> It perverts the freedom of movement between jobs that people have a fundamental right to.

I was always fascinated that the US simultaneously had this health care system, and also a cultural obsession with small business (this may have faded over the years, but was a huge talking point in the 90s and noughties, especially on the right).

“People should start small businesses! Oh, also, if you do that you may die” was just such a perplexing message.

Being from a developed English-speaking country, where we get a lot of American media, it’s very easy to just assume that America is pretty much like a bigger version of what I’m used to. Until it comes to the jarring, utterly alien things, like healthcare.

> but the fact that access to healthcare _EVER_ factors in to your career is manifestly wrong.

ABSOLUTELY. I should be able to independently choose my healthcare coverage. I purchase my home/renters insurance, my car insurance, my liability insurance, my life insurance, etc. separately from my employer. Why not health insurance???

Employer-tied health insurance is literally federal law in the U.S.

It still boggles my mind how widely supported the ACA employer mandate ("Obamacare") was by my fellow Americans.

And disappoints me that the mandate wasn't repealed in 2017-2018 when it appeared the right politicians were in place.

The widely supported aspects of the ACA were guaranteed issue and the elimination of low quality plans (which really were pretty useless as insurance). Those things cost a lot of money and forcing employers to pay into the system (think of the mandate as a tax) is one of the ways they were paid for.

It's fine to not like it, but it was probably one of the less disruptive options for collecting more health care dollars.

As far as I can figure, there's really only 2 paths forward for the US system. Dump more money into it or train lots more providers. People don't seem to think we are short on doctors, but the market looks sort of exactly supply constrained, where everyone is busy and prices go up up up. Of course, because we are stupid, some of the most significant healthcare regulations...limit supply.

> think of the mandate as a tax

It's not a tax though. It's finding, choosing, paying for a particular insurance plan for their employees.

Thus, insurance being tied to employment.

Okay, I didn't really address that. I would argue that it didn't change the situation that much, because the situation prior to the ACA was that being in a group plan (employer coverage) was the best way for people with significant medical needs to maintain insurance.

For many people, "A good job" has long been one that came with health coverage (and given the expense of insurance, this continues to be the case).

It would be excellent for us to have a situation where people bought their health insurance individually. I think requiring more employers to provide insurance probably was an incremental step in that direction, as counter intuitive as it is, because it addressed the situation that existed in an achievable way.

My last job's insurance plan cost me $800/mo (family) just for the pleasure of having. Even with the insurance (which changed half way through employment) things like my migraine medication was still $150/mo on top of that (before the change it was not much).

This was actually much better than the job before that because at least the company paid for my coverage (may be confusing but that's still $800/mo out of my pocket to cover my family).

So yes, just the job you choose can be rather drastic changes in take home pay due to insurance coverage, so a huge impact on what companies you decide to work for.

You can imagine the headache each year when it comes time to have to choose insurance plans again.

On that migraine medication... all insurance companies limit the amount I can receive each month the a number much fewer than the migraines I get.

These migraine meds expect that you take it on the onset of the headache, often before you know it's even a migraine otherwise they don't work. So you are left with this decision, do I possibly suffer for the rest of the day or use up my stock for something that may not need it.

Worst part about it is, when you get that yearly headache from dealing with insurance plan renewal, you have to pay full price for the headache medicine because your deductible and out-of-pocket counters reset to zero!

Adding insanity to insult and injury.

As an Americam, I'm free to move about, but I don't move jobs very often. I consider healthcare benefits when I move, but only that I have them and that my new salary pays for them completely. If the new employer pays a smaller percentage of my healthcare bill, then my salary must increase by that amount. I've never switched jobs and had my overall salary decrease.

I wouldn't stay in a bad job for the benefits, but I'm a technical employee, who happens to have lots of choice.

I have had to choose between working at a fast food restaurant (crappy job) and working as a math tutor (awesome job), but the tutoring gig was a contract deal and as such they were not required to provide any health benefits. Working as a tutor for a couple months was really great, but in the end I had to go back to working fast food so that I can pay for medications and a surgical procedure. Yay Capitalism!

So on the topic of healthcare linked to employment, what would it have looked like if you took some of the tutor money and bought your own healthcare?

I want to say that maybe the fast food job simply paid more if you factored in the healthcare, but maybe it's that the fast food company can get way better insurance rates than you alone?

You are right, it comes down to the bargaining power of large corporations. The hourly rate of the tutoring gig was higher, but I would also have been paying a lot more for insurance, so it would even out. I also have to take brain medications which complicates things, because a lot of insurance plans don't provide good mental health care coverage, adding a layer of complexity to my decision making process.

