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Apr 24 11

Patent Medicine

by Editor

I am an employee. And I am also an employer. That simple duality makes possible some interesting insights into the healthcare debate in the US—and two steps that could be taken to address cost-of-coverage issues by expanding access-to-coverage opportunities.

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As an employee, I pay significant premiums for health insurance for my family, north of $1,000/month. Although my employer offers a good subsidy, that subsidy is capped, meaning that it continues to decline as a proportion of my premiums with each year. (Healthcare premium increases have been averaging more than 10% annually for the last decade, a number much higher than inflation or any cost-of-living salary adjustment.) Still, the benefits of the program are clear, most notably that the negotiated rate to insure my family is less than I would pay if I bought the coverage myself, directly. After all, that is a large part of the purpose of employer-driven healthcare: cost savings through group buying, along with pre-tax deductions.

However good this is, though, there are limitations. I work for a small company, which means our ability to negotiate rates is limited. Stupidly, the law prevents companies like mine from joining forces with other small businesses to create a consortium—to get more people into a single plan, and therefore more people paying negotiated rates. Whether in a place like Manhattan or on Main Street, USA, this approach undermines the purpose of insurance; allowing businesses to buy plans together easily would deliver more customers and support the overarching health of the nation. Any actuarial issues, such as concerns about different jobs and different health risks, could be accommodated by defining how consortiums can be created, rather than simply ruling them out.

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If I feel fortunate as an employee, I feel stuck as an employer. We have two household employees: part-time childcare workers, legal employees who pay their payroll taxes, and for whom we carry state-mandated worker’s compensation and disability insurance. It couldn’t be more above-board. We also pay them a salary that averages out to a bit more than $16.50 an hour. According to data from the Center for the Child Care Workforce, that is 70% more than the national average for childcare workers ($9.73/hour) and 44% more than the average wage for childcare workers in New York State. If you factor in more than 4 weeks of paid vacation a year, plus food when they are working, it isn’t ungenerous.

Yet there’s no healthcare benefit. As generous as I would like to be, I cannot afford it, and as a household employer with two part-time employees, I have no bargaining power to command lower insurance premiums, even if I didn’t subsidize them.

That situation is more than just unfortunate. It puts stresses—and costs—on other parts of our economy and our healthcare infrastructure, in ways that are extremely detrimental and short-sighted. For example, when one of our babysitters was sick recently, she had to visit the ER for treatment, and then spent the night in a hospital bed. Ultimately, most of the cost for that will be paid for by us—not us, her employers, but “us,” American taxpayers generally, through government healthcare programs for the un- or under-insured. Unfortunately for our employee, a visit to the ER is cheaper for her than a visit to a private doctor, because without insurance, most doctor’s fees are costly. (That is not even taking into consideration the costs and stresses to us as employers, faced with finding an immediate solution to a childcare need.)

According to the Bureau of Labor Statistics (BLS), there were 1.3 million child care workers in the US in 2008, 33% percent of whom were self-employed. The BLS also forecasts 11% growth in this area through 2018, predicated in part on the importance of child care to the overall economy, by freeing parents to work in other jobs. (The BLS does not make clear whether those are 1.3 million employees reporting their income, or if it includes what is likely a significant portion of household / child care workers in the gray economy.) It is difficult to find good statistics on how many of these 1.3 million child care workers have health insurance, but the odds are that most of them do not, particularly if they are household employees like ours.

News stories on the scope on healthcare in America talk about the roughly 40 million uninsured people, but rarely delve into whether these people are employed in jobs that cannot give them affordable insurance. And those BLS statistics are separate from an exploration of others working at the lower end of the economy, as part-time household employees doing cleaning or yard-work. For example, there are statistics on those working as maids and housekeeping cleaners: 887,890 people as of 2009, with average annual earnings of $20,840. But that is hardly enough to afford health insurance and, in any case, this data does not include those who are self-employed, people who may be even less likely to have insurance, unless they are married to someone who has it.

