[Taikonerd]

> We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)

Doesn't this already partly exist? My (US) employer offers an HDHP (high-deductible health plan) that comes with an HSA.

(It's not quite what you described, because you have to use the insurer that the company picked. I think you're describing something more like the Singaporean system with Medisave.)

[stetrain]

The main difference there is that with an HDHP your employer is still the one choosing the insurance provider, and the insurance provider views your employer as the customer. There's no risk that you as an individual will switch to another provider as long as the employer remains with this one.

Removing that layer of indirection would make it your own choice to pick a provider, and the provider is then incentivized, at least a little bit, to provide you with a good outcome or else you may freely switch to another provider.

There's also the component that, right now, you lose the discounted group rate insurance premium as soon as you lose or leave a particular job. Putting the purchasing power with the end consumer means that you can keep your provider at the same premiums even if you switch jobs. All that might change is your employer contribution.

[estearum]

I think the mechanic they're trying to speak to is that due to insurance being tied to employer, no insurance plan (besides Medicare/Medicaid) is truly motivated to ensure good health outcomes beyond a ~4 year horizon. You'll switch jobs and get a different plan.

[Ichthypresbyter]

FEHB plans would also have this incentive. I think at least historically Federal employees didn't switch employers as much (though job-hopping between agencies happens), but more importantly if you retire from the Federal government you keep your health insurance.

[snarf21]

Yeah, what I'm suggesting is that your premiums are funded through your HSA, not just your deductible and medicines. Obviously, the max HSA funding amounts would have to change.