How to solve the health-care mess

The issue of health insurance is not going away. Obamacare might be allowed to collapse, causing pain for millions who will lose coverage, as well as untold damage to a sector that constitutes about one-sixth the economy. The law might limp along without the fixes needed. Or it might be replaced. But the issue of how best to provide health care will be with us for as long as people get sick.

Before Congress changes the insurance landscape, the politicians need to know where the gaps are.

The U.S. Bureau of Labor Statistics' (BLS) annual Employee Benefits report was released recently. The most eye-opening number was that only 67 percent of private-sector workers even have access to health insurance at their workplaces. Worse, only about half actually take the benefit. Even in the public sector, only about 70 percent use their health-care benefit.

The nearly half of the private-sector workers and 30 percent of the public sector employees who don't get insurance from their employers have to secure coverage some other way. That explains the need for the government to fill the huge gap in coverage.

A rational national policy should be directed at those who have problems getting health insurance. The BLS report provides some insights into those groups.

If you are employed in the private sector, you'd better be working full time. Only 19 percent of those employed part time have access and only 11 percent have coverage. In comparison, 88 percent of full-time private- and public-sector workers have access, and 65 percent make use of it.

There is a similar gulf between union and non-union workers. Almost 95 percent of union workers — private and public — get health benefits, and almost three-quarters of them use it. In comparison, fewer than 70 percent of non-union workers have access and fewer than half of private sector workers use it.

Lesson No. 1: If you want health benefits, work at a unionized or government job.

Then there is the income issue.

If you earn in the bottom 10 percent of wages, the ability to get health benefits is limited. Only 22 percent of those workers have access to insurance and only 12 percent have coverage.  Meanwhile, 94 percent of the workers earning in the top 10 percent of the wage distribution have access.

If you are in management or a professional occupation, health care is readily available. Production workers, who are largely unionized, also have the benefits. But only about half those working in a service or sales occupation have health benefits, and maybe 30 percent use them.

Lesson No. 2: Work in a high-paying occupation or industry and you get health care benefits.

Next there is the cost of coverage.

For individuals, it doesn't matter whether you are a full-timer or part-timer, whether you work in management or sales or service, in large or small companies, or for the most part, in high- or low-paying jobs. If the firm provides the benefit, it pays about 80 percent of the costs. The public sector pays a slightly higher share, 86 percent.

However, if you need family coverage, grab your wallet. Businesses fund only about 67 percent of the costs and you'd better work for a large company. They subsidize about three-quarters of the cost, compared with only 63 percent for smaller firms. The government is in the middle, paying just over 70 percent.

Lesson No. 3: Don't have a family, or else be prepared to pay more for health care coverage.

OK, what should we make of the numbers?

The obvious is that you have to have a full-time job, make decent money and/or work in a unionized or public-sector position and be single to get health-care benefits that are highly subsidized.

But most important, even if you have a job, there is no assurance you will have access to medical care.

Also, the low benefit-usage rate of low-income, non-union or government workers implies that even if insurance is available, it may not be affordable. Access and usage are two different things.

The private sector does as well as it can to provide health coverage. It is a benefit that helps attract and retain employees.

Unfortunately, businesses can do only so much.  There are many who don't have access to coverage or cannot afford it.  That is where government must bridge the gap, since we all pay for those who don't have insurance but use the health-care system.

And that is why we need a health-care program that makes health insurance affordable for as many people as possible.