Employment-based health insurance: past, present, and future.
We review the rise, stabilization, and decline of employment-based insurance; discuss its transformation from quasi-social insurance to a system based on actuarial principles; and suggest that the presence of Medicare and Medicaid has weakened political pressure for universal coverage. We highlight employment-based insurance's flaws: high administrative costs, inequitable sharing of costs, inability to cover large segments of the population, contribution to labor-management strife, and the inability of employers to act collectively to make health care more cost-effective. We conclude with scenarios for possible trajectories: employment-based insurance flourishes, continues to erode, or is replaced by a more comprehensive system.
Enthoven
Alain C
AC
Stanford University Graduate School of Business in Stanford, California, USA. enthoven@stanford.edu
Fuchs
Victor R
VR
D003361:Cost Allocation; D017047:Cost Sharing; D017049:Employer Health Costs / Q000639:trends; D018588:Fee-for-Service Plans; D005544:Forecasting; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000639:trends*; D006801:Humans; D007750:Labor Unions; D008484:Medicaid / Q000639:trends; D020402:Medical Savings Accounts; D006278:Medicare / Q000639:trends; D012959:Socioeconomic Factors; D019464:Tax Exemption; D014481:United States