What makes the whole thing supremely ironic is that employer-provided medical insurance started as a market response to a pair of governmental intrusions on employer-employee relations: the wage freeze of the middle 40s and the withholding of income tax from workers' wages.

The wage freeze, justified on the grounds of the war emergency, made it impossible for employers to bid for labor by wage competition. Noncash benefits were an end run around the freeze. The withholding of income taxes (also justified as an emergency measure, but hey, isn't that emergency over yet?) made increments to one's monetary compensation less attractive than those noncash benefits, other considerations notwithstanding. So in the face of the confiscatory rates of the 40s and 50s, the practice continued and expanded after the freeze was lifted.

It is normal for anything that's been given freely for this long to come to be seen as a "right." The defense and enforcement of rights is the government's demesne, so people who feel they're being deprived of their rights will naturally turn to the government. And so the juggernaut accelerates: political positive feedback. But positive feedback always destroys what it touches.

Verbum sat sapienti.

There would be a lot of clear benefits from moving away from employer-provided health insurance (no pun intended). The one problem that I haven't thought or heard of a good solution for is people that are "high risk", or have pre-existing conditions. More expensive premiums/coinsurance would work OK for the financially well-off, but not for the lower end of the payscale. I'm sure there are ways to deal with this problem though, and I'm all in favor of moving towards a more market-based health insurance system.

The solution has been proposed: phaseout the tax deductability of employer-paid health insurance and let employee-paid health insurance remain deductable.

The price of health insurance is high because the price of health care service is high.

Health care service is high (in part) because health care recipients aren't paying for the service out of their pocket. If they were, they would negotiate better prices.

Health insurance companies do negotiate on their own behalf, but they don't make the decision whether to seek care. A person who has coverage might go to the doctor for any little thing - when a Tylenol cold capsule would do just as well. A person without coverage will take that cold capsule and go to bed.

Obviously that person without coverage is in trouble when a real emergency arise. Or, more likely, they fall back on the state. The poorer communities in my area often call the fire department when their kids are sick - talk about inefficient.

I agree that tying health coverage to employment isn't a good system. But buying coverage on your own is problematic or impossible for those who need it the most - the old or chronically ill.

But few who've experienced it would want all medical care to be like our state hospitals here or Canadian hospitals.

I'd recommend that counties set up health insurance pools. When you move to a county you sign up for the pool. The pool is bid out every year and some health insurance company covers the whole county. It would have to cover all doctors and other licensed providers in the county and have some kind of arrangement for emergency care outside the county or specialists outside the county. To hold prices down there would have to be some restrictions on the use of specialists even within the county - you'd need a referral from a GP.

The whole system would have to be supported by a county tax (or maybe state taxes allocated to the county for this purpose).

Anyway, I think these issues could be worked out and it would be a good compromise. It would allow universal coverage without government takeover of healthcare. It would provide a way for unemployed or ill people to be part of a pool. There could even be a way to encourage people to take that cold capsule rather than go to the ER.

Let's say you report a high income on your federal income tax. When you go to a doctor, you would have to show your insurance card and pay a certain co-pay. Those who earn less would pay a smaller co-pay, but the point of the co-pay is to discourage government sponsored hypochondria.

Absolutely right. The less regulation and red tape is associated with jobs, the better the market will distribute jobs. That means people will be better able to work the hours they want, and also that more people who want to work, will.

Hell, if we got rid of the minimum wage, we could open up all kinds of marginal employment jobs for college students like me. I hate being poor.