The most surprising thing I learned over the course of last night’s town hall meeting with Congressman James Langevin was of the Congressman’s strong commitment to maintaining the employer-based system as the basis of American health insurance. I had thought that most current support for the employer-based system (outside of the insurance industry) sprang from a small-c conservative reluctance to alter what’s in place now. Contrary to this idea, Congressman Langevin spoke very actively of wanting to maintain the employer-basis. (He also made it clear that he does not favor a change to a single-payer or a Canadian-style system).
If there was one big-picture healthcare issue I would ask the Congressman to reconsider, the wisdom of maintaining an employment-based system would be it.
Congressman Langevin spoke of ending insurance company “monopolies” over their customers as one of his policy goals. But those monopolies as currently structured are largely artifacts of the employment-based system, where employees are directed to a single insurance company by their employers and told that they can deal with that company, or else get nothing. “Exchanges” are supposed to remedy this take-it-or-leave-it aspect of health insurance, by giving everyone a choice of different companies to deal with, but while the goal here is a laudable one, using “exchanges” to achieve it is a gimmick.
The problem is that the employment-based system did not grow out of an unregulated market; it was created by advantages granted to corporate purchasers of health insurance, by the Federal government, including 1) tax-advantages for corporate insurance purchasers, but not for individuals 2) liability advantages for corporately purchased insurance plans, but not for individually purchased ones and 3) prohibitions against purchasing insurance across state lines, limiting the insurance pools that individuals can choose to join.
Having the government use its tax and regulatory power to strongly tilt the system in favor of employment-based monopolies, and then try to fix the problems it has created by adding new regulations and a new bureaucracy in an attempt to simulate a market is a Rube Goldberg approach to health coverage. The more efficient and more rational solution is to simplify things, by removing the advantages the government has given to corporate health insurance purchasers over individual ones and allowing people purchase their health insurance like they purchase their other kind of insurance.
When regulation has failed miserably, it doesn’t automatically mean that the answer is more regulation. It often means that the government has to get out of the way and let people make their own choices