(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.