Should Public Health Care Replace Employer-Sponsored Insurance?

With the presidential primaries looming, we’re hearing more about health care initiatives designed to control costs and improve patient care, including proposals to expand Medicare. As an HR practitioner with more than 35 years of experience in benefits design, I often wonder if there’s an easier way to administer health insurance in the U.S. But Medicare-for-all is not the answer to the country’s health care challenges.

From HMOs to PPOs to high-deductible insurance, the U.S. has long been the land of employer-sponsored plans. Given the wide variety of plan designs, and differences in the ways states regulate insurance, will the U.S. ever be able to unite behind a single public plan? I don’t think so. Something so complicated would take years (or even decades) to debate, let alone implement.

But it would be a mistake to trade away the many advantages that come with employer-sponsored plans. 

For businesses, these plans provide flexibility to tailor coverage and benefits to a particular employee population and its needs—a hallmark of the U.S. health care model. To make sound choices about benefits that resonate with their distinct employee groups, employers receive information from insurance carriers about plan utilization. Moving to a one-size-fits-all public plan would remove the creativity and flexibility that businesses and workers rely on under the U.S. model.

For job candidates and current employees alike, health benefits and salary rank as the most important pieces of an employer’s total rewards package. Employees generally like their employer-sponsored health insurance plans because they’re less expensive than those that workers could get on the open market. (When given the opportunity to participate in employer-sponsored health insurance, more than 80 percent of employees typically enroll.)

Employer-sponsored health plans provide workers with access to more physicians, hospital services and durable medical equipment than Medicare does. A reduction in these benefits or an increase in costs would create financial stress for many.

Employer plans also create a “one-stop shop” for workers. Premiums are conveniently paid through automatic paycheck deductions. And human resources departments and benefits specialists stand ready to provide direction and answer questions.

Part of my concern about a government-sponsored Medicare-for-all-type of plan stems from watching my parents navigate Medicare in their retirement years. The system can be complex and frustrating.

I’ve seen my parents and other retirees add supplemental Medi-gap insurance to their Medicare plan to cover things like crutches and walkers—benefits they were accustomed to receiving in their employer-sponsored plans prior to retirement. And frequently, as people age and require more medical services, they need to add a pharmacy plan or increase coverage in Medicare Part D, the optional Medicare prescription drug benefit.

The Medicare system can also be a bureaucratic puzzle, where care is granted for some and denied for others. Appeals can be costly and potentially detrimental to one’s health. Ultimately, all of this will reduce access to health care and could discourage Americans from seeking medical attention until the situation is dire. And I can only imagine the new taxes we would have to pay to expand Medicare. I prefer to stay the course with employer-sponsored plans.  

Brenda Rushforth, SHRM-SCP, is chief human resources officer at Pomona College in Claremont, Calif., a member of the SHRM Advocacy Team and Chair of Legislative Affairs for Professionals in Human Resources Association (PIHRA), SHRM's largest affiliate chapter.