The Amazing Maze of US Health Care

Imagine that an employer can hire professional talent for a day, a week or for years and not have to consider health care as a fixed cost.

Imagine that same professional talent is without work, whether through illness or simply lack of work, and yet does not have to worry about paying for health insurance.

Sound like a health reformers ideal.  Provide employers the flexibility to hire talent as needed.  Provide health care for workers even when they have no income.

This model exists now

This is the model of the multi-employer health & welfare plan.

Multi-employer plans are common in those unionized industries with seasonal or irregular employment: transportation, needle trades, construction trades, and theater trades, for example.  They are governed by a board with equal numbers of employers and union representatives.  Employers pay a negotiated rate per hour worked into the Fund and the Fund provides benefits through periods of employment and transitional unemployment.  Some funds are fiscally sound enough to provide benefits through retirement. Read the rest of this entry »

The American Benefits Council, the preeminent advocate of employer-sponsored benefit programs in Washington D.C., offers this prescriptions for health care reform – build on what works.

Fit for the Scrap Heap

Employer sponsored health insurance is not a system that works.  I say that as a 25 year employee benefits professional.

Despite what its proponents say in its support, their actions tell a different story.

Employers want out.

And the numbers over the last 15 years show they are getting out.

They are dropping their health care plans.  Fewer employers offer plans and those plans cover fewer employees. Read the rest of this entry »

Wednesday, September 9^th, President Barack Obama stood before the American people and a joint session of Congress and said:

If you are among the hundreds of millions of Americans who already have health insurance through your job, … nothing in this plan will require you or your employer to change the coverage or the doctor you have.  (Applause.)  Let me repeat this:  Nothing in our plan requires you to change what you have.

Someone will need to explain to me why this is a good thing.

The door may blocked

As the President was speaking these words, the 70 workers at SK Hand Tool Corp in Chicago, IL were without health insurance because their employer had made that decision for them.  It had unilaterally stopped paying for health insurance for its employees.

An inviting portal

As the President was reassuring Americans that they could keep their health insurance, the employees of SK Hand Tools, represented by Teamsters Local 743, were starting the third week of a strike to keep their health insurance.

That strike would eventually last for ten weeks.

There is an overwhelming body of health policy research that supports the necessity of continuity of care to improve population health outcomes.  Yet for most Americans, employment is not a continuous engagement.

Why do we build a system that relies on continuity on another system that flourishes on discontinuity?

Read the rest of this entry »

Most people across the political spectrum agree that health care is a social good.  They agree that someone else’s health is in their interest.

People may not express it that way.  But as the adage goes- actions speak louder than words.

We support health care for old people through Medicare.  It was Republican President George W. Bush who partially filled the biggest gap in coverage for older people with legislation to add prescription drug coverage to Medicare.

We support health care coverage for poor people through federally supported state Medicaid programs.

We support the Children’s Health Insurance  Program (CHIP) that expands Medicaid programs to the children of the working poor.

We support health care for Native Americans through the Indian Health Service.

We just seem to have a problem with people who work.

It might seem logical that, since we clearly have recognized that health care is a social good, that we should require all employers to provide health insurance.  After all, we require employers to pay for workers’ compensation insurance, and unemployment insurance. Read the rest of this entry »

The Society for Human Resource Management (SHRM)has approximately 250,000 members representing the varied disciplines and commercial interests within the  human resource profession.   As a benefits professional with expanded human resource responsibilities, I recently joined SHRM.

No one there {Photo by JLM}

So I was disappointed to learn that SHRM does not support the recently passed House health care reform bill, HR 3962, The Affordable Health Care for America Act.

My readers will know I consistently argue that relying on employment as the primary gateway to the health care system is outmoded and ultimately harmful to the American economy.   Part of that argument is because employer sponsored health care limits the flexibility of employer human resource policies and the mobility of the workforce.

Does SHRM share those views?

Apparently not.

What does SHRM say? Read the rest of this entry »