I think you are framing it as a top down objective, but I think it's the opposite. Employers themselves offer healthcare because it's a way to attract employees. You can get other health plans (e.g. Obamacare) but they are not as competitive as employer-sponsored plans. To not have employer-sponsored plans, you would have to either 1) ban employer-sponsored plans 2) offer other plans that are competitive. #1 seems unrealistic, #2 is possible but would have to probably be done by the state, which the US doesn't really love.
I want to point out that the above analysis is completely ahistorical and does not track the path dependence and latent contexts of the development of the modern US healthcare system. The above is not an explanation, it is a post-hoc rationalization.
Any argument that claims anything is "the way it is" because of the ways people act today is only talking about current incentive structures and has nothing whatsoever to do with the systems and tendencies that have created what we see today. Current incentive structures are a product of the system they are expressed from, not the other way around.
There are competitive plans on the individual market. (Your local insurance market may vary.)
I could get approximately equivalent insurance for about 40% cheaper if I went on the individual market. But, my employer pays 75% of my employer sponsored plan.
The real problem is how expensive healthcare is in the US.
Compare Cignas global plan with and without US coverage. Somehow they can easily cover essentially all of the rest of the world for far less than the US.
Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare. Some spend less total, per capita, than we do just from public spending that we already do (medicare, medicaid, CHIP, public employee healthcare plans, military care like VA and Tricare, et c.) without even having universal care like ~everyone else does
> Last I checked, pretty much the entire rest of the OECD was between 40% and 70% of US per-capita spending on healthcare.
Per capita numbers can be misleading on healthcare as health is labor intensive, so countries with higher wages will have higher per capita costs with otherwise similar systems.
OTOH, the US spends the second highest share of GDP on healthcare, globally, behind Tuvalu, and about a time and half the GDP share of the second highest large, developed state (Germany). [0]
Yeah, like part of the reason Taiwan, say, is so much cheaper, is that wages are lower across the board.
Canada? Switzerland? Germany? Yes they pay a lot worse for some jobs (software developer, and, more relevantly, doctor) but ordinary fully-loaded employee costs aren't that different from the US. Admittedly, the countries more comparable to the US tend to be more in the 60-70%-of-US-spending range, than on the lower end.
That does mean that even allowing a generous premium over the most-comparable peers, we should be able to cut total healthcare spending 20% while covering everyone and removing a major drag from our economy, and a major factor reducing overall US QoL. As it is, we're struggling (and largely failing) to even keep cost increases to merely the inflation rate.
I was recognizing the potential problem with per capita numbers only for the purpose of specifically pointing out that they aren't misleading in this case because the same thing is there in the per-GDP numbers.
IMO, the population covered by employer-sponsored group policies is significantly healthier than the population shopping on the exchanges. The biggest weakness of the ACA was that it didn’t ban employer-sponsored coverage as a means to force everyone into the same free market.
