By Roger Bybee May 13, 2011

Roger Bybee is a Milwaukee-based freelance writer and former editor of the Racine Labor weekly.

Original Article on In These Times

Despite its $14.2 billion in profits last year untouched by federal income taxes, General Electric is now demanding that its unionized workers accept a new high-deductible “Health Choice” health savings account plan.

GE’s demands are particularly obscene because it is sitting on $25 billion in savings and is threatening to close more U.S. plants, i.e. move more jobs to Mexico, China and elsewhere. And they’re particularly dangerous because GE is modeling bad behavior for other corporations to emulate.

As UE-GE Conference Secretary Steve Tormey has said, “Nobody is more symbolic of the assault on workers than General Electric.” The United Electrical workers union, one of a handful of unions now negotiating with GE, warned its members:

...numerous studies of these high-deductible plans...reveal that employees forced into plans like Health Choice are "significantly more likely to avoid, skip, or delay healthcare because of costs" than those with more comprehensive insurance. ... What GE is really saying with Health Choice is that medical expenses are no longer primarily their responsibility, but that of GE employees.

But GE is only the latest entrant among employers trying to establish a new healthcare normal by thrusting heavy additional costs onto the backs of working families. And the much-trumpeted federal healthcare “reform” legislation may actually exacerbate this race to the bottom.

(Of course, public employers—like the state of Wisconsin, led by labor’s arch enemy Gov. Scott Walker—have also been pushing to make public workers take up even more of the burden of healthcare costs. This despite the fact that, as David Cay Johnston has pointed out without managing to dent mainstream media coverage, public employees have always been paying 100 percent of their benefit costs. When they gained improvements in health and retirement benefits, they had to sacrifice on wage increases.)

How federal healthcare ‘reform’ helps drives the race to the bottom

The race to the bottom is, unfortunately, likely to be intensified as we get closer to fully implementing the Affordable Care Act in 2014. In fact, the ACA may well tend to establish a bare-bones, high-deductible policy as the new norm. The taxation of perversely mis-labeled “Cadillac” benefits has the very real potential of putting the squeeze on union-won healthcare benefits, especially in high-cost states.

Despite the efforts of AFL-CIO Richard Trumka and others to limit the damage created when the Obama administration suddenly adopted John McCain’s regressive idea of taxing better benefit plans to fund expanded healthcare coverage for the uninsured, it may not take long before fast-rising medical inflation pushes the dollar value of union-won health benefits up to the Cadillac level, as IUE-CWA Local 201 President Jeff Crosby has noted.

As Dr. David Himmelstein and Steffie Woolhandler wrote recently,

And as employers emulate this inadequate coverage, the race to the bottom leaves an increasing number of Americans UNDER-insured. Public workers are just the latest group to see their coverage downsized. What used to be called "health insurance" is now labeled "Cadillac coverage" – and reserved for those who drive Mercedes.

Himmelstein and Woolhandler remind us that the Democrats’ ACA plan was based on the Massachusetts model passed in 2006 with Gov. Mitt Romeny’s signature, and whose “achievements” are much less than splendid. Bankruptcies caused by catastrophic medical costs, which account for over half of all bankruptcies, are still rising in Massachusetts, they state:

While only 4 percent of the state's residents remain uninsured, much of the new coverage is so skimpy that serious illness leaves families with crushing medical bills. For instance, the cheapest (and most commonly purchased) coverage available to a 56-year-old Bostonian through the state's health insurance exchange costs $5,616. Yet, if you're sick, the policy doesn't start paying bills until you've paid a $2,000 deductible. And even after that you're responsible for 20 percent of the next $15,000 in medical expenses.

Insurers try blackmail

By basing itself on the Massachusetts plan which keeps for-profit insurers as the parasitic middlemen at the core of the healthcare system, the ACA sacrificed the potential for comprehensive, high-quality benefits covered from the first dollar.

This potential has been underscored in the fight over retaining ACA’s requirement that 80 percent of premium revenue be used by insurers to provide healthcare and improve quality, freeing up 20 percent for profit, bureaucratic overhead, and sales and promotion.

No less than nine states are seeking waivers from the 80 percent requirement, falling prey to insurers’ blackmail demands. Insurers are threatening to stop selling individual coverage in a number of states unless they can spend, in several cases, just 65 percent on paying for healthcare and quality improvements.

Both the states and the Obama administration are petrified by this coercive technique. The Obama administration’s timid mentality was revealed in this statement by Robert Laszewski, a consultant to the health care industry and a former insurance executive. “The last thing the Obama administration wants is the Des Moines Register writing about 500 people who lost their health insurance in Iowa because of the Obama health plan,” he chortled.

Singe-payer destiny?

The emerging situation is not pretty. Major corporations and right-wing state governments are fighting furiously to shift more costs onto workers and their families. Instead of setting a new, higher standard, ACA effectively serves to reinforce a new lower standard of “acceptable” coverage. Given this, the limitations of the ACA may become very obvious very quickly both to the public and Congress.

There may even be a possibility that that the essential need for maximum-strength single-payer or “Medicare for all” healthcare system—unburdened by for-profit insurers—will become evident much faster than most have imagined. (Sens. Bernie Sanders (I-Vt.) and Rep. Jim McDermott (D-Wash.) introduced single-payer bills in Congress this week; Vermont has now passed its own single-payer system into law.)

Himmelstein and Woolhandler make the case concisely:

While the ACA can’t live up to its “affordable care” moniker, a single-payer reform could save $400 billion annually on administrative costs, enough to offer every American first-dollar, comprehensive coverage. While U.S. insurers fight tooth and nail against the 20 percent limit on overhead, Canada’s single-payer program runs for 1 percent.