The recently passed health care bill has much that is good in it, which readers will know about without being reminded here. But compared to the ideal, it is pretty bad. But it is probably the best possible under present political conditions, which are themselves pretty bad.
Hence, I am prepared to give not three cheers but one and a half to celebrate its passage. A one-payer, Medicare for all would be simpler, more efficient, and would guarantee every citizen health care.
The employer-based system was a war-time exigency that allowed employers to give benefits instead of raising wages, which was prohibited under war time rules. It is complex, inefficient, clumsy, generates many inequities, and leaves millions uncovered . Additionally, it proves that the free market is not appropriate for providing health care, for reasons any economics textbook will enumerate when stating market limitations.
But it continues out of inertia and because of the political power of those who benefit from it, e. g., health insurance and drug companies and many individuals and families who have good coverage and are fearful of change. (Mine is free, except for co-payments under the generous spousal provisions of my wife's former employer-- The University of Rochester.)
I wanted the present measure to pass and watched every vote in detail on C-Span2, the principle being that when the ideal is impossible, the best presently achievable is usually better than nothing.