It's a big mistake to link health care and employment. It's bad for American competitiveness. It's bad for the American worker. We should have a progressive tax based public system. I believe in single payer but there could be room for private insurance to compete if it wants too, by having them provide medicare-plus type programs, or even by giving American citizens a voucher which they can use for public or private insurance.

Business lobbies should be out there advocating for single payer tax based health care. Every American business is competing against businesses around the world that don't have to pay for health care. And how many Americans might love to start their own small business if they didn't have to, first of all, face the loss of their own health care, and, secondly, didn't have to assume responsibility for the health care of their employees?

A majority of the electorate supports a single payer system. Unfortunately, that discussion is not happening here. It is unsafe to suggest that Obama be held to any of his campaign promises. A major health insurance company is holding a fund raiser for Pelosi. In a few short years premiums in California will exceed forty thousand dollars a year. Two out of five of working age in California are out of work. Who is repealing Medicare part D? What a sellout.

I repeat. It is not allowed to suggest on this site that funding wars in Afghanistan and Irag is part of the problem. That comment was deleted in recent days. A Senate war committee has approved another 128 billion and that may last until Spring. Where is the Democratic Party on this? There is much to be blue about.

An excellent post, column and question Jeff.

Historically, employer based health care came about and grew as the direct result of Roosevelt's Wage Rationalization Board in the late 1930's. In an attempt to curb inflation, Roosevelt in effect curbed and attempted to control wage increases across the board.

Kaiser Shipyards found an interesting twist and way around the edict. Why not offer full time employees Health Insurance at no cost to them? It was low cost and seemed like a great way to retain a trained workforce. When you add in that the benefit cost was a deductible business expense it became a "no-brainer". They also later became the for runners in what we know of today as HMO's.

Here we are 70 years later and Health Insurance costs many employers who offer it upwards of 8% - 11% of actual payroll. there is a reason that GM gave the UAW $5.3 Billion in their last contract negotiations so that the UAW would take over the health care funding for UAW workers, retirees and their dependents. UNCONTROLLED COST.

In an effort to contain health care costs that often rose at 2X inflation, employers turned to cost sharing, increased co-pays, deductibles and reduced coverage options. With many employer plans now days costing upwards of $200/month for employees, many younger, healthier employees opted out of the plans. This negative selection had a slingshot effect in that the older, less healthy employees and their families continued to drive up costs without the healthy employees paying in to offset the rising claims costs. Ergo, up go the employer rates again.

Add to that ever increasing mandates of what an employer offered plan MUST contain, costs to the employer kept rising. When you add in the complexity of HIPAA, COBRA and annual open enrollment, many employers would welcome a reasonable payroll tax in order to get out of providing health insurance altogether. The unintended consequence is that several, no many employers will dump their plans and pay the payroll tax, forcing their employees and families into the Exchange.

Some may say that the Obama mandate that ALL citizens have some form of minimum coverage will cause more younger employees to opt into their employer plans. The major stumbling block here is ERISA, that pesky employee benefit set of regulations that prevents employers from forcing all employees into their plans unless there is no monthly cost charged to the employee.

I look forward to what others have to write on this topic.

Marv - as far as I know there are no manual/editorial deletions. It's the sucky work product upon which this site is built and maintained. Comment threads are truncated, erratic, peek a boo.

Many have said Obama should get the hell out of the wars. And others have taken less radical stances, but related to it... doubt anyone says that those billion-dollar sinkholes have no effect upon our current economic woes!

Do suspect you posted a fanatically anti-Obama diatribe, and, yes, you are right: we are in ObamaLand here. Folks don't like it. Diatribe, unlikeable. Monomaniacal dislike for the Prez, same.

However, bet if you presented a well-spoken expression of your concerns and not a base-level rant against the man and his legitimacy, folks would probably engage thoughtfully.

