[akgoel]

I hear this all the time, and I somewhat disagree. The problem is that unhealthy people do not want to pay the full amount of their risk-adjusted rate into the risk-pool. Therefore, they need healthy people to subsidize them. It makes sense that pooling a group of employees together would be uncorrelated to health status, and would therefore make a good proxy for a risk-pool.

[smt88]

Some of the most common jobs in the US are driving trucks and working in warehouses. Those people are not some kind of random sample of healthy and unhealthy people. They tend to have chronic pain and metabolic disease at young ages.

If you want to pool healthy and unhealthy people together, you use the system that has worked in every other developed country, some for almost 100 years: pool everyone together. The whole point of a functioning government is for all of us to pool resources together to reduce risk for ourselves in our daily lives. Private health insurance makes absolutely no sense.

[ahartmetz]

>almost 100 years

110-140 years in Germany, depending on "how everyone" you want. The workers were getting restless (protesting) about some of their hardships, so the conservative emperor asked the conservative chancellor to do something about their welfare in order to keep them away from the bad people (communists, socialists).

[sergiogdr]

Thank you for this.

[vel0city]

What if I stead of making the pooling "employees" we pooled on something else, like "citizens" or "residents"?

Why should it be "employees"?

[sneak]

Because not everyone wants to pay for the same class of service.

The lowest common denominator is something like the NHS, with its well documented problems.

Many people wish to pay the minimum possible, and many people wish to pay for higher service and lower wait times. There must be some way of deciding who is prioritized for access to limited resources, and incentivizing increasing supply.

[awongh]

That makes logical sense in terms of grabbing onto a specific mechanism for risk hedging, which would be how we accidentally and naturally arrived at this system.

But it doesn't make sense within a larger society in that you drop out of the pool of insurance-eligible people as soon as you have a health issue that limits your employability.

In fact, that specific case makes it seem totally insane and backwards. Why would you link a thing like employment to your health when your ability to work is directly tied to your health? What a crazy catch-22.

[ghaff]

As I understand it, a lot of reason was originally to end-run around wage controls and then got enshrined through some combination of collective bargaining and then generalized employee expectations. But to your point, even if you decouple from employment, it doesn't really help if you're paying $7K+ for individual health insurance as a person who is too ill to work. (Yes, larger companies in particular have disability insurance but this is hardly universal.)

[fsmv]

The risk pool should be as large as possible, the whole country, to minimize costs for everyone.

It's deeply unfair to tell someone that lost their job that they also now have no access to healthcare.

[mgh95]

> The risk pool should be as large as possible, the whole country, to minimize costs for everyone.

The risk pool being larger does not necessarily improve the risk pool.

[RobotToaster]

> The problem is that unhealthy people do not want to pay the full amount of their risk-adjusted rate into the risk-pool.

You think it's a problem that those with genetic disabilities don't want to be priced out of having health care?

[formerly_proven]

Most unhealthy people are unhealthy by choice.

[s1artibartfast]

That is an argument for mandatory healthcare, not tying it to employers.

The real challenge with employer-tied healthcare is the lowest wage workers would not be able to afford it otherwise.

High pay workers would receive a salary bump to compensate if healthcare were decoupled. Low paid workers wouldn't because they are already compensated above the market clearing rate for their labor.

[aqme28]

Why would it be uncorrelated? It is not unheard of for people to lose their job due to health issues, which then means they lose health coverage too. It's like they never really had coverage at all.

[Glyptodon]

There are lots of ways to have big risk pools. The bigger issue is that the things you most need insurance for are often so bad you won't be able to work or won't remain employed.

On top of that, historically the connection discouraged entrepreneurship.(With the exchanges I think that's maybe slightly less the case. Though risk pools issues with small businesses do favor larger businesses IMO.)