The answer is less but at the local level in the form of loosening zoning and other regulations in order to allow for the building of more and denser housing.
We have a housing shortage[0] plain and simple and NIMBY is holding back progress on the issue.
I've often wondered this. We already know that individuals by and large hate employer-based healthcare coverage but at what point to employers relvolt? The costs on employers are large and getting larger in terms of contributions to premiums as a benefit needed to attract talent, not to mention considerable time and manpower spent sourcing and managing coverage for employees.
Sort of. The Stabilization Act of 1942 (act of Congress) authorized FDR's Executive Order 9328 [0], which was a price/wage stabilization Order meant to keep the economy stable during WWII.
Because companies could no longer compete via wages, they began competing with fringe benefits -- health insurance being chief among them. It's been that way ever since.
> I would have to quit if my company wasnt providing a reasonable medical coverage because these costs can otherwise bankrupt a person in this country
Your insurance would be functionally quite similar if you purchased it in the private market, and its relative cost compared to your company's premiums depends on your age (and smoker status) compared with the average at your company.
But the upshot is that your cash compensation is probably quite a lower because your employer is paying for your healthcare bills. This bundling doesn't necessarily serve you or your employer, though if you're an older employee with dependents who are also covered, you may be benefitting from an implicit subsidy by younger employees without dependents.
>, you may be benefitting from an implicit subsidy by younger employees without dependents.
And they in reverse benefit from me paying a higher tax bracket because of my higher income. This is one of those tradeoffs we all make in a society.
We'd all be better off at the end of the day if healthcare was separated out from work and we'd just pay it out of taxes directly, like every other reasonable country out there.
> This is one of those tradeoffs we all make in a society.
...ooookay? Not sure how to process this defensive take, but at least you make it clear what demographic you belong to.
My point was entirely financial: on the (heavily regulated) open market, health insurance for older folks is more expensive than for younger folks, while companies typically pay the same premium for each individual employee regardless of age.
I'm not making any claims about whether younger employees benefit from this weird arrangement---which is what you seem to be addressing here---just noting that they would pay less on the open market than their employers are paying on their behalf, while older employees would likely pay more.
(I say this as a parent who very much benefits from employer-sponsored healthcare.)
It doesn't help your case to be hyperbolic, you just come off as irrational and emotional. The average ACA insurance plan costs $477 per month. You can pay that with a job paying federal minimum wage, the lowest legal wage allowable by law anywhere in the country. That's miles away from bankruptcy.
Federal minimum wage is $7.25/hr. Average full-time working hours in a month is ~168 hours. So $1,218. Minus FICA (7.65%), $1,124.83. That healthcare plan, before copays or whatever other costs, is already 42% of your income. You've got $647 to budget with for the rest of the month.
That said, if you're on minimum wage, you're getting other subsidies for the plan and might qualify for Medicaid anyways, so honestly looking at this average cost and comparing incomes is already a pretty useless comparison anyways. You'd have to know what all you qualify for which will vary from state to state. So nobody getting paid minimum wage is spending $477/mo for health insurance.
>That average ACA insurance plan also covers almost nothing. All health insurance is not equal.
That's absolutely the case. I have an ACA plan and in order to get decent coverage (as well as a $600 deductible and $5900 annual out-of-pocket costs) along with significant co-pays for hospitals and durable medical goods, I pay nearly $15,000/year.
And premiums just keep going up and up -- something like 15-20%/year, while more and more stuff (all radiology[0], many drugs and pretty much anything other than routine care and consults) requires pre-approval from third-parties engaged by the insurance company who generally take several weeks to make determinations, which can significantly delay urgently needed care.
Even worse, many providers refuse to accept plans sold on ACA marketplaces, which, in many cases, leaves the providers who are accepting Medicaid[1] and Medicare[2]. Those are generally not the top tier, despite the huge premiums (in my case, nearly USD$1100/month -- just for me) charged by the insurers.
