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Paying the healthcare costs of obesity
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The employment-based health insurance system isn't a very good model, though, although it's nice if you have a good stable job with benefits. Employers hate it, too (I say as someone who is a part-owner of a small business.) Question is if we could get anything better, as ACA is still built around the same in large part.0
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lemurcat12 wrote: »The employment-based health insurance system isn't a very good model, though, although it's nice if you have a good stable job with benefits. Employers hate it, too (I say as someone who is a part-owner of a small business.) Question is if we could get anything better, as ACA is still built around the same in large part.
Small businesses were typically not part of that system back then. I'm sure small business owners do hate being forced to provide insurance now under ACA. It is an added burden that discourages small businesses from growing beyond a certain point. At any rate, the insurance I had as a benefit with a large company was quite good. And, the employers offered it in order to be competitive with other employers in the area and be able to attract good employees. It worked both ways. Large stable employer with benefits attracts good stable employees to work for them. I disagree with your premise that ACA is built around the same in large part. But, I will agree that the result is roughly the same. My coverage through my current employer (a large company) is half the coverage I used to get, quadruple the deductible, with three times the premium. That is because forced participation has limited supply/availability and driven up demand/price. And, if you work for a small company with a health plan or have to get your coverage through the ACA exchange, you are going to pay just as much as I pay or more, and only get coverage for catastrophic illness or injury once you meet your $10,000 deductible. So, employment-based insurance is not nearly the same as it used to be when insurance companies competed for the business of those large employers. But, the end result is some have better rates and slightly better coverage than others (though not nearly what I had in the nineties), and the ones who don't or won't are still skipping out on their bills (whether it be the $10,000 deductible or the monthly insurance premiums).0 -
lemurcat12 wrote: »The employment-based health insurance system isn't a very good model, though, although it's nice if you have a good stable job with benefits. Employers hate it, too (I say as someone who is a part-owner of a small business.) Question is if we could get anything better, as ACA is still built around the same in large part.
Small businesses were typically not part of that system back then. I'm sure small business owners do hate being forced to provide insurance now under ACA. It is an added burden that discourages small businesses from growing beyond a certain point. At any rate, the insurance I had as a benefit with a large company was quite good. And, the employers offered it in order to be competitive with other employers in the area and be able to attract good employees. It worked both ways. Large stable employer with benefits attracts good stable employees to work for them. I disagree with your premise that ACA is built around the same in large part. But, I will agree that the result is roughly the same. My coverage through my current employer (a large company) is half the coverage I used to get, quadruple the deductible, with three times the premium. That is because forced participation has limited supply/availability and driven up demand/price. And, if you work for a small company with a health plan or have to get your coverage through the ACA exchange, you are going to pay just as much as I pay or more, and only get coverage for catastrophic illness or injury once you meet your $10,000 deductible. So, employment-based insurance is not nearly the same as it used to be when insurance companies competed for the business of those large employers. But, the end result is some have better rates and slightly better coverage than others (though not nearly what I had in the nineties), and the ones who don't or won't are still skipping out on their bills (whether it be the $10,000 deductible or the monthly insurance premiums).
It's more complicated than that. Many small businesses have always provided insurance (we have), because you have to to compete in the market. We hated the system before ACA too (in some ways it was better, in some ways worse). Big companies don't generally like having to provide it either, although they had better risk buckets (which ACA actually should help smaller businesses with, while interfering with the flexibility of what we can offer if we choose to offer it -- generally small businesses are exempted from ACA if small enough).
It's not particularly efficient, because employees don't tend to understand that it's part of compensation, so you get no credit for it, and it means that you can't fully base compensation on merit, since a significant chunk of it gets tied into fixed cost (other than family size and whether you take it or use a spouse's) insurance.
It's also bad, IMO, because it interferes with employee mobility. For example, my dad was lucky that my mom had excellent insurance (which wasn't that common for a woman back then). If she hadn't, he would have had to stay in a job he hated rather than start his own business. Untying insurance from employment would help prevent that (especially for single people).
