Employer Sponsored Insurance

In case you hadn't noticed, American voters want health care reform. Now.

The latest evidence comes from a Diageo/Hotline poll earlier this month, which found that 62 percent of voters support or strongly support "the President enacting a major overhaul of the U.S. health care system." And support comes from across the board: more than one-third of Republicans, nearly two-thirds of independents, and 87 percent of Democrats favor it. And 94 percent of the health reform supporters want Congress to do it this year.

The over 65-year-olds were the least supportive (we would guess because they are afraid of changes to Medicare) but even in this group 56 percent support reform.

Looking at income levels, those earning $100,000 or more a year were the least supportive. Yet again, more than half (58 percent) of this group backed reform.

The Washington Post's Ceci Connolly reports that Wal-Mart, once widely critiqued for having many uninsured workers, is now seen as an innovator. She writes about how the huge retailer is expanding coverage, trying to control costs, and experimenting with care management programs to improve outcomes and quality. The company still has its critics, naturally, but its efforts also say a lot about what businesses can (or can't) do in the current health care climate:

A few months ago we wrote about a provocative study that questioned whether job-based wellness programs really paid off—and if so when, and for whom. If a business pays for wellness and prevention in 2008, would any of the workers still be on that payroll when the health-savings accrued years in the future (assuming that the investment did pay off in better health and lower costs?)

It's going to take more than one more study to answer that question, but new research from Blue Cross and Blue Shield of North Carolina does provide some encouraging results. According to a report in the Raleigh News and Observer, companies willing to make even modest investments in wellness initiatives—such as health screenings in the workplace or giving workers paid time off for doctor's visits—saw a healthy return (pun intended) within a few years.

"The things that employees value the most aren't always the things that cost a lot of money, and in fact, it can be just the opposite," Don Bradley, chief medical officer for Blue Cross told the newspaper. "You don't have to build a gym, but just give the opportunity to get outside and do some exercise."

On the front page of Monday’s Washington Post Michael Fletcher reported two salient facts. One, the Census Bureau estimates that real (inflation-adjusted) median family income has fallen 2.6%, or a bit more than $1000, since 2000. Two, the Bureau of Labor Statistics reported that as of December 2007, benefits now comprise 30% of total compensation, up from 27.4% in 2000.

Fletcher’s piece attributes the decline in net income to an increasingly vivid tradeoff between wages and employer contributions to employee health insurance, and cites many examples to buttress his point. Firms certainly do try to match total compensation – wages plus benefits -- with worker productivity, and if health care costs keep growing faster than everything else, it makes sense that wage and income growth must suffer as a result.

But what few seem to have noticed is that even if you count employer premium contributions as part of employee income (as most economists argue you should), family health insurance premiums have risen to 17% of median family income (using 2006 data, the latest available), up from 7% in 1987.