I tend to agree with your direction here Scott.. corporate America is no longer what it used to be.. the advantages to being employed by these are no longer worth much. It is a sad fact of globalization.. too bad.. once upon a time I was very loyal to AT&T.. they took care of me (with good pay and benefits) and I really worked hard for them.. glad I retired before they changed the pension formula. These days everyone is for themselves.. oh well.. at least we can get quality and value from Asia.

Sorry to go a bit off topic Scott.. we old folks tend to do that

Couple of problems with your argument. First, wouldn't “checkups and oilchanges” level medical care be covered by GPs? And you want to cover it. fine. That we don't have enough GPs right now and will crush them under the weight of the future demand is noted.

You don't want to cover specialists. why? Specialists are there for, usually chronic or emergent problems. So, ok, critical problems will be covered, but chronic disease won't? I have deadly allergies that require management by an allergist. My partner has fibromyalgia and occasionally needs a rheumatologist and a physical therapist to manage her symptoms. What about medically-reliant disabled? Not covering chronic health issues like this is effectively financially disenfranchising a whole class of people because of medical necessity. That's not cool, that's not fair.

Of course, I'm sure that's not what you meant. So that stuff is covered too.

So… what's not covered? Elective procedures? Those already aren't covered, mostly. (some will always sneak through, regardless of the system.) So, you've described a single-payer HMO.

So perhaps some incentive for becoming a GP. I think the reason we don't have enough GPs now is the financial reward of specializing.

I don't know if government health care should cover specialists necessarily, unless the person has no access to private health care. I'm not against private health care and think it should still exist on some level. I'm just saying that perhaps like auto insuranc, health insurance should be more portable.

Right now if you don't have a job the likely nothing is “covered” because most folk don't have real insurance unless they're full time and salaried.

The problem with pairing health insurance with your job is the same problem with having your retirement primarily invested in company stock. Too much of your worth is tied to the company. Ask Enron employees how that worked for them.

If you loose your job, you loose your insurance. If you get sick and want or need to change jobs, you have to make sure the new job will take your pre-existing condition (I think most will, if you had insurance before)

Another problem is that it separates the beneficiary of the service from the one paying for it. Your employer's priorities in buying health care are likely to be different than yours. They want a good value or maybe jsut the best price, you are likely going to want to know more about the kind of coverage and the reputation of the company.

As far as types of insurance, we have a health savings account. We pay full price for the first $4000, the insurance company pays full price for the rest. Simpler for them to manage, cheaper for us. We can set aside money in our HSA pre-tax to pay for the expenses we need to pay before the deductible. My employer offers both a PPO and the HSA. They pay part of the premiums of the PPO plan, but because the HSA premiums are much lower, I think they pay 100% and contribute some toward the $4000 deductible. They pay out less on the HSA and our out of pocket, even after covering the remainder of the deductible is less as well. What's more, our out of pocket is capped at $4000 each year. It's essentially a catastrophic plan. If by chance we don't spend the $4000, it goes into a retirement account for us. We hit the deductible every year, in fact we've already hit it this year.

It's a great plan, but because folks are conditioned to believe that they shouldn't pay full price for health care, it took some discussion for folks to see the benefits. Paying full price also exposes you to the cost of health care and being able to keep the remaining money gives some incentive to spend less, in theory.

The HSA sounds like a good deal. We have flexible spending for health care stuff (which is different, but also helpful).

The HSA sounds like a good deal. We have flexible spending for health care stuff (which is different, but also helpful).

[...] We live in a country where your health insurance is tied to your employer, a horrible idea in my mind. [...]