"I don't work for the salary, I work for the health coverage" . please explain

Anybody know how to say derecho adquirido in English? I realize that the legal systems in America and in Spain are completely different and based on different principles, but yes, in many places there’s the notion that if a certain benefit has been available long enough, people are entitled to go on having it. Same way as anybody would get pretty angry if their SO had been putting out regularly for years and all of a sudden didn’t, with no explanation other than “not now honey”… the legality may be different, the psychology isn’t.

I don’t know the legal terms for it, but yes, the principle certainly exists here as well. And one thing that many companies are doing to save money on health insurance and accommodate the principle you mention is changing the benefits for new hires. So Scott, who has been there for twenty years can get health insurance for his wife and dependent children paid for by the company, Joe who has been there for five years can get health insurance for himself and his dependents through the company, but must pay out of pocket for the dependents, and Susie who just got hired is told she’s lucky that she gets health insurance at all.

I live in Canada and to be honest, even I work where I do in part for the benefits; you would have to give me an extremely substantial raise - five digits - to get me to work somewhere with no health benefits. My employer pays for 100% of prescriptions, 90-100% of all dental costs, money for eyewear, I get private rooms for hospital stays, money towards my fitness club costs, plus a big life insurance policy, disability insurance, so on and so forth. If I worked somewhere without those benefits I’d have to make a lot more money to pay for that stuff myself.

I earn ~$125K USD/year, am self employed, and have a genetic condition that excludes me from private insurance… although I have never needed any treatment and didn’t even know I had it until I was applying for insurance.

If we move back to America, my wife will get a job solely for the purposse of getting health care for us. The amount she would earn would be 100% offset by the higher taxes I would pay in the US, so she would litterelly be working only for health insurance.

While I haven’t looked at the specifics of Wyden’s plan, it does have one very good thing going for it, IMHO. I am convinced that the ultimate answer to this mess is to decouple employment from health insurance. It wouldn’t necessarily have to be made illegal to offer health insurance. Simply ending the tax subsidy available to employers who do would probably end it for all intents and purposes.

Not sure if *derecho adquirido * translates to English, but I speak Spanish so I get the meaning. ERISA, the law that governs pension and health benefits in the US, specifically does allow employers to discontinue benefits. It is primarily concerned with making employers offer benefits to all employees on equal terms if the employer wants the benefit of tax deductible premiums/contributions. In other words, it is primarily concerned with highly compensated employees not getting a better deal within the tax deductible plan. But if an employer wants to completely discontinue insurance and pension for all employees (or all new hires) tomorrow, that is allowed. The company may see a mass exodus of employees, but no mass influx of lawyers. Between ERISA and employment at will, an employer really can discontinue that stuff across the board without legal concerns. Note: if the employees are in a union, things may well be different. Also, if the changes are in any way discriminatory against employees 40 and above, there is a separate law (ADEA) that would apply. That may motivate employers to continue benefits for employees with longer service (presumable older, in general) although the law does not specifically require it. State laws may also provide additional restrictions/requirements. IANAL.

That’s right. I can think of several other reasons to decouple health insurance from employment:

  1. Price transparency. The true cost of health care and health insurance is fragmented, hidden from the health care consumer. Right now health insurance is paid via government (taxes) and employers (retail prices) As long as employers keep absorbing premium increases only policy wonks will care about “the rising cost of health care.” Once we’re paying for it out of pocket (even if it is tax-deductible) then people like Scarlett67’s husband suddenly become more interested in why we pay 2x and 3x more per person than other industrialized nation yet there are still some 26 million uninsured.

  2. More incentives for patient involvement. I see people every day who demand brand name drugs for no other reason than preference and because the insurance company that I work for pays for them. There are a hundred small choices like this that a person make that drive up the cost for everyone. With employers and insurances hiding the true cost of those decisions there is no incentive to make better ones.

2b) Greater incentive for healthy choices. If walking 20 minutes a day (free) can cut dosage of your blood pressure medication in half (est $180/month) you may get off the couch more often.

  1. Catch the people who currently fall through the gaps. The self-employed, the single SAHM, the part-timer, the Wal-Mart employees, and those who retire too early for Medicare are locked out of our current insurance system. The independent review of Wyden’s plan estimated that it would cover 99% of our citizens.