ACA is absolutely built primarily around the employer market -- the US system is so beneficial to people who have good employer-based insurance that it's impossible to really move away from it. There are lots of reasons why insurance costs are going up, many of which would have existed without ACA, but the bigger point is that tying insurance to a job really doesn't make sense and is inequitable. Something had to be done for people who didn't win that lottery for some reason or another (and increasingly businesses were already finding ways to avoid putting workers on insurance, because it's expensive).
My employer-based coverage has always been excellent too -- with a big employer and then a small employer in the same field that, like I said, had to compete. That doesn't mean the system was working overall. (I hate ACA too, but no more than the prior system and I think it can be improved. More so, I think we need to look at the various European models, which offer a number of different approaches.)1 -
the health effects of metabolic syndrome affect the skinny as much as the fat they just don't look it2
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The US COULD have a more affordable health care system if 45% of taxes weren't spent on defense (more than practically all countries spend together on defense). Mind you I'm not saying reduce what we need to do to protect the country as a whole, but when we spend 3 trillion on planes (F35 series) that aren't even finished yet (ongoing delays and overbudget) and likely won't be needed on US soil unless a war comes over here, diverting some of that money instead to a more "user friendly" health care system would help. Hell, even kids would be able to get college education with that money. Of course with the money spent and profited on due to defense cost, that's likely not going to happen.
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lemurcat, you and I will just agree to disagree. There is no lottery. Employment is almost always a direct result of personal choices. ETA: I also don't accept that people are just too stupid to realize that employer provided health insurance does reduce their wage rate as it is included as part of their total compensation package. I'm sure some are, but I still don't accept it (as an excuse).
ninerbuff, LOL, you said "spent on defense", like that's what's actually going on! Yeah, just because they call it "defense spending", doesn't mean that's what's going on. They should probably call it "offense spending". But, I know, I know, that was kind of your point (wasted money). Just struck me funny.0 -
frammis4242 wrote: »the health effects of metabolic syndrome affect the skinny as much as the fat they just don't look it
True, but the "gifts" that come with metabolic syndrome more often than not come with obesity
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I'm sure small business owners do hate being forced to provide insurance now under ACA. It is an added burden that discourages small businesses from growing beyond a certain point.
Small and midsized business owners seem to have no problem getting around this to further their own financial interests. They simply hire part time workers, rather than full time workers, so they don't have to provide health insurance. Unless it's the sister of a good friend or an old college roommate's son or daughter - something like that. For nepotistic arrangements such as this, exceptions will be made and the hire will be full time and fully insured.
Also, most small and midsized business owners discourage overtime opportunities or simply sleaze out of paying it altogether after the employee works 10 or 12 hours straight.
These charming shortcuts, along with the fact that the average employee of a small or midsized business gets only 3 to 5 paid sick days a year and maybe one week of vacation pay if they're lucky, makes for a very polarized workplace culture. And, needless to say, the ball's not in the court of the employee at all.
When I see business owners giving a kitten about things like this, and caring about whether their employees live or die, or whether they have to sleep in shelters because they can't pay market rent, or whether they haven't had a physical exam in 5 years because they can't pay out of pocket for it, then I'll have more sympathy.
I remember an old boss of mine offering to rent me one of his units in a large apartment building that he owned when he learned I was looking for a place. He owned more than one of these buildings. It was a side venture. The rent was $1,200 monthly with no heat or hot water, for a one bedroom in what amounted to nothing but a slum. I reminded him that he paid me $600 a week net to basically run his office for him at his small business - and, thanks - but it wouldn't be something I could afford at the moment. He chuckled and said "What?! Hey! You should talk to your boss about that!" Chuckle, chuckle, chuckle.
Nice way to make a living, huh? I'd rather live on a modest wage, refrain from exploiting others while denying it, stay within my means and go to sleep in a small, rented apartment with a clean conscience.
