Hillary Clinton defended the Affordable Care Act in the most recent debate as being a good system that shouldn’t be “dismantled” by offering single-payer insurance to all Americans.
First, an aside: Medicare as it is now configured works through for-profit insurance companies. Extending Medicare to everyone as Bernie Sanders has suggested would not necessarily mean the end of all those insurance companies; it would just mean extending the Medicare bureaucracy to everyone. As far as bureaucracy goes, however, it’s one of the most efficient and competent in our (lousy) U.S. federal system of healthcare delivery.
Back to employer-provided health insurance. This system evolved to fill a vacuum. It was demanded by labor unions and extended to many salaried employees as a “fringe benefit” at a time when employers were competing for “good people” to hire. So-called “fringe” benefits, especially for management, evolved in the 1950s-1970s when the tax rate on top wage earners was high, and mere salary increases didn’t mean as much to an executive’s pocket as health insurance and other fringe benefits (such as, in the case of the top salaries, country club memberships).
Unions have very little power anymore, even in industries where they predominate. And the employment market for all positions, from lowest paid wage earner to highest paid executive or professional, is a hirer’s market. Employers no longer feel compelled to compete with benefit packages the way they used to (back when Hillary and I graduated from college.) They no longer feel that they have to compete with good salaries and wages either. That’s a larger issue that is at the base of this problem: The system is rigged against working people, whether they earn an hourly wage or a monthly salary.
Today, even with the Affordable Care Act, employers are NOT providing the kind of coverage they did when health insurance was a vital part of the employment package. Self-insured employers don’t even have to abide by the requirement to refund excess premiums. And while insurance companies can no longer cancel coverage for “pre-existing conditions,” that has not stopped them from putting extraordinary pressure on employers to find a reason to fire employees who run up high medical bills. Not only was I warned about that by an agent for one of the health insurance companies, I have relatives who have lost their jobs for that very reason.
The agent actually quit the company he was working for and is now an independent agent, helping people choose from among the many Medicare plans. The way it works, he said, is that when someone gets cancer or some other very expensive medical condition, they should brace themselves for the possibility of losing their job. The possibility can be the worst for people whose family members have high medical costs, because then the employer is less vulnerable to accusations of discriminating against someone for being sick.
The Family and Medical Leave Act was supposed to bar employers from firing someone because they got sick. But it is quite easy in most states to fire someone for a trumped up reason, or no reason at all, in so-called “at will” states. After my son-in-law came back from paternity leave and a bout with Crohn’s Disease, his supervisor had to search way back for a flimsy reason to fire him. If it had been “for cause,” the employer could have fought to deny paying him unemployment, but they did not. Because if the case had come to anyone’s attention in government, the employer would have been vulnerable to a charge of discrimination under FMLA. Any time unemployment insurance is cheaper than health insurance, you are vulnerable to a layoff or “at will” loss of job because of medical costs.
Let’s be blunt: Employer-provided health insurance only works for people who are employed, and only then for those who are employed by employers who welcome ways to treat their employees fairly. And even then, the insurance companies (or managers of insurance, in the case of self-insured employers) pressure employers to reduce costs by firing people.
Health insurance should not be tied to employability. Those people who are not employed (and their families) may be the very ones most in need of good medical care. Why is that so hard to understand?
Access to medical care should not depend on your income or your job or that of your spouse or parent or guardian. That is the primary point of health care for all. Any company — employer or insurance company or pharmaceutical corporation — that would argue against that point is making greed more important than life.
Gandhi's Seven Sins: Wealth without work; Pleasure without conscience; Knowledge without character; Commerce without morality; Science without humanity; Worship without sacrifice; Politics without principle.