Health Care Leninism

Paul Krugman offers a good run-down of the two major schools of thought on health care, and then concludes with his take on where Bush's proposals are going:

Now here's the thing: in the name of consumer-directed health care theory, Bush is proposing changes that would essentially encourage people to move into the individual market — which wastes a lot of money, and doesn't and can't work for those most in need — while undermining the employer-based system, which isn't wonderful but is still essential. In particular, healthy high-income people would be encouraged to drop out of employment-based plans, leaving behind a sicker risk pool, driving up rates, and pushing employer-based care in the direction of an adverse selection death spiral. The plan we're supposed to learn about tomorrow doesn't sound big enough to have catastrophic effects, but it's a step in the wrong direction.

I can't get that worked up about Bush's plans. I agree with Krugman and liberals everywhere that consumer-directed health care won't work. But suppose it does? Well, that'd be a pleasant surprise. And if it doesn't, it'll be easier to build a rational universal system on the ashes of a wrecked employer-based system than it'll be to cobble one together using employer-based health care as a foundation. On most topics, I think there's very good reason to be skeptical of "things have to get worse before they get better" kind of thinking, but there are, I think, good reasons to make an exception on the health care front.

Comments

I can see why things will get worse, but I'm not sure that the likely result isn't that they will just stay worse.

Posted by otto | January 23, 2007 6:05 PM

bush's health plan won't work for those who need it. If you don't have 7,500 dollars worth of non-payroll, non-social security taxes, then it won't work. I'm sure Matt doesn't realize how many people don't have to pay that much, but a lot of other people do. bush's plan can't work, pretending it's even possible it can is like pretending we can simply nullify gravity, despite the fact that we're not even sure what exactly a graviton is. It's like thinking that somehow, somehow if we keep dropping apples that one of them has to fall upwards.

Posted by soullite | January 23, 2007 6:17 PM

Re: In particular, healthy high-income people would be encouraged to drop out of employment-based plans, leaving behind a sicker risk pool

Why? the tax treatment won't matter whether they're insured by their employer or by themselves: if they want an expensive all-frills policy they will likely run afoul of the deductible limitation. Meanwhile, people who have to pay out of pocket (many self-emploted workers, small business owners, anyone paying COBRA) will get a tax break. Sorry, but this latest proposal is actually a bit progressive since it duns those with gold-plated plans and gives a much needed break to people who need it. In fact the Right is already panning the idea precisely because it does (potentially) raise taxes on the rich! Now it's certainly no panacea, and no substitute for comprehensive reform, but from what I can see, it's a small step toward helping those struggling to pay for insurance.

Posted by Jonf | January 23, 2007 6:28 PM

yeah, I've got this guy, wants to sell me shares for faster than light flight. the physicists all say it won't work, but what do they know? anyway, I think I need to waste a bunch of money and time first so it will be obvious that it's a bad idea instead of investing in something reasonable. after I lose all that money it'll be easier to recognize a good investment, maybe 10, 20, 30 years from now, maybe after I'm dead.

Posted by supersaurus | January 23, 2007 6:30 PM

I have to second otto's comments.

"But suppose it does? Well, that'd be a pleasant surprise. And if it doesn't, it'll be easier to build a rational universal system on the ashes of a wrecked employer-based system than it'll be to cobble one together using employer-based health care as a foundation." -M.Y.

With all due respect, thats a crummy way to look at what would be an absolutely epic disaster for millions of people.

One, the period between decent, destruction ('ashes'), and rebuilding would be slow and tortuous; years or decades during which millions of poor and middle class people would be way worse off than they are now. There would be massive bankruptcy at least, a general economic meltdown at worst.

Two, given the powers that be in the US, there is little reason to think a rebuilding would take place at all. We'd be stuck with ashes.

Posted by Matthew C | January 23, 2007 6:31 PM

we do have to give it to MY -- when he wants to punt on an issue, he makes no bones about it.

Posted by right | January 23, 2007 6:38 PM

People continue to talk about providing health insurance to the uninsured. What is really needed is universal health care not insurance. This is what exists in other advanced countries.

Why it isn't proposed here is due to the power of the insurance middlemen. Neither party wants to tangle with these entrenched interests. As an example United Health Care just posted profits of $1.2 billion for the most recent quarter. Think how much further the health dollars would go if this money wasn't being extracted from providing actual services.

