NYTimes Article on US Health Care by Author "Sick"

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NYTimes Article on US Health Care by Author "Sick"
Published as an article in the 4/1/2007 New York Times Magazine Section
What’s the One Thing Big Business and the Left Have in Common?
By JONATHAN COHN

The struggle to establish universal health insurance, dormant for more than a decade, is back. Should it actually succeed over the next few years, historians may trace that triumph, at least in part, to a news conference on Capitol Hill — and to a most unusual figure who participated in it. The event took place in early December, just after the Democrats won back control of Congress. Its sponsor was Senator Ron Wyden, Democrat of Oregon, who was unveiling what would become the first universal-coverage proposal of the new political alignment. The impending change in Congressional leadership lent the announcement greater significance than usual — Wyden’s proposal would actually get a hearing, for one thing.

In many respects, the news conference seemed rather mundane. Universal health care has always been a liberal’s cause, after all, and Wyden is one of the Senate’s most liberal members, somebody who has long defined universal coverage primarily in terms of fairness and equal opportunity. Among those flanking Wyden onstage were other longtime advocates of universal coverage, including Andy Stern, president of the Service Employees International Union. He, too, paid homage to the traditional rationale, arguing that Wyden’s plan “sets down a moral test: Why doesn’t every American have the right to the same health care as the president, the vice president, 535 members of Congress and three million federal workers?”

One of the men alongside Wyden and Stern stood out, however, politically if not visually. He was Steve Burd, chairman and C.E.O. of Safeway supermarkets. Nobody has ever accused Burd of having a bleeding heart: a former management consultant with a graduate degree in economics, he became notorious two years earlier when he helped lead California grocers into battle with their labor unions over employee medical benefits. Burd insisted that the unions accept skimpier insurance to save his company money. In the four-month walkout that ensued, newspapers ran articles about checkout clerks defaulting on their cars and homes. Union supporters blasted Burd as “evil” and “a rat.” At one point, a group of clergy members marched on Burd’s California estate, holding a prayer vigil and delivering a handwritten plea for him to compromise. He didn’t. And eventually he won, forcing major concessions from the union.

Yet here was Burd in Washington, arm in arm with one of labor’s most passionate leaders, endorsing a plan in which the government would guarantee affordable, high-quality insurance to every single American. “Our nation is facing a crisis that requires immediate attention,” Burd declared. “Working together, business, labor, government, consumer groups and health-care providers can collectively solve this problem.”

And while the “working together” line had the feel of boilerplate, Burd meant it. In the year that Wyden took constructing his proposal, Burd was quietly advising him; eventually they or their staffs were conferring almost every week.

When Burd wasn’t working with Wyden, he was talking about health care with another audience: his fellow C.E.O.’s, whose support for universal coverage he was trying to secure. Soon that effort may also produce results. When I spoke to Burd recently at Safeway’s headquarters in Pleasanton, Calif., just east of San Francisco Bay, he told me that within weeks he expects dozens of companies to join a nonprofit advocacy group he is organizing called the Coalition to Advance Health Care Reform. Burd declined to reveal their names or the exact number of corporations participating. He did say that they represent a broad swath of corporate America and that all will be known when the group goes public later this spring. Burd also confirmed that one of the coalition’s officers in Washington will be the longtime Republican Party operative Ed Gillespie — whose presence in an organization explicitly endorsing “universal health coverage,” as the coalition’s founding principles do, would seem about as likely as the presence of George W. Bush himself, whose disdain for anything resembling “government-run health care” is a matter of public record.

Is all of this indicative of a broader shift in the politics of health care? Perhaps. As health care has become more expensive and even middle-class Americans have become anxious that their hold on employer-sponsored coverage is precarious, politicians have been talking seriously again about making health insurance a birthright, just as it is in every other developed nation. Not long after Wyden unveiled his plan, former Senator John Edwards, who is running for president, offered a detailed universal-coverage proposal of his own. His chief rivals for the Democratic nomination, Senators Hillary Clinton and Barack Obama, have pledged to insure all Americans. Meanwhile, Mitt Romney of Massachusetts signed a statewide universal law last year before leaving the governor’s office; his campaign for the Republican nomination now proclaims it his major policy achievement. Gov. Arnold Schwarzenegger, another Republican, has proposed a similar system for California.

But it is corporate America’s interest that is most striking. For many years, the only business leaders openly calling for universal coverage were mavericks like Howard Schultz, the chairman of Starbucks, who has long preached the need for business to show greater social responsibility. The C.E.O.’s rallying to universal coverage now — particularly in the last few months — are acting not so much out of social solidarity as out of financial necessity, as the burden of financing workers’ premiums has become ever more onerous.
“The refrain from business was, ‘We can’t afford to do universal health care,’ ” says Wyden, whose plan calls for shifting responsibility for buying insurance from employers to individuals. “Now the refrain is, ‘We can’t afford not to do it.’ ” The Business Roundtable, one of Washington’s most influential business lobbies, now endorses universal coverage, at least in broad principle. And probably no spectacle captured the spirit of the times more than a joint conference held in February by Andy Stern and a man he has spent much of the last few years attacking, Lee Scott, the C.E.O. of Wal-Mart. Together the two pronounced the need for universal coverage by 2012.

Of course, at that news conference, Scott didn’t go into great detail about exactly what kind of universal health-care system he would like, just as the Business Roundtable shied away from specifics in its statement. And that’s the rub. In the early phases of the last great debate about health-care reform, during the early 1990s, prominent business leaders sent out strikingly similar signals — suggesting they were ready to embrace universal health care, for the same essential reasons they cite now. At one point, a coalition of business leaders put out a “play or pay” proposal that would have required corporations either to insure their workers or to pay into a common fund for the uninsured. But as President Clinton’s health-care plan lost political momentum, the business community’s support for universal health care faltered and, eventually, collapsed. Is its support any more reliable now? “This is precisely the political equation the Clintons bet on,” says Jonathan Oberlander, a health-policy scholar at the University of North Carolina. “Sorry to say this may turn out to be another mirage.”

Burd, who like most successful business leaders does not lack self-confidence, vows to see this campaign through and to bring his fellow C.E.O.’s along with him. Veteran universal-coverage supporters like Stern and Wyden who have worked with Burd say they think it’s possible he will do just that. But even they concede that Burd’s ideas — and more generally, the ideas of the business community — don’t line up perfectly with their own. How far can such a coalition go? And, no less important, where will it go?

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Jonathan Cohn is the author of “Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price,” to be published next week. He is a senior editor at The New Republic and a senior fellow at Demos.
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