Covering retiree health-care liability.

Terrified about the spiraling cost of retiree health care? There are two choices: Prefund the liability or cut back on benefits. But there may be hidden costs for those who choose the latter option: eroding employee motivation, productivity, and trust.

Commenting on the malleability of numerical data, former British Prime Minister Benjamin Disraeli said, "There are three kinds of lies: lies, damned lies, and statistics." But when it comes to health-care costs--particularly those related to retiree health care--the grisly statistics aren't lies, but a damning indictment of a system in total disarray. According to the Commerce Department, health-care costs nationwide last year rose 11.5 percent to $838.5 billion--and on their present course will reach $1 trillion sometime in 1994. Such costs devoured more than 14 percent of economic output in 1992, and the percentage, like every other number in this arena, promises to skyrocket.

On the corporate level, meanwhile, the general cost crush has been exacerbated by a change in financial accounting standards that requires U.S. businesses to account now for the future costs of retiree benefits. Under the new regulation, FAS 106, companies can decide to take a single charge before the first quarter of 1993, or they can spread out the charges over 20 years.

The ruling has been a wrecking ball on corporate balance sheets. Ford Motor--which opted to take a big hit now--swallowed a non-cash, fourth-quarter, after-tax charge of $7.5 billion. Chemical giant Du Pont, too, took a one-time charge of $4.8 billion.

One way out of the squeeze, of course, is to waffle on past agreements. Concurrent with its accounting adjustment, Du Pont decided to reduce health benefits for the 145,000 current and former employees of its U.S. chemical division. In an even more draconian measure, Unisys, a Blue Bell, PA-based computer and defense equipment manufacturer, announced it was phasing out its contribution to premium payments on retiree health care starting Jan. 1. Company contributions will cease completely in 1996.

Solutions, though difficult, do exist for those willing to prefund their liability over time. Roundtable discussion leader Fred Van Remortel, president and CEO of Premit Group, a New York-based consulting firm, describes one option: the formation of a voluntary employee beneficiary association--a tax-free investment trust funded by employee life insurance policies. Among those quick to adopt the strategy was H.B. Fuller, a manufacturer of adhesives and other specialty chemical products. Fuller Chairman and CEO Tony Andersen, another roundtable leader, describes his company's decision-making process both below and in a separate article this month (see "How to Fund Retiree Liability"). Among the benefits of Fuller's trust-insurance vehicle: Its equity appreciation isn't taxable, and contributions to it are deductible.

The retiree health-care problem, of course, is exacerbated by trends outside soaring costs. For one thing, the population itself is aging, steadily pushing higher the ratio of retired to active employees. Another factor: Layoffs associated with tough times have forced many companies to offer lucrative early-retirement packages to their workers in a desperate effort to trim down. In the wake of rationalization, Kansas City-based Armco Worldwide Grinding Systems found itself with an astounding retired-to-active ratio of 2.8-to-1. Nationwide, the ratio stands at 0.5-to-1, although older industries, such as automotive, oil, and heavy manufacturing average closer to 1-to-1.

The discussion that follows is a wide-ranging, often technical exchange of ideas, that provides details for cost-saving tax, investment, and finance strategies. But at heart--as several roundtable participants point out--the issue of retiree health-care funding is essentially a human resources problem. At a time when companies are touting employees as their greatest resource and asking them to take on more responsibility in an increasingly team-based environment, what will be the effect on motivation and productivity of employers doubling back on a benefits promise?

"In dealing with retiree health-care liability, it is important to remember the sacred promise that cements the relationship between employer and employee," warns Premit's Van Remortel. "When you tamper with that, trouble arises."

DISMAL DIAGNOSIS

Fred Van Remortel (Premit Group): By giving a broad overview of the technical nature of the retiree health-care problem, I hope I'm not shot as the messenger bearing bad news.

First, the $64,000 question is how did corporate America get into this mess with respect to benefit promises? The first employer-sponsored health-care plan came about in Texas at Blue Cross Blue Shield. These plans became increasingly popular after World War II, because wages and prices were frozen, and employers sought to reward employees who did a great job during trying times. The solution was non-wage benefits.

These benefits have continued to accelerate through the years. I believe 1965 was the only year that Medicare provided essentially full health care to retirees 65 and older until the end of their lives. Life expectancy continues to climb--from age 69 1/2 after the war to 80 1/2 for women and 79 for men. In many companies, the ratio of retired to active employees also is growing rapidly. As more workers retire, our current retiree health-care system threatens to break the back of the corporate promise.