Other countries have better overall health and spend about half as much as the US. They just don't have all the middlemen pushing up costs and denying benefits.

Posted by robertdfeinman | January 23, 2007 6:48 PM

I'm telling hilzoy about you.

The problem I have with this scenario is that when the Health Care Revoultion comes, the consumers will not be adequately organized. I think in the final negotiations we will need many medium size political entities.

In the other great moments of American liberalism those entities were labor unions. Walter Ruether expected employer health care to collapse, but I bet he expected strong unions to be around to work the rubble.

Those political players could be the states like Mass and Calif, who will have compelling interests, but Dixie will as always vigorously resist.

Posted by bob mcmanus | January 23, 2007 7:13 PM

Its a trap. If the Democtats endorse this broken proposal they get the blame for breaking it and will be unable to offer any proposals of their own.

The reason to not get excited about the Bush proposals is that he is utterly irrlevant. He does not have the ability to introduce legislation in either house. Even if the Republicans had not lost the midterms they would not be signing on for another Social Security reform type fiasco.

From now on Bush has no more influence than the average blogger on legislation.

Posted by Phill | January 23, 2007 7:30 PM

"And if it doesn't, it'll be easier to build a rational universal system on the ashes of a wrecked employer-based system than it'll be to cobble one together using employer-based health care as a foundation."

And in the meantime mothers and fathers will die of cancer and leave orphaned children, young people will be bed-ridden with chronic pain, and premature infants who could have had normal lives will become retarded and crippled for life.

Honestly, Matt, this post is juvenile. It's far below what you're capable of.

Posted by JR | January 23, 2007 7:33 PM

"Honestly, Matt, this post is juvenile. It's far below what you're capable of."

I do not think it juvenile, if a little narrow. Over at Max Sawicky's, the commenters are wondering if Charlie Rangel, who gets 2/3 of his campaign money from the finance industry, is about to cave on Social Security.

Mark Schmitt has it. Starve-the-beast was really radical, and is working like a charm. The Reagan-Bush tax cuts/deficits had real consequences:fiscal, political, societal. Schmitt himself can't even conceive of raising tax to pre-Bush levels, let alone pre-Reagan levels.

The bill is coming due, and blood is gonna flow. Just a matter of whose, not whether. For a while, it will likely be the poor's blood, and lower middle class. In Iraq, in waiting rooms of bankrupt big-city hospitals. You would like to think their suffering could help create a good outcome.

Fuck yes, I am talking about revolution. All decent people must.

Posted by bob mcmanus | January 23, 2007 7:51 PM

Yeah, well as a fifty five year old who is now, since December last, for the first time in his life without health insurance, and unable to buy any because of a chronic illness (pre-existing condition, in insurance jargon), I'd say that we've hit that point Matt.

Even if you are a healthy twenty something with insurance, can you not see that the system is already wrecked?

Posted by ken | January 23, 2007 7:59 PM

Matt: "And if it doesn't, it'll be easier to build a rational universal system on the ashes of a wrecked employer-based system than it'll be to cobble one together using employer-based health care as a foundation."

Matt, if you're ever sick, and trying to raise money for treatment, please don't ask me for a donation. I figure that you'll base your new, healthier body on the ashes of your old, sick body.

Posted by Barry | January 23, 2007 8:01 PM

I can't get worked up about Bush's proposals because they aren't going anywhere. If this had been last year, Congress would have held hearings, votes would have been scheduled, we'd all had to have fought these proposals, meaning we'd all had to have worked out their consequences in detail. But now, these proposals are dead on arrival in Congress. They aren't going to even bother hold hearings on what are, after all, half-baked, unthought-through ideas. No tax-writing committee is going to even look at them. What's the effect on tax receipts? No-one knows. No-one's done any analysis.

It's good to point out how bad the ideas are, if you can do so without much effort. But don't waste much time on them. Spend your time opposing the things that are likely to happen.

Posted by jim | January 23, 2007 8:11 PM

Like his HSA accounts, the effect of the new proposals is to drain the healthiest people out of conventional insurance groups thus causing their premiums to rise at an even faster rate. His proposals are worse than rearranging the deck chairs on the Titanic because they cause the ship to sink faster.

Posted by gregpstone | January 23, 2007 8:52 PM

Barry gets at the heart of it. Anyone who advocates deliberately making things worse, or not caring much if they get worse for others, forfeits my sympathy when their own need comes. And it will.

