Why should your employer have any say whatsoever about how you manage your reproductive health? Why? Can you think of one good reason? Your employer, of all people, influencing the most intimate decisions in your life -- could anything be more ridiculous?
Because it's all we have ever known in the U.S., we Americans think it normal for employers to be enmeshed in the provision of health care for their employees.
Few realize that this arrangement is both unique and absurd in comparison with other industrialized countries, where employers have absolutely nothing to do with health care. Nothing. Nada. Zip. Zero. Abroad, nationally funded programs enable private doctors and hospitals to care for one and all, unfettered by what any employer does or does not like -- just like Medicare, the most popular and cost-effective health care program in America.
People who feel insulted by the notion of the U.S. following anybody else's lead are quick to bad-mouth the national health programs elsewhere. And while one can find something to criticize about any of them, the fact is that they produce healthier citizens than our way does -- by a long shot.
The New England Journal of Medicine shows Americans floundering around in 37th place in terms of health status (e.g., mortality, life expectancy). Did you get that? Thirty-seventh place. Despite spending nearly twice as much per-person as the next most-costly nation's program.
Let's review the reasons why it is time to sever the connection between employers and health care.
First, the connection was simply an accident of history, rather than a carefully designed arrangement to provide the most cost-effective care possible for Americans. In the race to secure scarce labor right after World War II, employers (who were constrained by wage and price controls) offered health coverage as a fringe-benefit inducement for new hires. Our whole messy, expensive, ineffectual system evolved mindlessly forward from that moment.
Second, employers are burdened not only by paying for employees' health care but in maintaining the internal bureaucracy to manage those benefits. U.S. employers find it increasingly difficult to compete with non-U.S. companies because of the financial burden of covering employees' health -- even after their retirement, in many cases. What is more, the issue of health care coverage is a perennial aggravation to both employers and labor unions as they negotiate appropriate compensation; this bone of contention simply need not exist.
Third, the scattergun array of private payers who administer employers' coverage has failed miserably in their half-hearted efforts to bring sanity to their reimbursement policies. No wonder. When presenting a cost-saving idea to the medical director of one of the two largest private health insurers in the country, I was told bluntly and without embarrassment that saving money was not a concern of theirs, as they simply pass increasing costs along to the employers (and their co-paying employees) as increased premiums. They largely shell out whatever providers put on the bill, irrespective of the value any particular procedure or medication might have in restoring the patient's health.
By contrast, Medicare conducts extensive clinical research on the most cost-effective actions and tailors reimbursement accordingly. And what some call "Obamacare" is boosting this research dramatically. Medicare's purchasing power has proved to be vastly more effective in restraining costs than the feeble and inconsistent efforts of private payers, most of whom eventually just fall into line behind whatever Medicare is doing. If all they are doing is mimicking Medicare while adding costs as a for-profit middleman, why do we need them?
Fourth, if anyone still doubts the idiocy of the U.S. practice of issuing health care coverage through employers, these past days surely must have banished their doubts for good. While other industrialized countries serenely offer pre-paid healthcare for all their citizens irrespective of employment, we find ourselves the laughingstock of the world as we bicker over whether employees of Roman Catholic organizations can be denied employer-sponsored coverage for contraception.
And now, to make the matter even more ridiculous, Congress may soon be voting on a proposal to let any employer restrict any facet of coverage that doesn't happen to fit that employer's own idiosyncratic sense of morality and ethics. Where will this deepening entanglement of bosses with their employees' health matters ever end? And why would we even perpetuate it, let alone exacerbate the problem?
I have been an employer, and I can tell you that employers already have enough to worry about: solvency and profitability, competition, workforce capabilities, innovation, markets, product safety, and legitimate governmental protections like OSHA. Can't you just imagine the coast-to-coast whoosh of relief if employers awoke one morning to find the whole health care mishegas gone forever from their To-Do list?
And can't you just imagine the coast-to-coast whoosh of relief if the unemployed and the about-to-be unemployed all awoke that morning to find themselves members of Medicare for All? That's actually the best reason of all. No more terror of falling out of a job and into medical bankruptcy. No more being reduced to medical beggars cringing hopefully at the door of the Emergency Room. And for the employed, no more revealing your most sensitive medical situations to a fellow employee in the H.R. department as you grope for a pathway forward through the confusing coverages.
To be sure, Medicare for All means that some taxpayers will find their tax dollars supporting particular health care activities they may deplore (e.g., contraception).
But we citizens already do underwrite all manner of expenditures, from health care to warfare, that include elements certain individuals may personally object to. It's called democratic majority rule. Who better to define health care benefits for American citizens -- the American citizens themselves or their employers?
