Solidarity at Breakfast
About 170 people came together for a ‘Solidarity Breakfast’ for Workers’ Memorial Day in Syracuse last month. Bringing 170 people out for an event, especially for a breakfast that cost $25, is no mean feat, so mega kudos should go to the organizers who included the Occupational Health Clinical Center, the Area Labor Federation, several union locals, the Worker Center of Central New York, Workers’ Compensation attorneys, and community activists. The reason for listing specific organizations is to illustrate the second remarkable feature of the gathering: the bringing together of people and groups who don’t normally interact directly all that much but need to do so more often. So even though most attendees ate their scrambled eggs at a table with their own ‘kind’, the act of coming together in the same room to break bread and share an experience that included speakers, awards, and songs is a notable achievement.
The breakfast program emphasized several themes. Workers’ in our region who lost their lives on the job in the past year were remembered, and the stepson of a worker recently killed on the job spoke movingly of the devastating impact of his stepfather’s death. Mother Jones gave Workers’ Memorial Day its slogan: “Mourn for the Dead, Fight for the Living” and the rest of the program was focused on the “Fight” half of her exhortation.
Immigrant workers were a major focus for four of the awardees. After receiving an award for his many years of health and safety worker with the Tompkins County Workers’ Center, Carlos Guttierez reflected on his younger days in his native Chile where he was imprisoned for three years by the Pinochet dictatorship for the ‘crime’ of being an activist in support of President Salvador Allende. He pointed out the connection between him being forced to leave his country over forty years ago due to a US backed coup that overthrew Allende, and more recent waves of immigrants from Mexico and Central America also forced to leave their countries largely due to US policies, this time economic rather than military or political.
Other awardees, Arely Tomas, a Workers’ Center activist, and Dolores Bustamonte, an apple farmworker activist were recognized for their commitment to struggling for their and their co-workers’ rights in the workplace, struggles made immensely more difficult by their undocumented status. Both have been arrested by Immigration and Customs Enforcement (ICE) and face possible, if not likely deportation. The unspoken irony of their stories is that they are pushed out of their own countries by US policies, come to the US because they are essential to the US economy, and work hard to save money for a hoped for return home someday, only to be demonized as job stealers, freeloaders, and criminals, and hunted, arrested and expelled as ‘illegal aliens’.
Carly Fox, another awardee for her advocacy work with the Worker Justice Center explicitly drew the connection between immigrant rights and health and safety through the specific example of the Green Light Campaign. The campaign is an effort underway in New York State to pass legislation allowing undocumented workers to apply for drivers’ licenses. Without the ability to drive, farm workers toil in isolation and depend on their bosses’ generosity, expensive rides from local entrepreneurs, or favors from friends for even simple tasks like getting to the grocery store for food. Isolated and dependent, workers are easier for the boss to keep under surveillance and control. Workers who lack access to spaces outside their employers control are unlikely to know their rights, let alone organize effectively or access resources to help act on them. From a health and safety standpoint this practically guarantees the employer can require workers work under whatever conditions s/he creates, unimpeded by any health and safety demands. When a worker suffers a job related injury or illness the employer can control the medical treatment by determining where the worker goes for care and maintaining a presence in the treatment process. Access to transportation is a fundamental need for these workers.
Local labor unions and individual union members have typically figured prominently in struggles over health and safety issues. Pat Greenberg, formerly a hospital nurse and just retired as a union representative for 199SEIU was another awardee and she exemplifies the committed union member in it for the long haul. In over 25 years Pat was involved in many union efforts, beginning with the organizing campaign that brought a union to Crouse Hospital’s nurses, and going on to bargaining and serving as a union representative. Along the way she developed and interest in safety and health and participated in successful statewide efforts to pass legislation mandating safe needles and safe patient handling regulations, addressing major concerns of nurses and other health care workers. Pat’s activities illustrate the fact that health and safety conditions are not separate from other workplace concerns of union and non-unions workers alike. Lousy workplace conditions are typically not restricted to one issue, and a boss looking to save money by cutting corners will often include shortcuts in safety and health in his or her efforts.