Here in the US, we need a single-payer solution in the worst way. The profit motive for healthcare distorts things in so many ways -- with patients getting poor coverage/care and providers getting squeezed by insurers to tweak their quarterly numbers. It's disgusting.
Totally false. I've been on ACA silver plans and all expense paid corporate plans. At the end of the day the true costs are pretty equivalent - $20K for a family of 4 per year in cash going to insurance/healthcare. With ACA, that is subsidized massively downward for lower incomes. And the employee pays some. And if you are truly poor (in most states) you get free medicaid plans.
>And if you are truly poor (in most states) you get free medicaid plans.
The quality of care for Medicaid patients is generally crap. Go and ask your doctor if they accept Medicaid patients, or even those on ACA plans. I'd wager the answer is a big 'no'.
The differences in quality of care and levels of access are stark, with most Employer subsidized insurance >> ACA plans >> Medicare >> Medicaid.
Again, 100% false on ACA. (I would agree that medicaid is a PIA, but it's free!) The ACA plans are run by the same carriers as employer plans in my state. Blue Cross, Harvard Pilgrim, etc. Networks are exactly the same. Price is equivalent. If you are paying less through your employer it is because employer is paying insurance company or self insuring instead of paying you the cash.
For many industries, especially blue collar, it would actually be much better for employees to do ACA plans as they would pay much less for their healthcare post subsidies.
The ACA has been such a boon for small businesses and entrepreneurs - before ACA you basically couldn't get insurance. Now it is actually a non issue.
>Again, 100% false on ACA. (I would agree that medicaid is a PIA, but it's free!) The ACA plans are run by the same carriers as employer plans in my state. Blue Cross, Harvard Pilgrim, etc. Networks are exactly the same. Price is equivalent. If you are paying less through your employer it is because employer is paying insurance company or self insuring instead of paying you the cash.
Sorry for the late reply. That may be true in your state[0], but in mine all the insurers that have employer plans (although providers made sure to ask whether your plan was ACA or not -- "we don't accept ACA plans!" before then) have left the ACA marketplace. I admit that they did try to raise premiums 20-30% a year before quitting the marketplace -- I declined to pay that much more, although premiums have risen that much and more with the insurers still on the ACA marketplace.
So, while there may be places where the ACA provides decent coverage at a reasonable rate, there are other places (sadly, like where I live) that it does not.
On the whole, I'm glad the ACA exists, as it provides insurance to many who could never have afforded it in the past.
That said, it's far from what we really need -- a single payer system like Medicare, but for everyone.
Have you even looked at the deductible/out of pocket on those plans? With most of them you're looking at $10k out of pocket max.
My employer paid for health care has that same monthly cost for my entire family with a $1500 out of pocket max. I don't think you have the first clue how much money that $8500 difference is for the average american.
Uh what? This isn’t _just_ bankruptcy through heart attack or whatever.
Plenty of people are on treatments that absent insurance (in the US) become unaffordable the moment you don’t have actual good insurance (ACA care is basically “don’t go bankrupt through accident/emergency). Couple that with the massive cost you get when you switch to having to buy multiple plans and you get trivially screwed.
You cannot easily lose employer provided insurance, and that’s part of what keeps wages low.
They won't. Sure it's expensive, but it gives them control over employees. Losing benefits is a fear for a lot of people. Gaining benefits is a badge of honor for some people.
Why would they? They often pass the cost increases to the employees and employer-tied healthcare it's a useful retention tool as people are far less likely to quit if their treatments would suddenly become very expensive.
> They often pass the cost increases to the employees
Up to a limit.
In well compensated white collar industries like Software, Life Sciences, and even Hardware, a good health plan can be a major differentiator or ensure strong employee retention, because a $20-30k raise is basically $12-18k after tax (not bad, but not worth the amount of headaches)
I know some larger companies in the Bay Area that don't pay as competitive as Netflix but provide BCBS at a very low cost.
