Statement of Joseph T. Hansen, UFCW International President,
Excerpted from Remarks Presented to the
International Foundation’s 2007 Washington Legislative Update session on the “”Value of the Employment-Based Health Care System-Is It Worth Saving?””
Washington DC–Fixing our health care system is going to require us to come together—and act together—all across the country. In listening to the needs and concerns of Americans from every walk of life and every area of the country—as I did as part of the congressionally mandated Citizens Health Care Working Group—one thing became clear to me that we should always remember: First—“do no harm”.
“Do no harm” should be the central rule and guiding principle of the current health care reform debate. Unfortunately, “do no harm” seems to have been lost in the rush to pronounce the current employment-based system dead, and that creates the risk of misdiagnosing the problem and writing flawed prescriptions for the future.
The starting point too frequently in this debate is the presumed death of the employment-based system. But the fact is employer-sponsored health benefits remain the mainstay of health care for the overwhelming number of working Americans. Almost two-thirds of American workers get health care at work—about the same today as almost 2 decades ago.
The employment-based system has remained remarkably stable and resilient—particularly when you consider the rapidly increasing costs and the explosion of new technology over the past 20 years:
- The percentage of workers employed in workplaces offering health insurance is at about 81%—only a modest decline from the levels of the late 1980s.
- The percentage of workers choosing to take employer-provided insurance is at about 84% —only a slight decrease from the 1980s.
We cannot just abandon the current system. Everyday, those of us working in the employment-based system confront the challenge of providing health care for millions of workers. The harm done in declaring the system dead is that it becomes an excuse for too many employers to evade their responsibility to provide health care—and, becomes an easy way for those employers to avoid the public opinion consequences of that irresponsibility.
We are not proposing that we stand still, or that we should preserve the past. We must have a positive program of reform—a reform program that addresses the real issues in our current health care system.
We are spending too much and getting too little for it. On key measures of health care outcomes—preventable deaths, longevity, and infant mortality—the U.S. falls behind most advanced nations. The U.S. preventable death rate is 30 percent higher than those of France, Japan, and Spain. For both total costs and administrative costs, the U.S. exceeds almost all advanced countries in the world.
Our current system does not work at the most fundamental level—it does not prevent preventable death—despite how much money we spend.
Reform must focus on outcomes, and the central question is—how do we improve outcomes?
Our health care system currently focuses on the wrong issues, focusing resources more on reacting to diseases rather than in promoting healthy lives. We have to think differently about care. We have to think about funding for healthy diet planning as well as caring for those afflicted with diabetes. We must have benefit packages that promote health and promote effective management of chronic conditions.
We must reform and restructure the insurance market. Private insurance companies are at the center of the current system—and find themselves often in conflicting roles among providers, beneficiaries, employers and government. The conflicting relationships do not necessarily get resolved in the best interest of health care—but, only in the best interest of the insurance industry. Reform must focus on care quality, fairness, access, affordability and shared risk.
We need a different starting point for the health care reform debate. It is not whether or not the employment-based system is dead. The reform discussion should start with the question of improving outcomes. We should determine the best method to promote better outcomes. And, we should make the system accessible, fair and affordable for all.
Current reform proposals do not fully deliver on the principles I think most Americans believe in. More than 30,000 engaged in a national dialogue under the auspices of the Citizens Health Care Working Group to set out a set of principles to reform our system. Those principles focus on universal participation—with access to quality care without regard to financial ability or health status. Americans believe this as a core value of our country. Americans do not see health care as a consumer commodity. They see it as an essential part of our national community, and that we all share in it and we all take responsibility for it.
Can the employment-based system be used as a platform for reform? Yes, but we cannot have an employment-based system where some employers can choose not to participate; we must set universal standards of coverage, care quality and affordability across all employers; and we must redesign the benefit package to focus on promoting health and care management.
Is the employment-based model the only model that can work for reform? No, it is possible to move to a universal Medicare system with a re-designed benefit package focused on promoting health and care management.
Whether the employment-based system is worth saving is a question for the American people. In the meantime, until we move forward to put comprehensive health care reform in place, we must do no harm.
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