5 ms·

My wife is looking to change jobs in the midwest of the US. When we search, however, the majority of openings are less than full time and have no health insuran

My wife is looking to change jobs in the midwest of the US. When we search, however, the majority of openings are less than full time and have no health insurance benefits. And she is a public employee and looking to stay in the public sector.

antisthenes 4y ago
The jobs can't afford to provide healthcare either. The underlying harsh truths of health care in the United States is that it became bloated by design (incentives for high base prices), and also that the US population is incredibly unhealthy. And that a few million of health care workers (mostly in insurance companies) will have to lose their jobs to make it fair for the rest of us. But because unhealthy people are lumped together with healthier ones, it tends to lower the costs to a tolerable (still very high) level. Also, many workers don't pay their full premiums, which again helps mask the true costs of health care. Eventually it will all come crashing down and there will be far more suffering than there had to be, had we addressed the problem earlier and in full (Gut the insurance companies, Single-Payer, Cost ceilings on critical medication).
- ok_dad 4y ago
  I agree with your assessment that single payer is necessary, but as for the millions of job losses claim, I don’t agree. Those millions of jobs are for doing something right now, so do you think that something will be eliminated just because the government took over and what is that something? I don’t believe that many jobs could be effectively useless, but I stand to be corrected.
  - missedthecue 4y ago
    If they all get jobs with Government Healthcare inc, where are the actual savings coming from? Who is going to be earning less? The profit margins of healthcare insurance companies are almost nothing. Look at Humana for instance... 2.5% net margins. Cut that out and every american saves $5 a month.
    - ok_dad 4y ago
      That’s my point, kinda. I expect there to be some savings, but I’m not sure where from and how much. I feel like millions of jobs is a lot though.
      - mjevans 4y ago
        Best case: they're not kept on as 'No men' (contrast, 'yes men' for underlings who are just empty enablers), but transferred to scientifically evaluating and seeking the best treatments. Worst case: we go back to what things were before the ACA where if you had a preexisting condition you were screwed.
        ok_dad 4y ago
        Yea, I'm thinking that there might be a lot of administrative work that could be eliminated by a centralized electronic system for single payer care, but the way I see this going right now is the government adding another layer of administration on top of the current system to operate it (literally privatising it), and then adding a centralized directory of service charges and moving towards eliminating the parts of the system that are unnecessary under this scheme while also working with the same companies as currently exist to merge all EHRs into one common system. I expect most of the cruft of the current system to remain for several decades or more, plus more government cruft, but the upside is that we can eliminate the profit as a goal and probably balance half or more of the government cruft with eliminating inefficiencies. If they privatized pharma and the EHR software companies, too, then that would probably immediately lower prices due to the insane profit motives for investors in those areas, but that would never happen. I think we might save some money right away, but more likely we'll lose a bit, gain the ability for our citizens to not have to worry as much about their jobs being their literal lifeline, and over time we'll save more and more versus the current system due to an increased quality of living due to better health outcomes and longer lives.
    - noelsusman 4y ago
      There wouldn't be much actual savings without massive disruption for providers. Right now Medicare and Medicaid are cheaper per patient largely because they pay below cost for the same services. They are subsidized by private insurance. A move to Medicare for all at current reimbursement rates would require drastic budget cuts at every healthcare provider in the country. That may be what's necessary to fix the broken system, but it would involve a lot of pain.
  - 317070 4y ago
    David Graeber has a long book on this, called "Bullshit Jobs". It turns out many of those people do think _their own_ job is useless and could effectively be removed with no impact. In the book he offers some numbers on the healthcare system in the US, where in administration and insurance there are indeed many such bullshit jobs. What is worse, they often bring a bureaucratic burden on people like nurses, who do have real work to do. (All by the assessment of the people doing the bullshit job) He offers quotes to show this was even the point of view of Obama > Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” Graeber describes this comment as a “smoking gun” of bullshittization. “Here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs,” he writes. Politicians are so fixated on job creation, he thinks, that no one wonders which jobs are created, and whether they are necessary. Unnecessary employment may be one of the great legacies of recent public-private collaboration.
    - ok_dad 4y ago
      I think a lot of people think we can eliminate a lot of things, but cannot properly pick the things to eliminate. I think there is a lot of bullshit we hate to do, that is still necessary; or alternately, we can't eliminate it due to some sort of momentum or systemic reliance on that bullshit. In healthcare, I imagine there is a lot of bullshit that would still have momentum in a post-single-payer world that we couldn't eliminate right away, but I still want that. See my other recent comment, I went into more detail on why I think single-payer would be great, but isn't a panacea for healthcare costs and efficiency.
vinyl7 4y ago
I noticed that this became more and more common back when ACA was passed. It's cheaper to hire a lot of people part time than it is to hire fewer full time people because of the benefits they would be required to cover
- JoyfulTurkey 4y ago
  It has definitely been a trend at the public entity where she works. When full time employees leave/retire, two part-time positions are created to replace that person instead of hiring one full-time employee.
- rdtwo 4y ago
  Since health insurance is 20-30% of the benefits package it’s cheaper to either hire under the full time bar or work people 7 days a week 10hrs a day and just pay the overtime differential. I think the calculus has swung enough that overtime at 1.5x is actually cheaper than adding new employees.

