On the Profoundly Ironic Illogic of Screaming “Keep Your Government Hands Off My Healthcare!”

When a system has been in place throughout your entire nation since well before you were born, it’s easy to make the conclusion--unwarranted, given a lack of exploration of the evidence--that it's normal and that it makes sense. So it is, it seems, with the opinion of many Americans about our employer-based healthcare system, which is anything but normal among the major economies of the Western world.

It is a natural human phenomenon, one of the faults in our cognitive wiring. Thinking that “the way it’s always been” is normal and sensible is no different than a child who is just beginning to become aware of foreign languages refer to his or her own native tongue as “normal talk.”

To those who, at town hall meetings, are screaming “KEEP YOUR GOVERNMENT HANDS OFF MY HEALTHCARE,” or brandishing signs with similar messages of indignant protest, I would ask you to take a close, critical look at one very fundamental but largely ignored question.

To indulge, for the sake of argument, in some phraseology that might among some readers get my non-party-affiliated, more-or-less centrist self branded as a lot more Lefty than I in fact really am, I would like to ask: why in the WORLD, out of all the scenarios one could possibly envision, would you want your EMPLOYER’S bottom-line-driven hands on your healthcare?

If you are concerned about a government healthcare plan infringing upon your privacy and your constitutional rights to life, liberty, and the pursuit of happiness, I would suggest taking a closer look at whether you might be much more vulnerable to abuses in those areas from your employer.

The right to privacy is all but non-existent in a workplace setting. Once you cross the threshold of your office building, you waive, by implied contract, many of the rights and protections you enjoy when you are out in public. Your employer can archive your e-mails and read them if they wish. Your employer can monitor your activities with hidden cameras, without your knowledge. Your telephone calls "may be recorded for training and quality assurance purposes." And your employer, of course, is involved much more intimately in your daily life than the government could ever be, unless, perhaps, you work for the government.

The potential for abuse may be greatest in small-to-midsize companies, in which the administrative infrastructure for ensuring the protection of employee rights to privacy and non-discrimination may be non-existent, as may the checks and balances to prevent personal and private information from getting into the wrong hands and being misused.

Here is just one of many scenarios. Imagine you work for a small firm of about 25 people, in which, as is often the case in small offices, there is virtually no privacy, and everyone pretty much knows everyone else’s business.

Let's suppose, further, that you or a dependent covered under your plan have had a serious, chronic illness that will require very expensive treatment for some time to come. And everyone in the office knows it, from the owner of the company right down to the guy who comes in to empty the trash at night.

And suppose, for the two years running during which this illness has been an issue, your company's health insurance provider has hit your company with a hefty increase in premiums. In a small office, it wouldn't be hard for the owner, or the operations or HR manager, or whoever else might be responsible for benefits, to put two and two together and figure out just what might be playing an important role in the increasing costs.

And finally, imagine that, after years of glowing performance evaluations, the boss suddenly becomes concerned about some previously undiscussed flaws in your performance, and dismisses you for cause -- or, even more stealthily, promotes you to be head of a new department and then, not long afterward, decides that the new department no longer fits the corporate strategy, eliminates the department and, by extension, the need for your job.

Illegal? Yes. But also difficult, if not virtually impossible, to prove. And even if you could prove it, doing something about it would be very costly--both monetarily and, quite possibly, professionally. Most employees, particularly in small communities, or in smaller industries in which managers in competing companies tend to know one another, would likely rather move on than risk the possible stigma that can follow someone who has sued a prior employer.

Do you think this scenario is unlikely? I don't. I'm sure it plays out in various permutations and combinations all the time, all over the U.S., with its wonderful, employer-based healthcare system. The best healthcare system in the world, say those who are fighting the current reform effort and screaming at the town hall meetings.

Unfortunately, many of us seem to be stuck in a cognitive loop when it comes to seeing the flaws in the most basic attribute of our current system, and to envisioning alternatives. Sphere: Related Content

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