When Pam first went into HR, she pictured herself across the table from nervous job candidates as the company representative who would calm their jitters and help them navigate a successful job offer process. She imagined having career conversations with high-potential employees and the occasional difficult performance discussion that would leave a manager better at managing people when he left her office than when he had walked in.
What Pam did not imagine, at any point during her coursework in organizational psychology or the two summers she spent interning, was that she would one day spend 7 days standing beside a folding table in the breakroom, flanked by the broker’s rep and a bowl of branded stress balls, explaining to a warehouse supervisor why his free preventive visit produced a bill because the doctor also asked about his knee.
And yet every October, there she is, fluent (or fluent-ish) in a language she never set out to learn and wondering, somewhere between her tenth and fifteenth explanation of coinsurance, whether plunging the salad fork from her desk drawer into her eyeball might offer a merciful exit from open enrollment season.
Pam, if you haven’t guessed, is a composite of nearly every HR generalist I’ve worked alongside. And more than once she’s been me.
A Language Re-Learned Once a Year
Each fall, organizations ask employees to make some of the most consequential financial and medical decisions of their year using a vocabulary (deductibles, coinsurance, out-of-pocket maximums, HSA versus FSA) that most people are never formally taught and yet need to relearn every autumn. It’s a bit like being handed a phrasebook at the airport in Paris and being told that you have until mid-November to negotiate a lease, a car loan, and a surgical consent form entirely in French. (You also come to understand that you’ll then forget all of it by spring and be handed a slightly revised phrasebook next year.)
The research on this all is interesting. In 2013, Carnegie Mellon behavioral economist George Loewenstein and a team of colleagues surveyed a representative sample of Americans who had private health insurance, and more than 90% of the survey respondents felt confident they understood copays, deductibles, and out-of-pocket maximums, and 57% said the same about coinsurance. The confidence of all involved was misplaced; measured comprehension fell well below what the respondents believed they knew, as a mere 14% of survey participants turned out to be adept in their self-declared understanding.
The PUSH/PULL of the Norman Door
And yet HR’s instinct, and I say this with love and a fair amount of personal guilt, is to treat benefits illiteracy as a failing by the employees. They didn’t read the email. They skipped the webinar. They opened the benefits guide – saw a stock photo of a family laughing on a beach – and promptly closed it. But when a majority of reasonably intelligent adults consistently struggle with understanding the language and then ultimately choosing insurance options, perhaps the problem sits with whoever designed the choices.
Cognitive scientist Don Norman made this argument decades ago in The Design of Everyday Things, and designers now use the term “Norman door” for any door so poorly built that someone must tape a sign reading PUSH to the glass. A door that needs instructions is a badly designed door. By that standard, the American health plan is a Norman door with a forty-page user manual, and the Affordable Care Act’s requirement that health plans and insurers provide a standardized Summary of Benefits and Coverage along with a uniform glossary of terms is essentially the federal government taping PUSH to the glass. (When a product requires a legally mandated glossary, we’ve got some problems. Know what I mean?)
Pam in HR can simplify the menu and redesign the comparison charts in her pamphlets all she likes, but she’s still speaking in a language that nobody uses the other eleven months of the year.
How in the World Did This Land in HR’s Lap?
Nobody sat down, once upon a time, and decided that the person who recruits your engineers should also explain your prescription drug formulary. The arrangement arrived by accident, in stages, and mostly because of a war.
The prehistory begins in 1929, when Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, offered local schoolteachers a prepaid plan covering a set number of hospital days for a modest monthly fee, a model that eventually grew into Blue Cross. The real turning point came during World War II, when Congress passed the Stabilization Act in October 1942 to freeze wages and prices and hold down wartime inflation. Tucked inside was a carve-out that exempted “insurance and pension benefits in a reasonable amount” from stabilization, and employers who were desperate for workers but forbidden to raise pay did what any enterprising employer would do and started competing on benefits instead. In 1943, the IRS ruled that workers didn’t owe taxes on premiums their employers paid, and the National War Labor Board reaffirmed that fringe benefits were outside the wage freeze.
And thus, what began as a clever wartime workaround hardened into permanent HR infrastructure.
Melissa Thomasson, an economic historian at Miami University who has studied this period extensively, told a Senate committee in 2017 that when the tax exclusion was codified in the 1954 Internal Revenue Code, it prompted employers to enrich existing plans and more firms to begin offering coverage, cementing the employment-based system along with several distortions, including lower wages and workers afraid to leave jobs for fear of losing coverage. Somewhere along the way, the personnel department inherited the paperwork, and the paperwork eventually became a profession.
Today, employer-sponsored insurance in the U.S. covers 154 million people under the age of 65, and the average annual premium for family coverage reached $26,993 in 2025, with workers contributing $6,850 of that on average. Pam, who wanted to spend her days coaching managers, is now the primary customer-service representative for what amounts to a $27,000 annual purchase per family, made on behalf of people who didn’t even get to pick the vendor.
HR’s Been Deputized
The translation work is exhausting, but it’s the enforcement work that troubles me more. Over the past two decades, employers have been encouraged (by brokers, carriers, and the steady upward creep of premiums) to manage costs by managing employees’ bodies, and HR has been handed the badge.
So now we administer the tobacco surcharge and collect the signed affidavits. We run the biometric screening events, track the wellness points, levy the spousal surcharge, and cheerfully promote the step-count challenge in the company newsletter. And then, on a different day and in a different meeting, we ask those same employees to trust us with their complaints about a manager, their accommodation requests, and their candid thoughts about their career goals.
It’s difficult to be a strategic advisor, a professional confidante and the health police – and I’ve never been convinced that employees consider all of those to be compatible roles for one person.
Of course, most of the developed world decided long ago that none of this should run through the employer. Coverage in the UK, Canada, France, and the Nordic countries doesn’t hinge on where you work, and even Germany, whose system is funded through payroll contributions, lets people choose their own sickness fund rather than asking an HR generalist to curate a plan menu and teach coinsurance in the breakroom.
I’d happily trade our arrangement for any of theirs.
Workers could change jobs without doing an actuarial calculation first, employers could compete on wages and work design rather than on formularies, and Pam could go back to recruiting. But that isn’t the system we have, and it won’t be the system we have during this fall’s open enrollment season.
Translating Anyway
So every HR professional learns to translate, and the best HR teams I know have gotten remarkably good at it. They pare down the menu offerings, set sensible election defaults, and replace the convoluted coverage grids with real-world scenarios that walk through what happens if you break your arm, have a baby, or fill a monthly prescription. They talk about HSAs throughout the year instead of cramming the whole curriculum into two weeks in the fall. And those top HR teams have also stopped assuming that when an employee makes a poor choice, or can’t remember what her coverage entails, it’s because she didn’t care or was lazy.
What bothers me, though, is that every single improvement Pam makes renders the arrangement a little more tolerable – and a tolerable system is far easier to leave alone than a broken one. The better HR becomes at explaining a language that shouldn’t exist in their world/role, the less pressure anyone feels to stop speaking it. And honestly … I’m not sure whether Pam’s hard-won fluency is part of the solution or one of the reasons we’re still stuck with the problem.
