Intuit asked Mailchimp employees to pay medical costs out of pocket

https://twitter.com/dvsch/status/1458813237651247109

by luu • 4 years ago

381 346 4 years ago

Tweet is dated November 2021.

obi1kenobi• 4 years ago

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?

PaywallBuster• 4 years ago

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• 4 years ago

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.

imglorp• 4 years ago

Why is health insurance tied to employer, again? Is there a reason that should continue?

fennecfoxen4• 4 years ago

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.

zamalek• 4 years ago

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.

RC_ITR• 4 years ago

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)"

bogomipz2• 4 years ago

"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?

lettergram• 4 years ago

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.

alex_young• 4 years ago

A bunch of rare events would bankrupt anyone who encounters them?

munk-a12• 4 years ago

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.

dmitriid• 4 years ago

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.

_moof• 4 years ago

The federal health insurance mandated in the US was repealed as of 2019. You may still be subject to a state mandate though.

bogomipz2• 4 years ago

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.

smsm422• 4 years ago

If you made it illegal, people would start creating risk pools in ways that are technically legal. Such as membership clinics, special-purpose clubs, etc.

grecy• 4 years ago

Why is health insurance legal?

Why have health insurance at all? It's just a middle-man for profit scheme between patient and health care.

Just have mandated health CARE for all and do away with health insurance altogether. Lots of companies would lose billions, but average people on the street would be the ones not spending that money.

notch656a9• 4 years ago

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.

etchalon2• 4 years ago

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.

munk-a12• 4 years ago

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.

maxerickson3• 4 years ago

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...

croutonwagon2• 4 years ago

Most companies (and employees) consider this part of the compensation package.

In most cases there is not an avenue to recover any lost compensation if you opt out of health insurance. If an employer offered a higher base pay for those not on their insurance plan, you probably WOULD see a much higher rate of those securing their own plans in the open market.

lvl102• 4 years ago

Because that’s the way US stays competitive. /s

lkxijlewlf• 4 years ago

Right? I believe that practice should be banned. There's really NO reason for it now.

briffle• 4 years ago

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.

pessimizer2• 4 years ago

Unions started offering it, so employers were granted a tax break to provide it instead in order to weaken the unions.

Domenic_S• 4 years ago

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...)

candiddevmike3• 4 years ago

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.

mrtranscendence4• 4 years ago

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.

auxym• 4 years ago

Good NPR Throughline episode on the subject: https://www.npr.org/2020/09/28/917747287/the-everlasting-pro...

CodeWriter23• 4 years ago

Why is health insurance tied to employer, again?

Because Democrats’ plans for universal healthcare rely on forcing employers to pay for it.

ryanSrich• 4 years ago

I’m not sure of the underlying reasons, but I know most employers make it slightly cheap enough to be more affordable than Obamacare. But it’s still insanely expensive (ex: I pay $1920/m + $22k deductible for a family of four).

pyuser5835• 4 years ago

Yes. If I recall, it goes back to the Great Depression when there were cash shortages (and other issues).

It incentivized employers to compensate with benefits, not cash.

Around the same time, unionization became much more popular, and with it negotiated compensation (more benefits).

These were big issues in the North. In the South, the economy has was still largely rural, and many states provided publicly funded hospitals - so the dynamics were different.

There was a move for employers in to provide health insurance pre Great Depression. That was because larger employers could use their size to negotiate deals with hospitals. So health coverage was worth $individualPrice to an employer, but $negotiatedPrice to the employer.

In general, insurance providers preferred going through employers because employed people are healthier and file fewer claims.

Geico was an acronym for “Government Employees Insurance Corporation” which was a thing because government employees were a pretty safe bunch to insure.

So even back then, many of the dynamics we see now existed: negotiated prices, grouping, etc.

andrei_says_• 4 years ago

Ultimately because it drives down the cost of labor by locking employees in.

