Employers who want to scrap group health plans and give employees money to buy their own insurance have the sympathy of some Business Insurance readers.
But other BI readers, agreeing with my last column that these employers simply want to get out of the business of buying health care and hope to save some money, think the move to consumer-directed health care purchasing is a wrong turn.
Wally Pliszka, director of workers compensation at Cooper Industries Inc. in Houston, writes: ``One of the interesting things about employer-sponsored health care in the United States is its genesis. As you probably know, it did not come about as a conscious policy decision at all; instead, it was an employer response to...price controls during the Second World War. One has to wonder whether this is the best method of system design.
``The problem with health care in the United States is that none of the participants seems happy with the current system. Employers find it too expensive. Employees find it too restrictive. The government believes that it doesn't cover enough people. Providers find there to be too much oversight. Insurance companies find it unprofitable. Have I missed anyone?
``I'm not certain that consumer-directed health care is necessarily the solution, but, in a capitalist society, it seems to have a stronger claim to legitimacy than does our present system.''
John Sloway, a consultant who works for Keenan HealthCare, wrote: ``I am neither for, nor against, consumer-directed health care purchasing, but I am for anything that will improve the `quality' of care patients receive (whatever the prevailing definition might be), both in the short- and long-run.
``It is not that employers do not care, but I propose that most do not know. As a benefits broker and consultant exclusively to the hospital and health care industry, even this supposedly savvy group of purchasers does not like being responsible (or blamed) for the health plan choices they make. The playing field changes so rapidly, with much of the information I need to know to make choices on behalf of my clientele being labeled as `confidential.'
``If the employers I work with could reduce or eliminate their involvement in health plans, they would. I honestly would not blame them.''
Among those supporting the current system of group health care plans, Albert C. Jones, executive vp of Jones Management Consulting Inc., wrote: ``Amen and about time. Finally, someone knowledgeable about health care benefits has spoken out.
``Not unlike cash balance pension plans (and those at least benefit some workers), consumer-directed health care purchasing is the darling of employers...looking to cut employee benefits while pretending to help employees.
``It is hard to see cost savings from the additional administration this will require, or from negotiations with health insurers who deal one-on-one with consumers. After all, leveraging purchasing power to reduce costs and/or improve service is one of the reasons group contracts are so popular...in many fields.
``I have spent many years as a volunteer on regional health care coalitions working on quality and education issues. Almost every time employers have to make a choice between cost and quality, quality hardly merits passing consideration. Quality is a most important component of health care purchasing: it almost always generates better medical outcomes and lower costs.
``Employers embracing self-directed plans should acknowledge that reducing their health insurance outlays is their main objective. Enlightened employers should turn their back on this short-sighted approach and seek employee satisfaction and cost savings through rigorous quality studies and standards.''
And Nathaniel B. Taft, a White Plains, N.Y., lawyer, wrote: ``Cheers for saying so well what had to be said.
``The world has three different types of benefit plans: The socialistic ones, America's employer-driven ones, and the catch-as-can ones of the underdeveloped nations. Our system, for all its faults, is still the best. And those who try to undercut it should be ashamed of themselves.''
Mr. Taft warns: ``Running away from corporate responsibility reminds me of the kindergarten tale of Chicken Little. When an acorn fell on her head, she panicked, crying `The sky's falling in,' and terrifying all the barnyard animals so much they ran straight into the jaws of the fox.''
I wish I had thought of Chicken Little.
Publishing Director Kathryn J. McIntyre's commentary appears fortnightly and at www.businessinsurance.com. She can be reached at kmcintyre@crain.com