Excellent point. So, once again, ACA doesn't help the situation. It only gives small business owners greater incentive to keep workers part-time and zero incentive to employ full-time help. In effect, it has only compounded the problem. Now, a formerly full time job that maybe didn't have benefits becomes a part-time job, still with no benefits. Now, the employee either gets another job or jobs, adding to their transportation costs and potential stress (health problems), or they jump on the public assistance wagon to supplement their housing, food, etc. As for the slum lord, jeez, sounds like that's what the housing cost was in that area. If it weren't, he wouldn't be able to charge that much for a slum apartment. Again, this comes down to personal choices. I personally choose not to live in an area where the cost of living is astronomical AND the wages are low and/or only part-time work is readily available. Doesn't make fiscal sense at all.0 -
lemurcat, you and I will just agree to disagree.
Works for me. I feel constrained in what I can argue anyway, given that we aren't supposed to be political. You just used my post about my mom's cancer as a springboard for a claim that the old system was not broken and ACA is terrible, so I felt compelled to respond so it didn't appear I was nodding along. While I have issues with ACA myself (not as major as yours), I 100% disagree that the old system (which also existed because of the gov't, not the free market) was not broken, and the fact my mom had a job with good employer-based insurance (as do I) doesn't say anything about whether it is or not. No one, absolutely no one, makes the strawman argument that you were arguing against--that pre-ACA no one could afford cancer treatment.1 -
lemurcat12 wrote: »lemurcat, you and I will just agree to disagree.
Works for me. I feel constrained in what I can argue anyway, given that we aren't supposed to be political. You just used my post about my mom's cancer as a springboard for a claim that the old system was not broken and ACA is terrible, so I felt compelled to respond so it didn't appear I was nodding along. While I have issues with ACA myself (not as major as yours), I 100% disagree that the old system (which also existed because of the gov't, not the free market) was not broken, and the fact my mom had a job with good employer-based insurance (as do I) doesn't say anything about whether it is or not. No one, absolutely no one, makes the strawman argument that you were arguing against--that pre-ACA no one could afford cancer treatment.
There are many on this thread who suggest that (or other major illness, not just cancer treatment), and they were the one's I was disagreeing with. If you feel offended that I used your post about your mom's illness, I apologize for offending you. You said she survived, didn't know it was a sensitive subject. But my point was exactly opposite of what you just said. I proposed that people could afford treatment because they acted like adults and made adult decisions (including employment decisions), taking unplanned illness into account.0 -
lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.0
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lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
It just kind of reads like, stay in a soul sucking job no matter what you actually want to learn and do for a living. At least, your potentially sad existence would be insured if you were to become diagnosed with a devastating illness. To some of us, that seems like an area with improvement opportunities2 -
lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
Yep, I would like to do something different, but providing for my family was/is the highest priority so I do a job that is okay but pays the bills well and includes insurance.
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lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
It just kind of reads like, stay in a soul sucking job no matter what you actually want to learn and do for a living. At least, your potentially sad existence would be insured if you were to become diagnosed with a devastating illness. To some of us, that seems like an area with improvement opportunities
Agreed. Sounds awful. But, if that was the result, that would still be directly due to personal choices. And, in a marriage/family, it takes both partners to make the right choices. Her parents did. One of them had a great job with great benefits, which allowed the other one to follow his dream. Maybe that's idyllic. But, once again, I made those choices for myself. I don't see how others justify that they should get to follow their dream and have a total stranger take up the slack because their dream didn't include A. employer sponsored coverage, or B. enough income from their dream job to take care of their own stuff.0 -
Packerjohn wrote: »lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
Yep, I would like to do something different, but providing for my family was/is the highest priority so I do a job that is okay but pays the bills well and includes insurance.
