An Argument Against Single-Payer Health Care

Before the latest Bernie Sanders boomlet dissipates, let me surprise you with a little bit of researched anti-socialism. The United States is uniquely committed to providing health care to most of its working-age citizens through their employers. This is not the most efficient method of delivering health care, but it may well be the most effective.

Sen. Sanders and his supporters claim that they’ve run the numbers and a single-payer system would cost less money. They insist they’ve completed their cost-benefit analysis, but all they’ve really done is a cost tally and no analysis. Our employer-based health care delivery system adds benefits they haven’t measured — but others have.

Over 95 percent of large employers in the United States were providing their full-time employees with health care coverage before the Affordable Care Act became law. Most small businesses wished they could do the same, but their premiums were on average almost 20 percent higher than large companies. Smaller risk pools caused higher insurance rates.

Health care exchanges have removed that competitive disadvantage for small businesses. That’s good, because two-thirds of all net, new private-sector jobs are created by small businesses.

But we skipped a step. Why did large businesses provide health care coverage in the first place, when they could have used that money to pay higher wages instead? Understanding those benefits will show what we’d risk losing if we switched to a single-payer system.

An attractive benefits package is perceived by current and prospective employees as more valuable than its cash value. Health care coverage can give a company an edge when hiring.

Recruiting and training workers is expensive, so companies save money with every employee who doesn’t have to be replaced. A 2004 study by the Corporate Leadership Council measured that benefit. Adding health insurance as an employee benefit reduced staff turnover by 87 percent.

The same CLC study also saw a 20 percent improvement in job performance after health care was added to an employee’s benefit package. Some productivity increases are easy to attribute to the benefit, but other advantages are less obvious. Workers get preventative care more often when their out-of-pocket expense is minimal.

It’s cheaper to keep people healthy than it is treat their sicknesses. But it may not be their own fever or cough that’s slowing them down. It might be their daughter’s fever or cough. If they were up all night, worrying how they would pay for another doctor visit, or whether they should go to the emergency room, their productivity at work will plummet.

Worry is a kind of invisible illness. If somebody is worried sick, they really are sick. It affects their work.

The obverse is also true, but in this case more important. When an employee feels taken are of, they are more productive. Security sprouts as gratitude. Inside this subtle dynamic lies the largest benefit we’d lose if we switched to a single-payer system.

As things are currently designed, employees feel grateful for their health care coverage to their employers. This produces tangible benefits for the employer, but additional benefits ripple out into the community.

Employees who feel secure will work harder, stay longer, and learn more about the work they do. They accept more responsibility, they earn more money, they settle down and they grow — personally and professionally. Many of those benefits redound to their employer and to the community where they live and work.

If workers feel grateful instead to the government, how are they likely to express that natural sense of indebtedness? Will they cheat less on their taxes? Will they vote more? Speed less? If they credit government for underwriting their doctor visit, there’s not much upside for society.

A single-payer system would reduce the cost of delivering health care benefits, but it also would reduce the societal benefits that flow from job security and satisfaction. If our goal is to root people in their communities and build a great society, the system we have right now provides the foundation for what works best.

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Don Kahle (fridays@dksez.com) blogs at www.dksez.com.