But while the awardees were celebrated at the breakfast, a deeper reality was left unspoken. Labor unions, especially industrial unions, have shrunk to only a portion of their previous size and no longer wield the clout they once did among employers and politicians. On the other side, Workers’ Centers have made tremendous strides in their abilities to reach and organize amongst the unorganized, but they remain relatively small and short on resources and capacity. Consequently, many of the unorganized remain outside of their embrace. The old cliché of solidarity forever is not really a cliché in this context. If we are to play a serious role in preventing workers from getting injured or ill on the job solidarity is an absolute necessity.
Its easy to assert the need for solidarity, and relatively easy to put together a breakfast once a year. But it will take much more than an exhortation to move people to real unity of purpose and action. On the one hand a worker is a worker is a worker. All have a common interest in bettering their working lives, resisting their bosses’ efforts to squeeze more profits by squeezing workers, and making the workplace safe enough so that they are assured of going home after work instead of to the hospital or morgue. These common interests should bring all workers together, no matter their skin color, gender, sexual preference, ethnic background, age, religion, or any other of the many characteristics that divide us.
On the other hand, differences are real and have long histories often making it very difficult for us to overcome our divisions and see the commonalities that unite us. So while we strive for solidarity we must also understand, acknowledge, and grapple with our differences. Why is this so essential? For one thing who we are is shaped by our experiences and the world we live in, and in turn we perceive the world we live in based on who we are. African-Americans who have experienced the racism so pervasive in this society, tend to see the police, for example in a much different light than whites who have not had those experiences. The same for women, who as the MeToo movement has shown, experience daily the impact of male entitlement, and unsurprisingly often see gender relations quite differently than men. By acknowledging these and other differences we enable all to speak their truths and offer approaches and solutions to problems that utilize their insights, concerns and perspectives to lead to more comprehensive and effective strategies.
The other, and probably more difficult issue to confront is to come to some understanding how the racist, sexist, homophobic milieu that we have breathed in like the air that surrounds us, unnoticed and unseen, has shaped us. This is not to imply it has shaped us all in the same ways. If we insist on ignoring these issues it is likely that whatever organization we create or campaign we pursue will reflect the milieu from which it has sprung, and our divisions will remain an enduring impediment to solidarity and the power that comes from unity.
Despite our best intentions and efforts, creating solidarity while acknowledging differences will be a bumpy, difficult, and sometimes painful process. There is no guarantee of success, and there are certain to be mistakes, false starts, and a need to reflect and change paths. There will be no movement forward, however, if we are not able to keep coming into the same room for the rest of the year after Workers’ Memorial Day, with goodwill in our hearts, and a commitment to a common goal of preventing workers from dying or getting injured or ill on the job. In that room we will need to ban defensiveness and ego and engage each other, listening closely, and responding with generosity and openness.
Employers Should Pay the Full Share of the Costs of Occupational Injuries and Illnesses: Local Actions
Michael B Lax
What can workers and their allies do to make employers pay their fair share of occupational injuries and illnesses?
Organizing or waiting for legislation or regulations to make employers pay for the costs of workplace illnesses and injuries may take years and is not guaranteed of success. In the meantime workers, unions, Workers’ Centers, health and safety professionals and activists, and other allies can be engaging in activities that can create change in other ways.
Increasing workers’ safety and health knowledge and skills is a fundamental underpinning to the power workers’ need to make change at the workplace, legislatively, or via regulations. It follows logically then, that knowledge and skill building should be a central focus of efforts by worker health and safety advocates. Knowledge includes a technical component (eg assessing workplace hazards, ways to eliminate or effectively control hazards) and a rights component (ie what are workers’ health and safety rights and how can they be implemented).
To make change knowledge must be translated into effective action, so it is crucial that worker education is organized around this goal. This means barriers to workplace change are explicitly identified and addressed. In order to do this the experiences of workers themselves are essential, as they are the ones able to educate the educators on what the realities of their workplaces are. It is only upon a clear assessment of those realities that effective action can be based.
