Business Leaders Envision a New Rx

Among large employers, benefits are almost universal. Smaller firms usually provide them, too. Only the micro-firms (fewer than 10 workers) have passed the tipping point: just 45 percent cover their workers today, compared with 57 percent in 2000.

Small businesses aren't contributing much to the discussion of fundamental change. They would also like multistate plans but within the present system. Their efforts are bent toward reducing state oversight so they can offer cheaper, less-comprehensive coverage.

Bare-bones policies might raise the number of insured. (I say "might" because subsidized state small-business pools haven't been successful.) They would also reduce the number of people insured against chronic or expensive diseases such as diabetes or breast cancer. That's no advance.

All the presidential candidates are addressing the question of universal health coverage, in one form or another. That alarms the factions who worry that change will come at their expense.

In the early 1990s, when the Clinton health-care plan was on the agenda, the opposing groups cranked out press releases, claiming to have better proposals of their own. As soon as the Clinton plan went down, the press releases stopped.

I thought about that when I got a release from the National Federation of Independent Business supporting a system that's universal, private, affordable, efficient, realistic, blah, blah, blah -- what I call adjective-based reform. The NFIB commissioned a study, and I wish them well, but they're not thinking outside the box. What's interesting about ERIC is its fresh approach.

One type of company coverage that has passed the tipping point is subsidized health insurance for retirees. Fewer than half of large employers now provide it, said Ron Fontanetta, a principal at the consulting firm Towers Perrin in New York. Of this group, most are covering their current retirees. But only 67 percent say they'll offer retiree coverage to the people working there today, and fewer than half will cover new hires. You can be sure that those percentages will go down.

The more that businesses retreat from their workers and retirees, the bigger the constituency for government-based overhaul. That might be the best option in the end. If not, serious businesspeople, like those in ERIC, need to get cracking on universal care right now.

Jane Bryant Quinn, author of "Smart and Simple Financial Strategies for Busy People," is a Bloomberg News columnist. Alexis Leondis in New York contributed to this column.