[HN Gopher] Intuit asked Mailchimp employees to pay medical cost...
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Intuit asked Mailchimp employees to pay medical costs out of pocket
Author : luu
Score : 245 points
Date : 2022-04-11 18:16 UTC (4 hours ago)
(HTM) web link (twitter.com)
(TXT) w3m dump (twitter.com)
| PaywallBuster wrote:
| Mr Derrick seems to have gotten triggered by all this, which
| looks nothing but the unfortunate side effects of the US
| tax/legal system, and in that regard I'd guess it occurs often
| enough.
|
| In the other hand consider that Mailchimp employees probably
| fared much better working on a digital all online product and
| getting their above average salaries than the average person, who
| actually lost their jobs, savings and health insurance due to
| covid
| bartvk wrote:
| Is it really the unfortunate side effect of the US tag/legal
| system? As an outsider (from Europe), it seems that Intuit was
| able to take over Mailchimp, but was not able to smoothly
| transition their new employees from one insurer to another.
| bpodgursky wrote:
| This happens all the time when people switch insurance or go onto
| COBRA. You get retroactively covered for some period after your
| new plan becomes active.
|
| It doesn't end up with people paying tens of thousands out of
| pocket, people just don't pay the bills that come in during that
| period, and kick them to insurance later. It sucks but is not
| really uncommon or possibly even something Intuit has a ton of
| control over.
| sc68cal wrote:
| How many people realistically go into COBRA. Have you seen the
| premiums? For family coverage it can easily be thousands per
| month.
| imglorp wrote:
| Why is health insurance tied to employer, again? Is there a
| reason that should continue?
| auxym wrote:
| Good NPR Throughline episode on the subject:
| https://www.npr.org/2020/09/28/917747287/the-everlasting-pro...
| fennecfoxen wrote:
| Historical and tax reasons. It started back in the era of WWII
| wage controls. It continued to be an okay way to do group
| insurance without facing major problems with adverse selection.
| Being able to pay for it with a pre-tax payrolld eduction is
| the other big reason it thrived.
|
| Given the mandates on insurance there are _some_ reasons it
| should continue, but they are not really _good_ reasons.
| bogomipz wrote:
| >"Given the mandates on insurance there are some reasons it
| should continue, but they are not really good reasons."
|
| Besides the fact that there doesn't seem to be any better or
| viable alternative available in the marketplace what are the
| other reasons?
| RC_ITR wrote:
| > It continued to be an okay way to do group insurance
| without facing major problems with adverse selection.
|
| This is sort of a hot take, but there are plenty of examples
| of things like this in the US that have the unstated
| parenthetical "(because poor and minority populations were
| ignored by the system completely)"
| zamalek wrote:
| > some reasons it should continue, but they are not really
| good reasons.
|
| Many of those reasons are legislature that allows insurance
| companies to do/demand things that they really shouldn't be
| able to. _Even if_ the goal isn 't public healthcare, America
| still needs a major healthcare insurance restructuring.
| rhacker wrote:
| I think that should look like this: HMO style access for
| all - automatically. Rebate if you decide to up it with PPO
| style insurance (or beyond). So you get 200 per month off
| taxes to pay towards your own insurance.
|
| Also, get it out of the employers hands - as in make it
| illegal to offer any benefits and let the employee get paid
| 100% of their salary instead. Also make it so that
| employers can't legally collect taxes without consent.
| pessimizer wrote:
| Unions started offering it, so employers were granted a tax
| break to provide it instead in order to weaken the unions.
| Domenic_S wrote:
| This is super incorrect; if anything, employer-based health
| insurance _strengthened_ the unions ' ability to negotiate
| for their workers. As a sibling comment mentioned, the major
| catalyst was WWII wage controls:
|
| > _During World War II, wage and price controls prevented
| employers from using wages to compete for scarce labor. Under
| the 1942 Stabilization Act, Congress limited the wage
| increases that could be offered by firms, but permitted the
| adoption of employee insurance plans. In this way, health
| benefit packages offered one means of securing workers.
|
| > In the 1940s, two major rulings also reinforced the
| foundation of the employer-provided health insurance system.
| First, in 1945 the War Labor Board ruled that employers could
| not modify or cancel group insurance plans during the
| contract period. Then, in 1949, the National Labor Relations
| Board ruled in a dispute between the Inland Steel Co. and the
| United Steelworkers Union that the term "wages" included
| pension and insurance benefits. Therefore, when negotiating
| for wages, the union was allowed to negotiate benefit
| packages on behalf of workers as well. This ruling, affirmed
| later by the U.S. Supreme Court, further reinforced the
| employment-based system._
|
| - Health Insurance in the United States, Melissa Thomasson,
| Miami University (https://web.archive.org/web/20110903053358/
| http://eh.net/enc...)
| candiddevmike wrote:
| So health insurance companies only have to convince your HR
| department to use them through some kind of grift instead of
| competing for your individual business on things like cost and
| in-network providers. Because the health insurance industry is
| focused on metrics like "number of lives we brought in this
| quarter" from massive deals that abstract your individual
| agency as one of a thousand+ lives covered under your employers
| plan. Who cares if you need to speak to a supervisor because
| your claim was denied, you're not going to get your company to
| switch plans.
|
| Before someone says "but the healthcare marketplace", it's a
| joke. The individual plans we have today are ridiculously
| expensive because: A) the government will pay for folks who
| can't pay for them, so easy money for the insurance companies
| and B) the folks who can pay really need it (healthcare is
| inelastic), they're so few though so there really is no
| downward price pressure to compete for them.
| mrtranscendence wrote:
| > the government will pay for folks who can't pay for them
|
| This depends on your state. Some states, like Wisconsin,
| won't offer medicaid for income reasons alone. I'm unaware of
| health insurance policies being cheaper in Wisconsin, though
| perhaps it's the case.
| lettergram wrote:
| Why is health insurance legal?
|
| Serious question, right now it's legally mandated to have. What
| would happen to medical prices if that requirement was
| reversed?
|
| Just food for thought. If you model it you'll find interesting
| results.
| munk-a wrote:
| Lets look back to the 90s when it wasn't legally mandated:
| some people did just fine (those with a lot of cash sitting
| around), most people suffered worse than they do today and
| some people were completely screwed by the system.
