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Has anyone considered this?

badger's picture

One of the goals of single-payer health insurance is to put the health insurance companies out of business. Another is to reduce the paperwork load at doctor's offices, clinics, hospitals and for other health care providers.

In fact, without accomplishing those two goals, it's unlikely that single-payer health insurance will show a savings, as another goal (perhaps not stated explicitly) is to increase the utilization of health care services, and that represents a big increase in costs. The offset that leads to a net savings is largely the elimination of health insurance companies and the clerical personnel health care providers employ to deal with insurance.

According the the EPI, health insurers employ more than 444,000 workers. According to the BLS, health care providers employ more than 2.4 million workers in "Office and administrative support occupations" (bottom of Table 2, middle of the page). It seems fair to assume that at least 1/4 of those - about 600,000 workers - are needed to deal with insurance red tape. That's probably an underestimate.

So it would seem single-payer means that over 1 million people will lose their jobs. The incoming adminstration hopes to create 3 million jobs over the next 2 years (not allowing for the loss of 1 million health insurance related jobs), so the loss of an additional million jobs is significant. What happens to the 1 million who lose their health insurance related jobs?

I'd be surprised to find anyone here hateful enough to just say "Who cares?" or "They deserve it!". While I think it's likely that single-payer will overall create more jobs (for example, by lifting the health insurance burden from employers), I think it's unlikely that any of those losing their jobs as the health insurers disappear are going to become future auto workers, or find work in the areas targetted by the proposed stimulus package - infrastructure, education and health care. They simply lack, for the most part, the necessary skills as well as not necessarily being in a location where the new job creation will occur.

To achieve the savings single-payer advocates envision, it's actually necessary to eliminate those 1 million+ paychecks.

So again, what in the single-payer plan provides for the needs of the over 1 million people who will lose their jobs, and the effects those job losses will have on the economy?

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Submitted by hipparchia on

has provisions for retraining all administrative personnel who lose their jobs as a result of single payer being passed, with up to 2 years unemployment benefits. that's more than most people get when their jobs disappear. and 'administrative' jobs [sales and marketing too to some extent] are fairly portable from one industry to another.

many companies that sell or administer health insurance have other kinds of insurance too -- property, life, etc. you can insure just about anything. also, there's nothing that says that these companies can't sell supplemental health insurance for stuff like cosmetic surgery, or for covering deductibles and copays if incorporate those into a single payer system, or for experimental treatments if we decide to not cover those in a single payer system.

the big increase in costs from increased utilization isn't going to be as big as the overall savings.

there will be a surge of people who have been putting of care, so yes, spending will jump. but various experts predict that will level off in 2-5 years.

additional cost containment, besides ridding the system of administrative overhead, will come from the government using its bargaining power to buy drugs and physician/hospital services at lower costs. additionally, hr 676 provides for conversion of hospitals, etc to public or non-profit status, over a 15-year period. 15 years ought to be long enough for anybody to find a job.

as you say, single payer is expected to free up money for hiring more workers in various industries, but something else to keep in mind: "administrative" positions are often low-paying clerical-type work, how many of those people take such jobs entirely to provide insurance for their families? i know several who would quit their jobs tomorrow and start their own businesses, or work part-time at something they like better, or take a low-paying clerical job at a nonprofit or charity, or ....

i'm not going to cry if the overpaid executives lose their jobs, though.

Submitted by hipparchia on

yes, somebody has considered this -- john conyers.

badger's picture
Submitted by badger on

about whether it's been considered. The followup of course is whether the consideration is sufficient.

For example, the link you supplied has no overall provision for retraining - it only assigns "first priority in retraining and job placement in the new system", which is quite different. The new system, if it's a significant improvement over the old system, is not going to have over a million slots for displaced workers to get priority for.

Also, unemployment (which is a fairly complex system, so I'm not 100% sure of this) is largely administered by the states, who can borrow money at interest from the Federal government if they have shortfalls (which in the current economy plus a million more unemployed they will almost certainly have), but there are also penalties to the states for underfunding (happened in the early 80s as I recall). States are already struggling, and this appears to be another unfunded mandate. Whether the money to pay the benefits would actually exist is a serious question in this economy.

At any rate, two years of pay below the poverty level (and unemployment checks are based on previous income) isn't much assistance.

