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Employment-based health insurance jibes poorly with job insecurity | Opinion
Many Americans currently get health insurance through their jobs. Losing their jobs, they also lose their insurance. Given recent advances in artificial intelligence (AI), which may destroy many jobs, Americans could therefore be in for a lot of pain.
Alarmists going back to the English Chartists have worried that new technology would destroy most jobs. So far, that has not happened.
A notable example: the three hundred thousand American telephone operators whose jobs were destroyed by the dial telephone did not remain unemployed, and we all benefited from the cheaper phone bills this automation permitted.
However it is possible that AI may finally vindicate the Chartists by eliminating millions of jobs. Unlike the case with the telephone operators, replacement jobs may take time to develop or may not develop at all.
An obvious problem in the AI age may therefor be how to replace the incomes lost by all the unemployed workers. Discussions along the lines of universal basic incomes (UBIs) are already perking up.
But even if incomes were replaced, the former workers would still have lost their medical insurance.
This problem should not be a partisan football. Conservatives and liberals, the well-educated and the poorly-educated, city residents and country residents, are equally vulnerable to losing their jobs in the AI age. And there is an obvious way to eliminate at least this one basic insecurity from American life: a single-payer insurance program financed through the tax system.
Sometimes this is called Medicare-For-All, but it would need to be a greatly improved Medicare, since the current Medicare-For-Some program does not cover dentistry and includes expensive co-pays and deductibles. Similar problems exist for seniors insured through Medicare Advantage plans.
Lacking a single-payer insurance system, the massive unemployment caused by the Covid shutdowns drove some people into Medicaid. Others were able to purchase subsidized insurance through the Affordable Care Act marketplaces, but this required making careful comparisons of competing insurance plans with varying “in-network” doctors, which not all Americans were well equipped to do.
Job-based insurance was already a problem even before the pandemic and AI came along. The growing number of gig workers already have no employer to negotiate insurance for them. Workers who are seriously injured, ill, or worn out often find it impossible to continue in their jobs. At the very time when medical insurance is badly needed for their treatment, their job-based insurance can go away when their job goes away.
And it may be difficult for the ailing person to concentrate on the complicated decisions needed to get insurance under the Affordable Care Act.
To date, single-payer medical insurance has been politically impossible because so many people are satisfied with their job-based insurance and fear that coverage would not be as good under single-payer.
It has not helped that people seem to think, wrongly, that their employer is bearing most of the cost of their current insurance, but they know that single-payer insurance would require an increase in their income tax.
A prerequisite of single-payer insurance will therefore be an educational campaign demonstrating that the tax increases necessary to pay for medical insurance will be less than people are already indirectly paying in the form of lower wages.
After all, employers are not pulling the money they remit for employee insurance out of a hat. They are just subtracting it from the pot of money from which they pay other fringe benefits and wages.
Republicans have shied away from single-payer for ideological reasons—-distrust in “big government” and the like. And except for a few politicians like Bernie Sanders, Democratic politicians have abandoned the idea because it is currently unpopular.
The prospect of increased job insecurity up and down the economic line brought on by AI should help make the public receptive to a well-designed educational campaign. All we need for for some politicians—conservative or liberal— to seize the opportunity to become the needed educators.
— Paul F. deLespinasse is professor emeritus of political science and computer science at Adrian College. He can be reached at pdeles@proaxis.com.
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