Ann Marie Marciarille:
Missouri State of Mind: Attention Wal-Mart Shoppers: Wal-Mart Shops for Value: Wal-Mart… is a brilliant illustration of our larger ambivalence over employer-sponsored health insurance…. Wal-Mart gained notoriety… in 2005 with the release of internal documents discussing the need to drive down employee health care costs… [by] hir[ing] younger presumably healthier and perhaps childless individuals…. Wal-Mart and every large employer of low-wage and low-skilled employees had and has every incentive to seek the employment turnover necessary to keep health care costs low and demand for employer-sponsored health insurance lower…. Wal-Mart's interest… in advance screening job applicants… by requiring lifting, carrying, and walking in every job description….
Wal-Mart has [also] announced plans to expand and strengthen their Centers of Excellence Program… direct contracting for certain procedurally based care with some of the highest quality and lowest cost providers in the country. And Wal-Mart -- master of distribution chain logistics -- will transport its eligible employees and their caregiver companions to these centers.
This is a powerful move towards quality and better outcomes for Wal-Mart employees who are fortunate enough to be covered under Wal-Mart's employer-sponsored insurance. And we will all benefit, whether or not we are Wal-Mart employees or even Wal-Mart shoppers… [as they] send a strong signal to the market for commercial insurance that cost-effective quality care will be sought even if health insurance intermediaries lack the interest or incentives to organize health care provider contracting….
So, there we have it. A history of employer-sponsored health insurance designed to serve the interests of higher-wage and skilled employees and their employers struggling to find a place in time and history where the low-wage unskilled want in to the employer-sponsored health insurance tent. And an incipient revolution in health care service contracting for those lucky enough to be inside the employer-sponsored health insurance tent designed to make the care delivered there higher quality and more affordable…. [A] three tier health care system: commercially insured, government-funded insured, and uninsured all… in the employee group of one large American employer.