Friday, July 3, 2009

Health care employment, health care and the economy - Obama Dilemma

The Obama Dilemma – how to implement a single payer health system without harming the single greatest employer of American – is vividly on display in the July 2 amd 3 news.

Overall, the health care sector—from physicians' offices, to residential mental health homes, to blood and organ banks—reported 20,800 payroll additions in June, and 127,300 new jobs in the first half of 2009, preliminary data show. In the first half of 2008, the health care sector grew 179,400 new jobs, and averaged about 30,000 new jobs per month.

The fastest area of job growth in the health care sector continues to be in the ambulatory healthcare services, which reported 12,400 new jobs in June, and 83,700 new jobs in the first half of 2009, preliminary data show.

This health care job growth creates a dilemma for President Obama. Obama, you see, has promised to save the economy by spending $330 billion to make the health system more “efficient,” that is, by making the system more “rational” by paying less to hospitals and doctors, and to health plans and drug companies, who collectively employ millions of people. The health care industry is, in fact, the the biggest and only growth sector in the American economy. You can slow its growth, but it will come at the cost of jobs.

Peter Goodman, “Joblessness Hits 9.5%, Deflating Recovery Hopes, Administration Defends, Stimulus Spending as Still Sufficient, Recovery Hopes Deflate as Jobless Rate Hits 9.5% “July 3, New York Times

For another month, manufacturing jobs disappeared, dipping by 136,000, while contraction jobs shrank by 79,000 and retail by 21,000. Health care remained a rare bright spot, adding 21,000.

Martin Kettle, “Obama’s Future Depends Upon His Nation’s Health,”July 3, The Guardian

Be in no doubt, though, that the fate of his reform plan will define the fate of his presidency. It will do so because of two overwhelming reasons. First, because the US healthcare system is so huge. And second, because it has defied the efforts of all those who have tried to reform it in the past. It will be healthcare – not Iraq, Iran, nuclear weapons, climate change, the budget, or even the banks – that frames the verdict on the Obama administration.

Will Wilkinson, “Demcoratic Health Care Vs. Democracy,” July 3, The Week

President Obama has confessed that he'd aim for a Canadian-style, single-payer health-care system if he were "starting from scratch." Of course, nobody gets to start from scratch. We've always got to start from here.

The fact that American voters have repeatedly resisted a move to any system of universal health care underscores for many liberals the danger of leaving the protection of basic rights to the discretion of the democratic public. And so, in one of the profound ironies of American politics, even the Democratic Party abjures the fundamental democratic responsibility of honest persuasion when it comes to nailing down its contested vision of our basic rights.

Nobody gets to start from scratch. And that means sometimes things that shouldn't be on the table are on it. If so, how do we take them off? Not by lying to one another. The worth of trust and cost of mutual hostility are too high. Our democratic burden is to help others see what we think we see. And if we fail, we keep trying. We might try this sometime. Maybe, then, we could find a way to trust one another enough to create a health-care system that really delivers for everybody. Until then, we'll get the system we deserve.

The good news for Obama is: the American people want "reform" - lower prices and wider access. The bad news is that they don't want reform if it interfers with their own private plan, which covers 70% or so of Americans, if it narrows, access to providers and technnologies, and if it interferes with their conservative values - smaller government, lower taxes, freedom to choose, and equal opportunity but not necessarily equal uniform access and results for all.

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