user72685 · HackerTrans

The employer picking up 100% of the premiums (which, in a self-funded plan like this, are paid into the plan trust) just makes this kind of stuff even more likely. If an employee or employee's covered spouse or dependent has health issues requiring $XXX,XXX/year of treatment, getting rid of the employee will directly save the company $XXX,XXX/year. Quite a powerful incentive for scumbags, even if it's completely immoral and illegal (ERISA 510).

user72685

8년 전discuss

Also worth noting that self-funded plans will have their premiums set based on the plan's actual claims experience, which means employers with a sicker risk pool will pay more. This also encourages discrimination against older or unhealthy/disabled workers, since they statistically cost more. (This is illegal, but it happens all the time and is hard to prove.)

user72685

8년 전discuss

> sure, but the employer doesn't pay any tax on this type of benefit, whereas we would both face additional taxes if they simply paid me more.

That argument seems like the equivalent of wasting money just for a tax deduction. You are right in a way though: if a single-payer plan is financed through progressive taxation or a payroll tax with no or a sufficiently high cap, higher earners will end up paying more than under the current system while lower earners will pay less.

> all i'm pushing back on is the original statement that "people should demand an end to private insurers". people who don't get insurance through their employer and/or can't afford it themselves should probably oppose private insurance.

Unless you get sick, are unable to work as a result, exhaust FMLA (if available), and can't get coverage through a spouse or parent (if under 26). Then hopefully you've got the savings or disability insurance to pay for COBRA (under which you have to pay the full premium your employer is currently paying) and/or Marketplace insurance in the interim, or you're stuck with Medicaid. Even worse, most Marketplace plans have narrow networks, so you may find that you're not able to keep some of your doctors -- particularly the specialists you're likely to need for an extended illness. Medicaid is even worse, because the reimbursement rates are so low.

And hopefully none of that happens to a loved one, who may not be in the relatively good position you are.

And that's ignoring the moral argument in favor of, well, not allowing people to die in a supposedly first-world country because they can't afford healthcare.

user72685

8년 전discuss

Ask your Representative and Senators to sign on to HR 676 (https://www.congress.gov/bill/115th-congress/house-bill/676) and S 1804 (https://www.congress.gov/bill/115th-congress/senate-bill/180...), if they haven't already.

user72685

8년 전discuss

How much does that plan actually cost? Your W-2 should include the value of the employer's subsidy.

You're still paying for inflated healthcare costs either way; in a competitive labor market (not always the case but certainly is in SV), reduced benefit costs would be expected to increase cash compensation.

user72685

8년 전discuss

> I do love "sensible policy changes" that work by extracting money from physicians to cover patient bills rather than actually fixing the systemic dysfunction.

The article says insurers are required to pay:

> The doctors would instead have to work with patients’ insurance, which would pay the greater of the following two amounts: > > * The median in-network rate negotiated by health plans > * 125 percent of the average amount paid to similar providers in the same geographic area

That seems more than reasonable to me. They will get greater than market rate, if you define "market rate" as rates negotiated between insurers and doctors and not whatever nonsense they can get away with charging when the patient does not have pricing information and often isn't in a position to make a decision anyway.

> Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care.

They are already required to pay for out-of-network emergency care even if the plan ordinarily doesn't cover out-of-network services at all, but they are only required to pay the usual and customary rates for those services, not the inflated nonsense bills (unless it's a state-regulated plan where state law requires the insurer to pay the inflated bills).

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