The Kansas City Star, Mo., Diane Stafford column: Job-based health insurance has lost its luster

Most job hunters want to find a job with health benefits.

But what happens the next time they're laid off?

Clearly, it's past time to separate health insurance from employment.

Forays into "consumer directed" plans and "employee wellness" programs -- such as HMOs and PPOs before them -- have done squat to fix the expensive and arbitrary employment-based insurance system that covers about six in 10 Americans.

In the 1940s, when war-related wage controls put a lid on pay raises, employer-based health insurance was born. As an alternate form of compensation, health benefits were a means to attract and keep good workers.

Did anyone then foresee health benefits becoming the albatross that drags down the global competitiveness of U.S. companies?

Still, the fearsome costs of COBRA coverage, the inability to get individual coverage with a pre-existing condition and the high costs of open-market policies all make employer-subsidized plans the holy grail of health care.

It's time to acknowledge that the adoration is misplaced.

Employment at a sponsoring firm shouldn't be the measure by which one has access to affordable health care. What about the workers who toil for employers who can't or won't subsidize policies?

Fewer than half of small businesses provide employee health insurance.

Attempts to mandate employer-subsidized coverage are going nowhere -- and they shouldn't. They're not fair, either, given arbitrary cutoffs for which establishments would fall under the mandate.

Fifteen employees? You're covered. Fourteen employees? You're not. You call that fair?

Meanwhile, about 2 percent of employers annually are opting out of providing employee health insurance plans.

And at workplaces that still sponsor health insurance plans, the rumbles of discontent mount with each passing open enrollment week.

It's not just that costs continue spiraling for both employers and employees. It's that workers are wiser to the fact that there's just one pot of money for pay and benefits.

Every dollar that goes to an employee benefit is a dollar that comes out of base pay.

But here's the crucial question with an still-unknown answer:

Without a semi-paternalistic, employment-based system, will people be responsible health care consumers?