Amy, I am pretty sure you dislike single payer, so with the exception of single payer national health plans, are there any countries that have a health insurance policy for its citizens that is not tied to employment?

I absolutely do agree with you that it's a tragedy that US health care is tied to employment, amongst the reason Matt Welch cites, I think in general we would be far more innovative and have a lot happier population if people did not have to stick to jobs they think suck in order to get decent health care.

But apart from national healthcare and/or single payer plans, are there any examples of countries that have divorced health care from employment, and what do those countries do?

I may be wrong but I believe that we are the ONLY country with healthcare tied to employment.

http://www.npr.org/templates/story/story.php?storyId=114045132

An official at Baylor University Hospital in Dallas noticed that Americans, on average, were spending more on cosmetics than on medical care. "We spend a dollar or so at a time for cosmetics and do not notice the high cost," he said. "The ribbon-counter clerk can pay 50 cents, 75 cents or $1 a month, yet it would take about 20 years to set aside [money for] a large hospital bill."

The Baylor hospital started looking for a way to get regular folks in Dallas to pay for health care the same way they paid for lipstick — a tiny bit each month. Hospital officials started small, offering a deal to a group of public school teachers in Dallas. They offered a plan for the teachers to pay 50 cents each month in exchange for Baylor picking up the tab on hospital visits.

When the Great Depression hit, almost every hospital in the country saw its patient load disappear. The Baylor idea became hugely popular. It eventually got a name: Blue Cross.

"When I actually started studying this stuff, I got interested because I wondered why we have an employer-based system," Thomasson says. "It comes right out of Blue Cross." The genius of that approach, she says, was marketing it to groups of workers.

The Modern System Is Born

Soon, Blue Cross coverage was available in almost every state, though not many people bought in. The modern system of getting benefits through a job required another catalyst: World War II. Thomasson says that if the Great Depression inadvertently inspired the spread of employer-based health insurance, World War II accidentally spread the idea everywhere.

"The war economy is an entirely different ballgame," Thomasson says. The government rationed goods even as factories ramped up production and needed to attract workers. Factory owners needed a way to lure employees. She explains that the owners turned to fringe benefits, offering more and more generous health plans.

The next big step in the evolution of health care was also an accident. In 1943, the Internal Revenue Service ruled that employer-based health care should be tax free. A second law, in 1954, made the tax advantages even more attractive.

Thomasson cites the huge impact of those measures on plan participation. "You start from 9 percent of the population in 1940 to 63 percent in 1953," she says. "Everybody starts getting in on it. It just grows by gangbusters. By the 1960s, 70 percent [of the population] is covered by some kind of private, voluntary health insurance plan."

Thus employer-based insurance, which started with Blue Cross selling coverage to Texas teachers and spread because of government price controls and tax breaks, became our system. By the mid-1960s, Thomasson says, Americans started to see that system — in which people with good jobs get health care through work and almost everyone else looks to government — as if it were the natural order of things.

But to Thomasson and other economic historians, there's nothing natural or inevitable about it. Instead, they see it as the profound result of historical accidents.

One of the biggest problems is not that it's tied to employment, but that it is regulated by each state. You can't buy a policy in one state and change jobs to another state and take the same policy with you. Each state has an Insurance Commissioner charged with regulating the insurance industry in that state.

The other issue is that we've conflated health insurance with healthcare. We need to unbundle the two. You don't go to the auto insurance company to purchase gasoline or get a tune-up.

Putting health care back on a market model will promote competitive pricing - instead of insurance-mandated pricing with complex codes and billing procedures, necessitating a billing specialist in every medical office.

A few issues.

1. COBRA is not a plan. You aren't covered by COBRA. COBRA lets you stay on your old plan after you leave a job. But of course you have to pay the full cost. Not just the amount the employee used to pay but the full tab including what your employer chipped in.
2. If this is accurate what was up with California? I applied to BCBSoT. I still hold a grudge against BlueCross because of it. Essentially anyone weaker than superman they wouldn't cover. Instead by rejecting you you then became eligible for the Texas supported plan for people with preexisting conditions. You weren't forced to join but you had to be rejected in order to be eligible to join. Incidentally BCBSoT managed that plan. Hint hint, nudge nudge.
3. Does Welch have any idea what his employers were paying? $212/mo was a reasonable price for bare bones catastrophic coverage in Texas before O-care. Given the difference in cost of living between here and California $357/mo looks quite cheap.
4. That Reason article is just pants on head stupid. Politics is the art of the possible. No, you don't get everything you want. That is just how it is. The 'skinny' plan was an attempt to move in the direction most of the GOP wanted to move. They didn't have the votes to go any further so they tried to take baby steps. In the end they didn't have the votes for even that.

