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How do you eliminate wasteful jobs without backlash? Stop hiring and let attrition take care of the problem? In 2009, they'd have to look to increase employmen

How do you eliminate wasteful jobs without backlash? Stop hiring and let attrition take care of the problem? In 2009, they'd have to look to increase employment elsewhere.

oh_sigh 8y ago
That's still painful, because you have an entire pipeline of people feeding those useless jobs. Yes, the ones with the useless jobs get to stay, but the many people who were planning their lives around getting a useless job(with their useless skills) now need to find something to do. Let me be clear: I don't support keep useless jobs around simply because it would be painful to the employee to lose their job.
- kimdotcom 8y ago
  Isn't another benefit that this will foster greater entreupenurship and thus create 'job creators'? Right now, if you are employed and have insurance, you are really just subsidizing these jobs - middle-class welfare.
ethbro 8y ago
Based on my experience (working around insurance IT during ACA implementation), the best solution is setting performance goals, then rebating some of the savings to the party for exceeding them. With the rebates tailing off after a number of years. This allows the party cutting costs the flexibility to reallocate now-redundant people directly to problem areas, without having to procure additional funding. The rebates cover the cost of retraining (maybe mandate this for for-profit parties).
- throwaway080383 8y ago
  Why wouldn't the party simply fire the "redundancies" and pocket the money?
  - ethbro 8y ago
    Not-for-profit insurances entities (e.g. Blue Cross Blue Shield) legally can't pocket (in any beneficial way) the savings. Aside from that, there's a huge amount of undocumented knowledge in the field. Given its stability, people can still work 20-30 years for the same company. Given there are always areas who need more people, I can't believe you'd rather have someone who knows nothing than the person with 20-30 years of experience (salary aside, admittedly).
- telchar 8y ago
  I would dispute that. My experience in the hospital side of same field has been that within the framework of the existing healthcare system it's hard to reduce costs without worsening health outcomes. The costs we can cut most easily are staff, services and supplies. Cutting services reduces revenue, nullifying incentives. Trying to deliver the same services with reduced staff and supplies impacts quality. The jobs that can be cut without reducing quality are the administrative nonsense like dickering back and forth with the insurance company, but those jobs also can't be cut without reducing revenue. It would take a change to the way we pay for healthcare to significantly reduce costs, and/or getting the cost of pharmaceuticals under control. There's a lot of fat in pharma too but that's another conversation.
  - ethbro 8y ago
    I believe you. Providers are ultimately the profit center, and insurance operations the cost center.
LyndsySimon 8y ago
I would argue that it simply isn't the responsibility of the state to ensure that there is a continuing market for a given set of skills. Sure, it's a problem when industries and job classes disappear - but keeping them around doesn't solve the problem, it only defers it. In many (most? all?) cases it even makes it worse.
- forapurpose 8y ago
  People about to lose their job and therefore their home, health insurance for their family, children's college fund, etc. need a solution, not a theory of why that solution isn't some particular institution's responsibility. If not government, then who?
dragonwriter 8y ago
> In 2009, they'd have to look to increase employment elsewhere A goverment-mandated major healthcare streamlining would reduce health administration and support (financing, management, IT, billing, coding, legal support, etc., etc., etc.) in the long term, but in the short term it would create lots of jobs—and mostly in the same general space—in a a surge that (with the most likely kind of implementation timeline) would ramp up over a couple years of implementation planning, stay steady for a few years of main implementation, and then taper off to the new, lower equilibrium as new systems and processes moved from implementation to routine operation. Probably no better time for that than an economic downturn where employment was soft, if the government is deficit funding to subsidize the implementation costs. It's basically a short-term jobs program with long term dividends for the whole economy.
- photojosh 8y ago
  I really how you've framed this. In a sense, it's much like other investments in infrastructure (except digital, rather than a highway or rail line): lots of jobs during construction, and then once it's done it's a public good. Perfect for during a downturn. I work in automation, and what's happened when a location introduces our tech is not an immediate loss of jobs, but rather the existing employees move to higher productivity roles. Any job losses eventually come via attrition and non-replacement.
mac01021 8y ago
Foster competition? If a company can capture a greater share of the market by offering the same service with a lower premium, isn't that what they'll do? I don't know why that effect is not present now, but it could have much to do with the way most people get insurance through a group policy provided by their employer (and therefore get no chance to shop around).
- zbentley 8y ago
  > I don't know why that effect is not present now Inelastic demand. Whether you have a debilitating/life-threatening illness, or are worried whether the lump in your throat is heartburn or the cancer that'll end your life, your incentive to engage with competing market presences is massively diminished for several reasons (urgency, many people have a desire for their life-or-death decisions not to be commoditized, etc.).
  - mac01021 8y ago
    That explains why people don't shop around for health care. But it doesn't explain why they won't shop around for health insurance.

