Connecting More Dots

I’ve often argued that universal healthcare–Medicare for All–would spark an outpouring of entrepreneurship. If you want to open a shop, or go into the widget-making business, one significant barrier to doing so is the need to offer (very expensive) health insurance to your employees. Of course, you could decide not to provide that benefit, but you wouldn’t be very competitive in the market for good workers.

I understand, dimly, the historical reasons why the U.S. linked employment to health care, but it has always seemed to be a bad idea. What about people who don’t/can’t work? What about independent contractors? Why should an employer have to assume the costs–and risks–of employees’ health? Other countries do not couple jobs and insurance in this way–health insurance is provided as part of the social safety net, and the costs are spread much more widely.

Yesterday, in a Facebook post, a friend of mine explained why medical insurance provided through government–decoupled from employment–would boost the economy and make American businesses more competitive.

As he noted in his post, when you buy a product, all the costs of creating that product are reflected in the price: production, workers’ wages and benefits, materials. Most of the nations with whom we trade big-ticket items have had government-sponsored health care for decades, and at far lower cost. As a result, Saab and Mercedes, among others, are able to compete unfairly with American-made autos whose prices include a hefty private-sector health care premium. (I’ve seen numbers suggesting that this was one of the reasons GM and Chrysler went bankrupt; healthcare coverage for current and retired employees added over 2000 to the average price of their cars.)

If we really cared about keeping U.S. businesses competitive–and the health insurance system comprehensible–we’d have Medicare for All, or at least for anyone who wanted it.  Given our political environment, and the lobbying clout of Big Insurance and Big Pharma, that was never in the cards.

Obamacare was (barely) politically feasible because it was originally the Republican alternative. With all its warts, it’s a step in the right direction, but if we want America to remain competitive,  we will eventually need to separate access to health insurance from the vagaries of employment.


    When I was young and in my first njob, my employer paid for my health ins AND I paid for my own blue cross / blue shield. After a car wreck requiring a brief hospital stay and some plastic surgery to put my nose back on, I had NO BILLS to pay. Amazing lesson
    In the states where the government is working AGAINS the ACA, I think the Federal government
    should just open up Medicare to any person so impacted by their governor.
    The state of IN won’t participate in ACA: Come to us and join Medicare.
    Problem solved
    If I remember the numbers right, GM & Ford save about $2,500 per car they assemble in Ontario rather than Detroit. ALL of that due to Health Ins Costs.
    Want the JOBS Back? Medicare for all

  2. Once the public gets a taste of the ACA, they may discover that things could be a lot better for them and for business if we had Medicare for everyone. And we will join the civilized world. First we have to get rid of some of the Congressional crazies.

  3. Let’s not even add the travesty that is dental insurance. I have terrible teeth, and sought for a long time dental insurance. I found that for about $500-1,000 annually, they will only cover a couple cleanings (maybe an X-ray) and at best a filling or two. If you are unfortunate enough to need more advanced care, you’re SOL. It’s a nightmare. I wish they would have addressed dental insurance in the Affordable Care Act. In the meantime, if you’ve got great teeth be glad, if you don’t have great teeth… I don’t know what to say (the VA recommends Vicodin for the pain– as they don’t cover teeth unless your teeth were injured during service– other places just say they’re sorry and can’t help).

    Sorry for the digression, it’s my problem du jour.

  4. Great idea, PatMcC! Let people in nonparticipating states into Medicare. That would get them on board fast. Even if the Medicare eligibility age had been lowered to 55, so many jobs would have opened up. My husband and I let all our employees go through attrition over a dozen years or so because of unaffordable insurance costs. Now we exclusively use subcontractors. Last year, our Anthem BCBS group policy for the two of us was about $2200 per month, a real profit-killer. Next year, we’ll have almost the identical Anthem policy through the exchange for a fraction of that. What will we do with the savings? Pay down debt and purchase new equipment. Why does that logic escape the GOP? What is so scary about good government?

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