Imagine if businesses did not have to worry about their employee's healthcare. Instead they could focus on the business at hand. Maybe this is just a crazy idea.
I completely agree. While it's counter intuitive, many businesses want to maintain control of employee's healthcare. Some companies look at it as a way to compete by offering better benefits than their competitors. A lot of companies like controlling healthcare because it keeps employees tied to their employer. If you temporarily lose your insurance when you switch a job, all of the sudden switching doesn't look as good. When you get to really larger companies, then they have the ability to self-insure, which means they can control the costs a hell of a lot more.
Of course, since many companies prefer less regulation, the last thing they'd want to do is hand over the keys to what they do for the healthcare for their employees over to the government. With things how they are now, they can always cut or pair back their plans if they want to cut costs. That lever would be gone with single payer.
Like many things, the system is set up to benefit those in charge rather than those who it's meant to serve. You can look just about anywhere outside the US and see that universal healthcare is a much better system, but better for who? Not much of a benefit for those who make the decisions, so we keep the flawed system we have.
>> Some companies look at it as a way to compete by offering better benefits than their competitors.
Do they really? I've see only select hedge funds actually advertise their health plans. Even that is usually that "we pay 100% of premiums." Most plans are impossible to assess until you actually get to the job and see the tiers available and support available. The devil is in the details -- network coverage for your specific state, co-insurance, co-pays, deductibles, % premium paid, support like QoS/tier.
Competition based on benefits really comes in at the low end and the top end of employment.
If you're a tradesperson, just having insurance coverage is a big thing. It doesn't matter if it's not great, it's better than nothing. Leaving a job with insurance for one without insurance is likely going to cost you thousands of dollars out of pocket for the same coverage.
At the top end, companies will have plans that cover so many things at very high percentages, meaning that your out of pocket for health insurance will be surprisingly small. Less competitive companies simply can't offer that.
It's only in the middle where the details of a plan matter, and those are going to be the hardest details to find.
It doesn't take people long to learn that outside of extreme life shattering cases insurance nets you negative. That is, once a hospital that treated your broken arm learns you have insurance they will increase your net cost, that is (again) they will charge some to your insurance and then also the amount you pay out of pocket is somehow more than what they'd charge an uninsured person. Health insurance for the 20-40 crowd is a diabolical racket.
Someone has to pay for healthcare. If not the employer directly, then they’ll pay for it through higher wages. Are you suggesting employees stop paying for healthcare altogether?
Healthcare thru employment began as a perk for employees. Everyone else just paid out of pocket for regular care. And yes, it was priced into wages.
Even today, most people will pay several hundred dollars a month for insurance; the employer will pay several hundred dollars and the plan will still have a $2K or so deductible. That's a lot of money that most people make no use of at all.
Not necessarily: I gain the ability to switch insurances (imagine, for example, a "free market" where insurance has to compete…), job losses or changes don't affect my insurance, etc. Actual competitive pressure and lower switching costs should, in theory, drive the price down.
Also, IIRC, insurance premiums paid with post-tax dollars are deductible, so they're not really post-tax. However, that deduction is part of the itemized deduction — while currently most people are not itemizing (as they do not have enough itemized deductions to hit the "it is worth it" threshold), my napkin math says that throwing HC premiums in there — since HC is so damn expensive — tips the scale / breaks the threshold for basically any normal income level.
But this is also an "imagine if" thread. Imagine if we made healthcare premiums outright deductible to alleviate the problem you've identified?
I also was buying out of pocket while employed for awhile. Unless you have a qualifying event you can only switch insurance at the beginning of the year, at least from the insurance options I was able to find that fit my family.
I honestly didn't even realize the thing about the standard deductible until I had already done it. I was shocked to find I couldn't deduct it because I'd have to use the itemized deduction which would have been lower. I just assumed my insurance could have been deducted like it was when I bought it through my employer... how wrong I was.
But yes I would absolutely prefer the "imagine if" scenario.
But you're right, this taxation intertwine is another tangle that shouldn't exist. Too much energy is spent by everyone trying to optimize take home pay, coverage etc.; and lower wage workers who just don't have the mental cycles to do any thinking get shafted.
It's not a compelling argument for society, but it's a compelling argument for the individual at the instantaneous moment of making that microeconomic decision.
The US pays more per capita for healthcare than any developed nation. We should redirect those funds to more taxes to pay for Medicare for all. Costs will go down and your healthcare will no longer be tied to your employment. As a bonus, everyone gets healthcare.
