If Businesses Can Mandate Vaccines, They Should Mandate Affordable Healthcare, Too

By Robert Pearl, M.D., Contributor
If private institutions can save lives with vaccine mandates, could they also save lives by lowering the costs of medical care? getty

Earlier this year, Houston Methodist gave its 26,000 hospital employees an ultimatum: Get vaccinated or get a new job. It was one of the nation’s first vaccine mandates. And it was a big, multilayered risk: with legal, financial and ethical consequences all hanging in the balance.

In the end, more than 150 hospital employees refused, filed a lawsuit and lost in spectacular fashion. U.S. District Judge Lynn Hughes called the plaintiff’s anti-vaccine argument “reprehensible,” ruling that the hospital’s policy was “a choice made to keep staff, patients, and their families safer.”

Private sector gives U.S. vaccination rate a shot in the arm

Thanks to the courage of hospital leaders and the wisdom of the courts, Houston Methodist is now reporting a nearly 100% vaccination rate among its workforce.

With legal backing and majority support from U.S. workers (52%), big businesses like United Airlines, Google, Facebook and dozens of other top-tier companies have issued ultimatums of their own. And though the White House had insisted for months it would not force workers to comply with a vaccine mandate, the Biden administration signaled last week that OSHA, the workplace safety regulator, will soon develop rules requiring vaccinations or once-a-week testing for companies with more than 100 employees.

And assuming these public and private-sector mandates hold up in court, we’re left with one very important public-health question: Do ultimatums like these actually keep people safe?

The answer is more yes than no.

Mandates have kept Americans safer, healthier

“There is strong behavioral science evidence that [vaccine] mandates will be highly effective,” according to Lawrence O. Gostin, global health law professor at Georgetown University, writing in Scientific American.

To demonstrate, Gostin notes, “Influenza vaccination is highest among healthcare workers (94.4%) in settings where flu shots are mandated” and that “the private sector has wide discretion in setting conditions for workers and customers.”  

In addition to past successes, businesses are seeing progress with vaccine mandates right now. One week after Delta Air Lines announced plans to charge unvaccinated workers a $200 monthly fee, the company’s chief legal officer Peter Carter told Bloomberg, “We went from 11 [worker vaccinations] a day to 55 in one day.”

According to a survey conducted by Willis Towers Watson last month, more than half of U.S. companies planned to impose COVID-19 vaccine mandates in the workplace by the end of 2021 even before the OSHA announcement. While it might take more than mandates to stamp out the coronavirus, our nation is undoubtedly safer because of the private sector’s bold leadership.

Pivoting to protect workers from high-costs of healthcare

So, why stop with vaccines? American businesses have the ability and opportunity to solve our nation’s other major medical crisis: the unaffordability of healthcare.

If private institutions can save lives with vaccine mandates, they could also save lives by lowering the costs of medical care. To do so, businesses must team up, demand greater efficiency and quality from healthcare’s stubbornest forces, and drive innovation in an industry that’s still stuck in the last century.  

It’s the moment of truth for medical spending

As a national line item, healthcare consumes close to $4 trillion a year, comprising 18% of the U.S. GDP. By the start of the next decade, yearly healthcare spending will surpass $6 trillion.

Combining those costs with debt from federal stimulus packages, Americans will owe a staggering $40 trillion by 2030, the highest debt in U.S. history. To put that number in perspective, picture each man, woman and child owing lenders $110,000 (plus interest).

In response to growing unaffordability of medical care, 80% of CFOs are expected to implement aggressive cost-containment measures this year, which include scaled-back employee benefits, further layoffs and accelerated automation.

U.S. employers can no longer keep pace with 5.5% annual healthcare rate increases, which radically outpace overall inflation. Their employees, who’ve long offset rising costs through their enrollment in high-deductible health plans, can no longer shoulder the financial burden. Already, half of Americans say one large medical bill would force them to borrow money, sell their home or declare bankruptcy. Right now, U.S. patients owe collection agencies over $140 billion in unpaid medical bills.

Since 2004, independent studies have confirmed that the United States has the “most expensive and least effective” healthcare system in the developed world.

