alt Hacker News> Healthcare costs, and hence health insurance premiums, are the same with or without an employer intermediary.
If you read the fine print of a health "insurance" plan at a large company, you might discover healthcare costs are directly covered by the employer and the insurance company just administers the plan according to "set rules".
In practice, this operates as blame as a service.
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American health insurance is insurance in name only - picture health insurance models laid on top of your car:
Imagine your car gets totaled. Your insurer says, "Hey, we're going to pay out $25K for your vehicle. So you have a $1,000 deductible, so that's $24,000, and then your copay for a total loss is $2,000, so that brings us down to $22,000. For total losses, your coinsurance as your contribution for your vehicle coverage is 20%, which is $5,000, so here's a check for $17,000. But that's only if you're buying a Hyundai, otherwise the vehicle is out of network and you'll get a check for $8,500 instead."
> If you read the fine print of a health "insurance" plan at a large company, you might discover healthcare costs are directly covered by the employer and the insurance company just administers the plan according to "set rules".
Generally this is done by a TPA (third party administrator). In many ways you can do as you wish, but as insurers have already done the actuarial work, it's generally easier to use a plan and tweak it if desired (like "Give us this plan but pay for 1 massage/week") versus having to figure that out yourself.
Sure, but the doctors/medicine/hospitals/liability are not any cheaper.
So the healthcare isn’t cheap, but the employer is able to gain more control over their employees by tying a piece of their non employee life to the employer creating more friction to prevent people from shopping for jobs with higher pay, and the employee is getting a small tax benefit.