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Those people generally have really good insurance

That’s one of the key issues of tying health insurance to employment: it creates a backwards system where the affluent pay basically nothing for care and those who make little pay a great deal

There’s a weird curve at the bottom because of government services like Medicaid, with these you also pay very little to nothing, but in most states you have to basically be destitute to qualify

It’s one of the most frustrating things about being someone who takes insurance as a career. The people I see who make $30-40k or less? They have 4-10,000 deductibles and pay 10-30% coinsurance after, on top of hundreds of dollars of premiums coming out of their check (that percentage wise take up a huge chunk of each pay). Their out of pocket max is also very high so their medical spending has to be pretty crazy to get to the point where they just don’t have to pay anymore

But the people who make 100k? 150? 200+? They almost always have nice PPOs. They pay $5-30 per visit. They have lower out of pocket max (though tbf still fairly high, it’s insurance) so their copays can go away (but this is uncommon, tbf). They pay more out of their check but not as much as you’d think because it’s usually more heavily subsidized by their employer (“nicer benefits for essential staff”) and given their substantially higher income it’s often much less percentage wise of their net earnings.

So someone says “go see a therapist”. If you’re making 40k a year with avg benefits that might mean you’re now on the hook for $120 a week for weeks or months (or more!) because of your high deductible plan, until you finally hit that deductible. If you’re young and healthy and don’t utilize much you may never hit it just going to therapy. Even if you do you’re still on the hook for 12-36 dollars a meeting after that. Meanwhile the 150k a year tech bro or banker goes and pays $10 a week.

It’s not always like this of course. Sometimes low earners get bad PPOs with high copays that feel criminal ($75 per meeting). Sometimes high earners do high deductible plans because they realize the accounting makes more sense for their medical spending. Or sometimes they work for a company that cheaps out on benefits even though it pays a few people very lucrative salaries. Etc

But it’s also one of the hard issues to solve as a result. In an ideal world the people who have more resources would pay more and the people who have less would pay less. The sliding scale payment system where the wealthy subsidize those who have less. But people are greedy and don’t want to give away their money. And guess who has more political power and also tends to vote more?