[WalterBright]

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.

[y7]

> The obvious solution is to make it tax-deductible.

Or make employer paid health insurance count as income and therefore not tax-deductible.

[WalterBright]

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.

[okasaki]

That's how it works in the UK

[wombatpm]

Or lower the age for Medicare every year until everyone is covered.

[SpaceNoodled]

We could just lower it once, to zero, and be done with it.

[ethbr1]

The US healthcare system is like the Titanic: it turns slowly, and you don't want to fuck around with hitting icebergs.

[SpaceNoodled]

So fucking sink it. All heath "insurers" do is just delay and deny coverage anyway.

[ethbr1]

> So fucking sink it

Let's think through the implications of that.

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.'

[SpaceNoodled]

You say this as if people aren't already dying of lack of care. And it's already disintegrating. Check back up in your estimated month as the realities of ACA subsidy drops start to kick in.

[WalterBright]

We could. Who is going to pay that bill?

[arcticbull]

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.

https://www.healthsystemtracker.org/chart-collection/health-...

"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.

[wombatpm]

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.

[8note]

would it actually be that different of a bill?

i imagine its already doing the most expensive part, treating people who are almost dead who have lots of procedures that could be done.

picking up people that need basically no care sounds pretty cheap by comparison

[WalterBright]

Estimates of Medicare errors, fraud and abuse are around $60 billion. Greatly increasing the scope of it will, inevitably, increase that figure.

[gusgus01]

Estimates of health insurance fraud is also around $30 billion, so same order of magnitude, and considering the margins of error and the fact that they are estimates, by definition, it makes it hard to say public health insurance is more fraud ridden then private. Plus due to the inherent differences there are probably differing avenues of research and estimating possible between private and public insurance, and heck whole different forms of draining money that might affect ease of uncovering the level of fraud between private and public, which would make it have an even larger margin of error.

[hysan]

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.

[jagged-chisel]

I don’t see how this addresses the comment you replied to.

[wwweston]

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.

[Dylan16807]

> 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.

[wwweston]

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.

[WalterBright]

I suggested an alternative solution to the one proposed by the comment I replied to.

[jagged-chisel]

I don’t understand how “make it tax-deductible” is an alternative to “nationalize healthcare so it’s not tied to employment.”

[WalterBright]

Sorry, I don't know how to make it any clearer.

[jagged-chisel]

It’s already tax deductible. Just saying “make it tax deductible” doesn’t explain what you mean.

[WalterBright]

It's complicated. From google:

* You must pay the premiums with after-tax money.

* Your total qualified, unreimbursed medical and dental expenses (including premiums and costs like co-pays, deductibles, prescription medications, etc.) must exceed 7.5% of your Adjusted Gross Income (AGI).

* You can only deduct the amount of expenses that exceeds this 7.5% threshold.

* You must choose to itemize deductions instead of taking the standard deduction.

Most taxpayers use the standard deduction as it is often larger than their total itemized deductions.

[zeroonetwothree]

It would make insurance less tied to employment without nationalizing it.