Last week on the eve of the Health Care Reform Summit, I wondered if the changing nature of work, the real driver underlying the need to reform our current employer-sponsored health care system, would be mentioned. I even created a brief survey asking you to place your bets, on “How will the ‘changing nature of work’ as key health care reform driver show up in tomorrow’s summit?” The responses were split:
- 50% said, “It will not be mentioned at all,” and
- 50% said, “It will be mentioned, but tangentially.”
No one picked the other option which was, “It will be front and center.”
So, who was right? Well, after reading the complete transcript from the day provided by Kaiser Health News (via Dr. David Ballard at the American Psychological Association), both groups were correct to a degree. The increasing flexibility in the way we work as the powerful reason “why” we need to reform our health care system did come up, but very briefly and very tangentially.
Specifically, there were SIX references that linked nature of work and coverage. Only six, out of a six-plus hour summit. To be fair, there was a great deal of discussion about the need for exchanges where individuals and small businesses could purchase insurance, and the requirement to extend coverage of dependent children under their parents’ policies up to 25 years old.
But there was little explanation as to “why” there were so many millions of people either on their own, working in a small business, or without insurance in their early 20’s. Answer: the change in work which involves more flexibility in type of employment beyond the traditional 1950’s “right out of school, work full-time for a big company for life” model.
Here are the six most specific references (I am not identifying the speaker or the political affiliation, if you are interested please review the transcript):
“Doing this will take legislation. I've been through this before. I was here when we had the Clinton debate. It was started, some of you will remember, by Lee Iacocca, who said we cannot export our automobiles, there is a thousand-dollar cost for health care in every one of them; my competitors are way ahead of me, they are eating my lunch. That was one of the main reasons, Mr. President, if you recall, that we decided we had to do something about that.
In the 13, 15 years since that has happened we have done nothing about health care; we don't export so much anymore; the automobile business is basically gone; we have done nothing to encourage entrepreneurs. The Speaker spoke to this, this morning. We need to think more about the economic benefits of doing this. Those of us who are trying to redo some trade policies and maybe let us make something else again in the United States really want to make sure that it succeeds. And this would be a great part of that. I think it's terribly important that we do that.”
“But I want to talk for a moment about what it means to the economy. Imagine an economy where people could change jobs, start businesses, become self-employed, whether to pursue their artistic aspirations or be entrepreneurial and start new businesses if they were not job-locked, because they have a child who's bipolar or a family member who's diabetic, with a preexisting condition, and all of the other constraints that having health care or not having health care places on an entrepreneurial spirit.”
“It is a system that is not a market for about 40 million Americans who are either in an individual policy or in a small group policy, have no choice, there is no competition.”
“So what does that mean when you want to change jobs; what does that mean when you want to start your own company? It means you go without insurance or you pay some policy that has a $5,000 deductible or $7,000 deductible.”
“This legislation is about innovation.”
“My mother, who was self-employed, didn’t have reliable health care, and she died of ovarian cancer.”
I am not a health care expert, so I can’t comment on what health care reform should look like. However, I am a work+life flexibility expert who studies this issue from many different perspectives everyday. And there is one thing that I know for sure: What “work” looks like over the course of a career is only going to continue to become more flexible and non-linear. Therefore, the current employer-based health care coverage delivery system is unsustainable.
Although I’m not qualified to comment on what reform should look like, I’m afraid I have to agree with those who say we must do something. I am discouraged, however, that so little of the public debate centered upon the real reason “why” we need reform now, which is the changing nature of work. It’s an important reality that those in power don’t seem to grasp fully. Let’s see what happens.
What do you think? Are you surprised? Like me, are you discouraged?