There are plenty of people in the GOP, and some among the Democrats, who have come up with better ideas for a health-care system. The problem is, the GOP leadership seems to be under the impression that Obamacare is widely popular, and they fear the backlash that always comes from the entitlement classes whenever they lose access to taxpayer money. I've seen a revealing interview with Eric Cantor this week: He bare-faced admits that the Republican leadership never had any intent to repeal Obamacare, and that all words to the contrary were just campaign rhetoric. GOP voters figured this out, and that's one of the reasons we got Trump. (Not that Trump is helping the situation any, as it turns out, but the same-old-same-old was definitely not going to produce the desired result.) The GOP leadership will be perfectly happy to let Obamacare continue. In fact, if/when the Democrats proceed along their plan for Obamacare to evolve into full-up socialist medicine, the GOP will make a show of protesting, but they won't really do much to stop it. After all, Congress and the federal agency leadership will quietly put in carve-outs for themselves and their families, so it doesn't matter to them personally.

The other issue is that we've conflated health insurance with healthcare. We need to unbundle the two. You don't go to the auto insurance company to purchase gasoline or get a tune-up.

This. Imagine how much your car insurance would cost you if it provided $5 copays on your oil changes and other routine maintenance?

The only single payer plan that I support is me paying the doc straight up. And there are ways of getting pre-tax money from an employer into a Health Savings Account, which would go towards paying for services rendered.

After all, Congress and the federal agency leadership will quietly put in carve-outs for themselves and their families, so it doesn't matter to them personally.

If we have an Article V convention of the states, one of the first proposed amendments to the Constitution should be that Congress can not exempt itself from the laws it wants to apply to everyone else.

One rule of law for everyone.

Related: https://twitter.com/DRUDGE/status/891838462625816578

Even simpler solution: Let people go to the Veterinarian. Yes, that tongue in cheek quip does necessitate treating people like dogs but I'm quite serious. Our dog was mauled by a pit this weekend. It was a scary amount of blood, one wound across an eye. $148.xx! Amazing amount of care for the money.

I think we owe it to the wealthy, those who own our political elites, to adopt expensive health insurance for all.

Combined with a robust eugenics program we can cull the poor and/or sickly, thus improving humanity's overall vitality AND reducing rush-hour traffic.

Win-win.

Interesting article, fwiw, I thought it had started in 1933 with Kaiser

http://www.kaiserthrive.org/kaiser-permanente-history/

I am always astounded at those who think the solution to too much government interference is MORE government interference.

Why cant heath insurnace be sold across state lines?

Why does/did the government regulate the insurance industry so that individuals buying on their own didnt get the tax breaks corporations did?

If the ACA was so fucking great why did congress exempt themselves and why did Obama use executive orders to gut entire sections of the law?

What kind of morons are you people to think even MORE government regulation and oversight will fix this when LITERALLY SIXTY YEARS of history says the exact opposite 100% of the time?

I think we owe it to the wealthy, those who own our political elites, to adopt expensive health insurance for all. ~ Gog_Magog_Carpet_Reclaimers at August 1, 2017 9:12 AM

Trump is considering removing the [debatably illegal] subsidies Congressional representatives and staffers receive to purchase their healthcare off the ACA exchanges. Let them have the same experience as the rest of middle class America.

If the ACA was so fucking great why did congress exempt themselves and why did Obama use executive orders to gut entire sections of the law?

Sarcasm, right?

It's pretty obvious the repubelicans are not scared of the electorate...7 years of continuous promises, then Bitch Mcconell does nuthin'

"Why does/did the government regulate the insurance industry so that individuals buying on their own didnt get the tax breaks corporations did?"

To protect us from Nazis. Duh. ;)

The fix, again...

"It's pretty obvious the repubelicans are not scared of the electorate...7 years of continuous promises, then Bitch Mcconell does nuthin'"

I think it's worse than that... the current GOP leadership would be perfectly content to be a permanent minority party, as long as the Democrats throw them a few bones here and there.

Heck Cousin Dave, plenty of them would be happy to join the Democrat party. This is the heart of the civil war in the GOP. Commerce party politicians want Tea party votes because they need them to win. But they don't want any of their policies to pass.

And for the record I think McConnell actually did try to pass a bill this time. But he only got serious a month or so ago when he realized Republican voters were getting mad that he wasn't getting anything done. Given the choice McConnell would keep Obamacare. After all he just spent the first six months of the year trying to save it.

perfectly content to be a permanent minority party, as long as the

Yes, I believe that was what Bitch and Romney Ryan were aiming for...a cushy job, not much to do

"Why cant heath insurnace be sold across state lines?

What makes you think insurance companies even want to sell policies in different states?

