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John R. Christiansen's avatar

I think you overstate employers' power here::

"But for employers to address the inadequacies of this system there must be accountability and that can only happen when employers recognize that they have all the leverage in crafting their health benefits."

Employers do have leverage, and a lot more than they think they have, but not "all" of it. As I'm sure you're following in January the Dept of Labor launched a lawsuit against BCBSM {Blue Cross Blue Shield MN) alleging it over-stepped its authority as TPA of self-funded plans; whatever the merits of the complaint the allegations describe a situation in which the plans ceded most of their authority to BCBSM, though it's not clear to me the extent to which the plans might have formally delegated the authoriity by contract versus BCBSM possibly exercising de facto authority. There are also a number of self-funded plan actions around related issues, for example a couple of cases against Anthem (Bricklayers, a class action and Owens Minor, settled).

I do agree that in the final analysis employers which bear the financial risk should have the ultimate leverage, but recognizing and realizing that authority is at least not common.

Thanks for raising an important but uncommon topic!

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Heike Larson's avatar

I've been looking for a good overview article on Substack on employer-based health insurance--thank you!

There's one key problem with employer-based plans you don't mention: the time misalignment of incentives. As we switch plans yearly, the insurer has an incentive to minimize care *this year*--instead of helping the insured stay healthy for the long term. I think that is in part why we don't have "healthy living" discounts or incentives--as compared to car insurance, say, which offers safe driving discounts.

I wrote about that here: https://heikelarson.substack.com/p/why-is-there-a-safe-driving-discount

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