BelCan 16 hours ago From the Financial Times Article
“Which leaves me wondering why US multinationals are not agitating for nationalised healthcare?” This is a good question to ask, given all the aforementioned negatives that Ms Foroohar correctly brings up, and one that is asked all too infrequently. Unfortunately, the author does not actually answer this question. Let me make a few suggestions regarding an answer:
1. Although employer-sponsored healthcare came out of a tight and restricted WWII labour market (which Ms Foroohar rightly points out), it can have positives for employers. One of these is added control of employees: when employees fear being thrown into the vicious “free market” of individually-purchased health insurance, they fear even more being fired, made redundant, or quitting. Although Obamacare has mitigated that vicious individual market substantially, Obamacare only came into effect in 2014, which is relatively recent, given all the time since WWII when this control was an entrenched part of the American labour market.
2. Another positive for employers, related to control, is the ability to find out about employees with health problems/risks and figure out ways to get rid of them. Self-insured companies who know who is using what insurance for which treatment is one means. Another means of doing this is the rise of so-called “Employee Wellness Programs” that allow employers to financially penalise employees who choose to not share personal health information with their employer. Recently, the US House of Representatives brought up a bill to allow employers to financially penalised employees who choose to not share genetic data. (see https://www.nytimes.com/2017/03/10/health/workplace-wellness-programs-health-genetic-data.html and https://www.nytimes.com/2016/01/25/business/employee-wellness-programs-use-carrots-and-increasingly-sticks.html) Many American companies’ own dystopian employee policies seem to privilege the control and invasion of privacy of their employees over the huge cost that the current system entails as they continue to enmesh themselves in the status quo.
3. For certain US multinationals, or perhaps more accurately, large US-based corporations, the largely employer-based, dysfunctional American healthcare system has been a boon, indeed, for health insurance companies, it is the basis of their business. American health insurance companies have seen their stock prices rise, on average 300% in just the past seven years, far outpacing the S&P 500. For more on this see, https://www.nytimes.com/2017/03/18/business/health-insurers-profit.html . One must mention pharmaceutical companies as well, and in this case, it is pharmaceutical companies everywhere that profit off of the unregulated drug prices in America’s healthcare market. R&D costs that produce drugs that benefit consumers globally (or at least in other wealthy countries) are paid for largely by Americans (given the marginal costs of most pharmaceuticals are very small, it is still worth selling at regulated prices elsewhere). These two industries, together, are massive, and, just as narrow interest groups defeat policy that benefits the larger (cf. Olson’s public interest theory), so these industries lobby to maintain a dysfunctional status quo in the US.
4. There is also the way that an employer-based, private healthcare system meshes into the racist and classist realities of American society. In the post-war period, this privatised health insurance system created a sort of socialism for the white-collar middle class (with the tax deductions for the insurance provided in their administrative jobs) and unions that made sure that the better-off white working class got their health insurance as well, As for the poor, the Black working class, well, American society did not want to provide for them. While the following article (from Forbes, certainly no leftist publication) is perhaps insufficient in terms of complexity and nuance, it gets at the essential reality: https://www.forbes.com/sites/chrisladd/2017/03/13/unspeakable-realities-block-universal-health-coverage-in-the-us Much of the hatred and suspicion in the US of more socialist-type insurance stems from the feeling that “those people” are getting something that they do not deserve. The right in the US has tried to twist this reality into the US representing the last stand of “freedom” against the “vile socialism” of other wealthy countries’ government-controlled systems – as if the freedom to not have access to healthcare when one needs it because one chose to buy an iPhone instead were a positive development for society.
Regarding the final point in the piece, putting some transparency on the system may lessen some costs for employers. But, ironically, those lower costs for employers may only perpetuate what remains an essentially rotten employer-based sytem, not disrupt it.