What’s wrong with US Healthcare 2: Employer-provided
This is more straightforward than my first post about what’s wrong with healthcare in the US: it’s provided mainly through employers.
While this is a-okay as long as (1) you have a job, (2) your employer happens to offer coverage, (3) the coverage is affordable, (4) you don’t get very sick, when those four conditions don’t coincide there’s a problem. For many people, they don’t coincide.
You could lose your job — it seems to be happening to a lot of people, even people who are good at their jobs. How do you pay for COBRA then? Especially with a tough job market where a new job is hard to find, and also considering that many employers have significant waiting period before a new hire is eligible for coverage? How do you pay for private insurance when COBRA runs out? What if you can’t get private insurance because you, oh I don’t know, sprained your ankle last year? (I’m not exaggerating. I know a twenty-something athlete turned down for that reason. At least that was ostensibly the reason.)
Your employer could stop offering coverage or you could have a job where it is not offered. I used to work in a garden center, and I was not eligible for insurance because my hours were drastically cut each winter, meaning I was never full-time for a long-enough continuous period of time to qualify. Almost no one at the company was eligible. You might say, “get a better job.” Fine, okay. But who are you going to ask what’s eating your garden next year? Policies like this encourage an awful-lot of turnover and lack of experienced staff doesn’t make a good knowledge-based business. Guess why I don’t work at garden centers anymore? Yes, now you know. That is, really and truly, the main reason.
Your employer’s coverage could be unaffordable. I don’t think that needs much elaboration.
You could get really sick. This is the stupidest part of the whole set-up. I have personally encountered several people (I’m not including people I know only in cyberspace here) who have gotten very ill, used up all their sick time, lost their jobs and insurance, and basically become bankrupt (sometimes actually so.) When I last worked for the state (aka “benefit city”), there were several people in that exact situation except they hadn’t actually lost their jobs yet — the other employees were “donating” their leave and sick time to the sick people so they wouldn’t be fired for absenteeism. That is lovely and kind, but also totally messed up. What happens with all the donated time runs out? What if one of the other people gets sick? Oooooo, it was such a perverse and nauseating situation! These were people with supposed coverage! This is what can happen to them!
There are other valid gripes about insurance being provided through employers: it’s expensive for the employer, it puts small and new businesses at a significant disadvantage in attracting labor, even though small business is the biggest generator of jobs as I hear, it creates an incentive for businesses to hire more part-time employees to avoid the insurance costs of full-time employees, it keeps people from starting their own businesses because they will lose their coverage. Hm, this is fun in a heart-racing, angry adrenaline sort of way. Let’s talk about all that later.