> He had a son with severe Autism and Microsoft's health benefits were very important to him.
This really sucks for him. Through should Microsoft _not_ layoff specific people due to health conditions? Is that something we require from companies?
Employer provided health care insurance came about during WW2 because Roosevelt froze wages. Companies discovered they could "raise" wages by paying for the insurance themselves.
The practice persisted because employer paid health insurance is tax-deductible, while it isn't if a person pays it out of pocket.
The obvious solution is to make it tax-deductible.
True. Total employee compensation is around 145% of their salary. The government could tax that extra 45%, but I doubt that would fly politically.
Typical accounts of employee compensation only measure wages and salaries. I've only seen the WSJ using total employee compensation, which is a far more realistic figure.
Well you see it would free up a huge amount of money that employers are currently paying to insurers. If you take that money (by raising the Medicare premium on employees), plus the existing medicaid budget, existing medicare tax and payroll tax contributions America's healthcare system would receive over 40% more money to cover care per capita than the next leading contestant. Almost 2X the OECD average. In PPP dollars no less.
"But where would the money come from" is one of the wildest questions to ask about a system that already costs double the average. I'd say, give or take, the same place its coming from now, but like, less.
I pay $2k a month through work for a plan. I could pay that plus the payroll deduction plus the pittance my employer kicks in. I’d make that trade all day every day.
Wouldn’t that leave out the set of people who have no income? For example, long term unemployed, adults switching careers and needing to take a long time off for education, etc? While the solution gets close, I don’t think it’s strictly the same thing. Add on top of that our unnecessarily complicated tax system and this sounds even less equivalent.
It doesn’t. It’s part of a rosary of things people wield to stave off thinking about the topic. You can do other things besides nationalizing all care or insurance, but when you hear people talk about “open up markets to cross state competition”, or “everyone gets an HSA”, or “make insurance tax deductible/it’s fdr’s fault”, it’s rarely about the specific policy, those are liturgical texts / catechisms designed to give the impression of solutions without substance.
Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group (of people generally healthy enough to work) and that’s one way of getting balanced risk pool if you’re not doing community rating or a societ wide pool.
> Tax deductibility is only a very minor reason why most private insurance is employer provided; the much larger reason is that employment is a decent way to get a reasonably distributed group
From what I saw, the combination of "no exclusions for pre-existing coverage" and "penalty for not having health insurance" worked pretty well to balance the risk pools without nationalized healthcare.
I would still like nationalized healthcare, but I think there are other ways to fix the problem at hand of people being dependent on their jobs for healthcare.
Absolutely. I'm a fan of the ACA's patchwork of wonky choices including no pre-existing exclusions and community rating. Additionally the subsidies made it genuinely accessible for most, at least where they made it through attempts to hamstring them. It's been one of the most helpful practically advanced policy achievements of my lifetime, even with all the effort to destroy it (which has recently found new success and may even succeed entirely in the end).
Universal insurance could be better, and perhaps the day will even come when the American electorate recognizes priorities like this and candidates who will advance that kind of policy, contrary habits of the past notwithstanding.
How about you do some research on the kind of healthcare that people in countries with socialized healthcare receive.
6 month waitlists for a cancer screenings, multi day emergency room waits for broken bones, maybe you've heard of the oh so wonderful death pods in Canada?
Our system is by no means the best, but I'll take it any day over socialized systems.
This is not my experience in Canada. It is not the experience of anyone I know.
There are often long wait times in ERs for things that are non urgent. I waited 5 or 6 hours my last visit after initial assessment.
I’ve known a few people that had life threatening cancers here: they were treated quickly, and compassionately by the health care system.
There are bad wait times for some things: a hearing assessment took 6 months (there are private options for this but many people would rather wait - they trust the system more). There is a shortage of family doctors. Medications are not fully covered.
But I promise you we have no death pods in our hospitals. If you get hit by a car, diagnosed with cancer, need an X-ray, a breathing test, etc. You get that care.
It’s nowhere near perfect, but I’m thankful for it and most people I know feel similarly.
Can you cite the sources you researched? I’ve known people from all over the world and none of them found that to be true: the American healthcare system was commented on in disbelief over both the cost and difficulty of getting treatment compared to where they had previously lived.
