Which conveniently hides the fact that many state and local governments are cutting hours to do the same business is doing. Wal Mart gets called out because of past activities amongst major unions to denigrate them because of their anti-union stance. The idea being, get the biggest retailer and the rest fall into line.
However they merely reflect what many other type of employers do, they just are more noticeable because of their size.
"Forty-one percent of the businesses surveyed have frozen hiring because of the health-care law known as Obamacare. And almost one-fifth—19 percent— answered "yes" when asked if they had "reduced the number of employees you have in your business as a specific result of the Affordable Care Act.""
I think it's some kind of give and take. More hits for Forbes and you can piggyback off their name. I'm kinda vexed by the entire thing. I hear people say they've been mentioned "by Forbes" or that "they're in Forbes", but really they're on this blog site. It seems dishonest somehow, but I'm not sure how or if that's the right label. I think Forbes is really risking their online brand with this stuff. It's not always super clear what's a blog and what's a Forbes writer.
Yet another example where perverse incentives lead to unintended effects.
The problem with Obamacare is that it doesn't address the primary problem: health insurance is tied to employment.
Until we get past that we are going to have a broken system where the customer is not the customer. The insurance company and then your employers are the customer.
Linking your ability to see a doctor for a reasonable fee to your ability to find a decent employer strikes me as a monumentally short-sighted decision (if one was ever really made) on our part.
The problem is that quality healthcare didn't become an entitlement over night. For many, many years most (all?) people didn't have access to quality healthcare. Over time more and more people got access to quality healthcare until the number of people reached a critical point where people decided they were entitled to it. Before it was viewed as an entitlement it made sense for businesses to offer it as a perk.
I think you got it wrong. The exchanges may be a first step in separating healthcare from employers. If I can buy into an exchange there is less risk for me. The risk is spread throughout the exchange. As a want-a-be entrepreneur I think the current system stinks
It might be a step, but the obvious first step is remove the laws that make employer based insurance so much more attractive. Specifically the huge tax advantage, and group insurance laws. The whole ACA is a really complicated partial fix to the employer - healthcare problem.
The same people that pay for other essential basic services like roads, firetrucks, police, elementary schools, judges, etc. etc. etc. - i.e. everyone through taxes.
If I pull a fire alarm when there's no fire, I get fined. If I speed on the highway or run a tollbooth without paying, I get fined. If I decide not to go to elementary school, I get fined. https://en.wikipedia.org/wiki/Truancy#United_States Who decides what health care I have access to, and what health care I'm required to take (vaccines, vitamins, exercise, etc)?
Have you lived outside of the US at all? Perhaps in a country with universal health care?
I only ask because anyone who has knows that in a vast majority of examples, the simple act of guaranteeing basic care has nothing at all to do with the questions you raise, in the same way that not paying to use the interstate has nothing to do with you being able to drive to your friend's house for free.
Yes, but given that variants of this system are in place all over the world, your questions have already been answered a hundred times over, should you choose to look for the answers.
Yeah there are a lot of different ones. I'm asking for grecy's opinion. Anyway if you want my "answer", I think we shouldn't do it. Tyranny can be much more efficient than democracy but that doesn't mean it's reliable. Same with socialized healthcare. Corruption is too easy and too damaging to gamble with.
If you want my answer, I think your opinion is ignorant and ignores basic fact in favour of ideology for ideology's sake. Unless of course you also support disbanding the entire US Armed Forces (you know, those guys with guns and stuff that can literally destroy anything that we've socialized?), your stance is hypocritical.
You are the epitome of the exact thing that you fear, and you don't even seem to realize it.
edited: If I were doing ideology for ideology's sake, I would support disbanding the whole US armed forces. But in capitulation to "fact" I only support getting rid of most of it. I'm not in favor of the military-industrial-congressional complex.
edit2: what does the military have to do with socialism, anyway?
Reading down the thread, you seem interested in my reply.
> Who decides what health care I have access to
Society decides, in the same way it decides how to spend any tax dollars, such as when and where to build new public roads, when to open a new elementary school to better serve the changing population, etc. etc.
Keep in mind, any "heath care you have access to" is just the minimum provided to everyone. If you want to buy more/better care, you are absolutely free to do so with your own money. Go nuts. I've been living under this system in Canada and Australia for the majority of my life and have never felt the need to buy more converge, but that's just me personally. My aging parents buy extra.
> and what health care I'm required to take (vaccines, vitamins, exercise, etc)?
This is a great question. It's very topical right in Australia [1] as one state (NSW) now requires mandatory vaccinations before children can attend child care centers. This is analogous to you being required to buy car insurance before you can drive on public roads - if you don't, it's too risky for everyone else and society has deemed that unacceptable. You also can't nail together a few pieces of timber and call it a house, as it doesn't meet building codes, etc.
Of course, you are free not to participate in these rules - you just don't drive a car or build a house. NSW is now saying if you don't want to get vaccinations, then you don't get to participate in child care centers as it makes the cost to high for everyone else.
It remains to be seen if the people of NSW agree with this or not. If not, the rules will change.
Keep in mind that all of these rules are set by the society we live in. Plenty of people chose not to live within these rules. They break the rules and often face consequences as you mentioned (fines) or, if you chose, you can just move into the middle of nowhere in Alaska and do whatever the hell you want, and actually not be a part of any society. (I live right near Alaska, I know tons of people doing this)
--
Based on your other comments further down, I have to say that it doesn't look like you're against universal health-care per se, but you in fact have absolutely no confidence that your society can determine what that would actually look like. You've lost all faith that your system of government is actually representing the interests of the people, so you would rather it doesn't represent any interests at all, and "butt out" of your life
This is a sad shame, and it's actually the root of the issue here. If you don't trust your system of representation to represent you, then of course you don't trust it with something like your health, or anything else for that matter.
Simple. When the idea was devised, it was thought to be a good way to make employees more dependent on their employers..i.e. makes it more costly to strike/quit/get fired.
Linking basic* health care to employment as a default is ridiculously stupid. There is no real relation between a person's health and their job.
You can either view basic health care as a benefit to society as a whole, like a highway or a fire truck, and socialize it, or you can view it as a product for sale.
Viewing it as a benefit of a particular employment is not logical. This is like trying to mandate that your employer pay for your car insurance... there is no connection of mutual benefit.
Basic health care needs to be connected to the individual, while "extended health care" (or additional options, etc) can certainly be offered as a benefit. The employer does have an interest in you getting back to work faster, being in better health than the average, reducing the stress of your medical issue, etc, etc.
Interestingly enough, a socialized (single payer/universal, etc.) system of basic health care with privatized add on's and extras is basically the way every civilized society on the planet operates except the USA.
*You can define "basic" differently, but for my argument I mean a level of care that ensures a respectable level of heath is maintained... usually it is simply seeing health care as a human "right" and therefore not subject to withholding by the state or other actors.
I've lived and worked in Australia and Canada for many years.
In Australia, everyone gets sufficient basic care from taxes, and if you want, you can buy extended care. It has nothing to do with your employer.
In Canada, everyone gets very basic care from taxes, and if you want, you can buy extended care, or your employer might do that for you (implied: If you're lucky).
After living and working under both systems, I find giving my employer power over my healthcare to be a nasty draconian measure that I don't like at all, and I see no benefits.
Disclaimer: I work in the health insurance industry in Canada, for a Third Party Provider.
Canada and Australia are basically the same, but in Canada there is a default understanding that most employers will help to sponsor an extended health/insurance plan.
I see no real issue with this, as it certainly does NOT mean they in any way control your options. As healthcare becomes increasingly expensive, the ability for employers to offer this benefit is degraded. None of that prevents you from doing what you want in terms of extra coverage though.
Most full time jobs that are also considered "careers" will offer some form of insurance benefits, and that usually includes health care. Aside from cost, the benefits of Group Insurance is that there are no pre-existing condition exceptions. You have guaranteed acceptance as a nature of your employment. This is a huge upside for people that aren't prefect medical specimens, and as a result employer offered extended coverage is significantly cheaper for the individual.
As I said you are starting to see changes mainly due to demographics and cost increases. The switch to Flex benefits, health spending accounts and such will see more "individualization" of health care costs in the future. Personally, I think HSA's are the best possible way to offer extended health benefits to employees, and I expect they will grow in popularity; analogous to what RRSP's have done to pension plans.
