So this is another way that tying health insurance to employment creates pockets of unfairness and undesirable outcomes. While I'm not sold on having a government run healthcare system (the pandemic only reinforces this), there are plenty of hybrid systems out there in other industrialized nations that might (must recognize each country's situation is unique) have better outcomes.
>> the risk in the public ACA pool is lower than the employer's pool of employees
as a general rule, the public pool is substandard rating.
That's a weird way of putting it. Young people are getting far less value from their healthcare premiums than the old. That's how the entire system is able to work.
Health insurance, social security, medicare etc. all discriminate against the young in favor of the old. And I'm not passing judgement for or against such a system. That's just how it is.
The ACA is actually a wealth transfer from the young to the old, like social security, because the young pay much more than their portion of healthcare costs, while the old have a ceiling on their healthcare costs.
Whether this is good policy is for the think tanks and politicians, but after the ACA it is not true that health insurance discriminates against older Americans.
Medicare exists only for the elderly.
A reminder that government services suck on purpose. There is no reason for government healthcare to be ineffective other than the malicious intent of those who run our government (D or R).
Yes. Government employees and elected officials have weekly meetings with a standing question: Where are we doing things well? And then they coordinate to fuck it up and make it suck. /s
I have these 2 questions/thoughts:
1) Do you think it's a good idea to have all the branches of the government controlled by 1 party? We actually had this a few decades ago in the Czech republic and we refer to that period as "totalita" or dictatorship. Let's say the wet dream (based on comments like yourself) of all Democrats becomes real and they control everything from communal level to presidency. How is it different than China, USSR or Czechoslovak Socialist Republic?
2) What has changed in the past half a year? If I am not mistaken, Democrats have had control of the presidency and house for over half a year now. I admit HN is my only source of news, but it seems like there are still ICE camps. There is still half-built wall between US and Mexico. The US still drones countries on the other side of the world. From the statistics people are still living paycheck to paycheck and can't afford healthcare (I understand the plague has its fair share here too). The US still helps Israel, which is IMO a rogue state at this point, as per the Pegasus scandal.
1b) We don’t really need 1 party. More than 2 parties would be great as well. But really we just need the Republican party to not be obstructionist nor actively harmful to democracy.
2) Democrats have the presidency, which, while having greatly expanded powers over the last 50ish years, is still a relatively weak executive. The Democrats have a narrow majority in the House and Senate; due to parliamentary rules, the narrow majority that they have does not allow them to pass or amend laws as freely as you may think. The Supreme Court, while notionally non-partisan, is filled with a majority of conservative Justices which can dissuade or reverse policy made by more liberal branches of the government (federally, or at state levels).
2b) 6 months is not a long time for governments the size of the US. Barrack Obama likened it to a large ocean-liner: there’s a lot of built up momentum, so it takes a long time to stop it or change direction.
Would you mind elaborating on that? From my own perspective the federal government’s ability to help fund and drive the vaccine development and then to purchase in quantities to get the entire population vaccinated is actually proof of how powerful a single payer system could be. I’m curious as to what I might be missing.
1. Fund and drive vaccine development
2. Purchase large quantities
Neither of those is what I want from my insurance company. How much are those two things costing me? If my taxes just went up $100/year for the next 3 years to pay for that vaccine, that maybe wasn't ideal. If my taxes went up $10 total, that was an awesome deal. If I have no idea how much that vaccine cost me, and nobody else seems to have a way to figure it out, that's really bad. One of my biggest complaints about health insurance in general is the lack of transparency. If government control reduces transparency, that would be bad.
Are governments or private companies more transparent?
If you have 90 units of work to be done you might hire 9 workers at 10 units each. If the standard work goes down by 10%, you now need 10 workers at 9 units each. Your workers have increased by 11.1% (given by 1-1/(1-0.1))
A reduction from 40 to 32 would reduce hours per worker by 20% but increase workers and total health care costs by 25%.
https://www.npr.org/2021/07/06/1013348626/iceland-finds-majo...
> Now, research out of Iceland has found that working fewer hours for the same pay led to improved well-being among workers, with no loss in productivity. In fact, in some places, workers were more productive after cutting back their hours.
For the record I fully support any push to reduce the amount of work people are expected to do, but claiming there's no impact because of productivity gains just doesn't add up in many cases.
For sure, some jobs are more affected than others. But there are few jobs that aren't affected at all, and we shouldn't cut off the nose to spite the face.
The study wasn't restricted to desk jobs. Broader studies and international comparisons lead to a similar though weaker conclusion; in general more working hours over the range seen in most of the world (from about the mid-20s average hours worked per week, including both full workweek length and time off up) leads to a dramatic fall off in per-hour productivity.
Maybe, maybe not. Perhaps being better rested makes them collaborate better with the other chefs. Maybe the improved morale helps come up with a new menu item, or a more efficient way to make a dish. Maybe they wind up staving off carpal tunnel.
But no task that actually needs done is purely coverage related. If you want someone to watch dor security purposes, you want them to actually effectively secure it to some level, and if average ability to do that drops from overwork you need more people; if you want someone to run a cash register, just having a body next to it isn't enough, they have to actually perform correctly.
This is similar to what's happening right now with companies that try to do locality adjustments for remote workers -- they get out-competed by companies willing to pay full price regardless of location. Eventually this will cause locality adjustments to vanish completely imo.
Assuming per-hour productivity is constant, which it is not; productivity goes down with more hours worked (both in a “full work week” and in the annual number of full work weeks.)
A rule of thumb is a worker's full cost is 2x their salary in the US. This varies, but it makes the math easy.
So costs would increase about double that. But if your workers are doing creative work, they might be more productive now per hour and that might offset the costs.
Declining marginal productivity by hours worked per unit time definitely applies to repetitive physical labor past, too.
While the rest of your comment is a fair concern, I want to push back on this default assumption.
While I'm sure there are roles that are pretty much 1:1 with output to hours worked, I don't think it's always true.
I think for software developers, for example, I get 90% of the productivity out of the first 32 hours of work that I would get out of 40 hours of work.
If you reduce hours per worker by, say, 10% you just pay each worker 10% less and hire 10% more workers, right? It's not so simple. If you try to cut the health insurance premium of each worker by 10% the policy becomes unattractive. If you keep the same policy, you increase your health insurance costs by 10%.
For this and other reasons, it's time to separate health insurance from employer.