[Ididntdothis]

At least they can stay on their health insurance. It’s always mind boggling that in the US you will not just lose your job when you get laid off but also your health insurance. For a lot of people this is life threatening.

[synaesthesisx]

Man, it sure would be great if we could decouple health insurance from employment like other reasonable countries. It would be a shame to literally have your existence threatened by absurd factors well outside of your control (like your employer unable to meet payroll due to a global pandemic).

[unlinked_dll]

More small/medium sized businesses should be on board with this too. No one likes dealing with insurance companies/plans.

[acwan93]

With gigwork and independent contracting becoming a significant part of our economy, I can’t agree more. It seems archaic to bundle health insurance to my workplace. I can purchase auto, home, life, and whatever other insurance on my own, why not health?

[dylan604]

You can buy health insurance on your own. It's just not going to be subsidized by your employer. If you thought your health care premiums through work were high, just wait until you see how much more it goes up with out the employer contribution. Easily double would be a first guess.

[MereInterest]

It is also higher due to having a poorer negotiating platform. When an employer threatens to have hundreds to thousands of workers switch coverage, it can decrease the price. When an individual threatens to switch, the result is a shrug. Scaling this up is a good reason to support a single-payer system.

[gruez]

>It seems archaic to bundle health insurance to my workplace. I can purchase auto, home, life, and whatever other insurance on my own, why not health?

Because if you get it through your work, you don't have to pay tax on it. Also, getting it through work also decreases the risk of adverse section on the part of the insurer, making it cheaper.

[Ididntdothis]

“Because if you get it through your work, you don't have to pay tax on it.”

That’s not a natural law but something that should be changed immediately. There is no justification for this.

[MuffinFlavored]

> it sure would be great if we could decouple health insurance from employment like other reasonable countries.

How does this work in Denmark? I read they were the gold standard for how a nation should do health care, but I also read they don't do insurance solely as a public option through the government.

[Ididntdothis]

If it’s like Germany they have highly regulated insurance companies. There are public and private insurers. Private insurance is only available for higher incomes. The main thing in Germany is that your premium is based on a percentage of your salary so the less you make the less you pay. There is also a cutoff from a certain salary on so the premiums don’t keep going up when you make above that cutoff amount. If you are unemployed the employment agency keeps paying. If you are on welfare then that department will pay. So you can never fall out of insurance.

Another big aspect is that the amount doctors and hospitals can charge and what insurance reimburses is regulated. So you don’t have the situation where hospitals charge whatever they feel like and the insurance reimburses whatever they feel like and the patient sits in the middle and has to figure it out somehow or potentially go bankrupt.

There is much more detail but I hope I got the basics right. You hear a lot of bad stories too but overall the system is way more predictable and just than the US system. I have experienced both and I can see the US system only making sense for millionaires or healthy people. Otherwise it’s an insanely bureaucratic, expensive and merciless system where every hospital visit is a big gamble. And definitely don’t get any chronic disease or they will bleed yoU dry.

[kempbellt]

Then let's do it

[maximente]

unlikely as both parties are beholden to big corps which love the idea of existential crisis (getting fired => lose insurance => medical bankruptcy) preventing normal individuals from engaging in entrepreneurship/competition/healthy lifestyles

[xster]

#yang2020

[Ididntdothis]

Did Yang run on health care reform? Last time I read about him he was babbling about “choice” and “market” but seemed to have no real plan other than the magic of the free market. If the health care situation doesn’t change then all of UBI will be eaten up by health care soon.

[omegaworks]

> Did Yang run on health care reform?

Marginally. His plan was basically the same as Buttigieg's: Medicare for all who want it.

Of course, they never talked about how that would actually reduce your choices as employers opted to stop covering health insurance and you were stuck with the smaller Medicare provider pool.

One of the big structural advantages of the real Medicare for All plan is that it would eliminate "networks" all providers would be required to accept the M4A single-payer.

[xster]

Ya, he ran specifically to decouple healthcare from employment. It's thematic with the whole financial security to pursue entrepreneurship part of the message (which doesn't work if you have to take all that money and buy health insurance for your employees)

[Der_Einzige]

You gotta vote then. You need to get other people to also vote for candidates who would do it. You need to convince the other sides supporters to abandon their support for the other side.

