The COVID-19 pandemic has put in clear relief how important access to workplace protections and affordable health care is. So many people are currently unable to prioritize their health first because they have to work — and the ones unfortunate enough to come down sick with the virus are often left stuck with a bill they can’t afford.
The reality of having to work without suitable healthcare, exacerbated in the last decade by the massive growth of permalancers and the gig economy, has created a labor class that’s deeply vulnerable. One in ten Americans don’t have health insurance, and surveys suggest independent contractors are twice as likely as full-time employees to have no coverage. This tension over health-care costs is fuel for the labor strikes around the U.S., directed at major corporations like Amazon and Apple, and the concerns aren’t going away even if the coronavirus does. After all, even those who do have employer insurance plans are increasingly finding that out-of-pocket costs can still ruin them.
Given that these rising costs and the challenge of insuring employees is confounding employers, too, you have to wonder: Why aren’t more business leaders in favor of a universal, government-run health-care system like Medicare for All?
It would remove a huge chunk of the calculus (and paperwork) required by companies in determining worker wages and taxes. It would also streamline medical bureaucracy, taking the burden off smaller companies with few HR resources. Not to mention, ignoring the entirely dystopian implications for a second, healthier employees are more productive — something that even the most cartoonishly villainous capitalist could see the upside of.
And yet not a single Fortune 500 CEO has thrown their weight behind Medicare for All. The reason why is as complicated and stubborn as the mythology of American industry itself. One of the most obvious factors is that employers controlling insurance means workers largely have less mobility to move companies and types of jobs — an issue economists refer to as “job lock.” So companies want to be able to wield health care as a powerful bargaining chip, especially for those with families or long-term health conditions.
Then there’s the natural revulsion that many corporate leaders have toward increasing government influence — and potentially regulation and taxation — under a single-payer program. Labor organizer Mark Dudzic, who worked with the oil industry on health-care issues, describes it as a fear of “slippery slopes.” You hear the fear when the CEO of UnitedHealth says single-payer would “surely jeopardize the relationship people have with their doctors” and “destabilize the nation’s health system,” despite a track history of countries like Taiwan transitioning from a private system to single-payer to great success. (So much for American exceptionalism.)
There is a silver lining here for the debate around Medicare for All: CEOs from smaller companies are showing a lot more enthusiasm for fundamental reform. That makes sense, given that smaller employers have been getting screwed the hardest by rising insurance costs. The existential problem at hand for the American workforce is even attracting allies from the health-care industry like UMass Memorial CEO Eric Dickson, perhaps the first health-care system leader in America to really stick his neck out on the issue. A transition to single-payer “might devastate” providers like UMass Memorial, but Dickson says it would most rapidly ameliorate the issues the U.S. system faces, including the burden doctors themselves face in navigating the system.
“I still believe single payer is the way we have to go in this country. It’s the only way to solve most of the problems we have in health care,” Dickson told Health Evolution.
If you’re one of the 156 million Americans who get insurance through their employers, odds are your out-of-pocket costs will keep increasing, as they have since the Great Recession. If you’re an employer, odds are that mounting costs will hurt your ability to give raises and increased benefits. There are many great lessons, both optimistic and difficult, to be learned from nations that already have pioneered a turn toward single-payer. But it’s becoming clearer that without greater support from American business leaders, we will lose time, and lives, to a health-care network that is proving less acceptable each year.
It might feel like it’s the destiny of large corporate entities to oppose Medicare for All; even President Harry Truman’s idea for nationalized health care was shut down by the Chamber of Commerce, all the way back in 1945, just as the American public showed tentative and growing interest in the model. Perhaps this is merely one of those blind spots that business leaders often have, as they clutch to an old way that worked for a long time. But with the pandemic laying the flaws of the system so bare, you have to wonder when the top minds in American industry will finally reconsider.
At least Warren Buffett likes flirting with the idea of single-payer. As his right-hand man, Berkshire Hathaway vice chair Charlie Munger, said of the status quo: “The whole system is cockamanie.”
Who else will hear it?