Employers Should Not Be Providing Health Care
The rotten mess that is Obamacare that ruined my previously affordable care did nothing to fix a major problem in healthcare -- how, in a world where people change jobs with frequency, healthcare is still tied to the workplace.
Think of what this means: To have continuity of care, some people can't leave a job they've outgrown or one that has become terrible for them.
There's another cost -- and I note this as an atheist who is deeply committed to supporting people's freedom to peacefully practice their religion. Some religions are opposed to providing birth control or abortions. I'm, well, personally opposed to their opposition, but that's really none of my business, is it?
Well, what shouldn't be part of their business is being forced to violate their religious principles to cover the cost of women's birth control or abortions.
The LA Times Editorial Board contends: "Allowing employers a 'moral exemption' from offering birth control coverage is immoral."
Uh...how could it be moral to force people to violate their religious beliefs?
A bit from their editorial:
It is unjust and un-economical to deprive women of easy and affordable access to birth control. The issue here should not be an employer's religious or moral beliefs but the needs, beliefs, health and safety of the employee. Why should our employers make the moral or religious decisions about our healthcare? Besides, it is already clear that there are plenty of ways for employers to register their objections and then allow insurance companies to step in and provide the insurance. That's accommodation enough.
How arrogant: "That's accommodation enough." (Written in the voice of a bratty, foot-stomping 11-year-old.)
Why, indeed, should our employers make decisions about our healthcare?
They should have been removed from the picture long ago.
Every person who wants to have a health insurance provider should do what I did from my 20s on, which is sign up for a provider (in my case, an HMO), for which I paid, sans employer, every month.
I have a psychiatrist who's very, very good, who prescribes Adderall for me. If my healthcare were tied to a job (if I worked at a company instead of as a writer), I'd have to leave him if I left my job. This is ridiculous.
What should be "rolled back" is not new rules the Trump admin put into place, but the practice of having employment and healthcare tied together.
Your employer's religious beliefs don't conflict with your healthcare -- or really, it's none of your employer's business -- if they aren't, in some way, part of providing it.
As far as employer provided healthcare goes, the way I see it is it is compensation for the job. The employer should have no right telling the employee how they get to spend their money.
If an employer can dictate what an employee spends the health care portion of their salary on, why couldn't they tell them how to spend all their money?
lujlp at January 2, 2018 11:13 PM
I think you bring up a good point, luj.
Thoughts, everybody?
Amy Alkon at January 3, 2018 4:50 AM
@lujlp: Why let an employer have a say in what an employee spends his/her money upon when the Government can do that? Employers and employees tend to form personal relationships, sometimes which have strong bonds of loyalty and friendship (since most employers have less than 50 employees). By making spending decisions controlled by regulations, people are made more dependent upon the Government and become less willing to question officials.
The core issue in ObamaCare isn’t about providing access to health care at an affordable cost - it did neither of those (costs have continued to rise rapidly and, try to find a provider who will accept new patients who have coverage obtained through an Exchange). There are several other ways to lower costs and increase ability (allowing insurers to cross state lines and individuals and small employers to join groups, and so take advantage of group rates, are only a couple ideas.)
Rather, it’s about control. The ACA transferred control of about 1/8th of the economy to federal bureaucrats in the DC area, who are overwhelmingly liberal Democrats. The Republican proposals would transfer that control to state governments (where, not coincidentally, Republicans have much greater support). Unfortunately, the debate is about which level of government has the control, rather than returning the decision to individuals and making it a condition of employment bargaining chip between employers and employees.
Wfjag at January 3, 2018 4:59 AM
While I agree with you about severing healthcare from employment, this is unnecessary hand-wringing. You would not automatically have to leave your preferred psychiatrist. The entire time I was in California, I had Kaiser. Every employer offered it as an option. So, I had 15 years of seamless healthcare.
The biggest obstacle in making health insurance portable is not employment, it's that insurance is regulated state by state. So, if you stay with the same employer, but transfer to a new location out-of-state, you have to get a new health insurance plan.
Conan the Grammarian at January 3, 2018 6:31 AM
"...easy and affordable access to birth control."
Of course, by "easy and affordable", they mean free. We've got two groups of people here, one that wants X and one that doesn't. And the people who want X want the other group to pay for it, and they're using the force of government to make that happen. And this is independent of where the insurance comes from. Women in the U.S. have collectively decided that they have a right to free birth control. So from now on, when you take out a health insurance policy, it will be mandated by the government that you will get, and pay for, birth control "coverage" whether you want it or not. It's simply welfare, enacted by regulatory fiat and paid for in a way that bypasses the U.S. Treasury and the spending powers of Congress.
Expect to see a lot more of this. I'm seeing women increasingly state that all of their health care should be free, including childbirthing and abortions. And they have the political power to make it happen, Constitution be damned. The government will simply mandate that insurers provide it, and extract payment from men, by means of mandatory coverage, to make it happen. Your legislative representative will never have to vote on it.
Cousin Dave at January 3, 2018 7:04 AM
The thing is, modern medicine is only about 100 years old. Prior to the Influenza Pandemic of 1918, the scientific method was not in general use by medical practitioners. Most doctors learned their craft as apprentices, not in medical schools.
Bleeding by leeches was a common treatment before and during the Pandemic of 1918, despite the fact that it weakened, and sometimes killed, the patient. The practice was based on the ancient Greek idea of bad blood, not on any success rate or scientific inquiry attached to it.
When the Constitution was written, you were more likely to be killed by your doctor than be cured by him. George Washington died in horrible pain from the treatment his doctors were giving him. President James Garfield was killed by doctors poking around in his wound with unwashed hands, and not from the assassin's bullet.
The idea of mandating equal access to medical care was ludicrous. Everyone had access. Some quack came over to your house, fed you a concoction of poisonous chemicals or bled you with leeches, took one or two of your chickens, and left you to get better or die. There were no expensive machines or drugs, no medical school loans to be paid off. The doctor was just some guy who did an apprenticeship, like the blacksmith or the cobbler.
In fact, back then, your surgeon was likely to be the local barber. The helical red, white, and blue barber pole is supposed to harken back to those days with the red and blue representing blood and the white, bandages. Some accounts ascribe the red to the bloody bandages wrapping around the blue and white barber pole in the wind.
And the surgery provided was mostly amputations and tooth extractions; without anesthesia. During the Civil War, more deaths resulted from attempts to treat the wounded and disease than from the enemy. In fact, the Korean War was the first conflict in history in which the wounded taken to an aid station had a fair chance of survival.
It wasn't until 1761 that human medicine and veterinary medicine were separated with the opening of a French school of veterinary medicine. Prior to that, your doctor treated both humans and animals.
So, when we talk about medical care and rights to it, let's keep in mind, this is all new to us. We haven't been doing it successfully for all that long.
Read The Great Influenza by John Barry for a nice overview of the onset of modern medicine.
Conan the Grammarian at January 3, 2018 8:44 AM
The probelm has never been employers providing health insurance.
The problem has always been the federal and state governments mandating what must be covered in those policies.
The even bigger problem has been government intervention in the marketplace essentially forcing doctors and hospitals to shift the unreimbursed costs of medicaid and medicare onto the insurance companies and the uninsured.
Isab at January 3, 2018 9:18 AM
I absolutely agree with this. Having purchased individual health insurance since I turned 24, Obamacare and the Trump veneer placed over it hate personal responsibility and want to make it impossible.
Instead of all these employer threats - go look at the disaster that is/was SHOP (is it still open?) - WTF was I supposed to choose for my five employees a "Bronze" health plan that looked like major medical with a $10k deductible and only sardonically call it a fringe benefit because they drove every plan out of the market other than pure garbage? - the answer was simple, and the Republicans would not do it:
Tax benefits.
If an employer can deduct it as an expense, and you are the recipient of the benefit, it's income to you.
The tax reform bill should have gotten rid of all of these con-jobs (Roosevelt through Nixon) to slip in various things outside of wage income. Let it all be wage income - your money in your check, your health insurance, your tuition reimbursement, your life insurance, all of it.
El Verde Loco at January 3, 2018 9:34 AM
Self-purchased and group-purchased plans need to get the same tax status as employer-paid plans. They need to be either all tax exempt, or none.
Cousin Dave at January 3, 2018 9:56 AM
Terrible point Lujlp. Your employer didn't offer you healthcare dollars to spend as part of compensation. They didn't offer you dollars at all. You aren't the one spending the money. If you were then they couldn't do anything about it. The fact that they can influence such things shows your whole argument is false.
If you want control then you need to spend your own money.
