The reason is explicable - health insurance paid by the employer is tax-deductible, while insurance paid by the employee is not. Therefore, employers include it as a way to increase total compensation at a lower cost.

The origin of the practice was in WW2, when Roosevelt froze wages. To attract more and better employees, the companies threw in health insurance as a way around the restrictions.

Thanks for reminding us that state intervention is the source of the problem.

Stop linking medical insurance to employment via this tax bigotry. Buy it on the open market instead, or subsidize it if you're a leftist, but don't put that burden on jobs, you'll only get fewer jobs with greater hassle. People can agree to the arrangements they prefer, and it's not for us to second guess that. If there are people who end up coming up short, then you can help them yourself, or force the whole society to chip in (again, if you're a leftist), but don't force such considerations on the fragile links among private individuals and businesses.

>The reason is explicable - health insurance paid by the employer is tax-deductible, while insurance paid by the employee is not.

It would be very easy to reverse, if literally anyone was willing to.

Hillary was for single payer. Trump ran on repealing even the ACA. I don't think it's as simple as literally anyone.

I'm not talking about changing the healthcare system entirely, but the tax deduction status.

Right, but we're currently at a point politically where we're heavily considering regressions in healthcare and insurance, not progressions. We're talking about bringing back denying coverage for existing conditions and allowing insurance to deny medication on grounds of religious reasons.

Changing the tax deduction status would harm businesses, and therefore I can't see a conservative administration ever letting that fly.

Which goes again to my original point.

Sure, but the inexplicable bit is that there's no actual reason it has to be that way.

There's no reason why a law cannot be passed amending the tax code to make health insurance premiums paid by an individual tax deductible.

I'm not saying it would be easy to get such a law passed, but that doesn't change the fact that it's stupid to have health insurance tied to your employer.

(At any rate, health insurance premiums are tax deductible, but the rules are annoying and require that your healthcare spending be a certain percentage of your income.)

I can spell it out, if it helps. In a country with exorbitant healthcare costs, it means that leaving your job means that you (and often your family) don't get healthcare.

I'm thinking you misinterpreted the comment you responded to? I read it as saying that you don't necessarily have to have employment linked healthcare just because you have at-will employment.

The "inexplicably" being a commentary on the wisdom/sanity/compassion of linking healthcare to employment, rather than a claim that the parent comment had made an inexplicable leap of logic

But the discussion wasn't about "generic at-will" employment. It started as "American at-will" employment.

> > I have come to the conclusion that the American “at-will” employment model is actually a good thing and benefits workers

It may seem like you can just walk away from a job but realistically most people can't.

"Most people" are not dependent on health insurance for their average needs, except in the long-term or unexpectedly.

Then of course, being unemployed, you have the option of COBRA (you probably don't want that though), and if it does not make you immediately eligible for Medicaid in your state (40 of 50 have Medicaid expansion), it would make you eligible for the ACA subsidized plans. NB: more than one-third of employer-sponsored plans are HDHPs, meaning employees have deductibles in the thousands of dollars anyway.

It's certainly a disruption, and it's one more thing to consider, but the idea that "most Americans" are one job loss away from being killed by lack of health care is not remotely true - most people don't need health care that regularly, unemployed people have insurance options, and at a last resort, for the most part, you can accrue unlimited medical debt in most places with few real-world consequences.

My wife was once a day light on her birth control. Nine months later, she delivered a boy.

For most women of child bearing age, between birth control and annual visits, healthcare is pretty important.

Birth control is available over the counter in the US. If you have specific need, it’s very cheap and your doctor will almost always just call in refills without charging you. The meds themselves are not expensive.

Annual visits are also not actually that important. They’re perfunctory. They can certainly be put off for a few months in a ok except a few one in a million cases.

And at any rate, as I said, losing your job in the US means your insurance is disrupted, not that you are now uninsured. Pregnancy even in states without Medicaid expansion will get the mother and child on Medicaid.

Of course, at the risk of being silly, it’s also true that missing a day of birth control is not what got your wife pregnant. ;) it’s pretty surprising to me how many people (now with children) thought birth control meant they wouldn’t get pregnant. There definitely needs to be better education on this. Taking birth control, even regularly, even with an IUD, is more like a backstop and should not be relied on for your primary protection. The odds are low but when you play them a few times a week for ten years…

I very much read it as I responded, and re-reading, still interpret it as such.

Kirkules is correct.

My apologies, I stand corrected.

If you lose healthcare """insurance""" when you lose your job, you never had real insurance to start with.

(The system might work if some lag was introduced (a year of keeping that level of insurance??), but I'm not sure that this duration would not quickly get sapped by perverse incentives ?)

COBRA?

That’s super expensive. ACA is often better but that may change now with the republicans having control of congress.

> That’s super expensive

COBRA costs you exactly how much you + your employer were paying for that insurance.

It's expensive because your employer's share of insurance was a significant part of your compensation (And because US healthcare costs are pants-on-head insane.) I'll point out that it's generally quite expensive to, like, stop getting paid.

Practically, post-ACA, health insurance in the US is about as tied to employment as having a roof over your head and food on your table is. If you don't have employment, or money, you're going to be in trouble - but that's the case with everything you need to live, not just healthcare.

Our regulations (including the medical guild) and legal structure (including crazy malpractice payouts for unintentional mistakes) forces everything to be more expensive than necessary. We are very far from a free market, even if we stopped with the untaxed benefits.

US healthcare is a market but not for patients. Insurance, employers and hospitals negotiate a lot. But people who get employer based insurance just have to accept what they are given. Pretty crazy.

Don’t most large employers essentially self insure? They only outsource the administration to insurance companies, not the float.

Sure. The point is that the employer does all the selecting of options and the patient/employer has to take what the employer chose. No market for the patient.

Aren't healthcare costs in line with the very high US income levels (with people spending a high fraction of their income in it, because they can afford to), and the main issue is inequality (including lack of real insurance)?

We left the free market of healthcare behind because it was awful for consumers. People who were disabled or otherwise had chronic conditions were, more or less, completely screwed. Not to mention these regulations are very much necessary. We want educated and highly certified doctors cutting you up.

COBRA is an expensive joke

It is, though, because it kind of transfers most of the power in the relationship to the employer. Without it, I imagine they'd find some other way, or lobby the state away from at-will employment.