make their continuation, indeed their mandating, worthwhile even if some important limitations of the system cannot be fully corrected? Each member of the committee has a somewhat different answer to this question, one affected to varying degrees by the practical reality that this system is what is in place and is familiar and perceived as valuable to most Americans. Nonetheless, most committee members foresee a continued deterioration in the quality and scope of health coverage unless major steps are undertaken to reduce or correct the serious weaknesses in the system. Most believe it unlikely that a larger proportion of small employers will voluntarily and independently provide the coverage and assistance offered by large employers.

Overall, policymakers and reform proponents of all stripes may both overstate and understate the advantages and disadvantages of current arrangements, a circumstance made easy by the diversity of these arrangements. As noted above, those who would limit employer involvement in health benefits largely or entirely to a financing role may overestimate the degree to which employers will acquiesce in funding increased spending under such circumstances.

Despite the diversity of its views on specific directions for health care reform and the role of the employer, the committee would not like to see lost the help that employers can provide to employees facing problems with their health coverage. Because imperfect performance can be expected from a single national system or a competitive market based on individual (not employer) choice, employers might very well see advantages in a new kind of "employee assistance program." This program could provide employees with aid in understanding their health plan coverage or help in resolving problems with denied claims, bureaucratic inertia, or whatever similar difficulties a reformed system might present.

Furthermore, the committee would not like employers to become unconcerned about the link between health coverage, health status, and worker well-being and uninterested in efforts to improve assessments of the cost-effectiveness of specific medical services and health care providers. Because workplace and community health promotion programs, local health care initiatives and institutions, and other health-related activities have attracted employees' and employers' support for reasons beyond any specific tie to their health benefit programs, some continued support can be expected and fostered.

Given the creativity shown by both public and private sectors in the past and the considerable accomplishments of employment-based health benefits, there is reason to be optimistic that decisionmakers—if they can agree on a basic framework for reform—can find a positive role for employers. That role may be larger or smaller than it is today, but in either case it should be designed to support the country's broad objective of securing wider and more equitable access to more appropriate health care at a more reasonable cost.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement