In a message reminiscent of one that former Alcoa chief executive officer Paul O'Neill has delivered many times, Merck & Co.'s top officer yesterday exhorted Pittsburgh's corporations to involve themselves in reshaping the nation's health-care system.

In a speech to the Allegheny Conference on Community Development and in a meeting later with the Post-Gazette's editorial board, Raymond V. Gilmartin, chairman, president and CEO of the New Jersey-based pharmaceuticals giant, said the health-care system "is way under-performing its potential."

He said corporations can force change by bringing the same purchasing standards to bear in obtaining health benefits for employees as they do in purchasing the goods and services they need to make their products.

Gilmartin called on employers to begin looking as much at the "value" of the health care their employees receive as they do at the price.

Hospitals and doctors historically have resisted efforts to measure the quality of care they deliver, and corporations once deemed that impossible. However, Gilmartin noted that the Pittsburgh Regional Healthcare Initiative, which O'Neill helped found and now serves as CEO, represents efforts in the right direction.

He urged business leaders to embrace such efforts, which attempt to study the outcomes of patient care. Absent data on outcomes, business also can look to data on how regularly institutions and doctors provide certain kinds of care as a good indicator of their quality. The more often they dispense particular treatments, the better they're likely to be at doing so, he said.

Gilmartin said better quality in medicine is in the business community's self-interest because it could help tame skyrocketing health-care costs. "In the 1980s, the conventional wisdom was that quality really was all the same," and that "the only way to control costs was [by setting] global budgets," he said. "That's changing."

Gilmartin said rising numbers of uninsured Americans and the lack of prescription drug coverage for many retirees covered by Medicare also underscore the failings of the nation's health system. Providing care for the uninsured, many of whom delay treatment because they can't afford it, represents a "hidden tax" on businesses whose premiums reflect the cost of that care, he said.

To provide coverage for those who lack insurance, he advocated expansion of tax-subsidized coverage now available to certain workers who lose coverage when they lose their jobs. The subsidized coverage, at the moment, is restricted to workers who have been displaced by foreign competition or whose bankrupt employers have had to turn their pension plans over to the Pension Benefit Guaranty Corp., a government-sponsored insurer.

He said he was averse to national health-care plans like Canada's, and said seeking drugs from Canada wasn't the solution for seniors who lack prescription coverage. He said there's no assurance that drugs purchased there were produced there or shipped from reliable sources and said "counterfeit" drugs pose a "significant" and dangerous problem. Government price controls are the main reason drugs were less expensive in Canada, he said.