For example, even if plan A and plan B cost the same amount out of my pocket, but Plan B does not cover my medications until after a $5,000 deductable, it really isn't helping me because all of my medications added up over a year come to just under $5,000.

There are so many layers of bureaucracy and complexity and institutional inertia keeping this exploitative system moving, it really needs to just be burnt to the ground so we can start fresh.

"It is absolutely beyond the pale for the healthcare access of someone and their family to be linked to their employment. It perverts the freedom of movement between jobs that people have a fundamental right to."

It's not really linked to employment. Employers pay for it, yes, but anyone can go on the open market and get their own insurance. I'm a consultant and have been paying for my own insurance for me and my family for a decade.

In addition to this, there's something called cobra, that allows you to pay for health insurance for awhile after you leave an employer. Unless the person in this article went over a year between jobs and never even tried to buy his own insurance, his lack of coverage is an exaggeration.

"I'm sure there are an assortment of remedies, but the fact that access to healthcare _EVER_ factors in to your career is manifestly wrong."

It really doesn't. The majority of companies provide healthcare for their employees. I've even worked for a company of 10 people and had fantastic healthcare.

"Have you ever decided _not_ to take a risk starting your own small business because of loss of healthcare coverage?"

No. You can pay for your own insurance, which includes doctor prescription, checkups, and you won't go bankrupt in an emergency (or paying for the insurance).

"Have you ever had a family crisis and through it been forced to continue working in order to keep healthcare coverage?"

Even if you have 0 coverage, a hospital will be forced to take you. If you get bills, you can negotiate with the hospital and you can get your bill down 90%. There are some nonprofits that will actually pay your bills for you if you really have no money.

Most of these articles are FUD to push everyone to go to Universal healthcare. Sure our system has problems, but a government takeover will not solve the issues.

Insurance was never meant to be used for everything. We need to get rid of the insurance companies and allow hospitals to actually charge patients the true value of things (which would immediately bring the costs of most things down).

Surgeries and procedures that happen often would be brought down due to competition and the ones that don't happen that often could be covered under some sort of insurance.

Platic surgery and Lasik eye surgery are good examples of this in action. A decade ago, they were both very expensive. Competition has brought the costs down considerably. My parents both got Lasik surgery without insurance and paid under $1000. 10 years ago, it was $10,000.

I also really never got the 'not being able to start a business' mentality. Sure you have more risk, but it will take you much longer to actually have a running business if you have an increased amount of taxes due to universal healthcare.

In most European countries, you need to involve the unions after a certain amount of employees. This combined with large amounts of taxes impedes growth.

I would be interested to see how many larger companies in Europe actually started and grew there or grew large in another country and then opened up an office/location there. I'm guessing more of the latter than the former.

I appreciate the thoughtful response. I have a lot to say on the matter but it goes well off-topic of, "healthcare shouldn't be bound to employment". However, I am curious. Technically, yes, you can go get your own healthcare and reject the employer's offerings? Is that a real-world practical option that people can and do opt to take?

Yes. Tons of people buy their own health insurance in the US. I have done so for my entire adult life.

Is it basically equal cost to the insurance most companies would be providing access to?

I have no way of knowing. I’ve never had a job that provides insurance. And I think most jobs do not break out the portion of compensation that pays for health insurance.

It seems like you're ignoring a lot of facts and making rash generalizations to justify your political position. In particular, this is stood out to me as blatantly wrong:

>You can pay for your own insurance, which includes doctor prescription, checkups, and you won't go bankrupt in an emergency (or paying for the insurance).

I know somebody who got in a car accident out in the hilly area of town, had to be airlifted to a hospital, and have his skull and spine reconstructed. The guy's a doctor who runs a private practice and he was buying his own insurance, the insurer decided what they were going to cover and what they weren't going to cover, and now he is literally 2 million dollars in debt (2 occupants in the car). And that's somebody who makes a hell of a lot of money compared to fast food workers, who are equally likely to get in car accidents!

You are either naive or fooling yourself if you don't see that this system is broken and exploitive.

Something is not adding up here. Health insurance in the US has annual out of pocket maximums that would have limited his total payments for the incident and all subsequent care to something like $15k/year for his entire family.

Only if they approve it and assuming the doctor takes your insurance. They may not approve it because you are out of network, they deem it not medically required or a drug that they will not pay for because there is a generic.