Yes it is. The system has some very deep issues due to government involvement/meddling with both healthcare and insurance, but at least you can still receive life saving treatment in a timely manner.
They can be in disbelief all the want, but when people in countries with socialized healthcare get cancer or other life threatening medical conditions they come to the US and a private healthcare to get treated.
That’s one country, and I note that the authors of that paper directly contradict your thesis: “the Commonwealth Fund’s survey results show that other universal health care systems (eg, the Netherlands, Switzerland, Germany, Australia, and France) have much shorter wait times than Canada does”
The American system is also not looking so good as our wait times have been going up and access has been worsening for much of the country, especially over the last year.
What does 'usually' mean? In my experience 'usually' has never worked in my favor. Say it does, does it kick in immediately? What do they have to do to switch over providers? Does all currently being coveraged treatment just move over to being covered by Medicaid automatically or will they need re-approvals?
If you are saying they are covered either way, why not just have consistent healthcare coverage for them and for everyone, all the time?
In my state it would kick in immediately. You would report your current income, which is now $0 since you just lost your job.
Virtually every provider in my state is in-network for the various Medicaid options to choose from, so you would not need to "switch over providers". It's usually better than private insurance.
As far as "why not just have consistent healthcare coverage for them and for everyone, all the time", because it would be very expensive to do so? Medicaid covers poorer Americans (including people who just lost their jobs), not the entire population.
(Looking at this from an American centric point-of-view):
The Czar of health-care in the US today is a brain-worm addled, drug-addicted, vaccine-denying, conspiracy mongering, incompetent jackass. And the overall current administration has shown itself to be hostile to basically anyone who isn't a cis-gendered, white, heterosexual, Christian male.
How many of us really trust these people to make good decisions regarding our health-care? A position that they (or their delegates) would find themselves in if we "nationalize health care".
I think this is a classic example of an idea that sounds good on paper, but doesn't survive contact with reality.
In the UK, it's operated as trusts separate from day to day government. In Canada it's provincially administered. In Australia, Medicare is a national, tax-funded system with independent statutory authorities overseeing parts of it. Germany, France, Japan have social insurance systems.
I would imagine individual states would manage their own health services, with the federal government acting as more of a coordinating and standard setting body. At least that's how it works in UK, Spain etc.
Even so, the issues I am referring to go all the way to the top (POTUS) and descend down through everybody in the reporting chain to various degrees. And even for people who are Trump supporters, just ask yourself the question "What happens if the ONE PERSON I HATE MOST gets elected POTUS in a world where I depend on the federal government for health care?"
I know in years past we all though the US government was somewhat immune for really radical swings in direction and what-not, but I think now we have an existence proof that really sudden and radical changes can happen.
Legally, Microsoft, or any company, cannot use any personal factors in determining who to lay off. If they do, they risk a very real lawsuit. All one needs to do is show some evidence of discrimination, and the EEOC doesn't charge a dime, the worst they will do is deny to pursue. If that happens, most private lawyers will take the case on contingency.
This is the reason you see sweeping cuts without regard to age, sex, etc.
There have also been lawsuits in the past that have settled out of court where a company's layoffs appear to overly inflict damage on one class vs. another, even if the intent was not to do that.
I am not defending these companies at ALL btw. I just have a bit of experience in this area due to the legalities, and I wanted to share it.
I am also not saying that companies don't do this, but the smart ones don't, and the smart ones at least try to at least avoid making it look obvious.
In Germany, yes. For mass layoffs, this absolutely has to be considered. In general, the older the employee is, or if the employee has dependents, the more difficult it gets to both fire them or lay them off.
The regulations that make it hard to lay off someone have an equal and opposite effect of making companies very reluctant to hire. This impedes the efficient allocation of labor, resulting in a poorer GDP.
How much of this years GDP growth in the USA went to average citizens? What does GDP growth matter if your citizens have zero access to healthcare, can't improve their conditions, can't innovate, can't try new ideas because they are tied to healthcare via their current job?
How much of American GDP growth goes to Billionaires and isn't a useful health metric?
Billionaires become billionaires by making and selling things people want. Obviously, a lot of people want what they are selling, and think it is worth buying.
