I had one of those moments last week when the stars aligned that I wanted to share and along the way share some things I learned about the looming healthcare debate.
On Tuesday April 21, around 1 pm I was working on promotion ideas for my forthcoming book, This is Not How I Thought It Would Be: Remodeling Motherhood to Get the Lives We Want Today. One of the things on my list was to figure out how to reconnect with Karen Kornbluh. Karen and I crossed paths in the first couple of years after we’d both had our first child and after we’d both read Ann Crittenden’s The Price of Motherhood and wanted to work on related issues. She was in DC and I was in CA but we spent time on the phone with a couple of other partners in crime and she ended up joining a group of Mothers & More members in a hotel room in New York one weekend in lengthy discussions designed to articulate the Mothers & More POWER Plan, an articulation of the issues Mothers & More wanted to tackle.
I’d watched Karen’s career at the New America Foundation, then as policy director for Senator Obama, then to candidate Obama’s chief policy director and the author of the 2008 Democratic platform. I wanted to reconnect to tell her about the book so I was googling her.
In the string of hits, up pops a mention of a speaking appearance she had scheduled to talk about healthcare reform. At Pitzer College in Claremont. 45 min from me. At, get this, 4:15 pm THAT DAY! I had to read the webpage three times to believe it. Then I emailed the contact to confirm it. And promptly jumped in the shower and hightailed it out to Claremont to see her.
So by a twist of fate, I was googling Karen at 1 pm, and sitting at Pitzer listening to her by 4:15. Can you imagine how ticked I would have been if I’d googled her the day after that??
I want to share the highlights of her talk, and relate it back to the connection between healthcare reform and the types of customized job structures that are best for families, companies and all employees. I was so excited to hear her frame these issues in a way so similar to how I’ve framed them in the book.
She started by talking about how broken our entire social insurance system is for the 21st century – that includes healthcare, Social Security, unemployment insurance and other core systems. Working America has changed so much she pointed out. From a Breadwinner/Homemaker family model to what she calls Juggler Families. From 40 hour a week/40 year family wage jobs to 1/4 of workers in non-standard jobs.
She pointed out, as I do in my book, that employer provided healthcare happened in WWII because a wage freeze drove employers to offer health benefits as a way of competing for workers. A system that doesn’t fit our workforce today.
She explained that the cause of the looming federal debt is skyrocketing healthcare costs, not Social Security which is often trotted out as the villain. Reforming healthcare is inextricably linked to fixing the economy and the deficit. She shared that the administration views the financial crisis as having a silver lining because it forces us to deal with all this. Or to quote Rahm Emanuel, “Never let a serious crisis go to waste.”
She said that the administration had rejected the either/or thinking about healthcare. That we can have either cost or quality but not both. Either broad access or cutting the deficit. Either private insurance or affordability. Either employer based or universal coverage.
The model being proposed embraces both/and. If you like your current coverage, you keep it. At the same time, private insurers would be available along with a newly formed public plan that people could opt into and still receive the tax subsidy normally applied with employer based coverage. The public plan would in theory keep the private insurers honest and competitive in price. And if it was good, and lots of people opted into it, then we might move closer to a single payer system.
I’m simplifiying quite a bit and she talked about several other elements of healthcare reform, but that’s basically the idea at this stage. Several people in the audience pushed the single-payer system, advocated by Healthcare NOW, as the solution instead.
So here are my thoughts. First, while I like the principles the administration laid out to guide healthcare reform, an important one is missing. One of the missing pieces of the healthcare debate is how our current system reinforces the standard 40-50 hr a week job. That divides employees into two groups, one group with full-time jobs and access (at least a lot of the time) to health benefits and another group working non-standard jobs that are denied benefits by their employer and often can’t get private insurance either. Employers have an incentive to hire workers (especially low wage workers) into part-time jobs and save money by not providing benefits. Or they hire full-time workers and work them long hours since the benefits are already paid. Even employers who want to offer good jobs that are non-standard find their hands tied when it comes to providing benefits, even proportional benefits. (70% job = 70% cost of benefits covered for example).
For an economy where non-standard jobs are increasingly common, where both mothers and fathers in particular want good jobs that still leave room in their lives to care for their children, and where boomers are “retiring” but may need or want to work at something less than full-time, this system just doesn’t fit anymore.
So while I’m glad that the principles for reform include making sure health insurance is portable, I’d want to add a principle that health care reform should: Encourage and support employers in offering a variety of job structures that fit their employees and their business needs.
Employers with workers on non-standard schedules shouldn’t be off the hook for either providing proportional benefits or paying into a system that those workers can access. Employers who want to offer customized job structures – which all the research says is good for the employer and the employee – shouldn’t have their hands tied by the healthcare system.
So, that means that for me, in the current proposed plan, having a public plan – and one that makes it easy for non-standard workers to access it – is an absolute requirement. At least then non-standard workers have an option to turn to and can ask employers to subsidize their costs. You can be sure many interests will fight the idea of a public plan, but for anyone who cares about seeing our workplaces come into the 21st century by moving away from the standard 40-50 hour job to customized jobs that work for everyone, be sure to speak up about the necessity of a public plan and requirements that employers and private insurers need to provide access to non-standard workers. Of course, a single-payer system could be designed to address this problem as well, but it doesn’t sound to me like that option is politically realistic at this time
Okay, off my soapbox and back to my time at Pitzer. After her talk, I caught up with Karen, who gave me a big hug. She was excited about the book and we talked shop for a while as I walked her out to her ride to the airport. I felt like I was meant to be in that room for so many reasons. I was thrilled to see a friend and hear about all the great work she’s been doing. The whole experience gave me a shot in the arm as I reach the final phase of edits to my book. And I got the very latest overview of the looming healthcare debate.
Thank god for google and a bit of fate on a Tuesday.