A Defining Moment on Health Care?

An astonishing group gathered yesterday in our nation's capital to discuss the urgent need for healthcare reform in America. A purposefully balanced partnership of corporations and labor leaders, and of Republicans and Democrats, joined together in initiating what they hope will be a vigorous and effective debate on how to fix our broken health care system.

A former senator and one-time Reagan administration chief of staff, Howard Baker, and a former chief of staff for President Clinton, John Podesta, moderated a press conference held to announce the coalition's campaign, titled "Better Health Care Together." The chief executive of Wal-Mart, a company roundly criticized for providing inadequate health care insurance for its employees, Lee Scott, sat side by side with a nemesis, the head of the Service Employees International Union, Andy Stern. The president of Kelly Services, Carl Camden, spoke for the independently employed, while Intel, AT&T, and the Communications Workers of America also weighed in.

Maybe, just maybe, this will prove to have been a defining moment in American history. Our optimism is based on the universal understanding voiced by those present that the employers of America can no longer afford to shoulder the burden of health care insurance for every American.

This is a breakthrough. As Mr. Stern said, "Businesses cannot continue to price the cost of health care into their products and compete on the world stage." The president of the CWA, Larry Cohen, said, "Nearly every labor relations conflict in this country is related to health care. It puts a huge strain on the competitiveness of our companies and threatens the survival of employees and employers."

Where have these visionaries been, as company after company was crushed by the weight of their health care burdens?

Mr. Baker expressed optimism that the group's efforts would bear fruit. "Most major ground shifts in policy have occurred when an issue's time has come. Health care reform's time has come, and we hear our citizenry demanding that politics itself needs to reform, and become less confrontational. Consequently, we think we can bring about a policy change in a short period of time."

It should be noted that the group shied away from embracing any particular policies, but rather adopted four overarching and pretty innocuous principles:

First, that every person in America must have quality, affordable health insurance coverage; That individuals have a responsibility to maintain and protect their health; That America must dramatically improve the value it receives for every health care dollar, and, finally, that businesses, governments, and individuals all should contribute to managing and financing a new American health care system.

Notably, there weren't any representatives of the medical establishment present. Drug companies are undoubtedly breaking out in the corporate version of hives thinking that Wal-Mart is going to be leading the country's charge against high-cost medicine.

Doctors, hospitals, and HMOs were also not represented. You can be pretty sure that any efforts to reconfigure the flow of funds among various health care intermediaries are going to run into the lobbying equivalent of the Berlin wall — hard to scale or circumvent. Nonetheless, there is reason to hope. Americans are increasingly frustrated with the inequitable and inefficient delivery of health care in this country. Nearly every speaker cited the damaging statistics that health care in America accounts for 16% of GDP, more than any other country, and yet our system frequently fails to tend to the 47 million Americans who are uninsured. Several speakers cited tragic, real-life examples of individuals who have not been able to obtain care for treatable diseases, and who have consequently died. Others referenced the rather poor rankings of America when it comes to infant mortality or life expectancy.

Also, as entrepreneurs and the self-employed become a larger segment of the population, their lack of access to insurance will be in the spotlight. The chief executive officer of Kelly Services, Carl Camden, criticized current policies which, in his view, penalize the self-employed unfairly by requiring them to purchase insurance with after-tax dollars.

As this group gathers in more corporations and more labor unions, it will surely have a voice. Whether that voice will become more garbled as it speaks for an ever-larger group remains to be seen. Principles are one thing, but gaining consensus on implementation will be another.

Various speakers acknowledged that political leadership would be needed to move the debate forward and to accomplish any real change before the self-imposed 2012 deadline. However, it was noted that Governor Schwarzenegger's proposed health care reform proposal in California could lay the groundwork for similar moves elsewhere in the country, and at the same time provide much-needed research on how certain measures might actually work.

The California proposals emphasize, for example, personal responsibility (principle no. 2). Mr. Schwarzenegger was able to demonstrate support from a broad array of labor and business groups, and also from the medical community, for his suggestions that Californians should be rewarded for living a healthy lifestyle. His program would require health plans and insurers to offer benefits and incentives to encourage weight reduction or breast cancer screenings, for instance.

Efficiency moves in California include measures such as requiring all providers to adopt e-prescribing to cut down on errors and to implement measures to prevent infection — a huge cost today.

Amid all the talk of change, Mr. Baker, the former senator, felt the need to put in a good word for America's existing health care system, which he described as the best in the world. One hopes that the coming tide of reform will not wash out the good with the bad. One also hopes that new policies will not become an excuse for expensive new bureaucracies.

What will be needed is leadership with a demonstrated penchant for hard-nosed planning and negotiation, and an efficiency mantra. And, most important, intelligence. Mayor Bloomberg?