No Revisit, This Time, On Employer-Based Health Insurance

In the earliest stages of his administration's engagement with the healthcare reform issue, President Obama made it clear that a "Canadian-type" model won't work for us, at least not now, since we are not starting from scratch.

This makes complete sense from a pragmatic perspective. If we were to try to start from scratch, the likely result would be the same 30-plus years of inaction we have already endured, with the status quo becoming worse and worse.

But, speaking from the North American summit today, President Obama made another remark that made his point on "the Canadian question" a bit clearer. He said that the reason a Canadian model won't work is that "we have an employer based system here," suggesting that he is resigned to the idea that a revisit of the employer-based insurance model is something that simply can't happen now.

This is a shame. Again, from a pragmatic perspective, he is probably correct. Any short-term effort to dismantle the system of employer-based coverage would almost surely be doomed to fail. Not the least among the reasons for this is the level of influence that industries vested in the status quo appear to have on our legislators.

But I hope the administration and its supporters do not lose sight of a revisit of employer-based coverage as a longer-term issue, because I believe that the employer-based model is the single biggest flaw in our current system.

Within the rest of the industrialized world, the employer-based system is truly an oddity. It is a remnant of the so-called "Gilded Age" in the United States, which on one hand is famous for the prosperity achieved by the few but on the other for the abuses of workers that were permitted by a hands-off government.

The fundamental flaw of employer-based healthcare is this: everything can be hunky-dory for your regular checkups, treatment of mild chronic illness, and so on, until you either get very sick, change jobs, or lose your job. When you don't need your health plan all that much, everything is fine. But when you get sick enough to REALLY need your health plan, chances are you will lose it, because you may also be too sick to work and, as a result, will lose your job.

This flaw in the model is so basic and obvious that it goes beyond illogic and into the territory of absurdity and insanity. I challenge anyone to persuade me otherwise with a cogent argument for why this model makes sense.

But until then, I can only conclude that there will be no meaningful healthcare reform until the employer-based model is either replaced entirely or supplemented with a viable, robust system of backup coverage for those who lose their employer-based coverage due to illness, economics, or other reasons. Sphere: Related Content