s/o Health Insurance

[purplejackmama]

So why IS health insurance tied to employment? Help me understand this.

 

Full disclosure: we have always been either self employed or independent contractors so we have never benefitted from the incredible health insurance that others mentioned in the last thread. Obviously, this skews my view.

 

I just want to pay a fair price for adequate coverage.

[Guest]

It wasn't always. Companies used it as a perq to attract employees, and then it became standard.

[wapiti]

IIRC, it goes back to wage controls during WW2.  Benefits were offered to attract employees because higher wages were not allowed.

[Carol in Cal.]

The government has allowed companies to write this off as part of their compensation expenses, and before the ACA, insurers gave guarenteed coverage (regardless of health) to employees of a company large enough to provide economies of scale by doing so.  Providing health insurance to all employees gave companies a more stable, healthy workforce, without having to commit to wage increases.  

 

The rest is history.  

 

At this point, though, the ACA seems to be distorting that previous distortion of the market.  Now insurance firms cannot turn people down who are in poor health, and also there is some fiscal discouragement of employers providing really excellent medical coverage, both of which militate toward higher prices across the board for consumers.  It's hard to see where this will land, since the penalties for not buying coverage are also increasing.  

 

To me it feels like we took a really bad system and made it worse for almost everyone.  Although I'm very glad about those in really poor health who now can get coverage.  But it's become so expensive for so many people.

Edited May 23, 2016 by Carol in Cal.

[Twigs]

… To me it feels like we took a really bad system and made it worse for almost everyone.  Although I'm very glad about those in really poor health who now can get coverage.  But it's become so expensive for so many people.

:iagree:

[Guest]

The government has allowed companies to write this off as part of their compensation expenses, and before the ACA, insurers gave guarenteed coverage (regardless of health) to employees of a company large enough to provide economies of scale by doing so. Providing health insurance to all employees gave companies a more stable, healthy workforce, without having to commit to wage increases.

 

The rest is history.

 

At this point, though, the ACA seems to be distorting that previous distortion of the market. Now insurance firms cannot turn people down who are in poor health, and also there is some fiscal discouragement of employers providing really excellent medical coverage, both of which militate toward higher prices across the board for consumers. It's hard to see where this will land, since the penalties for not buying coverage are also increasing.

 

To me it feels like we took a really bad system and made it worse for almost everyone. Although I'm very glad about those in really poor health who now can get coverage. But it's become so expensive for so many people.

It was always really expensive and the price was going up each year. I'm grateful for the ACA because DH is uninsurable (through no fault of his own). At least now, he can get (crappy crappy) coverage. Edited May 23, 2016 by Moxie

[goldberry]

When I went from employed to self-employed, all the policies I was quoted excluded all the conditions that I and my husband had.   I was on meds for depression and took a migraine medicine (not daily but as needed, so maybe once a year.)  My husband took allergy meds once a year in the spring.  I thought they only excluded things like diabetes or cancer, but nope, they could and did exclude anything we had. :glare:

 

Employee plans were not allowed to do that, exclude conditions or entire employees, because they were working with a group and had to cover the whole group.  I guess the idea was that everyone got a better deal when a whole group was included.  That seemed to be part of the advantage of covering through employers.

 

Under ACA individual plans are no longer allowed to do that either.  That would make me happy, except now we can no longer afford ANY plan due to the crazy price increases.  So... there ya go.

Edited May 23, 2016 by goldberry

[purplejackmama]

Goldberry, I hear ya!

 

But why can't all humans be "one group."

[kewb]

Count me as another thankful for aca or my dh would be uninsurable,   

 

As someone else said a job with benefits used to be the gold standard of emplyment.  Companies used it to woo excellent employees. Thanks to increasing costs and demands on doctors from insurance companies I see a rise in concierge medicine in my area.  Doctors don't take any insurance.  You pay an exorbitant fee but the doctor actually spends time with you and makes a diagnosis based on a thorough exam.  So even witht the aca people with money will always have access to excellent health care while the rest of us try to make it work.