When I worked at Baker they gave out coupon books as part of our compensation. I never used a single one. The whole idea was moronic. At least according to me. But I couldn't move those dollars they spent on useless coupon books over to sandwiches. It wasn't my money. And it is as simple as that. If you want control then you should spend your own money.
Ben at January 3, 2018 10:09 AM
As far as I could tell Verde the Ryancare plan was just to repeal the individual mandate. I strongly stress that I may wrong. But as I read things it is still legal to offer a non-Obamacare insurance plan. Not required but possible. The difference is non-Obamacare plans don't offer the Obamacare tax deduction which makes them substantially more expensive. The Ryan plan repealed that tax. Hence accelerating the Obamacare death spiral. Insurers don't want to offer non-Obamacare plans since they lose out on a lot of benefits that way. But if no one is buying them then it doesn't matter. The rest of that law was pretty much fluff. Gibberish that didn't make a difference and looked like it was in there to hide the tax law change.
I agree it was a pretty useless change. Only would have accelerated things that already are happening. Of course none of that matters. They didn't have the votes to pass an essentially toothless and irrelevant bill. So they are unlikely to have the votes till after midterms for anything useful. And perhaps not even then.
Ben at January 3, 2018 10:19 AM
> Garfield was killed by doctors
> poking around in his wound
> with unwashed hands
Thass not what I hoid....
Crid at January 3, 2018 10:34 AM
Also, "onset of modern medicine" is an interesting locution.
See also, Arno Karlen. It's an easy to read book, because so many chapters go the same way.
After God-knows-how many loops like that, the (surviving) Western seafarers had immunity for all sorts of disease that would decimate or devastate newly-contacted populations who'd lived in blessed isolation. White guys didn't need to pass infected blankets to American natives: they were going to drop like flies anyway.
And they did... As the predecessors of their European visitors already had.
Crid at January 3, 2018 10:53 AM
Well, it didn't happen all at once, so I needed a word that described the process by which it came into common practice. "Onset" seemed as good as any, and better than some.
Remember, Germ Theory, the basis of modern medicine, was not accepted immediately. Even after its acceptance by scientists, it took a while to filter down to the medical community. When the doctor teaching you is a Miasma Theory guy, you get taught Miasma Theory, not some new-fangled egghead theory they got up at the college.
Even while they were spreading smallpox to the natives, the colonists didn't understand why their plan worked, just that it did.
As for James Garfield, had his doctors been more respectful of Joseph Lister's theories, he might have lived. Lister's theories about germs and sterilization were known at the time, but not given much credence in the medical field. There, the Miasma Theory held sway.
Garfield's doctors probed his wound track with unsterilized instruments and fingers; with at least one such probing puncturing his liver, which created a new wound track that soon filled with pus. The doctors insisted the bullet had gone rightward, when it had in fact gone leftward.
The doctors didn't allow Alexander Graham Bell to use his new metal detector on the president's left side, only his right, and missed the bullet, resulting in even more unsterilized probings to find the bullet.
The unsterilized probings left him with a raging infection which stole his ability to digest solid food. He was given nutrient enemas to sustain his life, but what killed him was the raging infections caused by unsterilized probings.
On a side note, I'm going to name my new band, Unsterilized Probings.
Conan the Grammarian at January 3, 2018 12:04 PM
We have employer-provided health insurance because during World War II wages were controlled by the government. Kaiser was already providing health care (not insurance but care) to his employees, and the unions working elsewhere (newly emboldened by near-total wartime employment) demanded the same thing or they would strike. "Not equipped to give you health care." "Then give us health insurance, instead." "Can't, that would be an increase in your wages." "Mr Roosevelt, who depends on us unions for electoral support, is the provision of health insurance a taxable event, ergo wages?" "Why no, no it is not." Once the big unionized companies had it, then every other employer had to provide it to compete for labor. And here we are.
El Verde Loco is right, health insurance provided by your employer should be taxed as income. It would soon go away.
Foaming Solvent at January 3, 2018 1:55 PM
Couple of items:
If an employer has, say, $100 per month to add to his employees' compensation package, he has some choices.
If he pays you, between one tax and another, depending on state and local taxes and individual's marginal tax bracket, plus possibly work comp premiums and tweaking life and disability and retirement premiums, the employee might realize $50. Do your own math, but it won't be close to $100.
