There are a lot of things about our health care system in the United States that need to be fixed. Passing health reform was a start, but it still leaves a lot to be desired. One of the remaining problems, as I see it, is a continued reliance on an employer-based system. Ideally I’d like a single-payer system, or at least a public option. In fact, I think I really prefer a strong public option over single-payer–I see tremendous potential through competition–and right now we lack that competition. But more to the point, there are some tremendous drawbacks to employer-sponsored coverage.
For instance, if you really need your health insurance, you may be afraid to leave or change jobs, a phenomenon known as “job lock.” You also wind up getting compensated in the form of benefits you aren’t easily able to quantify while rarely seeing your paycheck increase at all (especially if you account for annual inflation). But the worst thing–the thing you absolutely have the least control over–is that with an employer-based system, you can lose your coverage if your employer decides to stop providing benefits, and you will lose your coverage (save COBRA) if you happen to lose your job. Fun fact? Both of those scenarios are much more likely when the country goes through an economic recession.
But according to a recent study of the near-universal coverage system in Massachusetts, published in Health Affairs, a public option can lead to such a problem being avoided. The study finds that Massachusetts has gone through the recession just like every other state–seeing large increases in unemployment, state budget problems, and the like–but has been quite different in one key respect: Unlike other states, the uninsurance rate in Massachusetts did not increase during the recession. That’s remarkable evidence in support of severing insurance coverage from employment–perhaps not entirely, but at least in part. In other words, it should be a one-way street of necessity: You should be able to get insurance through your employer, but you should have affordable options for maintaining coverage in the absence of an employer-based option.