Don't be naive. Medicare reimbursement rates are artificially fixed below the market rate in order to hold down the federal budget. This kind of works right now because Medicare ends up with a hidden cross subsidy from commercial health plans with higher rates (often explicitly set as a fixed multiple of the Medicare rate). If we put everyone on "Medicare For All" then those subsidies will disappear and queues will get much longer. So not everyone "gets" healthcare if they have to wait a year for an elective procedure.
Also, original Medicare Part A/B doesn't cover certain types of healthcare at all such as prescription drugs. So not everyone on Medicare "gets" healthcare today. That's why many Medicare beneficiaries choose to pay out of pocket for Drug Coverage (Part D), Medicare Advantage, and/or Medicare Supplement (Medigap) insurance.
Sure but that’s not gonna happen. Workers mostly ever only get things taken away these days. It wouldn’t mean that money is available somewhere else all of a sudden to pay for healthcare.
If Congress could decide to agree on something, they announce taxes are being raised by X% to provide Medicare for all next year. Next year, employers stop providing healthcare via insurance companies and everyone signs up for medicare. Done.
One of the huge fights about ACA from the left was so-called "Cadillac Plans": Unions negotiated excellent medical insurance coverage in lieu of wages for their members. If you suddenly axed employer-provided coverage, nearly every union in the US would want to renegotiate contracts to account for that.
Tying health insurance (via tax benefits) to employment was a explicit decision by the US government to make people work, but it also makes people stay in worse jobs longer out of fear.
80 years ago, in the context of the war economy of WW2
How is that relevant? Democrats have been pushing for Medicare for all or some other fully socialized system since the Kennedys, while republicans have shown zero ability to do anything but ban you from buying cheaper drugs
Pretending this is "gubermint bad" is just ignorant. It also just, wasn't the government's explicit doing. The government froze wages during a literally existential war. Look at Russia right now for why that's generally a good idea. Companies responded by offering non-wage payments of various sorts.
The US built a significant fraction of ALL war material for the allies in WW2. They did this through significant amounts of command economy. Building a Liberty transport ship every other day was done by centralized planning, NOT the free market. See the US's current difficulties buying 155mm howitzer rounds for examples of how the "free market" is worthless at dealing with real wartime production concerns. We didn't build 50k tanks by waiting for the free market to collect a payday. We didn't build more aircraft carriers than the rest of the world combined by relying on the free market.
So why haven't republicans fixed this in the near 70 years of political dominance they've had in the US? Democrats have consistently pushed for solving this shitty situation for decades, but have never gotten the votes needed to even get into government.
Don't pretend what the US does amounts to genuine care.
The philosophy behind a business caring for employees and implementations of slavery are two fundamentally different topics, only confused when buying into US propaganda.
Everyone needs healthcare, and offering the benefit is mostly untaxed, so it's just a way of offering a higher compensation than the competition that doesn't. End result is most every professional full time job offers it, because taxed can't compete with untaxed.
Crazy! Imagine if human beings did not have to worry about losing access to healthcare for themselves and their children because their company went bankrupt or they got laid off. So Crazy!
The craziest thing to me is paying less even accounting for insurance for simple seasonal illnesses. Do I have strep? Go to hospital and pay $400 to find out yes/no and then get prescription covered by insurance at opaquely priced pharmacy of your choice. Go to private practice pay $25 and get yes/no and then you can freelance prescription.
What I don't see are businesses advocating for someone to take this work off their hands.
I gotta wonder how much hassle this is if it doesn't cause them to advocate for alternatives. Rather lobbying efforts and such seem to focus on other things.
Businesses should get out of health insurance and also things like 401k. Give the same tax benefits to everybody. I am totally convinced that cost would go down if employees could choose health plans for their own needs instead of the employer choosing what's best for the employer.
They don't have to, it's a perk I'm sure that many (me included) rather have their employer pay/take care of, than to do it out of pocket with higher salary.
American mindset. In some countries it's just provided to everyone equally.
And no, we don't have the wait times Americans are afraid of. I can visit a doctor the same day and get treatment. My friends back in the US are desperately trying to find appointments with everything filled months down the line. America has the worst of all systems combined.
Solve that problem first and maybe I'll change my mind. Otherwise I'm being honest in my situation. IME employer provided insurance is way better than what I can find on my own.
That's because health insurance in the US sucks major ass. It's just bad, period. More expensive for comparatively much worse care and worse outcomes on Average.
Americans (I'm an American) sometimes have a preconceived notion that, if something is really expensive, it must be good. No... no that's not necessarily the case.
The insurance companies would love for you to believe that, but in actuality, we're just getting fucked. It's just a worse system overall, in pretty much every metric you could possibly choose.
