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(Don's Report to the World)
A Modest Proposal To Promote Wellness, Save Money and Fix the Health Care System: Eliminate All Employer-Based Health Insurance (Encore)
Want to make someone groan? (Don't worry, this is not an x-rated joke or explicit set of instructions for marital happiness.) Use the cliché, "I told you so." Nobody wants to hear that. It's off-putting and it sounds like gloating.
Well, sorry but I can't help myself—I told you so! I wrote that the time had come to end employer-funded health insurance—years ago. Now, it seems others are joining my bandwagon. I'm tempted to say, graciously of course, "What took you so long, people?" Of course I won't say that.
"Stein's Law" is an economic rule, seemingly obvious, to the effect that when something can't go on forever, it will stop. Stein's Law has been invoked recently by several politicians to describe our broken, bloated medical system.
I have been vindicated. Others are urging the same fundamental change I advanced at this website. One prominent champion for a single-payer system that removes employers from the burden of providing health insurance in the physician brother of the president's chief of staff, Dr. Ezekiel J. Emanuel. Dr. Emanuel is an oncologist and medical ethicist, brother of Rahm Emanuel and the "first doctor" on the president's health policy team. In a recent book and in articles and lectures, Dr. Emanuel urges "a guaranteed health care access plan." Instead of employer plans, all Americans would receive vouchers to enroll in health plans.
In addition, Democratic Congressman John Conyers has introduced a universal healthcare bill (H.R. 676). This bill would establish a single-payer system akin to Medicare, but under a new National Health Insurance Program (NHIP). In this bill, employer-funded health insurance would end.
All of which brings us back to "I told you so." Here is my prescient rant from January 30, 2006.
As medical treatment costs rise and several once great American companies fail, in good part due to bloated employee entitlements, the popular post WW II benefit of subsidized health insurance has come under scrutiny. Scrutiny is fine and well justified. However, what is needed now is an end to scrutiny. No more time-wasting scrutiny is needed or justified. What seems abundantly clear is that employer-based health insurance, the payee for the health care of 64 percent of Americans under 65, must be eliminated. In its place, America needs a universal coverage plan. The latter should be designed to provide basic medical benefits for all, with compelling incentives for citizens to stay well in the first place.
General Motors faces a one billion dollar increase in medical costs (for a total of $7 billion) in 2006. Currently saddled with the medical bills for 1.1 million workers, retirees and family members, GM paid just under six ($5.8) billion last year for this devastating entitlement. How can GM carry such a load and still compete with Toyota and other foreign automakers with no such burden? The answer, of course, is that it can't. Neither can other US companies facing similar, if less spectacular, medical entitlement burdens compete globally with firms located in countries that offer universal medical care.
There is also the fairness question, though what seems fair, of course, depends on where you stand. Few of us can be objective about fairness if our interests are affected by the choices. Still, many might see a problem in the fact that half the tax subsidy for company-paid health insurance goes to families earning in excess of $75,000 a year; a quarter of that accrues to families with incomes over $100,000. annually. As you might expect, most (two-thirds) of the 45 million without health insurance last year (or 18 percent of the 65 and under population) made little more than the amount the federal poverty level, according to a report by the Kaiser Family Foundation.
Here are some additional facts to consider when pondering the idea that company-sponsored health insurance (in fact, medical benefit payment plans) should be eliminated by the creation of nationalized health care for all.
- 45 million Americans lack health insurance. Not everyone works at a company that subsidizes all or even part of the costs of medical care.
- Employee health insurance is subsidized by all taxpayers via tax policies. How much is this subsidy? About $130 billion--enough to buy everyone in this country a basic level of care via universal coverage.
- Medicare and Medicaid spending could also be eliminated. This would provide another $180 billion in 2010 that could be applied to an even more generous but still basic level of care for all citizens.
Of course, my idea to phase out employer-based health coverage will encounter stiff resistance from the health insurance and pharmaceutical industries. After all, these industries currently rake in billions as middlemen and middlewomen between patients and caregivers, a "service" that contributes nothing to overall care or better health status. The drug industry gave us the "Harry and Louise" campaign in 1993 -1994. These attack ads helped sink Hillary's health reform plan. I can imagine the awful things that Harry and Louse would say about me, but somebody's got to speak up. (By the way, while Hillary's plan was pretty awful, its shortcomings were not addressed in the scare-tactic "conversations" dramatized by actors who played Harry and Louise.)
Another problem with employer-sponsored medical insurance is that the subsidy promotes wasteful medical spending. The well-to-do gain low cost coverage in such high amounts that they feel entitled to a "more is better" way of thinking. This, in turn, leads to more use of the system than is usually appropriate, which, naturally, adds to the unstoppable inflation of medical costs. As often noted here and elsewhere, no nation spends as much for medical care—$5,400 per person per year a few years ago, undoubtedly much higher now.
Well, what do YOU think? Do you believe the country would be better off without employer-based health insurance for a privileged few in favor of a restructuring that grants basic medical access for all? I'd be delighted to hear from you.
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