|
| If it was illegal to pool health prices via insurance
| (instead of just not legally mandated for everyone to be
| insured) then the effect would be that those who went
| bankrupt under the old system would instead be dead.
| jtbayly wrote:
| Why would those people die? I don't follow.
| munk-a wrote:
| You'd make it illegal to pool costs by barring insurance
| - meaning that healthcare providers would either need to
| provide service gratis for the majority of the population
| (which is, really, just another form of insurance so
| that's out) or they'd need to secure a personal loan with
| their bank some time between getting hit by a truck and
| the operating table.
|
| And for pre-existing conditions and long term health
| disabilities - the individual would need to somehow
| justify the profitability of their existence to a private
| underwriter who was willing to bear the cost - in most
| cases those people "aren't worth the cost of keeping them
| alive" (assuming you're looking strictly at numbers).
|
| Hence - a lot of people would end up dead.
| notch656a wrote:
| Can you really call it 'insurance' when it's a pre-
| existing condition? I realize we can call insurance
| whatever we want, but when I think of insurance I think
| of it a way to pool for mitigating risk of the unknown.
|
| No one would sell insurance that would fix your already
| destroyed roof.
| giaour wrote:
| > No one would sell insurance that would fix your already
| destroyed roof.
|
| But they will sell you homeowners insurance in areas
| prone to wildfires or hurricanes. The difference is that
| you are expected to know the amortized cost of disasters
| for your property and either insure against it or simply
| accept the risk. Either way, you as a homeowner are
| supposed to make an informed decision. If disaster is too
| likely to occur in a certain area, you can either move or
| not purchase a property in the first place.
|
| Science still hasn't figured out how to let us move into
| healthier bodies or choose our bodies prior to birth, so,
| alas, we are forced to seek fairness through other means.
| com2kid wrote:
| > But they will sell you homeowners insurance in areas
| prone to wildfires
|
| And in areas with wild fires, tar roofs aren't legal for
| new construction! Roofs have to be built out of something
| non-flammable.
|
| Lessons to be learned perhaps.
| munk-a wrote:
| Well, whatever we call it we as a society need to choose
| whether we want to keep people with expensive preexisting
| conditions alive. I don't think it's really necessary to
| debate the point since almost every western country has
| decided that their ethics fall in the camp of "Yes, we
| support those people and give them the best life
| possible" whenever they're actually pressed on the
| matter. For a while the US skated by on budgetary excuses
| but all the while I think society still idealistically
| held on to that standard - I think this point is fairly
| debatable though.
|
| I think it's more a question of whether we'd be willing
| to install and maintain a roof on a building that had
| been designed without a roof in mind or whether we'd tear
| down the building to make room for a new one. You'd
| probably rationally lean in the second direction for a
| house - but when we're talking about a human life the
| math changes for a lot of people.
|
| Either way, a return to an insurance-less situation would
| leave people with preexisting situations out in the cold,
| unless your definition of insuranceless involves
| government subsidies for all preexisting conditions and
| at that point you're basically talking about medicare for
| all.
| giaour wrote:
| > meaning that healthcare providers would either need to
| provide service gratis for the majority of the population
| (which is, really, just another form of insurance so
| that's out) or they'd need to secure a personal loan with
| their bank some time between getting hit by a truck and
| the operating table
|
| There's also the Chinese model, where you or your family
| are expected to have substantial cash savings on hand for
| any medical emergencies.
| jnwatson wrote:
| Even with good insurance, medical costs in the US can
| exceed the savings of even the most thrifty.
|
| My uncle spent $1.7 million in 3 years to care for my
| aunt, and that is with excellent insurance.
| munk-a wrote:
| I'm not particular familiar with Chinese health insurance
| - if you lack those cash savings are you left out in the
| cold? Does the government step in?
| giaour wrote:
| I don't have any direct experience with the Chinese
| health care system, but there's a lot that is not covered
| by insurance, and bribing doctors or hospital
| administrators to receive better or quicker care is
| supposedly widespread (and therefore is or is perceived
| to be necessary).
| https://www.newyorker.com/magazine/2014/08/25/under-the-
| knif... is a good overview.
| [deleted]
| [deleted]
| _moof wrote:
| The federal health insurance mandated in the US was repealed
| as of 2019. You may still be subject to a state mandate
| though.
| dmitriid wrote:
| > If you model it you'll find interesting results.
|
| No, we won't. The results are entirely predictable. Without
| medical insurance people die and/or go bankrupt.
|
| The main problem is that most Americans for some reason
| cannot imagine a system other than the US system, and equate
| all medical insurance with that.
| jjtheblunt wrote:
| Those might be the interesting results, though, referred
| to?
| bogomipz wrote:
| I'm not following your first question do you mean to say why
| is mandating coverage legal?
|
| My understanding of the mandate was that(theoretically) by
| more people being insured the population be healthier and
| that would someone how drive prices down. Obviously that's a
| farce as prices go up year over year. It would be interesting
| to see how much more basic procedures would be now after
| being adjusted for inflation compared to what they were in
| say the 90's.
| OldTimeCoffee wrote:
| This ignores the elephant in the room that in the 90s
| insurance companies just wouldn't pay, claim pre-existing
| condition, and bankrupt the patient.
| alex_young wrote:
| A bunch of rare events would bankrupt anyone who encounters
| them?
| [deleted]
| notch656a wrote:
| You're free to buy privately and cancel your employer
| insurance. I have never heard of an employer that won't let you
| cancel your insurance.
| munk-a wrote:
| Negotiating as an individual in a market made up by large
| blocks makes you very easy to ignore. If everyone moved off
| employer insurance and into the market then, assuming we
| didn't have massive market corruption (which I think is a
| pretty big assumption), we'd all be on an even playing field.
| Asking individuals to do this independently is just a recipe
| for them to fail.
| ihumanable wrote:
| I think auto insurance is a good indicator of how it would
| play out if you made everyone do individual insurance.
| Insurance would still likely need to be legally mandated,
| like auto insurance, so that the insurance market would be
| solvent.
|
| From there, insurance would likely break down into high
| cost / high coverage, mid cost / mid coverage, low cost /
| legally mandated minimum coverage.