Exactly!0 -
lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
It just kind of reads like, stay in a soul sucking job no matter what you actually want to learn and do for a living. At least, your potentially sad existence would be insured if you were to become diagnosed with a devastating illness. To some of us, that seems like an area with improvement opportunities
Agreed. Sounds awful. But, if that was the result, that would still be directly due to personal choices. And, in a marriage/family, it takes both partners to make the right choices. Her parents did. One of them had a great job with great benefits, which allowed the other one to follow his dream. Maybe that's idyllic. But, once again, I made those choices for myself. I don't see how others justify that they should get to follow their dream and have a total stranger take up the slack because their dream didn't include A. employer sponsored coverage, or B. enough income from their dream job to take care of their own stuff.
It's not like that all over the world. In some places you do have to pay for care, so certain illnesses would be a death sentence if you didn't have money.0 -
lemurcat12 wrote: »lemurcat, you and I will just agree to disagree.
Works for me. I feel constrained in what I can argue anyway, given that we aren't supposed to be political. You just used my post about my mom's cancer as a springboard for a claim that the old system was not broken and ACA is terrible, so I felt compelled to respond so it didn't appear I was nodding along. While I have issues with ACA myself (not as major as yours), I 100% disagree that the old system (which also existed because of the gov't, not the free market) was not broken, and the fact my mom had a job with good employer-based insurance (as do I) doesn't say anything about whether it is or not. No one, absolutely no one, makes the strawman argument that you were arguing against--that pre-ACA no one could afford cancer treatment.
There are many on this thread who suggest that (or other major illness, not just cancer treatment), and they were the one's I was disagreeing with.
I think you misunderstood their arguments. They weren't saying no one could afford it. They were saying most without insurance could not. Obviously lots of people have insurance (and did pre ACA). No one thinks otherwise.
And thanks for the apology. No biggie. Just why I felt I had to engage.0 -
lemurcat12, you even said it yourself. Your dad would have had to stay in a job he hated if not for your mom's insurance . . . again, adult responsibility. He would have stayed in his job for the insurance if she had not had coverage. That's just what grown ups do.
It just kind of reads like, stay in a soul sucking job no matter what you actually want to learn and do for a living. At least, your potentially sad existence would be insured if you were to become diagnosed with a devastating illness. To some of us, that seems like an area with improvement opportunities
Agreed. Sounds awful. But, if that was the result, that would still be directly due to personal choices. And, in a marriage/family, it takes both partners to make the right choices. Her parents did. One of them had a great job with great benefits, which allowed the other one to follow his dream. Maybe that's idyllic. But, once again, I made those choices for myself. I don't see how others justify that they should get to follow their dream and have a total stranger take up the slack because their dream didn't include A. employer sponsored coverage, or B. enough income from their dream job to take care of their own stuff.
How would (hypothetically) affordable non job based insurance that didn't kick off/refuse to insure people with preexisting conditions be any more "having someone else pay for you" than employer-based insurance that already offered those benefits.
In a true free market (which I'm not really suggesting), there'd be no employer-based with those benefits either. In a way (and this is the premise of this thread) ALL insurance involves some people paying for others. With health care it's just that we all know there's a risk and we all get old and riskier.
My mom didn't have a "great job with great benefits." She had an okay job (because that's all she was interested in, it was just a job) with great benefits because she worked for a state university (so living off the taxpayer, I suppose). (She does not have a great pension, for the record.) My dad made more money that her working for himself. He simply would have had a hard time getting insurance that way for a family, or at least (back in the day) insurance that couldn't deny you for a preexisting condition, etc.
It's funny, since back in the day being entrepreneurial was promoted by conservatives as a good thing. Go out and build something. Be a job-creator. Tying insurance to the job was seen as bad because it prevented people from taking risks. Heck, even just look at McCain's health insurance proposal which would have been hated more than ACA because it attacked the employer-based insurance model much more.0 -
I wonder what kind of innovation we'd see as a country if people felt less tied to jobs they hated. I wonder what changes would come to certain industries if they lost the hook their job benefits held on people.2
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And even in 1996, I in speeches propose the following amendments to the Constitution:
Article XXVIII: Every newborn shall be sincerely welcomed and cared for until maturity.
Article XXIX: Every adult who needs it shall be given meaningful work to do, at a living wage.
-Kurt Vonnegut0
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