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Why Doesn’t Your Health Insurance Belong to You?

By Dr. Evan Saulino
. 2 Comment(s)

 “Betty” was fighting breast cancer and getting the treatment she needed.  But her alcoholic, increasingly violent husband made a hard struggle worse.   Asked why she didn’t leave him, she answered matter-of-factly, “I get health insurance through his job. If I lose that, I lose my life.”

Like the hard-to-look-at, worst-case scenario pictures in Dermatology textbooks, “Betty” is a shocking example of how our system of employer-based health insurance locks Americans into increasingly bad choices.

There’s more subtle dysfunction in doctors’ everyday interactions with patients. In my practice, nearly all my new patients say their employer changed insurance plans, or their job changed, and they were forced to find a new doctor. Continuity of care with a doctor/medical team is associated with all sorts of improved outcomes, yet more than one in ten Americans change doctors every year, and evidence suggests nearly all of them do this involuntarily

Why does our job control our choice of health insurance and access to the doctors we want to see?  Why doesn’t your health insurance belong to you?

America’s employer-based system of insurance developed as an accident over 60 years ago. In the 21st century, American businesses cannot compete globally with companies in nations with more rational designs for insurance financing. 

This Labor Day, its important to recognize that American workers are at even more risk. 

As a former UFCW and AFSCME member, I understand the perspectives of union members who fought hard for their benefits and don’t want the system to change.  My mother got pneumonia out picketing in an ice storm (a teachers’ strike about guess what? - health benefits).   But every trend shows our current course guarantees workers will increasingly get the short end of the stick.

A survey just released by the Kaiser Family Foundation (summarized well in this LA Times article) demonstrates that we’ve reached a tipping point.   Last year the entire cost of health insurance premium increases was paid by workers, not employers.  Employers accelerated their strategy of shifting costs to workers and their costs held steady.  At the same time benefits were cut, workers were hit with the largest annual insurance premium increases since the survey began in 1999.

The Affordable Care Act did a lot of things that will help a lot of my patients, but it does little that will change these trends in the near future.   

However, using strategies that have flown mostly under-the-radar, the ACA does provide a few ways we can begin to shape a system that offers Americans better choices.  

Just as states should set up the rules governing their Exchanges to transform financial incentives in health care, they also should give any individual who wants it the freedom buy insurance in the Exchange.

Synergistic with strong Exchanges is a provision championed by Senator Ron Wyden (D-OR).  This would allow workers who cannot afford the insurance their employer offers  - a group of Americans clearly growing - the choice to jump in and get more affordable insurance through their state’ Exchange.

Share Your Comments


  1. Don


    As a retired UFT member I know that the employer based model became something that people cherished. The employer paid for a good portion of the insurance.

    But there is no reason to connect health insurance to employment at all. If the employer goes out business, the employee loses. If the employer decides to cut benefits with a cheaper plan, the employee loses.

    The expense to most employers make their relative competitiveness to companies in more enlightened countries very poor. We need to get rid of

    employer based insurance altogether and create a design that makes health insurance similar to auto insurance. I own it. I choose the best company and I can change policies.

    Changing doctors because of changing insurance is the most idiotic American idea that I can think of.

  2. William Gillanders


    I fully support Evan's perspective that it would help if the Exchanges could be a catalyst for uncoupling health insurance from employment. I like the proposal he outlines (apparently supported by Sen. Wyden). This is also a point that should be made at the Oregon public hearings soliciting feedback on the Exchanges.


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