[abeppu]

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but:

- job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point

- except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do

- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"

Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.

[kevincox]

Not to mention that tying your insurance to your job is a *huge* pain. If you switch jobs or get fired you need to deal with coverage gaps, considering individual coverage for the duration, and you may need to switch care providers depending on what your new coverage is.

It is just a really awful system overall.

[giovannibonetti]

> It is just a really awful system overall.

You mean for the user. It is great for the insurance companies, though, since tying health insurance to employment indirectly keeps the average user age lower, thus making the overall scheme more profitable.

As a general rule, people use health benefits more as they age.

[cmiles74]

It's really tough on people with a particular health condition and it can turn into an additional expense if a critical provider is suddenly out-of-network. Employers have definitely given me side eye when I've asked for details on the health insurance plan.

United Healthcare is pretty big in the US, they are also famous for forcing people to spend a lot of time on the phone, waiting on hold or advocating for care. I expect this ends up taking time that the employee would otherwise have been working as well as negatively impacting morale.

[DrScientist]

Markets require information to operate efficiently, but it's not actually in the interest of the companies involved. Who wants to have to endlessly ruthlessly compete? They would much prefer monopolies or cartels - however governments regulate against those.

Hence the "Confusopoly".

The more complex and opaque the system is, the more opportunities for value extraction by those on the inside.

[preg_match]

The main reason health insurance matters so much is it can't be bought. No amount of money can "upgrade" your employer plan to a good one if it sucks. If you have a nice PPO with a low deductible and low out of pocket max, that's a diamond in the rough. If you switch to an HMO, now you can't arbitrarily see specialists. Yes you could maybe cover the deductible cost or whatever, but your actual care will be impacted. And money can't fix that.

Most people don't care, including me. Until I got cancer, then I cared, because suddenly this was the stuff that could make the difference between me living and dying.

While I am incredibly privileged, it shouldn't be this way. Beyond the waste it's horribly anti-competitive for consumers. Consumers want better plans, and they have the money. They can't get them. That's a huge smell for "the market is fucked". And fucked it is, beyond belief.

[vel0city]

I can only speak to my own experiences with salaried work. I'll also preface that I don't like healthcare being tied to employment.

All the job interviews that went to the point of discussing compensation, healthcare benefits were almost always included when negotiating what actual compensation would be. A difference of them covering several hundred dollars a month in premiums and them matching some % of HSA contributions is several thousand dollars a year in compensation differences. When multiple job offers are pretty close, that can make a difference.

Also, the few times employers have offered healthcare concierge as a benefit it was definitely mentioned in the overall compensation package.

[balderdash]

I don't think think I've ever had a job offer where this wasn't a topic of conversation. its further down the flow signing bonus, salary + bonus/equity/incentive are obviously the big ones, but I've always seen vacation, 401k+match, summary health care, relo package, etc care before accepting an offer admittedly its never been a obstacle and probably only moves the total comp needle a couple of percent. honestly its always been the easiest place for me to pick up money with little push back (extra week vacation, 5 years seniority at start for full 401k vesting/match etc.)

[lII1lIlI11ll]

> Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives

There are countries where private health insurance works great. The problem in US is how it is regulated.

[insane_dreamer]

> it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point

I disagree. We went over healthcare benefits with a fine tooth comb when my wife was deciding to take a position. It certainly mattered.

Another factor is that even if the employer covers nothing and you have to pay the entire premium, just being able to buy the plan through the employer is _significantly_ cheaper than buying it as an individual.

[tsunamifury]

At the high end in tech it’s just assumed it’s all good plus you can make choices on what plan of several offered.

But for many normal jobs it’s very normal to use health care coverage as a negotiation or decision point.

[dsr_]

My workplace has made health insurance a competitive point: zero employee premium, zero copays except for an ambulance call which does not result in an admission, zero Rx costs. Full family coverage.

The dental coverage was screwed up for the first 4 months of the year. An assumption was made that all dental plans were basically the same in terms of payments to dentists. This turned out not to be the case.

Everyone should have this, but until we do, it will be a reasonable negotiating point. Why should non-health-care employers be in the healthcare business?

[drakythe]

Chiming in to say that health insurance and benefits are a huge part of what I look for in job listings, and all of my friends currently looking for new jobs too. It may feel less relevant when we were young, but approaching middle age and it becomes a huge driver of continuing in a shitty job and in accepting an offer.

[gruez]

>- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"

"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.

[Schlagbohrer]

And in the US a new worker can only join the healthcare plan during certain times of year! New workers often have to wait months with a health insurance gap before they can get on the new plan.

[itsmartapuntocm]

That's not true. If you're new there's a special enrollment period right after you start.

[petcat]

That's up to the new employer. Federal law only requires special enrollment within 90 days of hire. So technically there can be up to a 3 month gap.

In practice, that is very rare. Usually new coverage becomes effective on the hire date.

Workers changing jobs often just elect for COBRA or selecting a temporary subsidized ACA plan to bridge the gap though. Nobody is really forced to go without coverage.

[plagiarist]

I am not an expert but I am pretty sure changing a job is a "qualified life event" that allows an out-of-band change. I hate privatized insurance but I didn't think this thing in particular was a problem.

[dudul]

That is incorrect. When you start a new job you have a few weeks to enroll.

However, you sometimes have to wait for the plan to begin coverage. Something like "after 30 days of employment", or "on the first day of the first full month of employment". These are indeed idiotic limitations.

Worst case scenario, if you are changing job and something really bad happens during these 2 weeks where you don't have coverage you can retroactively enroll in COBRA.

[dudul]

It may just be a me thing, but when discussing a job offer I always ask for details about the health insurance. I want to see the premiums, what is covered, the networks, etc. All the details given to current employees when they go through open enrollment. And I can count on one hand the times where it was difficult to obtain from the recruiter or "HR lady".

That being said, nothing tells me the plans won't completely change in a few months of course. That's just the "game" and I also hate it.

Just give me the money directly and let me pick my plan from a marketplace that doesn't suck balls. If employers still want to give some incentives to be more competitive fine, but I shouldn't have to time my job switching to avoid coverage gaps.

[Aurornis]

> job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point

Health insurance has been a primary topic in every job offer I’ve had, my entire career.

If a company won’t discuss the insurance situation or provide details about the employee contribution, that’s a warning sign. This is a routine topic for negotiations and any company hiding this data is not a company you want to be working with.

[ryandrake]

Are there really employers who negotiate this? Every job I've ever had in tech had a single "medical benefit" package that everyone just got. You couldn't negotiate your particular health insurance premium or what portion the employer paid for. Everyone gets the same thing. The only choice I've ever seen was a menu of two options: PPO or high-deductible plan.

So it's good to know the details of the plan (so you know your doctor isn't going to suddenly be out-of-network) but there's not much you can do with this info besides "take the job or leave it."

I'm sure when it comes to executive compensation, everything is open to negotiation, but not for us worker bees.

[Aurornis]

They don't negotiate the terms of your health insurance.

It's presented as part of the negotiation for total compensation.

You have to know the benefits to be able to understand the total compensation, which is what you're negotiating.