Who "pays" for health insurance

My friend Henry has an interesting post in response to a post at Healthy Policy about states mandating employer-based health coverage. his post also features a series of comments about who really "pays" for it if employers are "forced" (meaning legislated) to provide health insurance to employees.

Henry says: the employee pays for it, because that extra $xxx won't be paid in salary anymore.

His commenter says: the customer pays for it, because the company will raise prices to pay for it.

That's so nice that they know exactly how the employer income statement would change to support higher health care costs, but I have to point out that both contentions are pretty much assumptions made to support a pre-determined opinion on the subject of employer-based health coverage.

How about the employer gives up their $1M/quarter lease on a private corporate jet for the CEO and has the CEO fly coach like all of the CEO's employees? (Yes, I speak as a former employee of a company that kept a corporate jet even as our share price tumbled, net loss per share skyrocketed, and as lay-offs came at regular intervals.)

How about the employer doesn't pay consultants to come up with one more logo change (the 3rd in 5 years) thinking a new logo will "re-invigorate the brand"? (Yes, I say this, even as a marketing person who now consults, because I have lived through the ridiculous expenditures with high-priced consultants whose output lasts for about 3 months before being forgotten and discarded.)

My point is that health care is an expense. There are two sides to every income statement: income and expense. Companies, whether public or private, set financial targets and budget accordingly. And anyone who has sat through the endless corporate budgeting process knows there is more than one way to skin a bloated corporate fatcat.

We are not a pure capitalist society...we regulate how much profit ends up being made in many different ways. Companies are free to make fair profit, not unfettered profit. That's how we have environmental protections and minimum wages and the Family and Medical Leave Act and patents, for goodness sake, even though companies could rightly argue they diminish their ability to make as much profit as they could.

So, I'm no naif...I know the likely chosen methodology for meeting financial targets will be at the expense of the customer or the average working stiff, rather than at the expense of the Executive Staff or the Board of Directors or God forbid, the shareholders. But let's not pretend that's some mandate or some economic requirement. It's choice and priorities.

Comments

[ShortWoman]

Mandated employer provided health insurance is a non-starter. First of all, it falls disproportionately on small employers, without doing a darn thing for the self/un-employed. Second, it reinforces the disconnect between health care users and health care providers with two mandated middlemen (boss and insurance company). Employers will still have a vested interest in getting the cheapest, lowest quality coverage possible, and employees will still be left with high out-of-pocket expenses. Insurance companies will still be out to take in as much money as possible while paying out as little money as possible.

If we aren't going to go for full-on socialized medicine, we at the very least need for insurance companies to re-mutualize, and for that line on the front of the 1040 to allow *everybody* to deduct insurance premiums.

[Elisa Camahort]

Hey, I'm sure you're right Bridget, but my point was not to support or oppose employer-based coverage. My point was that I saw a flaw in their arguments...and it's the most common line of reasoning I see.

Frankly your point about the disconnect between provider and patient is one we've discussed on HealthyConcerns before, and is one I find very convincing.

[Kate Steadman]

Elisa,

Thank you for interjecting some reality into the word quibbling! Fantastic post.

[Elisa Camahort]

Thanks, and thanks for stopping by, Kate!

[Elisa Camahort]

Thanks, Kate, and thanks for stopping by.

[Bob]

To quote: "we regulate how much profit ends up being made in many different ways. Companies are free to make fair profit, not unfettered profit. That's how we have environmental protections and minimum wages and the Family and Medical Leave Act and patents, for goodness sake, even though companies could rightly argue they diminish their ability to make as much profit as they could."

Well that's about as far off base as one can be.

Except in a monopoly, the free market determines price, and in turn profit margins. Only in regulated industries, such as financial services and (sometimes) utilities, are profits controlled by outside forces.

Gov't imposition in things like minimum wage, FMLA, COBRA, HIPAA (just to name a few) all add to the cost of operation of a business. The business reacts by increasing prices (if they can without losing a competitive edge) or reducing costs in other areas (such as payroll) to offset these gov't mandates.

[Elisa Camahort]

Bob: we are making EXACTLY the same point, actually. Let me, therefore, re-phrase for you, although I think most people got what I meant:

"we regulate how much profit ends up being made in many different ways."

should have been:

"we regulate THINGS THAT CAN IMPACT how much profit ends up being made in many different ways.

[Bob]

Thanks for the clarification.