While basic OSH education can and should be spread as widely as possible among working people in all types of workplaces, additional education can be provided to a much smaller number of workers that gives them the ability to train others, and to serve as an OSH resource and advocate in their workplace and perhaps in their community. For this to be successful, consideration must be given not only to the content of the training, but also how to make it something people who are already limited in their free time because of their work, family and other obligations, will find appealing and worth their time. In addition, structures need to be in place to ensure ongoing communication and support of trainees. Newly minted workplace OSH advocates may need additional training, as will need support dealing with the issues they are called to confront.
The provision of OSH training presupposes an organization or organizations capable of carrying it out. In our community a variety of organizations do this work or aspects of it. Existing efforts would be amplified by all of those involved coming together to collaborate on a joint plan and strategy. This would include local labor unions, Worker Center, Occupational Health Clinic, and safety and health training organization. Besides pooling and maximizing resources, the strengths of such a collaboration would include an increased ability to compete for additional funding from grant and other sources, and greater potential clout when approaching employers, government bureaucrats, and politicians. Beyond these benefits a collaborative organization could conceive and carry out other projects with the aims of empowering workers, and of convincing legislators and regulators to undertake efforts to make employers pay their share of workplace illnesses and injuries.
Examples of some organizational activities could include:
1) Serving as a support for workers trying to change conditions at a particular workplace. Support could include helping strategize action, participating in meetings with the employer, and public campaigns to draw attention to the issues raised by workers.
2) Providing opportunities for workers from different workplaces or industries to come together and share experiences and strategies
3) Gathering data and publicizing area workplaces with patterns of workplace injuries and illnesses
4) Publicizing worker experiences with the Workers’ Compensation system and abusive employers
5) Create and advocate for best practices to eliminate/reduce workplace hazards as an alternative to reliance on OSHA standards, or lack of them
A collaborative group could also marshal its resources for political purposes. It could develop a workers’ health and safety legislative/regulatory agenda, organize support for the agenda among allies statewide, and advocate for the agenda among politicians and regulators.
The efforts described do not directly address the issue of requiring employers to pay the full costs of workplace illnesses and injuries. Instead they provide the precondition or platform on which a more direct campaign can be built.
Employers Pay the Full Share of the Costs of Occupational Injuries and Illnesses?
Michael B Lax
Picking up on the theme of the most recent blog piece: “There are many ways that can be imagined to make employers pay the full, or at least more, of the costs of the injuries and illnesses their decisions have caused, and for which they should be responsible.” The conceptual approach to make this happen is pretty simple:
1) Increase the recognition of occupational injuries and illnesses. Force these conditions out of hiding and into an appearance on (potentially) public data sources such as Workers’ Compensation, OSHA injury and illness logs, and state mandatory reporting databases (eg occupational lung disease, heavy metal registry, pesticide registry in New York State).
2) Augment and publicize the underlying data that links health conditions to workplace conditions and exposure to workplace hazards.
3) Deter employers from failing to correct hazardous workplace conditions by making it expensive, financially or otherwise, to ignore their responsibilities to prevent workers from getting sick or injured.
4) Empower workers to not only know what hazards they are exposed to, but to investigate health and safety conditions, to know their health and safety rights, to have access to occupational health and safety resources independent of their employer, and to assert their demands without fear of retribution.
As always, translating a simple concept into an effective action is the difficult part. Should the focus be on actions that can be realistically accomplished within a short time frame? Should the emphasis be on long term change of unclear feasibility? Perhaps the answer is that this dichotomy is not necessary and a strategy that combines short and long term goals and that maintains the flexibility to adapt to a shifting political economic milieu should be sought.
Over the long term regulatory and legislative changes will be necessary to implement an “Employer pays for making workers sick or injured” agenda. On the federal level this would be impossible, at least at the moment, so little effort should be squandered in that arena. On a state level in New York, though hardly easy, the prospects for change appear, if not immediately doable, at least within the realm of the thinkable. The elements of an agenda might include:
1) Make the data from all sources (Workers’ Compensation, state registries, OSHA injury and illness logs) publicly accessible with names of employers. Provide and annual report on the data from these sources.
2) Require employers to investigate all injuries and illnesses and make changes to reduce/eliminate responsible hazards. Employers should document these efforts. Fine non-compliant employers.
3) Employers with patterns of injuries and illnesses should be required to access OSH resources to evaluate the workplace and make remediation recommendations. Employers would be required to document they have made recommended remediation changes. Fine non-compliant employers.
