Employers may be wary of their health insurance partners but they share in an opposition to single-payer health insurance.

You would think that large employers would say to heck with the health insurance and health care status quo. You would think that they have had enough of the annual negotiation performances played by brokers, consultants, and health insurance representatives. You would think this, but you would be wrong. Large employers are generally opponents of a single-payer (e.g., Medicare For All) system that would replace their private group insurance plans. They may not enjoy participating in the ritual pretense of controlling health insurance costs, but they find it preferable to the alternative—losing control of a powerful financial tool.

There are several reasons why big companies and the health care industry do not support Medicare for All or single-payer health insurance.

Large organizations that are not part of the health care industry oppose single-payer because they would no longer be able to use health insurance as a recruitment/retainment tool, or as way of manipulating the total compensation their employees receive. These organizations may also benefit financially from health care industry stocks. And you've got to figure that large corporations don’t want to upset each other because the shoe could easily be on the other foot, so it is best to have each other’s backs.

Health care organizations have even more at stake in the single payer debate. According to a Kaiser Family Foundation report, health care employment accounted for about 9% of all employment in the U.S., in 2017. The industry, with the exception of some groups like Physicians for a National Health Plan (PNHP) and a few others, vehemently opposes single-payer health insurance. The Healthcare Leadership Council, a health care industry lobbying group, lists insurers, hospitals, drug makers, medical device manufacturers, pharmacies, health product distributors, and information technology companies as part of the health care industry. Add to that the thousands of companies and freelancers that support these organizations... The bottom line is that the health care industry employs millions of people, and makes tons of money for Wall Street—a gig they would like to keep.

Small Employers Will Save Us

Health care reform isn’t over. Everyone agrees that health care costs is THE problem we must resolve, and that the solutions proposed by insurers and adopted by private sector organizations large organizations are band aids. So far the reforms taken to make health care more affordable and available involve transferring costs from one group to another. Large organizations can play this shell game better and longer than smaller companies because insurers realize from time to time they have to let the big guys win (or think that they've won). Small employers on the other hand do not have this kind of clout, and usually follow the lead of larger organizations when it comes to plan design, financing, and other health insurance reforms.

The Teachers Will Save Us

This year, teachers in West Virginia went on strike to protest growing health insurance costs and other issues. The actions in West Virginia led to a wave of teacher demonstrations over pay and benefits in several other states. Teachers put their school districts on notice that they were failing at providing affordable health insurance. So while it may not be teachers that save us from the health care status quo, their actions put companies on notice that business as usually is no longer acceptable in terms of health care costs and coverage.

Conclusion

Employers large and small are gearing up for another annual benefits open enrollment. As they fight it out with health insurers over the cost of administrative services (for self-funded groups) and premiums (for insured groups), they probably won't give much thought to giving up the ritual. But they should prepare for the inevitable reform that is coming, and more and more health care reform looks like it’s headed in the direction of a single-payer, public model. Employers of all sizes need to think about what, if any role, they want to play in a single-payer system. Will they offer supplemental health insurance coverage or some other benefit(s)?

Tags: Medicare For All, Single-payer