Searching for a cure

I'VE BEEN LISTENING to a lot of

And wow, do people ever want to talk about health care. Last month, I was at the World Health Care Congress in Washington with about 1,800 attendees, and right before that, with 500 business owners and executives at the Crain's Chicago Health Care Forum that Workforce Management co-sponsors along with Crain's Chicago Business. Those are just two of the many conferences, forums and events focused on one thing: how to lower costs and provide better health coverage to more Americans.

Health care is a huge expense in the U.S., costing nearly $2 trillion in 2005, according to The Wall Street Journal. Health care spending makes up 16 percent of our gross national product. Despite that, some 47 million Americans don't have coverage, and the fear is that as our . workforce ages and costs continue to rise, fewer people will be able to stay covered.

This was the focus of Safeway CEO Steve Burd, one of the keynote speakers at the Washington conference. Burd said that the problem we have with health care is not that we spend too little on it-the U.S. spends more per capita on health care than any country in the world. But he also noted that 70 percent of health care costs are driven by behavior, and 74 percent of all costs are confined to coverage of four chronic conditions: cancer, diabetes, cardiovascular disease and obesity.

In Burd's view, you need to affect behavior if you want to affect health care costs. At Safeway, where the focus has been on helping workers stay healthy by eating right, exercising and focusing on preventive care, Burd says that health care costs are down 13 percent since 2005. If that sounds like modest savings, consider that overall costs for the typical company went up about 20 percent during the same period.

He also thinks there are a lot more savings to be had. "I think we can lower health care costs by 40 percent," Burd says, and he claims that just about any company can see savings of 15 percent, minimum, if they have a behavior-driven health care strategy.

Problem is, behavior-driven plans have had mixed success because they come down to a simple premise: getting workers to take better care of themselves, usually through a program of incentives that reward good behavior. That sounds good in theory, but it doesn't always work in practice, because getting people to sustain good behavior over time, even with incentives, is hard to do.

Some companies have taken the punitive approach. Chicago-based Tribune Co. kicked off the new year by charging smokers $100 more per month for their health care. That plan lasted until late last month, when Tribune's new management reversed itself, saying, "While well-intentioned, we think the tobacco-use fee implemented by the previous management team is inconsistent with the new culture we're developing-we'd rather you use your own judgment when it comes to tobacco use, not impose ours upon you."

I was surprised that Tribune dropped its yousmoke, you-pay provision, partly because it really seemed to reflect the in-your-face style of new chairman and CEO Sam Zell, but also because it was a very interesting strategy for a very difficult problem.

It's unfortunate that Zell isn't following through, though, because this is an approach worthy of debate and discussion, given the huge health costs associated with smoking.

That's what the thousands of people attending health care conferences are looking for: new ideas and approaches that are worthy of serious discussion and debate. Steve Burd and Safeway have a lot of good ideas, but so do (or did) people like Sam Zell and Tribune. We're going to need to seriously consider all of them if we ever hope to find the right mix to get quality health care coverage to everyone without bankrupting business and government in the process.