4) Convene a statewide panel to re-define occupational disease for Workers’ Compensation that recognizes the various ways work can impact health, and that provides guidelines for assessing the role of work and working conditions in the production of disease.
5) Require employers to pay an injured worker at the 100% rate of compensation as long as they are unable to do their regular job. This would include payment until they either: return to their regular job, return to some other work, go through a vocational rehabilitation program and job re-training
6) Require employers to create a health and safety committee. Workers should have paid time to participate including meeting amongst themselves; investigating hazards, injuries, and illnesses; access to independent OSH resources who have the ability to come into the workplace and inspect; and training for committee members.
7) Adequate funding for the already existing state OSH infrastructure including the Occupational Health Clinic Network, and the Occupational Safety and Health Training and Education Program. These programs serve as important resources to workers and employers.
8) Creation and enforcement of state safety and health standards that address hazards not currently covered by OSHA. For example, a statewide ergonomic standard is one to consider.
At the moment this proposed agenda is aspirational as opposed to realistic. It is clearly not meant to be all-inclusive, but rather a starting point for discussion. Perhaps pieces of it can be hived off and pursued individually, since the whole is unlikely to be accepted as a unified package. Any successful pursuit will require building the political power necessary to push it through the legislative/regulatory process
Hard to go from concept to action to success
What to focus on?
Legislation policy? Long term and difficult- federal forget it, state possibly
Empowering workers- what can advocates/activists do?
Community health and safety committee
Worker training- beyond information
Public naming and shaming
Access to data- WC, registries with names
Tie WC to workplace changes- mandatory- make resources available- allow access to workplaces
Worker health and safety committees- paid time to do- mandatory investigation of accidents
SAFETY PAYS!!.......NOT REALLY
Michael B. Lax
Common decency would argue that if I am responsible for someone getting hurt or sick, I should also be responsible for paying for the resulting medical and other costs. The same principle should be applied to the workplace. Business owners and managers create the conditions under which ‘their’ employees work. They decide what product or service is going to be provided as well as how the work is to be done. These decisions determine what the risk of injury or illness will be, and is the reason the Occupational Safety and Health Act of 1970 declares that it is the employer’s responsibility to create and maintain a safe and healthy workplace.
Business practices are not, however, based on common decency, but rather, on dollars and cents. Owners figure out how much it’s going to cost to prevent injuries versus the cost of compensating, and sometimes replacing, those who get injured or sick on the job. Compensation and replacement are typically cheaper.
The total cost of workplace injuries and illnesses is estimated to be $249.6 billion dollars a year in the United States. Of that total, Workers’ Compensation accounts for $55.4 billion, or 22%. About $13 billion (13%) is covered by private health insurance which ultimately comes out of the pockets of a combination of individual workers and employers. The rest, $162.2 billion (65%), is financed by injured workers, their families and taxpayers.1 Employers are on the hook for only about $64 billion (26%) of the costs through the premiums they pay for Workers’ Compensation and their contribution to general health insurance. Until employers are forced to pay a much greater share of the costs of the injuries and illnesses they are responsible for causing, there will continue to be little incentive for them to pursue workplace changes that would make the workplace safer and prevent workers from being injured or sickened.
Why do business owners pay such a small portion of the costs?
One major reason is that only a small proportion of work related illnesses and injuries are recognized. Occupational diseases like asthma, contact dermatitis, and cancer are notoriously hidden and treated as general health conditions using health insurance, and if necessary. If disability benefits are sought for these conditions, they are frequently paid for by taxpayer funded Social Security Disability Insurance (SSDI). Even a disease that rarely has a non occupational cause like silicosis, a scarring of the lungs due to exposure to particles of silica from jobs like foundry work or granite counter top cutting, only finds its way into the Workers’ Compensation about a third of the time. Even acute injuries where the link to work is much more simple to see are often treated as non work related.
