[rayiner]

I don't even need public healthcare. I just want something that does away with the current employer-sponsored system. We should make it easier, not harder, for people to move between jobs, take gaps to start companies or get new training, etc. We shouldn't be discouraging younger workers from getting preventative care so they can stay healthy and keep contributing to the economy.

[mrbird]

David Goldhill wrote an excellent piece in The Atlantic a few years ago on this topic. The fix is quite simple, but nearly impossible to implement: Stop using insurance for health care, and buy actual insurance (you know, for catastrophes).

How often do you use your car insurance? Fire insurance? That's because insurance is designed to never be used, by most people. Health insurance has been unfortunately recast into comprehensive health care, with disastrous results. But the system is very entrenched now.

http://www.theatlantic.com/magazine/archive/2009/09/how-amer...

[caseysoftware]

That's the core concept behind a Health Savings Account and has been excellent in my case.

If you think of it as a 401k - put money when you're young before you need it - I think it is viable for many people under in their 20's and early/mid 30's.

But HSA's were eviscerated until Health Care "Reform" so it probably doesn't matter now anyway..

[davidmr]

I'm sure that you're aware of this (and is why you used the word "many"), but the fundamental problem with this is the assumption that you're saving when young for what you need when old. There are those of us who aren't particularly healthy through no fault of our own.

While I'm sure no system under the sun could be made universally fair, it seems particularly unfair to saddle people with vastly different costs based on purely external factors. With nearly every other expenditure I can think of, a person has a choice whether to pay it or not, or at the very least whether to pay more or pay less. If I wind up in the hospital, there are a certain number of things that need to be paid for no matter what. My employer gives me an option for a regular PPO and an HSA-based PPO. The latter would have cost me several thousand more a year.

And all of this notwithstanding, this methodology of health care payment doesn't appear to me to work for people who actually have no or very little money. I'm fortunate enough to not be one of those people at the present, so I couldn't say for sure how an HSA-based health care system would be any better or worse for them than our current system.

Of all the things I'm thankful for, being thankful that it's not my job to try to figure this stuff out is near the top of my list.

[billpaetzke]

Ya the problem there is you'll pay 2-4x more per event because you don't get the health company negotiated rate.

[specialist]

I don't get the negotiated rate business. With a large enough pool (eg universal coverage) the costs level out. The divide and conquer scam played by US insurers is just a way to segment the market to maximize their profits.

[techdmn]

Seconded. I'm starting a new job Monday, a large part of being able to switch was having my wife start a job that also provided insurance. I could have bridged the gap with a spare $1500 a month, but having an alternative in place certainly helps.

[yaks_hairbrush]

Absolutely, yes! I was and still am upset with PPACA because it reinforces the horrid employer-provided care model.

[tptacek]

No it doesn't. It doesn't scrap employer-provided care, but it takes significant steps towards alternatives.

The major reason employer-provided care is dominant is that employer care is guaranteed-issue and automatically deducted. Employees of large companies are not screened or given physicals before insurance is extended.

Under PPACA, all health insurance is guaranteed issue. And while enrollment isn't automatic, it's enforced; you're fined if you don't get insurance.

[jacoblyles]

Employer provided care also comes out of pre-tax money. So employers get a big discount compared to what you would pay for the same plan.

[cma]

The new plan does make it easier to move between jobs, take gaps etc.: pre-existing conditions no longer matter when getting insurance, and the employer tax break for providing insurance is now extended to individual health insurance as well (which used to only happen if medical expenses exceeded X% of your income).