[Guest]

I wish we could put some of this toothpaste back in the tube.  I wish we could --

 

--deal with some of the litigiousness of our society.  While I would never outlaw lawsuits, it is clear that the lawsuit mania has jacked up prices for medical care.  Too many tests because doctors are afraid to diagnose without them, even though they are 99% sure of their diagnoses without them.  One of my friends has MS and the doctor wanted a yearly MRI.  At what, $3000 a pop?  She asked what would be the purpose of the MRI.  Turns out is was so the doctor could see the progression of the lesions.  It had nothing to do with anything that could make the MS better...no decisions would be made based on the MRI...it's just "standard practice."  SHE knows when she's having an exacerbation, and an MRI is just $3000 out the window, so she stopped doing it annually.  I think she does it every 5 years now, sort of as a "baseline" for information.  

 

--have some expectation that normal medical care is out of our own pockets.  I know for a fact that when I quit my job with the A++++ health coverage, suddenly I didn't need to go to the doctor as often...and I got a lot more concerned about staying healthy.  There's a difference between what started out to be "health insurance"--to protect against catastrophic illness or accidents, and "health care coverage", which is essentially for MOST people just smoothing out the payments for their medical care, some paying more and some paying less.  I do think we as a society can do something to level this out for everyone so that Fate doesn't make one family suddenly lose *everything* or have to choose between eating and dying...but there is an awful lot of standard care that we could expect to be part of life.  

 

--I wish we could be made aware of what something (a test, a visit, a med) costs.  We would probably be more able to control costs.  Last month I got a prescription, took it to the Costco pharmacy, and found it was $283.  I was shocked.  I called the doctor right back and asked if there was another option--and yes, there was, and it was $28.  I have NO CLUE why he prescribed the expensive med.  I am self-pay and told him so.   Also see MS story above.

 

Employers pay for that insurance; it's pay you don't get, really.  THAT is one reason I wish the insurance (and a lot of other benefits) were not tied to employment.  I'd rather have the cash and make the best decision for ME and my family, as regards ALL the company benefits.  I would have made better decisions than my company did, and made more money, too.  

 

 

 

 

 

[Bluegoat]

Goldberry, I hear ya!

 

But why can't all humans be "one group."

 

They can - it's called universal insurance.

[Serenade]

 

 

--have some expectation that normal medical care is out of our own pockets.  I know for a fact that when I quit my job with the A++++ health coverage, suddenly I didn't need to go to the doctor as often...and I got a lot more concerned about staying healthy.  There's a difference between what started out to be "health insurance"--to protect against catastrophic illness or accidents, and "health care coverage", which is essentially for MOST people just smoothing out the payments for their medical care, some paying more and some paying less.  I do think we as a society can do something to level this out for everyone so that Fate doesn't make one family suddenly lose *everything* or have to choose between eating and dying...but there is an awful lot of standard care that we could expect to be part of life.  

 

 

 

I think this is important.  I think in order to have a viable, sustainable healthcare system, people will need to go back to paying for basic care themselves and saving the insurance for big-ticket needs.

[Alessandra]

This may anger some people, but I wish people who got insurance through employers had to pay income tax on the employer paid portion.

 

I also wish the *full* amount of self paid medical costs counted as a deduction on personal income taxes.

 

The system is just so stacked against the individual.

 

I get the best insurance available in my state, gold plan

$1000 deductible

$4000 stop loss

No out of network coverage

 

Last time I looked at teacher plans

$100 deductible

$400 stop loss

Out of network coverage provided (at lower percentage than in network)

 

My taxes help pay for the teacher (and teacher family) plans

 

Some towns around here pay employees if they decline insurance (say, because a spouse has insurance).

 

Grrrrr....

