat.

~~~
jimmy1
I think your phenomena might be due to startups? Obviously this is a startup
focused board so I am not saying this to mean go one way or another, but I
ditched the startup, job hopping life a little while ago, and had to deal with
"insurance bs" roughly two times in 7 years.

I am either the luckiest person alive, or maybe there is additional benefits
not obviously well represented here to working for a stable, revenue producing
organization, but I don't seem to encounter what seems to be the well-
represented insurance pains documented here (probably a little bit of both, in
my guess).

~~~
dwater
My partner has been employed with the same large international company for 8
years. She had an elected procedure done that is required by law to be fully
covered by insurance. She had 3 calls leading up to the procedure with her
health insurance company each time asking them if they were certain it would
be covered 100%. I thought that this was overkill but she was worried to the
point of being paranoid about it. They assured her each time she would not
have to pay any money at all for anything.

The procedure was in December. After the procedure she received a 6-figure
bill, which she then had to follow up with hours of phone calls back and forth
to the insurance company, hospital, and doctor's office. They sent her a
revised bill for somewhere around $8,000, and then another revised bill for
around $4,000.

The insurance company says it's because the doctor coded the procedure
incorrectly. The doctor says the hospital coded it incorrectly. She has had to
file an appeal with the insurance company, and the only reason it looks like
it will work out is because the insurance company records all phone calls and
was able to get records of her original calls before the procedure asking if
it would be fully covered. She has still been told to expect that they will
deny her first appeal and she'll have to appeal a second time in order to get
it covered. This has been causing her immense stress for the past 4 months as
she does not have enough money to pay even the $4,000 bill out of pocket.

My experience is that your experience actually is extremely uncommon in
America today. Most people who have to interact with the health care system
beyond annual checkups have to deal with something like this.

~~~
pxeboot
She is lucky she is getting that even partially covered if she only got a
verbal agreement. My insurance policy has a clause that anything they say over
the phone is not a promise to pay. You have to call AND get something in
writing to even be eligible for a dispute later.

------
benatkin
When I quit my job in SF in November 2017, I had $1200 on my FSA. When I
switched to COBRA, my FSA account kept its balance, but my VISA card
associated with it immediately and unexpectedly stopped working. I was seeing
a psychologist at the time and it was awkward when I didn’t pay him right away
because I thought it would be fine to try and fix my card and pay him the next
day (which I did). It felt awkward enough to me that I stopped my therapy
sessions with him, because I felt like it had become strained. Anyway, the
company stopping my card from working was intentional. It was the same company
and the same account but my card didn’t work anymore and I had to go through
the trouble to submit a claim, and they acted like this was by design that my
FSA card would stop working when I quit and switched to COBRA.

Now I’m working remotely and am in a new state (Florida) and not sure I’ll
stay here long enough to switch everything to this state. I needed to get a
fever checked out and ended up paying out of pocket because I was told over
the phone that they accepted my out of state insurance, but when I got there
in person, they didn’t.

What a mess.

------
aNoob7000
Health insurance in the United States is a shit show. The Medicare for all
that Bernie is proposing is a reaction to the inability of Congress to
meaningfully fix the issue.

I personally would prefer a market based approach to fixing the issues with
obtaining medical care, but Congress can't do anything because there's just
too much money and influence involved.

~~~
davidw
Italy has a thriving market based private health care industry. You can call
in and get prices and everything.

Just that it's in addition to the single payer system, which means the private
one is cheap because the competition is 'free'.

As a % of GDP, Italy spends a lot less than the US in health care, and people
live long and productive lives.

I mention Italy because 1) I lived there and 2) it's not some perfectly run
place where everything works. It's not, and yet the health care is still
better, overall, than in the US.

~~~
dv_dt
All other first world nations pay less. On average they pay less than half
what the US pays. The fully socialized systems, like the UK, seem to trend
lower in cost, as low as one third the cost of the US. But really, the
takeaway should be you need universal healthcare with significant government
cost controls on drugs and procedures, after that almost any arrangement of
public/private administration works (but the caveat that it looks like the
more private companies are in the healthcare mix, the higher the costs seem to
run).