Maybe. Hope your comment resurfaces. The only time editorial work is done is when things are radically radically off-topic and vulcan in nature, my impression. Inded, I've never gotten to actually SEE one of those deleted comments, so rare. I think they lie, it's like that little white birdie spotted in Arkansas - all see-say.

Has anyone else had this thought? Who are these politicians kidding? Add a tax upon the insurance industrialists and it WON'T be backfed onto us?

Indirect pressures to weaken a now-ill-fitting system will only be foisted upon the ones you seek to free. A direct and overt initiative is really the only way to do this.

Please...

At my company we had a serious debate about 20 years ago regarding dropping medical insurance for employees and simply adding the cost of the premiums to their salary package. In hindsight we could have saved a hell of a lot of money by offering modest wage increases which would have inflated over the years at a CPI of 3 -6% instead of continuing to pay medical premiums which are inflating at 18% or whatever.

We ultimately decided to keep the medical insurance program because we did not want our employees distracted by the risk of going without medical insurance in the current medical cost environment. A compound fracture broken leg could bankrupt somebody living paycheck to paycheck, not to mention heart problems or whatever.

Decoupling medical insurance from employment may or may not be a good idea, but if employers drop the insurance it is going to be mighty interesting to see the "sticker shock" experienced by employees who shop for private health insurance. I think the premiums on our employer provided health care through Providence Health Plan are well over $1000 per month for a couple with no kids. From what I have read, the cheapest family plans in Mass. under their mandatory coverage program run $700 per month and those plans are hardly generous in coverage and benefits. How many wage earners are going to be able to spend $1000 per month to purchase medical insurance, even if their employer offers some additional compensation in lieu of employer-provided insurance?

Dave I fail to see the confusion in Labor's duality on the subject. They want single payer minimum health care for everyone else and want collectively bargained, employeer paid health care insurance for their members.

This is by no means a slam at Labor. They rightfully would want years of high priced plans bargained for to be kept for thebenefit of their dues paying members. To advocate otherwise would be aginst their own self interest.

Actually, Jeff, you've put you're finger on why a lot of NW Democrats aren't actually progressives. At the same time, though, I had to do some searching on the web to see if you have affirmatively articulated your position on what health insurance reform should be, and I couldn't find much. Even your own blog "REALLY Taking America Back" links to a Daily Tidings story which is no longer accessible. And in case it hasn't been noted to you, the messaging for Ron Wyden in your post is such positive spin that it hides as to the reality of the moral bankruptcy of his positions on health care so far.

(And neither you nor he seem to have any historical awareness that his idea was put forth during the OHFB process last year. Exactly this proposal was explicitly put forth as a boost to small business proprietors by grassroots advocacy groups arguing for a state public plan in the state Exchange. Or at least neither you nor he have given credit to that effort that I can find.)

And also, I have to say frankly, the title of your book "As If We Were Grownups" is trite and pedantic. So you'll have to forgive me if off the top it's hard to give you much credibility based on the facts in hand. Do you really want to be made "smarter", or are you just playing games?

I'll treat you "As If (You) Were A Grownup" for the sake of argument, by taking your question at face value and respond to it thusly: In the realm of the economic and health care realities we all have at stack in this political fight, you entirely miss the point. Here's the bottom line:

1) Unlike what Obama said, we should settle for no less than a single payer if you really don't believe employers should be the collecting agent for health insurance funding. This is what I support, but I recognize it's not going to happen and politics is the art of the possible. If you're just shilling for Wyden (and I'm not saying you are, but you haven't said you're not), this is even more of a non-starter, so your question wouldn't be honest and we'd be done.

2) Given that Republicans and Democrats in the pocket in the industry are allowed to take single-payer off the table, we should have a real public national insurance plan, meaning a Medicare Part E anyone can buy into from day 1. That's ANYONE, as in employers who want to offer insurance as a perk to their employees, employees who don't like whatever their employers might offer, and those of us who don't have either choice from time-to-time. Unlike the only lie Obama told in his speech, that is based on a system we already have, and that we can build on faster and with less disruption than what he and Congress has proposed. FEHPB, BTW is a private, managed-care system based on the private health insurance industry and by definition incorporates all of the problems.