Not crazy. Caring about the business without caring about the people who literally are and empower the business is simply dehumanization.
It's been done to death. Literally.
Edit: People seem to think I'm proposing businesses keep operating how they are. I'm suggesting businesses that truly care need people running them who know how to care, not the normalized psychopathy that's become corporate culture. I'm not suggesting current or past harmful relationships with businesses continue or that even those businesses should continue.
Crazy. The whole notion of employer sponsored health insurance is a historical accident and never made any logical sense. I don't want my employer to care about me at that level and prefer a straightforward transactional relationship.
Should business also care about their employee's diets and fitness regimes? There are things that are outside of the purview of a business and the healthcare of their employees, outside of the direct impact of the business's work environment on the employee's health, should not be part of it.
Another way to say it, there is more to health than how an employer affects a person's life, and those things are none of the business' business.
Yes, businesses would be better off if they cared about wellbeing to such a degree. That doesn't mean control employees, though.
It means to actually care about the quality of food the employees have access to and the quality of culture surrounding them. It means caring about the environments people live in. It means recognizing people LEARN to make harming choices through harm (individual, familial, social, collective, cultural, systemic...etc) so recognizing repair is needed & pursuing that. This is what lobbying would be about without dehumanization.
Don't get lost in the fascist fantasies of what it means to care.
I don't want my employer to be involved in any of that though. Otherwise we'll be having a lot more conversations with people who are completely unqualified to make any determinations about things like my mental health.
If you think health insurance is expensive now, wait until it's free!
In all seriousness, if a private business with all the incentive in the world can't figure out how to lower healthcare costs, I don't see how punting to the government would somehow be better.
Everyone that proposes a single payer can't explain who makes less money. Will we save money by the doctors getting paid less? The drug companies? Where do these savings come from?
Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.
The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better
Single payer is cheaper. The US spends more per capita than any other developed nation and is not even capable of providing health care to all of its citizens.
Move to single payer, kill the medical insurance industry, and save these costs:
The health insurance industry employs approximately 605,000-912,000 people directly. The top 10 companies generate over $1.5 trillion in combined revenue annually. Conservative estimates suggest these companies spend $45-90 billion annually on employee salaries.
> The US spends more per capita than any other developed nation and is not even capable of providing health care to all of its citizens.
US has medicare and medicaid. It actually spends more than most other countries. I guess they need to spend more to save money?
Again throwing around stats about health insurance industry is not an argument. That money gets spent on something unless you think there is some grand cabal of health insurance companies to do make-work and hire people and set money on fire for no reason. Why doesn't some greedy capitalist start a health insurance company, set slightly less money on fire and provide great healthcare?
Yes, exactly. We spend more far more and get less because we do not have a single payer system like the rest of the world. We are lining the pockets of healthcare execs and unnecessarily employing hundreds of thousands of people at insurance companies and private companies to manage employee benefits.
The reason you have health insurance, and you don't just pay for healthcare, is because pooling together a lot of people and paying for all of them is cheaper than paying for each individually.
You've probably noticed that, the bigger the company, the better the health insurance plans. Why is that? Their risk pool is bigger.
Follow the logic. What's the biggest risk pool you can use? The entire US population. What would then provide the lowest per-capita cost? Spreading the cost across the entire US population. It's economies of scale.
Bonus: we can also eliminate much of the administrative aspect of healthcare because we are no longer coordinating thousands of separate insurance entities. You mentioned make-work - yes, we have that. Why does a hospital need 500 billing specialists? You tell me.
What do you think is so unique about the US that it is incapable of having similar pricing and quality of care compared to the rest of the developed world?
"The US spends more in public spending on healthcare than other countries" isn't some great gotcha, it's proof that healthcare access in the US is vastly more expensive than in those companies.
Some great quotes from your own link about US healthcare:
> The underlying challenges in fixing U.S. healthcare may be multi-faceted and complex, but the overall diagnosis is clear: costs are out of control.
> In other words, costs seem to be out of whack across the board in the United States, regardless of whether it is private or public care being discussed.
> Spending keeps rising, but the effect of that spending seems to have decreasing marginal returns on life expectancy – a metric that is an important indicator for the overall effectiveness of any health system.
> It’s clear that Americans aren’t getting bang for their buck when it comes to medical treatment – so how is it to be fixed?
Your own link comprehensively and thoroughly disputes your original assertion:
> If you think health insurance is expensive now, wait until it's free!
> The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better
Given that all those countries pay less for the healthcare they provide AND have better morbidity and life expectancy outcomes, I dunno, that sounds "better" to me, but apparently you have a different definition?
