In a great historical irony, the evident faults of employer-sponsored insurance are helping fuel a new appetite for Medicare-for-all, a single-payer system where everybody gets health coverage from the government. But the work-based system, for all its flaws, could also be the biggest barrier to enacting single-payer. Shifting 160 million people from the coverage they currently get through their jobs to a new government plan is a lot of disruption — and disruption, especially in health care, has historically made a lot of Americans nervous.

If Medicare-for-all is ever to become more than a campaign slogan, its proponents must solve that riddle.

Ending work-based insurance is still a humongous challenge

Medicare-for-all has become incredibly popular among the Democratic base, but the primary problem it will face is that many people are fine with the insurance they have today. They might not love it, but they are familiar with it, and for the people who don’t incur regular medical bills but want to be protected from an emergency, the benefits you receive through work-based insurance are probably sufficient.

“It’s a real barrier to doing anything big,” says John Holahan at the Urban Institute, who helped create a proposal explicitly designed not to disrupt work-based insurance. “Most people with employer plans are reasonably happy with them.”

By Dylan Scott

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