Advocates of private, profit making health insurance say we should leave it to employers to provide the needed insurance for health care. Few advocates of private employer provided insurance, however, fail to mention the fact the employer will not provide insurance when they leave the company. That makes the employer provided health insurance a snare, a trap, a form of enslavement for the benefit.
The moral reality is health care is a right, versus the current state as a privilege.
"Enslavement by Health Insurance"
By: Richard Amerling, MD 30 August 2010
https://aapsonline.org/enslavement-by-health-insurance-2/
"“You load sixteen tons, what do you get,
another day older and deeper in debt,
Saint Peter don’t you call me ’cause I can’t go,
I owe my soul to the company store”
—-“Sixteen Tons” Merle Travis
According to Wikipedia, the “company store” in this classic country song refers to the “truck system” where employees are paid in substitute currency, known as “scrip.” This limits employees’ ability to choose how to spend earnings, generally to the benefit of the employer. In closed economic systems, such as existed in various mining towns, workers had little choice but to buy from the company store, which often led to significant indebtedness, limiting their ability to leave the system. This created a form of indentured servitude, prompting legislation that made payment in other than legal tender illegal."
Servitude for health care insurance.
"Since insurance is “in kind” payment in lieu of wages, it sustains the illusion that “someone other than you” is paying for your medical care and creates an incentive to use the benefits. Along with low-deductible, “first dollar” coverage, this clearly led to overutilization of health care services, which drove up both prices for services and insurance premiums. Most people are unaware of how much their insurance costs. It is probably between $10-20,000 per year. This money would be added to your paycheck, taxable, if there was no insurance provided. When your employer deducts money from your paycheck for premiums, what they are really doing is shifting wages into non-wage benefits. Assuming you are healthy and don’t use much health care, this is a bad deal financially and leaves you poorer."
How health insurance can work if we allow if people get a fair pay check . . . BETTER!
"Imagine how transformed the landscape would be if individuals purchased their own health insurance (as we do for all other types of insurance). As proposed by George W. Bush and others, this could be done immediately and painlessly by transferring the tax break on health insurance from the employer to the individual. A competitive market for individual health insurance policies would spring up overnight. The majority of consumers would likely prefer a high-deductible policy to cover against a significant illness, coupled with a Health Savings Account, from which routine care could be financed. Groups could form to enhance purchasing power, and to cover those with significant pre-existing conditions.
According to 2008 Census data, of 45.6 million uninsured, 32.1 million earned over $25,000 per year (including 9.1 million earning over $75,000). Many of these people chose not to buy health insurance, seeing it as the bad deal it is. Many would likely buy a catastrophic policy were one available. Far from being unable to get care, they can freely choose any physician they like and pay cash. In many ways they enjoy more freedom than the 200 million covered by private insurance and the 87.4 million covered by government insurance. Too bad we will all soon be enslaved under ObamaCare, and will “owe our soul” to the federal government."
"The Price of Life: From Slavery to Corporate Life Insurance"
"Coal embodies capitalism’s most telling paradox: that the most lucrative industries are often the most dangerous. And from the days of slavery to the present, corporations have found ways to profit from the resulting deaths."
Michael Ralph Spring 2017
https://www.dissentmagazine.org/article/price-life-coal-slavery-corporate-life-insurance
"Donald Trump became the forty-fifth president of the United States in part based on the claim that he would restore jobs by reviving the nation’s coal industry. But coal embodies capitalism’s most telling paradox: that the most lucrative industries are often the most dangerous. From the time it was first discovered in the United States in 1701 in Chesterfield County, Virginia, coal promised to revolutionize the world of energy and transportation. Yet, coal is responsible for untold damage to the environment and has led to the exploitation of workers—as laborers and assets—stretching back to the age of legalized slavery."
Slaves first, then free men were coal miners needing protection. But coal companies never really protected their miners, never.
"What Percent of Health Insurance is Paid by Employers?"
Christina Merhar 8 Nov 2018
https://www.peoplekeep.com/blog/what-percent-of-health-insurance-is-paid-by-employers
Yes, employers contributions reduce the cost, but, often, the employer provided insurance plan gives us things we do not need, or do not give us what we want. We take it, or we leave it. We pay for everything in the plan no matter what.
"The Real Reason the U.S. Has Employer-Sponsored Health Insurance"
By Aaron E. Carroll Sept. 5, 2017
"The basic structure of the American health care system, in which most people have private insurance through their jobs, might seem historically inevitable, consistent with the capitalistic, individualist ethos of the nation.
In truth, it was hardly preordained. In fact, the system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. Unfortunately, what made sense then may not make as much right now.
Well into the 20th century, there just wasn’t much need for health insurance. There wasn’t much health care to buy. But as doctors and hospitals learned how to do more, there was real money to be made. In 1929, a bunch of hospitals in Texas joined up and formed an insurance plan called Blue Cross to help people buy their services. Doctors didn’t like the idea of hospitals being in charge, so some in California created their own plan in 1939, which they called Blue Shield. As the plans spread, many would purchase Blue Cross for hospital services, and Blue Shield for physician services, until they merged to form Blue Cross and Blue Shield in 1982.