Employer’s cost per employee is much much lower than an employee’s cost directly from insurer. The employer “sells” the benefit to the employee at a higher perceived cost because of this.

Without an employer’s discount, an employee simply cannot get the same insurance coverage.

Thus, the employee agrees to working pay and conditions which would not be agreeable without the pressure to get health coverage.

Hence, lower cost of labor to the employer and pressure to keep the current structure in place.

oofabz• 4 years ago

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.

forty3• 4 years ago

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• 4 years ago

Is health insurance not provided by the state in France? I thought employer-provided health insurance was just was an odd Americanism.

pnutjam• 4 years ago

Last US company I worked for, before the current one, instituted tiered policy costs. I made more, so I paid more for identical coverage. I thought it was good. They had pretty decent insurance.

chromaton• 4 years ago

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_go13• 4 years ago

These plans can have substantial subsidies.

ACA subsidies disappear once you make $50k or more a year.

heavyset_go13• 4 years ago

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.

zaroth3• 4 years ago

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.

jwilber• 4 years ago

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.

mywittyname3• 4 years ago

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.

kukx• 4 years ago

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.

bduerst5• 4 years ago

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.

tiahura• 4 years ago

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.

usefulcat• 4 years ago

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.

maxerickson3• 4 years ago

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.

deelowe• 4 years ago

I think they would, at least in the short term. Most companies already include benefits their offer package.

bb886• 4 years ago

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.

mbostleman2• 4 years ago

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.

nitwit005• 4 years ago

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.

JamesBarney3• 4 years ago

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.

closeparen• 4 years ago

Companies are paying the increase in productivity to the professional-managerial employees who are actually more productive because of technology, scale, etc. and not to the masses whose productivity is the same as ever.

Even when we talk about redistributing this increase, we mostly talk about redistributing it from the professional-managerial employees, who populate the higher personal income tax brackets, not from the companies themselves (corporate tax) or their owners (wealth tax). If you are right that companies and their owners are pocketing it, then we are looking for it in the wrong places. But it seems like it really is largely going to the PMC.

WalterBright5• 4 years ago

There is no indication at all that companies would compensate employees more if they didn't have to pay for their health insurance.

Employers use a figure called "total compensation" for what it costs them to employ someone. This includes salary and the cost of all the benefits, including all the so-called "employer paid" taxes and benefits. The WSJ ran an article long ago that showed employee productivity matched total compensation, not salary compensation.

Employers certainly do care about the cost. They don't care what percentage of those costs go to employee takehome pay. But offering pre-tax health insurance means the employer can offer less total compensation.

Any economic article that talks about salary instead of total compensation is either ignorant of accounting reality or is trying to mislead.

jackconsidine• 4 years ago

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?

candiddevmike3• 4 years ago

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.

tyingq• 4 years ago

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.)

Spooky23• 4 years ago

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.

bb886• 4 years ago

If corporations are dictatorships, HR is the intelligence agency working against the population.

morpheuskafka2• 4 years ago

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• 4 years ago

What plans are available to you will depend on which state you are in.

heavyset_go13• 4 years ago

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• 4 years ago

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.

inportb• 4 years ago

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).

troupe• 4 years ago

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• 4 years ago

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.

bushbaba2• 4 years ago

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_go13• 4 years ago

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.

businesscasual3• 4 years ago

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.

macinjosh• 4 years ago

Wouldn't it be easier if we all jumped into the vat of jelly with the matrix connection jacked into the back of our necks!? We wouldn't have to eat or poop or sleep. We could just trust the powerful to make every decision for us. It would be soooo much easier.

Forgive me, but when it comes to my healthcare I want the most choice and control as I can have. I don't want to be stuck with whatever some bureaucrat decides is worth it.

Lastly, people make stupid decisions and they get hurt. They go rock climbing or skydiving, they ride their bikes on busy streets. Why should I shoulder the responsibility for people's poor life choices.

