# The ethics of health insurance **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [December 5, 2024, 3:45am UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177 "2024-12-05T03:45:03Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [December 6, 2024, 4:40pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/81 "2024-12-06T16:40:01Z")
> [@Pedro](#): > > Depends. How do you feel about paying 20% to 50% more in income tax for that nice perk? I also would no longer have to pay for health insurance premiums out of my own pocket every paycheck. I am currently paying 30% of my weekly wages for health care coverage. If I no longer had that and my taxes went up 20% I would actually SAVE money! And I’m someone with employer-provided coverage, people shopping on the exchanges are even worse off. They might welcome no longer needing to pay premiums even if their taxes went up 40%! I think you are not taking into account the portion of wages a US citizen has to fork over on a regular basis to have health care, even “employer provided” health care. Plus the insecurity of losing that coverage if you lose your job. ---
**Author:** ![Dinsdale](https://avatars.discourse-cdn.com/v4/letter/d/97f17d/32.png) [@Dinsdale](https://boards.straightdope.com/u/Dinsdale)\ **Post date:** [December 6, 2024, 4:48pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/82 "2024-12-06T16:48:15Z")
> [@Broomstick](#): > > > [@Pedro](#): > > > > So serious question, why is healthcare so different from other free markets in the US? > > Power imbalance. I may misremember, but I recall reading that the US healthcare lobby is larger than the military and energy lobbies (the next 2 largest) combined. Might have SOME impact… ---
**Author:** ![Spoons](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spoons/32/3141_2.png) [@Spoons](https://boards.straightdope.com/u/Spoons)\ **Post date:** [December 6, 2024, 4:49pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/83 "2024-12-06T16:49:36Z")
> [@Pedro](#): > > Depends. How do you feel about paying 20% to 50% more in income tax for that nice perk? Just because I’m curious—where are you getting those figures from? Do you have a cite for those? ---
**Author:** ![Ellecram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ellecram/32/18948_2.png) [@Ellecram](https://boards.straightdope.com/u/Ellecram)\ **Post date:** [December 6, 2024, 4:56pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/84 "2024-12-06T16:56:47Z")
> [@Cervaise](#): > > > [@snowthx](#): > > > > Agree on the need for travel insurance, but my point is taking _time_ to travel. Like between jobs. > > Not to rub it in, but we don’t need to wait to change jobs. By law, we all get about five weeks of vacation, not counting two weeks worth of national holidays sprinkled around the calendar. I’m in a senior position and get even more time. We take two two-week holidays every year, with lots of time left over. > > > [@Pedro](#): > > > > Depends. How do you feel about paying 20% to 50% more in income tax for that nice perk? > > Nope. Our total net household “tax and administrative expense” burden is lower than it was back in the States. Maybe your assertion is true elsewhere, but it doesn’t apply to me and my family. I work in county government in the US and get 6- 8 weeks of vacation plus 6 weeks of sick time per year. I travel every year - two international trips and a score of domestic trips. We have had excellent health insurance that pays for everything for the 30 years I’ve worked there. However, it seems that might be changing in the coming years. When I started we even had legal insurance which I used to do a will at the time. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [December 6, 2024, 5:05pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/85 "2024-12-06T17:05:49Z")
> [@Spoons](#): > > > [@Pedro](#): > > > > Depends. How do you feel about paying 20% to 50% more in income tax for that nice perk? > > Just because I’m curious—where are you getting those figures from? Do you have a cite for those? Is the proctologist in-network? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [December 6, 2024, 5:12pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/86 "2024-12-06T17:12:09Z")
> [@Ellecram](#): > > I work in county government in the US and get 6- 8 weeks of vacation plus 6 weeks of sick time per year. I travel every year - two international trips and a score of domestic trips. I work in the “private sector” in the US and I get 2.5 weeks of vacation time during the year, but for 3 solid months at the end of the year and selected weeks at other times during the year I’m not allowed to take any of it. Also, I get no paid sick time. If I don’t want to lose my job I need a doctor’s note/expiation for any absence longer than a day or two. Which, if my insurer deems the visit “not medically necessary” will cost a _minimum_ of $150 and likely much more than that as literally _nothing_ would be covered, it would all be out of pocket. At that, my situation is better than some jobs I’ve had that offered NO health insurance and no paid time off. ---
