Health-Care Reform

WHO will pay for health care? That's the central issue in the recent strikes against four regional telephone companies. Those walkouts are only the most headline-grabbing manifestations of an intensifying issue in the United States. Like many companies, the Baby Bells have been jolted by the skyrocketing cost of health insurance. So they want to shift some of the expense to employees. The companies contend that their economic stability, and thus workers' jobs, are at risk.

There's no disputing that employers are paying more for health-care benefits. Last year alone companies' health-insurance costs rose about 20 percent. The leading reasons: the soaring costs of high-tech diagnostic and treatment procedures, catastrophic-illness coverage, and an aging population that requires more medical services over a longer span of years. (Health benefits for retired workers is rapidly growing as a corporate expense).

To contain costs, many employers want workers to contribute more money to health care through higher insurance premiums and deductibles, and partial co-payment of hospital bills.

Cost containment is prudent for business, but it can work hardship on workers. Then there are the 37 million Americans who have no health insurance at all. Many of them are virtually denied non-emergency medical care.

The drag on corporate ledgers, the rising resentment of workers, the precariousness of uninsured people, deluxe medical practices, the padding of health-care bills, and the inequities inherent in a system that rations health care by the ability to pay are combining to impel some major rethinking of the American health-care system.

Attention should focus on:

Protecting the unprotected. The US is the only industrialized country in which a large percentage of the population lacks health coverage. Yet universal health-insurance programs, like that adopted in Massachusetts last year and the national plan favored by Senator Kennedy, aren't cheap.

Weighing tradeoffs. American health care is expensive, but of high quality and delivered quickly. Under Canada's system, care is free (except through taxes), but cost containment results in long waits and a shortage of cutting-edge treatment and research.

Burden sharing and cost containment. Situations vary, but, in general, American workers must become accustomed to contributing more substantially to the cost of health care. Business no longer can shoulder the full load. This gives workers greater incentive to participate with employers in improving health-care efficiency. An element of cost containment may be wider health-care delivery through organizations like HMOs.

Tax code. Under present law, some people can pay for health care with pretax dollars, others must use aftertax dollars. Code changes might increase both equity and efficiency.

America's health system needs to be fairer in terms of equal access and treatment, and spiraling costs must be held down. The trick will be to achieve this without sacrificing quality and innovation.