Last night, a dear friend of mine told me that he may have lost his health coverage through Medicaid. No warning. He got a call from the pharmacy saying the insurance didn’t go through. If this is true, he may be in real trouble.
He has cystic fibrosis, and he needs about $70,000/year in medicine to survive. He has also devoted his life to the unlucrative work of independent journalism and political activism. He lives on almost nothing and has a place to sleep only thanks to a generous arrangement with a generous church. While he contributes more to society than the average millionare, our system seems on the brink of deciding that he doesn’t deserve to live. Just another of the millions of stories about how utterly broken the American health care system has become.
Today in The New York Times, Paul Krugman makes clear how dangerous John McCain’s health care plan is. But in its fundamentals, I’m concerned that Barack Obama’s plan, as well as his general approach to labor, is dangerous too. Neither reflects the needs of a twenty-first century citizenry and workforce.
I’m 24 years old, and my grandfather in his mid-eighties doesn’t quite understand what’s taking me so long. By my age, he was married, and he had a job at RCA that could’ve lasted him a lifetime. All told, after college he couldn’t have had more than five serious jobs, and most of his life he had only one. I have had five jobs in the past year.
Today, fewer and fewer of us devote our lives to a single company. We change careers, get laid off, work as consultants, go back to school, and repeat. And for good reason. The world isn’t like it used to be. American industries compete in a global marketplace, and they have to be agile in order to keep up. No matter what the Democrats promise the big old unions, jobs are going to keep going overseas. If they don’t, consumer prices will go through the roof. Though Obama recognizes the demands of the market, he has not been willing enough—as willing as McCain has been, even—to tell American workers that they will need to be willing to retrain and retool if they want to stay competitive. This could be the mother of many false promises to come, meant to assuage the Democrats’ labor union base.
Currently, employers receive significant tax incentives for providing health benefits to their employees. And insurance providers can give much lower rates to people through corporate plans. Consequently, the health insurance regime is structured around employers and employees. However, in the new world order, this approach is dangerous and out of date. It leaves out a growing class of workers—freelancers, independent contractors, and of course those employed by companies that don’t offer benefits. Forget it if you actually pursue the American dream and start a small business. My father, who co-owns one of the last remaining small real estate firms in the Washington, D.C. area, has to buy health insurance as an individual.
Anyone who’s tried that knows how expensive it is. I would have had to go that route, if I hadn’t been lucky enough to find the Freelancers Union. In New York City, the same Blue Cross/Blue Shield plan went from around $800/month to around $200/month when I joined up with them. No background checks on health history. Some annoying paperwork to be sure, but I’m in.
For my friend losing his Medicaid, there’s no affordable alternative in sight.
I hope that the Freelancers Union represents a new kind of worker’s organization that spreads very, very quickly. You’re not just a member by virtue of having a certain job. And isn’t the organization’s primary objective to keep you from being laid off, whether your job is competitive or not. Instead, they support you wherever you’re working, providing insurance as well as a training seminars, political advocacy, and a community to network with. Almost like a church or a Masonic lodge. A new, yet old way of organizing workers.
In the current political climate, where a European-style single-payer system isn’t in the cards, such organizations are a plausible alternative. They still leave room for the competition that the free-market folks think will prevent the inefficiencies of a single-payer model. Because employees are not so dependent on companies for basic needs, both are freer to maximize utility in the marketplace.
Fortunately, Obama’s health plan features a government-run program that allows people to buy affordable insurance as individuals. This is a vital step in the right direction. But if he is serious about both a humane health insurance market and a competitive labor market, he has to go farther to detach benefits from jobs and create tax incentives for organizations that stay with people in both good times and bad. Vital services like health care need to go to people qua people, not just insofar as they also happen to employees.
Ironically, we should listen to the stumbling McCain did after being caught saying that “the fundamentals of the economy are strong” a week before the financial system collapsed. The fundamentals of the economy, he claimed, are not corporations or markets, but people:
“The economic crisis is not the fault of the American people. Our workers are the most innovative, the hardest working, the best skilled, most productive, most competitive in the world, that’s the American worker.”
It may be jingoistic stump-talk, but it’s talk worth trying to live up to.