Selzer & Company, Inc.

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Selzer & Company, Inc.Selzer & Company, Inc. Case Studies - Non-Profit Organizations & Government

How can you solve systemic problems?


Sometimes when you look only at the squeakiest wheel, you fail to notice the whole car is falling apart.


The Iowa Department of Public Health won a federal grant to explore options to cover the uninsured. The U.S. Census consistently showed Iowa to have one of the lowest rates of uninsured in the nation. Work with a policy expert revealed the high cost of making any meaningful dent in that number.

We recommended looking at the issue more broadly. Our study of Iowa business executives showed the growing burden rising health insurance rate were to Iowa businesses. Our work predicted that businesses would soon not be able to swallow those increased costs and would have to begin passing them onto their employees, even as they wished otherwise. Working with a health economist, we estimated the impact of rising health insurance costs on the state economy and formulated the lost state tax revenue resulting from businesses (and individuals) having to spend more on health insurance premiums.

A study of health consumers soon after confirmed the bigger problem for Iowa is in employees' dependence on their work-sponsored health insurance. They make major life decisions based on what would happen to their health insurance. Rather than appreciating health insurance as a perk, employees see it as a must-have and it now chains them to their jobs. The tail wags the dog.


This work was unlike any study conducted by the states participating in the federal grant program. It won national acclaim from leaders in the health care community and was presented to a meeting of the board of the National Coalition for Health Care. The ideas presented in this work have become part of the common wisdom on how national policy needs to address health care. It is no longer a matter of just figuring out a way to cover the uninsured-it is a matter of much broader reform.

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