Providing medical insurance to employees, once considered a relatively inexpensive fringe benefit, has become a costly burden. In earlier, more innocent times, health-care benefits were extended to retirees free of charge. But in recent years, health-care costs have increased exponentially.

An additional burden is FAS 106, legislation that forces companies to account for future retiree health-care liability today. People ask, "How can the Financial Accounting Standards Board do this to us?" Guess what? We did this to us. FASB just demanded that we all be on the same footing, that we all disclose with respect to the present value of a liability. It goes to the balance sheet like any other identifiable and measurable liability.

Every period, an interest cost is tacked on to the obligation--over and above the hard cash expense and the fact that new people are eligible for retirement every day. So we continue to accrue new liability for each new person who retires.

In the spring of 1985, when I worked with the Gates Corp., now known as Gates Rubber Co., I remember being stunned when the company admitted a liability of a third of a billion dollars. However, that liability never appeared on the balance sheets or income statements. At the time, I was convinced that Gates had to be one of the few corporations in America that had such a significant liability with no recognition of it.

Talk about being naive. Eventually, it dawned on me that Gates was not unique. If anything, it was very much in the mainstream.

Nobody wants to talk about this issue. Many CEOs say, "Maybe the liability issue will go away. Maybe we'll have national health care." It's amazing how quickly some CEOs, who are supposed to be the stalwarts of the free enterprise system, have become champions of nationalized health care. They suggest that an autonomous government body can administer a national health-care plan more efficiently than corporate America.

Corporate America may be a lot of things, but it does know how to operate efficiently. Even so, unless it figures out how to play catch-up--catch-up with a 40- or 50-year accumulated liability--it'll be in deep trouble.

Ultimately, there's only one answer: You must fund. You must set aside assets. People are yelling gloom and doom, and screaming there's no tax-favored way to fund this liability. I say there is.

Premit Group spent millions of dollars playing the legislative game, the treasury game, and the IRS game to ensure our funding program was on a secure regulatory and legislative footing. And people still said you can't fund retiree health-care liability. I know what they were doing. They were trying to defeat FAS 106. They were hoping that if corporate America couldn't fund this liability--if they could talk down the standard--FASB would back off. That didn't happen.

There are ways to fund the liability. We have two favorites: a variable life insurance policy inside a voluntary employee beneficiary association (VEBA) and a 401(h) plan.

A VEBA allows funds for future retiree medical benefits to come from life insurance policies taken out on current employees and from underlying asset fund investments managed by the insurance carrier, with the VEBA trust named as beneficiary. The corporation gets a full-blown federal income tax deduction for the contributions to a VEBA trust.

A VEBA is designed to get around the unrelated business income tax imposed by the Deficit Reduction Act of 1984. In 1987, we went to three of the major life insurance companies in the U.S.--Prudential, Metropolitan, and Massachusetts Mutual--and asked how we could eliminate the big liability and the tax imposed on earnings gains on assets.

Prudential was the first to design an investment-grade, variable, self-directed life insurance contract for the VEBA trust. This is a separate account, an insurance contract. It is a cash accumulation vehicle with different investment buckets or sub-accounts that allows you to select your own asset allocation strategy and your own investment managers.

The end result is a clone of the pension trust. The vehicle looks like a 401(a) defined benefit pension trust. An employee benefit trust is established, and the company makes a cash deposit into the trust company. You pick the trustee--it can be Wachovia or First Trust or State Street. The employee benefit trust also purchases and owns life insurance policies.

Most senior executives cringe when they hear the words life insurance. They have been beaten up for years by fellows who come along with the deal of the decade. The premium loads, the mortality costs, and other expenses keep adding up. And sure as heck, your golfing partner who sells insurance during the week has taken you for a ride.

But the VEBA is not the same situation. Loads--including compensations and set-up charges--are usually 150 or 200 basis points in the first year. That's only in the premium paying years.

The ongoing cost of the insurance is 50 to 60 basis points a year. On the other side of the equation, assuming 10 percent earnings gains and a trust tax rate of 31 percent, is 310 basis points of tax, as a function of the principal amount. We're trying to get rid of that.

Arnold Pollard (CE): Why is life insurance necessary?

