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Why Should Employers Control Health Care Benefits?

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?
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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