Americans may think that health care is a universal right, but for most people in the United States, it's a benefit that can be extended, altered or revoked on a moment's notice.
The 2010 health care overhaul seeks to change that. The legislation would extend insurance to millions more people and ensure that millions more who have it now don't lose it.
On Monday, the Supreme Court began hearing a constitutional challenge to the Patient Protection and Affordable Health Care Act. Two years after its passage, the measure remains unpopular with voters, largely because of the perception that it represents a massive intrusion by Big Government into individual and family health decisions.
But that intrusion already occurs. The only difference is that it's not Big Government, but Big Business.
Currently, about 170 million American workers and their family members receive health care insurance through an employer-sponsored plan. Who those workers can see, what is covered and, most important, how much it will cost is largely determined by who they work for.
A few years ago, for example, when I naively believed I could make a living outside of journalism, I took a job at a small communications agency. My family premium increased from about $335 a month to more than $900 and a higher out-of- pocket deductible.
That's the state of the U.S. health-care system today. Unless you are elderly, disabled or poor, your access to health insurance is determined by your employer's willingness to subsidize it or your ability to pay for it yourself.
It is a creaky, inefficient and dysfunctional system that produces mediocre to poor results, despite having the highest costs in the industrialized world.
No wonder, then, that Corporate America is tired of paying so much and getting so little, or why it continues to shift more of those costs to workers.
The average annual premium for family coverage has doubled in the past decade and now tops $15,000, with more than $10,000 coming out of the employer's pocket, according to a 2011 survey by the Kaiser Family Foundation and the Health Research and Education Trust.
Premiums paid directly by workers have increased 131 percent since 2001, more than four times the rate of inflation, while the employers' share has jumped 113 percent.
Higher out-of-pocket costs have accompanied those premium increases. Last year, for the first time, half of workers at small firms faced annual deductibles of $1,000 or more. In 2006, that figure was 16 percent. At large firms, the share has grown from 6 percent to 22 percent over the same five years.
Companies also are insisting on having a bigger say in the lifestyle choices its workers make.
Initially, these wellness programs debuted with a soft-sell, "carrot" approach, such as a small premium reduction for completing certain classes. Increasingly, though, companies are picking up a stick and punishing workers who engage in unhealthy habits.
Wal-Mart workers who smoke pay $2,000 extra for health insurance every year. PepsiCo charges employees $50 a month extra if they have diabetes, a manageable but incurable disease often linked to obesity. A few years ago, Safeway began plotting the body mass index of some of its workers. Gee, I wonder how they might use that information.
All these private-sector, market-based efforts have done little to instill healthy behaviors or curb galloping health care costs. At $2.6 trillion, health care accounted for almost 18 percent of gross domestic product in 2010.
There were some legitimate differences in opinion about whether Obamacare would slow the growth in health care spending or improve health outcomes.
Given the financial stakes for America's employers, you would think they would have rallied around a compelling alternative proposal.
That's what happened in 1993, after all, when President Bill Clinton tried to enact health care reform.
The Health Equity and Access Reform Today Act, sponsored by 19 Republican senators, included a concept first championed by the conservative Heritage Foundation. It required "each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."
This time around, though, the U.S. Chamber of Commerce, the leading Washington lobbyist for big corporations, spent more than $80 million trying to defeat health care reform. Most other big business groups fell lockstep behind Republican legislative leaders, who made defeating health care reform their highest priority.
They may yet win, but it's hard to see how the rest of us do.
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