In October, an internal Wal-Mart memo provided an insider’s view of the debate about health care going on inside the world’s largest retailer.

Prepared by a Wal-Mart executive, the memo outlined measures the company could take to reduce its spending on health care. Essentially, the memo laid out a strategy to attract young, healthy workers and to create obstacles that might prevent older, sicker or disabled workers from applying for a job.

During the same week, Wal-Mart announced that it was introducing a new, lower-cost health insurance plan that would place a greater emphasis on preventative treatments and keeping workers healthy than its earlier plans, which were largely out of the price reach for most of its workers.

For Wal-Mart, the new insurance and potential strategies are all about reducing its costs. But the implications are much broader. As Wal-Mart goes, other companies – and especially larger retailers – are likely to follow.

On Monday, the Sun Journal reported results of a long and difficult effort to gather information about Maine’s largest employers and the conditions faced by their workers. The results mirror similar studies conducted elsewhere. Wal-Mart ranks as the state’s third largest employer, behind Hannaford Brothers Co. and L.L. Bean Inc., and just ahead of Bath Iron Works at No. 4 and Maine Medical Center at No. 5.

Of the 6,500 people who work for Wal-Mart, 1,001 received public support from the state in the form of MaineCare, food stamps or TANF. National numbers add more context. According to Wal-Mart, about 46 percent of the children of its employees either don’t have health insurance or rely upon government-provided services. About 20 percent of the company’s workers have no health insurance at all.

Earlier this month, Wal-Mart, reacting to the loads of negative publicity it has received, held a conference and invited scholars to present papers examining the company’s effect on the economy. Wal-Mart deserves credit for not stacking the deck in its favor because the reviews were mixed, at best.

On the positive side for the company, researchers found that Wal-Mart increased employment in the communities where it was located by 1 percent to 2 percent over the long-term. Another study found that the stores’ low prices saved consumers about $263 million in 2004, or about $895 per person.

Researchers also found the Wal-Mart’s presence depressed wages in the area, sometimes by as much as 5 percent. Michael Hicks of the Air Force Institute of Technology in Ohio and Marshall University studied Wal-Mart’s effect on state health care spending. He found that each Wal-Mart employee added $898 in Medicaid spending and that a 1 percent increase in the company’s market share in a state translated to a 1.5 percent increase in Medicaid spending.

In addition to purchasing cheap imports, largely from China, Wal-Mart has maintained its low-cost culture by shifting some of its health care spending onto the government. In Maine, where the state has generous eligibility requirements for MaineCare, that can be a substantial cost.

Maine’s fourth largest employer, right behind Wal-Mart, is BIW, with about 5,500 workers. Of those, only 8 (or about .15 percent) receive public assistance from the state. BIW is locked in a struggle for its life with a Navy that seems determined to kill it off and a larger shipyard in Mississippi. At what point does the temptation of the example set by Wal-Mart begin to bleed over into other industries, long known for good pay and benefits?

Wal-Mart is a publicly owned company that exists to make money for its shareholders. It has little incentive to provide better pay or benefits to its workers. But the fragmented health care system in the United States depends on employers to provide access to insurance to a majority of the population. If cost trends continue, the Faustian bargain between the government and employers to provide health insurance will collapse, leaving more people to fend for themselves or do without.