because it was haphazardly stitched together we ended up with healthcare that
1. does not cover everyone
2. it is rationed by for-profit companies
3. is is expensive and can bankrupt you
4. tied to employment which means you can lose it easily
5. confusing since you often have to deal with paperwork and multiple providers
If you are rich and can afford it the american system is great but it is awful for everyone else.
The reason health insurance became an employment perk was because of a tax loophole created during World War II. From A History of Employee Benefits and Taxation[1]:
> At the same time, the federal controls on wages was leading to significant angst and frustration among the labor market, and the threat of widespread strikes and other forms of labor protest became a serious threat to the economy and war effort. In response, the War Labor Board implemented a new income tax exemption to employers sponsoring employee health plans. This made employer contributions deductible on federal returns, while the benefits were entirely tax-free, to the employees [3].
> What started as a measure to avert crisis and labor strikes ended up becoming an expectation. As more and more employers leveraged these tax-benefitted health plans, American workers grew accustomed to getting their health insurance through work, rather than as individuals. The end of the war and the return home of American GIs exposed more workers to the new system, reinforcing its popularity and utilization [3]. By the 1960s, employer-sponsored health insurance plans had overwhelmingly displaced the formal individual market, a status that has persisted right into the start of the 21st century and provided a central tenant of the Affordable Care Act of 2008 [4].
In my opinion, this is yet another example of how even the most well-intentioned legislation can have disastrous consequences if it fails to account for incentives and second-order effects.
This quotation carefully skirts around the actual reason why health insurance became an employment perk and why a tax loophole was created during WWII. In an intentionally deceptive way (not by the poster, but by the original author.)
People were getting their insurance through their unions. Before the unions started doing this, nobody associated health insurance with employment. This made people grateful and happy with their unions. The government, in order to weaken the unions, paid employers to give their employees insurance with a tax break.
Not understanding this makes the first sentence completely unconnected to the rest of the text. Health insurance was not a raise, heath insurance was an intentionally union-breaking subsidy to businesses to give bosses more leverage on wages.
> People were getting their insurance through their unions. Before the unions started doing this, nobody associated health insurance with employment. This made people grateful and happy with their unions. The government, in order to weaken the unions, paid employers to give their employees insurance with a tax break.
Do you have a source for this? Nothing I've read has made such a claim. Even the NYT says that the root cause of employer-based health care was wage freezes during WWII followed by the tax-exemption of employer-provided health insurance.[1][2]
Goes to show that health care is not the only factor that people consider when starting a business. It's possible that other factors are significantly more important, enough so that people will start businesses in the US despite the poor health care - in my experience the availability of investment and networking opportunities is a huge factor.
Coming from middle class in France to upper-middle class in the US, the quality of care in the US is so subpar it makes me sad.
Sure, in exchange, you don't have to plan your annual visit to the optometrist 3 months in advance, but I'd rather have a doctor that actually cares instead of useless shiny tech.
Same (but not from Canada, from a former communist Eastern European country where there's universal healthcare). And I was in a much higher on the income ladder in said country then here in the US (relative to the country median income) and yet the health care I get in the US on the employer included plan is many times better then what I got back in Europe. To be fair I was going to the state health facilities there where my income level could afford me to go to private institutions which were vastly better, but you see, in the US I didn't have to do anything special to get better healthcare, I just went with what my employer gave me and it's much better than what the state gave me in Europe (and I was paying, in form of taxes, much more for it too).
I'm in the same boat as refurb, however these are just anecdotal experiences. It's possible that we're in rich areas (I know I am) and so the quality of the care reflects the clientele. In Canada it's more of a one-size-fits-all approach, but that one size is better than the average US hospital.
I would agree that the quality of care in the US has a much bigger spread than Canada. However, as a middle class person in both countries, there are benefits that you get in the US, you don't get in Canada.
> you don't have to plan your annual visit to the optometrist 3 months in advance
Actually, US health insurance plans generally don't cover optometry. That's a separate "vision" plan that you generally only get through an employer if you are lucky. If you don't have it such a plan, you pay out of pocket.
1. does not cover everyone 2. it is rationed by for-profit companies 3. is is expensive and can bankrupt you 4. tied to employment which means you can lose it easily 5. confusing since you often have to deal with paperwork and multiple providers
If you are rich and can afford it the american system is great but it is awful for everyone else.