Van Remortel: The Deficit Reduction Act of 1984 imposes an Unrelated Business Income Tax on the earnings gains on assets in the trust. If you had $100 in the trust, and you earned at 10 percent, the trust tax rate applies on that 10 percent. Having life insurance gets rid of this tax. The other option is to put triple tax exempt municipal bonds in the trust.

Now, back to the plan. The real home run for a corporation making contributions to its pension fund is something called a 401(h). You can put 25 percent of your pension fund contribution into a segregated retiree health-care account called a 401(h) account.

Many corporations are already heavily overfunded on the pension trust side; they are no longer regularly making new contributions from period to period.

The 1990 Tax Act said if you're overfunded--more than 125 percent overfunded--you can do a 420 Transfer. You can pull some of the money from your overfunded pension fund and pay for retiree health-care benefits.

But, if you do that, you must vest the benefit promise: You must guarantee a minimum benefit level. You can't set one level today with no co-payments and no deductibles, and then next year decide to manage the liability by introducing co-payments or deductibles. You're frozen in place for the years you do the transfer.

We know of about 30 companies that have implemented this program. It is a complicated strategy, one that involves a host of legal, tax, and accounting implications.

But aside from these technical matters, keep one thing in mind: In dealing with retiree health-care liability, it is important to remember the sacred promise that cements the relationship between employer and employee. When you tamper with that promise, trouble arises.

Recently, two corporations sued their retirees over health care. When it comes to that, something is wrong with the nature of the relationship between employer and employee. A retiree is rather defenseless: He has a defined income stream, a defined benefit stream, and probably few resources to start screwing around with lawsuits brought by his former employer.

WHAT ELSE CAN YOU DO?

J.P. Donlon (CE): What are other options to a 401(h) plan and a VEBA trust?

Van Remortel: Procter & Gamble created something called an HSOP which is an ESOP funded through a 401(h) account and $1 billion of the company's stock. However, this program was overruled in Washington. At Procter & Gamble the program was grandfathered in, but it is the only company with that type of deal.

Another problem cropped up in September with the SEC's ruling that a company cannot fund its FAS 106 liability with its own securities. If this decision stands, it puts a chink in the armor of a number of companies that had focused on a variation of the ESOP theme.

I think the best approach is to set up a health-care account within the context of a 501(c) (a) or 401(h) plan. Of course, one of the realities is that the benefit stream would be taxable--just as a 401(k) benefit stream is taxable.

The bottom line boils down to this: Do you want a tax-free benefit? Or do you want deductions to the trust? Or do you want tax-free earnings gains? The Treasury Department says you can only have two of the three. The decision is yours.

We know the employer makes tax deductible contributions to the fund, but it is the employee who pays the tax when he retires.

The retiree's health-care benefit stream will be taxed at the very least as a monthly equivalent to premium cost. So if the equivalent of a monthly premium for health care for you and the little lady is $350, that amount is tacked onto your reportable income at the end of the year. And you pay tax on it.

From the employer's point of view, that's fine. But he has to address the staggering accounting issue and balance sheet hit he's left with.

Companies that change from the cash method of accounting to the accrual method of accounting mandated by FAS 106 take a big earnings hit. The only way to deflect that hit is to have assets earnings that can be recognized under FAS 106 as after-tax earnings.

ASSETS AND LIABILITIES

R. Quintus Anderson (The Aarque Cos.): Actuaries say, "This retiree health-care cost has accelerated at 20 percent for the last five years, therefore, it will accelerate at 20 percent per year for the next umpteen years." That, of course, is ridiculous, because eventually you would absorb the GNP.

In terms of accounting, we have liabilities that are even more specific than health care, but they are not recognized on the balance sheet. For example, look at leases. We have a lease footnote that we don't set up as a liability.

Besides that, we have a number of specific income streams that we don't set up as an asset. It's a ridiculous concept.

We're in the same boat as many companies. We are a product of some downsizings. We have a shrinking number of active employees supporting a growing number of retirees. Steel and automobile companies face this problem today. Companies such as IBM and Kodak will face it tomorrow.

Van Remortel: Historically, the employer has not been a prudent purchaser of health care. In the last couple of years, I've seen CEOs direct their treasurers and chief financial officers to get into the benefits and human resources operation and get rid of the health-care liability. It's no longer just a benefits or human resources issue; it's a financial issue. We need to make the best deal--one that takes into account employees' needs as well as employers' cash constraints.