I find giving my employer power over my healthcare
You simply don't do this in Canada, although many people do have that impression. Example: Me. I have my government health care, my employer health care that I pay a portion of, and some extra private care that I elect to pay for.
I think you and I have discussed this before on HN.
>I see no real issue with this, as it certainly does NOT mean they in any way control your options.
Of course it does. In Canada I'm looking at moving jobs right now, and one of the things I'm weighing up is the health benefits now vs. the new position. I also would love to take 2 years off work to pursue my photography and writing passions, but I worry what I'll do without my company paying my my group plan.
My options are without question controlled by my employer. In Australia, that is not so.
> Aside from cost, the benefits of Group Insurance is that there are no pre-existing condition exceptions. You have guaranteed acceptance as a nature of your employment.
If the care provided by my taxes was sufficient (as it is in Australia) there would be no pre-existing condition exceptions. In Australia, you have guaranteed acceptance as a nature of being born.
> and as a result employer offered extended coverage is significantly cheaper for the individual.
You've been tricked into thinking group plans are cheaper... if the government was buying a group plan for everyone, it would be drastically cheaper again.
> Personally, I think HSA's are the best possible way to offer extended health benefits to employees
Why do health benefits need to be offered to employees? Why only offer them to a subset of the population, that is, those with jobs? Surely it's better to offer them to everyone.
My options are without question controlled by my employer.
Eh? Google search "Private Insurance Canada" and tell me how your healthcare is "controlled" by your employer. This is like suggesting your employer "controls" how you can use your car because they offer you free parking.
>If the care provided by my taxes was sufficient
How is Canada's healthcare not sufficient, exactly?
>You've been tricked into thinking group plans are cheaper..
Erm, remember that part where I said I was in the industry? Yeah, I know they are on the average cheaper. Plans vary though, of course, but pooling is a significant part of insurance. In 99% of cases, a pool of white collar office workers performs better than a pool of everyone.
>Why do health benefits need to be offered to employees?
They don't. That's why they call them benefits.
>Why only offer them to a subset of the population
We don't. Canada has universal health care and extended insurance is available for everyone that wants to pay for it.
>Surely it's better to offer them to everyone.
They are.
The idea that every possible health problem and treatment that one can conceive of should be offered to everyone for free is about as dumb as saying someone should pay for everything themselves. Extended benefits are for services that we've already determined are "extras" to basic, guaranteed health care.
I'm not sure you have a strong understanding of the purpose of our system to be honest.
> I'm not sure you have a strong understanding of the purpose of our system to be honest.
I've been here for 7 years, I think I have a pretty good understanding. I'm just not expressing to you well enough what I mean.
I know Canada has health care for all, and I know you can optionally buy more with your own money. Great.
All I'm saying is I wish employers were not involved in buying it for me. Healthcare should be divorced from employment for a whole range of reasons. Go and live in a country where healthcare and employment have nothing to do with each other and you'll see what I mean. I'm not just talking about me either, I'm talking about my friends, neighbors, workmates. Their options are all limited because they don't want to change employer because of the health benefits.
Your point is still not relevant because it's offered as a benefit, not control. Complaining about it is like complaining that you're being paid a specific salary and not another one. Don't like it? Go somewhere else. Want to go somewhere else and don't like it? Don't go there then.
Part of an employer offering health benefit is to compete against other employers. They don't have to buy it, and you don't have to accept it. However, few employers offer a buy-out policy, which is something I would really like to see.
Currently I'm on GWL through my employer. While it's not the greatest, it's not bad for the amount of money. However, if I had the choice, I'd take the money from my employer and add my own cash to it to buy something like Blue Cross.
You should look into this, because although it isn't advertised, you can in fact opt out of your employer's plan in a large majority of cases. There could be exceptions if your employer is smaller and/or several people have already opted out.
Couple of things to note first however:
1. It's not impossible, but it isn't likely that you'll be able to find the same coverage on an individual plan for the same price. You could choose to opt for less/different coverage of course that is more to your liking.
2. Talk to your employer... they may be quite interested in learning why you don't care for the plan. One of the reasons I so like HCSA's is that you aren't limited to such a narrow scope of services... it is basically your company saying "Hey, for medical and dental here's $2K a year. Spend it on whatever CRA figures is a medical expense." A good benefit consultant should be able to work with your employer to make their plan something that is attractive to employees.
3. Pay attention to the things your employer pays for beyond health and dental. They're probably paying for Life Insurance, Dependent Life, ADD, LTD etc etc. Some of these benefits can be a lot cheaper in the plan, and are nothing to top up. Life Insurance for example you can buy as much as you want.
4. Make sure you qualify health wise. Apply for some optional life through your employer before you go out on your own. It would really suck to be rejected privately, then not qualify for re-entry in your employers plan either.
5. I'll say this to anyone - Buy Critical Illness insurance. As much as you can afford. This benefit is such a gimmie it's not even funny. It is basically free money to you (for anything) if you contract a major illness. Buy a house with it if you want. Take a vacation. No restrictions, no caveats. With cancer rates approaching 50%, it sure would be nice to temper your chemo treatment with a new Porche or a trip to Europe wouldn't it?
1.) Insurance providers are, unfortunately, set up that way in Canada. Bulk processing of applicants is cheaper administratively than lots of individual applicants. I think any insurance company that wants to rock the boat will take a long hard look at this group vs. individual practice.
2.) GWL's 50-75% coverage vs. Blue Cross' top-tier 90-100% coverage is a no-brainer if you want to spend the extra (a lot) of money.
3.) They are, which is why I haven't switched. I get minimal life, dependent, ADD, and LTD. In fact, it is so minimal that I went and got extra that isn't tied to my employment. The company won't stop paying for it though, because they want the $60k they'll get if I die or am permanently disabled.
4.) Fully passed.
5.) I've heard this before. I'll have to look into it. Despite being more fiscally conservative than most other Canadians, budget is still tight.
1. I'm in the industry. It has more to do with pooling of risk than bulk processing, but same idea more or less. Insurers can and do rock the boat all the time, but around the core players their nature is to be conservative. Check out HSCA plans for an example of innovation here.
2. That's your plan, not the carriers themselves. Both offer everything from nothing to 100% coverage. Sounds like you have a pretty low end plan. Seriously, talk to your employer about an HCSA... you can use it to pay deductibles and it is designed exactly for plans like yours.
3. The company won't stop paying for it though, because they want the $60k they'll get if I die or am permanently disabled.
Pretty sure this isn't happening. In fact, I'm pretty sure that's not even legal. They may have an additional benefit as part of their general insurance policies (key man, etc.) but all the payout for a life/add claim goes 100% to the people you've designated as a beneficiary.
5. Getting 15k-20k of CI for under $10 a month is the average rate. That's probably less than you spend on coffee. Given your LTD is probably about as good as the 75% EHC you have, I'd look into it. Nothing like not having to worry about expenses when(if) you get sick. Covers everything from heart attacks to cancer. You can usually insure your spouse too.
>All I'm saying is I wish employers were not involved in buying it for me.
I still don't understand this. What difference does it make? In most cases, you're getting a deal.
It's a benefit. The same way free coffee is a benefit. What you are suggesting is akin to saying that because you aren't a coffee drinker, there's something fundamentally wrong with employers providing coffee a little/no cost. Nothing is stopping you from paying for better coverage on your own the same way nothing is stopping you from going to Starbucks.
It might not matter that much to you, which is certainly fair. Tell your employer as much. I can tell you that most would relish not having to fork out as much cash as they do for their plans if they didn't have to.
I suppose you're going to tell me to get $100 worth of cell calls for $30 a month?
You've been tricked by marketing, and you're eating it up. The system doesn't have to be the way it is, and you're saying it's better this way because "you get a deal" because of the bulk-buying setup. If the practice of employers buying healthcare was outlawed, the system would change, and it wouldn't be more expensive for individuals to buy what they want/need.
> It's a benefit. The same way free coffee is a benefit.
Except that the healthcare is not free - it's coming out of your salary, and the choices are being made for you.
