LawBeefaroni wrote:Except that your employer presumably has greater leverage in the insurance market than you do. And generally an employer that errs on the side of excellent coverage is going to have less care-averse and/or bankrupt employees. What do you think most people would do if they suddenly got a portion of their employer's premium liability along with their own contribution? Unless you force them to spend it all on healthcare, you're are going to have a lot of employees with new cars and appliances.
The best way to put the burden on the employee is aggressive cost sharing, not completely washing your hands of any responsibility, and market leverage, as an employer. Employers are starting down the former path. Well, they were.
A couple of thoughts:
1) My particular employer probably doesn't have any greater leverage than I do. It's a very small company. He's just awesome, that's all.
If he doesn't have any leverage, he should. As a side project last year I got group leverage for a bunch of 3-20 employee independent offices. There are several fast-and-loose rules that small businesses can use to get at least
2) As a general rule, employers aren't using their leverage to the benefit of employees. Employers are using their leverage to the benefit of employers.
Often the benefits of the employee and employer align.
3) One size does not fit all. The insurance plan that I need is not the insurance plan that some of the older folks need, or some of the younger folks, or some of the folks that are the same age. My employer has no opportunity to comparison shop based on what *I* need from a health insurance plan.
This is true. It's a trade off between cost and customization. And if everyone only buys what they think they need
the sick and elderly will be priced out of insurance. And so you'll end up paying for them anyway (or you'll be stepping over their corpses in the street).
4) The best way to put the burden on the employee is to recognize that as a strategy for insuring people - tying it to employment is stupid, for all the same reasons that I wouldn't want my car insurance tied to my employment.
Ok, but right now most people not insured by the government are insured by their employers. I agree that it should be a strategy for all health insurance and there is nothing keeping it off the individual marketplace.
5) I might spend it all on hookers and blow. But I've got kids, and they need to be kept healthy, and I need insurance to do that. So I probably won't spend it all on hookers and blow. But yes, I almost certainly won't spend it on health insurance, because I don't need the extensive health insurance policy that my employer currently offers.
You might not need all the bells and whistles, I agree. And you're probably well equipped to make the proper decision for you and your family. Everyone else feels the same way. But not everyone else is right.
6) And here's where I'm asking questions - one of the reasons that I suspect that the individual exchanges are how they are is that there are 100+M healthy people that aren't buying insurance through them, no? If the exchanges are limited to individuals and the previously uninsurable, that will jack up premiums over time, no? By getting all manner of healthy folks out of employer-sponsored plans and into exchange-based plans, that changes the balance, no?
That was the intent. And it's true, in theory, it should work that way. Getting all those healthy individuals into the pool will lower everyone's cost. Part of the failure of the ACA Exchanges was the gutting of the language that required greater participation. It's not something you can gradually shift to. Everyone in or it doesn't work
7) I don't have any leverage when it comes to buying car insurance, except that I do. Why? Because me buying car insurance is tied to free market principles. While I must buy car insurance here in NJ, I don't have to buy it from any particular insurance company. The insurance company must do what they can to attract my business. The insurance company must then do what they can to retain my business.
Employer-provided health insurance is stupid.
If we mandated insurance, as in you had to have it as a condition of driving your body around legally, and didn't allow people to opt-out by paying a token penalty, that would be a great model.
Have you tried pricing out individual coverage? I'd recommend doing so and seeing what kind of coverage you can get at what price.