February 20, 2007
Tuesday PM

SAN FRANCISCO -- Is momentum building in efforts to overhaul the ailing U.S. health care system? I'm inclined to say yes.

That's not to say we're close to a workable solution (or any solution). But it's increasingly clear that major employers recognize a tipping point has been reached in terms of runaway insurance costs, and that they're willing to play a much more active role in pushing policymakers to take action.

"We need to change the political environment so that lawmakers from both parties understand that it's to their advantage to address this," said John Castellani, president of Business Roundtable, an association of chief executive officers of some of the biggest U.S. companies.

The CEOs of Business Roundtable represent a combined workforce of more than 10 million employees and about $4.5 trillion in annual revenue.

Castellani and I spoke last week after I wrote about a new health care reform effort announced by Wal-Mart, the Service Employees International Union, AT&T, Intel and others.

My take was that it's great these guys are talking about health care. But it's not enough to simply declare, as Wal-Mart and friends are doing, that our system is broken. Everyone knows the system is broken. What's needed now is a plan to fix things.

As a Wal-Mart spokesman acknowledged to me, "Now we need to get some ideas on paper and figure out how we're going to do this."

Castellani was similarly noncommittal when I asked what sort of remedy his group favors when it comes to addressing America's health care woes.

"What we're putting on the table is that this is something that needs to be addressed immediately," he said. "We're also putting on the table that there are no bad ideas here."

So, I asked, would Business Roundtable, which includes among its members the heads of some of the country's biggest insurers, get behind a government-run system similar to universal-coverage programs in place in every other industrialized democracy?

"Nothing is out of the question at this point," Castellani replied. "Everything is under discussion."

Really?

"All of our members face the same problem," Castellani said. "Costs are going up dramatically and the quality of care is no better than in countries that pay a lot less. We recognize that we need a solution that works for everyone and we're committed to finding it."

That's not quite an agenda for change. But that's $4.5 trillion in revenue talking, not to mention millions of dollars in political contributions.

And that's why I say there's momentum building for actual reform, and not just another discussion that goes nowhere, as was the case with recent efforts to tackle Social Security's financial troubles.

Another encouraging sign is that coalitions are forming that comprise economic and political forces that have long been at odds. In the most striking example, Wal-Mart, the country's biggest private employer, has joined with SEIU, the biggest labor union.

"What unites us here today is our shared belief that it will be a far greater America when we get affordable health care for all Americans," SEIU President Andy Stern said at a recent news conference.

Similarly, Castellani pointed out that Business Roundtable has joined separately with SEIU and AARP for a campaign called Divided We Fail, which aims to ensure the long-term financial and health security of all Americans.

Not so long ago, Business Roundtable and AARP were on opposing sides when it came to President Bush's ill-fated proposals for fixing Social Security. On health care, though, they see eye to eye.

"We're good buddies and we're working together," declared Bill Novelli, head of AARP. "If AARP and Business Roundtable and SEIU can come together, so can lawmakers."

Collectively, the three organizations represent about 50 million people, he observed. If that kind of muscle doesn't get the attention of policymakers, nothing will.

"We've reached the end of our rope," Novelli said. "We need policy change and we need everyone to come to the table."

The stakes couldn't be higher. About $2 trillion is spent annually on health care in the United States. Of this amount, according to estimates, a third is squandered on bureaucratic overhead.

Meanwhile, the United States is spending twice as much, on average, than the 21 countries that enjoy a longer life expectancy.

And to top it all off, we still have about 47 million Americans with no health insurance whatsoever - a scandalous situation for the wealthiest nation in the history of the world.

While none of the private-sector forces advocating change is prepared yet to back a specific plan, much less acknowledge that a government-run (or single-payer) system presents considerable advantages from a cost-saving perspective, it's important that they're not ruling anything out.

Castellani said he's held talks recently with House Speaker Nancy Pelosi and senior White House officials. So far, he said, everyone's keeping an open mind.

"Within the next three or four months, you're going to see some specifics about what can be done," Castellani pledged. "These conversations are going on right now."

That's not a solution. But it is progress.

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