The Real Reason the U.S. Has Employer-Sponsored Health Insurance

Like I mentioned, Canada implemented many of the same wartime rations on goods and controls on wages-- with the distinction that Canada was under wartime restrictions for twice as long as the US. All said, over 10% of the population served in the military with very little conscription due to internal conflicts with French-Canadians. The pressure to keep wages was certainly there, although I can't find resources on if and how companies sweetened the deal for employees with other benefits.

Before the war, many provinces had attempted to pass healthcare legislation but were halted by financial limitations or from opposition from doctors. Shortly after the war Saskatchewan managed to pass legislation to subsidize doctor visits by entrenching a common practice for communities to pool resources to attract doctors to service rural and remote parts of the province. Perhaps this is the distinction: local and provincial governments across the country were involved right from the beginning in providing healthcare. Canada's relatively homogenous citizenry may have also helped: most Anglophone Canadians saw themselves as a body of British subjects and this likely helped themselves band together to provide a common good.

I suspect that segregation in many places in the US acted to form healthcare in a less communal nature around private businesses where discrimination was easy to enforce.

"socialism" may have been the instrument, but why did the AMA use it to scare people out of supporting Truman's plan? Because they felt the plan encroached on their power. That's why the AMA advocated for expanded private insurance---as a bulwark against government takeover of medical care. So it may be that the "P" word is more important: "protectionism".

See http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...

Socialism brings ruin to whatever it touches. Canadian healthcare is not an exception but Venezuelan and Cuban healthcare are much better examples.

And this is a pretty big problem.

It's far more than that. Because health care costs are artificially jacked up (so that insurance can "negotiate" them down), anyone without health insurance can be screwed, even if you aren't "poor". So - anyone that doesn't have employer-provided health care and isn't eligible for Medicare/Medicaid.

Examples: I once tried to buy some nasonex (or equivalent) without my insurance info. $180. When I didn't pay and returned with my insurance info, it dropped to $5ish. My wife gets bi-weekly injections that stops her psioratic arthritis (which she's had since her teens) from crippling her. With insurance, $50/month. Without....we were quoted in the thousands, each month.

It is very, _very_ easy for me to see situations where you need health care to be able to work, and you need work to afford health care.

And this does impact employer lock-in. Every time I switch jobs (and to a lesser but still notable degree, when my company switches insurers), we have to do a new dance of:

* getting registered for insurance. Most places backdate your insurance to date of hire, but if you want to actually get the benefits immediately, it usually takes weeks to get your info from your employer to the insurance company and then they "process" it. (I have been told by one company that it takes them 1 business day to know they GOT a fax from my company, and another 2 business days to "process" it.) From experience I can say that if you make yourself enough of a problem you can drop this down to 5-10 days, but it takes a lot of work and that's still a ridiculously long time.

* Did I mention that it's quite common to have a by-mail pharmacy? That's a separate company from your insurance, so step 1 has to repeat for the new company (that process is usually faster, but it's still easy to lose another day to it). Oh, is your drug expensive and/or restricted? That might be handled by a specialist pharmacy, which is a 3rd company. (that last is not a guarantee - I've seen it in about 50% of my insurance

* Once you have the insurance info, now you need to get the doctor to send in the prescription. For basic drugs that's simple and automated, but for expensive and/or restricted drugs, that's more hoop jumping. Have you tried to get a hold of the average american doctor's office? My experience is you call, get transferred to a nurse's voice mail. Leave a message, and in 8-24 hours they will call you back. Re-explain whatever you said in the voice mail, and they say that will need the doctor's okay. Enter a second 8-24 hour wait. Now the doctor's office will send the prescription to whatever pharmacy you need...who will reject the request because they need justification (Silly me, I thought the prescription WAS the justification). Now the doctor needs to call the insurance company directly. Which is, you might guess, usually harder that getting them to send in the prescription in the first place. (we've had wonderful doctors for this and terrible doctors for this...and in my opinion the terrible doctors are only terrible on a relative scale - I hate the hoop jumping and I'm not doing it for multiple patients)

And all of this presumes the drug ( or non-pharmaceutical care) is covered in the first place. Every time I consider switching jobs, I have to find out if they will cover my wife's treatments. (Figuring out if something specific is covered is non-trivial and I have a degree of mistrust about the results).

I'm fortunate enough to have a good wage and many job prospects. I can easily imagine someone in less beneficial circumstances getting locked into a job by the above.

Isn't it messier than that? I'm pretty sure you could decline your employer provided coverage and buy a plan from an ACA marketplace.

It's just that it wouldn't make sense to do that at an additional cost of thousands of dollars.