Death, Healthcare and The Employer Albatross

Posted By on Mar 3, 2010

dead endI’ve been pretty quiet on the whole healthcare debate up until now. It’s a mess. It’s more than a mess, it’s a crazed storm of clucking and feather rustling, posturing and lobbying, advertising and cajoling, misinforming and undereducating. But while all this is going on in my former hometown of Washington, DC, people are dying.

Yes, I said people are dying, and I’m not saying it to be dramatic. It’s happening about once every fifteen seconds every single day in every way imaginable. (Yep, someone just died as you read that stat.)

Is this my employer’s fault? Is it even their responsibility to be in the middle of this mess in the first place? I say it is not. But of course I’ve already completed my homework assignments.

As a society we are generally too lazy to study issues that are literally a matter of life and death. Instead we consume sound bites like Milk Duds and never get full despite an obvious stomachache. And by the time we pause due to personal crisis or calamity, it’s too late for the homework to have mattered.

My challenge to you all is to be well-informed citizens and then render your opinion. So roll up your sleeves and let’s get to work.

Assignment #1 – How We Got Here

As Dr. David Blumenthal described in his must-read New England Journal of Medicine article, Employer-Sponsored Healthcare Insurance in the United States: Origins and Implications:

The heavy reliance on employer-sponsored insurance in the United States is, by many accounts, an accident of history that evolved in an unplanned way and, in the view of some, without the benefit of intelligent design.” ~ Dr. David Blumenthal

…and that’s just on the first page. What’s interesting is to learn that FDR has a chance to pass universal healthcare in 1933 as the country emerged from the Great Depression. He elected not to do so for a variety of reasons. But what will we do as we emerge from a similar crisis? Read the article and you’ll be a hit at HR cocktail parties on the origins of the second largest cost center to your employer.

Assignment #2 – The Complexity of the Current System

Now the we’ve raised this unwieldy giant, how difficult would it be to untangle the complex ecosystem and put the genie back in the bottle? This is a two-parter and you need to study both:

This American Life – Episode 391 – More Is Less: An hour explaining the American health care system, specifically, why it is that costs keep rising. One story looks at the doctors, one at the patients and one at the insurance industry.

This American Life – Episode 392 – Someone Else’s Money: A deeper look inside the health insurance industry includes the dark side of prescription drug coupons, the four accidental steps leading to employers paying for healthcare, a story about pet insurance. and a surprising reason why insurance companies dump members.

This is a free podcast. You own an iPod, right? If so, you can download these for free and listen at your leisure. If not, you can click on the links above and listen on your computer at the office while your benefits department attempts to stem the 20%+ rise in annual healthcare costs. No excuses people.

Assignment #3 – Where We’re Headed

This one is going to be the most difficult, but I’m giving you two sources so you have both sides of the debate (which probably has 1,000 sides, so perhaps two is a disservice):

The White House: They have a site with a ridiculous amount of content, but to stay current, click here and here to understand what is on the table right now.

The U.S. Chamber of Commerce: As the designated representative of many US businesses, you should study their positions as described here and here for a completely different point of view.

In Conclusion…

I work to earn pay. I don’t work to earn a prescription, or a physical, or a lobotomy, or chemo, or any of the 100,000+ things that might go awry with my mysterious human body. I offer a service. I receive compensation in return. In my opinion, that should be the extent of the equation.

If we expect to remain competitive we need to innovate and ideate at every turn. But here’s the kicker – employers have a cost albatross around their neck and it’s choking the machine to a halt. I want a government that does care if I live or die, not an employer who wants a health risk assessment upon hire. And if you believe that competitive advantage is a key driver of growth, here’s a map of countries with universal healthcare that just may have a leg up in the very near term:

universal healthcare map

Ok, I started this debate so please weigh in without sparing my emotions. Should employers be in the healthcare mix at all? Am I single handedly trying to destroy our union (as I’m certain someone will suggest)? Share your comments below and let’s keep the conversation going.


  1. Well said, Mark, and thank you for sharing sources of information from which folks can get a more balanced and objective perspective rather than the too-be-expected posturing and brinkmanship we see in the news. Employer provided health care is one of those important history lessons that just never got the attention it deserved. It’s important for people to understand how we got here, not that it will completely answer the question of how to “fix” it, but to better understand the forces at work. We’ve already seen what happens when those who feel they “have all the votes” try to ramrod something through. American politics is a perfect example of how everybody will continue to try to squeeze the best deal out of an already won situation until they break it again, because in the end, that’s all they were using it for.

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  2. mark, this is fabulous. i wish i could find the other “this american life” podcast where they share interviews with insurance agents who dump people or put amazing obstacles in their way to getting the care they need.

    i’d love two things — first, is for us to move past employer-provided benefits. the second is that, as we move along the continuum toward this, that employers invest more in better dialogue and more sophisticated, better solutions to address the current situation. companies have not done a good job outlining to their employees why they are messing with what employees consider to be their private affair: their health. nor have they done a good job respecting and better engaging their employees and their families in creative, patient/employee-centric solutions that help them be in better control of their health and to make hard-to-make changes.

    thanks for pulling this together for us,

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  3. I would also highly recommend reading Paul Starr’s Pulitzer Prize-winning “The Social Transformation of American Medicine,” which was prescient in 1982 about the rise of the bureaucratic conglomerate of insurance companies.

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  4. other good reading about patient control, data, and our muddled system can be found in “the decision tree” by thomas goetz. i’m working my way through it now. while it doesn’t equip you to suddenly be in control of your outcomes — the system is still a major obstacle — it gives you a fresh way of viewing the potential future of health care.

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  5. Sorry, Mark, but I’m not so much concerned about who pays for health insurance but rather how it ended up in the hands of for-profit companies — including the 13 Blue Cross & Blue Shields owned by Wellpoint, now trying to raise individual coverage premiums in your new home town by 13 percent, despite recent profits of $2.7 billion.

    Why are companies that openly say they won’t pay out more than 70 cents for every premium dollar collected (CA law), the only sources of insurance. Why are they all in it for the money? Perhaps my college classmate Dave Blumenthal’s article (thanks for the link) will explain that as well.

    Meanwhile, people with a limited time to invest in learning more might listen to Jim O’Connell, Ceridian’s inside the Beltway guy for legislative affair, explain his view of what’s going on at Which you can get from iTunes or listen on your computer.

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  6. Typo: 39 percent increase sought by Wellpoint.

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  7. I have the smartest readers on the planet. Great comments all. It’s crunch time on this issue so I hope people are taking the time to do their homework and let their voice be heard!

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  8. I think employers should be removed from the healthcare mix.

    If that were the case, individuals could land the job which suits them best, rather than end up working for a company just because they offer the best healthcare benefits package.

    Currently, small businesses simply cannot compete with the big guys when it comes to salary/benefit packages. Removing health benefits from the compensation package would help to level the playing field between small and large firms…. See More

    My father has been running his small business for 25 years, and I know firsthand how difficult it is for them to obtain an affordable health insurance plan. Because the premiums he is quoted are so high, he does not provide health insurance coverage to his employees. He can compete with salaries, but not with the health benefit packages offered by large corporations.

    Everyone, please ask yourself the following two questions:

    1) Who would you rather have choose your health insurance plan: you or your employer?

    2) Would you rather work somewhere you love, or somewhere just because they provide you with health insurance?

    I believe that if we ended employer-based health coverage we could achieve an affordable healthcare system for all individuals.

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