gives far too much power in the marketplace to employers
Having been on the employer side, it also puts distortions on their decision making. Some examples I had to deal with…
• You have an employee who is not working out, you aren't happy with his work, he has been unable to improve, and he isn't particularly happy failing day in and day out either, you'd like to terminate his employment, but you also know he has a dependent with mind bogglingly expensive health care issues that will take long term treatment and won't be eligible for coverage anywhere else because they are now pre-existing conditions. (Also know that whatever that dependent costs is going to get added to your next year's "insurance" premium in the negotiations.)
• You hire a guy that has been an independent consultant around town for many years. A few months later he needs expensive heart surgery, so you carry him for a while during recovery (and pay for all the health bills in next years "insurance" negotiation), after which time he stops producing work until you figure it out and fire him. He then goes back to his independent consulting work after using you for an expensive surgery and recovery. Now, remember that the next time you think about hiring a pudgy 40 year old man who currently does not have insurance.
Excellent point. Leaving insurance decisions to the individual would take these issues out of your hands, and let you operate more efficiently. And to elaborate on the employee side, employees wouldn't have to feel so tied down to particular employment situations simply because of health issues.
Insurance is fundamentally a group activity --it is a shared risk pool. There is no such thing as individual insurance. The question is how groups are formed. Currently, US does it around business units. UK does nationwide.
Good point. Using those terms, doing it around business units seems to be more harmful than doing it around an entire nation (or even just a state). Tying to a business/company means people themselves are artificially tied to a particular company when they might be better suited (talent/skills/lifeneeds) to be at a different company.
Having been on the employer side, it also puts distortions on their decision making. Some examples I had to deal with…
• You have an employee who is not working out, you aren't happy with his work, he has been unable to improve, and he isn't particularly happy failing day in and day out either, you'd like to terminate his employment, but you also know he has a dependent with mind bogglingly expensive health care issues that will take long term treatment and won't be eligible for coverage anywhere else because they are now pre-existing conditions. (Also know that whatever that dependent costs is going to get added to your next year's "insurance" premium in the negotiations.)
• You hire a guy that has been an independent consultant around town for many years. A few months later he needs expensive heart surgery, so you carry him for a while during recovery (and pay for all the health bills in next years "insurance" negotiation), after which time he stops producing work until you figure it out and fire him. He then goes back to his independent consulting work after using you for an expensive surgery and recovery. Now, remember that the next time you think about hiring a pudgy 40 year old man who currently does not have insurance.