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Employer-Based Health Care, Meet Massive Unemployment

The coronavirus pandemic is exposing a central flaw in America’s health care system.

By Jeneen Interlandi

Ms. Interlandi is a member of the editorial board.

In the early months of 2020, Americans were engaged in the perennial election-year debate over how best to reform the nation’s health care system. As usual, the electorate was torn and confused. Polling indicated that a small majority of likely voters favored a new universal system that would cover everyone. But that support evaporated when it was made clear that any such overhaul would involve abolishing the private insurance market. At the time, nearly 160 million Americans received their health benefits through an employer, and the vast majority of them liked that coverage just fine — maybe not enough to sing about it, but enough to be wary of a potential replacement.

Then came the pandemic of the century. And the highest level of unemployment since the Great Recession. And the most concentrated wave of job loss in the nation’s history — more than 40 million Americans filed new unemployment claims between mid-March and late May. It will take time to ascertain the full impact of those losses on the nation’s health insurance rate, but an early survey from the Commonwealth Fund is not encouraging: 41 percent of those who lost a job (or whose spouse lost a job) because of the pandemic relied on that job for health insurance; 20 percent of those people have not managed to secure alternative coverage.

Nothing illuminates the problems with an employer-based health care system quite like massive unemployment in the middle of a highly contagious and potentially deadly disease outbreak. For one thing, uninsured people are less likely to seek medical care, making this coronavirus that much more difficult to contain. Also, people with chronic or immune-compromising medical conditions are particularly susceptible to this new contagion — which means the people most in need of employer-sponsored health benefits are the same ones who can least afford to return to work at the moment.

“The pandemic has amplified all the vulnerabilities in our health care system,” says Drew Altman, president of the nonpartisan Kaiser Family Foundation, including “the uninsured, racial disparities, the crisis of unmanaged chronic conditions and the general lack of national planning.”

As dire as the crisis is, though, it’s also an opportunity to look at health care reform with fresh eyes — and to maybe, finally, rebuild the nation’s health care system in a way that works for all Americans, not just the wealthy and the well employed.

The first step will be acknowledging the problems of our current system. If American health care were its own country, it would be the fourth largest in the world by gross domestic product. The nation spends an average of $3.5 trillion per year on health care — more than Japan, Germany, France, China, the United Kingdom, Italy, Canada, Brazil, Spain and Australia combined — and still loses more people to preventable and treatable medical conditions than any of those countries do.

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