  2. Help US companies be more competitive on the global market. I’m not a protectionist by any means but the burden of health care puts us at a disadvantage compared to the rest of the world.

This is why these plans scare me. . . I can’t “make healthy choices” to make my medication cheaper. Neither can my mom. I have bad genes I can’t do a damn thing about. In order to punish the portion of the population who are taking medication instead of making lifestyle changes, you’re screwing over everyone with conditions completely unrelated to how much they excersize or how much they diet.

That is a consideration if I were only advocating Consumer Directed/High Deductible Health plans. However, community rating would mean that you would probably be in an even larger group than you are now. The current underwriting process for indvidual plans means that insurance companies get to cherry-pick their members, which causes adverse selection and defeats the purpose of having insurance in the first place.

Of course, your case illustrates a larger issue: you are no longer a “risk”. You are a certainty. It’s the same problem facing P&C insurers in the gulf coast. You are the best argument we have for universal health care (not insurance), but that’s not going to happen in the forseeable future. This plan has a chance.

Interesting graph: The Kaiser Family Foundation found that for 2003, the top 1% of the population spent 23% of all health care dollars.

I’m a second-generation example of working for the insurance.

My father worked two jobs. He liked one (selling used cars) and didn’t like the other (working as a guidance counselor at a middle school). I know that his decision to keep working as a guidance counselor was at least partly motivated by the fact that the school district could offer much better health insurance than the family-owned business he sold cars for could.

If we weren’t in a group insurance plan, no insurer would even want to look at me and Mr. Neville. He has a health problem for which he takes expensive medications, and I take antidepressants, which at least one insurance company spokesman has said that some people take recreationally (visualize a googolplex of :mad:s and :rolleyes:s here, which would literally fill up the observable universe more than a googol times over over, and you get some idea how offended I am at their saying that). As a result, at least one of us always has to be in a job that offers good medical benefits (that don’t exclude pre-existing conditions) and where there is little to no chance of layoffs. Our career choices are limited because of this- if we wanted to start our own business, we couldn’t do it because of the health insurance costs, even if the business would be successful. Though the academic job search process has been pure, unadulterated hell, the health insurance issue makes me glad that Mr. Neville is planning to get a job as a professor of astronomy, rather than a job in the business world that might bring in more money but have less certainty with respect to health benefits.

I think it would solve the problem, but not the way you’re anticipating. Basically, there are three groups of people in this country: a small handful who are wealthy enough not to worry about their medical costs, a large group of people who have their medical costs covered by their employee insurance, and another large group who don’t have employee insurance and are very worried about medical costs. If you eliminated employee insurance, you’d be moving everybody into the second group into the third group. The short term effect would be 99% of the people in this country would be worried about their medical costs. But the longer term effect would be that every candidate, of every party, running for office in 2008 would be a strong supporter of universal public health care.

Actually, that seems about right. The third group is growing rapidly already. Also, the number of people who can envision themselves winding up in the third group is growing rapidly. IMHO, that’s why there have been several proposals to expand health insurance availability to those without employer-based insurance lately. As your second group grows smaller and less secure, politicians are considering the third group’s concerns. Again IMHO, there are probably both universal healthcare and universal health insurance approaches that would work at least as well as what we have now.

It was a tiny company (less than 10 employees, IIRC.) I didn’t look at the whole policy super carefully since he didn’t take the offer, but from what I understood only employees got any sort of coverage, and even then they had to pay a substantial amount for it. Maybe small businesses have different standards they go by. I can understand why a small business would have a hard time providing good coverage, it is expensive for them too.

I’m almost working for the insurance alone right now. I only pay $30 a month for family coverage right now which includes health, dental, vision, I.E. the whole shebang. I also make a lot more at this company than I would doing the same job at another company. If I left this company or were let go, I wouldn’t be able to get within $10 an hour for a similar job and I would have to pay substantially more for my family’s coverage whether it was through my hypothetical new job or through my wife’s coverage. My wife’s company offers family coverage but we have declined so far because it is so much more expensive than mine and also more limited. IF something were to happen at this job though, we can enroll and just suck up the costs, we’ve checked into it already.

Emo Song Name!!! (it’s the new Band Name :))