The Employer-Based Health Insurance System

Many observers point to our employer-based system as one significant source of our difficulties with insurance coverage and argue that using employment as the core basis for health coverage is flawed. In contrast, Sherry Glied builds an impressive defense for the advantages of an employer-based system, although she recognizes the need to add other mechanisms for those who are not employed or employed in circumstances where employer coverage is unavailable or not affordable. Employer-based coverage leads to variability in comprehensiveness of coverage and cost, but Glied argues that such insurance offers significant advantages in promoting efficiency, facilitating choice and flexibility, and avoiding the heavy bureaucracy and cumbersome aspects of large governmental systems. In contrast, advocates of a single-payer approach typical of Canada and the U.S. Medicare program point to the relatively low administrative costs compared with the more pluralistic private health care system.