Who should help pay for health care? At its heart, the health reform debate is about this question.

Right now, you and I pay for health care, as evidenced by the growing mountains of medical bankruptcies in this country. Health care costs are heaped on consumers and on their employers, while insurance companies profit.

Under reform, this burden would be more fairly distributed. Consumers would still pay for health care, but government would help them shoulder the burden. That’s not enough, however. Insurance companies would have to compete with a public health insurance option, driving down costs. And lastly, employers would have to continue chipping in.

At least that’s how it should be. However, business right-wing groups like the Chamber of Commerce are against this “employer mandate,” claiming, like everything they disagree with, that the provision would destroy business. (Some employers, like Wal-Mart interestingly, disagree.)

Employers do help pay for health care now, as most people get their health care through work with at least some help from their employer. Asking employers to share the responsibility for providing health care to their workers would strengthen the employer based health care system, a system business defends as necessary for attracting talent. Employer responsibility provisions would also ensure people get not just health care, but good health care by requiring employers to meet a minimum standard for health benefits.

Of course, employers could choose not to offer health care, and that’s their right. But if they do, they should not get off Scot free. It’s only fair to ask employers, who share in the fruits of a healthy workforce, to help pay to keep that workforce healthy. If employers don’t want to provide health benefits, they should pay the government to provide benefits for them.

This is how the “pay-or-play” provisions in health reform should work, and it is how they do work in the House health reform bill, HR 3200 [pdf]. Jacob Hacker, one of the fathers of the health reform plans promoted by President Obama and others, feels these pay-or-play provisions are a necessary part of reform. For moral reasons, I agree.

Of course, it helps that this idea is not only fair, but popular. In Kaiser’s August health care tracking poll [pdf], 68% of people thought a pay-or-play requirement was a good idea:

Employers should have to help pay for health coverage, just like consumers and government, and the American people agree.

Too bad Senator Max Baucus doesn’t. His bill, released yesterday, has no measures to hold employers responsible. To make things worse, it has a “free rider” provision that would discriminate against the hiring of older workers, poor and minority workers, workers with children, and unmarried workers.

Sounds like reform that works for business better than it does for you, right?

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