**Author:** ![Ellecram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ellecram/32/18948_2.png) [@Ellecram](https://boards.straightdope.com/u/Ellecram)\ **Post date:** [December 6, 2024, 5:14pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/87 "2024-12-06T17:14:34Z")
> [@Broomstick](#): > > > [@Ellecram](#): > > > > I work in county government in the US and get 6- 8 weeks of vacation plus 6 weeks of sick time per year. I travel every year - two international trips and a score of domestic trips. > > I work in the “private sector” in the US and I get 2.5 weeks of vacation time during the year, but for 3 solid months at the end of the year and selected weeks at other times during the year I’m not allowed to take any of it. Also, I get no paid sick time. If I don’t want to lose my job I need a doctor’s note/expiation for any absence longer than a day or two. Which, if my insurer deems the visit “not medically necessary” will cost a _minimum_ of $150 and likely much more than that as literally _nothing_ would be covered, it would all be out of pocket. > > At that, my situation is better than some jobs I’ve had that offered NO health insurance and no paid time off. I stayed with my particular job because of the excellent benefits we have always been provided as well as proximity to my home. Never made a ton of money but always felt like I was taken care of as far as health insurance/time off. I can’t imagine not having sick time. I am trying to use my sick/vacation time up before I retire. I would be reimbursed at the end but I’d rather have the time off. I was also allowed to buy back my military time to increase my pension. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [December 6, 2024, 5:36pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/88 "2024-12-06T17:36:40Z")
If I wreck my car, I pay my affordable deductible like $500 and I’m covered. If my house burns down, I pay my manageable deductible like $1000 and I’m covered. The health insurance model is Pay your premiums Then pay for copays Then pay a percentage of the unaffordable medical costs And your deductible is $1M And it resets every year. It is a complete scam ---
**Author:** ![snowthx](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowthx/32/10660_2.png) [@snowthx](https://boards.straightdope.com/u/snowthx)\ **Post date:** [December 6, 2024, 5:39pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/89 "2024-12-06T17:39:15Z")
> [@Broomstick](#): > > > [@Ellecram](#): > > > > I work in county government in the US and get 6- 8 weeks of vacation plus 6 weeks of sick time per year. I travel every year - two international trips and a score of domestic trips. > > I work in the “private sector” in the US and I get 2.5 weeks of vacation time during the year, but for 3 solid months at the end of the year and selected weeks at other times during the year I’m not allowed to take any of it. The point here is that absent a universal system setting the core level of insurance coverage for everyone, there is going to be wild swings in who has access to what (just like there are wild swings in who gets how much vacation time based on where they may work). Some full-time workers in the US have access to very good insurance, and others who are also working full-time may have access to none (e.g. “gig economy” workers, employees of small businesses, etc.). ---
**Author:** ![Ellecram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ellecram/32/18948_2.png) [@Ellecram](https://boards.straightdope.com/u/Ellecram)\ **Post date:** [December 6, 2024, 5:43pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/90 "2024-12-06T17:43:04Z")
> [@snowthx](#): > > > [@Broomstick](#): > > > > > [@Ellecram](#): > > > > > > I work in county government in the US and get 6- 8 weeks of vacation plus 6 weeks of sick time per year. I travel every year - two international trips and a score of domestic trips. > > > > I work in the “private sector” in the US and I get 2.5 weeks of vacation time during the year, but for 3 solid months at the end of the year and selected weeks at other times during the year I’m not allowed to take any of it. > > The point here is that absent a universal system setting the core level of insurance coverage for everyone, there is going to be wild swings in who has access to what. Some full-time workers in the US have access to very good insurance, and others who are also working full-time may have access to none (e.g. “gig economy” workers, employees of small businesses, etc.). Yes I understand that. I am just pointing out my own personal experience. I have been lucky in this regard. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [December 6, 2024, 5:49pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/91 "2024-12-06T17:49:17Z")
