“Employer-provided health care is the biggest obstacle to grassroots movement for single-payer in America. Because if you ask most Americans, ‘What do you pay for health care a year?’ They’ll go, ‘I don’t know. My employer provides it. I just have a little bit taken out of my check.’”
This was former Vermont Governor Peter Shumlin speaking to an interviewer, as recorded in The Commons on October 4, 2017 and online. Shumlin served as Governor from 2011 to 2016 and had to pull back from single-payer health care in Vermont, much to the consternation of activists. (His explanation of what happened in Vermont makes for a very revealing and instructive read which we will not explore here.)
Shumlin’s comment on employer-provided health care is an intriguing perspective on the health care debate and one not usually heard. As we have seen before, the United States is one of the few nations in the world – and the only advanced democracy – that does not offer comprehensive, government-run health care for all its citizens. For this and other reasons, our costs are astronomical compared to other nations’, and our overall health, based on many quality-of-life measures, is significantly worse. The Affordable Care Act (ACA, Obamacare), which has many features of a government-run system, is admittedly in need of improvement, and Democrats are submitting bills to that end, but the Republicans in control of Congress and the White House are determined to make the ACA collapse and/or repeal it so are not bringing these bills to the floor for debate.
Shumlin’s observation is revealing in several ways. First, in a number of the successful government-run systems in other countries, employers are involved, but in different ways than in the US system. As Steven Hill notes in Europe’s Promise, whereas in nations that use a single payer system, “the principal source of funding is general taxation and the centralized system is mostly owned and operated by the national or local governments, which establish price levels and cost controls” (140). However, other nations use a “shared responsibility” model of health care, where “workers, employers and the government . . . contribute their fair share to guarantee universal coverage, reasonable costs, and quality care” (140). In the excellent French system, employers contribute 70 percent of compulsory payroll deductions, but these employers “contribute a smaller amount toward their employees’ health care than U.S. employers pay toward their employees’ health care” (140-41). European nations utilize only nonprofit insurance companies (whereas our system is based on a perverse for-profit system) and negotiate price controls, which the US does not do (141). For many reasons, including Euroskepticism on Americans’ parts and on that of American media, we tend to be egregiously unaware not only of how much we pay for health care but also of how superior European systems are to our own.
Second, many Americans, probably including many who have employer-based insurance, do not realize that benefits they now enjoy are due to the ACA: insurance policies are required under the ACA to contain certain provisions, such as a wide array of screenings. The Republicans are trying mightily to “dumb down” or eliminate many of these provisions, and the rhetoric generally focuses on benefits of the ACA only to the unemployed, very poor or working poor, not the middle class. But 150 million American workers would stand to lose benefits they now take for granted if the ACA were to be repealed, crippled or significantly modified. The ACA is not just for extremely vulnerable citizens.
Thus, Shumlin’s observation makes a vital case for solidarity between Americans – those who enjoy high-quality health care coverage through their employers and those of us who do not have that option. We are suffering tremendously as a nation because of the dysfunction of our health care system – the high costs of care and drugs, the poor health of millions of us, and the indirect costs to society that must be paid for by our taxes – so it is imperative that we all work together to find an optimal solution. We cannot allow politics to pit Americans against each other! As noted elsewhere, Sen. Bernie Sanders’ Medicare for All bill is one approach to the health care problem; the Republican leadership should bring this to the floor for discussion. Tell your elected officials!
Hill, Steven. Europe’s Promise: Why the European Way is the Best Hope in an Insecure Age. Berkeley and Los Angeles, CA: University of California Press, 2010.