In an economy where workers depend on their employers for health benefits, talent that could otherwise be blazing new technological trails or innovative ideas is instead shackled to employers to guarantee their kid's medical care. And it's remarkable how far this dynamic reaches.

I would be curious to know if there is much if any empirical evidence to support the notion that American creativity is being shackled by the health care system because it prevents people from leaving their jobs.  My gut tells me that it might be a minor factor, but other factors are much more important.

My view is that the reason why health care is an American competitiveness issue has less to do with individuals' ability to move around and switch jobs and much more to do with the costs that must be borne by American corporations.  American corporations are at a competitive disadvantage in terms of the capital they have to invest in new products, marketing, R&D etc. because they spend so much money on their employees' health care.  This is especially true for those companies that are heavily unionized and which cover retiree health care as well.  GM has been described as a social insurance company that sells cars to fund its employees' health benefits.

I am actually the author of a book on how businesses can control health care costs.  So believe me when I say that this is becoming a major, major issue.  Where before the health plan was the province of the Human Resources department, now it is a CEO and CFO-level concern.

So Democrats are presented with a dilemma.  In order to expand the coalition of groups that are working for universal health care, including a possible shift to a government-run system, they might have to embrace and get in bed with big business.  At the very least, they might have to take business seriously and try to convince them to join the bandwagon, instead of assuming that they are an enemy.  This is surely a stupendously obvious and effective way to peel off a natural Republican constituency and bring them into the Democratic fold.  Unfortunately, many if not most Democratic activists instinctively distrust, if not outright loathe, big business.  That's why someone like Mark Warner is worth a good look in '08.  As a Democratic entrepreneur, he might just be the one to bridge that gap.

No one can write something like this:

Sick people aren't ever likely to be a big concern for big business unless they are profiting from their illness.

and say they respect big business.  Give me a friggin' break.  It's not the job of business to care about sick people.

And whoever said anything about being "owned" by big business. Democrats don't have to agree with everything business wants. But they should recognize that Democrats concern for universal health care and business' concern with controlling costs represents an opportunity for both groups that is there for the taking if only they can get over their mutual suspicion.

No doubt the insurance and HMO sectors would resist significant change to the current system. But it is a myth that they are making big bucks. HMOs aren't especially profitable.

The only major players in the current system that are unquestionably, outlandishly profitable are the major pharmaceutical companies (although their profitability and growth rates have declined in recent years) and high-end medical specialists.  Almost every other part of the health care system is not especially profitable or, in many cases, not profitable at all.

It's one of the wonders of our system that we can spend so much money, yet not that many are actually getting rich off it.

bluebell

It's not the job of business to care about sick people.

Well, of course not!  Why would you have them write your health care legislation? 

Sorry for the rant, but this party's biggest problem is that it no longer can connect with the American people.  You have to convince them that they are at the heart of at least one issue.   I don't know why "progressives" must approach every issue like an accountant.  I know accountants who have more passion about health.  

Once upon a time, Democrats had a genuine passion about social issues.  Americans came to expect that even if they didn't always agree on every social program.   We've lost that connection.  We have the programs without the heart.   I don't believe we'll win till we get that heart back, but then I am a bleeding heart!

Both of these approaches - appealing to the "moral imperative", and appealing to "national competitiveness" - are interesting as supplementary appeals, but are radically misguided if conceived as the leading idea in a Democratic health care pitch to voters.  They both suffer from the wonk's obsessions with aggregate, macro-level problems and fail to aim the message at individuals concerned about their own health care.  With apologies to John Kennedy, American voters are saying to the parties: "tell me not what I can do for my fellow man and for American business; tell me what you can do for me."

The voter doesn't care as much about:

• American creativity is harmed because employees are shackled to their employers;

as they do about:

• I am trapped in my job because of my damn health care plan; and it sucks.  I want to be able to look for new job and not have to worry about my health care.

Employers don't care as much about:

• America is losing the global competitiveness fight because of spiraling healthcare costs;

as they do about:

• I can't afford to get my employees quality health care and compete with my Chinese competitors at the same time.  I either skimp on healthcare and lose quality workers, or shell out for the health care and go out of business.  Either way I'm screwed.

 
Stop thinking so much about the complaints of economists, political philosophers and bioethicists regarding our current health care system, and think more about the answers you will get from individual voters if you ask them about their own health care.  I suspect you will get some combination of the following:

• I don't have any;
• It is too expensive; 
• I have to fill out too many stupid forms;
• It is unfair.  My health care isn't as good as the health care of people in other parts of the country.  And it's not as good as the health care of people who are richer than me, or have better jobs;
• It's too damn complicated; 
• My deductibles are too high;
• I can't get to see the specialists I need to without going through an idiotic rigamarole for months of getting referred up the HMO food chain;
• It's insecure.  I have health care today, but don't know whether I will have it tomorrow;
• Drugs cost too much; all the rest of it costs too much as well;
• I don't like my doctor;
• I'm sick of having to do a damn research project every time I need some health care; to find out what is covered and what isn't;
• Not everything that should be covered is covered.
• I am a slave to my health plan.
  

So here is the message we want to give to Mr. and Ms. voter:  We are going to make your health care cheaper, simpler, better and more secure.

Then figure out how to do it.  Think in terms of what we are going to deliver to Americans - not interms of plans, philosophy and academic think tank debates.  That's for the experts.  If those experts can come up with some sort of plan that will be clearly better for, oh let's say 70% of Americans, then we have a winner.