My modest solution to the insurance problem here would be a law extending coverage through group plans, as directed by members of the group. Not for free, but for the same negotiated rate as part of one’s extended family, or perhaps through an additional, per-individual rate as part of the group. This simple change would make it possible to embrace a huge portion of the uninsured throughout the country. Moreover, it should benefit the insurance companies as well as the individuals: the companies get more people paying premiums, while the individuals get access to healthcare service necessary to keep themselves and the broader population healthy.

We have a national calling to a higher purpose on this issue, one that is conveniently overlooked by all those Tea Party-loving “Constitutionalists” out there. Our failure as a society to tackle this problem—even to enact simple solutions that would support the expansion of health insurance—is not just to my detriment, or that of our childcare employees. It’s a national disgrace.

Mar 26 11

Clean Sweep

by Editor

Since September 11, 2001, three things in particular have been abused in the United States: our civil liberties, our finances, and our Congress.

You’re probably thinking: Congress? They’re not exactly a target for pity. And it’s true—to a degree. Previous incarnations of Congress were complicit in the first two issues, having abrogated so much responsibility to President Bush’s “muscular” executive branch, and permitting or encouraging everything from the Patriot Act to warrantless-wiretapping to unaffordable and unsustainable tax cuts and expenditures. The current 2008 Congress was not much better and the 2010 Congress is not exactly off to a great start.

Yet Congress—the Congress in office at the time of the terrorist attacks and every Congress since then—has not really been itself. Both the House of Representatives and the Senate are composed primarily of people who may be elected by the people, but who serve primarily other masters: the people who pay their bills. Yes, in theory that’s us, we the people; but we don’t pay their bills, we just pay Congressional salaries and amazing healthcare and retirement benefits. Their broader bills are paid by the wide range of outside special interests, arrayed across the entire political spectrum. This is not a left or right issue, it’s not a Republican or Democrat issue: it affects every member of Congress on each side of the aisle. I know of no exceptions, including those who are technically “Independent.”

So here’s my modest proposal for 2012: a Clean Sweep Campaign. A nation-wide movement to effect a total cleaning of house in Congress in 2012, in order to elect people whose interests are exclusively in public service and who understand that their election to Congress means they are there to serve us, the people, and no one else. The Clean Sweep Campaign would function like a seal of approval, a verification that the candidate (and elected member) followed these principles:

  • Candidates must not accept any special interest funding during the campaign period. This means no money or in-kind support (like campaign staff) from unions, PACs, dedicated special interests such as the NRA or Emily’s List, and no money from businesses or lobbyists of any kind. Period, no exceptions.
  • Candidates may take donations from individual constituents—but only from individuals who are able to vote for them, i.e., citizens within their constituency areas. Candidates may take donations from people with affiliations to specific interests—e.g., a voter who also supports Planned Parenthood or the Family Research Council—but no money may come directly from any outside organizations.
  • Candidates may not accept bundled donations.
  • Candidates may have party affiliations, as a means of describing political perspectives (to the extent that “Democrat” and “Republican” mean anything other than “self-interested”) but also cannot accept any money from them. Again, only donations from constituents may be accepted. (Political parties may provide in-kind support, such as human resource support for office management, campaign positioning counsel, or door-to-door canvassing.)
  • Candidates may not have served as a lobbyist within the immediately preceding election cycle, i.e., within the last two years.
  • Candidates may fund themselves, but only equal to the maximum donation received from every constituent in their district (or, for Senators, their state). Candidates may fund themselves even if they are able to raise the maximum donation from every constituent but, again, it cannot be more than a 1:1 match.
  • Once elected, candidates must subscribe to the same code, including its broader implications: no junkets or trips, no paid-for dinners with lobbyists or other outside interests, and no in-kind support from outside supporters.

Is money the most problematic and pernicious influence in politics is money? Yes and no. No to the extent that “influence” covers a much wider terrain than just financing, and no because not every member of Congress is out for direct personal gain.

But yes because, more than anything else, money is the thing that influences the direction of politics. Sure, Meg Whitman and Carly Fiorina were defeated in California, despite the investments they made in their own campaigns; but those candidates and those campaigns were anomalies. Most of the time, the better funded candidate wins—and stays in office, well-funded, until some more significant demographic trend forcibly knocks them out.

