[stult]

I don't get why decoupling insurance from employment isn't a bigger part of the healthcare reform discourse. It's the most obvious, easiest, lowest hanging fruit for improving the US healthcare system, and almost uniquely politically acceptable to both Democratic and Republican voters. Decoupling also doesn't entail disrupting any of the established incumbents (pharma, AMA, insurance companies, etc.) who typically kill any reform. The policy is also arguably market-oriented, or at least is not a form of government intervention that would otherwise offend Republicans, yet benefits individuals over large companies so can appeal to Dems too.

The Republicans have utterly failed to offer *any* alternative at all to Obamacare after 16 years, which is insane for many reasons, but especially considering that they could have put decoupling insurance from employment at the heart of an alternative (even more than the ACA) market-oriented reform. Letting individuals choose their own insurance would put more pressure on insurance companies to actually deliver quality care because, unlike employers, individuals are highly sensitive to the quality of care they receive and are more likely to switch insurers if the insurer unreasonably denies claims or otherwise fails to deliver a decent product. On the other side, individuals are also more sensitive to costs so with greater control over their plan choices would be more able to pick plans that are structured to match their anticipated costs.

In other words, individual insurance would improve the functioning of the market, which should in theory appeal to Republicans. Instead, they only focus on making individuals pay more at the point of care, on the theory that cost-sharing discourages insured people from over-consuming healthcare. Yet they don't think about how the current system makes it impossible for individuals to be truly cost sensitive when selecting plans.

I would guess the Republicans haven't adopted the idea because they are not really in favor of free markets, they are in bed with big business, and employer-provided insurance tends to favor larger companies that can demand better terms from insurers, that can amortize the HR overhead over a larger number of employees, and that tend to benefit disproportionately from lower labor mobility compared to small business (people are more likely to be involuntarily locked into a big company job for security than at a small business, and it's harder for people who are worried about maintaining quality healthcare access to move to a startup, reducing the competition experienced by the bigger companies).

[jsdalton]

I’m likewise baffled. Healthcare spending is a major cost for all employers. Decoupling healthcare from employment would theoretically remove this cost immediately. Shouldn’t pro-business groups have long been lobbying for this?

The fact that they are not tells me there must be some other financial incentives at work that are unclear to me.

[megaman821]

I think a lot of people want to decouple insurance from employment but the mechanics would be tricky.

Ideally all business would take what they pay for insurance and stick it in the employee's paycheck and then the employee would buy insurance with that money. Reality says, a lot less people end up having insurance if you do it that way. Maybe force companies who once offered insurance to fund an employee HSAs and change the HSA rules so it can be used to buy insurance. It would take some thoughtful design to actually pull off the transition while keeping people on insurance.

[sarchertech]

> The Republicans have utterly failed to offer any alternative at all to Obamacare after 16 years

That’s because before Obama picked it up, it was the Republican free market compromise plan in the face of a growing for socialized healthcare.

And now the Republican Party has been taken over by Trump. To the extent any political party has real principles they have given up theirs completely. Their principles are whatever Trump says they are this week.

So the question is “why hasn’t Trump pushed for separating healthcare from employment?” And the answer to that could be as simple as because he doesn’t think it’s exciting enough.