Had there actually been a retraining provision, I would have had more negative comments to make about the insufficiency of that kind of solution, but there isn't one, so I won't.

So far the answer to whether we've considered this is "yes, if ignoring it almost completely is the same as considering it". Whether this is generous compared to other situations where people have lost jobs doesn't pay the rent or put food on the table for over a million workers, and this differs in that it's a situation where we'd be legislating jobs out of existence.

It seems to me we need to do a lot better.

tartu's picture
Submitted by tartu on

system be providing a sound health care to the people of this country that is medical necessity-driven rather than profit-driven? I would think that this will be a higher priority goal over putting insurance companies our of business and making life easier for the doctors.

badger's picture
Submitted by badger on

Do you have a way to design a universal single payer system that allows health insurance companies to continue functioning at their current level of employment and allow doctors to retain all their staff that does nothing but process insurance claims?

How would that be paid for and why would we do it?

And if you believe that this is about the quality and availability of health care and not about money, wouldn't a fair solution include some adequate compensation or other arrangements to those we inevitably throw out of work?

There are other possible ways to achieve health care goals without single payer (although I think single payer is the best solution) - that isn't the question here. The question is, if single payer is our chosen solution, are we going to deal with all of the consequences of converting to single-payer, one of which will almost certainly be the loss of more than a million jobs.

Submitted by lambert on

What were their solutions?

Since IIRC, this was one of Obama's objections to the idea (more "controversy") it would behoove us to have the strongest possible counter when it is raised.

I agree that it's part of Conyer's plan, but I think real evidence from past implementations would make the strongest possible case. I mean, you can see the Harry & Louise ads on this one, right?

(Personally, I'd work out a way to give them jobs in green insurance. Changes to code, changes to how houses are built, and the impact of climate change -- huge. Give real work that matters, instead of the denial of care crap.)

badger's picture
Submitted by badger on

that I heard earlier this week that the US is essentially the only country that approached health care through a private, largely employer-based system, and if that's true, there is no comparable example to work from. Even situations where a country nationalized a major industry aren't applicable, because we're not talking about nationalizing the health insurance industry as it exists today - we're talking about eliminating it or at least radically downsizing it.

At least as far as HR676 goes (from Hipparchia's link above), I don't think you can say any of this is really dealt with in Conyer's plan.

But I would agree with your closing parenthetical in spirit, if not in substance. I think these people have skills that are transferrable to other areas, if we provide guarantees those other areas will have the jobs to fill. That kind of solution, clearly spelled out, would be my first choice, especially because it doesn't delay the implementation of single payer. The other alternatives I can think of - killing the health insurance industry more slowly, by attrition, for example - also delay the implementation of a true single payer system. That in turn leaves the door open to changing course the next time the majorities in Congress shift.

badger's picture
Submitted by badger on

I agree that H1-B visas should be eliminated, I don't see turning insurance clerks into engineers, programmers and other similar trades as a viable solution.

Most of them need to support their families while they get 3 or 4 years of training; a lot of them are going to need more than 3 or 4 years of training to remediate their lack of technical education in the first place; a lot won't want to do it at all.

And recent history demonstrates that the jobs they retrain for might not exist by the time they finish re-training. H1-B isn't the only factor killing technical employment in the US.

Submitted by Randall Kohn on

I think paid retraining might be feasible as a partial solution. Bringing back customer service jobs to America, by legal mandate if necessary, would help as well.

But your point is well taken: This will not be so easy after all. But there are always things we can do to assuage our problems. Our elites talk hope out of one side of their mouths and shoot down every useful approach with the other.

vastleft's picture
Submitted by vastleft on

The solution of the sort that says, "well, cancer has its good points!"

The health-insurance model needs to be ripped out by the roots. Adequate support for displaced workers needs to be part of the plan, but not-ripping-the-cancer-out-by-the-roots should be off the table, not for a cancer this profoundly deadly.

herb the verb's picture
Submitted by herb the verb on

Nobody gave a thought to the millions of jobs in the photo and printing industries which were eliminated by the revolution in digital cameras, cheap laser printers and the internet. No legislation was enacted to outlaw those industries' demise. They didn't even pray on the denial of life-saving services.

