Rarely does a day pass, now, without the appearance of some news report or commentary regarding who is, or isn't, covered by health insurance, or who is paying what for health insurance coverage. These pieces tend to fall into four categories: (1) the "how will we as a nation afford this" policy analyses, (2) the "labor v. management" stories, (3) the "whose fault is it?" attempts to find the bad guys who are doing this to us, and (4) the "individual hardship" human interest profiles. Often, these approaches are interwoven in a single presentation.
When I began practicing labor law, shortly after the earth's crust had cooled, it was still common to refer to the compensation paid for work as being composed of two elements: "wages" or "salary", and "fringe benefits." Among the bundle of "fringe benefits" was group health insurance coverage. No longer is health insurance on the fringe. It has become THE central form of compensation to be managed by employers, and sought by workers.
This is noteworthy, not least because in 75 to 80 years of government mandating minimum compensation for most workers, there has not been a statutory requirement that employers generally pay any particular amount of compensation in the form of paid medical bills. The closest our system has come are the federal and state "prevailing rate" laws that require employers performing public works to contribute to union-sponsored health insurance plans. Even the recent Massachusetts statute does not require work compensation to be paid in the form of health benefits, but uses the tax incentive approach to . . . well, let's use a future post to examine what Massachusetts is trying to accomplish. In short, our law has not made health care, or health insurance coverage, a right accompanying employment.
About thirteen (13) years ago, a nascent federal plan to provide Americans with "universal health care" was scorned into oblivion. Now, the Citizens Health Care Working Group has prepared recommendations for universal health coverage to go to Congress this Fall. We are poised, therefore, to again debate whether health care (as differentiated from health insurance) will be recognized as a right accompanying participation in our society.
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