
Health Insurance Shouldn't Be Tied to Employers - aaronbrethorst
https://www.nytimes.com/2020/06/29/opinion/sunday/coronavirus-medicare-for-all.html
======
qalmakka
I'm European, and I think that healthcare should be considered a human right.
Not giving someone in need a potentially life-saving medical treatment is
completely unfair, and a big red flag honestly. Life doesn't give the same
opportunities to everyone, some people have been born in better environments
or have simply been less fortunate then others, and I think it's the state's
responsibility to create a system where these things are taken into account.
Denying this is plain greed from the richest who don't want to subsidize
healthcare for the poorest, without realizing that a society where people are
less worried about their future would benefit them too; it puzzles me that so
many people on the other side of the pond think of this almost as if it was
some form of bolshevism while it is instead just plain and simple basic human
decency.

~~~
silvestrov
> plain greed from the richest

Health care is cheaper when it is single payer due to the overhead/collusion
of the insurance industry. This overhead is bigger than the inefficiencies of
public run hospitals.

So paying only for yourself ends up being more expensive than paying for other
people too.

~~~
missedthecue
Single payer is literally just health insurance, but it's provided by one
entity (the government) which has a monopoly. The way they reduce costs is by
rationing care.

~~~
URSpider94
That’s not the full story. Insurance companies today already ration care :
they won’t pay for expensive brand-name medicines and they often won’t approve
surgeries without requiring extensive pre-qualifications and alternate
treatments. Which is mostly for the best.

Single-payer would have other effects. One, by ensuring that everyone has
access to preventive and non-emergency care, it would reduce the overall cost
of care. Today, the uninsured wait until they are horribly ill to show up at
the ER where they are treated as public charges. Those people are also not
effective at their jobs, and die earlier, which is an added cost. Net-net, a
healthier population will be less expensive to care for and will be more
productive.

Second, a single-payer system will replace hundreds of independent insurance
companies that compete with each other with a single system, increasing
efficiency,

Third, a single-payer monopoly can negotiate with providers to reduce cost.
When you represent all of the patients in the country, you can demand the
lowest rates. The government already does this today with Medicare, which is
why many people call this plan “Medicare for All.”

There will undoubtedly be some care rationing, but I expect that as in the UK
there will be the option to buy private insurance on the retail market, or to
pay cash for procedures that you want but which aren’t covered - as it is
today for cosmetic surgery. Insurers dont cover plastic surgery, but that
business seems to be booming.

------
andrewstuart
In Australia, health insurance isn't related to employment at all.

It seems a strange idea that it should somehow be connected to your employer.
I can't see any reason why it would, only reasons why that would make things
problematic and complex for no gain.

~~~
splintercell
IIRC, It was a tax benefit introduced to the employer back during WW2, those
who were offering health benefits to their employees.

~~~
willcipriano
It was in response to a national wage freeze. Due to WW2 too few workers
existed for the jobs available as such any one worker had incredible
bargaining power. Wages were frozen by law[0] and firms found other benefits
to offer in order to attempt to compete with each over for workers.

[0][https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942](https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942)

------
dmckeon
The impact to labor mobility is significant: people who rely on employer-
provided health care would be more reluctant to change jobs if there is any
risk of discontinuity of health care for chronic conditions, or a higher cost
for any conditions pre-existing before the new job starts. The US has not had
indenture by name for decades, but we still have it via health care.

------
amanaplanacanal
This biggest problem with employer paid health insurance is that the people
who receive it are sheltered from a lot of the problems with the current
system. It’s easy to say everything’s fine when you are happy with your
current situation.

Imagine if senators and congress had to buy their own individual plans.

~~~
dpeck
this is the answer to why so many things are the way they are. Those with
enough money to make something not be a problem, don't tend to even think
about it again after writing the check/swiping the card.

------
chansiky
> But employer-based insurance is heavily subsidized by the federal
> government.

I don't know enough about how the health insurance beast works, but it would
seem that if the federal government stopped giving an unfair advantage to
organizations, then the unfair advantage would stop existing for these
organizations that were given the unfair advantage and fairness would somewhat
return for individual persons.

------
fallingfrog
When the current health insurance system was created in the 1950’s, there was
a very specific family structure in the United States where the man would work
for a wage, and the woman would stay at home with the children. So if the
health insurance was attached to the man’s job, then she was dependent on him
for healthcare. So you have to understand that on the American right wing, the
current health care system is seen as a lynchpin of the “American way of
life”.

Not only that but as many black people work the kinds of low wage jobs that
don’t offer health care. If we created a public system for everyone, then
taxes on white income and property would be used to pay for black people to
have health care, something which in the United States is a hard sell. That’s
why you will often see people holding signs saying something to the effect of
“racial equality is communism”.

------
blackrock
Please do something useful and fund a movement to dissociate the two. People
are imprisoned to their employers that provides decent health care, especially
those with family and children.

Health care costs should be completely 100% tax deductible.

When I go to the dentist, I have no clue what he is going to charge me. He
could price a procedure at $1000 or $5000. I, as an individual, have no
ability to negotiate with him about his price. I just know that I have a damn
root canal, and I’m dying in pain, so fix it! And then, you’re slapped with
the expensive bill.

~~~
dwd
Rather than health care costs being completely 100% tax deductible, you just
need the health insurance premiums to be covered, and you can index the
deduction against taxable income if you want.

The kicker, and this is where the US mindset gets hung-up is that you need to
incentivise the insurers to cover everyone (including preexisting conditions)
by making it mandatory for everyone to have health insurance so there are
enough healthy people (who don't make claims) in the system to make it
profitable.

