December 7, 2008

Healthcare Shouldn't Work This Way

Justin Katz

Tied to employment, that is:

As jobless numbers reach levels not seen in 25 years, another crisis is unfolding for millions of people who lost their health insurance along with their jobs, joining the ranks of the uninsured. ...

About 10.3 million Americans were unemployed in November, according to the Bureau of Labor Statistics. The number of unemployed has increased by 2.8 million, or 36 percent, since January of this year, and by 4.3 million, or 71 percent, since January 2001.

Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits. On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.

Most people who are unemployed for a time manage to continue making payments for cars and auto insurance, houses and home-owner's insurance, and so on. There is no reason that employers ought to have the power of life and death over their employees. And there's no reason that we should take that power from them and give it to the government.

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Justin -

Employers, by and large, do not have the power of life and death over their employees. The insurance companies that the employers buy insurance through have that power.

I just received a very rude shock for my company's health insurance renewal. Our rates increased 23.7%! This on top of a 14% increase the previous year.

I purchase our insurance through Blue Cross/Blue Shield. The average age of my staff is 40, most with families.

It turns out that 11.3 out of the 23.7% increase was because RI Law removed the 'healthy company' discount that a generally healthy company has received for the last 8 years. When I enrolled a new employee, that employee had to fill out a health questionaire. Now, the questionaire is gone, and I am paying 11.3% more per year for the same health care INSURANCE that I got last year. Now, I am simply subsidizing the health care for less healthy companies.

The whole point of insurance is to pay a premium based on your level of risk that you will require to file claims against the insurance. Those with homes in hurricane-prone areas pay more for homeowners insurance than those who live away from the coast. A person with advanced heart disease will pay much more for a life insurance policy than someone in fine health. Rhode Island has now taken health care premiums for small businesses and essentially socialized the premiums across all of the companies.

Blue Cross offers about 30 different plans, most of which cost the same. The only real difference between the plans is how the premium is divided between the employer and the employee.

Interestingly, the premiums offered by Tufts and United Health are ridiculously close to BC/BS. I would feel comfortable going out on a limb and suggesting that there is not nearly enough competition in the insurance market in RI.

We have an awful system of insurance now. Unless your company is large enough to self-insure, there is virtually no way that a small business can reduce the overall cost of insuring its employees.

Posted by: Ken Block at December 7, 2008 7:18 PM

Well, the "life and death" thing was admittedly a tad hyperbolic, but the point was that losing health insurance should not go hand in hand with losing a job (and neither should it be under the control of the government). The two should be separate.

I'm not sure how the bulk of your comment, while informative, is relevant to that specific point.

Posted by: Justin Katz at December 7, 2008 7:25 PM

It was just a long winded way of agreeing with you, while venting a bit about my insurance woes.

Posted by: Ken Block at December 7, 2008 7:58 PM


I’ve paid for my own healthcare insurance since the 1970s. Better to take control of your own life than try and live it with someone else jerking the strings.

Moving to Hawaii I’ve found State of Hawaii is the only state in nation closest to providing universal healthcare coverage to total state population. Employers are required under state law to provide healthcare insurance to employees working 20 hours or more a week.

Hawaii Medical Services Association (Blue Cross Blue Shield) just instituted first in nation 24/7 telephone or INTERNET (with video) talk with a doctor for a $10 copay or higher charge for non-member which will lower demand on hospital emergency rooms..

In case of emergency calling 911 is still highly recommended to everyone.

Hospitals and doctor offices encourage medical emergencies to enter for professional attention where no one will be turned away if they do not have medical insurance or ability to pay for services. It’s strange to see these types of caring signs.

Hospitals here are supported by grants and gifts for providing care for those with no insurance.

Hawaii has one of the longest living populations in the nation.

Justin you’ve got to take charge of your life.

Posted by: Ken at December 7, 2008 8:01 PM

I guess what I'm not sure of is how those two sentiments (health insurance should not be linked to employment AND health insurance should not be linked to government) are compatible.

If health insurance costs money, then it is linked to some extent to employment (or welfare benefits) since people can't afford insurance without some sort of income.

That leaves government-funded (not necessarily government-OPERATED) health insurance as the only real alternative - at least for those out of work.

What other alternative do we have? I really don't see this issue as a Left vs. Right issue. It isn't in other countries for the most part. It's a Life or Death issue.

Indeed, how can anyone who considers themselves anti-abortion support a private health insurance system in the US that *encourages* abortion? It really boggles the mind.

I'm certainly not pro-abortion (far from it...though I don't really know anyone who is), though I am pro-choice. It infuriates me, however, that my health insurance premiums support a system that results in abortions due to insurers' actions (or lack thereof) on a daily basis.

Posted by: Ken at December 7, 2008 10:09 PM

Ken #2:

By your measure, everybody is ultimately enslaved either by an employer or by the government. I'd take the view that the necessity to contrive systems to help those who cannot help themselves does not negate the principle of freedom for the rest of us. Especially when no other system is workable for the long term, in my view.

Note that the chronically unemployed must be supported by government whether the bulk of healthcare falls to employers or to the state. The unavoidable circumstance should not be considered the prerequisite for the best possible system.

Abortion, in this topic, is incidental. A government-run system could, if anything, more easily shift to encouragement of the killing of unborn human beings, perhaps in a targeted fashion. The more freedom you had to choose your insurer (or general coverage, if we were to move toward allowing insurance to be insurance again), the more power you'd have to change their practices.

Posted by: Justin Katz at December 7, 2008 11:08 PM


Are your only realistic options for buying your auto insurance via your employer, i.e. your employer picks the one insurer that will sell to you at a reasonable price?

If not, does the government sell you your auto insurance, or do you buy from a company that's not linked to your employer or run by the government?

What's difficult to understand here?

Posted by: Andrew at December 8, 2008 12:08 AM


You're right on. Healthcare tied to employment only serves to punish those who work for smaller companies and favor those who work for larger ones.

Posted by: Rasputin at December 8, 2008 4:25 PM
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