BY MORTON MINTZ

Numerous strong and sometimes poignant questions that reporters could ask employers in their communities about health insurance are starkly visible in a recent talk by a businessman who operates 20 restaurants in south central Pennsylvania.

“So I’m an employer being successful in the current system, but I think the system stinks,” said Alan Jacobs, one of 15 panelists who addressed a health-care conference at Franklin & Marshall College in Lancaster, PA.

The sponsor, Progressives4Pennsylvania, is leading an effort to make Pennsylvania the first state to adopt single-payer universal health insurance, which is basically Medicare for all.

Jacobs went to work for Isaac’s Deli in 1983, after graduating from Millersville University. He has been with it ever since and is now its president. About 200 of the approximately 650 employees are in its health plan.

Insurers sometimes “fight with each other to get the other to take on the cost,” Jacobs said. “They each think they are doing me a favor, but I foot the bill for their dispute, and in the meantime, my employee can’t get claims paid.

“From a health care perspective, it sure seems like the incentives are upside down.”

In any given community, how many employers would say either that the incentives are OK or that they “are upside down”?

“Your employer – me – is bureaucrat No. 1. Every year, I make decisions for my employees about how much their out-of-pocket expenses will be, and how much their deductible will be, and what we will or won’t pay for. Every couple of years when we change plans we give our employees a new list of doctors that are on our plan. If they are lucky, their doctor is on our list. If not, too bad.”

How many employers also see themselves, however unwillingly, as bureaucrats? Do they think it’s right or wrong that they should be making decisions of the kind Jacobs has to make, such as deciding what employees’ deductibles will be?

“When an employee gets sick and misses work, they go through the drawn out process of losing their job because they can’t work because they are sick, and they eventually loose their eligibility and lose their coverage.

“This is a horrible occurrence.”

How many employers agree that such an occurrence is “horrible?”

“When a person needs insurance the most, they lose it. This is the final brutality caused by linking health care to employment.”

How many employers think it’s fair and right for an employee who “needs insurance the most” to “lose it?” How many believe that health care should be linked to employment?

– The author is a senior adviser to the Nieman Watchdog project and an occasional contributor to The Oklahoma Observer. He may be reached at mintzm@earthlink.net.

Here is the full text of Alan Jacobs’ remarks:

I am Alan Jacobs, President of Isaac’s Restaurant & Deli. We are a local employer with 20 restaurants and about 650 employees. We have about 200 people on our health plan.

As a business person, I could talk about the economic advantages of a single-payer system, but that’s not my elevator speech about healthcare. Here it is.

At Isaac’s, we play the insurance game quite well. We offer health insurance for anyone working 25 hours a week, and that’s helped us to retain a very loyal workforce.

So I’m an employer being successful in the current system, but I think the system stinks.

The way I see it, I am the ultimate health insurance consumer in our system. I buy insurance every year, and the insurance companies work hard to give me a product that I can afford and will buy. They try to keep my premiums low, which they do by trying to avoid paying medical bills. [It’s like auto insurance: if you wreck your car, your rates go up].

So their job is to deny and delay paying medical bills as much as possible, which they think they are doing on my behalf, because they are keeping my rates low.

As a business, I buy several kinds of insurance – medical, liability, workers comp, and auto. Each one of those insurances has a medical component, and each one wants to keep my cost low by not paying claims. Sometimes the companies fight with each other to get the other to take on the cost. They each think they are doing me a favor, but I foot the bill for their dispute, and in the meantime, my employee can’t get claims paid.

From a health care perspective, it sure seems like the incentives are upside down.

This is not a partisan issue, but when I heard John McCain say he doesn’t want any bureaucrat making decisions about our health care, I’m afraid he’s a little late to the game. Your employer – me – is bureaucrat No. 1. Every year, I make decisions for my employees about how much their out of pocket expenses will be, and how much their deductible will be, and what we will or won’t pay for. Every couple of years when we change plans we give our employees a new lists of doctors that are on our plan. If they are lucky, their doctor is on our list. If not, too bad.

We also review drug use, and each year we give our employees something called a formulary. That’s a list of drugs that we will pay for. If their drug is on the list, they’re lucky. If not, too bad.

My insurance company is bureaucrat No. 2. They delay payments, deny payments, and get my employees all tangled up in paperwork so they can avoid payments in a particular year. If my insurance company can find a loophole so they don’t need to pay a claim, that’s good for them, and they think that’s good for me. They are selling me a product, and they are trying to keep it affordable.

This might be all be well and good if the so-called free-market system was actually working to keep costs down. However, on a global scale, we as a country spend twice as much per person on healthcare, and our health outcomes are actually worse. If I had an employee who came to me with the results of his brilliant cost savings plan, and his conclusion was that it’s costing twice what our competitors pay, and it’s making it difficult for us to provide goods and services to our customers, but his conclusion is that we need to keep at it because it’s the only plan that will work; I would tell him to hit the trail.

But I probably wouldn’t fire him outright, maybe just demote him, because he has a family, and he gets his health coverage from us.

Which brings me to my final point. When an employee gets sick and misses work, they go through the drawn out process of losing their job because they can’t work because they are sick, and they eventually lose their eligibility and lose their coverage.

This is a horrible occurrence.

When a person needs insurance the most, they lose it. This is the final brutality caused by linking health care to employment. So that’s why I’m here tonight, lending my voice to this movement.