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Comment by projectileboy | Hacker News Reader

Very true. Unless you have a sick family member. Until the ACA, you were 100% trapped. Now, you’re not officially trapped, only trapped in practice, because when you switch health plans, the providers who have been working with your kid for the last few years are no longer in your network, and... you get the picture.

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This is more a problem of the US american healthcare system than one of the nature of the employer-employee relationship.

Yes exactly. In my country (Australia), the majority of employers don't pay for health insurance. Either you rely on the public health system, or you pay for private health cover yourself. So, losing my job, or changing jobs, has no direct impact on my health insurance (beyond the impact on my ability to afford private health cover if there is any reduction of income)

It's also worth adding that the public health system is pretty good, or at least better than some other "first world" countries.

In the 1950s, employee benefits became non-taxable. Prior to that, employees would get health insurance as individuals and their plans would never be tied to a particular employer, kinda like how it currently works in Switzerland. So that one law drove our entire health insurance system to where it is now.

It actually started due to WWII.

> Once America became embroiled in World War II, there was great concern that rampant inflation would threaten America's military effort and undermine its domestic economy. The concern was valid, as Americans had witnessed what inflation had done to war-torn Germany, devastating its economy and giving rise to Hitler's regime.

> To combat inflation, the 1942 Stabilization Act was passed. Designed to limit employers' freedom to raise wages and thus to compete on the basis of pay for scarce workers, the actual result of the act was that employers began to offer health benefits as incentives instead.

> Suddenly, employers were in the health insurance business. Because health benefits could be considered part of compensation but did not count as income, workers did not have to pay income tax or payroll taxes on those benefits. [0]

You can also read about this in a 2017 NY Times article [1]

[0] https://www.griffinbenefits.com/blog/history-of-employer-spo...

[1] https://web.archive.org/web/20210109190532/https://www.nytim...

You were not 100% trapped, by collapsing the propositions of an argument you destroy a meaningful distinction. It is very different to be a serf in fact and a serf in practice. Serf's were legally defined as property and could be bought and sold with land and killed if they failed to work according to the Lords liking. No company can compel you to work on threat of death. Does employer linked insurance suck and have negative, unintended consequences, yes, but you can quit with two weeks notice and find another job with health insurance. The distinction does matter.

That's not entirely true. If you had a "gap in coverage" e.g. you were without insurance for too long (about 30 days?) then limits on pre-existing conditions, etc. might be an issue when you get insurance again. But if you were just changing jobs, going from one employer plan to another, it wasn't an issue (at least it wasn't for me, and I changed jobs many times before ACA, including going back and forth between employer and individual plans). And if for some reason there was going to be a gap between jobs, you could pay for gap coverage under COBRA, or get a short-term individual plan.

> Until the ACA, you were 100% trapped

It is unclear how premiums that exceed income along with deductibles that exceed rent are a freeing experience.

Haha... indeed. I meant specifically from the perspective that you were in a situation where leaving your job meant you were now uninsurable (in many states, at least). I have an entirely separate rant on how the ACA stuck people with higher deductible health plans outside of employers (like me and my family) with virtually all of the risk of the formerly uninsurable. It was more politically expedient for the Democratic Congress of ‘09 to not really try to fix the problem.

It was fairly maddening hearing endless glory heaped upon the ACA, while most sq mi of the US remained saturated with uncovered Americans.

At least until 2017. After that it seemed a little okay to discuss the realities of the ACA.

I mean... it was an improvement, and certainly did enable coverage for a lot of people who otherwise would have gone without. But it was such a lost opportunity, and I wish the Dems could just own up to that and push for something more. The problem is that both sides are so deep in the industry’s pockets, that I don’t think real reform is even possible.

> it was an improvement and ... enabled coverage for a lot of people

This is kind of my point. The ACA was designed to benefit the middle class and non-vulnerable. At which point the middle class and non-vulnerable (and the press) stopped caring about who had healthcare.

To drive home that point: A few years ago I ran ACA quotes for typical income levels (typical for non-wealthy regions, 12k-32k) and found that premium cost steeply dropped for each 10k rise in income.

My primary issue isn't that this happened, it's that we weren't told. It's that ACA supporters + the entirety of press compulsively gloss over ACA realities.

> I wish the Dems could just own up to that and push for something more.

I suggest that uncovered Americans don't need something more. They need something.

> The problem is that both sides are so deep in the industry’s pockets, that I don’t think real reform is even possible.

Pols trading law/power for campaign cash is the other thing that news orgs have ~0 interest in.

My family migrated to different employer healthcare with zero changes on the provider side other than premium cost.

Perhaps we’re lucky or the system is already monopsonized in our area. However, sometimes you can also get the same network at your new employer (e.g. Kaiser or other HMOs).

That said it’d be a lot better with single payer and the largest risk-pool of an entire country.

Is there a reason to regularly switch plans? I keep the same one each time annual enrollment comes up.

You may be forced to switch when changing employers or when leaving your job and COBRA is not a good option for you.

They were specifically referring to the difficulty of switching companies.

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