> It is trivial to go to healthcare.gov and buy the same health insurance an employer subsidizes for employees.
This is so shockingly false in most states that I don't understand how you feel you have enough personal experience to state this so confidently.
Neither California nor Texas have any PPO-style plans available on healthcare.gov. For all the public / self-employed plans, "Out-of-network" means "Pay for it yourself, this is not covered at all." That's a huge barrier to care when you need an urgent care and it's not clear which doctor at which urgent care might be covered.
Additionally the rates aren't just different due to subsidy, but due to quality of the participant pool. Many large employers are self-insured / self-funded, and the insurance company just administrates the fund, reimbursements, etc. However, the unsubsidized rates (made known to us via COBRA) are still much, much lower than the healthcare.gov rates because the participants are generally healthy, wealthy, and young.
When you buy healthcare.gov you get the shitty rates. This isn't just a difference of degree ... having a $100 deductible vs. a $6,000 deductible, or a $1,000 OOP max vs. a $22,000 OOP max literally makes the difference whether I can get my gastrointestinal cancer kept in check every year or not. I can afford the COBRA premiums for that $1,000 OOP max, but I absolutely cannot afford the healthcare.gov plan with >$15,000 in premiums on top of the $22,000 OOP max that I'm guaranteed to hit every. single. year. to get the care I need.
Anyone who is pro-business, pro-entrepreneur, should generally be for good public healthcare. This would relieve businesses of a LOT of administrative burden and overhead to let them focus on their core value proposition. It would also facilitate a lot of good startups by freeing people to go build something great. A lot of potential capital growth, innovation, and disruption is being wasted because the people who can do this are stuck in place.
This is not my experience in NJ and WA. Both had PPO plans with wide networks (BCBS at least) available, and I have never had to worry about out of network providers.
Everyone can find out the cost of their health insurance including employer subsidized in box 12 code DD of W-2. Mine have been very close to the healthcare.gov prices, which NJ conveniently lists here:
https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...
Also, the individual maximum out of pocket maximum is much less than $22k:
>Anyone who is pro-business, pro-entrepreneur, should generally be for good public healthcare. This would relieve businesses of a LOT of administrative burden and overhead to let them focus on their core value proposition.
The current situation where businesses get to silo wealthy, young, white collar workers into healthier pools of insureds, and the ability to purchase insurance with pre tax money rather than post tax for individuals whose employer does not subsidize is all beneficial to large employers. Which is how they like it.
If the US is going to stick with insurance system, then at least everyone should be dumped on healthcare.gov and employers completely removed from the equation.