It would really help if we had a politican who was somehow electable in the primary and didn't hold policies which are deal breakers for the other sides voters. For example, on gun rights or (god forbid) abortion

Unfortunately, if you try to be pro gun in the democratic party they will eviscerate you in the primary. Just look at Bernie sanders in 2016 vs Clinton on the Brady Bill. Until we can convince republicans that the dems won't take their guns away, it's basically impossible to convince a good portion of Trumps base to abandon their support. I don't advocate for pro-life dems but if you really want republican votes you may have to at least pretend to be pro-life.

None of these are easy, but it must be done or else it's more of the same crap.

[smartstakestime]

you can buy your own health insurance. This is like saying that because you dont get free lunch anymore that losing your job is "life threatening". Somebody has to pay for it. This liberal mindset of "make rich guy pay" is at its core lazy and selfish.

I think that the health industry itself is a scam, and over priced by bureaucracy but that doesnt mean that another person should take your burden. Your health is your responsibility not your employers.

Employers shouldn't be playing health insurance because that shouldn't be necessary. Minimum wage should cover basic care. Either minimum wage is too low or basic care is too high. We kinda take care of this through taxes but its a bandaid on a corrupt overpriced monopoly industry.

[JoeAltmaier]

In this climate you can't buy your own - its 3X the cost and not subsidized by your employer makes it worse.

But I agree the connection between health insurance and employment is artificial. I'd rather see some basic universal health, plus a market for better plans.

[jcranmer]

If you get health insurance via your employer, the value of that health insurance is not considered income, and is tax-free. If you pay for it yourself, you get no tax benefits for doing so.

That kind of skews incentives a fair amount.

[gregkerzhner]

This is not true (at least if you are a contractor or are self employed). You deduct your health insurance premiums (and all sorts of other expenses like home office) as business expenses. After that’s done you pay tax on the rest. source - I’ve been contracting for 6 years and buying my own insurance.

[DoofusOfDeath]

Yes, the momentum of U.S. healthcare's structures and practices is extremely frustrating. Watching the planning and implementation of the Affordable Care Act was very disheartening. I'm genuinely curious what circumstances or events would / shall be necessary to effect large-scale improvements.

[wedowhatwedo]

It's hard to accomplish something when half the team is paid to stop the project at any cost.

[bilbo0s]

Being able to keep the health insurance is a life saver. And yes, we really need to rethink this whole, "employer bound health insurance"-thing.

Maybe it made sense in the world of easy access to middle class jobs that was the 1950's, 1960's, and 1970's, etc. But today things are significantly different and we haven't adapted to reflect that reality.

[danans]

> And yes, we really need to rethink this whole, "employer bound health insurance"-thing.

This may end up being the most important silver lining of the COVID19 situation.

> Maybe it made sense in the world of easy access to middle class jobs that was the 1950's, 1960's, and 1970's, etc.

It made sense for those who could get those jobs, but US society of the 1950s-1970s was pretty selective as to to whom it availed such jobs and attached health benefits.

[filmgirlcw]

Yes. Although I will note that labor unions were also more powerful then, which allowed a broader class of people to have jobs that offered benefits.

I don’t disagree that the system was still selective as to who had access, but the Reagan-era attack on organized labor and workers rights had sweeping, sweeping impact that continues today.

The problem is that many boomers (sorry mom and dad), who had more entry-level or even middle-class jobs in the 70s and then went on to big corporate jobs in the 80s, either are unaware of this shift or are unwilling to acknowledge it happened. People say, “well when I was your age my health insurance was free or super cheap” — as if that is applicable 40+ years later. It’s similar to my uncle not understanding why someone like me, who makes well into six figures a year, has no aspirations of home ownership, not understanding that the only cities I’m willing to live don’t have housing equivalent to my rent for under $1m. He just thinks, “I bought a house at your age” — not realizing his house was $80k and even with inflation, wouldn’t be possible now. Or like how I had to explain to my mother that no, despite working for the second-most valuable company in the world (technically it has the highest market cap today), I do not have a pension. I laughed when she asked.

[pmiller2]

More like it made sense in the early 1940's when there were wage and price controls due to WW2, and it just kinda stuck.

[digitaltrees]

This is an important historical fact that many people don’t know.

[dankoss]

This is not strictly true. Health insurance has always been available for purchase by individuals, and the ACA expanded access to this by providing income-based subsidies. When you lose your job, you lose access to your employer's subsidy and risk pool.

