Apologies for going off topic somewhat–healthcare is not a primary topic of this blog. However, the big issue in the dispute between the union and TriMet isn’t pay, but healthcare benefits. Costs for have been growing without bound, and are expected to grow. Health care costs for public employees are taking an ever bigger share of public budgets. And the beneficiaries of this largesse aren’t bus drivers, teachers, cops, or firefighters–who simply want to have access to decent healthcare–but the medical industry (including insurance), which is a continually growing segment of the economy.
The Affordable Care Act (more commonly known as Obamacare), which fully takes effect in 2014, will help somewhat, but a primary focus of the ACA is providing affordable healthcare options for the poor, particularly those who presently don’t qualify for Medicaid, but are priced out of the private insurance market. Obamacare generally doesn’t replace private health insurance for those who have access to group policies for their employer.
The dirty linens of Obamacare
Any government involvement in the healthcare industry seems to annoy conservatives, particularly in today’s polarized climate–such proposals draw comparisons to Soviet gulags and other examples of tyranny. This despite the fact that the ACA is similar to conservative proposals advanced in the 1990s as alternate proposals to Hillarycare (and is also quite similar to Romneycare, the health plan which is law in Massachusetts). But several aspects of the ACA have annoyed liberals as well–chief among them is that it doesn’t drive healthcare costs down sufficiently. It helps in many regards, by providing baseline insurance to the poor and uninsurable, and thus discouraging the common practice of indigent persons showing up at the ER for minor complaints, knowing that they cannot be denied treatment for an inability to pay (and stiffing the hospital, and the rest of us, with the bill). Instead, the poor can have access to preventative care in doctors offices, a far more cost-effective way of practicing medicine. However, it lacks the primary advantage of single-payer systems (including Medicare): by having a government monopsony being the primary purchaser of health care, prices can be driven down. (Which is bad for doctors and pharmaceutical companies, but good for the rest of us). Of course, a public option was DOA on arrival in Washington DC for this reason (among others).
Another interesting aspect of Obamacare is that it largely leaves traditional employer-provided group plans alone. Workplaces, particularly larger ones, provide good risk pools for purchasing insurance, and employers enjoy tax advantages in buying health insurance that individual purchasers do not. A particularly controversial aspect of Obamacare was organized labor’s insistence on no provisions taxing or levying a surcharge on so-called “Cadillac health plans”–high end plans, generally enjoyed by high-value employees (such as executives) and by unionized labor. The health plan enjoyed by TriMet’s workers would undoubtedly be considered a “Cadillac” plan, were that provision included in the ACA.
The provision protecting Cadillac plans was naturally denounced by many conservatives as union pork. However, organized labor (in particular, the AFL-CIO) have long taken the position that they would be willing to abandon “Cadillac” plans in exchange for a public option.
And the saving grace
Given the political constraints and implementation choices of the ACA, it probably isn’t going to help resolve the present TriMet/ATU debate, even when it comes fully online in 2014. While Obamacare will reduce health expenses by ending certain wasteful practices, the lack of cost controls doesn’t attack the primary problem, and the ACA is focused at the low end of the market–those unable to afford (or qualify for) insurance. However, the ACA contains an important escape clause: it makes it easier for states to experiment and set up their own healthcare systems, so long as the levels of coverage provided are as good or better as the national baseline. Oregon has long been an innovator with the Oregon Health Plan, a limited single-payer system which attempts to close the Medicaid gap, and OHP’s champion is once again in the governor’s mansion.
A greater hope lies in California, which is the state which has come closest to implementing single-payer on a state level. Bills to implement single payer have previously passed in both houses, only to be vetoed by the Governator; the current governor, Jerry Brown, has stated an intent to sign such a bill if it passes. A proposal this session failed to pass, when several conservative Democrats turned against it.
The current legislative session is almost over in Salem, and given the 30-30 split in the Oregon House, a single-payer system here would be unthinkable this time around. But if Democrats retake control of the House, and keep or expand their hold on the state Senate, could it happen here? And would a single-payer system, which would presumably obsolete the existing healthcare arrangements between TriMet and its drivers and mechanics, receive the support of organized labor in the state?
(Or as an alternative–would a state government employees health plan, covering all public-sector workers in the state, regardless of union affiliation, be a possible proposal?)
Could the current crisis in public employee healthcare costs be the impetus for the state to do what so far the healthcare industry has resisted? After all, it’s our money that pays for public employee insurance. And the current fight over benefits for bus drivers vs service cuts and fare hikes is not an enjoyable one–instead of arguing about who gets what slice of an ever-shrinking pie, maybe labor, ridership, and TriMet management can come together in support of an arrangement which is mutually beneficial, not just to TriMet employees and customers, but to everyone in the state.