By NextBestFitDecouple coverage from employment
Replace employer-sponsored insurance with public or individually chosen coverage so leaving a job never ends coverage.
Follows from single payer.
Review ledgerHow this path connects
This path
Decouple coverage from employment
Requires:
Single public payer for everyoneTens of millions of people have no coverageChosenConcrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- End the tax exclusion for employer health premiums (or make it irrelevant by ending employer plans for covered services)
- Require employers to report premium savings and pass them into wages for a transition period
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Job lock: people stay in jobs to keep insurance
Replacing employer insurance with public or individually chosen coverage lets people leave jobs without losing insurance. This ends job lock and makes entrepreneurship and early retirement easier.
What it creates or worsens
- Transition disruption: jobs, companies, and familiar coverage
Replacing employer coverage ends a benefit many workers value.
7 paths soften this
Phased transition in wavesTransition disruption: jobs, companies, and familiar coverageChosenFast transition in one or two yearsTransition disruption: jobs, companies, and familiar coverageRejectedState pilots firstTransition disruption: jobs, companies, and familiar coverageRejectedRegulated multi-payer: everyone must have a non-profit or tightly regulated planTens of millions of people have no coverageRejectedPublic option alongside private insuranceTens of millions of people have no coverageRejectedLower the Medicare age step by step (and enroll children at birth)Tens of millions of people have no coverageRejectedPrivate supplemental plans for extrasLosing the choice of health plan and insurer competitionChosen - Limits choice or applies one rule to every setting
Employers lose health coverage as a recruiting tool.
Who's affected
Who gains
- People whose job, income, or home changes
- Job lock: people stay in jobs to keep insurance: Would-be founders, early retirees, and caregivers stay in jobs to keep insurance.
Who loses
- Employers
- Job lock: people stay in jobs to keep insurance: Benefits help employers keep workers who would otherwise leave.
- Health insurers, brokers, and their shareholders
- Job lock: people stay in jobs to keep insurance: Insurers and brokers sell group coverage through employers.
- Transition disruption: jobs, companies, and familiar coverage: Insurers lose their core business, and shareholders lose value.
- People with employer coverage
- Transition disruption: jobs, companies, and familiar coverage: People leave plans most of them rate well, and must re-learn how coverage works.
- Insurance and billing workers
- Transition disruption: jobs, companies, and familiar coverage: Jobs selling coverage and processing claims end.
Other ways to soften the losses
- Require employers to pass premium savings into wages
Where it has been tried
- Canada, UK, Taiwan: Job changes never affect health coverage.
- Canada: Canada's public and primary voluntary health insurance covered 100% of the population in 2023, with public hospital and physician coverage based on residence.Sources: OECD (2023)