Dave Westmark has a big-picture view of the health-benefits controversy.

As a member of the Tillamook School Board, where he has served for the past 12 years, he helps negotiate benefits and other issues for that community’s more than 200 school workers.

As vice president of human resources at Tillamook Cheese Inc., a post he has held since 1990, he designs and negotiates benefits programs for 550 union and non-union employees.

He calls health benefits “the Number One or Number Two negotiating item that people spend the most time on.”

“Everyone knows the cost is going up and there’s only ‘X’ amount of money to spend,” Westmark says. “So, difficult decisions have to be made on both sides. Coming to a compromise is becoming more difficult.”

Westmark has seen double-digit increases in health-benefits costs at Tillamook Cheese. As a result, he says, employees now pay more out of their own pockets and receive less company-paid coverage. Plans that once covered 100 percent of care now cover 80 percent. Also, employees are required to pay part of their premium.

For the future, Westmark expects to see increased use of higher deductibles and what are called health reimbursement accounts for his company’s workers. He says employees might have to pay $1,500 or more each year for health care – at least five times higher than their current deductibles – before their insurance would start picking up the tab. The high deductible would make it easier for the company’s health-insurance provider to offer a lower premium.

To ease employees’ financial pain, the company would contribute to an account that workers could use for their care. A balance in a worker’s account at the end of a year would be carried over into the following year, allowing the account to grow.

Westmark says that when employees have to pay more out of their pockets for health care, they become better consumers. He says employers need to support that change by providing – or by working with their insurance carriers to provide – solid information for employees on choosing doctors, hospitals, medicines and treatment methods.

Westmark says the private sector has a jump on school districts in this aspect of health benefits. He says school districts’ history of providing full coverage has shielded workers from most decisions about health-care costs.

He knows that the health-benefits issue raises difficult considerations for employers. Appearing to cut back on benefits can make it harder to keep and reward good workers. Nonetheless, he says, it’s time for school districts to put more of the responsibility on their employees.

School workers, he says, “have to become more involved in making good decisions about their health care.”