Notwithstanding a weak economy and global competitive pressures on U.S. business, American employers prefer a status quo scenario with a complement of wellness, chronic care management and evidence-based care combined with greater consumer-direction in the form of tax credits to buy private health insurance.

Aon Consulting surveyed 1,100 employers in June 2009 and found that 93% of employer benefits managers favor continuing with an employer-based health care system. At the same time, 81% reject a Canadian-style national health plan replacing the current system. And two-thirds of employers oppose an employer mandate.

According to Aon Consulting’s Health Care Reform Survey Report, the top 3 preferred ways to finance health reform are:

1. To utilize comparative effectiveness to eliminate low value added medical services and pharmaceutical drugs

2. To change physician and hospital reimbursement

3. To levy individual lifestyle taxes on tobacco, alcohol and other ‘undesirable’ products.

Health Populi’s Hot Points: It’s intriguing, if not confounding, that employers generally want to build on the current fragmented health system and lay over it “wellness, chronic care, and evidence-based medicine.” And what of global competition vis-a-vis companies whose health care is subsidized by general taxes?

What about reinventing the health system on a strong foundation of primary care?

Perhaps when employers told Aon they favored “changing physician and hospital reimbursement,” they’re speaking to re-engineering health care delivery. That’s the only way we’ll be able to rationalize costs and get to serious chronic care management–where so many costs are generated that could be averted earlier in the progress of disease.

A July 2009 Issue Brief from The Commonwealth Fund, Failure to Protect: Why the Individual Insurance Market is Not a Viable Option for Most U.S. Families, asserts that in the past three years, 3/4 of people who tried to buy coverage in the individual health insurance market didn’t purchase a plan because they couldn’t afford one, no plan fit their needs, or they were rejected due to pre-existing conditions. The Holy Grail of a true consumer-directed market continues to evade those Americans who would like to behave like health citizens but cannot do so due to the insurance industry’s lack of innovation along with sound public policy that will support and drive innovation and engagement.

As the Fund notes, “Given the declining economy and mounting job losses in the face of rapidly rising health care costs, the time has never been more urgent for policymakers to forge consensus around strategies for reform that provide affordable and comprehensive coverage for all.”

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