antisthenes 4y ago

The jobs can't afford to provide healthcare either. The underlying harsh truths of health care in the United States is that it became bloated by design (incentives for high base prices), and also that the US population is incredibly unhealthy. And that a few million of health care workers (mostly in insurance companies) will have to lose their jobs to make it fair for the rest of us. But because unhealthy people are lumped together with healthier ones, it tends to lower the costs to a tolerable (still very high) level. Also, many workers don't pay their full premiums, which again helps mask the true costs of health care. Eventually it will all come crashing down and there will be far more suffering than there had to be, had we addressed the problem earlier and in full (Gut the insurance companies, Single-Payer, Cost ceilings on critical medication).

ok_dad 4y ago
I agree with your assessment that single payer is necessary, but as for the millions of job losses claim, I don’t agree. Those millions of jobs are for doing something right now, so do you think that something will be eliminated just because the government took over and what is that something? I don’t believe that many jobs could be effectively useless, but I stand to be corrected.
- missedthecue 4y ago
  If they all get jobs with Government Healthcare inc, where are the actual savings coming from? Who is going to be earning less? The profit margins of healthcare insurance companies are almost nothing. Look at Humana for instance... 2.5% net margins. Cut that out and every american saves $5 a month.
  - ok_dad 4y ago
    That’s my point, kinda. I expect there to be some savings, but I’m not sure where from and how much. I feel like millions of jobs is a lot though.
    - mjevans 4y ago
      Best case: they're not kept on as 'No men' (contrast, 'yes men' for underlings who are just empty enablers), but transferred to scientifically evaluating and seeking the best treatments. Worst case: we go back to what things were before the ACA where if you had a preexisting condition you were screwed.
      - ok_dad 4y ago
        Yea, I'm thinking that there might be a lot of administrative work that could be eliminated by a centralized electronic system for single payer care, but the way I see this going right now is the government adding another layer of administration on top of the current system to operate it (literally privatising it), and then adding a centralized directory of service charges and moving towards eliminating the parts of the system that are unnecessary under this scheme while also working with the same companies as currently exist to merge all EHRs into one common system. I expect most of the cruft of the current system to remain for several decades or more, plus more government cruft, but the upside is that we can eliminate the profit as a goal and probably balance half or more of the government cruft with eliminating inefficiencies. If they privatized pharma and the EHR software companies, too, then that would probably immediately lower prices due to the insane profit motives for investors in those areas, but that would never happen. I think we might save some money right away, but more likely we'll lose a bit, gain the ability for our citizens to not have to worry as much about their jobs being their literal lifeline, and over time we'll save more and more versus the current system due to an increased quality of living due to better health outcomes and longer lives.
  - noelsusman 4y ago
    There wouldn't be much actual savings without massive disruption for providers. Right now Medicare and Medicaid are cheaper per patient largely because they pay below cost for the same services. They are subsidized by private insurance. A move to Medicare for all at current reimbursement rates would require drastic budget cuts at every healthcare provider in the country. That may be what's necessary to fix the broken system, but it would involve a lot of pain.
- 317070 4y ago
  David Graeber has a long book on this, called "Bullshit Jobs". It turns out many of those people do think _their own_ job is useless and could effectively be removed with no impact. In the book he offers some numbers on the healthcare system in the US, where in administration and insurance there are indeed many such bullshit jobs. What is worse, they often bring a bureaucratic burden on people like nurses, who do have real work to do. (All by the assessment of the people doing the bullshit job) He offers quotes to show this was even the point of view of Obama > Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” Graeber describes this comment as a “smoking gun” of bullshittization. “Here is the most powerful man in the world at the time publicly reflecting on his signature legislative achievement—and he is insisting that a major factor in the form that legislature took is the preservation of bullshit jobs,” he writes. Politicians are so fixated on job creation, he thinks, that no one wonders which jobs are created, and whether they are necessary. Unnecessary employment may be one of the great legacies of recent public-private collaboration.
  - ok_dad 4y ago
    I think a lot of people think we can eliminate a lot of things, but cannot properly pick the things to eliminate. I think there is a lot of bullshit we hate to do, that is still necessary; or alternately, we can't eliminate it due to some sort of momentum or systemic reliance on that bullshit. In healthcare, I imagine there is a lot of bullshit that would still have momentum in a post-single-payer world that we couldn't eliminate right away, but I still want that. See my other recent comment, I went into more detail on why I think single-payer would be great, but isn't a panacea for healthcare costs and efficiency.

vinyl7 4y ago

I noticed that this became more and more common back when ACA was passed. It's cheaper to hire a lot of people part time than it is to hire fewer full time people because of the benefits they would be required to cover

JoyfulTurkey 4y ago
It has definitely been a trend at the public entity where she works. When full time employees leave/retire, two part-time positions are created to replace that person instead of hiring one full-time employee.
rdtwo 4y ago
Since health insurance is 20-30% of the benefits package it’s cheaper to either hire under the full time bar or work people 7 days a week 10hrs a day and just pay the overtime differential. I think the calculus has swung enough that overtime at 1.5x is actually cheaper than adding new employees.