With the center-right dialogue going on at the Sacramento Bee Crossroads/Healthcare blog, moderator Daniel Weintraub invited participants to critique employer-based healthcare. He got several folks to weigh in, and then added another jab of his own recently.
The conversation sounded a little like the great Yankee catcher and policy wonk Yogi Berra, who said of a local restaurant, “nobody goes there anymore, it’s too crowded.” The employer-based system, for all its flaws (and there are many–more later), does cover almost 19 million Californians, more than half of the population. I prefer and strongly advocate for a universal system, like SB840(Kuehl) or Medicare for all, but it seems important that reformers also should be mindful that many consumers want to protect the coverage they have now. It’s worth noting that several other European countries with universal systems rely on some form of employer-based coverage.
Employer-based coverage does three things well:
1) It is the system we have now, so people are familiar with it.
2) It captures the financing of employers and brings those funds into the mix, alongside taxpayer-generated funds.
3) It pools people together to share the risk and cost of health care, to better negotiate for the best price, and to allow us to broaden the risk so that when I have a major emergency, I don’t have to face that burden alone.
#3 is the core value, and this is common to group coverage, whether through public insurance programs or employer-based coverage. As a group, it is harder for insurer to try to pick us apart based on our age, gender, geography, or health status, to deny anyone of us health coverage, or to charge discriminatory rates.
But like the popular restaurant, now we seem to have many proposals that includes at least the concept of an employer mandate. Why? Because it makes sense to build on what works in the health care system. And when you are looking for money in the system, it makes the most sense to see if everybody is paying their fair share. We all pay more if some pay less, including employers that don’t provide health coverage to their workers.
SB2 and some of the current prosposals try to deal with the issues of group coverage through employers. Many “pay-or-play” models offer employers the ability to choose to join an even bigger pool, which for smaller employers would likely provide more choices for their workers, and remove the burden of administering the benefit. Having a statewide insurance plan that workers are in (like a CALPERS or Healthy Families) would also provide more opportunities for portability, allowing a person to keep coverage when switching jobs.
Let me be clear: it order for this to work, the employer requirement can’t be simply a token amount, such as the $295/worker that the Massachusetts plan imposes. It really needs to set a standard for on-the-job benefits, much like the minimum wage does for pay. If there is an amount required, it needs to be similar to the actual amount it would cost to insure their workforce. Otherwise, the system doesn’t work. That’s one of the things we’ll be looking for in the various proposals for next year.
Watch for other Yogi lessons soon…