A few weeks ago, I attended a regularly scheduled board meeting at a credit union.  The CFO was delivering his financial report that included the line item reflecting the cost for employee health care.  There was a discussion about this important issue and the impact it was having on the credit union.  Based on that conversation, it seemed to make sense to try to clarify some of the issues that can provide foundations for a greater understanding of this massive problem. 

Regardless of the field in which you work, whether in the credit union industry, another not-for-profit organization, the corporate world, small business or government, the cost of medical care has been growing and is projected to continue growing as a percent of your pay and of the gross domestic product of the nation. Currently, health care costs represent 18% of GDP, up from 12% just 10 years ago and projected to become as much as 25% of GDP in the next 10 years.  There is now a significant focus on reducing costs and gaining efficiencies through innovative solutions. 

The American health care system embodies a structure that has made it difficult to control costs. Let's call it the "health care triad". To illustrate the situation, when you buy something, e.g., a car, a house, even a meal in a restaurant – there are three roles that you play and that you balance: the "Payer", the "Purchaser" and the "User".  If you go to dinner, you pay the bill, you decide where to go and what to eat, and you consume the food. You fill all three of the roles and the roles balance each other.  How would that change if someone else were paying the check? Imagine the result if someone else decided what restaurant you went to and what you would eat.  Imagine what the restaurant would serve if it knew you could order anything and you did not have to pay for it.