If, on the other hand, he improves the group health plan, the entire amount goes to the insurance company. Does he get more appreciation for a net increase in an employee's net pay of $50? or a reduction in deductible from $250 to $100?
Also, since this process allows the entire issue to be entirely invisible to the employee, the presumption of how much a fat policy costs is considerably under the reality. When an employee goes on COBRA, there's a sticker shock of some heat.
Richard Aubrey at January 3, 2018 2:37 PM
Employers have always sought untaxed benefits to lure employees. From health care in the '30s and '40s to company cars in the '70s and '80s to stock options in the '90s, companies have used untaxed benefits to attract and retain employees. Since the company pays a percentage of any actual income as a tax, an untaxed benefit costs the company less than paying the same amount in actual income. And, since it is not taxed, it gives the employee something that would cost him real money if he had to get it for himself.
The government gets savvy to these schemes quickly and moves rapidly to tax them. Taxing them is successful because most of those untaxed benefits are provided only to higher-income or management employees, so the masses were unaffected by the taxes. Taxing health insurance, however, will hit everyone and will not be easily sold to the public at large.
Conan the Grammarian at January 3, 2018 2:55 PM
"It is unjust and un-economical to deprive women of easy and affordable access to birth control."
Just how outrageously expensive are those condoms? More expensive than a daily cup of Joe at Dunkin? or even more than a skinny soy double latte at Starbucks?
charles at January 3, 2018 7:39 PM
Again: Already Solved.
But since this idea does not give power to government, and the public still thinks money is coming to THEM, it will never be tried.
Radwaste at January 3, 2018 7:44 PM
This is all stupid, and if the U.S. would have the sense to go with a healthcare system similar to that of France, which even Reason editor Matt Welch prefers to that of the U.S., we'd be in a much better place:
http://reason.com/archives/2009/12/07/why-prefer-french-health-care
Obamacare sucks, but is markedly better than what preceded it in terms of coverage and cost containment, and we'll still lag comparable countries in most health-related metrics - moreso now that the end of the Obamacare mandate pushes healthier people out of markets.
And yeah, if you're a god botherer, fine, don't use birth control. But STFU and follow the law about the benefits you're required to provide your employees. This trend of letting anyone fuck over others just because their bad interpretation of what some dead dude in the Middle East thousands of years ago might have said is a terrible trend in our country.
thisisallstupid at January 3, 2018 9:46 PM
> Obamacare sucks, but is markedly
> better than what preceded it in
> terms of coverage and cost
> containment
Dafuq?
Crid at January 4, 2018 5:06 AM
Anyone who approaches such matters with impatient condescension for "god botherers" should probably not be worrying his pretty little head about public policy.
Crid at January 4, 2018 5:08 AM
I believe during the whole Sandra Fluke controversy, it was pointed out that the same birth control that was too costly for the poor Georgetown students to purchase without Obamacare, the uninsured purchase of which would cause them grievous financial difficulty, was only $9 at the nearby Target.
Conan the Grammarian at January 4, 2018 6:20 AM
I believe during the whole Sandra Fluke controversy, it was pointed out that the same birth control that was a grievous financial burden without Obamacare to cover the costs and ensure access was only $9 at the nearby Target.
Conan the Grammarian at January 4, 2018 6:24 AM
"Obamacare sucks, but is markedly better than what preceded it in terms of coverage and cost containment,..."
Got any documentation of that? Obamacare policy premiums on the exchanges have been soaring from the get-go, and insurers were pulling out of markets before 2016 election campaigning even started. From my own perspective, our policy at work has gotten much worse. Our policies have been going up at about 25% per year (mercifully, this year's increase will be smaller), our co-pays doubled, our deductible went from $2000 to $8000, anything more sophisticated than having temperature taken requires insurance pre-approval, and the prescription plan has dropped coverage for most non-generics. And I work for a pretty good employer; people who are working for small businesses or are self-employed are getting hit a lot harder. The only "cost containment" being achieved is from denying treatment, or making it so difficult to get that most people give up.
Cousin Dave at January 4, 2018 7:07 AM
The US is the only nation I know of where health care is linked to employer. There were historical reasons for this but it s really silly. C'mon Americans, get your act together.
hans tholstrup at January 6, 2018 12:37 PM
"C'mon Americans, get your act together."
Why? Do you need saving from the German invasion or something?
Gog_Magog_Carpet_Reclaimers at January 9, 2018 5:19 PM
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