Americans on Medicare love it. Let's share those benefits with all Americans, and get a grip on runaway costs at the same time.
Why wouldn't we?
(For more on Medicare for All, check out http://www.medicareforall.org.)
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What now? Should we struggle on with a payment system that was adopted in the 1950s to compensate for wage and price controls? Or should we recognize that the situation is different, and develop a rational system for providing a decent life to all in view of the great leaps government sponsored and private research has made in all aspects of medical practice?
We have the examples of at least 37 national-health systems that produce better outcomes than ours. If it weren't for the PAC-sponsored hysteria defending profiteering and obstructing progress, we could already have had a solid system in place for almost 20 years. Maybe even the Nixon system--forty years.
folks with no insurance get care, folks with insurance get care....
anyone can go to the er....
i am one employer that wishes i didnt have to pay for it though, let 300 million consumers do that with whatever company they want to.
Second, the author alleges we are the laughingstock of the world over the contraception controversy. The only reason that would be the case is that the rest of the world does not have the history of freedom of religion in the constitutions as we have here and they therefore cannot appreciate the depth of the issue. It is not about contraception, but about freedom from government interference in religion. If an employer wants to provide a benefit that does not violate its beliefs, the government does not have the right to force them to provide the service. That is unique to the US.
Aside from the fact that the current system is grossly inefficient and unfair, it is probably unsustainable in the long run. We don't cover enough of the population and the cost are becoming unmanageable. The current economic situation has highlighted the fact that when a person loses their job, they also lose their health coverage. Large groups of uninsured citizens only drives costs up that much more. Is this really a sensible outcome?
Sure, a large section of the population sees this as government control of a liberty, but common sense needs to intervene here. Health care cost are causing many companies to be uncompetetive world-wide and that cost is continually going up. The only solution left to us may be total government-run healthcare. Necessity will ultimately lead us to that end.
We actually cover the vast majority of the population, about 85% (and BTW studies indicate that most of those are happy with the care they get). If you factor out illegals (included in the studies that say 85% are covered), young people who willfully opt out, and people who are without health insurance only temporarily, the figure of those covered is much higher.
The bottom line is that the vast majority of Americans have health insurance and are pretty happy with it. They are not happy with rising costs which needs to be addressed, but they tend to happy with the care.
Much like our education system, what you put into the system determines what you get out of it. We do run behind the world in many statistics regarding health, but medicare is not going to fix that either. Believe me when I say we do need to work to get everyone covered. We can't afford the young single person who doesn't pay into the system and then wants the coverage once they are sick.
I give the author credit for some good ideas, but we dont need more politics and the whim of the party in power to control the healthcare more than it is.Let's fix medicare long term before we expand it.
Exactly--universal health care would be the biggest job stimulus bill ever, leveling the playing field between small and large businesses and making US businesses more globally competitive. Too bad the politicians cannot see this. Even the big corporate donors cannot see this.
The COST of healthcare will not change -- If anything it will increase -- If for no other reason than 30 Million new insureds will enter the picture who are most likely not going to contribute to the cost -- Passing the cost right back to those who can not see the faulty vision.
But I'll wager we have the most profitable system. We Americans measure everything in dollars and cents, you know.
"-- just like Medicare, the most popular and cost-effective health care program in America... the scattergun array of private payers who administer employers' coverage has failed miserably in their half-hearted efforts to bring sanity to their reimbursement policies.. By contrast, Medicare conducts extensive clinical research on the most cost-effective actions and tailors reimbursement accordingly... Medicare's purchasing power... Americans on Medicare love it..."
You use Medicare a lot to argue that employers shouldn't be involved in health care insurance. Maybe or maybe not. I've bought my own for years so don't care. But if Medicare is your proofpoint, go back and check your facts. About 50% of the people on Medicare get their main health care insurance from their former employer. Ususally the employer requires the retiree or disabled former employer sign up for Medicare but the employer (or union) provides the main protection (because Medicare is terrible insurance and do not protect against medical catastrophe). Another 25% of opted for Medicare Part C, which Medicare describes as a "private option." 15% buy supplemental insurance to make up for the problems with Medicare. Less than 10% of us on Medicare love it enough to depend on it.
In addition, Medicare is administered by a "scattergun array" of private insurers.
Also, the employer does NOT mandate that the employee take Medicare, the Government does. The rest of the numbers you are pulling out of your nether regions.
First reaction was not to respond to your ignorant statement but just in case anyone reads this in the future, I never said anything about COBRA. 50% of seniors get their healthcare insurance from their former employers as a benefit of their former employment there, not because they were laid off. You really need to think before you comment