~~~
aantix
Without the U.S. subsidizing the drug research R&D, who pays for it?

You could fill notebooks with worthy, approachable hypotheses for any number
of diseases that could show promise if given the funding.

But if everyone makes it law to cap prices - fewer scientists, labs, studies
are performed.

The money has to come from somewhere.

I think countries take for granted the progress we've made. No progress is
made without incredible intellectual efforts and monetary backings.

~~~
dv_dt
This paper gives pretty interesting breakdown of how private companies are
increasingly bad at paying for it.

[https://www.ucl.ac.uk/bartlett/public-
purpose/sites/public-p...](https://www.ucl.ac.uk/bartlett/public-
purpose/sites/public-
purpose/files/peoples_prescription_report_final_online.pdf)

One quote from the paper: In the last ten years, Pizer has spent US$139
billion on share buybacks and dividends compared to US$82 billion on R&D.

Edit: It shouldn't require massive profit margins to make the drug industry
work for a basic human need like healthcare. Other sectors for human basics
like the grocery industry, run on margins of 1-5%.

~~~
aantix
Food production is predictable. Finding a safe, effective treatment for
Alzheimer’s is not.

If you want thin margins, maybe government research wing can take its findings
from idea to market (imagine waiting on a cure and that’s your only hope?)

But you can’t force a private company to operate on low margins by way of
capping prices, you’ll kill them. You can’t taje away their ability to control
their risks (cash flow). Drug R&D already has a huge failure rate and now the
company can only take a 5% profit on the slight chance they’ve found something
effective?

~~~
dv_dt
If you look at the paper, private drug discovery is creating drugs at a
declining rate. I would suggest this is because those private efforts are much
less research than development, and it's actually the public system that
drives much fundamental research. And the drugs to market rate is in serious
decline because of a the widespread application of increasingly austure public
funding budgets for medical research causing an early pipeline bottleneck.

~~~
aantix
When you dump a link to a 60 page pdf and you’re going to reference it, please
list the page number and/graph you’re referring to. I don’t want to guess.

~~~
dv_dt
Sorry, Fig 1, page 15 is the data on drugs discovered per billion. Table 1, pg
18 shows some sample breakdowns of drug investments broken down between basic
research and commercial development.

I don't necessarily subscribe to everything in that report, but I do think
that modeling drug development in terms of a simple risk-reward model for the
private drug industry needs further thought.

------
pnathan
One of the fundamental reasons why I haven't really bothered doing startups or
running a small business myself is the radical uncertainty over health
insurance for myself and my family. It's not just plain $$$ and career risk,
it's the "suppose you will go bankrupt and your family has permanent medical
issues now" risk. That game is for the wealthy or healthy single people

In addition, each insurance plan has slightly different doctors that sign on,
so when there are changes, you might wind up needing to use different doctors
or worse, health systems.

It'd be much better for me, personally, to require providers to all accept
some US Public Single Payer plan (or whatever you call it) as part of opening
a practice and seeing patients.

(I don't speak in any sense for my employer, who is in the health care space:
this is just an engineer's personal musings)

~~~
henrikschroder
> One of the fundamental reasons why I haven't really bothered doing startups
> or running a small business myself is the radical uncertainty over health
> insurance for myself and my family.

I joined a startup once, but it was in Europe, so these issues weren't even on
my radar or the company's radar. With government healthcare and government
unemployment insurance, it's a no-brainer. The only risk is to your lifetime
earning potential. Stay at a solid job with a solid salary, or take a shot at
the startup lottery. Your health or your family or your home are just never on
the line by taking that risk.

The amount of time and worry you have to spend on healthcare for yourself and
your family in the US is absolutely off the charts, and this cost is
completely hidden! Time that companies have to spend on acquiring healthcare
insurance for their employees is _wasted_ time. Time that employees have to
spend on researching the insurance options their company is offering them is
_wasted_ time. Time that you spend dealing with healthcare providers to ensure
that you're covered by your insurance is _wasted_ time.

