Why a Single-Payer Healthcare System Is Inevitable

By Robert Reich, Robert Reich's Website

24 August 16

he best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest health insurer, and by Humana, another one of the giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.

The problem isn’t Obamacare per se. It lies in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making this structural problem more obvious.

In a nutshell, the more sick people and the fewer healthy people a private for-profit insurer attracts, the less competitive that insurer becomes relative to other insurers that don’t attract as high a percentage of the sick but a higher percentage of the healthy.

Eventually, insurers that take in too many sick and too few healthy people are driven out of business.

If insurers had no idea who’d be sick and who’d be healthy when they sign up for insurance (and keep them insured at the same price even after they become sick), this wouldn’t be a problem. But they do know – and they’re developing more and more sophisticated ways of finding out.

Health insurers spend lots of time, effort, and money trying to attract people who have high odds of staying healthy (the young and the fit) while doing whatever they can to fend off those who have high odds of getting sick (the older, infirm, and the unfit).

As a result we end up with the most bizarre health-insurance system imaginable: One ever better designed to avoid sick people.

If this weren’t enough to convince rational people to do what most other advanced nations have done – create a single-payer system that insures everyone, funded by taxpayers –  consider that America’s giant health insurers are now busily consolidating into ever-larger behemoths.

UnitedHealth is already humongous.

Aetna, meanwhile, is trying to buy Humana in a deal that will create the second-largest health insurer in the nation, with 33 million members. The Justice Department has so far blocked the deal.

Insurers say they’re consolidating in order to reap economies of scale. But there’s little evidence that large size generates cost savings.

In reality, they’re becoming huge to get more bargaining leverage over everyone they do business with – hospitals, doctors, employers, the government, and consumers. That way they make even bigger profits.

But these bigger profits come at the expense of hospitals, doctors, employers, the government, and, ultimately, taxpayers and consumers.

There’s abundant evidence, for example, that when health insurers merge, premiums rise. researchers found, for example, that after Aetna merged with Prudential HealthCare in 1999, premiums rose 7 percent higher than had the merger not occurred.

What to do? In the short term, Obamacare can be patched up by enlarging government subsidies for purchasing insurance, and ensuring that healthy Americans buy insurance, as the law requires.

But these are band aids. The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people.

Or else a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care for everyone.

We’re going to have to choose eventually.

ALSO SEE: New Lawsuit: Fox News Is a
"Sex-Fueled, Playboy Mansion-Like Cult,
Steeped in Intimidation, Indecency and Misogyny"

ALSO SEE: The Explosive New Sexual
Harassment Allegations Against
Bill O’Reilly, Detailed

Fox News and the Repercussions of Sexual Harassment

By Margaret Talbot, The New Yorker

23 August 16

ne of the surprising things about the Fox News sexual-harassment story is that the women who have come forward with allegations include several of the network’s better-known anchors and reporters. You might think that professional power could stave off the kind of spin-around-and-let-me-see-your-ass leering and straight-up demands for sex that Gretchen Carlson, Megyn Kelly, and others say they endured from former Fox News chairman Roger Ailes and other male supervisors. (Ailes and his lawyer, Susan Estrich, continue to deny the allegations.) But that does not seem to have been the case.

In some ways, the situation at Fox was extreme: the seventy-six-year-old Ailes, who stepped down from the chairmanship on July 21st, soon after Carlson filed her lawsuit, seems to have taken management tips from some minor but debauched Roman emperor. According to Gabriel Sherman, an editor at New York magazine who has kept a close eye on Ailes and Fox News for several years now, the former chairman spent millions of dollars from the network’s budget to settle sexual-harassment claims and to maintain a cadre of consultants and private detectives, who worked out of what was known as “the Black Room,” keeping tabs on journalists like Sherman and others who’d covered him aggressively. How did he get away with it? “It was the culture,” one Fox executive told Sherman. “You didn’t ask questions, and Roger wouldn’t entertain questions.” When it came to sexual harassment, ideology surely played a role, too: given the pervasive scorn at Fox for “political correctness,” or feminism of any stripe, it must have been especially hard to be an ambitious woman who chose to make a stink, to risk looking like what Carlson says Ailes called her—“a man hater.”