~~~
JumpCrisscross
> _you need to incentivise the insurers to cover everyone (including
> preexisting conditions) by making it mandatory for everyone to have health
> insurance_

There’s a stupid simple workaround. Everyone gets taxed equal to the lowest-
tier health insurance. When a health insurer signs someone up, they can claim
from this kitty. Insurers can’t deny signing someone up for the lowest tier.
When insurers breach certain actuarial limits, for example, if their pool of
insured proves unusually old or sick, they can claim from this kitty.

If the limits are properly set, healthy people foregoing insurance becomes a
non-issue. They’re pre-paying for a benefit they fail to claim.

~~~
brokensegue
Isn't this basically what Obamacare tried to do? Except with a lower tax?

~~~
dwd
I believe they tried but couldn't get it to pass.

This is the Australian model. If you don't have insurance there's a Medicare
surcharge based on your taxable income. The Gov gives you a tax rebate if you
do have insurance.

[https://www.ato.gov.au/Individuals/Medicare-levy/Private-
hea...](https://www.ato.gov.au/Individuals/Medicare-levy/Private-health-
insurance-rebate/)

Premiums go up each April within an allowable increase and are published on a
Gov site.

I worked on integrating this for a comparison site years back - the market is
pretty competitive, but has been broken to an extent in recent years by
providers signing up as preferred partners with various insurers and insurers
just buying up providers.

An interesting side is the APRA regulations regarding how many policies an
insurer is allowed to issue based on the capital they hold. They needed
monthly caps on how many policies they wanted (we got feeds back on leads that
signed up) and some of the smaller ones occasionally asked to be removed from
the panel when they were hitting their limit.

------
Barrin92
I think employer based healthcare works fine in more corporatist countries.
Here in Germany we have a multi-payer system that includes the option for
employer-based plans, but it's embedded in a culture that isn't going to throw
you on the street in a pandemic, and there is of course the rest of the public
healthcare system to catch people. In federal states purely national systems
are hard to realise.

The US has the same issue I think, not to mention that the federal government
doesn't always seem to be in good shape. Maybe better to go deeper than just
healthcare and ponder whether the liberal capitalism needs to taken down a
notch in favour of putting other stakeholders first instead of centralising
healthcare further.

~~~
nicbou
That's incorrect. German health insurance is not tied to your employer. Losing
your job has no impact on your coverage, and your employer has no say on how
you are insured.

If you are curious about how German health insurance works, I wrote a long,
detailed, thoroughly verified guide about it for expats. It's a good intro to
the system.

[https://allaboutberlin.com/guides/german-health-
insurance](https://allaboutberlin.com/guides/german-health-insurance)

~~~
Barrin92
I am German and you're not correct. There are several types of public
insurance. If you've chosen to be a member of a _Betriebskrankenkasse_ or
_Innungskrankenkasse_ , your insurance status is tied to your job, because
that insurance is provided by your employer.

Should you lose your job you are entitled to a month or so of additional
coverage called _nachgehender leistungsanspruch_ and you can obtain public
health insurance through a non jon-related public insurer.

That's why the German system is universal (you're never going to be
uninsured), but the option for employer-based insurance exists and is quite
popular.

~~~
nicbou
Fair point. This is a blind spot in my research, and I will amend the article
when I find the time. They at least deserve a mention. There are no notable
differences: same price, same coverage, and no particular gotchas.

That being said, I can't think of a scenario where you'd want to keep a
specific job for health insurance reasons. In that sense, your health
insurance is not tied to your job. If you were with a BKK, you'd fall back
into the public system, which should provide equivalent coverage.

------
missedthecue
It's not really tied to employers. There's no law stopping you from purchasing
it yourself. The government just gives a tax break to companies who give it as
a benefit. So they hugely incentivize it.

~~~
robbyt
As someone who buys their own insurance, I have to say there are so many
problems with the process. You make it sound like it's as simple as ordering a
pizza...

Firstly, the major insurance companies don't want to talk to you, so you need
to buy through a broker. The broker is suppose to help you pick the plan
that's right for you, but realistically they will email you a few PDFs with
5-7 plans that are all extremely similar, full of jargon, and difficult to
understand.

Find a better broker? Hah, good luck...

So after you become an expert on insurance jargon, and ask your broker lots of
question, you're now ready to start paying. For small plans with fewer than 5
people, get ready to pay anywhere from $700-1k per month for the most basic
high deductible plan.

Then after about a year, you'll get an email and phone call from your broker
because your plan is no longer available. So you need to pick a new one, that
has slightly different features and costs $20-100 additional per-year.

The American health insurance is a parasite.

~~~
lotsofpulp
> You make it sound like it's as simple as ordering a pizza...

It is as simple as going to healthcare.gov

You don’t need a broker and it takes 15 minutes at most. It’s just as
expensive as any employer sponsored insurance, except for a handful of self
funded plans from white collar companies which might be able to offer cheaper
insurance since the employees skew young and higher socioeconomic class.

~~~
aaomidi
This is completely false. Insurance is far cheaper for large companies since
the risk is being spread amongst a very large pool of individuals.

~~~
lotsofpulp
The pool of lives of a whole state is large enough. Where some large companies
benefit is having younger workers who are in a higher socioeconomic class,
which usually means healthier and therefore less expensive.

Checkout code DD of box 12 on your W-2 and compare to the same metal level
plan for your state here:

[https://www.kff.org/health-reform/state-indicator/average-
ma...](https://www.kff.org/health-reform/state-indicator/average-marketplace-
premiums-by-metal-tier/)

I’ve compared it with a few different people working in Fortune 100 companies
and it’s almost the same.

