Employer-based health insurance: a failed approach

by Phillip Blackerby on January 7, 2009 · 11 comments

in Payers

The U.S. is the only country on the planet pursuing employer-based health insurance. It was started by the labor movement as a way to increase benefits without increasing taxable wages in an era when income tax schedules were much more progressive. The U.S. was the first country to develop any mechanism for widespread health insurance, but no other country followed our now-failed model of employer-based health insurance plans.

Today, U.S. employers are at a competitive disadvantage relative to employers in other countries because of ever-rising employee health insurance costs. Virtually every other developed country taxes its citizens and businesses to subsidize health care, with modest co-payments from patients. In these countries, health care is either a citizenship right or a human right, not an employment right.

One consequence is that our manufactured goods–in particular–are relatively more expensive in international markets than comparable manufactured goods from other countries, just due to health insurance costs.

Another consequence is that U.S. residents are less-healthy than citizens in most other developing countries, and our health care costs are much higher per capita; we spend more for a lower level of health overall. In the U.S., insurance companies focus on how to off-load sick people to improve financial performance. Single-payor systems can’t off-load patients, so they soon figure out that health care prevention is cheaper than health care, and they invest significantly in preventative health care.

Employer-based health care made sense only when no other country was investing in widespread health insurance and governments were reluctant to recognize health care rights. Today, neither of these conditions exist, but we remain stuck with this failed system.

  • kflanagan

    I'd like to add that it's not just the employers that are at a disadvantage, the workers are as well.

  • TomHagan

    Other problems with emplyer-based healthcare:

    Employees are afraid to change jobs for fear of losing health insurance. This is antithetical to the “friction free ” economy advocated by the Libertarians and Free Market advocates.

    The cure for this is supposedly to mandate “portable” insurance. This will probably end employer payement for good. Imagine an employer confronted with a plethora of plans, benefit levels and carriers. An administrative nightmare, and one presenting unsolvable fairness issues due to different benefit levels. Solution: quit providing coverage.

    When you are laid off, you lose your insurance. Even if COBRA is subsidised, how can you pay anything after your income stops?

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    I could agree to most of the points you have covered in this post, I particularly liked the line, health care is either a citizenship right or a human right, not an employment right. you have really put a great effort by posting this article, just keep going like this.

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    It's really a failed approach, I don't think any employee would like to have a employer based insurance looking at the way market is moving!

  • Brad

    I compleatly agree that employer-based health insurance is a a failed approach. However, there are some factual errors in Phillip Blackerby's post that should be corrected.
    1. “It was started by the labor movement as a way to increase benefits without increasing taxable wages in an era when income tax schedules were much more progressive.” Not quite correct. It was started during World War II by Francis Perkins and Walter Reuther as a temporary measure to provide health insurance to defense plant workers and share the profits that GM and Ford were making from defense contracts. There was a wage and price freeze in effect – but GM and Ford were making record profits from their military contracts. The UAW was prohibited from asking for any wage increases, yet felt that the union members deserved something. The goverment ruled that health benefits purchased by the employer would not be considered wages, and so would be exempt from from the freeze. They would also be exempt from taxes. That was where this whole system started.

    2. ” The U.S. was the first country to develop any mechanism for widespread health insurance, but no other country followed our now-failed model of employer-based health insurance plans.” Bismark in Germany enacted compulsory employer-employee health insurance in 1884. That system has survived Germany's defeat in two wars, Post-WWII division and reunification. It has been repeatedly tweaked, but the model remains the same: employers and employees each pay half of a comunity rated premium to non-profit health insurers.

    Among the differences are that Germany has community rating, no underwriting, no pre-existing condition exclusions, compulsory purchase, extensive regulation, and non-profit insurers.

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    I'd like to add that it's not just the employers that are at a disadvantage, the workers are as well.

  • http://www.belmos.com Weight Loss Pills

    I'd like to add that it's not just the employers that are at a disadvantage, the workers are as well.

  • RichardFlemming

    Health insurance companies won't be able to off-load sick people anymore and they won't able to refuse health insurance to chronically ill people. The new passed bill will asure that health care is offered to all people with more equity than before. Hopefully all will work as planned.
    _________________________________
    PEO

  • RichardFlemming

    Health insurance companies won't be able to off-load sick people anymore and they won't able to refuse health insurance to chronically ill people. The new passed bill will asure that health care is offered to all people with more equity than before. Hopefully all will work as planned.
    _________________________________
    PEO

  • Pingback: Healthcare Reform: Universal Healthcare versus Single-Payer and the “Uniquely American” Solution (UPDATED) « The Confluence

  • msaiwn

    Another consequence is that U.S. residents are less-healthy than citizens in most other developing countries, and our health care costs are much higher per capita

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