Employees haven't been smart shoppers either. For 40 years, employees traipsed off to purchase health care as if they were drunk. You don't want to have to shop around when you're ill. When you are sick, you go to the doctor or hospital and take what is given to you. It's always expensive, and sometimes services are duplicated. I think the employer has to step up and become a more efficient purchaser of health care.

Richard M. Clarke (Akzo America): But aren't we doing that? Our most important asset is going to become our most expensive one: people. For that reason, we must employ our creativity to find a way out of this mess. There will be managed health-care plans. There will be audits. There will be a financially controllable element, just like inventory. The beneficiary of all this will be the people we employ.

Management still needs to go to a Business 101 class to learn how to deal with people. Most of us don't know what the hell we're talking about. We can manage crises and issues, but when it comes to doing the correct thing for people, we have a hard time saying, "I have to be harsh and disciplined and make a profit, but I'm going to be a nice, good fellow, too." We need more executive training, not further government intervention, despite what public opinion polls seem to indicate. I just hope President Clinton doesn't tax us to inefficiently provide something that doesn't work.

Albert A. Cardone (Empire Blue Cross Blue Shield): All of us have told our retirees, "We'll pick up what Uncle Sam doesn't pick up."

The less the government covers, the more we have to pay. We have to pay attention to what's happening in Washington and hold the legislators accountable. We have to watch out for business leaders who have different agendas, who want to let Washington chew on the problem. They discovered the sharing concept. If you gave the store away, you bet you want national health insurance because you're well above the average, and you want to share with everyone to get down to average. You'll take a payroll tax, and you'll come out a winner.

As of January 1, we implemented a managed care point-of-service product for our 9,500 people. I've put off dealing with the retirees. I want to hold off until the last possible moment before I intrude and reduce their already limited options. In the end, I think we will stay with managed care rather than a cost-sharing approach.

MONEY BACK GUARANTEE

Clarke: I'm amazed at the way people can perform when they realize if they do better than the average, something comes back to them. In our company, we have so many different plans and so many different ways to pool the assets that we've spent a lot of time arguing about who pays the budgeted fee, because some will be penalized.

We've gone to a rebate system whereby actual performance determines the final number of dollars that are spent. So we can tell our employees, "Look, your trust paid the dividend to you. You're not only not sick, here's $150 back."

Under such a system, I think employees are going to surprise us--not just by being healthy, but by helping us to manage this cost.

Anthony L. Andersen (H.B. Fuller): Let me tell you about my experience at H.B. Fuller. The company is 105 years old. We are a specialty chemical company. We've been a public company for 25 years, and we've been recognized as a socially responsible outfit. H.B. Fuller has a solid value system: We rank customers first, employees second, owners third, and community fourth.

Basically, the company helps employees over their tough times, and the people help the company over its tough times. Survival and continuance depend on recognizing liabilities and building assets and equity against them. Planning for liability growth in medical costs requires investments in equities.

Anderson: What are you doing to contain these costs?

Andersen: For one thing, we have tried to make our employees active partners in health-care decision making. We created an employee and retiree committee. The members came back with some very thoughtful suggestions.

Edward L. McMillan (Purina Mills): Do your employees carry any of the funding costs of their benefits?

Andersen: Relative to the roughly $4,500 per year, per person cost we have today, they carry a small amount. We may have to change that in the future.

Bernard J. Korman (Mediq): Have you considered giving your employees the $4,500 and the responsibility of purchasing their care and sharing in the savings over and above that?

Andersen: Yes, we thought about it. But it wouldn't fit in our culture. Our employees trust the company.

In addition, I think it's hard to ask people to tuck away the amount of money that will be required for them as retirees with fixed incomes to handle the bounce in medical care costs.

But besides the funding problems, people also need accurate information about the costs involved. That's where the employee and retiree committee comes in. One funny thing about the committee was that we assumed the members would want our benefits guy sitting with them. But at first they didn't want anybody from the human resources department sitting in on their meetings. A little later, they wanted more information, more facts, and they invited him back in to find out the real costs.

Society is going to pay those costs. The only questions are: What group will pay for them, and who will manage them? It will either be companies or the government.

