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The ‘Original Sin’ of the U.S. Health Care System
We need something better than employer-sponsored health insurance
The fact that half of all Americans with health insurance get it through their jobs is a true oddity of the U.S. health care system. No other country operates in such a way. Yet surveys show that most people on employer-sponsored health insurance (ESHI) seem to be happy with it. So why shouldn’t we follow the old maxim “If it ain’t broke, don’t fix it?”
The Affordable Care Act took that approach. Rather than trying to replace ESHI, the ACA made having health insurance mandatory for employers with 50 or more workers. Yet serious health economists tell us that ESHI is “broke” after all. In fact, they say it is so profoundly dysfunctional that it deserves to be called the “original sin” of the U.S. health care system.
ESHI’s biggest problems come down to three things: job lock, which reduces labor mobility of beneficiaries; the fundamental inequity in how benefits disproportionately go to the highest-paid workers; and the increased fragmentation of health care finance that comes from a system administered by thousands of separate employers.
Job Lock
This term describes the tendency of employer-sponsored health insurance to discourage people from…