This assumes every business shares this vision. I'm sure big fortune 500 companies that can absorb these costs over competitors might see some value here[0][1] but I don't think the vast majority of businesses see it this way, most would seemingly benefit[2][3][4] by being able to attract talent more reasonably, and particularly helps small business and other smaller entities. Though I imagine there is an other components that drive support or resistance[5], I don't think its uniformly beneficial for business writ large to keep the current system
[0]: Though it wasn't broadly employers that opposed both the public option for the ACA or Medicare 4 All, but insurance companies and adjacent services most specifically.
[1]: Though, there is some notion (though no hard evidence) that bigger businesses can use it as retention and recruitment tool (https://www.marketplace.org/2021/06/10/why-dont-u-s-business...) I don't think their ability to recruit top talent rests solely on healthcare options, however.
This is a very well written comment, so thank you :)
What I'm saying is obviously speculation, but it's based on the following:
- large fortune 500 companies are the ones with actual political power. The vast majority of businesses are far less likely to be able to lobby for significant policy change.
- that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo.
- their ability to recruit kinda stopped after ACA. Before that, major players had 100% free healthcare, which was an actual recruitment advantage. Nowadays, it's pretty uniform so it does not matter. HOWEVER, I personally have some anecdata about folks who stay in big tech because they have kids with special needs, care which would be super expensive if they wanted to move to some small startup or even a government job.
>that said, if this was an actual issue wrt to budgeting and such, I'm sure the bean counters would have already lobbied internally for external lobby for universal healthcare, if that makes sense. The silence from the big players on this subject tells me they're more than willing to pay for their employee healthcare, otherwise they'd already have eliminated this cost center. So, they do have an incentive to maintain the status quo.
On this specifically, what I have read on the subject suggests that most businesses simply aren't evaluating this to begin with, even big ones, but the ones that have, such as the big 3 Automakers, are actually for universal health care (since it significantly reduces their costs for employee benefits, especially for retired workers) and other big businesses with manufacturing interests. Many large employers like state governments would really benefit from federally implemented universal healthcare as well and they do lobby for this.
I simply think that the insurance and adjacent industries have such targeted lobbying on this that other lobbying is more easily ignored, since GM for instance, isn't spending millions to specifically lobby for universal healthcare, while insurance companies and adjacent industries that benefit from the status quo directly lobby consistently spending millions against it, quite specifically
I wonder if it would be considered illegal age discrimination to offer a cash alternative to employer Healthcare. It may be the case that the insurers would heavily penalize the employer for doing this as well
I had one employer that offered that years ago. If you opted out of the healthcare plan they gave you $100 / pay period instead. I think the goal was to get married people to choose their spouses plan if they could. It seemed to me that the amount offered was too low to tempt anyone to actually take it. In my case it would have added like $300 per month to my spouses plan.
Have experienced this as my partner is from the greater NYC area. Cops will hand out these cards (or sometimes it is a little badge that you pin to your wallet or a larger badge that you stick in your rear window so they don't pull you over in the first place). It doesn't have to be a family member - I knew people who had them because their neighbor was a cop.
It's all part of a "I've got mine" culture that is comfortable with different sets of rules for different kinds of people. And it certainly fosters corruption, favors and deals done outside the normal channels.
This practice and anything like it should absolutely be outlawed and rooted out.
"There might be even a subconscious kind of thought of: Hey, if I got caught, if I ever did get in trouble, I have the resources — I could hire an attorney, or I could call somebody. I know how to make something happen."
For a wealthy person, this sort of theft is a "misunderstanding", for anyone else, it's a bigger risk.
Freakonomics is so consistently good. Dubner is one of the best interviewers out there. Great follow-up questions that force the guest to elaborate on or defend their positions. So many other interviewers in the business/econ/investing space just lob softballs.
This is why OpenAI should stick to keeping this a productivity tool. The "GPT Store" is a can of worms. Does OpenAI really want to play the same no-win moderation game that the other big techs have to play?
We have a housing shortage[0] plain and simple and NIMBY is holding back progress on the issue.
[0] https://econofact.org/the-housing-shortage-and-the-policies-...