That's such an excessively naive, childlike take that it's hard to know where to start. You don't become a billionaire by "making and selling things". That doesn't scale beyond the low millions. You become a billionaire by leveraging existing capital to rearrange bits of the economy in such a way that money flows towards you [note]. Productive output, be it goods or services (which you seem to have forgotten exist) is strictly optional. You think Warren Buffet sits in his garage cranking out widgets? What planet are you on?
[note] For example, you might contrive to purchase the entire supply of some valuable resource with inelastic demand, and then sell it back to people, perhaps at an inflated price.
> You don't become a billionaire by "making and selling things".
See Microsoft, Walmart, Amazon, Apple, Tesla, SpaceX, Pixar, Lego, and on and on.
> you might contrive to purchase the entire supply of some valuable resource with inelastic demand, and then sell it back to people, perhaps at an inflated price.
It is, but more generally. In many other countries, it is not so easy to lay off employees as it is in the US. It is also not necessary that your access to healthcare be contingent to your employer's whims.
Companies don’t have agency. People do. Compassion is a cross cultural value. Including amongst those that run companies.
For the most part none of us has any “required” obligation to anyone else.
Is it something we require of companies? No. But being a responsible, compassionate human being that considers the totality of circumstance is something I expect of that company’s leaders. Especially a company that has the money and need for technical skills elsewhere in the org.
The golden rule does not stop being true just because you are at work.
Preemptively: duty to shareholders is broader than short term profit maximizing. Avoiding bad PR like this is also in the service of MS shareholders.
As a side note: Nadella moved his home to Canada, while working at MS, so his special needs kid could go to a specialist school. That is absolutely the right choice. The argument that MS should not consider the health of their employees children is horseshit when they allow the CEO to set up house hours away in a different country for that exact reason.
At the end of the day, a kid suffered unnecessarily through no fault of his parents or his own.
And that's why people think 5 times before hiring such. It's already super hard to fire people unless they make gross mistakes. It's nearly impossible to fire someone like that. It's stupid.
Its not stupid rather humane, just very ineffective from economical perspective.
You want society where its everybody for themselves, fuck the rest, be lucky with ie your health so you and your family can have a decent life and one problem big enough can wipe you out? The benefit is more money, economy works better, is more agile to ever-changing situation. Just those extra money often go to that healthcare (since we all end up with various issues over time, the only exception is early death), or university for kids, or cost of properties.
Or something glacial, without real pressure to improve, more poor, but with additional safety nets.
I keep saying it over and over - EU should take over system (and mindset, good luck there) of Swiss folks. They strike the best balance between predatory capitalism that often grinds unlucky individuals and various safety nets (free top notch public education, almost free public healthcare, very good but not ridiculous social system etc). Unsurprisingly, mix of European competency and a bit of proper capitalism creates one of best stable living standards in the world, and arguably still The most free nation in the world (TM).
Its a place that french or germans just can't swallow - neighbor showing them how much better a similar society can end up functioning with few rather minor tweaks.
Read my comment history if you care, you couldnt be further from the truth.
What I wrote is reality about EU, whether you like it or not is another topic. I dont mention russia at all, that medieval shithole has (hopefully) no say in how European future will look like.
it is stupid because it leaves the company holding the bag.
The state can take over for such cases but instead, once a company hires such a person, they can become permanent leeches. Even when the company is having trouble with market/financials, it is difficult to cut.
> You want society where its everybody for themselves
Never said that.
> be lucky with ie your health so you and your family can have a decent life and one problem big enough can wipe you out?
How about working hard and taking care of health? How about not drinking/smoking, not doing drugs, and eating healthy?
> fuck the rest
Yes, fuck the ones who don't take care of health (and I'm not talking about homeless people) and then overburden the healthcare system. Why should we have to carry the weight of the trash humans? Why should one have to pay €1000+ every month for insurance, get cigarette smoke on face (of infant) while walking around in public places, and then watch these people drain healthcare?
In the US at least, there are needs-based high-risk insurance programs run by states that do just that.
Even so, while it's not a good argument against layoffs, the fact that it's even considered as such is in itself a reasonable argument against health care being tied to specific employment.