SURVEY SAYS – Should Health Insurance Be Linked to Employment?

June 11, 2009 (PLANSPONSOR.com) - Even more interesting (particularly as President Obama appears to be warming to the notion of taxing health care benefits), was this week's bonus question.

I asked readers if, in their opinion, it made “sense” to link health insurance to employment.

The responses were about as evenly divided as they could be.   A slim plurality ( 36.1% ) said that “yes”, it did make sense to make that link, while 30.6% said “no.”

The remaining third ( 33.3% )?   They said “it depends.”   As for what it depends on, here’s a sampling:

“Only if the cost would be reasonable for both employer and employee, without a crazy reduction or restriction of benefits.”

“Depends on the alternative — I haven’t heard any that I like so far. As an employee with a (still) very generous medical plan, any change would probably involve some sacrifice.”

“Depends on the size of the employer. It’s too much of a burden on very small employers.”

“Depends on what country you’re from. I was born and raised in the US and used to think health care was a right of the working people. My spouse is from England and thinks health care is a right to all citizens. This alternate view has certainly opened my eyes to the fact that there are other ways to implement health care that may be perceived as more fair.”

The comments this week came in on both sides of the issue, and neither side.   This week’s Editor’s Choice goes to the reader who said, “I see no problem with an Employer being able to get group discounts for any good or service. I do see a problem with requiring an Employer to provide any benefit, be it health insurance or car fresheners.”

Thanks to everyone who participated in this week’s bonus question!

Only if the cost would be reasonable for both employer and employee, without a crazy reduction or restriction of benefits.

Group plans make sense where you can spread risk factors and have a better way to negotiate a fairer price. For small employers, they should be allowed to group many small employers in order to make health care more affordable for both employers and employees.

Unless the government offers / requires 'universal' health insurance

I'd hate to throw out a system that works well for a lot of people. That said, I don't think it's sustainable in the long run without substantial reform, and I don't think that it's fair that people who lose their jobs lose their health insurance. However, let's be realistic. Compensation should be higher if employers don't have to provide for health insurance. But I wouldn't hold my breath for that increase in pay if it happens. Labor unions fought long and hard for the benefits many of us non-union workers enjoy and I don't think we can trust employers to do the right thing for employees - look at what happened to defined benefit pension plans - with the help of the federal government, of course. So what do I really think? Universal payer is the ultimate goal, supported by tax dollars from all of us.

Depends on the alternative -- I haven't heard any that I like so far. As an employee with a (still) very generous medical plan, any change would probably involve some sacrifice.

The last thing we need is a single payer (government bureaucracy run) system. Ours is not perfect, but it is far and above the world's best.

It makes sense right now because that's how it's been in the past. It's convenient, a good employee benefit, affordable. It has it draw backs though in terms of mobility (changing jobs) or finding yourself unemployed. However, anything put into the government hands means higher costs, greater inefficiency and increased paperwork (even though they have the reduced paperwork act).

It really isn't the employer's responsibility to provide health insurance, but we've allowed it to happen, so it would be difficult to stop it.

It makes no more sense than linking car insurance to employment. My understanding is that this practice came about during WWII, when wages were frozen and employers/unions were trying to add value to an employment package. (I heard this second hand- so don't know the exact facts.)

I see pros & cons. Anyone employed would receive health care. Are the premiums higher for small businesses as opposed to large businesses thus making the cost more burdensome to small businesses? How much would the employee be required to contribute? For someone making minimum wage it might not be affordable. There are a number of chronically unemployed individuals. What would their options be?

Everyone might get health insurance cheaper if they didn't belong to a group that has one employee with a large claim which drives up the cost for everyone.

It is up to the employer to decide what benefits they can afford to retain good staff. Socialized medicine will fail here just as it has everywhere else it's tied. It's the model that is flawed not the country where it's tried.

that's the big question right now. I think health insurance is a "benefit" that has become an "expectation." Other than to keep/recruit talent, I'm not sure why it's in the best interest of my company to pay millions of dollars in healthcare claims every year.

Can't imagine it being affordable otherwise. When did it become OK to not work for your livelihood, to expect to be taken care of, to whine and stamp about the "injustice" of inequalities between socio-economic classes? Jeepers.

That being said, the issue of portability is real and valid. I don't know how to solve for that affordably without socialism. Blech.

It makes sense from the point that a large group of people negotiate the premium. And I very much enjoy the fact that my employer pitches in on this BENEFIT. Health insurance doesn't have to be LINKED to employment; a group of people with green eyes could negotiate coverage with a provider. The real question is what about the unemployed uninsured that can't afford to take care of anything themselves. It is not our government's job to provide insurance or any other benefit to its citizens. If they would stay out of it, health care might be affordable. We need to start with the courts. If you choose to go to a doctor, you assume all the risks.

I also believe it makes sense to continue offering tax incentives to employers who do so. There appears to me to be no good reason to mess up the benefits that I, as well as many other employees, enjoy just because they are not available to everyone. I will acknowledge there is a need for alternatives to employment-based coverage for those who do not have it.

As a theoretical discussion it does not make sense but it has been part of the American employment circumstance for so long that severing the two will be very painful now.

Depends on the size of the employer. It's too much of a burden on very small employers.

I see no problem with an Employer being able to get group discounts for any good or service. I do see a problem with requiring an Employer to provide any benefit, be it health insurance or car fresheners.

If the insurance lobby is going to run the healthcare world, then the best way to get better rates is by larger groups. That would also extend to other types of groups, like professional associations, the AAA-type organizations and maybe some other groups with large populations. Who knows, they may go state by state to set the rates.

Only because it provides for a ready-made group that allows for better pricing than if it was purchased as individual coverage.

Health insurance is a great benefit and incentive that employers can offer to employees. While I think we need to provide better options for those who are not employed or whose employers do not offer health insurance, I would not want to see this employment benefit adversely impacted for those who have it.

Health insurance should be available to purchase in the same manner as we personnally purchase our car insurance. There should also be government oversight on the premiums that can be charged to individuals with pre-existing conditions.

For the most part, no. However, certain occupations would seemingly require higher levels of risk and potential health costs that would preferably be included as part of their benefits package.

The U.S. should have universal health care. Health care is a basic human right, not a privilege. Universal health care would also help U.S. companies to be able to compete with companies in other nations that do not have the burden of providing health care coverage to their employees.

Health care, like any other good or service, should be an independent decision paid for by the consumer. Having a third party payer, whether the employer or government has confused the process and caused most of the problems we have today.

No- although its a very nice benefit to have the cost shared by my employer - its hard to imagine that if employer sponsored health plans went away that it wouldn't end up costing the consumer a lot more money to have health insurance. Its a scary prospect.

I think everyone should have it, but people employed might have a different plan (and can pay more in premiums) than people that are not employed.

If we all had individual policies, we would all know the true cost of medical and poor health habits. Plus we would not be so dependant on our employers.

Depends on what country you're from. I was born and raised in the US and used to think health care was a right of the working people. My spouse is from England and thinks health care is a right to all citizens. This alternate view has certainly opened my eyes to the fact that there are other ways to implement health care that may be perceived as more fair.

«