So as I mentioned, I saw "Sicko." But even before I saw it, I'd been thinking about why we still don't have universal health care. I know the insurance companies and the AMA are powerful lobbies, but I think there's more to it than that This is what I came up with.
The vast majority of working Americans are at-will employees.1 Roughly, that means that they -- or their boss -- can terminate their employment relationship for any reason, or for no reason. There are exceptions, of course. Employers can't fire someone in violation of federal, state, or local anti-discrimination statutes. There are protections for whistleblowers. And some states recognize what's called an implied covenant of good faith and fair dealing that precludes firing someone for anything other than just cause.
Still, for the average at-will employee, the balance of power between you and your employer is tilted decidedly toward your employer.
How many times have you heard a fellow at-will employee say, "If it weren't for the benefits, I'd quit this job." By "benefits" they invariably mean their group health insurance policy, which, by contrast to people who buy medical insurance on their own, is a bargain.
Now what if those medical benefits were uncoupled from your at-will employment relationship? What if you could quit that job because you'd saved a little money, enough to keep you afloat while you looked for a new job? What if you didn't have to worry that you'd have to shell out anywhere from $400 (for an individual) to $1,200 (for a family) per month in health insurance premiums while you looked for a better gig, or one without a psycho boss, or one doing what you really wanted to do, or one in a new city or state, or one that was just different?
You'd be a lot more free now, wouldn't you? You'd certainly feel more free because you'd have one less (huge) thing to worry about.
In "Sicko" Moore mentions the benefits (to employers) of a frightened population of employees. If you're terrified of losing your job (and most people I know fear losing their jobs primarily because of "the benefits") you are a lot less likely to tell a bullying boss to knock it off, to say "I'm going home" after working late four nights in a row, to ask for a raise when you deserve it, and to stand up for yourself in the face of all sorts of small indignities that can come along with work.
There's a reason we don't have universal health coverage and I suspect it has at least something to do with the fact that the vast majority of Americans are at-will employees than it does any of the other reasons people say universal health coverage won't work here.
1Government, union, and contract employees are not at-will employees.