Yes, before anyone complains, I do think that CNBC is basically putting words in Howard's mouth by suggesting that this delay will signal a shift to a single-payer system. Having said that, this interview does allow Howard to make an important point, mainly that fewer people getting insurance from their employers will accelerate the shift to a more government-centred system of health care financing:
Former Vermont Gov. Howard Dean on Wednesday praised the White House's decision to delay a key provision of President Barack Obama's health-care reform law until 2015, which would have required employers to provide health insurance for their workers, because he thinks it signals a shift away from employee health care toward government-run health care.
Dean, a practicing physician before entering politics, told CNBC the delay of Obamacare's employer mandate could come with an "unintended consequence."
"I think what will happen is more people will migrate out of the employer-based health insurance and into the exchanges," Dean said on CNBC's "Squawk Box," suggesting a shift toward a single-payer health-care system, in which the government, rather than private insurers, pays for all health-care costs.
"And I think in the long run that's good, because I think in the long run I've always believed that you've got to divorce employment from health insurance in this country for a large number of reasons."
Divorcing insurance from employment is something that most reasonable people agree on -- heck, I'll even include (2008) John McCain
in that camp. When employers don't control your insurance, nobody can tell you that you don't deserve birth control, nobody is forced to stay at Widget Corporation XYZ because they have diabetes -- basically, well, freedom
And this is exactly why the employer mandate is bad policy -- American employers really are burdened by health care costs unlike those in other countries (i.e. Canada, Europe, Japan). And the Affordable Care Act discriminates against certain kinds of employers in determining responsibility for health care, whereas in a single-payer system, all employers are responsible for the same percentage of payroll tax to finance national insurance. Yes, with the mandate delayed, employers are not paying a penalty or paying additional payroll tax (i.e. basically they're freeloading in terms of the social contract), but, for a year, if this accelerates the demise of employer-provided health insurance, progressives should celebrate the mandate's delay (and, potentially, advocate for its demise).
Asked outright by CNBC's Joe Kernen if he'd like the government to handle everyone's health care, Dean withdrew, claiming "that's not going to happen."
"That doesn't even happen in Canada where they do have a single payer. So if we have a single payer, it's not going to end up being a Canadian single payer, it will be an American single payer, but that's not what's going to happen right now," Dean said, adding any change to the health-care system would have to be gradual.
Large employers will likely continue offering health insurance "for a while," Dean said, because the benefit helps attract and retain employees. Health insurance gives a big employer a "competitive advantage," he said.
Medium to small businesses, however, often struggle to pay the high cost of health care and would likely favor an end to the benefit, Dean said. If the government pays the health-care costs, he said, "it gets the monkey off the back of the business community."
So, CNBC raises the boogeyman of single-payer, because, well, they're CNBC, but Howard is really saying that employers do suffer when health care costs are their responsibility, this will push us in the direction of more government-financed health insurance, and, ultimately, that could mean a uniquely-American form of single-payer.
In short, here's my takeaway point for progressives from the employer mandate delay drama:
We, as progressives, finally have an opportunity to claim the moral high ground in the messy health care debate in this country that sits at the nexus of employment and how health care is to be financed. We can explain to Americans how, Democrats, too, believe that employers shouldn't be burdened by health care costs. And, let's be honest, without the support of big business, we're never going to get single-payer in America.