Wells Fargo Small Business Roundup

Small business owners have long known that health care is among the most expensive issues they face. To put it in perspective, figures from the National Federation of Independent Business (NFIB) show that companies with an average of 10 workers (which represent 80% of U.S. employees) are bearing the greatest burden of insurance premium increases, which have grown twice as fast as inflation for several years. And, according to nonprofit research group the Commonwealth Fund, workers at these companies pay 18% more for premiums than those at larger firms.

"The situation for small business is much worse than it was in 1994 [during the Clinton presidency] in terms of cost," says NFIB President Todd Stottlemyer. "We can't just say ‘no' today."

In an effort to effectively lobby the presidential candidates for better health care with a unified effort and message, the NFIB has developed a 10-point platform, built around what the right, financially sustainable health care system—one with the goals of access to quality care, affordability, predictability and consumer choice—should be:

Universal—All Americans should have access to quality care and protection against catastrophic costs. A government safety net should enable the neediest to obtain coverage. Lack of insurance is especially problematic for small businesses and their employees. In addition, having millions of uninsured Americans distracts us from focusing on affordability, quality and comprehensiveness of care and coverage. Current laws already provide some level of insurance for everyone, but coverage is expensive, inefficient and often inadequate—guaranteed access to emergency rooms is one example. Under this piecemeal coverage, costs fall arbitrarily and inequitably on individuals, providers, governments and businesses.
Private—To the greatest extent possible, Americans should receive their health insurance and health care through the private sector. One-size-fits-all insurance and care are not wise options in a nation of 300 million people. We need better health care delivery models, financial management systems and risk-sharing arrangements. America remains the world's engine of health care innovation, and entrepreneurship is the key to that innovation. Given the current financial path of health care, governments ought to be wary of taking on the entire burden.
Affordable—Health care costs to individuals, providers, governments and businesses must be reasonable, predictable and controllable. America's health care costs are high and growing more rapidly than earnings. Wages stagnate as health care costs eat further into take-home pay. Employers and governments struggle to balance budgets as health care costs rise. Health care uncertainties paralyze long-term financial planning.
Unbiased—Health care and tax laws should not push Americans into employer- or government-provided insurance programs and hobble the market for individually purchased policies. Small employers should be treated the same as large employers, who can already pool across state lines.
Competitive—Consumers should have many choices among insurers and providers. Policymakers must alleviate the limitations that state boundaries and treatment mandates place on competitiveness. In the next decades, America's capacity to deliver high-quality health care will face increased financial pressures. Maintaining or improving upon our current quality of care will depend critically upon our ability to develop newer and less expensive modes of treatment and delivery systems.
Portable—Americans should be able to move throughout the U.S. and change jobs without losing their health insurance. Our current health-insurance system locks people into jobs and localities. An existing health problem may make it impossible for an individual to change jobs. Employer-based health insurance and restrictions on purchasing insurance across state lines limit a worker's ability to seek higher pay, greater opportunity or a better locality for his or her family.
Transparent—Information technology should enable all parties to access accurate, user-friendly information on costs, quality and outcomes. Providers must be able to obtain relatively complete medical histories of patients. At the same time, patients' privacy must be guarded zealously.
Efficient—Health care policy should encourage an appropriate level of spending on health care. Laws, regulations and insurance arrangements should direct health care spending to those goods and services that will maximize health. Adequate risk pools throughout the health care system are vital to accomplishing these goals. To avoid catastrophe, incentive structures across the system need to be reconfigured to give consumers, providers and insurers the educational tools and the motives to use their dollars wisely and efficiently.
Evidence-based—The health care system must encourage consumers and providers to accumulate evidence and to use that evidence to improve health. Appropriate treatment choices and better wellness and preventive care should be key outcomes. Current information and decision systems make it difficult to accumulate, interpret and use evidence affecting treatment decisions. One result is overspending on treatments and underspending on prevention. Decision-makers must understand the impact of their decisions on both costs and outcomes. Such an understanding must be based on solid clinical and economic evidence.
Realistic—Health care reform should go forward as rapidly as possible, but not so quickly that firms and individuals cannot adjust prudently. It is important to assure that no one's quality of care suffers, as we move to provide coverage for all Americans.

"Reform is a delicate balancing act," according to the NFIB. "Moving too slowly will allow costs to rise too far and too fast. In the process, the health of Americans will suffer, and the financial security of some will be disastrously impacted. But excessive speed is also risky. Thus, we must assure that reform does not allow some Americans to slip through the cracks—to lose coverage or see their costs rise too rapidly. Somewhere in between is a seamless transition from the status quo to a more efficient and equitable system."