Most insurance in the first half of the 20th century was bought privately, but few people wanted it. Things changed during World War II.
In 1942, with so many eligible workers diverted to military service, the nation was facing a severe labor shortage. Economists feared that businesses would keep raising salaries to compete for workers, and that inflation would spiral out of control as the country came out of the Depression. To prevent this, President Roosevelt signed Executive Order 9250, establishing the Office of Economic Stabilization.
This froze wages. Businesses were not allowed to raise pay to attract workers.
Businesses were smart, though, and instead they began to use benefits to compete. Specifically, to offer more, and more generous, health care insurance.
Then, in 1943, the Internal Revenue Service decided that employer-based health insurance should be exempt from taxation. This made it cheaper to get health insurance through a job than by other means.
After World War II, Europe was devastated. As countries began to regroup and decide how they might provide health care to their citizens, often government was the only entity capable of doing so, with businesses and economies in ruin. The United States was in a completely different situation. Its economy was booming, and industry was more than happy to provide health care.
This didn’t stop President Truman from considering and promoting a national health care system in 1945. This idea had a fair amount of public support, but business, in the form of the Chamber of Commerce, opposed it. So did the American Hospital Association and American Medical Association. Even many unions did, having spent so much political capital fighting for insurance benefits for their members. Confronted by such opposition from all sides, national health insurance failed — for not the first or last time.
In 1940, about 9 percent of Americans had some form of health insurance. By 1950, more than 50 percent did. By 1960, more than two-thirds did.
One effect of this system is job lock. People become dependent on their employment for their health insurance, and they are loath to leave their jobs, even when doing so might make their lives better. They are afraid that market exchange coverage might not be as good as what they have (and they’re most likely right). They’re afraid if they retire, Medicare won’t be as good (they’re right, too). They’re afraid that if the Affordable Care Act is repealed, they might not be able to find affordable insurance at all.
This system is expensive. The single largest tax expenditure in the United States is for employer-based health insurance. It’s even more than the mortgage interest deduction. In 2017, this exclusion cost the federal government about $260 billion in lost income and payroll taxes. This is significantly more than the cost of the Affordable Care Act each year.
This system is regressive. The tax break for employer-sponsored health insurance is worth more to people making a lot of money than people making little. Let’s take a hypothetical married pediatrician with a couple of children living in Indiana who makes $125,000 (which is below average). Let’s also assume his family insurance plan costs $15,000 (which is below average as well).
The tax break the family would get for insurance is worth over $6,200. That’s far more than a similar-earning family would get in terms of a subsidy on the exchanges. The tax break alone could fund about two people on Medicaid. Moreover, the more one makes, the more one saves at the expense of more spending by the government. The less one makes, the less of a benefit one receives.
The system also induces people to spend more money on health insurance than other things, most likely increasing overall health care spending. This includes less employer spending on wages, and as health insurance premiums have increased sharply in the last 15 years or so, wages have been rather flat. Many economists believe that employer-sponsored health insurance is hurting Americans’ paychecks.
There are other countries with private insurance systems, but none that rely so heavily on employer-sponsored insurance. There are almost no economists I can think of who wouldn’t favor decoupling insurance from employment. There are any number of ways to do so. One, beloved by wonks, was a bipartisan plan proposed by Senators Ron Wyden, a Democrat, and Robert Bennett, a Republican, in 2007. Known as the Healthy Americans Act, it would have transitioned everyone from employer-sponsored health insurance to insurance exchanges modeled on the Federal Employees Health Benefits Program.
Employers would not have provided insurance. They would have collected taxes from employees and passed these onto the government to pay for plans. Everyone, regardless of employment, would have qualified for standard deductions to help pay for insurance. Employers would have been required to increases wages over two years equal to what had been shunted into insurance. Those at the low end of the socio-economic spectrum would have qualified for further premium help.
This isn’t too different from the insurance exchanges we see now, writ large, for everyone. One can imagine that such a program could have also eventually replaced Medicaid and Medicare.
There was a time when such a plan, being universal, would have pleased progressives. Because it could potentially phase out government programs like Medicaid and Medicare, it would have pleased conservatives. When first introduced in 2007, it had the sponsorship of nine Republican senators, seven Democrats and one independent. Such bipartisan efforts seem a thing of the past.
We could also shift away from an employer-sponsored system by allowing people to buy into our single-payer system, Medicare. That comes with its own problems, as The Upshot’s Margot Sanger-Katz has written. She also has covered the issues of shifting to a single-payer system more quickly.
It’s important to point out that neither of these options has anything even close to bipartisan support.
Without much pressure for change, it’s likely the American employer-based system is here to stay. Even the Affordable Care Act did its best not to disrupt that market. While the system is far from ideal, Americans seem to prefer the devil they know to pretty much anything else."
Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. Follow him on Twitter at @aaronecarroll. His coming book, The Bad Food Bible, will be published on Nov. 7.
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