Having most people obtain medical insurance, and therefore their healthcare, from their employers is a peculiar tradition that leads to several less-than-optimal situations.
I would venture to guess that most employees don’t know the cost of their insurance. They probably pay a portion of the cost through a deduction on their payroll checks and they know what that amount is, but that is a long way from knowing the total cost. Knowing — and having to pay for — the entire cost of something is a good motivator for controlling its cost.
It makes no more sense for employers to provide health insurance than it does for employers to provide auto or homeowners insurance.
With employer-provided coverage, when people change jobs, they likely lose their coverage.
At most companies, employees are not rated according to their likely healthcare expenditures. There may be a cost for a single employee, another cost for an employee and spouse, and another cost for employee with spouse and children. Never have I seen a case where the cost to the employee was based on how many children there were in the family, even though each additional child adds a predictable risk and associated cost. Other types of insurance, such as auto and homeowners, are priced very carefully based on the characteristics of the driver, auto, and property being insured. This illustrates that present health insurance plans are not so much insurance against catastrophic loss as much as they are pre-paid healthcare plans that cover every little cost. But even then, they aren’t priced very carefully according to their likely cost.
Having employers provide healthcare removes choice from employees. If an employee doesn’t like the plan offered by their employer, they are certainly free to purchase one they prefer. But this will likely be more expensive, partly because of the fact that employer-provided plans are paid for with pre-tax dollars. A plan that is privately purchased would be paid for with after-tax dollars.
Removing the ability to choose health care plans from most people also removes competition amongst health care plan providers. Introducing competition to the marketplace is good for consumers.
The fact of employer-provided health insurance creeps into issues such as same-sex marriage. Advocates of same-sex marriage or civil unions point out that same-sex partners are denied the employer-provided health coverage that their partner enjoys.
What if we decided to stop employer-provided health coverage? There are a few obstacles.
Currently, since health insurance is often paid for with pre-tax dollars, people would pay more in tax. This could be overcome, of course, by lowering tax rates.
It may be that employers, since they often purchase insurance plans for large numbers of employees, are able to get price discounts based on volume. Wholesale purchasing, so to speak. I do not know how this would impact families purchasing plans one at a time. There may be significant sales costs. Certainly families would face choices and would have to think about them. But being more informed is better.
Some people, undoubtedly, would decide to forgo the purchase of health insurance, and therefore risk becoming a burden to us all if they become ill. This is a real problem because currently our healthcare system treats those who can’t afford to pay, sometimes with little concern given to if they will ever be able to pay. (Recently the New York Times and Wall Street Journal have given coverage to cases where hospitals have aggressively collected debts from poor people. The Times thought this a tragedy.) The fact is that the cost of care given to those who can’t — or won’t — pay is paid for by the rest of us who do pay. It would take a disciplined system to refuse to treat those who have chosen to forgo purchasing insurance.
In a Reason Magazine article titled Mandatory Health Insurance Now! we find this paragraph:
Why not just tell Americans they are responsible for buying their own health insurance from now on? If people couldn’t pay for medical care, either through insurance or out of pocket, they wouldn’t get it. “After people begin to notice the growing pile of bodies by emergency room entrances,” Tom Miller wryly suggests, “they will quickly get the message and go get medical coverage.”
The solution to the problem, the article says, is in the slogan for a proposal by The New America Foundation: “Universal coverage in exchange for universal responsibility.” All of us would have to purchase our own insurance plans. The employer-provided plans would end. The problem, of course, is that even a plan covering only catastrophic expenses for a family of four might cost $3,600 annually, which is out of the reach of many low-income families. So the rest of the taxpayers would have to subsidize the purchase of these plans. We already do this now, so does anything change?
Yes, I think things would change for the better. If we could truly enforce the “universal responsibility” part of the plan — everyone has to pay his or her own way — this plan has a chance.
To Guarantee Universal Coverage, Require It
Health Insurance Required
Universal Coverage, Universal Responsibility: A Roadmap To Make Coverage Affordable For All Americans (full report)