David Wessel, in his Wall Street Journal column on April 12 hits on a recent HP topic -- the future of the employer-based U.S. health care system. Here's what he had to say: "The notion that requiring employers to provide health insurance is the best route to universal health care is fading. Sure, nearly 60% of Americans still get health insurance on the job. But even in a growing economy with a tight labor market, employer coverage is eroding. Fifteen years ago, says Joseph Antos of the conservative American Enterprise Institute, 'Large employers were concerned about rising health spending, but they were not leading the march to a big solution.' Now they want out. Employers -- either through premiums or through taxes -- will be paying part of the health care tab for a long time, but there is surprising interest in requiring that every individual get health insurance, and then subsidizing those who can't afford it."

To add credence to Wessel's opinions, consider the remarks (printed in  Pam Belluck's April 11 New York Times article) of Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority in Massachusetts. That's the governing body directed by former governor and presidential candidate Mitt Romney and now Governor Deval Patrick to implement universal coverage in the state.

Says he: "(Affordability standards) was always the most difficult and innovative element (of the state's groundbreaking healthcare law). To do this right means walking a tight rope. We don't want to be too punitive, we don't want to put too high a standard of affordability, but we don't want to let too many people out of a universal requirement. We've been putting a lot of stakes in the ground, but this is the center pole that will allow us to put up the tent and get everybody cared."

The plan offers free insurance for those below 150% of the poverty level and a sliding scale for those between 150% and 300% of the poverty level. John McDonough, executive director of the citizen advocacy group Health Care for All had his doubts initially but now supports Governor Patrick and is optimistic. His words: "It doesn't go the whole way, but it's good enough for today. I know there's a lot of trash talk around the country about 'Oh, it's falling apart in Massachusetts.' It ain't true. We are going to be far and away the state with the lowest number of uninsured by a country mile."

One final caution from the Associated Industries of Massachusetts' VP of Government Affairs Eileen McAnneny. Representing 7,500 state workers, she says, "You have to be very careful -- if you set up subsidies that are more generous than employee plans, that encourages employers to drop coverage."

Maybe so. But perhaps the time has come for a proper revamp. After all, we are the only developed country in the world that ties health coverage to employment, ensuring that the loss of a job will be a double whammy and run a high risk of driving families into medical bankruptcy.