Do we want to keep it with employers?

(cross-posted from tpm)

There’s an essential question beyond the incremental debate.  When considering health care reforms, do we want to continue working in an employer-based framework?

John McDonough from the MassHealth campaign writes:

It’s not the size of the assessment, and it’s not the total revenue needed to fund reform – other ways to square those circles. It’s the establishment of a new principle: all businesses with at least ten workers have a responsibility to cover their workers or to pay something for the cost of their coverage.

Is this the principle we want to reify?  The problem with the Massachusetts bill is that it’s laying the foundation for health care as an employer- sponsored right.  And in the long run, that’s not the way to frame health care.

Health care needs to be established as more than a right, and particularly more than an employment- linked right.  It’s a necessity. To pave the way for something substantial, that inimitable necessity needs to be the foundation. 

In his last post, Ezra wrote:

The politics of health care are the politics of economic security, and no one is comfortable with what they don't understand. So as much affection as I have for all the FEHBP expansions and tax credits proposed by various think tanks and pols (see PPI's new proposal for a good example), the way forward is not a technocratic compromise that cleverly mixes market mechanisms with regulated insurers and individual mandates in order to emerge as ideologically indistinguishabl e as possible. Single-payer, presented without compromise or apology, is simplicity itself.

He’s quite right to peg the security argument with health care reform.  As our health system rapidly shifts and premiums sky rocket, things feel very insecure.  And the continuation of the employer-health insurance connection reinforces that perception. 

When insurance was first pegged to employment, the employer- employee relationship was quite different.  There was a sense of job security unknown today.  The average working person today will have many different employers.  Assuming employer-based universal coverage, each time they change employers adds an expensive administrative cost.

There's also something to be said for relieving the burden of rising costs on businesses.  Reforms like the MassHealth bill have nothing to say to GM or Ford.

Further, a continued employer-based system (again with a universal mandate) will be a patchwork system.  How are we paying for the self-employed? Those who do not/cannot work?  This can certainly be done; Germany and Japan have employer-based systems and still have better care than the United States. 

But as Ezra said, single-payer is simplicity itself.

 

Comments

[Felix Kasza]

I grew up in Austria and worked all over Europe, including nearly six years (1992-1998) in Germany and a few more (1998-2004) in Luxembourg, right next door.

Germany does not really have an employer-based system. The employer and employee both pay an equal share of a mandatory premium; the split was made to make the numbers look better to the employee. In short, it works more like Medicare tax, only at unprecedented levels of taxation. Non-employees get the amount torn out of their unemplyment cheques.

Even this still leaves huge holes in the budgets of health insurance and social security, deficits which are covered with yet more taxes.

And you know what? The quality of care is _still_ abysmal. "Too little to live, too much to die" is what Germans say about the care provided as standard.

If you want to find arguments for a single-payer system like Germany has, you may want to look elsewhere; the German system is on the verge of breaking down because it can no longer be financed.

Cheers,
Felix.

[Martha Grant]

Theoretically, your argument is sound. After all, if we get more people covered under an employer-based framework that means there's less of an incentive to change. Makes sense.

But what does this mean practically?

You talk about which is 'better': single-payer or an incremental approach. That's fine, and certainly has its place. But even as we sit here and post, thousands upon thousands of Americans are desperately ill and without insurance. In the end, this argument should be about who can save lives best. Frankly, that means we need – indeed, it is a necessity – to take an incremental approach.

A better proposal than MA’s, more feasible and cost-effective, is currently making its way through the NY legislature. It needs support . While you can read more details here, it essentially requires corporations over a hundred workers (rather than ten) to provide health insurance. Practically, this makes sense.

The facts are that we can’t get single-payer now, and I, personally, cannot justify sacrificing individuals for a theoretical cause. I'm not saying we should abandon universal healthcare; but in the meantime we should help who we can.