Another destroyed industry may be pharmaceutical sales and all of the other, basically parasitic businesses which feed on the current system. Will "Tell your doctor about" be tossed into the dustbin of history? I would note here that I just returned from a business trip to Holland and didn't see a single commercial for Viagra or Cialis or any other drug, neither did I see any ads for Lasik or miracle fat cures, but sadly, ending private health insurance won't get rid of chat line ads....

I think the minor point Hipparchia made about people choosing to drop out of the work force when the health insurance these positions provide is gone is also a notable one. Plus, a robust public health care system from my understanding doesn't outlaw an additional private health care, which provides services deemed "elective" by a single payer system.

What worries me more about this issue is so many people seem to think there won't be any "denial" of care under single payer. Of course there will be, and my worry is that single payer will make health care MORE political rather than less.

For example, when you think "elective surgery", "elective procedure", or "elective medication', what exactly comes to mind? Will the attendant care required by those "electives" not be covered? What if the method of care for an illness that YOU want, is not the one that the SYSTEM wants you to pursue? Will attendant care to elective care be covered by single payer? We are going to want/have a private industry alternative to cover these things. Other countries have that too.

badger's picture
Submitted by badger on

to the elimination of jobs in the photo and printing industries because we had an economy in the late 90s/early 00s which could absorb a lot of displaced workers - at one point Greenspan raised interest rates because he thought unemployment was too low. We don't have that economy now, won't have for quite a while, and the failure to do the right thing in one instance, if it was that, doesn't make it desireable to the fail to do the right thing in this instance.

We also shifted jobs from one technology to another. If part of single-payer is to assume all of these jobs will just exist in a different form under a government-run system, then it's plain deceit to pretend the projected savings will exist. You get a lot of the savings by not writing as many paychecks, and that's a desireable feature of single-payer. That's not to say those people should be without paychecks from some other source, preferably one that makes them a productive part of the workforce.

But we have in the past offered substantially more assistance than is evident in HR676 with things Trade Adjustment Assistance (goes back to the late 70s and I don't remember the exact acronym) and other retraining and re-employment programs.

One of the arguments I don't buy in this discussion is the "Oh, they really didn't want those jobs anyway" argument which is what's being said in the "drop out of the workforce" arguments. Offer those people the opportunity to retain comparable employment and if they refuse it, fine. But don't decide for them.

herb the verb's picture
Submitted by herb the verb on

about the millions of manufacturing jobs that have been lost because we have a health care policy in this country that punishes employers for having employees. Apparently you are unconcerned that small business owners, farmers, and the self-employed can't afford health care coverage in the current system. Apparently you are unconcerned that people who work for small businesses typically do not have health care coverage because those businesses can't afford to offer that coverage to them. Apparently you are unconcerned that people with pre-existing conditions are (illegally or not) discriminated against in employment since hiring them would be punitively expensive to the very meager few small businesses who DO offer health coverage as part of their benefits. Apparently you are unconcerned that employer based health insurance is one of the biggest obstacles to economic growth in this country. I really could go on and on about this and I apologize for not providing the links above, but try these below:

Committee for Economic Development
Health care, life expectancy, Economic Development
The Health Care Cost Crisis in Wisconsin:
Health Care Services: Three Critical Roles in Rural Economic Development

Just google "economic development" with "health care", and you will get pages and pages of interesting reading about the millions of jobs that are lost specifically BECAUSE of the health insurance system that we have and it's punitive effect on employment.

And if you think small business is not what is going to get us out of this depression, I urge you to READ THIS!

You say that I and others are not concerned about health insurance industry workers. I say you seem unconcerned by the millions who are ALREADY UNEMPLOYED as described above.

splashy9's picture
Submitted by splashy9 on

It seems to me that universal single payer health care will create more jobs than will be eliminated, when you include all the new businesses that will be started up by those that are finally free of having to work in stifling big business jobs.

That's not to mention there will be many jobs needed to be filled actually taking care of those that have been "rationed" out because they can't pay.

badger's picture
Submitted by badger on

So where's the adequate support for displaced workers?

Submitted by lambert on

... so we can then advocate it. As we agree, it's taken account of in HR676 already. If you want more concrete plans, or an actual legislative proposal, perhaps you could invest a little time in actually researching the issue, or creating a plan yourself?

nihil obstet's picture
Submitted by nihil obstet on

I'm a firm believer in guaranteed employment. Jobs should be offered at a living wage to those who need them, whether they're textile workers whose jobs went to Mexico after NAFTA, typesetters whose jobs disappeared as newspapers folded or consolidated, auto workers whose jobs were eliminated by increasing productivity, or even scummy loan officers who flacked predatory loans whose jobs disappear when their financial institution fails.