Things will get worse for a lot of people without anyone on the general side of social justice and humanity helping.

Posted by Bruce Baugh | January 23, 2007 9:00 PM

"Things will get worse for a lot of people without anyone on the general side of social justice and humanity helping."

So much for that callous fucker Lincoln.

Posted by bob mcmanus | January 23, 2007 9:07 PM

And what do all the sick, injured, pregnant and dying do if they fall in the donut hole of "things are worse right now but soon they'll get better"? Pretty easy for a healthy 20-something blogger to say "Let's blow up the whole system and start over with something else" while such recklessness makes no provision for others while all hell is breaking loose. Matt, you've never struck me as so cavalier. Sort of Bush's Mini-me almost.

Posted by steve duncan | January 23, 2007 9:18 PM

"...forfeits my sympathy when their own need comes."

And both of the liberals used the personal charity meme, the conservative meme:MY won't get their help when the crunch comes. It is all about what Bruce does, what Bruce feels. Even, or especially liberals, don't understand corporate or social responsibility. People bleeding to death on emergency room floor: Why, I will write a check, because that makes me feel good, eases my conscience, and most importantly, doesn't hurt anybody.

I want the poor guy hurting to know the world cares about him. Not me. I ain't got that ego. And I am willing to hurt people. Lots of them.

A tax increase on the rich hurts the rich. No tax increase hurts the poor. I hurt people every second I live. People just with play with these hypocritical liberal delusions and justifications.

Posted by bob mcmanus | January 23, 2007 9:23 PM

And if it doesn't, it'll be easier to build a rational universal system on the ashes of a wrecked employer-based system than it'll be to cobble one together using employer-based health care as a foundation.

Bingo!

You hear similar complaints about the gubernator's proposal; namely that it would incentivize lots of firms to pay the optional payroll tax because it's cheaper than buying health insurance (and this trend, if sufficiently widespread, would undermine employer-provided health insurance in California). I say, sign me up! I want to undermine this non-sensical system.

Funny, everybody -- left and right alike -- have been saying for some time now that tying health insurance to employment is a bad thing. Along comes a plan to do something about it, and suddenly you don't hear these arguments anymore. From my early reading of reactions, by the way, the only people who hate the president's plan more than liberal Democrats are conservative Republicans. I, bleeding centrist that I am, don't like Bush's proposal either, but not because it's not a move in the right direction, rather, I think it's far too timid).

Posted by Jasper | January 23, 2007 9:31 PM

When you make things worse, they are worse. Making health care worse can mean destroying decent lives. Look for instance at the teeth of children from poor families. A foolish post.

Posted by Jennifer | January 23, 2007 9:31 PM

From now on Bush has no more influence than the average blogger on legislation.

True. And a terrific line. Indeed, he's probably got less influence than some bloggers.

Posted by Jasper | January 23, 2007 9:34 PM

Even if you are a healthy twenty something with insurance, can you not see that the system is already wrecked?

Unfortunately for you, not enough people can see that it's wrecked, because for them, it isn't. The one or two referenda that allowed voters in this country the choice of adopting single payer models were defeated overwhelmingly. Maybe a Democratic administration can cobble together the votes to get you insured (I sincerely hope so) but as long as there's a big, big majority of Americans (85%+) who possess health insurance, I think truly shaking up the status quo temporarily (even if it increases pain in the short run) only gets us to univeral coverage more quickly.

Posted by Jasper | January 23, 2007 9:42 PM

When you make things worse, they are worse. Making health care worse can mean destroying decent lives.

Jennifer: Things are getting worse even if we do nothing. Trouble is, things are getting worse slooooooooowly. I'd just as soon get the worsening over with.

Posted by Jasper | January 23, 2007 9:43 PM

"Making health care worse can mean destroying decent lives."

Matthew is denying health care to no one, and he hinself is making nothing worse. There is nothing in the post that should lead antone to say so.

The title uses the word "Leninism" The classic story is that Lenin would not help private charity efforts against starvation because he wanted to "highten the contradictions" At least before the Revolution, Lenin did not starve anyone, or make things worse. He sought comprehensive enduring solutions rather than instant palliatives.

Now the question is whether slightly ameliorative efforts will actually postpone Universal Care, and in truth cause more short and long harm than they relieve. I believe they will, and do so currently.