3) Now the question really is: What do YOU support as a money-collecting approach. People writing a check themselves, or just having it taken out of their paycheck just like their private 401K deduction and their public SSI contribution?

Therefore question I assert you should be asking, if you're serious about this is:

Is a mandate to buy insurance WITHOUT the choice --- either individually or through our employer --- to participate in a public national health insurance plan on day 1 --- by writing a check or payroll deduction --- as many Democrats except the Progressive Caucus, but including Wyden are actually s behind, and Republicans will actually support acceptable? Or do we have to shake the very foundations of our current political establishment by working to defeat any Democrat or Republican who supports and votes for a bill that does that?

I guess until you clarify your position on that essential proposition, it's hard to take you seriously. You want to be talked to "As If (You) Were a Grownup", don't play games.

BTW - It would be a scoop if you can get Wyden on the record stating he will oppose any bill that has a mandate but which doesn't include a robust public national health insurance plan anyone can choose from day 1 regardless of what their employer does. And so far, Wyden's hasn't confirmed on the record his choice proposal wouldn't do the latter even if included in a bill that included some trigger-based public option intentionally designed to fail.

Dave I fail to see the confusion in Labor's duality on the subject. They want single payer minimum health care for everyone else and want collectively bargained, employeer paid health care insurance for their members.

Kurt you are flat wrong in your hyperbolic framing of this. Certainly post the Johson era, Labor and through the start of this decade, Labor never took a formal position in advocacy for single-payer for anyone.

In the last few years, as health insurance became something for which Labor can no longer bargain so effectively, and costs have skyrocketed, the AFL-CIO and other unions have started to come out for the complete restructuring of our national health insurance system along the lines of what I stated above.

Your supposed history of the employer-provided health insurance industry has a certain spin to it also that is at variance with the facts, but so be it.

This got garbled, but not that I noticed in the Preview for some reason:

Is a mandate to buy insurance WITHOUT the choice --- either individually or through our employer --- to participate in a public national health insurance plan on day 1 --- by writing a check or payroll deduction --- as many Democrats except the Progressive Caucus but including Wyden are actually behind, and which many Republicans will support, acceptable? Or do we have to shake the very foundations of our current political establishment by working to defeat any Democrat or Republican who supports and votes for a bill that does that?

Is a mandate to buy insurance WITHOUT the choice --- either individually or through our employer --- to participate in a public national health insurance plan on day 1 --- by writing a check or payroll deduction --- as many Democrats except the Progressive Caucus but including Wyden are actually behind, and which many Republicans will support, acceptable?

Run on sentance of the year award!

Kurt, thanks for the chance to repeat the question, as it was properly punctuated, and not technically a run-on sentence:

Is a mandate to buy insurance WITHOUT the choice --- either individually or through our employer --- to participate in a public national health insurance plan on day 1 --- by writing a check or payroll deduction --- as many Democrats except the Progressive Caucus but including Wyden are actually behind, and which many Republicans will support, acceptable? Or do we have to shake the very foundations of our current political establishment by working to defeat any Democrat or Republican who supports and votes for a bill that does that?

For those like Kurt who function at the level of scoring points (and making stuff up as noted above), here is the eight-grade version:

Is a mandate to buy insurance WITHOUT the choice to participate in a public national health insurance plan on day 1 as many Democrats except the Progressive Caucus but including Wyden are actually behind, and which many Republicans will support, acceptable? In this case, "the choice" means we can participate in the national insurance plan either individually or through our employer. And "participate" means by each of us having the option to write a check or elect a payroll deduction to pay for it. Or do we have to shake the very foundations of our current political establishment by working to defeat any Democrat or Republican who supports and votes for a bill that does that?

