HEALTH CARE/Joan Retsinas

‘Lean On Me’ — Heavily

Forget the Independent Man, the citizen-bulwark of American independence. We have elevated another icon, the Independent Businessman, a commercial superhero who spearheads an idea into a financial empire. Think Bill Gates, or Steve Jobs, or Sam Walton. This one evokes a laissez faire world where savvy acumen can blossom into wealth, jobs, and wealth – provided that a pesky Uncle Sam leaves it alone to blossom.

This icon is a myth. Uncle Sam stands behind the infrastructure of that financial genius. From Apple to Walmart, every business is hooked up to customers and investors via cyberspace; and the Department of Defense initially developed the internet. Similarly, every business that transports its merchandise across the country relies on the federally-financed system of roads. (I suspect that when President Eisenhower proposed the interstate highway system, conservatives objected to this federal intrusion onto states’ domain.) Imagine the unsafe inefficient chaos of airlines whisking through whatever airspace they could claim. As for the immensely profitable pharmaceutical sector, basic scientific research, funded by Uncle Sam, undergirds many of the breakthrough treatments. Name a success tale: Uncle Sam is three, maybe two, steps behind the meteoric rise.

Less overtly, Uncle Sam has long shored up the wages of America’s entry-level workers. On $10, $12, $14 an hour, a family cannot live at what even the freest market conservatives would consider a decent standard of living. Add up the costs of housing, food, clothing, transportation. Even in parts of the country where housing is cheap, a family is hard-pressed to get by. So Uncle Sam has subsidized housing, food (not just food stamps, but the school lunch programs), day care, transportation, and income. Some might argue that the subsidies are too generous, that we are morphing into one of the Western European nations famous for big-government spending. Yet without those subsidies, we’d see the kind of distressing poverty common to non-Western emerging markets, the ones unfettered by government.

Health care too is subsidized. Unless we want higher morbidity and mortality statistics, workers need access to physicians, hospitals, and treatments. Our safety net of publicly funded free clinics is porous; our nonprofit hospitals do not readily accept non-paying patients. To gain access to health care, Americans need insurance. Americans over age 65 rely on Medicare – a program that has been around so long few recognize Uncle Sam standing behind it. Through Medicaid and more recently through the Children’s Health Insurance Program, the government has insured people under age 65 who are poor enough to qualify – a standard set by states. To date, working people have fallen into the ranks of the uninsured if their employer hasn’t offered health insurance, or if the workers couldn’t pay the premiums. Large companies have largely insured their workers, even those earning low wages.

Before the Affordable Care Act, part-time workers presented a dilemma for large companies. If they refused to insure those workers, the workers would end up uninsured – unless those workers were poor enough to qalify for Medicaid (or the States’ Health Insurance Program.) So the nifty business solution was clear: carve them out of the regular insurance offered to employees. States, though, as well as unions and consumer groups, not surprisingly, objected; and large employers, like Walmart, retreated, and stopped much of the wholesale worker-dumping.

Now, thanks to the Affordable Care Act, companies once again see a loophole: they can legally dump. The law is clear: large (over 50 employees) companies must insure their workforce. But only full-time workers. The companies need not insure part-timers, people working less than 30 hours a week.

But rest assured: the companies can “lean on” Uncle Sam, to quote Bill Withers’ song. These employees will have access to all the care they may need. Uncle Sam will be there. Under the Affordable Care Act, part-timers can enroll either in th

ueir states’ Medicaid programs, or get a subsidy for insurance under their states’ exchanges. From the vantage of the business, the solution is perfect: the employee gets insurance; the employer doesn’t pay. Walmart set the pace of retreat. Target has followed (Paul Ziobro and Louise Radnofsky, Wall Street Journal, Jan. 21, 2014 ). The companies can salvage their profit margins – thanks to Uncle Sam.

How strange that when government bolsters America’s workers, conservatives object. Yet when government bolsters industrial megaliths, conservatives overlook that bolstering, instead praising the acumen of independent entrepreneurs — even though the entrepreneurs are leaning heavily on Uncle Sam.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, March 1, 2014

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