Americans Prefer Their Employers, Not the Government, to Provide Health Benefits

People want more medical leave, but like other perks, they prefer for it to come from companies.

Thierry Charlier / AP

Most Americans don’t get fully paid medical leave, but they want it. According to a massive Pew Research survey released today, only 47 percent of people who took time off from work for medical or family reasons did so while receiving their regular salary, while 36 percent took time off with no pay. (The rest received partial pay.) Those at lower incomes were much less likely to get paid leave than wealthier people were.

The U.S. is the world’s only advanced economy in which workers aren’t guaranteed paid leave of any kind, and Americans don’t seem too happy with this status quo: 85 percent of respondents told Pew that workers should get paid leave to deal with their own health conditions. (Americans were more likely to endorse paid medical leave than maternity, paternity, or caregiver leave.)

Interestingly, the survey respondents—regardless of political affiliation—overwhelmingly thought employers, not the federal government, should be responsible for paying them during their leave.

The most popular way to bring about paid leave in the U.S. was to encourage employers to provide it by offering tax credits. (This business-friendly proposal far outranked taxing rich people more.) People were about evenly split on whether the federal government should require employers to offer paid leave or not.

“In general, the public has a more positive view of policies that incentivize employers or employees rather than those that create a new government fund to finance and administer the benefit,” the Pew researchers write.

This mirrors an interesting quirk in health care: People seem to trust their own employers more than the federal government to handle their health benefits and insurance, even though people end up more satisfied when the government provides it.

In some ways, this is just a side effect of Americans’ eroding trust in government, which is near all-time lows. Just one in five Americans trust the government “always or most of the time,” according to a 2015 Pew poll. Meanwhile, American trust in businesses is considerably stronger. Not only does “big business” outperform Congress on measures of public confidence, “small business” is the one of the most trusted “institutions” in the U.S., according to Gallup—second only to the military. That faith is revealed in this current Pew survey on paid leave, in which two-thirds of workers said they “believe their employer cares a great deal or a fair amount about the personal well-being of their employees.”

It’s also reflected in Americans’ ambivalence about leaving health-care up to the government. In the years before Obamacare was passed, the majority of people Gallup surveyed said it is the responsibility of the government to make sure all Americans have health-care coverage. After the law was implemented and its warts became evident, however, the majority of Americans began saying insurance coverage wasn’t the government’s role. Now, the number is back up to a slight majority of 52 percent—still lower than any time before 2009.

And only about half of those who say the government should have a role in ensuring health-care coverage say that insurance should be handled solely through the government (as in, through a single-payer system), rather than through corporations.

Just where does this trust in the redistributive power of corporations come from? It likely dates back to that (in)famous work ethic of our Protestant forbears, but in The Atlantic last year, Elizabeth Samet offered up a more recent source: The influential steel magnate Andrew Carnegie. In The Gospel of Wealth, he wrote that “it was the ‘duty of the man of Wealth’ to solve ‘the problem of Rich and Poor.’ His philanthropy was animated by the idea that the rich man was in fact better suited than government to addressing the issue by virtue of his ‘superior wisdom, experience, and ability to administer.’”

Ironically, when the government does provide insurance, people seem happy with the arrangement. Gallup has also found that people on Medicaid or Medicare are more satisfied than those on employer-based plans.

This trend helps explain why Trump’s promise to “run the country like a business” inspired so much enthusiasm, as well as why so many people on Medicaid voted for Republicans, who are trying their best to cut the program. Many likely figured that if Trump really did bring back blue-collar jobs, they’d be better off with their new employers than they would staying on Medicaid. Take, for instance, the case of this Trump-supporting former coal miner in West Virginia interviewed by The Washington Post’s Jessica Contrera:

As for the other problems in his life, he has put his hopes in Trump, who came to West Virginia saying he would bring back coal and put miners back to work. When Trump mentioned repealing Obamacare, Clyde wasn’t sure what that might mean for his Medicaid. But if he had a job that provided health insurance, he reasoned, he wouldn’t need Medicaid anyway, so he voted for Trump, along with 74 percent of McDowell County.

The Trump administration has promised to revamp both paid-leave and health-insurance policies, and it seems clear that people want more generous benefits. It’s just that they’re not quite ready to entrust the government to provide them. Instead, they’d rather look to the leaders they feel are really on their side: their bosses.