COBRA isn't employer-paid healthcare, its an ex-employee option to pay for the previously-employer-offered plan, while the employer offers a plan to current employees.

If there are no more company operations and no current employees, there is also no plan and no COBRA.

This could also be an issue if a company restructured so it didn't have to offer employees health care because of size or everyone being part time or whatever: COBRA doesn't guarantee that there is a plan from your former employer, it just gives you a right to pay for it yourself if there is, for a certain period of time.

Cobra is such a huge slap in the face too for most people. We know you just lost your income as of today, but do you wanna buy this health insurance plan for 3K a month?

You can often use it to game insurance between jobs though. You have like 60 or 90 days to decline coverage, and it backdates to the day you lost coverage.

So 46 days of gap between job 1 and job 2? Don't get cobra, just tough it out. If medical bills are >= 3k, then go ahead and sign up for cobra and get a chunk covered.

The COBRA option is pretty nice to have available as gap coverage if you need it even if it is pretty expensive at the family level. (Of course, personally paid 100% medical insurance in the US in general is expensive--especially at the family level.) COBRA at least means you don't potentially have to switch medical providers because of a short-term switch in insurance.

If my understanding is correct, the idea behind cobra is to use it just-in-time for healthcare operations that are more expensive than the monthly premium, ie a $25k surgery + $15k hospital stay

That's a hack that is often described on HN, but the point of COBRA is, as the name suggests, continuity (originally, in part because pre-ACA an issurance gap itself had adverse consequences to future insurability, and acquiring private-market insurance isn’t typically instant, but also because people often have ongoing medical needs where a discontinuity in coverage could disrupt service, )

Yes—something people today might not know is that before the ACA, you could be denied insurance coverage for "pre-existing conditions," which in practice meant anything medically recorded before you were insured. Changing insurers (because you changed jobs) didn't reset this period, but having a gap over a certain length did—I believe it was 60 days. So it was very important to make sure you maintained coverage, or else your ongoing cancer/arteriosclerosis/diabetes/etc. treatment was suddenly 100% out of pocket.

Also, COBRA and medical insurance in general used to be a much smaller fraction of middle-class take home pay, so it was a lot more realistic to elect to pay it out of savings even if you weren't concerned about all the above.

It can be a slap but sometimes an employer will discount the COBRA insurance for a period of time.

Oh, you forgot the mandatory 5% fee, too.

If your employer was paying $3,000/mo for your insurance, it's going to be $3,150 for you.

Fuck whichever lobbyists made sure that was allowable.

> Oh, you forgot the mandatory 5% fee, too.

It's not mandatory and its capped at 2%, not 5%, but, yes, there is a potential additional charge beyond just the full cost (what would be the employer + employee share, for a current employee) of coverage.

I do appreciate that. Have edited my comment with your correction.

> COBRA doesn't guarantee that there is a plan from your former employer, it just gives you a right to pay for it yourself if there is, for a certain period of time.

When a business close, if there is no money to pay the insurance company, the plan will be terminated by the insurance company, and correct, there will be no COBRA. Bad situation.

You know, it's rather impressive the lengths the US will goto to avoid socialized/single-payer health plans (for anyone who isn't in the military or poor or over 65 at least). That sounds rather cockamamy to me.

Medicare: 65,748,297 people enrolled

Medicaid and CHIP[1]: 85,614,581 people enrolled

Military [2]: 9.5 million enrolled

The US has not one but two of the largest single payer health insurance programs in the world.

Medicare alone has more people enrolled than all European single payer programs other than Germany (pop 83,294,633) and the UK (pop 67,736,802).

[0] https://medicareadvocacy.org/medicare-enrollment-numbers/ [1] https://www.medicaid.gov/medicaid/program-information/medica... [2] https://www.health.mil/Military-Health-Topics/MHS-Toolkits/M...

I don't think having discrete programs for subsets of the population is single-payer. Single-payer to my understanding means that the health system itself has a single payer. Having the government pay for some patients and a myriad of insurance plans covering the bulk of other patients is not single payer.