E4YomzYIN5YEBKe• 4 years ago

Food is more important than healthcare. Do you think the production, selection, and distribution of food should be decided by the state?

lowercased7• 4 years ago

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• 4 years ago

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.

flatiron• 4 years ago

Those healthy people have sick spouses and children though. That part doesn’t add up.

sterlind• 4 years ago

I am increasingly disabled, but I'm still managing to keep my job and its amazing health insurance, thank God.

Insurance this past year has paid for like, a couple dozen specialist visits, 6 MRIs, weekly rehab, a reclining desk and a power wheelchair. I maxed out my deductable in February :D

My health would be better if I could go on disability but that pays like, $1K a month and is ridiculously hard to get.

efficax• 4 years ago

They could offer higher salaries, but would they? And employers are able to negotiate better plans than you can get in the individual market. There's no way i could get the plan i have through my work for the about $12000 they spend on it.

But I agree, healthcare should be provided by the federal govt like in every other advanced nation

gamblor956• 4 years ago

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

This is wrong on so many levels.

First, employers get a tax break because compensation expenses are generally deductible as "ordinary and necessary business expenses" required for the employer to be competitive in the labor market.

Second, employer policies are cheaper because the risk pool is cheaper to insure than the individual pool, so the insurers can make the same or more profits despite charging lower premiums.

The combined effect is to make employer-based health insurer significantly cheaper on both a pre-tax and post-tax basis than individual plans. But even without the tax benefit employers would still be incentivized to provide health benefits in a labor-competitive market. For example, many still provide free meals and parties to employees, even though meals are only partially deductible and parties are not deductible at all.

smsm422• 4 years ago

1. You can get some of the tax break if you use HDHP plan + HSA. It's limited to about 7K though, because if everybody would take big tax breaks, who'd pay for those trillion dollar bills they're passing every year now?

2. US healthcare system is incredibly hostile to people trying to pay their own costs and designed to be maximally obscure and confusing. Imagine buying a car where your car dealer, tire manufacturer, window glass manufacturer and upholstery supplier bill you separately. Now imagine when you come to the dealer and ask how much the car would cost, they shrug and tell you you'd know when the bills come, just relax and sign on the dotted line. If you really insist, they could give you an estimate - something between 1K and 100K dollars - but they don't guarantee anything, it's just an estimate. And no, you can't choose the suppliers upfront or know which ones they'd use - this you'd also know only when the bills come. And no, there's no way to know when or how it happens - they bills would just show up one day as a surprise. Sounds like a nice experience? That's how the healthcare system works, day to day.

3. The frustrating part is that most of the people think it's the only way to manage it, and those that don't think that the only way to fix it is to nationalize the whole thing. I mean we can create insanely complex supply chains (think how many people cooperated on making a car? And you still can come to a single place and pay for it with a simple transaction at cost known in advance - magic!) - but somehow healthcare is where it all disappears and figuring out the separation of labor thing becomes the problem of the end user.

majormajor2• 4 years ago

The choices of plans offered by companies is far, far smaller than the choices available to me on the open market.

On the flip side, the cost my employer pays for my plan is far lower than they would bill me for it on the open market. Last time I looked at the individual market it was amazing how bad even plans for $500-1000 were! They could give me a raise exactly matching what they'd stop paying and I'd still lose out.

Edit to clarify: That's not a "this is cheaper to us after we account for the tax break." That's a "this is the rate it costs us" vs "this is the rate it would cost you" difference.

The negotiation power difference is real. Private market health insurance would need to be well-regulated or we'll all just get screwed even more.

Employers like this because it gives them power over employees and makes it more attractive than being an entrepreneur not just to save money on taxes.

amarshall• 4 years ago

Indeed, and the commenter you’re replying to said just that.

NoblePublius2• 4 years ago

There is no “tax break.” It’s unlawful for me not to buy health Insurance for my employees (more than 50) and you aren’t allowed to shop the open market if you work for me. Average cost per employee is $1150 this year (up about 11% over last year). Thanks Obama.

synaesthesisx2• 4 years ago

Dude $1150 per employee is literally nothing. That's less than $100/month, per employee, for health insurance.

