Evolving Beyond Traditional Employer-Sponsored Health Insurance

Transcript

STUART BUTLER: I immigrated to the United States about 30 years ago and I think like all immigrants to the United States, one of the things that surprised me, actually rather shocked me, was that your access to health care and what health care you got depended on who employed you, and it differed widely. This was a real curiosity to me as it is I think for almost everybody who comes because it is really unique certainly in major countries this system here. So I have spent a lot of time pondering that, and I think like a lot of people who have pondered it, we see a system today which I think most people would say is creaking and may be leaking. It is creaking in the sense that I think many people feel it is under enormous strain, that there are all kinds of issues associated with it that worry people who are employed, and employers, and people who are concerned about the issue of universal coverage, and it is leaking in the sense that people are becoming uninsured particularly in certain employment sectors and that worries people, the growth of the uninsured and so on and the trend line in that area.

So I thought a lot about this and the paper is really an attempt to see how we can chart a different course for the employment-based system, that uniquely American institution, but do so recognizing that it has got to move in a somewhat different direction to reflect what is really going on in the real world.

The premise of the paper is not, and I want to emphasize this, is not that the employment-based system in the general sense of the word should be abandoned in this country. It is, however, that the sort of classical, traditional version of employer-sponsored insurance cannot deliver the goal of economic security for millions of Americans and it must be helped to adapt into a somewhat different design in order to achieve not this universal coverage but security for those who are within it. So the aim of the proposal is to revisit and somewhat change laws that in my view currently constrain the ability of the employment-based system to adapt, that these laws are obstacles, and actually the way we think about it to some extent is an obstacle to this as well. The idea by doing this is actually to strengthen the notion that your place of employment is important in how you get coverage, but to allow that system to evolve so that the objectives of universality, of assurance, of choice in coverage and so on are achieved.

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