Whenever Europeans ask me about health care in the United States, I always have to set aside some time to explain that most (non-elderly, non-poor) Americans get health insurance through their employer. Europeans find this difficult to understand, because it seems so weird and arbitrary -- getting health insurance from the company that employs you makes just about as much sense as getting vaccinations from your plumber. Yet that's the way it works for many Americans. And it creates problems largely unknown in the rest of the industrialized world -- in particular, people stuck in jobs they don't like because they can't afford to lose their health insurance.
But, as Kevin Drum reports, the situation is changing fast:
Over the past decade, the number of Americans with employer-sponsored health insurance has dropped from about 70% down to nearly 50%. Note that this is for the non-elderly only, so it's not due to the aging of society or the growth of Medicare. This is working-age people only. As Krugman says, our weird employer-based health insurance scheme is "coming apart at the seams."
Most Americans simply have no clue how bizarre it is that we rely on employers to provide health insurance for most people. We've all grown up in this sytem, so it seems completely normal. But it's not. It happened through a weird combination of historical accidents, and it makes no sense. Why should an airplane manufacturer also be in the healthcare business? Why should you lose your health insurance if you get laid off? Why should your choice of doctor be limited by your employer's choice of insurance carrier? (And why should it change whenever your employer decides to change carriers?) Why should your boss be allowed to dock your paycheck if you don't get the medical "counseling" he deems necessary? (Yes, this is real. And it's rapidly making its way to a corporation near you.)