As they said, it is bizarre the lengths the US will go to to maintain its layered system. It seems purpose built to screw people over.

I think it would likely be called a non-universal multiple single-payer system if you want to get pedantic about things, but either way given that Americans spend more on healthcare in relative terms while lagging in most health measures makes it all seem very foolish.

We do not have universal single-payer but we have a few very large government-run single-payer systems.

If you have an example of a country with a single program that has more effective outcomes for a population of similar makeup and size, that would be a useful comparison.

A significant administrative vost benefit to single payer is not having to identify the correct payer, do coordination of benefits, etc.

With multiple “single-payer” systems in the same population (often serving overlapping populations with each other and private health insurance) you've negated that benefit.

You’ve also negated the market power advantage of monopsony purchasing by having multiple of them, and again having them coexist with private health insurance.

(And that's even before considering that while Medicare and some state Medicaid plans have single payer components, Medicare is not a single-payer plan covering the listed number of beneficiaries, but instead just under half are in the single-payer traditional Medicare, and that Medicaid isn't a single payer plan, or even a plan, at all, its a funding mechanism for state-operated plans, each of which may or may not operate entirely as a state-level single-payer plan.)

> With multiple “single-payer” systems in the same population (often serving overlapping populations with each other and private health insurance) you've negated that benefit.

Turkey's system used to have that exact flaw (three single-payers, to be precise) until 2008. All merged thereafter.

> The US has not one but two of the largest single payer health insurance programs in the world.

Neither Medicare as a whole nor Medicaid is single-payer. (Individual state Medicaid plans may be single payer plans, but very often they aren't, either.)

Traditional Medicare is single-payer, but the majority (as of this year) of Medicare beneficiaries use partially-subsidized private insurance (Medicare Advantage) plans, not traditional Medicare.

When you start to list all the groups that already get free healthcare, it looks like only middle class workers actually pay:

- seniors

- native americans

- low income women

- single moms

- military

- illegal immigrants

- homeless

- government employees

The debate about government healthcare is so far gone, we can't even imagine what a "free market" for healthcare looks like. It's time to throw away all these special programs and just get one system for everyone.

I don't think military medical coverage really counts as single payer; it's an in-house employer plan, it's just that the employer is the federal government. Just because the federal government is paying for it, doesn't make it single payer.

Re: medicare, I think a reasonable way towards universal single payer (or whatever you call medicare advantage plans, as a sibling notes) would be to drop the eligibility age over many years, and eventually get full coverage; and at the same time, add all kids to medicaid. Ex: years 1-10, reduce medicare eligibity age by 1, have medicaid cover kids less than year number; after ten years, medicare covers you at 55, medicaid covers kids less than 10. Years 11-20, reduce medicare eligibity age by 2, still increase kids by one year per year; after twenty years, medicare covers you at 35, and medicaid covers until 18. Years 21-28?, add medicare one year from both ends, and I think at year 28, everyone is covered. Congress should adjust the rollout schedule regularly, as scaling problems emerge, or don't; if after a couple years it becomes obvious that it's too slow or too fast, it can be adjusted; it'd also work, but be more complicated, to do it on a % basis --- once a year, determine what age (years + months even?) would result in a 1% enrollment increase, and do that, you'll finish before 100 years, but I'm not doing the math to figure out how much sooner.

Not only this, COBRA may end up costing you up to 102% of the total premiums. Yes you read that right. Employers can add a 2% fee because they are helping you with COBRA administration (if they do). COBRA is garbage and in general, healthcare dependent on EMployers is garbage but this is unfortunately how America works.

COBRA is mandatory, but the person laid off has to pay for it

Isn't COBRA for layoffs not shutdowns?

Only if there still is a group health plan to pay for. If the company has shut down, there is no health plan, and therefore no COBRA. (Although, in general, with ACA, marketplace plans are not clearly worse than COBRA would have been.)

Oh, hell, totally didn't think of that. Ugh