That doesn't change the fact that heath insurance and healthcare is expensive, it's just pointing out that the only way most people can afford to have it is because their employer is paying for most of it. If that cost was more transparent to salaried people, it might spur a more useful conversation about how to bring down the cost of healthcare.

[Loughla]

At our institution, every staff member is required to be a part of the rotation on the benefits committee. Also, we are required (state funded institution) to send out the full cost of every staff and faculty member to them every year.

When the letters go out, people open their eyes when they see the institution spent 1/3 of their salary on health insurance. You can tell when someone is on the benefits committee, because they don't complain about salaries for about 3 years.

[pjdemers]

>> Health insurance has always been available for purchase by individuals Not true. Before Obamacare, anyone with a pre-existing condition was excluded. "Pre-existing condition" means you ever saw a doctor more than once for the same thing. My family was denied because one of my children was in the hospital for a week AT BIRTH. She was 5 when we applied, and not been sick for a day since then.

[RandallBrown]

Depends on the state of course, but some (Washington at least in 2017) have totally free healthcare if you have no income.

It was extremely easy to sign up on the healthcare exchange. The coverage wasn't great, but it was free and better than nothing.

[heymijo]

> At least they can stay on their health insurance.

FTA: At least through May

[ryaan_anthony]

Only if you are fired or quit. If you are laid off, you have the option to continue your insurance at your employers discounted rate. The program is called COBRA if you want to look into it.

[Klathmon]

COBRA is temporary (for 18-36 months depending on the situation), and you need to not only pay what you have been paying, but you also need to pay the "employer's share". And it must be identical to the plan you left, so you can't reduce coverage or change anything at all about the plan or you'll lose eligibility.

That means people who quit or are laid off will end up having to pay more for their healthcare at a time when they don't have any income.

COBRA also has a lot of hidden "gotchas", like for example if the employer you left stops maintaining any health plan, your COBRA plan can also be terminated. (This means if the company shuts down, all past employees lose any ability to use COBRA. And this can happen even after you leave and are already on COBRA)

Also if you fail to pay the premiums for any reason, your plan can be terminated, and even worse you won't be allowed to sign up for a new plan via the Marketplace until the open enrollment period.

[filmgirlcw]

Yup — almost made this comment in another thread. There are tons of gotchas with COBRA. Sure, if you can afford it, it can be better than the alternative (especially if you have expensive medications or a pre-existing condition that requires lots of ongoing treatment), but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent — and as you say, if you’re late at all with COBRA, you lose it.

The fact that the United States doesn’t have universal, affordable healthcare is a travesty and the fact that our system has persisted for this long is utterly insane.

[omgwtfbyobbq]

Late with Cobra is different from most insurance because you can pay the month after you receive services, not before.

This also allows you a little more flexibility than with a traditional plan where you have to prepay. For instance, if you're going to enroll in a new plan as of January, and don't end up using any medical services in December, you can decide in January not to pay for that month and Cobra will terminate coverage.

You don't have that option with a normal plan.

[usaar333]

> but I’ve had plenty of friends who have at various stages had to face questions about health insurance or rent

Do affordability tests not apply once you are laid off? I would think your premium subsidies would go up and you can get an ACA plan.

At least living in CA, it generally feels like we have universal, affordable (by some definition) healthcare, but I'm sure there are edge cases where the affordability calculation breaks.

[filmgirlcw]

Affordability tests are based off what you’re projected to make and if you have any income or savings at all, that can impact that directly. Moreover, depending on your needs, the cheap plans might not work out. If you’re diabetic and require insulin and testing strips and other stuff, a high-deductible plan probably isn’t going to work out. The same is true if you’ve got specific prescriptions you need covered that are only up to a certain amount on a lower-tier plan or aren’t available unless you pay more. So in some cases, the ACA plan could cost the same as COBRA, and you’d be stuck starting from zero with your deductible, which if you had paid into under your employer, could be significant.

But beyond that, let’s say you anticipate you can make $3000 a month freelancing. Now, this isn’t enough for your rent and your insurance, but it’s still too high, perhaps, to qualify you for a lower-rated ACA plan. And it is certainly too high for Medicaid. So if you live in a high-priced city, you’re now stuck having to decide what you pay for — and that’s not always easy. Remember, it’s not like moving is that easy — you may have to break a lease (which costs money you don’t have), and you’re unemployed so signing a new, less-expensive lease is going to be challenging too.

