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?
This is always what I think of when I hear arguments that our health care is "free market". If it were, you could fire AETNA and go back to Kaiser. But that's not the case, so insurers aren't really beholden to satisfying their users, because their users aren't their customers.
This is the kind of story libertarians can’t imagine because they simply lack an imagination. We don’t choose when we get sick. Your companies merger should have had no impact on your ability to get healthcare. What an absolutely insane thing to read.
Someone at some point should have told you this, but it rarely gets communicated until its too late. If you have peripheral neuropathy, even if you are not a diabetic, you should be doing nightly foot inspections with the aid of a mirror.
It drops the likelihood of acquiring an amputation by around 70%. Pretty much all my patients who have had amputations acquired them because they didn't know about a foot wound before it became infected and spread to the bone.
Simply flashing your feet at a mirror kept propped next to a nightstand can significantly improve your overall health outcomes.
Fucking brutal, man. Murica, I guess.
Holy. Fucking. Shit. I’m sorry you had to go through that. That’s really horrible.
I got a question!
How did forcing the doctors who knew you were in the midst of a sensitive medical situation not get forced into violating their hypocratic oath?
So, a couple of things... Kaiser is a membership hospital, if you aren't a member, you don't get in and as of 1/1/2019, I wasn't a member anymore. :(
There is this thing called "Continuity of Care" but that only applies for services I had under the old hospital that aren't available under the new one.
Because the new hospital DOES have a cardiac department, continuity of care didn't apply.
Lastly, the Hippocratic Oath is largely a myth. ;)
https://www.health.harvard.edu/blog/the-myth-of-the-hippocratic-oath-201511258447
"According to a 1989 survey, barely half of U.S. medical schools used any form of the Hippocratic Oath and only 2% used the original. In a 2011 study published in the Archives of Internal Medicine, about 80% of practicing physicians reported participating in an oath ceremony, but only a quarter felt that the oath significantly affected how they practiced."
thank god capitalism is the most efficient system people ever imagined!
I read that with EU dates and thought it was weird to wait from Nov to March to get your heart looked at, and then March to Jan to actually have the operation. ISO 8601 FTW.
Really sorry for you both and your toes though, that sucks. Glad you're still with us!
That's in the same category as "who would consider health care an appropriate industry for profit?".
Who would consider it? The same people who are coming for public education.
The cruelty is the point.
Their end goal is a population of moronic wage-slaves who are living a barely subsistence lifestyle that will believe anything told of them rather than challenging the wealth, power, and right to rule of the ruling class.
They aren't just conservative, they're regressive. They long for the days of Feudal lordship with themselves cast as the lords.
coming for?
I think that there are spaces in healthcare where you could safely apply a free market. "Hey, yeah, I see you have a cane, but have you tried my super luxury high speed low drag jet-powered hover cane? Guaranteed to be 1000% more like a Nerf commercial than any standard cane!"
"Woah, check it out, we built an MRI that's way cheaper and doesn't scare the shit out of people!"
"Hey, I found a medicine that cures baldness!" Etc.
Right? I can see the intersection of luxury (in the sense that not buying it incurs no cost, not even an opportunity cost), convenience, and healthcare being a place where there's room for the free market. The problem is that we've gone and applied it to everything, including all kinds of things that shouldn't be free market. Then you end up with all kinds of goofy fucking bullshit like corporates parenting stuff that the DOD paid to develop (Epi Pens, vaccine adjuvants, etc), GSK opting to develop a singles vaccine instead of a tuberculosis vaccine, etc, etc, etc. Oh, that last one is real. Here: https://www.propublica.org/article/how-big-pharma-company-stalled-tuberculosis-vaccine-to-pursue-bigger-profits
This is probably an unpopular take on Lemmy, but I believe that free markets generally work well where they exist. But there's a lot of things that have no business being free markets, like healthcare, and aren't free markets (and won't behave like them) even if you try super hard to pretend that they are. You see, a truly free market requires the ability to say no and suffer no cost. You can buy Bob's Widget, Jan's Widget, or no Widget and be perfectly fine. This is not the case in healthcare. If you're having a heart attack, your choices are:
-Agree to pay for this widget but we can't/won't tell you how much it costs until we're done.