How do you eliminate wasteful jobs without backlash? Stop hiring and let attrition take care of the problem? In 2009, they'd have to look to increase employment elsewhere.

oh_sigh 8y ago

That's still painful, because you have an entire pipeline of people feeding those useless jobs. Yes, the ones with the useless jobs get to stay, but the many people who were planning their lives around getting a useless job(with their useless skills) now need to find something to do. Let me be clear: I don't support keep useless jobs around simply because it would be painful to the employee to lose their job.

kimdotcom 8y ago
Isn't another benefit that this will foster greater entreupenurship and thus create 'job creators'? Right now, if you are employed and have insurance, you are really just subsidizing these jobs - middle-class welfare.

ethbro 8y ago

Based on my experience (working around insurance IT during ACA implementation), the best solution is setting performance goals, then rebating some of the savings to the party for exceeding them. With the rebates tailing off after a number of years. This allows the party cutting costs the flexibility to reallocate now-redundant people directly to problem areas, without having to procure additional funding. The rebates cover the cost of retraining (maybe mandate this for for-profit parties).

throwaway080383 8y ago
Why wouldn't the party simply fire the "redundancies" and pocket the money?
- ethbro 8y ago
  Not-for-profit insurances entities (e.g. Blue Cross Blue Shield) legally can't pocket (in any beneficial way) the savings. Aside from that, there's a huge amount of undocumented knowledge in the field. Given its stability, people can still work 20-30 years for the same company. Given there are always areas who need more people, I can't believe you'd rather have someone who knows nothing than the person with 20-30 years of experience (salary aside, admittedly).
telchar 8y ago
I would dispute that. My experience in the hospital side of same field has been that within the framework of the existing healthcare system it's hard to reduce costs without worsening health outcomes. The costs we can cut most easily are staff, services and supplies. Cutting services reduces revenue, nullifying incentives. Trying to deliver the same services with reduced staff and supplies impacts quality. The jobs that can be cut without reducing quality are the administrative nonsense like dickering back and forth with the insurance company, but those jobs also can't be cut without reducing revenue. It would take a change to the way we pay for healthcare to significantly reduce costs, and/or getting the cost of pharmaceuticals under control. There's a lot of fat in pharma too but that's another conversation.
- ethbro 8y ago
  I believe you. Providers are ultimately the profit center, and insurance operations the cost center.

LyndsySimon 8y ago

I would argue that it simply isn't the responsibility of the state to ensure that there is a continuing market for a given set of skills. Sure, it's a problem when industries and job classes disappear - but keeping them around doesn't solve the problem, it only defers it. In many (most? all?) cases it even makes it worse.

forapurpose 8y ago
People about to lose their job and therefore their home, health insurance for their family, children's college fund, etc. need a solution, not a theory of why that solution isn't some particular institution's responsibility. If not government, then who?

dragonwriter 8y ago

> In 2009, they'd have to look to increase employment elsewhere A goverment-mandated major healthcare streamlining would reduce health administration and support (financing, management, IT, billing, coding, legal support, etc., etc., etc.) in the long term, but in the short term it would create lots of jobs—and mostly in the same general space—in a a surge that (with the most likely kind of implementation timeline) would ramp up over a couple years of implementation planning, stay steady for a few years of main implementation, and then taper off to the new, lower equilibrium as new systems and processes moved from implementation to routine operation. Probably no better time for that than an economic downturn where employment was soft, if the government is deficit funding to subsidize the implementation costs. It's basically a short-term jobs program with long term dividends for the whole economy.

photojosh 8y ago
I really how you've framed this. In a sense, it's much like other investments in infrastructure (except digital, rather than a highway or rail line): lots of jobs during construction, and then once it's done it's a public good. Perfect for during a downturn. I work in automation, and what's happened when a location introduces our tech is not an immediate loss of jobs, but rather the existing employees move to higher productivity roles. Any job losses eventually come via attrition and non-replacement.

mac01021 8y ago

Foster competition? If a company can capture a greater share of the market by offering the same service with a lower premium, isn't that what they'll do? I don't know why that effect is not present now, but it could have much to do with the way most people get insurance through a group policy provided by their employer (and therefore get no chance to shop around).

zbentley 8y ago
> I don't know why that effect is not present now Inelastic demand. Whether you have a debilitating/life-threatening illness, or are worried whether the lump in your throat is heartburn or the cancer that'll end your life, your incentive to engage with competing market presences is massively diminished for several reasons (urgency, many people have a desire for their life-or-death decisions not to be commoditized, etc.).
- mac01021 8y ago
  That explains why people don't shop around for health care. But it doesn't explain why they won't shop around for health insurance.