Why the US is the only country that ties your health insurance to your job
Why the US is the only country that ties your health insurance to your job
Nobody would build a system like America’s on purpose.
This is super personal to me because it almost killed me. I've told this story on reddit, but it bears repeating:
tl;dr lost my doctors due to an insurance change 4 weeks in to a 6 week open heart surgery recovery...
In 2018, my company was in the process of being sold. No big deal, above my paygrade, nothing for me to worry about.
Then I got sick right after Thanksgiving. Really bad heartburn that lasted 5 days. It wasn't heartburn. I had a heart attack. 12/3 I had open heart surgery, single bypass, and that started a 6 week recovery clock.
On 1/1, the sale of my company closed and we officially had new owners. I also officially lost all of my doctors because the new employers don't do Kaiser in Oregon. They do it in WA and CA, but each state has to be negotiated and they never had presence here.
1/2 I start working with Aetna to find doctors, hospitals, etc. Beyond the cardiologist I need a new pharmacist, podiatrist, diabetes care and a general "doctor" doctor.
Fortunately, my new employer is a big enough fish, they have their own concierge at Aetna and she gets me into the Legacy system.
On 1/3 I start developing complications, but I don't know it at the time. It starts with a cough. All the time. Then, when I try to lay down, like to sleep, I'm drowning, literally choking and gagging.
The concierge and I try to get an appointment, we're told 2-3 months. For a dude still recovering from open heart surgery? Best they could do is 2 weeks. 1/14.
I can't lay down to sleep so I buy a travel neck pillow and sleep sitting up.
I get to see the new doctor at the "official" end of the 6 week recovery. He doesn't know me or my history so he wants to run tests.
I'm sitting at home playing video games and waiting on test results when the call comes... Congestive heart failure. Report to the ER immediately.
My heart developed an irregular heart beat, which caused fluid build up in my chest. They admitted me and were getting ready to pull fluid off me.
"What happened to your foot?"
"I dunno, what happened to my foot? I can't feel my feet."
Remember when I said I was sitting around playing video games, waiting for test results? Yeah, my foot was touching a radiator and I didn't know it. 3rd degree burns, first four toes. Pinkie was spared.
So I'm in the hospital a week. I lose 4 liters of water per day. 50 lbs. of water. No wonder I was drowning. Regular bandage changes.
So now I'm facing two procedures. Electrocardio version to fix my heart, skin grafts to fix my toes.
This whole time the new insurance covers 80% until I reach the out of pocket maximum of $6,500. Then it will cover 100%.
The old insurance? ER visit for heart attack, hospital admission, 8 days in the hospital, open heart bypass... $250.
So we hit the out of pocket maximum almost immediately. My wife had a problem with her foot running through the Seattle airport. The doctor who did her toe amputation was decided to be out of network so that was another $1,100.
I was never unemployed through all this. I had enough vacation and sick time banked to cover it. Cobra didn't apply. Buying my old insurance wasn't an option, it was far too expensive without employer backing. Income is too high for assistance (thank god) and I took steps to max out my HSA account, which is good because we drained it twice.
Three 1 week hospital stays (2 for me, 1 for my wife), multiple ER visits, two more major medical procedures... That would be enough to break most people even with good insurance.
So if you read any of that, let me ask you something... Why does the quality of my health care and my quality of life have to depend on who I work for and what insurance companies they choose to work with?
History lesson time: This wasn't done on purpose. It's an artifact of decisions made by Congress during World War II to support war production.
So many young men were away at war that it created a labor shortage, even with some women entering the work force. This led to spiraling increases in wages that were threatening the viability of critical war manufacturers.
In an effort to protect this manufacturing sector, Congress capped wage increases. But those corporations were still competing for workers and now they were no longer able to offer them higher and higher wages. So instead, they started offering them "perks" like health insurance, pensions, and paid time off.
THEN:
"In 1943 the War Labor Board, which had one year earlier introduced wage and price controls, ruled that contributions to insurance and pension funds did not count as wages. In a war economy with labor shortages, employer contributions for employee health benefits became a means of maneuvering around wage controls."
Emphasis mine. And guess what? When those young men returned from war and re-entered the work force, they wanted those perks too. So which company was going to be the first to deescalate the arms race and NOT offer health insurance?
And those perks being so ubiquitous meant the government never had an incentive to provide health coverage directly to anyone of working age, so we only have Medicare for retirees.
Wage slavery.
No small businesses want to mess with this shit. Just give everyone health insurance, all the time, without the interference of corporate greed. Doing so would reap a huge savings of scale efficiency. Get rid of the middle man.
My wife and I were just talking about this. We pay $600/m and the very few times we go to a doctor we end up paying anyways. We never meet the deductible but we can't not have insurance because we have a kid who does need it. In the twelve years we have paid we have never reached the deductible even with having a kiddo who's had surgery. Once you get past october it seems like they charge it to the following year if your close to meeting the deductible it's insane...
So we don't fuck off work to mass protest and dine in the flesh of the wealthy.
Saved you a click.
Because we've regressed into one of those shithole countries our wannabe dictator keeps harping about.
It even happens in Canada, just to differing levels.
We don't have a national pharmacare plan so any drugs you need outside a hospital will come out of pocket.
You either need to pay for private insurance or get it via a job where it becomes mandatory for full time employees (possibly past a certain enployee count)
Personal experience: having guaranteed health care not tied to my employment is a huge burden off my shoulders. I am so grateful that my wife and I are taken care of, and I vote for people who try to make it happen for everyone. But let’s face reality, there are huge entrenched interests that oppose any kind of universal plan, so the ACA with all its flaws is probably the best we will get for quite some time. Even where I live, in California, with the legislature and all statewide elected offices under single-party control for years now, it hasn’t happened. The ACA was a deal with the devil to get more people insured, yeah, but insurance is no guarantee of health care. I’m glad I have the latter.
Answer: greed
Greed. Anything weird or shitty we do, it's because of greed.
It’s a benefit that makes you beholden to your employer. Especially when switching employers meant switching insurance and any condition that developed under your previous insurance could be viewed as a “pre-existing condition” to your new insurance and would not be covered.
This is the best summary I could come up with:
“In an ideal world, that might not be the best way to organize the health care system,” Eric Toder, institute fellow at the Urban-Brookings Tax Policy Center, told me.
Insuring people through their work offered two advantages that were obvious to employers, hospitals, and policymakers, Paul Starr, who wrote the seminal history The Social Transformation of American Medicine, told me.
During the Great Depression, FDR considered making national health insurance part of his signature New Deal legislation — which would have made the US a pioneer — but those provisions were nixed to prioritize the Social Security retirement and disability programs, among others.
After the war, Harry Truman made another attempt at national health insurance, but it was scuttled over opposition to new taxes and dogged by association with left-leaning economic ideas during the Red Scare.
When Vox conducted focus groups on single-payer in 2018, led by opinion researcher Michael Perry, one concern we heard was from people who mostly like the insurance they have and were worried about losing it under Medicare-for-all.
But the state legislature kept cutting taxes, and, in turn, copays for teachers kept going up — eventually costing Salfia and her family $100 just to show up at the emergency room or urgent care.
The original article contains 1,873 words, the summary contains 208 words. Saved 89%. I'm a bot and I'm open source!
Because too many people try to find jobs that let them smoke weed so they have to up the negative consequences of getting fired.