Individuals should still have an option to choose a plan on the open market if they desire, but they're highly unlikely to find a plan for $100/month.

Supermancho2• 4 years ago

I wish employers did not provide health insurance, even though I have a chronic medical condition.

I've had multiple open heart surgeries. My medical events are relatively rare (every couple years) and I recently went completely septic for 4 days (started to have multiple organ failure ~3 days from no-return) due to a cascade of underlying issues. I know my medical coverage and it's been critical to my survival for my entire life.

I have NEVER used employer health insurance and anyone with major medical conditions would be foolish to depend on employer coverage in most cases. The offered plans are basically a big deductible with some minor coverage for non-catastrophic, no surgical coverage, nothing chronic. More expensive plans cover more dependents. Gee thx. It's all but useless and I have simply declined it everywhere for the last 25 years to keep the ~25$/mo, as I have paid my own (car payment-sized) platinum level health insurance plan everywhere I've gone (and my wife's). The type of company - Finance, Medical, Marketing, Retail, Consulting (ironically the best I've found), doesn't make much of a difference. Every now and then you find some employer that will "cover your healthcare 100%" which is inevitably code for "cover the plans we choose, which aren't different than anyone else".

rmatt2000• 4 years ago

What kind of car do you drive?

seattle_spring2• 4 years ago

My health insurance costs me $0 (fully employer paid), has a $300 deductible, and a $3k annual maximum. Last year they covered more than $100k worth of expenses without even a small amount of fight.

This is a similar plan to my last 3 employers, companies of various sizes HQd in either SF or Seattle. If I had "multiple open heart surgeries," it would cost me a max of $3k in a calendar year.

Where are you working that you are not being provided similar plans?

capdeck• 4 years ago

There is also another differentiator - companies buy insurance for all employees (i.e. in "bulk") when if everyone were to buy it privately, insurance companies will have to sell it in "retail". As is always the case with any business - bulk customers have preferential treatment, lower prices, better terms, you name it. Retail always pays it in full. While current employer based insurance model is broken, I don't think goin "full retail" will change the situation much. We'll end up in a situation similar to wireless service market - 3 major players with overpriced plans and lots of cheap MVNOs that stop having any coverage 5 miles down the highway.

WalterBright5• 4 years ago

The reason for employer-offered health care plans is they are paid from pre-tax earnings. If the employee paid for it themselves, it would be paid by post-tax earnings, making it much more expensive.

philwelch• 4 years ago

Group health insurance is inherently cheaper than individual health insurance, regardless of any tax incentives.

TheRealNGenius• 4 years ago

ah yes privatized healthcare. Spoken like a true American.

https://www.reddit.com/r/PoliticalHumor/comments/u15pwv/univ...

devoutsalsa• 4 years ago

USA employers started offering health insurance during World War 2 as a means of enticing women to come to work, as there weren’t enough men to fill the positions. And once that trend started, it simply never stopped.

https://www.npr.org/templates/story/story.php?storyId=114045...

tallanvor• 4 years ago

It's true that they started offering health insurance during WWII, but it wasn't specifically to entice women into the workforce, rather it was to be competitive when Roosevelt created the Office of Economic Stabilization, which froze wages. Offering health insurance was a way to get around this.

https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...

benatkin• 4 years ago

I don't quite understand what you're envisioning. Our system depends on many employers paying for health insurance. You would have to change a lot of things about our system for it to be decoupled.

In South Korea the healthcare premiums are split between employees and the employers: https://en.m.wikipedia.org/wiki/Healthcare_in_South_Korea They don't have to negotiate group plans and maintaining coverage when switching jobs is pretty seamless.

There has to be a plan if employers stop providing insurance en masse, and I'm not sure it's a good idea to stop getting premiums from the source of personal income entirely. That seems to be a convenient place to get the kind of money that healthcare demands.

drewrbaker• 4 years ago

I run a 20 person digital agency in Los Angeles.