Posted by bob mcmanus | January 23, 2007 9:46 PM

> And if it doesn't, it'll be easier to build a
> rational universal system on the ashes of a wrecked
> employer-based system than it'll be to cobble one
> together using employer-based health care as a
> foundation.

Matthew,
You are what? 25? 27 years old? About 10 years from the point where significant things will start going wrong with your body. You can wait 6-8 years for the "worse to get better" theory to operate. Perhaps others can't?

Cranky

Posted by Cranky Observer | January 23, 2007 10:03 PM

Matt is right. People are not going to accept major health insurance changes until fear of the known is greater than fear of the unknown. That may be sooner than we think.

Posted by Marvyt | January 23, 2007 10:03 PM

"On most topics, I think there's very good reason to be skeptical of "things have to get worse before they get better" kind of thinking, but there are, I think, good reasons to make an exception on the health care front."

This is an incredibly short-sighted position to take. I don't know very much about Matthew, but can only assume he is a relatively young man without any wolves at his door. I can't believe anyone with aging parents, children, or health problems of his/her own could suffer through the health care system getting much worse than it already is.

Posted by Square Mom | January 23, 2007 11:08 PM

1. Americans love doctors, mostly.
2. Americans hate health insurance companies, snide billing administrators, small-print policies, etc. They hate hearing about billion-dollar profits and fat fucking CEOs buying yachts on the back of their monthly premiums while they argue over the phone over a co-payment.

Stuff the consultants' mouths with gold, put the private insurers out of business. This is not a hard policy to sell.

Posted by pseudonymous in nc | January 24, 2007 12:31 AM

I won't speak for MY, but under pressure from hilzoy at Obsidian Wings, I have done some exploration over there of Leninism and what it might mean in the American Health Care context. I don't know if I can link, but it is in comments of a recent post.

If Marvyl is correct that a discourse about Health Care is impossible without including private insurance, which makes rational change impossible: then the non-cooperation with institutions, vanguardism, waiting for the collapse, installation of single-payer by the elite, and then explaining the program ... is a way to go.

The people cannot understand "single-payer" in America, private insurance is too powerful and connected.

Posted by bob mcmanus | January 24, 2007 12:41 AM

"This is not a hard policy to sell."

Experience says otherwise, the vote in Oregon for instance.

And simply that Bush was able to put forth a con as a serioud proposal, that he could even say, shows we have great difficulty and intransigent opposition.

Posted by bob mcmanus | January 24, 2007 12:44 AM

A salutary onus

The only thing standing between us and the clearly best system of paying for health care, a national health insurance, is the self-interest of some high-roller campaign contributors, the health insurance industry and Big Pharma. In our political system as it stands right now, that means that the best health care funding system will not happen, no matter how great the public benefit, unless other interests able to contribute even more decide that the issue is important enough to them that they interpose their greater clout. The only candidate for a more powerful interest group than the coalition of the health insurance industry and Big Pharma that I see, is the potential coalition of all the rest of the business world that currently pays through the nose for expensive, bad quality, health insurance for their employees. Let these employers off the hook for that health insurance, and we disperse the only coalition with enough political firepower to kill off the health insurance industry, and deflate most of Big Pharma's huge profit margins. This political ju-jitsu, rest assured, is the sole design feature that recommended the Bush plan to its creators.

Posted by Glen Tomkins, MD, MPH | January 24, 2007 1:01 AM

All this plan does is make more secure those who are already far too safe. It's a tax giveaway for wealthy individuals, because this is not a way to pay for health care. This is a tax cut. If you do not have the money to pay for health care out of pocket, this plan does NOTHING for you. Unless you don't get how tax deductions work, you have to know that. You won't get mass support on something that helps only a tiny amount of the uninsured.

As for coalitions with enough firepower to force healthcare, well you're all not too bright. Any President with his own parties majority and the actual will to force a plan through can get a plan. Make no mistake about that. Don't mention clinton, it's not analogous. Half our party isn't made up of conservative southerners anymore. And to be honest, those people had the skeletons in their closets to force their hands too. Clinton worried too much about being liked. Health insurance companies have money, Presidents have real power. The power to collect information on Senators, the power to blackmail them. The power to force through bitterly opposed legislation. They just need the will to use those powers. Making a better world means operating by the rules of this one. Not your own imagined rules the other side never plays by.

