The obvious solutions include new hybrid classifications or mandating certain benefits based on tenure. Why is this not considered? Why take away choice from those who specifically decided not to get a full-time driving job (which have always existed)?
I think a more productive line of debate would be:
1. Do we, as a society, believe we should only care for those who can be productive?
2. Do we, as a society, value things other than productivity?
3. Do we, as a society, believe it is the place of a governing body to ensure a standard quality of life (whatever that standard may be)?
Putting barriers around who deserves what doesn't really serve to do much other than exclude people who don't know how to work the system, or those who are unable to work the system.
In some countries these decisions are made for you and funded through taxes and fees. Other nations require you to plan your own way. The USA leans toward the individual over the state.
Certain things like healthcare should be revamped to remove the ties to employers but it's important to keep the prevailing culture in mind. People overwhelmingly still want the ability to choose here - what they lack are the options to choose from.
As an example my grandfather lost his leg to a blood clot due to being sent to an overwhelmed hospital that left him sitting undiagnosed for hours on end - it is easy to read that scenario as being forced into a lack of care, but choices wouldn't help things here. If he had a choice he would have advocated for going to his family doctor first which would have made the situation worse - in all honestly hospital overcrowding and underfunding is the only thing that led to him losing his leg.
Healthcare is a sector of the market that most people here (even me - and I work in a company that deals specifically in the US healthcare market) don't have enough knowledge to make intelligent choices in because the knowledge needed to comprehend all the random crap that can go wrong with your body is intensely deep.
I also don't think it's far to say the US favors individuals over the state - the US cares very little about individual health. And that's not precisely what you meant when you said it favors individuals over the state but I think it's important to highlight that the situation in the USA is quite detrimental to a lot of individuals.
And yes, I do want to choose my healthcare. I want to select the plan that best fits my needs. If you want a larger simpler plan that covers everything then you can choose that.
Me having choice does not take away from you, it only provides more for both of us.
And I especially don't understand how it doesn't lead to exactly the problematic outcome we are talking about which is that poor people can't afford access to quality healthcare.
You don't "choose" what level of fire department protection you need. How is healthcare different? I suppose you can always hire your own private firefighter/doctor...
So long as you give people the choice, and it's based on PERSONAL financial contributions rather than government-organized taxes, those with less means will have less access to a finite set of healthcare resources and result in systemic inequalities.
I suppose I can imagine that there is some "ultra deluxe" version of healthcare where instead of crutches you get a wheelchair, and instead of a shared recovery room you get your own, and I do support those with the means to pay extra for something like that. But the baseline HEALTHCARE access part needs to remain the same...
The issue is that better coverage requires private insurance, mostly offered through corporations. Smaller companies can't compete, some people can't leave a bad job because of losing their plan, and others are limited to public options because they don't work. This is the overwhelming problem with USA healthcare. There aren't actually many choices because of this complex and outdated connection between jobs and benefits.
I know that today America has choice. But it leads to the highest healthcare costs in the Western World (to allow for middlemen healthcare companies to be some of the largest privatecompanies in the country), with the worst quality for the poorest people.
So the question is, how do you solve the problem of universal access while giving people the "choice".
> The issue is that better coverage requires private insurance, mostly offered through corporations
Not in the rest of the western world. We just simply don't have these companies. They don't need to exist. They are a form of corporate socialism transferring wealth from taxpayers to mediate something that can be handled directly.
Health insurance companies is a moral failure. I'm going to double down on my metaphor. Fire engines don't check your insurance to decide if they should put your fire out. That used to be how things worked 100 years ago.
The choice for better healthcare is limited and locked behind employment. That's the problem, instead of letting everyone have access to all plans, and the solutions are too complicated to discuss here. However insurance is not a moral failure, it's a financial and risk management concept. Just because your government manages somethings for you with your taxes doesn't mean it doesn't exist.
I understand that when you're a fish it's hard to understand what water is, but the fact that employment plays any part into this whatsoever is a problem. Nobody in Canada or the UK or Luxembourg (some countries i have some experience with) would ever factor in healthcare in a decision to start or leave a job. It is absolutely not a variable.
Yes, I've said exactly this about half a dozen times now. It seems you're arguing based on myths and preconceived notions against the USA rather than actually responding to anything I've said. Let's end it here.
I just don't understand you acknowledging that healthcare choice being locked behind employment and insurance companies middlemen being a problem yet still wanting "healthcare choice." What does that mean to you if you don't have the others any longer?
I absolutely want to choose my healthcare.
The choice being discussed here is specifically around health plan particulars like stronger vs. weaker drug covers - surprising you by not covering any oncological drugs - or having a different balance between deductible and cost.
I'm still trying to grip why people care about choice though since most of those become non-issues with national insurance - most of those choices are about how you're going to balance paying for care with limited resources, while in nationalized systems the question of cost is mostly or fully removed - it's just the auxiliary costs that still can bite you (i.e. parking costs at a hospital, costs for a private room for recovery, etc...)
People have preferences for different doctors. Choosing different doctors is part of choosing your healthcare. Personally, I order my own tests and come to doctors with recommendations and ideas to discuss. Not all of them are open to this collaborative approach.
In terms of choosing insurance... It's a little silly to talk about what people want. What many people want is to go to whatever doctor or hospital whenever they want and have someone else pay for it. They often foolishly choose to limit out of pocket costs at point of service, while paying for coverage they don't need. Different people have different concerns. My preference is for my insurance to be for when I need it, and "first dollar coverage" is insuring me for an expense I can already afford, making it a bad deal.
To me the "prevailing culture" is more about the vibrancy of walking into a vendor and directly paying for services that you would like, rather than needing to appeal to some bureaucracy (whether "public" or "private") to convince it to agree that you "need" something. The medical system is currently so far from this, that I don't think it has much bearing on the practical reforms being discussed. Although I would love to see reforms in this direction as well - eg published price lists uniform for any payer, and a prohibition on arbitrary post-facto billing.
It's more like the providers have to conform to the Medicare pricing, instead of screwing the payers. This is why we need single pricer. Simply put into Medicare pricing agreements that the provider cannot charge anyone more than they charge Medicare or Medicaid. Not only does it avoid the price gouging of the uninsured and privately insured, it also ends the whole concept of out of network. Very few providers can survive without Medicare funds.
Politically I wonder what's holding this back, as it seems like it would be more palatable than Medicare for all. Silent hospital lobby? Big insurers that don't actually want to make their market more efficient as they're effectively cost-plus entities?
Not balancing this means society will go into decline one way or the other.
Offering basic levels to society members is health if the society can afford it and allows the society to grow quickie because risk is removed.
This is overly simplistic. Someone providing child or elder care is providing social value in a way which should not be measured against economic measures of production. Life is not an economic zero-sum game.
You might "work" 2h a month, because you spend the rest of it caring for family members, or maybe you're trying to get that first draft/beta version out the door.
Or you might just not want to work.
We need to stop assigning so much worth to work. We know automation is coming, and we know that not everyone is going to be able to find work in the future.
I mean it as a serious question, as it's not clear to me what the difference between benefits and salary is (not being from US).
I understand that the health insurance is one of them (and, to be clear, I do believe you should have that whether you work 0 or 100 hours a month).
But what are others? Pension contribution is just a part of your salary that you are required by law to put aside. Guaranteed minimum time off comes to mind, but that obviously makes less sense if you are already not working too much. What else?
There are millions of employees in the US who work part-time and choose their own schedules.
They do not allow you the same flexibility to work for the next 30 minutes, take a few hours off, then work another hour this evening without doing anything more than just starting or stopping the app whenever you feel like.
How would you replicate that with part-time hours?