The amount of time we have to spend each year sorting out our healthcare for the entire company is mind blowing. You are totally correct, it becomes a full time job for 3 or 4 weeks for myself and another partner. So much effort and knowledge required for something that isn’t even our core business! And it inevitably causes drama with employees who don’t like some part of the group plans we end up with. Very stressful.

We only offer it as our employees all say that this benefit is really important to them. I didn’t know it was a tax break for us to be honest.

I wish more employees thought like you did. Our average monthly cost per employee is about $500 for a “silver” PPO plan, and about $110 for dental. Average age of our employees is below 30.

I’d gladly pay employees the $610 extra a month just so we don’t have to deal with it and the drama that comes with it. This would actually save us money from the energy wasted dealing with insurance companies. And no one who’s dealt with our insurance plans over the years has had a positive experience. My brother (who worked for my company) cut his chin while out of state. Required 2 stitches, and he just walked to the closest ER to get them. $3500 it ended up costing him, even with our insurance and countless hours fighting the insurance companies too. Didn’t even see a doctor, a nurse did the stitches. It’s a joke.

Other than salaries, health insurance is the largest expense for our business. Think about that at the scale of the entire economy and its mind blowing the wasted energy/effort on this “system”.

I’m originally from Australia. We have “socialized” healthcare there. My brother is back visiting family currently and got an x-ray and ultra sound for $310. The American system is absolutely embarrassing.

helsinkiandrew• 4 years ago

Why is this? (I'm used to European 'socialized' healthcare). Is it just the amount and type of cover offered by different policies is wide and opaque, the age/health of the employees effects the price/cover?

Aren't there insurance brokers that provide tools to compare simply. Would a system that allowed employees to vote/order the cover they would like in the plan and then you to adjust the price point until you get matching policies that provides an acceptable level of cover.

tssva• 4 years ago

"Considering the tax situation, it's curious that Intuit would not choose to take this tax break."

Intuit did provide health insurance to these employees and take the tax break. There was a small gap between when the previous MailChimp insurance ended and MailChimp employees were placed on the Intuit offered health insurance. Once on the Intuit provided plan coverage was retroactive to the date the MailChimp plan ended. The employees could submit claims to the Intuit plan for reimbursement of medical expenses paid during the gap. The issue is that floating the money during this time could significantly impact the finances of the employee or that the employee may not have the funds to do so at all.

thfuran• 4 years ago

This would allow me to purchase my own health insurance at rates comparable to what I'm offered at work.

Would it? The employer can still call up an insurer and say "if you can give me a better deal than X, I'll buy insurance for 1,000 people" whereas you have maybe 5 potential customers to bargain with.

duxup• 4 years ago

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• 4 years ago

It's still asking employees to float their enormous mega-corp employer potentially thousands of dollars (each) in short-term loans.

nightski• 4 years ago

It's more like floating the insurance company. The employer would never directly pay these things.

luu• 4 years ago

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.

tgsovlerkhgsel2• 4 years ago

s/pay medical costs out of pocket/front medical costs/

Shorter and as I understand it more correct.

Animats• 4 years ago

What do you expect from a company whose business is spamming?

endisneigh2• 4 years ago

What I don't get is why can't someone, say, one of us, pool together our own insurance that exists outside the employer?

dangrossman3• 4 years ago

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• 4 years ago

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

Dove• 4 years ago

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.

ihumanable3• 4 years ago

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

sc68cal2• 4 years ago

That exists, it's a plan called medicare for all.

bpodgursky• 4 years ago

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.

sc68cal2• 4 years ago

How many people realistically go into COBRA. Have you seen the premiums? For family coverage it can easily be thousands per month.

toast0• 4 years ago

COBRA wasn't that far off of marketplace prices for me. If I thought I'd use the better coverage/better benefits during the COBRA period, and I was confident my former employer would inform COBRA users of issues at least as well as they did employees, I might have considered it.

