Employer mandate. That's a term we thought had gone the way of dinosaurs, fee-for-service medicine and Soviet-style central planning.
But leave it to those wily politicians in Massachusetts to resurrect what was considered the dead meat of healthcare reform.
Democrats in the state House of Representatives want employers to pay at least 50% of the cost of a basic health benefits plan for employees who work at least 20 hours a week and are not covered by another health plan.
The money would help expand coverage to 75,000 uninsured children, give tax breaks to employers offering insurance and provide subsidies for low-income workers. Massachusetts has an estimated 700,000 uninsured residents.
On its face, the idea seems preposterous, given the political climate and anti-regulatory fever sweeping the nation. After all, even President Clinton has acknowledged that the days of Big Government are over, though the jury may still be out in Massachusetts.
Actually, however, the 50% employer mandate is something providers should support as a way of facing the chronic problem of health insurance for working Americans and their families.
The Employee Benefit Research Institute estimates that 39.4 million Americans had no health insurance in 1994 and that more than 80% of those are members of households with at least one full-time worker. In a nation where small business is generating most of the job growth, the situation could worsen.
While it's understandable that the small-business community opposes an insurance mandate, the fact is employer-based coverage is the backbone of the American healthcare system. A 50% contribution for high-deductible, no-frills coverage for workers should be considered a cost of doing business.
Massachusetts providers do have reason to offer only lukewarm support for the concept because the House has proposed using $200 million of a state uncompensated-care pool to help fund the program.
But the bottom line is that sacrifice from all sides is necessary if the state and, for that matter, the nation are ever going to deal seriously with the uninsured problem. Although anti-government philosophy is in vogue, we may be only one recession away from reviving talk of a single-payer, nationalized healthcare system.
To its credit, the American Hospital Association also has decided to put more emphasis on access to care and the plight of the uninsured. In the end, it's best that the business community and providers meet this challenge head-on before it becomes a crisis Big Brother thinks can only be solved with a more socialized approach.