But to wring one's hands over potential lost employment that demands the sacrifice of 100,000 people a year as a separate issue comes across as concern trolling. "What do we do about people losing jobs through no fault of their own?" is a valid question. Selective application of the question based on political preferences for or against a policy is not.

badger's picture
Submitted by badger on

Refugee from Cheetopia or just unable to deal with the issue that a pet-policy has a nasty downside that no one's considered or made an allowance for?

My question is precisely "What do we do about people losing jobs through no fault of their own?", but I'd add "whose jobs we fully intend to legislate out of existence". I haven't said anywhere that this is a reason to oppose or delay single-payer - I've said this is a part of single-payer that isn't getting any consideration and deserves some.

DCblogger's picture
Submitted by DCblogger on

First of all the IT side of the insurance industry is being shipped to South Asia, so we are losing those jobs anyway.

Second of all, the insurance industry isn't going anywhere, it is only HEALTH insurance we intend to abolish. Canada has a vibrant insurance industry, they just don't do health (except insuring Canadians who travel to the US).

Abolishing health insurance parasites will free up billions of dollars which will create a massive stimulus. There will be jobs in admitting in hospitals, because this will be a massive help to our remaining public hospitals.

People will start businesses and will need insurance for those businesses. This is NOT going to be like other dispalcements, the worker bees of the insurance industry have skills that easily translate to other jobs, specifically other kinds of insurance or financial industry jobs.

badger's picture
Submitted by badger on

of how many IT jobs are going to Asia, it remains a fact that as of last year there were 444,000 domestic jobs in the health care industry, and some hundreds of thousands of jobs on the health care provider side related completely to health insurance matters. What's the quantity of jobs leaving the country and how many will be left? Without numbers there's no way to assess the magnitude of the problem, besides offshoring not affecting the (probably larger) provider side of the employment equation at all.

The rest of the post strikes me as "the market will take care of the problem". I quit believing in that argument about anything about the second time I heard it put forth. Having skills is not the same as having a job, particularly in the economy as it is and probably shall remain for some time. But I would agree most of these people do have skills which could be utilized if the effort were made to do so.

Either there's some positive efforts to deal with what seems to me to be a significant problem, or it's ignored. If you want to ignore it, just say so.

zuzu's picture
Submitted by zuzu on

Yes, some of the insurance companies will shrink as their functions become obsolete, which means that a lot of workers who now perform the administrative functions that cost so damn much money and prevent health care dollars from going to health care will lose their jobs. There will also likely be layoffs in the health-care-billing sector, as doctors and hospitals would no longer need to keep someone on staff just to chase down payment from the insurance companies, who make money when they *don't* pay medical bills.

But that doesn't mean that the doctors and nurses and medical technicians and dentists and physician assistants will be out of work, or out of business. There might even be an expansion in these jobs as the people who haven't been getting care because they're uninsured start getting care.

You're also forgetting that adminstrative people have transferrable skills. We're not talking loggers here, who have specialized skills. Admins can admin in many environments. And there certainly can be programs put in place to cushion the landing for some of these people.

Displacement of workers, though, especially when the number who might lose their jobs are fewer than those who lose their jobs through the lousy Bush economy in a few months, is hardly reason to not put in place something that will benefit everyone in the country.

And think about this: those workers might be laid off, but they won't lose their homes because of unpaid medical bills. And they might just feel well-situated to start a business of their own if they don't have to worry about health care, either for themselves or for any employees.

vastleft's picture
Submitted by vastleft on

"Has anyone considered this?" Thu, 12/25/2008 - 11:48pm — badger

"That's answers my question about whether it's been considered. The followup of course is whether the consideration is sufficient." By badger on Fri, 12/26/2008 - 1:12am

"I've said this is a part of single-payer that isn't getting any consideration and deserves some." By badger on Fri, 12/26/2008 - 12:50pm

Am I to assume that the last of these comments means "I have said that it isn't getting any consideration, but it turns out that I was, in fact, wrong. I should have said that it is getting some consideration but perhaps it deserves more"?

badger's picture
Submitted by badger on

I wasn't aware if this had been taken into account - that would be why the title was a question. I'll even admit to being wrong about it not having been considered, as there are a couple of pitiful lines in HR676 that address the situation.