And for the Kurt's, the elementary school version:

Is it mean to make people give their money to selfish people they don't like just so they can go to a doctor when they get sick? Shouldn't people be able to put their money together with everybody else so we all can go to the doctor when we get sick? Should we tell people who don't think we should be able to do that we don't want them to be in Congress anymore?

So much for "As If We Were Grownups" Jeff.

Thanks again PNP for reminding me why I rarely, if ever, respond to those without the cajones to use their own name. Have a nice day in your underwear wadded up paradise.

Thank you for finally asking the $64,000 question. Here is my take on it --

Many unions think their best argument for relevance and growing union membership is that their members get the best health benefits. (They are right about this-union members on the whole have better health benefits.) The unions have been losing membership steadily and fear an end to the employer provision of health care will further weaken their case and further hasten their decreasing membership. So they have acted like most people and organizations do, out of their perceived self-interest.

It is true that a few unions have had success negotiating some pretty sweet health benefits that could be partially taxed as income under some of the proposals out there, but these instances constitute a very small minority of union contracts and benefits.

Here is where money comes into play. Unions are funding most of the progressive lobbying, grassroots, and media campaigns, so the rest of the left (except for those truly devoted to single-payer) have been largely captive to the unions' marching orders. To protect their left flank virtually every union says they are for single-payer, but not one union has funded a major media campaign to fight for it. This allows them to tell their rank and file, who mostly favor single payer, that they are representing them, while they spend their dues to maintain the status quo.

One of the wacky dynamics now developing is that since the public option will only be open to the currently uninsured, if those uninsured people become union members with health benefits they will find themselves kicked out of the pubic option. Not sure that is going to work out very well for the unions.

My conclusion is that we have been co-opted and duped. Single-payer should have been the starting point for the left, and not public option. At the end of the day the US will continue to be the only country reliant on employers for health coverage, and we will continue to pay the price with our physical and economic health.

Kurt: that's underwear-wadded-up Paradise.....

bex

Kurt Chapman:

In an attempt to curb inflation, Roosevelt in effect curbed and attempted to control wage increases across the board.

Bob T:

This was enhanced even more during the wartime wage freezes that were implemented in order to minimize opportunities for companies to lure workers away from other companies, since the government didn't want to have much interruption in wartime industries by having welders and riveters and engineers leaving to go from place to place following good pay offers. The health care packages fill in for that.

Kaiser was not the first large company to offer such packages, but earlier ones in the 1800s and early 1900s obviously had nothing at all to do with being ways of adapting to government distortions.

Where this went wrong was in how the government saw this as a cheap and easy way for them to play politics, and they encouraged the growth in this method by passing laws allowing businesses to deduct costs of these health care plans while prohibiting this for individuals. The result was that there was no level field in the growth of individual, private health insurance policies. The mandates of covered items also reduced this potential large system. Once again, do-gooder government manipulators squashed potential alternatives and then later blamed "the free market" for failing to provide much.

Bob Tiernan Portland

Jeff Golden:

Why have most of us blue-ish folks generally lined up behind employer-based health insurance, tending in recent years to push for stronger employer mandates?

Bob T:

Maybe because too many people were taught that the employers were bottomless pits of money who could be squeezed for more and more pay and benefits without ever causing them to go out of business or relocate elsewhere, and that there'd never be such harm because every penny squeezed out of the company meant only that the owner's paycheck would shrink so he'd have to settle for one vacation home instead of two.

Bob Tiernan Portland

Contrary to "the answer is depressing," trade unions have very little to do with it. Rather it is a combination of desire to compete for employees and tax incentives such that a dollar of compensation in health insurance benefits is worth more than a dollar of taxable wages.

Thank you Chris, the point I was trying to make precisely. As I noted, Labor has not in contemporary times ever supported single payer for everyone else, nor have they per se endorsed the current system. They worked with what they had and, as you note, are quickly become one of the lead advocacy groups, given political reality, for a robust public option, re Trumka. Unfortunately, most of the self-identified progressive movement hasn't actually been there fighting the bare-knuckles fight this requires.

