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[politics] Healthcare reform and the liberation of labor - Lakeshore — LiveJournal
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Jay Lake
Date: 2010-03-23 05:52
Subject: [politics] Healthcare reform and the liberation of labor
Security: Public
Tags:healthcare, politics
An observation I've made before, and haven't seen covered much in the press or the commentariat (though maybe I'm not looking in the right direction) is that healthcare reform will quite possibly significantly remake the employer-employee relationship.

Since about WWII, the most ordinary model for Americans to receive healthcare coverage (ie, insurance) has been through the workplace. It's my understanding that this was deliberate industrial policy at the time, presumably to stabilize the workforce and countervail the pressures of unionization. Everyone in the workforce today entered the workforce under that assumption. You get a (decent enough) job, you get health insurance.

That bargain started to fall apart in the 1980s with the increasing use of part-timers in blue collar jobs and contractors in white collar jobs. That, of course, was all about reducing the cost of benefits for the employer. Companies like Wal-Mart and McDonald's build their entire cost-of-labor around such measures, as do many high tech companies. Part of the reason for so many millions of uninsured and underinsured today is the erosion of benefits in the non-unionized workforce.

(I am neither a healthcare historian or a labor historian, so take all of the above with a grain of salt.)

The profit-driven nature of market-based insurance has introduced so many restrictions that for a lot of workers, myself included, the only access to health insurance is through non-qualifying employer-sponsored groups. In my case, one of my dependent insureds has a chronic illness that barred me from the private market for years before my own cancer made me uninsurable, so this has long been an issue in my professional life.

The full terror of unemployment for someone like me isn't loss of income, it's loss of healthcare coverage. The last time I was unemployed, 2002-2003, my COBRA costs were $1,400 per month. Which was more than my unemployment compensation.

How many millions of Americans with insurance are tied to their jobs by similar issues?

If HCR delivers what it's said to deliver (assuming the Republican ideologues in the Senate don't find some last-minute way to halt the reconciliation bill), those millions of Americans will no longer be tied to their benefits package. Yes, most of us need an income. (And fortunate are you who do not.) But incomes don't have to be paychecks from statutory employment.

I predict a sharp increase in labor mobility in this country, along with a parallel sharp increase in new small businesses as well as independent innovation. Because what we've just done is unchain people from their workplaces. There's a lot more ways to make money than there are to find health insurance. Obama, Pelosi and Reid have just freed us to explore those ways. Which would seem to me to be a conservative ideal, would it not?

What will the social consequences of this be? I don't know, but I'm guessing some pretty fundamental changes are in store for American society over the next years, if the GOP doesn't freeze all of us out. Increased economic prosperity and personal opportunity, reduced unemployment, and better treatment of employees by employers as competitive options open up for the workforce.

Optimism? Sure. But think about it. Take this idea right down to the personal. How many people do you know who are trapped in jobs for the healthcare?

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User: (Anonymous)
Date: 2010-03-23 12:59 (UTC)
Subject: (no subject)
My husband. He wants to go back into private practice, but he had a CABG fifteen years ago and can't get private insurance, and he's a few years too young for Medicare. We're literally counting down the months until he can quit this job and he can COBRA for long enough to make it to Medicare.
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reddiana
User: reddiana
Date: 2010-03-23 13:02 (UTC)
Subject: (no subject)
Whoops, the previous anonymous commenter was me.
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User: nicosian
Date: 2010-03-23 13:26 (UTC)
Subject: (no subject)
wholeheartedly concur, sir.

I know more than a few contractors, freelancers, entrepreneurs of varying flavor that are able to do just that, and even HIRE people as their business grows, because health care expenditures aren't dumped on the business so much to the point that they can't do this.

My employer can't lord my health care access above me to get me to work. ( it evens out considerably, the abuses that employees suffer for, just to keep their job and insurance if they're so lucky as to have it)

We don't have to take crummy jobs just for coverage and it's definitely a factor in how fast we were able to get on our feet again after a round of 2001 layoffs. ( that and again, no massive COBRA style scheme of payments.)

Like you, I'm fairly untouchable by a private insurer but it's never been a worry in canada.

And our taxes? Ain't that bad. Less than my friends making half as much in North Carolina, when we sat down and talked numbers.

I know way too many american friends stuck in jobs JUST for insurance alone. ( and more stuck in jobs that had it and cut it or don't offer it at all, and a few on disability because they can't afford premiums with a pre existing but if they had the medical care they'd be happy as a point of pride, to be working. Is it not far cheaper to cover someone's modest health care cost and let them work? The US system is so penny wise, pound foolish.)