-Die
That's not a free market, that's not how free markets work.
My comment was a bit of a simplified hot take. And your perfectly valid reasons are why I didn't also throw housing and food right in there in the same take.
See... you kid, buuuuuut...
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.
You forgot this part, before WW2:
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.
So old people chose something that benefits themselves only over something that benefits everyone.
I mean, penicillin wasn't publicly available until 1941. So at that time, we barely had healthcare that was even worth paying for. I can understand why they deprioritized it.
I think people forget we've had truly modern healthcare for less than a century
And you also can't discount the role Unions played in the American healthcare system. Because not only can you get healthcare through your employer, if you're in a union you can get coverage through your union. And there was a time when unions had their own doctors on payroll.
Nice recap. Thanks.
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.
Indentured Servitude is the point. Business want to make it difficult for you to find another job.
I don't think that's actually true in this particular case. Just about every single full time job has to offer a health insurance plan because all of their competitors are doing it. You simply can't attract good labor without it. So the motivation of the company providing you with health insurance isn't necessarily to keep you there, but rather to get people in the door to begin with. If the motivation was to keep you there, they'd offer a health insurance plan so amazing that you realistically couldn't go anywhere else without taking a cut.
On a larger scale though, there are lots of reasons that people want to keep this system intact. In particular, the societal "benefit" of extracting the maximum amount of work possible out of its populace.
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...
That’s not the problem with the healthcare in the US, because that eventually flips and you hit your deductible every year.
The problem is you lose healthcare if you need to quit your job and you pay more than any other country. And I attribute that simply to the middle man, aka the health insurance companies. They don’t seem to provide any benefit other than contributing at least 10% for pure profit reasons to the $3.4 trillion we spend every year on healthcare.
My biggest problem is some schmuck who I doubt has a medical degree, and has never seen me as a patient, but has absolute power over what a MEDICAL DOCTOR deems necessary.
At that point it really begins to sound like practicing medicine without a license to do so, let alone the knowledge required to get an MD.
Thats insane.
Here in Brazil I pay around 65-70 dollars per month and then I have full hospitalization coverage and full doctors appointment coverage.
And there are better options lol
Damn I know Brazil has its issues but clearly medical coverage isn't one. I don't think the US has a single insurer that covers a full hospital stay. The only doctors appointments I've ever seen covered is the yearly physical.
I tell anyone and everyone we will not get universal healthcare until this is prohibited. Certain votes feel having a job with benefits is something they have earned. They see it as some badge of honor or some.
Abolish it. Make it illegal.
Shit I've worked my way from homeless to well into 6 figures and have "amazing" healthcare. I still want universal healthcare because I'm not a fucking idiot. I want to have the option of leaving my employer and starting my own company without the massive cost of healthcare hanging over my head. I can't understand anyone who thinks otherwise. Literally everyone would save money.
I'm still salty from working at a mediocre company and getting a $7k bill from a doctor for putting a scope into my nose for literally 15 seconds. And more recently, I went to a chiropractor (controversial I know but it helps me a lot) and got a $300 bill after being promised that it would only be $20.
I'm supposed to have great insurance too. I scratched my eye in my sleep bad enough I needed help. Went to the ER, they said come back in two hours or it would be really expensive. So I go back two hours later when the "urgent care" is open. I had to pay $500.00 for them to look in my eye and say yup its scratched, here's a script for some drops. My insurance covered $40.00.
So we don't fuck off work to mass protest and dine in the flesh of the wealthy.
Saved you a click.
TLDR It's a deductible expense for the business, it's taken out pre-tax for the worker, and businesses get way better rates than if a individual was to go get a quote for the same plan.
That only makes sense because the system is so goddamn stupid.
The "most powerful nation in the world," but when it comes to our health, we just let the capitalists bend us over...
don't bend too far, unless you have employment health insurance.
The last part isn't always true. When I stopped teaching, I was able to get a plan from the same insurance company with a lower premium and with a deductible that was about 20% of the deductible that teachers have.
