There is an opportunity to use this interregnum in the health care debate to reboot and put together a coalition for health care change that would be unstoppable. The key? A plan that gets employers out of the health care business. This coalition would put on one side not only most moderate and progressive elements of society but also most small and large businesses – with the notable exceptions of health insurance companies and bankruptcy attorneys.
Obviously, most businesses, large and small, would be thrilled not to have to carry the financial costs and administrative headaches that come from being responsible for their employees’ health care. Big, international businesses would be able to compete on a level playing field without having large and rapidly growing health care costs that their competition from all other industrialized countries do not have.
Small businesses would be able to compete for quality workers without the disadvantages of either not providing health care or paying more for the same coverage without the buying power of the large firms. Companies large and small won’t need to use manpower to administrate the complicated, time-consuming administration of our byzantine health care system instead of applying that time and attention to their core business. And, with proper health care, employees should be more productive and less distracted by worries about their and their families’ health.
For consumers, portability, access to all health care plans – not just the options your employer provides - and the economies of scale of joining large national plans are obvious. How many people are forced to stay in jobs that are not working for them because they are afraid to lose their health care? How many people are unable to innovate and start their own companies because they can’t take the chance of leaving their current health care coverage?
I won’t pretend to be wonky enough to put together the plan. Frankly, I think there are a lot of ways it could work. But roughly, I see a ten-year transition to a plan that weans our health care system off of business. Businesses would continue to pay a payroll tax – probably somewhere from 5%-10% of their payroll – into a general fund, but would be freed from the overhead and uncertainty of rapidly increasing premiums and managing their employees’ health care. A single payer plan would probably be the most efficient, but other systems including private health care providers plus a public option could work. Allowing all Americans to buy into Medicare may be the easiest way. The incremental costs of adding new customers to Medicare would be low relative to starting a new program. Perhaps the compensation Medicare pays to health care providers (doctors, hospitals) would need to be adjusted and, of course, provisions would have to stop the practices of declining coverage due to pre-existing conditions and dropping customers because they got sick.
On the political side, a plan that most businesses and consumers would support would seem to be unstoppable. A progressive health care system that would be strongly supported by everyone from large manufacturers to the Chamber of Commerce would be a slam dunk that would drive a wedge through the current Republican coalition. Even many red-meat Republicans would see the value of getting their health care independent of their place of employment, especially if they are at risk of being laid off or are considering moving to another job or locale.
It’s a great opportunity to reset the entire debate by aligning the interests of most businesses and consumers and packaging it, rightfully, as a pro-business move that greatly improves America’s ability to compete in the global economy. Let’s tear up the Frankenstein compromise plans that are on the table and put together a bigger, stronger coalition with a new assumption: what’s good for GM – and just about every other business – could be equally good for the average American.