|
| The poor would end up with the low cost / minimum coverage
| plans as cost would likely end up being the main motivating
| factor. Given that 6-in-10 Americans can not afford an
| unexpected $500 bill (https://www.cbs19news.com/story/34248
| 451/6-in-10-americans-d...), this would likely be the
| coverage level chosen by about half of Americans. These
| policies would be affordable, but I expect the deductibles
| and co-pays would be high enough to make it prohibitively
| expensive for policy holders to actually get much utility
| from them.
|
| The other half would end up with the better plans, unless
| they were more comfortable with risk and elected for the
| cheaper plans. Their lot is probably pretty similar to
| today.
| jandrewrogers wrote:
| That article says that 60% of Americans don't have $500
| _in a savings account_ , not that they don't have $500.
| Savings accounts are an anachronism, it is like saying
| Americans don't have phones if they don't have a
| landline. By that standard, I'm flat broke.
|
| Americans can afford a $500 expense just fine. The median
| American household has ~$1000/month left over after all
| ordinary living expenses, per the US Bureau of Labor and
| Statistics.
| notch656a wrote:
| I did this exact thing (bought privately) for awhile
| because I wanted to decouple my insurance from employment.
| It's actually very easy.
| etchalon wrote:
| When we were a smaller group, we had to forbid it, because
| otherwise our group wasn't large enough to qualify for a
| group plan.
| phil21 wrote:
| This is very strange, it's not even remotely rare to
| decline employer coverage - probably half my team either
| has their spouse on our company coverage, or no company
| coverage since they are covered by their spouse.
| notch656a wrote:
| In my jurisdiction this practice (forced insurance) would
| almost certainly be illegal if any unauthorized payroll
| deduction were included.
| [deleted]
| maxerickson wrote:
| Most employers don't offer to pay the premium out instead of
| the coverage, so they usually offer a much better deal than
| the alternatives.
|
| Like if your contribution to your insurance is a few hundred
| a paycheck there is a pretty good chance that the employer is
| paying in quite a bit more than that.
|
| https://www.kff.org/health-costs/report/2021-employer-
| health...
| CodeWriter23 wrote:
| > Why is health insurance tied to employer, again?
|
| Because Democrats' plans for universal healthcare rely on
| forcing employers to pay for it.
| lvl102 wrote:
| Because that's the way US stays competitive. /s
| lkxijlewlf wrote:
| Right? I believe that practice should be banned. There's really
| NO reason for it now.
| briffle wrote:
| Or at least made optional.
|
| Do you want our health insurance plan, or an extra
| $1500/month to find your own on the open market would be an
| interesting way of looking at it.
|
| But either way, both your employer and your cost for health
| insurance should show up on everyone's pay statements. Most
| have no idea what their employer pays for insurance.
| 0xbadcafebee wrote:
| Twitter is not a blogging platform and makes for bad HN stories.
| You don't get the full picture or context and they aren't updated
| later.
|
| https://slashdot.org/story/21/11/11/1634237/intuit-slashes-p...
|
| https://www.businessinsider.com/mailchimp-employees-shocked-...
| Animats wrote:
| What do you expect from a company whose business is spamming?
| floatinglotus wrote:
| There is no depth to shoddy crappy business practices at Intuit.
| Seriously, this is an evil company.
| cudgy wrote:
| Yet another reason for medical care to have nothing to do with
| your employer ... thank Obama for sealing that deal with the ACA
| / Big Insurance Company Handout. Good luck severing the
| connection.
| anonymousisme wrote:
| Agree. Creating corporate sovereignty for insurance companies
| just re-enforces government interference in a free economy. As
| a result of the interference, health providers have
| continuously raised their prices far beyond what anybody would
| pay in a free market. If nobody had insurance, what do you
| suppose would happen to health care costs? Answer: They would
| adjust to what the market will bear.
| ihumanable wrote:
| Someone about to die from a medical episode will bear a
| surprising amount to not die.
| lotsofpulp wrote:
| If you researched the negotiations that led to the ACA, you
| would see that the public option was favored by Obama, but had
| to be nixed to get a few holdout senators on board. You can
| thank the Obama admin for at least getting rid of pre existing
| conditions clauses and for out of pocket maximums, which was
| more progress that anyone has made before or after.
| tgsovlerkhgsel wrote:
| The worse a company treats its employees, the less loyal they
| will be, and the more likely it is that one of them decides to
| earn money by abusing their insider access, either out of greed
| or despair.
|
| Like when someone at Mailchimp sold out the users of various
| Mailchimp customers to criminals
| (https://twitter.com/Trezor/status/1510558771944333312).
| nine_zeros wrote:
| Why can't health insurance be like car insurance again?
|
| Why can't individuals negotiate premiums?
|
| Why can't individuals switch to another insurance provider at any
| time?
|
| Why can't insurance providers cover 100% over anything prescribed
| by medical practioners?
|
| Seriously, why does any medical treatment in America have to be
| so opaque and stressful? We are regressing as a society if life
| is not becoming easier.
| TheMagicHorsey wrote:
| I don't know ... this guy seems to have no knowledge of how
| complicated transferring employee benefits between organizations
| is. Its not so simple as just hitting a switch. The whole system
| conspires to fuck over individuals and small companies. Its
| nearly impossible to smoothly transition benefits during an
| acquisitions unless you get things exactly right ... or the
| acquirer is someone like Google that has an endless pool of money
| and just throws money at the problem to avoid a PR issue.
|
| As for this guy complaining about his acquisition bonus. Why
| didn't he negotiate for stock when he was hired? I have always
| negotiated for a lower salary and more stock, as I wish for the
| lottery ticket and potential upside. If he wanted to trade off
| cash for stock, he could have done that. And it that was not on
| offer at Mailchimp then why didn't he go work somewhere else?
| Seems like they had some inducement, right? Or did he not
| understand the terms of his employment.
|
| People are so TERRORIZED by the fact that they are only paid the
| amount they negotiated in their employment contract. YES,
| capitalism sucks if you just naively enter into employment
| without understanding what the compensation entails.
|
| What would you like instead? Employment at a Public Sector Unit?
| I can assure you PSUs suck BAD for engineers. My father and
| uncles worked at PSUs before immigrating to the US and improving
| their fortunes 20X to 50X (no exaggeration).