The barriers to recognizing a health problem as work related are tremendous. They include reluctance on the part of workers to admit they were injured at work or to suggest their symptoms might be caused by something they work with. Many workers are anxious to avoid any action that might antagonize their employer or threaten their job. Its better to just keep things quiet and not rock the boat. Employers are interested in keeping their costs low and avoiding hassles that interfere with getting things done at work. Their interests are aligned with those of their Workers’ Compensation insurance carrier, and the practical result of their shared approach is to attempt to deny as many claims as possible, preventing them from being compensated and from being identified. Those interests are also reflected by a Workers’ Compensation system and process that upholds many of their denials, and makes the process so burdensome for the injured worker that many claims that should be compensated are dropped or denied.
Another reason for the poor identification is that all injured workers must have their condition diagnosed by physicians who are poorly trained in the identification of occupational injury and disease. Doctors receive minimal training on their role in helping their patients access Workers’ Compensation benefits leading to frustration and ineffectiveness. They are uninterested in participating in a Workers’ Compensation system that delays their payment, requires them to continuously defend their medical decisions, prevents them from practicing good medicine by denying and delaying testing and care, and sometimes drags them into court to have their opinions picked apart.
Finally, there is the overarching problem of lack of knowledge that handicaps all of the participants in this arena. Chemicals and other materials are constantly being introduced into workplaces without being tested for their potential effects on human health. As a consequence, it may take years of exposure to large numbers of workers, before a pattern of harm can be discerned.
Even when occupational injuries and illnesses are recognized, however, they do not necessarily lead to preventive efforts by employers. There is no feedback loop between Workers’ Compensation and the workplace. Neither insurance carriers, nor the Compensation Board require employers to make workplace changes after injuries or illnesses, even when a pattern of them is discerned. And the threat of being meaningfully penalized by OSHA or a state regulatory agency is extremely low and does not act as a deterrent. OSHA’s resources are stretched thin and it would take the agency over a hundred years to actually inspect all workplaces. Even when OSHA cites a company for violations, the fines are typically low. Most employers can fly below the radar and not be too concerned about a possible inspection.
Even though they pay such a small proportion of the costs of workplace injuries and illnesses, employers have continuously sought to reduce their responsibility even further. Unsurprisingly these cost reduction strategies have avoided serious attention to preventing work related injuries and illnesses through improvements in workplace conditions. Workers’ Compensation reform has focused, for the most part on limiting benefits to injured workers, limiting conditions recognized as work related, and requiring injured workers to get care from doctors chosen and paid for by their employer. Reining in health care costs and improving productivity has generally followed an individual responsibility approach, encouraging workers to get healthy through lifestyle and behavioral changes, and penalizing those who don’t. This approach ignores the potential contribution of working conditions to these problems and their associated costs.
There are many ways that can be imagined to make employers pay the full, or at least more, of the costs of the injuries and illnesses their decisions have caused, and for which they should be responsible. Workplace safety will pay only when employers can no longer socialize the costs of injury and illness.
1 Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Quarterly. 2011 Dec:89(4):728-72
WHY IS UNIVERSAL HEALTH CARE AN OCCUPATIONAL
SAFETY AND HEALTH ISSUE?
Michael B. Lax MD MPH
Workers injured or made ill on the job in New York state face major problems accessing the health care they need. Among those problems two stand out:
- Locating a physician who accepts Workers’ Compensation (WC) as payment
- Workers Compensation insurance carriers deny payment for medical care for all kinds of reasons, resulting in delays in necessary testing and treatment that can last months or even years
These fundamental problems undermine one of the ostensible purposes of the Workers’ Compensation system: providing timely and appropriate medical care to injured workers. As a consequence, health conditions often worsen or fail to improve, and can become needlessly prolonged or even permanent. Careers can be unnecessarily curtailed, and the lack of ability to earn a living may be devastating, condemning an injured worker and his/her family to impoverishment. Significant and long term mental health impacts are frequent as another result.
The likelihood of these problems being fixed is virtually zero within the confines of the current WC system. The many forces driving doctors in the community out of the WC system remain, while the system seems unable and/or unwilling to institute countermeasures to keep physicians participating, let alone bring back practitioners who have already left. Meanwhile the abusive behavior of the WC insurance carriers continues unabated with challenges to every aspect of care provided by physicians including: diagnoses made, testing requested, and treatment recommended. Not only does this place a tremendous burden on the doctor and her/his office, it also prevents the practice of high quality medicine. The Workers’ Compensation Board ( WCB) and legislature have likewise failed to confront and curtail the powers of the insurance industry.
