Carl Camden, CEO of Kelly Services, began his address by  observing that, ten years ago, too many in the business community were happy to  stay on the sidelines—and many were, in fact, in active opposition to health  care reform.

“It’s different now,” he said. “Health care reform will be  influenced by the 2008 election,” he added, “and I expect little will happen  until 2009. But we need to do the work now so that come 2009 we can put forward  legislation for aggressive reform.”

Camden emphasized the fact that “twenty-five to thirty million Americans are free agents. . . . They are freelancers, independent consultants, et cetera. These highly skilled people don’t ‘fit’ into the current system. At Kelly these are our core constituency. They are very independent and do not view any single company as home. They laugh at us who believe in the social contract between employer and employee.”

Continuing, he said that “The current health care system doesn’t meet their needs. It doesn’t even recognize that they exist. The free agents are driven into the individual market.” In the meantime, “lots of people are choosing this independent lifestyle. Eighty-one percent voluntarily choose their status as free agents.”

“We can’t make health insurance a barrier to being an entrepreneur,” Camden said, declaring that “free agents are at the heart of America’s edge.”

“Good policy is good politics,” he added. “The first political organization that speaks well for this group—and understands that health care is their number one issue—will have great power.”

Michael Critelli, chairman and CEO of Pitney Bowes, Inc., began by noting that “too often, the debate is framed in terms of healthcare versus no healthcare.” Continuing, he said that “affordable coverage is one of five pillars of moving people toward health.”
In this country, he said, “our biggest source of health costs is preventable chronic diseases,” adding that many of these chronic diseases are “lifestyle-driven.”

The second pillar Critelli mentioned is “access to screening and immunizations, and access to information, in the form of an electronic health record.” Regarding access, he also pointed to the lack of “walk-in clinics” open evenings and weekends as a real problem, saying that Pitney Bowes pays millions for ER visits. “In New York City, for example, many of our employees work in Manhattan but live in the outer boroughs where there are virtually no walk-in clinics. This means that if they are sick in the evening or on the weekend, they can go to a walk-in clinic for treatment of a routine infection or a minor injury.” Critelli indicated that his company has been urging New York hospitals to open walk-in clinics, but in economic terms, for hospitals it works out better for them to let patients come to their ERs.

The third pillar, he said, is to “do things to reward providers for achieving better outcomes. We need to reward people who are doing a lot of a particular procedure and doing it well.”

Critelli’s fourth pillar focuses on financial incentives that would encourage people to take care of themselves. “One of the things we did is to reduce the cost of tier-one drugs for chronic diseases, making them virtually free of charge,” he said.

Finally, as a fifth pillar, he said that Pitney Bowes has asked itself, “How do we create an environment where people engage in healthy lifestyles? One thing the company has focused on is the food it makes available in its cafeterias, and how it is priced.” He pointed out that “in the U.S., agriculture department subsidies tend to subsidize the [ingredients of junk foods] while and healthy foods, such as fresh fruit and vegetables and organic foods, do not get the same support.” This, he suggested, is one reason poorer employees tend to eat less healthy foods.

As far as whether the employer should be the primary driver of health care reform, Critelli asked, “Does the government care if you are healthy? Does the insurer care? No, their goal is to cut costs.”

(Here I would add that, while Pitney Bowes has an excellent record for offering rational benefits, most employers don’t. Too many employers take a short-term view of reducing costs of health insurance—in large part they need to meet Wall Street’s short-term earnings expectations. So we can’t count on employers caring if their employees are healthy. Here, I would be interested in readers’ comments.)

Responding questions from the audience, both Camden and Critelli addressed the question of whether employers should charge smokers and obese employees higher premiums. (Or to put it another way should they penalize those who are overweight or smoke. In this case the difference between a “penalty” and an “incentive” is largely a semantic distinction. See “Should People Who Don’t Take Care of Themselves Pay More?” on www.healthbeatblog.org.)

Here Camden responded that “If employers who are responsible for paying part of costs, they should be able to offer incentives to reduce wrong behavior. Whether it will be effective or not, I don’t know.”

Critelli added that “When it comes to obesity, there are many contributors—I don’t think all of them are within the control of the individual. . . . When it comes to penalizing people who are overweight, I don’t think we know enough about how to get people back to a good weight. But we can make sure in our cafeteria they pay considerably more for junk food than healthy food.”

“Smoking is different,” Critelli added. “If you refuse to participate in smoking cessation programs and continue to smoke, I’m very comfortable with penalties.”

Returning to the issue of penalties for obesity, moderator Dallas Salisbury noted, “None of the body mass indexes we use have been adjusted for body frame, bone style, body shapes that are quite different from average. The implementation of these things is very complicated. BMI [body mass index], a very generic measure, is not customized.”

Finally the moderator raised the question of whether employer-based insurance is a dying system, pointing out that “Some say employers don’t want to be in the business [and] would rather someone else take it over.” Camden replied, “The problem I have the employer-based system is that it is already failing 47 millions Americans who are uninsured. An employer-based system is an incomplete system.” Continuing, he said that “some employers would choose to continue to cover employees. But many CEOs have told me that they do not want to be in the business of managing health care or managing health care options. Many would opt out if an alternative were available.”

We need to think of the employer-based system as not the system, but one of several systems. It cannot be the solo way we provide health care. Camden agreed: “It is incomplete.”

Finally, Critelli asked, “Who is going to resist health care reform? Those who are profiting from our dysfunctional system.” And here he pointed to those hospitals who find that it makes better economic sense for them to have patients come to their ER rather than to build walk-in clinics where patients can find care on weekends and evenings.