Your post above says "Adequate support for displaced workers needs to be part of the plan ...". Can you show me where adequate support has been incorporated into a single payer plan?

I haven't seen it yet. Semantic arguments don't alter that.

Submitted by lambert on

Quickly...

The problem has certainly been "taken into account" -- see (too lazy) Conyer's HR 676 site, which is explicit that programmatic support is needed.

Je repete, that as a prophylactic to the next series of Harry & Louise ads, the issue needs not merely to be addressed, but stomped as a surpassingly bad argument; one easy way to do this would be to show what happened to other countries that adopted single payer, or, as DCBlogger begins to do, explain why better jobs in a non-parasitic, non-cancerous industry can be made available (given a level of leadership....). Surely we should be thinking opportunity here?

I don't think it's useful or interesting to go round and round about what's missing and the adequacy, or not, of what's been proposed.

Wouldn't it make more sense to propose something positive?

badger's picture
Submitted by badger on

I think it would make a lot more sense to propose something both positive and workable.

Submitted by ohio on

caused by people in the health insurance industry losing their jobs because we enact single payer. Google "single payer" and re-training and you'll get plenty of hits.

I'm not quite sure what your argument is here. Are you saying that single payer isn't worth doing because people will lose their jobs? Lots of people are going to be losing their jobs. The 1 million people you refer to will be part of the thousands who will be unemployed. Without single payer, there is absolutely no guarantee these people won't lose their jobs anyway.

I get your point: with single payer legislation, we're guaranteeing that some of them will be unemployed. But we're also going to see massive spending on infrastructure projects, so we're also legislating opportunity.

And there's another huge difference: single payer means we all benefit. That people who are unemployed will have guaranteed healthcare under single payer may or may not help them breathe a little easier as they decide about retraining or looking for a job, but I bet it will.

I think you have misidentified the problem: the problem isn't "What do we do with these redundant health insurance workers?" but "How do we offer opportunities to anyone who loses his or her job to help them find work with comparable compensation?"

That's a much larger question. Single payer can be part of the solution for the thousands who are or will be unemployed---health insurance is one less thing for you to worry about. Go ahead and take than LPN course or get into that welding program because single payer means the safety net has been strengthened for each of us.

(FTR, "compensation" here can mean "money," but it can also mean things like job satisfaction. For example, you may make $82,000 a year with full benefits at a job you hate but if your health insurance is guaranteed, you may be willing to take a job you really want but only pays $45,000.)

Edited to add: badger, thank you for raising the issue. For me, it stresses the importance of getting single payer through and fast---because lots of people are going to be hurting and if we don't alleviate some of the hurt soon, it's just going to grow. Do I have ideas on how to get rolling? Sure. Ideas are easy. Getting them done is hard.

badger's picture
Submitted by badger on

I did your recommended google and it did turn up some interesting hits. One, for example, is this article entitled The Great Retraining Lie (it addresses TAA, not single payer, but the principles are the same), which saves me writing a lot about retraining, except to mention that retraining on a scale of hundreds of thousands is not something simple to accomplish. It'd also be more efficient to re-use the skills people already have rather than giving them new ones, and there are a lot of ways the government could enable that.

The other thing it turned up is a couple of statements that I would agree with. From the Unitarian-Universalists:

These workers must be guaranteed retraining and placement in meaningful jobs.

and the identical statement in a a 2003 article in the American Journal of Public Health.

The other references (in the first two pages and a quick look) refer to HR1200, which is from 2005 (probably not active) and apparently was written by McDermott (your rep?) and includes the following language:

WORKER ASSISTANCE- A State health security program may provide that, for budgets for years before 2009, up to 1 percent of the budget may be used for purposes of programs providing assistance to workers who are currently performing functions in the administration of the health insurance system and who may experience economic dislocation as a result of the implementation of the program.

While I think that's marginally better than HR676 (it at least guarantees some funding), it doesn't meet the standard of "guaranteed retraining and placement in meaningful jobs", which is what I'd want to see.