> [@Broomstick](#): > > I also would no longer have to pay for health insurance premiums out of my own pocket every paycheck. I am currently paying 30% of my weekly wages for health care coverage. If I no longer had that and my taxes went up 20% I would actually SAVE money! I can’t understand why people don’t understand this. It’s simple math. I get the impression that they think they would have a ‘new tax’ _and_ have to pay their current insurance premiums. With UHC, you’re still paying premiums (in the form of a tax), but it’s cheaper than what you’re currently paying for private insurance – even though you’re helping to support _everybody’s_ medical welfare. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 6, 2024, 6:04pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/92 "2024-12-06T18:04:30Z")
> [@Johnny\_L.A](#): > > I can’t understand why people don’t understand this. It’s simple math. I get the impression that they think they would have a ‘new tax’ _and_ have to pay their current insurance premiums. With UHC, you’re still paying premiums (in the form of a tax), but it’s cheaper than what you’re currently paying for private insurance – even though you’re helping to support _everybody’s_ medical welfare. About half of Americans currently get their health insurance through their employers, and they generally do not, themselves, pay the full cost of their health insurance premium. Arguably, most of them likely do not actually realize how much their current health insurance actually costs. Most employers these days require employees to pay a portion of the premium, but on average, an employee only pays for about 17% of the cost of an individual policy, or about 29% of the cost of a family policy. ([Cite: Kaiser Family Foundation](https://www.kff.org/health-policy-101-employer-sponsored-health-insurance/?entry=table-of-contents-how-much-do-workers-contribute-towards-the-premiums-for-employer-sponsored-health-insurance)) If employers were no longer on the hook to provide health insurance for their employees, it’d be a cost reduction for the employer, but I’m highly skeptical that they would pass any of those savings on to the employees as a wage increase. So, for an American who currently has “group” coverage, they, themselves, are not currently paying anything close to the full cost of their insurance, and it’s entirely possible that they could wind up paying more, out of pocket, for coverage under a UHC program. ---
**Author:** ![Q.Q.Switcheroo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/q.q.switcheroo/32/5713_2.png) [@Q.Q.Switcheroo](https://boards.straightdope.com/u/Q.Q.Switcheroo)\ **Post date:** [December 6, 2024, 6:14pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/93 "2024-12-06T18:14:59Z")
> [@Saint\_Cad](#): > > Then pay for copays > Then pay a percentage of the unaffordable medical costs > And your deductible is $1M And your out-of-pocket maximum is higher. ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [December 6, 2024, 6:21pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/94 "2024-12-06T18:21:07Z")
For people interested in a pretty quick high-level overview, may I offer three cites. Each can be scanned pretty quickly and/or offers a summary: [1] > **[Improving the Prognosis of Healthcare in the United States](https://pmc.ncbi.nlm.nih.gov/articles/PMC8572548/)** > > Although healthcare expenditure per capita is higher for the United States than any other country, over 37 million Americans are entirely without health insurance and 41 million more have inadequate access to care. Whereas ongoing efforts to repeal... [2] [**Commonwealth Fund: U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes**](https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022) [3] > **[Americans’ Challenges with Health Care Costs | KFF](https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/)** > > This data note reviews our recent polling data that finds that Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes. The problems are many. The costs are high. The outcomes are relatively poor. The stress of the existing system is, in itself, a health care crisis. IMHO, discussions about the ethics of health insurance (and health care, generally) should probably begin there. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [December 6, 2024, 6:43pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/95 "2024-12-06T18:43:26Z")
