IN WHICH I MAKE VARIOUS POINTS ABOUT HEALTH CARE. NO, REALLY. I've a feeling lots of folks� eyes glaze over when I start posts with "there's a new study out of...," but hang on a second, this one's a good one. The Commonwealth Fund reports that a full nine out of every 10 Americans who seek private insurance never buy. Of those who do apply for a plan, 20 percent are turned down or charged much more for a preexisting condition. And of those who settle for a cheaper, high-deductible plan, 40 percent eventually realize that some of their medical costs aren't covered by insurance. In other words, insurance in the private market is expensive -- too expensive for most of those seeking it. Employers aren't picking up a portion of the costs, there's no risk sharing, so your past conditions and personal proclivities come into play, and it's not tax deductible, as it is for businesses. Add in that most folks rich enough to easily purchase private insurance will work in a position or for an employer who offers coverage, and you get a sense of how we're subsidizing -- through employer deductibility -- the wrong end of the spectrum. The bottom line is, for most folks, the only road toward comprehensive coverage is through corporate headquarters. It is, of course, a little unclear what social good is advanced by making it far cheaper (even in total terms) to buy coverage through your workplace than on your own, unless we believe that avid entrepreneurs should chill out and keep on with their data entry or think corporations don't have quite enough power over their workers. It has always seemed to me that a system where the government guarantees everyone insurance is optimal, and one where individuals are all forced to purchase coverage is workable. But the employer-based system is scarcely even a distant third -- it's a mess. Assume you've got a great idea, a dull job, and a kid with asthma. You look into private-market insurance and realize it's too expensive, or risky. So you stay at your job. That's not precisely the outcome I'd think our society would, or should, favor. Health care could be an enabler: Were it guaranteed to us all, it could offer the base safety and security that would allow us to pursue dreams, and larks, and low-compensation-but-potentially-high-return ideas. You could start a band, or finance an invention, or start-up a start-up. When those work out, they could be lucrative and beneficial to society. When they don't, you can reenter the mainstream workforce. But if you can't afford health care, but feel you need it, you never get that chance. In that way, employer-based health care drags down our economy, not to mention our personal efforts at fulfillment and innovation. It could be quite the opposite, with health care providing the base security for all sorts of wonderful things and guaranteeing that a failure will not bring long-term, disastrous consequences down on you or your family. It could be.
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Ezra Klein