> It might not matter that much to you, which is certainly fair. Tell your employer as much
You miss the point. It's not about me, it's about society as a whole. From experience, I can tell you Canadians are a lot more reluctant to change employers than Australians, in part because their healthcare is tied to their employer. As a consequence, Canadian employers have a lot more power than Australian ones.
My brother had been in Canada for 6 years straight when he went back to Australia. After 1 month there I asked what was the biggest difference between Aus/Canada that he could notice. Without hesitation, he said "Employees in Australia are treated much better than Employees in Canada... nobody ever talks about healthcare in Australia, as it's a basic right of being born, and has nothing to do with your job"..
Until you've lived somewhere where unemployed (and never employed) people have the same set-up as CEOs, you won't know what we're talking about. Do yourself a favor - go and experience it.
>You've been tricked by marketing, and you're eating it up.
Um, no... I've seen the actuarial tables, understand them and program systems to support them for the industry. Unless you are in exceptional health and remain so, group insurance is by far the better deal in most cases. That's why employers offer it!
Please just concede this point until you actually understand how actuarial science works. There are indeed some bad deals out there (looking at you flex plans), but group vs. individual insurance isn't one of them.
> it's coming out of your salary, and the choices are being made for you.
No, not really. This may be true of your specific plan but many plans are 100% employer paid. Employers offer benefit plans in lieu of salary because there are different tax breaks and such associated with not paying salary directly - ei and cpp contributions, for instance. If an employer pays you $300 a month in benefits it does NOT mean that they could pay you $300 more in salary and it would be a wash.
>"Employees in Australia are treated much better than Employees in Canada.
That may be, and I'm sure it varies greatly by industry and other variables... but that isn't at all what we are discussing here, is it?
The parent comment we're replying to, and the highest rated comment in this thread starts with:
> Linking basic health care to employment as a default is ridiculously stupid.
People are agreeing with that, and I'm saying it also applies to extended healthcare.
My argument: health and employment should be divorced.
Your argument: you get a better deal when they are connected.
I think you're being naive because you're being tricked by marketing and the current system and rules. If they entire system were overhauled to divorce them, there is no reason it needs to cost more to buy as an individual. I ask you - how much profit are health care providers making in Canada under the current system? With those billions in profit, surely there is room to change the pricing scheme so it doesn't cost more for individuals.
I made the parent comment. I also pointed out as to why employers offering extended services works in the very next sentence. You are providing no real evidence to the contrary other than the fact that Australia doesn't do it. Apples to oranges.
There is no viable reason why employers should be banned outright from offering extended benefits as a condition of employment to compete for talent.
If they entire system were overhauled to divorce them, there is no reason it needs to cost more to buy as an individual.
A simplistic example: Employer A, hiring white collar office workers will get better rates when they say that they won't hire someone that is a (for example) a pilot, so the insurance company excludes all pilots from the base tables they use to rate the group. You as an individual don't get this luxury. You use a larger pool of people, but they aren't predefined as much into your own lifestyle subset, ergo, you don't get the benefit of lower rates. Even better, your employer's annual renewal actually takes into account the actual experience of your company directly. So, if everyone in your office sees the doctor one less time this year over last, your rates go down. You don't get this benefit in individual insurance - the pool is just too big to make a meaningful difference to a single data point.
At any rate, HN comments is not the right environment to teach someone actuarial math. Read the link for more details.
how much profit are health care providers making in Canada under the current system?
The nice thing about using math is that everything is out in the open. Profit on insurance premium is actually pretty low - in the 5-10% range. It's strength though is that it is entirely predictable, so it is rare that the profit is suddenly a loss. Insurance companies make most of their money through selling services and via investments.
My conclusion here is that although well intentioned, I think you are entirely ignorant of the topic at hand.
> Linking basic health care to employment as a default is ridiculously stupid. There is no real relation between a person's health and their job. Basic health care needs to be connected to the individual, while "extended health care" (or additional options, etc) can certainly be offered as a benefit.
I put it to you that no white collar (and a chunk of Blue collar) employers in Canada don't give "extended health care" as part of employment.. which is to say the basic health care provided in Canada is not sufficient for those people. They need those extras. For those people to have sufficient coverage, their healthcare is now tied to their employment, which you yourself said is "ridiculously stupid". There is no moral justification for this, only the monetary one (which I'll address below)
> There is no viable reason why employers should be banned outright from offering extended benefits as a condition of employment to compete for talent.
There absolutely is when those extended benefits are required to live at an acceptable standard for lots of people, which essentially makes them basic benefits, just using different semantics.
Of course, the Canadian government only wants to scale-back the basic benefits and increase the public's reliance on "extended health care", thus transitioning the system to more closely match the current US system, where if you don't have a job with "extended health care", your health care sucks.
> Interestingly enough, a socialized (single payer/universal, etc.) system of basic health care with privatized add on's and extras is basically the way every civilized society on the planet operates
Yep, and Canada is one of the few where your employer gets to stick it's nose into those add on's and extras, which is, as you say "ridiculously stupid"
> This statement shows a complete lack of understanding of actuarial science, which is the basis of all insurance. See Here: ...
It's very interesting to me that I'm talking about trying to increase the standard of living, freedom of choice, and people's HEALTH, and you're constantly talking about bean counting, expenses and accounting.
It's sad that you actually work in the health industry in Canada, and you're more interested in schooling me on basic accounting principles than having a discussion on how the system could be modified to actually increase people's standard of living.
That's exactly what's wrong with the American system - accounting is more important than health care - and you're so far into the Canadian system you can't even see you're justifying the way in which Canadian system is doing the same thing on the basis of accounting.
Here's how it works in Australia: if you are looking to move to a different employer, you weigh up the perks of one job versus the cash of the other (perk-less) job.
Here's how it works in Canada: if you are looking to move to a different employer, you weigh up the perks of one job versus the cash of the other (perk-less) job.
Here's how it works in the USA: if you are looking to move to a different employer, compare the health care first, then start worrying about salary and perks.
The corporations in Canada don't offer you anything that you can't get yourself, the healthcare isn't more expensive than the rest of the world for no good reason (looking at you, USA), and the only difference comes down to whether you end up with 10 years of history with one health insurer or not.
Socialized health care might work in Canada (pop. 34.48 million) or Australia (pop. 22.32 million), but it will never work in the US (pop. 313.9 million). It's way too expensive. US federal spending for both Medicare/Medicaid is already 23% (Social Security is 22%) of the federal budget in 2012. You want to add another unfunded entitlement program that will cost tax payers $4-$6 trillion?
Here's a little fun fact: Canada and Australia's GDP COMBINED won't be enough to pay for Obamacare.
I hear this argument all the time and it's complete nonsense.
Yes, America has a large population, but that means it also has a very large number of taxpayers, therefore an enormous budget. If anything, economies of scale mean America can provide health care at a lower per capita cost than smaller countries.
Your argument is such nonsense it suggests that merely dividing America up into 10 countries each of 30 million would mean it could provide healthcare at a more affordable rate. Nonsensical at best.
>Yes, America has a large population, but that means it also has a very large number of taxpayers, therefore an enormous budget.
I don't blame you if you think this way. You're canadian. You don't know wtf you're talking about. ;)
1. Not everyone in the US has a job. More than 23 million Americans are unemployed/underemployed.[1] And are therefore paying very little/not paying taxes. A large population means a large pool of tax payers, and an even larger pool of non-tax payers.
2. Income inequality. The middle-class/rich are paying more taxes."CNN: The rich pay majority of U.S. income taxes"[2] The top 10% earners of this country already pays more than 70% of all the income taxes.
3. Entitlements are already killing the US economy. 62% of the federal budget goes to entitlement.[3] Where are you going to get the $4-$6 trillion to pay for Obamacare??? OH RIGHT, 4 straight years of trillion dollar deficit under Obama. The government is already borrowing money to pay for existing entitlements![4]OR tax wealthy people! (those earning more than $250K under Obama's plan).
you are laughably uninformed about the issues regarding entitlements in America.
> I don't blame you if you think this way. You're canadian. You don't know wtf you're talking about. ;)
Australian, actually. I just live in Canada. I spent 1.5 years living and working in America too.
Those problems or "issues" you present are not unique to America. Every country in the world has unemployment, income inequality and entitlements.
