Didn’t Obamacare fix that?
Gradually these perks started to become as important of a consideration as the salary itself. Unfortunately health insurance is easily misused. We started relying on it to pay for all health care, rather than to actually mitigate the risk of a sudden medical bill. The result has been a rapid and continual increase in the price of health care over the last 70–80 years caused directly by the fact that nobody pays for the services they use, but instead pays into insurance plans that then pay for the care.
In fact, I think this guy overstated the risk to his health. If you get fired you don’t actually lose your insurance. You sign up for continuation of coverage from COBRA, taking over payments for the insurance from your employer, and then purchase an individual or family insurance plan of your own before COBRA runs out. Or get hired somewhere else and sign on to one of their insurance plans. Either way you’ve lost nothing, at least in terms of health care.
I don't think it's as simple as that. Empirically, lots of countries have health insurance systems whose incentive structure could be described in the same way, yet the US is an extreme outlier in healthcare costs. Something else must be going on.
- top-skill, top-paid specialists
- world-class research hospitals with near-luxury-level amenities
- cutting edge pharmaceuticals, including absurdly expensive novel biologics
that is enjoyed by, say, a junior Microsoft developer and her family in Seattle.
One example of how this plays out as GP described is childbirth: There’s something like a 5X cost disparity for a typical birth process between a perfectly competent regional hospital and an elite research institution. But the typical well-insured US mother-to-be doesn’t spend a moment thinking about that difference vs., say, the reported quality of the food.
Obviously, this is not every American’s experience with the system, but for the portion of outlier costs that aren’t related to outlier US population health trends (e.g. obesity), it’s an important part of the story.
Your definition of "typical" apparently is very different from my own, or we are thinking about "well insured" very differently. Every pregnant person that I've ever talked to, if they have a choice at all, has weighed the projected cost heavily in their decision on where to give birth.
The typical person in the US has a deductible that runs well past several thousand dollars and then they have to pay a coinsurance amount, which could be up to 25% of the cost, up to absurdly high out of pocket maxes.
And yes, the cost weighs highly in mind every time we make a decision about whether we need to go to the doctor or not. Not knowing if this trip to the doctor is going to be the one that bankrupts us (cancer diagnosis?), I tend to simply not go unless a limb is falling off. My wife on the other hand came from a country with socialized health care, and can't shake the habit of just going to the doctor whenever she feels ill or injured. Then I have to be the bad guy with the "honey I know you feel sick but do you feel that sick? We're looking at a minimum bill of many hundreds of dollars out of pocket every time you go."
Just a new source of income to pay the rent, or a free place to sleep since you can’t afford rent anymore, now that you’re paying for health insurance instead.
It can easily be dispensed of and nothing would change, people would simply need to go to healthcare.gov.
Health insurance and healthcare is NOT tied to your employer in the US.
However, many employers pay 50% to 70% or even 100% of the health insurance premiums for their employees, and employees can use pre tax income to pay health insurance premiums if purchased by their employer.
The problem has always been this tax advantage of your employer purchasing it, AND most Americans opting to not purchase it due to cost.
Note that there are significant subsidies available if you earn less than 400% of the federal poverty level, although that may still leave many unable to purchase it (or the deductible/oop max is so high it would not make any difference).
> If you end up needing a hospital stay, you could be in trouble if the "wrong" doctors do a drive-by.
This is not true since the No Surprises Act went into effect Jan 1, 2022. Everything is considered in network in an emergency, and if a doctor works in an in network hospital, then the doctor is considered in network too.
Usually in an emergency I don't have the presence of mind to direct the ambulance to the right hospital (in case the emergency turns into an overnight stay), and it's all the more important if the plan doesn't have good (or any) out of network benefits.
By "insist," I mean that leaving would be against medical advice -- and I know some insurance will refuse to pay for the preceding stay.
I wish this stuff weren't so hard to make sense of.
Who knows how well it works in practice.
Also, the age rating factors being capped at 3 allows older people’s health insurance premiums to be much lower before age 65, although I maintain that this young to old wealth transfer is not beneficial for society.