Canadians in four provinces and one territory face elections in October. While voting is an act of citizenship for individuals, many organizations seek to understand and sometimes influence issues that are important to them as well. But for most employers, health hardly ever makes the A-list of mission-critical policy and program issues. Organizations might need to get more political and more strategic about their very large role in our health care system.

To start, employers (and often employees) contribute billions to support health services. Consider these recent figures:

• Employer-sponsored extended health and dental plans cost $21 billion in 2008. An estimated $6 – $7 billion more was paid for disability plans.
• In 2009, workers’ compensation boards collected $8.8 billion in employer premiums.
• Payroll-based health, or health and education, taxes are levied in ON, QC, MB, and NL. The Ontario Employer Health Tax collects about $4.5 billion.
• Premium taxes are collected by all provinces, and sales tax is also paid on premiums in ON and QC. In 2009, Ontario employers paid $390 million in premium tax, and $1 billion more in retail sales tax on group plans.
• Canada Pension Plan Disability Benefits total $3.6 billion, and Employment Insurance pays out over $1 billion in sickness benefits.

Between employers (the lion’s share) and employees, these figures alone total almost $47 billion. The employer stake is very large, and very fragmented. Putting these numbers together is the only way to begin to shape a business case in strategic and, yes, political terms.

With so much money at stake, why aren’t employers on board? Where are the organizations that represent their interests? The Canadian Federation of Independent Business and the Chambers of Commerce could say much more about the overall health system and the scope and importance of employer-funded or sponsored health services. Insurers could provide much better industry-level data to help employers benchmark their benefit plans, or to help researchers better understand the importance of private health insurance.

It turns out employer advocacy with governments would likely be supported by employees. The 2011 sanofi-aventis Healthcare Survey, through its 1,598 plan member respondents, reported that a strong majority (86%) of plan members agree governments should actively support workplaces that promote better health and fitness. And almost two-thirds (63%) said governments should be highly involved in encouraging healthier employees and workplaces, with 30% more believing there should have at least moderate engagement. Finally, respondents agreed there should be tax incentives to encourage employers to provide (64% agreement) and individuals to participate (73% agreement) in worksite health initiatives. The survey report makes it clear that employees are well aware their employers have an important stake in health, and see opportunity in closer collaboration with governments.

Such arguments are made not to divide us and splinter the debate even further, but to see opportunity by working together. One of my academic mentors (Dr. Terry Sullivan) reminded me of a good example. Private plans could get better clinical and economic reviews by using and helping to fund organizations like the Canadian Agency for Drugs and Technology in Health, and the pan-Canadian Oncology Drug Review. More Canadians would get the benefit of better evidence. Employers could stop paying for products and services for which there is no compelling efficacy or cost-effectiveness. The employer influence might help speed these reviews, and ensure they become more relevant to workplaces. There are advantages for everyone in exploring such a model.

The famous Dofasco (now ArcelorMittal Dofasco) slogan "Our product is steel. Our strength is people" explicitly links products, performance, and the workforce. Looking after all those assets by taking a strategic and collaborative role in health issues fits well with a longer-term strategy to prevent illness and injury and improve access to health services.

With so many provincial elections at hand, the opportunity this time around is lost. But there will be a next time, and perhaps employers of all sizes and sectors will begin to engage governments in thoughtful initiatives in the interest of both parties, and the citizens they represent.

Sources: (1) 2011 sanofi-aventis Healthcare Survey, available at www.sanofi.ca. (2) Canadian Life and Health Insurance Association (www.clhia.ca): Key Statistics, and selected Budget Submissions. (3) Canadian Institute for Health Information (www.cihi.ca). (4) Annual reports of provincial Workers’ Compensation Boards, available at: www.awcbc.org. (5) 2011 Ontario Budget, available at: www.fin.gov.on.ca. (6) Reviews of selected national and provincial websites of Chambers of Commerce (available at:www.chamber.ca). (7) The website of the Canadian Federation of Independent Business (www.cfib.ca).