It's simply a question of where you want your government to spend the tax dollars it collects. Currently, they spend it blowing things up while tens of millions of it's citizens are without basic healthcare.
>It's simply a question of where you want your government to spend the tax dollars it collects. Currently, they spend it blowing things up while tens of millions of it's citizens are without basic healthcare.
62% of the US federal budget goes to entitlements (Medicare/Medicaid/Social Security). That's ONLY $2 Trillion. 18.7% goes to the defense spending. [1]
Implementing Obamacare will cost $4-$6 Trillion. WHERE DO YOU SUGGEST WE GET $4-6 TRILLION? Even if you cut 100% of the defense budget it won't be not enough to pay for Obamacare.
>62% of the US federal budget goes to entitlements
In other words, 62% of your revenue goes back to the taxpayers that provided that revenue. If anything, I'd be complaining about the other 48% if I were you.
>Implementing Obamacare
The argument that Medicare costs x and support y people, and Obamacare costs 2x and supports 2y people, therefore full universal care would cost 100x and support 100y people is flawed.
Clearly, if the US went universal, the massive administration costs associated with HMOs and such would no longer be an expense to be paid. Instead of being a large employer within your currently broken system, you replace the system.
There is a reason your health spending is almost double per capita to the next highest nation, and it has nothing to do with your population.
I happen to be married to an American and have discussed this topic at length with many of my American relatives.
The big problem is that Obamacare is nothing like a universal system or even the Canadian system, and it does not address the colossal spending costs.
Also, I think Canada happens to have built its medical system at a bit of a sweet spot time. We have enough people paying enough taxes to give a pretty decent average quality of care (assuming you don't live in the boonies). Too many more people or too little taxes and the system will fall apart.
As run4yourlives said,
> There is a reason your health spending is almost double per capita to the next highest nation, and it has nothing to do with your population.
Ditto. Canada and other countries aren't doing that. So in the mean time our skilled workers will keep going to the USA to get salaries 3-5x higher than what they would make and keep on taking the money out of the USA.
>
The big problem is that Obamacare is nothing like a universal system or even the Canadian system, and it does not address the colossal spending costs.
>In other words, 62% of your revenue goes back to the taxpayers that provided that revenue.
Except that the middle class, rich and younger people are paying for majority of the taxes that are spent for entitlements. And you're asking them to pay for another unfunded mandate. Your socialist views have no place in America.
Australia have universal healthcare but your taxes are sky high, zero innovation, zero growth, no jobs, etc. horay for socialism. Give me one innovation that came out of australia? ZERO. (ok i love ac/dc but they dont count) :)
It DOES not "work in every other developed nation on the planet"
spain, greece, germany, france, cyprus and 99% of all socialist countries have declining economies, high unemployment rate, high taxes, ZERO innovation, etc. Hey but they have free health care! horay for socialism!
That's because the Canadian government employs 3.6 Million government employees out of 17 Million of your total labor force. WOW! talk about big government! That's almost 25% of your total labor force!
% of gov't employees in the US is only 15% of our labor force. Considering the size of our country, military, etc. that figure is small compared to Canada's labor force-gov't employee ratio.
NICE TRY ;)
I get it that you're proud of your universal healthcare system. I honestly wish we have one but the issue is COST. if you can think of a way to implement universal healthcare without bankrupting our country i want to hear it.
This crazy line of reasoning is the perfect analog to the notion, associated with liberals, that services provided by the government are "free." You are basically thinking that if a service isn't provided by the goverment, you can consider it free. Well, guess what, we are still going to have those trillions needing to be spent on healthcare, and it's got to come from somewhere. If it's impossible to fund collectively, the alternative (funding it out of all of our pockets individually) is impossible too.
> Interestingly enough, a socialized (single payer/universal, etc.) system of basic health care with privatized add on's and extras is basically the way every civilized society on the planet operates except the USA.
I simply don't trust our (the USA's) federal government to handle a socialized system with any amount of efficacy or competency. We would need a fundamental cultural change and a massive restructuring of current spending. Like that will happen any time soon.
Plus, I don't think such a system should even be possible with our form of government because of the powers enumerated by the Constitution. If there were to be a socialized system, it should happen at the state level and perhaps the federal government could help regulate / control interstate issues. Or, I suppose, we could try to pass an amendment.
Plus, I don't think such a system should even be possible with our form of government because of the powers enumerated by the Constitution.
Pretty sure your federal government can recognize human rights, and ensure they are respected. Health care is the one section of the Universal Declaration of Human Rights that the US has not ratified.
I share your pessimism though in any meaningful change taking place. The USA has a rather bizarre view of the role of health care in society as compared to other nations.
> You would have to be astoundingly incompetent to make a socialized system more expensive for the USA.
Well we do spend more per capita on education than any other nation (and not have results to show for it) and education is dominated by the government. Our government is astoundingly incompetent. And I see no reason why the government would magically make healthcare cheaper just because it would get EVEN MORE involved.
> Pretty sure your federal government can recognize human rights, and ensure they are respected.
If this is what you're referring to (in Article 25 (1)):
> Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Constitutionally, no. Most of this should be (but of course isn't, given that we have Social Security, Medicaid/Medicare, TANF, etc.) left to the states. All powers not explicitly described by the Constitution are left to the states per the 10th amendment in the Bill of Rights. And personally, I would be fine with this. I would rather not have the monolithic and inscrutable federal government we have today. I would prefer to leave it to the states whether or not they want to recognize the U.N. Universal Declaration.
You say that it isn't logical, but logic isn't your argument it's an argument of basic human rights (which I tend to agree with you on).
To play the devils advocate, linking health care to your job means that productive citizens are being taken care of. This fosters a "survival of the fittest" situation.
That isn't really how it plays out, but I think that's the allure to many of us Americans. I've spoken with others who who believe that you must work to earn certain things, such as health care. It is often toted that people who are obese, smoke, do drugs, and participate in other health risks are more likely to be on government aid than those who "earn" it. They use this fear of being taken advantage of to fuel a desire a knee-jerk reaction to health care.
Yet there are valid concerns. Especially with the migration of such an entrenched system.
If the US government is going to take on Health Care that money needs to come from funds already in the budget. The US government is poised on the edge of failure, the only thing keeping us going is a mass faith in the ability of the government to pay back it's loans, and thus receive more.
Also this points to a bigger break in the system. US Agencies (I can't speak to foreign agencies) incentivise the spending of your whole budget. If you don't spend it all then obviously you don't need it all. This creates a mad spending rush at the end of the fiscal year and an atmosphere where you have not only the right but the obligation to spend your budget.
I think a lot of people are intimidated by the concept of introducing another burden to the US budget when we are already incentivising the wrong thing.
I think if we could cut back the budget in other areas, this would make it possible to introduce a true health program.
I'm only touching on a few reasons why this isn't being done immediately. I do think that our defense budget is outlandish and could be put directly towards health care, but that is a huge transition in the work force. That is soldiers to medicare specialists. That sort of transition will take time.
You make some great arguments, even as devil's advocate, so I feel the need to offer as much of a rebuttal as I can.
linking health care to your job means that productive citizens are being taken care of
Assuming productivity is related to the selling of your time to another actor is outdated 20th century thinking. People can and are becoming increasingly productive without having "jobs" that fit a definition. Entrepreneurs, contractors, part-time workers, stay at home parents, students... all of these people are outside of the employer/employee equation and thus don't have access to health care because of it.
Tell me, who's more valuable to society, employee #992232 of big corp the next Richard Branson? Tying health care to employment ensures the former, not the latter is given incentive. This is precisely what we don't want.
If the US government is going to take on Health Care that money needs to come from funds already in the budget.
This is a much more practical argument and it is difficult to rebut directly. Essentially though, you are correct: something else would need to be sacrificed. There is, of course, an obvious target: http://armscontrolcenter.org/issues/securityspending/article...
In addition to that though, spending on Medicaid and Medicare within the current system is hugely inflated, from what I can see. US per capita administrative costs are triple that of Canada: http://pweb1.rwjf.org/reports/grr/036617.htm
So, even without a military cut back, the money is already being spent, just on HMO's instead of actual health care.
