When we talk about health care reform, it’s easy to focus on copays or premiums and forget what’s at stake: nothing less than the expansion of freedom itself.

While some employer-insured Americans are satisfied with the health care they receive, tethering health insurance to employment generates enormous economic anxiety and insecurity, shaping and constraining the life choices and aspirations of millions of people. People take jobs they find otherwise undesirable and stay in ones they’d otherwise quit. They curb their demands on the job for fear of getting fired and losing their health insurance. They’re prevented from realizing their potential not just because they might not get the care they need or because they might still end up in bankruptcy, but because of the oppressive hoops they must jump through to acquire health insurance.

For most Americans, a job is a job. This isn’t to say that people at all rungs of the economic ladder can’t derive meaning from their work (among non-elite professions, clergy and firefighters stand out in job satisfaction studies). But for the majority of Americans, work is more of an obligation than a passion. They do it to survive.