As pandemic-triggered weekly job losses climbed into the millions and then tens of millions this spring, a cry went up among the healthcare-concerned on Twitter: now the catastrophic weakness of an employer-based health insurance system will hit home.
To which, a reasonable counter: what about Japan? The country has truly universal healthcare, and about 60% of the population is insured through employers. Almost all the rest are insured through residence-based plans run by local governments, including citizens' plans for the nonelderly, covering 27% of the population, and specialized plans for the elderly, covering 13%, according to the Commonwealth Fund. Those proportions are broadly similar to those of the U.S., leaving aside 10% of the U.S. population that was uninsured just prior to the pandemic. In the U.S., about 54% of the insured population is covered by employer-sponsored plans, 22% by Medicaid, and 15% by Medicare.
Jon Walker has suggested that adapting Japanese model might provide the least disruptive route to universal coverage for the United States:
All adopting a Japanese type of system would require is for the U.S. to take what it is currently doing and heavily standardize it. The biggest change would be scrapping the individual non-employer-based market to put everyone on a government plan, but the individual market is the least popular part of our system anyway.Americans, like the Japanese, have regionally-based government-run and financed health plans for the (mostly) non-elderly. They're known as Medicaid.*
