A Quick, Dirty, and Slightly-Biblical History of Employer-Based Health Care

Nathan Newman accuses me of making a mantra of "Little is more anti-worker than forcing them to depend on their employer for medical care." Well, gotta admit, it's catchier than "Om." But he's for the employer mandate in a serious way, which I find so baffling I need to keep reciting my mantra just to stay calm. So, herewith, a quick history of the foresight, vision, and planning that resulted in the glorious invention known as employer-based health care:

• In the beginning, there was a tax quirk, and the tax quirk was with employers, and the employers provided health care: Journey back with me, if you will, to a land before time, or at least digital clocks. World War II is raging, the Greatest Generation's menfolk are proving themselves freedom's ablest gladiators, and the women are riveting their pretty little hearts out. Do-gooder liberals, keen to protect against war profiteering, inflation, and labor unrest, institute wage and price controls, and heavy marginal tax rates on corporations. It is a great burden. But hark! There is a loophole in this here socialism: fringe benefits are not covered! Health care purchased by the employer is tax deductible! And with the GNP growing by 75 percent between 1939 and 1944, corporations vastly preferreth to plow their massive profits into benefits that help them attract workers, rather than taxes, which the Book of Burke have shown an abomination. And thus we had employer provided health care, and lo it was good.

• This tax quirk, this heavenly gift of deductability, was retained by our benevolent government for society's wide beneficence after the war. Then, the newly-formed National Labor Relations Board, in their infinite wisdom, ruled that any employer unwilling to bargain over health insurance was engaging in unfair labor practice, and were thus sinning before the eyes of the council, and could be punished by stoning* or fines. And so the unions joyously rushed forth, demanding health care for their members and their members only, and offering the merest sacrifices to the Truman and his dream of government provided health care. But lo, the sacrifices were poor, and they were not heeded by congressional Republicans, and so a darkness fell across the land. They would soon repent, but the spirits behind national insurance, once wronged, are not easily sated, and so despite many attempts at atonement, the unions have been forever stifled, and even now, are seeing their efforts strangled and twisted by the deterioration of the system they encouraged.

This is the story of employer-based health care, a wartime tax quirk that emerged the central organizing principle of our system. It was a bad quirk, and it is a bad system. And while some defend its merits, pointing to those like Germany, they similarly do not know that Bismarck, hallowed be his name, wanted socialized care, but was afraid of empowering political opponents within the state, and so decided to amass strength by offering health benefits to those in particularly influential professions, piecemeal and as necessary. Tying health care to employers is a mistake, an unintended consequence, but lo it keeps being repeated, and sadly, it keeps being defended.

*There are no recorded instances of stoning.