If they can’t be fixed then why bother writing about these problems? Because if we look beyond the confines of the existing set-up there is a simple solution: universal public health care. A system such as Ontario’s single payer program resolves these issues.
The division of health care into two parallel systems, one for general health and one for work related health problems, is a consequence of the US’ peculiar history. Workers’ Compensation systems were created in one state after the other in the decade or so following the Triangle Shirtwaist fire in Manhattan in 1911. Labor and its allies had been arguing for some time for a system to quickly and fairly provide medical care and compensation to injured workers as a replacement for workers having to sue their employers. Workers filing suit occasionally won significant sums, but for the vast majority the process was extremely burdensome and the barriers to winning a case made it very difficult for an injured worker to prevail. The sight of 146 bodies piled up near blocked exits and on Greene and other surrounding streets after the Triangle Shirtwaist fire galvanized reformers and gave the necessary push to pass Workers’ Compensation legislation. By the time general health insurance became widespread and often employer based in the following decades, the Workers’ Compensation system was already well established.
Participation by physicians in WC is voluntary and a significant section of MDs has always chosen not to accept WC. In the past their reasons have included: low reimbursement, delays in payment, excessive paperwork, and demands to testify in court. WC underwent a significant reform in NY in 2007. As these changes were implemented incrementally over the next few years, many more physicians exited the system. The perceived increased demands of the reforms were the straw that broke the camel’s back and led many practitioners to declare “enough!”. As a result injured workers, especially outside the larger urban centers are unable to find doctors to treat their work related condition. Even those with doctors who have been treating them under WC often find themselves out in the cold as their physician informs them that s/he no longer will be accepting WC and will stop providing their care.
A single payer universal health care system could address the problem of participation quite simply. Private health insurance and WC insurance would be eliminated, to be replaced by a government entity that would be responsible for financing all health care costs: a single payer. All patients would be covered for all health conditions. All health care providers would participate and provide care to all without needing to concern themselves about the work relatedness of a health problem. The issues of WC reimbursement rates, delays, paperwork, and court testimony become non-issues in a universal health care system, removing the disincentives MDs face in under the current system.
Universal health care would also resolve the issue of poor quality care under WC as a consequence of insurance carrier abuse. In a single payer system the rules of what is approved and reimbursed are the same, whether a condition is work related or not. This is not to say the system is dispute or delay free, but there are far fewer than under the current system in the US. In addition, there is only one level of care, in stark contrast to NY where the health care received under WC is subject to so many challenges and barriers erected by the insurance carriers.
The resolution of these key issues with a universal single payer system is not just theoretical. Just across the border in Ontario, for example, a single payer system has been in place for decades. There, injured workers have no problem finding a doctor to get treatment. They do not have their testing or treatment delayed, interrupted, or blocked altogether by a WC insurance carrier. Instead, the treatment they receive is the same any other resident would be provided, whether or not the condition is work-related. Ontario and Canada is just one example of how the system has already proven itself. Many others could be found across the developed world.
Advocacy for single payer universal health care in the United States has been going on for decades. There is a tendency for politicians of both major parties to dismiss it as a possibility, Republicans mostly because they are opposed on ideological grounds to what they call (inaccurately) ‘government’ based medicine, and Democrats because ‘it’s just not realistic’. In the current Trump and Republican dominated administration it might seem like a pie in the sky goal. HOWEVER…popular energy in favor of universal health care has arguably never been higher. Bernie Sanders’ campaign made the issue a central plank of its platform, generating widespread support. He and many others continue to press for this kind of change. With popular support continuing to rise, the deficiencies of the current market-based health care system becoming ever more obvious, and the lack of any credible Republican alternative, there is legitimate reason for optimism for single payer.
In the meantime, the New York State Assembly, led by Assembly Health Committee chair Richard Gottfried, has succeeded in passing the New York Health Act, legislation for the establishment of a single payer universal health plan for all New Yorkers, the past three years. Every year support has increased in the Republican controlled state Senate and last year was just one cosponsor short of majority support. In this context, it is no longer unrealistic to think that the New York Health Act could soon pass the New York legislature. As it stands now, the bill does not include health care currently provided under Workers’ Compensation. Its sponsors, however have expressed an openness to eventually wrapping WC into the system.
