Getting Medical Insurance From Your Boss Is a Bad Idea

According to the new "ABC News" poll on health care, Americans are eager to have the government force employers to provide heath insurance: "Nearly eight in 10 favor a federal requirement that all employers offer insurance to their full-time workers."

Why?! Do our employers pay for our food, clothing, or shelter? If they did, why would that be good? Having my health care tied to my boss invites him to snoop into my private health issues, and if I change jobs, I lose coverage.

Employer-paid health insurance isn’t free. It just means we get insurance instead of higher salaries. I’d rather have the cash and buy my own insurance. Companies only provide it because of a World War II-era tax break that never went away.

But people think it’s something for nothing. In Maryland, the legislature even tried to single out Wal-Mart for a special employee health-insurance mandate. Luckily, the courts struck down that law. It would have some cost workers their jobs, and all of them would have been paid less.

Anyway, insurance is a terrible way to pay for things. It’s expensive and wasteful. Some years ago, an insurance CEO said that it costs $35-$50 to process a $25 claim.

Insurance burdens us with paperwork, invites cheating, and, worst of all, creates a moral hazard that distorts incentives. The first question people ask a doctor who recommends a test is not "Do I really need that?" but "Does my insurance cover it?" Insurance raises costs by insulating consumers from medicine’s real prices.

Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything would cost more because demand would rise and supermarkets would stop running sales. Why should they — when their customers barely care about the price?

Suppose everyone had transportation insurance. The roads would be crowded with Mercedes. Why buy a Chevy if your employer pays?

We have gotten so used to having "other people" pay for most of our heath care that we routinely ask for insurance with low or no deductibles. This is another bad idea.

Suppose car insurance worked that way. Every time you got a little dent or the paint faded, or every time you bought gas or changed the oil, you’d fill out endless forms and wait for reimbursement from your insurance company. Gas and mechanic’s prices would quickly rise because service stations would know that you no longer cared about the price. You’d become more wasteful: jackrabbit starts, speeding, wasted gas. Who cares? At most you’re paying 20 percent of the bill.

Insurance invites waste. That’s a reason health care costs so much, and is often so consumer-unfriendly. In the few areas where there are free markets in health care — such as cosmetic medicine and LASIK eye surgery — customer service is great, and prices continue to drop.

The ABC News poll suggests that people understand that. When asked about "consumer-directed plans," "nearly eight in 10 Americans think that allowing people to shop around for their own medical care would be an effective way to control costs." But many people still want a free lunch: "consumer-driven care looks less popular if it’s accompanied by the risk of higher out-of-pocket expenses."

Somehow people seem to believe "insured" means free.

This is not to say that we don’t need insurance. We need it to protect us against financial catastrophes that could result from a stroke or heart attack. That’s why Health Savings Accounts, which cover smaller out-of-pocket health expenditures, are paired with high-deductible catastrophic insurance. That’s a good thing.

But America’s demand that insurance cover everything from pets to dental work puts us on slide toward bankruptcy.