That's not what I'm suggesting at all. The point I'm making is that employers are not capable of being optimizers because they will generally be willing to spend more on medical care than individuals, and it's because they think about money very differently from individuals. Employers are generally able to swallow a premium increase of $15,000 -> $20,000 per employee per year (it just gets rolled up into total compensation). It's usually a drop in the bucket for employers, but to an individual that's actually a lot of money. It's the same reason why corporations typically cover business class (or economy plus) air travel without blinking an eye, whereas many individuals spring for
basic economy depending on their willingness to pay. Showing employers the shape of their medical care spend doesn't change that equation all that much for the same reason that enterprises today are willing to spend more on SaaS licenses than individuals (or even small businesses) regardless of how precisely their QuickBooks or NetSuite instance shows them the shape of their SaaS spend. I work in insuretech too, sometimes even work directly with employer HR teams, and see this behavior all the time.
We agree that employers should not be the optimizers here. It's not that they need to step up their spend management game, it's that
the way they play that game will always be different from the way individuals play that game, and that's a big part of why per capita $'s spent are even able to be so inflated in the first place.
What I'm suggesting is that the proven private sector model is one where employers are simply not involved, not a part of the equation. Private insurance purchased on the individual market. That's exactly how it works in Switzerland, the Netherlands, and also how it works in Medicare Advantage (seniors directly buy their insurance plans using dollars they theoretically set aside over the course of their lifetime through Medicare FICA taxes).
The most practical way to get there, in America, would be to either enact Medicare Advantage For All, or to tweak the employer mandate to only include ICHRAs rather than group health insurance. ICHRAs are employer-sponsored funds (in lieu of employer sponsored insurance) that the employee-beneficiary uses to buy health insurance on the individual market.