Passing the New York Health Act is a crucial step on the road to changing the WC system and providing for the medical needs of injured workers. Health and safety advocates should see this as a top priority for our action agenda. And hopefully we can convince other advocates for New York Health of the importance of including the WC piece as a necessary part of truly providing universal health care in New York State.
Inclusion of medical care for injured workers in New York Health should, however, not let employers off the financial hook for the responsibility they bear for working conditions causing worker injuries and illnesses. Injured workers and their families, and taxpayers already pay a high proportion of the costs of occupational illness and injury. To avoid socializing what should be the employers’ responsibility even further, New York Health should explore options for making sure employers pay their fair share, and include an effective mechanism in the universal health care system to be created.
The following resources are useful for anyone seeking more information:
Campaign for New York Health
Focused on the campaign for universal single payer health care in NY state
National coalition campaigning for federal single payer legislation and support for state plans
Physicians for a National Health Program (PNHP)
National organization of physicians, medical students, and health care professionals advocating for single payer. Their site has a lot of data on all aspects of the issue.
The PNHP Metro chapter has been supporting the campaign for New York Health
This site describes his support for federal single payer legislation
GOVERNMENT RUN LIKE A BUSINESS? MORE LIKE BUSINESS RUNNING THE GOVERNMENT
March 31, 2017
Michael B. Lax, MD, MPH
Some say that Donald Trump doesn’t really have an ideology. He’s a businessman, meaning a pragmatic dealmaker, skilled in the art of negotiation. With these character traits, he’ll be good at getting the job done, breaking through the grid lock created by politicians beholden to partisan ideologies.
Trump supporters are also fond of the idea that government should be ‘run more like a business’. They seem to share the conception described above, of non partisan government committed to efficiency and results. But in addition there is an economic component: that like a business, government should be responsible with its money, balancing expenses and revenue, and accumulating no debt; that the government should only collecttaxes to fund itself for limited and essential functions; and that those limited and essential functions do not include the redistribution of resources to address, even partially, inequalities.
Trump has only been in office for about two months, but he has striven to put his immediate stamp on Washington, and has already provided ample illustration of what ‘running the government like a business’ means in practice. When I write ‘Trump’ in this context it includes the congressional forces and energies his election has unleashed.
The first example is the Republicans’ health care bill. Their efforts to pass legislation have been stalled, temporarily at least, in large part over an argument about how free the private health insurance market should be. Obamacare relied on the private health insurance market, but created controls meant to increase the accessibility of insurance and to establish a minimum baseline for what policies needed to cover. Trumpcare’s initial approach reduced some of these controls, but it wasn’t enough for the conservative marketeers, who demanded that all restrictions on insurance companies be removed. These included lifting the prohibition on excluding people with pre existing conditions, as well as ending the requirement that insurance cover basic and essential services such as prescription drugs, mental health care, pediatric services, maternity care, substance addiction, and emergency care. The rationale is that competition between the ‘freed’ insurance carriers will eventually force premium rates down. The reality is that millions will be priced out of the market, and many of those who can afford insurance will have cheaper plans, with high deductibles that cover very few services.
In a separate health related action, Republicans proposed a bill called the Preserving Employee Wellness Act. Under this law employers would be able to coerce employees into participating in wellness programs that require genetic testing. What is the point of this legislation? Businesses need to minimize their costs so they can maximize their profits. Health care costs tend to increase faster than inflation and businesses have long been complaining about the drag they place on profitability. Obamacare opened the door to employers pushing employees into wellness programs, saving companies money in the short term by imposing penalties on employees who didn’t participate or didn’t reach health goals. The Republicans’ bill would extend this opening to allow genetic testing. What would this information be used for? Its hard to imagine it being used for anything other than discrimination. Workers testing positive for certain conditions, or the risk of certain conditions, could be denied employment and/or health insurance as employers seek to control health care costs by excluding individuals with potentially costly health conditions.