Our system isn't perfect but the boogeymen of 6 months for an MRI! government telling us what to DO! rationing! waits forever! simply isn't the case. Surgery a month ago ( a surprise unplanned not quite emergency, was very well handled and I got care I couldn't probably dream of in the US, being as I said, completely untouchable.)
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cathshaffer
User: cathshaffer
Date: 2010-03-23 19:48 (UTC)
Subject: (no subject)
I may be wrong, but I think you will still have the large health care payments if you are unemployed. Even now, COBRA is generally more affordable than an individual health plan. The government will have tax credits to offset the cost, but I think you only get a full credit if you are at or below the poverty level. Am I right? Does someone know? The bill is pretty complicated.
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User: deire
Date: 2010-03-23 13:37 (UTC)
Subject: Yo.
Contract IT work for 6 years. Workers get angry at the contractors, but seriously--no one prefers contract work to being a 'real' employee with benefits.
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Amanda
User: cissa
Date: 2010-03-23 22:00 (UTC)
Subject: Re: Yo.
Not always, actually. My husband worked as a contractor for over 15 years, out of choice. Now, we were lucky because we could get fairly reasonable health insurance through a trade group he was in. But- the company he worked for most of that time was willing to pay him 3-4 times as much as a contractor than they were if he'd accepted permanent employment with them (and yeah, that includes the benefits). It had to do with how their budgeting and accounting procedures worked. It made no sense overall, I grant you- but the contracting was better for them than hiring him at an appropriate salary would have been.

But- they cut costs and dumped the contractors, and he's since found a regular employment gig that he likes even better, at a reasonable percentage of the contracting money.

His contracting situation, though, was not all the unusual for a certain se4gment of high-tech workers during some span of time. Mostly, the employees envied the contractors in that very particular situation.

Still: what he has now is better (better company).
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Paul
User: horrorofitall
Date: 2010-03-23 13:44 (UTC)
Subject: (no subject)
Well the history of labor in the US is a bit more complicated than you outline here, especially post WWII. But you can go here to see we stumbled into employer paid health care here http://www.npr.org/templates/story/story.php?storyId=114045132 it is a pretty good primer.

As for labor mobility, comes more from a mobile workforce, ie renters and those that don't own homes. They have the ability to move long distances to take new jobs. Those that own homes can really only change work places within a defined radius of their home. That is not a mobile workforce by your definition if they are able to change jobs because of healthcare coverage is freeing them from staying in a job. Though you make a minor point, there will be people that would be able to move jobs because they may not be tied to their current position based on healthcare coverage. However, if that same person is tied to a mortgage their movement would not be as great or as good for a growing economy as one that is able to pull up stakes on short notice and go where the jobs are.

This thinking is contrary to both the Clinton's Administration as well as other administrations push for home ownership. Where homeownership is good and may build community. A mobile workforce is able to grow economies due to the ability of viable workers moving to where the jobs are.

As for labor history and specifically Labor Union history, I'm more familiar with the turn of the century growth of labor unions and the radical left in the US from 1873 to the 1920s, but after WWII and the industrialization of the US economy on grand scales had an effect on unionization but not as much as the unions began to fold in on themselves because of shear size. They no longer really existed to support workers but to more support themselves by adding more members. The political power garnered by unions as their sizes grew outweighed they grass roots labor organization.

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Reannon
User: reannon
Date: 2010-03-23 14:18 (UTC)
Subject: (no subject)
But that assumes that changing jobs means changing towns. In Jay's example, we'll see more people going independent, either as a contractor or to start up a small business. That wouldn't require leaving town.
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Kari Sperring
User: la_marquise_de_
Date: 2010-03-23 13:46 (UTC)
Subject: (no subject)
The US is an awful warning to the rest of us sometimes, about the consequences of anti-union activity and unrestrained capitalism. I hope your vision of a freer and healthier future comes true. (Yes, I'm an unreformed British socialist from a pro-union family -- I count a genuine union martyr among my ancestors. I'm incurable.)
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e_bourne
User: e_bourne
Date: 2010-03-23 13:46 (UTC)
Subject: (no subject)
As a small business owner, I (we) are hoping it will ease up our health care costs and enable us to, in the next year, employ one to two additional people. The rise of health care, which we pay 100% for all our employees, has equaled the FTE of one person, which has prevented our expansion out of the NW. We are seriously hoping to open an office elsewhere, and that has been one of our hiring/training constraints. The cost of hiring a person + healthcare + other benefits as well as the rising cost of maintaining everyone else's healthcare has been a serious precluding factor to our growth, and I suspect in that of other small businesses. Forgive my moment of snark. I thought I was a capitalist for owning a small business and employing 25 people and wanting to expand. I must be a socialist.
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cathshaffer
User: cathshaffer
Date: 2010-03-23 19:50 (UTC)
Subject: (no subject)
Why do you think that HCR will reduce your costs?
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Michael Curry: minifesto jefferson
User: mcurry
Date: 2010-03-23 13:53 (UTC)
Subject: (no subject)
Keyword:minifesto jefferson
I agree with your assessment overall (better access to insurance can lead to greater mobility for labor), but, while the current HCR bill should make it possible for people with pre-existing conditions to buy health insurance, that will just free them to go into the non-group insurance market.