Posted by soullite | January 24, 2007 8:50 AM

As a healthcare professional, I have watched with dismay the piecemeal destruction of our concept of healthcare by the adoption of "reforms" over the past 30 years.

Few of these reforms have helped the healthcare "consumer". Some of them might have helped, like stopping the overbuilding of hospital beds, if the big corporations did not simply laugh and ignore the regulations. In fact, probably the most substantive and actually implemented reform I have seen is the ending of the literal 'free lunch' for doctors that used to be simply charged against the patient's general account for a hospital stay.

Now we have a bunch of commenters saying "Oh, we can't wait, people are sick!" Get real- tinkering around the edges is waiting. As a caregiver for a gravely disabled person I watched with dismay as the Clintons unveiled a plan that did nothing for the gravely ill. Presumably the Bush plan is the pony part of the act, promising tax breaks to people who pay no taxes anyway, because they have no money.

There's an old joke about how you have to get the mule's attention, and then he'll work. Well, the 'mule' in this case is the American people, and we'll have their attention once life has whopped them alongside the head with a health crisis. Believe it, people who have had that happen are not interested in filling out one less form, or possibly being eligible for an insurance plan with a $5000 deductible.

If you can explain in simple and cogent terms why universal coverage is the solution, and how it will not force you to change your doctors, you're part of the solution. If you can't, you're part of the problem.

Posted by serial catowner | January 24, 2007 9:03 AM

i had an oh-so-clever response where i struck out "consumer directed health care" and inserted "plan for a 'surge' in Iraq" and the like, but, quickly realized the formatting was beyond my capability.

the point, however, was that this post (just like defenses of the "surge" that essentially act as if we're playing with house money, and, hey, what could be the harm?) shows a jarring lack of imagination about the downsides of a win for the other side on this.

somebody needs to explain to me carefully why, say, the share of uninsured rising form 16% to, say, 30% is utterly out of the question and will such a move will surely yield to glorious, guaranteed single-payer nirvana before this happens.

josh bivens

Posted by josh bivens | January 24, 2007 10:13 AM

It is very educational and interesting. Thanks for sharing it.

Posted by Leopold | January 24, 2007 11:32 AM

Where's the incentive to bail on one's emplopyer coverage? It's not as if the employer will instead give you the money he spends on your premium. No, the company will just pocket it.
To work some numbers here, my health coverage at my emplopyer is currently about $450/mo (real numbers here, but rounded), of which I pay about 60/mo while the employer pays $390. Now, I could purchase an adequete policy (not as good as my workplace policy) for about $240/mo (aagin, a real number, rounded). But That's $240 out of pocket instead of the $60 I am paying right, and even with a tax break worth about $60 (assuming middle class tax bracket), I don't come ahead, in fact I'm paying $120/mo more than I was, while my employer is $390/mo richer. Where's the benefit to me?

Re: You are what? 25? 27 years old? About 10 years from the point where significant things will start going wrong with your body.

Um, isn't that a little pessimistic? I'm almost 40. The only significant problem I have is asthma, which has been with me since I was 18, albeit exaccerbated by my move to Florida a few years ago. Believe it or not people do not fall apart in their middle 30s.

Posted by JonF | January 24, 2007 12:50 PM

It's not as if the employer will instead give you the money he spends on your premium.

Huh? Why not?

Posted by Al | January 24, 2007 1:52 PM

I am all in favor of undermining employer-based health insurance, but the point of Leninism is that you have something in hand, ready to go, with which to replace the failed system. Right now, single-payer health care seems so foreign to most Americans under 60 that it would be easy for its enemies (not opponents--enemies) to stampede the populace into accepting something far worse.

You need to get the camel's nose under the tent.

I say the Democrats need to propose--and pass--an expansion of Medicare so that it covers all children under 18. Take children out of the employer-based system altogether (none of this insurance only for poor kids crap). Such a proposal would be a winner on so many levels:

* Since it makes it easier to take care of children, it's pro-family

* Since it reduces the insurance exposer of employers, it's pro-business

* Since it will likely increase the overall state of health of America's children and make them more productive workers down the line, it's pro-economy

And it also introduces the concept of government-provided insurance coverage to millions of middle class Americans. What's more, when many of these children grow up and out of the program and get a taste of crappy private insurance, they will become a growing and vocal constituency for single-payer health coverage for everyone.

