Porter article in NEJM on health care reform principles

There's an article by Michael Porter in NEJM early release this week. For those of you who don't know Porter, he is a Harvard Business School professor and founded The Montior Group (consulting).

NEJM -- A Strategy for Health Care Reform -- Toward a Value-Based System.

He has a few major points -

1) health insurers should compete on value instead of cost - they should be required to measure and report their subscribers' health outcomes, thus driving consumer-driven value purchasing of insurance

2) Employers should be kept an integral part of health insurance in America - they have a vested interest in keeping the health of their employees

3) Eliminate the burden on people who have no access to employer based health coverage - reduce tax deductibility of insurance purchased be individuals and through employers

4) Make individual insurance affordable through large regional (not national) high-risk pools that can spread risk

5) Provide income based subsidies to lower income people to buy insurance

6) Everyone must be required to purchase insurance

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I am pretty much on board with most of these proposals (especially six - was one that made me more of a Clinton fan during the primaries, and I'm glad Obama is now considering it) . But number two is a bit funny - since most people switch their jobs and careers numerous times in their life, I'm not convinced employees have that much stake in improving quality of their employees. The value of any interventions they undertake are likely to be accrued by Medicare in the end. So seems to me that if the average employee is only around for two to five years, that employers have little incentive to improve their employees health care.

Now, there may be other reasons to keep employers in the health care insurance game, but I'd like to hear them, because I haven't been convinced yet.