[coryking]

> health insurance and how it's tied to employment

Without getting too political, I really feel like untying health insurance from employment would transform the labor market and encourage far more entrepreneurial endeavors. People could take more risks if they didn't have to worry about losing healthcare coverage.

There are obvious tradeoffs involved, but I really never see this aspect considered in public debate. Making healthcare independent of employment really empowers people to do their own thing.

[lotsofpulp]

> There are obvious tradeoffs involved, but I really never see this aspect considered in public debate.

It was a big aspect in 2009/2010 when ACA was being passed.

The reason people want insurance tied to employment is because they benefit from lower premiums because their risk pool experiences less healthcare costs than the general public.

If everyone was dumped into one marketplace and risk pool, then the insurance premiums would have to rise for those working in white collar businesses who had previously been able to enjoy lower premiums since the nature of employment as a requirement precludes many sick people experiencing healthcare costs.

So when people complain that ACA increased their healthcare costs, what they are actually complaining about is having to now share risk pools with sicker people who previously were not getting healthcare period.

The optimal way this would work is if everyone was dumped onto healthcare.gov, and they picked whatever health insurance plan they want, and then naturally the premiums would balance out over time so that the costs are spread amongst the whole population.

Basically, taxpayer funded healthcare, except instead of one managed care organization (the US federal government) you have multiple (United Health, Anthem, Kaiser, CVS, Humana, etc).

[ahelwer]

Why continue to allow the existence of these various parasitic middlemen health insurance companies with their redundant bureaucracies and the N x N billing problems, networks, etc. they introduce?

[lotsofpulp]

Because there are insufficient votes in Congress to change it. Even the current implementation of various managed care organizations and mandatory coverage with limits on premiums and out of pocket maximums BARELY passed.

And it was gutted pretty quickly when the most important part of it, mandatory purchasing of insurance (I.e. a tax), was repealed in 2017.

[mjevans]

Which is crazy from the simple standpoint. All businesses other than health care coverage providers would benefit from never needing to worry about this HR burden again.

Probably those small companies lobby / donate to both parties to prevent a single payer system where normal workers and normal employees don't have to care.

[lotsofpulp]

They're not small companies, the managed care organizations (MCOs) are some of the biggest companies in the US.

But I do not think their lobbying is what prevents single payer. For one, single payer (taxpayer funded healthcare) still uses managed care organizations in the US. The only difference is that instead of paying insurance premiums to MCOs, you pay taxes to the government. The government then goes out and hires the MCOs to ration healthcare and implement various formularies and double check doctors' orders to limit spending and prevent waste. This currently happens with Medicare (over 65 years of age), Medicaid (low income/wealth), and Tricare (for military).

So the MCOs are involved in the healthcare delivery no matter what. The only difference is for non military, non poor people pay MCOs insurance premiums instead of taxes to the government, with which the government then hires MCOs to do all the administrative work of dealing with patients, doctors, finding fraud, approving/denying medicines, negotiating pricing, etc. Although, the government sets pricing in big ways too, via reimbursements for Medicare/Medicaid.

In any case, the elephant in the room is and always has been how much do people with money want to pay for people without money. The more obfuscation there is, the less healthcare is delivered, and the less it costs people who would be net payers into the system.

Sidenote: I think governments (politicians) like the system of using MCOs because they take the heat for any rationing or mistakes in the implementation. It's not the government denying you, it's UHC denying payment, even though the government gave the formulary to UHC to implement.

[908B64B197]

That's one of the reasons a lot of businesses in tech are founded while still in school: You get to keep your (low premium) coverage.

[pkaye]

Isn't a lot of Europe like this? Do they have more entrepreneurial endeavors than the US?

[idiotsecant]

Yes, in some places. In the US the entrepreneurship rate measuring the % of the population involved in that kind of activity hovers around 14%-ish. There are European countries like Estonia and others in the north and baltic regions that beat that rate while still providing high quality universal healthcare. As a rule, though, it seems like western European countries are significantly less entrepreneurial.

I think the entrepreneurial rate has a lot more to do with cultural attitudes around risk and individual success. Some countries like Italy, for example, have rates in the very low single digits. I'm not sure you can overall make a case for universal healthcare increasing entrepreneurial enterprise. Whether it might increase it specifically in the US might be a different question, though.