> [@kenobi\_65](#): > > About half of Americans currently get their health insurance through their employers, and they generally do not, themselves, pay the full cost of their health insurance premium. Arguably, most of them likely do not actually realize how much their current health insurance actually costs. The former president gave everyone a letter last Spring, showing how much it costs the company to employ them. (He thought it was useful. Most of us thought it was crass.) My medical insurance – only for me – costs $561.31 per month. I’ve just checked my most recent pay stub, and my share of that is $204.40 per month. So I pay about 36% of the premium. In addition, $50 per month goes into an HSA. So my total medical coverage expenses are $254.40 per month. Using the numbers from the link I posted earlier, I would be paying $101.38 for private insurance in the UK – less than 1/5 the cost of my current coverage. My Medicare deduction is $63/month. With UHC, they could increase the employer and employee deductions eight-fold, and it would still be less than my current private insurance. _And_ I’d still have insurance if I found myself unemployed. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 6, 2024, 6:49pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/96 "2024-12-06T18:49:20Z")
> [@Johnny\_L.A](#): > > Using the numbers from the link I posted earlier, I would be paying $101.38 for private insurance in the UK – less than 1/5 the cost of my current coverage. Less than 2/5 (39.9%), but, point taken. ---
**Author:** ![snowthx](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowthx/32/10660_2.png) [@snowthx](https://boards.straightdope.com/u/snowthx)\ **Post date:** [December 6, 2024, 6:54pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/97 "2024-12-06T18:54:28Z")
> [@Johnny\_L.A](#): > > I can’t understand why people don’t understand this. It’s simple math. I get the impression that they think they would have a ‘new tax’ _and_ have to pay their current insurance premiums. With UHC, you’re still paying premiums (in the form of a tax), but it’s cheaper than what you’re currently paying for private insurance – even though you’re helping to support _everybody’s_ medical welfare. Concise and well stated. I would add that the “everybody” part is the stumbling block most likely in accepting this truth. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [December 6, 2024, 7:07pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/98 "2024-12-06T19:07:35Z")
> [@kenobi\_65](#): > > Less than 2/5 (39.9%), but, point taken. Cerebral flatulence. Thank you for the correction. > [@snowthx](#): > > Concise and well stated. I would add that the “everybody” part is the stumbling block most likely in accepting this truth. 'Why should I have to pay for those lazy people’s health care? 😡 ’ What they miss is that _their_ health care is being subsidised by healthier people, just like it is with for-profit insurance. Only cheaper. ---
**Author:** ![Pedro](https://avatars.discourse-cdn.com/v4/letter/p/919ad9/32.png) [@Pedro](https://boards.straightdope.com/u/Pedro)\ **Post date:** [December 6, 2024, 7:48pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/99 "2024-12-06T19:48:15Z")
> [@Dinsdale](#): > > I’m not sure it is such a great question. (In addition to the very valid points made by **puzzlegal**.) Ever heard of agricultural subsidies? Or dietary recommendations set by the USDA? Exactly what is “non-socialized” agriculture and where is that practiced? Irrelevant nitpick. I’m not defending an unregulated health care private system. Socialized agriculture is one which is centrally planned and where all means of production belong to the state and workers receive a fixed wage. By way of analogy that is what is practiced in many universal healthcare systems in western democracies. Thanks to **puzzlegal** for the comprehensive and interesting response by the way. ---
**Author:** ![Pedro](https://avatars.discourse-cdn.com/v4/letter/p/919ad9/32.png) [@Pedro](https://boards.straightdope.com/u/Pedro)\ **Post date:** [December 6, 2024, 8:25pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/100 "2024-12-06T20:25:17Z")
> [@Spoons](#): > > Just because I’m curious—where are you getting those figures from? Do you have a cite for those? I asked ChatGPT: ```auto Gross salary of 28k EUR: France: income tax 31.8% US: income tax 20.3% Gross salary of 45k EUR: France: income tax 41.2% US: income tax 24.4% Gross salary of 113k EUR: France: income tax 59.4% US: income tax 34.2% ``` France/US: ```auto Gross salary of 28k EUR: +56% Gross salary of 45k EUR: +68% Gross salary of 113k EUR: +73% ``` Seems like I underestimated for the lower brackets where the median gross income is. [Previous page](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177.md?page=4) [Next page](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177.md?page=6)