IIUC, COBRA rates are more or less the total employee and employer rate, maybe plus a limited administration fee? Also, I don't think COBRA pricing varies by age, but marketplace plans do, so if my spouse or I were older, COBRA might have been a good deal.

All that said, I think most people switching jobs keep the COBRA paperwork in case something big happens before they get new coverage in place. There's a grace period on the first payment, if you need coverage, you can pay until the grace period and get retroactive coverage; if you don't need coverage, don't pay. Some people even prepare the payment but leave instructions to send it in if they're incapacitated.

0xbadcafebee• 4 years ago

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-...

nulbyte• 4 years ago

The tweet definitely leaves a lot out. My initial impression was, "that sounds reasonable." I got insurance retroactive to my hire date when I switched jobs last, but it took time for paperwork to be processed, so of course I would pay up front before then. But the article reads more like the sellers dropped the ball by cutting the insurance without ensuring their former employees were properly taken care of. There is plenty of blame to lay at Intuit's feet, but it's not like the former owners of Mailchimp didn't know what everyone else knows. Sounds like they just wanted some quick cash and everything else was someone else's problem.

lifeplusplus• 4 years ago

Didn't MailChimp employees got bad deal because they had no equity to begin with of my memory serves me right

jlmorton• 4 years ago

On the other hand, Business Insider has a giant paywall that doesn't let you view anything at all, and Slashdot links to Business Insider.

cudgy2• 4 years ago

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• 4 years ago

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.

ihumanable3• 4 years ago

Someone about to die from a medical episode will bear a surprising amount to not die.

lotsofpulp6• 4 years ago

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.

cudgy2• 4 years ago

https://www.theatlantic.com/politics/archive/2010/02/why-oba...

This article presents your viewpoint along with quite a few others which mostly point toward Obama’s ineffectiveness and lack of effort toward accomplishing this while having a clear Democrat majority in both houses.

No surprise though as Obama era is not the only failure to move toward single payer … look at what California managed to accomplish with a vast majority of liberal Democrats a couple months ago …

https://m.northcoastjournal.com/NewsBlog/archives/2022/02/01...

tgsovlerkhgsel2• 4 years ago

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).

twobitshifter• 4 years ago

The thing is that pre-acquisition mailchimp was an example of a place tech employees loved to work but not for the equity. The founders built a strong internal culture of private ownership and then bailed for a payday. If any other company sold out and employees got short changed, it wouldn’t make the news.

https://www.businessinsider.com/mailchimp-insiders-react-to-... > When employees were recruited to work at Mailchimp there was a common refrain from hiring managers: No, you are not going to get equity, but you will get to be part of a scrappy company that fights for the little guy and we will never be acquired or go public.

cwkoss2• 4 years ago

Mailchimp workers should go on strike until their healthcare coverage is properly functioning

inopinatus• 4 years ago

One might equally suggest that all American workers should go on strike until their healthcare system is properly functioning.

kieselguhr_kid• 4 years ago

It's not the worst idea

HigherPlain• 4 years ago

Most americans are happy with their employee health plan. Why would they go on strike?

oneepic• 4 years ago

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• 4 years ago

That works if you have thousands of dollars available to cover the bills until you get reimbursed.

kenjackson• 4 years ago

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.

kube-system• 4 years ago

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.

woobar• 4 years ago

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.

TheMagicHorsey3• 4 years ago

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• 4 years ago

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.

TheMagicHorsey3• 4 years ago

I agree with that. But employment is generally at-will in tech. Not fixed-term. Would he prefer to be terminated? When you go from one company to another there's a change in benefits. He could have COBRA for a period of time and then be back on the payroll of the acquiring company. That's no better.

phonon• 4 years ago

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...

abeppu• 4 years ago

Its not so simple as just hitting a switch.