PERVERSE INCENTIVES 

Phillip M. Nudelman (Group Health Cooperative of Puget Sound): Everyone I talk to in corporate America says, "Let's do something before the government does." We have an excess of physicians, an excess of specialists, who are paid under a fee-for-service system. We bless this motivation system in business, but in the health-care arena, it is one that is causing the problem.

The more you do, the more you get paid. That's an incentive for physicians--people who have mortgages to pay and kids to send to school. There is a huge gray area where about 30 percent or 40 percent of the operations that are done, the prescriptions that are written, the lab tests that are processed may not be necessary at all.

This perverse system of incentives forces us to call for some government intervention. That doesn't necessarily mean government has to pay for or drive health care. It means a partnership where we have insurance reform, provider reform, and malpractice reform to nullify the perverse incentives. At the insistence of the private sector, we are going to get that.

Andersen: In terms of partnerships, the Minnesota state legislature recently passed a law to accommodate insurable interest. Previously, I couldn't own a life insurance policy on a person and be his beneficiary, because, obviously, I'd go out and kill him to get the benefit. Because of the change, we were able to pre-fund our liability through our tax-sheltered VEBA trust.

Clarke: The partnership I would recommend is one with your employees. The problem is, how many senior executives do you think are competent to discuss this issue with their employees? Not as many as I'd like to see.

In order to bear the costs of offering a certain level of benefits, one solution might be to cut the work force. But most of us can't do that. So I have to look at first-dollar coverage and at managed health care. I have to audit the cost to see if the process works. If you don't start dealing with the hard-nosed aspect that you're going to take some things away from your employees, you're going to be in trouble.

We're a Dutch company, and we grew by acquisitions. We decided we would treat all of our retirees the same, regardless of where they came from. They are now Akzo employees and will be treated as equals. Legally, some were entitled to more than others. But we won't insist that those who have less stay with less.

Donlon: So you're going to raise benefits?

Clarke: Absolutely.

William C. Ferguson (NYNEX): But you will reduce the benefits of some?

Clarke: We can't legally do anything to those already retired. But we can grandfather in a reduction for those about to retire.

McMillan: Another comment about partnership with employees and employee participation: We have a self-insured health program. Retirees pay half the premium and the company pays the other half. But as the costs go up, they are passed on to the retirees.

The incentive to those covered is that the ultimate cost of coverage is based on their ability to manage their insurance costs. This is not a total solution. But having the employees assume some responsibility is an important part of the equation.

Jack W. McNutt (Murphy Oil): We have kept our health-care costs to about $2,400 per employee, which is close to the national average. Our employees and retirees share in these costs. That has helped us to successfully limit the liability.

LET'S MAKE A DEAL 

Donlon: Let's talk about trade-offs. How do you get the health-care message across to union labor?

Ferguson: In 1985, our total health-care costs for active and retired employees were $240 million. In 1992, they were $524 million. Our cost per employee is $3,800. Between 1991-1992, the figure went up about 18 percent. We thought we would be able to hold the increase to 12 percent, but for a number of reasons, that just wasn't possible.

But in terms of the labor unions, it's been a tough road. We haven't begun to get a grip on this problem. When we had a strike in 1989, we found out that health care has a very emotional pitch. People were willing to make significant trades, in terms of wage increases, to keep what they had in health care. From management's point of view, that strike boiled down to one basic truth: There is a total cost to the business comprised of wages and benefits. We only have so much to spend; employees decide how. In the short-run, this trade-off works: It helps the corporation manage its total costs. In the long run, however, it doesn't address a problem that is picking up speed.

Landon H. Rowland (Kansas City Southern Industries): We represent a company that has collective bargaining experience with national rail workers. We've inherited some rich benefit programs. None of these people is ready to make the kinds of compromises to adjust to this outrageous inflation in health-care costs.

We also have quite a few retirees. We need to get some measure of control over costs. Our ultimate goal is to be responsive and deal with the realities in our marketplace.

This may disappoint you well-intentioned, socially responsible leaders, but I have to say this: Cost-sharing mechanisms are fine, but they aren't the ultimate solution to the health-care problem.

Ferguson: The fundamental problem is that we are failing to link the cost-causer and the service provider. We have this insurance organization in between.

Whether we like it or not, the government's right in the middle of this. I'm not suggesting we turn to a Canadian plan, but the government is a big presence in health care with Medicare, Medicaid, and all of their bureaucracy, paperwork, and legislation.

