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.
The US healthcare system is non-functional for a month: what happens?
Hospitals and providers start running into cash flow problems and begin having difficulties providing service.
Fraud skyrockets because everything is getting blanket-approved because none of the data used for verification is available.
And about a month after that, people start dying from lack of care, after the last financial reserves of the system are exhausted.
Because that's the path the system was on when Change went down for several weeks, only averted by HHS/CMS saying 'Here's money, just do procedures, we'll worry about it later.'
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.
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.