
The Real Reason the U.S. Has Employer-Sponsored Health Insurance - rafaelc
https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html?mabReward=CTS2&recid=7a8dd53f-90e3-496a-53a6-1d1d718a777a&recp=2&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine
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api_or_ipa
Explaining away US healthcare as an artifact of WWII by claiming European
countries turned to nation health schemes because of economic ruins ignores
one very important counterpoint: Canadian healthcare.

Canada had no wartime ruin, and indeed, excelled after the war by advances in
industrialization from the demands of WWII-- much like the US. Actually,
Canada got it's universal healthcare because of the efforts of Tommy Douglas
and the CCF in Saskatchewan and an entire history of social democracy in
Canada that's worth studying. Sufficient to say, I think the author needs to
look deeper into the social fabric of American life to see the barriers to
socialized healthcare.

~~~
mikestew
This article describes how employer-sponsored healthcare started, but it
avoids the reasons why it continued. And the reason Truman didn't get support
for his universal healthcare plan was the "S" word: "socialism".

From
[http://www.pbs.org/newshour/updates/november-19-1945-harry-t...](http://www.pbs.org/newshour/updates/november-19-1945-harry-
truman-calls-national-health-insurance-program/) (first link I found, it's
documented numerous places): _" Almost as soon as the reinvigorated bill was
announced, the once-powerful American Medical Association (AMA) capitalized on
the nation’s paranoia over the threat of Communism and, despite Truman’s
assertions to the contrary, attacked the bill as “socialized medicine."_

Never mind that Mussolini's brand of socialism might be just a _tad_ different
than the kind that gives you socialized medicine, but one need merely utter
the word to get those knees a-jerkin'.

~~~
VeronicaJJ123
Socialism brings ruin to whatever it touches. Canadian healthcare is not an
exception but Venezuelan and Cuban healthcare are much better examples.

~~~
dang
You've posted quite a few generic-ideological-battle-style comments to HN.
Those are off-topic here. Would you please read the site rules and follow them
when commenting?

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

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k__
To me it sounds like slavery.

I mean, if you get old and/or sick you are stuck with your employer. How crazy
is this?

~~~
didgeoridoo
This is primarily a problem for people who are older but not yet eligible for
Medicare (government health care that becomes available at age 65). Basically,
don't lose your job between age 50 and 65, unless you have literally hundreds
of thousands of dollars saved just to pay for huge individual market insurance
premiums.

~~~
ergothus
It's far more than that. Because health care costs are artificially jacked up
(so that insurance can "negotiate" them down), anyone without health insurance
can be screwed, even if you aren't "poor". So - anyone that doesn't have
employer-provided health care and isn't eligible for Medicare/Medicaid.

Examples: I once tried to buy some nasonex (or equivalent) without my
insurance info. $180. When I didn't pay and returned with my insurance info,
it dropped to $5ish. My wife gets bi-weekly injections that stops her
psioratic arthritis (which she's had since her teens) from crippling her. With
insurance, $50/month. Without....we were quoted in the thousands, each month.

It is very, _very_ easy for me to see situations where you need health care to
be able to work, and you need work to afford health care.

And this does impact employer lock-in. Every time I switch jobs (and to a
lesser but still notable degree, when my company switches insurers), we have
to do a new dance of:

* getting registered for insurance. Most places backdate your insurance to date of hire, but if you want to actually get the benefits immediately, it usually takes weeks to get your info from your employer to the insurance company and then they "process" it. (I have been told by one company that it takes them 1 business day to know they GOT a fax from my company, and another 2 business days to "process" it.) From experience I can say that if you make yourself enough of a problem you can drop this down to 5-10 days, but it takes a lot of work and that's still a ridiculously long time.

* Did I mention that it's quite common to have a by-mail pharmacy? That's a separate company from your insurance, so step 1 has to repeat for the new company (that process is usually faster, but it's still easy to lose another day to it). Oh, is your drug expensive and/or restricted? That might be handled by a specialist pharmacy, which is a 3rd company. (that last is not a guarantee - I've seen it in about 50% of my insurance

* Once you have the insurance info, now you need to get the doctor to send in the prescription. For basic drugs that's simple and automated, but for expensive and/or restricted drugs, that's more hoop jumping. Have you tried to get a hold of the average american doctor's office? My experience is you call, get transferred to a nurse's voice mail. Leave a message, and in 8-24 hours they will call you back. Re-explain whatever you said in the voice mail, and they say that will need the doctor's okay. Enter a second 8-24 hour wait. Now the doctor's office will send the prescription to whatever pharmacy you need...who will reject the request because they need justification (Silly me, I thought the prescription WAS the justification). Now the doctor needs to call the insurance company directly. Which is, you might guess, usually harder that getting them to send in the prescription in the first place. (we've had wonderful doctors for this and terrible doctors for this...and in my opinion the terrible doctors are only terrible on a relative scale - I hate the hoop jumping and I'm not doing it for multiple patients)

And all of this presumes the drug ( or non-pharmaceutical care) is covered in
the first place. Every time I consider switching jobs, I have to find out if
they will cover my wife's treatments. (Figuring out if something specific is
covered is non-trivial and I have a degree of mistrust about the results).

I'm fortunate enough to have a good wage and many job prospects. I can easily
imagine someone in less beneficial circumstances getting locked into a job by
the above.

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flukus
Has there ever been an effort to ban employer sponsored health care? I bet it
would be a much bigger issue for people if they were paying for it personally
rather than having their employer shell out.

~~~
paulddraper
For me, that was the most egregious part of Adorable Care Act: I have to tie
medical insurance to my employer.

And there was a failed effort to repeal the ACA.

It drives me crazy. I can choose auto insurance, life insurance, home
insurance, disability insurance all independently from other decisions, but
health is this special category that is legally linked to my employer.

~~~
maxerickson
Isn't it messier than that? I'm pretty sure you could decline your employer
provided coverage and buy a plan from an ACA marketplace.

It's just that it wouldn't make sense to do that at an additional cost of
thousands of dollars.

~~~
paulddraper
Correct.

You could decline the benefits if you really wanted (e.g. if you were
Christian Scientist), but you lose thousands of dollars of your compensation.

The ideal would be for your employer to deliver the same value in the form of
salary, and then you have the choice free and clear.

~~~
RightMillennial
TIL: "Christian Scientist" does not refer to someone who is both a Christian
and a scientist. It's some quacky, new religious movement, anti-science cult.

[Edit] Corrected "new age" to "new religious movement".

~~~
paulddraper
> new age

1870s

> anti-science

Though popular medicine was only a little sciency when they were founded.

> quacky

They use to have lots of celebrity adherents: Joan Crawford, Mickey Rooney,
George Hamilton. Kind of like Scientology nowadays.

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VeronicaJJ123
> and the wage freezes and tax policy that emerged because of it.
> Unfortunately, what made sense then may not make as much right now.

I wish NYT does a piece on origins of minimum wage. Minimum wage was brought
int to make sure black people dont find employment.

~~~
zaccus
No it wasn't. Please stop.

