I feel that the way that Americans generally get their healthcare insurance from their employer is a massive impediment to job mobility and the free market.
As an Australian, I find it quite bizarre when I read about Americans saying “I was thinking of switching jobs, but I stayed where I was for the better health cover.”
How is that not the very definition of market failure and inefficiency?
Seems to me that untold millions of man-hours are wasted every year in the US due to people having to research the healthcare plan of their prospective new employer(s) before deciding whether or not to take a new position.
Maybe I’m missing something here, but I don’t understand why your “Libertarians” don’t have more of a problem with this issue. In fact, I don’t think I’ve ever seen it mentioned.
US Dopers: When you’re thinking of changing jobs, how much time do you spend thinking about your healthcare insurance?
A lot. Currently, I make a nice salary but my health insurance sucks. It sucks (high deductible, very few services covered, etc) so much that I haven’t been to the doctor since grad school. Why bother getting basic blood work done when you have to pay out of pocket for each lab? If I found a job that paid 10% less but offered better health insurance, I’d break ranks with my company in a heart beat.
You aren’t missing the point. Our private health insurance system has been established in law as an anti-competitive system meant to benefit the health insurance providers and their customers who are the employers. People had high hopes that public health care would change this situation, but it’s just a sellout to the insurance companies. Any number of people have sold their soul to the company store in order to maintain their health insurance.
This goes back to WWII when there were wage and price controls in place. Employers had to offer benefits instead of wages to attract employees. The key benefit was Health Insurance. Now we’re stuck with this crazy system and everyone thinks it’s “normal”. AFAIK, we’re the only country that does this. And since this benefit is tax deductible, employees don’t see the real cost and it’s way more expensive to buy insurance on your own, since it’s not deductible in that case.
Trust me, Libertarians and libertarians have a big problem with this.
It is so far, but in principle it doesn’t have to be. As with the financial industry, all that’s necessary is to have a government that favors the interests of people over capital. This will happen eventually. With the former system it wasn’t going to happen ever.
This aspect of our health care system is constantly brought up in the debate. I have argued that 100% of medical costs, including insurance, should be a deduction - that would help make it easier to purchase your own own policy with pre-tax money.
As for job changes, I will admit that I have been able to play in the start-up game thanks to being on my wife’s policy.
Our current system is indeed nuts. But it’s also unfixable. Just making modest reforms and requiring participation brought cries of “Socialism!” “Death Panels!” If you want to really fix it, let everyone who wants to join Medicare.
I find it odd to agree with John on (l,L)ibertarian issues, but I thinks he’s correct in this case. We have no idea how competitive health care systems would have worked out because there aren’t any. I don’t mean unregulated, but right now insurers and providers are sucking up profits simply because they have no responsibility to provide value for their services. I support the idea of limited public healthcare to ensure no one is left out of the system, but I think the current approach will take a very long time to arrive at a system that actually provides an overall benefit to the public.
How is this different than any other benefit that an employer might offer?
When I look into switching jobs, in addition to salary, I’m considering insurance, vacation policy, bonuses, commissions, how flexible are the hours, can I work from home, what is the retirement plan like?
It’s a stupid system, based in history and not in sense.
I’m a big advocate of free market capitalism, but I don’t believe free market forces are in effect in the US health care system. The consumers are dependent on their employers to make choices in their behalf.
I do wonder whether free market forces would be terribly effective even in the ideal case. A big problem is that by the time you find out if your brand is any good, it’s too late to fix it. That’s also true of home insurance, but home insurance is a much simpler product, and considerably easier to learn from the experience of others. The results of a bad choice are also considerably less significant; in the worst case you file for bankruptcy and lose your investment, and rent after that. With health insurance (pre Obamacare) you pretty much lose the ability to insure anything related to any health conditions you’ve acquired.
I’ve always been covered, including when I was self-employed. But now at age 55 with adult-onset asthma, my choices are limited (or would be, without Obamacare.)
I’m a proponent of the individual mandate; one of the things that separates me from libertarians. It’s the only way to avoid a penalty for pre-existing conditions, even when someone has made a point to be covered at all times.
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When I look into switching jobs, in addition to salary, I’m considering insurance, vacation policy, bonuses, commissions, how flexible are the hours, can I work from home, what is the retirement plan like?
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All of those (except “benefits” that aren’t related to the business) are directly related to the business, and are appropriately part of the negotiation. But should it affect which house I live in? Should it affect what kind of car I drive? Should it affect what type of food I eat? Nope, it shouldn’t.
Even the retirement plan IMHO needn’t be part of it, other than knowing how much the employer is willing to co-contribute. The allocation of funds should be directed by me (as it is now, for many if not most US employers, thanks to IRA/401k funds).
But it does affect what health care insurance I get. That’s an arbitrary artifact of American history, not a designed solution that suits the problem.
Because, unlike bonuses or commissions, it’s about your right to live. And vacation policy in the US is also a joke. Live to work, or work to live?
I honestly don’t get why you Americans don’t pool your resources to help out your fellow citizens who fall ill or get injured. It seems like the most basic of common sense to me.
Every other Western/First World country does this.
I could accidentally walk in front of a bus tomorrow. I could get MS. Or cancer. My child could be born prematurely and have some kind of costly medical condition as a result.
To boil it down; myself and my family might draw the short straw in life.
And in every scenario imaginable my fellow Australians would help me out, no questions asked. Every one of us shares the same risk of getting hit by a bus, so we take the costs of that risk on together. We pay for each others misfortunes because we know that there, but for the grace of god, etc.
I call that the freedom of living in an actual society. You Yanks call it “socialism”.
I’ve lived in the US, and I know that your nation sees the definition of freedom very differently. I find that incredibly sad.
It does have a big impact on a job search. In my industry (I.T.) there are always lots of opportunities out there for 6-12 month contract jobs with no benefits. But I have a family, so forget that noise! Even if it pays $20/hour more, it’s not worth it when I have to cover my entire family with private health insurance.
If someone has a spouse with a job with benefits, they can pursue those types of jobs, but for me it is not an option. I have to stick to full-time positions, which are few and far between on the job market, compared to contracts.
Another aspect of the current arrangement here in the US is retirement and health care. With Medicare (our socialist medical safety net) not kicking-in until you are 65 years old, if you wanted to retire at the age of 60, you would need to budget bare minimum $2,000+ a month just to have health insurance on the open market as an individual policy holder, for 60 months. Ouch - that IS an impediment to freedom.
Also, if you wanted to take some time off, or start a new business, the status and cost of your health insurance is a major concern (and constraint) here in the US, especially if you have a family.
Ok, so where are you taking this debate, because you’re now making overly broad statements that aren’t even true. :dubious:
You’ve been given plenty of examples in this thread that Americans fully understand linking healthcare to employment distorts the job market.
And, if you’ve kept up with the US healthcare debate at all over the last several years (or even just read posts on the board), you understand there are many Americans who do want a single payer healthcare system similar to that used in other countries.
So, where are you taking this? That you just didn’t notice that lots of people (both liberals and big-L and little-l libertarians) don’t like linking healthcare to employment? Or why Americans don’t do something about it (big hint: we are, but different groups want different things - Libertarians more of a free market and liberals more a government run single payer system). Either way, that’s a debate that’s already been had multiple times on this very board.
It is an impediment, but probably less of one than you think. If health coverage was no longer tied to employment, then people would be saying “I was thinking of switching jobs but decided to stay because of the pension, or the vacation time …”. In my (limited) experience, these things sort of go together- I’ve never heard of a job that had good health insurance, but little paid leave or no/crappy health insurance, but generous leave policies.