[Guest]

This may anger some people, but I wish people who got insurance through employers had to pay income tax on the employer paid portion.

 

I also wish the *full* amount of self paid medical costs counted as a deduction on personal income taxes.

 

The system is just so stacked against the individual.

 

I get the best insurance available in my state, gold plan

$1000 deductible

$4000 stop loss

No out of network coverage

 

Last time I looked at teacher plans

$100 deductible

$400 stop loss

Out of network coverage provided (at lower percentage than in network)

 

My taxes help pay for the teacher (and teacher family) plans

 

Some towns around here pay employees if they decline insurance (say, because a spouse has insurance).

 

Grrrrr....

The last sentry is what I am talking about in my response: that was illegal in our state when I asked about it years ago. My dh and I both had super-gold coverage for both of us from our company but we were not allowed by law to have one of us opt out of the health-care and receive cash instead. I asked. That would have been at least $20,000 more for my paycheck.

[ktgrok]

I think this is important.  I think in order to have a viable, sustainable healthcare system, people will need to go back to paying for basic care themselves and saving the insurance for big-ticket needs.

 

The problem with that is you still end up with kids who can't afford to have their asthma treated or get meds for it. Because their parents didn't budget for it, or don't have the money. That's not  okay for me. 

[ChocolateReignRemix]

IIRC, it goes back to wage controls during WW2.  Benefits were offered to attract employees because higher wages were not allowed.

 

This is it in a nut shell.  There was also a significant change in the type of care available, starting with WW1.  (Wars tend to bring about medical advances via necessity.)

[LucyStoner]

The runaway costs of healthcare are most closely linked to the inelastic nature of demand for critical items and the lack of competitive price bidding and negotiation in our system. if my kid needs a medicine, I will pay $20 if that's the cost or I will pay $200 if that's the cost. I don't have any real ability to negotiate with the pharmacy over that and if my kid needs it, I'm finding a way to pay for it. Meanwhile, the same drug could be $6 in countries with single pay. We spend a larger amount providing healthcare to some Americans than most western countries spend to provide healthcare for everyone. They get cheaper prices in single payer systems because companies have to compete to sell to the national systems, who are going to take the best quality lowest price bids. Here, companies charge amounts which are often (even the rates insurance will pay) many times more than people get similar procedures with similar quality in a lot of other countries.

 

Lawsuits, over usage and disease prevalence don't actually drive up costs all that much. That's a bill of goods we've been sold to keep people thinking our problem is an easy fix with a partisan solution.

 

Why do we have employer based insurance? Because we didn't pass a national health plan in the 30s or 40s like a lot of countries and employers had to start using it as an incentive to get the best employees. Now that the infrastructure is built up around that, it's scary for a lot of people and jobs to undo it and implement something else.

 

From a business standpoint, having to provide insurance is a competitive disadvantage to our large companies in the global market with countries who do have national health systems and it's also one of the largest thing smashing down small businesses and innovation. I know people who keep their job for the benefits even though they want to start a small business. I know people with small businesses that can't afford to draw the talent they need to level up away from large companies because they can't offer competitive insurance packages.

 

So we got that and we don't know how to get out.

Edited May 24, 2016 by LucyStoner

[Alessandra]

The last sentry is what I am talking about in my response: that was illegal in our state when I asked about it years ago. My dh and I both had super-gold coverage for both of us from our company but we were not allowed by law to have one of us opt out of the health-care and receive cash instead. I asked. That would have been at least $20,000 more for my paycheck.

 

Being able to opt out and get paid is by no means universal here. But it has been in the papers a fair bit, because some towns have allowed payments in lieu of insurance for municipal employees, which is upsetting to many taxpayers.

 

The entire system upsets me..

 

Here's the article I was thinking of. It's a bit more complicated than I remembered.

 

http://www.northjersey.com/community-news/town-government/health-benefits-quandary-in-teaneck-1.1503292

Edited May 24, 2016 by Alessandra