a) What if you're self-employed? You're stuck with mediocre, expensive healthcare for the individual market.
b) What if the company is cheap or negotiates poorly the healthcare options? Sometimes they're mediocre.
c) Costs have been going up, and companies are finding ways to reduce costs (since someone has to pay for those padded healthcare executive salaries and healthy stock prices thanks for solid profit). Thus the same plan(s) get worse year after year.
d) there's a push towards 'high deductible, self-managed / pre-tax account' type healthcare, which is smiled upon as a fantastic way to give people choice. The reality is different, now not only is the healthcare company still the middleman that keeps a chunk that gets paid out to providers, but now it's up to you to 'negotiate' what healthcare service is important to you. Oh gosh, is it expensive? I'll skip this particular service.
The U.S. has got it all wrong, of course. I'm jealous of Swedish or other healthcare systems when I read through threads like these.
Bottom line: the mediocre healthcare system in the U.S. and the emphasis on giving middlemen lots of money for no reason is a barrier to innovation and self-employment. Why strike out on your own and take a risk on building something if you'll lose your precious company healthcare? This problem is only getting worse and clearly has an impact on the political discourse.
I ran my own small business, provided great healthcare for myself and a couple of employees, and managed to have good healthcare after I shut the company down and was unemployed for a while. I had to do a little research and make a couple good decisions, then it wasn't an issue. And that was before the Affordable Care Act, which provides free healthcare in many states for people who can't afford it.
The one thing is, if you are not working for a decent company, yes, you have to think about it and prepare for it before hand, it isn't all taken care for you without you doing anything. So I say, for the vast majority of people on HN it's not that bad.
And worst comes to worst, you are being irresponsible or have fallen through the cracks, and you get into a car accident, the hospital is going to take care of you anyway.
Well, in my state the individual market is tied to the state healthcare marketplace, and all of these are PPOs. At the worst, you'll pay $1200 a month for a plan whereby you have to stick to a finite network, and get approval every time from the primary care provider. And there's still a several thousand-dollar deductible. Even if I chose to offer $2000 a month for a plan that's a more open one, there's nowhere to give that money to someone.
I consider that a barrier to innovation / entrepreneurship because many people don't want to quit cushy jobs as employees for a situation like that.
It is most certainly not how it works in the UK! However for balance I should say that the employer does pay some tax and pension costs on top of your salary (employers NI and auto-enrollment pension). Whatever the advertised cost, you will be deducted tax and National Insurance by your employer.
So you get 30k before tax, 20k ends up on your account after tax deducted per month, and company pays state 30k more on top of the other 10k.
If you can't afford healthcare at all, they will bill you but you don't have to pay and they can't turn you away from a hospital emergency room. So basically government mandated free healthcare provided by private companies.
The problem is the lower and middle class, if you don't have insurance but do have something to lose, or if you have minimal insurance and a large medical issue, you can lose all your assets paying for healthcare.
What you said that's really interesting to me is that the high tax rate is paid in full by your company and not counted in your salary. Is that true all over Europe, like France for instance? I am always amazed by the really low salaries but if every bit of it is what you actually keep, it's not so bad. I didn't know it worked that way.