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The Real Reason the U.S. Has Employer-Sponsored Health Insurance

nytimes.com

11–20 of 39 posts

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#11
post #3

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.

When McCain ran against Obama he wanted to get rid of employer health care. I don't remember the details though.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#12
post #3

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.

> Has there ever been an effort to ban employer sponsored health care?

Yes, there is, but from the other direction from the one you are interested in (universal single-payer).

There's also been efforts to eliminate tax and other incentives and mandates that make employer-sponsored care common, which is probably closer to what you are looking for, though the people backing that would generally be ideologically opposed to prohibiting employer-sponsored health care.

> I bet it would be a much bigger issue for people

The reason health care is a major political issue across the spectrum is that it's costs are already a giant issue for most people. There's disagreement on what to do about it, not on whether it's a big issue that people feel significant impact from. Your solving a non-problem by looking for ways to make it a big issue.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#13
post #3

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.

I don't think there's been a serious effort yet. I seem to recall proposals floating around in the past 6 months, though. One thing I remember is making employer healthcare be taxable income.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#14
post #5

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?

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.

[deleted]

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#15

Earlier quoted context omitted.

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.

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.

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.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#16
post #5

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?

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.

And this is a pretty big problem.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#17
post #5

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?

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.

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.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#18

Earlier quoted context omitted.

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.

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.

[deleted]

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#19

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 To…

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... (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'.

Re: The Real Reason the U.S. Has Employer-Sponsored Health Insurance

#20
There is no such thing as a free lunch.

Someone always has to pay, and socialized healthcare just means that your neighbor has to pay for your poor lifestyle decisions.

Employer 'provided' healthcare is a voluntary, demand-driven benefit.

To re-purpose an earlier comment - socialism "sounds like slavery".

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