Could the continuing back-and-forth over contraception as an insurance benefit actually be an opportunity for consensus? Consider this outrageous idea: Neither government nor our employer ought to be responsible for our health care decisions. We can make our own, thank you.
That idea, though, would mean reversing the country’s biggest health care mistake, basing our insurance coverage on our jobs.
Less than two-thirds of all workers now have access to employer-based health care and that number has been in decline, especially for lower-income workers. Already small businesses are less likely to offer such plans and increasing insurance costs are clearly a competitive drag on business. General Motors spends roughly $5 billion covering more than a million employees and former employees.
The U.S. Chamber of Commerce calls health care the most expensive benefit paid by employers. One study by the Rand Corporation found that companies providing generous health care benefits grew less than their competitors in Canada, where the government pays for that health care.
But it’s not just the money. The amount of time a company spends on judging insurance plans, negotiating rates, and informing employees about changes every year, could be better spent on just about anything else. And from the employee point of view, we don’t get a lot of choice about what kind of health care plan we want.
The insurance menu is limited by the employer. (Talk about changing doctors: When a company changes carriers, it’s goodbye to the family practice where you’ve been going for years.) And that doesn’t even account for the many Americans who are tied to a job only because of a company’s health care benefit.
The conservative message should be clear. If you believe in a market-based system, then the individual, not the company (or a church organization), should be making decisions about their own health care needs.
Democrats have been clinging to the current system, in part, because labor unions have fought so hard to win health care benefits for workers. Giving up those employee benefits now would seem like a retreat. But the nature of work is changing. More of us work at home and some of us are even excited about the prospect of buying our own plan on the open market when the insurance exchanges begin in 2014.
How do you make the practical transition away from an employer-based system? Here is one idea: Give corporate America incentives and a deadline on when health benefits will no longer be eligible for a tax deduction. Then, as a transition, pick a year where every employee in America gets a “raise” equal to the amount that’s already paid in health care benefits. From then on health insurance would be an individual purchase, not an employment benefit.
The Affordable Care Act already provides a mechanism for health care insurance for lower-income Americans, so this could be the plan for everybody else.
Extricating ourselves from a historical mistake is a simply a problem to be solved. Shifting insurance to the individual could lift a burden from corporate America — and make it easier for all of us to buy health insurance at a reasonable price. Then we the consumers would have the power to pick contraception or any other benefit we think important without oversight from either our boss or the government. We’d be free to choose.
The writer was a Kaiser Family Foundation fellow on health care reform during much of the debate on the Affordable Care Act.