The Role of Medium-Sized Employers

Bruce Feinberg, DO: Approximately 60% of United States employer-sponsored health insurance is fully or partially self-funded, including fully funded and partially funded plus stop-gap insurance. Do you think the stakeholder segment is exercising as much power and influence as it can in driving positive change in healthcare? Is it getting at that same thing? But now we’re not talking about the megacompanies. We’re not talking about the companies with hundreds of thousands of employees. These are the companies with 5000 and 10,000 employees or less than that. Do they have any leverage in the current marketplace? How do they exercise it? What will change in order for them to exercise it?

Mark S. Soberman, MD, MBA, FACS: I don’t think that they’re exercising it as of yet. I think if they’re smart and forward-thinking, they should be because it’s in their best interest and their employees’ best interest. Again, I’m still just fascinated by the whole idea of this direct employer—provider relationship because I think it can work in small markets, it can work in large markets, and it can work nationally. If you’re a large employer in a county of 250,000 people and you have a health system there, why not engage a TPA [third-party administrator] directly and go ahead and enter into a relationship with that provider organization. I think it’s an opportunity. How quickly it will happen, how it will filter down, and to what level remain to be seen.

Michael Kolodziej, MD: I’m skeptical. I think my experience in meeting with plan sponsors is that they lean heavily on consultants. Since I’m a consultant, that’s a good thing. They listen to Mercer or Willis Towers Watson or whoever their chosen consultant is. They can have some awfully strange ideas, in my experience. Healthcare is very complicated. It’s very local, and I am very skeptical that most self-insured employees have any leverage with the people providing care. I just don’t think they do. It’s unfortunate.

Bruce Feinberg, DO: All right. A final thought as we close out this segment. One could argue that the ultimate consolidation is a single-payer system. I’m curious about where we are politically right now, and as that pendulum has quickly swung very far one way, do we see a potential to swing very far the other way? Do you foresee ever in this country a single-payer system as the ultimate expression of consolidation?

Mark S. Soberman, MD, MBA, FACS: I don’t know whether I would view it as consolidation necessarily because it is at the end of the day still 1 piece of the whole puzzle. Now politically, I don’t know whether we’re going to go there. You can argue for and against it. As we know, there are pros and cons to single-payer systems. There are some good things and there are some awful things about it that we’ve seen in other models. I don’t know that private insurance is going to go away in this country or that employer-based insurance is going to go away anytime soon. I don’t see it happening in the short term.

Dana Macher: I would say the same thing. I don’t see that happening even past the short term. What we’ve been talking about is consolidation. I think that a single-payer system would require regulation and a lot of things that we haven’t talked about today, and it’s very political. I just don’t think that is a possibility.

Michael Kolodziej, MD: As you know, I am apolitical, but one cannot have a single payer unless one has a solution for healthcare cost. Because if we assume that we’ll have a single-payer system without some mechanism for controlling the cost of healthcare, our country will be bankrupt.