Monday, December 18, 2017

From Employer Coverage to Single Payer Health Insurance

This holiday season I’ve heard several tales of woe from working class acquaintances, mostly self-employed, about Obamacare: how they are just above the subsidy cutoff and would rather pay the fine than buy expensive individual policies, or how they are just below and can’t afford to put in more hours per week.  I can understand why there is a lot of disappointment with the Democrats.

So what about single payer?  Along with free public higher ed, it’s supposed to be the leitmotif of the resurgence of the left, with even moderate politicians signing on, or claiming to, to save their skins.  And I’m all for it too.

But a big political obstacle is widespread employer-based health coverage, a benefit that would disappear under a universal system.  As a public employee, I have coverage of this sort myself, and it’s a big part of my overall compensation.  How do we fold the millions with adequate-to-good health plans into a new system financed through taxes?

I have an idea.  As single payer goes into effect, require every employer to publicly report how much it pays in the form of contributions to employee health insurance, documented by its payment record over the past twelve months.  The health care law would then mandate that this sum be returned as added wage payments to employees for some transitional period (such as six months) or the term of the employment contract, whichever is greater.  Ideally the law would specify a reasonably progressive apportionment of this payment across the workforce, such as equal lump sums.  At the end of the transition, wages increases and decreases would fall under the same employment law rules, such as they are, as before.

From the worker’s point of view, there would be no loss under the switch to single-payer, even if existing coverage were gold-plated; it would generate that much more wage income.  To the extent that the new system can reduce America’s bloated medical costs, workers could even come out ahead over time.  From the employer’s perspective it should be revenue expenditure-neutral, and changes in the composition of the compensation package should have little effect on HR.  In principle, then, it ought to address most of the political concern over how we can get from here—a fragmented, employment based health care system with both bright spots and gaping holes—to there.


Longtooth said...

There are a ton of “practlcal” problems in a transition to a universal health care system from the existing U.S. economic system. These would be a transitional challenge but not a serious obstical. The obstical is and will remain the notion of individualism that reigns supreme in the U.S. A universal health care system is a purely cooperative one, the antithesis of individualism’s religion.

Universal healthcare is social equality at its limit and our entire nation’s basis is founded upon & depends upon individual “freedoms”, predominantly of individual choice (& thereby individual responsibility’s).... colloquially “it’s your own fault”.

We have along way to go to remove the alter of individualism from our “way of life”. We can’t even remove the right to bear arms, or keep Church & state separate (despite the bill of rights) precisely because individual “freedoms” outweigh cooperative systems. Cooperative systems & individualism are mutually exclusive, so you get to prioritize one or the other, but both cannot exist without one being sacrificed for the other.

As I see it individualism is directionally toward chaos, separation from it only being by degree, & only tenuously at that. We have already once in our short history hit the chaos end of the spectrum— which resulted in our civil war, & we’still in the throes of coming out of it, at best, or not depending on your individual point of view.

If you left it up to the conservative side of preferences, we would all but dismantle labor’s SS system, Civil Rights, Voting Rights, Medicare, & interstate commerce interpretations giving the federal gov’t power over the individual states. We can’t even keep the mildest form of a conservative proposal for what we call the ACA from being slowly dismantled (recall that this was the conservative answer to avoid a universal health care system).... obviously not conservatively individualistic enough.

So we’re a long way yet from anything even remotely approaching a cooperative system of governance.

Peter Dorman said...

I fixed a glitch in the last paragraph.