To me, as a European, your summary of the US-perspective on health care explains a lot. Over here, universal health care is supported by public opinion, mostly because it is seen as a question of ethics (with a healthy dose of "it could happen to me" hedging).
The consensus here is that society has to take care of the sick, independently of the circumstances of their life. It is important to note that I wrote society, not state. The state is seen as the agent through which society effects this, not the principal actor. The fact that it is seen as a question of ethics and a part of "we the society" probably also explains the rather vitriolic contributions that some of my European compatriots provide in discussions on the US health care situation (even though it is probably none of our business).
But health care is linked to employment in most parts of Europe as well. Unemployment benefits allow you to pay for it but if you those run out or you don't take benefit of them for some reason (say you live on the street) you're out of luck.
Hell, even if you have a job you might have to pay for health care yourself due to certain circumstances and if you're in monetary trouble you might not be able to do so.
Not to forget that freelancing or self-employment might bring you to the point were beeing unemployed is more beneficial to you because you have to pay for everything yourself with much higher rates.
Many details of the implementation are different in the individual states of the EU, since the health sector has so far not been harmonized. My experience is from Germany, where there exists a mixed system in which you are not allowed to have no health insurance. If you are self-employed or earn enough, you can switch to a private insurance company.
You brought up one very important thing when you wrote about monetary trouble and self-employment. Because even a mandatory insurance scheme as the one in Germany has holes in it. I recently learned that, if you are self-employed, have private health care and run into financial trouble, you can end up in a state of "inactive health insurance", where you still have basic health insurance, but you always have to go to the emergency ward at the hospital. So far, a few ten thousand people are affected by this (out of 80 Million), but it is a de facto hole in the system.
However, when I point this latter situation out to people around here they usually become quite enraged. In a way, this reinforces my point about the perception of health care as an ethics issue.
> where there exists a mixed system in which you are not allowed to have no health insurance
True. If you don't have one you have to pay a fine. Which is troubling if you couldn't pay for it in the first place. I have that problem at the moment. I guess it's mostly my fault for not taking every help I could get. So far I haven't gotten any troubling mail, but I'm sure I'll be in trouble once I have to get back into it.
Everyone around me feels uneasy about this. I didn't have the need to go to the doctor in a very long time, but I can relate.
The title is completely unsupported by the content of the article, which presents no evidence that Obamacare is prompting the practice of hiring part-time workers. In fact, it clearly states that Walmart supported Obamacare because it fit with their part-time worker strategy, which was already in place. The article also states
"The recovering economy could also help force Walmart, and other like-minded employers, to back off this policy and hire full-time workers with benefits."
Actually, there are a lot of companies being forced into this, not just Wal-Mart. Most full-time jon vacancies are being simply deleted or relegated to two part-time employees because of the mandate in this legislation.
There's nothing political about the truth. To not recognize (or admit) the connection between the two is serious head-in-the-sand syndrome.
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[ 2.5 ms ] story [ 175 ms ] threadHowever they merely reflect what many other type of employers do, they just are more noticeable because of their size.
But of course this is a Forbes blog, and who knows what the political slant of the blogger is.
As state-mandated benefits go up, the marginal utility that an employee has to provide to be company asset go up proportionally.
"Forty-one percent of the businesses surveyed have frozen hiring because of the health-care law known as Obamacare. And almost one-fifth—19 percent— answered "yes" when asked if they had "reduced the number of employees you have in your business as a specific result of the Affordable Care Act.""
http://www.cnbc.com/id/100825782
I don't get why they keep running the thing though, it's systematically garbage, are the hits so much more important than the forbes brand?
The problem with Obamacare is that it doesn't address the primary problem: health insurance is tied to employment.
Until we get past that we are going to have a broken system where the customer is not the customer. The insurance company and then your employers are the customer.
Surely care should be available to all - if you are the CEO of a fortune 500, a temp at Walmart or even unemployed.
I only ask because anyone who has knows that in a vast majority of examples, the simple act of guaranteeing basic care has nothing at all to do with the questions you raise, in the same way that not paying to use the interstate has nothing to do with you being able to drive to your friend's house for free.
You are the epitome of the exact thing that you fear, and you don't even seem to realize it.
edit2: what does the military have to do with socialism, anyway?
How, exactly do you pay for a military?
How, exactly do you pay for universal healthcare?
Why is the implementation of one okie-dokie and the other the "path to tyranny"?
> Who decides what health care I have access to
Society decides, in the same way it decides how to spend any tax dollars, such as when and where to build new public roads, when to open a new elementary school to better serve the changing population, etc. etc.
Keep in mind, any "heath care you have access to" is just the minimum provided to everyone. If you want to buy more/better care, you are absolutely free to do so with your own money. Go nuts. I've been living under this system in Canada and Australia for the majority of my life and have never felt the need to buy more converge, but that's just me personally. My aging parents buy extra.
> and what health care I'm required to take (vaccines, vitamins, exercise, etc)?
This is a great question. It's very topical right in Australia [1] as one state (NSW) now requires mandatory vaccinations before children can attend child care centers. This is analogous to you being required to buy car insurance before you can drive on public roads - if you don't, it's too risky for everyone else and society has deemed that unacceptable. You also can't nail together a few pieces of timber and call it a house, as it doesn't meet building codes, etc.
Of course, you are free not to participate in these rules - you just don't drive a car or build a house. NSW is now saying if you don't want to get vaccinations, then you don't get to participate in child care centers as it makes the cost to high for everyone else.
It remains to be seen if the people of NSW agree with this or not. If not, the rules will change.
Keep in mind that all of these rules are set by the society we live in. Plenty of people chose not to live within these rules. They break the rules and often face consequences as you mentioned (fines) or, if you chose, you can just move into the middle of nowhere in Alaska and do whatever the hell you want, and actually not be a part of any society. (I live right near Alaska, I know tons of people doing this)
--
Based on your other comments further down, I have to say that it doesn't look like you're against universal health-care per se, but you in fact have absolutely no confidence that your society can determine what that would actually look like. You've lost all faith that your system of government is actually representing the interests of the people, so you would rather it doesn't represent any interests at all, and "butt out" of your life
This is a sad shame, and it's actually the root of the issue here. If you don't trust your system of representation to represent you, then of course you don't trust it with something like your health, or anything else for that matter.
[1] http://www.abc.net.au/worldtoday/content/2013/s3769940.htm
No one did. Employer-provided healthcare (and other perks) came into vogue during the wage freezes during World War II as a way to attract employees.
https://en.wikipedia.org/wiki/Health_insurance_in_the_United...
You can either view basic health care as a benefit to society as a whole, like a highway or a fire truck, and socialize it, or you can view it as a product for sale.
Viewing it as a benefit of a particular employment is not logical. This is like trying to mandate that your employer pay for your car insurance... there is no connection of mutual benefit.
Basic health care needs to be connected to the individual, while "extended health care" (or additional options, etc) can certainly be offered as a benefit. The employer does have an interest in you getting back to work faster, being in better health than the average, reducing the stress of your medical issue, etc, etc.
Interestingly enough, a socialized (single payer/universal, etc.) system of basic health care with privatized add on's and extras is basically the way every civilized society on the planet operates except the USA.
*You can define "basic" differently, but for my argument I mean a level of care that ensures a respectable level of heath is maintained... usually it is simply seeing health care as a human "right" and therefore not subject to withholding by the state or other actors.
In Australia, everyone gets sufficient basic care from taxes, and if you want, you can buy extended care. It has nothing to do with your employer.
In Canada, everyone gets very basic care from taxes, and if you want, you can buy extended care, or your employer might do that for you (implied: If you're lucky).
After living and working under both systems, I find giving my employer power over my healthcare to be a nasty draconian measure that I don't like at all, and I see no benefits.
Canada and Australia are basically the same, but in Canada there is a default understanding that most employers will help to sponsor an extended health/insurance plan.
I see no real issue with this, as it certainly does NOT mean they in any way control your options. As healthcare becomes increasingly expensive, the ability for employers to offer this benefit is degraded. None of that prevents you from doing what you want in terms of extra coverage though.
Most full time jobs that are also considered "careers" will offer some form of insurance benefits, and that usually includes health care. Aside from cost, the benefits of Group Insurance is that there are no pre-existing condition exceptions. You have guaranteed acceptance as a nature of your employment. This is a huge upside for people that aren't prefect medical specimens, and as a result employer offered extended coverage is significantly cheaper for the individual.
