“If you like your health care plan, you can keep it!” For years this simple, effusive rallying cry has been the informal slogan animating liberal opposition to a single-payer, Medical-for-All system. Initially popularized during the Obama administration’s reform efforts in 2009, the mantra has since been taken up, ironically enough, by those most hostile to real reform.

The problem with “If you like your health care plan, you can keep it,” and its misleading intimation of personal freedom and choice, has always been the same: in a system where health care for millions is actually contingent on their employment status, many lack either freedom or choice when it comes to how they’re insured against illness or injury — if indeed they’re lucky enough to be insured at all. Many employers are at liberty to switch employee plans at will and those who lose their jobs are liable to lose their coverage entirely.

More strongly than any other single moment in recent American history, the coronavirus pandemic is revealing the deep dysfunction of a system in which health and work are so intimately bound together. As a new report published by the DC-based Urban Institute rather ominously illustrates, as many as forty-three million Americans — and possibly even more — could lose their health insurance as the measures taken in response to the pandemic create spiraling unemployment on a scale unseen since the Great Depression.