Pre-WW2, many unions in the US had negotiated employer-paid health insurance as a (taxable) benefit. When the government capped wages as part of wartime price controls, these unions threatened to strike, which would have gutted industrial production. To avoid a strike, the government offered to temporarily make employer-provided health insurance a tax-free benefit.
Temporarily. And here we still are.
//Hacky solution to get a working prototype, should be refactored before deployment.
Legislative and regulatory debt can be a problem just like technical debt.
I really wish there was more appreciation for this outside of tech. I'm disdainful of a lot of SV libertarianism, to say the least, but will gladly make common cause on this one point.
The healthcare situation in the US may have started out as a hacky WW2 era fix, but has been explicitly and aggressively lobbied against for years at the highests levels of government.
Framing it in a technocratic context as "technical debt, but for laws and stuff" completely misses the intense crusade against it in the US.
During World War 2, the US implemented a national wage freeze, with an exemption for insurance and pensions. Since companies still needed to compete for workers, this led to a significant growth in those benefits.
Because the people who keep it that way are the same people you hear say dumb crap like, "I don't want to pay for someone else's healthcare (ignoring the fact that that is the definition of insurance!)" when anyone brings up changing the way healthcare is run in the US of A.
They think only people who work deserve healthcare.
You can save up enough money to pay the bills for a few months, but you effectively can't save up enough money to cover your own health care costs without some sort of insurance.
On the other hand, companies also spend significant resources being health insurance brokers. Getting rid of that burden would be particularly helpful for small businesses and startups.
I would be far more willing to risk assets I had if I knew I'd still have basic necessities in life. You know, the luxuries the very wealthy have...
But abstaining from health insurance right up until the point where you need it is the same as having other people pay for your healthcare. A ban on pre-existing conditions without an individual mandate is a form of welfare. So in actual practice many people who are nominally opposed to universally subsidized HC are in fact not opposed to universal subsidization of healthcare... as long as there's some nominal involvement with the insurance industry prior to use.
The broader point: many people don't realize that just because you're paying into something doesn't necessarily mean it isn't welfare. In a democratic society with a lot of individualism and distrust of government, sometimes this "hack" is the best way to deliver a welfare state. See also: social security.
+1 its unclear to me why the pricing would go down for higher number of employees? The risk profile is still spread across many people in the case of contractors.
A large company often self-insures the healthcare cost, and is buying health plan administration. If high costs are not observed, the reserves can roll over to future years. Even if they don't self-insure, the possibility can be used to negotiate lower prices, and having data on past claims can show a less risky pool, etc.
It's tied to employment because we have private health insurance and that doesn't really work without group plans. Employers are the most readily and widely accessible set of groups (unions are another for example).
I think it would be much more viable if we get rid of the employment requirements.
I never understood why healthcare was tied to employment. Yes, it's a nice benefit, but it's not like your health needs change significantly if your job changes.
Maybe employers for dangerous jobs could offer supplementary insurance in effect at the workplace or job site. But access to affordable day to day healthcare is something we all need from birth to death without interruption.
Especially when you consider infectious disease, the health of the community impacts all of us.