As I said you are starting to see changes mainly due to demographics and cost increases. The switch to Flex benefits, health spending accounts and such will see more "individualization" of health care costs in the future. Personally, I think HSA's are the best possible way to offer extended health benefits to employees, and I expect they will grow in popularity; analogous to what RRSP's have done to pension plans.
I find giving my employer power over my healthcare
You simply don't do this in Canada, although many people do have that impression. Example: Me. I have my government health care, my employer health care that I pay a portion of, and some extra private care that I elect to pay for.
>I see no real issue with this, as it certainly does NOT mean they in any way control your options.
Of course it does. In Canada I'm looking at moving jobs right now, and one of the things I'm weighing up is the health benefits now vs. the new position. I also would love to take 2 years off work to pursue my photography and writing passions, but I worry what I'll do without my company paying my my group plan. My options are without question controlled by my employer. In Australia, that is not so.
> Aside from cost, the benefits of Group Insurance is that there are no pre-existing condition exceptions. You have guaranteed acceptance as a nature of your employment.
If the care provided by my taxes was sufficient (as it is in Australia) there would be no pre-existing condition exceptions. In Australia, you have guaranteed acceptance as a nature of being born.
> and as a result employer offered extended coverage is significantly cheaper for the individual.
You've been tricked into thinking group plans are cheaper... if the government was buying a group plan for everyone, it would be drastically cheaper again.
> Personally, I think HSA's are the best possible way to offer extended health benefits to employees
Why do health benefits need to be offered to employees? Why only offer them to a subset of the population, that is, those with jobs? Surely it's better to offer them to everyone.
Eh? Google search "Private Insurance Canada" and tell me how your healthcare is "controlled" by your employer. This is like suggesting your employer "controls" how you can use your car because they offer you free parking.
>If the care provided by my taxes was sufficient
How is Canada's healthcare not sufficient, exactly?
>You've been tricked into thinking group plans are cheaper..
Erm, remember that part where I said I was in the industry? Yeah, I know they are on the average cheaper. Plans vary though, of course, but pooling is a significant part of insurance. In 99% of cases, a pool of white collar office workers performs better than a pool of everyone.
>Why do health benefits need to be offered to employees?
They don't. That's why they call them benefits.
>Why only offer them to a subset of the population
We don't. Canada has universal health care and extended insurance is available for everyone that wants to pay for it.
>Surely it's better to offer them to everyone.
They are.
The idea that every possible health problem and treatment that one can conceive of should be offered to everyone for free is about as dumb as saying someone should pay for everything themselves. Extended benefits are for services that we've already determined are "extras" to basic, guaranteed health care.
I'm not sure you have a strong understanding of the purpose of our system to be honest.
I've been here for 7 years, I think I have a pretty good understanding. I'm just not expressing to you well enough what I mean.
I know Canada has health care for all, and I know you can optionally buy more with your own money. Great.
All I'm saying is I wish employers were not involved in buying it for me. Healthcare should be divorced from employment for a whole range of reasons. Go and live in a country where healthcare and employment have nothing to do with each other and you'll see what I mean. I'm not just talking about me either, I'm talking about my friends, neighbors, workmates. Their options are all limited because they don't want to change employer because of the health benefits.
Part of an employer offering health benefit is to compete against other employers. They don't have to buy it, and you don't have to accept it. However, few employers offer a buy-out policy, which is something I would really like to see.
Currently I'm on GWL through my employer. While it's not the greatest, it's not bad for the amount of money. However, if I had the choice, I'd take the money from my employer and add my own cash to it to buy something like Blue Cross.
Couple of things to note first however:
1. It's not impossible, but it isn't likely that you'll be able to find the same coverage on an individual plan for the same price. You could choose to opt for less/different coverage of course that is more to your liking.
2. Talk to your employer... they may be quite interested in learning why you don't care for the plan. One of the reasons I so like HCSA's is that you aren't limited to such a narrow scope of services... it is basically your company saying "Hey, for medical and dental here's $2K a year. Spend it on whatever CRA figures is a medical expense." A good benefit consultant should be able to work with your employer to make their plan something that is attractive to employees.
3. Pay attention to the things your employer pays for beyond health and dental. They're probably paying for Life Insurance, Dependent Life, ADD, LTD etc etc. Some of these benefits can be a lot cheaper in the plan, and are nothing to top up. Life Insurance for example you can buy as much as you want.
4. Make sure you qualify health wise. Apply for some optional life through your employer before you go out on your own. It would really suck to be rejected privately, then not qualify for re-entry in your employers plan either.
5. I'll say this to anyone - Buy Critical Illness insurance. As much as you can afford. This benefit is such a gimmie it's not even funny. It is basically free money to you (for anything) if you contract a major illness. Buy a house with it if you want. Take a vacation. No restrictions, no caveats. With cancer rates approaching 50%, it sure would be nice to temper your chemo treatment with a new Porche or a trip to Europe wouldn't it?
2.) GWL's 50-75% coverage vs. Blue Cross' top-tier 90-100% coverage is a no-brainer if you want to spend the extra (a lot) of money.
3.) They are, which is why I haven't switched. I get minimal life, dependent, ADD, and LTD. In fact, it is so minimal that I went and got extra that isn't tied to my employment. The company won't stop paying for it though, because they want the $60k they'll get if I die or am permanently disabled.
4.) Fully passed.
5.) I've heard this before. I'll have to look into it. Despite being more fiscally conservative than most other Canadians, budget is still tight.
2. That's your plan, not the carriers themselves. Both offer everything from nothing to 100% coverage. Sounds like you have a pretty low end plan. Seriously, talk to your employer about an HCSA... you can use it to pay deductibles and it is designed exactly for plans like yours.
3. The company won't stop paying for it though, because they want the $60k they'll get if I die or am permanently disabled.
Pretty sure this isn't happening. In fact, I'm pretty sure that's not even legal. They may have an additional benefit as part of their general insurance policies (key man, etc.) but all the payout for a life/add claim goes 100% to the people you've designated as a beneficiary.
5. Getting 15k-20k of CI for under $10 a month is the average rate. That's probably less than you spend on coffee. Given your LTD is probably about as good as the 75% EHC you have, I'd look into it. Nothing like not having to worry about expenses when(if) you get sick. Covers everything from heart attacks to cancer. You can usually insure your spouse too.
I still don't understand this. What difference does it make? In most cases, you're getting a deal.
It's a benefit. The same way free coffee is a benefit. What you are suggesting is akin to saying that because you aren't a coffee drinker, there's something fundamentally wrong with employers providing coffee a little/no cost. Nothing is stopping you from paying for better coverage on your own the same way nothing is stopping you from going to Starbucks.
It might not matter that much to you, which is certainly fair. Tell your employer as much. I can tell you that most would relish not having to fork out as much cash as they do for their plans if they didn't have to.
I suppose you're going to tell me to get $100 worth of cell calls for $30 a month?
You've been tricked by marketing, and you're eating it up. The system doesn't have to be the way it is, and you're saying it's better this way because "you get a deal" because of the bulk-buying setup. If the practice of employers buying healthcare was outlawed, the system would change, and it wouldn't be more expensive for individuals to buy what they want/need.
> It's a benefit. The same way free coffee is a benefit.
Except that the healthcare is not free - it's coming out of your salary, and the choices are being made for you.
> It might not matter that much to you, which is certainly fair. Tell your employer as much
You miss the point. It's not about me, it's about society as a whole. From experience, I can tell you Canadians are a lot more reluctant to change employers than Australians, in part because their healthcare is tied to their employer. As a consequence, Canadian employers have a lot more power than Australian ones.
My brother had been in Canada for 6 years straight when he went back to Australia. After 1 month there I asked what was the biggest difference between Aus/Canada that he could notice. Without hesitation, he said "Employees in Australia are treated much better than Employees in Canada... nobody ever talks about healthcare in Australia, as it's a basic right of being born, and has nothing to do with your job"..
Until you've lived somewhere where unemployed (and never employed) people have the same set-up as CEOs, you won't know what we're talking about. Do yourself a favor - go and experience it.