When I see contributors responding point-by-point to a critique in the online forum, it usually sounds defensive to me, and tends to turn the energy towards the post-er rather than the issue at hand. And I much prefer this kind of conversation, with nuances that don't do well online, across from each other in a brew pub.

It's interesting you see an argument constructed to be as dense as possible as defensive, but difference is what makes the world go-round. As I noted, I wasn't saying you are a shill for Wyden, just that your article could easily cited by Wyden's rather skilled PR effort as supporting him. If you'll look back as I just did, you'll see how Kari tried to do that with the Rolling Stone article where he associated Kucinich, Sanders, and Wyden in his headline. This despite the fact that the gutting of the public option Tiabbi decries actually started with the bogus support Wyden offered. Hence my point about getting Wyden on the record. You can track one effort by people trying to do that here (Dr. Dean's project). Note all the "Dodges" for Wyden.

I appreciate your thoughtful answers, as I hope you might appreciate the fact this battle is going to take some brawlers too, and some of us feel someone has to step up, more reluctantly than you might think. My elementary school version is not too far off. We are likely to see Democrats offer a very mean bill that has a mandate with no meaningful public option with Democrats like Wyden offering all manner of self-serving deceitful rationalizations for not opposing it. The only thing that is going to stop it is tough love with Democrats as the Labor movement has now announced.

As an employer, I would gladly pay a percentage of payroll as a "health insurance tax" so that I could be done with the headaches and uncertainty of trying to provide insurance to my employees.

It's easier to get money from people that have it than people that don't?

Just a wild guess.

Tell me again why liberals should be able to decide that a person who wants insurance thru an employer who is willing to pay for it should have to get coverage from the government instead.

I thought liberals believed in 'freedom of choice'?

I thought liberals believed in 'privacy between a patient and doctor without government involvement'?

I thought liberals believed in 'letting the individual decide what is best for themselves'?

Tell me again why liberals should be able to decide that a person who wants insurance thru an employer who is willing to pay for it should have to get coverage from the government instead.

Joe, you are such a pathetic, dishonest, fool. At this moment, the proposal is that anyone should have the right to choose a high quality public national health insurance policy if that's what they want. It's our right as free people to exercise our liberty in a democracy by choosing to offer that public national health insurance if that's what we want to do. (It's also a moral obligation to do it, but that's way beyond the quality of your character). If the private insurance industry can't compete with that and goes out of business, that's their tough luck because they are such unfit competitors in the marketplace.

So why don't YOU answer the question: Are you actually one of those who supports the current corporate welfare state for the insurance industry? Do you support a bill that would further expand the corporate welfare state for the insurance industry by requiring that everyone buy insurance but not have the free choice of a public plan? Because that's what Republicans and corporate Democrats are hell bent on forcing down our throats.

If you are genuinely a patriot and defender of liberty, and from your childish, mean-spirited comments I sincerely have my doubts that you are, you'd first and foremost be against a mandate. But if a mandate is an unstoppable part of the bill, you'd demand everyone have the individual choice of a public plan.

And by the way, just how crazy will it drive you when the vast majority of employers freely CHOOSES the public plan for their employees because those employers decide that is in their best interest? Or are you against employers having that choice too?

Oh and by the way Joe: A national health insurance policy is about making payment and that's it. There is no government involvement between a patient and their doctor as you and your doctor make decisions about your medical care. Unlike with the private insurance industry that disgusting enemies of privacy like you support in which the insurance company makes the decision rather than you and your doctor what drugs and treatments you can have.

PNP wrote: "Oh and by the way Joe: A national health insurance policy is about making payment and that's it. There is no government involvement between a patient and their doctor as you and your doctor make decisions about your medical care. Unlike with the private insurance industry that disgusting enemies of privacy like you support in which the insurance company makes the decision rather than you and your doctor what drugs and treatments you can have."

