Employer health plans are getting pricier and skimpier

Insurance companies are mainly trying to combat fraud. They kick back claims if they are formatted wrong (why did you code an operation on the left knee when the right knee was the problem), or they deem that the work done was improper, unnecessary or does not fit the standard of care. Billing staff also handle accounts receivable and collections.

The biggest problem IMO is how we structure payment for health services in the USA. The fee for service model is highly inefficient and disincentivizes preventative care. All of the current proposals for universal healthcare do not address this fundamental problem, and so long as this remains in place we will continue to have the highest costs in the world. (disclosure, I am working to try and solve this problem)

If you were to pick countries to emulate, I would pick Singapore, Japan, the Netherlands, and Switzerland instead of Canada and the U.K.

It's not mutually exclusive with a Universal Healthcare plan, for one thing. But I think it's still a worthwhile goal with or without a separate initiative for universal healthcare.

It brings costs down, because many more people are now on a level playing field. If we stick with the current market-based system, this would make a big difference in actually having it start to function like a market. The average, middle class American will actually have to evaluate the costs of their plan and shop around for the best value, and they will also be very aware of how much they're spending and push for measures to bring down costs. If we do also build up a universal healthcare system, then working, middle class people will end up actually using the universal healthcare system, and again will be incentivized to push to make it work well.

As things stand today, people on the "open market" plans are clearly being treated as second class citizens, they're paying more and getting worse coverage than people who have a special connection (whether that's a company plan, union, etc). The taxing is also wonky and unfair, at least if I understand this correctly if I pay for a marketplace plan I'm paying with after-tax money, but if my company pays for my plan it's untaxed.

In my opinion there are also additional reasons this would be a net good thing, even if it were merely neutral on the two criteria that you call out. It will give people more freedom to do what they want to do -- right now if you want to quit a job or work only part-time, even if you have a source of income or savings to make it feasible, healthcare is a major hurdle. If you want to start a small business and need to offer healthcare for your employees, it's an even bigger hurdle. I would rather live in a world where it's as easy as possible to make your own path, and people are not beholden to a full-time job to have access to healthcare.

Sharing this idea in order to gather critique. The cost of healthcare in the USA is insane. Could we look for insight into the US Military? Example: This morning, a coworker told me she's going to have an operation on her back. The "cost of the tray" (I have no idea what this is) is $14,000. She has to pay $8,000 up-front two days before the operation, and the remainder will be financed over two years.

To me, it's insane to think the US Military pays $14,000 for this same operation in US Veterans' hospitals. Why don't we look into the military to see how they're doing it?

Or am I completely off-base here? Thoughts?

Healthcare is expensive and getting more so because of over reliance on insurance and government imposed restrictions on supply. See "Overcharged" for a detailed summary of the issues: https://www.amazon.com/Overcharged-Americans-Much-Health-Car...

This is really important. Pulled from the underlying study[1], employers cover 82%/70% (individual/family) of the cost of healthcare. Those numbers are down just slightly from 86%/73% in 2019.

Or, put another way, employers have borne 69%/80% of the cost of healthcare increases. You complain because your individual plan has gone up by $986 in 20 years? Your employer's cost has gone up $4,005. Oh, and that's with cutting the underlying coverage ("skimpier").

It negatively impacts wage growth because that extra $4k is a bottom-line benefit (or cost of employment, if you want to think about it that way).

Finally, note the disparity between individual and family plans. Employers are offering 2.5x more benefit—nearly $9,000 more—to workers with families.

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[1] http://files.kff.org/attachment/Report-Employer-Health-Benef...

Fig. 1.10 shows premiums increasing from $2,196/$5,791 in 2019 to $7,188/$20,576. (Note also that 72% of that is attributed to premium increases vs. inflation and worker earnings, per Fig. 1.14.) Fig 6.1 shows % of premium paid by workers going from 14%/27% to 18%/30%.