Delinking Health Care

You’d be pretty annoyed if your cell phone contract followed your job, or if your employer dictated which brand of car you could drive. Yet when it comes to health insurance, the notion that your employer gets to decide for you, and that if you switch jobs there is no guarantee you can keep your coverage, is pretty ingrained into the minds of Americans. Is there a good reason to keep doing things this way? I don’t see one.

The issue of employer-provided health care is in the news, as a poorly-done study is arguing that a large number of employers are planning on dropping their health care coverage in response to the new health care law. There is little reason to believe this is true, as many other studies show the opposite, and McKinsey refuses to release their study methodology, prompting many people to believe they are fudging their numbers. In the short term, it is important to reassure people that their employer will not drop coverage in the future during the implementation of the law. However, over the long term, I don’t see a need for any reason to link insurance to employment, especially since the goal is universal coverage. Why have one system for the employed, and one for the unemployed, especially if it is hard to move your coverage between the two realms?

Some may think that such a system would require single-payer health care. Sure, that would be easier to administer, but in no way would it be a requirement. You could just as easily be able to pick your insurance from several private options, in exactly the same way that you can go to one of several wireless phone providers to choose your coverage. For those who do not choose coverage, they would be assigned the baseline coverage from some private insurer by lottery. No penalties for not buying coverage and evading the mandate, no jail time, no fines. Just automatic signup. Plus, no changes to your coverage if you switch jobs or become unemployed.

When you get right down to it, if the goal is universal coverage, there is no good reason to tie insurance to your job. Obviously, the transition should be managed and orderly, but a transition should be made nonetheless to a system where employment matters as much to your insurance choice as it does to your choice of phone provider.