145 Pages Posted: 9 Jun 2010

Date Written: June 9, 2010

Abstract

The focal point of health care in the United States is employment-based group health insurance. Such insurance provides and controls the access of millions of working Americans to health care. It also does much to define the nature and content of health care itself. Americans' insurance companies usually pay for specific services that they receive. For millions of other Americans who participate in a health care program such as Medicare or Medicaid, the program names the price it will pay for individual health care services. Many providers regard those prices as too low. Employment-based group insurance is the source from which such providers may seek subsidization of the care they provide participants in such programs, i.e., by charging those with such insurance more. By establishing programs or rules, government in essence mandates private-sector payment of subsidies, e.g., those for Medicare, Medicaid, or MTALA. Employment-based group health insurance provides the wherewithal to pay for the health care of most Americans and to cross-subsidize the care of most of the very substantial remainder. Private entities administer the subsidies and do so without much outside oversight and with very little accountability to other participants in the health care system.