COST: This Time, There is No Plan B

We posted twice today about cost trends in the employer-sponsored insurance, and it brought to mind some comments Dallas Salisbury, CEO of the Employee Benefit Research Institute, made at a recent Alliance for Health Reform briefing, called "The Next 100 Days: Some Final Hurdles to Health Reform " (He spoke from a vantage point a few days before President Obama's speech to Congress)

Plan A, simply stated, was to pass President Clinton's health reform plan after reshaping it more to business's liking. If that failed,  Plan B was to kill it. Plan B, as we all recall, prevailed.

This time around, Salisbury said, there is no Plan B.

In other words, businesses have come to understand the unsustainability of our health care system. They understand the cost -- to themselves, taxpayers, workers and the government. And they understand the importance of offering health benefits on the job. The workplace-health insurance link may be a product of historical circumstances, but business now perceives it as a crucial component in attracting and retaining workers.

Now that doesn't mean that businesses, large or small, like everything in the bills pending in Congress. Not by a long shot. As Salisbury put it, they don't like state coverage mandates, they don't like individual mandates, they don't like employer mandates, and "any form of  employment pay-or-play mandate at this point is generally uniformly opposed. "

They don't like the public health insurance option either or major government intervention in the market. And they don't want any more cost-shifting. And they don't want any change in taxation of health benefits, or tinkering with ERISA. And they don't want to be told they have to DO anything that they don't want. And while we're at it, they are a little fuzzy about the difference between coverage and access to coverage.

But they understand the costs and the trends. They understand the economics of wellness and prevention and chronic disease. They understand the role health plays in worker productivity. So even though they dislike so much of what's being talked about, they hate doing nothing even more. Inaction is just too expensive.

Salisbury said:

"Will there be a bill? My response would be yes, I think there will be -- largely because of what I mentioned in the front end, which is most all of the interest groups involved with this business, labor, insurers, PhRMA, et cetera are still sticking to "we have a Plan A, which is we need health reform."

He said that whether the bill is bipartisan or Democrats only with their strange-bedfellow allies, result will be a bill that is "relatively comprehensive."

"I'll close with the final irony. Plan A is the necessity of comprehensive reform because the current system is unsustainable. There is no plan B they all say. There must be reform."