Robert Basile employs 45 people at his real estate development company in a rural corner of Berks County, not far from the Montgomery County line.

John Dodds works with low-wage earners and the unemployed in Philadelphia.

Different worlds, but the two men agree that it's important for the president to pay more attention to health care.

In President Bush's State of the Union address Tuesday evening, he talked about providing more health-insurance coverage using tax credits to help finance affordable plans through private insurers. Also, employees whose health benefits exceed a federal limit would be taxed on the difference.

Some analysts doubt that the plan will get anywhere - partly because it would help only three million to five million of the 46 million uninsured Americans and partly because the Democratic majority in Congress has different ideas about how to handle the problem.

But everyone agrees that something needs to be done.

"It's the most out-of-control expense category in our overall operating budget," said Basile, a principal in the Basile Corp., of Douglassville. Also, it is a distraction. "We have to spend a lot of time on it," he said.

"It's interesting that he is finally beginning to pay attention to the issue of the uninsured," wrote Dodds, director of the Philadelphia Unemployment Project, referring to the president. Dodds participated in an Inquirer online chat yesterday.

"The question is, will giving less coverage to the high end of the insured reduce health-care costs?" Dodds wrote.

Medical economist Mark Pauly, a Wharton School professor, another participant in the chat, said: "The most interesting part is the proposal to change the tax treatment of health insurance by the well-off insured that is intended to reduce their levels of medical insurance and therefore medical-care spending.

"This addresses what economists think is the easiest distorted incentive to correct," he wrote. Employees, he wrote, tend to choose the most expensive insurance plans when they are not taxed on them. Health benefits now are not taxed.

Tax breaks are not the point for the unemployed and uninsured low-wage workers, Dodds said.

"They can't afford the monthly premiums, and they tend to be in low tax brackets already," he said. The working poor who are uninsured "are living paycheck to paycheck. Individual policies can be denied due to pre-existing conditions."

Glenn Alvarez, a benefits analyst at Lincoln Financial Group in Philadelphia, said he thought that whatever the president proposed would be dead on arrival in Congress.

Alvarez attended a breakfast conference yesterday at the Four Seasons hotel held by Mercer Human Resource Consulting L.L.C. on how to reduce health-care costs by improving employees' health.

"The benefits package is part of our tool to recruit and keep employees," he said. "We have to be competitive with everyone in the market. But, at the same time, we have to watch the costs, so we're walking a tightrope."

Paul Fronstein, director of health research and education at the Employee Benefit Research Institute, a private nonprofit research group in Washington, said he doubted whether Bush's proposals would come to fruition.

But if they did, he said, "it would be the end of employment-based benefits as we know them."

Employers would rather give employees the money and let them shop on their own, he said. The result would be that the healthiest employees would get the best plans and the sickest ones, whose costs are now covered when their health risks are spread over a larger group, would find it difficult to obtain affordable insurance.

Still, he said, employers would be glad to have it be someone else's problem. "Employers have been struggling with health-care costs for years," he said. "They are tired of the headache."

Contact staff writer Jane M. Von Bergen at 215-84-2769 or