Employer-sponsored Insurance has one problem: it creates self-supporting insurance pools, which is inconsistent with universal coverage. ESI "works" because it prevents adverse selection. If you work for the company, you're covered. You can't opt out and wait until you get sick. Over the years, this feature has been eroded by options within private plans, but those options actually destroy the only conceptual benefit ESI confers. Once we decide that everyone should be covered for everything all the time, adverse selection stops being a thing, and private insurance pools stop being insurance pools.

ESI can provide a shopping service if purchasing groups (formerly known as insurance companies) can reduce costs by balancing network quality with bulk purchasing. But that feature needn't be employer-centric. Why doesn't Amazon or Wal-Mart have a network? And why would those networks be any better than the government's monopoly?

The bottom line is provider pricing. The only ways to reduce healthcare costs are to get people to live more healthily and to get providers to live less lavishly. Covid has shown us that Plan A is a non-starter. We'll see about Plan B.