To some researchers who’ve studied sexual harassment, though, the Fox News scenario doesn’t look like that much of an outlier. For one thing, some studies have found that women in positions of authority, especially in workplaces that are dominated by men, may be more likely to experience sexual harassment than women in lower-status positions. In a 2012 study called “Sexual Harassment, Workplace Authority, and the Paradox of Power,” the authors—Heather McLaughlin, Christopher Uggen, and Amy Blackstone—found that women in supervisor positions were more likely than non-supervisors to say that they had been sexually harassed on the job in the previous year. (This doesn’t seem to have been merely because supervisors as a group may be more knowledgeable about what constitutes harassment—the same pattern did not hold true for male supervisors and subordinates, for example.) When I spoke with McLaughlin, who is now a professor of sociology at Oklahoma State University, she called the study’s finding “counterintuitive,” because “to most people the most common scenario is still the powerful male boss and the vulnerable female secretary.” That scenario still happens, of course, but sexual harassment may be even more prevalent, she said, where women are “gaining power in the workplace, and it becomes a way of trying to reëstablish who’s actually in charge.”

McLaughlin says that these findings make sense, because, she believes, workplace sexual harassment isn’t really about sex; it’s about power. There’s probably a good deal of truth to that. Not that it explains every case: the person hitting on an attractive co-worker or subordinate might, after all, just be looking for sex at the place he or she happens to spend most of his or her time. (Although, in the age of dating apps, not to mention escort services and chat rooms, there are other, less potentially career-ending ways to get some. The appeal, for a guy like Ailes, of using the office as your personal hunting ground may have more to do with trying to leverage your authority there to get women who’d be out of your league on the more even playing field of Tinder.) But it’s true that the workplace commenter/ogler doesn’t necessarily think his or her perving is going to reap actual sexual rewards. Often, these comments aren’t admiring in any way, just gross or demeaning. (McLaughlin et al. found that a lot of sexual harassment was aimed at women who didn’t comport with traditional standards of femininity.) And it’s also true that, whatever the goal, the effect of such harassment is often to embarrass, unnerve, or undermine the professional confidence of the target.

Indeed, there’s another important way in which the allegations of sexual harassment at Fox News are not at all unique: they are a reminder of what a serious disruption harassment can be to a career. Take the case of Rudi Bakhtiar, who told the Times in July that, back in 2007, she lost a promotion she was expecting—to be a regular correspondent in Fox’s Washington bureau—after she turned down the sexual advances of a colleague who was about to become the bureau chief. Bakhtiar, who had been a foreign correspondent for CNN and who speaks fluent Farsi, had just scored a reportorial coup—getting herself into Iran for a meeting between Iranian and Iraqi leaders—and she was feeling confident about her prospects at the network. But she says things went badly for her after she rebuffed her colleague, Brian Wilson, and filed a complaint:

Wilson, contacted by the Times, said he strongly objected to Bakhtiar’s characterization of events. Bakhtiar reached a settlement with Fox for an undisclosed amount.

Bakhtiar says her agent advised her that she might have to start all over again in local news and work her way up. She couldn’t bring herself to do that, but she spent a few years out of journalism, working in public relations for an Iranian-American organization, before eventually taking a job as a producer at Reuters.

For many women, the climb back up is even tougher. McLaughlin told me that she and her colleagues are about to publish a new study in which they examined the long-term consequences of harassment. They looked at women working in a variety of fields, some of whom said that they had been the targets of unwanted sexual attention on the job when they were in their late twenties. Now, eight to ten years later, eighty-two per cent of the women who said that they’d experienced severe sexual harassment had changed jobs, compared to only fifty-four per cent of those who had not. (The study defined “severe” as unwanted touching or four or more incidents of other harassing behaviors.) People change jobs a lot in their twenties—often for better jobs—so it’s hard to draw too many conclusions from these numbers alone, but the contrast between the two categories is suggestive. And the women who had experienced harassment did see their earnings trajectories climb less steeply. “Compared to other working women,” McLaughlin said, “their earnings growth over this period of time was much slower over all, plateauing throughout their early thirties.”

This stall-out might have occurred for a number of reasons. In some cases, McLaughlin said, “it’s because women are giving up seniority and other advancement opportunities by starting over again with a new employer.” Moreover, “many of the women who quit switched careers—some quite drastically.” If they moved out of “highly competitive and masculine environments” that might pay well (say, banking) but that can also “be breeding grounds for a larger culture of harassment,” they sometimes ended in up in more “feminized and less lucrative fields” (say, retail).

Finally, McLaughlin said, some women who reported offensive behavior paid the price that women often fear: “They were labelled as untrustworthy or ‘not a team player’ and were subsequently passed over for promotion or excluded by their colleagues.”

Still, the more that powerful women who have experienced harassment come forward, the less likely it will be that employers can get away with punishing them. Though Fox News is doing its best to pretend that none of this ever happened, the revelations about Ailes may help others in the long run. As Paul Farhi, of the Washington Post, reported last week, the allegations and their fallout have scarcely been mentioned on the network—“no panel discussions, no diatribes from Fox’s famously aggressive hosts, no follow-up investigations, no tributes to the Ailes era”—but, try as it might, this story won’t go away.