I know nothing about this area, but why _isn't_ it as simple as flipping a switch? When the tweet mentions their insurance becoming retroactively available, this sounds very similar to the experience everyone has when starting with a new employer -- even if you're eligible for their insurance program with coverage starting your first day, it takes a bit for your benefits selection to end up in the insurance company's system.

Why? Why can't this be instant? Is something happening other than a couple writes in a DB somewhere? Why can the new employee not fill out the registration form online, and be immediately covered, and given a digital insurance card?

TheMagicHorsey3• 4 years ago

I have no idea. It has to do with the insured transferring from one insurer to another. There can be no overlap due to insurance laws and other complications. There has to be a perfect transition with 0 time in-between.

nine_zeros• 4 years ago

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.

floatinglotus• 4 years ago

There is no depth to shoddy crappy business practices at Intuit. Seriously, this is an evil company.

adapteva2• 4 years ago

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...

cromd• 4 years ago

Is that for a very large family? Or maybe I don't know what "family plan" means exactly. I just got a plan on my own, not far from New England. I am paying about $450 per person per month, and I thought it was the best plan listed from the provider. As of this morning's doctor visit, however, I do agree - much is broken!

adapteva2• 4 years ago

That sounds about right. Pricing varies by state and plan, but at 5-6 people you get to $2-3K / month.

jdavis703• 4 years ago

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 many responses on HN are over reacting. Employees are not on the hook for previously insured medical expenses.

Almost all medical offices are happy to work with patients if the situation is explained before hand. For example my HMO has printed signs at every intake counter reading “Can’t pay? Call this number to discuss payment options.”

This situation sucks, but it’s really not much different from forgetting your insurance number and needing the front desk to front you the copay or deductible.

no_wizard• 4 years ago

This is from 2021,

I wonder what the state of this situation is now. Have they actually managed to smooth the transition or is it still a bad deal for Mailchimp employees that stayed on post merger?

ng_xp• 4 years ago

Heard that most of them quit

andrew_• 4 years ago

Another vapid Twitter thread making it to the front page by pulling on emotional strings. Personally, I'd like to see some proof of the claim before entertaining it.

fnordpiglet• 4 years ago

Spam lords turn out to be slime balls. Shocking.

bArray3• 4 years ago

Your real problem is this:

In the US, your health insurance is tied to your job.

Why on earth is it that it doesn't matter which party gets elected, you can't seem to get universal health care? Pick California for example, it's a rich state with a massive homelessness problem. What do the homeless mostly suffer from? Addiction and mental health.

Living in Europe and not having to worry about any kind of random health issue is great. If you have some problem, you get it seen to as soon as possible and not worry about whatever it may cost. As an employer things are simpler too, and in the long run, likely cheaper.

It just seems incredibly backwards and I'm not sure it really actually serves anybody. If you're big Pharma, you want your patients to live longer, as they'll get older and have more issues that you can sell products for. If they lose their job, that's lost income.

dragonwriter• 4 years ago

What do the homeless mostly suffer from?

Not having a home.

xeromal• 4 years ago

People love conflating people living on the streets as just homeless, but the approach to solve the problem really requires two solutions. The first is to provide housing for the people mentally capable of taking care of themselves. The rest require either public housing in a facility that can take care of them (abandoned mentally ill) or rehab programs that will hopefully help addicts recover and reestablish themselves. The mentally ill and addicts will not be able to function with just free housing.

bArray3• 4 years ago

> What do the homeless mostly suffer from?
Not having a home.

There are typically quite some homeless programs running, but many get rejected for not abiding by the rules they (understandably) must have, i.e. don't be violent or do drugs. It's not enough to give these people a home, you must also address the reason they are homeless.

axiolite2• 4 years ago

Why on earth is it that it doesn't matter which party gets elected, you can't seem to get universal health care?

Because Republicans can tie-up such laws in committee to prevent it.

Obamacare is a huge improvement over what came before. It's rather absurd to complain it isn't enough.