| ezrast wrote:
| If employees shouldn't complain about not receiving benefits
| they didn't negotiate for, surely they should get to complain
| about not receiving benefits they did negotiate for. Knowing
| anything about benefits administration is not the employee's
| job and it being "complicated" is not remotely their problem.
| If the terms of MailChimp's acquisition were incompatible with
| the terms of its employment agreements, then it shouldn't have
| agreed to the acquisition. Or it could make an honest attempt
| at recompense such as through bonuses. But they don't get to
| both eat and have their cake.
| phonon wrote:
| > Why didn't he negotiate for stock when he was hired?
|
| Mailchimp didn't offer stock options, only yearly profit
| sharing. They claimed they were never going to sell the
| company.
|
| https://www.moneycontrol.com/news/business/why-intuits-12-bi...
| cwkoss wrote:
| Mailchimp workers should go on strike until their healthcare
| coverage is properly functioning
| inopinatus wrote:
| One might equally suggest that all American workers should go
| on strike until their healthcare system is properly
| functioning.
| [deleted]
| adapteva wrote:
| Family plan health insurance premiums on open market is $33K/year
| in New England (US). With group plans that goes down to
| $28K/year. A full time employee at $15/hr is $30k/year. The US
| healthcare system is fundamentally broken...
| oofabz wrote:
| I wish employers did not provide health insurance, even though I
| have a chronic medical condition. The choices of plans offered by
| companies is far, far smaller than the choices available to me on
| the open market. I don't want to have to find new health
| insurance if my employment situation changes, possibly leaving me
| with a gap in coverage. The expectation that employer-provided
| benefits are at no cost to the employee is a fallacy - if
| companies did not offer health care as a perk, they would be able
| to offer higher salaries instead.
|
| The only reason American employers are in the business of
| offering health insurance is because they get a federal tax
| break. This makes health insurance cheaper to the employer than
| to individuals. Given this, if my employer stopped offering
| insurance, they couldn't increase my salary enough for me to
| purchase the same plan myself. I think this is unfair - I would
| like to get the same tax break myself, or at least eliminate the
| tax break altogether so I am on an even playing field with
| businesses. This would allow me to purchase my own health
| insurance at rates comparable to what I'm offered at work.
|
| Considering the tax situation, it's curious that Intuit would not
| choose to take this tax break. It seems like a short term move
| that allows them to cut costs while exploiting the economic
| stickiness of employment. This move makes them less competitive
| for employees in the labor market, but that only affects them in
| the long term. In the short term, the employees they have will be
| hesistant and slow to find new jobs.
| jackconsidine wrote:
| I was under the impression (from being on the public market and
| later self-employed, company subsidized insurance which is
| altogether cheaper and better) that companies have pooling
| power which allows them to cut deals with insurers. Is that not
| the case?
| [deleted]
| candiddevmike wrote:
| There are two kinds of costs with health insurance for
| companies. The funding to pay claims and the administration
| of said funding to pay claims. The administration part is the
| money maker, and while ACA attempted to curtail what they can
| charge for this/profit from it, they do creative things like
| "outsource" IT or HR to a separate company (with the
| executives as ovepaid board members). It's kind of like tax
| evasion only instead of taxes it's reducing your premiums.
| lotsofpulp wrote:
| > they do creative things like "outsource" IT or HR to a
| separate company (with the executives as ovepaid board
| members)
|
| Source?
|
| I am seeing 10-K reports showing UHC, Anthem, CVS, Cigna,
| Humana, Molina, Centene, etc all with profit margins ~5% or
| less.
|
| Is the claim that executives at one or more of these
| companies is attempting to bypass ACA regulations (and
| violating fiduciary duties to their own employer) by
| overpaying for services to outside entities that the
| aforementioned executives control?
|
| Seems like a grand conspiracy theory.
| chevman wrote:
| Check out the VC arms of all these insurers. Lot of
| capital they got! :)
| candiddevmike wrote:
| It's real. You won't see this on the 10-K, you need to
| look at the 990s (which tend to be hard to find). Here's
| Blue Cross Blue Shield Association from 2017: https://pro
| jects.propublica.org/nonprofits/organizations/135...,
| under part 7, independent contractors, you see "HEALTH
| INTELLIGENCE CO LLC". This is Blue Health Intelligence
| (as in Blue Cross Blue Shield Intelligence):
| https://bluehealthintelligence.com/. Their board is made
| up of a bunch of blue cross execs.
|
| They spent 20+ million with this company, how much do you
| think the execs on the board get paid? No one knows
| because they're private/for profit and don't have to
| publish annoying things like a 990.
| lotsofpulp wrote:
| BCBS does not sell health insurance though. The companies
| I listed are health insurance companies, which would be
| subject to the ACA.
| tyingq wrote:
| Many large companies also self-insure to pay claims, and only
| pay the insurance company to administrate the plan. That
| makes the effective cost much lower (well, in relative terms
| anyway...health insurance in the US is broken.)
| inportb wrote:
| > I would like to get the same tax break myself, or at least
| eliminate the tax break altogether so I am on an even playing
| field with businesses. This would allow me to purchase my own
| health insurance at rates comparable to what I'm offered at
| work.
|
| Maybe not. Businesses have more negotiating power because
| they're bigger buyers, so they would still have access to more
| competitive rates. Unless you got together with a _lot_ of
| people to negotiate together (and this might be a startup
| opportunity).
| lowercased wrote:
| > The only reason American employers are in the business of
| offering health insurance is because they get a federal tax
| break
|
| The cost of paying me is also tax deductible, so they get a
| 'tax break' by paying me more money.
|
| > This makes health insurance cheaper to the employer than to
| individuals.
|
| I don't think that's the root. Large insurance companies seem
| to want to sell to larger companies - groups of people - vs
| selling insurance to individuals. Selling to a group is where
| it seems some price reduction happens. And... by and larger, if
| you're selling insurance to people _who are already healthy
| enough to be working regularly /fulltime_, your costs for
| insuring that 'pool' will be somewhat cheaper than the costs of
| insuring any random individual.