The problem then will be the cost of insurance, which can be significantly higher than for group plans, and any subsidies offered by the government will likely not end up being especially generous. It doesn't do much good to have access to insurance that you then can't afford (or can't afford to use once you've got it), so I think that any increase in labor mobility will be considerably less than it would have been with, for example, a public insurance option or, better yet, some form of single-payer.

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Mary Dell
User: marydell
Date: 2010-03-23 14:05 (UTC)
Subject: (no subject)
The day I adopted my son--who was born without his left forearm and hand--I effectively locked myself into my current job for the next 18 years. I daydream a whole lot about taking a job closer to home so I can spend less time commuting and more time with him. Thanks to the HCR bill, maybe in a couple of years that will be a possibility.
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cathshaffer
User: cathshaffer
Date: 2010-03-23 19:54 (UTC)
Subject: (no subject)
There's no reason you can't change jobs. As a participant in an employer provided group plan, you are already protected from pre-existing condition exclusion by HIPAA, as long as you do not let your previous coverage lapse before you enroll in new coverage.
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User: joycemocha
Date: 2010-03-23 14:30 (UTC)
Subject: (no subject)
Raises hand. Yeah, both DH and I would have moved on to other things by now if it wasn't for the healthcare.
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Keikaimalu
User: keikaimalu
Date: 2010-03-23 15:10 (UTC)
Subject: (no subject)
So here's what puzzles me. Paul & I met with an insurance broker a few months ago, because his COBRA runs out a few months from now.

She said insurance companies cannot exclude someone based on a history of cancer; they can't even ask about it.

That sounded -- sort of pleasant, but overly optimistic, to me. I mean, there's the law, and then there's what sharp employees do to hustle information their bosses want but can't legally acquire. We didn't end up applying then, but time is still running out, and unless one of us lands in a job with good benefits soon, we'll end up looking for private insurance. I'm concerned about potential unpleasant surprises of being turned down even though the insurance companies aren't supposed to know about our tumorous past.

Do you know anything about this, Jay?
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Jay Lake
User: jaylake
Date: 2010-03-23 17:07 (UTC)
Subject: (no subject)
She said insurance companies cannot exclude someone based on a history of cancer; they can't even ask about it.

I find that literally unbelievable, unless there's a Washington state law covering that issue. The whole point of the pre-existing conditions rules is precisely for the insurance companies not to have take on people with histories of illness.
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russ: quo vadis
User: goulo
Date: 2010-03-23 16:27 (UTC)
Subject: (no subject)
Keyword:quo vadis
Interesting argument, and it seems a valid point. I hadn't heard this notion before, that reducing people's dependency on their job to have any kind of private insurance would be a Good Thing that gives more work/career options to people.

It indeed seems a good bridge-building thing to the conservatives. So it's frustrating that I'd not heard this before. Why wasn't this point being made loudly and frequently? Yet another example of Democrat incompetence? Or more cynically, just another proof that most politicians are in the pockets of the insurance industry anyway?
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Magenta
User: magentamn
Date: 2010-03-23 17:12 (UTC)
Subject: (no subject)
As I understand it, health insurance was offered as a benefit during WWII because of wage freezes. The companies couldn't offer more money, but they could offer benefits. Also, there was a lot of dislocation of workers, so people didn't have their small town family physician available. And one of the largest industrial employers started one of the ground-breaking health care models - Kaiser aluminum spawned the Kaiser health care system.
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jackwilliambell
User: jackwilliambell
Date: 2010-03-23 17:14 (UTC)
Subject: (no subject)
I honestly don't know enough about this bill to make a call one way or the other. It is so complex and has been through so many changes!

My attitude right now is 'Wait and see.' Leavened with an appropriate amount of 'The government often screws things up.' Plus a pinch of 'Usually the only winners are the lawyers and the insurance companies.'

But I would sure like to see health insurance available for everyone, no matter their condition (health or financial). I'm concerned about the cost and, therefore, am not in sympathy with forcing people to buy it.
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Hyrkanian
User: hyrkanian
Date: 2010-03-23 17:25 (UTC)
Subject: (no subject)
We've (spouse & I) discussed this since HCR was first mentioned. He stays w/ his job, which no longer has anything to do with what he was hired (and loves) to do, mostly for the insurance, yes. He could make the same $$ going back to doing what he loves, on his own, but due to pre-existing conditions couldn't get insurance. So now, that may happen sooner rather than... never.

A lot of innovation that has stagnated due to lack of easily obtained health coverage stands to be freed up, and those small start ups that survive and thrive will possibly expand and hire employees of their own.

We also think it's possible that there will potentially be decreased unemployment across the board, as the people that want to break away from corporate jobs to start their own businesses will leave job openings for the new college grads coming up.
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