In the last 30 years, almost no issue has divided American employers and employees more than the rising costs of health care and health insurance. It’s the workplace, not Washington, that has been the real battleground. Those costs are behind many of the most contentious issues in the American workplace, and almost any issue that affects those costs has become white hot.
A debate recently before the Maine Legislature is an example. A bill there sought to mandate a minimum of six paid sick days annually at businesses employing more than 25 people. LD 1665 became one of the most contentious issues before the Legislature this year, pitting business interests desperate to avoid yet another health care cost from being borne by the employer against worker interests trying to protect employees from yet another economic repercussion of illness.
In an ideal world, this would not be an issue. No employee would have to feel as though she was risking her job to stay home when acutely ill. No employer would have to feel as though he were risking his business to take on the cost of mandatory sick days and force potentially ill employees to come to work. But a lousy econ-omy and ruinous health care costs have pushed many Maine businesses to the brink. They and other American businesses are trying to draw lines in the sand in front of the rising tide of the health care costs they bear; opposition to LD 1665 is just one such line.
Health insurance costs have fundamentally altered the relationship between the American worker and the American employer. For many employees, work is primarily the place to get health insurance, and secondarily the place to find gainful employment. The scariest thing about unemployment can be the loss of health insurance. Contract negotiations in many businesses have become largely about who bears what share of rising health insurance costs, not work conditions.
That model is one of contention over costs. What is needed is a model in which American employees and American employers progressively partner in a battle to control their collective health care costs, rather than progressively battle to shift health care costs to each other. Such a partnership often would put two of the most powerful forces in American society — employees and employers — on the same side in efforts to control costs.
When we choose to battle instead of collaborate, we not only pay the cost of battle, we also pay the cost of the lost opportunity to work together. In health care debates outside the workplace, the lack of such a partnership has meant employers and employees each have less leverage, because their initiatives are often contradictory. It has also meant efforts at cost control and reform are deprived of a potentially powerful joint lever for moving issues ahead.
Inside the workplace, this lack of collaboration has meant discourse over health care cost control is dominated by disagreements. Instead of discussing how to reduce employee absenteeism due to illness, for example, we are fighting over whether the employer should bear the cost of that absenteeism through paid sick days. In-stead of discussing how the employer and employee can work together effectively to reduce employee health care costs by reducing waste and improving employee health, we fight over how much of the cost we can shift to the employee. It’s like fighting over what shoes to wear while one of our legs rots off.
There are models for workplace partnerships aimed at controlling costs by improving employee health, developed by organizations such as the Wellness Councils of America, and model employee wellness programs in companies such as the Cianbro corporations. These don’t give us all of the answers, but promotion, prolifera-tion, and study of such efforts nationally would lead to the identification of successful models for all to follow. Health care organizations and insurers could help.
That kind of sea change in approach takes vision and gutsy leadership in the American workplace. The contentious alternative has been a model of miserable failure; let’s try a partnership model instead. Management and owners must take the first steps.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.