|
| > they couldn't increase my salary enough for me to purchase
| the same plan myself
|
| If the cost of my health insurance was deductible from my
| individual taxes, then the entire market would be turned upside
| down. There are certain thresholds that need to be met re MAGI
| (IIRC) before health insurance insurance premiums are
| deductible by individuals. I'm "self employed" so the entirety
| of my premiums are tax deductible, but for the average person
| working a W2 job someplace that doesn't provide health
| insurance for them, it's not a deductible expense, which is a
| total sham.
| bombcar wrote:
| It's a tax break for the employee and hence for the employer
| - they can spend $X on insurance and give the employee $x+tax
| rate in benefits.
|
| What should be done is entirely decouple it so that health
| insurance AND medical expenses are above the line deductible
| - or make none of it such. And then let employees pick
| whatever they want.
| bushbaba wrote:
| Better yet. The government should require all health prices be
| published online, with the same rate charged to all patients
| regardless of insurance provider.
|
| Make this similar to gym membership. Let each person decide
| where to go based on cost and needs. With insurance remaining
| their for catastrophic events only.
| heavyset_go wrote:
| People don't decide to have heart attacks or get hit by cars
| outside of a hospital that's in their network. Surviving
| heart attacks can cost half a million to over a million
| dollars if care was received out of network. Disability can
| easily costs millions over a lifetime, too. Price
| transparency won't suddenly make that affordable.
| troupe wrote:
| It is not just the tax break that makes it cheaper for
| corporations to buy insurance. Companies with a lot of
| employees pay a lot less than individuals because they pool the
| risk. Back before ACA you used to be able to get in a pool
| with, for example, other small business owners and pay an
| amount similar to what companies pay but as an individual. ACA
| made those plans illegal and insurance that used to cost $500
| per month jumped to $1800.
| matwood wrote:
| I wasn't aware the ACA made pooling illegal. Awhile back I
| tried to form a group with small tech companies in my town to
| do this, but the insurance companies all wanted a larger
| anchor company. None of the bigger tech companies in town
| wanted to participate b/c they saw their benefits as a
| competitive advantage. This was post ACA, and I don't
| remember anyone mentioning legality.
|
| Small companies get crushed by insurance. Giving employees
| extra money in their check and telling them to use it on the
| ACA is probably most effective for all parties at the moment.
| businesscasual wrote:
| But why do you have to think about this at all? Wouldn't it
| just be easier that this was provided by the state, so that all
| citizens could afford getting necessary health care. At the
| same time it would relive you of having to compare coverage,
| copays, deductibles or in general understand the full fine
| print of your insurance agreements. Most comparable industrial
| countries have found a pretty decent solution to this where you
| move the financial burden of many basic services (health care,
| schooling, etc.) from the public, over to the government -
| allowing all citizens to benefit from these, without having to
| wonder if the can afford it.
| morpheuskafka wrote:
| > The choices of plans offered by companies is far, far smaller
| than the choices available to me on the open market.
|
| Maybe I wasn't searching correctly, but I was recently
| discussing healthcare and taxes with someone and briefly
| searched on the Healthcare.gov exchange to look at prices.
| There were only three PPO plans (where you can freely go to any
| doctor in network), and all three were HDHPs, all from the same
| company. There were many HMO plans, some HDHP and others with
| low deductibles, but often extremely small local networks and
| limited choice of both PCPs and specialists.
|
| > This makes health insurance cheaper to the employer than to
| individuals.
|
| One other thing to note in your analysis is that most large
| employers are not buying any insurance, but actually self-
| insuring (funding the claims out of their own pool of money).
| So the employers are actually acting as insurance companies for
| their workers, rather than simply buying and reselling
| commercial insurance.
|
| There would be additional considerations beyond taxes in
| analyzing whether this type of insurance is more economically
| optimal, for example, the fact that each company has a distinct
| risk pool which may not be similar to the general population,
| depending on the company.
| DamnYuppie wrote:
| What plans are available to you will depend on which state
| you are in.
| heavyset_go wrote:
| This was my experience, as well, with the individual market.
| It is virtually impossible to replicate an employer-provided
| plan at all with market plans. You, as an individual, do not
| have the leverage to buy what most would consider good health
| insurance plans on your own.
| Rebelgecko wrote:
| Are you in a state that has pushed back against ACA? Or maybe
| you're only looking at the "bronze" tier, which will be
| skewed towards low cost HMOs and HDHPs?
|
| FWIW, in California I see like 5 different options for HMO
| across all of the tiers, a couple are local ones I've never
| heard of, but there's also some like Kaiser that are fairly
| large networks.
| heavyset_go wrote:
| I'm in a state that championed the ACA, and there are
| dozens of plans available on the individual market, but
| none of them are very good. There are plans from large
| insurers for large networks, but those plans are much worse
| than any group policy plans employers can buy from the same
| exact insurers. And it gets even worse if you want to buy a
| market plan that covers your family.
| morpheuskafka wrote:
| This is for Orange County, NC, which has not expanded
| Medicaid but is using the regular federal ACA marketplace.
| There are definitely a lot of low cost/quality HMOs at the
| Bronze level, but across all tiers there are 63 HMOs, 3
| PPOs, and 10 Point of Service (POS), a term I hadn't heard
| previously.
|
| For comparison, I am on my mom's insurance from Belk Stores
| which is self-insured, offering three different HDHP PPO
| plans with a pretty good network and a range of deductibles
| within the HDHP window. Premiums are pretty bad. My dad
| worked for a SP500 semiconductor company before retiring,
| about five years ago they switched to HDHP-only, which just
| two options both at the higher end of the HDHP range.
| Premiums were better, but actual coverage not much better.
| forty wrote:
| I don't know the US system at all, but here in France employee
| health insurance ("mutuelle") are mandatory. The main benefit
| is that the cost is the same for all employees, no matter their
| health condition, age, etc. Basically it's a solidarity thing
| which allows everyone in the company to be covered well for a
| reasonable price.
| mediaman wrote:
| Is health insurance not provided by the state in France? I
| thought employer-provided health insurance was just was an
| odd Americanism.
| yurishimo wrote:
| There are a number of other western countries that have
| private healthcare systems. The difference between their
| and ours is tight regulation and cost controls, often
| combined with a robust public option for the unemployed to
| fall back on.
