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
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)

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13 thoughts on “The Health Care Reform That Didn’t Happen (and would have really helped dads)

  1. Even moreso, Obamacare reinforces the public’s dependency on *INSURANCE* (ignore where the insurance plan is offered). Just as employer-offered insurance is a historic accident, so too is the notion of health insurance in general.

    Until the 50’s, people used to pay cash for their treatment. Look at what has happened to the cost of healthcare since. It is no coincidence. We have abdicated our healthcare decisions to people who are morally obligated to *PROFIT* from us, to people who are beholden not to the consumer, but to the stock holder.

    I see it every day with every new patient who comes into my office. Never to they say “I came here because I want to be treated right”. It’s always “you were on the list of people who take my insurance”. An informal poll of all my facebook contacts asking who would leave their dentist if he/she stopped taking their insurance… 99% said they would.

    The problem is cultural. Where healthcare is concerned people walk into any appointment expecting someone else to pay for it. It’s just expected. It’s assumed. You could justify this by pointing out the cost of healthcare and making the observation that normal people just can’t afford it anymore. You’d be right. Conspiracy theorists would say that health insurance companies have deliberately manipulated the market to make the public dependent on their services. I’m not sure the conspiracy theorists are wrong. My experience in my own private practice certainly supports that theory.

    Insurance is for catestrophic events, not the routine things that responsible citizens should be planning for and doing on their own. We dont’ expect our auto insurance to pay for our oil changes. We don’t expect our homeowner’s insurance to pay for our electric bills. Why then do we expect our health/dental insurance to pay for the things any responsible person should do. Routine checkups, physicals, cleanings… these are all things we can see coming and should plan for. Even birthing a baby — baring complications you have 9 months to get your act together for that bill.

    But that isn’t the way modern Americans relate to healthcare. “Who’s paying for this, because I’m not” is what we all think when we see a doctor.

    If my patients all paid cash I wouldn’t have to hire another employee purely for the sake of dealing with insurance companies. I also wouldn’t be taking a 25% hit on every single procedure I do (which makes it tough when your overhead is 70%). What influence do you think those factors have on the prices I charge. You walk into a doctor’s office with health/dental insurance, you’re driving prices up. It’s simple math.

    *ghasps for air*

    //rantover

    …for now.

    -DD

    • Hey DD, thanks for the comment, and I appreciate your view on HC considering your expertise.

      We’re not going back to bartering chickens, and we’re not really getting of the insurance model. But I agree things have to get a lot better, as the current HC system especially sucks for entreprenuers and small medical offices.

    • Excellent comment. Of course, you didn’t even touch on the fact that you have thousands of dollars owed to medical school, and worked for years as an indentured servant of the hospital. Doctors work longe hours than other professions and need to be compensated for the sacrifices they have made to practice. That is moral, right and good. If not, why would anyone ever do it? And then where will we be? Without good doctors, that’s where.

      • Agreed here as well. The excellent Steve Brill article in Time magazine shows that many in the HC system are making outsized profits by marking up each medical device thousands of percents ($7 charges for a single cotton ball, a hospital charging 10 times what an artificial hip cost them, etc.). He states that hospitals, device manufacturers, pharma companies are all working the system for extra $, and the only people not overpaid are the actual doctors and nurses.

  2. My thoughts on health care costs and insurance are in the process of going through a profound change, especially after reading the TIME magazine article and dealing with 6 figures of medical bills from my son’s birth and wife’s subsequent hospitalization(s).

    As I work through the itemized bills and try to negotiate reductions after the fact, the thought occurred to me that I would have been better off WITHOUT insurance – doctors and providers refuse to negotiate on the balance-billed portion since I am “insured”. (By balance billing, I am referring to the $16 of the $26 aspirin that Aetna did not pay for). The one doctor that did not know that we were “insured” accepted a 30% reduction on a bill (which was still 300% higher than what http://www.fairhealth.org listed as a Fair Market Value for the procedure, and over 1000% higher than the Medicare Reimbursable Rate for the same procedure).

    If I, as a lawyer, billed for my services like medical providers do, I would be tarred, feathered, and run out of town. In fact, there is infinitely more public scrutiny of lawyer billing than medical billing.

    It seems to me that the entire system is so far out of control that it will take a catastrophic collapse to allow a fix a chance to take root.

    Until then, I’m leaning heavily towards walking away from health insurance altogether, as it seems only to encourage providers to over-bill, and insurance providers to under-pay (after all, who doesn’t want their cut of the money-pie).

    To your original point, as a work-at-home dad paying an obscene premium for a family of 5 (the youngest of which has a special medical need) I am extremely disadvantaged by having insurance tied to employment. Perhaps I should run for Congress to ensure that my family has the best possible coverage and care; it probably would be cheaper than a year’s worth of premiums and medical bills. : )

    Nice blog, enjoy reading it!

    Peace,
    LBD

    • Thanks for the comment, and I’ll have to check out your blog, too. I agree with you and the other commenter that the problems in the HC system are enormous and probably requires a complete start over from scratch. Divorcing insurance from employment would be a start.

  3. Definitely Obamacare or Affordable Health Care act is one of the developing strategies that help to offer beneficial health care facilities to the people. Since from a decade we have witnessed a number of health care acts are introduced at regular intervals to protect the concepts of health and hazards and to provide beneficial health care facilities to the people, but still wondering with the fact that does these health care acts and plans are enough for a common man as he or she doesn’t get sufficient care from these acts. Due to health care frauds people are still suffering from various lacks and mishaps.

  4. Although, I can’t agree with all of what you say, I wholeheartedly agree with the basis of the article. Tying healthcare to a job is a HUGE problem. I used to submit insurance claims for services rendered by our company, on behalf of the patient. Here is why I support your article. Let’s say you have a medical problem and you need care and it needs to be precertified. The insurance company is divorced from the patient in this way….if you don’t get the service you need when you need it, as a patient, they really don’t care because the premium will be paid monthly by your employer whether you are happy or not. Let us continue in this thinking. If it was offered across state lines and divorced from employment, if you were unhappy with the service you got, you could go shopping just as we do with auto insurance, compare plans and make a decision to go with another insurer. All the companies would be encouraged to provide better service, compete for customers and we would all get better service. Of course, it is more complicated than that, but I agree if that one component were changed, without a one thousand page law, and everything else that is written it, we would all be better for it.

    • Thank you for reading and for your insightful comment. There are many things I would change about the HC system, but only wanted to focus on one aspect for this post. I think you are correct in that the further the decisions about choice and cost are from the final customer, the more distorted and less responsive the system is.

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