Money is also the most easily identifiable mechanism of control, the thing that voters can use to evaluate influence. And while the Supreme Court has ruled on a few occasions that spending money is a form of expression, and therefore cannot be legally eliminated, this poses no problem for the Clean Sweep Campaign: this approach is not about passing laws regarding spending—it’s a campaign about principles of representative independence, about inviting candidates to adhere to those principles, and about providing a stamp of approval when they do so. No one would force their hand—but every effort could be made by opponents to make clear that a given candidate is not, in fact, an independent representative of their potential constituents.

My motivation isn’t partisan: I’m not looking to elect more Democrats or Republicans, or to bolster the likes of the (equally corrupt and secretly funded) Tea Partiers. Political balance is important, as long as it is functional and effective in representing it’s constituency. But our Congress is not that. They don’t hear—can’t hear—the voices of their own people through all of the outside influences, factors that have little to do with the political realities of their states or districts, or about the long-term future of the country. And when they wave their well-funded flags in our faces, and proclaim their allegiance to our own interests, well … just take a look at the budget deficit, or the failed healthcare reform, or the not-even-failed-because-it-never-got-started effort to address long-term funding challenges for Social Security and Medicare, or shockingly absent prosecutions of bankers and investors who helped cause the financial crises, or … well, I could go on. Just take a look and ask yourself whether you think the people you elected to represent you in Congress are even close to fulfilling their responsibilities to you and your neighbors. I know mine aren’t.

It’s time to clean House (and Senate), and what better way than with a Clean Sweep.

Mar 20 11

War Torn

by Editor

In 1994, at the time of the Rwandan genocide, I was working for a small foundation in Washington, DC. My boss and I were both outraged by the dithering response of then-President Bill Clinton’s administration. He sat on numerous policy making boards around town, and knew lots of people—in government, in non-governmental organizations, in other foundations and think tanks. Call after call my boss made seemed to result in sympathy, lots of people agreeing that the situation was messy, but not much in the way of actual action.

One day, I came in to work and the two of us discussed it again. For me, the Rwandan genocide was reminiscent of American dithering during the holocaust, the kind of inaction so well documented by historians like David Wyman: we can mythologize Franklin Delano Roosevelt all we want, but in the end, addressing the mass murder of Jews (and others) was not a policy priority. For my boss, a producer of the movie Shoah, there was a sense of immediacy to the world’s failure to live up to the “never again” theme. He felt he needed to act, and where his phone calls had little impact, he thought a public platform might: he rounded up some big names, people whose opinions might matter to the Clinton administration, and took out full page ads in the Washington Post and New York Times calling on the US government to act.

This bit of history has been on my mind as I read the news about the attacks on Libyan government troops and military installations, in support of rebel groups that were about to be routed—and as I read the mostly ambivalent comments of people on Facebook, Twitter, and news sites. Suddenly, the United States and a selection of allies (including, shockingly, the typically risk-averse French) are launching another war. Maybe. Or maybe they just aim to degrade Libya’s military capabilities enough to give the rebels a (pardon the pun) fighting chance against Colonel Qaddafi.

I am not comparing Libya and Rwanda; the situations are very different. But the ambivalence people feel (including, it seems, our own president) strikes me as very similar. Especially when combined with the mental and financial exhaustion that comes from all this fighting abroad with uncertain goals, limited investments and thus limited impact, and a weariness over the enduring cycle of bad news.

In one of its opinion pieces this week, The Economist wrote encouragingly of military intervention in Libya. It included this argument: “Democracies wisely set obstacles in the way of those who seek to put the world to rights by fighting—however good their motives. Bitter experience in Iraq has taught how liberators soon come to be seen as oppressors. … At the same time, democracies shrink from the idea that might is right. After the genocide in Rwanda, nations took on a duty to stop mass-killing if they could. Kosovo, Sierra Leone and Liberia all showed that outsiders can in fact help avert catastrophes. The Arab awakening is all about human dignity and the rights of ordinary people—values that the West lives by and seeks to promote. For the West to turn its back on Libya’s rebels and to stand aside while its allies shoot protesters in Bahrain betrays its own values.”

