Single-payer proponents need to answer this question

Published: 1/19/2019 11:10:42 AM
Single-payer proponents need to answer this question

I have no doubt that single-payer health care is the way that this country should go. The USA does worse on health care than any other developed country.

But I have yet to hear any good ideas about how to overcome the biggest obstacle to going single-payer: what to do about the large number of people, quite possibly a majority, who are dependent on employer-paid health care either directly or indirectly through a relative and are reluctant to give it up. That effect is amplified by those who see single-payer as a form of socialism and therefore bad.

The system we have is the result of several historical accidents. The biggest one was the policy, instituted around 1940, to make health insurance a nontaxable benefit, thus inducing employers to provide it as a substitute for higher wages.

The effect of that policy was greatly amplified by having health insurance be a family benefit rather than an individual benefit. Since every added family member implicitly added to the employer’s costs, there was a disparity for employees between the cost of personally financed health care and the cost of employer-based health care. That became an even greater issue as fewer and fewer people became part of the traditional nuclear family consisting of a working husband, a homemaker wife, and several children. Gay marriages, domestic partnerships, part-time employment, and divorces added to the confusion.

Back in 1940 I guess that the fate of people who were self-employed or unemployed was not a major consideration, since in those days going without medical insurance wasn’t usually such a terrible fate. Medicine cost a lot less then (and was far less effective). Not so today.

Paul Abrahams


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