Um, no... I've seen the actuarial tables, understand them and program systems to support them for the industry. Unless you are in exceptional health and remain so, group insurance is by far the better deal in most cases. That's why employers offer it!
Please just concede this point until you actually understand how actuarial science works. There are indeed some bad deals out there (looking at you flex plans), but group vs. individual insurance isn't one of them.
> it's coming out of your salary, and the choices are being made for you.
No, not really. This may be true of your specific plan but many plans are 100% employer paid. Employers offer benefit plans in lieu of salary because there are different tax breaks and such associated with not paying salary directly - ei and cpp contributions, for instance. If an employer pays you $300 a month in benefits it does NOT mean that they could pay you $300 more in salary and it would be a wash.
>"Employees in Australia are treated much better than Employees in Canada.
That may be, and I'm sure it varies greatly by industry and other variables... but that isn't at all what we are discussing here, is it?
> Linking basic health care to employment as a default is ridiculously stupid.
People are agreeing with that, and I'm saying it also applies to extended healthcare.
My argument: health and employment should be divorced.
Your argument: you get a better deal when they are connected.
I think you're being naive because you're being tricked by marketing and the current system and rules. If they entire system were overhauled to divorce them, there is no reason it needs to cost more to buy as an individual. I ask you - how much profit are health care providers making in Canada under the current system? With those billions in profit, surely there is room to change the pricing scheme so it doesn't cost more for individuals.
There is no viable reason why employers should be banned outright from offering extended benefits as a condition of employment to compete for talent.
If they entire system were overhauled to divorce them, there is no reason it needs to cost more to buy as an individual.
This statement shows a complete lack of understanding of actuarial science, which is the basis of all insurance. See Here: https://en.wikipedia.org/wiki/Actuarial_science
A simplistic example: Employer A, hiring white collar office workers will get better rates when they say that they won't hire someone that is a (for example) a pilot, so the insurance company excludes all pilots from the base tables they use to rate the group. You as an individual don't get this luxury. You use a larger pool of people, but they aren't predefined as much into your own lifestyle subset, ergo, you don't get the benefit of lower rates. Even better, your employer's annual renewal actually takes into account the actual experience of your company directly. So, if everyone in your office sees the doctor one less time this year over last, your rates go down. You don't get this benefit in individual insurance - the pool is just too big to make a meaningful difference to a single data point.
At any rate, HN comments is not the right environment to teach someone actuarial math. Read the link for more details.
how much profit are health care providers making in Canada under the current system?
The nice thing about using math is that everything is out in the open. Profit on insurance premium is actually pretty low - in the 5-10% range. It's strength though is that it is entirely predictable, so it is rare that the profit is suddenly a loss. Insurance companies make most of their money through selling services and via investments.
My conclusion here is that although well intentioned, I think you are entirely ignorant of the topic at hand.
D'oh, I didn't see that.
> Linking basic health care to employment as a default is ridiculously stupid. There is no real relation between a person's health and their job. Basic health care needs to be connected to the individual, while "extended health care" (or additional options, etc) can certainly be offered as a benefit.
I put it to you that no white collar (and a chunk of Blue collar) employers in Canada don't give "extended health care" as part of employment.. which is to say the basic health care provided in Canada is not sufficient for those people. They need those extras. For those people to have sufficient coverage, their healthcare is now tied to their employment, which you yourself said is "ridiculously stupid". There is no moral justification for this, only the monetary one (which I'll address below)
> There is no viable reason why employers should be banned outright from offering extended benefits as a condition of employment to compete for talent.
There absolutely is when those extended benefits are required to live at an acceptable standard for lots of people, which essentially makes them basic benefits, just using different semantics.
Of course, the Canadian government only wants to scale-back the basic benefits and increase the public's reliance on "extended health care", thus transitioning the system to more closely match the current US system, where if you don't have a job with "extended health care", your health care sucks.
> Interestingly enough, a socialized (single payer/universal, etc.) system of basic health care with privatized add on's and extras is basically the way every civilized society on the planet operates
Yep, and Canada is one of the few where your employer gets to stick it's nose into those add on's and extras, which is, as you say "ridiculously stupid"
> This statement shows a complete lack of understanding of actuarial science, which is the basis of all insurance. See Here: ...
It's very interesting to me that I'm talking about trying to increase the standard of living, freedom of choice, and people's HEALTH, and you're constantly talking about bean counting, expenses and accounting.
It's sad that you actually work in the health industry in Canada, and you're more interested in schooling me on basic accounting principles than having a discussion on how the system could be modified to actually increase people's standard of living.
That's exactly what's wrong with the American system - accounting is more important than health care - and you're so far into the Canadian system you can't even see you're justifying the way in which Canadian system is doing the same thing on the basis of accounting.
Here's how it works in Canada: if you are looking to move to a different employer, you weigh up the perks of one job versus the cash of the other (perk-less) job.
Here's how it works in the USA: if you are looking to move to a different employer, compare the health care first, then start worrying about salary and perks.
The corporations in Canada don't offer you anything that you can't get yourself, the healthcare isn't more expensive than the rest of the world for no good reason (looking at you, USA), and the only difference comes down to whether you end up with 10 years of history with one health insurer or not.
In Australia, that doesn't happen.
Here's a little fun fact: Canada and Australia's GDP COMBINED won't be enough to pay for Obamacare.
"How Obamacare Will Further Explode the Deficit"
http://www.forbes.com/sites/peterferrara/2011/06/16/how-obam...
"CBO: Obamacare to Cost $1.930 Trillion, Leave 30 Million Uninsured"
http://www.weeklystandard.com/blogs/cbo-obamacare-cost-1930-...
Yes, America has a large population, but that means it also has a very large number of taxpayers, therefore an enormous budget. If anything, economies of scale mean America can provide health care at a lower per capita cost than smaller countries.
Your argument is such nonsense it suggests that merely dividing America up into 10 countries each of 30 million would mean it could provide healthcare at a more affordable rate. Nonsensical at best.
I don't blame you if you think this way. You're canadian. You don't know wtf you're talking about. ;)
1. Not everyone in the US has a job. More than 23 million Americans are unemployed/underemployed.[1] And are therefore paying very little/not paying taxes. A large population means a large pool of tax payers, and an even larger pool of non-tax payers.
2. Income inequality. The middle-class/rich are paying more taxes."CNN: The rich pay majority of U.S. income taxes"[2] The top 10% earners of this country already pays more than 70% of all the income taxes.
3. Entitlements are already killing the US economy. 62% of the federal budget goes to entitlement.[3] Where are you going to get the $4-$6 trillion to pay for Obamacare??? OH RIGHT, 4 straight years of trillion dollar deficit under Obama. The government is already borrowing money to pay for existing entitlements![4]OR tax wealthy people! (those earning more than $250K under Obama's plan).
you are laughably uninformed about the issues regarding entitlements in America.
[1]http://www.cnbc.com/id/49450120
[2]http://money.cnn.com/2013/03/12/news/economy/rich-taxes/inde...
[3]http://www.heritage.org/research/reports/2012/10/federal-spe...
[4]http://en.wikipedia.org/wiki/National_debt_of_the_United_Sta...
Australian, actually. I just live in Canada. I spent 1.5 years living and working in America too.
Those problems or "issues" you present are not unique to America. Every country in the world has unemployment, income inequality and entitlements.
It's simply a question of where you want your government to spend the tax dollars it collects. Currently, they spend it blowing things up while tens of millions of it's citizens are without basic healthcare.
62% of the US federal budget goes to entitlements (Medicare/Medicaid/Social Security). That's ONLY $2 Trillion. 18.7% goes to the defense spending. [1]
Implementing Obamacare will cost $4-$6 Trillion. WHERE DO YOU SUGGEST WE GET $4-6 TRILLION? Even if you cut 100% of the defense budget it won't be not enough to pay for Obamacare.
[1]http://www.heritage.org/research/reports/2012/10/federal-spe...
In other words, 62% of your revenue goes back to the taxpayers that provided that revenue. If anything, I'd be complaining about the other 48% if I were you.
>Implementing Obamacare
The argument that Medicare costs x and support y people, and Obamacare costs 2x and supports 2y people, therefore full universal care would cost 100x and support 100y people is flawed.