Just adding one provider to the network is an expensive, time consuming process. Creating an entire provider network from scratch, hundreds or thousands of miles away in a state with different laws would be quite a challenge.

Keep in mind that the insurance company has to go through the credentialing process for each provider which includes getting data on the quality of care, financials, background checks, pending lawsuits, etc. All that to compete with established companies. In a lot of cases, it wouldn't be worth the hassle.

" adding one provider to the network is an expensive, time consuming process. Creating an entire provider network from scratch, hundreds or thousands of miles away in a state with different laws would be quite a challenge."

If states would stop mandading ridiculous coverage and let the market operate, this would be no problem at all.

Also policies operate across state lines all the time.

Anytime you get treatment in a big out of state medical center they don't refuse your insurance because you live in another state. If they did, no one would ever go on vacation.

Even the needing to add preferred providers is part of the problem. How much does your auto insurance do this just for comparison? If you total your car they don't tell you which dealership you need to buy a new one from. But they do have preferred suppliers for body work and other things.

A huge part of the problem with the US health care system is that insurance has become prepaid health care. Preferred provider networks are a way to institute rationing and control fraud when a far more efficient solution is for people to just pay their own bills.

They need to credential the providers to make sure they don't keep the confidential medical records on shelves in the waiting room or keep the stool, blood and urine samples in the same refrigerator with the employees' lunches. Both true stories.

Sure, an HMO will pay for a hospital visit, but not a general checkup at some random doctor's office in another state.

It has nothing to do with coverage levels. Medical care is not the same as getting a dented quarter panel bumped out.

But they haven't really put a stop to any of those issues Jojo. So the credentialism isn't working. And instead insurance has doubled and tripped the cost of care. Not really a good trade off.

The insurance company I worked for didn't accept the doctor who had the medical records in the waiting room. One problem is, it's a lot easier to do the site visits and background checks on a doctor's office in the same area, than it would be to do all that in another state.

Instead of the credentialing personnel just driving out for the day, it would involve airfares, hotels, cabs and meals for days or even weeks. All that expense for a provider that might not make the cut. Now imaging doing that 150 times across a large state.

Then they'd have to create new offices, new marketing department, customer service department, etc. Plus, the insurance company would be competing with local insurance companies that already have the provider networks and infrastructure in place.

It's an enormous cost with no guaranteed reward. I don't see how they could offer a cheaper price when they'd have all these initial expenses.

"And instead insurance has doubled and tripped the cost of care. Not really a good trade off."

Are you saying we should scrap the insurance model of paying for health care?

That is why it needs to be the customer who decides Jo. They are the ones at the office. They are the ones affected the most by the care provided. Are they perfect in telling good practices from bad, no, certainly not. But depressingly they do a better job than insurance groups.

"Are you saying we should scrap the insurance model of paying for health care?"

At that time I was saying we need to stop offloading people's responsibilities off onto insurance companies. They don't do a good job of rationing or vetting and they never will. Instead people need to do that themselves.

As to scrapping our current insurance model, to a large extent yes it needs to go. We really need to move insurance to actually being insurance instead of prepaid medical care.
We also need to move to catastrophic care only. And we need to stop trying to get other people to cover each other's bills. If everyone gives you a dollar it is great. But if everyone gives everyone a dollar no one is richer. Especially if there is a government middle man taking a cut of those dollars.

The only parts of medical care where prices are dropping and quality is increasing is where insurance refuses to pay. Without people knowing how much they spent they just don't have the incentive to spend that money wisely. There is also a commonly noted trend where wages of the middle class have not kept up with upper class wages. People typically blame this on unfair capitalism and such. But if you look at costs to employers instead of just cash wages the increases track across the wage spectrum. It is just that more and more of what could be people's wages are getting consumed in insurance plans. People are spending thousands of dollars and don't even know it. If they did they would act differently.

I agree that it is insane for people to want to fully turn over control of our healthcare system to the federal government. The federal government is the entity that gave us our current system (how is that working?) Prior to Medicare and Medicaid, hospital stays were around $10 a day, once the government got involved, inpatient costs skyrocketed to over $100 per day. I have a picture of a hospital maternity bill from the 1940s that was $7.00 per day on a 1 page bill. Total cost? $65.00. That same hospital would charge over $2000 per day. The US government has their tentacles wrapped around our healthcare system and hospitals through red tape and regulations and it costs providers a ton of money to keep up with it. A provider's office has to have at least 9 positions/jobs filled in order to work within today's healthcare system.
contract person
credentialing person
insurance verification
authorization/referral clerk
coder
biller
follow up/collector
appeals
payment poster
Our healthcare system needs to return to a free market system. Anytime a party other than the individual pays it is always going to cost more.