The cover of Newsweek could be journalism school fodder for ways to stand out on the newsstand: "The Case for Killing Granny." That headline tugs at the soul, drilling down to the heart of the health care debate. The lion's share of health care costs in this country occurs during the final months and years of life, as doctors work valiantly to prevent our inevitable demise."

I have to be honest. Seeing the headline at a newsstand this morning made me take another direction with this blog. My first thought was to describe how the health care industry could learn a thing or two from lean and other improvement methodologies rooted in manufacturing. Doctors are paid by procedure, not results. The more tests they do, the more money they make. In manufacturing, it's the opposite. Fabricators strive to simplify. Simplifying parts, producing on demand, and making life easier for customers likely will garner more work in the long run ... right?

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Last week I met with my orthopedic surgeon to discuss my upcoming hip replacement procedure. I'm one of the growing numbers, particularly those in the 45 to 64 age group (baby boomers), who are having joint replacement surgery.

I'm not a newbie when it comes to this surgery. My left hip was replaced in 2004, and so far, I would categorize that operation as a great success—so much so that I am ready to have the right replaced.

Yes, there are minor issues.

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Various media have reported that a Whirlpool Corp. factory in Evansville, Ind., has suspended 39 workers who signed insurance paperwork claiming they don't use tobacco and then were seen smoking or chewing tobacco on company property. Tobacco users at Whirlpool pay an extra $500 in insurance premiums annually.

A company spokesperson said that the workers were seen by others smoking in designated areas outside the plant and could be fired for lying, pending fact-finding meetings with each worker. The Evansville courierpress.com reported that Whirlpool denied the use of surveillance cameras.

Reportedly, most of those suspended were production employees, but more suspensions could come, possibly including some administrative staff.

Why lie? And if you're going to lie, why run the risk of getting caught red-handed?

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Our society is driven by responsibility.

This is apparent in many ways: It came up yesterday on the fifth anniversary of the Sept. 11, 2001, terrorist attacks; it’s with many of us every day when we think of the war on terror and the United States’ responsibility to introduce democracy in other countries.

Responsibility also plays a role in less dramatic circumstances, be it in a rush-hour fender-bender (who’s fault was it?) or taking children to school and day care.

But what about health care? In some ways, the responsibility for health care coverage is an open issue: Whose responsibility is it?

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Just the other day I told my boss I needed to have my gall bladder removed.

His response? Better book your ticket to New Delhi.

OK, so this didn’t really happen to me, but it’s astounding to hear that more and more companies are outsourcing literally everything—including their employees’ health care.

To beat the high price of medical care that is only getting higher in the U.S., some employers are sending their staff to other countries for surgeries that would cost tens of thousands of dollars more to be performed in the U.S.

It’s no surprise to many that it’s getting increasingly expensive to do business in the U.S. With government regulations—including those that involve safety and the environment—our nation is just acting as a civilized society, but to do that costs more money than many manufacturers can afford.

Health care is just one more high price to pay to do business in the U.S., and it’s just another challenge facing today’s manufacturers, particularly the small ones, according to Tom Sullivan, chief counsel for advocacy of the U.S. Small Business Administration. During a recent visit to Chicago, Sullivan told me about his concerns for manufacturing and what he feels needs to be done to overcome those obstacles and keep America’s manufacturing base intact and strong.

One good thing about manufacturing these days, he said, is the amount of efficiency the industry has been able to achieve.

“There’s plenty of good news with the efficiency [in manufacturing], once thought to be impossible, with the type of manpower we have through system improvements,” he said.

But the cost of doing business in the U.S. is stifling those improvements, Sullivan said.

“When you look at the cost of doing business in the United States and compare it to China, India, and emerging democracies, you don’t see the same costs in other countries that we have to deal with,” he said.

Letting manufacturers buy new equipment with lower tax liabilities is helping manufacturers, but those initiatives need to become permanent, Sullivan said. In addition, the disproportion between large and small companies’ financial responsibilities when it comes to government regulations also needs to continue to shrink.

“The good news is that four years ago there was a greater disproportion,” Sullivan said. “We’re sensitizing the regulations to the nature of small business.”

But yet another issue manufacturers need to address is outsourcing—whether it’s labor, health care, or other needs that companies feel they can’t afford in the U.S.

“Outsourcing is like a tennis match,” Sullivan said. “The serve is the outsourcing and the volley is the insourcing. If you’re welding overseas, ask yourself, ‘Is there manufacturing opportunity to take advantage of that in the U.S.?’ They have to study the outsourcing/insourcing phenomenon.”

So what’s the next serve going to be? How much are we going to have to outsource before conducting business in the U.S. becomes something that doesn’t pick manufacturers’ pockets clean?

Read more about Sullivan’s conversation with me in the “Industry News” section of The FABRICATOR’s October issue.

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If you’re looking for a new career, maybe you should become a survey-taker. Think of a topic—any topic—and there probably is a related study. Recently I ran across surveys that told me "dashboard dining can affect vehicle resale values" (like we didn’t know that), and "mainland China exported more than 475 million parkas and windbreakers—about 30 percent of the global supply—in the first 10 months of 2005 (only 30 percent?)."

Many companies use surveys as marketing tools: "75 percent of the companies in our market prefer our widget"; "Our hotel was judged among the top in our worldwide survey"; "The drugs we produce cure all ills". The dashboard dining survey was conducted by Kelly Blue Book Marketing Research and Taco Bell, which is in the process of developing "mess-free" products. According to the survey, burgers and fries—neither of which Taco Bell sells—are the messiest foods motorists eat in their cars. Survey possibilities are endless.

Some of the latest surveys will supply topics that will be discussed in future posts on the fabricator blog. Today’s topic is a survey conducted by Watson Wyatt Worldwide and the National Business Group on Health about where health care benefit costs are headed and what companies are doing to keep them in check.

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