Don’t want to seem a contrarian, particularly on my first visit (Congratulations on the Monkeyfister award) but there may be an explanation of the AFL-CIO position here. It may seem counterintuitive but this move might actually get us closer to Single Payer.

Currently the economics of private insurance is based on exclusion. Insurance companies make money by insuring healthy people and excluding sickly people from coverage to start with and then by denying treatment even for those who are covered. Well the antidote to the first problem is to maximize automatic coverage, you get more people into pools where they have to be covered. And this is the case for most employer provided insurance plans, the insurance can’t screen out new hires. (Of course they can jack the cost of the plan up later, but that is a point to be discussed at another time.)

So the more people that fall into the category of ‘have to be covered’ the less profitable it will be for insurance companies to spend money screening people out. (Which by the way is central to the ‘mandate’ vs ‘no-mandate’ kerfluffle between the Clinton/Edwards approach vs the Obama approach to health care. Until we get insurance companies totally out of the picture (which is my preferred end game) they are not going to accept a system where people can opt out of insurance until they get sick and then automatically get a right to be covered.)

Currently neither public or private employers have any obligation to provide health coverage to retirees and most don’t. Certainly the State of Washington doesn’t. Which sets up a perverse incentive. I had a coworker in a midlevel government job that had in the past been a very successful in commercial real estate. He was making okay money at our job but really didn’t need it, he kept working because he knew no matter how successful your portfolio it will not survive an encounter with a major medical condition if you have to pay out of pocket. On the other hand his wife was free to take early retirement from her well-paid government job simply because her medical was covered under Jim’s plan. These people live to cruise and run their own cruise business out of their house, Jim would kill to be able to walk away from his County job and cruise full time at a profit (they set up and then lead cruise packages). But he can’t, he has some conditions that required surgery of a type that guarantees he could not even get private coverage.

Lots of people are in Jim’s position, eligible for early retirement either by investments, vesting in employer plan, or eligible for early retirement under Social Security. And in many, many cases only prevented from doing so by a lack of a bridge between employer covered plans and Medicare. Would employees benefit from an affordable bridge plan? Well if the alternative is no coverage at all, sure. Would employers benefit? Boy howdy, employees who are sticking around just for the benefits package are not likely to be your most productive ones. So what prevents employers setting up a win/win bridge health care plan? A certain Third Circuit decision in 2000.

Barbara, methinks you got this thing flipped. If the policy choice is coverage vs no coverage you want to come down on the coverage side and the EEOC ruling facilitates bridge coverage. Because the alternative is no coverage at all after you leave covered employment.

How does this advance single payer? Well if you have a system where people over 65 are universally covered by Medicare, people in the workforce are covered either by employer paid or employer subsidized insurance (through pools), and people in early retirement eligible for the same coverage as they got when they were working, all of a sudden you have the insurance system and medical care industry at large in a bind. If by and large you can’t exclude people and you are competing with a government plan that provides for all medically deemed necessary care, how do you make money? Answer is you don’t, your powers of resisting Medicare for all (i.e. Single Payer) start fading away.

If in fact some large percentage of Americans actually were getting employer paid medical coverage in retirement this would be seen as a huge takeaway from workers. But in fact this coverage is generally only available in industries where labor was able to get these kind of contracts pre-Medicare, e.g. Big Three Auto and Boeing. Now that Medicare is in place it is perfectly reasonable for big unions to trade off health care coverage for Medicare eligible workers for coverage for early retirees. It sounds perverse but anything which gets more people covered net advances Single Payer.

Do please check your blog’s email for a message from me (Monkeyfister). Therein you will find some very glad tidings, and some instructions for bring joy to someone else in this Holiday Season.

Also see here: http://monkeyfister.blogspot.com/2007/12/2007-golden-monkeyfist-awards.html

And then check your blog’s email.

Happy New Year!

–Monkeyfister
http://monkeyfister.blogspot.com/

1) Congress legalizes the cash balance pension plan game- which essentially removes “early “- prior to 65 – retirement subsidies and with few exceptions, those who could have retired at 60 with 100 percent benefits now must work till 65 to get 100 percent of (less) benefits. True the kinder do better under the Cash balance scene. But the overall effect is like moving the pot of gold at the end of the rainbow- while spilling out half the contents.

2) Now that the workforce must work loner- the government decides they must not only give the companies better tax breaks- but also figure out how to keep them in good health so that the older ones can work at full bore until they retire – or preferably drop dead soon after they become eligible. After all, SS was designed just that way- making the age to draw benefits near the age expected by the mortality tables to eliminate about half of the population. When the tables showed the expected age before the final shift got closer to 85- the financial basis went to hell.

Healthy corpses give a greater organic return in the Solyent green machine. Thats why the refer to personnel orgs as HUMAN resources – The new mantra – ‘ good till the last drop (dead) “