| forty wrote:
| I should add that in France, you can keep your employer
| health insurance _for free_ for one full year, in many
| cases when you lose your job which limit the risk of a
| "hole" in the health coverage.
| forty wrote:
| There is a "baseline" provided by the state, and the
| employer health insurance adds extra coverage.
| giaour wrote:
| France has private supplementary insurance programs in
| addition to the state run health insurance program.
|
| A good corollary in the US is Medicare: everybody over 65
| can enroll in Medicare Part A for free, but you can also
| choose Part B, Part D, and "medigap" coverage, each of
| which is optional and has a monthly premium.
| chromaton wrote:
| Depends. If your employer doesn't offer health insurance, you
| can shop for plans on the government health insurance
| marketplace. These plans can have substantial subsidies.
| heavyset_go wrote:
| > _These plans can have substantial subsidies._
|
| ACA subsidies disappear once you make $50k or more a year.
| Spooky23 wrote:
| Never underestimate the evil of HR. It's a way to offload
| headcount without a layoff.
|
| They probably agreed to not layoff Mailchimp employees in the
| sale, so they make them quit. Purging the sick, tbe pregnant,
| etc from the company is a way to cut costs, and doing so
| through some elaborate bureaucratic fuckup avoids government
| intervention.
| bb88 wrote:
| If corporations are dictatorships, HR is the intelligence
| agency working against the population.
| heavyset_go wrote:
| > _if companies did not offer health care as a perk, they would
| be able to offer higher salaries instead._
|
| Prices, including labor prices, are not determined by costs.
| There is no indication at all that companies would compensate
| employees more if they didn't have to pay for their health
| insurance. What is most likely to happen is that companies will
| pocket the difference, in the same way they've been pocketing
| the difference from increased productivity while letting wages
| become stagnant.
| nitwit005 wrote:
| You're worrying overmuch about "the market". The US health
| care system is pretend free market. The government is paying
| for much of US health costs, and regulating various aspects
| of it.
|
| What really matters is how the government policies would
| change when it's moved from employers to people. The
| government is likely to pay the costs for low income people,
| which will also mean their wages are likely not to rise.
| JamesBarney wrote:
| This argument relies on a really weird assumption that
| companies aren't already compensating employees as little as
| they can get away with. That companies could compensate
| employees less by not offering benefits but choose not to out
| of the goodness of their heart.
|
| If employers are already compensating employees as little as
| they can get away with then if they stopped compensating via
| insurance, they'd be required to compensate via salary.
| bb88 wrote:
| Labor price is salary + benefit packages. Reducing the cost
| of benefits from the equation would mean the company has
| extra resources.
|
| The company could:
|
| * immediately raise people's salaries
|
| * or hire in more people (which increases demand)
|
| * they could take the extra profit and distribute that to
| shareholders
|
| * or drop the price of their products and services and pass
| the savings on to the customer
|
| * or they could make capital investments.
|
| In most cases, I would expect salary prices to increase for
| labor (even if not immediately) or make people's current
| salaries more effective in purchasing power.
| AceJohnny2 wrote:
| Most of what you've described is "trickle-down economics",
| and, well...
|
| Also, you forgot the popular option:
|
| * give (bigger) bonuses to their execs
| JamesBarney wrote:
| If corporations could stop offering health insurance in
| order to increase profits, why don't they do it?
| heavyset_go wrote:
| They're legally required to offer health insurance plans
| for full-time employees.
| bb88 wrote:
| I'm not disagreeing, but this is the way corporations
| work in 2022.
| bduerst wrote:
| Health insurance is a budgeted overhead variable cost
| assigned to employee expenses. It's true that should HI
| disappear, not all of the HI cost will be transferred to
| employee salaries, but it's definitely a non-zero amount.
| munk-a wrote:
| And, I think, over time we'd see more and more of that HI
| cost be transferred to employee salaries. Supply and demand
| is often taught in classes as "If this bar shifts here the
| economically efficient price point shifts over to here" -
| the portion that ends up frequently omitted is that that
| shift takes time. It's why some taxes are leveraged on
| employers and some on employees - in the end the net result
| is the same, but we can end up enjoying decades of
| beneficial inefficiencies while the market works to respond
| to the shift.
| zaroth wrote:
| Budgets are set by costs. When you run a business, you care
| about the "fully burdened" cost of each employee, and you
| hire as many as you can within your budget. One of the line
| items in that is my half of the payroll tax. Another line
| item is health insurance. Another may be an offset for office
| space and equipment.
|
| Whether my fully burdened cost budget has a line item for
| health insurance being paid to a 3rd party or to the employee
| is totally irrelevant. Tax law currently happens to make it
| much more efficient for me to pay that money to a 3rd party,
| so that's where it goes.
|
| The reason I have that line item is due to a combination of
| market forces and regulation. By no means do I get to choose
| just not to pay it, if I expect employees to keep working for
| me, or the government not to shut me down.
| aYsY4dDQ2NrcNzA wrote:
| > When you run a business [...] you hire as many as you can
| within your budget.
|
| It sounds like you're saying that employers are always
| trying to hire as many people as possible.
|
| Which would be nonsense, of course.
| chrisseaton wrote:
| > and you hire as many as you can within your budget
|
| If you believe this then what's your explanation for why
| Google hires a smaller number of expensive engineers,
| rather than a larger number of cheaper engineers? They
| could hire 10x if they went for only lower-tier college
| new-grads!
| jwilber wrote:
| Yes. As someone with a chronic health condition living in
| America, I agree completely.
|
| Leaders of this country really do not care about the
| healthcare of its citizens (just look how long people with
| diabetes have been screwed, how long people have been able to
| lose literally everything over medical debt, etc.), I can't
| imagine leaving things to the individual would be helpful in
| any manner whatsoever.
| mywittyname wrote:
| They probably would. I've had a lot of jobs that heavily
| emphasize how much is paid for benefits, and often it's used
| as justification for why raises weren't offered that year.
| These places would probably be happy to give everyone a raise
| and do away with the frustration with medical benefits,
| especially plans whose cost go up like 20% a year.
|
| There are a lot of jobs which do not offer benefits, or
| benefits are offered with no part paid by the employer. These
| places would not offer raises, but these people would end up
| with better choices of private plans.
