As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Wednesday, July 01, 2009

Not Feeling Wal-Mart's New Concern Over Health Care Reform

I'm apparently supposed to be excited that Wal-Mart has come out for health care reform. And yes, some of the principles they announced as part of their support - like cost controls, such as a trigger for cuts in provider rates once spending reaches past a level of growth, or use of MedPAC to bring down costs (I'm warming to that) - look good. But in the main, they signed on because of the employer mandate. This is an area where Wal-Mart and the unions come to a point of convergence.

Wal-Mart, the nation’s largest private employer, joined hands with a major labor union Tuesday to endorse the idea of requiring large companies to provide health insurance to their workers, a move that gives a boost to President Obama as he is pushing for health legislation on Capitol Hill.

“Not every business can make the same contribution, but everyone must make some contribution,” Wal-Mart’s chief executive, Michael T. Duke, wrote in a letter to White House and Congressional officials, adding that he favored “an employer mandate which is fair and broad in its coverage.”

What an employer mandate does, of course, is entrench the employer-based health care system, a system that does not provide portable, affordable coverage for all Americans. I agree that, as long as we have an employer-based system, we should charge companies who do not provide health care for their employees and thusly put themselves at a competitive advantage. But the employer-based system does not necessarily provide the most efficient system. If the employer mandate becomes law, I don't see how we get out of it.

In addition, Wal-Mart has their own reasons for endorsing this:

I don't want to make too much of this: Wal-Mart may chicken out once the specifics of an employer mandate end up on the table. Even if they don't, they may not lift a finger to help. And, make no mistake, Wal-Mart is acting--as it always does--out of pure self-interest.

My undestanding is that, after all of these years, Wal-Mart has suddenly found itself in the same situation its competitors once did: Dealing with unpredictable health costs and facing new competition from businesses that have found ways to spend even less on employee health benefits. Is there some justice there? You bet.

Wal-Mart, after using their size to squeeze out competition for years, now wants a so-called "level playing field." But of course, it's not all that level. Maintaining equity on health care costs would simply allow them to benefit from their size again.

I'm OK with that if it brings down overall costs for consumers of health care. And this deal may help reach that goal. But an employer-based system of health care is an artifact that shouldn't necessarily be celebrated.

...I actually think it's a bigger deal that major medical groups are backing comparative effectiveness research, which could truly align treatments and costs instead of having doctors proscribe expensive care that isn't any more useful in curing patients.

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