That's how you make this issue work in America.

Posted by jlw | January 24, 2007 2:06 PM

JonF - I'm not supporting Bush's proposal, but I believe your math is off. The tax credit, whether you spend it or not, would be $7,500. Your health plan at $240/month carries an annual cost of $2,880. As long as you pay at least $7,500 in taxes, the claim is that you would make out in this deal by nearly $5K.

Posted by Mike | January 24, 2007 3:05 PM

Holy leaping logic, jlw!

"* Since it makes it easier to take care of children, it's pro-family"

Maybe for uninsured children. I don't see how taking currently insured children and putting them on different insurance (possibly better, possibly worse) will make it easier on anybody. It seems pretty convenient to have everyone in the family on the same insurance plan(s).

"* Since it reduces the insurance exposer of employers, it's pro-business"

How do you plan to pay for this proposal? Taxes? On income? On businesses? Also, I'm not sure the business community will agree that taking people currently covered by private insurance and moving them to gubmint programs is pro-business.

"* Since it will likely increase the overall state of health of America's children and make them more productive workers down the line, it's pro-economy"

I don't see how changing the payer for children's insurance will change the quality of healthcare. Also, given the reduction in cancer rates, the increased life expectancy, etc., that we've experienced under the current system (flawed as it may be), do you think that our health will improve even faster under single-payer? Consider that most of the life-changing medicines and technologies we have that increase health and life expectancy are developed by private health care and pharma providers and research foundations. Most of that is paid for by profits in the health care industry. I concede that there are some government grants that go into it.

"What's more, when many of these children grow up and out of the program and get a taste of crappy private insurance, they will become a growing and vocal constituency for single-payer health coverage for everyone."

I've never been on medicaid, so I can't really compare, but I seriously doubt it's better than my current private plan, which could be described as average.

Posted by Mike | January 24, 2007 3:21 PM

Mike:

You likely don't have a child. One of the most worrying fears for parents is how their job situation can affect their child's health insurance coverage. Guaranteeing that every child will have full, continuing heath insurance coverage no matter who they are or what happens to their parents is a winner on so many levels that I can't believe that you would dispute it.

Keeping this coverage constant and predictable will help in tracking things like vaccination, in epidemiology, in ensuring that children receive regular check-ups. Children in countries with such insurance coverage are healthier on average than American children, and they have longer life expectancies.

People who are on Medicare or are in the VA system report being happier with their coverage than people in the private insurance system. Parents with children in a properly designed Medicare-like system will likely have similar feelings.

American automobile manufacturers are very happy with the health coverage their Canadian workers receive. The only business that supports the insurance industry is . . . the insurance industry. And since Medicare-like health insurance systems are less costly than private insurance, overall costs will go down. Business will like this more efficient system--unless you think businessmen enjoy paying more money for a worse product.

We don't expect seniors to be subject to the employer-based healthcare system--why should we impose it on children?

Posted by jlw | January 24, 2007 4:00 PM

Re: It's not as if the employer will instead give you the money he spends on your premium.
Huh? Why not?

Why would the employer give the money away? I have heard of a few who have offered the choice of some pittance of salary increase to the whole work force if they'd agree to cancelling the company health plan across the board. My sister's shop tried that in union negotiations (and was turned down flat-- they offered a mere $100 a month) But what incentive would the company have to give away the money when they could keep it instead? Are you suddenly imagining that emplopyers are motivated by altruism and generosity toward their employees? Moroever, if the result of such a course was that they were stuck with a bunch of high-cost individuals in the company health plan they'd be screwing themselves to encourage the young and healthy to bail. I don't think they're quite that dumb.

Re: I'm not supporting Bush's proposal, but I believe your math is off. The tax credit, whether you spend it or not, would be $7,500. Your health plan at $240/month carries an annual cost of $2,880. As long as you pay at least $7,500 in taxes, the claim is that you would make out in this deal by nearly $5K.

Bush is not offering a tax credit. Where do you get that? He's is offering a tax deduction: you can deduct up to $7500 ($15000 for a family) a year from your gross income toward the purchase of health insurance. And I'm not sure from what I've read if this would even apply to those who take the standard deduction and do not itemize. So, no, there's no way you come ahead if you cancel your employer-provided insurance (unless you are paying 100% of the premium at work, no employer-paid benefit at all, and it's higher than what you'd pay for an individual policy.)

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