> if a private business with all the incentive in the world can't figure out how to lower healthcare costs
What if their incentives aren't to lower cost? Insurance companies make more when the obfusicate pricing and payout less. That's the opposite of incentive, it's a way to cover up your profits.
> Everyone that proposes a single payer can't explain who makes less money.
If you think the healthcare industry is just doctor-insurance-you, then you're nuts. Look up pharmacy benefit managers. They're basically third parties that are in place to jack up prices.
> Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.
Insurance companies have had their profits capped via the ACA for more than a decade now. Where they're making their money is by using more third parties in the middle to jack up pricing and increase costs so that A) their 2-6% is bigger, and B) their "investments" in the third parties are not regulated by the ACA so they can get their massive profits their.
> The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better
Its a very serious argument, you're just happy to dismiss it for some reason. If the entire developed world uses a different system than us, gets better results and for less money, then you'd have to be insane to insist that mimic those systems is not a serious alternative.
What you have is a really simplistic model of how private enterprise actually works. And what you need to understand is that economics is primarily driven by incentives, both for the individual and for the company. The only way to get different behavior out of actors in the economy is to offer different incentives, either naturally or by government fiat. Let me give you an example.
The health insurance company's bottom line profits are determined entirely by the volume of cash that they funnel to healthcare. Their profit margins are capped by law to X% of this volume. So the only way they grow year over year is to increase the amount of cash they hoover up and direct to healthcare providers. Because the stock market demands year over year growth, they are incentivized naturally and by fiat to increase the volume of cash that flows through their network. This volume of cash is directly spent on healthcare. So you can see pretty easily that the incentive structures in our society are geared toward raising costs steadily.
If you couple that with private equity buying up healthcare providers and globbing them together, then you can see that there's a whole market system being built to make healthcare more expensive so that health insurance providers can absorb more costs and therefore increase their year over year profits. PE companies increase the negotiating power with insurance companies, and costs increase. And when costs increase, the insurance company's profit increases proportionally year over year.
So what you're saying about private companies doesn't make any sense. There doesn't even have to be collusion, although United Healthcare, an insurance provider, owns Optum, a healthcare provider, and I suspect there is a lot of collusion in relationships like that. The incentives are perfectly aligned to create this situation.
That's not quite how the actual incentives work. Most commercial insurers (both for-profit and non-profit) are increasingly adopting the "payvider" business model pioneered by Kaiser Permanente. As health plans pressured network providers to cut rates, the providers responded with M&A activity (some financed by PE) to gain more negotiating power. In some regions there are only a couple large health systems left that dominate the local market. Like in the SF Bay Area, health plans are pretty much forced to have Sutter Health in their networks in order to maintain adequate coverage. So now the only lever that health plans have left to control costs for their customers (i.e. large employers) is to hire clinicians directly as employees and cut out the middleman. UnitedHealth Group has been particularly aggressive about this strategy but all of their major competitors are taking similar approaches.
> if a private business with all the incentive in the world can't figure out how to lower healthcare costs
Of course they can. But why on earth would they? Health insurers are mandated by law to not exceed certain profit margins, so the only/best way to make more money is not by increasing volume and lowering margin, it's by increasing costs for your target captive market. That flows down the chain, you increase the allowed costs, so providers increase to meet that (why wouldn't they?) and the only person left hurting is the policy holder (and their employer, paying some portion of it).
> unpersuasive. It's not a serious argument
Your argument amounts to "this doesn't make sense, why wouldn't companies look to lower costs" when lowering costs in the health insurance mathematically equals lowering your profits.
What's not a serious argument is this constant belief that America is unique. "We're bigger than other countries", "our population density is different", all these things.
But you're going to need to do better than a pithy "it's not a serious argument" with no substance behind it when acknowledging that the entirety of the developed world hasn't "solved" healthcare but does a better job at making it equitable and accesible to more, at a lower cost, with oftentimes better outcomes (looked at our mortality rates around childbirth, lately?). It's not about the quality of care, it's about a system that revolves around making more money, not patient care. Another simple example, my insurer, Aetna, simply refuses to authorize 90-day (or rather, anything beyond 30-day) prescriptions from any pharmacy except the pharmacy they wholly own. Why? That doesn't provide patient benefit. There's no discount - the charged amount for the 90-day script is 3x the cost of the 30-day. It provides a worse experience for the patient, removing flexibility for them. It doesn't change their pharmacy network - they're still serving pharmacies all over, just for a subset of patient needs.
No, it's just about money. Again, there's near no incentive in the current US healthcare market to compete on price. And that's why US healthcare is ~20% of GDP, double, if not triple the cost of other developed nations.
