LITTLE changes can make a big difference. Save a little every paycheck. Eat a little less. Exercise a little more.
You know what happens.
The account slowly builds for the unexpected expense or long-term goal. The weight, cholesterol and blood pressure drop.
As I think about health care debates in the news, that principle comes to mind.
Should we radically restructure Medicare and Medicaid, the health care programs for the elderly and poor?
Such suggestions frighten people and polarize politicians. So nothing happens.
But to let the two programs continue on their current courses is even more frightening. Why? The trajectory of soaring costs means we're headed for a crash.
So why not make smaller changes - corrections in course that would affect, but not devastate, the budgets of future recipients?
Health care is a far bigger part of the economy than in generations past, and its costs are a rising percentage of most household budgets. Yes, prices for care have risen. But nearly everyone also is consuming more care.
Can we really consume more without paying more?
The Kanawha County Commission is struggling with its own health care crisis.
It recently discovered that employees hired after 1998 cannot count on cheap health insurance from the Public Employees Insurance Agency when they retire.
That's because the county is self-insured. Years ago it decided to stop participating in the PEIA plan, and the PEIA board eventually decided to stop letting the county's retirees pick up coverage.
The rule change applies to people hired after 1998 and affects those employed not only by Kanawha County government, but also by other government employers that don't participate in PEIA for current employees.
The PEIA board had a reason for the change. It is faced with $8 billion in uncovered costs for health coverage pledged to public workers in retirement.
So Kanawha County officials must decide whether to do nothing, return to the PEIA fold, or come up with their own plan for providing coverage to the affected employees when they retire.
The second and third options come with price tags for the county and, thus, its taxpayers.
While the PEIA premiums for both the county and its employees appear to be a little cheaper, returning to the state-run plan would bring the county an annual assessment for the cost of - you guessed it - retiree health care. It would have to carry that figure on its books and, presumably, spend less elsewhere.
Of course, starting its own plan for retiree coverage also would be costly.