Leading up to tomorrow’s Health Care Summit, I’ve been trying to follow each political party’s public positioning as to why their approach is preferable.
You hear a lot about the current health care reality:
- 40+ million people uninsured, and growing.
- Unaffordable premiums.
- Inability to get coverage for pre-existing conditions.
You’re also presented with two very different solutions, one is more government regulated and the other driven more by the private market. But, what you don’t hear is “why?” Why do we need to undertake this massive, structural reordering of a system that’s worked for decades and continues to work for many?
The reason is simple and powerful: We must uncouple work and health care coverage, because the nature of “work” has radically changed over the last decade. And, since the recession began two years ago, the shift in what it means to “work” has accelerated even more rapidly. And it’s never going back to the way it was.
That fact needs to be much more front and center in the debate than it has been. Basically, it’s missing. For example, in this morning’s New York Times there’s a two page spread of articles discussing tomorrow’s Health Care Summit. Guess how many times the changing nature of work is explicitly mentioned as one of the key drivers behind the need for reform? Zero.
It’s not the 1950’s. You don’t get a job with General Motors at 18 years old, keep it for 40 years, and retire with a pension and company provided health care benefits. But, listening to the politicians from both parties I seriously wonder if they get it. Do they understand that in today’s economic reality an individual will have any combination of full-time, part-time, contract-based, entrepreneurial employment over the course of a career? In only one of those four scenarios is there a chance for employer-sponsored health care. One. And increasingly having a full-time job doesn’t guarantee coverage.
Imagine how different the conversation might be…if President Obama kicked off tomorrow’s summit by saying, “We remember a day when we could rely on our job to provide most of us with good, fair coverage for a lifetime. That day has passed. We live in a new global economic reality in which most of us will find ourselves, either voluntarily or involuntarily, in a position where affordable employer-sponsored care is not an option. We must adapt our system to this new existence.” With that fact as the back drop, it’s much harder to defend the status quo of an antiquated system.
Over the past couple of months my readers have thoughtfully commented on the need to reform health care primarily due to the changing nature of work:
“As you point out, in the USA, all roads lead to health care. We do not fully understand how deeply the idea of ‘benefits’ (read health insurance) has traumatized the national capacity for work life flexibility, entrepreneurship and boldness. It’s bred entitlement, shut down our creativity. We are trained from day one, by our education system, the generations before us and an entire social system: ‘Get a good, steady job, settle down. Play safe. Be careful.’”
“Uncouple health insurance from individual jobs (even if it’s financed by businesses) and the dynamic changes. Workers who would prefer higher hourly pay and more flexible hours could negotiate for that. Employers who would rather create a full-time or part-time role than hire a contractor for a particular position could do so. Job locked people could retire early, start businesses, or make their experience available to younger companies – which would improve the job market for everyone.”
The real “why” behind health care reform is that the nature of work has changed, and will continue to change dramatically. A system that provides health care coverage through employment is no longer sustainable. But, let’s see if that’s mentioned in tomorrow’s Summit. I’m taking bets as to whether or not it comes up and if it does, how. So cast your vote in the poll “How will the ‘changing nature of work’ as key health care reform driver show up in tomorrow’s Summit?”.
How did I vote? I think it will come up but only tangentially (really, I think it won’t come up at all, but I’m an optimist by nature). What do you think? Take the poll and let’s see what happens tomorrow.