Agreed. My employers plan is easily worse than what I could get on the open market. The issue is that they contribute quite a bit towards the plan. I wish they would provide it as a stipend and let me spend it on my own plan.
Canada's public/private system has a lot of this as well. Drug, dental, optical, anything else are part of employer's group benefits. There are public drug coverage options where your deductible is calculated as a percentage of your net income, and a public senior's plan with a flat deductible.
Tell me again why soulless corporations should not be in control of essential services for humans?
Canada's NDP wants to implement a federal public plan for these "extra" health services, recently made a deal with the Liberals to push a low-income dental benefit through, and they're very open that it isn't enough. Being in a union will likely negotiate you a better benefits package right now which is pretty lame considering how many people aren't in unions.
The funny thing in the US is they don't even get the benefit of the government negotiating prices with private health companies, their "medicare" is like a tax break but it basically just helps these companies keep their prices ridiculously high by softening the impact for patients. In the US system you're not really a patient though, you're a consumer of healthcare, like a customer.
For all its talk about free markets, the GOP vehemently defends this very not-free-market system. To be fair, the Democrats defend it to the death too, but they don't pretend like they value free markets, so they're just greedy and corrupt, not greedy and corrupt hypocrites.
Because we've regressed into one of those shithole countries our wannabe dictator keeps harping about.
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.
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)
Answer: greed
Greed. Anything weird or shitty we do, it's because of greed.
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 $100 just to show up at the emergency room or urgent care.
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Erm. So do most Western countries.
More than half of the coverage I receive through work insurance is not covered by universal healthcare.
Oh wait where else? I genuinely don't know this is a thing.
Canada my guy. We can go to the doctor, but many people do not have a family doctor to go to. You can go to the hospital for free, but assuming the hospital is open (brain drain means closed hospitals) you'll be triaged and if you aren't actively dying, you'll have to wait literally 24 hours to be looked at. That's where "Universal Coverage" ends. My employer covers my dental, vision, pharmacare, mental health, and physio. If I lost my job, my girlfriend and I would be fucked. Not sure why I was downvoted. People mad at my reporting the facts for some reason.
Yup in Canada there's public options for drug coverage but it's also part of employer's benefits plans, dental and optical aren't publicly covered either, although certain optical tests are.
It isn’t the only country, though. Japan does too. Basic facts…
It isn’t the only country, though. Japan does too. Basic facts…
What are you on about? I live in Japan. You can walk to the city office and get health insurance. Every resident is legally REQUIRED to have health insurance and many do not work. I got health insurance as a student when I first moved here.
Edit: added quote
He is right. In Japan there are 2 form of health insurance: from your company 社会保険 (shakai houken) or directly from the government 国民健康保険 (kokumin kenko houken). If you quit your job you loose your health insurance the very day you're unemployed and must go to your prefecture to ask the national one (you'll pay for it, around 200$-300$ a month).
Also in France your health insurance is also tied to your job. The french administration is a nightmare to me so I have no idea how to get anything if you're unemployed.
just like everything in life healthcare require the labor of other humans and is not free by any means. Some one has to pay for it
Okay this angry message certainly isn't directed at you and kinda wandered off topic but i started typing and it turned into a bit of a vent..
The problem is we've got bullshit ancillary companies wedged in the system wanting a cut. And even better, they get to overrule your doctor and deny you treatments if they think, from their fucking office chairs half way across the country, that what your doctor says you need is too expensive.
They'll do anything they can to shaft both medical facilities and patients alike in order to maximize their profit while providing nothing of value. How much time are hospitals/clinics/private practices wasting on dealing with the back and forth between insurance companies?
Between me and my employer we're easily giving 5 figures per year to these parasites. Make it a tax, pool it nationally to cover expensive procedures, cut out the worthless for-profit middlemen.
But oh no, it's the only way, see in Canada you have to wait months to see a doctor while you bleed out on the sidewalk.. right? 🙄
And yeah, we get rid of insurance companies and people working there lose their jobs. They've got the same struggles as the rest of us. That sucks, but it's not a valid reason to keep this system around.
