There are 156 million people in America with employer-provided insurance. Those people have a different obstacle course, but one that is still much harder to navigate if you earn less or are sicker. As the KFF data showed, a lot of these beneficiaries have garbage coverage, with high deductibles that make it unusable, saved only for true emergencies (and good luck telling which emergencies are worth going to the ER for, since you aren’t a doctor). If you do have one of those medical emergencies, you better cross your fingers that the doctor who treats you isn’t out-of-network, which you have no control over, landing you with a huge bill. You also better hope you don’t need an ambulance (let alone an air ambulance, the median price for which is $36,400), since those are the largest source of out-of-network charges: 51 percent of ambulance rides end up being out-of-network. And you better pray that your doctors don’t leave your insurance network, or the company decides not to cover your drugs or treatment. Some people have fairly nice employer-provided coverage, and aren’t very sick, so they don’t have to fight for coverage or find out what a surprise bill is. Congratulations to these lucky few.



If you are really quite well-off and have private insurance subsidized by your employer, the quality of American health care is great. You can access fancy private rooms, new treatments, hospitals with expensive artwork on the walls and a 24-hour Au Bon Pain. It’s the problems that everyone else has that caused America’s life expectancy to decline for the third year in a row this year, for its health care outcomes to be worse than other countries with single-payer systems. It’s what we do to poor people that causes our maternal mortality rate to be worse than any other developed country; it’s worse in Georgia (the state) than it is in Uzbekistan. But given how well the system works for the better-off people, can we really ask for fewer mothers to die?

The health insurance industry, the Democratic presidential frontrunner, and many feeble liberal pundits who have more to fear from a sub-par oyster at Le Diplomate than the possibility of navigating Medicaid coverage, are insistent that many people like their private insurance, and those people must be coddled and protected at all costs. Where Bernie Sanders says he’s never met a person who likes their insurance, the status quo defenders insist that those with employer-sponsored insurance will die to defend it. Many Democrats buy into this. Nancy Pelosi buys into this. Do not poke the sleeping beast of Americans who love their private insurance, for they will surely punish you by voting for the guys who recently tried to blow up the entire health care system.

It’s actually quite a challenge for supporters of preserving employer-sponsored insurance to argue this system is good.

It’s actually quite a challenge for supporters of preserving employer-sponsored insurance to argue this system is good. Its main virtue seems to be that its existence allows lawmakers to shove the larger problems to the side. Hence, the dependency on phrases like “people like it” (as an alternative to dying penniless) or are “satisfied.” To argue that employer-sponsored insurance is good invites the question: What is it about this means of insurance provision that’s so good? It’s hard to argue with a straight face that it makes sense to give employers the power to determine whether and how much health care their employees are allowed to have, or that it’s good for employees to be tied to jobs they hate, or for those workers to have no control over the possibility that their boss switches their coverage to something worse—potentially sending the beneficiaries on a mad scramble for a new primary care physician. The argument, instead, is that it would be disruptive to those employees, which is absurd given how tumultuous employer-sponsored insurance already is.