Clearly, if the US went universal, the massive administration costs associated with HMOs and such would no longer be an expense to be paid. Instead of being a large employer within your currently broken system, you replace the system.
There is a reason your health spending is almost double per capita to the next highest nation, and it has nothing to do with your population.
The big problem is that Obamacare is nothing like a universal system or even the Canadian system, and it does not address the colossal spending costs.
Also, I think Canada happens to have built its medical system at a bit of a sweet spot time. We have enough people paying enough taxes to give a pretty decent average quality of care (assuming you don't live in the boonies). Too many more people or too little taxes and the system will fall apart.
As run4yourlives said, > There is a reason your health spending is almost double per capita to the next highest nation, and it has nothing to do with your population.
Ditto. Canada and other countries aren't doing that. So in the mean time our skilled workers will keep going to the USA to get salaries 3-5x higher than what they would make and keep on taking the money out of the USA.
Exactly
Except that the middle class, rich and younger people are paying for majority of the taxes that are spent for entitlements. And you're asking them to pay for another unfunded mandate. Your socialist views have no place in America.
Australia have universal healthcare but your taxes are sky high, zero innovation, zero growth, no jobs, etc. horay for socialism. Give me one innovation that came out of australia? ZERO. (ok i love ac/dc but they dont count) :)
It works in every other developed nation on the planet AND we spend close to 50% per capita you do right now.
You spend so much on Medicare/Medicaid because of your system; the US government is simply just a big employer.
The idea that the US is somehow operating under a different set of rules for basic math is mind boggling to me.
spain, greece, germany, france, cyprus and 99% of all socialist countries have declining economies, high unemployment rate, high taxes, ZERO innovation, etc. Hey but they have free health care! horay for socialism!
See here: http://www.theatlantic.com/international/archive/2012/06/her...
You HAVE to provide universal health care because there are NO jobs in your pathetic country.
You were saying?
% of gov't employees in the US is only 15% of our labor force. Considering the size of our country, military, etc. that figure is small compared to Canada's labor force-gov't employee ratio.
NICE TRY ;)
I get it that you're proud of your universal healthcare system. I honestly wish we have one but the issue is COST. if you can think of a way to implement universal healthcare without bankrupting our country i want to hear it.
I simply don't trust our (the USA's) federal government to handle a socialized system with any amount of efficacy or competency. We would need a fundamental cultural change and a massive restructuring of current spending. Like that will happen any time soon.
Plus, I don't think such a system should even be possible with our form of government because of the powers enumerated by the Constitution. If there were to be a socialized system, it should happen at the state level and perhaps the federal government could help regulate / control interstate issues. Or, I suppose, we could try to pass an amendment.
You would have to be astoundingly incompetent to make a socialized system more expensive for the USA.
http://www.economicshelp.org/blog/6220/economics/global-heal...
Plus, I don't think such a system should even be possible with our form of government because of the powers enumerated by the Constitution.
Pretty sure your federal government can recognize human rights, and ensure they are respected. Health care is the one section of the Universal Declaration of Human Rights that the US has not ratified.
I share your pessimism though in any meaningful change taking place. The USA has a rather bizarre view of the role of health care in society as compared to other nations.
Well we do spend more per capita on education than any other nation (and not have results to show for it) and education is dominated by the government. Our government is astoundingly incompetent. And I see no reason why the government would magically make healthcare cheaper just because it would get EVEN MORE involved.
> Pretty sure your federal government can recognize human rights, and ensure they are respected.
If this is what you're referring to (in Article 25 (1)):
> Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Constitutionally, no. Most of this should be (but of course isn't, given that we have Social Security, Medicaid/Medicare, TANF, etc.) left to the states. All powers not explicitly described by the Constitution are left to the states per the 10th amendment in the Bill of Rights. And personally, I would be fine with this. I would rather not have the monolithic and inscrutable federal government we have today. I would prefer to leave it to the states whether or not they want to recognize the U.N. Universal Declaration.
To play the devils advocate, linking health care to your job means that productive citizens are being taken care of. This fosters a "survival of the fittest" situation.
That isn't really how it plays out, but I think that's the allure to many of us Americans. I've spoken with others who who believe that you must work to earn certain things, such as health care. It is often toted that people who are obese, smoke, do drugs, and participate in other health risks are more likely to be on government aid than those who "earn" it. They use this fear of being taken advantage of to fuel a desire a knee-jerk reaction to health care.
Yet there are valid concerns. Especially with the migration of such an entrenched system.
If the US government is going to take on Health Care that money needs to come from funds already in the budget. The US government is poised on the edge of failure, the only thing keeping us going is a mass faith in the ability of the government to pay back it's loans, and thus receive more.
Also this points to a bigger break in the system. US Agencies (I can't speak to foreign agencies) incentivise the spending of your whole budget. If you don't spend it all then obviously you don't need it all. This creates a mad spending rush at the end of the fiscal year and an atmosphere where you have not only the right but the obligation to spend your budget.
I think a lot of people are intimidated by the concept of introducing another burden to the US budget when we are already incentivising the wrong thing.
I think if we could cut back the budget in other areas, this would make it possible to introduce a true health program.
I'm only touching on a few reasons why this isn't being done immediately. I do think that our defense budget is outlandish and could be put directly towards health care, but that is a huge transition in the work force. That is soldiers to medicare specialists. That sort of transition will take time.
linking health care to your job means that productive citizens are being taken care of
Assuming productivity is related to the selling of your time to another actor is outdated 20th century thinking. People can and are becoming increasingly productive without having "jobs" that fit a definition. Entrepreneurs, contractors, part-time workers, stay at home parents, students... all of these people are outside of the employer/employee equation and thus don't have access to health care because of it.
Tell me, who's more valuable to society, employee #992232 of big corp the next Richard Branson? Tying health care to employment ensures the former, not the latter is given incentive. This is precisely what we don't want.
If the US government is going to take on Health Care that money needs to come from funds already in the budget.
This is a much more practical argument and it is difficult to rebut directly. Essentially though, you are correct: something else would need to be sacrificed. There is, of course, an obvious target: http://armscontrolcenter.org/issues/securityspending/article...
In addition to that though, spending on Medicaid and Medicare within the current system is hugely inflated, from what I can see. US per capita administrative costs are triple that of Canada: http://pweb1.rwjf.org/reports/grr/036617.htm
So, even without a military cut back, the money is already being spent, just on HMO's instead of actual health care.
The consensus here is that society has to take care of the sick, independently of the circumstances of their life. It is important to note that I wrote society, not state. The state is seen as the agent through which society effects this, not the principal actor. The fact that it is seen as a question of ethics and a part of "we the society" probably also explains the rather vitriolic contributions that some of my European compatriots provide in discussions on the US health care situation (even though it is probably none of our business).
Hell, even if you have a job you might have to pay for health care yourself due to certain circumstances and if you're in monetary trouble you might not be able to do so.
Not to forget that freelancing or self-employment might bring you to the point were beeing unemployed is more beneficial to you because you have to pay for everything yourself with much higher rates.
You brought up one very important thing when you wrote about monetary trouble and self-employment. Because even a mandatory insurance scheme as the one in Germany has holes in it. I recently learned that, if you are self-employed, have private health care and run into financial trouble, you can end up in a state of "inactive health insurance", where you still have basic health insurance, but you always have to go to the emergency ward at the hospital. So far, a few ten thousand people are affected by this (out of 80 Million), but it is a de facto hole in the system.
However, when I point this latter situation out to people around here they usually become quite enraged. In a way, this reinforces my point about the perception of health care as an ethics issue.
True. If you don't have one you have to pay a fine. Which is troubling if you couldn't pay for it in the first place. I have that problem at the moment. I guess it's mostly my fault for not taking every help I could get. So far I haven't gotten any troubling mail, but I'm sure I'll be in trouble once I have to get back into it.
Everyone around me feels uneasy about this. I didn't have the need to go to the doctor in a very long time, but I can relate.
"The recovering economy could also help force Walmart, and other like-minded employers, to back off this policy and hire full-time workers with benefits."
There's nothing political about the truth. To not recognize (or admit) the connection between the two is serious head-in-the-sand syndrome.