As to what my argument is, it's that a lot of people are going to be legislated out of jobs and I think we have a responsibility to those people. That would be what I'd want to see included in single payer legislation. I'd simply like to see a comprehensive solution rather than a half-assed solution.

There is always the problem of unemployed workers, but we rarely legislate workers out of jobs on this scale. Sure, I think the larger problem needs addressing, and I've thought so since the 1970s at least. But I've never believed we need to exacerbate the problem by legislating a large block of jobs out of existence and failing to take substantive measures to remediate the problem we're creating. (And as far as I'm aware, LPN courses went out of existence more than 20 years ago).

Submitted by hipparchia on

you're being a wanker a la ezra klein.

also, neither of your links works.

your homework assignment: call john conyers' office and ask him to give you all the details about this. then report back to us, because it will be another good argument to have when refuting the we can't do it concern trolls.

if, by enacting hr 676 tomorrow, we dropped down to canada's level of spending, we'd probably save somewhere between $800 billion and $1 trillion. instead we're only going to save about $350 billion.

this leaves at least $450 billion to spend on those 45 million uninsured, or $10,000 per person. there's a lot of room in that $10,000 to keep redundant health CARE [as opposed to health insurance] workers employed.very few of the uninsured are going to need $10,000 worth of health care tomorrow. i predict that very few people already employed by health CARE providers will lose their jobs.

health insurance won't disappear entirely either, but yeah, we'll need to find jobs for about 400,000 of them. looks like there's about $50,000 per person planned for. and not all of these people will have to go back to school, or anything as expensive and complicated as that. a lot of clerical, bookkeeping, accounting, and sales skills are readily transferable from one industry to another, and it may well be that wage subsidies for 6 months, 12 months, 24 months of otj training will suffice for most, which would only be possible if we're deliberately vague about how we're going to help displaced employees.

badger's picture
Submitted by badger on

An opening insult is an impressive argument - I guess I'll have to reconsider my position.

Embarrassingly, you're right that the links don't work. Here's another try:
EPI - health ins employment
BLS - provider employment
I'll test 'em in the preview this time before I post.

I have no doubt that single payer will save a substantial sum. I haven't argued that it wouldn't. That's not much consolation if it costs you your job.

Were I a union bargainer negotiating a contract for these workers, "it may well be" would be somewhere close to my "walk-away" point, and I'd point out that the UC benefits in HR676 are substantially different than "wage subsidies", both in kind and compared to the pre-existing wage. But I think the "deliberately vague" line is rather Obamesque. In fact "it may well be" really has a nice hopey ring to it.

Some people (see the reply to Ohio for links) have no problem saying "guaranteed retraining and placement in meaningful jobs", and I think that's a pretty good standard that I could get behind, and I think there are ways to accomplish that, including wording legislation to accomplish it. It indicates that at least some people have seriously considered the equity issue that exists here, although it apparently hasn't made it into any legislation yet.

Submitted by lambert on

That would be because HR676 hasn't passed.

However, as you see from the HR676 site, the issue of how to handle existing jobs in the insurance industry has been a concern of single payer advocates from the beginning.

As I said, the way forward is not to express concerns about what is not there, but to make positive suggestions about what should be. "Guaranteed retraining and placement in meaningful jobs" sound good to me; would that it had been applied universally to victims of this bubble and the last one (instead of only being raised as an issue when policy changes are suggested).

Does anyone know how Canada and other single payer countries handled the issue? Because they certainly must have. Perhaps we're not hearing a lot about the issue -- even from the people most invested in destroying single payer -- because it turned out not to be a problem?

Submitted by hipparchia on

the problem with canada is that they did this 35+ year ago, back when the for-profit insurance industry was not early so bloated as it is today. australia's conversion was about 25 years ago, and their insurance industry plays a larger role in their present system than canada's does in theirs, though i don't really know if there's a connection.

many of these people were paid to let people get sick and die, and got bonuses for increasing those numbers too. if there are jobs to be saved, i'd rather save those of the suv-makers, although i'd go for michael's solution here.