In Europe the time spent on this is, for the most part, 0. Companies don't
spend time on this. Employees don't spend time on this. But noone in the US
seems to regard this waste, this cost, as something fixable. Noone seems to
think of the competitive edge this gives EU companies, or want to have the
same competitive edge. Why? Why are US companies and US employees just
completely resigned to the thought that healthcare just is a massive
_necessary_ headache for everyone?

~~~
tanzbaer
And yet the US is still way more entrepreneurial.

------
Glyptodon
Employer sponsored health insurance is an outpost of neofeudalism. Swear your
fealty to a lord or go without.

~~~
jkingsbery
Employee sponsored health insurance is a result of "centrally planned"
economics - [https://www.nytimes.com/2017/09/05/upshot/the-real-reason-
th...](https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-
employer-sponsored-health-insurance.html) ... it has nothing to do with
feudalism or even what employers wanted, but has a lot more to do with
government officials who thought they could design an economy.

~~~
dredmorbius
The reasons things start, and the reasons they persist, are often quite
different.

The US doesn't seem to have subscribed to strongly-cenralised economic policy
for nearly 70 years. And yet the employer-feudal healthcare system continues.

Preponderance of evidence suggests that dominant economic, financial, and
power structures prefer it that way.

The origin story is an interesting footnote, no more.

~~~
jkingsbery
While it's true the reason things start and persist are different, many would
disagree about the level of central planning in the US, with healthcare being
an example odd where there is a good deal of government control (everything
from pricing of procedures, drug approval, and licensing to name a few).
Whether that's a good thing is another question, but I think it's
oversimplifying to conclude that the problem is all due to corporate feudal
overlords and not at all due to government policy. Further, there is a lesson
to be learned concerning unanticipated co sequences in the origin of the
current system that we're in danger of repeating by having further government
control of healthcare.

------
sairahul82
The fundamental problem is no body knows the cost of anything beforehand.
Neither insurance company not doctors tell the cost of the care. Its really
frustrating ! The first step to fix the problem is getting the cost of the
care transparently. Without this i am not sure how any of the scheme works
whether it is done by govt or private insurance companies !

~~~
pnutjam
This also translates to the cost for labor. How much your company is paying
for insurance seems to have little correlation to how good your insurance is,
so Company A could be paying an extra $5k per employee because they don't have
a good HR department.

It also means that every job offer has to be examined not only for salary and
culture, which are usually pretty easy to see; but also benefits cost. I've
had offers that were an over 20% raise which would have all been eaten by
insurance costs. I've looked at my "benefits cost breakdown" at similar
companies only to see that one is paying $90k for me and one is only paying
$70k, on similar salaries of around $60k.

These insurance costs are not something usually shared outside the company,
and they are hard to get until the last stages of your job offer.

------
SonicSoul
it's a shit show. I had "great benefits" at my last job accept when i needed
them

1\. when something happened and i needed physical therapy it turned out my
copay was like 6k so i just DIY my own therapy..

2\. when changing jobs i had a month gap, so i bought COBRA and 3 things went
wrong.

    
    
        a. it cost $1300 for a month of coverage (even with a 2k deductible)
    
        b. since my last day was before a weekend, they actually covered my only until that same day next month, so i still had a gap of coverage (might be my employer but still sucks people have to be faced with this bs)
    
        c. when i did go to a routine physical healthcare provider still denied the claim and i was sent a full bill. after hours of calling it turned out they initially rejected it, but then accepted months later and i was left with _*some*_ expenses ?!
    

all this BS while dealing with expensive benefit package.. i can only image
what self employed people must go through..

------
mlthoughts2018
I don’t understand why the article uses labor turnover or health plan churn.
Why would that be relevant to the original bolded premise that people like
their better coverage sponsored by employers?

If I leave a job or get laid off, usually I’ll get a similar job that has
similar insurance. Now maybe you could argue that there’s a big risk of an
insurance gap or that something like COBRA is unfairly priced, etc., but that
would have more to do with unemployment insurance and virtually nothing to do
with the basic structure of health insurance.

When I “churn” in the insurance market, it is almost always going to be a
super short-term switch from Insurance A to Insurance B (both via employers)
where A and B are incredibly similar.

That seems perfectly consistent with saying that people love employer-provided
insurance quality. The employers have to offer the same high quality insurance
everywhere, or else people won’t switch. As a result, they _do_ provide the
same high quality insurance everywhere, to ensure insurance is not a sticking
point that creates job movement friction.

Of course there are outliers offering bad insurance and classes of labor like
Wal-Mart retail staff that get screwed by deliberately bad corporate actors,
and I’m sure anybody reading this with a personalized anecdote will angrily
try to refute me.

But in the aggregate, these are exceptions, and most people like their
insurance for the most part and find that almost all possible employers (for
them) offer such a nearly fungible set of insurance plans that they can churn
jobs without significantly worrying that the insurance they like will be very
different at company A vs company B.

There could be many arguments for nationalized healthcare, but this article
seems pretty much wrong from its main thesis. People “keep” the private
insurance they like all the time, because “churning” the coverage is not at
all similar to giving up the coverage or making concessions or compromises for
the next plan of insurance you accept from an employer.

------
pbnjay
These numbers are super misleading. 72% were continuously enrolled, but 16%
switched to a different employer plan! We don't know how many of those were
the same employer or if the spouse just had access a better deal that year or
what. Either way, 88% were covered by their employer plan. 12% is entirely
different from 28%. We all have to do open enrollment, but that's entirely
different from losing coverage and finding something new!

I'm totally on board with Medicare-for-All but we don't need smoke and mirrors
and misleading statistics.

