Overview

Health Care: An Imminent Crisis
Health care costs are swelling out of control with tremendous impact on American business—large and small—citizens, and the U.S. economy. The cost of small business health insurance has increased by more than 70 percent in the last five years. And, less than 50 percent of all small businesses offer health insurance today, down from 68 percent just five years ago. The U.S. spends 15 percent of its Gross National Product on health care compared with a rich country average of 9 percent. Rising medical costs make health insurance unaffordable for the average American, with more than 47 million (16 percent) Americans uninsured. According to the 2007 Employer Health Benefits Survey, The Kaiser Family Foundation and Health Research and Trust, among firms with three to nine workers, the offer rate has dropped from 57 percent in 2000 to 45 percent in 2007.

Answering the Health Care Wake-Up Call
With experts seeing a health care crisis and calling for immediate and major health care reform, the Council of Smaller Enterprises (COSE) undertook a “scenario planning” exercise, a process charged with a goal: to envision the various potential “futures” of health care in the next five to 15 years, and in doing so, prepare COSE and its 17,000 members for what lies ahead. While the scenarios are not prescriptive of any one solution — they serve to narrate a number of potential futures that provide a centerpiece for discussion and a door opener to dialogue with thought leaders and policymakers on Capitol Hill and in Columbus.

Presenting Findings to Policymakers as They Craft Health Care Reform
With the 2008 elections looming, health care will once again be a key issue for discussion. And, COSE will once again be a key resource for policymakers as they determine the direction of health care reform. As a participant in Governor Strickland’s Health Care Advisory Team, COSE will share the findings with Ohio health care policy experts to help influence health care changes in Ohio in ways that will better assist small business and improve Ohio’s economic climate.

Why COSE?
Since its founding in 1971, COSE has been an outspoken advocate for the needs of small business and has been nationally recognized as an authority on small business health care. COSE’s health insurance plans cover more than 178,000 individuals. Over the years, COSE has crafted and lobbied for legislation to allow for group purchasing of health insurance for small businesses – which keeps operating costs down while providing access to quality and affordable coverage for their employees.

A Tool for Strategy: Scenario Planning
Scenarios are stories about how the future might unfold. For COSE, they are stories about how the health care issue may play out and the subsequent implications for members, small business, and our country. These scenarios are not predictions – instead, COSE developed provocative, plausible stories about how relevant issues external to COSE might evolve and impact the future of health care. These stories take into account various uncertainties, such as the future political environment, social attitudes, regulation, and the strength of the economy, and hypothesize about their effect on the state of health care on our country.

Enlisting GBN: Scenario Consultant Group and World Authority
COSE selected Global Business Network (GBN), the world’s foremost scenario consulting group, to lead a series of scenario planning exercises. GBN has collaborated with hundreds of corporate, non-profit, and government agencies across the globe. A highly diverse group of local and national health care experts — including physicians, respected health care trend watchers, journalists, authors, and executives from numerous small business and political organizations — joined COSE volunteer leaders and staff to drive the discussion about the health care system and where it might end up in the face of future uncertainties.

Scenario Planning Workshops
At the first of a series of two COSE-sponsored Scenario Planning Workshops, held November 28-29, 2006, industry observers discussed a variety of forces at work that create an uncertain future for health care. The group considered the evolving definitions of health and wellness; the evolution of today’s players and their roles in the health care system; the impact of technology and innovation; the impact of consumer empowerment; and evaluating the changing nature of the sources and uses of health care funding.

After facilitated discussions at two major conferences, the group provided the blueprint for four plausible scenarios for the future of health care in the United States. These scenarios revolve around uncertainties for the future related to the urgency for change in the system and the nature of the leaders of that change.

Scenario 1 – Where’s the traction?
The first or “status quo” scenario envisions health care insiders as having no incentive to reform the system, leading to continued erosion of benefits and functioning of the system. Cost shifting to those left in the system provides “band-aid solutions” while the number of uninsured continues to grow.

Scenario 2 – Don’t just stand there – do something!
The second scenario sees popular demand (the pinch of high health care costs) forcing powerful players such as the federal government to make quick but far reaching decisions about health care. Employer mandates and price controls are more prevalent and the system evolves into a minimally federally subsidized program.

Scenario 3 – No news … good news?
Evolutionary change characterizes the third scenario as the urgency for health care reform takes a backseat to other domestic and international political issues. In this scenario, consumers take more control of their own health and health care and market forces slowly bring change to the industry. Individuals and small business are caught up in a rapidly changing, confusing policy and benefits environment.

Scenario 4 – New powers, new system.
In the fourth scenario, in the midst of intolerable costs and a system in need of reform, new players and organizations step in to offer a different take on health care and its financing. New alliances emerge and significant changes in practices cut medical costs. Health information systems arise to become agents of change.

The final report expands on each of these scenarios and provides ideas about how each will impact key players and stakeholders in the future. COSE believes that this report will provide a framework with which policymakers may engage in dialogue and may assist them in reaching better conclusions about the direction of reform.

An Ongoing Dedication
In addition to improving management of COSE programs, the scenario planning findings will have an impact on the political scene. With the 2008 elections looming, health care will once again be a key issue and as they have in the past, and COSE will be a key resource on the direction of health care reform. COSE is already engaged with the Strickland Health Care Team and will share the findings with Governor Ted Strickland to help him enact health care changes in Ohio that will assist small business and create economic development in Ohio.

As a leadership organization, COSE is dedicated to responding to the intensity facing its membership. Through the COSE Advocacy Committee the organization stays current on trends, challenges and opportunities through its ongoing contact with government officials, opinion leaders and health care leaders, and moving beyond through forthcoming strategic initiatives that take the concerns of small business into the state and national spotlight.