Pick California for example, it's a rich state with a massive homelessness problem. What do the homeless mostly suffer from? Addiction and mental health.

California spends a considerable amount on generous public health programs. A great many homeless have health insurance from the public programs in California now. Tearing down all barriers would leave California at risk of medical tourism draining public funds.

bArray3• 4 years ago

Because Republicans can tie-up such laws in committee to prevent it.

But this doesn't explain why it hasn't been achieved on the state level.

Obamacare is a huge improvement over what came before. It's rather absurd to complain it isn't enough.

Not really, you can appreciate an improvement whilst looking forward towards further improvements.

California spends a considerable amount on generous public health programs. A great many homeless have health insurance from the public programs in California now. Tearing down all barriers would leave California at risk of medical tourism draining public funds.

This sounds like a solvable problem. You could have an upfront tax or medical availability delay of a few years to make health tourism really unattractive.

Blaming other people sounds like a great way to not deal with the issue.

anothernewdude• 4 years ago

Because America has a right-wing party and a far-right party.

neya• 4 years ago

"Known evil company treats its workers like crap"

Not really surprised. Both Intuit and MailChimp have been carcinogenic to their customers, vendors and employees for ages now. People should strike and/or complain to their local authorities especially when stuff like this is usually put out black and white in their employment contracts. It will be far more effective than just lashing out on Twitter.

pyuser5835• 4 years ago

I’ve been in this spot - a change in ownership, lapse in insurance, and having to cover it yourself until new insurance is retroactively applied.

It sucks. But it’s far from the worst pitfall of our system.

Dave3of5• 4 years ago

Looks like very old news. Although I would say that mailchimp as a company never looked employee friendly so at least for me it's no surprise. Intuit is definitely not an employee friendly company.

My advice is if you're still working for them find a new job.

cracrecry• 4 years ago

You always pay out of your pocket.

The concept that you make (bad bad) companies pay out of their (outrageous) profit is a delusion.

Companies just take part of your salary and with that they pay medical cost.

I actually prefer paying it myself and having this thing called "free market" or competence work for me.

But in places like the US the system is extremely corrupt and designed to make it impossible for the free market to exist. This is inherited by the political system making mandatory for business to handle that instead of individuals.

In other countries you have things like mutuality organizations of people to provide healthcare, much much better and cheaper that what I see in the US.

endymi0n• 4 years ago

There is never a free market in health care.

[…] As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction.

https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...

ipnon• 4 years ago

A free market of treatment options is feasible, but not a free market of insurance coverage. It's not really insurance if the unfortunate event is guaranteed to occur (has anyone in history been documented as never falling I'll?). The buyers have no option.

tikkabhuna• 4 years ago

This is what I love about the UK system.

- NHS takes care of emergencies. There is no stress of payment in these situations.

- I have private medical insurance through work. Its done by salary sacrifice so I can choose to take the money instead.

- I can buy private medical insurance separately. Providers like Vitality[1] offer things like Apple Watches and discount gym membership. Private medical insurance is generally quite cheap (Vitality just quoted me £40/month) as emergency care is done by the NHS.

- You can use private healthcare to speed up things that might take a while or you might not get an NHS referral for.

Of course there's some problems with the NHS in terms of wait times, but I believe that's more of an issue of funding. In the UK I feel like I have choice that won't break the bank and I'm also not going to die because I can't pay.

[1] https://www.vitality.co.uk/rewards/partners/active-rewards/a...

chirau• 4 years ago

I'm single, but how does employer provided health insurance work if both partners are provided it by their workplaces?

joshgachnang• 4 years ago

I just set up insurance for our startup. There are 4 possible plans: employee, employee + spouse, employee + dependents, employee + family. If you both get good insurance and low premiums, whoever gets the better would probably pick employee + dependents and your spouse use their employer’s.

x13• 4 years ago

fuck intuit

Intuit asked Mailchimp employees to pay medical costs out of pocket

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