The safety nets we have in place are really only designed for the very, very poor (and even then, they don’t go far enough). If you are anything but that — you’re really fucked, especially if you live in an medium-size or larger city/urban area.

[usaar333]

> That means people who quit or are laid off will end up having to pay more for their healthcare at a time when they don't have any income.

(ignoring tax issues) They aren't really "paying more", it's just their salary when they were working was higher than the top-line number.

[ragona]

Haha "discounted." Have you ever looked at the prices for COBRA? Cool, you just lost your job, here's a $1500/mo option.

[pound]

it's still technically discounted as those are group rates. Without it the same plan would cost even more for individuals.

[filmgirlcw]

Sure — but the point is that it isn’t a viable discount for most people who are laid off — regardless of your income level. A decade ago, when I went off my parents insurance (and before the startup I worked at offered insurance), COBRA was $1200 a month — it was more than my rent at the time. But my medication costs were $1500 or $1600 a month (primarily for an ADHD drug that was still under patent and no generic was available), so I paid it anyway. That was in part because my parents had really good insurance — and you’re paying to extend the same plan, you’re not able to negotiate for a different plan. When I last switched employers a few years ago, the COBRA amount was similarly high (I didn’t use it because my new employer had insurance but I saw the COBRA forms). Unemployment wouldn’t cover rent for many people — let alone COBRA.

[tomp]

Wow, sounds like you just discovered that health insurance is expensive! (Regardless of who pays it, your employer paying it is just a hidden reduction of your salary.)

[filmgirlcw]

That’s hardly something I “just” discovered. Practically every other first world country offers deeply subsidized or nationalized health care except the United States, and considering my 40% effective tax rate isn’t much lower than those places, I’d rather all citizens have access and not have to forego health insurance for food or rent.

[PopeDotNinja]

There's nothing discounted about COBRA. It's expensive as heck.

[rankam]

Sure, technically COBRA covers you, but have you have seen how much it costs? It is unaffordable for most. US healthcare is a joke.

[yCombLinks]

I pay $300 per month for health insurance and my company pays $700. If I lost my job I would have to pay it all.

[Ididntdothis]

COBRA is horribly expensive though.

[usaar333]

It's the same price as what your employer was paying. It's only more expensive than getting it yourself if you are A) younger than the average of your employers' pool or B) qualify for premium assistance/medicaid.

[henryfjordan]

You can use COBRA no matter the reason why you left your employer

[mlthoughts2018]

COBRA is so intractably expensive that the only responsible thing to do is assume COBRA doesn’t exist and base policies and assistance around that reality.

Any analysis / estimate / policy that starts from any assumption of the existence or usage of COBRA is therefore so unrealistic and inaccurate as to be completely ignored.

[cstejerean]

That's because insurance is expensive. The price you pay for COBRA is identical to how much that policy cost while employed, except that while employed the employer is paying a large share of the cost, and while on COBRA you pay the full cost yourself. Spending some time on COBRA is a good way to appreciate the high cost of insurance.

I spent 12 months on COBRA when I started my startup, and while I didn't enjoy paying close to $2,000 per month for insurance I couldn't buy a comparable plan on the open market for my family for less.

[mlthoughts2018]

I’m unclear the purpose of your comment. I never said insurance wasn’t expensive. Taking someone who has no choice but to base their life around not bearing that cost because they must rely on employers to bear it for them, then suddenly acting like it’s a benefit that they can optionally take on that cost their life has been fundamentally structured to not bear, is not a solution to anything.

Presumably the existence of COBRA is meant to assist people experiencing a hard time with health coverage. It does not achieve that purpose. If insurance itself is prohibitively expensive that mediating it through COBRA means people are unhelped by COBRA, then replace COBRA with something that pays the cost of the coverage. Take your pick of many options, but shifting the cost burden onto someone who was told to structurally depend on it being tied to employers is not a thing. It’s a non-thing that does not count as an assistance or benefit.

It’s like if you lost your job and suddenly now breathing oxygen costs an extra fee, but it’s OK because you can just pay the oxygen fee you were forced into letting your employer pay on your behalf.