Blog | Monday, October 2, 2017

Happy birthday, Emily

A couple of my recent blog posts have advocated for single-payer financing for health care in the United States as the most effective path to universal coverage and lower cost. This one is more personal, but also ends with the same conclusion.

My daughter Emily is an actor and singer. Like many artists, she gets by with a part-time job (without benefits) and professional gigs. And, until her recent 26th birthday, she had health insurance coverage as my dependent. She now faces the challenge of finding affordable coverage that will not disrupt her established patterns of medical care.

In many ways, she is fortunate. Until the Affordable Care Act (ACA), she would have been booted off my insurance coverage after she graduated college, and would probably have found it impossible to get private insurance because of pre-existing medical conditions. And even now, I can extend her coverage through COBRA for up to three years (and can afford to do so) or she can buy insurance (with some help) on the New York State Health Insurance Exchange. So this is not a crisis for us, but it points out another fundamental flaw of how health insurance generally works in the United States. It is, uniquely among other developed countries, tied to employment.

About half of all Americans have health insurance that is connected to their (or a family member's) job. In fact, this is often cited as a barrier to reform, since moving to a universal, government sponsored option would end employer-based insurance that a lot of people like. However:

 Fewer and fewer new jobs come with health insurance, as our economy moves to what Thomas Friedman refers to as “self-driving people.” Airbnb doesn't provide health insurance.

 Those with employer based insurance are paying a higher percentage of the premium, money that could go instead to fund a more efficient national coverage system

 Employers are increasingly trying to hold premiums down by providing insurance with high deductibles, limiting the utility of coverage for many

The bottom line for Emily and for the rest of us is that it no longer makes sense to link health insurance with employment, instead of making it universally available. Decoupling employment and coverage would free businesses to concentrate on their business, provide vital security for individuals in a rapidly changing economy, and reduce the complexity of the current “system” that drives waste and cost.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.