Submitted by hipparchia on

leaving aside the inescapable fact that many of these jobs were designed expressly to deny care for sick people, how many of them are truly meaningful? and are you saying that we have to guarantee that every $7/hr clerk gets free room and board and tuition to get their phd in biomedical engineering? [and thanks for that link on retraining, i've always thought it was a lie myself too. also, i'd like to raise taxes and guarantee a free college education to everyone.]

i'd rather just give them all a severance package of 2 years' salary tax free, with absolutely nothing for the upper level executives, and possibly the same for mid-level executives too.

you've taken a stab at quantifying an upper bound [thanks for those 2 links too] on the problem, but that's about it.

insurance companies hire doctors and nurses. i have no idea how many, and neither do you apparently, but we'll need more nurses and doctors actually practicing medicine once everybody in the country can get health care. i'm all for giving them some kind of incentive [and maybe hiring priority, but i'm less sure about that] to return/move to medical practice, but i balk at guaranteeing them any other employment.

clerical workers don't make a lot of money, and yes, trying to live on the miniscule amount of unemployment that low-paid workers get would be nigh unto impossible, and especially cruel if you're trying to support a family entirely on that one income. so how many low-paid workers are we talking about, and how many of them would be in this dire situation? i don't know and you don't say.

additionally, people really do take low-paying clerical jobs for a second income, and would be just as happy selling stuff on ebay instead of filing papers. how many of them would be ok with free health care as an offset to a drastically lowered income? you say that your feeling is that it isn't many, but what are you basing that on?

insurance companies have all kinds of workers of varying skill levels and pay grades. are there any estimates anywhere of which classes are more likely and which are less likely to find new employment easily?

and then there's the issue of a timeline for all this.

yes, hr 676 is vague on financing altogether, the unemployment and retraining, and also the financing of the whole thing. various schemes have been proposed, but none included. whether this was by design or accident, i can't say, but it does allow for financing decisions to be made at the time the bill is passed, decisions which could well be influenced by whatever the economic situation is at the time.

nor does it spell out in great detail exactly what medically necessary is. a good thing imnsho, since society's views on that could change over time and since i'd rather my doctor[s] be the one[s] to determine what's medically necessary, not a bunch of congresscritters.

i'm with you on being fed up with all the hopey changiness we've been hearing the past two years, but life is full of gray areas and the economy is floating like a lead balloon. it may make more sense to pass a sweeping wpa/ccc rescue for all of us, rather than attaching yet another point of contention to single payer.

Submitted by lambert on

Bingo:

It may make more sense to pass a sweeping wpa/ccc rescue for all of us, rather than attaching yet another point of contention to single payer.

Submitted by hipparchia on

not that anybody holding the reins of power has taken any of my good advice yet. ;)

nihil obstet's picture
Submitted by nihil obstet on

The effect of legislation is not limited to those who claim they're affected. NAFTA granted privileges to capital and enforced rights to labor arbitrage which caused very heavy American loss of jobs. Trying to draw a line between that as the effect of legislation vs. the loss of private insurance profits as the effect of legislation simply mystifies the way government power is used. Mystification of government power serves conservatives.

And what has addressing employment issues as part of other policy issues done? It's made it virtually impossible to reduce military spending because the bases, munitions contracts, and shipyards provide employment. It's given prisons a justification as economic development, not only locking up lots of our citizens but putting them in rural areas that need jobs despite their remoteness from the prisoners' families.

And in what policy issues is employment not considered? Remember how welfare reform was touted as ending a wasteful bureaucracy that trapped people in dependency? Remember how no one said, "Yeah, but look at all the social workers and file clerks and administrative personnel who will be without jobs. Sure, we think (not me, to be clear) welfare is a bloated wasteful, counterproductive program, but we have to be concerned about the people who will lose their jobs in the bloated bureaucracy"? Cutting any government program is done by legislation. But somehow, the argument is always "Those music teachers that we don't want to pay for any more aren't entitled to their jobs," rather than "We can't cut school programs without insuring that all the current employees are placed in comparable jobs."

The point is that employment arguments are always marshalled for or against other policies. This will continue to be true until we have a national employment and income policy. In the meantime, concern for the truly bloated, wasteful, and counterproductive bureaucracy of medical insurers is still far outweighed by the needs of us all. Let's not hold hands with conservatives who suddenly discover injustice to insurers' employees.

Incidentally, and perhaps off subject: do you know how bad those jobs are in a right-to-work state? Damn, those people have needed unions!

splashy9's picture
Submitted by splashy9 on

Unlike those that are losing their jobs right now.

They can become more innovative and start new businesses, free of the hassle of providing health care for themselves and their employees.