Wal-Mart and SEIU: Who drank the Kool-Aid?

Wal-Mart and SEIU, together with other large employer and union reps, formed the Better Health Care Together coalition and held a press conference yesterday.  Check out coverage in the N.Y. Times and the excellent roundup (including reactions from all angles) from the Kaiser Network’s Daily Health Policy Report.  The latter summarized news reports thus:

The purpose of the coalition — called Better Health Care Together — is to "end the nation’s reliance on employer-backed health insurance and develop a system for providing universal low-cost coverage within five years."  While the coalition offered no specific plan, it outlined four broad themes to fulfill this purpose: health coverage for every U.S. resident by 2012; shared financial responsibility by businesses, government and individuals; a sense of personal responsibility for maintaining health; and a more efficient health care system.

Summit to start working out the details will be held in May.

So, who drank the Kool-Aid? 

Unions see the writing on the wall — generous employment-based benefit packages are contributing to layoffs and buyouts, so unions need to serve their membership (and themselves, by ensuring that they can stave off loss of membership through buyouts, early retirements, etc.) by rejiggering this piece of the social contract.

Big employers are eager to embrace the President’s rhetoric about decoupling health care coverage from employment because it’s so damn expensive.

And now folks on both sides of the table come together with this pabulum.

No one can argue against the prompt roll-out of low-cost universal coverage that increases personal responsibility and consumer-directedness of care, and also increases the efficiency of the U.S. health care system.  But what what does it really mean? 

So far, it just sounds like cost-shifting to individuals with a vanishing tax benefit (medical inflation outpaces general inflation, so the value of the President’s proposed tax benefit will disappear over time).  Consumer-directed health care — in the form of HSAs and HDHPs — still hasn’t worked out all the kinks. 

Nobody really knows if this will work.  Maybe it will.  But for now, this exercise is generating more heat than light.

Update 2/9/07: For a more eloquent dissection of the current band-aid approach to fixing the health care coverage system in this country, together with a broad-brush proposal for sweeping reform (slightly more specific than that of the BHCT coalition), see the Victor Fuchs and Ezekiel Emanuel piece in Wednesday’s Washington Post.  (See also further discussion and link to a related Fuchs and Emanuel paper at the Health Affairs Blog.)  I agree that wholesale reform would probably be preferable to the incrementalism being bandied about in the political theatre, but I fear it is about as likely to be enacted as "HillaryCare."

— David Harlow