Kathryn Anne Edwards: Why health insurance is such a mess

The problem is buried so deep into our system of health insurance that no policymaker has the nerve to touch it: health and work shouldn’t be linked.

There’s scant labor market or health justification for a system built on employer-sponsored coverage, but entrenched interests override good health outcomes, controlling costs and providing coverage to as many people as possible.

The tax-preferred status of health insurance benefits that opts employers and employees out of income or payroll tax duties on those benefits totaled $384 billion in 2024.

Yet policymakers have made clear that rather than rock this boat, they’d prefer to wait for it to tip over on its own.

Congress’s failures

Congress’s lack of stewardship over health insurance dates back to its origins. The first such plan in t