Mild and moderate mental illnesses can hinder labor force participation, lead to work interruptions, and hamper earning potential. Targeted interventions have proven effective at addressing these problems. But their potential depends on labor protections that enable people to take advantage of these interventions while keeping jobs and income.

American policymakers and health policy analysts have a love-hate relationship with job-based health insurance. The policy press routinely runs articles about the demise of the current system of voluntary employer-sponsored health insurance coverage. Conservatives argue that it ought to be replaced with individually purchased insurance, such as tax-favored spending accounts. Liberals assert that government insurance ought to supplant it. Meanwhile, as the debate rages on about the future of employer coverage, states and the federal government pass legislation buttressing and building (...) on the existing employment-based system. Congress, in its recent Medicare reform legislation, not only extended publicly-financed prescription drug benefits to elderly Americans but also offered employers tax incentives to keep providing the prescription drug benefits they offer to their retirees. There is nothing new about this debate, nor the conflict in views it represents. Since its origins in the 1930s, employment-based coverage has been viewed with skepticism. Nonetheless, nearly three-quarters of a century later, the vast majority of Americans under 65 who have health insurance, and about 38 percent of those 65 and older who continue to hold private health insurance coverage supplemental to Medicare, obtain it through their current jobs (or in the case of retired workers, former jobs). The model of privately-sponsored and voluntary employment-based coverage is hardly anyone’s ideal of health system design, but it is a nearly unanimous second choice. (shrink)

American policymakers and health policy analysts have a love-hate relationship with job-based health insurance. The policy press routinely runs articles about the demise of the current system of voluntary employer-sponsored health insurance coverage. Conservatives argue that it ought to be replaced with individually-purchased insurance, such as tax-favored spending accounts. Liberals assert that government insurance ought to supplant it.Meanwhile, as the debate rages on about the future of employer coverage, states and the federal government pass legislation buttressing and building on the (...) existing employment-based system. Most recently, California has passed an employer mandate requiring employers to cover their workers and Maine has adopted a universal coverage initiative that includes a voluntary small employer insurance program offered through a state agency. (shrink)

Commentators on Uwe Reinhardt's Tanner Lecture. The Tanner Lectures are a collection of educational and scientific discussions relating to human values. Conducted by leaders in their fields, the lectures are presented at prestigious educational facilities around the world.

This paper examines the economic rationale of affordability exemptions in the context of a health insurance mandate. I provide an economic definition of affordability and discuss how it is implemented in the contexts of food, housing, and health care. Affordability standards are frequently used in making food and housing policy, but both empirically and theoretically health care operates quite differently than these other merit goods. This helps explain why the use of affordability in health policymaking is so different from its (...) use in these other contexts. I conclude with some suggestions about how to improve affordability exemption rules in health policymaking. (shrink)

Physician-based transparency approaches have been advanced as a strategy for informing patients of the likely financial consequences of using services. The structure of health care pricing and insurance coverage, and the low uptake of existing tools, suggest these approaches are likely to be unwieldy and unsuccessful. They may also generate new ethical challenges.