We need health-care legislation for 37 million people who aren't covered. Frankly, I'd rather see vouchers given out than to have to pay the cost of health care in taxes. But I'd also like to put a burden on the schools to educate people on how best to spend health-care money.

Korman: Maybe we just need leadership. We need to accept that because of technology and the aging process, we just can't afford to fulfill the expectations that were created in 1965.

Van Remortel: Perhaps there should be a leadership requirement where the titans of industry demand that health-care issues beyond their control be addressed.

Korman: Or, the answer could lie in a difficult concept: rationing.

Ferguson: The only way to ration is to institute a Canadian-type system. In other words, government would control the whole thing. That's not what I want.

Rowland: The question is: Do we have to do something compulsory; do we have to introduce contribution levels and place employees in a preferred provider situation with a point-of-service focus?

Whatever options we choose, I think attractive benefit levels gradually are going to erode, and we are going to be forced to put the burden of making some health-care decisions on employees.

BROKEN PROMISES

Andersen: What worries me is that our retirees, over the long term, will be given much less than they have come to expect based on what we told them. That does not build trust. For example, Minneapolis-Moline, a farm implement business, went belly-up and left 800 people, some who had been with the firm for 20 to 40 years, without pensions or healthcare. How many times can we company-types do that before people realize they have no reason to trust us?

Pollard: I don't think you are entirely right. Between the rate at which health-care costs are accelerating and the vast number--37 million to 40 million--of people who have inadequate coverage, there is no way you can make an unambiguous, unconditional promise to anyone about his retiree benefits.

The realistic way to deal with the situation is to put the facts on the table and to say, "We can't control everything. This is what we can control. But you are materially affected as a retiree by spiraling health-care costs."

Clarke: I think those 37 million people who don't have any health-care coverage should earn it somehow, just as 125 million people are earning theirs.

DIGGING OUT OF A HOLE

Donlon: What retiree health-care strategy could you implement immediately that would make a difference within your company?

Clarke: I think we have to form the same type of partnership with our retirees that we share with our employees. If we reached out more to them, we might be able to reach some sort of compromise.

Van Remortel: We need national leadership. If our ox is being gored, we come out of our hole and fight like hell. But as soon as we've diffused the problem--whatever it may be--we scurry back down the hole. The federal government shouldn't be the leader--it has had 25 years to demonstrate its inability to manage Medicare. There are leaders within the senior ranks of America's corporations who need to put their shoulders to the wheel and to focus beyond their own narrow, parochial interests.

Nudelman: I don't want to sound like an advocate for the government. But it is doing something right: steering retirees to managed-care risk contracts. These contracts can help to get rid of the perverse incentives of our system.

Andersen: I have a mug at home that says, "Carpe Diem." It's a great battle cry: Seize the day. All corporate types such as ourselves are in a footrace with elected politicians to see who's going to get the "atta boy" for solving the health-care problem. There's nothing I love more than competition. But I'm going to win the damned thing.

We have to cover the liability of retiree health-care. We can't duck it. It's not something you can leave at the office and go home and say, "I gave at the office."

David H. Elliott (MBIA): My company is the country's No. 1 insurer of municipal bonds. I'm in an unusual position in that I don't yet have a problem because we don't offer retiree medical care or health coverage.

For the future, however, I think we need a plan that will minimize the cost to the company, while satisfying the long-term and protracted employee concern about retiree health care. I am still looking for the magical solution.

Rowland: I'd like to go back to fundamentals, namely managing retiree health-care liability. For each of us, that liability is different: It could be contractual or expectational. I'm interested in including retirees in the health-care process, in allowing them to participate--both before and after retirement--in the formulation of a health-care plan.

Ferguson: I agree. We must help the retiree figure out how to spend health-care money better--whether it's his money or our money. The retiree problem only seems easier because of Medicare and the fact that we aren't paying for all of it.

We have to start with first principles: The principle of free enterprise, the principle of hooking up the person who spends the money with the person who pays the money, the principle of competition, and the principle of choice.

I wish we could start with a clean piece of paper--free of union contracts and promises--and find the right people who can sit down and devise ways to improve the system so that everybody wins.

Control on access is the bottom line. We must become prudent purchasers of healthcare. We can't give employees and retirees a health-care credit card that doesn't come with a monthly reckoning. Eventually, someone has to pay the bill.