Healthcare Reform: It's All About the Benjamins

My continuing objection to the U.S. healthcare model, with or without the currently proposed reform legislation, is that it relies upon an obsolete, anti-growth employment model that includes four invalid, or soon-to-be invalid, assumptions:

(1) Employment is continuous, or at least sequential, and each job has a duration on the order of several months or more;

(2) Employment compensation consists of only traditional salary or wages that correspond to time served rather than value added;

(3) Employment occurs, and healthcare benefits therefore accrue, within a single political jurisdiction;

(4) Ability to pay healthcare costs and insurance premiums depends upon one's salary or wages rather than one's accumulated wealth (as does the income tax, for that matter).

In a truly innovative, venture-based economy, creative contributors might work several hours for one client, work a month and a half for another, and have an intermittent gig with a third -- and that's only in one's main line of business. There might also be a side project or two, perhaps some online sales, investment income, capital gains, etc. Or perhaps a high-mobility worker travels from jobsite to jobsite, his or her geographic flexibility across state and national boundaries, going to where the work is, representing a crucial contribution to an efficiently operating global economic system.

Having healthcare benefits associated with traditional, full-time employment makes little sense in the current economy in which traditional employment describes the circumstances of fewer and fewer citizens. The high-volatility economy simply doesn't square with the traditional workplace assumptions underlying the healthcare debate. To reconcile healthcare reform efforts with modern workplace realities, a historical perspective may, ironically, provide the most illumination.

Consider that, similar to today's venture-driven economy, many of the nation's founders, including Washington, Franklin, and Jefferson, pursued multiple lines of entrepreneurial business, often simultaneously. This suggests a conceptual litmus test for evaluating today's healthcare reform proposals: would any proposed system under discussion that is still based on salary and wage income have covered Washington's leeches, Franklin's syphilis treatments, and Jefferson's extended family?