Did I mention that I interviewed Andy Stern on health reform last week and posted the transcript on TAP today? No? Well, I did. This part, in particular, struck me as insightful:
I was talking to someone who works a lot with business on health care, and he said to me "I finally have this insight after years of working with these people. They're stupid. Not on everything. But they just don't know much about this issue." Maybe, but it's just too universal. These are companies that operate around the world, which is also fundamentally different than 1993. So they've seen a Swiss system, a German system, the UK system, the French system. So I appreciate a CEO's not a genius on health care anymore than I'm a genius on Walmart's logistics. But I do think they have to be knowledgeable enough to say, "why do we want to provide this? Will it cost us more or less?" As a CEO you have to ask yourself these questions all the time. Is it worth greening your company or doing an environmental impact report. What's the return on investment on this? Is it better than letting someone else provide it and cap the money employers pay and let them stop managing risk, why wouldn't they want that? I don't know. Do you have a theory on why they want to be involved? I think people have a tremendous fear of letting go and not knowing what the consequences will be in the long run. Right now, in some ways they get to control their costs: They can cut the benefits, they can create co-pays and deductibles. So part of it is they don't want to be in a position where five years from now they're not in control of their own fate. I just think it's a basic "I don't trust that the situation, the system, the government, won't stick me with something I don't want." So they want some semblance of control.
It's become a habit of mine to ask health reform types why business wants to remain involved in the health system. And you usually get some semblance of Stern's answer: So long as they provide health care coverage, they control, on some level, costs. Maybe not well. But, at the least, if the situation grows too dire, they can just toss people off the rolls. Conversely, if the government takes it over, they lose control. They can't refuse to pay their taxes or decide to stop contributing to coverage altogether. Examined more closely, these objections don't make much sense: Most reforms that keep employers in the system assess some level of tax and most reforms that take them out of the system cap their total contribution. But most employers don't examine this stuff too closely. They know what they know. And they know that they trust themselves and they don't trust the government.Anyway, whole interview is here. We also talked about division in the Labor movement, the coalitions to watch, and the unsung heroes of health reform.
