> When your employer is shouldering $20k in health insurance premiums without really telling you, it's easy to feel like the costs aren't a problem.

Yes and this makes it really suck if you happen to be a sole proprietor or self employed.

It's over $500 a month here to get insurance for a single adult for the absolute most basic insurance possible with the worst possible service you can expect.

I don't understand how society puts up with this. It's not that just the service is horrible and massively over priced but it's a torturous experience just to interact with anything related to medical insurance. Like having to wait 30 minutes on hold or spending weeks trying to resolve things, or spending a month trying to find a doctor who even takes your insurance, etc..

Suddenly instead of getting the best treatment plan for your issue, it becomes a game of trying to extort you for doing the minimum amount of work while making sure you pay as much as possible out of pocket while already paying for insurance.

And then on top of that, it's like btw, $500 / month please or you run the risk of being bankrupt if you step foot inside of a hospital for anything that's non-trivial.

It’s a double whammy because the employer gets to deduct 100% of their contribution but the little guy buying it on the open market has to use post tax dollars.

Which is _bullshit_. Everyone should be able to deduct their out of pocket premium costs.

Or better yet, nobody.

This is probably a better idea. No hidden costs to any one. Employers would either lower salaries in America, or stop covering insurance.

When the cost of healthcare is visible, maybe then the majority who have employer provided insurance would then fight with the minority of us who use the marketplace, and shoulder the entire burden of the price.

Yeah either way. The playing field should be level.

I think that's where the scam sits. The cost is not being driven by the cost of actual healthcare anymore. It's being driven by how much companies are willing to pay for each employee. So instead of companies just paying the employees more per year, they're paying an insurance company about 10% to 20% of their salary.

Well, I think the actual problem is that there is no downward pressure at all for healthcare costs. And in fact all pressure is all upward, starting with the provider and the small network of sub-providers they represent. The complexity of billing allows the provider to "not know" what their own services cost! So anyone who complains is considered a cheapskate trying to skimp on their own health, or worse, on someone else's.

Its horrible. I had one billing department lady in the US literally tell me when I complained about the exorbitant cost of a simple ER visit (in the thousands), "Well, how much is your life worth?" After the steam stopped coming out of my ears, I was able to come back with: if that's your position, then why stop at 5k? Why not charge 50k? Or 500k? Why not take everything I have or will ever have? She didn't respond, and just looked at me thoughtfully, as if I'd just given her a really good idea.

That lady is in the wrong line of work.

The scam is that employers get to purchase the insurance with pretax money, whereas a person whose employer doesn’t offer health insurance gets to purchase it with post tax money.

In my outsider opinion, aside from very complicated legislation, it seems that your main problem is that you don't have a public, universal and suficiently competent competitor.

In Spain private healthcare is somewhat affordable, even full coverage plans, because everyone can walk away any moment.

AFAIK the situation is very similar in many other countries.

last I saw, roughly 80% of people in the US have employer provided healthcare. In a democracy a 20% minority has to be VERY vocal

edit: I was incorrect, this is 80% of people get healthcare from their employer OR the government. Only 20% of people are responsible for paying for their healthcare separate from their employer (if they have one)

That sounds fishy given the huge numbers of people covered by Medicare, Medicaid, and the VA.

Is that number out of the total of insured people? Because I guarantee you there are a LOT of people that faced with that choice don’t get insurance.

That must be 80% of people who have insurance and work full time. Something like 30-40% of Americans are on medicare, medicaid, or both.