In those studies, the nations with the highest-performing healthcare systems all have one thing in common: universal coverage. Here in the United States, calls for some form of Medicare expansion or “single payer” system have grown louder and louder. And, for years, I have explained (here, here and here) why it won’t happen. There are too many political and economic barriers standing in the way of a legislative solution to our nation’s runaway healthcare costs.

The time has come to accept the facts: An imperfect solution that businesses can implement is better than an ideal one that politicians never will.

An imperfect solution we can implement (in a single lifetime)

Our best bet for improving healthcare access and quality is to turn to leading companies like Microsoft, Netflix, UPS, Walgreens, Walmart and Walt Disney Co.—the same businesses that boldly imposed vaccine mandates.

About 155 million Americans (nearly half the U.S. population) receive employer-sponsored health insurance from companies like these. The private sector makes up the nation’s strongest unofficial payer network. Were they to join forces against rising costs, U.S. businesses could revolutionize the American healthcare system.

Success in this bold venture would not be easy. Companies must not only demand lower prices, but they must also hold the healthcare industry responsible for systemic change. Unless they do, insurers will merely skimp on coverage rather than making the improvements necessary to keep employees healthy and safe.

A letter to America’s insurance companies and healthcare providers

To that end, here’s a letter the CEOs of Fortune 500 companies could sign today, triggering the transformation of American healthcare by putting insurers and providers on notice:  

We the leading purchasers of health coverage in the United States are sick and tired of overpaying for healthcare that does not meet our standards of quality, convenience and affordability. Be advised that five years from today, the businesses included in this letter will only purchase health-insurance coverage that fulfills the following criteria: 

1. Prepaid, high-quality healthcare. We reject the current ‘fee-for-service’ payment model that reimburses doctors and hospitals for each new test and treatment because it leads to over-testing and over-treating patients. The fee-for-service model must be replaced with a prepaid reimbursement system known as “capitation,” whereby health insurers pay doctors and hospitals an annual, lump-sum for the totality of care provided to our employees. We know that capitation gives doctors incentives to focus on the quality of care they provide, not the quantity of it. Based on decades of research data, we are confident this payment model will lead to higher rates of medical prevention, lower rates of chronic disease, fewer medical errors and less wasted spending.

Additionally, we recognize that reducing costs won’t be enough to maximize employee health. That’s why we also demand a restructuring of the way healthcare is delivered. All providers in our networks will need to be part of a larger, integrated health system that prioritizes primary care, preventive medicine and the effective management of chronic diseases. All providers of care—including doctors and nurses—must answer to a centralized leadership team (just as our employees do). Those leaders will need to be accountable for continuous improvements in quality, patient satisfaction and care innovation while meeting our annual cost requirements.

2. Tech-powered healthcare. A high-quality, low-cost healthcare system cannot function without 21st-century technologies. Our employees deserve healthcare that is technologically advanced and convenient. All providers in our network must offer 24/7 access to excellent physicians via telehealth solutions (video visits, secure email, etc.). All providers must have 24/7 access to patient information via a comprehensive health-record system, and they must use data from those systems to make advances in evidence-based care. These changes will not only improve clinical quality but also result in cost savings with fewer delays in treatment, fewer ER visits and a healthier workforce overall.

3. Socially conscious healthcare We recognize that 30% of health outcomes are driven by circumstances that occur outside of healthcare settings. The lack of good food, jobs, housing and transportation all contribute to poorer health in our communities. We expect that the combination of capitation, care redesign and information technology will give doctors and associated health systems more time, incentives and resources to address these problems. However, since everyone must play a part in fighting health disparities, we will invest 10% of our total cost savings from this new healthcare model toward public programs for better nutrition, jobs, housing and transportation. 

Signed, American Businesses for Better Healthcare

That’s, of course, only the beginning. But it’s a necessary step forward. Over the past 30 years, elected officials have shown an inability to legislate solutions for the growing unaffordability of healthcare and our nation’s lagging clinical outcomes.

When the opportunity to protect the health of tens of millions of Americans through mandatory vaccinated arose, businesses and private institutions led the way. Now they have the opportunity to do the same when it comes to the urgent issues of medical costs, convenience and quality.

As it is with Covid-19, people’s lives and livelihoods depend on it.

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