One CEO's Health-Care Crusade

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Diverse Group of Advocates

The conversation this time may really be different. While in the past discussions over health-care reform repeatedly devolved into partisan sniping and, ultimately, inaction, there is now a growing consensus that the current system is broken and a diverse group of powerful advocates is leading the charge. There are businesspeople including Burd and Dicke, union leaders such as Stern, Republican politicians including Schwarzenegger and Presidential contender Mitt Romney, Democratic insiders like Hillary Clinton and John Edwards, and outside agitators such as Moore. "We've reached the tipping point where liberals and conservatives, Republicans and Democrats, business and labor realize that the most expensive option is the do-nothing course," says Karen Ignagni, CEO of America's Health Insurance Plans, an insurance industry trade group.

While Congress mulls incremental changes, states are becoming laboratories for experimentation. Last year, then-Massachusetts Governor Romney signed a bipartisan law to insure almost all the state's residents. It included an individual mandate to carry health insurance and offered financial assistance for poor and middle-income residents.

Schwarzenegger rolled out his proposal in January, with Burd at his side. "It's very important that we fix [the system] as quickly as possible," Schwarzenegger said in an interview with BusinessWeek. "A state ought not only to fix the little problems but to tackle big problems" (see BusinessWeek.com, 7/3/07, "Schwarzenegger's Health-Care Lift").

A Flight from Premiums

But not every executive attending the kickoff event at the state's health agency in Sacramento shared Burd's enthusiasm. Angela Braly, CEO of the nation's largest health insurer, WellPoint (WLP), agrees with several aspects of the Schwarzenegger approach, including universal coverage for children. But she says a guarantee of coverage for all would lead to a flight of healthier people from premiums, until they fall ill. That, she warns, "can destroy the marketplace."

The governor expresses no such fears and hopes that he can enact a bipartisan compromise into law that could become a model for national reform. "All great things start at a grassroots level, not in Washington," he says.

Watching the Sparks Fly

Back in Washington, words are much more common plentiful than action. More than a dozen lawmakers have proposals, the most comprehensive by Senator Ron Wyden (D-Ore.). It would phase out the employer-based coverage system and replace it with a package of government programs and tax incentives designed to cover all citizens. It would include an individual mandate, subsidies for working-class Americans, and a wellness initiative.

If the ideas sound similar to those backed by Burd, there's good reason. The conservative Burd and the liberal Wyden met in 2006 when the disciplined executive sought out the loquacious senator to discuss his business-based vision for health-care reform. Their initial hour-long appointment spilled into overtime, then into the Dirksen Senate Office Building stairwell as Wyden hurried away for a vote, onto the underground tram, and up and down the corridors of the Capitol. "You could see the sparks fly and the ideas going around and around in their heads," says Kevin Herglotz, Burd's top government-relations lieutenant. When Wyden unveiled his proposal in Portland, Ore., Burd was there to lend his support.

Still, veterans of past health battles predict that it could take three to five years for Washington to act. "We are a country of muddlers," observes Washington business consultant Art Lifson, a former Cigna (CI) vice-president active during the Clinton-era debate. "We seem to be much more comfortable making incremental changes."

All Eyes on New Hampshire

Two things could change that: the 2008 election campaign and SiCKO. Moore's movie skewers health insurers and Hillary Clinton, among others. The filmmaker is headed to New Hampshire to try to increase the visibility of the issue in the state that holds the first Presidential primary of 2008.

The Democratic frontrunners have beaten him to the microphone. Senators Barack Obama (D-Ill.) and Clinton (D-N.Y.) already have delivered speeches promising universal care and cost containment. Edwards, the 2004 nominee for Vice-President, has gone further, pledging to raise taxes on the wealthy to fund health insurance for all.

Politicians and directors aren't the only ones trying to keep the issue alive in New Hampshire. On June 25, the Business Roundtable's Castellani, SEIU's Stern, and AARP Chief Executive Bill Novelli held their own rally on the state house lawn in Concord, N.H., to push their pledge to make health security the top issue of the '08 campaign. "The American people are way, way ahead of the politicians on this," says Jim Papian, spokesman for the United Food & Commercial Workers Union, which has worked with Safeway's CEO on health policy issues.

Burd presses on, sensing a rare opportunity for sweeping change in the American economic landscape. He hopes to recruit even more evangelists to the cause, from business and beyond: "I don't want to be the only guy out there preaching the gospel."

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Richard S. Dunham is a senior writer for BusinessWeek. Epstein is a correspondent in BusinessWeek's Washington bureau.