A letter to the ATU
An open letter I once wrote to TriMet's union on health care
Note: for my current thinking see A bottom-up approach to health care
I am a transit rider and enthusiast in Portland, and know that TriMet and you disagree on the terms of the new contract, and moreover, that payment for fast-rising health insurance costs is a big part of it. I don\'t want TriMet to have to pay for the costs, but don\'t think that (beyond what\'s truly their fault) your members should have to pay either.
Furthermore, I came across an article recently that really describes the problems with the current health care system and why costs are increasing so much: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/
It\'s long, but the gist of it is that insurance gets in the way between the patient and the provider, resulting in the patient loosing control over their care and providers not having an incentive to control costs billed. There\'s other issues mentioned, too, like a lack of competition between providers.
I would like to see you and TriMet get together with the other unions in Oregon and the employers they have contracts with, as well as other employers, and try to get a version of what that article proposes. Specifically, I\'d like to see a ballot measure that:
- Gives people without group health insurance a tax credit (graduated towards middle- and low-income people and restricted to those who have been employed within the state) for putting money into a health savings account to be used to pay for health care directly (or to buy insurance)
- Replaces health insurance for government employees with the ability to get the same tax credit
- Encourages those (e.g. employers) that privately fund group health plans to buy into allowing the participants to use the tax credit instead, but makes sure that that the cost is not per-employee (ideally, all citizens would be covered using the credit)
- Has the government monitor rates charged for services paid for directly, and prevent unreasonable rates
- Allows people to borrow from future tax credits when their account currently doesn\'t have enough funds
- Provides government-paid co-insurance (based on need) for high-cost care needed due to catastrophic events
- Allows government to compete with private providers, but be treated as a private non-profit and not receive direct tax dollars
Money would come from funds now spent on government-provided health care and insurance, reducing business tax breaks, and, if necessary, increasing business tax rates (it\'s been said that they don\'t pay their fair share, and not having to pay for health care would benefit them).
Unlike other tries at government-provided, "single-payer" health care, I think this proposal has a chance in that it puts individuals, and not the government, in charge of the money and care.
Furthermore, switching from an employer-paid heath care model to an employee/government-paid one could increase the quantity, and quality, of jobs (and union members). Increasing employees would no longer mean increasing health care liabilities, and employers would not be encouraged to limit the number of workers (instead giving hours to existing employees as costly overtime, something I know TriMet does) or limit workers\' hours in order to keep them ineligible for full-timer health benefits.
Moreover, it would save unions a great deal of time, frustration and PR value now spent bargaining over health care.
I would like to discuss this and other union-related ideas with you and/or other interested parties. Thank you.