|
| Benefits are a huge burden for companies, especially smaller
| ones. Coordinating benefits is a seasonal full-time job that
| someone has to do. I've known of a few smaller family
| businesses that gave everyone a raise, and told them to get
| their own health care coverage on healthcare.gov.
| heavyset_go wrote:
| > _They probably would. I 've had a lot of jobs that
| heavily emphasize how much is paid for benefits, and often
| it's used as justification for why raises weren't offered
| that year._
|
| Sounds like an excuse to me, and if they're this bitter
| about paying for benefits, something tells me they'd be
| just as bitter towards giving substantial raises across the
| board for, essentially, no reason.
| mywittyname wrote:
| It's not out of bitterness. People don't necessarily
| realize that benefits are as expensive as they are, or
| that they had been increasing in cost so dramatically.
| It's more like, "sorry we aren't giving raises this year,
| but we are covering an added $400/mo in insurance costs
| for everyone."
| lowercased wrote:
| A few years ago I sat in with a client on an 'employee
| meeting' where they discussed raises/insurance. No one
| had ANY clue what health insurance premiums were. The
| owner asked people what they thought it was per month.
| "$75? $99?" They went around the room. I said "$600". The
| whole room looked at me like I was nuts. The owner said
| "$560". Audible gasps around the room. People had
| literally no idea how much this stuff costs (this was...
| 5 years ago, IIRC).
| munk-a wrote:
| I mean - that sucks and all... but cost of living is
| constantly going up. If a company can't afford to
| continue operating with the costs of wages that company
| should shutter its doors - that's brutal but it's also
| how markets are supposed to respond.
|
| In Australia minimum wage laws means that Starbucks
| locations rarely have more than two people on staff -
| that's just economic forces causing a rational business
| response.
| brightball wrote:
| Comments like this give the impression that there's an
| assumption that business owners are all just swimming in
| money and not one or two bad months away from bankruptcy.
| Most businesses do not survive more than 5 years for a
| reason.
| mbostleman wrote:
| Companies would "pocket" the difference? What pocket would
| that be exactly? Companies are in competition. While company
| A, might "pocket" the savings, company B will use it to their
| advantage in potentially any number of ways - paying
| employees more, reducing prices to customers, investing in
| new equipment. You refer to the 8 million companies in the US
| as if they're one entity that conspires in lockstep. That's
| not how it works.
| heavyset_go wrote:
| This would suggest that things like this[1] could never
| happen because of competition, but they have.
|
| [1] https://en.wikipedia.org/wiki/High-
| Tech_Employee_Antitrust_L...
| mbostleman wrote:
| Collusion is the antithesis of competition. And it's
| illegal, hence the litigation. I am referring to the
| behavior of a free market, not an illegally fixed one.
| usefulcat wrote:
| Imagine a scenario where overnight, all US companies stop
| offering health insurance. In this scenario, all those
| employees who used to have health care would now have to pay
| for it themselves (or do without it). So they're all going to
| be expecting an immediate raise to compensate for this
| increased expense, and if not they'll almost certainly be
| looking for a new job that pays a lot more (after all, it's
| not like they need their old job for the insurance any
| more..)
|
| If you're a company, unless you were already planning to do
| some mass layoffs, you're going to give most of them that
| raise because the alternative is having a bunch of people
| quit. And if you don't increase your offers for new hires,
| you probably won't be hiring anyone either.
| lowercased wrote:
| Perhaps insurance companies would have to start competing
| for the business of individuals and families, and...
| perhaps that competition should drive down the price some,
| so they could get our business? (ha ha ha, of course, not
| going to happen).
| KerrAvon wrote:
| The catalyst for that scenario is likely some form of
| effective universal healthcare, which you will pay for
| indirectly via taxes.
| axlee wrote:
| It will have to be paid for, as is everything, but it
| will cost much less both in aggregate and at a personal
| level. Source: any other country.
| tiahura wrote:
| _Prices, including labor prices, are not determined by
| costs._
|
| That's very much not the case for 99.9% of goods and
| services.
|
| Prices for labor, i.e. wages, are set by the demand for
| labor, and workers' opportunity costs.
| [deleted]
| kukx wrote:
| The companies compete for workers, especially highly skilled
| ones. One company rising wages would push others to react in
| a similar way assuming they compete for the same talent.
| munk-a wrote:
| _Somewhat_ and I think highly skilled workers actually
| "suffer" from the worst relative compensation. Most
| legitimate 10x-ish developers don't make 10x what their
| coworkers are making, they end up producing significantly
| more value for the company then they're costing with the
| excess value going to profits and subsidizing other
| employees.
|
| I personally think a model like this is pretty fair, if
| somebody is making 50k a year then pulling in 1M annual is
| pretty silly - but it makes sense to account for that
| difference with taxation rather than the arbitrary choices
| of private employers.
| heavyset_go wrote:
| And yet wages for highly skilled workers haven't kept up
| with productivity increases, cost of living increases and
| inflation in many parts of the country, including areas
| like SF or NYC where you find some of the highest paid
| workers.
| bb88 wrote:
| Productivity increases create less demand for labor, so
| you would expect the demand for labor to drop. If two
| workers now can do the job of four people five years ago,
| it doesn't mean the two workers get paid double.
| photochemsyn wrote:
| Not so sure about that. Anti-poaching agreements are
| supposed to be illegal but I imagine this kind of thing
| continues today in secret:
|
| https://www.cnet.com/tech/tech-industry/apple-google-
| others-...
| deelowe wrote:
| I think they would, at least in the short term. Most
| companies already include benefits their offer package.
| maxerickson wrote:
| That's fine, the idea isn't to get rid of employer provided
| healthcare to make salaries go up, the idea is to get rid of
| employer provided healthcare because of the problems that
| come with it.
| jdavis703 wrote:
| > The employees Business Insider spoke with said they would be
| covered retroactively only once the paperwork was finalized,
| which left them on the hook to pay upfront fees.
|
| This seems like people are over reacting here. Almost all medical
| offices are happy to work with patients if the situation is
| explained before hand. Heck, my HMO has printed signs at every
| intake counter reading "Can't pay? Call this number to discuss
| payment options."
| ericbarrett wrote:
| Tweet is dated November 2021.