Exactly. I don't know if the point of people who conflate national health insurance with national health care is to purposely muddy those waters (and I am for both) or just to display their ignorance.

PNP wrote:

"It's our right as free people to exercise our liberty in a democracy by choosing to offer that public national health insurance if that's what we want to do."

Not under our constitution it isn't. The constitution gives the federal government limited powers, not carte blanche to do whatever it pleases.

If you want a government that has unlimited power to do whatever it pleases, go find a comfortable dictatorship somewhere. Enjoy your life there.

PNP wrote:

"you'd first and foremost be against a mandate."

And I am.

PNP wrote:

"There is no government involvement between a patient and their doctor as you and your doctor make decisions about your medical care."

You've been lied to. The government will say what is and isnt covered and for who.

They will also have access to your medical records.

And when the government has established a monopoly, what happens to your choice then?

Where is the incentive for a monopoly to provide decent care? Or affordable care?

You will have a health care system with all the compassion of the IRS and all the efficiency of the DMV.

Quoting fashion ad of years ago: [husky voiced, large-eyed pinup beauty]: don't hate me because I'm a lib-er-ullllll.... prrrrrr.

Couldja see it in your heart, Joe, to see us all as humans? We believe in many of the things you folks labeled conservatives believe in. It's the interpretation that starts the conflicts.

@PNP In Joe White's fantasy world, both Medicare and Social Security are unconstitutional. Best not to engage him on this, as he seems impervious to reason.

As an Oregon employer whose employee (plus family) health care costs currently exceed 18% of payroll, I, more than many, have every reason to embrace "single payer" health coverage. Yet, despite much bickering on these pages, I've yet to see anyone describe a likely scenario for single payer's adoption by this Congress. I recently heard someone explain that the original Social Security legislation of the 1930's covered fewer than half of retirees. And the Civil Rights Act of 1957 had to be amended 3 times before achieving its current status. Barring someone demonstrating a reasonable path for single payer's success, at this time I'm perfectly willing to accept an employer based health isnurance system with the cost controls envisioned as a result of a strong public health insurance option.

It's already happened in New York, and President Obama was first to call for a 9-11 moment of silence giving a speech in New York. Fox News got bent out of shape due to a moment of silence White House memo. (Fox News needs hobbies.) The 9-11 attacks claimed another victim, as Leon Bernard Heyward, a NYC rescueworker, passed away in October 2008 due to dust inhalation that had hospitalized him since that horrible day.

rw wrote:

"don't hate me because I'm a lib-er-ullllll.... prrrrrr.

Couldja see it in your heart, Joe, to see us all as humans? We believe in many of the things you folks labeled conservatives believe in. It's the interpretation that starts the conflicts."

lol

I don't hate ya, or anyone, rw.

Yes, I believe that, in many cases, most conservatives and most liberals want the same things but we disagree on how to achieve that.

That's why its so disappointing to hear liberals frequently resorting to tactics such as 'you just want sick people to die in the streets', etc

Yes, we both want affordable, quality care for all.

I happen to believe that handing over care to a government monopoly will not achieve that, but will cause a worsening of the problems that do exist, and cause those with a good situation to make do with a far poorer level of care.

I'm all for people keeping their choices, and when you give it to the government monopoly, you've lost any choices because it'll never go back to what it was once the government gets it's paws in it.

Many of the problems that exist today are the result of poorly thought out government policies:

-- the law prohibits any group except employment-based groups (corporations and unions) from buying group health policies

-- the law exempts 'self insured' plans from many of the consumer protections that regular insurance plans must abide by

-- the law allows Medicare and Medicaid to pay less than the market rate, and allows medical providers to cost-shift, charging others with private plans for what M&M won't pay

thanks for the good laugh this morning, good to talk to you.

<h2>Insurance companies love the employer mandate. They only have to deal with a few people to sign up thousands. It's so messy to have to compete in the open market place for everyone.</h2>