THAT health care is the key issue in the Kroger strike should come as no surprise. Health-care coverage has always been an issue at the bargaining table. Today, it is the primary trigger of industrial strikes.

Only on the surface, however, is this a classic labor-management battle. Medical care is expensive, and getting more expensive every day. And as costs rise, fewer and fewer people can afford protection.

There are two interrelated issues here: (1) access to affordable insurance, to absorb spiraling costs, and (2) reforms and efficiencies in the delivery system, to lighten the financial burden insurance must cover.

Take the issues in reverse order. High cost can be alleviated through a variety of approaches:

• increased preventive care, reducing the incidence of disease;
• reduction of dangerous behaviors, reducing the need for services;
• integration of services, including a reduced duplication of infrastructure; efficiencies of scale, and more efficient use of the system.

The most obvious target, however, is administrative costs.

A New England Journal of Medicine study in 1999 found that 31 cents of every dollar of the total U.S. health spending went not to medical care, but to bureaucracy. Karen Davis, president of The Commonwealth Fund, notes "the U.S. spent $111 billion in 2002 on private insurance and government administrative costs," not including administrative costs related to enrollment. Administrative and clerical personnel accounted for over a quarter of the health labor force.

Here it should be noted, however, that public programs such as Medicare expend less than one-tenth the administrative costs of private for-profit insurance. More than 97 percent of the government dollars allotted to Medicare are spent on the payment of services for health care.

Then there is insurance. As the Kroger strike illustrates, the issue of affordable medical insurance is not limited to the unemployed and the poor. One in four working-age West Virginians, about 300,000, had no health insurance for all or part of 2001. Or viewed another way, over three-quarters of West Virginia¹s uninsured are employed full-time.

The cost of insurance has doubled in the last seven years and is expected to double again in the next five. Recent studies indicate that at the present rate of increase, the average annual cost of a family policy for West Virginians in 2007 will be $16,000!

Employers cannot realistically be expected to simply absorb such costs, and workers cannot expect to enjoy the premium and co-pay structures they have come to expect.

The Kroger strike should be a wake-up call. Neither side can solve the problem by shifting the cost to the other. Industry and workers, health providers and consumers, must all work together for a common solution. And just as clearly, government will have to play a role in the solution.

Progress can be achieved, but only if there is the political will and unity of purpose. Industry must not renege on its traditional responsibility to ensure a healthy work force. It is in their economic self-interest to have healthy employees. And workers must learn to restrict behaviors, like smoking and a sedentary lifestyle, that are deleterious to their health.

There is a saying that each of the participants has a preferred solution benefiting its own interests, and for each group the second choice is the status quo. This can no longer be acceptable.

The federal Health Care Access Resolution presently before both the House and Senate establishes 14 guiding principles for comprehensive universal health care. While this bill does not specify a specific policy, it does establish a commitment to the target of universal affordable health insurance.

On the state level, Gov. Wise has previously voiced support for affordable health-care coverage for all West Virginians. One can only hope that he decides to fight for a legacy of accomplishment in this area in the coming legislative session.

The Kroger workers, and all West Virginians, are watching. Well, they should!

But however the current strike is resolved, they must also get actively involved in shaping an ultimate solution: universal, affordable health care for all West Virginians.

Kurland, a Charleston activist, is health action coordinator for Covenant House.

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