The Health Care Reform That Didn’t Happen (and would have really helped dads)
Obamacare may be an improvement, but it missed a chance to sever access to health insurance from employment- to the detriment of working dads.
picture from http://svlg.org/policy-areas/health-policy/policy-priorities/state-health-care-reform-implementation
Part of me is afraid to even broach the topic of Health Care Reform, as it is politically radioactive (you should have seen the facebook fights my otherwise reasonable friends had over this the past few years). I don’t wish to rehash the debate, or devolve into cries of tyrannical government takeover vs. Dickensian dystopia. Further, the topic is far too complex to cover in a single blog post.
No matter what you think about Obamacare (I happen to think it is a small step in the right direction, your mileage may vary), it missed an opportunity to fix what, IMNSHO, is the greatest flaw in the US Healthcare system- the fact that, for most Americans, health insurance is tied to their employer.
Employer-based health insurance is a byproduct of historical accident. During World War II, the US instituted wage controls, so employers circumvented this restriction by offering health insurance as a way to attract and retain employees.
As Ezekiel Emanuel and Ron Wyden (who we really should have listened to more when debating health care reform) wrote in an excellent Wall Street Journal op-ed, employer-based health insurance may have been a good idea 65 years ago, but the world has changed a lot since then. People no longer stay at a single employer their whole working careers; employers no longer provide lifetime employment.
A fair look at Obamacare would say that, in terms of getting away from employer-based health insurance, it both helps (health care exchanges should help spur the individual market; better access for those who don’t have employer health insurance) and hurts (by reinforcing and further cementing the status quo of employer provision of health insurance). Again, your mileage may vary.
But this is not a health care policy blog- we’re focused on fathers and their work-family issues. Employer-based health insurance hurts dads, and I wish we did more to separate insurance from employers.
As discussed in a few recent FWF posts, men who are the primary or sole breadwinners for their families face intense pressure to provide– both money and health insurance.
If we are the sole source of health insurance for our families and we get insurance through our employer (as individual-market health insurance is outrageously expensive), we are far more likely to stay trapped in soul-sucking jobs, and far less likely to change jobs or start our own businesses. If the US divorced insurance form employment, we’d have more satisfied dad-entrepreneurs and a more robust economy.
How to do this? Well, that’s the trillion-dollar question.
I’m not an expert on this topic (although I do teach at a business school with an executive MBA program in health care, meaning I have to stay pretty well aware of things), but it seems we need to either have single-provider government health insurance (like Canada), nationalized health care (like the UK), or a private market-based system with regulations/subsidies to ensure access for all (something along the lines of the Wyden-Bennett plan, or Switzerland’s system). All have downsides, but all of these alternatives accomplish the goal of divorcing insurance from employment.
For me, this is the fundamental reform that would improve everything else. Unfortunately, since it appears the health care system can only be reformed once every 65 years, and only after years of hysterical political divisiveness (i.e., “death panels”), I’m not optimistic. Unfortunately, until there is more vision and less partisanship in Washington (good luck with that!), we dads will need to keep on waiting (waiting) for the world to change.
What do you think about employer-based insurance? Let’s discuss (calmly and civilly) in the comments section (I will delete anything that’s out of bounds)