“160 Million Americans Like Their Employer-Based Healthcare”—Are You Sure?

The ongoing healthcare debate never fails to include reference to this so-called truism—that when polled, Americans who receive employer-based health insurance “like it.” This unchallenged belief determines, and possibly distorts, the contours of the debate on Medicare for All. Given our experience with employer-based healthcare, which is central to the way America obtains healthcare, we struggle to understand how this can be. So, this week we explored the issue and found that our concerns were well founded. Let’s try to be fact-based and rational.

We began by searching for the polls that support the statement. We found only one, published in February 2018. It was sponsored by America’s Health Insurance Plans (AHIP), a national trade association of healthcare providers. AHIP found that 71% of Americans are satisfied with their current employer-provided health coverage. 

The first issue with this survey is the sponsor. AHIP is explicit in its bias, stating that “we are committed to market-based solutions and public-private partnerships.” Their conclusions are based on a survey of 1000 people who receive employer-based healthcare.

The second issue is that in the very same survey, 56% of respondents indicated that “coverage remains a key factor in their choice to stay at their current job.”  It strikes us that this finding is not particularly supportive of the existing system.

Findings by Gallup, a far less biased source of polling, find that Americans’ views are far more nuanced and are not nearly so supportive of the current system. In January 2019, Gallup found that 71% of Americans believe that American healthcare is “in crisis.” In April 2019, they found that 75% of Americans believe they “pay too much,” and 45% fear that “a healthcare event could result in personal bankruptcy.” Furthermore, 77% believe that the cost of the healthcare system “could cause significant and lasting damage to US economy.” And, in December 2018, they found that 30% of Americans routinely delay healthcare services due to cost. 

So, while it may still be true that Americans with employer-based coverage “like” their coverage, it does not necessarily follow that they would not “like”abetter system even more. 

As we show in our Healthcare Research, the world provides several examples of countries that do just that: they provide better healthcare outcomes at a much lower price. Citizens of these countries do not fear losing or changing their jobs for risk of losing their healthcare coverage. They don’t fear bankruptcy due to healthcare costs, and they don’t defer healthcare treatment due to cost. Perhaps a better question is “Would you ‘like’ your employer coverage if you had an option as good as the French, the Germans, and the Japanese have?”