As a small business employer, I've watched the cost of health insurance increase by 200-300% over the last four years. Last year we were "fortunate" to have an increase of only around 10%. It's gotten to the point where paying health insurance for a family is well over $1,000 per month now.
When health insurance was affordable I can see that it was a trivial benefit that employers could provide to their employees, and as I understand it, most employers did this, at least in the "professional" world, and the discrepancy between one employer and another was hardly worth thinking about as a person moved from one company to another. Now, however, as the costs have become so large, and the cost of insurance for our employees is much higher than our monthly rent, I seriously believe that the association between health insurance, employee, and employer is a wrong one.
The association should be a plain and simple relationship between a person and an insurance company. "Hi, my name is Al, and I would like to buy some insurance." The insurance company should then ask what they need to ask about your family, how many people will be on the plan, and your health history, instead of involving employers in all of this.
For instance, think of health insurance as just another service that a person needs to have as they walk through life. Most people think "I have to pay for a car (and auto insurance), and a place to live (and home insurance), and food, and so on", but they don't ask their employer to pay for all these things, do they? Now that would be interesting. "Yes, I'd like to work here. Can you tell me what your rent benefit is? And your food benefit? I see, and what about the car benefit?" That would be ridiculous, right?
Well, that's what I've come to think of health insurance benefits being provide by an employer. This is a bad idea.
I don't know what's wrong with the healthcare system, i.e., why these costs have gotten to be so high. But now that they are, it's a bad idea to associate healthcare benefits with the employer you work for. The relationship should be directly between an individual (or a family) and a health insurance company.
From the perspective of a small business owner, it appears that health insurance companies seem to give larger organizations big discounts, under the guise of "efficiency". But my argument is that they are trying to solve the wrong problem. It cannot be possible for the [insurance provider + employer + employee + family] relationship to be easier than a [insurance provider + employee + family] relationship. How can "COBRA Plans", and employees moving from one company to another possibly being easier than one person having insurance with one company for 20 years??? No way.
Think about what you go through on every visit to your doctor's office? "Has your health insurance changed since your last visit?", and you answer "Oh, yes, I changed employers and ...", followed by "All right, I need you to fill out all these forms (including your employer) before we can see you ..."
Think about this harder: If the average employee stays with a company for 5 years, there is a 100% turnover in the [insurance provider + employer + employee + family] relationship every five years! How is that easier than a person having working with the same insurance company their entire life??? How many people are employed by health insurance companies because of this one issue?
I understand that costs should vary depending on whether you have lived a healthy or unhealthy life, but a person's employer should not be involved in this equation.
Al, what went wrong? I'll tell you one biggie. No it isn't the frivolous malpractice lawsuits, though that is up there. No ,this one is under our control and we can "fix it". It is that we never ask "Doc, how much is that bypass going to cost me?" Or "Who says I need that test?" Or "Can't we use factory refurbished parts for Dad's hip replacement?" Or, my favorite "What's this on the itemized bill for my last visit? I don't think you used 4 tongue depressors. And you only had me 'Turn your head and cough' twice - What's with charging me for three? The family jewels are good, but there are still only two, doc!"
What I am saying is we never question why. If you ever did (and I have) they look at you like "Mr. Baker, this is your daughter we are talking about, not a 1996 Nissan Sentra that needs some 'bondo'. She needs this nose job or she may be shunned by society."
And when the Explanation of Benefits from our insurance company arrives, we never question 'Did the doctor charge the right amount?'
When my wife delivered our first child, I asked for a itemized statement for the entire stay at the hospital. It took three letters to two different hospital administrators and four weeks to finally get it. On it were 87 charges that were services, drugs and procedures that actually were rendored to two other women that shared her room while she recovered from the c-section. When I informed the insurance company, they said they would not pursue getting the $3,452.37 back from the hospital because 'It would cost us more than that to just file the paperwork'. CAN YOU BELIEVE THAT?
Imagine running a small business that way. Only the Health-care System and the US Government find this "normal". (That is why putting Health coverage under the US government will be a double disaster.... But I digress)
Well, you get the point.