~~~
pnutjam
This is still important. I changed insurance with no gap, but it reset my
fully paid deductible.

------
usermac
Healthcare finance is a mess in the US.

------
mnm1
Pelosi is a moron who doesn't even know how the current insurance system
works. Of course people lose their insurance. And ACA insurance often doesn't
cover the same things as the employer-based insurance. If people need to get
on Medicaid, they need to wait months before it starts, months without
coverage. Everyone needs healthcare and few people can afford to pay the
exorbitant costs of it in this country. And of course, if you get injured on
the job, you have to fight a whole different system that shouldn't exist
either. Of course Pelosi has her own insurance and plenty of money so like so
many rich assholes in congress and elsewhere doesn't care and doesn't want to
improve healthcare coverage for the rest of us. Let us get sick and die. Even
with insurance this is often the case. Pelosi's a moron on this issue and many
others. She's almost as clueless as the Republicans who get off on kicking
people off of Medicaid and watching them get sick and die. How can the US even
be considered a developed country anymore when we let our own people get sick
and die so a few rich assholes can get richer?

------
intopieces
Am I correct in understanding that Medicare for All plans to abolish private
insurance? I prefer there be a system where you can get private insurance if
you want, but if you go without you are automatically on Medicare.

------
jkingsbery
One thing this article doesn't discuss: at least some of the times where I
"lost" my employer-sponsored insurance (either because I switched jobs or
because my start-up decided to switch providers), it went to something better
than what I had before, and most of the time it was a change that was a matter
of indifference (from one major plan provider to another where everything was
pretty similar). In most universal health care proposals I've seen, "leaving,"
isn't really an option, you're just stuck with The Healthcare Option.

