Employer-based health care is a fine system — if you have an employer. And no pandemic. And an administration that is actually interested in the health of Americans.
Alas, COVID-19 has exposed the gaping holes in the United States’ nonsensical health care system.
Roughly 50 percent of Americans receive health insurance through employer-provided plans. And most of them like it. The company negotiates for group plans that reputedly hold down costs, and employees go to the doctor and pay a nominal fee when they get sick.
According to a survey last year by America’s Health Insurance Plans, 71 percent of those on employer-based insurance say they are satisfied. We won’t go so far as to call AHIP “the trade group for the bloodsuckers in America’s health insurance industry,” like an article in The New Republic did, but the organization does have a dog in the fight. So you can take the survey however you like.
The problem is that, like everything else, that employer-based system is being upended by the coronavirus. The Kaiser Family Foundation estimates that nearly 30 million Americans have lost job-based insurance in the wake of the pandemic because, well, when you or your parents don’t have a job, you don’t have job-based insurance.
In Washington, the Office of Financial Management estimated that 272,900 people lost insurance between March 15 and April 18, increasing the uninsured rate to more than 10 percent of the population. And this is in a state that cares about people’s health.
Nationally, about half of those who lost insurance are eligible for Medicaid or the Children’s Health Insurance Program; about one-third are eligible for subsidized plans under the Affordable Care Act. But, according to the Kaiser Family Foundation, the rest are out of luck because they live in a state that did not expand Medicaid under the Affordable Care Act (Washington and other “blue” states expanded it), and because they are ineligible for other subsidized programs.
So, at a time when we most need health care, fewer people have access to it. That is not an effective path for keeping the virus in check.
It didn’t have to be this way, and the story of employer-based health insurance is one of unintended consequences tracing back to World War II. As The New York Times explains, “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.”
So, President Franklin D. Roosevelt issued Executive Order 9250, which established the Office of Economic Stabilization and froze wages. With businesses unable to offer higher pay to attract workers, they started offering benefits.
Some might argue that our convoluted health care system is the result of government interfering with the free market by freezing wages. They would be right. But that does not absolve us of fixing the mess. And it doesn’t absolve Congress and the Trump administration from their duty.
Instead, the White House argued again last week in favor of overturning the Affordable Care Act. A brief filed by the administration in support of a lawsuit against Obamacare “manages to be both mind-numbingly dumb and completely terrifying,” health care expert Christen Linke Young of the Brookings Institution tweeted.
Which means it meshes with Republicans’ traditional approach to health care. As Michael Hiltzik writes for The Los Angeles Times, “The party doesn’t see health as a communal good, but merely something to be endowed upon those who can afford it; all others be damned.”
Whether or not you agree with that philosophy, it seems that trying to eliminate health insurance for 23 million Americans in the middle of a pandemic is particularly callous. And it seems that there are better ways for cultivating the communal good that is health care.
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