If you read the fine print of a health "insurance" plan at a large company, you might discover healthcare costs are directly covered by the employer and the insurance company just administers the plan according to "set rules".
In practice, this operates as blame as a service.
Imagine your car gets totaled. Your insurer says, "Hey, we're going to pay out $25K for your vehicle. So you have a $1,000 deductible, so that's $24,000, and then your copay for a total loss is $2,000, so that brings us down to $22,000. For total losses, your coinsurance as your contribution for your vehicle coverage is 20%, which is $5,000, so here's a check for $17,000. But that's only if you're buying a Hyundai, otherwise the vehicle is out of network and you'll get a check for $8,500 instead."
> If you read the fine print of a health "insurance" plan at a large company, you might discover healthcare costs are directly covered by the employer and the insurance company just administers the plan according to "set rules".
Generally this is done by a TPA (third party administrator). In many ways you can do as you wish, but as insurers have already done the actuarial work, it's generally easier to use a plan and tweak it if desired (like "Give us this plan but pay for 1 massage/week") versus having to figure that out yourself.
Health insurance is more insurance than car insurance in the US. There is a legal out of pocket maximum of $17k or so, and networks don’t matter for emergency situations. In fact, people get millions of dollars of healthcare from health insurance whereas auto insurance provides a maximum of $500k after which you have to use umbrella insurance.
Health insurance premiums are not insurance premiums, because legally, health insurance sellers cannot underwrite the health risks. Legally, young and healthy people have to subsidize old and sick, via age rating factor caps (3x and even 1x in NY and 2x in MA), and not being able to price pre existing conditions.
Which means health insurance premiums are mostly a tax if you are healthy and less than 50 years old or so, especially if you don’t plan on giving birth that year.
Auto insurance premiums are insurance, because the insurer is pricing your risk of loss, based on your driving history/driving distance/location/etc.
$1m Bodily Injury limits are sometimes available for auto policies. Many providers also don't offer over $300k, only some do the $500k option!
So the healthcare isn’t cheap, but the employer is able to gain more control over their employees by tying a piece of their non employee life to the employer creating more friction to prevent people from shopping for jobs with higher pay, and the employee is getting a small tax benefit.
My mom's plan randomly denied my medications all the time as a student. My current job's plan always provides coverage.
Both were the same insurance company, but she's in a different field with a more stingy employer.
That's missing the biggest problem, which is that the employer gets a free chance to extort the employee in all sorts of illegal ways lest they be cut off and die.
Wage theft is perhaps the biggest-value type of crime every year (sources disagree, but it's certainly higher than many), and that's only one kind of illegal thing employers do when they have all the leverage.
When one then compares US facilities to foreign ones, it's trivially easy to see that many parts of the system just look different, which comes from the perverse incentives of going through employers that aren't big enough to actually push down on providers' prices at all. Both truly private, low insurance systems and universal healthcare systems end up having much better incentives, and therefore lower prices, regardless of who is paying for them.
We get something similar when you compare US universities to those in Continental Europe. It's clear that over there, the finishing school component is so vestigial as to be practically invisible, whole the focus is a filtering mechanism that attempts to teach something. Go look at, say, Spain's universities and see how many open electives are there, or how many university-wide general requirements exist (0). Each degree is basically an independent unit, and chances are you'll never visit a building from a different school. Undeclared majors? Nope. Significant number of students living on campus? Nope. Sports teams, offering scholarships? Nothing of the sort. This also leads to much lower prices to the school itself, regardless of whether it's all paid by taxes or students.
Probably half the jobs in the US don’t pay enough for the employee regularly see a doctor. It might protect them for the $500k emergency heart bypass, but they are not going to be able to afford the $10k out of pocket costs or the ongoing healthcare expenses after they lose their job.
Wouldn't you like to STOP the insanity of "picking" a plan every year (or more) and also end the billing nightmare by just making it all single payer (the government of the people, for the people)?
It matters for early retirees (or these days, people forced out of job some years before they wanted to officially retire). Without self-employment income they can't deduct it, and often for similar reasons they can't itemize. They still get the standard deduction of course, but an person on an employer plan gets that + their cost of premiums, automatically.
While it may not be optimal, there is plenty of training/learning that happens in colleges.
Healthcare costs, and hence health insurance premiums, are the same with or without an employer intermediary. The only difference is with an employer intermediary, the insured gets to pay their premium with pre-tax income. The cost of the health insurance is still felt by the employer (shown in box 12 of code DD of everyone’s W-2), and seen by the employee in the form of smaller raises, or higher premiums/deductibles/oop max, or worse networks.
>People want job training, and it got shoehorned into extra departments at liberal arts universities intended as aristocrat finishing schools. Job training really has little to no relationship to liberal arts.
Job training didn’t get shoehorned, a cheap filtering mechanism for people worth betting on to be a good hire got shoehorned. But that filter simultaneously got worse and more expensive over time, making it a bad purchase for most students and bad signal for employers.