Whatever the merits of the more general arguments for or against, it seems
like we should at least not put a finger on the scale.

~~~
qqqwerty
It is highly unlikely that you will be left with no options. Under most
universal health care systems, private insurance plays a complementary
role[1]. Also, if we go the public option route, it would compete against,
rather than replace, the private insurance market.

[1] [https://www.vox.com/health-care/2019/2/12/18215430/single-
pa...](https://www.vox.com/health-care/2019/2/12/18215430/single-payer-
private-health-insurance-harris-sanders)

------
jwildeboer
People [in the US] … ;)

~~~
guitarbill
As much as your comment might be taken in the wrong way, it _is_ important to
point out first world countries have this sorted. I simply don't get it. When
did patriotism become about military might and waving flags instead of making
sure your fellow countrymen don't live in agony, fear, and poverty?

~~~
TheSoftwareGuy
I'd say about 1946, or whenever the cold war is said to have officially begun.
Or maybe even earlier during WW2.

That being said the sentiment was never a good one, and we do need to move on
from it.

------
TopHand
If you want a good example of government supplied health insurance, go to your
local VA hospital, and see if that is the kind of health care you really want.

~~~
mkane848
The goal is for government-funded, not government-run. At least in the context
of M4A.

------
camelNotation
Medicare-for-All is some sort of "far left" fantasy in the United States, but
single-payer healthcare is center-right dogma in every other developed
country. I have no idea why this is so hard for the American right to grasp:
single-payer healthcare is a social program, but it's not the same as
socialism. We aren't trying to steal the means of production from you in some
sort of revolution, we just don't want people to die from preventable things.
It is entirely possible to have a single-payer healthcare system alongside a
thriving capitalist economy. This sort of foundational public service actually
makes economies better, not worse. It's not a burden on the market to have
healthy workers.

~~~
maxxxxx
"single-payer healthcare is a social program, but it's not the same as
socialism"

American politics is geared towards appealing to the extremes. Social programs
are "socialist" and get connected to the Soviet Union, cuba and Venezuela. If
you say something that's even slight politically incorrect you are immediately
labeled as a "racist" that should be removed from your job and all public
discussion. There is no interest in discussing problems and finding solutions.
It's all about anger.

~~~
otaviokz
Couldn't agree more.

------
terryschiavo22
Yes, people do lose their insurance constantly when they switch jobs...and
then immediately sign onto their new plan. Is the argument that switching
insurance plans is stressful? What's stressful is remaining uncovered.
Switching plans is hardly comparable to the transition to a Medicare-for-all
program.

~~~
dragontamer
> Yes, people do lose their insurance constantly when they switch jobs...and
> then immediately sign onto their new plan.

Lets say you payed for insurance, but were healthy for the 90s. So ~10-years
of paying insurance. Around 2005, you are diagnosed with Diabetes, so your
insurance pays for your care.

Around 2007, the recession happens and you lose your job. You immediately find
a new job, but you need to get new insurance. Diabetes is now a "pre-existing
condition", so your insurance no longer covers your condition.

Its important to recognize that changing health-plans is a regular event, that
shouldn't punish people with chronic conditions. Diabetes is lifelong, once
you get it, you live with it for the rest of your life. Insurance companies
don't want to pay for that kind of issue. With all talk about "Repeal and
Replace", its important to recognize the tradeoff.

As long as "pre-existing conditions" are banned in the USA, I don't think its
a big deal to lose employer sponsored health care (at least, compared to pre-
Obamacare). We should build a world where it is easy to lose (and regain)
health coverage... compared to the pre-Obamacare world where it was a big risk
to lose coverage. Hopefully laws of the future make it easier to switch health
care plans without problems.

~~~
scarface74
If you find a new job and you’re eligible under group insurance, the insurance
company can’t deny a claim under pre-existing conditions. This was true before
the ACA. What the ACA changed was that insurance companies couldn’t exclude
treatment based on preexisting conditions if you go on the open market.

~~~
pickle-wizard
Pre-ACA group plans could deny preexisting conditions for a time period equal
to the time that you were uninsured.

When I switched job I would get a letter from previous insurance company
stating the dates that I was insured. Once I actually had to provide that to
the new company.

~~~
scarface74
It seems like we are both partially correct. They could deny you for up to a
year for a pre-existing condition prior to the ACA.

[https://twocents.lifehacker.com/you-could-be-denied-pre-
exis...](https://twocents.lifehacker.com/you-could-be-denied-pre-existing-
condition-coverage-by-1826865657)

