Health Care

Empowering individuals would create opportunities for more creative fixes

Now that the Supreme Court has affirmed almost all of the Patient Protection and Affordable Care Act, thereby puncturing the patchwork of coverages that has grown up piecemeal in this country to the disadvantage of many, there is an opportunity to create a much more functional basis for insurance coverage.

End the concentration of employer-based health insurance coverage – about 50 percent of workers have insurance through their workplace – in favor of coverage that is chosen by the individual, closest to meeting his or her needs, and is portable.

Give every individual, independent of where he works, the opportunity to pick the most appropriate coverage and to take it with him when he changes jobs, and communities. About 50 percent of workers already do that.

Employer-based insurance is a burden on mid-sized and small businesses that do not have the staff resources or the buying power to receive the variety or the pricing that large companies have.

Some business owners try to put some effort into identifying the most-appropriate coverages, and get it wrong; others simply let their employees fend for themselves. That unequal benefit ought to be ended.

Portability has value to the individual and to the nation’s economy. The best match between job interests and skills and the workplace, unrestrained by concerns about insurance coverage, adds to job satisfaction and to productivity. Significant components of the Patient Protection Act could support a move away from employer-based insurance. The across-state line exchanges, which will be structured by the states, will provide many more options for coverage. In the president’s plan are insurance-premium supplements for low-income earners, which will be necessary. The individual mandate means that every company employee will have coverage, in this case chosen individually. That also fits.

Let state governments, with federal premium assistance if need be, make it possible for individuals to have the most appropriate insurance at the lowest cost. States that are successful will especially benefit their own small businesses, and appeal to larger businesses that are planning to expand or to relocate.

It was during World War II that employers began to provide health insurance in order to set themselves apart in attracting employees, as wage controls made salary differences impossible. It is time to undo that, and instead create a new foundation for health-insurance delivery.

The president’s critics, mostly Republicans, ought to appreciate the central role for the individual in this scenario.

Some correctly will see this as reducing a business expense. But expect resistance from the unions. Advocating for health coverage is a major component of what unions offer their members; take that away and unions lose a major argument in favor of organizing.

We join those in saying that in no way have the decisions about health-care delivery, and the ways to pay for it, been finalized. The issues are large. The Patient Protection Act provides a radical new direction with the individual mandate foremost, but there are still opportunities to for logical adjustments. One is to replace the employer with the individual in coverage decision making.