By MATTHEW BRODSKY, senior editor/Web editor of Risk & Insurance®
Employers have been picking up the benefits bill (or most of it) for this country since the big WWII. At present count, they cover the tab for more than 160 million Americans. And if they're still willing to keep paying, I see no reason not to let them.
Sure, maybe there are a few little reasons. Our healthcare system, on many levels, sucks. As a nation, we spend $2.4 trillion a year on it, yet our ROI is bottom-barrel for the developed world, and sometimes even subpar for the developing world.
Part of the reason is the crumbling of employer-based benefits. Only 62 percent of Americans in 2007 got employer-based benefits, the lowest level in more than a decade. That translates into 37 million workers who either cannot afford their employers' plans or simply don't receive benefits from their bosses.
As I said, though, I'm pro employer-based. What's our other option? Some form of single-payer universal healthcare? Not even Massachusetts, the home of the Kennedys, went that route. The one major U.S. experiment toward universal healthcare is built on the backs of employers. Why? When the goal is 100 percent coverage, it makes no sense to break down the existing system and start at zero.
Or how about this abstract illustration? Our benefits system as an old car. Yet with this jalopy, you can't reach that tipping point when the costs of pouring trillions into repairs outweigh the money down and monthly payments for a new one. What new "car" would you get anyway? A Lexus? No. A single-payer system would be like trading in for a bus. I don't know about you, but at least where I'm from, public transportation gets more expensive, slower and later every year.
And are there even enough public buses for 160 million additional riders? Probably not, and until there were enough, the government would need to contract out to private busing companies. Who would they be? Operations with millions invested in lobbying city hall. In other words, our big health insurance companies, which would be hired to administer the millions of new policies and claims.
We'd get the worst of both worlds. A new bus system that's just as slow and inefficient as the municipal one, yet a million times more expensive because politicians would fatten up the contracts so they later could land a job with bus management (remember Medicare drug plans?).
So no trade-ins. Instead, we need a good mechanic, or a good team of mechanics, including the Obama administration, congressional leaders, employers, insurers, consumer groups and providers.
Together, they can repair, then pimp, our ride. For starters, assuming that the current administration's goal is universal healthcare, the mechanics should work to bolster the employer-based system, not weaken it. That means keeping benefits tax credits for large employers but also expanding them to smaller businesses, as well as letting these employers band together to buy insurance.
And let's be honest ... we'll need real employer-based healthcare, not cost-shifting to employees. More employers than ever deal with double-digit healthcare inflation by shoveling the costs onto workers. That's shirking responsibility and, until employee wages grow double-digit to match, will prove unsustainable.
To help employers take on their benefits responsibilities, our mechanics will also tackle the benefits price tag. One big way: force providers, insurers and brokers to reveal the actual costs of care. We need to know what the dealer's price is, not 300 percent of the MSRP.
Our government should also take on some costs of severely and terminally ill Americans. No one else wants them. Let's not forget setting up a marketplace where individuals outside the employer system can buy legitimately priced insurance, as well as subsidies for those families who need financial assistance. And wellness programs to get all us fat, grease-eating employees healthy.
I could keep going here. But I won't. My car analogy's run out of gas.
(Read Managing Editor Cyril Tuohy's Counterpoint here.)
June 1, 2009
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