Of course, The Economist neglects to mention Darfur, in Sudan, where we largely failed to stop the killings until it was too late. Or the multi-year war in Congo, also known as “Africa’s world war,” where more than 5 million people have been killed, and many more raped or brutalized, in another ethnically driven conflict. The Egyptians managed to overthrow Mubarak without outside military interference. Amidst all this, should we really treat the Libyans differently? How do we draw the line between Libya and Syria, where new reports suggest more protests and more crackdowns are also happening? And it must be acknowledged that we do this all while we rationalize military inaction in Bahrain, presumably because it would hurt the Saudi troops on the ground there, and thus our relationship with another major oil producer.

I sincerely wish the Libyan people well, and hope for their freedom amidst desperate circumstances. But consider me among the ambivalent, working hard not to veer much further towards the cynical.

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Updates: Some other articles of interest, from a few different sources, supporting reasons to be cautious about our Libyan engagement:

  • In the National Journal, Megan Scully writes of the costs of this initiative.
  • In the National Review, John Derbyshire writes of some of the criticism of President Obama and British Prime Minister David Cameron for this whole engagement.
  • In my view, the New York Times has been a bit of a cheerleader for this mini-war–but they have a piece by David Kirkpatrick that makes clear how little we really know about what to expect as an end-result in Libya.
Feb 27 11

And The Oscar Goes To…

by Editor

The Oscars are tonight and I have no plans to watch, as usual. Unlike in most years, I do feel a sudden compulsion to see one movie win. My pick: Gasland deserves the Oscar for best documentary, for being (as my wife aptly noted) a cross between An Inconvenient Truth and Erin Brockovich.

Directed by Josh Fox, the movie is disturbing and compelling, a race against an unseen clock to expose the devastation to drinking water and the environment caused by hydraulic fracturing (aka “hydrofracking”), a process for extracting natural gas from underground rock formations. The race is one that affects millions of people living along the east coast and those states just inland, to see whether the process of leasing land for hydrofracking and allowing new wells to be drilled can be stopped before the hydrofracking contaminates the water supply for about 16 million people. (So far, the outcome does not look good for those of us living in New York, Pennsylvania, New Jersey, and even Delaware.)

There are many, many problems one can point to in our society, from the financial shenanigans that helped bring about our recent depression, to our fundamental failure to confront “third rail” political issues like the funding of Social Security or Medicare and healthcare. What makes this story about hydrofracking especially powerful is that it connects all the dots on the spectrum: corporate malfeasance, political intransigence, bureaucratic expediency (because, yes, bureaucracies can be efficient when they want to be), hard science, loose medicine, and personal tales of loss in the face of all of the above.

Meanwhile, as if reporter Ian Urbina was watching the movie with me yesterday, the New York Times is running a story today about hydrofracking and its associated problems—though as usual (in service to “objectivity”) the article does what the documentary does not, in pointing out that there are always at least two sides to the story and that questions about “facts” remain.

In this case, it seems to me there are three sides: government officials who say all the right things about being watchdogs for the public good (while clearly failing); energy companies that downplay the known science (and working to hide what isn’t yet known) because it’s better for business that way; and environmentalists and average citizens who are witness to the devastation wrought by hydraulic fracturing, not least through the demonstrably flammable water emanating from the tap. Those scenes are a consistent highlight of the movie. Sadly, the Times neglects even to mention Gasland; this is all the more ironic given the scope of coverage the news organization is dedicating to the Oscars.

Our collective failure to confront this and other issues is more complicated than what is, or is not, reported in the news media. (Though that’s certainly one good starting point for a discussion.) Where An Inconvenient Truth may have been more abstract—it’s difficult to really grasp the implications of planetary changes you cannot see with your own eyes, as this recent episode of This American Life (#424, aired 14 January 2011) so ably demonstrated—Gasland is direct and in your face. A hard-to-avoid truth: your drinking water, and mine, may soon be ruined. If that’s not worth fighting for, what is?