Healthcare has significant effects on business sustainability leading to econ decline.

The United States is facing an economic crisis that is predicted to result, not only in much higher unemployment, but also in a significant decrease in personal wealth. Large corporations as well as small businesses are shedding employees in order to survive. 276 As we well know from the sorry sight of the CEOs of the big three automobile companies coming hat-in-hand to plead with Congress for a bailout, the cost of health care as well as other employment benefits is part of the reason that U.S. companies are not only unprofitable and uncompetitive, but perhaps also unsustainable. 277 As the saying goes, we are all feeling the pain. Is the pain sufficiently universal to create empathy for the less fortunate by the more fortunate; the kind of empathy that might support a redistribution of wealth? With the health care system an acknowledged mess, the economic system shaky enough to scare even those who currently have affordable health insurance, a terrible economy, and a new administration that believes in the power of government to solve problems, is the time right for systemic health care reform? In other words, has the policy window for health reform opened?278

Currently there are many reasons to believe that federal health care reform is an idea whose time has come. The President is a Democrat, and Democrats control both houses of Congress, but this does not guarantee a policy outcome. A recent Gallup poll on Americans' perception of the health care system versus their own health care demonstrates what seems to be an inexplicable attitude: while seventy-three percent of respondents believe that the health care system is in crisis or has major problems, eightythree percent rank the quality of their own health care as excellent or good and sixty-seven percent rank their own health care coverage as excellent or good. 279 Is there a coherent take-away message about what the electorate wants from this administration in the way of health care reform?

Certainly one interpretation is that whatever is done to reform health care, the majority of Americans are not only happy enough with the coverage they have, but more importantly, fear any change that might jeopardize or undermine their own personal coverage. This dichotomy may be even more compelling today because of the real fear of unemployment. It may be that hard times-rather than increasing empathy for those without employment and therefore without health insurance-increase fear and engender protectionism for what one has, however imperfect. In a culture that prizes individualism over community, and believes only in equality of opportunity, those who do not or cannot take advantage of opportunity are considered redundant and undeserving of support by the productive sector of society. 280 Rather, Americans need to believe in solidarity: that all members of society, regardless of their success or failure, deserve social aid in order to insure that everyone's health care needs are met.281 Social solidarity and human decency mean that health care be available to those who most need it, not just those who can afford it.282 Those who most need it are always the sick, and more often than not, those who can least afford it.

Although single-payer universal health care is a political, economic, and cultural non-starter, apparently health reform under the Obama administration is not. While many remember the systematic dismantling of the HSA by the various entrenched players in the health care arena, 28 3 there seems to be general agreement that it will not happen this time around. At the Wharton Entrepreneur Conference, there seemed to be general agreement among all the participants on the panel that health reform is nigh.28 4 As Len Nichols, a health economist and director of the Health Policy Program at the New American Foundation, a non-profit public policy think tank, put it, the current economic slump has "helped to make the case [that] we are indeed in one boat."25 Perhaps something positive will emerge from this economic disaster: the social solidarity necessary to make decent, affordable, health care available to all Americans. This solidarity would help to mitigate the pain we are all feeling, not only for ourselves and our families, but for all the strangers who make up this great nation.