In another recent action, Congress voted to repeal rules protecting the internet privacy of us all. Trump’s appointee as head of the Federal Communications Commission (FCC) enthusiastically supported the change which will allow internet service providers to collect information on every user’s browsing habits, app usage, location data, and more, and to sell that data to whoever pays. For their money, advertisers will be able to fine tune their ads to target individuals based on the profile constructed from the data. Though likely not intended, it will also give hackers much richer targets to steal. And intended or not, it will come in handy for government surveillance to keep tabs on users, whether citizens or not.
A last example, is another recent congressional vote, this one to use the power of the Congressional Review Act to repeal an OSHA rule requiring an employer to keep records of workplace injuries and illnesses. Under what was called the Volks rule, OSHA could cite employers who failed to record injuries or illnesses at their workplace during the five years they are required to retain these records. Republicans want the time period limited to just six months. Not only will this change reduce the number of employers who can potentially be fined by OSHA, it has the potential to further distort the real picture of workplace injuries and illnesses. With less reporting, Republicans will argue that workplaces are safer and the need for standards and enforcement requires less resources and attention.
What’s the common thread in all of these examples? They show the real meaning of ‘running government like a business’: freeing business from all forms of regulation that impede profitability. Nothing else really matters, not health, individual privacy, worker safety and health, nor coerced collection of genetic information for use in discrimination. The list of things that don’t matter has already gotten longer since I began writing this piece. The question is how long that list will get and what we will have sacrificed for the sake of profits along the way.
Those who will believe that our survival and prosperity depends on unleashing the power of unfetteredbusiness will be thrilled by the direction Trump and the Republicans are taking us. However, anybody who believed that ‘running the government like a business’ meant something else is in for a rude awakening, if they haven’t been shaken awake yet.
Of course focusing on Trump and the Republicans ignores the role the Democrats have played in bringing us to where we are now. But that’s a story for another time. Right now the Democrats are pretty irrelevant. Trump and the Republicans are in command of the moment.
"To the Editor" (posted on Syracuse.com 3/23/17)
Michael B. Lax, MD, MPH
So the big reveal has finally arrived. The Republicans have unveiled their shiny new replacement for the Affordable Care Act (ACA). Mark Davis (Post Standard 3/9/17), a columnist for the Dallas Morning News, enthusiastically welcomes the news. His column is useful because it clarifies what the Republican plan is really about, despite the rhetoric from Republican proponents. Ryan and Trump promise us the best health care in the world, and that no one will lose their insurance. Their rhetoric is so far from reality it seems incredible to think they actually believe their own words.
Instead of universal access and high quality care, the Republican plan is all about cutting health care costs. Through knocking people off Medicaid and slashing funding for those left, one big chunk is saved. Another chunk is saved by replacing subsidies for those who need them to buy private insurance, with regressive tax credits too small to allow many to afford insurance. The result will be millions, perhaps as many as 15-20 million, losing health care coverage. Davis is more honest than Ryan and company, at least admitting that this is likely to be the case.
Davis also does us the favor of making clear that the Republicans’ approach is driven by ideology, rather than rationality. Cut costs, shrink the government role, and make every person responsible for him/herself is their mantra. In this world, universal access to health care is not even a professed goal. It can’t be afforded and would require what Republicans see as the immoral transfer of funds from the haves to the havenots through insurance or taxes. In their eyes, if you’re poor and can’t afford health insurance, it’s your own fault, so live with the consequences.
Roger Marshall, Republican Congressman and practicing physician from Kansas, was recently interviewed by the BBC about health care. When asked how the Republicans’ plans would be any different from pre ACA days, when as many as 45 million people could not access health care due to lack of insurance, he responded that he “rejected (the interviewers) premise. Anyone can get health care. All they have to do is go to the emergency room. And besides, there are some people who just don’t want to get care.”
The vision of people like Davis and Marshall is cruel and delusional. Americans need to ask themselves if this is a vision they want to share of themselves and ourcountry. Does ‘making America great again’ mean every individual for him/herself? Whatever happened to ideas of solidarity and community, a sense that we are all in this together?
What is ironic, is that an alternative path to reform health care that ensures universal access, preserves quality, and controls cost has been well tested in almost