Health Insurance Costs for Businesses to Rise by Most in 15 Years

Original Article ↗ Hacker News Discussion ↗

Employer-Based Insurance and Its Problems

  • Many argue employer-sponsored coverage is a historical accident that never made logical sense and traps people in jobs (“golden handcuffs”).
  • Critics want employers out of healthcare (and 401k-style benefits), preferring higher wages or employer subsidies for individually chosen or ACA plans.
  • Others note employers often like the current setup: benefits are a recruitment tool, a retention lever, and large firms can self-insure and gain cost advantages over smaller competitors.
  • Tax treatment is central: employer premiums are effectively untaxed, while individuals face limited deductibility and complex HSAs, which especially harms small business owners.

Single-Payer / Medicare for All vs. Status Quo

  • Strong contingent: the US spends more per capita than other rich countries yet has worse access and outcomes; single payer or “Medicare for All” would use risk pooling, kill a lot of administrative waste, and detach coverage from employment.
  • Advocates emphasize simplified bureaucracy for patients, doctors, and employers, plus greater labor mobility and small-business formation.
  • Skeptics ask where savings come from if insurers’ margins are only a few percent, warn Medicare rates rely on cross-subsidies from private plans, and fear longer queues and gaps in coverage (e.g., drugs).

Incentives, Middlemen, and Cost Drivers

  • Several comments dissect incentives: medical loss ratio caps push insurers to grow total spending, not cut it; employers respond by raising deductibles and copays.
  • Others focus on provider-side consolidation and private equity, pharmacy benefit managers, and “payvider” models (insurer-provider hybrids) as key cost inflators.
  • Disagreement: some say blaming insurers ignores that most money goes to wages, drugs, and devices; others see insurers and intermediaries as a major part of the US–Europe cost gap.

Worker Experience and Political Outlook

  • Many share experiences of care being cheaper out-of-pocket than via insurance, and of chaotic transitions between jobs, COBRA, and exchanges.
  • Some predict more employers will drop coverage and pay ACA penalties, possibly pushing exchanges into a “death spiral.”
  • Politically, several see Medicare for All as economically rational but blocked by entrenched industry interests and bipartisan failure; frustration ranges from cynical resignation to openly alarmed rhetoric.

Other Proposals

  • Ideas span from making GLP‑1 obesity drugs ubiquitous to full nationalization of insurance (and sometimes hospitals).
  • There is no consensus on whether the main fix is single payer, provider reform, or both.