Wal-Mart’s healthy change

Americans agree on health care. Ask them, “Who should pay for it?” and they all answer, “Not me.”

But follow up with, “Who, then?” and you have a fight on your hands.

Wal-Mart has greatly improved the quality of the conversation with its newfound support for requiring employers to help pay for their workers’ health coverage. Its bombshell statement astounded the U.S. Chamber of Commerce and National Retail Federation.

Five years ago, Wal-Mart led the “not-me coalition.” The name of the game was ensuring that most of its employees’ health care costs landed on other shoulders.

Georgia complained that Wal-Mart had sent 10,000 of its workers’ children into the state health program. In California and Washington state, Wal-Mart battled proposals to create a health tax for companies that did not insure their workers.

Local companies that covered workers were all for the “tax.” The Brown & Cole supermarket chain in Washington (now The Markets) protested that spouses of employees joined its health plan because their own companies wouldn’t cover them.

An internal Wal-Mart report found that 22 percent of its workers received coverage under a husband’s or wife’s policy. Five percent were on Medicare, and 3 percent on Medicaid or other state-run plans. And 4 percent were insured through their parents or school.

Since then, Wal-Mart has spruced up and expanded its employee health benefits. In 2004, only 45 percent of its workers had coverage. Now, 52 percent do. Wal-Mart has cut the waiting time for getting such benefits and offers more insurance options.

Wal-Mart clearly does not want to become the one on whom others dump their uninsured workers. But as a provider of coverage with 1.4 million U.S. workers, Wal-Mart wants the exploding costs of medical care brought under control. That can’t be done without universal coverage.

In a letter to President Barack Obama, Wal-Mart said: “We are for shared responsibility. Not every business can make the same contribution, but everyone must make some contribution.” The liberal Center for American Progress and the Service Employees International Union – not your usual Wal-Mart cheerleaders – co-signed.

Some accuse Wal-Mart of simply seeking to quash a proposal in the Senate Finance Committee that would place health-coverage mandates on companies with low-wage workers. Whatever its motivation, the retailing giant is on the right side this time.

Frankly, all the talk about which employers will pick up how much of the health care tab is unfortunate. There is no rational reason why companies should be paying these bills in the first place. (It’s a fluke of wage and price controls during World War II.)

One virtue of the bipartisan Wyden-Bennett health proposal is that it would take managing medical coverage out of the workplace. So would a “single-payer” system, which would move that burden over to the government (and taxpayers).

Although single-payer plans are often characterized as socialism on the march, it’s instructive to note a new poll by the Committee for Economic Development. Among 300 leaders of companies that cover workers, 36 percent supported a single-payer system. (Over 60 percent said they want the government, rather than themselves, organizing American health care.)

A single-payer system makes the most sense – especially if it’s really a multi-payer system. In a true single-payer plan, such as Canada’s, the government picks up all the bills. In a multi-payer model, such as France’s, the government pays for certain basics, and people buy private insurance for everything else. The French system gets top grades for quality of care, and it would give Americans more freedom to obtain fancier health services.

Ask Frenchmen, “Who pays for health care?” and only the destitute could honestly answer, “Not me.” That’s the way it should be here, too.