Health care conundrums

February 17, 2017

As I advance in age, I am exposed more and more to the health care industry, despite having enjoyed relatively good health until recently.  As a retired New York State employee, I am blessed with excellent health insurance that covers most doctor visits, medical tests and procedures, as well as prescription drugs, with only a relatively modest co-pay. Here are a few observations:

First, it appears that many of our health problems are what a friend of mine calls “diseases of affluence.”  More appropriately, they should be called “diseases of lifestyle,” since they affect people of all socioeconomic strata.  A lot of these are directly influenced by government policies.  For instance, our auto-centric physical infrastructure minimizes the opportunities for and pleasures of walking and cycling, and cannot help but contribute to obesity and other problems based on lack of physical activity.  Our government subsidies to cane sugar and corn (the main ingredient of high fructose corn syrup) help make junk food and sugared soft drinks attractively priced.  This is especially so for the poor, since the SNAP program (formerly known as Food Stamps) allows their purchase with SNAP benefits.  If we collectively spent more on complete streets that were friendly to pedestrians and cyclists, as well as cars, how much could we save on health care (not to mention on school transportation)?  How about if we stopped subsidizing sugar?  I think it would be worth a try.

For all the criticism leveled against it, the Affordable Care Act (“Obamacare”) has achieved something great — it has shifted the dialog from whether health care insurance should be extended to many of those who don’t have it to how the present system should be replaced or improved.  Neither Trump nor his minions are suggesting that those who obtained health insurance through Obamacare should lose it, meaning that they recognize that there is no going back on government’s commitment to growing numbers of its citizens.  Whether things actually get better or worse remains to be seen, but at least no one is talking a bout a pre-Obamacare “reset.”  To me, that is yuge.

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What goes around . . .

August 3, 2016

This little item in the Albany Times Union (the longer story linked to in the item is behind the paper’s pay wall) about the burden of rising pension costs is unusual only because of the employer — NYSUT, the teachers’ union.   NYSUT’s own management is clearly aware of the burdensome costs of benefits for its own employees, and its officers appear to be willing to take a cut while they negotiate similar cuts with their employees’ union.

Of course, NYSUT’s role as bargaining representative for its members is different from its role as an employer, and it is charged by law to represent its members’ interests.  In playing that role in contract negotiations, I don’t think NYSUT would be receptive to the concept of givebacks by its members.

What I suspect I won’t see is any of the school districts asking for the kind of givebacks NYSUT appears to believe warranted with respect to its employees (and leading the way by imposing them on their own staff).  One reason for public employee unions’ great success has been the lack of aggressive counter parties representing the taxpayers in contract negotiations, though I am sure the School Boards’ Association would argue to the contrary.  There are many reasons for this: the understandable urge (especially when spending other peoples’ money) to show appreciation for the good work teachers do, the large financial and political clout of the unions, and the fact that the better the deal for teachers, the better the deal for management, who must of course, be paid more than the rank and file in the trenches. Of course, in a competitive market for teachers, salary and benefits must be competitive, but smart management would make sure they were regardless of union pressure.

Recently, a caller to one of our local public broadcasting stations expressed the dilemma of wanting to support local public education but wanting to remain in his house, which was becoming increasingly  less affordable due to rising school taxes, among other things.  The moderator pooh-poohed him with the usual response — “nothing’s too good for our kids.”

Like that caller, I see both sides, and I certainly don’t want to return to the days of exploitation of teachers.  However, I wonder who is representing this taxpayer, and how strongly.  Only when both sides have equal bargaining power can a reasonable balance of interests be struck.