| [deleted]
| duxup wrote:
| > until their health insurance retroactively becomes available
|
| I feel like the title is missing that bit.
|
| Doesn't make it ok, but the situation is dramatically different
| with even the limitations of a single tweet compared to the
| title.
| brimble wrote:
| It's still asking employees to float their enormous mega-corp
| employer potentially thousands of dollars (each) in short-term
| loans.
| nightski wrote:
| It's more like floating the insurance company. The employer
| would never directly pay these things.
| luu wrote:
| If you can suggest an edit that will fit within HN's title
| length limit that conveys the sentiment of the entire tweet,
| please feel free to do so. Appending enough of the missing text
| to convey anything useful violates the limit, but maybe the
| title could be compressed in another way.
|
| I don't think I can edit the title anymore, but one of the mods
| can edit it.
| tgsovlerkhgsel wrote:
| s/pay medical costs out of pocket/front medical costs/
|
| Shorter and as I understand it more correct.
| obi1kenobi wrote:
| Interesting detail I wasn't familiar with, and very unfortunate.
| I know I wouldn't have been happy to be put in that situation :(
|
| It was published on Nov 11, 2021 so perhaps consider a (2021) tag
| in the submission title?
| endisneigh wrote:
| What I don't get is why can't someone, say, one of us, pool
| together our own insurance that exists outside the employer?
| sc68cal wrote:
| That exists, it's a plan called medicare for all.
| dangrossman wrote:
| Insurance does exist outside the employer. I've been self-
| employed all my life, so I've been purchasing my own insurance
| without an employer for about 20 years. I used to go directly
| to a company like Aetna or Blue Shield to buy my coverage, now
| I go to healthcare.gov once a year to pick a plan.
| andrewxdiamond wrote:
| The gap here is that employer paid plans are subsidized by
| the employer, who uses them as a tax write off, making un-
| subsidized plans much more expensive in comparison
| ejb999 wrote:
| >>employer paid plans are subsidized by the employer, who
| uses them as a tax write off,
|
| Calling them a 'tax write-off' makes it sound like
| something sinister is going on - just about everything a
| business pays to run their business is deductible, and thus
| a 'tax write-off'.
|
| Do we call buying paper for the xerox machine a 'tax write-
| off' and thats the only reason business buy paper?
|
| Its a cost of doing business - just like rent, payroll,
| heat, electricity etc - there is no special 'write-off' for
| providing health insurance for a typical company.
| dangrossman wrote:
| Mentioning that they're a tax write-off goes towards
| explaining why employer-subsidized plans can be cheaper
| than purchasing your own plan: the employer is buying it
| with pre-tax dollars, where an employee can only buy that
| plan with post-tax dollars.
| dangrossman wrote:
| True. If you're self-employed, your health insurance
| premiums are personally tax deductible. If you're not and
| you make up to 400% of the federal poverty level, the
| government subsidizes marketplace plans for you similar to
| an employer. It's not just the self-employed that buy their
| own insurance, but all the millions of hourly employees
| that aren't offered healthcare benefits through their
| employer(s) either.
| endisneigh wrote:
| I have no tax knowledge at all, but if you were to create a
| pass through corporation who purchased the health insurance
| on the behalf of its members, could you deduct said fees
| and then pass the savings onto the members the following
| years?
|
| I guess the overhead of setting up such an organization
| plus the fact that said corporation wouldn't actually have
| any revenue are big issues.
| lotsofpulp wrote:
| You do not have to do all that, simply being self
| employed is enough. The people getting screwed are those
| employed by employers that do not offer subsidized health
| insurance. They simply have to pay for health insurance
| with post tax dollars.
| mywittyname wrote:
| Individuals may qualify for a subsidized plan purchased
| through healthcare.gov.
| Dove wrote:
| You can! When you do that, you essentially get a "Health Share"
| organization, wherein you pay cash for health care and they
| reimburse you. Google the term to see which ones are out there.
| They are typically much, much, much cheaper than traditional
| insurance.
|
| The biggest drawbacks to such an approach are that you have to
| deal with the quirks and rules of your organization -- read the
| terms carefully -- and that you have to deal with the paperwork
| from the medical system yourself. That doesn't sound so awful
| until you experience it. You can find reasonable primary care
| as a cash patient -- direct primary care is everywhere now, and
| almost certainly what you want: a monthly payment for someone
| on call to deal with your issues. Urgent care is generally
| reasonable, too, being an up front single bill at a fixed price
| per type of issue. But Lord have mercy on you if you need to
| visit a hospital. The paperwork is _stunning_. A couple years
| ago, I went in for some observation and antibiotics for a
| couple of days, and came out with a dozen bills, all of which
| have to be called on, paid, negotiated, and some of which are
| possibly fake.
| ihumanable wrote:
| And because they aren't regulated, they can just decide not
| to provide any coverage at all.
|
| John Oliver covered Health Care Sharing Ministries (often
| called Health Shares or HCSMs) a while ago
| https://www.youtube.com/watch?v=oFetFqrVBNc
| oneepic wrote:
| So what? Can't you just pay at the time of the visit and then
| file a claim? Your insurance should become retroactively
| available.
| TheCoelacanth wrote:
| That works if you have thousands of dollars available to cover
| the bills until you get reimbursed.
| kenjackson wrote:
| But, at least for the hospitals and doctor's I work with,
| they all have zero interest payment plans. It is extra work
| to deal with, but drastically reduces the cash outlay.
| woobar wrote:
| Usually the first bill arrives 30+ days after the service.
| And by the time you get final notice to pay it will be 6-12
| mos after the first bill. Not defending Intuit or MC here,
| but this situation is not exactly as it is painted in that
| Tweet.
|
| Considering there were no more publicity about this since
| tweet date (November 2021), it wasn't a big deal.
| kube-system wrote:
| It is not uncommon for paperwork to be delayed when switching
| insurers. I've had it happen at previous employers. The
| normal course of action in this circumstance is that you pay
| the bill after your insurance paperwork is sorted out.
|
| If you go to the hospital and didn't know that your insurance
| expired, you probably won't even see a bill for a month,
| after the hospital gets the denied claim from your previous
| insurer. At which point, you'll give them the updated
| information, and they'll file the claim with the new insurer.
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