The reason health insurance became an employment perk was because of a tax loophole created during World War II. From
A History of Employee Benefits and Taxation[1]:
> At the same time, the federal controls on wages was leading to significant angst and frustration among the labor market, and the threat of widespread strikes and other forms of labor protest became a serious threat to the economy and war effort. In response, the War Labor Board implemented a new income tax exemption to employers sponsoring employee health plans. This made employer contributions deductible on federal returns, while the benefits were entirely tax-free, to the employees [3].
> What started as a measure to avert crisis and labor strikes ended up becoming an expectation. As more and more employers leveraged these tax-benefitted health plans, American workers grew accustomed to getting their health insurance through work, rather than as individuals. The end of the war and the return home of American GIs exposed more workers to the new system, reinforcing its popularity and utilization [3]. By the 1960s, employer-sponsored health insurance plans had overwhelmingly displaced the formal individual market, a status that has persisted right into the start of the 21st century and provided a central tenant of the Affordable Care Act of 2008 [4].
In my opinion, this is yet another example of how even the most well-intentioned legislation can have disastrous consequences if it fails to account for incentives and second-order effects.
1. https://taxandbusinessonline.villanova.edu/resources-taxatio...